What Is ERP Therapy for OCD and How Does It Work?
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ERP therapy is a type of treatment that exposes you to thought triggers associated with obsessive-compulsive disorder (OCD). Studies at the Northwestern University Feinberg School of Medicine by Clara Law show that ERP therapy improved OCD symptoms by up to 50-60%.
Patients should understand ERP therapy and how it differs from other forms of treatment because it helps manage their expectations. This article will offer more insight into this form of therapy and why it shows great potential for you as well.
- Amanda Mulfinger, PhD, LP
- Updated: July 4, 2025
Table of Contents
Key takeaways:
ERP is the core, action-based treatment for OCD, directly exposing you to triggers while preventing compulsive rituals.
Unlike talk therapy, ERP actively rewires the brain, teaching it that feared outcomes won’t occur even without performing rituals.
Sessions involve a “fear ladder” of exposures, practicing response prevention, and crucial homework for real-life application.
ERP’s effectiveness lies in inhibitory learning, building new neural pathways that reduce anxiety and compulsive urges over time.
Expect discomfort initially, but consistent ERP, often adapted with other treatments, leads to significant and lasting symptom relief.
What Is ERP? The Core Treatment for OCD
ERP is a type of therapy where patients receive controlled exposure to the intrusive thoughts that trigger an OCD episode. It differs from talk therapy because it relies on actions rather than just mere discussions. ERP is used alongside other forms of treatment to offer long-term results.
Defining ERP in Simple Terms
ERP stands for Exposure and Response Prevention. During this type of therapy, clients learn to resist their urges and compulsions by gradually getting trigger exposure. The brain becomes accustomed to the anxiety until the latter eventually fades.
The procedure addresses both the obsession and the compulsions because the individuals face the triggers for intrusive thoughts head-on. Still, therapy prevents the clients from engaging in their usual rituals. This breaks the anxiety cycle as the thoughts fade.
ERP treats OCD differently from talk therapy and CBT because it doesn’t just make you talk about your triggers. It puts them right in front of you in a controlled fashion. The initial discomfort fades as the behavior pattern shifts in a different direction.
Why ERP Is Different from Talk Therapy
ERP is different from talk therapy because it actively prevents the ritual from starting when exposed to the trigger. Talk therapy and CBT talk you through what you should do or think once exposed to the triggers. However, there’s no saying how you will react when exposed to the trigger outside of the office.
This form of therapy is action-based because it actively interrupts the OCD cycle. Once that happens, the therapists support you with structured exercise that directly changes your behavior.
The compulsion fades after repeated interrupted exposure because the brain learns the ritual is not necessary. The process is similar to phobias, where studies by Katherina K. Hauner at Northwestern University show that 95% of patients significantly recover after a year of therapy.
How ERP Sessions Actually Work
ERP sessions work by noting down your triggers and gradually exposing you to them within a controlled environment. Treatment starts with small triggers and goes up as the days or months pass.
Step 1 – Assessment and Psychoeducation
The first step is an assessment of your condition. The therapist notes a patient’s symptoms and guides them in the following ways:
They conduct a comprehensive assessment of the symptoms. Here, clients share their experience and questions.
- Patients set goals about what they want to obtain from the treatment (e.g., decreasing the rituals).
- The therapist uses psychoeducation to explain how OCD works. This empowers patients and helps them prepare for the triggers.
- The therapist explains what each session will involve and what to expect during the procedure.
Once the intake is complete, sessions begin with their gradual exposure.
Step 2 – Creating the Exposure Hierarchy
OCD situations are ranked based on their difficulty. This is referred to as the “fear ladder,” where you are first exposed to the least distressing element. Clients rank them before exposures begin and gradually work through them during each session.
Most therapists use the Subjective Units of Distress Scale (SUDS) hierarchy for symptom ranking. Here, scenarios receive ranks from 0 to 100, with the highest number suggesting extreme anxiety.
Therapists design this exposure hierarchy in collaboration with their clients. This ensures that their goals are achievable and that therapy is relevant.
For example, someone with contamination OCD might rank a bus handrail as 40, but a public restroom is a solid 80. Knowing this lets the therapist decide where the exposures begin.
Step 3 – Response Prevention in Action
After the exposure, individuals learn to resist the ritual. The goal is to neutralize the behavioral response that reinforces the OCD cycle. Instead of acting on their urge, the clients try to resist and remain in that anxiety-riddled situation.
Common rituals include:
- Excessive hand washing
- Repeat checking
- Counting
- Tapping in patterns
- Seeking reassurance
Discomfort is normal, especially in the early stages of therapy, when the anxiety peaks. The compulsions fade once the brain realizes that the catastrophic consequences won’t happen.
Therapists are there to coach and encourage you during these moments. This makes it easier to go through emotional discomfort.
Step 4 – Homework and Real-Life Application
Individual therapy continues at home, where clients practice what they learn in therapy. The patterns change when you reinforce new learnings and rewire the brain.
Studies by Samuel E. Cooper at the University of Texas at Austin show that up to 60% patients with OCD who go to therapy sessions relapse. This frequently happens because the patients limit their exercises in the therapist’s office.
Progress builds when you apply the right exercises based on your OCD. Here are a few exercise examples to use:
- Checking OCD: Leave for work without checking the lock or go out and don’t check the stove.
- Harm OCD: Look at a photo that has a knife in it or spend ten minutes in the kitchen.
- Contamination OCD: Touch a doorknob every day, and don’t wash your hands right away.
Consider writing exposure logs for self-tracking purposes. This helps you and your therapist in the long run.
Cooper, S. E., & Dunsmoor, J. E. (2021). Fear conditioning and extinction in obsessive-compulsive disorder: A systematic review. Neuroscience & Biobehavioral Reviews, 129, 75–94. https://doi.org/10.1016/j.neubiorev.2021.07.026
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Why ERP Is So Effective for OCD
ERP is effective for OCD because it rewires the brain’s responses to intrusive thoughts. These thoughts make the brain think that something catastrophic will happen if you do not perform the ritual.
Active exposure and resistance make the brain immune because it learns that nothing will happen.
ERP and the Brain’s Learning Systems
ERP relies on inhibitory learning to rewrite the neural pattern. In simple terms, it means that the brain rewires itself and associates different things with a situation or a thought.
When you skip a ritual and it doesn’t lead to catastrophic results, the brain creates a new neural pathway. This causes the anxiety to decrease because the brain no longer expects the worst from skipping the ritual.
The option is in great contrast with the outdated habituation model. Indeed, the concept is similar, as it believes anxiety fades with repetition. Still, unlike ERP, which rewires the brain, habituation relies on avoidance.
Outcomes and Long-Term Benefits
The average successful treatment involves reduced rituals and more flexible behavior. Most patients notice symptom relief within a couple of months. Studies by Hyunsik Kim at Sogang University, Seoul, reveal that 22.5% of patients showed dramatic improvement after 8 weeks, whereas 52.1% showed moderate results.
The progress is gradual but easily measurable. Clients who go through functional recovery can return to their lives as the rituals lessen. The therapy also empowers them, since they will no longer feel like they are prisoners of the rituals.
Unlike other outdated therapies, ERP focuses on relapse prevention. Your brain doesn’t just learn to ignore your compulsion; it starts believing that it’s not as bad as you may have thought.
What ERP Therapy Feels Like
ERP therapy feels uncomfortable, but only in the beginning. The anxiety drops when your brain stops associating the ritual disruption with a disaster. Things become easier after that.
Kim, H., Wheaton, M. G., Foa, E. B., & Simpson, H. B. (2023). Identifying trajectories of symptom change in adults with obsessive compulsive disorder receiving exposure and response prevention therapy. Journal of Anxiety Disorders, 96, 102711. https://doi.org/10.1016/j.janxdis.2023.102711
Emotional Challenges (and Triumphs)
Fear and discomfort are normal during ERP Therapy. Studies by Edna B. Foa at the University of Pennsylvania School of Medicine suggest that peak discomfort happens within 10-20 minutes of the session. Discomfort fades after about 40 minutes as the brain no longer thinks your resistance is a threat.
Expect to go through the following emotional challenges during ERP:
- Intrusive thoughts
- Difficulty resisting compulsion
- Feeling overwhelmed
- Anxiety rises gradually
Progress occurs when your fear curve gets smaller and smaller. Clients persist through their discomfort, and then those 20 minutes become 18, 15, and so on. Your distress tolerance gets higher, making the sessions more bearable.
Examples of Common ERP Exercises
Some common examples of OCD exercises include touching objects that you would normally avoid or resisting the urge to act. This way, the rituals pause, and repeated exposure helps to lock that behavior in completely.
Here are a few ERP exercises to try out for contamination OCD:
- Touch a public doorknob and don’t sanitize your hands immediately
- Use a shared keyboard without washing your hands
- Eat something from the fridge without checking the expiration date
Clients engage in numerous exercises, depending on the subtype. For example, for symmetry OCD, consider resisting the urge to reposition an object that looks uneven. If you have checking OCD, try not to turn back and check if you locked the door.
These save time from your daily life, and the brain eventually learns that the ritual is no longer necessary. Even if things don’t go as planned, it knows that the events are not really as catastrophic.
Therapists offer a full list of triggers to purposely expose yourself to. It’s important to do it in a controlled way so you don’t worsen the symptoms. As a licensed therapist, Dr. Noah Scanlon can help you reach that goal.
Abramowitz, J. S., Foa, E. B., & Franklin, M. E. (2003). Exposure and ritual prevention for obsessive-compulsive disorder: Effects of intensive versus twice-weekly sessions. Journal of Consulting and Clinical Psychology, 71(2), 394–398. https://doi.org/10.1037/0022-006x.71.2.394
Who Is a Good Fit for ERP Therapy?
The best fits for OCD therapy are teens and adults whose lives are disrupted by the OCD episodes. Each client is different, so therapy can be adapted based on the symptoms and possibilities.
OCD Presentations That Respond to ERP
Some of the most common subtypes of OCD that respond well to ERP include the following:
- Contamination OCD
- Checking OCD
- Harm OCD
- Scrupulosity OCD
- Symmetry OCD
These lead to a feeling of uncertainty and frustration when the intrusive thought comes in. Clients respond by starting the rituals (e.g., washing their hands or saying a prayer). ERP helps them learn how to resist that urge so they reclaim their time and nerves.
Therapists assess the severity of your condition and determine whether you fit the client profile or not.
When ERP Needs to Be Adapted
In some cases, you may be advised to follow a combination therapy. This includes CBT and medication, along with ERP. SSRIs are commonly used for severe symptoms. They reduce baseline anxiety and improve the chances of recovery.
Medication is not meant as a way to skip ERP, but to help the patients participate fully in their recovery sessions. If you have co-occurring conditions such as PTSD or depression, our therapists adjust your treatment plan to include supportive approaches.
Clients participate in the sessions online or in person, depending on their needs. For instance, if a patient has crippling contamination OCD, telehealth brings the support to their home. As the sessions evolve, clients are asked to occasionally come into the office, even if it’s just an exercise.
How to Get Started With ERP at Cabot
Patients get started with ERP at Cabot Psychological Services by scheduling an appointment. You’ll have to meet our licensed therapists so they can create a suitable plan for your needs.
Meet Noah Scanlon, Your ERP Therapist
Noah Scanlon is a licensed therapist who has been dealing with mental health conditions for more than a decade. He places great importance on patience and empathy, as each person recovers at their own pace. Patients trust him for his ERP expertise and the ability to make the sessions tolerable.
Noah’s continued education offered him the expertise to work with conditions such as depression, anxiety, PTSD, and more. That said, his OCD specialization makes him a suitable long-term provider who can help you obtain good results.
Schedule Your First Appointment
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Clients can make a booking via email or phone call for the Minneapolis and Medina locations. The appointment system lets you choose a time that works best for you.
If you can’t make it into the office, feel free to opt for telehealth. Our therapists welcome old and new clients, regardless of issues. Your care begins the moment you reach out.