Committing to Exposure and Response Prevention (ERP): What to Expect and How to Succeed
The gold-standard treatment for OCD is Exposure and Response Prevention (ERP)—a specialized form of cognitive behavioral therapy that helps people retrain their brain’s relationship to intrusive thoughts, fears, and compulsions. As an OCD specialist who uses ERP every single day with clients, I wanted to create this post to explain how ERP works, what to expect during treatment, and the common pitfalls that can slow progress.
My hope is that this gives you clarity, motivation, and confidence as you consider taking the important step of treating your OCD.
What Is Exposure and Response Prevention?
People with OCD often respond to intrusive thoughts or anxiety by doing compulsions—mental or physical behaviors meant to reduce discomfort or prevent a feared outcome. Many have never been taught that there is another option.
ERP creates a new learning experience by helping you:
Face the feared trigger (Exposure)
Refrain from doing the compulsive behavior (Response Prevention)
When you do this consistently, your brain learns something new and powerful:
You can tolerate discomfort, intrusive thoughts aren’t dangerous, and compulsions aren’t necessary.
Here are the three main mechanisms through which ERP works:
1. Disconfirmation
ERP helps you disprove the fear your OCD has been convincing you to believe.
For example:
“If I don’t do this compulsion, I’ll never stop thinking about it.”
“If I don’t check again, something terrible will happen.”
“If I sit with this guilt or doubt, I won’t be able to function.”
ERP shows you, through direct experience, that these fears are not true.
Sometimes the proof comes quickly; other times it builds gradually.
2. Mastery
ERP teaches you that even though you have OCD thoughts, you don’t have to respond with compulsions.
You learn:
“I can choose not to do the compulsion.”
“I can allow the urge to be there without acting on it.”
“Discomfort doesn’t control me.”
It may feel uncomfortable at first, but mastery develops as you repeatedly choose aligned action over compulsions.
This is an incredibly empowering and key part of treatment. You do have a choice in the matter.
3. Habituation
Habituation is the process through which repeated exposure makes something feel less intense over time.
Think of watching a scary movie ten times. The first time you’re tense and startled. By the fourth or fifth time, your body barely reacts.
The same thing happens in ERP:
Your distress response decreases
Your brain stops sounding the alarm
You learn through experience that you can handle it
This isn’t about eliminating anxiety completely but about reducing its power over your life.
ERP Is Hard—But It Shouldn’t Be Overwhelming
When people first hear about ERP, the idea of intentionally facing fears can sound intimidating. It is uncomfortable at times. ERP is truly a short-term discomfort for long-term freedom treatment.
But here’s what matters:
You start small
Exposures are manageable, not overwhelming
You build confidence gradually
We work as a team
There is decades of research showing ERP to be one of the most effective treatments for OCD. Your motivation and willingness to engage in the work, ultimately your buy-in, plays a major role in your success.
If you are still ambivalent about tackling OCD, it may not be the right moment to start ERP.
ERP works best when someone is tired of OCD controlling their life and ready to reclaim their time, energy, and joy. Find your why before starting treatment.
Common ERP Pitfalls (and How to Avoid Them)
Pitfall #1: Only doing exposures in session
This is one of the biggest barriers to progress.
If you meet with your therapist once, maybe twice a week best case scenario, for one hour each time, that alone is not enough for your brain to habituate. ERP requires repetition between sessions for the new learnings to click. Homework isn’t optional, it’s literally essential.
Doing exposures on your own:
Builds independence
Increases mastery
Strengthens habituation
Proves to you that you can do this
Think of ERP like learning a new skill or a new language: without practice, progress stalls.
Pitfall #2: Measuring success by how anxious you feel
Many people believe, “If I’m still anxious, I must be doing this wrong.” Not true.
Success in ERP is measured by:
Did you complete the exposure?
Did you prevent the compulsion?
Not by “Did my anxiety go away?”
I help clients shift their mindset:
“You felt guilty and you still completed the exposure. Did anything else actually bad happen? No. That is success.” This is inhibitory learning which you can read more about here.
In ERP, feeling anxiety while continuing the exposure actually means your brain is learning.
The Hardest Moment: The Beginning
Clients tell me again and again: The hardest part of ERP isn’t the exposure itself: it’s the moment right before the exposure.
The anticipatory anxiety is often worse than the actual exposure:
Touching the “contaminated” item
Reading the feared script
Looking at the triggering photo
Saying the scary thought out loud
Once the exposure actually begins, most people are surprised at how manageable it feels. They often describe a sense of accomplishment, pride, and relief afterward. I remind people of their past successes every time we build a new exposure: “If you did that, you can absolutely do this.”
Final Thoughts: ERP Is Worth It
ERP is challenging, empowering, and life-changing. It teaches you that you are in control; not OCD. Through ERP, you learn that you are stronger than your anxiety, that intrusive thoughts will happen, and that you don’t have to respond to them every time. You learn that uncertainty is tolerable and that it’s possible to reclaim your life from OCD rather than organize your life around it.
I can’t promise a life free from anxiety or intrusive thoughts, but I can say that when clients truly commit to ERP, they often experience a significant reduction in symptoms. Over time, OCD can become an occasional voice in the background rather than the force directing daily decisions. With intention and practice, you can live your life fully, guided by your values instead of fear.
By Andrea Born-Horowitz, LCSW
