If you’ve been looking into treatment for OCD, you’ve certainly seen references to Exposure and Response Prevention, also called ERP for short. It’s considered the “gold standard” treatment for OCD, and decades of psychological research has shown it is safe and effective. 

But that doesn’t mean it’s not still intimidating to consider! 

If you’ve been feeling hesitant or confused about what to expect in Exposure and Response Prevention, this article is for you. In this article, we will review how ERP works and what you can expect to happen in an ERP session. To begin, we will first review what Obsessive Compulsive Disorder is and the many different ways it can manifest. 

What is OCD?

Simply put, Obsessive Compulsive Disorder, usually abbreviated as OCD, is a mental health condition involving a pattern of unwanted thoughts (called obsessions), which cause anxiety and distress, which in turn lead to repetitive behaviors (called compulsions) that attempt to escape the anxiety. Compulsions often do decrease anxiety… but only in the short term. Over time, obsessions return, and because compulsions previously provided short-term relief, the compulsions occur again, and the cycle repeats. 

Obsessions can take many forms, such as:

• Contamination obsessions involving fear of coming into contact with bodily fluids, disease, dirt, or environmental contaminants like radiation
  
  
• Violent obsessions such as the fear of acting on impulses to harm oneself or others
  
  
• Responsibility obsessions, which include having the fear of being responsible for something terrible to happen or that one’s carelessness will cause harm to others
   
• Perfectionism obsessions, like being fixated on evenness, exactness, a need to know, or a fear of losing or forgetting important information
  
  
• Identity obsessions, such as being excessively concerned about one’s sexual orientation or gender identity 

Compulsions can also take many forms, including:

• Washing and cleaning oneself, environments, or objects
  
  
• Checking and rechecking behaviors, which could involve objects (like checking locks repeatedly) or events (like checking that you didn’t harm others)
  
  
• Repeating compulsions, such as repeating body movements, doing tasks a certain number of times, or repeating activities like going in and out of a door
  
  
• Mental compulsions, like reviewing events to prevent harm, praying to prevent harm, counting to end on a “good” or “safe” number, or mentally replacing words to “cancel out” a bad word 

Is OCD A Serious Condition?

OCD is not just a personality quirk or a preference for things to be orderly. OCD is often a debilitating, highly impactful condition that causes disruptions to many areas of a person’s life. 

For example, OCD can cause compulsions so time consuming it’s difficult to get to work on time or complete work tasks, sometimes resulting in lost employment. It can create anxiety so intense that it can feel impossible to maintain relationships, parent a child, or go on dates. It can lead to physical injuries when compulsions are extreme, such as repeated handwashing with harsh chemicals. 

People living with OCD often experience profound suffering, and getting the appropriate treatment is important to reduce symptoms and improve their quality of life. 

What is Exposure and Response Prevention (ERP)?

Exposure and Response Prevention, called ERP for short, is a specialized form of Cognitive Behavioral Therapy and is considered the gold standard, frontline treatment for OCD. Like all forms of Cognitive Behavioral Therapy, ERP helps people understand the relationship between their thoughts, emotions, and behaviors and helps them use that understanding to create the changes they want in their lives. 

Specifically, ERP teaches people with OCD how to break out of the cycle of obsessions and compulsions, which perpetuate each other in an endless loop. You can read a detailed description of this cycle in our last post about OCD, Exposure and Response Prevention (ERP): A Powerful Tool for Managing OCD and Anxiety.

ERP disrupts the cycle by blocking compulsions, which temporarily reduce anxiety but ultimately fuel more obsessions. By preventing a compulsive response, ERP creates space for a new path forward: facing fears, learning better tools to cope, increasing confidence, and leaving behind the obsessive-compulsive cycle. 

What Happens in an ERP Session?

You can expect four main components to any ERP session:

1. Assessment and Planning

While the most detailed assessment will occur early in therapy, assessment is an ongoing process. You’re likely to complete questionnaires on a regular basis, and your therapist will assign homework that is used to improve your treatment outcomes and guide planning for each new session.

2. Engaging in Exposure

In each session, your therapist will help you begin to slowly face your triggers. This is done in a gradual, systematic way, so you will face more minor fears first. As you increase confidence and decrease symptoms, you’ll progress to facing more significant triggers.

3. Preventing Compulsion

As a central part of ERP, you will actively work to refrain from performing compulsions while facing your triggers. This means resisting the impulse to engage in the behaviors, mental rituals, or other things you used to do to try to cope with the obsession or the anxiety it causes. Instead, with the support of your therapist, you accept and feel the anxiety without trying to escape or control it.

4. Processing the Session

After the hard work of exposure and response prevention, you and your therapist will discuss the experience, how you managed it, what you can learn from it, and what next steps will be.

Is Exposure Therapy Safe?

For people who have healthy coping skills for managing discomfort, exposure therapy like ERP is very safe. For clients who don’t have those skills, therapy can prepare them for future exposure therapy by teaching coping and guiding them through practice to strengthen the skills. 

However, exposure therapy is inherently uncomfortable. After all, ERP asks clients to resist familiar habits of compulsions that soothe their anxiety and to instead face their anxieties and uncertainty. This is hard work, but it is also work that pays off with increased freedom and decreased anxiety. 

How Effective is ERP?

ERP is considered the most effective, most evidence-based treatment for OCD for people of any age. ERP has been researched extensively for decades, and as such we know that it works well for people of all ages, walks of life, and even if they have co-existing other mental health conditions, like depression or anxiety. 

Research indicates that ERP has a success rate of 65% to 80% in children, adolescents, and adults. Some people who complete ERP experience a significant reduction in symptoms, and some have their OCD symptoms disappear entirely. It's difficult to know exactly what your outcomes will be until you try, but there is very strong research to suggest ERP results in significant benefit for most people with OCD.

How Long Does ERP Take? 

The most effective approach to any therapy, including treating OCD with ERP, is to tailor the duration of treatment to each unique person’s needs, goals, preferences, and abilities. Therefore, there's no one answer to this question.

However, psychological research tells us that most people begin to experience a significant decrease in OCD symptoms within eight to sixteen weeks of starting ERP.

The total amount of time treatment will take depends on several factors. Weekly or even more frequent sessions will likely progress treatment at a more rapid pace. Consistent completion of at-home exposure practice outside of appointments also helps symptoms decrease faster, resulting in bigger benefits and shorter durations of therapy.

Getting Started In Therapy

Obsessive-Compulsive Disorder is a heavy burden that often feels like it consumes your entire life, limiting your choices in life, and leading to other problems like depression, loneliness, and shame. Living with OCD is far more difficult than any therapy, even a challenging one like Exposure and Response Prevention. 

Remember, while Exposure and Response Prevention is uncomfortable, it is strongly supported by research evidence that tells us it is safe and effective for many people. At this time, it is even considered the “gold standard” therapy for treating OCD. 

Your psychologist will provide you with support, structure, and a sense of safety along the way. Psychologists at Aviva are trained to help you develop a customized treatment plan that will allow you to overcome anxiety, break free of the obsessive-compulsive cycle, and have greater confidence and freedom in life. You can get connected with a psychologist who has expertise in overcoming phobias by filling out the Request an Appointment form.

Selected References:

Cleveland Clinic. (2025). ERP therapy helps you face fears and resist rituals in a gradual, supportive way. It’s helpful for OCD and other anxiety disorders. In Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/erp-therapy

Foa, E. B., Yadin, E., & Lichner, T. K. (2012). Exposure and response (ritual) prevention for obsessive-compulsive disorder: Therapist guide (2nd ed.). Oxford University Press.

Grayson, J. (2014). Freedom from obsessive compulsive disorder: A personalized recovery program for living with uncertainty (2nd ed.). Berkley Books.

International OCD Foundation. (2023). What is OCD? In International OCD Foundation. https://iocdf.org/about-OCD/ 

National Institute of Mental Health. (n.d.). Obsessive-Compulsive Disorder. https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd