I Think I Have OCD… Now What? Understanding Exposure and Response Prevention (ERP)

Article written by Denver ERP Therapist, Quin Axelson

If you live with OCD, you likely know how exhausting it is to feel trapped in the cycle of intrusive thoughts and rituals that only bring short-term relief. Y

ou may have even found yourself googling symptoms, searching for a way out. In doing so, perhaps you came across something called Exposure and Response Prevention (ERP).

Before you let the name scare you off, let’s break down what ERP actually is, why it works so well, and why it may just be exactly what you’ve been looking for to finally feel lasting, tangible relief.

What is ERP?

ERP is widely recognized as the “gold standard” treatment for OCD – and for good reason. In essence, ERP is a behavioral therapy that helps you gradually face situations, thoughts, or feelings that are anxiety-provoking.

Instead of avoiding what makes you anxious or relying on rituals to ease discomfort, ERP teaches you to sit with those feelings in a safe, supportive, and structured way.

With practice and consistency, ERP works by interrupting the OCD cycle and gives you tools to feel in control of your thoughts, choices, and most importantly, your life.

How does ERP work?

ERP has two main parts:

• Exposure (“Facing your Fears”): With the support of your therapist, you’ll gradually and intentionally begin to confront the things that trigger anxiety – whether it’s a thought, object, memory, or situation. This does not mean diving headfirst into the scariest scenario right away. Rather, it’s a step-by-step process that begins with small, achievable goals of your choosing.
• Response Prevention: This step involves not engaging in the rituals that OCD urges you to perform in order to temporarily feel “better.” Here, resisting the urge to engage with OCD takes away OCD’s power and when repeated, allows you to regain autonomy over your choices.

At first, ERP can sound intimidating – and understandably so!

That said, it’s important to know that ERP is designed work with, not against you.

What this means is that your therapist will work with you at a pace that feels safe, first and foremost, but also doable and empowering. And while it may feel hard to believe, ERP is one of the most well-researched, effective treatments available for OCD, proven to help across many nuanced presentations.

What to Expect in ERP Therapy:

• Getting Started: Your ERP therapist will begin with guiding a gentle and collaborative exploration of your symptoms, triggers, and goals, as well as the ways OCD is impacting your life. This helps us create a personalized roadmap for therapy.
• Integration of Coping Skills: Before diving into exposures, your therapist will help you build a toolkit of strategies – like mindfulness, grounding, and emotion regulation techniques – so you feel more equipped to manage anxiety, even outside of exposures.
• Psychoeducation: Understanding how OCD functions is key to recovery. Together, with your therapist, you’ll look at how OCD shows up in your life and what keeps its cycle going. When you understand what’s happening, you can begin to address it.
• Doing the Work – Gradually: ERP is a one-step-at-a-time process. Once you feel equipped to start ERP therapy, your therapist will introduce self-selected exposures that bring up very small and manageable levels of anxiety, slowly working our way up to more challenging ones. For example, if you experience contamination OCD, you may start by reintroducing the word “germs” into our vocabulary, gradually working up to more challenging exposures like using doorknobs. Each session, your therapist will check in to make sure that things feel doable and adjust the pace accordingly.
• Between-Session Practices: Real growth often occurs between sessions. You’ll work on ways to carry what you’re learning in session into your everyday life. This is often where individuals build the confidence and independence they need to regain control.
• Long-Term Benefits: While ERP can feel challenging, it’s backed by decades of research highlighting its effectiveness. ERP often leads to longer-lasting improvement than many other approaches – including medication for some individuals.

Understanding OCD As a Faulty Alarm System

One helpful way to think about ERP is by picturing OCD as a faulty alarm system.

In moderation, anxiety is your body’s natural way of alerting you of danger. But when OCD is involved, that internal alarm goes off even when there’s no actual threat – like every time you burn a piece of toast or light a candle – situations that likely post no real risk.

Imagine contamination OCD, for example. You touch a doorknob, and your brain insists your hand is contaminated. Suddenly, you feel a surge of fear and an urgent need to protect yourself. The compulsion – maybe sanitizing your hands or the doorknob – is your brain’s attempt to “turn off” the alarm.

It brings short-term relief, but it also reinforces the belief that the danger was real. So, the next time you encounter a similar situation, the alarm sounds again and the compulsion takes place, thereby reigniting the pervasive, demanding cycle of OCD.

Reducing OCD symptoms means learning to resist these compulsions, even when the alarm feels real, so the brain can recalibrate its alarm system.

The Benefits & Research Behind ERP Therapy

So, why ERP? Here’s what many people notice when they commit to ERP therapy:

• You build resilience. Over time, your window of tolerance for discomfort and uncertainty expands.
• You take back control. Instead of OCD being in the driver’s seat, you gain more say in your thoughts, behaviors, and daily choices.
• You get your time and energy back. Less time spent on compulsions means more space for the things you actually enjoy.
• It works for visible and invisible compulsions. ERP is highly effective for both visible compulsions (like checking or cleaning) and invisible ones (often called “Pure O”), such as mental reviewing, avoidance, or trying to stop distressing thoughts.
• You can do ERP from home. Virtual ERP therapy can be just as effective, if not more effective, as in-person ERP therapy – offering increased flexibility and accessibility to care. Virtual therapy of this kind allows us to practice exposures in your own environment, with real-time support from your therapist as challenges come up.
• The relief lasts – finally! With consistent ERP, many people experience lasting relief from symptoms.
• It helps beyond OCD. Many people also experience a reduction in overall anxiety, stress, and even depression or panic symptoms.

Why ERP Now?

OCD has a sneaky way of strengthening its grip over time, but the good news is that it’s never too late to start taking back your power.

If you or a loved one are struggling with obsessions, compulsions (whether physical or mental), or both, starting ERP therapy now is the most effective way to break the cycle and regain control.

We would love to be a part of your healing journey and are so glad that you are here, taking the first step toward real, lasting change. Reach out today to get started!

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Denver Therapist | Quin Axelson

Quin Axelson offers ERP therapy for older teens and adults who suffer with the disruptive cycle of OCD. She brings a wealth of knowledge, experience, warmth, and curiosity to her work with clients. Quin understands the nuances of OCD and how it often doesn’t stand alone.

In addition to helping people with OCD, she also provides therapy support to people with trauma, complex family systems, athletes and their loved ones, anxiety, depression and life transitions.

At DMC, we are excited to have Quin’s understanding and knowledge as part of our collective learning and team support to better support our clients.