What can I expect when I start Exposure and Response Prevention (ERP)?
If you’ve been considering therapy for obsessive-compulsive disorder (OCD) or anxiety, you may have heard of Exposure and Response Prevention (ERP). The name itself can feel a little intimidating, but understanding how it works—and what the process feels like—can help reduce uncertainty and make the first step easier.
ERP is a highly effective, evidence-based approach for OCD and related anxiety disorders. At its core, ERP helps you learn that while anxiety and intrusive thoughts are uncomfortable, you can live a full life without letting them control your choices. Here’s what you can expect when starting ERP:
1. A Safe, Collaborative Beginning
The first step in ERP is building trust with your therapist. You won’t be pushed into anything right away. Instead, your therapist will spend time getting to know your symptoms, the patterns you experience, and how OCD or anxiety shows up in your life. This helps create a roadmap that feels safe and manageable for you.
2. Understanding the Cycle
Before exposures begin, you’ll learn about the cycle of fear, avoidance, and compulsions. For example:
An intrusive thought or worry shows up.
Anxiety builds, and the urge to perform a ritual, check, avoid, or seek reassurance grows stronger.
The compulsion may bring short-term relief, but it keeps the fear alive in the long run.
ERP works by breaking this cycle—so you can retrain your brain to recognize that anxiety will pass even without the compulsion.
3. Creating an Exposure Hierarchy
Your therapist will help you build a list of feared situations or triggers, from the least distressing to the most challenging. This is called a hierarchy. You’ll never be thrown into the hardest scenario first. Instead, exposures are done gradually, at a pace that balances challenge with support.
4. Exposure in Practice
An “exposure” means deliberately facing a fear in a controlled way—without using avoidance or rituals. For example:
Someone with contamination fears might touch a doorknob without washing their hands immediately afterward.
A person with intrusive doubts about harm might write down the feared thought without trying to cancel it out.
At first, this will feel uncomfortable. Anxiety usually rises quickly, but the key is what happens next.
5. Response Prevention: The Turning Point
This is where the “response prevention” part comes in—you practice resisting the urge to do the compulsion or ritual. While anxiety may spike, your body naturally cannot stay at that peak forever. Over time, the anxiety begins to lessen on its own.
This process teaches your brain a powerful lesson: “I can handle the discomfort, and nothing catastrophic happens when I resist the compulsion.”
6. Learning to Tolerate Uncertainty
One of the hardest parts of OCD and anxiety is the demand for certainty—absolute proof that a feared outcome won’t occur. ERP helps you build tolerance for uncertainty, which is a normal part of life. Instead of trying to erase doubt completely, you’ll learn how to move forward even with it.
7. Gradual Progress, Real-Life Gains
With repeated practice, the triggers that once felt overwhelming begin to lose their power. You’ll notice more mental space, more freedom in daily life, and less time lost to rituals or avoidance.
ERP isn’t about “getting rid” of anxiety forever—it’s about changing your relationship with it so it no longer dictates your actions.
8. What Clients Often Say
Many people describe ERP as challenging but deeply empowering. While the process can feel uncomfortable at first, clients often report:
A growing sense of control
Less fear of their thoughts
Greater confidence in facing daily situations
Final Thoughts
ERP is about reclaiming your life from OCD and anxiety. It doesn’t happen overnight, but step by step, you’ll discover that you’re stronger than your fears. The discomfort is temporary; the freedom you gain is lasting.
