OCD and ERP Therapy: Symptoms, Treatment, and What to Expect

What is OCD?

Obsessive-compulsive disorder (OCD) consists of a cycle of obsessions and compulsions. Obsessions involve thoughts, images, or urges that elicit an unpleasant emotion such as distress, anxiety, or guilt (American Psychiatric Association, 2022).

These obsessions are often intrusive, unwanted, and relentless. To get rid of the obsessions, those with OCD tend to do one of two things:

1. Avoid the situation so that their obsessions are not triggered, which is often not possible long term, or 

2. Engage in a compulsive behaviour (also known as rituals). Compulsions can be visible to others (e.g., handwashing in a specific routine, tapping objects in a certain order, arranging and rearranging items, asking others for reassurance) or mental, where the compulsions typically happen within the mind and are tougher for an outside person to see (e.g., repeating phrases or numbers to oneself, intentionally replacing a mental image with another, rumination, or mentally reviewing a situation). These compulsions often create relief, but this relief is only temporary and strengthens the OCD cycle. 

This cycle is what makes OCD unique and different from other mental health concerns. It is important that therapists parse out what may be generalized anxiety, aspects of obsessive-compulsive personality disorder, body dysmorphic disorder, trichotillomania, excoriation disorder, hoarding, motor tic disorder, and Tourette’s disorder (American Psychiatric Association, 2022; Van Ameringen et al., 2026; Szejko & Müller-Vahl, 2021).

It is important to differentiate OCD from other concerns because treatment approaches that may be effective for these other mental health concerns do not necessarily address the OCD cycle. OCD requires treatment that specifically targets the obsessions, compulsions, avoidance, and other neutralizing behaviours that keep the cycle going, which is why ERP is a core component of evidence-based OCD treatment (Van Ameringen et al., 2026)

Although the obsessions in and of themselves are distressing, the compulsions tend to be the actions that take one out of the present moment, are mentally taxing, and time-consuming. Hence, one of the primary treatments for OCD is exposure and response prevention (ERP), where we aim to interrupt the OCD cycle after the obsessions create distress by resisting the urge to engage in compulsive behaviours.

What is Exposure and Response Prevention (ERP)?

Exposure and Response Prevention (ERP) is a form of Cognitive Behavioural Therapy (CBT) used to treat Obsessive-Compulsive Disorder (OCD). ERP involves gradually and intentionally facing situations, thoughts, or feelings that trigger obsessions while learning to resist the compulsive behaviours or mental rituals typically used to reduce distress. Over time, this process helps individuals build tolerance for uncertainty, reduce their reliance on compulsions, and break the cycle of OCD.

The Goal of ERP

The goal of ERP is not necessarily to make the obsession or anxiety disappear. Instead, ERP helps you learn that you can experience uncertainty, anxiety, and distress that come from obsessions without needing to perform a compulsion or avoid the situation.

In other words, ERP aims to interrupt the OCD cycle rather than trying to eliminate every unwanted thought, image, or urge. 

Why ERP

ERP has decades of research supporting its effectiveness and is currently considered the gold-standard, first-line psychological treatment for OCD (Hezel & Simpson, 2019; Van Ameringen, 2026). It is not like a typical therapy treatment. ERP gets clients to do the opposite of what the OCD cycle expects: approach a situation that triggers obsessions, stay with the distress, and not engage in the compulsion. This teaches clients a few things: 

• That they can tolerate uncertainty/anxiety/distress without needing to make it go away.

• That obsessions are just that… they are obsessions! (e.g., thoughts, urges, feelings). They do not define who we are or what we will do in the future.

• While this is not always guaranteed, most clients find that tolerating the discomfort and not participating in compulsions will allow the urges to perform compulsions/avoid the situation to decrease.

• They learn that the fears associated with not completing the compulsions may or may not happen, but that they can handle that uncertainty.

• They gain an increased sense of mastery when dealing with their OCD. Over time, when clients consistently apply the ERP principles, they are able to respond to their OCD without the assistance of a therapist. I’m always half joking with clients when I say that part of ERP is to work myself out of a job. I want you to get so good at ERP that you don’t need me anymore!

Important considerations with ERP

As mentioned, ERP is different than most therapy, in that you are willingly being exposed to distress. But there are some important considerations with this treatment:

• Your therapist should spend time adequately explaining what ERP is and what to expect.

• Although by signing up for ERP, you are being exposed to distress, as a client, you have the right to refuse to take part in an exposure or withdraw from an exposure at any time. Like with all therapies, consent to participate is of utmost importance. 

• While I am not a fan of assigning formal home practice (e.g., tracking sheets) in my other therapy sessions, I find that with ERP, it is a must. I see the most improvement from clients who apply what they have learned in session outside of session. This has also been demonstrated in the scientific literature (Pine et al., 2026; Simpson et al., 2012). I wish I could say that we could improve your OCD symptoms by addressing it 50 minutes a week/bi-weekly, but this is just not the case. OCD has a very large habitual and behavioural component, and it is of utmost importance that ERP is practiced consistently outside of session.

• ERP is hard. I’m not going to lie to you or deny that. However, most clients say that it is hard for a finite period (we aren’t going to be asking you to do extreme exposures for life) in exchange for a long-term payoff. 

The goal with ERP is not to never experience the intrusive thoughts or anxiety again. The goal is to build the confidence that, when OCD shows up, you can choose how you respond to it rather than letting OCD make that decision for you. Many clients have reported that once they get the hang of ERP, it is incredibly freeing. 

At Heal With Me Psychology, I aim to approach ERP collaboratively, thoughtfully, and at a pace that respects each client’s unique situation and experience. Each ERP session is individually tailored to your needs, goals, and readiness for treatment.

If you would like to learn more about what ERP can look like, how it may help with your OCD, and whether this treatment may be a good fit for you, don’t hesitate to book a free 15-minute consultation with me (Gemma)!

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

Hezel, D. M., & Simpson, H. B. (2019). Exposure and response prevention for obsessive-compulsive disorder: A review and new directions. Indian Journal of Psychiatry, 61(Suppl 1), S85-S92. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_516_18 

Pine, A. E., Liu, Q., Storch, E. A., Geller, D. A., Small, B. J., Wilhelm, S., & McGuire, J. F. (2026). Homework adherence in exposure-based CBT for youth with obsessive-compulsive disorder: Clinical outcomes and predictors across treatment. Behaviour Research and Therapy, 105050. https://doi.org/10.1016/j.brat.2026.105050 

Simpson, H. B., Marcus, S. M., Zuckoff, A., Franklin, M., & Foa, E. B. (2012). Patient adherence to cognitive-behavioral therapy predicts long-term outcome in obsessive-compulsive disorder. The Journal of Clinical Psychiatry, 73(9), 1265. https://doi.org/10.4088/JCP.12l07879 

Szejko, N., & Müller-Vahl, K. R. (2021). Challenges in the diagnosis and assessment in patients with Tourette syndrome and comorbid obsessive-compulsive disorder. Neuropsychiatric Disease and Treatment, 1253-1266. https://doi.org/10.2147/NDT.S251499 

Van Ameringen, M., Fineberg, N. A., Ravindran, A., Arnold, P. D., Beaulieu, S., Brakoulias, V., Brietzke, E., Dowlati, Y., Drummond, L. M., Ferretti, C. J., Feusner, J. D., Freire, R. C. R., Frey, B. N., Gardiner, S., Geller, D. A., Giacobbe, P., Goldman Bergmann, C., Grassi, G., Greenberg, E., … Dell’Osso, B. M. (2026). Canadian Network for Mood and Anxiety Treatments (CANMAT) and International College of Obsessive-Compulsive Spectrum Disorders (ICOCS) 2025 international guidelines for the management of patients with obsessive-compulsive disorder. Journal of Psychiatric Research, 199, 404-488. https://doi.org/10.1016/j.jpsychires.2025.12.039.