Exposure and Response Prevention (ERP)
The gold-standard treatment for breaking free from obsessive-compulsive cycles and anxiety-driven avoidance.
If you live with OCD or anxiety, you know what it is like to be caught in a loop. A disturbing thought appears. Anxiety spikes. You perform a compulsion—mentally or physically—to make it go away. It works, briefly. Then the thought returns, and the cycle starts again.
The compulsions and avoidance feel protective. They promise relief, certainty, and safety. However, they teach your brain that the thoughts are dangerous and that the only way to cope is to keep performing rituals. This cycle creates a profound sense of "stuck-ness," shifting your attention away from the things that are most important to you. ERP breaks that cycle.
What Is ERP?
Exposure and Response Prevention is a type of cognitive-behavioral therapy originally developed for OCD and now recognized as highly effective for most anxiety disorders. It is the most well-researched treatment available. It does not work by eliminating intrusive thoughts; it works by changing your relationship to them.
The Two Core Components
Exposure: Deliberately and gradually facing the thoughts, images, situations, or sensations that trigger your anxiety without trying to neutralize or escape them.
Response Prevention: Resisting the compulsions, rituals, safety behaviors, or avoidance strategies you typically use to reduce anxiety or gain certainty.
The Real Goal of ERP
The goal isn't to prove the thoughts are harmless or to make anxiety go away. It is to learn that you can tolerate uncertainty and discomfort without needing to control it. Over time, the anxiety loses its grip and mental flexibility returns.
How ERP Actually Works
ERP is not about reducing anxiety in the moment. In fact, early in treatment, exposures often increase anxiety temporarily. This is expected and is not a sign that something is wrong.
ERP works through a process called inhibitory learning. When you face a feared situation and resist the compulsion, your brain learns something new: that the catastrophe you feared did not happen, or that you could handle the discomfort without ritualizing. This doesn't erase the old fear association; it creates a new, competing one that becomes stronger with repeated practice.
What ERP Looks Like in Practice
We start by understanding your specific triggers and avoidance patterns. From there, we build a hierarchy of exposures, starting with challenges that feel difficult but doable. Exposures are always collaborative. We do not surprise you or push you into something you are not ready for.
Examples of exposures might include:
Touching a "contaminated" surface without washing.
Writing or saying a disturbing thought without neutralizing it.
Leaving the house without checking locks or appliances.
Tolerating intrusive images without seeking reassurance.
Staying in a situation that triggers panic without escaping.
Common Concerns About ERP
"Won't exposures make my anxiety worse?"
Early in treatment, anxiety will temporarily increase. This is part of how the learning works. We start with manageable challenges and build gradually. The increased anxiety is time-limited and purposeful, not traumatic.
"What if I can't resist the compulsion?"
Slips happen. Progress is measured by your growing ability to notice when compulsions are pulling you, not by perfection. Even partial response prevention builds learning.
"I've tried ERP before and it didn't work."
Sometimes previous ERP focused too much on anxiety reduction rather than learning to tolerate uncertainty. We can explore what didn't work and adjust the approach to your specific presentation.
A Personalized and Compassionate Approach
Traditional ERP can sometimes feel mechanistic. My approach integrates exposure work with psychological flexibility and self-compassion. We explore what your fears cost you and how to build a life where OCD or anxiety doesn't call the shots. You're not just eliminating rituals; you're reclaiming the capacity to make choices based on your values.
Does ERP Work?
Yes. Decades of research support ERP as the most effective treatment for OCD and most anxiety disorders.
For OCD: Studies consistently show that 60–80% of people who complete ERP experience significant symptom reduction.
For Anxiety Disorders: ERP has strong evidence for panic disorder, social anxiety, phobias, and health anxiety.
Beyond OCD and Anxiety: Emerging research shows exposure-based approaches are effective for depression (behavioral activation), anger problems (exposure to triggers without aggression), and other conditions where avoidance maintains distress.
If you've tried other therapies and haven't found relief, it may be because those approaches didn't directly address the compulsive cycle. Insight doesn't break the compulsion; practice with uncertainty does.
About the Author: Kevin Jaworski is a licensed therapist (LPCC) specializing in OCD and anxiety disorders. He provides telehealth therapy throughout Ohio. Kevin utilizes evidence-based approaches including ERP, I-CBT, and ACT to help clients break free from obsessive patterns and reconnect with their lives.