What is ERP Therapy for OCD?
- ammclaughlin3
- Oct 2
- 5 min read
Updated: 7 days ago
I'm Autistic (and disabled - so need to save pace points/spoons), so if it's alright with you, I'm just going to dive on in! Cool?
Cool!
There are a few types of therapeutic modalities that have been shown to be effective at managing obsessive compulsive disorder (OCD). Therapeutic modalities that have proven to be effective are called, "evidence based therapy," or "evidence based treatment."
One of evidence-based therapy for OCD is called, "exposure and response prevention" or "exposure and ritual prevention" or ERP / EXRP for short.
What is ERP?
Before we talk about what ERP is, we first need to explain the cycle of OCD.
The OCD Cycle
Here’s how OCD tends to work:
Obsession (intrusive thought)
Meaning attached to the thought → anxiety/discomfort
Compulsion or ritual (action to reduce anxiety)
Temporary relief
Example: “I have a thought I might get fired → I feel anxious → I proofread my email several times → my anxiety goes down.”
The problem is that compulsions reinforce the OCD cycle. They teach your brain that:
The intrusive thought is dangerous.
Relief only comes from compulsions.
Uncertainty can’t be tolerated.
Over time, OCD demands more and more, until life feels smaller and more limited.
How ERP Therapy Breaks the OCD Cycle
With ERP, you intentionally face your obsessions and anxiety without doing the compulsion. For example, your therapist might encourage you to send a work email without rereading it ten times.
Why? Because ERP helps you:
Learn that thoughts are just thoughts (not facts).
Realize your obsession is not dangerous.
Discover you can tolerate discomfort and uncertainty.
Retrain your brain to no longer rely on compulsions for relief.
Curious if ERP therapy for OCD could help you (and live on Wahpekute land, colonized as MN)?
The reason we do this, is not because we're assholes that enjoy making our therapy participants anxious for no reason, but because we want you to:
Learn that your thought is just a thought, and does not = fact.
Your thought / obsession is not dangerous
Learn that the thing™️ you fear happening may not actually happen
Learn that you can tolerate anxiety / discomfort / uncertainty
De-condition your brain's pattern that only expects relief when you engage in a compulsion.
What to Expect During ERP Therapy
When folks are doing therapy for intrusive thoughts, AKA OCD, and doing ERP, sessions are usually pretty structuredm goal-focused and collaborative. Here’s the general process:
Identify obsessions, compulsions, and core fears.
Build an exposure hierarchy (starting with lower-level triggers).
Practice exposures with your therapist’s support.
Prevent compulsions and sit with anxiety until it naturally decreases.
Learn to tolerate uncertainty and reclaim time/energy from OCD.
You won’t start with the scariest thing right away — exposures begin in the low-to-middle range of difficulty (think 3 out of 7 on an anxiety scale).
Want to understand the process in more detail? (see the image below ⬇️ )
ERP Steps
Now that you know a bit more about ERP, you might be wondering what the research shows.(Permission to skip this section, or any section, really)!
The Research
ERP therapy is one of the most studied and effective treatments for OCD. Research shows that 60–70% of people with OCD experience significant symptom reduction with ERP.
👉 Want to work with an OCD specialist in Minnesota who actually uses evidence-based therapy?
ERP and Autism/ADHD
ERP is considered the gold standard OCD treatment, but it may not work the same way for everyone — especially for Autistic folks, PDAers, or ADHDers.
Why?
Many Autistic people find it harder to generalize or habituate.
ERP relies on tolerating uncertainty, which can be extra challenging if your nervous system already runs on high alert.
Sensory overload or unpredictability may make ERP harder unless adapted.
That said, ERP can still be helpful for Autistic people and ADHDers — it just needs to be done in a neurodivergent-affirming way. That means working with a therapist who:
Understands the overlap between OCD and Autism/ADHD.
Avoids exposures that overwhelm your sensory system.
Paces therapy at your speed.
I myself (an AuDHDer) went from "extreme" levels of OCD to "moderately severe" with ERP. And I've worked with Autistic folks who have OCD and have seen reductions in their OCD symptoms.
Why Work With an OCD Specialist
Not every therapist is trained in OCD treatment. In fact, general talk therapy can sometimes make OCD worse if it reinforces compulsions.
An OCD specialist will:
Recognize subtle obsessions and compulsions.
Teach ERP therapy the way research supports it.
Prevent you from starting with exposures that are too hard, too fast.
👋🏼 If you’re looking for ERP therapy in Minnesota (Wahpekute land), I can help. I’m trained in ERP and Inference-Based CBT (I-CBT) for OCD, anxiety, and phobias — and I bring my own lived experience with OCD to the work.
Final Thoughts
ERP therapy is a powerful, evidence-based treatment for OCD. While it’s not for everyone, for many people it leads to life-changing improvements. And if you’re Autistic, ADHD, or otherwise neurodivergent — ERP can still be effective, especially with the right therapist.
Stay tuned for our next blog post - all about another type of therapy for OCD; Inference-Based Cognitive Behavioral Therapy (I-CBT).
✅ Ready to take the next step toward OCD recovery? Schedule your free consultation today and see if ERP therapy might be the right fit for you.
References
Ferrando, L., Ehrlich, P., & Simpson, H. B. (2021). Treatment of obsessive-compulsive disorder: Review and meta-analysis of randomized controlled trials. Journal of Psychiatric Research, 139, 158–168. https://doi.org/10.1016/j.jpsychires.2021.05.022
Foa, E. B., Liebowitz, M. R., Kozak, M. J., Davies, S., Campeas, R., Franklin, M. E., … & Tu, X. (2005). Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive–compulsive disorder. American Journal of Psychiatry, 162(1), 151–161. https://doi.org/10.1176/appi.ajp.162.1.151
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(S1), S85–S92. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_518_18
Mao, Y., Wang, Y., & Yuan, C. (2022). Efficacy of combining exposure and response prevention with pharmacotherapy for obsessive-compulsive disorder: A meta-analysis. Journal of Affective Disorders, 297, 115–124. https://doi.org/10.1016/j.jad.2021.10.080
Miegel, F., Schiele, M. A., Schlagenhauf, F., Kroczek, A., Reuter, M., Deckert, J., … & Lueken, U. (2025). Exposure therapy in mixed reality for obsessive-compulsive disorder: A randomized clinical trial. JAMA Network Open, 8(1), e2149604. https://doi.org/10.1001/jamanetworkopen.2025.49604
National Institute for Health and Care Excellence. (2024). Obsessive-compulsive disorder and body dysmorphic disorder: Recognition, assessment and treatment (NICE guideline CG31). https://www.nice.org.uk/guidance/cg31
Reid, J. E., Laws, K. R., & Drummond, L. M. (2021). Cognitive behavioural therapy with exposure and response prevention in the treatment of obsessive-compulsive disorder: A meta-analysis. BMC Psychiatry, 21, 203. https://doi.org/10.1186/s12888-021-03171-z
Song, X., Li, Y., & Zhang, H. (2022). The efficacy of exposure and response prevention for obsessive-compulsive disorder: A meta-analysis. Frontiers in Psychiatry, 13, 813928. https://doi.org/10.3389/fpsyt.2022.813928
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