Choosing ERP Therapy

Exposure Response Prevention Therapy, as I have mentioned before, is the treatment of choice for OCD.  Though it is intensely anxiety provoking and difficult to do, the results are often dramatic. I have always credited this therapy for saving my son Dan’s life.

In a thought-provoking post entitled “No one should do exposure and response prevention!” , Dr. Jonathan Grayson argues that nobody should engage in ERP therapy just because the experts say it is the right thing to do. Rather, for it to work, the OCD sufferer needs to really believe that this therapy is the best way to proceed. In short, the desire to participate in ERP therapy needs to come from within.

Though this advice can apply to many therapies for many disorders, it can get complicated with OCD (so what else is new?). Even though they know it is illogical and their sense of security is false, some OCD sufferers find it too hard to give up the “safety” of their rituals.  It is a risk they are either unwilling or unable to take. In addition, those with OCD are often steered by what they perceive is right and therefore may agree to engage in ERP therapy because it is the “right thing to do,” and not because they truly believe it will help them.

When Dan spent nine weeks at an intensive residential treatment program for OCD, he learned a lot about how OCD operates, and quickly came to the realization that ERP therapy was his ticket to freedom. In my experience, those with OCD understand better than anyone what their disorder entails. They know they act irrationally, but they are rational people. Just read any OCD sufferer’s blog, and you are bound to see a phrase like, “I know this sounds crazy but….”

It is far from easy to muster the courage to fight OCD, but it is possible. Empowered with knowledge, strength and desire, those with OCD can take the necessary responsibility for their recovery. And while the battle may be long and torturous, the choice to keep fighting is what really matters.

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16 Responses to Choosing ERP Therapy

  1. pjbs says:

    Thank you for a very encouraging post. May those who want to see “the light at the end of the tunnel” find the strength and courage to do what Dan did. Your last paragraph is a “masterpiece” and should hang on the walls of all who suffer from disorders that interfere with their life..
    Keep up the good work……I appreciate it!!!!!!

  2. I always read your posts. It is helpful to hear from other parents of kids with OCD. I think what has been most challenging is that at the age of 8, my daughter was unable to understand the OCD nor agree to see it as seperate from herself. And even now at nine, for her to fully own working on it, is a challenge. It is not easy as a parent to help a child with OCD, because like you say, they need to want to be helped and sometimes she just doesn’t want help.

    • Anna Costina says:

      Hi, My daughter is also nine and suffering. It breaks my heart not being able to help her. I’m trying to get her help, yet it’s so hard to find someone who specializes in OCD in children. Have you had better luck?

      • Hi Anna, Have you tried connecting with the IOCDF for possible referrals? There are some great specialists for kids out there; you just have to find them. If you’d like to email me at and let me know where you live, I might know of some people.

  3. ocdtalk says:

    By the time Dan was diagnosed with OCD he was old enough to really understand it. You bring up a good point about OCD in younger children. I’m sure just being there for her is more helpful than it probably seems to you, and when she is ready, you will be able to steer her toward the right help. I’m wondering if you’ve checked out any children’s books on OCD? Maybe they might be helpful for your daughter? A few that come to mind are: Mr. Worry, What to Do When your Brain Gets Stuck and Up and Down the Worry Hill. Good Luck!

  4. Lolly says:

    Very well written. I am a supporter of ERPT, and I know it works from personal experience. I have recently completed a 6 month out patient ERPT program at the University of Pennsylvania in Philadelphia…

    It’s all about knowing your OCD, knowing your triggers, and knowing that you can overcome anything once you have the tools to work through it.

  5. ocdtalk says:

    Thanks for sharing your first-hand experience and I think your last sentence sums it all up!

  6. I have read that post before (and have attended seminars led by Grayson at the OCD conference), and I agree, I think it’s best if OCD sufferers choose do to ERP (rather than being forced into it either by others or because it’s the “right” thing). I also think that taking a leap of faith in the fact that it will work is also helpful; however, I have often found it so frustrating because, no matter how much I learn about OCD, no matter how much I believe that ERP and CBT are my ticket to freedom, no matter how good I get at recognizing my behaviors as compulsive, I still struggle to resist. Even when I started treatment, CBT and ERP really did just seem to make sense treatment-wise – it was what I had always hoped someone would tell me – no you don’t NEED to do compulsions, in fact the only make the problem worse. There was an immense sense of relief that came from learning this. It just made so much more sense than anything else I had been told before. Since then I have come a long, long way, but I still sometimes wonder, how do you get yourself to not only believe in, but ACT, on your faith in CBT and ERP? It’s something I get better at every day but still struggle with more than I’d like to.

  7. ocdtalk says:

    Thank you so much for your comment. While I can read, write and theorize all I want, it is those of you who actually have OCD that can give us all a window into this disorder. Your post shows how it is never straightforward or easy, and how fighting OCD is, indeed, an ongoing battle. I’m no expert, but the fact that you say “It’s something I get better at every day” suggests to me that the longer you continue fighting, the more you will improve and (hopefully) the easier it will get. Thank you again for your insights!

  8. Mary says:

    My niece is 47, she’s had OCD since she was a child but doesn’t acknowledge that & believes that it had taken over her life in the last 20 years. She doesn’t read well, can’t use the computer (its intimidating to her) and can’t or won’t write a letter or a journal. She lives in Las Vegas and for years was a 21 dealer, managed her OCD, but in 2008 was fired from her job after the death of her aunt. Since then it’s been a downhill slide and gets progressively worse. Each time i present a treatment suggestion she resists or throws up some road block. She’s been in a relationship with a man who services her OCD and hates him, treats him really bad. They fight all the time, I mean serious fighting. He uses her to get money and she resents him for that plus the more he services her OCD the worse it gets. It’s a sick and perverted relationship. She inheriated some properties and money from the deaths of other family members but can’t manage any of it and her live-in has bilked her for most of the liquid assets, so she beleives that she can’t afford inpatient treatment, which is what i think she needs. She doesn’t seem willing to put forth effort to get better and thinks that Dr. Grayson’s inpatient treatment is some magic pill that she will be cured but it’s unatainable because of the cost and proximity. I’m now her only living relative. I know i need to help her but i’m running out of time and options. (i’m 66) I know she feels isolated, she can’t drive, she can’t shower, she takes a lot of xanax and alcohol. What can i do? Would a telephone consultation with another OCD suffer help? Anything… and suggestions.

  9. ocdtalk says:

    Hello Mary,

    I am so sorry to hear that your niece is suffering. It sounds like she has additional problems aside from her OCD. You seem very caring and I’m sure it is upsetting and frustrating to you to feel so helpless. This article on recovery avoidance may be helpful to you:

    If I were you, I would contact the IOCDF (International OCD Foundation), as they can advise you and steer you in the right direction. Good Luck and please keep me posted.

    • Mary says:

      Thank you for the link to this article. It did offer me more understanding of the avoidance of treatment behavior. Although i can say that it is disappointing and truly tragic I don’t intend to give up hope for her to regain control of her life. Not servicing her OCD & other reassurance demands is a positive step for all of us and I’ve told her before that i wouldn’t participate in that. However, she is in a relationship with someone who does and until the incentive to seek treatment is enough she will continue to suffer.
      Again, thank you for your help, it is deeply appreciated.

  10. ocdtalk says:

    You are welcome, and you and your niece are in my thoughts.

  11. Stephanie says:

    I was very encouraged by your blogs. My daughter has just turned 4 and I am certain that she will eventually be diagnosed with OCD. When she was 2 she started obsessing about the specific order things were done in, specifically socks and shoes. Then it progressed to the exact way the line in the sock sits on her foot, how far out the tongue on her shoe is. Over time she is displaying more signs like how far apart things need to be when she is playing, or the bedtime ritual needing to be exact. Any of these things are not right and it causes a tantrum. As soon as I recognized her compulsion to do things a certain way I started challenging that. For socks and shoes I am constantly changing the order they are done in. When that line isn’t perfect I distract her with the next item and then I point out that the sock was ok after all when she has calmed down. My husband insists that I am torturing her and just need to go with the flow to avoid the battles. I can’t take her to a therapist because of the expense. Her pediatrician acts like it is normal but having 2 other children that were not this way and seeing the way her “triggers” are increasing and predictable tells me that it is more than that. Your blog has given me some support to show my husband that I am not wrong for not going along with her compulsions. It has also given me the terminology to look up the best way to treat her compulsions. My goal is to keep this from taking over her life as she gets older.

    • ocdtalk says:

      Thank you for sharing, Stephanie. I am a strong believer that nobody knows a child as well as his/her parents, and so I am glad you are trusting your instincts and learning about OCD. If yo do feel, down the road, that your daughter needs professional help, I hope you will check out various resources for affordable therapy. Good Luck and please keep me posted as to how things are going.

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