Let’s Talk about ERP Therapy

by stuart miles freedigitalphotos.net

A version of this post first appeared on my blog in July 2013……

If you’ve followed my blog for a while, you know I’m a big proponent of exposure and response prevention (ERP) therapy for the treatment of obsessive-compulsive disorder. I don’t delve into the details often, as I’m not a therapist or an expert on ERP. However, I do think it’s important for anyone whose life has been touched by OCD to have a good basic understanding of this therapy.

The premise behind ERP Therapy is straightforward: face your fears repeatedly, and eventually they will cease to frighten you. Sounds easy (well, at least to those of us without OCD). But as we know, nothing related to obsessive-compulsive disorder is simple, and in fact, ERP Therapy can get quite complicated. Just as an example, I’d suggest taking a look at this great guest post written by Dr. Seth Gillihan, on mental rituals, OCD, and ERP. His discussion and the ensuing comments demonstrate how important it is to work with an experienced therapist who really understands the complexities of OCD and ERP.

Like OCD, ERP Therapy is often misrepresented by the media and misunderstood by the general public. Reality shows where patients are asked to do things such as licking toilet seats do more harm than good. Someone with OCD who is already apprehensive about beginning treatment will surely stay away after seeing this portrayal.

So we need accurate, quality information. While this article, written by Tom Corboy, MFT of the OCD Center of Los Angeles, focuses on ERP Therapy for the treatment of Harm OCD, it can easily be applied to the treatment of other types of OCD as well. I love the analogy he uses in the last sentences when explaining ERP Therapy:

The primary behavioral therapy tool used when dealing with Harm OCD is called Exposure and Response Prevention (ERP).   While cognitive therapy challenges the content of our intrusive thoughts, and mindfulness addresses our perspective towards those thoughts, ERP directly confronts the behaviors done in response to those thoughts.  While mindfulness and cognitive therapy set the table, ERP is the main course.  This is where the real work gets done.

I recommend reading the whole article, but also want to share Mr. Corboy’s clarification of some basic ground rules of ERP Therapy:

  1. We won’t ask you to do anything we wouldn’t do ourselves.
  2. We won’t ask you to do anything illegal, immoral, or dangerous.
  3. We will never force you do anything.

Just as we need to spread the word as to what OCD really is and is not, we also need to provide accurate information about exposure and response prevention therapy. I believe those who have already successfully undergone ERP Therapy for OCD are an invaluable resource. Was it different from what you expected? Were there any big surprises? How helpful was it to you? What were some of your best/worst experiences? Demystifying ERP Therapy might be all that is needed to inspire some people with OCD to commit to it. And as so many of us know, that can be the beginning of a new life – one free from the confines of OCD.

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4 Responses to Let’s Talk about ERP Therapy

  1. Always so important to share about ERP. Thank you for doing so! I’ve been concerned lately on some of the OCD groups and support forums I’m involved with how ERP is hardly mentioned and I see a lot of misinformation. There’s no replacement for good information and I appreciate your being a trustworthy site for people to come to!

    • Thank you Angie! I’ve also noticed that ERP is not mentioned nearly enough. Some sites don’t even mention CBT. I’ll keep spreading the word, and I know you do as well!

  2. MICHAEL M says:

    Have to say, I’m not a big fan of traditional couch therapy. These type of services are extremely pricey, yet by many accounts, are disappointing. It’s not enough to say “you must face your fears”. One need TOOLS ready to combat these fears.

    Indeed, I’m extremely hesistant to pay big money to someone who “sounds” good, is basically talking nonsense, but is seen making multiple trips to the bank. And, before I know it, I’m out thousands of dollars. Then there’s the guilt where “society” accuses you of not wanting to spend the money to get help for your loved one – in my case, for my 19-year old son.

    My son’s OCD got worse coincidentally when he began his new job just two months ago. We suspected, that he had tiny signs of it as a toddler. It still is not at the point that it’s interfering with his work and scholastic career, it’s just when he’s at home and has time to himself. The blank, locked stare, the changing of clothes, repetitive foot movements, and the anger which ensues once he’s “called” on it.


    You mentioned that you went through something like 7-9 therapists before you found relief for your son. I don’t want to test my son’s endurance in this way. I want to find that professional who will HELP my son with minimal dilly-dallying.

    Can you suggest, given your experience, how I can begin the task of finding THAT professional who will help him without sinking money into a bottomless pit?

    Anyway, thank you!

    • Hi Michael, I understand what you are saying. If you read (or have read) my book and/or my blog you will know that exposure and response prevention (ERP) therapy is the evidence-based therapy for OCD. The trick is to find a qualified therapist who truly knows ERP therapy. Unfortunately some therapists say they use ERP but either don’t, or don’t really understand it well. The IOCDF website has a lot of helpful hints (so does my blog) on how to find a good therapist to treat OCD. Good luck!

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