By Clinical Psychology Registrar James Clancy
Starting Exposure and Response Prevention (ERP) for obsessive-compulsive disorder (OCD) is challenging, it intentionally pushes you towards facing your OCD. It’s natural to feel scared, confused, and overwhelmed at first. In this blog we will explore these challenges to provide clarity and reassurance as to the efficacy of this Gold-Standard therapeutic approach.
Why ERP Feels So Backwards
OCD and anxiety teaches you that engaging with safety behaviours such as avoidance, and checking, or completing rituals, will keep you safe from the triggering stimuli;
ERP asks you to do the opposite:
- Go towards the thing that is causing the anxiety
- Then don’t do the ritual that usually makes you feel safe
Your brain and body are used to responding to OCD’s alarm as urgent and real. When you stop following OCD’s rules, the alarm often gets louder for a while. That doesn’t mean ERP is harming you, it might mean you are touching the problem at its core, while also taking back your autonomy.
The “Spike” at the Beginning
It is common for people notice a spike in anxiety when they start ERP. This can look like:
- Strong urges to return to rituals and safety behaviours
- More intense or frequent intrusive thoughts
- Questioning the competency of the practitioner, the efficacy of the therapeutic approach, or your capacity to engage with the process
- Feeling exhausted or emotional after exposures
The discomfort and/or distress at the start of ERP is a sign that you’re changing the pattern, not a sign that you’re broken or beyond help. This increase in distress is common because you’re moving towards feared stimuli while reducing access to that safety net. It’s like gently removing training wheels from a child’s bike, wobbly and uncomfortable at first, but necessary if they want to ride on their own.
OCD May Adapt When You Start ERP
When you begin ERP, OCD may change tactics. Instead of the doubts resulting in the treatment, it may say things like:
- “If this feels this uncomfortable, maybe ERP isn’t going to work for me.”
- “What if ERP makes you lose control?”
- “You’re not doing it right; you’ll never get better.”
Notice that these are new doubts, which can be viewed as logical concerns in isolation but may be your OCD adapting to maintain the status quo. OCD is very good at sounding reasonable when it wants to pull you away from change. Part of ERP is learning to spot these as more OCD, not new feared stimuli.
Why Your Anxiety Feels So Intense
There are a few reasons the early stages of ERP can feel so intense:
- You’re used to instant relief
Engaging in a safety behaviour or ritual give fast, short-term relief, it may also be a habit you’re performing subconsciously. When you start to reduce this engagement, you lose that immediate comfort, even though you gain long-term autonomy. - Your brain thinks discomfort is danger
OCD has trained your brain to treat certain thoughts, feelings, and emotions as danger. ERP slowly teaches your brain that feelings are uncomfortable, but not automatically dangerous. - You’re letting go of certainty
OCD (and anxiety) wants certainty: “What if…?” questions with perfect answers. ERP helps you move toward “I can’t be 100% sure, and I can still live my life.” That shift can feel very challenging at first.
What ERP May Actually Looks Like
ERP does not mean:
- Feeling calm during every exposure
- Never feeling doubt or frustration
- Doing the hardest possible task straight away
Instead, effective ERP usually looks like:
- Starting with moderately challenging triggers
- Staying with the discomfort long enough to notice it rise and fall
- Reducing engagement with safety behaviours and rituals, even if you don’t do it perfectly
- Coming back to exposures again and again, even when you don’t feel like it
You don’t have to be brave, certain, or motivated all the time, but it does require you to keep moving in the direction of becoming habituated with unpleasant thoughts, feelings, and emotions associated with the feared stimuli.
How to Tell If It’s Working (Even When It Feels Uncomfortable)
Early on, progress can be subtle. You might not notice a big change in the content of your thoughts, feelings, or emotions, but you may see small shifts like:
- You can delay engaging with a safety behaviour or ritual even by a few minutes
- You can sit with anxiety a little bit longer than before
- You can do an exposure that felt unthinkable a month ago
- Your whole day isn’t consumed by one obsession in the way it used to be
Sometimes the thoughts don’t change much at first, but your relationship to them does. You start to think, “This is an OCD thought,” instead of “This is my thought.”
Ways to Make the Early Stages More Accessible
You can’t make ERP easy, but you can make it more accessible:
- Go at your pace
Collaboratively work with your practitioner to choose exposures that are challenging but not overwhelming. It’s okay to break tasks into smaller steps. - Name what’s happening
Saying “This is my OCD” can create a little distance when anxiety spikes. - Expect that this is challenging
Assume that the first few weeks may feel tough. When it happens, you can say, “I anticipated this and I’m ready.” - Focus on values, not just fears
Remember why you’re doing this: to take back your autonomy over OCD to live the life you choose. - Be honest with your practitioner
If something feels too intense, confusing, or impossible, say so. Good ERP is collaborative, not forced.
You’re Not Doing ERP “Wrong” Just Because It Feels Hard
If you’re starting ERP and it feels confronting, that doesn’t mean you’re weak, broken, or secretly dangerous. It means you’re touching the very thing OCD has told you to avoid for a long time.
Feeling anxious, distressed, exhausted, and uncertain, is part of the therapeutic process, not a sign that you are failing. In time, with repetition, and support, many people working through challenges associated to OCD, find that the same triggers that once felt unbearable start to feel boring or manageable.
The goal isn’t to enjoy or dismiss uncertainty or enjoy anxiety, it’s to have them show up without running your life.
References
Australian Psychological Society. (2023). Evidence-based psychological approaches for obsessive–compulsive disorder. Australian Psychological Society.
Overview page: https://psychology.org.au/for-the-public/psychology-topics/obsessive-compulsive-disorder
Boeding, S., Paprocki, C. M., & Abramowitz, J. S. (2022). Mechanisms of exposure and response prevention in obsessive–compulsive disorder. Frontiers in Psychiatry, 13, 973838. https://doi.org/10.3389/fpsyt.2022.973838
International OCD Foundation. (2025). Exposure and response prevention (ERP). International OCD Foundation.
https://iocdf.org/about-ocd/treatment/erp/
Kircanski, K., Mortazavi, A., Castriotta, N., Baker, A. S., Mystkowski, J. L., Yi, R., & Craske, M. G. (2019). Exposure and response prevention in the treatment of obsessive–compulsive disorder: Current perspectives. Psychology Research and Behavior Management, 12, 193–210. https://doi.org/10.2147/PRBM.S211117
MI Psych. (2025). Exposure and response prevention (ERP): Treating OCD & anxiety. MI Psych.
https://mi-psych.com.au/therapies/exposure-response-prevention/
National Collaborating Centre for Mental Health. (2005). Obsessive–compulsive disorder: Core interventions in the treatment of obsessive–compulsive disorder and body dysmorphic disorder(Clinical Guideline CG31). National Institute for Health and Care Excellence.
Guideline page: https://www.nice.org.uk/guidance/cg31
Vervliet, B., Craske, M. G., & Hermans, D. (2013). Fear extinction and relapse: State of the art. Annual Review of Clinical Psychology, 9, 215–248. https://doi.org/10.1146/annurev-clinpsy-050212-185542
