What Treatment Looks Like

OCD can be debilitating, and thankfully there is treatment, and treatment is effective. There are various treatments for OCD, and I’d like to share two with you across this post and the next: Exposure and Response Prevention (ERP) and Inference Based Cognitive Behavior Therapy (I-CBT). In this post, we’ll focus on ERP. The next post covers I-CBT and briefly discusses the role psychiatric medication plays in the treatment of OCD.

Exposure and Response Prevention

ERP is by and large considered the most effective OCD treatment, backed by decades of research. ERP is focused on helping clients learn to tolerate uncertainty.

The therapist and client meet to discuss the range of obsessions and compulsions and make a record of them, along with any associated triggers and consequences. All of these items may become targets of subsequent exposure work.

To help clients tolerate uncertainty, the therapist and client select an obsession and craft an exposure hierarchy. An exposure hierarchy is a list of challenging activities that touch upon the obsessive theme. For example, if the client has a fear of contamination, the therapist and client will make a list of scenarios in which the client fears becoming contaminated.

These activities are then generally organized from toughest to least tough or most distressing to least distressing. Next, the therapist and client typically select a lower-level item to work on and a response prevention plan to help the client not engage in compulsive behavior. These response prevention plans sound like, “When OCD asks me to do this compulsion, I will do this instead.”

These response prevention plans are most useful outside of sessions but may be practiced in sessions. In session, however, the client and therapist will select an item from their exposure hierarchy and do it in session together. If the client is willing and somewhat fearful of touching doorknobs, then doorknobs will be touched in session. The client’s distress will likely increase, and in session, the client will not be allowed to use their compulsions to tolerate the distress. In many cases, the client will be asked to do nothing.

This is scary, I know, and that’s why it’s important that the client and therapist have a strong relationship and that the exposure item selected is something the client is willing to do. The client’s willingness to do the exposure is a key function of treatment.

The client will need to learn to tolerate the distress without using the compulsions, and distress is monitored using a Subjective Unit of Distress (SUD) scale. The client will do nothing until the SUD has decreased by at least 50% if not greater. Ideally, in session we look for near-complete distress habituation if possible. So what does this look like?

If the client touches two doorknobs and their distress spikes to 40%, this may be tolerable enough. The client will then sit on the couch doing nothing as the distress naturally abates. Talking is allowed, and other activities could be acceptable; however, the therapist and client need to do their best to avoid any behavior that could serve as reassurance and/or anxiety-relieving, as it’s important for the distress to decrease without intervention.

These exposures are systematically addressed in session and at home. Out-of-session practice is critical for this treatment. The more successes the client has, the more they will recover. It is also possible for a client to complete one exposure and then borrow the benefits from it, making the next exposure a little easier. The result of exposure work is that the client becomes more courageous and more willing to tolerate distress, and the things the client once obsessed over are no longer worrisome.

What to Keep in Mind

Reading about ERP can feel daunting. Facing the very things OCD tells you to avoid is a lot to ask, and it’s understandable if that makes you want to wait. If that’s you, you’re far from alone. OCD can impact anyone; according to Harvard Health, it affects up to 3% of people globally, and a 2025 study of adults in 10 countries found that only about 1 in 5 adults with OCD had received any mental health treatment in the past year.

It may help to remember that ERP is gradual and collaborative. You and your therapist build the exposure hierarchy together, you start with a more manageable item, and each exposure is something you’re willing to do. Treatment is effective, and you don’t have to take that first step alone. If you’d like to revisit the earlier posts, you can find what OCD actually is and how compulsions differ from everyday habits.

Don’t Go without Support

OCD is not likely to resolve on its own, and treatment will likely be needed. With treatment, OCD symptoms can improve significantly, and you will be better equipped and prepared to resume life.

When should you consider reaching out for help? On some level, we addressed this in the first post. It’s when the symptoms of OCD are running through your life. You’re late to work and missing meetings, spending more time entertaining compulsions than with your own family, or worse yet, you’re on the brink of losing a job or a relationship. You’ve not seen your friends in months because you’re afraid you won’t be able to stop counting at the dinner table. You doubt whether you’re the kind of person who could lead a normal life.

You now have a name for this, and it’s called Obsessive-Compulsive Disorder, or OCD. You’re not just a particular person or someone preoccupied with neatness. OCD is a debilitating mental health condition, and you may have already gone months or years without help. Now is your time to schedule a consultation with us.

If you’d like to learn about other treatment options before you reach out, the next post covers Inference Based Cognitive Behavior Therapy (I-CBT) and the role of medication.