OCD Treatment: How ERP Therapy Works and What to Expect
OCD takes different forms rather than following a uniform pattern. For some, it may involve repeated checking or cleaning, and for others, it can involve intrusive thoughts, fears about harming someone, or a constant need for reassurance. These experiences often share a cycle between an unwanted thought or feeling and the behaviours a person uses to try to make that discomfort go away (Abramovitch et al., 2021).
Though OCD is a serious mental health issue, it is treatable. One of the most well-researched treatments for OCD is cognitive behavioural therapy (CBT), which is a form of psychotherapy aimed at changing unhelpful thinking patterns and behaviours (Beck, 2020). A specialized form of CBT, that is considered one of the primary evidence-based psychological treatments for OCD, is called Exposure and Response Prevention (ERP) (Reid et al., 2021).
However, this is not where the treatment for OCD begins.
What Does OCD Treatment Involve?
The first step in OCD treatment is to share an understanding of what OCD looks like for you. It is crucial for your mental health professional to learn your typical thoughts, fears, compulsions, and other compensatory behaviours that are in the way of your daily life. OCD does not look the same for everyone, so treatment must be tailored to the individual for the best possible outcome (Leckman et al., 2004). Research has consistently found that an individualized approach of CBT with ERP can significantly reduce OCD symptoms and improve quality of life (Öst et al., 2015; Reid et al., 2021).
A large part of this treatment focuses on learning to respond differently to intrusive thoughts and uncomfortable feelings rather than continuing to use compulsions to get rid of them (Abramovitch et al., 2021; NICE, 2005).
What Is ERP Treatment for OCD?
Exposure and Response Prevention (ERP) is a type of CBT specifically adapted for OCD. ERP works in two parts: the first involves gradually facing something that triggers your OCD, and the second is where you work to resist the compulsion that OCD tells you to perform (Foa et al., 2012).
For example, someone with Contamination OCD might feel an overwhelming urge to continuously wash their hands after dealing with uncooked chicken. As part of ERP, they might gradually practice touching the trigger and then reducing the number of times they wash their hands.
ERP helps you learn that you can experience discomfort without needing to perform the compulsion, and that this change in response is what will allow you to change the cycle (Foa et al., 2012).
What Happens During ERP Therapy for OCD?
Since ERP is individualized, you and your mental health professional will work together to identify what exactly may trigger your OCD; this is where we can determine how to begin.
Exposure hierarchy is a facet of ERP that positions situations from manageable to difficult, where you gradually work your way through the list of exposures to resist the behavioral compulsions that follow the stimulus. Depending on the type of OCD you experience, exposure may include (Foa et al., 2012):
Leaving the house without repeatedly checking that all appliances are turned off
Touching something you deem contaminated and delaying hand washing
Making a small mistake without correcting it
Resisting the urge to ask someone for reassurance
Leaving something imperfect
ERP can also involve a degree of mental compulsions; these are harder to recognize. Examples include: replaying conversations long after they ended, analyzing what your thoughts mean (or if you really mean them), and even mentally checking how you feel. These can all become a part of the OCD cycle, but by delving into the process of ERP treatment, you can learn everyday skills that carry over into situations outside of the therapy room (Abramovitch et al., 2021).
How long does OCD treatment take?
There is no set number of sessions for OCD treatment. Some people may participate in weekly therapy for several months, while others may benefit from a more intensive treatment schedule. Treatment length is based on many factors such as severity of the symptoms, symptoms' interference with everyday life, and even the type of compulsions involved (NICE, 2005).
It is also important to note that the perspective you have on the treatment journey matters as well. Your only goal should not be to complete a certain number of sessions; instead, it should be understood that therapy is about developing skills that you can continue using when/if OCD shows up again in the future.
Can you do OCD treatment online?
OCD treatment can be done online, and we offer virtual OCD treatment at the OCD and Anxiety Clinic of Ontario.
For many people, virtual therapy can be just as helpful as attending appointments in person. Research on internet-based CBT and ERP has found meaningful improvements in OCD symptoms, particularly when treatment is guided by a trained therapist (Andersson et al., 2012; Wootton et al., 2019). In other words, being on a screen does not mean you are missing out on the core parts of OCD treatment.
In fact, ERP can often be practiced within your own home and everyday environment. Your therapist can work with you to identify situations that trigger your OCD and help you practise responding differently to those triggers between sessions.
Virtual treatment can also make therapy more accessible for people who have busy schedules, live farther from the clinic, or simply feel more comfortable starting treatment from home.
That said, online therapy is not necessarily the right fit for everyone. Your clinician can help determine whether virtual treatment is appropriate based on your symptoms, treatment goals, and individual circumstances.
Should I See an OCD Psychologist or OCD Therapist?
Both psychologists and therapists offer OCD treatment, and it can be confusing to know what to look for.
In Ontario, psychologists and Registered Psychotherapists are regulated professionals who can provide psychotherapy within their respective scopes of practice. Their education and professional roles differ, but when it comes to OCD treatment, one of the most important questions to ask is whether the clinician has specific training and experience in CBT with ERP (NICE, 2005).
Rather than focusing solely on that professional title, consider asking about the distinction so you can be properly treated by a source who is familiar with the field of OCD and compulsions.
Can medication play a role in OCD treatment?
Medication decisions should always be discussed with a qualified medical professional.
Sometimes medication does have a role in OCD treatment. Depending on the severity of someone's symptoms, their treatment preferences, previous treatment experiences, and other individual factors (NICE, 2005).
One of the medications with the strongest evidence for treating OCD is selective serotonin reuptake inhibitors (SSRIs), which are a common class of prescription medication (NICE, 2005). Research even suggests that combining evidence-based psychological treatment with this medication can be helpful for some individuals (Mao et al., 2022).
What are the different types of OCD?
People often talk about OCD as if there are different types, but in reality, OCD is not always divided into neat categories. People can experience several symptom themes at once, and these symptoms can change over time (Leckman et al., 2004).
Some common OCD presentations include:
Contamination OCD: fears about germs, illness, chemicals, or being contaminated, often accompanied by washing, cleaning, or avoidance.
Checking OCD: repeated checking or doubts about whether something has been done correctly or whether harm could occur.
Symmetry and “just right” OCD: a strong need for things to feel even, symmetrical, complete, or arranged in a particular way.
Intrusive thoughts: unwanted thoughts or images involving topics such as harming others, sex, religion, morality, or relationships. These thoughts can be particularly distressing when they feel completely inconsistent with a person's values.
Mental compulsions: repetitive thinking, analysing, reviewing memories, mentally checking, or trying to achieve certainty can also function as compulsions.
(Abramovitch et al., 2021; Leckman et al., 2004).
Beyond all of these common OCD symptom dimensions, it is clear that understanding the cycle in which OCD continues is the most important. ERP can be adapted to the individual's symptoms, whether the compulsions are physical, mental, or both (NICE, 2005).
How do I start OCD treatment?
If you think you may be experiencing OCD, the first step is to speak with a mental health professional who has experience treating OCD.
When contacting a clinic, there are a few key questions that should be asked. These include:
Does the clinician specialize in OCD?
Do they provide CBT with ERP?
Do they work with mental compulsions as well as physical compulsions?
Is virtual treatment available?
How often are sessions typically scheduled?
Will I have ERP exercises to practise between appointments?
You also do not need to be completely certain that you have OCD before reaching out for help. An assessment can help you better understand what you are experiencing and whether OCD treatment is appropriate.
If OCD is taking up a significant amount of your time or affecting your relationships, school, work, or everyday life, specialized treatment can help you break that cycle. Specifically, if you are looking for OCD treatment in Ontario, the OCD and Anxiety Clinic of Ontario offers assessment and evidence-based treatment for OCD and related anxiety concerns. Reach out to our clinic to learn more about our treatment options and whether CBT with ERP may be right for you.
If you are looking for OCD treatment in Ontario, you can book an appointment with the OCD and Anxiety Clinic of Ontario.
References
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