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Exposure with response prevention (ERP)

Exposure with response prevention also known as ERP is the gold standard treatment for OCD. ERP is a specific form of cognitive behavioral therapy (CBT) for OCD. The basic principles surrounding ERP for OCD is to face your fear without engaging in a ritual (exposure + ritual prevention). However, we know this process can be extremely challenging and sounds much simpler than it often is. Specific steps are recommended in ERP and if possible it is best to do this type of treatment with an OCD specialist.

Important ERP steps

  • Understand your OCD and OCD symptoms
  • Identify a fear to work on
  • Develop an OCD hierarchy for your fear
    • Rank exposures for your fear on a scale from 1-10
    • 1 should be at the bottom of your hierarchy which the least anxiety provoking exposures for that fear and 10 at the top with the most challenging exposures listed there
  • Begin exposures with ritual prevention
    • Systematically work your way up your hierarchy starting with the lower level exposures and working your way up to the high level exposures
    • An exposure should be repeated multiple times without any rituals. Once an exposure no longer causes distress/anxiety you can move up to the next higher level exposure
    • Continue this approach until you reach the top of your hierarchy at which point you can move onto another OCD hierarchy if you have one


Remember repeated exposures with ritual prevention will allow you to habituate to a fear. Anytime you engage in a ritual both the fear and OCD cycle are reinforced.

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