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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.

Videos: OCD Treatment

Choose a title below to view related OCD videos

Exposure with Response Treatment is the gold standard in treating Obsessive Compulsive Disorder (OCD). CBT and CT alone will not be successful. Visit the for a free interactive ERP tool.

Dr. Elizabeth McIngvale talks about getting through OCD treatment. She explains sometimes getting through treatment can be scary, though, and challenging but the moment you start actively participating in ERP treatment, you will start to learn to manage your OCD and take back your life.

Learn the difference between Cognitive Therapy (CT), Cognitive Behavioral Therapy (CBT), and Exposure and Response Prevention (ERP). Discover the best treatment option for Obsessive Compulsive Disorder (OCD).

Jonathan S. Abramowitz, PhD, ABPP, explains that the first line treatment for OCD is Cognitive Behavioral Therapy (CBT), specifically Exposure and Response Prevention (ERP). There is medication for OCD, but they don't work as well as therapy does.

Dr. Elizabeth McIngvale talks about where to start once you learn you have OCD and what worked for her.

Throstur Bjorgvinsson, PhD, ABPP, explains that the most effective treatment is cognitive behavioral therapy (CBT), specifically exposure and response prevention (ERP). There is medication that can be helpful, but ERP has been proven as the best treatment for OCD.

Dr. Eric Storch explains treatment options such as Cognitive Behavioral Therapy (CBT) with Exposure and Response Prevention (ERP) and medication. Visit for more educational videos and resources about OCD and other mental health disorders. Visit for a free interactive tool that walks users through the ERP steps to manage OCD.

Throstur Bjorgvinsson, PhD, ABPP, explains that cognitive behavioral therapy, or CBT, is a form of psychotherapy. It is effective in treating many different disorders, though CBT is done differently for different disorders.

Throstur Bjorgvinsson, PhD, ABPP, says that CBT treatment usually takes 12-20 sessions that last from 50 minutes to 90 minutes. Treatment can potentially last longer depending on the severity and complication of a person's OCD.

Throstur Bjorgvinsson, PhD, ABPP, says that trust and honestly between a person and his therapist is extremely important. There are some cases where there is little to no trust between a therapist and patient, or in some cases, the therapist is not qualified to be working specifically with OCD.

Throstur Bjorgvinsson, PhD, ABPP explains that residential treatment is needed if outpatient therapy is not enough. Someone may also do residential treatment if they have time off of work or cannot find resources around where they live.

Throstur Bjorgvinsson, PhD, ABPP, first explains that residential treatment is not the same as inpatient treatment. He then goes into what treatment might be needed for a person with OCD.

Throstur Bjorgvinsson, PhD, ABPP discusses that there are currently two programs in the United States that specialize in children and adolescence with severe OCD. Residential treatment is very helpful for some children with severe OCD.

Throstur Bjorgvinsson, PhD, ABPP, discusses that in order to be successful in treatment for OCD, one needs to be honest with himself about what he is struggling with. There needs to be trust and collaboration between the therapist and patient.

Jonathan Grayson, PhD. discusses how every person with OCD wants to be 100% certain of something. However, instead of trying to gain 100% certainty, a person should try to learn to live with uncertainty.

Jonathan Grayson, PhD. explains how nothing in life is certain. A person with OCD wants to be 100% certain of something, but in reality, nothing is 100% certain. Instead of trying to be 100% certain of something, a person needs to be aware that life is full of uncertainties.

Dr. McIngvale shares her personal experience with OCD treatment. It is different for everyone because everyone responses differently to treatment. She explains CBT with ERP and engaging in treatment is worth the results.

Dr. Bjorgvinsson gives an example of Exposure with Response Prevention, creating a hierarchy, doing exposures, and more.

Ben Eckstein, LCSW, discusses the use of exposure and response prevention (ERP) when treating contamination obsessive-compulsive disorder (OCD). He explains hierarchies, which are the ratings of triggers that cause the least amount of anxiety to the most amount anxiety.

Ben Eckstein, LCSW, describes cross-contamination. During cross-contamination, a person touches something that is contaminated. He then touches another part of his body in order to "spread" that contamination. While this can be distressful for someone with OCD, it's a great tool to use for therapy.

Jonathan Grayson, PhD, discusses that there is treatment available for OCD. Both the American Psychological Association and the American Psychiatric Assosiation both agree that ERP is the best treatment for OCD. If you are doing CBT, it's best to make sure that it's specifically ERP.