OCD Series – Post 1: Understanding OCD and ERP

Introduction

Obsessive–Compulsive Disorder (OCD) can feel like living with an unwanted “bully in the brain.” Intrusive thoughts arrive uninvited, anxiety spikes, and rituals or mental checking temporarily relieve the fear—but the cycle always comes back stronger. For many, OCD is exhausting, time-consuming, and deeply discouraging.

The good news is that there is a highly effective, evidence-based treatment: Exposure and Response Prevention (ERP). ERP is the gold standard for OCD worldwide. This post—the first in our OCD Series—is designed to accompany your first therapy session and give you the background you need to understand what’s happening in your mind, why OCD persists, and how ERP helps you regain freedom.

What is OCD?

OCD is a mental health condition characterised by two main parts:

• Obsessions – intrusive, unwanted thoughts, images, or urges that cause distress.

• Compulsions – repetitive behaviours (external actions or internal mental rituals) aimed at reducing distress or preventing feared outcomes.

Some common obsessions include fears about contamination, harming others, religious or moral “blasphemous” thoughts, needing symmetry or “just right” feelings. Compulsions might include handwashing, checking, counting, seeking reassurance, or silently repeating phrases.

Importantly, OCD is not about being “quirky” or “tidy.” It’s a serious condition that can take hours of someone’s day, disrupt relationships, and limit life opportunities.

The OCD Cycle

OCD keeps itself going through a predictable loop:

1. Intrusion: An unwanted thought, image, or urge pops up.

2. Distress: The thought feels threatening, immoral, or catastrophic.

3. Compulsion: To reduce the distress, the person engages in a ritual.

4. Relief: Anxiety drops—but only briefly.

5. Reinforcement: The brain learns that compulsions “work,” making obsessions come back stronger.

Here’s an example:

• Intrusion: “What if I left the stove on and the house burns down?”

• Distress: Anxiety spikes.

• Compulsion: Checking the stove repeatedly.

• Relief: Anxiety lowers—but only until the next intrusive thought.

• Reinforcement: The brain mistakenly “rewards” checking behaviour, making OCD more powerful.

Why Avoidance and Rituals Don’t Help

It’s natural to think: “If I just check again, or avoid that situation, I’ll feel better.” But each time you perform a ritual or avoid a trigger, you teach your brain:

• The thought was dangerous.

• You couldn’t handle the anxiety without the ritual.

In other words, OCD tricks you into believing rituals are necessary for safety. This is why avoidance and compulsions keep OCD alive.

How ERP Works

Exposure and Response Prevention (ERP) breaks the cycle.

• Exposure: You gradually face the thoughts, images, objects, or situations that trigger anxiety or obsessions.

• Response Prevention: You resist doing the usual compulsion or ritual.

Over time, your brain learns:

• Anxiety naturally rises and falls without rituals.

• Feared outcomes don’t happen—or if they do, you can handle them.

• You are stronger than OCD wants you to believe.

This process is called habituation (getting used to the anxiety until it fades) and inhibitory learning (developing new learning that overrides the OCD associations).

Common Myths About ERP

1. “ERP will make me do the scariest thing right away.”
   – False. ERP is gradual and collaborative. You and your therapist build a hierarchy, starting with lower-level challenges.

2. “ERP is about proving my fears wrong.”
   – Not exactly. It’s about learning that you can tolerate uncertainty and distress, even without certainty.

3. “ERP means never feeling anxious again.”
   – No. ERP helps you relate differently to anxiety so it no longer controls your life.

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Building an Exposure Hierarchy

An exposure hierarchy is like a ladder of challenges:

• Low-level triggers (e.g., touching a doorknob once and not washing).

• Medium-level triggers (e.g., touching a rubbish bin without washing).

• High-level triggers (e.g., using a public toilet without hand sanitiser).

Together, we rank situations from least to most distressing (often on a 0–100 SUDs scale: Subjective Units of Distress). Then, step by step, you practice exposures while preventing rituals.

Normalising Anxiety and Uncertainty

Anxiety during ERP is not a sign of danger—it’s a sign that your brain is learning. Think of it like a workout: your muscles feel sore when they grow, your brain feels anxious when it’s rewiring.

ERP also targets intolerance of uncertainty. Most people with OCD crave 100% certainty (“What if I missed something?”). ERP teaches you to live with the normal uncertainty that everyone experiences, without rituals.

Client Exercise: Journaling Intrusive Thoughts

To prepare for ERP, try this exercise:

1. Over the next week, notice intrusive thoughts when they appear.

2. Write them down without censoring. Example: “I might harm my child with a knife.”

3. Next to each thought, write how anxious it made you feel (0–100).

4. Notice how often similar thoughts repeat.

This exercise isn’t about analysing or pushing thoughts away—it’s about seeing them as mental events, not truths.

What You’ll Learn in Therapy

Session by session, ERP helps you:

• Understand how OCD works.

• Build a hierarchy of triggers.

• Practice exposures with your therapist’s support.

• Learn to resist compulsions.

• Develop distress tolerance skills.

• Reclaim time, energy, and freedom from OCD.

Practical Tips to Begin

• Use a curious mindset: “Let’s see what happens” instead of “I must make this anxiety go away.”

• Expect discomfort: ERP is not about comfort—it’s about freedom.

• Celebrate small wins: Every resisted ritual is a victory.

• Stay consistent: Daily practice rewires the brain faster.

• Bring compassion: OCD is not your fault; recovery is possible.

FAQ

Q: What if my anxiety never goes down?
A: That’s okay. The goal is not to get rid of anxiety but to learn you can tolerate it and still act according to your values.

Q: What if my obsessions feel “too dangerous” to face?
A: ERP is collaborative. You’ll start with manageable steps and progress at a pace that builds confidence.

Q: Can ERP cure OCD?
A: ERP doesn’t “cure” in the sense of erasing intrusive thoughts, but it changes how you respond to them. Most people experience significant relief and improved quality of life.

Reflection Prompt

Take a few minutes after reading:

• What are your top three obsessions?

• What rituals or behaviours do you do to feel safe?

• How much time do these take from your day?

• What might life look like if OCD had less control?

Conclusion

OCD is powerful, but it’s not stronger than you. Understanding the cycle is the first step toward breaking free. With ERP, you learn to face fears, tolerate uncertainty, and stop compulsions—giving you back the freedom OCD has stolen.

This post is just the beginning of your journey. In our next session (and in Post 2 of the OCD Series), we’ll explore how to tolerate distress during exposures, and the skills you can use when anxiety feels overwhelming.

OCD Series – Post 2: Tolerating Distress in ERP

Introduction

If you’ve started Exposure and Response Prevention (ERP) therapy for Obsessive–Compulsive Disorder (OCD), you already know the process isn’t about feeling comfortable. It’s about retraining your brain by allowing anxiety to rise, staying with the discomfort, and resisting rituals.

The question many people ask at this stage is:
“How do I actually sit with this much distress without giving in?”

This post—the second in our OCD Series—is designed to accompany your second therapy session. It explores how ERP uses discomfort as a teaching tool, why anxiety during exposures is expected, and what strategies you can use to tolerate distress without rituals.

Why Anxiety Rises in ERP

During ERP, you deliberately trigger the thoughts, images, or situations your OCD fears most. Naturally, anxiety and uncertainty spike. This isn’t a sign of failure—it’s the therapeutic goal.

When you don’t do the compulsion:

• Your brain learns that anxiety isn’t dangerous.

• You discover that you can handle uncertainty.

• Over time, the feared situation loses its power.

Anxiety in ERP is like a workout for your nervous system. You’re strengthening your tolerance muscle, one exposure at a time.

Habituation vs. Inhibitory Learning

Two main scientific models explain why ERP works:

1. Habituation: If you stay with a fear long enough, anxiety naturally rises, peaks, and falls. Over repeated exposures, the anxiety decreases faster and less intensely.

2. Inhibitory Learning: ERP doesn’t erase old fear pathways—it builds new ones. You learn “I can have this thought and nothing bad happens,” which overrides OCD’s alarm system.

Either way, the process requires tolerating distress long enough for your brain to rewire.

The Role of Uncertainty

OCD thrives on the demand for 100% certainty:

• “What if I left the door unlocked?”

• “What if I ran someone over and didn’t notice?”

• “What if I acted on a violent thought?”

ERP doesn’t promise certainty. Instead, it helps you live with normal uncertainty—the same uncertainty everyone faces but OCD exaggerates.

When you learn to say, “I can’t be 100% sure, but I can live with that uncertainty,” OCD loses its grip.

Skills for Tolerating Distress

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Here are practical techniques that help you ride out the storm of anxiety without rituals.

1. Mindful Observation

Notice the thought or feeling like an observer:

• “Here is anxiety.”

• “My brain is telling me a story.”

• “This is OCD, not a fact.”

Mindfulness shifts you from reacting to noticing.

2. Grounding

Bring yourself into the present moment using your senses:

• Name 5 things you can see.

• 4 things you can touch.

• 3 things you can hear.

• 2 things you can smell.

• 1 thing you can taste.

Grounding helps anchor you while anxiety runs its course.

3. Urge Surfing

Imagine the urge to ritualise as a wave: it rises, peaks, and falls. Your job is not to fight or avoid it, but to “surf” until it passes.

Remind yourself: “If I don’t act on this compulsion, it will eventually fade.”

4. Breathing for Tolerance

Instead of using breath to “calm down,” use it to create space for discomfort:

• Inhale: “Here comes anxiety.”

• Exhale: “I can let it be.”

This shifts the focus from escape to willingness.

5. Acceptance Statements

Try phrases such as:

• “I am willing to feel this anxiety if it means living by my values.”

• “Discomfort is temporary. Freedom is forever.”

• “I don’t have to like this, I just have to allow it.”

6. Values Anchoring

Connect exposures to what matters most. Example:

• “I’m resisting handwashing because I want to spend more time with my kids.”

• “I’m facing this intrusive thought because my values are stronger than OCD.”

Client Exercise: Create a Distress Tolerance Toolbox

Write down 5 strategies you’ll use when anxiety spikes during ERP. Examples:

1. Grounding (5–4–3–2–1).

2. Urge surfing visualisation.

3. A values reminder statement.

4. 10 slow breaths with acceptance.

5. Calling a supportive friend (without reassurance-seeking).

Keep this list handy—on your phone, in your pocket, or taped to your mirror.

Reflection After Exposures

After each exposure, ask yourself:

• How high did my anxiety go (0–100)?

• Did it eventually come down, even a little?

• What did I learn about my ability to tolerate discomfort?

• What would OCD have me do, and what did I choose instead?

This reinforces progress and helps track patterns.

Common Pitfalls and How to Handle Them

1. Compulsion Creep

   • You may find yourself performing rituals subtly (e.g., mentally reviewing, subtle avoidance).

   • Solution: Be honest with yourself and your therapist—small compulsions count.

2. White-Knuckling

   • Trying to “tough it out” with gritted teeth.

   • Solution: Shift to a willingness mindset—let anxiety come and go rather than bracing against it.

3. Avoiding Exposures

   • Fear of distress can lead to procrastination.

   • Solution: Break exposures into smaller steps and remind yourself why you’re doing them.

Case Example

Sarah has contamination OCD. She avoids touching public surfaces and washes her hands dozens of times a day. In ERP, she begins with touching her own doorknob without washing. Anxiety rises to 80/100. Using urge surfing, she notices her body’s discomfort rise and fall. After 15 minutes, anxiety drops to 40. She realises: “I didn’t wash, and nothing catastrophic happened.”

Over weeks, Sarah moves up her hierarchy—touching shopping trolleys, pressing lift buttons, eventually using a public toilet. Her anxiety still rises, but she now knows she can ride it out without compulsions.

Encouragement: Anxiety as a Teacher

It’s easy to see distress as the enemy. In ERP, distress is the teacher. It shows you where OCD is strongest, and each time you tolerate it, you weaken OCD’s hold.

Think of distress as a signal of progress. The more willing you are to feel it, the freer you become.

Reflection Prompt

Take 10 minutes and journal:

• What was my most difficult exposure this week?

• How did I respond to the urge to ritualise?

• Which distress tolerance strategy worked best for me?

• What value am I moving toward by doing ERP?

Conclusion

ERP therapy is not about comfort—it’s about freedom. Distress during exposures is not a sign that you’re failing, but proof that you’re retraining your brain. With tools like mindfulness, grounding, urge surfing, and values anchoring, you can tolerate discomfort and take back your life from OCD.

This is a courageous journey. By practicing these skills, you’re building resilience, confidence, and a new relationship with uncertainty.

In Post 3 of the OCD Series, we’ll explore how to live by your values instead of fears, integrating Acceptance & Commitment Therapy (ACT) principles into ERP.

Post 3: Living by Your Values, Not Your Fears

Introduction

ERP teaches us how to face fears and resist compulsions, but it’s not just about “getting rid of anxiety.” If recovery were only about reducing symptoms, life might still feel empty. What really drives change is the shift from living under OCD’s rules to living guided by your values.

This post—the third in our OCD Series—introduces how Acceptance & Commitment Therapy (ACT) can strengthen ERP by helping you connect to what truly matters, so you live more by choice and less by fear.

How OCD Narrows Life

OCD is a master thief. It steals:

• Time – hours lost to rituals and checking.

• Freedom – avoiding places, people, or activities.

• Meaning – focusing on safety instead of what’s important.

Over time, life becomes about avoiding anxiety rather than pursuing joy, connection, or purpose. Even when rituals “work,” they don’t bring fulfillment—just temporary relief.

Values vs. Fears

Here’s the turning point:

• OCD says: “Stay safe. Be certain. Avoid risk.”

• Values say: “Live fully. Be present. Choose what matters.”

Values are directions you move toward, not checkboxes you tick off. For example:

• Value: Being a caring parent.

• OCD rule: “Don’t touch your child until you’re 100% sure your hands are clean.”

• Values-based action: Hug your child despite OCD’s fear.

By shifting focus to values, ERP becomes not just about tolerating anxiety, but about choosing a life worth living.

The ACT Model: Willingness + Values

ACT (Acceptance & Commitment Therapy) adds two powerful tools to ERP:

1. Willingness – saying yes to uncomfortable thoughts, feelings, and sensations, instead of fighting them.

2. Values – clarifying what truly matters and letting that guide behaviour.

ERP + ACT together = I am willing to feel anxiety if it helps me live by my values.

Practical Ways to Connect to Values

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1. Identify Core Values

Ask yourself:

• What kind of person do I want to be?

• What do I want my life to stand for?

• If OCD wasn’t in charge, how would I spend my time?

Write down 3–5 top values (e.g., family, compassion, honesty, adventure, creativity).

2. Translate Values into Actions

Values only matter if they show up in behaviour. For example:

• Value: Health → Action: Eating balanced meals even when OCD says food might be “contaminated.”

• Value: Connection → Action: Spending time with friends instead of isolating to avoid intrusive thoughts.

3. Values as Motivation During ERP

When anxiety rises in exposures, remind yourself:

• “I’m doing this so I can tuck my kids in without rituals.”

• “I’m willing to feel this uncertainty to live more freely.”

Values give ERP purpose.

4. Daily Check-In

At the end of the day, ask:

• Did I act more by OCD or by my values today?

• Where did I choose avoidance? Where did I choose meaning?

• What’s one small step I can take tomorrow toward my values?

Client Exercise: The Values Compass

Draw a compass with 4 quadrants labelled:

• Relationships

• Work/School

• Health

• Growth/Spirituality

In each, write 1–2 values-driven actions you want to take this week—even if OCD protests. Use this compass when planning exposures to remind yourself: ERP is not punishment—it’s practice for living freely.

Example: OCD vs. Values

OCD Rule: “Don’t take public transport—you might contaminate yourself and others.”

Value: Independence & Adventure.

ERP + Values: Riding the bus as an exposure, while focusing on the value of freedom to go where you want.

This turns ERP from a scary challenge into a step toward a richer life.

Integrating ACT into Exposures

Here’s a step-by-step:

1. Identify the exposure. (e.g., touching a bin without washing).

2. Name the anxiety. “Here’s OCD telling me I’ll get sick.”

3. Anchor to values. “I’m doing this because I want to spend more time with my kids, not washing.”

4. Stay willing. Notice the discomfort, breathe, and allow it to be there.

5. Reflect. Which part of today was values-driven, not OCD-driven?

Common Barriers

• “But I don’t feel motivated.”
  – Motivation often comes after taking values-based action, not before.

• “My values feel distant.”
  – That’s normal when OCD has been in charge for years. Start small.

• “I still feel anxious even when I follow my values.”
  – That’s okay. ACT isn’t about comfort—it’s about meaning.

Reflection Prompt

Journal on these questions:

• What value is OCD pulling me away from most?

• What is one small exposure I could tie to this value?

• If I lived 10 years by my OCD rules, what would I lose? If I lived 10 years by my values, what might I gain?

Conclusion

ERP changes your relationship with fear. ACT changes your relationship with life. Together, they help you not only resist compulsions but also build a meaningful existence that OCD can’t control.

Living by values doesn’t mean anxiety vanishes. It means OCD no longer gets to dictate your choices—you do.

In Post 4 of the OCD Series, we’ll explore how to maintain recovery and prevent relapse, so your progress keeps building long after therapy ends.

Post 4: Recovery & Relapse Prevention

Introduction

You’ve worked hard. You’ve faced fears, resisted compulsions, and taken steps toward living by your values. But recovery from OCD isn’t just about what happens during therapy—it’s about what happens after.

Many people worry: “What if my symptoms come back?” This is a common concern, and the good news is that ERP equips you with tools to manage setbacks and continue growing.

This post—the fourth and final in our OCD Series—focuses on long-term recovery and relapse prevention. It will help you prepare for challenges, respond to setbacks, and keep moving forward in your life.

What Progress Looks Like

Recovery from OCD is not a straight line. Some days anxiety is low, other days it spikes. What matters is not the absence of intrusive thoughts, but your ability to:

• Recognise OCD when it shows up.

• Resist compulsions more consistently.

• Live by values even when anxious.

• Bounce back more quickly after setbacks.

Progress is measured by freedom and flexibility, not perfection.

Relapse vs. Lapse

It’s important to distinguish:

• Lapse: A temporary slip—doing a compulsion or avoiding an exposure.

• Relapse: A sustained return to old OCD patterns without corrective action.

Everyone lapses. The key is responding quickly:

• A lapse is a learning opportunity.

• Relapse prevention is about recognising small slips before they spiral.

Why Setbacks Happen

Common triggers for setbacks include:

• Stressful life events (work pressure, family issues).

• Fatigue, illness, or low self-care.

• Big life changes (moving house, becoming a parent).

• Avoiding ERP practice because “I’m doing well.”

These moments don’t erase your progress—they’re chances to strengthen recovery skills.

The Relapse Prevention Plan

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Here’s how to prepare for long-term success:

1. Keep Practicing ERP

Think of ERP like exercise: stop training, and muscles weaken. Make exposures a lifestyle:

• Touch something mildly triggering and resist washing.

• Allow intrusive thoughts to sit without analysis.

• Remind yourself: “I don’t need certainty to move forward.”

2. Set Early Warning Signs

Make a list of red flags that OCD is creeping back:

• Checking rituals return.

• Avoiding certain situations again.

• Asking loved ones for reassurance.

• Spending more time ruminating.

Awareness is the first defence.

3. Build a Support System

• Tell a trusted friend or partner about your recovery plan.

• Join a support group or online community.

• Stay in touch with your therapist for booster sessions.

Recovery doesn’t happen in isolation.

4. Use Self-Compassion

Self-criticism fuels OCD. Self-compassion breaks the cycle:

• Instead of: “I’m failing again.”

• Try: “I’m human. Lapses happen. I can get back on track.”

Compassion helps you respond flexibly instead of rigidly.

5. Anchor to Values

Revisit your values compass from Post 3. Ask:

• “Am I moving toward what matters, or away from it?”

• “What small step today would align me with my values?”

Values remain your compass no matter how strong OCD feels.

Client Exercise: Relapse Prevention Worksheet

Create a one-page plan with these headings:

• Early Warning Signs: (list your personal red flags).

• My ERP Tools: (distress tolerance skills, mindfulness, urge surfing).

• My Support People: (names, phone numbers).

• My Motivating Values: (reminders of why recovery matters).

• My Commitment Statement: (“If OCD returns, I will…”).

Keep this in a visible spot or on your phone.

Example: Relapse Prevention in Action

John completed ERP for checking compulsions. Six months later, during a stressful work project, he noticed checking his front door three times before leaving. At first, panic set in: “I’m relapsing.” But instead of spiralling, John referred to his relapse plan. He identified it as a lapse, did an exposure the next day (locking the door once and leaving), and anxiety passed. His setback became a booster, not a breakdown.

Long-Term Recovery Strategies

• Regular ERP Practice: Keep doing small exposures.

• Booster Therapy Sessions: Book check-ins when needed.

• Lifestyle Habits: Prioritise sleep, exercise, nutrition, and connection.

• Mindfulness Routine: Even 5 minutes daily helps anchor you.

• Celebrate Wins: Acknowledge progress, no matter how small.

Reflection Prompt

Journal on these questions:

• What are my three biggest early warning signs of OCD returning?

• How do I usually respond to a lapse? How can I respond differently?

• What values will help me stay motivated if recovery feels hard?

• Who can I reach out to for support when I need it?

Encouragement: You Are Not Your OCD

ERP doesn’t erase intrusive thoughts, but it transforms your relationship with them. Setbacks don’t define failure—they’re reminders of your resilience. Every time you resist a ritual, ride out distress, or choose a values-driven action, you strengthen freedom.

Recovery is lifelong, but so is your capacity to grow. You are not your OCD—you are the person who chooses how to respond.

Conclusion

This series has walked you through the journey of ERP:

1. Understanding OCD and ERP

2. Tolerating Distress

3. Living by Values

4. Recovery & Relapse Prevention

Together, these tools give you the knowledge and strategies to take back control. Remember: ERP is not about perfection. It’s about progress, willingness, and living a life guided by values instead of fear.

If you’d like support in continuing your journey, I’m here to walk alongside you.