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:
Intrusion: An unwanted thought, image, or urge pops up.
Distress: The thought feels threatening, immoral, or catastrophic.
Compulsion: To reduce the distress, the person engages in a ritual.
Relief: Anxiety drops—but only briefly.
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
“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.“ERP is about proving my fears wrong.”
– Not exactly. It’s about learning that you can tolerate uncertainty and distress, even without certainty.“ERP means never feeling anxious again.”
– No. ERP helps you relate differently to anxiety so it no longer controls your life.
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:
Over the next week, notice intrusive thoughts when they appear.
Write them down without censoring. Example: “I might harm my child with a knife.”
Next to each thought, write how anxious it made you feel (0–100).
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.
