OCD relapse prevention and the 50-pound backpack

 Key Takeaways

• OCD relapse prevention matters because unaddressed physical and mental compulsions can slowly put OCD back in charge.
• The goal of exposure and response prevention therapy for OCD (ERP) isn’t to eliminate every symptom, but to build a joyful, meaningful life while living with uncertainty.
• Relapse is not failure. It’s often a sign that certain compulsions or avoidance patterns need renewed attention.

• Relapse prevention isn’t constant self-monitoring. It’s noticing where OCD is interfering in your life, honestly and self-compassionately, and making a sustainable plan to address those symptoms.

Estimated reading time: 6 minutes

Living with untreated OCD is a lot like carrying a backpack filled with 50 pounds of weight.

You carry it everywhere. It slows you down. It makes everything take more effort. Lugging it around is exhausting. And somehow, it seems to get heavier over time.

What makes having a 50-pound backpack especially hard is that it’s likely no one knows you’re hauling around that tremendous amount of weight in every moment of every day.

This can leave you feeling isolated, even from those you love most.

How ERP lightens the load

When you begin exposure and response prevention therapy, ERP, the evidence-based therapy for OCD, you start taking weight out of the backpack.

Not all at once, and not perfectly, you practice noticing and/or triggering obsessions and choosing not to respond with compulsions. You work to embrace uncertainty instead of trying to eliminate it. You learn how to interrupt mental rituals and not have conversations with OCD in your head.

Through this work, the backpack gets lighter. And when the backpack goes from 50 pounds, where your life is all OCD all the time, down to 10 or 15, where OCD is only bothering you for a few hours a day or less, life feels dramatically different. Tasks feel easier. Decisions feel less loaded. Your mind has more space.

The goal of ERP isn’t to throw the backpack away

Some people may reach a point where OCD symptoms are minimal or barely noticeable. But a more realistic goal is one I learned from Dr. Jonathan Grayson and share in Is Fred in the Refrigerator? Taming OCD and Reclaiming My Life :

…the goal of ERP therapy is to live in a world of uncertainty and be happy anyway (p. 167)

Intrusive thoughts are part of life. From time to time, OCD may react to them. That doesn’t mean you’re back at the beginning. It means you’re human.

Trying to do ERP perfectly to eradicate OCD often leads to micro-monitoring your recovery, which strengthens the very pattern you’re trying to weaken.

Why OCD relapse prevention matters

When you’ve been carrying 50 pounds for years, having only 10 or 15 pounds in the backpack after doing lots of ERP can feel almost weightless.

And that’s where the problem can begin.

When things start to feel “good enough,” it’s common to ease off doing ERP. Not because you’re doing something wrong, but because you want to get back to living your life. Which makes total sense!

The challenge is that when 10 or 15 pounds remain in the backpack, and you have only a few hours or less of OCD a day, compulsions are still happening, including those that are subtle. And compulsions, even small ones, are what allow OCD to slowly regain ground.

The tricky part is that you don’t notice the weight creeping back up. For instance, 25 pounds still feels so much better than 50 that it doesn’t register as a problem at first.

But this is one of the most common ways OCD relapses happen.

Relapse is not failure

If this has happened to you, it doesn’t mean you failed. It doesn’t mean ERP “didn’t work.” And it definitely doesn’t mean you should beat yourself up.

Relapse happens because you’re human. Again, we’re not trying to do OCD therapy or OCD relapse prevention perfectly. Of course we want to get back to living our lives as soon as we can. But…

…sometimes in our hurry to reclaim our lives and in our joy at having found some freedom from OCD through ERP, we unknowingly sabotage our progress by leaving symptoms unaddressed simply because things are so much better than they used to be.

None of that erases the progress you made, however. As Jon Hershfield and I explain in Everyday Mindfulness for OCD, you can’t ever go back to where you were before you started ERP treatment because you know way more now than you did then.

When relapses happen, we simply want to start applying that knowledge to address the weight in the backpack in a bit more systematic way.

Opening the backpack again

OCD relapse prevention isn’t about constantly monitoring yourself or staying on high alert. In fact, as mentioned before, that can lead to the ritual of micro-monitoring OCD, which makes things worse. Instead, relapse prevention is about being willing, from time to time, to open the backpack and take an honest look at what’s inside.

OCD already pushes you toward over-analysis. Relapse prevention isn’t about analyzing more. It’s about briefly stepping back and asking, “What am I honestly doing right now?” For instance:

• Which compulsions am I really doing (even the teeny, tiny ones that OCD say don’t matter)?
• Which obsessions seem to keep coming up?
• Where is avoidance putting its foot down and dictating what I still can’t do?
• Where is mental rumination starting to spin in the background of my mind?

You don’t need to do this in your head. In fact, it’s usually more helpful to jot things down in a notes app, a journal, or a document or spreadsheet. Seeing patterns written down often brings clarity without turning into rumination.

We want to take these notes self-compassionately, by the way. Beating yourself up for having symptoms is treating yourself like OCD treats you, which makes you feel worse. Self-compassion in practice is truly acknowledging what symptoms you’re still having, congratulating yourself for having the courage and willingness to do so, and making a doable, sustainable plan for removing as much of that weight as you can from the backpack.

Making a plan without doing it perfectly

Once you can see what’s adding weight back into the backpack, the next step is to make a plan to address it.

This doesn’t need to be overwhelming or all‑or‑nothing. OCD relapse prevention works best when it’s realistic and sustainable.

You might choose one or two exposures to focus on rather than trying to tackle everything at once. You might return to structured ERP for a period of time. You might focus specifically on interrupting mental rituals that were easier to overlook before.

Relapse prevention works best when it feels sustainable, not heroic.

And you don’t have to do this alone.

Many people benefit from booster sessions with an OCD therapist. Others find support through groups or ERP-focused courses, or asking a family member or friend to be an accountability partner.

Progress, not perfection

OCD relapse prevention isn’t about emptying your backpack forever.

It’s about knowing how to take weight out when you notice it building up again.

Recovery is rarely a straight line. It often includes stretches of freedom, periods of drift, and moments of recommitment. None of that erases what you’ve learned.

You already know how to do this.

The backpack may get heavier from time to time. But now you know how to open it, look inside, and start removing what doesn’t need to be there.

That knowledge stays with you.

When the backpack starts getting heavier

If you’ve noticed your backpack getting heavier lately, I’d love to hear what that’s looked like for you.

Or, if you’ve caught it early and lightened the load before it built back up, what helped?

Where do you tend to get stuck when OCD starts creeping back in?

Leave a comment below. Your experience may help someone else recognize what’s happening in their own recovery, and it helps me know what would be most useful to write about next.