Key Takeaways
- The risks of ERP for OCD aren’t based on the scary stories OCD uses to keep us stuck.
- Instead, they’re typically short-term challenges we face as our brains learn a new way responding to intrusive thoughts.
- Common risks of ERP include a higher level of overall anxiety, OCD pushing back as it tries to regain control, and a wider range of emotions.
- Does ERP make OCD worse? It can sometimes feel that way at first because of these risks. But paradoxically, these experiences are part of how ERP helps weaken OCD over time.
Estimated reading time: 6 minutes
The risks of ERP for OCD are not what you think
In my memoir Is Fred in the Refrigerator? Taming OCD and Reclaiming My Life, I describe the moment I first heard about exposure and response prevention therapy (ERP) at the IOCDF conference in 2010 after I’d been struggling with untreated OCD for years:
“We all know,” Dr. Reid Wilson began, looking confidently into the audience as stragglers took their seats, “that ERP is the gold-standard treatment for OCD.”
What?
My heart stuttered, missing a beat.
What did he just say?
I tried to make sense of his words. ERP. Enterprise Resource Planning software? That was the only ERP I knew of…was he saying software was the treatment for OCD?
In that moment, my vision changed, narrowing so I could only see Dr. Wilson—and so he was talking only to me.
“ERP. Exposure and Response Prevention therapy. You expose yourself to obsessions and then prevent yourself from doing rituals. This will, of course, make you really anxious, but over time your anxiety will come down and your brain will learn that those obsessions aren’t something to be afraid of. Through repeated practice, that’s how you get better from OCD.” (pp. 154-155)
You might be thinking, “Wait. The treatment for OCD, the very thing that’s causing me to be so anxious, is also supposed to make me anxious? I don’t get it.”
If you’re considering ERP for OCD, that reaction is completely understandable and one I hear often from people who are beginning therapy. ERP asks you to face the very thoughts and situations that OCD tells you to avoid. It also asks you to stop doing the compulsions that temporarily lower your anxiety.
But ERP isn’t asking you to put yourself in truly dangerous situations (even though OCD will likely say that’s what you’re doing). Instead, ERP asks you to do what matters to you even if OCD doesn’t like it and without doing rituals.
Understanding the real risks of ERP for OCD can help you approach treatment with more confidence because:
- The risks of ERP for OCD aren’t based on all the scary stories that OCD is using to keep us stuck, and
- They’re the very mechanisms that allow ERP to weaken OCD.
Let’s look at the three risks of ERP for OCD I typically talk about with clients before we begin working on exposures.
Risk #1 of ERP for OCD: Your anxiety level may stay higher
When you start doing ERP, your anxiety often increases during exposures. That’s not a mistake in the therapy. It’s the point.
For years, compulsions have been artificially lowering your anxiety. When you remove those compulsions, your brain no longer has its usual escape route. So anxiety goes up. Sometimes it rises and then falls. Sometimes it rises and stays elevated for a while. So sometimes people notice their overall anxiety level is higher in the early stages of ERP.
Why this is also an opportunity
Your brain learns through experience. When you face a feared situation and don’t do compulsions, your brain begins to learn something new:
- Anxiety can rise without needing to be controlled
- Intrusive thoughts don’t have to dictate your actions
- You can handle more discomfort than you originally thought you could
That learning is the foundation of recovery. In other words: the increase in anxiety is the doorway to new learning.
Risk #2 of ERP for OCD: OCD may push back
OCD doesn’t like ERP because ERP takes it out of the driver’s seat of your life. When you stop doing compulsions, OCD often responds by turning up the volume because it wants to stay in control.
People sometimes experience:
- More intrusive thoughts
- Louder obsessions
- Urges to do new compulsions
- A stronger urge to try to find certainty
This is extremely common. In fact, it often means you are directly challenging OCD’s system.
Why this is also an opportunity
Think of OCD as a system that has been running your brain for a long time. When you begin ERP, you are changing the rules of the game. OCD may try harder for a while because it’s used to winning.
But every time you refuse a compulsion, you send your brain a new message: OCD doesn’t get to run the show anymore. That’s how the balance of power slowly shifts.
Risk #3 of ERP for OCD: You may feel more emotions
One way to think about this is like removing a dam from a river. For a long time, compulsions were acting like the dam, holding back emotional water. When the dam comes down, the water begins to flow again.
When people stop doing compulsions, they sometimes notice a wider range of feelings emerging beyond anxiety, such as:
- frustration
- sadness
- grief
- regret
Why this is also an opportunity
Feeling emotions again is part of healing. OCD often traps people in a narrow cycle of fear and compulsions. But you can’t selectively numb emotions. When compulsions are used to push away difficult feelings like anxiety, they also tend to block most other emotions, including those that are uplifting.
ERP gradually opens the emotional system back up. This is also why working with a skilled ERP therapist can be helpful as you learn how to navigate these experiences.
This can feel intense at first, but it also reconnects you with parts of life that OCD may have been blocking.
Am I going to experience all these risks of ERP for OCD?
Not necessarily.
Some people experience one of these. Some experience several. And some experience none of them.
So why do ERP if these risks exist?
Because ERP offers something OCD never can: a path back to your life. ERP helps you:
- stop organizing your life around OCD’s fears
- rebuild confidence in your ability to handle uncertainty and anxiety
- spend less time trapped in compulsions
- make decisions based on what matters to you
Over time, the goal is not to eliminate every intrusive thought or every wave of anxiety. The goal is something far more powerful: to reclaim your life from OCD.
Yes, ERP is challenging. But the risks you experience along the way are often the very signals that your brain is learning a new way forward and OCD is beginning to lose its grip.
If you’d like more reflections like this about OCD recovery and everyday ERP, you’re welcome to join my newsletter here.
Want to learn more about reclaiming your life from OCD?
The moment I first heard about ERP was just the beginning of my OCD recovery journey. I share how you can apply what I learned to your own recovery in my memoir, Is Fred in the Refrigerator? Taming OCD and Reclaiming My Life. Click here to purchase your copy.
