Therapy for OCD and Intrusive Thoughts Using ERP
OCD therapy focuses on helping you break out of obsessive thought loops, compulsions, reassurance-seeking, and the constant need to feel certain.
Therapy is not about “getting rid" of thoughts. It’s about changing your relationship with them so they stop controlling your life.
What is OCD?
Obsessive-compulsive disorder (OCD) involves obsessions, compulsions, or both.
Obsessions are recurring thoughts, images, urges, or doubts that feel unwanted or distressing. They can show up around many themes, including harm, contamination, relationships, health, morality or religion, sexuality, responsibility, or things feeling “just right.”
Intrusive thoughts happen to many people. Having a disturbing thought does not mean you want it to happen or that it reflects who you are. With OCD, thoughts can become caught in a cycle of doubt, distress, and attempts to get certainty or relief.
Compulsions are actions or mental rituals someone feels driven to do in response to an obsession or a sense that something is wrong. They may briefly reduce distress, but the doubt often returns.
OCD can make ordinary uncertainty feel urgent and make it seem as though you need to think, check, avoid, or seek reassurance until you feel completely certain. The thoughts and rituals can take up a lot of time and make it hard to feel present in your own life.
The OCD cycle can look like this:
Research shows it takes an average of 14-17 years for someone with OCD to get an accurate diagnosis and effective treatment for OCD...
Learn More About Finding The Right Therapist For OCD From The International OCD Foundation
What can OCD symptoms look like?
OCD can be difficult to recognize when rituals happen silently or when avoidance and reassurance-seeking have become part of daily routines.
Compulsions aren’t always visible. They may include:
- Checking, washing, repeating, arranging, or starting over
- Mentally reviewing events, analyzing thoughts, or trying to “figure out” what they mean
- Repeating phrases, counting, praying, or neutralizing thoughts in your mind
- Asking other people for reassurance or searching online for certainty
- Avoiding situations, people, objects, or information that trigger doubt
- Monitoring your feelings or reactions to determine what they “prove”
- Following rigid rules to prevent a feared outcome or make something feel complete
My approach to OCD treatment
ERP is the gold-standard treatment for OCD, and I am actively working towards an independent certification in Exposure and Response Prevention. ERP is the foundation of my OCD treatment. We identify the obsessions, compulsions, avoidance, and reassurance-seeking that keep the cycle going, then gradually practice responding differently.
I may also use alternative or second-line approaches in addition to ERP, like CBT, psychoeducation, and DBT skills, to support the work. IFS-informed parts work can help us approach the protective intentions behind OCD patterns with curiosity, while continuing to change the compulsions that keep the cycle going. If distressing past experiences are also part of what you’re working through, we can discuss whether EMDR may be appropriate alongside OCD-focused treatment.
What ERP actually looks like
We map your OCD cycle.
We identify the thoughts, images, urges, or situations that trigger distress, along with the compulsions that follow.
We look for less visible responses too, like mentally reviewing, checking how you feel, avoiding triggers, or asking for reassurance.
We choose a place to begin.
Together, we make a plan for practicing with OCD triggers. We start with steps that feel challenging but workable, then build from there. You’ll also identify the ritual, avoidance, or reassurance response you want to practice changing.
You practice facing a trigger.
An exposure might involve touching an object, leaving something unchecked, having an uncertain thought without solving it, or entering a situation OCD tells you to avoid. The practice is tailored to your OCD; it isn’t about choosing a random fear or proving that nothing bad can happen.
You practice response prevention.
As you face the trigger, you work on not doing the compulsion, mental ritual, avoidance, or reassurance-seeking that OCD is asking for. We’ll talk through what feels difficult and adjust the plan collaboratively.
Common questions about therapy
How do I know if what I’m experiencing is OCD or anxiety?
OCD often involves intrusive thoughts, images, sensations, feelings, or doubts that create distress, followed by something you do mentally or physically to feel better, get certainty, prevent something bad from happening, or figure out what the thought means. The compulsions are not always obvious, which can make OCD difficult to recognize.
What if I don't have obvious compulsions?
Compulsions can happen entirely in your head. Rumination, mentally reviewing memories or conversations, checking how you feel, analyzing your thoughts, trying to “figure something out,” replacing bad thoughts with good ones, or repeatedly testing whether something feels right can all function as compulsions. OCD does not have to involve visible rituals.
Does having an intrusive thought mean I secretly want it to happen?
No. Intrusive thoughts can be unwanted, upsetting, confusing, or completely inconsistent with how you see yourself. OCD often becomes especially distressing because it attaches significance to the presence of a thought and creates pressure to determine what it says about you. Treatment focuses on changing how you respond to the thought rather than proving what it means.
What types of OCD do you work with?
I work with many OCD presentations, including relationship OCD, health anxiety, harm OCD, contamination concerns, checking, moral or scrupulosity OCD, existential fears, “just right” experiences, somatic or sensorimotor OCD, and primarily mental compulsions. OCD can attach itself to nearly anything that matters to you, so treatment is not limited to a particular theme.
Does ERP mean you are going to make me do my worst fear right away?
No. ERP is collaborative and individualized. We identify the situations, thoughts, sensations, and compulsions involved in your OCD cycle and determine exposures that actually target that cycle. The goal is not to overwhelm you or prove that your fears are irrational. It is to help you practice responding differently when OCD demands certainty or relief.
What does OCD therapy with you actually look like?
We start by understanding your individual OCD cycle: what triggers you, what OCD tells you the problem is, and what you do to feel safer or more certain. Therapy may involve psychoeducation, identifying subtle compulsions, practicing ERP together, reducing avoidance and reassurance-seeking, and learning how to tolerate uncertainty without needing to resolve every doubt.
What if I've had OCD for years and nothing has helped?
Many people spend years treating OCD as generalized anxiety or trying to reason their way out of intrusive thoughts without realizing that reassurance, analyzing, thought challenging, or avoidance may be reinforcing the cycle. OCD-specific treatment focuses not only on what you think, but on what happens next and how changing that response can change the cycle.
Can EMDR be used if I also have OCD?
Yes, when appropriate. ERP remains an important evidence-based treatment for OCD, while EMDR may be incorporated when distressing experiences, memories, triggers, or beliefs are also affecting you. Treatment is individualized so that trauma processing does not become another way of trying to eliminate intrusive thoughts or gain certainty from OCD.
What if I can't tell whether something is a compulsion?
That is very common, especially with mental compulsions. We can look at the function of the behavior rather than simply whether the behavior itself is “normal.” We may ask what you are hoping to accomplish, whether you feel driven to do it, and whether you are using it to reduce distress, prevent something, feel certain, or make a thought go away.
What if my OCD keeps changing themes?
OCD can shift from one concern to another. You may finally feel like you have resolved one fear only for a new doubt to appear. Rather than trying to become an expert at disproving every theme, treatment focuses on recognizing the underlying OCD cycle and changing how you respond to it regardless of the content.