Sara Brungardt, PhD., LPC

Owner & Director of CalmOCD

Scottsdale, AZ • Tucson, AZ • Sandy, UT
Virtual in 15 states

Let me be honest with you about something.

Every week, we sit across from people with OCD who have already tried to get better. They found a therapist, did the work, and walked away feeling more confused or more hopeless than when they started. And almost every time, the therapy they received had the same name: Exposure and Response Prevention.

ERP is often called the “gold standard” for treating OCD. In the right hands, it genuinely is. The problem is that quality ERP is genuinely hard to find, and that gap is exactly what this article is about.

This is our attempt to explain why.

OCD is Already Misunderstood. Its Treatment Is Not Far Behind.

The World Health Organization ranks OCD among the top ten most debilitating mental health conditions in the world. Not top fifty. Top ten. And yet it remains one of the most trivialized and misrepresented conditions in popular culture, reduced to jokes about hand washing or “being a little OCD” about organization.

That misunderstanding doesn’t stop with the general public. It reaches treatment rooms too.

Because OCD is so widely misunderstood, treating it well requires something most therapists simply have not been trained to do. And here is the uncomfortable truth: in our field, anyone can call themselves an OCD specialist. Any therapist, psychologist, counselor, social worker, or marriage and family therapist can add the word “specialist” or “coach” to their bio and start booking OCD clients the same day. No governing body stops them. No certification is required.

We are not saying this to tear anyone down. We are saying it because people with OCD deserve to know what they are looking for and what they should avoid.

So What Is ERP, Really?

Exposure and Response Prevention has two parts, and the second part is often the most important.

The Exposure piece means deliberately facing the thoughts, images, situations, and triggers that set off your anxiety and obsessions instead of avoiding them.

The Response Prevention piece means choosing, in that moment of discomfort, not to do the thing your brain is screaming at you to do.

That thing you feel compelled to do to make the fear go away is called a compulsion. And compulsions are not always physical. Checking the lock is a compulsion. So is silently reassuring yourself that you are a good person, mentally replaying an event to make sure nothing bad happened, or Googling symptoms at 2 a.m. If you are doing it to neutralize distress, it counts.

The logic of ERP is elegant: every time you perform a compulsion, you teach your brain that the fear was real and the ritual kept you safe. When you stop the ritual and tolerate the discomfort, the brain slowly but genuinely learns otherwise.

When ERP is done well, it works. The problem is how often it is not done well.

Two Things Good ERP Never Does

Good ERP Is Not Sudden

You should not walk into your first therapy session and immediately face your worst fear. A skilled therapist builds a gradual, collaborative process where you are challenged, yes, but never blindsided.

Good ERP Is Not Extreme

Effective exposures do not need to be reckless or cruel to be therapeutic. If a therapist is pushing you into situations that feel harmful or absurd, that is not courage building. That is a red flag.

And perhaps most importantly, good ERP produces progress. It does not leave you feeling stuck with little improvement.

It Starts With Education. Real Education.

Here is something that surprises a lot of people: the most important part of OCD treatment often is not the exposures themselves. It is what comes before them.

Good treatment begins with deep, thorough psychoeducation, and that education should continue throughout the entire therapeutic process not just during session one. Your therapist should not simply hand you a worksheet or workbook. They should help you understand your brain: what increases your OCD symptoms, what decreases them, and how recovery actually works.

That includes understanding your specific OCD cycle not OCD in the abstract, but yours. Exactly how your obsessions begin, what emotions they stir up, what compulsions follow, and why that momentary relief feels so convincing even though it reinforces the disorder.

It also means understanding what is happening neurologically when an intrusive thought hits. Why does the brain treat certain thoughts like emergencies? Why is it so difficult to “just let it go”?

It means getting honest answers to the questions many people are afraid to ask out loud:

• Why do I have this?
• Will it ever actually get better?
• Could I pass this to my children?
• Will I ever have a normal life?
• What if this is not OCD at all and I really am a horrible person?

It means learning how to respond to intrusive thoughts, because that is a skill and skills must be taught.

It means learning how to process the emotions OCD creates anxiety, shame, guilt, and the deep fear that something is fundamentally wrong with you.

And it means understanding your compulsions well enough to begin resisting them, including the ones that happen entirely inside your head.

The Bigger Picture

ERP is an evidence based treatment for OCD, but the best care does not stop there.

Skilled OCD specialists often draw from multiple evidence based modalities to support healing from every angle:

• Acceptance and Commitment Therapy (ACT) helps you stop fighting your thoughts and start living according to your values anyway.
• Mindfulness teaches you to observe your mental experience without becoming consumed by it.
• Metacognitive Therapy shifts your relationship with thoughts by targeting the beliefs you hold about thinking itself.
• Dialectical Behavior Therapy (DBT) builds emotional regulation skills that make recovery more sustainable.
• Radically Open DBT (RO DBT) addresses overcontrol, rigid perfectionism, emotional suppression, and social disconnection that can fuel OCD.
• SPACE (Supportive Parenting for Anxious Childhood Emotions) helps loved ones stop accidentally reinforcing OCD behaviors.
• Inference Based CBT (I CBT) helps identify and correct the faulty reasoning processes that fuel obsessional doubt and can even be used as a standalone treatment.

None of this replaces ERP. It is what helps ERP last.

What We Actually Want for Our Clients

Our job is not simply to reduce your anxiety score.

Our job is to understand your brain so completely every pattern, every trap, every way OCD has learned to hook you that we can teach you how to outmaneuver it.

More importantly, our job is to help you stop feeling like a victim of your own mind.

There are parts of the OCD experience that are outside your control. But people are often surprised to discover there are also parts that are within their control.

We want our clients to wake up knowing not hoping, knowing that they can handle whatever OCD throws at them.

That confidence does not come from avoiding triggers or maintaining perfectly controlled anxiety levels. It comes from doing hard things and learning from them.

That is what we celebrate.

Not low anxiety. Learning.

Are you holding your child for the first time in months? Sitting with discomfort without falling apart? Realizing the mental ritual you have done for years never actually kept you safe? Reconnecting with friends again?

That is healing.

The brain is building new pathways, and that is what recovery looks like.

One Last Thing

If your OCD therapist spends sessions simply asking how your exposures went and then moves on with no deeper processing, no pattern recognition, and no discussion about what happened or why that is not enough.

ERP works, but it does not work in a vacuum.

The conversation matters enormously.

Why This Discussion Matters: The Risk

The suicide risk associated with OCD is widely considered underestimated. It takes an average of at least a decade for someone to receive an accurate OCD diagnosis, and 95% of those diagnosed do not receive the most effective treatment (Deusser et al., 2025).

In clinical samples, the mean lifetime suicide attempt rate among people with OCD is 14.2%, with studies ranging from 6% to 51.7% (Albert et al., 2019). Another study found suicide risk to be ten times higher in individuals with OCD (Fernández de la Cruz et al., 2017).

This is why we are speaking out.

The consequences of getting this wrong are not abstract. They are not just clinical.

They can be fatal.

Part Two Is Coming

What Do Exposures Actually Look Like in OCD Treatment?

There is more to say, and it matters.

Albert U, De Ronchi D, Maina G, Pompili M. Suicide Risk in Obsessive Compulsive Disorder and Exploration of Risk Factors: A Systematic Review. Current Neuropharmacology. 2019;17(8):681–696. doi:10.2174/1570159X16666180620155941.

Deusser, R., Saxena, S., McCracken, A., Tentoni, N., Cogen, S., Crofut, R., Litvin, B., & Arfanakis, J. (2025). America’s OCD Care Crisis: National Findings on the Failure of Effective OCD Treatment to Reach Patients. International OCD Foundation.

Fernández de la Cruz, L., Rydell, M., Runeson, B., D’Onofrio, B. M., Brander, G., Rück, C., Lichtenstein, P., Larsson, H., & Mataix Cols, D. (2017). Suicide in obsessive compulsive disorder: A population based study of 36,788 Swedish patients. Molecular Psychiatry. Published online July 19, 2016.