What’s the Best Treatment for OCD?

Living with OCD can feel like your brain is on high alert — a constant alarm going off over your fears and worries. But learning to face your fears, one small step at a time, can actually help you manage and overcome them.

This idea lies at the heart of exposure and response prevention (ERP) therapy. Instead of avoiding your fears, ERP teaches you to respond to them in a healthier way, lessening the anxiety they bring over time.

ERP might sound scary — you’re purposely facing the things that make you anxious, and that feels totally backwards. But the truth is, avoiding your fears can make them worse. ERP gives you the tools to take control of them. And the best part? You won’t be doing it alone.

How does ERP work?

A primary care doctor or school counselor might refer you to a mental health professional who specializes in OCD treatment because ERP typically begins in a clinical setting. Your therapist will take time to get to know your symptoms, make a proper diagnosis, and build a treatment plan that feels doable for you.

In building your treatment plan, your therapist will help you “map” out your symptoms. They might ask questions and ask you to rate your anxiety level. Let’s say you’re afraid of germs. They might ask, “On a scale of 0 to 10, how anxious would you feel if I dropped my pen on the floor and asked you to pick it up?” Or “Would you feel less anxious if you used a tissue to pick it up?”

Remember, you’re not actually doing these things yet, or possibly ever. They are “what if” questions. Rating how anxious you would feel in a given situation helps you and your therapist set up a fear hierarchy. The first thing you’re going to tackle is the thing that makes you the least anxious — something you rated a 0 or a 1.

The point is, you’ll start small. Depending on your fear and how much anxiety it brings you, you might sit with your therapist and first look at pictures or watch videos. Or you might practice saying a word that reminds you of your fear. Think about ERP as if you’re wading into a swimming pool rather than jumping in at the deep end.

What is “response prevention”?

As you are gradually exposed to your fear, you will also work with your therapist to respond to it in a different way. It’s called “response prevention” because you’re working on preventing the response you were using before.

Again, you’ll start small. For example, after an exposure — say picking that pen up off the floor without a tissue — you’ll practice holding the pen for five seconds without washing your hands immediately afterward. Later, you might practice holding the pen and then touching your shirt, neck, or face. That may sound intense, but learning to sit with anxiety in manageable doses helps you retrain your brain to understand that the danger of contamination isn’t as terrible as your mind makes it out to be. And over time, your intense need to respond to your anxiety in a certain way, like constant handwashing, fades.

ERP can help with all kinds of OCD

Fears about germs or contamination are a common form of OCD, but ERP can help people who deal with anxiety in less common or obvious ways, too. You might find yourself holding water in your mouth in public to avoid accidentally saying something offensive, or keeping your hands buried deep in your pockets to prevent yourself from picking your nose. Your therapy might involve practicing talking to a friend without asking them if you’ve accidentally cursed, or even briefly touching your nose in public as your therapist observes you. Spoiler alert: People will not care as much as you think they do!

Outside of therapy, you will be asked to begin applying ERP techniques through structured “homework.” The final phase of ERP often focuses on relapse prevention, to help you develop strategies if your symptoms return.

ERP is often used alongside other treatments like antidepressant medications or cognitive behavioral therapy. And for some, talk therapy can also be helpful, especially if working through your feelings aloud helps you process them. However, ERP is widely recognized as the gold-standard treatment for managing symptoms of OCD, showing you that fear doesn’t have to control your life.