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ERP Therapy for OCD & Anxiety
Exposure & Response Prevention Therapy in North Vancouver
What is ERP?Exposure and Response Prevention (ERP) is the gold-standard therapy for OCD.
ERP is extensively researched, evidence-based, and effective. In addition to OCD, it also works really well for anxiety and related disorders such as phobias.
ERP is a branch of Cognitive Behavioural Therapy (CBT) designed specifically to interrupt the cycles that keep us stuck in OCD/anxiety.
The core idea: OCD is maintained by both avoidance and compulsions. By facing feared situations while resisting compulsions, ERP teaches the brain that the feared situation is not dangerous or urgent, and that compulsions are not required to keep us “safe.”
Naturally, it can feel scary, even unbearable, to think about facing feared situations. But ERP isn’t a let’s-toss-you-into-the-deep-end-without-a-life-jacket kind of therapy; it’s a how-about-we-dip-our-toes-in-for-5-seconds kind of therapy. We start with something manageable, and slowly work our way up at a pace that feels uncomfortable yet doable.
HOW EXACTLY DOES IT WORK?
ERP involves 2 key components working together: exposure (gradually facing the feared situation) and response prevention (resisting the compulsions that normally follow).
Exposures are creative exercises that we build together, with a goal of triggering your anxiety just enough that you’re uncomfortable but still capable of handling that discomfort. Exposures can be literally anything - the only criteria is that they cause that discomfort, and you feel the urge to do compulsions or avoid.
Some examples include:
Spinning until you get dizzy (fear that you might pass out or throw up).
Touching doorknobs or other public surfaces, not washing your hands, and eating a snack (fear of contamination).
Reading a story about someone who went to jail for a crime they didn’t commit (fear of being linked to a crime you had nothing to do with).
Taking embarrassing photos on your phone and leaving them in your library (fear that someone might see them/you might accidentally post them to social media).
Compulsions are anything that follows the unwanted thoughts/images, and are believed to play a role in maintaining the OCD cycle. Compulsions can be physical (behaviours that an outside observer can see) or mental (thoughts inside your head). They are things that you feel like you must do to get relief from the intense distress caused by the unwanted thoughts.
Why does ERP work?
Studies with brain scans show us that the OCD brain struggles with a few things:
it’s overly sensitive to detecting threats, like a fire alarm that goes off when you blow out a candle.
it has a hard time with communication between key areas.
deactivating when a threat has been detected and neutralized with either behaviour or logic (for example, when you check the temperature of chicken, but your brain still says “what if it’s undercooked?”).
ERP slowly rewires the brain, teaching it which threats are actually urgent and which are false alarms, and helping it to understand when “enough is enough” (no, you don’t need to check more than once to confirm that the stove is off - you know it’s off after the first check).
WHAT DO SESSIONS LOOK LIKE?
EARLY SESSIONS: We start by getting to know your story.
What has anxiety/OCD taken from you? When did your symptoms start? How would you like your life to be different?
NEXT: We identify the cycle that’s keeping you stuck.
What are the intrusive or unwanted thoughts/images that you are experiencing? How much distress do they cause you? What compulsions have maintained these fears? What have you had to avoid to protect yourself from these thoughts/images?
EXPOSURE HIERARCHY: We rank the distress that each scenario or situation causes you.
This helpful tool provides us with a lot of insight when we start to create exposures. The goal here is determine where to start (hint: we will want to choose something that makes you just uncomfortable enough that you experience distress, but you’re able to tolerate it without compulsions).
EXPOSURE TIME: We start exposures in session and at home.
A lot happens here. First, we select exposures that we can do together in session. Exposures are then assigned as homework that you can practice for a short time each day. Lastly, this is the time where you will do your best to cut out (or cut down) compulsions when you experience those thoughts/images in real life (more on this below).
Who is a good fit for ERP?
ERP might be right for you if:
you struggle with intrusive thoughts or images,
you feel pulled into loops, rabbit holes, and endless “what ifs",”
it feels like anxiety is calling the shots, instead of YOU,
talking about your thoughts has not been helpful (or maybe made things feel worse),
you’re ready for a challenge and want to stop avoiding or being ordered around by anxiety/OCD.
ERP might not be right for you if:
you do not want to exposure yourself to triggers outside of day-to-day life,
you don’t want to eliminate or focus on compulsions,
you’re more interested in talk therapy than behavioural therapy.
Thankfully, there are other options that are also highly effective for OCD.
I offer both Acceptance and Commitment Therapy (ACT) and Cognitive Behaviour Therapy (CBT); both are great options for OCD when provided by an OCD-informed clinician.
I do not offer Inference-Based Cognitive Therapy (IB-CBT or I-CBT), however, this is a branch of CBT that is also specifically designed to work with the doubt in OCD.
STOP, DELAY, MODIFY
Some compulsions are easier than others to eliminate. This is where “stop, delay, modify'“ becomes SO important.
STOP doing compulsions altogether - this is the end goal.
DELAY engaging in the compulsion for a manageable period of time.
MODIFY the compulsion if stopping or delaying feel too challenging.
What does this look like in practice? If you can’t completely stop washing your hands when you experience intrusive thoughts about contamination, try holding off on washing them for 5 minutes. After 5 minutes, you can choose to delay again, or wash them.
If delaying is too challenging, we try modifying the compulsion in some way. For example, we might suggest using a different soap or washing in the kitchen instead of the bathroom sink.
In ERP, we work closely with families
OCD is sneaky and does a wonderful job of pulling the whole family into compulsions.
When you're in distress, the people around you naturally want to help. So they answer reassurance questions, adjust routines, and go out of their way to reduce your anxiety. These things come from a place of love. But over time, they also feed the OCD cycle, providing temporary relief while making the anxiety louder and more demanding.
This is called family accommodation, and it's something we address directly in ERP. Part of the work involves helping the people around you support your recovery without participating in compulsions.
frequently asked questions
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That varies significantly from person to person. On the lower end, some people see significant improvement in as little as 8 sessions. On the higher end, ERP can take upwards of 40 weeks for more complex cases. The average person spends 16-24 sessions in therapy.
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Yes! ERP is a highly effective treatment for phobias.
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No. Exposures are built collaboratively, and we always start where you feel ready. With that being said, ERP does involve tolerating discomfort by design, and part of my job is to gently encourage you to push a little further than feels comfortable. The goal is to be just uncomfortable enough that you handle the exposure without “white-knuckling” your way through.
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Yes! There are many ways that we can work with this and slowly increase that comfort with discomfort. For example, we might try exposures where you think the thought, spell it in your mind, imagine saying it, etc. We start small and work our way up.
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The short answer to this is: no, not if the therapist is adequately trained in ERP. I specialize in anxiety and OCD - I have been trained in ERP and continue to expand my knowledge. I seek consultation and supervision on a regular basis. I also work closely with clients to make sure things feel right and make sense to you.
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The key is the second part, Response Prevention. Facing a fear without resisting the compulsion doesn't break the OCD cycle, it just restarts it. ERP works because you face the fear AND resist the urge to seek relief through a compulsion. That combination is what teaches your brain that the thought isn't dangerous and that you can tolerate the uncertainty.
Also, ERP isn’t “white-knuckling” through the fear, ERP is a thoughtful and gradual process. -
Most general talk therapy isn't designed for OCD (and actually makes it worse). ERP is different because it targets the cycle directly rather than exploring the content of the thoughts. If you've spent time in therapy talking about your intrusive thoughts without things improving, that’s not surprise; talk therapy can often work as a compulsion, making the OCD cycle stronger.