Healthcare: Psychiatry and Behavioral Sciences

Treatment Steps


Exposure and Prevention Treatment Steps (ERP)


Step 1: Understand your OCD and OCD symptoms.

Step 2: Identify target fears to work on.

Step 3: Develop an OCD hierarchy for your fear. Rank exposure to your feared trigger (without doing rituals/avoiding) on a scale from 1-10. One should be at the bottom of your hierarchy with the least anxiety provoking exposures for that fear and 10 at the top with the most challenging exposures listed there.

Step 4: Begin exposures with ritual prevention.

  • Systematically work your way up your hierarchy starting with the lower level exposures and working your way up to the high level exposures.
  • Even as you practice "harder" tasks, it is still helpful to go back and challenge old things that you may have conquered.
  • An exposure should be repeated multiple times without any rituals. Once an exposure causes limited distress/anxiety you can move up to the next higher level exposure.
  • Continue this approach until you reach the top of your hierarchy.

Remember repeated exposures with ritual prevention will allow you to habituate to a fear. Anytime you engage in a ritual both the fear and OCD cycle are rewarded by virtue of reducing your distress.


Relapse Prevention


Even when you reach the top of your hierarchy or hierarchies it is important to continuously engage in relapse prevention. Basically it is adopting a position where you learn to confront your fears directly when triggered, whatever the content. Whether you have completed your OCD treatment with a treatment provider or engaged in ERP for your fears on your own, it is of upmost importance to continue to engage in ERP in order to maintain your progress. Planned (i.e., setting time aside to do this) and unplanned exposures (i.e., taking on provide an opportunity to pull out your OCD tools you have learned and engage in ERP in order to continue to decrease your OCD symptoms and face fears as they arise. There are many tools such as websites, self-help workbooks, etc. that provide ERP accountability through various tools.


Medication for OCD


Medication is another effective form of OCD treatment; ideally CBT with ERP is recommended in conjunction with medication for OCD. Medication questions should be directed to a psychiatrist who treats OCD. Visit the International OCD Foundation’s Medication for OCD page for more information regarding medication.