Gabby Salomone, LCSW

Exposure and Response Prevention Therapy: A Powerful Tool for Healing OCD

Living with Obsessive-Compulsive Disorder (OCD) can feel like being trapped in a never-ending cycle of fear, where we constantly need to take action to calm our intrusive thoughts. But there’s hope. Exposure and Response Prevention (ERP) therapy is a highly effective treatment for OCD. Let’s dive into what ERP therapy is, how it works, and why it might be helpful for you.

Woman struggling with OCD sitting on a couch

What is Exposure and Response Prevention Therapy?

Exposure and Response Prevention is a type of Cognitive Behavioral Therapy (CBT) specifically designed to treat OCD. It’s like a workout for your brain, challenging the patterns that keep OCD in control. The therapy involves two main components:

Exposure: Facing your fears head-on
Response Prevention: Resisting the urge to perform compulsive behaviors

Think of ERP as learning to swim by getting in the water, rather than just reading about swimming techniques. It’s hands-on, practical, and sometimes uncomfortable – but it works.

How Does Exposure and Response Prevention Work for OCD?

Imagine you’re afraid of dogs. ERP would involve gradually exposing you to dogs – maybe starting with pictures, then videos, then being near a dog on a leash, and eventually petting one. At each stage, you’d resist the urge to run away or engage in safety behaviors.

For OCD, the process is similar. Here’s a breakdown:

Identify Triggers. You and your therapist make a list of situations that trigger your obsessions.
Create a Hierarchy. Rank these situations from least to most anxiety-provoking.
Exposure. Starting with lower-anxiety situations, you’ll face your triggers in a controlled environment.
Response Prevention. Instead of performing your usual compulsions, you’ll work on sitting with the anxiety and practice different coping skills.
Repeat and Progress. As you become more comfortable, you’ll move up the hierarchy to more challenging situations.

The goal? To teach your brain that the anxiety will pass without performing compulsions, and that your fears often don’t come true.

Why is Exposure and Response Prevention Effective for OCD?

ERP isn’t just about facing your fears – it’s about rewiring your brain. Here’s why it’s so powerful:

Challenge False Beliefs. OCD often involves overestimating threats and underestimating your ability to cope. ERP helps you gather evidence that challenges these beliefs.
Builds Tolerance. By repeatedly facing your fears without engaging in compulsions, you build a tolerance for uncertainty and anxiety.
Provides New Learning Experiences. ERP creates opportunities for your brain to learn that the feared outcome often doesn’t happen, or isn’t as bad as anticipated.
Breaks the Cycle. OCD thrives on avoidance and compulsions. ERP disrupts this cycle, weakening the hold OCD has on your life.

What to Expect in ERP Therapy

Starting ERP can feel daunting. Remember, you’re not diving into the deep end right away. Here’s what you can expect:

Assessment. Your therapist will work with you to understand your specific OCD symptoms and triggers.
Education. You’ll learn about OCD and how ERP works.
Planning. Together, you’ll create a personalized exposure hierarchy.
In-Session Exposures. You’ll start with exposures in therapy sessions, with your therapist’s support.
Homework. Between sessions, you’ll practice exposures on your own.
Progress Tracking. You’ll monitor your anxiety levels and the effectiveness of exposures.

Is ERP Right for Everyone with OCD?

While ERP is highly effective for many people with OCD, it’s not a one-size-fits-all solution. Some considerations:

Severity. For severe OCD, medication may be recommended alongside ERP.
Motivation. ERP requires active participation and a willingness to experience temporary discomfort.
Co-occurring Conditions. Other mental health issues may need to be addressed concurrently. If you have trauma especially, ERP may not be right for you (at least at first).
Personal Preferences. Some people may prefer other forms of therapy or a combination of treatments.

Tips for Success in ERP Therapy

If you’re considering or starting ERP, here are some tips to help you get the most out of it:

Be Patient. Progress takes time. Celebrate small victories along the way.
Stay Consistent. Regular practice is key to seeing results.
Be Honest. Open communication with your therapist is crucial for tailoring the treatment to your needs.
Practice Self-Compassion. ERP can be challenging. Be kind to yourself throughout the process.

A Path to Freedom from OCD

Exposure and Response Prevention therapy offers a powerful path to healing for those struggling with OCD. By facing fears head-on and resisting compulsions, you can break free from the cycle of obsessions and compulsions. Remember, seeking help is a sign of strength, not weakness.

If you’re battling OCD, consider talking to a mental health professional about whether ERP might be right for you. We have a number of OCD therapists at our practice, all who specialize in ERP. We would be honored to work with you. Learn more about our approach here.

Gabby Salomone, LCSW is the Clinical Director of Therapy for Women Center and specializes in OCD, Health Anxiety and Eating Disorders. She is certified in Exposure and Response Prevention and works out of our Philadelphia offices.

Why Do We Get Sad on Birthdays? How to Beat the Birthday Blues

I don’t know about you but with another year around the sun I can start to feel my birthday blues approaching. It is going to be a “milestone” birthday and I will be the first to admit that I have good years and bad years when it comes to my day of birth!

What do I mean when I say good years and bad years?! Well sometimes I’m really excited for my birthday and want to celebrate. Other years I have panic attacks the days leading up to and including my birthday. I’ve denied how old I am for a number of years (cough cough I’m 29… again) and I get sad/depressed. Ten years ago, I had a complete meltdown, cried, thought I was “old” and just utterly felt lost. For a number of reasons, none having to do with my age, it was one of the hardest years of my life.

So as the countdown begins to my birthday it caused me to do a little thinking, and some research into why I get like this. And drumroll please… ANXIETY!! Ahh anxiety… cue “Hello darkness, my old friend!”.

What Causes the Birthday Blues?

So here are a few reason why we get anxious… our mortality, we are afraid of getting old and death. We question if we are important to people and worry “will they remember it’s MY birthday”, this leads to negative internal conversations which usually go something like; “if they don’t remember, does that mean they don’t really like/care about me?!”, no, people are busy and forget dates often. Other reasons we freak out are heightened expectations, feelings of lack of accomplishments, social pressures, “milestone” birthdays, social media and overall less excitement as we get older.

6 Tips to Cope With Birthday Blues…

1. Lower your expectations

If you build something up in your head and it doesn’t go exactly as planned you will feel disappointed and focus on what didn’t go right versus what you did do and what went well. Humans are negative and we focus on the negative, especially when we have one idea in our head and it does not happen. So lower your expectations, less is more!

2. Reflect on your accomplishments from the past year

Write down the things you have done this year. They can be big or small, if you remember them they count and mean something to you!

3. Beat birthday blues by imagining the future

Write a list of 5-10 things you want to accomplish this year, personally, and professionally. Once you have written them down you can start planning out what steps you will take to accomplish these goals! To figure out what steps you need to take, trying using SMART goals,, because they are Specific, Measurable, Attainable, Realistic/relevant and Time-bound.

4. Let people know you want to celebrate (if you do)

Your friends and family can meet your needs if you do not tell them!! They are not mind readers, so they won’t know if you want to do something or not unless you speak up. Also, it is annoying when people start to ask you what you want to do and you’re like “IDK”, but we all know we have some idea about what we do or don’t want to do for our birthdays!!

5. Do something fun/special for yourself & be easy with yourself.

Take the day off, get a mani/pedi, treat yourself to breakfast, buy the flowers, etc. Don’t wait for others to plan something, or suggest something! Speak up!! It is your birthday after all, and it’s a great day to be nice to yourself and to treat yourself!

6. Diversify your feed

Thankfully we live in an age where more people form all different walks of life are online. There are even pro-aging influencers. Imagine how you want your life to be like when you are 60, 70 or 80 years old. Follow people who are that age who you admire (and not because of how they look!). This can help you remember that your life is absolutely still worth living as you age. I love Lyn Slater and her book, “How to be Old.”

Remember, there are a lot of people who feel the birthday blues. You are not alone. But it is up to you to cherish it and spend your birthday however you want, with whomever you want! Also, don’t forget age is just a number, you’re as young as you feel on any given day!!

Gabrielle is Therapy for Women’s Clinical Director and specializes in anxiety, depression, eating disorders, health anxiety, and OCD. To learn more about Gabrielle, read her bio here.

Looking for a therapist or unsure where to begin? Get started on our booking page.

How to Cope with COVID-19 if you struggle with OCD and Anxiety

If you have OCD and are struggling with the news, keep reading! Gabby is our in-house expert on OCD, eating disorders, anxiety, and more. She knows all too well that anxiety can be intrusive and at times, it can feel like it’s taking over– especially when it’s anxiety in regard to a global pandemic. Gabby put together some quick tips to keep your anxiety manageable, and day (hopefully) a little less stressful.

By now I am sure you are feeling burnt out hearing and reading about Covid-19. So I am going to try and keep this simple. In treatment, I honestly believe less is more. I like to keep things simple and I try to not over complicate things when teaching skills on how to cope and work through the anxieties of day to day life. Right now we all need to give ourselves some compassion and space, to feel all of what we are feeling. If you are feeling a little (or a lot) panicked right now that’s okay because there is a lot of uncertainty in the world. Remember this is the first time any of us are going through this.

How To Cope With Covid Anxiety and OCD

Try to limit news to 10 minutes a day.

If that feels too hard, try 10 minutes in the morning and 10 minutes in the evening. You do not need to know or be the expert on everything about Covid-19 (!), what the government is doing or not doing, or how many more people have gotten it. Ten minutes per day should be enough time to get you all of the information you need to keep yourself and your loved ones safe and informed. The more news you consume, the more you feed your anxiety and this fuels you to check/google/seek reassurance more and more! This strengthens your OCD.

Practice Mindfulness to Combat OCD

Mindfulness is about paying attention on purpose, with purpose, in the present moment and without judgement of our emotions or our thoughts. Practicing for a few minutes each day can help ground you. Take a few deep breaths in and out, feel the flow of the breath, how it expands your chest and stomach and then push it all out, release and notice the sensations you feel. Go outside, notice what you see, hear, physically feel, and smell. Tune into what’s around you and let your thoughts come and go, don’t judge them and don’t engage with them, just let them BE!

Follow A Daily Routine

Whether you are working or not right now, set yourself up with a daily schedule to follow. Eat 3 meals and enough snacks each day. Make sure you drink some water, we can’t survive on only coffee, and alcohol. Make sure you are getting up and going to bed around the same time each day. Flannel after 3 days smells like failure! Take a shower, brush your teeth, eat breakfast, make a list of what you want to do that day. If you don’t have anything pressing that needs to be done, think about projects that you have been putting off! Or something you have been wanting to try or saying that you don’t have time for, set a time in your schedule and DO IT!

Worrying Fuels OCD

Try to not engage in the worry thoughts, worrying doesn’t actually solve the problem at hand. It only fuels your OCD. If it is too hard to not engage with the worry thoughts, try postponing your worry. Conversely, set a specific time each day to worry. When you notice that you are worrying write it down. Then, when your worry time comes, go through your list and see if you are still worried about it. Only focus on the worries that are still bothering you. Spend about 30 minutes problem solving your worries for the day.

Allow Space to Grieve

Grieve the loss of things that have been cancelled. Allow space to be sad for things that aren’t happening right now, the things that you have been looking forward to. I’m not saying that those things will never happen again, what I am saying is that right now they are paused and I have zero clue when we can reschedule them for.

Reframe Your Perspective

Try reframing/reappraising your thoughts around what is going on. Remember, this is not personal. List out the facts that you have and the facts that you don’t have. With everything going on in the world remember what you can control and what you can’t control. Lots of things are out of our control and the more we try to control them the more we feel out of control. Remember the only thing you have control over is your behaviors. You don’t have control over your thoughts or your emotions. Remember, you only have control over the behaviors that you do when you have those unwanted thoughts or unwanted emotions. You can not control others, you can only control how you respond to those around you!

For more support with OCD, reach out to book an appointment or contact us with questions!