Living with obsessive compulsive disorder is no easy thing.
For so many adults, teens, and kids across New Jersey, OCD wreaks havoc on daily life, creating exhausting cycles of obsessive thoughts and compulsive behaviours that can feel completely out of their control.
At Monmouth Integrative Counseling Services, with offices in Manasquan and Brick, New Jersey, and also available via telehealth statewide, our trained therapists offer exposure and response prevention (ERP), which is considered the first-line treatment for OCD.
The first step in ERP therapy is a comprehensive assessment where the therapist evaluates the patient’s symptoms and triggers. ERP should be delivered by qualified mental health professionals such as psychiatrists, psychologists, social workers, or mental health counselors.
If you or someone you care about is struggling with intrusive thoughts, repetitive behaviors, or overwhelming anxiety tied to feared situations, understanding how ERP works can be a huge first step towards getting your life back on track. ERP is also effective for other anxiety-related disorders such as panic disorder and social anxiety disorder.
What is Exposure and Response Prevention?
Exposure and Response Prevention, or ERP for short, is a specialized form of cognitive behavioral therapy (CBT) and behavioral therapy that’s specifically designed to treat OCD. The good news is, it really does work—research shows ERP therapy is the most effective treatment for OCD, helping about 80% of people experience significant symptom relief, and it outperforms other treatments such as cognitive therapy and relaxation therapy in reducing OCD symptoms.
ERP therapy is made up of two main parts: the exposure component and response prevention therapy.
The exposure component involves working with your therapist to gradually face the things that trigger your obsessions—this is known as facing fears in a safe and structured way. ERP exercises are a key part of treatment, often practiced with professional guidance during sessions and as homework. During exposure, you are exposed to triggers to challenge your feared outcomes, helping you learn to tolerate anxiety without resorting to compulsions. There are three main types of exposure used in ERP: in-vivo exposure (facing your fears in real life), imaginal exposure (imagining the worst-case scenario in a structured way), and virtual reality exposure.
Meanwhile, response prevention therapy is all about resisting the urge to perform compulsions—this is called ritual prevention. Instead of doing all the usual rituals and behaviors that you use to try and manage your anxiety, you allow yourself to feel anxious and let things go as they come.
Over time, as you keep doing this, you find that your OCD symptoms get less and less and you start to feel more in control of your life.
How ERP Works in Clinical Practice
ERP therapy works by breaking the cycle of obsession and compulsion. The thing is, when you get an intrusive thought, it creates a lot of anxiety. You then try to deal with that anxiety by doing a compulsion – and that compulsion feels like it works, but what it actually does is make the problem worse. This is all down to classical conditioning.
When you work with an ERP therapist, they’ll help you to gradually reduce your reliance on compulsions. This is often done through an inhibitory learning approach, which is all about building new ways of thinking and doing things rather than just trying to get rid of your anxiety.
Patients may experience discomfort during ERP therapy, but the process is designed to be gradual and supportive. Therapists ensure that exposures in ERP are safe and manageable, creating a supportive environment for facing fears. It’s important to note that low adherence to completing exposures assigned between ERP sessions predicts higher symptom severity post-treatment.
This isn’t quite the same as systematic desensitization – where you try to get used to things by pairing them with relaxation. With ERP, you’re actually facing up to your fears head on and stopping yourself from doing the things that make your OCD worse.
Managing Intrusive Thoughts
Managing intrusive thoughts is one of the biggest challenges for people living with obsessive compulsive disorder, but it’s also where exposure and response prevention (ERP) therapy truly shines. Intrusive thoughts—those unwanted, distressing ideas or images that seem to pop up out of nowhere—can trigger a cycle of anxiety and compulsive behaviors that feel impossible to break. ERP therapy, recognized as the gold standard treatment for OCD by organizations like the American Psychiatric Association and the World Health Organization, offers a proven path forward.
In ERP therapy, you’ll work with a trained therapist to face your intrusive thoughts head-on, using a structured approach rooted in cognitive behavior therapy and behavioral therapy. The process is all about gradually exposing yourself to the thoughts, images, or situations that trigger your anxiety, while practicing response prevention—meaning you resist the urge to perform compulsive rituals or avoidance behaviors. Over time, this repeated practice helps your brain learn that these thoughts, while uncomfortable, aren’t actually dangerous, and you don’t need to perform compulsions to feel safe.
Here’s how managing intrusive thoughts with ERP therapy typically works:
- Identify Your Triggers: With the support of a mental health professional, you’ll pinpoint the specific thoughts, situations, or images that set off your anxiety and compulsive behaviors.
- Build an Exposure Hierarchy: Together, you’ll create a list of triggers, ranked from least to most distressing. This helps you approach your fears in a manageable, step-by-step way.
- Start Exposure Exercises: Beginning with the least anxiety-provoking item, you’ll practice facing your triggers—either in real life (in vivo exposure) or through imaginal exposure—while resisting the urge to perform compulsions.
- Practice Response Prevention: Instead of falling back on ritualistic behavior or avoidance, you’ll allow yourself to experience the emotional response and anxiety, learning that it will naturally decrease over time without the need for compulsive rituals.
- Repeat and Reinforce: Through repeated practice exposures, you’ll gradually reduce your OCD symptoms and build confidence in your ability to handle distressing situations.
This approach, grounded in classical conditioning and the inhibitory learning model, has been shown in systematic reviews and clinical practice to significantly improve treatment outcomes and reduce symptom severity for people with OCD. ERP therapy can also be adapted to help with related mental health disorders, such as body dysmorphic disorder, panic disorder, post traumatic stress disorder, and even some eating disorders.
Treating OCD Throughout New Jersey
Here at Monmouth Integrative Counseling Services, our team of experienced therapists provides behaviour therapy and talk therapy for OCD and other mental health issues. We have offices in Manasquan and Brick, and offer telehealth therapy all across New Jersey. Access to specialized care in New Jersey can also be found through directories like the International OCD Foundation (IOCDF) and Psychology Today.
Our approach to treating OCD combines cognitive therapy, exposure therapy and ERP techniques—each treatment plan is tailored to the individual’s unique obsessions, OCD severity, and overall mental health needs. ERP is personalized and may be delivered in-session or via telehealth by licensed professionals in New Jersey. Patients should discuss their interest in ERP therapy during their first visit with a mental health professional. ERP therapy typically lasts between 12 to 20 sessions, depending on the severity of symptoms and individual progress.
And the good news is that ERP isn’t the only treatment we offer—we can also combine it with other kinds of therapy, or work with you to get you the medication management you need. However, combining ERP with medication does not enhance its effectiveness, as outcomes are similar to ERP alone. Some people even find they’ve got co-occurring anxiety disorders, post traumatic stress disorder or panic disorder—and in those cases, we’ll develop a comprehensive treatment plan that takes all of that into account. Compared to other treatments such as talk therapy, medication, or stress management therapy, ERP has been shown to be particularly effective for OCD, either on its own or as part of a broader treatment plan.
New directions in ERP research are exploring innovative approaches to improve treatment efficacy, including integrating biological and psychological frameworks and developing novel therapies to better address patient needs.
Is ERP Right for You?
You might be wondering whether ERP therapy is right for you. Well, here are some signs that it might be:
- You experience ongoing intrusive thoughts that trigger obsessions\
- You perform compulsions to try and reduce your anxiety\
- You find yourself avoiding things to prevent feeling distressed\
- You spend a huge amount of time each day trying to manage your OCD symptoms* Struggling with Obsession Fears, Checking, Perfectionism or Rituals?
OCD is one of many mental disorders that require timely intervention. If your symptoms are getting in the way of work, school, your relationships, or even just making it through your day to day, a pro should give you a hand figuring out what needs to happen next. Getting help early on really can make a big difference, and treatment can actually start to roll back the impact OCD is having on your life.
Patients should be their own advocates and communicate openly with their mental health providers about their treatment preferences. Lots of people put off getting help because they’re too embarrassed to own up to their obsessive thoughts or to admit to what they’re actually scared of. Thing is, though, OCD is a legit mental health problem and you can get treatment for it. ERP is something that’s been backed by loads of research, and it’s even got the approval of the top mental health organizations.
Building Up the Courage to Face Your Fears
One of the coolest things about exposure and response prevention is that it lets you figure out that all that anxiety you’re feeling is just uncomfortable, not actually going to kill you. Starting ERP can be a difficult decision because it may feel like you are choosing to put yourself in danger, but many patients experience significant improvement in their symptoms after ERP. The more you go through this, the more confident you’ll become in your ability to face those fears without always going back to your old compulsions.
ERP has been shown to reduce OCD symptoms, improve quality of life, and decrease sleep disturbances. That changes the whole dynamic with those intrusive thoughts you get. Instead of trying to banish every single idea that makes you anxious, you start to see that thoughts are just thoughts – they’re not a threat to you. As you start to ease up on the avoidance, you’ll find that your daily life starts to get a lot more manageable.
You might not get to a point where you never feel anxious at all, but that’s okay. What you should be hoping for is that you get your life back in a real way – get some of that time and freedom back that OCD had taken away from you. Relapse prevention planning is also an important part of ERP therapy, where therapists discuss strategies to prevent symptom recurrence and help you maintain your progress.
Get Started with ERP Therapy in Manasquan or Brick, NJ
If you’re looking for OCD treatment in Monmouth or Ocean County, our team at Monmouth Integrative Counseling Services is here to help. We offer exposure and response prevention in a supportive environment, helping you face your fears effectively and start to move towards real change.
We’ve got offices in Manasquan and Brick, and we also do telehealth visits state wide, so getting the help you need isn’t a giant hassle.