Exposure and Response Prevention (ERP) therapy for OCD in Guelph
For obsessive-compulsive disorder
Exposure and Response Prevention (ERP) is a therapy approach designed specifically for obsessive-compulsive disorder (OCD). If you’re living with OCD, you’re probably familiar with how small life can feel. You know the distress that unwanted, pushy thoughts bring. So you do something to make the distress go away. Maybe you check the stove one more time, or ask someone to tell you everything is fine. Maybe you rehearse a conversation in your mind over, and over, and over.
The relief is real, but it’s short-lived. This keeps OCD alive. Every time an intrusive thought is met with an attempt to dissolve the discomfort, that association strengthens. Your brain learns that the thought must have been worth taking seriously, that the distress is real, and the behaviour you do to respond is the only way out.
ERP works to break that loop in two places. The “exposure” part means you gradually (and safely) go towards the situations that set off the distress. The “response prevention” part means you then practice not doing the ritual that usually makes the distress go away.
With repetition, you learn from your own experience that the distress comes down on its own, whether you do the ritual or not. You also learn that you can handle uncertainty better than OCD has been telling you that you can.
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ERP is for OCD specifically, not for anxiety in general. But OCD shows up in a lot of different ways:
Fear of contamination, with the washing or cleaning that follows it
Checking things over and over, like locked doors or sent emails
Intrusive thoughts about harm
Obsessive doubts about your relationship or your partner
Moral or religious obsessions
Needing things to feel “just right,” like arranging or redoing things until they do
Rituals that happen only in your head, like replaying conversations or repeating phrases to cancel a thought out
Compulsively seeking reassurance from those around you
You might think that behaviours like these are “just” anxiety, because that’s what they feel like from the inside. But they’re quite often OCD, and they don’t have to have power over you
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ERP is a structured therapy. We’ll spend the first 2 or 3 sessions exploring how OCD shows up for you. We’ll write down what your obsessions are and what your compulsions are, including the ones you might not have though “counted” because they happen inside your head.
Then we’ll build an exposure hierarchy, or ladder, that gets you moving toward the distressing thoughts and situations, so you can learn a different way to live your life without being ruled by what OCD tells you.
You’ll do some of the practice in sessions, and some of it on your own time. We’ll choose those practice pieces together, and keep them small, yet effective enough to fit a normal week. We’ll also write down how each one goes, because sometimes progress is easier to see when it’s on paper.
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ERP asks you to walk toward what you avoid, and to hold off on the rituals that usually make the fear stop. Some of it is uncomfortable, but that’s part of how ERP works. Every step has a reason we can explain, and the pace stays yours the whole way. Don’t worry! We’ll start small.
Questions about ERP in Guelph
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They overlap, so they’re easy to confuse. What differentiates OCD from generalized anxiety is often the way the thoughts and behaviours work.
With anxiety, the fear or worry is often about a perceived or real threat, and the behaviour is intended to reduce or avoid that threat. Once the threat has passed, the anxiety generally decreases.
With OCD, the fear or worry is often about uncertainty or the fear of not knowing, which is followed by behaviours that are meant to stop that discomfort and obtain certainty. The relief that comes in OCD is often temporary, and the doubt returns. OCD happens in a loop every time; anxiety doesn’t.
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No, we’ll work with you to do this gradually. We’ll approach the discomfort and gently challenge you to do the things that feel scary, so you can experience something different than what OCD tells you is true. We won’t ever make you do something we wouldn’t do, or something that is unsafe or harmful.
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No. We’ll spend the first few sessions working an assessment. We can’t diagnose (because that’s not a social worker’s job), but we can still get a feel for how severe your experience with OCD is. ERP works without a formal diagnosis.
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Yes, and many people do both. We’ll work alongside your family doctor or psychiatrist. However, we won’t advise you on medication itself, because that’s outside what a social worker is allowed to do.
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Yes, Golden Horizons can meet virtually with you anywhere in Ontario or Alberta.
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Yes. The International OCD Foundation (IOCDF) calls ERP the gold-standard psychological treatment for OCD, and it explains on its site what the treatment involves and why it works.
