ERP for ROCD: What Treatment Looks Like When Doubt Feels Constant (part 2)
In my last post, I gave a VERY brief description of how exposures work in Exposure and Response Prevention (ERP) for OCD. You can check that out here: What Treatment Looks Like When Doubt Feels Constant (part one).
ERP for Relationship OCD (ROCD) does not look different from using ERP for other OCD subtypes because all OCD subtypes are still OCD. In fact, OCD is not about the content of your obsessions; it is actually about your relationship to doubt, fear, and uncertainty. OCD just latches onto what matters most to you, so if you're struggling with ROCD, my guess is that relationships are very important to you.
Understanding Response Prevention
In this blog, I want to talk about the other half of ERP: Response Prevention. Response prevention, also called ritual prevention, is where we work to not engage in compulsions during and after exposures, and eventually as a way of life. What I mean by a way of life is that when you are treating your OCD, you're working toward having a life free of compulsions, not just when you are doing planned exposures. What I love about ERP for OCD is that this comes naturally after doing many exposures because what you learn from doing ERP-that your fears don't come true and you can handle distress and uncertainty-is applicable to all other areas of your life.
Additionally, when you do ERP, you start to see that you can face your fears without engaging in compulsions in all areas of your life, not just during the planned exposures in therapy. This is how ERP organically helps you move toward reducing compulsions in your life in general.
Why Reducing Compulsions Is So Difficult
So how do we learn to not do compulsions? How do we actually do response prevention? In my experience, reducing physical compulsions like checking, doing something in a certain way (like tapping something), organizing something, moving in a certain way, etc., or doing research like Googling something for long periods of time, is fairly simple. But simple does not mean easy. You have to work on not doing compulsions while riding the wave of anxiety, which is hard when your core fears are triggered.
Learning to Ride the Wave of Anxiety
Riding the wave of anxiety means that we know anxiety doesn't last forever-it will eventually dissipate, and you will move on with life when you don't engage in compulsions. You already ride the wave of anxiety in other areas of your life untouched by OCD, but in the OCD area, you have forgotten this natural ability. Let me use an example that most of us can relate to-and yes, it's possible this example is something your OCD latches onto, but my hope is you can still relate, because chances are you have been through this or you have watched someone else go through this cycle of anxiety.
An everyday example
Let's say you can't find your wallet or your phone. You've been looking all over your house and your car, you've asked your partner several times if they have seen it, and you've checked your purse about a thousand times, and it still can't be found. I imagine anxiety has spiked at this point, and you're thinking of all the repercussions of not being able to find your wallet or phone. Eventually, 24 hours have gone by, and it's still nowhere to be found.
Is anxiety still as high as when you first realized you couldn't find something important? No, it's not-most likely you're in problem-solving mode now as you try to replace the lost items. You might be frustrated or disappointed, but the anxiety has dissipated. Why did anxiety dissipate in this example? Because you allowed yourself to feel anxious without judging yourself for the emotion, and then you accepted what happened: you seem to have lost something, and there is nothing you can do about it now except problem-solve.
Yes, there is a risk that someone is using your bank cards or phone, but you'll deal with that-you have to. There is nothing you can do about it right now. The allowance of emotions and acceptance without ruminating about all the what-ifs, stopping the checking and searching when it felt appropriate to end the search, stopping asking others if they had seen what you lost when it felt appropriate to stop asking, and then moving forward with your life by problem-solving is what helped you ride the wave of anxiety.
Rumination vs. Problem-Solving in OCD
This is what we do in ERP therapy for OCD. We stop doing unnecessary compulsions so that you can learn that your body can experience distress and eventually return to baseline without as much distress. You then learn that you can accept the inherent risk and uncertainty of life and move forward.
You also learn the difference between ruminating and problem-solving: ruminating is reviewing the same thing over and over, like a debate that won't end. Problem-solving is looking at the choices you have, often realizing the situation is imperfect and there might not be a perfect choice, then making a decision and moving forward.
In next week's post, I will talk more about response prevention skills and what that looks like in ERP for ROCD.
ERP Therapy for OCD in Boston, MA and Online in California
Learning how to step out of the OCD cycle takes practice, support, and a clear understanding of how OCD operates. Exposure and Response Prevention (ERP) is one of the most effective ways we know how to treat OCD, and over time it can help people relate differently to doubt, fear, and uncertainty.
I'm Jen Lescher, LCSW, and I specialize in ERP therapy for OCD and Relationship OCD (ROCD). In my work with clients, we focus on understanding how OCD shows up in your life and building practical skills that help you respond differently when obsessions and compulsions appear.
I offer ERP therapy in Boston, MA, and I also work virtually with clients throughout Massachusetts and California, which allows people to access specialized OCD treatment from wherever they are located.
If You're Recognizing Yourself in This
If you've been reading this series and noticing the patterns of rumination, checking, reassurance-seeking, or trying to "figure out" your fears, you're not alone. These are very common experiences for people living with OCD.
My approach focuses on helping you gradually step out of the cycle so that fear and doubt no longer dictate your choices.
If you're curious about whether OCD therapy might be helpful, here are a few next steps you can take:
Learn more about ERP therapy and how OCD treatment works
Explore additional blogs on OCD, ROCD, and anxiety
Reach out to schedule a consultation if you're considering therapy
Additional Resources for OCD, Anxiety & More
In addition to personalized OCD therapy, I provide resources to help you bring what you're learning in sessions into everyday life. The Common OCD Themes page explores the intrusive thoughts and behaviors many people experience. The OCD and Social Life page focuses on how OCD can affect friendships, dating, and relationships, sharing practical strategies to strengthen connections and build confidence while managing symptoms.
About the Author Jen Lescher
I'm a therapist, a devoted coffee lover (truly of one my favorite daily comforts), and someone who really values small moments of presence. That might look like slowing down with mindfulness, getting lost behind my camera, or taking a quiet walk just to notice what's around me. Photography, in particular, helps me stay grounded and curious-two qualities I bring into my work with clients as well.
I've been interested in healing and spirituality since my teenage years and have explored many paths along the way, from meditation to energy-based practices. At the same time, I'm just as likely to be blasting music in the car or deep into a true crime podcast. To me, healing isn't only about stillness or insight-it can also include movement, humor, and moments of joy. Therapy should have space for all of that.
I've worked in a wide range of mental health settings since 2007, and that experience shaped one of my core beliefs: healing is never one-size-fits-all. It's personal. It changes over time. It can feel messy. And it's always possible.
Training & Background
Inference-Based CBT (ICBT) for OCD - The OCD Training School & The Cognitive Behavioral Institute
Certified in Exposure and Response Prevention (ERP) - The Cognitive Behavioral Institute
Gottman Method Couples Therapy - Level 1
Master's in Social Work - Portland State University, 2012
