What Is ERP? How a Therapist in Boston, MA Uses Exposure and Response Prevention for OCD
ERP therapy stands for Exposure and Response Prevention therapy, and it's considered the gold standard treatment for OCD. If you’ve been learning about OCD, my guess is this is something you already know. But what exactly is it? How does it work? And why does it work?
Let’s break it down, word by word.
First: What is Exposure?
Exposure means facing your fears—often things you’ve been avoiding, or things you only do with a lot of rituals (also known as compulsions).
For example, let’s say you’re struggling with contamination OCD and have been avoiding public restrooms because you’re afraid of getting contaminated by the germs. But, by avoiding public restrooms, you might end up missing out on things you care about—like concerts, work events, eating out with friends, etc. So you can see how avoidance starts to seriously impact your quality of life.
So, guess what we’re going to do in ERP?
Yep—we're going to public restrooms.
But probably not right away, especially if public restrooms bring up a ton of anxiety or disgust. Instead, we’ll approach them slowly, strategically, and collaboratively. That might mean starting with something like using a friend’s bathroom, or standing near a public restroom, or just touching the door of the restroom. It could even start with looking at images of gross public restrooms.
Why Pacing Matters in OCD Treatment
Once those things no longer activate your OCD—or you’ve learned you can tolerate the distress—we move on. Eventually, we’re in a public restroom. And we don’t stop there. Now we’re doing things like actually touching surfaces, maybe touching your face afterward, and even using the toilet.
I know these things sound difficult. But I want to emphasize: we go slow. We move at a pace where your brain has the chance to build confidence—where it learns you can handle these situations. Your brain starts realizing that it can tolerate anxiety and uncertainty, and over time, you stop feeling scared of what you have been avoiding.
Next, What is Response Prevention?
But exposure doesn’t work without its other half: Response Prevention.
So what is response prevention?
It means not doing your compulsions during or after you’ve done the exposure. Using the public restroom example, response prevention might look like not washing your hands, not using hand sanitizer, not washing in a ritualistic way. It also means resisting the urge to research what diseases you could catch, not asking others for reassurance, and not changing your clothes. You get the idea.
But here’s the thing: compulsions aren’t always physical. In fact, many people don’t have any physical compulsions at all—theirs are entirely mental.
Navigating Mental Compulsions in OCD
Examples of mental compulsions include:
Rumination – going over the same thought or scenario again and again.
Memory checking – mentally reviewing something that happened.
Neutralizing – trying to “cancel out” a bad thought by thinking something good.
Fortune telling – trying to predict or mentally calculate an outcome
...and there are many more mental compulsions.
At the core, all of these are attempts to find certainty and feel reassured.
ERP Isn’t Just About Behavior—It’s About Thoughts Too
So in the public restroom example, even if someone isn’t washing their hands, they might still be mentally repeating thoughts like, “I’m probably fine,” or “There’s no way I could get sick from that.” That’s still a compulsion—and it’s still reinforcing the idea that public restrooms are dangerous.
This is where response prevention becomes crucial.
In ERP, we learn how to disengage from these mental compulsions, which is tricky—but absolutely possible. How?
Well, mental compulsions are habits. They’re not automatically happening to you. They’re things your brain has learned to do—and just like any habit, they can be unlearned. That means you can learn to respond differently to intrusive thoughts, anxiety, and fear.
Healing with ERP for OCD in Boston, MA
As an OCD therapist in MA, I believe this is the most healing aspect of ERP.
I often hear people say, “I tried ERP and it didn’t work for me.” And you know what? That might be true. I’m the first to say that people are complex and no clinical intervention is perfect. It is possible that ERP just isn’t the right fit for some people.
But—more often than not—what I think is happening is this: they’re not doing response prevention. And even more specifically, they’re not doing response prevention for their mental compulsions.
It’s much easier to monitor physical compulsions. For example, someone can clearly tell me whether or not they washed their hands several times after using a public restroom. But as an ERP therapist, I also need to know what’s happening in their mind. Because if someone is going into a public restroom, but then spends the next hour mentally spiraling—ruminating over whether they’ll get sick, trying to reassure themselves they’re safe—that’s still sending the message to their brain: “This place is dangerous.”
That’s why a big part of how I practice ERP involves what I call mind training.
Mind Training & ERP Therapy for OCD
We learn how to reduce rumination, how to practice attention training (so you can actually place your focus where you want it), and how to let go of the mind’s constant attempt to find certainty—so you can start turning toward what matters to you.
Most people aren’t consciously aware of how they use their minds. But with OCD, we have to get really intentional about it—until that intentionality becomes second nature. And here’s the really cool part: this work doesn’t just help with OCD. It creates more peace and clarity in every area of life.
Why? Because you’re no longer constantly overthinking, analyzing, or trying to control things that are outside of your control. You learn to let go of the mental tug-of-war. You learn to respond to uncertainty with flexibility, instead of fear. And that shift—learning to live without needing constant certainty—makes space for more freedom, presence, and ease in your life overall.
OCD Therapy Across Massachusetts & California
In OCD therapy, I help clients move beyond the cycle of doubt and fear by learning to loosen control, embrace the uncertainty that comes with relationships, release perfectionism, and build trust from within. If these are struggles you recognize in yourself, know that support is here. I provide virtual OCD and anxiety therapy for adults throughout MA & CA, so you don’t have to be in Boston to begin this process. If you’re struggling, OCD therapy can offer guidance, tools, and relief—right where you are.
Begin Healing with ERP for OCD in Boston, MA & Beyond
If you’re looking for ERP for OCD in Boston, MA—or anywhere in Massachusetts or California—you don’t have to navigate the challenges of OCD alone. As an OCD and anxiety therapist, I specialize in using Exposure and Response Prevention (ERP), the gold-standard treatment for OCD, to help clients break free from cycles of fear, avoidance, and compulsions. With specialized OCD therapy services, we’ll work step by step to reduce anxiety, strengthen resilience, and create space for the life you want to live.
Here’s how to get started:
Schedule a free 15-minute consultation to share your experiences and learn how ERP can support your recovery.
Begin virtual ERP therapy for OCD from anywhere in MA or CA, tailored to your specific symptoms and needs.
Start practicing new skills, facing fears with support, and building freedom from OCD’s grip one step at a time.
Additional Services Offered
Along with one-on-one OCD therapy, I also offer supportive resources that address challenges many clients face outside of sessions. On the Common OCD Themes page, you can explore detailed insights into recurring thoughts and behaviors, helping you feel validated and less isolated in your experience. The OCD and Social Life page offers guidance for managing friendships, dating, and relationships while living with OCD and anxiety. These resources are designed to complement therapy by providing practical tools and new perspectives, extending your growth and healing beyond the therapy room.
