A step-by-step guide to building your own exposure and response prevention plan for OCD.
I created this for anyone who doesn’t have the resources or access to an ERP-trained therapist yet. It walks you through the treatment planning I do with clients, in plain language, one step at a time. It’s inspired by Kimberley Quinlan, LMFT, and her Your Anxiety Toolkit podcast episode on building an exposure plan.
Start my planOpens on isitocd.com, my free OCD resource site
This is not a diagnosis or therapyThis guide is education. It can’t diagnose OCD or replace care from a licensed professional. If you’re looking for help, please reach out to a licensed, ERP-trained clinician near you. You can search the Is It OCD? directory or the International OCD Foundation directory. In crisis? Call or text 988.
First, what OCD is
Obsessive Compulsive Disorder (OCD) is a mental health disorder that involves obsessive thoughts, feelings, sensations and urges, and compulsive behaviors.
The obsession
An obsession involves intrusive and unwanted thoughts that create significant anxiety, uncertainty and discomfort. They often show up as “what if?”
“What if I left the stove on?” “What if I hurt someone?”
The compulsion
A compulsion is a repetitive behavior done to reduce the anxiety and uncertainty the obsession creates. It brings quick relief, but it only reinforces the obsession.
Physical: something others can see, like checking, washing or asking for reassurance
Mental: something done in your head, like reviewing, counting, praying or trying to figure it out
Avoidance: staying away from people, places or things because of fear
Up to 17 yearsis how long research has found it can take from first symptoms to the right treatment. Read the study
2%of people with OCD in a national health-record study were documented as receiving ERP. Read the report
60%is the average drop in OCD symptoms with ERP. Source
ERP is the gold-standard, first-line treatment for OCD. It’s recommended by the American Psychiatric Association and the International OCD Foundation, and it works for children as young as six through older adults. The problem isn’t that OCD can’t be treated. It’s that so few people get the right treatment, or get it soon enough.
ERP stands for exposure and response prevention. You may hear it called “exposure therapy,” but exposure is only half of it. ERP is the gold-standard treatment for OCD, and it has two parts that must happen together, plus a third that helps your progress last.
1 · ExposureFacing your fears
You face the thing that scares you or makes you uncomfortable, on purpose: a thought, an image, a sensation, a place or not knowing for sure. Instead of avoiding it, you lean in, starting small.
2 · Response preventionReducing safety behaviors
You reduce the compulsions and safety behaviors you use to get rid of the discomfort. They feel helpful in the moment, but they cycle you right back into anxiety and keep OCD going.
3 · Managing self-criticismBeing kind to yourself
Self-compassion means treating yourself the way you’d treat a good friend who’s having a hard time. Kimberley Quinlan calls it a helpful tool for managing the shame, blame and negative self-talk that often come with OCD.
What research showsSelf-criticism tends to lower confidence and increase fear of failure. People who are self-compassionate are less afraid of failing and more likely to try again after a setback, which is exactly what ERP asks of you.Center for Mindful Self-Compassion · Kimberley Quinlan, Episode 7: Self-Compassion
Why you need bothSay you go out in public and don’t wash your hands. That’s the exposure. But if you come home and wash for an extra long time, the response prevention didn’t happen, and the compulsion undoes the work. ERP works when you face the fear and don’t do the compulsion, during or after.
How you’ll build your exposure plan
ERP treatment usually moves through stages: assessment and education, treatment planning, mindfulness, self-compassion, ERP itself, and relapse prevention and maintenance. This guide focuses on treatment planning: getting clear on your OCD and turning it into a plan.
1
Identify your obsessions and compulsionsYou’ll answer five questions, as honestly and as gently as you can: What do I avoid? What scares me? What physical behaviors do I do to relieve my fear or discomfort? What mental behaviors do I do? What do others do to reduce my anxiety?
2
Look at family accommodationThis is when a loved one changes what they do to ease or relieve your anxiety, like answering the same question again or avoiding a topic. It counts too.
3
Separate fear from your religion, culture or valuesAm I doing this because of a true religious, cultural or personal belief, or because of fear and uncertainty? If it’s your belief, it’s not a compulsion.
4
Create your exposure hierarchyFor each fear-driven behavior, write the opposite, then rate how hard it would be from 1 to 10. That becomes your ladder, and you start where it’s challenging but doable.
5
Plan your response preventionFor every step, decide which compulsions you won’t do, during and after.
6
Watch for self-criticism and self-punishmentHarsh self-judgment, holding back good things from yourself, building a case against yourself and isolating can all undo your hard work.
You’ll finish with a plan you can save as a PDF, plus a log for each practice. Everything you type stays on your device. Nothing is sent to me or anyone else.
How this can help you
1Before
It’s hard to name what’s wrong
Compulsions feel like the only way to feel safe
Some compulsions don’t look like compulsions
“Exposure” sounds scary and vague
2With a plan
You can see your OCD cycle clearly
You know what’s fear and what’s your faith, culture or values
Clear steps, and the compulsions to resist
You know where to start, and why
3With practice
What you feared usually doesn’t happen
You can handle anxiety and not knowing
Confidence builds one step at a time
You can bring your plan to therapy
4Keeping it going
Keep practicing when things feel better
A setback isn’t starting over
Watch for compulsions in new forms
Notice how far you’ve come
Ready to start?
Build your plan now. If you’re in DC, Maryland or Virginia and want support along the way, you can bring your plan to a consultation with me.