OCD Treatment · Telehealth · Adults
ERP therapy for OCD the treatment that actually works.
Exposure and Response Prevention is the gold-standard, evidence-based treatment for OCD. When OCD or intrusive thought loops come up, I use Exposure and Response Prevention but not the fast, all-at-once version people sometimes picture. My approach is gentle and paced to where you actually are, not where a textbook says you should be. Most of the people I work with on this are early in figuring out what's going on, some without OCD ever having crossed their mind before we started.
What ERP is and why it's different.
Most people with OCD have received anxiety treatment coping skills, thought challenging, mindfulness, relaxation techniques. These approaches aren't wrong for anxiety. For OCD they often make things worse over time, because they treat the anxiety rather than the mechanism that's producing it.
OCD operates through a specific cycle: an intrusive thought or trigger produces obsessional anxiety, a compulsion provides temporary relief, and the relief reinforces the cycle. The compulsion doesn't have to be visible. It can be mental reassurance, reviewing, checking, seeking certainty, or avoidance. What matters is that it provides relief and that relief is what keeps the cycle running.
ERP interrupts the cycle at the compulsion. Instead of performing the compulsion that would normally reduce the anxiety, you practice sitting with the uncertainty and discomfort without responding to it. Over time the brain learns that the obsessional thought is not actually dangerous and does not require a response. The anxiety decreases not through avoidance or reassurance but through direct experience that the feared outcome doesn't materialize and the discomfort is tolerable.
This is counterintuitive. It is also what decades of research supports as the most effective treatment for OCD available.
What ERP looks like in practice.
ERP begins with a thorough assessment of your specific OCD presentation the triggers, the obsessions, and the compulsions that are maintaining the cycle. From that assessment we build a hierarchy: a structured list of exposures ordered from least to most distressing, so we work in a graduated, collaborative way.
We don't start at the hardest thing. We start where you have enough tolerance to practice, and we build from there. Every step of the hierarchy is something you understand and have agreed to nothing happens in ERP without your informed participation.
Sessions are structured and focused. We spend time in session doing ERP work, not just talking about it. Between sessions you practice the exposures we've worked on. The combination of in-session work and between-session practice is what produces lasting change.
Most people who complete a full course of ERP see meaningful reduction in OCD symptoms. For many the improvement is significant. This is not a treatment that manages symptoms indefinitely done correctly, ERP produces real and lasting change in how OCD operates in your life.
OCD presentations I work with.
OCD is highly variable. The intrusive thoughts and compulsive responses look different from person to person, which is one of the reasons it's so frequently misidentified. Some of the presentations I work with most often:
Health OCD — sometimes called health anxiety involves a compulsion cycle centered on fears about illness, symptoms, and medical certainty. Googling symptoms, seeking reassurance from doctors or loved ones, avoiding anything that might trigger health-related thoughts. The reassurance never holds because the problem is the cycle, not the information.
ROCD — relationship OCD is OCD targeting the relationship. Intrusive doubts about whether you love your partner, whether they're the right person, whether your feelings are real. The doubt feels urgent and specific but it doesn't resolve through reassurance or through genuine relationship evaluation. That's the OCD mechanism.
Harm OCD involves intrusive thoughts about causing harm to others or to yourself that feel like evidence of dangerous intentions. They aren't. The distress these thoughts produce is itself evidence that they're OCD, not desire. ERP is highly effective for harm OCD.
Scrupulosity involves intrusive thoughts related to morality, religion, or ethics fear of having sinned, of being a bad person, of violating values. The compulsive response is often mental reviewing, confession, or reassurance seeking.
Pure O — so called because the compulsions are less visible is a misnomer. There are always compulsions. They are usually mental rather than behavioral, which is why they're harder to identify and why ERP needs to target them specifically.
Why virtual ERP works.
ERP delivered via telehealth is as effective as in-person ERP for most OCD presentations. For some presentations particularly those involving home-based compulsions or avoidance of specific environments virtual ERP has a practical advantage because we can work directly in the environment where OCD shows up most
Virtual therapy also removes the geographic barrier that has historically limited access to ERP-trained therapists. Specialist OCD treatment is not available everywhere. Telehealth means adults in Colorado, Idaho, and South Carolina can access evidence-based OCD care regardless of where they live in those states.
About Brittaney.
Brittaney Wood is a Licensed Professional Counselor specializing in OCD, ADHD, and eating disorders in adults. She is trained in ERP and works with OCD as a primary specialty not as one of many conditions she sees occasionally. ERP is a specific clinical skill that requires training and practice to deliver effectively. It is the primary treatment modality used for OCD in this practice.
She is licensed in Arizona, Colorado, Idaho, and South Carolina and delivers all therapy via telehealth.
Common questions about ERP.
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A: Most people see meaningful progress within 12 to 20 sessions of structured ERP, though this varies depending on the complexity and duration of the OCD presentation. Some people move faster. Some need more time. A Good Faith Estimate — which outlines expected session frequency and anticipated cost — is provided before the first session so you have a realistic picture before committing.
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A: ERP is a specific form of CBT — Cognitive Behavioral Therapy — but the two terms are not interchangeable. General CBT for anxiety typically involves thought challenging, relaxation, and coping skill development. ERP specifically targets the compulsion cycle through structured exposure and response prevention. A therapist who practices general CBT is not necessarily trained in ERP. For OCD, the distinction matters.
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A: ERP is uncomfortable. It involves deliberately confronting the thoughts and situations that trigger OCD without performing the compulsion that would relieve the anxiety. That's genuinely difficult, and it's appropriate to acknowledge that. It is also time-limited discomfort in service of a lasting outcome, and it's done collaboratively — nothing on the hierarchy is approached without your understanding and agreement. Most people who complete ERP describe it as hard and worth it.
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A: ERP delivered poorly or incompletely often doesn't produce the expected results. Common problems include exposures that aren't specific enough to the actual OCD presentation, hierarchies that move too slowly to produce habituation, or an approach that inadvertently incorporates reassurance. If previous ERP felt incomplete or didn't address your specific OCD subtype directly, it may be worth trying again with a clearer framework.
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A: No. Many clients arrive with a generalized anxiety diagnosis and a pattern that looks like OCD on assessment. We'll do a thorough intake to understand your specific presentation. If OCD is what we're treating, we use ERP. The formal diagnosis label matters less than getting the right treatment approach.
OCD is treatable. ERP is how.
If you've been managing OCD without the right treatment or if you've never been sure whether what you're experiencing is OCD a consultation is the right starting point. It's free, it's brief, and it's how we figure out whether this is a fit.
Virtual · Licensed in CO · ID · SC · Currently accepting new clients