Office hours: 9:00am - 6:00pm
- new York, USA
- Support@ThoughtshiftTherapy.com
- 914-215-5409
Obsessive-Compulsive Disorder (OCD) is a mental health condition characterized by intrusive, distressing thoughts (obsessions) and repetitive behaviors or mental rituals (compulsions) performed to reduce anxiety. These compulsions can provide temporary relief but often reinforce the cycle of OCD.
Intrusive thoughts that are unwanted and distressing. This leads to the urge to do compulsions such as excessive checking, mental rituals, or seeking reassurance, to lessen the momentary fear.
OCD often presents in common themes. While intrusive thoughts and compulsions may vary from person to person, they are typically driven by similar underlying fears. Because of this, these experiences are often grouped into themes to help better understand and treat them.
These are some of the more common ways OCD can show up. If your experience doesn’t fit neatly into one category, you’re not alone—OCD can take many forms, and treatment can still be highly effective.
Fears related to germs, illness, or feeling “unclean,” often leading to excessive washing, cleaning, or avoidance. Contamination also includes emotional, physical and somatic feelings outside of typical germs or illness.
Intrusive thoughts about causing harm to oneself or others, even when there is no desire or intention to act on them
Fears of being responsible for something bad happening (e.g., leaving the stove on, causing someone emotional pain, doors unlocked), leading to repeated checking or reassurance-seeking.
A strong need for things to feel even, exact, or “just right,” often involving arranging, ordering, or repeating behaviors.
Intrusive doubts about one’s sexual orientation, leading to checking feelings or attraction.
Doubts and uncertainty about relationships, including questioning feelings, compatibility, or a partner’s qualities. Can also include fears of infidelity on both sides.
Intrusive, repetitive fears about illness driven by a need for certainty, often involving checking, researching, or reassurance-seeking.
Distressing thoughts about the nature of reality, death, existence, or meaning, leading to rumination and difficulty feeling grounded.
Fears about doing or having done something wrong, immoral, or against one’s beliefs, often involving guilt, rumination and reassurance-seeking.
Unwanted, distressing thoughts about harming children, often accompanied by fear, avoidance, and reassurance-seeking.
Persistent doubt about past actions or events, leading to repeated mental review or attempts to feel certain.
Intrusive thoughts or images that feel disturbing, inappropriate, or out of alignment with one’s values (e.g., sexual, aggressive, or moral themes). These thoughts are unwanted and often cause significant distress
The OCD cycle starts with an intrusive thought (obsession) that sparks anxiety or distress. To relieve the discomfort, a person engages in a compulsion—a repetitive action or mental ritual. This provides temporary relief, but it reinforces the idea that the obsession was a real threat, making future anxiety even stronger. Over time, the cycle repeats, keeping OCD in control. Breaking this cycle with Exposure and Response Prevention (ERP) helps weaken OCD’s grip by teaching the brain that anxiety passes without needing compulsions.
Effective treatment often includes Cognitive Behavioral Therapy (CBT), particularly Exposure and Response Prevention (ERP), which helps individuals confront fears and resist compulsions in a controlled way.
Anxiety doesn’t last forever. When you resist rituals, the discomfort fades over time and so does your urge to do compulsions.
The feared outcome usually never happens, or isn’t nearly as catastrophic as OCD claims.
You learn to sit with intrusive thoughts and tolerate uncertainty without reacting, taking your power back from OCD and feeling more in control.
Exposure and Response Prevention (ERP) follows a structured approach designed to support gradual, meaningful progress through consistency and measurable steps. While each client’s experience is individualized, sessions are guided by a clear framework that helps track growth and build momentum over time. Think of this as a foundation that shapes the direction of our work together.
It’s important to understand that OCD is a chronic condition. While research shows that the majority of individuals experience significant improvement with ERP, this does not mean that intrusive thoughts disappear entirely. Rather, the goal is for these thoughts to become far less distressing and more easily dismissed.
ERP is not about “curing” OCD, but about helping you reach a place where it no longer controls your life or defines how you live it.
We can discuss any questions, concerns, or fears about beginning ERP in a free consultation prior to beginning.
Our initial sessions include psychoeducation to help you better understand obsessions and compulsions and how they differ. We then complete the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) together; a structured assessment that helps us identify your specific obsessions and compulsions. Because this is a thorough evaluation, it may take anywhere from one to three sessions, depending on your individual experience and symptom severity.
At the end of this process, you’ll receive a Y-BOCS score, which helps us better understand the severity of your OCD and guides our treatment planning moving forward.
You will receive your first homework assignment of tracking your obsessions and compulsions on a self-report form to better understand the frequency and intensity of symptoms day to day.
After completing the Y-BOCS, we move into a functional analysis. This step helps us identify the internal and external triggers for intrusive thoughts, clarify the underlying fears driving them, and recognize patterns of compulsions or avoidance. This deeper understanding allows us to thoughtfully design exposures that are targeted, gradual, and effective.
You will continue tracking your obsessions and compulsions on a self-report form to better understand the frequency and intensity of symptoms day to day.
Once we’ve gathered a comprehensive understanding of your OCD, your therapist will introduce a shared ERP workbook. This will include your exposure hierarchy, homework journal, and resources for exposures, all in one place to help guide your progress.
You’ll also receive psychoeducation on the different types of exposures we may use, including in vivo, interoceptive, and imaginal exposures. We introduce the Subjective Units of Distress Scale (SUDS), a 0–100 scale used to rate anxiety levels, and work together to establish your personal anchor points. From there, we begin ranking your exposures and identifying a starting point for treatment.
Ongoing sessions focus on practicing exposures in session while working to resist compulsions, along with assigning structured homework to continue the work outside of sessions. Exposures are typically completed once per day for about 20 minutes.
Consistency and repetition are key components of progress, helping build confidence and reduce anxiety over time.
While ERP is often structured around an average of 27 sessions, every client is different, and the timeline may vary based on individual needs and progress. Once you’ve worked through your exposure hierarchy and built consistent progress, we transition into relapse prevention.
Relapse prevention focuses on maintaining gains through continued practice of previous exposures and developing the skills to navigate future intrusive thoughts and uncertainty with confidence.
It’s completely normal to feel hesitant about starting a therapy that asks you to face fears you’ve been avoiding or that cause significant distress. Below, we answer common questions with honest, practical guidance to help you feel more prepared and supported as you take this step.
No. ERP is always gradual and collaborative. We start with more manageable exposures and build up over time as your confidence grows. You will never be pushed into something you’re not prepared for.
Feeling anxious is a natural part of the process, but you won’t be facing it alone. Your therapist will guide you through each step and help you learn how to tolerate and move through the discomfort in a supportive, structured way.
Very gradual. Together, we create a step-by-step plan (called a hierarchy) that starts with lower-intensity exposures and slowly progresses. The goal is to make the process challenging, but still manageable.
Yes. ERP is a collaborative process, and your voice matters. We move at a pace that feels appropriate for you while still encouraging meaningful progress.
That’s okay. It’s completely normal to feel hesitant. We can spend time building up to those exposures so that when you do approach them, you feel more prepared and supported.
Progress in ERP often looks like a gradual reduction in anxiety, less reliance on compulsions, and an increased ability to handle uncertainty. Over time, situations that once felt overwhelming begin to feel more manageable.
At times, anxiety may increase when you begin facing fears you’ve been avoiding. However, this is a temporary and expected part of the process. With consistency, your anxiety begins to decrease, and you build confidence in your ability to handle it.
Many people worry that their symptoms are “too much,” but ERP is specifically designed to treat OCD across a wide range of severity levels. The process is always tailored to you, starting at a level that feels manageable and building from there.
Not necessarily. ERP can be highly effective on its own although a combination of ERP and medication management has higher success rates for more severe cases. Some individuals choose to incorporate medication as an additional support, but this is a personal decision that can be discussed with your therapist and, if needed, a prescribing provider.
Cleopatra is an ERP-certified Licensed Mental Health Counselor who brings both clinical expertise and personal insight to her work. Having navigated OCD herself, she understands how intimidating ERP can feel and is committed to making the process as collaborative, supportive, and manageable as possible.
You can learn more about her personal journey with OCD and her approach to ERP in her article, “Overcoming OCD: A Personal Journey Through Intrusive Thoughts and Exposure Therapy“.
All of our therapists offer a free 15-minute consultation. Simply click “Request a Free Consultation”. You’re also welcome to book directly with a therapist through our “Our Therapists” page.
If you’d like us to check your insurance before getting started, just fill out the form below and we’ll get back to you as soon as possible.
