Cognitive Behavioral Therapy (CBT) & Exposure and Response Prevention (ERP) for OCD
My Experience Treating OCD
I have over six years of experience treating obsessive-compulsive disorder (OCD) in children, adolescents, and young adults through individual therapy, parent coaching, and intensive treatment (multiple sessions per week with exposure practice for one to two months).
For the past several years, I led the adolescent intensive outpatient program at The Concord Center, a well-established group practice specializing in evidence-based treatment. In this role, I helped develop and refine the treatment curriculum, provided clinical guidance and consultation to the team, and worked directly with adolescents, young adults, and their families.
This experience has given me a deep understanding of the many ways OCD can show up, as well as the strategies that help individuals break free from its grips. My approach combines evidence-based treatment with warmth, humor, and a genuine appreciation for how hard this work can be.
Understanding OCD: You're Not Alone
One of the first things I want clients to understand is that OCD can feel weird, but that doesn't mean there's something wrong with you.
Many people with OCD experience intrusive thoughts or urges that feel embarrassing, disturbing, or completely out of character. You may worry about what these thoughts say about you or feel ashamed to share them, even with a therapist.
Here's the thing: OCD creates some pretty strange thoughts and behavior patterns. And while those experiences can feel unsettling, they're actually very common within OCD. Having an intrusive thought doesn't mean you believe it, want it to happen, or that it reflects who you are.
OCD is also more common than many people realize. Research suggests that approximately 1 in 40 adults will experience OCD during their lifetime, and at least 1 in 100 children and teens have OCD (International OCD Foundation).
Understanding how OCD works, and recognizing that you're not alone, is an essential first step toward feeling less controlled by it.
How Does CBT and ERP Help with OCD?
Cognitive Behavioral Therapy (CBT) helps you understand the connections between your thoughts, feelings, and behaviors. Exposure and Response Prevention (ERP) is the behavioral component of CBT for OCD and is the gold standard, evidence-based treatment.
With OCD, unwanted thoughts, images, or urges (called obsessions) can trigger anxiety, guilt, disgust, or uncertainty. In response, you engage in certain behaviors or mental rituals (called compulsions) to feel better, gain certainty, or prevent something bad from happening. While compulsions often provide temporary relief, they ultimately reinforce the OCD cycle.
The cognitive component of CBT focuses on building awareness of these patterns and learning to relate to your thoughts differently. One helpful skill is cognitive defusion, which involves creating distance from your thoughts rather than automatically treating them as facts. For example, instead of getting caught up in the thought, "What if having this thought means I'm a bad person?" you could practice saying to yourself, "I'm noticing the ‘I’m a bad person’ thought” again.
The goal isn't to eliminate uncomfortable thoughts or convince yourself that everything will be okay. It's to change your relationship with those thoughts so they have less power over you.
The behavioral component of CBT, called Exposure and Response Prevention (ERP), involves gradually facing situations, thoughts, or feelings that trigger OCD while practicing resisting the compulsions that follow.
For example, ERP might involve:
Contamination fears: Touching a public bench and resisting the urge to wash or sanitize afterward.
Intrusive thoughts: Practicing saying or writing an uncomfortable thought without immediately reassuring yourself that you don't believe it.
Fear of uncertainty: Making a decision without repeatedly checking, researching, or asking others for reassurance.
I won’t ask you to immediately jump into overwhelming, scary exposures right away. We work collaboratively to build the skills and confidence to approach feared experiences at a manageable pace.
Together, these cognitive and behavioral strategies will help you recognize OCD's patterns, tolerate uncertainty and discomfort, and make choices based on what matters to you rather than what your OCD demands.
Making ERP Meaningful: The Role of Values
One of the most important parts of my approach to OCD treatment is connecting ERP to what matters most to each individual.
ERP is hard work. Facing fears and resisting compulsions can feel incredibly uncomfortable, especially when OCD is insisting that we need to do something to feel safe or certain.
That's why I believe there needs to be a meaningful why behind the work.
Sometimes that means stepping back and considering the bigger picture: What would life look like if OCD weren't making so many of your decisions? Maybe it's having more freedom, being more present with friends and family, trying new experiences, or spending less time caught up in rituals.
Other times, values-driven action becomes the exposure itself.
For example, someone with contamination fears might choose to attend a friend's play despite worries about sitting in a crowded auditorium with people coughing. Instead of making the decision based on what OCD wants them to avoid, they make it based on something they value: showing up for a friend.
This shifts the focus from simply tolerating discomfort to building a life that feels more fulfilling, meaningful, and aligned with who you want to be.
When ERP becomes a way of moving toward the life you want, rather than just an exercise in facing fears, it boosts motivation and follow-through.
Taking the Next Step
OCD can be exhausting, but it is also highly treatable. Through a values-driven approach, we'll work together to better understand your OCD, change the patterns that keep it going, and make more room for the things that matter to you.
Interested in learning more about OCD treatment? Reach out to discuss individual therapy or parent coaching.
