Exposure Therapy Isn’t About Comfort — It’s About Lasting Change
Exposure therapy takes courage — not comfort.
October Is OCD Awareness Month
October is OCD Awareness Month, marked by an internationally coordinated effort to raise awareness for obsessive-compulsive disorder and its related conditions. This year’s campaign ran from October 12–18, highlighting education, advocacy, and hope for those affected by OCD and anxiety.
Closer to home, Indiana hosted its first-ever IOCDF One Million Steps for OCD Walk — and I was thrilled to attend. Standing alongside patients, families, and clinicians reminded me why I do this work: to reduce stigma, spread evidence-based knowledge, and champion treatments that help people reclaim their lives.
When we talk about what actually works, one approach always rises to the top: ERP (Exposure and Response Prevention) — a form of exposure therapy that remains the gold standard for OCD and anxiety disorders.
What Is Exposure Therapy?
Exposure therapy isn’t just for OCD — it’s an effective treatment for all anxiety disorders, including panic disorder, generalized anxiety, phobias, health anxiety, and social anxiety.
At its core, exposure therapy means facing the thoughts, feelings, or situations you fear — on purpose — without doing the behaviors that temporarily make you feel safe.
It’s not about “getting rid” of anxiety. It’s about teaching your brain something new:
“I can feel anxious and still be okay.”
That might mean touching a doorknob and resisting the urge to wash your hands. Or speaking up in a meeting and letting your voice shake. Or noticing your heart race and choosing not to escape. Each moment of willingness helps your brain learn that discomfort isn’t danger — and that you’re stronger than your fear wants you to believe.
Why ERP Gets a Bad Rap
ERP works — but it sometimes gets a bad reputation. Many people say, “I tried that, and it didn’t help.” In most cases, ERP didn’t fail — bad delivery did.
Bad ERP feels like punishment or flooding. Good ERP feels collaborative, purposeful, and empowering.
Good ERP vs. Bad ERP
Good ERP
✅ Collaborative and supportive
✅ Clear rationale — patients understand why they’re doing it
✅ Tied to personal values and goals
✅ Focused on learning and growth
✅ Builds long-term resilience
Bad ERP
🚫 Overwhelming or forced
🚫 Little to no explanation
🚫 Reduced to a checklist of tasks
🚫 Focused only on getting rid of anxiety
🚫 Undermines long-term resilience
When ERP is done well, it changes not just behavior — it changes identity. It helps people see themselves as capable, not fragile.
The Missing Ingredients: Acceptance + New Learning
Acceptance (Radical Willingness)
ERP isn’t about making fear disappear. It’s about saying,
“Anxiety and uncertainty are part of life. I can live fully, even when they’re here.”
That’s radical acceptance — not liking discomfort, but allowing it while you keep moving toward what matters.
Inhibitory Learning (New Learning)
ERP used to be thought of as “stay with it until your anxiety goes down.” Now we know the real change comes from new learning:
Old learning: “If I touch this, something bad will happen.”
New learning: “I touched it, and nothing catastrophic happened.”
Deeper new learning: “Even if something bad did happen, I could handle it.”
That last part — “I can handle it” — is where freedom begins.
What Life Looks Like After ERP
Here’s the part most people struggle to imagine: what does “freedom” actually look like?
It’s not a life without anxiety — it’s a life not ruled by it.
A woman who once avoided public restrooms can now pile her kids into the car and take a spontaneous road trip. She doesn’t plan every stop or sanitize every surface. She just goes — windows down, music up — because being with her kids matters more than staying perfectly clean.
A man who used to reread every email for hours now hits “send” in real time. If there’s a typo, he shrugs and keeps moving, because connection matters more than perfection.
A teenager who once feared getting sick can finally share a pizza with friends, laughing mid-bite instead of scanning the table for germs.
A parent who used to avoid bedtime stories because of intrusive thoughts now tucks their child in every night, knowing that having a thought isn’t the same as acting on it.
And someone who once white-knuckled their way across bridges now rolls down the windows and drives straight across — not because the fear is gone, but because the freedom is stronger.
Life after ERP is about presence over protection — showing up to what matters, even when your brain whispers, “What if?”
Anxiety still visits sometimes. But it no longer calls the shots.
ERP = Long-Term Payoff
Quick fixes and reassurance offer temporary comfort — but fear always finds its way back.
ERP, when done right, creates lasting change. It rewires how you relate to fear itself. It builds resilience, acceptance, and courage — skills that carry far beyond the therapy room.
That’s why ERP is worth it. Not because it feels good in the moment, but because it leaves you stronger for the long haul.
The Bottom Line
ERP isn’t about comfort. It isn’t about erasing anxiety. And it definitely isn’t a quick fix.
It’s about lasting change — learning to live a rich, meaningful life even with uncertainty tagging along for the ride.
It’s about the moment you stop asking, “What if I can’t handle this?” and start realizing, “Even if I can’t control it, I can handle it.”
That’s not just therapy.
That’s freedom.
