Online ERP Therapy for OCD: What Happens in Sessions
What is OCD?
What is ERP?
ERP is a form of cognitive behavioural therapy (CBT) designed specifically for OCD. It has two parts:
- Exposure — gradually and deliberately approaching the thoughts, situations or objects that trigger your anxiety.
- Response prevention — choosing not to carry out the compulsion, and allowing the anxiety to rise and fall on its own.
Repeated practice teaches your brain that the feared outcome is unlikely, and that you can tolerate uncertainty and discomfort without rituals. CBT including ERP is the psychological treatment recommended for OCD in NICE guidance.
What happens in ERP sessions, step by step
1. Assessment and understanding your OCD
Your first sessions focus on understanding your OCD: what the obsessions are, which compulsions and avoidance you use, and how it affects your life. Many people find it a relief simply to describe their thoughts to someone who understands OCD and isn’t shocked by them.
2. Learning how the OCD cycle works
Your therapist explains why compulsions keep OCD going, and how ERP breaks the cycle. Understanding the “why” makes the practice feel much more manageable.
3. Building your exposure hierarchy
Together, you create a list of situations ranked from mildly uncomfortable to very difficult — sometimes called an exposure ladder. You always start near the bottom.
4. Practising exposures, with support
In and between sessions, you practise steps from your ladder while resisting compulsions. Your therapist helps you plan each step, notice what happens, and adjust the pace. You are never forced to do anything you haven’t agreed to.
5. Reducing reassurance and hidden rituals
Much of OCD is invisible — mental checking, reviewing or asking others for reassurance. Part of ERP is noticing and gently reducing these too, often with family members involved where helpful.
6. Building independence and preventing relapse
As things improve, you become your own therapist: planning your own exposures and knowing how to respond if OCD tries to come back.
Does ERP work online?
Yes — and in some ways online ERP has advantages. Many OCD triggers are at home: checking doors and appliances, contamination worries in the kitchen, or intrusive thoughts in specific rooms. Online sessions mean your therapist can support you with exposures in the real places where OCD shows up, rather than in a clinic room.
Online sessions also save travel time and make it easier to keep regular appointments — which matters, because consistent practice is what makes ERP work.
ERP for children and teenagers
ERP also works well for children and young people, with parents closely involved — for example, learning how to step back from reassurance in a supportive way. Read more about our OCD therapy for children and teenagers.
Will ERP make my anxiety worse?
Anxiety rises during an exposure, which is expected and part of the process. Because steps are gradual and planned, most people find it manageable — and over time the anxiety becomes much weaker.
Do I have to tell my therapist my intrusive thoughts?
It helps, but you can go at your own pace. OCD therapists hear all kinds of intrusive thoughts and understand that having a thought is not the same as wanting it or acting on it.
Can I do ERP if my OCD is mostly mental?
Yes. Exposures can include writing or listening to feared thoughts, and response prevention focuses on reducing mental rituals and reassurance-seeking.
Is ERP the same as CBT?
ERP is a specific type of CBT developed for OCD. Many therapists combine ERP with other CBT techniques.
Ready to take the first step? Our UK-accredited therapists offer online ERP therapy for OCD for adults, children and teenagers. Book an intro call to talk through how we can help.
If you need urgent help
We are not an emergency service. In the UK, call 999 or go to A&E in an emergency, call NHS 111 for urgent advice, or Samaritans on 116 123 (24/7). Outside the UK, contact your local emergency services.
