Exposure and response prevention, or ERP, is the therapy approach recommended by the National Institute for Health and Care Excellence (NICE) for adults with OCD. In sessions, you and your therapist map the specific thoughts and situations that trigger your rituals, then agree a step-by-step plan to face them without carrying out the compulsion.
For the wider context of how I work and the options available, my guide on how OCD therapy works in London covers symptoms, NHS versus private routes, and how to choose a qualified practitioner.
How exposure and response prevention works
The therapy brings together two active components:
- Exposure: Deliberately turning toward the thoughts, images, physical sensations, or situations that trigger your anxiety or doubt.
- Response prevention: Choosing, with agreed support, to hold back from the compulsion that usually follows, whether that is checking, washing, repeating, seeking reassurance, or running silent mental rituals to neutralise the thought.
The aim is never to flood you with distress or push you into overwhelming situations. We build each exercise together, agreeing the pace in advance. When you stay in the triggering situation without performing the ritual, your nervous system gradually learns that the spike in anxiety peaks and settles on its own, and that the feared outcome does not occur.
The clinical evidence
NICE recommends cognitive behavioural therapy incorporating ERP as the first-line psychological intervention for adults with obsessive-compulsive disorder (guideline CG31). The guidance matches treatment intensity to how significantly OCD affects your daily routine, ranging from targeted weekly therapy to combined therapy and medication for more severe difficulties.
Standard counselling or supportive listening can feel validating, but without structured exposure and response prevention, it rarely changes the underlying OCD loop.
What happens in sessions
In the first two sessions, we map how your OCD operates day to day. We list your typical triggers, note what urges or fears they provoke, and score how difficult each one feels. We then arrange these into a graded ladder, starting with steps that feel achievable and working up gradually.
Sessions take place weekly for fifty minutes. Each week we review the exercises you tried between sessions, identify where difficulties arose, and plan the next step. Most progress happens outside the clinic room, through brief, planned moments of practice in the settings where your OCD actually shows up: at home, on your commute, or at work.
If an exercise feels too difficult, we break it down into smaller, manageable steps. ERP requires steady commitment, and our work remains collaborative throughout.
When to seek immediate support
Therapy sessions provide structured, planned support rather than emergency cover. If you are experiencing a mental health crisis or feel unable to keep yourself safe, please contact your GP, call NHS 111, call Samaritans free on 116 123, or call 999 in an emergency.
Arranging OCD therapy in London
I provide OCD therapy in London in person at Harley Street and City Road, as well as online across the UK. Consultations begin with a complimentary 20-minute phone or video conversation to discuss what you are experiencing and whether ERP is appropriate for you.
This article is provided for educational and informational purposes only. It does not constitute a personal clinical assessment or treatment plan, and reading it does not establish a therapist-client relationship.
Sources
Clinical recommendations in this article reflect the National Institute for Health and Care Excellence guideline on obsessive-compulsive disorder and body dysmorphic disorder (CG31). Sources retrieved October 2026.