Exposure Therapy for OCD: Facing Fears, Finding Freedom

Obsessive-compulsive disorder (OCD) is a complex and often misunderstood mental health condition. It’s marked by a cycle of obsessions—persistent, unwanted thoughts or images—and compulsions, which are repetitive behaviors or rituals performed to relieve the anxiety triggered by those obsessions. 

OCD can take many forms. For some, it manifests as compulsive checking or cleaning. For others, it involves intrusive thoughts about harm, morality, or contamination. Regardless of the specific content, the distress it causes can be overwhelming and interfere with everyday life. 

While many people experience intrusive thoughts from time to time, OCD becomes a clinical concern when these experiences are persistent, distressing, and impair one’s ability to function. Fortunately though, there are evidence-based treatments for OCD including Exposure and Response Prevention. 

One of the most widely used treatments for OCD is Exposure and Response Prevention (ERP). This is a specialized form of cognitive behavioral therapy. At its core, ERP helps individuals face their fears in a safe and structured way. 

Exposure therapy works by gradually introducing someone to thoughts, images, or situations that provoke anxiety or obsessional fears without allowing the usual compulsive response. Over time, this process helps reduce the emotional power of those fears. By resisting the urge to engage in compulsions, the brain begins to re-learn that the feared outcome is unlikely or manageable. 

A commonly used example is of someone with contamination fears who might be asked to touch a doorknob and then resist the urge to wash their hands. While uncomfortable at first, repeated practice with support from a trained therapist can lead to significant symptom relief and a renewed sense of control. The person will come to see that they don’t always need to wash their hands after touching surfaces and may build on this exposure by trying it in different settings or waiting longer and longer before washing their hands. 

ERP is not about forcing someone into upsetting situations. It’s a gradual and collaborative process that respects each person’s limits while helping them expand their ability to tolerate distress and live more freely. 

Starting ERP can feel daunting. Many individuals worry they’ll be pushed too far or won’t be able to manage the anxiety that exposures bring. These concerns are valid—and they are also part of what makes OCD so powerful.  

Readiness for exposure therapy doesn’t mean being unafraid. It means being willing to try, with the support of a skilled clinician who understands your specific fears and history. 

You might benefit from ERP if: 

• You feel stuck in a cycle of obsessions and compulsions that limit your life. 

• You recognize that you’re engaging in behaviors that relieve stress in the moment, but are not solving the underlying distress. 

• You are open to working with a therapist who can help you gently challenge the OCD cycle. 

• You’re willing to feel discomfort in service of long-term healing, even if the path forward feels uncertain. 

At Alta Mira, we meet each client where they are. Exposure therapy is always tailored to the individual and integrated into a broader, compassionate treatment plan that includes emotional support, education, and skill-building. 

OCD often co-occurs with substance use disorders, and the relationship between the two is more common than many realize. Studies suggest that up to 25% of individuals with OCD may also struggle with addiction at some point in their lives. 

There are many reasons for this overlap. Living with untreated OCD can be exhausting and isolating. Some turn to alcohol or drugs in an attempt to quiet the obsessions or escape the anxiety that compulsions can’t fully soothe. Over time, these coping mechanisms can develop into substance use disorders. 

In some instances, individuals recovering from addiction may begin to notice obsessive thoughts or compulsive behaviors that were previously masked by substance use. In either case, integrated treatment is essential. 

At Alta Mira, we specialize in addressing co-occurring OCD and addiction. Our team of clinicians is trained to work with both conditions simultaneously, this ensures that the underlying drivers of each are understood and treated together.