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ERP Tip of the Day #2

Exposure ERP Tip doorknob dirty

I’m going to do this and ride the anxiety wave no matter what. Bring on the bad thoughts.

It’s ERP tip time. This series of posts focuses on tips to enhance the effectiveness of your exposure and response prevention (ERP). If you’re interested in more ERP tips, click the following link for all the posts in this series.

Exposure and Response Prevention (ERP) Tips for OCD

Without further ado, here’s another ERP tip to consider when designing your next exposure.

ERP Tip #2

When completing your next exposure, avoid rules that dictate what you’re allowed to think during the exposure. If you try to complete an exposure without having a certain bad thought, chances are that you’re setting yourself up to think that very thought. Instead, design your exposure around having that very same unwanted thought.

I love it when people with OCD do exposure, but I don’t love it when they have a long list of impossible preconditions that dictate the form of their OCD exposure.

The most glaring example of this is when people dictate the thoughts that they should have during exposure.

OCD ERP Tip Don’ts

What I don’t like: I’m going to touch that doorknob, but I really hope that it’s not wet or slimy. When it’s wet or slimy, it makes me think that it has blood on it, and that I might really be contracting AIDS. I really don’t want to die, so I’m okay with touching that doorknob, just as long as it’s dry as a bone, so that it doesn’t freak me out.

What I don’t like: I’m willing to walk across that mystery spot in the parking lot, just as long as it doesn’t look at all red or brown or sticky or possibly organic in some form or another. If it looks that way, it really freaks me out and then it makes me think that I’m tracking AIDS blood everywhere.

What I don’t like: I’m willing to look at pictures of kids, just as long as I don’t have sensations in my groin. When I have those sensations, it really freaks me out and I think there may actually be something wrong with me.

What I don’t like: I’m okay with holding my baby, just as long as I don’t think about throwing him down the stairs, snapping his neck, or doing something inappropriate to him. If those violent OCD thoughts show up, I’ll be really freaked out, and I won’t be able to handle it.

What I don’t like: I’m okay with looking at pictures of the devil, just as long as I don’t have unwanted religious thoughts like praying to him while I’m doing it. I mean, I’d really like to have negative thoughts about him while looking at him, but if I happen to have good thoughts, well then that would really freak me out.

OCD ERP Tip Do’s

What I like: I’m going to do this and ride the anxiety wave no matter what. Bring on the bad thoughts.

Here’s what happens when you use exposure and response prevention (ERP) tips and choose to do an OCD exposure and purposely think a bad thought:
1) You have taken control back and are offensively striking back at your OCD.
2) You are approaching a bad thought with a pro-coping mindset (instead of approaching it with surprise or shock).
3) You’re guaranteed an opportunity to face your fear. You’re not leaving it up to chance.
4) If your OCD has the tendency to try to one-up you, you are one-upping it.

If you don’t want to have a certain thought, that very thought will be the one that shows up. Save yourself some time, and just go for that thought. Yes, I mean that thought.

Implement this OCD ERP tip in your exposures for maximum benefit!

Questions?  Comments?  What has been your experience in embracing unwanted thoughts?
Sound off below.

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  1. Great tip! I think you sum it up and explain it well when you say OCD should be fought offensively, as defensively just won’t work!

  2. Hello Dr. Seay,

    Will the thoughts eventually go away or the person will only feel “less anxious” about them? Will the certainty they once had that they aren’t a pedophile or homicidal, suicidal, etc, come back?

    ERP can make us feel even worse, more anxious and even less sure about ourselves and our own values, at least in the beginning, right?

    Thank you. Have a great week!

    • Your question is a bit trickier than it may seem at first glance. The “best” treatment goal is to work on getting better at having bad thoughts, instead of eliminating them. Accepting the thoughts conditionally as a way to feel “less anxious” tends to be counter-productive, as this can easily turn into a ritual. Conditional acceptance also keeps you framing anxiety as your enemy, and it also sets you up to be continually mentally checking, “Are the thoughts gone yet?”, which in turn gives rise to more thoughts.

      ERP can be very uncomfortable at first, but living with uncertainty gets easier and easier with practice.

      Hope this helps.

  3. Hi Steve. Retroactive jealousy is a king of ROCD?

  4. Hello , I have ROCD but I dont know how to cope with it . I often believe my intrusive thoughts , any tips how to do ERP becuase when I make a script I dont really feel anxious, and often I think I dont have OCD at all .

    • One of the trickier aspects of OCD is the fact that you can’t perfectly know whether or not you have it. It truly is a disorder characterized by uncertainty — often even uncertainty about the diagnosis itself! If you could definitively know that you have OCD (and that it’s not something else), OCD would lose all its power and recovery would be instantaneous. This is pretty much true of all OCD, regardless of the OCD subtype.

      In general, ROCD typically responds to scripting, as well as in vivo exposures. If your scripts aren’t generating anxiety, then you might benefit from working with a OCD therapist who could help you tweak things appropriately. Also, if you’re engaging in any rituals or avoidance, this would prevent you from benefiting fully from your ERP. Make sure you’re addressing response prevention, as well as implementing exposure.

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