What is Exposure and Response Prevention (ERP)?

Exposure and Response Prevention (ERP) is a highly effective, evidence-based therapy for Obsessive Compulsive Disorder (OCD) and related anxiety disorders. ERP helps individuals face feared thoughts, images, or situations (exposure) while learning to resist compulsive behaviours or avoidance (response prevention).

ERP is based on the principle that avoidance and rituals keep anxiety going. In treatment, you’ll gradually face anxiety-triggering situations in a safe, structured way—without engaging in the usual coping behaviours. Over time, this reduces the power of intrusive thoughts and builds confidence in your ability to tolerate discomfort.

What conditions can ERP help with?

ERP is most commonly used to treat: Obsessive Compulsive Disorder (OCD) Health anxiety Phobias Social anxiety Panic disorder Certain presentations of eating disorders

Yes. ERP is a core component of Cognitive Behavioural Therapy (CBT) for OCD and anxiety-related conditions. It combines behavioural strategies with cognitive understanding to support long-term recovery.

Yes. ERP is considered the gold standard treatment for OCD and is strongly supported by research. It is recommended by NICE guidelines and widely used in both NHS and private settings.

What happens during an ERP session?

You’ll work collaboratively with a psychologist to develop a hierarchy of feared situations. Starting with manageable exposures, you’ll gradually face triggers while learning not to engage in compulsions. Sessions are tailored to your pace and guided by evidence-based protocols.

Can I do ERP therapy online?

Yes. We offer ERP therapy both in person at our London clinic and online, depending on your needs. Many clients benefit from flexible delivery, especially when working with real-life triggers in their home or work environment.

Exposure and Response Prevention

Exposure and Response Prevention, often called ERP, is a practical, evidence-based therapy that helps people gradually face feared thoughts, feelings, situations or triggers without using the rituals, avoidance or reassurance-seeking that keep anxiety going. It is most often used for obsessive-compulsive disorder, but it can also be helpful for some forms of anxiety where avoidance and safety behaviours have become part of the problem.

Many difficulties are maintained not just by the original fear, but by the patterns that develop around it. You might avoid certain places, seek reassurance, check repeatedly, mentally review events, neutralise thoughts, wash, count, repeat, confess, research online, or try to feel completely certain before you can move on.

At Hampstead Psychology, we offer ERP therapy in Hampstead, London, and online across the UK and internationally. We help you understand what is maintaining the cycle and work in a careful, structured way to reduce the power of intrusive thoughts, compulsions and avoidance.

This page is for information and does not replace a clinical assessment, diagnosis, or medical advice.

When Exposure and Response Prevention Therapy might be helpful

You might recognise some of these experiences:

You have intrusive thoughts, images, doubts or urges that feel distressing or difficult to dismiss.
You feel driven to check, clean, repeat, count, confess, ask for reassurance or mentally review things.
You avoid situations, objects, people, places or thoughts because they trigger anxiety.
You feel you need certainty before you can stop thinking about something.
You spend a lot of time trying to neutralise, undo or prevent feared outcomes.
You know the fear may be excessive, but it still feels hard to leave alone.
You feel caught in a cycle of anxiety, short-term relief and then more anxiety.
You want therapy that is structured, practical and focused on changing the cycle.

If this sounds familiar, ERP may help. It is particularly useful when compulsions, rituals, reassurance-seeking or avoidance are keeping anxiety active.

What Exposure and Response Prevention can help with

OCD and intrusive thoughts

ERP is one of the main evidence-based therapies for obsessive-compulsive disorder. It can help when intrusive thoughts, images, doubts or urges lead to compulsions, avoidance, reassurance-seeking or mental rituals. Therapy helps you gradually face triggers while reducing the responses that keep the OCD cycle going.

Checking, reassurance seeking and doubt

ERP can be helpful when anxiety is maintained by repeated checking, asking others for reassurance, researching, replaying conversations or trying to feel completely certain. Therapy helps you build tolerance of doubt and uncertainty, so you can respond differently without needing to keep checking or reviewing.

Contamination fears and washing rituals

ERP is often used when fears about contamination, illness, dirt, germs or harm lead to washing, cleaning, avoidance or repeated rituals. Therapy helps you gradually approach feared situations in a planned and supported way while reducing the behaviours that keep the fear feeling urgent.

Harm, responsibility and fear of causing damage

Some people experience intense fears about causing harm, making a mistake, acting out of character or being responsible for something terrible happening. ERP helps you understand how responsibility, threat and uncertainty become amplified, and supports gradual work to reduce avoidance, checking and mental rituals.

Anxiety, avoidance and safety behaviours

ERP can also be useful where anxiety is maintained by avoidance or safety behaviours. This might include avoiding particular situations, over-preparing, carrying out rituals, seeking certainty or relying on behaviours that make anxiety feel safer in the short term but keep it going over time.

Man taking notes on the couch in office._edited.png

Related difficulties we often see together.

Many people come to ERP with more than one difficulty. OCD may sit alongside anxiety, panic, depression, health anxiety, perfectionism, shame, burnout or relationship stress.

Therapy works best when we understand the whole picture while keeping the work focused. We look at how intrusive thoughts, anxiety, uncertainty, compulsions, avoidance and reassurance-seeking interact in daily life.

What keeps problems going?

ERP focuses on the cycle of anxiety, compulsion and short-term relief. A thought, feeling, image, bodily sensation or situation triggers distress. You then do something to reduce the anxiety, such as checking, washing, avoiding, asking for reassurance, mentally reviewing or trying to neutralise the thought. This may bring relief in the short term, but it teaches the brain that the trigger was dangerous and that the ritual was needed to stay safe. Over time, the anxiety returns and the urge to repeat the behaviour becomes stronger.

ERP helps break this cycle. By gradually approaching feared triggers and reducing the response that usually follows, you learn that anxiety can rise and fall without needing rituals, avoidance or reassurance to make it go away.

How Exposure and Response Prevention helps

At Hampstead Psychology, ERP is not delivered as a generic set of tasks. We begin by understanding the specific cycle you are caught in, including your triggers, intrusive thoughts, compulsions, avoidance, reassurance-seeking and safety behaviours.

Therapy then helps you build a careful, realistic plan for change. This may include gradual exposure to feared triggers, reducing rituals, practising uncertainty, changing reassurance patterns and learning how to respond differently when anxiety or intrusive thoughts show up.

What to expect from sessions

Sessions are structured, collaborative and paced carefully. We develop a shared formulation of what is keeping the problem going, then use this to plan exposure work that is manageable, meaningful and linked to your goals.

The work may involve practising between sessions, reviewing what happens, and adjusting the plan as confidence develops. ERP is not about forcing you into overwhelming situations. It is about helping you approach feared experiences in a supported and systematic way.

How long does therapy take?

This depends on the difficulty, how long it has been present, and how many patterns are involved. Some people benefit from focused ERP for specific compulsions, fears or avoidance patterns. Others may need longer therapy, especially where OCD or anxiety is linked with trauma, shame, depression, perfectionism, relationship stress or longstanding patterns of avoidance. We review progress together so therapy remains purposeful and aligned with your goals.

ERP therapy in London and online

We offer Exposure and Response Prevention therapy in person in Hampstead, London, and online across the UK and internationally. Both in-person and online ERP can be effective.

Take the next step

If you are feeling stuck in OCD, intrusive thoughts, compulsions, checking, reassurance-seeking, avoidance or fear of uncertainty, ERP can offer a practical and evidence-based way forward. Contact Hampstead Psychology to enquire about ERP therapy in London or online.

Useful links: Anxiety, Depression, Stress and Burnout, Insomnia and Sleep Problems, Fees, Meet the Team, Contact.

Urgent Help

If you are worried about immediate risk to your safety, call 999 or go to A&E. If you need urgent support but it isn’t an emergency, contact NHS 111 or your GP. You can also contact Samaritans on 116 123 (24/7).

Meet The Team

At Hampstead Psychology, all of our psychologists have extensive training to doctoral level and decades of experience in their field of expertise. You will be matched with a psychologist that has the knowledge and skill to help you understand and overcome your problem - not just in the short term but for good.