What if Exposure & Response Prevention (ERP) Makes Me Worse?

“Can My OCD Get Worse With ERP? 

On Facebook and in my own practice, that question gets asked a lot. It sounds very similar to the question children ask before getting an injection, “Is this going to hurt?”

The doctor tells the truth, “Yes, it’s going to hurt! But, not for long.”

Engaging in ERP is not something your brain will immediately register as a good thing. You’re going out of your comfort zone and all the bells and whistles in your amygdala will be sounding off! “DANGER! DANGER! DANGER!”

That’s why many people choose not to do ERP. It doesn’t feel right. It doesn’t feel good. Your brain will tell you to turn back.

It’s hard to find a pace that is “just enough.” It’s scary to move forward with exposure exercises. You won’t want to provoke your anxiety. You’ll worry it’s too much.

But, how else can you become desensitized? How else can you disprove OCD and throw it under the bus for being such a liar?

“Just enough” is the sweet spot. Some people flood and go for the big guns. “Let’s just get this over with” and they take on their worst nightmare. For them, that’s “just enough.”

Not everybody can confront their fears that way. 

Find a pace that challenges you and then build momentum. Do one thing that scares you and hit it with repetition. Then do something else that scares you, “just enough” and repeat, repeat, repeat. Keep building.

You’ll discover you can tolerate a lot more than you thought you could. And…your confidence will grow.

Growing Means Ouch

In 1979, Open Heart surgery was practically barbaric. The scar I have is 100 times wider and longer than people who have the surgery nowadays. Sometimes I feel like Frankenstein.

I’ll never forget that tube down my throat and having to be suctioned. The tears rolled down my face the first few times. Then I got used to it. Nowadays people have the breathing tube removed and leave ICU within 18 to 24 hours of surgery. I was kept on life support for over 72 hours.


I was in my late teens and didn’t want the surgery. At first I denied I had the problem and tried to negotiate with my doctor. But, he told me I had a hole in my heart the size of a quarter. The surgery had to be done or I’d be dead before age 40.

My life depended on this barbaric surgery. They sawed through my bones and wired them back together.

After the first day of surgery I refused pain medicine. I leaned into the pain. I wanted to get out of that hell hole. Every time I so much as sneezed, I thought I was tearing the stitches that held my heart repair together.

I mustered through. I wanted out of that place. I wanted to live my life. Within 10 days of surgery I was playing tennis.

My Strangely Wrapped Gift

A few months after surgery I went on a date with a young man who came highly recommended by my co-workers. He picked me up at the store and my co-workers said, “have fun!”

Against my wishes he drove me to his house. His parents weren’t home. He brought out an astrology book and told me the stars indicated we would make good sexual partners. I told him no. He said yes.

I thought quickly. I told him I just had open heart surgery. He saw the red, swollen scar. I told him I would die if I was traumatized. He was angry. “You should have told me about this.” He brought me back to the store. I was safe.

Doesn’t look or feel like a gift

In so many ways, open heart surgery was my strangely wrapped gift. 

Just because something hurts or scares you doesn’t mean you shouldn’t do it. When deciding whether or not to do ERP, consider the track record of people who have done it.

It’s a mighty fine track record.

And, I hope those of you who have done it will leave a comment and encourage those who are on the fence about it. There are people who need to hear from you. How bad was it before ERP? How terrifying was ERP? How’d you make out? Please leave your anonymous comment.

Remember this, wherever you are, it’s where you’re supposed to be. We will always be given opportunities to grow and learn. Lean into it.

OCD is a strangely wrapped gift. It doesn’t feel like it at first. Neither did open heart surgery. 

11 thoughts on “What if Exposure & Response Prevention (ERP) Makes Me Worse?”

  1. ERP is definitely hard, but like ripping off a bandaid, the pain is only temporary and it has to be done! You can’t leave a dirty bandaid on a wound, it won’t heal! Much like you can’t expect to get much relief from OCD without doing exposure therapy. It will be hard for a bit but then your brain will snap into place and you will eventually feel the benefits.

  2. Thanks for putting this out there…. I would so love to hear some stories from people that have gone through ERP, & came out the other side healthier & happier, despite the initial fear. Thank you!!

    1. This was emailed to me for you: “I have lived with ocd for 30 years and believe me I have been to hell and back many times.OCD has driven me to clinical depression many times. I have seen at least a half dozen psychiatrists,most of whom where clueless about ocd.The first time I felt any lasting peace of mind was after I had been going to Tammy LaBrake for awhile and had been practicing ERP. Make no mistake about it is horrifying to face head on that which you fear most in the world however it is the only way I have ever found relief from my intrusive thoughts.No matter what the nature of your ocd is,if you expose yourself slowly,step by step to the monster who is stealing all your precious time, you will make that monster smaller and smaller until you say okay, I have a life to live”

  3. When I first started ERP I was not functioning. I was litterally living in a dark crippling tunnel, and had so many things that I couldn’t do. I had a beautiful baby who I couldn’t hold or touch without vomiting. I went way too long “getting by” but not really. My husband and mother maxed out thier FMLA , I couldn’t be alone, I was on a strong mix of drugs that did nothing for my thoughts. I was to the point that in my head that seeing Tammy was my last resort before finally checking myself into the hospital. (I’m sure she still remembers me asking her several million times if she was going to send me there lol)
    ERP is hard work, but I’m living proof that it works. As I started with Tammy I always asked myself before a tough exposure, “Is this exposure really any worse then the pain I’m in now?” 99% of the time the answer was no. I found no matter how hard the exposure was, I was already enduring the same, if not a higher level of anxiety avoiding it. The exposure at least brought me closer to my goal and closer to functioning. The pain eventually would pay off. Sometimes I would only gain a minute of freedom, but I learned to cherish that minute, five minutes, half hour and eventually days and weeks. I’ve met so many people on my OCD journey who would not be where they are today without working with Tammy and working through ERP. Start small and as Tammy says celebrate your victories!

  4. Hi, I suffer from OCD and emetophobia, which is an intense fear of vomiting. I recently vomited for the first time in eight years during a family vacation and was terrified. I contemplated killing myself to ensure it would never happen again, and even stopped eating for a while out of fear that the norovirus that had hit me would come back with a vengeance. But I’ve been forcing myself to continue eating and taking my medication. I’ve also been doing an exposure therapy program created by a woman who suffered from emetophobia herself, Anna S. Christie. Today I moved on to level 9 of her program and looked at graphic, full-color images of people vomiting without even batting an eye. I’m far from cured, but I’m working hard and moving in the right direction. Thank you, Tammy! Boss it back!

  5. When I initially started doing ERP, it was the hardest thing I’ve ever done! Years later, I still do ERP. It’s a part of life. I’ve accepted that I am an ERP lifer! The pain from OCD is far worse than the exposures. If I continue to feed the OCD, the pain becomes greater. If I do ERP, it’s an OUCH! initially, but then it’s freeing and allows me to be happy and live my life! It allows me to live w/my OCD happily (and even laugh at my OCD) and gladly and makes me THANKFUL (yes, thankful!) for my strangely wrapped gift!

    When I question whether I should do an ERP or compulsion, I weigh the energy it takes from and the outcomes I get. Compulsions appear helpful, but for me, they take a lot of energy from me. The rewinding and replaying is exhausting! So, if I am going to put energy into something, it better be for a better outcome! The more energy I put into compulsions, the more energy it robs me from things I enjoy. The more energy I put into ERP, the more energy I have for things/people I love. So, what’s the better choice?! 🙂

  6. After having my second son and experiencing PP OCD for the first time I had researched and found that ERP was really the go to method for managing OCD. I was thankful that Tammy was someone trained in it that was nearby. I had really no clue what type of ERP I would have to do since mine is intrusive thoughts about hurting people— so that was a little intense, asking myself “am I going to have to act out these horrific scenes in my head”. When Tammy taught me about picture drawing, you would think “so easy” but for me it really wasn’t. To draw and write words of these messed up thoughts was REALLY SCARY— I fought doing it because of the unknown results it may have– like will this make it worse. What helped me to get started was listening to others about what they had to do for their exposures and then I realized I was not alone. I saw how doing the ERP helped them. So I drew my pictures and honestly it was freeing to get out of my head these thoughts. And just like Tammy talks about– doing it repetitiously makes the thought become extremely boring. So boring for me that I was able to direct my attention elsewhere in terms of how I spent my time doing things I had enjoyed and actually being able to enjoy them. I have to say one of my weaknesses is keeping up with the ERP such as doing the drawings as once I start to feel better I move onto other life projects; that happened after I had my son and then when I had my daughter I was sorta back at square one having to draw again. ERP is anxiety provoking— it’s meant to be but just sometimes even knowing that I have that tool eases my mind.

  7. I am getting exposed to all kinds of my fear within different environments. At first, I was very angry and tried to reaffirm my avoidance by saying it would be less upsetting to just continue to avoid it, but a few months into it, I learned thats just how I am feeling, and that there is something better going on via the ERP: my expected outcome is being replaced by an actual outcome. My constant state of alert has faded gradually. Don’t get me wrong, my OCD rituals do return when I am under stress…and I have to regroup and re-apply a lot of effort to keep working at it, but overall things are improving while doing ERP. ERP is not fun, but as Tammi has said many times in her blog: the amount of anxiety experienced in Avoidance over time can hugely outweigh the anxiety experienced in ERP.

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