A Leap of Faith: When ERP Feels Hard to Trust
About this Series
This article is part of an ongoing series based on my MSc research into why people struggle to engage with ERP (Exposure and Response Prevention) — the gold-standard therapy for OCD. The research analysed over 100 interviews from The OCD Stories podcast to explore the real challenges people face in starting, sticking with, or completing ERP.
Each post focuses on a different theme that emerged from the study — bringing together lived experience, research insight, and practical ideas for what might help.
Starting ERP can feel uncertain — like stepping into something unfamiliar and hoping it will hold.
In my research, a clear pattern emerged: for many people, ERP didn’t just feel hard to do — it felt hard to trust. Some described it as “reckless,” “irresponsible,” or even “dangerous.” Others said it felt counterintuitive, as if they were choosing to suffer on purpose.
For some, the doubts went deeper. ERP seemed to challenge their sense of meaning, morality, or faith — asking them to tolerate thoughts they considered unacceptable or sacred. When the work felt at odds with their beliefs, it could be hard to tell where therapy ended and identity began.
This mix of fear, confusion, and values conflict appeared again and again in the interviews I analysed. It highlights that for many people, the question isn’t just Can I do ERP? — it’s Can I trust it?
Why This Happens
ERP isn’t only difficult to carry out — for many, it’s difficult to believe in. And that hesitation makes sense.
A recent study found that nearly half of the general public had never heard of ERP — and among those who had, many described it as dangerous, distressing, or unethical (Johnson et al., 2024). Participants rated ERP as less helpful than avoidance or reassurance-seeking, strategies that actually reinforce OCD.
Viewed from the outside, ERP can sound extreme: intentionally triggering taboo thoughts or touching feared objects. Without context, the idea can seem reckless rather than therapeutic.
This misunderstanding feeds into the doubt people feel when starting treatment. If society sees ERP as unsafe, it’s easy to question whether you’re doing something harmful rather than healing. It can also clash with expectations: many people come to therapy hoping to eliminate intrusive thoughts, not to face them. Learning that ERP is about changing your relationship with anxiety — not erasing it — can initially feel unsettling.
These concerns can be especially strong when OCD targets morality, faith, or taboo content. Scrupulosity — obsessions about sin, morality, or blasphemy — is associated with greater OCD severity and often harder engagement (Buchholz et al., 2019). When someone equates thoughts with actions (a process called thought–action fusion), ERP can feel like a moral risk — as if having or triggering those thoughts means endorsing them.
The encouraging finding is that understanding changes everything. Leeuwerik et al. (2023) found that when people truly grasped the OCD cycle — how compulsions sustain it and how ERP disrupts it — motivation and willingness increased significantly. This understanding usually developed gradually, as psychoeducation was revisited and tailored throughout therapy.
In other words, trust grows through clarity and collaboration. When ERP is explained carefully, linked to your values, and delivered at a pace that feels respectful, it becomes less a leap of faith and more a guided step toward recovery.
What Can Help
If ERP feels hard to trust, you’re not alone. Doubts and fears about ERP are common and valid. The goal isn’t to ignore them, but to bring them into the conversation and work through them together.
Here are some things that might help in therapy:
1. Keep revisiting the “why.”
Understanding why ERP works is one of the strongest predictors of sticking with it (Leeuwerik et al., 2023). That understanding shouldn’t happen just once at the start — it needs to be personalised and revisited as new challenges arise. The clearer the link between exposures and how they break the OCD cycle, the easier it becomes to stay motivated when fear shows up.
2. Clarify expectations early.
Many people begin ERP hoping their intrusive thoughts will disappear. Realising that the goal is to change your relationship with those thoughts — not erase them — can feel confusing at first. Talking early about what progress looks like can prevent frustration later and keep therapy focused on meaningful change.
3. Bring values and beliefs into the room.
If OCD latches onto faith, morality, or identity, it’s essential that ERP respects those parts of you. Research shows that scrupulosity is linked to greater symptom severity and lower engagement (Buchholz et al., 2019), so aligning the process with your values is key. Exploring how to work with uncertainty without compromising what matters most can make ERP feel safer and more authentic.
4. Ask to see the roadmap.
ERP can feel less intimidating when you know what to expect. Mapping out what the process might look like — including early steps, pacing, and goals — helps turn a vague threat into a concrete, collaborative plan. It’s also a reminder that effective ERP doesn’t mean diving straight into your biggest fear.
5. Start with understanding, not exposures.
Spending time mapping your triggers, rituals, and values before jumping in can make ERP feel more relevant and less random (Becker-Haimes & Sanchez, 2024). This foundation helps both therapist and client see the full picture and design exposures that actually fit your life.
6. Build trust gradually.
ERP doesn’t have to begin with big leaps. Starting with smaller, “trust-building” exposures allows you to experience firsthand that anxiety can rise and fall safely. Each success builds confidence for the next step.
Key Takeaway
If ERP feels risky or difficult to trust, it doesn’t mean it’s the wrong approach — it means you need space for clarity, collaboration, and reassurance that your values will be respected. When ERP is explained clearly, paced appropriately, and connected to what matters most to you, it becomes less about blind faith and more about informed courage — a process you can trust, one step at a time.
References
Becker-Haimes, E. M., & Sanchez, A. L. (2024). The road to equitable obsessive–compulsive disorder treatment: Commentary on justice-based treatment considerations for identity-related obsessive–compulsive disorder. Clinical Psychology: Science and Practice, 31(4), 479–482. https://doi.org/10.1037/cps0000233
Buchholz, J. L., Abramowitz, J. S., Riemann, B. C., Reuman, L., Blakey, S. M., Leonard, R. C., & Thompson, K. A. (2019). Scrupulosity, Religious Affiliation and Symptom Presentation in Obsessive Compulsive Disorder. Behavioural and Cognitive Psychotherapy, 47(4), 478–492. doi:10.1017/S1352465818000711
Johnson, H. M., Wall, A., Arendtson, M., & Lee, E. B. (2024). Public perceptions of exposure and response prevention for obsessive-compulsive disorder [Preprint]. Southern Illinois University – Carbondale.
Leeuwerik, T., Caradonna, G., Cavanagh, K., Forrester, E., Jones, A.‐M., Lea, L., Rosten, C., & Strauss, C. (2023). A thematic analysis of barriers and facilitators to participant engagement in group exposure and response prevention therapy for obsessive–compulsive disorder. Psychology and Psychotherapy: Theory, Research and Practice, 96(1), 129–147. https://doi.org/10.1111/papt.12430
