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.
👉 Read more about the study here: [Why I Turned to Podcasts to Study OCD Therapy].
Introduction
ERP can feel less like starting a treatment and more like stepping off a cliff — shaky, uncertain, hoping the ground will appear beneath you.
In my research, a clear pattern that emerged was this: for many people, ERP didn’t just feel hard to do — it felt hard to trust. Some described it as dangerous, reckless, or even at odds with their beliefs.
When trust feels shaky, people might go through the motions but never fully lean in — or drop out before ERP has a chance to work. This theme, which I call A Leap of Faith, is about what makes ERP so hard to trust, and how to make it feel safer to take that leap.
What This Feels Like
For many people, the doubt starts the moment they learn what ERP involves. Just understanding what’s being asked — to face fears on purpose, to stop neutralizing thoughts — can feel reckless or even dangerous.
As one person in my research study put it:
“I understood what ERP was… but I just couldn't figure out how to do it. I really couldn't… I was certain that it was irresponsible, that it was dangerous.”
Others described how backwards it all felt — like choosing to suffer:
“Like the thought of, I'm going to make myself feel worse before I get better, initially was very difficult for me to comprehend.”
And for some, the challenge was about more than fear — it was about meaning. ERP seemed to ask them to set aside deeply held beliefs or values:
“You're essentially being asked to let it all pass [with ERP]… let stuff like religion pass. But… if that's something that is of importance to you… how do you find that line between letting everything pass… and then living your own autonomous life where you're able to have a point of view?”
This mix of fear, confusion, and values conflict came up again and again in the interviews I analysed. It can leave you wondering whether ERP is truly safe — not just physically, but emotionally and morally.
Why This Happens
ERP isn’t just hard to do — for many people, it’s hard to trust. And that mistrust is understandable.
A recent study found that nearly half of the general public didn’t even know what ERP was — and those who did often described it as dangerous, traumatising, or even unethical (Johnson et al., 2024). People rated ERP as less helpful than strategies we know actually make OCD worse, like avoiding triggers or getting loved ones to participate in rituals.
When you think about it from the perspective of someone just hearing about ERP, this reaction makes sense. The message they’re getting isn’t just “this will help,” but “this might harm you.” The idea of purposefully triggering taboo thoughts or touching feared objects can sound extreme — even to people who don’t have OCD.
This misunderstanding can create a deep sense of unease. If the wider world sees ERP as dangerous, it’s easy to feel like you’re doing something reckless, not healing. It can also create a painful mismatch of expectations: many people come to therapy hoping to get rid of their thoughts. So when they’re told that ERP isn’t about making obsessions disappear, but about learning to live with uncertainty, it can feel like the rules changed halfway through.
These fears can be even more intense when OCD touches on morality, faith, or taboo thoughts. Research shows that scrupulosity — obsessions about sin, morality, or blasphemy — is associated with greater OCD severity, and past studies suggest it can be harder to treat effectively (Buchholz et al., 2019). If you’ve been taught that thoughts are morally equivalent to actions (a thinking style called thought–action fusion), ERP can feel like a moral risk — as if triggering those thoughts means you’re sinning or condoning them.
The good news? Research also shows that understanding is one of the strongest predictors of sticking with ERP. Leeuwerik et al. (2023) found that when people began to really understand the OCD cycle — how compulsions keep it going and why ERP helps break it — they described feeling more motivated and more willing to do exposures. This understanding usually took time, with psychoeducation revisited throughout therapy to keep motivation strong.
In other words, trust grows when ERP is clearly explained and connected to your values. When therapists slow down, clear up misconceptions, and work with you to find a way forward that doesn’t compromise what matters most, ERP stops feeling like a blind leap and starts feeling like an informed step.
What Can Help
If ERP feels like a leap you can’t fully trust, you’re not alone. Many people start therapy with doubts, misconceptions, or fears that ERP might be harmful. The key isn’t ignoring those doubts, but bringing them into the open and working through them with your therapist. Here are some ways to make ERP feel less like a blind leap and more like an informed step:
Keep revisiting the “why.”
Leeuwerik et al. (2023) found that participants described understanding the treatment rationale as central to sticking with ERP. But this isn’t a one-off explanation — it works best when it’s personalised to your fears and revisited as new challenges come up.
You might say: “Can we keep coming back to why we’re doing this exposure and how it breaks the OCD cycle? That helps me stay motivated when it feels scary.”
Clarify expectations early.
Many people come to ERP hoping their thoughts will disappear. When they learn the goal is to change their relationship with thoughts, it can feel like the rules shifted mid-game. Talking about what progress actually looks like helps prevent frustration later.
You could ask: “What does progress in ERP look like? How will we know if it’s working, even if the thoughts don’t go away?”
Bring values and beliefs into the room.
If your fears touch on faith, morality, or identity, it matters that ERP respects those parts of you. Research suggests that scrupulosity is associated with greater OCD severity and can make treatment engagement more difficult (Buchholz et al., 2019), so finding ways to align ERP with your values is key.
You might say: “Some of my worries feel tied to my faith/identity. Can we talk about how to do ERP in a way that doesn’t go against what I believe?”
Ask to see the roadmap.
Seeing what ERP might look like step by step can turn it from a vague threat into something more concrete and doable. It also reassures you that you won’t be dropped straight into your worst fear.
You could ask: “Could we sketch out what the first few steps might look like, so I know where we’re headed?”
Start with understanding, not exposures.
Taking time to map your triggers, rituals, and values before jumping in helps ERP feel relevant rather than random (Becker-Haimes & Sanchez, 2024).
You might suggest: “Before we dive in, can we spend some time mapping how OCD shows up for me and what matters most, so exposures feel like they fit my life?”
Name fears openly.
Trust grows when you don’t have to hide doubts or worries about ERP. Bringing fears into the room gives your therapist the chance to explain, adjust, or reassure without undermining the process.
You could say: “Part of me feels like this exposure might harm me — can we talk through that before we try it?”
Test the waters first.
Instead of a blind leap, ERP can be about dipping a toe in and seeing what happens. Starting with smaller “trust-building” exercises shows you that anxiety can rise and fall safely.
You might ask: “Can we start with a smaller version of this exposure so I can get a feel for how it works?”
Key Takeaway
Feeling like ERP is “dangerous” or “irresponsible” doesn’t mean you can’t benefit from it — it means you need more clarity, more trust, and more collaboration. When ERP is explained clearly, connected to your values, and paced with you rather than at you, it stops feeling like a blind leap and becomes a path you can walk with confidence.
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
