A Step Too Far: When ERP Crosses From Doable to Overwhelming

Written By Ian O Brien

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.

ERP is meant to stretch you — but there’s a fine line between hard and too much.

For some people in my research, that line got blurred. Exposures didn’t just bring discomfort — they brought panic, exhaustion, or collapse. Instead of building confidence, the work left them feeling unsafe or ready to quit.

Several described shaking, crying, or experiencing full-body panic during exposures. Others said the fear of “getting it wrong” felt catastrophic — as if one misstep could ruin their lives. For a few, the distress became so overwhelming that the idea of facing more uncertainty felt unbearable.

When ERP pushes too far too fast, it can backfire. People may force themselves through exposures only to crash afterward, or disengage completely — not from avoidance, but from self-protection.

This theme explores what happens when ERP crosses that invisible line — from a guided challenge into something that feels like a threat — and what helps bring safety, pacing, and collaboration back into the process.

Why This Happens

Feeling like ERP is “too much” doesn’t mean you’ve failed — it usually means the exposure wasn’t the right fit for where you were that day. Research shows exposures work best when they spark enough anxiety to challenge you, but not so much that they push you into panic, dissociation, or avoidance (Craske et al., 2014). If fear shoots too high, the body slips into survival mode, and the chance for new learning gets lost in the scramble.

At the same time, research shows that the goal isn’t to keep exposures comfortable or to expect a smooth, linear drop in fear. In fact, Kircanski & Peris (2015) found that for young people with OCD, exposures with more ups and downs in distress — including moments of very high anxiety — actually predicted better outcomes at follow-up. This matches findings in adults that variability helps the brain form stronger, more flexible learning about safety (Craske et al., 2014).

In other words, it’s not about keeping anxiety low — it’s about finding the “therapeutic edge”: exposures that stretch you enough to bring up fear and trigger new learning, but not so far that you shut down or lose trust in the process. When that balance is missed, ERP can feel either too mild to create change or so intense that it feels unmanageable — and both can stall recovery.

What Can Help

When ERP feels like “too much,” the answer isn’t to avoid exposures — it’s to recalibrate them so they stay challenging enough for learning, without tipping you into shutdown or despair.

Here are some things that might help in therapy:

1. Co-create exposures that stretch, but don’t break

Exposures work best when they sit on the “therapeutic edge” — high enough to spark anxiety but not so high that you lose the ability to stay present (Benito & Walther, 2015). Collaborating closely with your therapist on which step to take next helps keep the work both tolerable and productive (Jordan et al., 2017). Breaking larger challenges into smaller, achievable steps can build momentum and confidence without tipping into overwhelm.

2. Lean on therapist support early

Early, guided exposures can make a big difference. Doing exposures together in session — or watching your therapist model one first — helps you learn how to stay with discomfort safely (Jordan et al., 2017). Structured debriefing and celebrating small gains along the way can strengthen motivation and make the process feel more manageable (Voderholzer et al., 2020).

3. Adjust pacing and add support when needed

If exposures routinely leave you panicked or depleted, it’s a sign that something in the pacing or support structure needs attention — not that ERP isn’t for you. Gordon et al. (2023) recommend checking for underlying factors like depression or trauma that may be interfering with progress. Adjusting the pace, integrating grounding skills, shortening sessions, or adding brief check-ins between appointments can restore stability and make ERP feel safe enough to continue.

Key Takeaway

When exposures feel unbearable, it’s not a sign that ERP “isn’t for you” — it’s a signal to adjust how the work is being done. With the right pacing, therapist support, and creative exposure design, ERP can be challenging but still doable — and that’s where the most powerful learning happens.

References

  • Benito, K. G., & Walther, M. (2015). Therapeutic Process During Exposure: Habituation Model. Journal of obsessive-compulsive and related disorders, 6, 147–157. https://doi.org/10.1016/j.jocrd.2015.01.006

  • Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy, 46(1), 5–27. https://doi.org/10.1016/j.brat.2007.10.003

  • Gordon, C., Gasbarro, A., Wendell, V., Fischer, S., Hardin, R., & Marino, J. (2023). Assessing exposure and response prevention readiness for clients with obsessive compulsive disorder and co-occurring conditions: A decision-making model and case example. Professional Psychology: Research and Practice, 54(4), 305–313. https://doi.org/10.1037/pro0000516

  • Jordan, C., Reid, A. M., Guzick, A. G., Simmons, J., & Sulkowski, M. L. (2017). When exposures go right: Effective exposure-based treatment for obsessive–compulsive disorder. Journal of Contemporary Psychotherapy: On the Cutting Edge of Modern Developments in Psychotherapy, 47(1), 31–39. https://doi.org/10.1007/s10879-016-9339-2

  • Kircanski, K., & Peris, T. S. (2015). Exposure and response prevention process predicts treatment outcome in youth with OCD. Journal of abnormal child psychology, 43(3), 543–552. https://doi.org/10.1007/s10802-014-9917-2

  • Voderholzer, U., Hilbert, S., Fischer, A., Neumüller, J., Schwartz, C., & Hessler-Kaufmann, J. B. (2020). Frequency and level of self-efficacy predict the effectiveness of therapist- and self-guided exposure in obsessive compulsive disorder. Behavioural and Cognitive Psychotherapy, 48(6), 751–755. https://doi.org/10.1017/S1352465820000582

Ian O Brien
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The Grind of the Work: When ERP Feels Relentless and Draining