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 designed to stretch you — but there’s a fine line between challenging and overwhelming.

For some people in my research, that line became blurred. Exposures didn’t just bring discomfort — they led to panic, exhaustion, or shutdown. Instead of building confidence, the process left them feeling unsafe or discouraged.

Several described shaking, crying, or experiencing intense physical panic during exposures. Others said the fear of “getting it wrong” felt catastrophic — as if one misstep could have irreversible consequences. For a few, the distress became so great that even the thought of further uncertainty felt unbearable.

When ERP moves too far too fast, it can lose its therapeutic balance. People may push themselves through exposures only to crash afterwards, or step back completely — not from avoidance, but from self-protection.

This theme explores what happens when ERP crosses that threshold from guided challenge into perceived threat, and how to restore safety, pacing, and collaboration to bring the work back within reach.

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 that exposures are most effective when they provoke enough anxiety to challenge you, but not so much that they trigger panic, dissociation, or avoidance (Craske et al., 2014). When anxiety rises too sharply, the body slips into survival mode, and opportunities for new learning are lost.

At the same time, the goal isn’t to keep exposures comfortable or to expect a steady decline in fear. Kircanski and Peris (2015) found that for young people with OCD, exposures involving more variability — including moments of high distress — predicted better outcomes at follow-up. Similar findings in adults show that variability helps the brain form stronger, more flexible safety learning (Craske et al., 2014).

In other words, the aim isn’t to minimise anxiety, but to find the “therapeutic edge”: exposures that stretch you enough to promote new learning, but not so far that they feel unmanageable. When that balance is missed, ERP can become either too mild to create change or so intense that it undermines confidence and trust in the process.

What Can Help

When ERP feels overwhelming, the solution isn’t to abandon exposures — it’s to recalibrate them so they remain challenging but tolerable.

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 unmanageable, it’s not evidence that ERP “doesn’t work” — it’s a signal that the balance needs recalibrating. With the right pacing, therapist guidance, and support structure, ERP can stay challenging without becoming overwhelming — and that’s where the most meaningful progress occurs.

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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Exposed by Exposure: When ERP Means Facing Shame as Well as Fear
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The Grind of the Work: When ERP Feels Relentless and Draining