Afraid to Start: Why ERP Can Feel Impossible at First

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 is widely recognised as the most effective treatment for OCD. For many, it’s life-changing.

But that doesn’t mean it’s easy. In fact, one of the clearest patterns from my research was this: many people never make it past the starting line.

This post explores why ERP can feel so hard to begin, what research and lived experience tell us about those fears, and some

What This Feels Like

For many people, the hardest part of ERP isn’t the exposures themselves — it’s getting started. Just the thought of what ERP might involve can spark fear strong enough to stop therapy before it even begins.

As one person in my research study put it:

“I was reading about ERP and what that would require of me… to face my fears head-on. I was like, that is crazy. I’m never going to do that.”

Sometimes this hesitation is reinforced by others who don’t understand ERP. As one participant shared:

“Their immediate reaction was, you don’t want to do that because you’re putting yourself in front of your biggest fear. Why would you want to do that? And I was like, yeah, you’re right… that doesn’t make any sense.”

Others described how searching online made the fear even worse:

“When she first mentioned ERP, the first thing I did was go and Google ERP… you find all these horror stories. I was like, no, no, sorry, stay off that. So I didn’t go down that route.”

For some, that fear meant years of delay:

“It was so scary for me that I decided to go in a different direction of treatment. It was a very wrong mistake I made, and I paid [for] it for years.”

This mix of dread, doubt, and delay came up again and again in the interviews I analysed. It can leave you feeling like you’re standing at the edge of something that might change your life — but taking the first step feels unbearable.

Why This Happens

If you’ve ever felt terrified to even start ERP, you’re far from alone. Many people describe it as an inner tug-of-war: part of you desperately wants to get better, but another part is overwhelmed by fear about what treatment might involve.

Research shows this fear isn’t just you. In one UK study, people who had been through several failed attempts at CBT said that therapy often felt invalidating or too rigid, leaving them doubting whether they could trust the process (Millar et al., 2020). Others said the hardest part wasn’t even doing the exposures — it was working up the courage to disclose their symptoms in the first place, or to believe that the therapy would actually help (Marsden et al., 2018).

It’s also worth remembering that ERP has what researchers have called a “public relations problem.” In a recent study, nearly half of participants had never heard of ERP, and those who were shown examples of exposures often rated them as dangerous, traumatising, and unethical — especially when they involved contamination, harm, or taboo thoughts (Johnson et al., 2025). Most even said the fictional client should find a new therapist. This matters because these are the same messages people often hear from family, friends, or social media before ever setting foot in therapy — reinforcing the sense that ERP is too extreme or unsafe.

So the big takeaway across all these studies? Fear, shame, and doubt at the beginning are normal — and they are shaped by more than just your personal anxiety. They’re reinforced by cultural messages, misconceptions about ERP, and sometimes even by well-meaning friends and family. Struggling to engage doesn’t mean you’re weak. It usually means the way therapy was introduced or supported didn’t quite meet you where you were. With the right relationship, explanation, and step-by-step pacing, ERP can shift from feeling impossible to being something you can gradually lean into.

What Can Help

If you feel frozen at the thought of ERP, the good news is there are ways to make those first steps less overwhelming. Research suggests it isn’t about pushing harder or “toughing it out” — it’s about making the process clearer, more personal, and grounded in safety.

Here are some things that can really help:

Make it Personal and Meaningful

ERP works best when it’s grounded in your life — your fears, values, and the patterns OCD follows. Recent research highlights that when therapists integrate your unique context — your triggers, beliefs, family, and community — ERP becomes more relevant, equitable, and engaging (Becker-Haimes & Sanchez, 2024; Pinciotti et al., 2024). This isn’t about delaying treatment — it’s about making sure you know why each exposure matters. When ERP is linked to what OCD has been stealing from you, it stops feeling like a random set of challenges and starts feeling like a path back to freedom.

Try this:

Ask your therapist: “Before we start exposures, could we spend a bit of time mapping out my triggers and what matters most to me, so we can link each step of ERP to the life I want back?”

Address Sensitive Areas Upfront

If OCD touches on faith, morality, or identity, naming that early is key. The goal isn’t to challenge your beliefs — it’s to frame ERP as a way to build tolerance for uncertainty, not to make you “less moral.” A short values conversation upfront can take away a huge source of fear.

Try this:

Ask your therapist: “Can we talk about how to do ERP in a way that respects my beliefs, so I feel safe starting?”

See the Roadmap Before You Walk It

Around a quarter of people with OCD refuse ERP at the outset (Maltby & Tolin, 2005). Research suggests this is often less about doubting ERP’s effectiveness, and more about the fear of beginning such an intense treatment. Seeing what ERP will look like — a gradual, step-by-step plan rather than a sudden plunge — can make it far less intimidating.

Try this:

Ask your therapist: “Could we sketch out a sample hierarchy together so I can see what this might look like before I start?”

Hear from People Who’ve Done It

Hearing recovery stories — whether through podcasts, videos, or support groups — can help ERP feel more approachable. Research suggests that direct-to-consumer efforts, including personal accounts shared through media, play an important role in reducing stigma and building hope and credibility for evidence-based treatments (Gallo et al., 2013).

Try this:

Look for podcasts, blogs, or support groups where people share their ERP experiences. If you’re in treatment, you might ask: “Is there a way to connect with someone who’s been through ERP?”

Key Takeaway

Being afraid to start ERP doesn’t mean you’re failing — it means you’re standing at the edge of something important. With the right support and pacing, that first step becomes possible — and every step you take after that builds courage and freedom.

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

• Gallo, K. P., Comer, J. S., & Barlow, D. H. (2013). Direct-to-consumer marketing of psychological treatments for anxiety disorders. Journal of Anxiety Disorders, 27(8), 793–801. https://doi.org/10.1016/j.janxdis.2013.03.005

• 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.

• Maltby, N., & Tolin, D. F. (2005). A brief motivational intervention for treatment-refusing OCD patients. Cognitive behaviour therapy, 34(3), 176–184. https://doi.org/10.1080/16506070510043741

• Marsden, Z., Teahan, A., Lovell, K., Blore, D., & Delgadillo, J. (2018). Patients' experiences of cognitive behavioural therapy and eye movement desensitisation and reprocessing as treatments for obsessive‐compulsive disorder. Counselling & Psychotherapy Research, 18(3), 251–261. https://doi.org/10.1002/capr.12159

• Millar, J. F. A., Halligan, S. L., Gregory, J., & Salkovskis, P. M. (2020). When cognitive behavioural therapy for obsessive compulsive disorder fails: Service user perspectives [Unpublished doctoral thesis]. University of Bath.

• Pinciotti, C. M., Wadsworth, L. P., Greenburg, C., & Rosenthal, K. (2024). Justice-based treatment considerations for identity-related obsessive–compulsive disorder. Clinical Psychology: Science and Practice, 31(4), 466–478. https://doi.org/10.1037/cps0000224