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.
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 widely recognised as the most effective treatment for OCD — and for many, it’s life-changing.
But that doesn’t make it easy. One of the clearest patterns from my research was how often people never made it past the starting line. The idea of deliberately facing your worst fears can feel impossible, especially when those fears already dominate daily life.
For some, simply hearing what ERP involved triggered panic — it sounded unbearable, even unsafe. Others were warned off by well-meaning family or friends who couldn’t understand why anyone would choose to face their biggest fears on purpose. Searching online sometimes made things worse, with negative accounts framing ERP as something to endure rather than a process of learning and healing.
For many, this fear led to hesitation or years of delay. ERP came to represent both hope and threat — something that might finally help, but might also overwhelm them.
This theme explores that early moment of hesitation — the emotional tug between wanting change and fearing what it might take — and what helps those first steps become more possible.
Why This Happens
If you’ve ever felt terrified to even start ERP, you’re not alone. Many people describe it as an internal conflict: part of you wants recovery, but another part fears what treatment might involve.
Research supports this experience. In one UK study, people who had been through several failed attempts at CBT said therapy often felt invalidating or too rigid, leaving them unsure whether they could trust the process (Millar et al., 2020). Others said the hardest part wasn’t doing exposures, but finding the courage to disclose their symptoms or believe therapy could truly help (Marsden et al., 2018).
ERP also faces what some 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 often rated it as dangerous, traumatising, or unethical, particularly when it involved contamination, harm, or taboo fears (Johnson et al., 2025). These same ideas frequently appear in conversations with family, friends, or online communities, reinforcing the sense that ERP is extreme or unsafe.
The takeaway across these studies is clear: fear and doubt at the beginning are common — and they’re shaped by more than personal anxiety. Cultural narratives, misconceptions about ERP, and even well-meaning advice can make treatment feel out of reach. Struggling to begin doesn’t mean weakness; it often means the way ERP was introduced or supported didn’t yet match your readiness. With the right relationship, clear explanations, and gradual pacing, ERP can shift from something to fear into something you can approach step by step.
What Can Help
If ERP feels overwhelming to even imagine, there are ways to make those first steps more approachable. Research suggests it’s not about forcing bravery, but about building understanding, safety, and trust.
Here are some things that might help in therapy:
1. Make it Personal and Meaningful
ERP works best when it’s tailored to your life — your fears, values, and the patterns OCD follows. Studies show that when therapists connect the work to each person’s unique context — including their beliefs, family, and community — ERP becomes more relevant, equitable, and effective (Becker-Haimes & Sanchez, 2024; Pinciotti et al., 2024). Linking exposures to what OCD has been taking from you helps transform them from random challenges into steps toward freedom.
2. Address Sensitive Areas Upfront
When OCD themes touch on faith, morality, or identity, it’s crucial to name that early. The goal isn’t to challenge your beliefs, but to frame ERP as a way of building tolerance for uncertainty — not as a test of what you value. Starting with an open conversation about values and boundaries can make the process feel safer and more respectful.
3. See the Roadmap Before You Walk It
Around a quarter of people with OCD refuse ERP at the outset (Maltby & Tolin, 2005). This hesitation is often less about doubt in ERP’s effectiveness and more about fear of what it involves. Seeing what the journey might look like — through a shared hierarchy or a sample plan — helps replace uncertainty with clarity and trust.
4. Hear from People Who’ve Done It
Hearing about ERP from people who’ve been through it can make a big difference. First-hand accounts — in podcasts, blogs, or support groups — help replace fear with familiarity. When you see that others have faced similar fears and found relief, ERP can start to feel less like an impossible idea and more like something within reach.
Key Takeaway
Feeling afraid to start ERP doesn’t mean you’re not ready — it means you’re standing at the beginning of something that matters. With clarity, collaboration, and pacing that respects where you are, those first steps become possible. Each small move forward builds courage — and with time, that courage becomes 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
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
