Life in the Way: When Real-World Pressures Make ERP Hard to Keep Up

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 doesn’t happen in a vacuum — it has to fit into real, busy, unpredictable lives.

Many people in my research described the difficulty of finding time and space for exposure work while managing jobs, studies, parenting, and everything else competing for their energy. Some had to make major sacrifices just to give ERP the focus it needed. Others got creative, finding brief moments in the day to practise between tasks, often while exhausted.

Family dynamics added another layer. Well-meaning relatives or partners sometimes gave reassurance or stepped in to help, unintentionally undoing progress. Others struggled with frustration or misunderstanding from loved ones who expected faster results.

For these individuals, the challenge wasn’t lack of motivation — it was the sheer effort of fitting demanding therapeutic work into the realities of everyday life. ERP became one more thing to manage in an already full world.

Why This Happens

ERP is structured, deliberate, and repetitive — and real life often isn’t. Leeuwerik et al. (2023) found that personal circumstances like work demands, childcare, mental health challenges, and major life transitions influenced whether participants could attend sessions and complete ERP tasks between sessions. For some, these pressures made it hard to prioritise exposures; for others, they contributed to missed sessions or inconsistent practice.

At home, these challenges can be magnified by family dynamics. Research shows that most families accommodate OCD at least some of the time — by offering reassurance, helping to avoid triggers, or directly participating in rituals (Stewart et al., 2020; Albert et al., 2017). This usually comes from a place of love — family members want to reduce distress and keep daily life moving — but accommodation can accidentally reinforce OCD’s cycle, preventing the person with OCD from facing their fears long enough to learn that anxiety can pass on its own.

Accommodation also carries a cost for loved ones: studies link it to higher caregiver distress, frustration, and burnout (Albert et al., 2017). Over time, this can create tension at home, or pressure to “get better faster,” adding another layer of stress for everyone involved.

The encouraging news is that family involvement doesn’t just prevent problems — it can actively make treatment better. Stewart et al. (2020) found that family-integrated CBT improved not just OCD symptoms but also depression, anxiety, functional impairment, and even family relationship quality. Crucially, programs that focused on reducing accommodation saw greater improvements in patient depression — suggesting that teaching families to step back from OCD’s rules can boost recovery for both the person with OCD and the people around them.

What Can Help

When life feels too busy for ERP, the solution isn’t to simply “push harder.” It’s to make ERP workable within your real-life context — so it becomes part of daily living, not another impossible task on the to-do list.

Here are some things that might help in therapy:

1. Fit ERP Around Real Life

ERP works best when it’s built into existing routines rather than treated as a separate task. Collaborating with your therapist to adapt exposures around work, study, parenting, or other commitments can make the process more sustainable (Williams et al., 2012). Linking exposures to meaningful values — such as parenting moments, relationships, or hobbies — helps them feel purposeful instead of burdensome. Everyday experiences also offer natural “bonus exposures” when OCD appears unexpectedly; treating these as opportunities for practice can strengthen progress (Abramowitz & Arch, 2014).

2. Use Tools to Stay on Track

Digital tools like exposure logs, habit trackers, or ERP apps can make it easier to stay consistent and share progress between sessions. While most mental health apps lack strong validation, they can still help with structure and accountability when used alongside therapy (Van Ameringen et al., 2017). Online ERP is also a well-supported alternative for mild-to-moderate OCD, offering flexibility when in-person sessions aren’t possible (Machado-Sousa et al., 2023).

3. Make Family Part of the Plan

Family members often give reassurance or make accommodations that reduce short-term distress but maintain OCD’s cycle over time (Albert et al., 2017). Involving loved ones in psychoeducation can help them move from rescuing to supporting — and reduce the burnout that accommodation often causes. Stewart et al. (2020) found that family-inclusive CBT not only reduced accommodation but also improved relationship quality and overall wellbeing.

4. Revisit and Adjust Regularly

Life changes, and ERP plans should too. Missed exposures or reduced motivation often signal the need to adjust pacing or support, not abandon the process. Revisiting goals, scaling exposures, or shifting session frequency can keep the work realistic and maintain momentum.

Key Takeaway

ERP doesn’t have to take over your life — but it does have to take place within your life. When exposures are shaped around your schedule, supported by family, and adjusted as life changes, ERP becomes less of a burden and more of a rhythm you can keep. The goal isn’t perfection — it’s consistency that works in the real world.

References

  • Abramowitz, J. S., & Arch, J. J. (2014). Strategies for improving long-term outcomes in cognitive behavioral therapy for obsessive-compulsive disorder: Insights from learning theory. Cognitive and Behavioral Practice, 21(1), 20–31. https://doi.org/10.1016/j.cbpra.2013.06.004

  • Albert, U., Baffa, A., & Maina, G. (2017). Family accommodation in adult obsessive-compulsive disorder: clinical perspectives. Psychology research and behavior management, 10, 293–304. https://doi.org/10.2147/PRBM.S124359

  • 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

  • Machado-Sousa, M., Moreira, P. S., Costa, A. D., Soriano-Mas, C., & Morgado, P. (2023). Efficacy of internet-based cognitive-behavioral therapy for obsessive-compulsive disorder: A systematic review and meta-analysis. Clinical Psychology: Science and Practice, 30(2), 150–162. https://doi.org/10.1037/cps0000133

  • Stewart, K. E., Sumantry, D., & Malivoire, B. L. (2020). Family and couple integrated cognitive-behavioural therapy for adults with OCD: A meta-analysis. Journal of affective disorders, 277, 159–168. https://doi.org/10.1016/j.jad.2020.07.140

  • Van Ameringen, M., Turna, J., Khalesi, Z., Pullia, K., & Patterson, B. (2017). There is an app for that! The current state of mobile applications (apps) for DSM-5 obsessive-compulsive disorder, posttraumatic stress disorder, anxiety and mood disorders. Depression and anxiety, 34(6), 526–539. https://doi.org/10.1002/da.22657

  • Williams, M. T., Domanico, J., Marques, L., Leblanc, N. J., & Turkheimer, E. (2012). Barriers to treatment among African Americans with obsessive-compulsive disorder. Journal of anxiety disorders, 26(4), 555–563. https://doi.org/10.1016/j.janxdis.2012.02.009

Ian O Brien
Previous

Out of Reach: When OCD Fears Feel Hard to Capture in ERP
Next

A Shifting Target: When OCD Keeps Moving the Goalposts in ERP