The Grind of the Work: When ERP Feels Relentless and Draining
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 isn’t a quick fix. It asks you to face fears, resist compulsions, and repeat — often for weeks or months at a time.
Many people in my research described ERP as relentless. The daily effort to face fear and stay with uncertainty could feel gruelling and emotionally draining. For some, the hardest part wasn’t any single exposure — it was keeping the practice going day after day.
Progress often felt slow, leaving people tired and unsure if change would ever come. And when anxiety finally eased, motivation sometimes dipped, creating a cycle of pause and relapse that was difficult to break.
This theme explores that reality of ERP: the fatigue it brings, the doubts it stirs, and what helps people sustain effort when the process feels demanding.
Why This Happens
Feeling worn down by ERP isn’t a sign you’re doing it wrong — it’s a natural response to what the therapy asks of you. ERP involves repeatedly confronting what feels most threatening, resisting rituals, and allowing anxiety to rise and fall on its own. That takes energy. Over time, it can feel unrelenting.
In my research, people described how this ongoing effort gradually eroded motivation, particularly when progress felt slow or uneven. Research shows that “sudden gains” — rapid, dramatic improvements — occur in only about a quarter of people during ERP, with higher rates in contamination OCD and lower rates for taboo, moral, or harm-related obsessions (Buchholz et al., 2019). For most, progress is gradual, which can make it hard to see change even when it’s happening.
Encouragingly, Buchholz et al. (2019) found that people who improved more slowly reached similar long-term outcomes as those who improved quickly. Slow progress is still progress. But without clear expectations, that slower pace can feel discouraging and drain motivation.
Therapeutic collaboration can make a major difference. Leeuwerik et al. (2023) found that clients stayed more engaged when therapists regularly revisited why ERP works, how it applied to their symptoms, and what setbacks meant. When therapists linked exposures back to each person’s broader goals and normalised fluctuations, clients reported feeling more able to persist through dips in motivation.
The relational quality of therapy also matters. Lee & Rees (2011) found that people were more likely to stay with ERP when therapists paced the hierarchy collaboratively, modelled exposures in session, and offered steady encouragement. Feeling respected and supported gave them the confidence to keep going through the difficult stretches.
In short, the difficulty of ERP isn’t only about doing exposures — it’s about maintaining hope and endurance long enough for the learning to take hold. When therapy is paced, collaborative, and values-driven, the process becomes more sustainable. Without that support, it can begin to feel like endurance without purpose.
What Can Help
ERP can be demanding, but there are ways to make it more sustainable and to preserve motivation when it feels draining.
Here are some things that might help in therapy:
1. Revisit the “why” regularly.
When you’re deep into ERP, it’s easy to lose sight of why you’re putting yourself through it. Revisiting the treatment rationale — not just at the start but throughout therapy — helps keep exposures purposeful and connected to your values (Leeuwerik et al., 2023). Understanding how each exercise links to the bigger picture can make even the hardest days feel worthwhile.
2. Pace for stamina, not speed.
ERP isn’t a race. Research shows that fear of being pushed too far too fast is a major reason people refuse treatment (Maltby & Tolin, 2005). A graded, collaborative approach — one that challenges without overwhelming — builds confidence and staying power. The best pace is one that stretches you just enough to learn, but not so much that you burn out.
3. Celebrate small wins.
Motivation grows when progress is visible. Reviewing what you’ve already achieved helps reinforce a sense of mastery — something research shows is essential for ERP success (Jordan et al., 2017; Voderholzer et al., 2020). Noticing even small improvements — tolerating a trigger a little longer, doing one fewer compulsion — helps sustain belief in the process.
4. Find energy in the work.
ERP doesn’t have to be all grind. Humour, creativity, and playfulness can make exposures more engaging and less intimidating. Pairing exposures with activities that matter to you — like walking, music, or connection with others — can help balance the emotional load.
5. Connect it to what matters most
ERP isn’t just about reducing anxiety; it’s about reclaiming your life from OCD. When exposures are explicitly linked to your values — the relationships, passions, and freedoms OCD has restricted — the work becomes more meaningful and energising (Pinciotti et al., 2024).
6. Turn practice into a lifestyle
Exposures are most effective when they become part of everyday life. Practising in different settings strengthens learning and reduces relapse risk (Voderholzer et al., 2020). Seeing daily triggers as opportunities rather than obstacles helps transform ERP from a treatment plan into a way of living with more freedom and choice.
7. Plan for maintenance early
ERP doesn’t end when symptoms improve. Building a maintenance plan early — continued practice, booster sessions, or peer support — helps protect progress and prevent relapse (Külz et al., 2020). Long-term change comes from steady commitment, not perfection.
Key Takeaway
Feeling exhausted or disheartened by ERP doesn’t mean you’re failing — it reflects how demanding the process can be. When the work is paced, collaborative, and grounded in your values, endurance becomes possible. ERP is less about powering through and more about building stamina — one step, one exposure, one day at a time.
References
Buchholz, J. L., Abramowitz, J. S., Blakey, S. M., Reuman, L., & Twohig, M. P. (2019). Sudden Gains: How Important Are They During Exposure and Response Prevention for Obsessive-Compulsive Disorder?. Behavior therapy, 50(3), 672–681. https://doi.org/10.1016/j.beth.2018.10.004
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
Külz, A. K., Landmann, S., Schmidt-Ott, M., Zurowski, B., Wahl-Kordon, A., & Voderholzer, U. (2020). Long-Term Follow-up of Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder: Symptom Severity and the Role of Exposure 8-10 Years After Inpatient Treatment. Journal of cognitive psychotherapy, 34(3), 261–271. https://doi.org/10.1891/JCPSY-D-20-00002
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
Lee, Y. H., & Rees, C. S. (2011). Is exposure and response prevention treatment for obsessive–compulsive disorder as aversive as we think? Clinical Psychologist, 15(1), 17–21. https://doi.org/10.1111/j.1742-9552.2011.00001.x
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
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
Twohig, M. P. (2009). The application of acceptance and commitment therapy to obsessive-compulsive disorder. Cognitive and Behavioral Practice, 16(1), 18–28. https://doi.org/10.1016/j.cbpra.2008.02.008
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
