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 — again and again.
Many people in my research described ERP as relentless. The daily effort to face fear and ride out anxiety could feel “brutal,” “gruelling,” and “absolutely draining.” For some, the hardest part wasn’t the exposures themselves — it was keeping up the work day after day.
Progress often felt slow, leaving people emotionally exhausted and unsure if change would ever come. And when things finally eased, motivation sometimes slipped, making it tempting to pause the work — only for OCD to tighten its grip again.
This theme explores that side of ERP: the fatigue it brings, the doubts it stirs, and what helps people keep going when the work feels never-ending.
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 means deliberately facing what feels most threatening, resisting rituals, and sitting with anxiety until it rises and falls on its own. That takes energy. When you do it day after day, it can feel relentless.
In my research, people said that this constant effort slowly eroded their motivation — especially when progress felt slow or uneven. Research shows that ‘sudden gains’ — those big, dramatic improvements you sometimes hear about — 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 many, progress is gradual — which means it’s easy to feel like nothing is changing, even when it is.
Here’s the encouraging part: those who improved slowly ended up with similar long-term outcomes as those who improved quickly (Buchholz et al., 2019). Slow progress is still progress. But without clear expectations, that slower pace can feel like failure and sap your motivation to keep going.
This is where good psychoeducation and collaboration matter. Leeuwerik et al. (2023) found that people stayed more engaged when they repeatedly revisited why ERP works, how it fit their particular symptoms, and what setbacks meant. When therapists helped them link each exposure back to their bigger goals — and reminded them that ups and downs were normal — they reported feeling more willing to keep going even when motivation dipped.
Other research shows that the “human” side of therapy is just as important. Lee & Rees (2011) found that people were more likely to stick with ERP when therapists worked with them to pace the hierarchy, model exposures in session, and provide steady encouragement. Feeling respected and supported gave them the strength to face the grind.
In other words: the difficulty of ERP isn’t just about doing exposures — it’s about holding onto hope long enough for the work to pay off. When therapy feels collaborative, paced, and connected to what matters to you, the grind becomes something you can endure — and even grow through. Without that support, it can start to feel like punishment rather than treatment.
What Can Help
ERP can feel like an exhausting marathon, but there are ways to keep the work sustainable — and your motivation alive — even when it feels like too much.
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 like ERP is endless, exhausting, or too much to keep up with doesn’t mean you’re failing — it means you’re human. The grind is real, but it’s also where real change happens. By pacing the work, celebrating small wins, and weaving practice into everyday life, ERP becomes less of a daily battle and more of a steady climb toward freedom — one step, one exposure, 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
