What is Exposure and Response Prevention (ERP)?
Exposure and Response Prevention (ERP) is a structured, evidence-based form of Cognitive Behavioral Therapy that is considered the gold-standard treatment for OCD and many anxiety disorders. ERP is designed to help people break free from cycles of fear, avoidance, and safety behaviors by changing how the brain responds to perceived threats.
At its core, ERP involves two key components. Exposure means gradually and intentionally facing the thoughts, sensations, situations, or uncertainty that trigger anxiety. Response prevention means learning to resist the behaviors you typically use to try to feel safe, such as avoidance, checking, reassurance seeking, mental reviewing, or other rituals. Rather than trying to eliminate anxiety, ERP teaches you how to allow anxiety to rise and fall on its own without taking action to control it.
Through repeated practice, the brain learns that anxiety and uncertainty are uncomfortable but not dangerous, and that feared outcomes do not need to be prevented in order to stay safe. Over time, fear loses its urgency, avoidance decreases, and confidence increases. ERP does not rely on reassurance or logic alone. Instead, it creates change through experience, helping you retrain your brain and regain flexibility, independence, and control in your daily life.
Exposure and Response Prevention Therapy (ERP) For OCD in Denver, CO
Gold Standard OCD Treatment
There are many different therapies used to treat OCD, and ultimately, the “best” therapy is the one that leads to real, lasting improvement for the individual. In medical and mental health fields, the term gold standard refers to the treatment that has been studied the most, tested the most rigorously, and is recommended by medical providers as the first-line approach before turning to secondary or tertiary options. It does not mean it is the only option or that other approaches cannot be helpful, but it does mean it has the strongest scientific support behind it.
When it comes to OCD, Exposure and Response Prevention (ERP) is considered the gold-standard treatment because it directly targets the fear-compulsion cycle that keeps OCD alive. ERP works by helping you gradually and intentionally face the thoughts, images, urges, sensations, or situations that trigger obsessive fear, while resisting the urge to perform compulsions, seek reassurance, mentally review, or avoid. Over time, your brain learns that anxiety and uncertainty can be tolerated without taking action, that feared outcomes do not need to be prevented at all costs, and that compulsions are not necessary for safety. As compulsive behaviors decrease, obsessions lose their power, anxiety becomes more manageable, and you regain a sense of flexibility, confidence, and freedom in daily life.
Online ERP Therapy Denver
ERP Therapy Sessions From Home
Online ERP therapy provides a supportive, structured space to practice responding differently to your OCD. These sessions help you develop the tools and behaviors you need to reduce anxiety and regain control. Online sessions are offered throughout Colorado. Many clients see meaningful progress in as few as 8-12 sessions.
Convenient access to specialized OCD care without the stress of travel or long commutes
Online sessions allow for real-world practice in actual environments where OCD shows up most. This could be your home, your car, the store, outside, etc.
Structured, step-by-step exposure work with ongoing guidance and support
Session frequency is flexible to your needs, with the long-term goal of gradually reducing both session frequency and duration as symptoms improve
Lasting, meaningful reduction in anxiety, obsessions and compulsions over time
OCD Intensive Outpatient Program (IOP) Denver
Intensive ERP Support for More Severe OCD Symptoms
This level of OCD therapy provides more frequent sessions, hands-on exposure work, and close support between sessions to help you break down long-standing patterns, reduce compulsions and avoidance, and gain confidence in managing anxiety and uncertainty. The OCD IOP is offered virtually throughout Colorado, and in some cases can include in-person home visits or additional in-person exposure practice (within the Denver Metro Area).
Structured, high-frequency ERP therapy sessions to target more severe OCD symptoms
Ideal for more severe symptoms or when weekly ERP therapy isn't enough
Available virtually throughout Colorado for flexible and convenient access to OCD treatment
Increased support and guided exposure practice to break entrenched patterns and build lasting confidence
What to Expect from ERP Therapy?
Starting Exposure and Response Prevention (ERP) therapy can feel intimidating, especially if you’ve spent years trying to avoid fear and discomfort at all costs. That makes sense. ERP does not ask you to stop having intrusive thoughts or anxiety. Instead, it teaches you how to respond differently when they show up. From the very beginning, our work is collaborative, structured, and paced to match your readiness. You are never forced into anything.
Learning How OCD Really Works
Early sessions focus on building a clear understanding of how OCD operates in your life and why your brain keeps sending false danger signals. You’ll learn how intrusive thoughts are misinterpreted as threats, why anxiety spikes so quickly, and how compulsions, reassurance seeking, mental reviewing, and avoidance provide only temporary relief while strengthening OCD over time. We spend time carefully mapping your personal OCD cycle so you can see exactly how your responses are keeping the disorder alive. From there, you’ll learn the rationale behind Exposure and Response Prevention and how ERP works to retrain the brain by reducing fear, increasing tolerance for uncertainty, and breaking the pattern that allows OCD to maintain control.
Gradual, Structured Exposure Practice
Exposures are carefully planned exercises designed to help you face the thoughts, images, urges, sensations, and situations that trigger OCD in a gradual and intentional way. This includes in-vivo exposures, where you confront real-life situations you’ve been avoiding, as well as imaginal exposures, which involve intentionally bringing to mind feared scenarios that cannot be practiced directly. During exposures, the goal is not to make anxiety go away, but to practice responding differently to your brain’s alarm system by resisting compulsions, reassurance seeking, mental reviewing, and avoidance. As you repeatedly allow anxiety and uncertainty to be present without trying to neutralize them, your brain learns that these internal alarms are false, and over time, they begin to lose their intensity and influence.
Managing Anxiety as It Rises and Falls
Learning to manage and tolerate anxiety as it naturally rises and falls during the early stages of exposure work is an important step in OCD recovery. Rather than trying to eliminate intrusive thoughts or prove they are untrue, you practice responding to them with openness, non-engagement, and willingness to tolerate uncertainty. Over time, this changes your relationship with both anxiety and doubt. With repeated practice, anxiety tends to peak at lower levels, fade more quickly, and show up less often, allowing you to move through daily life with greater comfort, confidence, and flexibility—even when uncertainty is present.
Building Lasting Change Through Practice
ERP is an active, skills-based therapy that goes beyond talking about symptoms and focuses on practicing new responses in real time. Treatment includes structured exercises and intentional practice between sessions so you can apply what you’re learning to everyday situations. Over time, as your brain learns that intrusive thoughts and anxiety do not require action, most clients experience meaningful relief from both obsessions and compulsions, increased tolerance for uncertainty, and a renewed sense of confidence in daily life.
Specialized ERP Therapy in Denver, CO for All OCD Themes and Subtypes
I treat all OCD themes and subtypes. While I’ve listed some of the more common themes below, OCD doesn’t always fit neatly into one category. You don’t need to have everything figured out before starting treatment; understanding your symptoms and identifying the patterns is part of my role. Whether your OCD fits a well-known theme or feels confusing, unique, or hard to explain, we can sort through it together.
ERP for Contamination OCD
Contamination OCD involves intense fears of becoming contaminated or spreading some form of contamination. The feared “contaminants” can include germs, chemicals, emotions, or even other people. To feel safe, individuals may wash, clean, avoid contact, or seek reassurance. Exposure and Response Prevention (ERP) helps individuals gradually face contamination-related fears, reduce rituals and avoidance, and relearn that discomfort or uncertainty about feared contaminants does not equal actual danger.
ERP for Intrusive Violent, Sexual, and Taboo Thoughts
Intrusive, violent, sexual, and taboo thoughts are unwanted, distressing mental images or urges that go against a person’s values and sense of self. These thoughts can feel alarming and lead to guilt, fear, and shame. To feel safe, individuals frequently attempt to suppress their thoughts and engage in compulsive efforts to “prove” they’d never act on them. Exposure and Response Prevention helps individuals face these disturbing, intrusive thoughts without trying to neutralize or suppress them, reduce mental and physical compulsions, and relearn that having a thought, no matter how taboo or alarming, does not mean you want it, will act on it, or that it reflects your character.
ERP for Harm OCD
Harm OCD involves intrusive fears of accidentally or intentionally causing harm to oneself or others, often triggering guilt, panic, and compulsive checking or reassurance seeking. These thoughts are unwanted and distressing, not reflections of intent or desire. Exposure and Response Prevention (ERP) helps individuals face these fears, reduce compulsions, and relearn that thoughts of harm don’t equal danger or action.
ERP for Relationship OCD (ROCD)
Relationship OCD (ROCD) involves intrusive doubts and fears about one’s partner, relationship, or feelings. Doubts such as “Do I really love them?” or “What if they’re not the right one?” These thoughts create anxiety and lead to compulsions like constant reassurance seeking, comparison, or overanalyzing feelings. Exposure and Response Prevention (ERP) helps individuals confront the doubts and “what ifs” that fuel Relationship OCD, reduce reassurance-seeking and mental checking, and relearn that uncertainty about relationships is normal and not a sign that something is wrong.
ERP for Pedophilia OCD (POCD)
Pedophilia OCD (POCD) involves intrusive, unwanted sexual thoughts or fears of being sexually attracted to or harming children. These thoughts are unwanted and distressing, not reflections of intent or desire. Common compulsive behaviors include mental checking, avoidance, or reassurance seeking. Exposure and Response Prevention (ERP) helps individuals with POCD face these fears safely and learn that thoughts do not reflect intent, character, or risk of acting on them.
ERP for Existential OCD
Existential OCD centers on intrusive, unanswerable questions about life, reality, death, or the meaning of existence. People with this form of OCD often get stuck in endless rumination, trying to find certainty about questions that have none. Exposure and Response Prevention (ERP) helps individuals learn to tolerate uncertainty and disengage from overanalyzing, allowing them to reconnect with the present moment and live more fully.
ERP for Moral or Religious Scrupulosity OCD
Moral or Religious Scrupulosity OCD involves obsessive fears of being immoral, sinful, or offending one’s faith or values. Individuals may engage in excessive praying, confessing, reassurance seeking, or mental reviewing to feel “pure” or “good enough.” Exposure and Response Prevention (ERP) helps individuals face these fears while learning that uncertainty, imperfection, and doubt are normal parts of faith and morality, not signs of wrongdoing.
ERP for Sexual Orientation OCD (SO-OCD)
Sexual Orientation OCD involves intrusive, unwanted thoughts about one’s sexual orientation, regardless of how a person identifies. Someone who has always identified as straight may suddenly start experiencing intrusive thoughts like “What if I’m actually gay?” while someone who identifies as gay may experience intrusive doubts that they are actually straight. These thoughts are not part of a natural or authentic exploration of identity; they are ego-dystonic, distressing, and create a sense of “what if I’m not who I’ve always thought I was?” In response, individuals may engage in compulsive behaviors like checking for certain feelings, analyzing physical reactions, reviewing past experiences, or seeking reassurance in an attempt to feel certain. Exposure and Response Prevention (ERP) helps individuals face intrusive doubts about their sexual orientation, reduce checking and reassurance-seeking, and relearn that uncertainty or unwanted thoughts about identity do not signal a real shift in orientation or require compulsive analysis.
ERP for Checking OCD
Checking OCD involves repeated behaviors or mental reviews to prevent harm, mistakes, or accidents. Things like repeatedly verifying that doors are locked, appliances are off, or messages were written correctly. These checks provide temporary relief but reinforce doubt and anxiety over time. Exposure and Response Prevention (ERP) helps break this cycle by teaching you to face uncertainty and resist checking, allowing confidence and trust in your memory and actions to naturally return.
ERP for Hyperawareness or Somatic OCD
Hyperawareness or Somatic OCD centers on an obsessive focus on automatic bodily sensations or processes, such as blinking, swallowing, breathing, or heartbeat, or on being overly aware of one’s own thoughts. This heightened self-focus can make once-automatic sensations feel unbearable or constant. Exposure and Response Prevention (ERP) helps retrain attention and reduce anxiety by teaching you to allow these sensations or thoughts to exist without trying to control or escape them, so they fade naturally from awareness.
ERP for Magical Thinking OCD
Magical Thinking OCD involves the belief that certain thoughts, numbers, words, or actions can cause or prevent bad outcomes, even when there’s no logical connection. People with this form of OCD may feel intense responsibility to think or act “just right” to keep something terrible from happening. Exposure and Response Prevention (ERP) helps break this false link between thoughts and outcomes, teaching the brain that thoughts are not dangerous and that safety doesn’t depend on mental rituals or superstitions.
Start Anxiety and OCD Therapy Today
If Anxiety or OCD has been controlling more of your life than you want, help is available. With the right treatment, it is possible to break out of the cycle and move forward with greater clarity and confidence.
I offer a free 20 minute online consultation to answer questions, discuss your symptoms, and help you determine whether my approach is the right fit.
Meet Denver ERP Therapist, Josh Kaplan, LCSW
Hi, I’m Josh Kaplan, LCSW. I’m an anxiety and OCD therapist who specializes in Exposure and Response Prevention (ERP) therapy in Denver, Colorado. I’ve spent the majority of my career studying, refining, and applying ERP not only in the treatment of OCD, but across a wide range of anxiety disorders, including panic disorder, agoraphobia, health anxiety, and specific phobias. While ERP is most widely known as the gold-standard treatment for OCD, research consistently shows that exposure-based approaches are the most effective interventions for anxiety disorders more broadly. I’ve completed advanced training in ERP and consider it my primary treatment modality. My work is structured, evidence-based, and focused on creating real, lasting change by helping clients face fear directly, reduce avoidance and safety behaviors, and rebuild confidence in their ability to tolerate uncertainty and discomfort.
Over a decade of exclusive specialization in treating Obsessive-Compulsive Disorder (OCD) and Anxiety Disorders using Exposure and Response Prevention Therapy (ERP)
Advanced expertise in Exposure and Response Prevention (ERP)
Structured, clear, actionable, and collaborative treatment that helps clients understand the “why” behind each step of therapy
Contributing member of the International OCD Foundation (IOCDF)
CBT 4 Anxiety