Exposure and Response Prevention (ERP) for OCD in San Antonio and Across Texas
ERP is the most widely studied psychotherapy for OCD.
Leading clinical guidelines recommend it as a first-line treatment [1, 2]. ERP has two parts. Exposure means gradually and deliberately facing the thoughts, images, and situations that trigger your obsessions. Response prevention means choosing not to do the compulsion, whether that's washing, checking, seeking reassurance, avoiding, or reviewing in your head. Each time you face a fear without the compulsion, your brain learns that you can handle the doubt and discomfort, and that the compulsion isn't what keeps you safe [3]. Over time, the obsessions lose their urgency.
A free 15-minute call. No forms, no commitment. Just a conversation about what you're facing.
Is ERP effective? Yes.
A meta-analysis of 37 randomized controlled trials found large improvements from cognitive-behavioral treatment for OCD, including ERP, compared with waitlist and placebo [1]. A 2024 review of 48 randomized trials found ERP had the largest effect of any psychological treatment for OCD [6]. In a landmark trial, 86% of people who completed ERP responded to treatment, compared with 10% on placebo [5]. For teens, ERP is among the most effective treatments, and research suggests it works about as well by telehealth as in person [7]. Individual results vary. ERP isn't the only option. If ERP has felt too overwhelming in the past, Inference-Based CBT (I-CBT) may be a good alternative.
A free 15-minute call. No forms, no commitment. Just a conversation about what you're facing.
What ERP looks like in practice
| OCD theme | Example exposure | Response prevention |
|---|---|---|
| Contamination | Touching a doorknob, then eating a snack | Not washing or sanitizing afterward |
| Checking | Locking the door once and leaving | Not going back to re-check |
| Harm OCD | Holding a kitchen knife while cooking | Not mentally reviewing or seeking reassurance |
| Relationship OCD | Writing "I may never feel 100% certain" | Not comparing, testing, or asking for reassurance |
| Scrupulosity | Praying once, imperfectly | Not repeating the prayer or confessing again |
These are examples only. Your plan is built around your own symptoms, at a pace you agree to. If ERP has felt too overwhelming in the past, Inference-Based CBT (I-CBT) may be a good alternative.
Frequently asked questions
Is ERP scary?
It can feel hard, and that's part of how it works. But you're never pushed further than you agree to. We start with exposures that feel manageable and build from there.
Does ERP work for mental compulsions or "pure O"?
Yes. Response prevention includes mental compulsions like reviewing, analyzing, neutralizing thoughts, and seeking certainty. Learning to spot and drop them is a central part of the work.
How long does ERP take?
It varies with your symptoms and goals. We review your progress together regularly and adjust the plan as you go.
Can ERP be done online?
Yes. We offer ERP by secure telehealth anywhere in Texas, and many exposures can be done right in your own home. You need to be physically in Texas during each session.
How much does ERP cost?
Individual sessions are $150 for 50 minutes. We're a private-pay practice, and clients working with Luke Mayeux, LPC, can request a superbill for possible out-of-network reimbursement.
References
- Öst, L.-G., Havnen, A., Hansen, B., & Kvale, G. (2015). Cognitive behavioral treatments of obsessive–compulsive disorder: A systematic review and meta-analysis of studies published 1993–2014. Clinical Psychology Review, 40, 156–169. https://doi.org/10.1016/j.cpr.2015.06.003
- Koran, L. M., Hanna, G. L., Hollander, E., Nestadt, G., & Simpson, H. B. (2007). Practice guideline for the treatment of patients with obsessive-compulsive disorder. American Journal of Psychiatry, 164(7 Suppl), 5–53. https://pubmed.ncbi.nlm.nih.gov/17849776/
- Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy, 58, 10–23. https://doi.org/10.1016/j.brat.2014.04.006
- Huppert, J. D., & Siev, J. (2010). Treating scrupulosity in religious individuals using cognitive-behavioral therapy. Cognitive and Behavioral Practice, 17(4), 382–392. https://www.sciencedirect.com/science/article/pii/S1077722910000490
- Foa, E. B., Liebowitz, M. R., Kozak, M. J., Davies, S., Campeas, R., Franklin, M. E., et al. (2005). Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder. American Journal of Psychiatry, 162(1), 151–161. https://doi.org/10.1176/appi.ajp.162.1.151
- Wang, Y., Miguel, C., Ciharova, M., Amarnath, A., Lin, J., Zhao, R., Toffolo, M. B. J., Struijs, S. Y., de Wit, L. M., & Cuijpers, P. (2024). The effectiveness of psychological treatments for obsessive-compulsive disorders: A meta-analysis of randomized controlled trials published over last 30 years. Psychological Medicine. https://doi.org/10.1017/S0033291724001375
- Steele, D. W., Kanaan, G., Caputo, E. L., Freeman, J. B., Brannan, E. H., Balk, E. M., Trikalinos, T. A., & Adam, G. P. (2024). Treatment of obsessive-compulsive disorder in children and youth: A meta-analysis. Pediatrics. https://doi.org/10.1542/peds.2024-068992
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