Moss & Moon Counseling
Less time answering fear.
More time living your life.
ERP Therapy for OCD in Columbus, Ohio
What is Exposure Response Prevention and How Does it Work?
Exposure and Response Prevention, or ERP, is an evidence-based form of cognitive behavioral therapy and a first-line treatment for obsessive-compulsive disorder (OCD). It works by helping you gradually change the cycle that keeps obsessive fear, doubt, and compulsive behavior alive.
OCD often begins with an intrusive thought, image, sensation, urge, or unanswered question: What if I hurt someone? What if I made the wrong decision? What if I'm contaminated? What if this feeling means something about me? What if I can never be completely sure? The mind responds by searching for relief—checking, avoiding, researching, reviewing memories, asking for reassurance, repeating something until it feels “right,” or trying to solve the thought internally.
Those responses can bring relief for a moment. But they also teach the brain that the alarm must have been important—and that a compulsion was necessary to feel safe. Over time, the world can become smaller while OCD demands more and more attention.
ERP helps interrupt that cycle.
Together, we intentionally and gradually practice approaching the situations, thoughts, feelings, sensations, or uncertainties that OCD has taught you to fear or avoid. The response prevention piece means practicing something different afterward: rather than automatically checking, reassuring, analyzing, avoiding, or performing another ritual, we create space for the discomfort and uncertainty to exist without having to resolve it immediately. This is the central process of ERP.
And importantly, this is collaborative work. ERP is not about surprising you with your biggest fear, forcing you into something you aren't ready for, or seeing how much distress you can tolerate. We build a treatment plan together, understand how your particular OCD cycle operates, and choose exposures intentionally. Over time, you have opportunities to discover that anxiety, intrusive thoughts, and uncertainty can be present without having to organize your life around them.
The goal isn't to never have another intrusive thought or uncomfortable feeling. The goal is to loosen OCD's authority over what you do next—to build greater flexibility, tolerate uncertainty, and make choices based increasingly on what matters to you rather than what fear demands.
Freedom isn't finally getting the certainty OCD promised you. It's discovering you can live without it.
Exposure Response Prevention Intensives:
More Time to Practice Freedom
For people who feel ready to step more fully into the work, I also offer ERP intensives—extended sessions that create uninterrupted time to understand your OCD cycle, practice meaningful exposures, and strengthen your ability to respond differently when fear and uncertainty arise.
Traditional weekly therapy can be incredibly effective, but sometimes a 50-minute session simply is not enough time for the kind of experiential work ERP asks of us. An intensive gives us more room to move beyond talking about OCD and into carefully planned, real-time practice.
Depending on your treatment goals, an intensive might allow us to complete several related exposures, repeat an exposure enough times to notice new learning, practice outside of the therapy room, or work with situations that require more time than a standard session allows. We also have space to pause, reflect on what you are learning, adjust the plan together, and identify how you will continue practicing in everyday life.
On the day of your intensive, you are my only client. Extended sessions are approximately three to four hours, which allows the work to unfold without the pressure of watching the clock or abruptly stopping in the middle of something important.
An ERP intensive is not about throwing you into your biggest fear or trying to create as much anxiety as possible. Exposures are collaborative and intentional. Together, we identify the places where OCD has been limiting your life and practice approaching uncertainty while gradually reducing the compulsions, reassurance, avoidance, checking, rumination, or other strategies OCD has taught you to use for relief.
The goal is not to prove that nothing bad will ever happen or to finally give you perfect certainty. It is to help you discover, through experience, that you can feel doubt, discomfort, or uncertainty and still choose what you do next.
ERP intensives may be especially helpful if you:
- Feel ready to devote focused time to changing a particularly entrenched OCD pattern
- Have exposures that are difficult to complete within a traditional therapy hour
- Would benefit from practicing ERP in real-world situations with therapeutic support
- Find yourself understanding ERP intellectually but struggling to put it into practice
- Want concentrated support building momentum in your treatment
- Live farther away or prefer periodic, longer sessions rather than relying exclusively on weekly therapy
Readiness for an intensive is something we determine together. More time does not mean pushing harder; it gives us more room to practice deliberately, notice what OCD does, and experiment with choosing differently.
The rate for an ERP intensive is $725 for up to four hours. Limited sliding-scale availability may be available for intensive sessions; please reach out for additional information.
OCD asks you to organize your life around feeling certain. ERP helps you practice living your life before certainty arrives.
What to expect
ERP is active and experiential, but it should never feel like something being done to you. We work collaboratively to understand how OCD operates in your life and gradually practice responding to it in new ways.
1. We map your OCD cycle
Before beginning exposures, we spend time understanding the particular shape OCD takes for you. Together, we identify intrusive thoughts, fears, triggers, avoidance patterns, reassurance seeking, checking, rumination, mental rituals, and other compulsions that may be keeping the cycle going.
Because compulsions are not always visible, part of our work may simply be learning to recognize when OCD has quietly pulled you into trying to solve, neutralize, review, or gain certainty.
2. We build a plan together
We identify situations that OCD has made difficult and create a range of possible exposures—from relatively manageable challenges to experiences that may feel more difficult.
This is not a list of things I am going to make you do. You are an active participant in deciding what we work on and when. We choose exercises intentionally, based on your goals, readiness, and what will help you reclaim more of your life.
3. We practice response prevention
This is where much of the change happens.
When OCD creates discomfort, it usually offers a familiar solution: check again, ask someone, research it, avoid it, review the memory, analyze the feeling, confess, repeat the ritual, figure it out.
During ERP, we practice noticing that urge without automatically obeying it.
Together, we may experiment with delaying a compulsion, reducing it, changing how you respond to it, or allowing yourself not to do it at all. Over time, this gives your brain an opportunity to learn something new: uncertainty and discomfort can exist without requiring an emergency response.
4. We practice approaching instead of avoiding
During an exposure, you intentionally come into contact with something that brings up uncertainty, anxiety, discomfort, or an obsessive fear.
An exposure might involve an external situation, but it can also involve a thought, image, memory, physical sensation, written statement, imagined scenario, or simply allowing an unanswered question to remain unanswered.
The purpose is not to prove that your fear is impossible or reassure you that everything will be okay. Instead, we practice making room for uncertainty without immediately trying to make it disappear.
5. We notice what you learned—not whether you “did it perfectly”
After an exposure, we slow down and reflect on what happened. We may notice what OCD predicted, what you experienced, what surprised you, what urges appeared, and how you were able to respond differently.
Success in ERP is not measured by whether your anxiety went away.
Sometimes it will. Sometimes it won’t.
The more important question is: Were you able to make a little more room for uncertainty and choose your response instead of letting OCD choose it for you?
6. We bring the work into everyday life
ERP becomes most powerful when the learning begins to travel beyond the therapy room. Together, we develop practices for the time between sessions so that you can continue experimenting with new responses in ordinary life.
Over time, what once felt like a very deliberate therapy exercise can begin to become something more natural: noticing OCD, recognizing the invitation into the old cycle, and deciding whether you want to follow it.
Who ERP can help
ERP is most commonly used to treat Obsessive-Compulsive Disorder (OCD) and related patterns in which fear, doubt, or discomfort become caught in a cycle of avoidance and compulsive attempts to feel certain, safe, or “just right.”
OCD can look very different from person to person. It is not always about contamination, organization, or visible rituals. For many people, the most exhausting parts of OCD happen entirely inside the mind.
ERP may be helpful if you find yourself struggling with:
Intrusive thoughts or images
Checking and reassurance seeking
“Just right” experiences and perfectionism
Fear of making the wrong decision
Harm OCD
Relationship OCD
Rumination and mental compulsions
Contamination fears
Health-related OCD
Existential OCD
Sexual or identity-related intrusive thoughts
Scrupulosity and moral OCD
The content of OCD can change. The cycle underneath it often stays remarkably similar. Something feels threatening or uncertain, your nervous system sounds an alarm, and you feel compelled to do something—externally or internally—to make the discomfort go away. The relief works briefly, which teaches the brain to ask for the ritual again the next time uncertainty appears.
ERP focuses less on proving whether the obsession is true and more on changing your relationship with the question itself.
Questions people ask about ERP
Does ERP really work?
Yes. ERP is considered a first-line psychological treatment for OCD and has decades of research supporting its effectiveness. Major OCD treatment organizations and clinical guidelines recommend cognitive behavioral therapy that includes Exposure and Response Prevention as a core treatment for OCD.
Can I do ERP if I also have trauma or PTSD?
Yes. OCD and trauma can coexist, although they may require different therapeutic approaches.
Because my work is trauma-informed, we will remain attentive to your nervous system, history, boundaries, and readiness while doing ERP. When both trauma and OCD are present, part of our work is determining what needs trauma processing and what needs response prevention so that one condition is not inadvertently reinforcing the other.
Will ERP make me face my worst fear right away?
No. ERP with me is collaborative, intentional, and appropriately challenging—not overwhelming or coercive.
We build toward exposures thoughtfully and choose them together. ERP does involve discomfort, because continually avoiding discomfort reinforces OCD, but you will not be surprised or forced into an exposure without your knowledge and consent.
How long does ERP take?
ERP looks different for everyone, but 20–30 sessions is a common range. The timeline depends on your symptoms, goals, pace, and how consistently you practice outside of therapy.
Weekly sessions can work well, while more frequent sessions or ERP intensives may help build momentum and shorten the overall course of treatment. Between-session practice also matters—the more often you apply ERP in everyday life, the more opportunities your brain has to learn something new.
Before beginning exposure work, I also prioritize building a solid, trusting therapeutic relationship so you feel safe, informed, and actively involved in the process.
Can ERP be done online?
Yes. I offer ERP via secure video for Ohio residents, although I prefer in person sessions for this work. Many clients find it just as effective as in-person work.
How much does ERP cost?
Standard sessions are $275 for 75 minutes or $180 for 50 minutes. Intensive ERP sessions of three to four hours are $725. I provide superbills for out-of-network reimbursement as well as limited sliding scale spaces.
Ready when you are
You don’t have to have the words for what happened. You just need to know you’re ready for it to feel different.