ERP
Core Mechanism
Prolonged exposure to obsessional triggers while refraining from the compulsion permits new learning; whether that learning is habituation or inhibitory (the old association overridden rather than erased) is still contested
Ontology
Obsessions are maintained by compulsive neutralization; avoidance prevents disconfirmation
Therapeutic Voice
"I know this feels unbearable. Touch the doorknob, and then we sit here without washing while you tell me every couple of minutes where the anxiety is between 0 and 100."
View of the Person
An organism whose avoidance maintains fear; exposure permits new learning that inhibits old associations
Evidence
NICE: recommended for OCD. APA Div 12: Strong Research Support
30+ RCTs
Cochrane review; multiple meta-analyses
Gold standard for OCD. Very strong evidence base.
Conditions
Epistemology
Blind Spots
Highly effective for OCD but narrow in scope; exposure without relational attunement can feel mechanical
Contraindications
Active suicidality, active psychosis, severe depression that prevents engagement in exposure tasks, untreated PTSD where OCD exposures overlap with trauma content, clients who have not given informed consent to tolerate distress
Training
Graduate CBT training + specialized ERP for OCD training. IOCDF resources
BTTI through IOCDF
BTTI: 3 days + supervised ERP cases
$1K-3K
Philosophical Roots
Mowrer (two-factor theory); Pavlov (classical conditioning); Rachman (habituation); Craske (inhibitory learning); empiricism broadly
Related Modalities
ERP in 1 Comparative Clinical Vignette
Each vignette presents the same client through multiple theoretical lenses side by side — showing how ERP formulates presenting problems, sets treatment focus, and sounds in the consulting room compared with other approaches. This comparative pedagogy is unique to Epoché Clinical; no other clinical reference systematically formulates the same case across traditions.
Test Yourself
Why is response prevention essential for OCD?
Show answer
The compulsion neutralizes the exposure, so nothing new is learned. Refraining lets the client find out that the feared outcome does not arrive and that the anxiety is survivable.