Exposure & Response Prevention (EXRP)

Your Path to Freedom from OCD & Anxiety

✔ Standard 55-minute sessions

✔ Private, comfortable office or therapy room

✔ Options for weekly, multiple times per week, or monthly sessions

✔ We adjust meeting frequency based on your progress and evolving needs

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Inspiring

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Committed

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Inspiring 〜 Committed 〜 Growing 〜 Caring 〜

At South Hills Counseling, we believe Exposure & Response Prevention therapy offers a powerful opportunity for meaningful change and freedom from obsessive-compulsive patterns.

Our approach creates a comfortable, supportive atmosphere where you can face your fears, discover new responses to anxiety, and develop strategies that promote lasting healing and growth.

We tailor our therapeutic methods to your unique needs, helping you transform your relationship with uncertainty and anxiety.

SESSION ENVIRONMENT

✔ Relaxed, welcoming space with comfortable seating

✔ Structured sessions that gradually build your tolerance for uncertainty

✔ Complete confidentiality, with clear explanation of legal exceptions

✔ Collaborative approach to designing personalized exposure exercises

What is Exposure & Response Prevention?

Exposure and response prevention (EXRP) is the evidence-based treatment of choice for learning to manage obsessive compulsive disorder (OCD).

In this treatment, individuals with OCD are "exposed" to their fears (thoughts, feelings, sensations) and they learn to tolerate them without engaging in their typical response (checking, asking for reassurance, engaging in a compulsion or ritual, ruminating, worrying).

When an individual is "wired" for OCD, their brain tells them that certain thoughts and feelings are dangerous. So they learn to "protect" themselves any way that lowers their perception of danger (usually how anxious/nervous/uncertain they feel). For example, you might think, "what if I'm really gay and I'm lying to myself and my partner?" or, "what if I don't really love them/they're not 'the one.' " If you have OCD, alarm bells will begin ringing and you will begin thinking of how terrible your life will be and how you're not really the person you thought you were.

You might feel ashamed and guilty for lying to everyone around you.

You might even "confess" to your partner that you had these thoughts and worry that they will break-up or divorce you, but you just can't keep this to yourself. Or, you might be afraid that that's what would happen if you were just "honest" with yourself and "brave" enough to tell them so you keep quiet and say nothing. You might become detached, jumpy, or avoidant, or you might become overly dependent and pestering.

If this is you, we would encourage you to speak to an OCD specialist before making any drastic decisions in your relationship. OCD can make you doubt your feelings and what you think you know about yourself and others. It makes you think you need to know for sure. THIS IS A LIE. We can't know most things in life for sure. Even people who don't have OCD have doubting thoughts in their relationships. The difference is that their brains do not react to doubt with an overwhelming "danger" reaction (fight/flight) and they are able to make choices in their relationship that are independent of their feelings.

Goals of EXRP Therapy

EXRP Therapy at South Hills Counseling addresses your specific concerns and aspirations.

Personalized Objectives

  • Learning to face feared thoughts, feelings, and situations without compulsions

  • Reducing the power of obsessive thoughts and intrusive images

  • Building tolerance for uncertainty and anxiety

  • Decreasing reliance on safety behaviors and reassurance-seeking

  • Developing values-based decision making independent of anxiety

  • Reclaiming time and energy previously spent on rituals and obsessions

  • Improving quality of life and functioning in important life domains

Growth-Oriented Approach

Our therapy goes beyond symptom reduction to foster comprehensive development:

  • Focusing on acceptance of thoughts and feelings rather than control

  • Building psychological flexibility and resilience

  • Enhancing values-based living and meaningful engagement

  • Creating lasting change that extends beyond therapy sessions

  • Developing a new relationship with discomfort and uncertainty

AREAS OF SPECIALIZATION

✔ Traditional OCD (contamination, checking, ordering, counting)

✔ Relationship OCD (ROCD)

✔ Sexual orientation OCD (SO-OCD)

✔ Religious/moral scrupulosity

✔ Perfectionism and fear of making mistakes

✔ Health anxiety and illness concerns

Our Approach to EXRP Therapy

How EXRP Works

In EXRP, you gradually expose yourself to thoughts, images, emotions, situations, and sensations that may trigger your "smoke alarm." This is the part of your brain that detects and tries to prevent potential threats (fight/flight). If you are willing to tolerate the discomfort of the alarm (anxiety, worry, panic, shame, guilt, doubt), you often learn that the perceived threat isn't actually dangerous, that you don't need to do anything about it, and that over time it may become less scary/triggering.

The perceived threat in most of these situations is a thought or an emotion ("I might be gay," "I may get sick," "I feel anxious so something must be wrong"). But if you can give yourself the chance to face these "threats" by accepting that you may never know for sure, or that maybe you don't really know who you are or whether you're sick, you're learning to tolerate the feeling of uncertainty. Over time, your brain may stop flagging these thoughts and feelings as "threats," and you may experience decreased anxiety/worry/rumination.

The Goals of Treatment

NOTE: Decreasing anxiety or stopping thoughts/feelings is not the goal of EXRP. The goal of EXRP is to learn to tolerate the thoughts and feelings without engaging in your typical reactions. You also learn to intentionally shift your attention to those things that matter most to you in life (values), and you practice making these choices over and over, instead of following your automatic desire to decrease your anxiety/distress (usually by "doing something" such as getting reassurance, performing a ritual, ruminating, etc.).

Many people find that if they stop engaging with the distressing thoughts and feelings, their anxiety does subside. But this can't be your main focus. It's like trying not to think of CHOCOLATE CAKE after I tell you not to think about it or picture the last time you ate it or what it would be like to taste it right now. This is thought suppression, and it doesn't work. What does "work" is accepting that humans have thoughts and feelings, and as a human you may sometimes feel uncomfortable, experience intense emotions, and have thoughts you don't like or that are inconsistent with your values. If this is the case, you can learn to make room for these thoughts and feelings without needing to do anything about them and move forward with your life.

Frequently Asked Questions

  • While facing fears is a component of EXRP, the therapy is much more comprehensive. It's about learning to relate differently to your internal experiences (thoughts, feelings, sensations) and building your capacity to tolerate uncertainty. EXRP also involves learning to make choices based on your values rather than being driven by anxiety reduction. Our therapists provide structure, guidance, and support throughout this process.

  • The goal of EXRP is not to eliminate anxiety entirely—anxiety is a normal human emotion that everyone experiences. Rather, the goal is to reduce its interference in your life and change your relationship with anxiety. Many clients find that their anxiety does decrease significantly over time, but more importantly, they learn that they can function well even when anxiety is present.

  • Most clients attend weekly sessions for 12-20 weeks, though this varies based on the severity of symptoms and individual progress. Some people with milder OCD may see significant improvement in 8-12 sessions, while those with more severe or complex presentations may benefit from longer treatment. We'll regularly evaluate your progress and adjust the treatment plan accordingly.

  • EXRP is designed to be challenging but manageable. We start with exposures that cause moderate anxiety and gradually work up to more difficult ones as your tolerance increases. You'll always be involved in planning exposures, and we'll never force you to do something you're not ready for. The process is collaborative and paced according to your readiness.

  • This is a common question, and part of what makes OCD so challenging. Our specialized assessment process helps distinguish between OCD and other types of concerns. Generally, if you're experiencing intrusive, unwanted thoughts that cause significant distress, and you engage in mental or physical behaviors to reduce that distress, OCD may be present. A thorough evaluation with one of our specialists can provide clarity.

Ready to Begin Your Journey to Freedom Today?

We look forward to supporting you on your journey toward greater freedom, flexibility, and values-based living. South Hills is here to help guide you in breaking free from OCD and reclaiming your life!