Sasha* had spent months doing ERP — Exposure and Response Prevention — the gold standard for treating OCD. She put in the work. She followed the plan, sat with her anxiety, and really committed to the process. No matter how much she resisted her compulsions, something just wasn’t landing.
Sitting in my office, she said, “ERP is not working. What else can I do for OCD? Maybe therapy won’t work for me.”
She’s not the only person who feels this way. I’ve worked with several clients who gave ERP everything they had and still felt stuck. It’s not because ERP doesn’t work. It’s a strong, research-backed treatment that’s helped a lot of people. I’ve seen it give people their lives back. But no single treatment works for everyone, and that includes ERP.
If it didn’t work for you, that doesn’t mean something is wrong with you. You’re not broken. It just means you might need a different approach.
In this free class, I talk about what that approach can look like. If ERP hasn’t felt like a good fit or you didn’t get the results you hoped for, this might help you understand why and show you a different way forward.
What Is ERP and Why Is It Used for OCD?
Exposure and Response Prevention is a well-established therapy that has two main parts. First, exposure involves intentionally approaching situations or thoughts that bring up anxiety, instead of avoiding them. The idea is to show your brain that you can handle distress, and that anxiety doesn’t have to be dangerous or permanent.
The second part, response prevention, is about reducing the rituals or behaviors you use to try to feel better or prevent something bad from happening. These are your compulsions. While they might bring short-term relief, they often keep people stuck long-term. Over time, they can actually make you more sensitive to anxiety rather than less.
ERP is supported by decades of research and it can be very effective. But it’s also hard work. It requires a certain level of willingness to be uncomfortable, which isn’t always possible depending on where someone is emotionally, mentally, or even just in life.
For some people, ERP feels overwhelming. And even when they try it, they don’t see lasting changes. That’s especially true for folks who deal with a lot of mental compulsions—things like rumination, mental checking, body scanning, or replaying memories. These aren’t always obvious and can be really hard to disengage from.
Why Doesn’t ERP Work for Everyone?
ERP requires both exposure and response prevention. You might be doing the exposure part of therapy, but if the response prevention part isn’t also in place, the strategy probably won’t be very helpful. Exposure also works best with a certain mindset that includes a willingness to feel uncomfortable and an acceptance of difficult feelings.
That’s where traditional ERP sometimes hits a wall. ERP focuses on what you’re doing but not always on why your brain feels so convinced that something bad might happen if you don’t act.
This is where Inference-Based Cognitive Therapy, or ICBT, comes in. It starts in a different place. Instead of focusing on how to stop compulsions, ICBT looks at the thoughts and reasoning process that lead to the obsession in the first place.
This is the approach that finally worked for my client, Sasha.
ICBT is An Alternative OCD Treatment That Focuses on Doubt
One of the key ideas in ICBT is that intrusive thoughts don’t just come out of nowhere. The fear you feel is part of a reasoning process—a story your mind builds based on imagination rather than reality.
If we can slow down and look at how that story got constructed, we can start to undo it. And when the story falls apart, the fear just doesn’t feel as relevant anymore.
That’s a big difference between ICBT and ERP. ERP teaches you to sit with the urge to do a compulsion and ride it out. ICBT helps you see why the compulsion isn’t necessary to begin with.
It focuses on helping you reconnect with your common sense, your present moment experience, and your ability to trust your own judgment. For a lot of people who didn’t respond to ERP—or who just found it too intense or confusing—ICBT offers a totally different approach.
ERP Didn’t Work. Want to See If ICBT Might Be a Better Fit for You?
I’ve put together a short, free class where I explain what ICBT is, how it works, and why it might be a better fit if ERP didn’t work for you.
It’s about 15 minutes long, and in it, I walk you through:
– The top mistake I see people make when they’re stuck in the OCD cycle
– Three thinking patterns that keep OCD going
– What it looks like to approach OCD from an ICBT lens and how that can free you up
You’re Not Failing. You Just Might Need Something Different
If ERP hasn’t worked for you, please know that doesn’t mean you’ve failed. It’s a great treatment but it’s not the only one.
You’re allowed to try something else. You’re allowed to find what works for your brain. And you’re allowed to believe that things can get better, even if that hasn’t happened yet.
If you’re ready to explore a different way of working with OCD, I hope you’ll start by watching the class.
*Name changed for privacy. This story reflects a blend of common experiences from clients I’ve worked with over the years.*
FAQ: Alternatives to ERP for OCD
Q: What should I do if ERP didn’t work for my OCD?
A: If ERP hasn’t helped you, that’s okay. ERP works for a lot of people but some people don’t benefit. Inference-Based Cognitive Therapy (ICBT) is a research-backed alternative that focuses on how OCD-related doubt is created in the mind, and helps you stop the cycle before compulsions even start.
Q: What’s the difference between ERP and ICBT?
A: ERP focuses on helping you face your fears and resist compulsions. ICBT is a cognitive therapy that works by helping you understand why the fear feels believable in the first place.
Q: Is ICBT effective for people who struggle with mental compulsions or rumination?
A: Yes. ICBT is helpful for people who deal with internal compulsions like mental reviewing, checking, or trying to “figure it out.”
Q: Is ICBT a replacement for ERP?
A: ERP and ICBT are different options for OCD. You don’t need to start with ERP and then try ICBT. You can read more about why ERP might not be working for you here.