Exposure & Response Prevention (ERP) Therapy in Ottawa
Evidence-Based Treatment for OCD, Intrusive Thoughts, & Compulsive Behaviours
Obsessive-Compulsive Disorder (OCD) is more than being organized, careful, or particular. OCD can involve persistent intrusive thoughts, unwanted mental images, fears, urges, or doubts that create significant distress. In response, individuals may engage in compulsions, rituals, avoidance, reassurance-seeking, checking behaviours, mental review, or other actions intended to reduce anxiety.
While these behaviours often provide temporary relief, they can unintentionally strengthen the OCD cycle over time.
Exposure and Response Prevention (ERP) is considered the leading psychological treatment for OCD and is widely recommended as a first-line evidence-based intervention. ERP helps individuals gradually face feared thoughts, situations, sensations, or uncertainties while reducing the compulsive responses that keep OCD going.
At Fireside Psychotherapy, ERP can be used as part of a personalized treatment plan designed to help you develop greater confidence in managing uncertainty, reduce the influence OCD has on your life, and regain time and energy currently consumed by obsessions and compulsions.
What Is Exposure & Response Prevention (ERP)?
Exposure and Response Prevention is a specialized form of Cognitive Behavioural Therapy (CBT) developed specifically for the treatment of OCD.
ERP involves two key components:
Exposure
Exposure means gradually confronting thoughts, situations, objects, images, memories, sensations, or uncertainties that trigger anxiety and obsessive fears.
Examples may include:
- Touching an object perceived as contaminated
- Leaving home without repeated checking
- Experiencing uncertainty about a decision
- Encountering intrusive thoughts without seeking reassurance
- Being exposed to situations normally avoided because of OCD fears
Response Prevention
Response prevention involves resisting the compulsive behaviours, rituals, mental review, reassurance-seeking, avoidance, or checking behaviours that normally follow the obsession.
The goal is not to force yourself to “stop thinking” about a fear. Instead, ERP helps you learn that anxiety and uncertainty can be tolerated without relying on compulsions to feel safe. Over time, this process helps reduce OCD’s influence and allows individuals to respond more flexibly to intrusive thoughts and fears.
Understanding the OCD Cycle
To understand ERP, it helps to understand how OCD operates.
Many individuals experience a cycle similar to the following:
Obsession
An intrusive thought, image, fear, urge, or doubt appears.
Examples include:
- “What if I contaminated someone?”
- “What if I left the stove on?”
- “What if I made a terrible mistake?”
- “What if this thought means something bad about me?”
Anxiety or Distress
The obsession creates discomfort, fear, guilt, shame, uncertainty, or anxiety.
Compulsion
A behaviour is performed to reduce distress.
Examples may include:
- Checking
- Washing
- Repeating
- Reassurance-seeking
- Avoidance
- Mental reviewing
- Counting
- Researching
Temporary Relief
Anxiety decreases temporarily.
Reinforcement
The brain learns that compulsions appear to reduce distress, making it more likely the cycle will repeat. ERP targets this cycle by helping individuals break the connection between obsessions and compulsions.
How Does ERP Work at Fireside Psychotherapy?
ERP helps retrain how you respond to obsessive fears. Instead of trying to eliminate uncertainty or obtain perfect reassurance, therapy focuses on helping you experience uncertainty without engaging in rituals.
Research suggests ERP works by helping individuals learn new responses to feared situations while reducing avoidance and compulsive behaviours. Over time, feared outcomes often become less threatening, and anxiety becomes more manageable.
Importantly, ERP does not involve throwing someone into their greatest fear immediately. The process is gradual, collaborative, and carefully planned. You and your therapist work together to create a structured treatment plan based on your specific symptoms, goals, and comfort level.
What Are Exposures?
One of the most common misconceptions about ERP is that exposures are designed to overwhelm people. In reality, exposures are planned carefully and collaboratively. An exposure is simply an exercise that helps you approach something that OCD tells you to avoid.
Examples may include:
Contamination OCD
- Touching a doorknob without washing immediately afterward
- Handling everyday objects without excessive sanitizing
Checking OCD
- Leaving the house after checking the lock once
- Resisting the urge to return and verify
Harm OCD
- Being present with intrusive thoughts without seeking reassurance
- Allowing uncertainty about fears to exist without attempting to neutralize them
Relationship OCD
- Resisting repeated analysis of relationship doubts
- Reducing reassurance-seeking from partners
Each exposure is selected based on your goals and readiness rather than a predetermined formula.
What Is an Exposure Hierarchy?
ERP often uses what is known as an exposure hierarchy. This is a structured list of situations that trigger anxiety, organized from less distressing to more challenging experiences.
For example:
- Touching a public surface for a few seconds.
- Waiting before washing hands.
- Touching a commonly used object.
- Eating without excessive sanitizing rituals.
- Engaging fully in activities while tolerating uncertainty.
Starting with manageable challenges allows you to build confidence and develop skills before progressing to more difficult exposures. Exposure hierarchies are a common component of ERP treatment planning.
Does ERP Mean Anxiety Goes Away Immediately?
No. In fact, ERP often involves experiencing anxiety intentionally. This can feel counterintuitive because most people naturally try to reduce anxiety as quickly as possible.
ERP teaches something different:
You can experience discomfort, uncertainty, doubt, or anxiety without needing to perform compulsions.
During treatment, many individuals discover:
- Anxiety rises and falls naturally.
- Distressing thoughts are not dangerous.
- Uncertainty can be tolerated.
- Compulsions are not required to remain safe.
- Feared outcomes are often less likely than OCD suggests.
Over time, many people report feeling less controlled by obsessive fears and compulsive behaviours.
What Conditions Can ERP Help Treat?
ERP is most strongly associated with Obsessive-Compulsive Disorder, but it may also be incorporated into treatment for certain anxiety-related concerns involving avoidance and fear-based behavioural patterns.
ERP is commonly used for:
Obsessive-Compulsive Disorder (OCD)
Including obsessions and compulsions involving:
- Contamination fears
- Checking behaviours
- Harm-related fears
- Religious or scrupulosity concerns
- Relationship OCD
- Perfectionism-related OCD
- Sexual-orientation OCD
- Responsibility OCD
- Existential OCD
- Intrusive thoughts
ERP is considered a first-line psychological treatment for OCD across major treatment guidelines.
Health Anxiety
Some individuals engage in repeated body checking, online research, reassurance-seeking, or avoidance related to fears about illness.
ERP principles may help reduce these behaviours.
Specific Phobias
ERP-based strategies can help individuals gradually approach feared situations while reducing avoidance.
Panic-Related Avoidance
Exposure techniques may also be incorporated into treatment when individuals avoid situations because of feared physical sensations. The suitability of ERP depends on your circumstances and diagnosis. Your therapist can help determine whether ERP is appropriate for your needs.
What Your ERP Journey May Look Like
Every person’s experience with ERP is different, but treatment often includes the following stages:
Step 1: Assessment & Education
Your therapist learns about your obsessions, compulsions, avoidance patterns, and goals while helping you understand how OCD operates.
Step 2: Creating an Exposure Plan
Together, you identify situations, thoughts, or experiences that trigger OCD and develop an exposure hierarchy.
Step 3: Building Tolerance for Uncertainty
As therapy progresses, you learn that uncertainty can be experienced without relying on rituals or avoidance.
Step 4: Applying Skills in Everyday Life
The ultimate goal is to help you use ERP skills beyond therapy sessions so that OCD has less influence over daily functioning.
ERP often includes practice between sessions because meaningful progress frequently comes from applying skills in real-world situations.
In-Person ERP in & Virtual Therapy Across Ontario Centretown, Ottawa& Virtual Therapy Across Ontario
We believe quality mental healthcare should fit seamlessly into your life. We offer flexible therapeutic formats to ensure support is accessible whenever you need it:
In-Person Therapy in Downtown Ottawa
Our clinic is located in a quiet, welcoming heritage space at 428 Gilmour Street (between Kent and Bank Street in Centretown). Designed with warmth and comfort in mind—far from a clinical office setting—our practice provides a grounded space to do deep therapeutic work. Street parking and public transit options are conveniently located nearby.
Virtual ERP Across Ontario
Prefer the comfort of your own home or need flexibility around a busy schedule? We offer secure, PHIPA-compliant teletherapy across all of Ontario. Research indicates that Exposure & Response Prevention (ERP) Therapy delivered through secure video therapy can be effective for many of the same concerns addressed through in-person treatment, giving you access to top-tier care from anywhere in the province.
Meet Your ERP Therapist(s)
Alice Lurie is the founder of Fireside Psychotherapy and has over 20 years of experience supporting individuals and couples through anxiety, depression, stress, grief, emotional regulation challenges, and relationship concerns. She integrates ERP with other evidence-based approaches to help clients build practical skills and achieve meaningful, lasting change.
Alice Lurie
M.A., Registered Psychotherapist & Founder of Fireside Psychotherapy
Credentials
- Gottman Level 1 & 2
- Gottman Couples Addiction & Recovery Training
- Cognitive Behavioural Therapy (CBT)
- EMDR
- REBT & MBCT
- Specialized training in stepfamily therapy
Areas of Specialization
- Individual Therapy & Couples Therapy
- Anxiety
- Depression
- Stress & Grief
- Emotional Regulation
- Relationship Challenges
20 Years of Experience
Alice offers direct billing for select insurance providers, including Canada Life, Medavie Blue Cross, Manulife, and Sun Life. Coverage and eligibility may vary by plan.
Why Choose Fireside Psychotherapy for ERP in Ottawa?
Choosing a therapist involves more than finding someone familiar with OCD. Effective ERP requires a structured, evidence-based approach delivered within a supportive therapeutic relationship.
At Fireside Psychotherapy, treatment begins by understanding your specific experiences, concerns, strengths, and goals. It is not delivered through a one-size-fits-all protocol. Instead, your therapist works collaboratively with you to create a treatment plan tailored to your circumstances.
Because OCD can present in many different ways, therapy focuses on understanding the particular obsessions, compulsions, avoidance patterns, and fears affecting your life. From there, exposures can be designed to support meaningful progress while respecting your pace and readiness for change.
Whether you are struggling with contamination fears, checking behaviours, intrusive thoughts, reassurance-seeking, or other OCD symptoms, ERP can provide a structured framework for reducing OCD’s impact on your daily life.
What Sets Fireside Psychotherapy Apart?
At Fireside Psychotherapy, we recognize that seeking treatment for OCD can feel intimidating. Many individuals arrive in therapy after years of managing symptoms privately or feeling misunderstood by others who may not fully appreciate the impact OCD can have.
Our approach emphasizes collaboration, respect, and individualized care. Therapy is not about forcing you into situations before you are ready. Instead, your therapist helps you understand the rationale behind ERP, build confidence in the process, and develop skills that support long-term progress.
Fireside offers both in-person and virtual therapy options in Ottawa, allowing clients to access support in a way that fits their circumstances and preferences.
Most importantly, therapy focuses on helping you reclaim areas of your life that OCD may have restricted—whether that involves relationships, work, school, family responsibilities, personal goals, or everyday activities.
Frequently Asked Questions (FAQ)
Q: What is Exposure and Response Prevention (ERP) therapy?
A: Exposure and Response Prevention (ERP) is an evidence-based form of cognitive behavioural therapy (CBT) commonly used to treat obsessive-compulsive disorder (OCD). It involves gradually approaching thoughts, situations, or experiences that trigger anxiety while learning to resist compulsions, rituals, or avoidance behaviours. Over time, ERP helps people respond differently to distress and uncertainty without relying on compulsions to feel safe.
Q: What conditions can ERP therapy help treat?
A: ERP is best established as a psychological treatment for obsessive-compulsive disorder (OCD). Exposure-based approaches may also be used for certain anxiety-related concerns, including specific phobias, social anxiety, and panic-related fears. The treatment plan depends on the person’s symptoms and clinical needs, as different conditions may require different exposure strategies.
Q: How does ERP therapy work for OCD and intrusive thoughts?
A: ERP helps people with OCD face distressing thoughts, doubts, or situations without performing the compulsions they typically use to reduce anxiety or seek certainty. These compulsions may include checking, reassurance-seeking, mental reviewing, or repeated research. Through planned practice, people learn that they can experience uncertainty and discomfort without needing to neutralize every intrusive thought.
Q: What happens during an ERP therapy session?
A: An ERP therapy session typically involves identifying triggers, understanding the compulsions or avoidance behaviours that follow, and planning individualized exposure exercises. The therapist helps the client practise approaching manageable fears while resisting the usual compulsive response. Sessions may also include reviewing progress and planning practice between appointments. The process is collaborative and adapted to the client’s needs and readiness.
Q: Is ERP therapy supposed to make you face your biggest fears immediately?
A: No. ERP therapy does not require someone to confront their most distressing fear immediately or without support. The therapist and client develop a personalized plan, often beginning with manageable challenges and progressing as skills and confidence develop. The goal is to learn to tolerate distress and uncertainty without relying on compulsions, not to overwhelm the person or eliminate all anxiety before moving forward.
Q: How is ERP different from traditional CBT?
A: Traditional CBT often focuses on identifying and evaluating unhelpful thought patterns alongside behavioural strategies. ERP is a specialized CBT approach that focuses on gradually confronting triggers and reducing compulsions, rituals, and avoidance. For OCD, ERP directly targets the cycle of obsessional distress and compulsive responses. A therapist can help determine whether ERP, another CBT approach, or a combination of methods best suits an individual’s needs.
Q: How long does ERP therapy take to work?
A: The time needed to benefit from ERP varies depending on symptom severity, the complexity of OCD, treatment goals, and the consistency of practice. Therapy typically involves an assessment, a personalized exposure plan, and repeated practice over time. Your therapist can discuss the expected treatment process and review your progress, but there is no guaranteed number of sessions or fixed timeline for improvement.
Q: Is ERP therapy available online in Ottawa and across Ontario?
A: Fireside Psychotherapy offers in-person therapy at 428 Gilmour Street in Centretown, Ottawa, and virtual therapy across Ontario. If you are considering ERP for OCD or anxiety-related concerns, contact the practice to confirm therapist availability and experience with ERP. Your therapist can discuss whether virtual or in-person sessions are appropriate and how exposure exercises can be planned safely for your circumstances.
Ready to Pull Up a Chair at Fireside Psychotherapy?
Living with OCD can be exhausting. Intrusive thoughts, compulsive behaviours, and constant uncertainty can consume significant time, energy, and emotional resources. Exposure and Response Prevention offers a structured, evidence-based approach for breaking the OCD cycle and reducing the power that obsessions and compulsions have over your life.
If you are looking for Exposure and Response Prevention (ERP) Therapy in Ottawa, Fireside Psychotherapy can help you explore whether this approach aligns with your needs and treatment goals.
Contact Fireside Psychotherapy today to learn more and take the next step toward living with greater freedom, flexibility, and confidence.