OCD Treatment and Courage: Adapting with ERP, CBT, and ACT

Therapy is often portrayed as a process filled with comfort, relief, and positivity—a place where we “make the bad go away” and “feel better.” While these outcomes can emerge over time, the therapeutic journey—especially when treating Obsessive-Compulsive Disorder (OCD)—is rarely linear or easy. It requires discomfort, courage, and a willingness to embrace uncertainty. The "maybe", "sometimes", "I don't know" that can create so much anxiety and feel so uncomfortable in the body.

As OCD therapists, one of the most profound lessons we’ve learned is that meaningful change often happens in moments that feel anything but comfortable. Healing is not about eliminating fear, but about learning to relate to it differently—with courage and adaptability.

This post, written in recognition of OCD Awareness Month, aims to shed light on the treatment process and to highlight the incredible resilience we witness in individuals living with OCD. Regardless of how differently OCD presents from person to person, the qualities of courage and adaptability consistently stand out as essential components of recovery.

OCD: Beyond the Stereotypes

No two people with OCD experience it the same way. The disorder includes a wide range of obsessions (intrusive, distressing thoughts, images, words, or urges) and compulsions (repetitive behaviors or mental acts intended to reduce distress or prevent feared outcomes). These can combine in unique ways, making OCD deeply personal and often misunderstood.

Contrary to popular portrayals, OCD is not simply about cleanliness or organization. At its core, OCD is about uncertainty and fear—and the individual’s attempts to avoid or neutralize that fear. OCD can get in the way of a person's quality of life, relationships, personal experiences, habits, food, and body. Recovery, therefore, requires facing that fear directly rather than escaping it.

ERP: Facing Fear to Reclaim Freedom

The gold-standard, evidence-based treatment for OCD is Exposure and Response Prevention (ERP), a specialized form of Cognitive Behavioral Therapy (CBT). In ERP, clients are guided to gradually confront feared situations (exposures) while refraining from engaging in compulsions (response prevention).

The goal of ERP is not to make anxiety disappear, but to help the brain learn—through direct experience—that anxiety can be tolerated and that feared outcomes are often less catastrophic than they seem. Over time, this process retrains the brain’s alarm system, reducing the intensity and frequency of obsessive fears.

When we begin working with someone with OCD, we often tell them:

“Don’t measure your progress by how you feel. Measure it by what you are willing to do differently.”

This principle captures a key component of CBT and ERP: success is not the absence of distress, but the willingness to act in the presence of it, especially when you don't even feel motivated! Each act of courage—touching a feared object, resisting a mental ritual, or tolerating uncertainty—is a victory that moves clients toward greater freedom.

ACT and the Power of Psychological Flexibility

While CBT and ERP focus on behavioral change and fear learning, Acceptance and Commitment Therapy (ACT) complements this process by emphasizing psychological flexibility—the ability to stay open to difficult thoughts and emotions while committing to actions that align with personal values.

In ACT, clients learn to observe their internal experiences (like anxiety, intrusive thoughts, or urges to ritualize) without judgment or avoidance. Instead of trying to control these experiences, they practice making space for them, allowing values-based living to take the lead.

For individuals with OCD, this shift can be transformative. Fear and anxiety stop being obstacles to avoid and instead become signals of growth, especially when you make recovery a lifestyle filled with exposures that lead to new adventures and deeper courage. When this happens, clients begin to see distress not as a sign of failure, but as evidence that they are engaging in the work of recovery.

Adaptability and Courage: The Heart of Recovery

Adaptability in OCD treatment means learning to coexist with uncertainty, to modify rigid patterns of thinking, and to reinterpret discomfort as progress. People with OCD often demonstrate remarkable adaptability—they take what life gives them and use it to grow stronger.

Courage, meanwhile, is the foundation of every exposure, every moment of sitting with uncertainty, every act of letting go of control. It takes immense bravery to confront the very fears your mind tells you to avoid. Yet, with each courageous step, individuals reclaim their autonomy and expand their comfort zone and capacity to live freely.

A Messy but Meaningful Process

OCD treatment is rarely neat or pretty. It involves discomfort, self-doubt, and persistence. Yet, it is deeply rewarding. No one chooses to have OCD—but many choose recovery and to face their fears, tolerate uncertainty, and commit to living fully despite it.

Through ERP, CBT, and ACT, individuals learn that fear is not the enemy—it’s the teacher. And with courage and adaptability, they rediscover the freedom to live a life guided by values, not by fear.

At Home For Balance, our team of professionals provides personalized and holistic care that supports well-being and relief from OCD, including OCD associated with eating disorders and substance abuse. Through CBT, DBT skills, ACT, and a nurturing and empathetic approach, we support clients who are struggling with OCD and other comorbidities. For more information about how to participate in this FREE support group and work with one of our clinicians, please contact us today at info@homeforbalance.com or call us at 561.600.1424 for a FREE 30-minute consult!

Please visit https://iocdf.org/ for more information on OCD.

Below are some of our favorite BOOKS!

The OCD Workbook: Your Guide to Breaking Free from Obsessive-Compulsive Disorder (4th Edition)by Bruce M. Hyman, Ph.D., and Cherry Pedrick, R.N.→ A classic self-help resource grounded in CBT and ERP, ideal for clients looking to actively participate in their recovery.

Stuff That’s Loud: A Teen’s Guide to Unspiraling When OCD Gets Noisy by Ben Sedley, Ph.D., and Lisa Coyne, Ph.D.→ An accessible, ACT-based workbook for teens learning to manage intrusive thoughts and anxiety with self-compassion.

Integrating ACT and Mindfulness

The Mindfulness Workbook for OCD: A Guide to Overcoming Obsessions and Compulsions Using Mindfulness and Cognitive Behavioral Therapy by Jon Hershfield, MFT, and Tom Corboy, MFT→ Combines mindfulness and CBT/ERP techniques to help individuals respond to intrusive thoughts with acceptance rather than resistance.

References

• Abramowitz, J. S., McKay, D., & Storch, E. A. (2017). The Wiley Handbook of Obsessive Compulsive Disorders. Wiley-Blackwell.

• Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy, 58, 10–23.

• Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2016). Acceptance and Commitment Therapy: The Process and Practice of Mindful Change (2nd ed.). Guilford Press.

• Twohig, M. P., & Abramowitz, J. S. (2018). Acceptance and commitment therapy for obsessive-compulsive disorder: A review of the evidence. Journal of Obsessive-Compulsive and Related Disorders, 18, 100–108.

• Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99(1), 20–35.

• Huppert, J. D., & Roth, D. A. (2003). Managing resistance in cognitive behavioral therapy for OCD: A clinical guide. Cognitive and Behavioral Practice, 10(2), 126–136.*