What is ERP (& Why We Love It!)
By Mind Chicago co-owner and therapist, Dr. Lee Wells
If you’re a parent who’s heard the letters “OCD” or “ERP” tossed around but aren’t quite sure what they mean, you’re not alone. Acronyms can feel like alphabet soup, and when it comes to your child’s well-being, you deserve clarity—not more confusion.
So let’s start with the basics: what is OCD, really?
Obsessive-Compulsive Disorder (OCD) isn’t about being neat, organized, or “quirky.” It’s a serious condition where the brain gets caught in a sticky loop:
Obsessions are unwanted, intrusive thoughts or images. For example, a child might constantly worry, “What if something bad happens to my family if I don’t check the locks a certain way?” or “What if my hands are contaminated and I make someone sick?”
Compulsions are the rituals or behaviors that temporarily soothe the anxiety—but ultimately keep the worry alive. For instance, a child might wash their hands over and over, check the door or stove multiple times before leaving the house, or repeatedly ask a parent for reassurance that “everything is okay.”
It’s painful to watch, and even harder for kids who feel trapped in their OCD. Some children may spend hours each day performing these behaviors, missing out on school, friends, or family time. Research tells us it takes people an average of 7 years to get the right diagnosis and treatment for OCD. Seven years! That’s far too long for anyone—especially kids and teens—to wait.
The Impact of OCD on Children and Teens
OCD isn't just about thoughts and behaviors—it's about how those thoughts and behaviors disrupt a child's life. Research highlights the significant distress and functional impairments experienced by youth with OCD:
Distress and Impairment: Research shows that nearly 90% of children with OCD reported at least one significant impairment in functioning, with many experiencing difficulties at school, home, and socially. Parents often observe these challenges more acutely than the children themselves.
Quality of Life: Research indicates that children and adolescents with OCD have a reduced quality of life compared to their peers without the disorder. This reduction is linked to the severity of obsessive-compulsive symptoms, functional impairments, and associated internalizing symptoms like anxiety and depression.
School and Social Functioning: OCD can severely impact a child's ability to attend school and engage in social activities. Research suggests that nearly a quarter of youth with OCD experience significant difficulties attending and/or engaging meaningfully in school.
Understanding these impacts underscores the importance of early intervention and effective treatment strategies to help children and teens manage OCD and improve their overall well-being.
Now to the good stuff… what is erp?
You may have heard of Exposure and Response Prevention (ERP) as the gold-standard therapy for OCD. At its core, ERP is about two things:
Exposure: Safely and intentionally confronting the thoughts, images, objects, or situations that trigger anxiety.
Response Prevention: Resisting the urge to perform compulsive behaviors that usually follow.
Traditionally, ERP was explained as gradually “facing your fears” in a step-by-step hierarchy. Today, we understand that it works best when it’s flexible, varied, and focused on teaching new ways to respond to anxiety, rather than simply reducing fear in the moment.
How it Works
ERP doesn’t erase fear, and that’s actually a good thing. What it does is help the brain create new ways of responding that compete with old, anxiety-driven habits. When a child resists a compulsion while feeling anxious, they’re not magically making the fear disappear—they’re teaching their brain something powerful: that anxiety-provoking thoughts and situations don’t always predict danger, even when OCD tries to convince them otherwise. Each time this happens, the child strengthens a new “safety memory” that gradually overrides the old, automatic fear response. Over time, these new memories add up, giving children the ability to tolerate anxiety, navigate uncertainty, and live their lives without being controlled by OCD.
In other words, ERP isn’t about making anxiety disappear—it’s about teaching the brain: “I can handle this, even if I feel anxious.”
The International OCD Foundation (IOCDF) compares obsessional fear to a path carved by running water. Over time, anxiety and compulsions create a deep, well-worn groove—like a stream cutting into the earth. ERP is like carving a new path alongside the old one. At first, the new path is narrow and effortful, but with repeated practice, it becomes deeper and stronger than the old groove. Eventually, when anxiety arises, the brain naturally starts to follow this healthier path—allowing your child to respond differently and gain freedom from OCD.
What it looks like in practice
Let’s start with short example:
Hand-washing OCD: A child who fears germs might start by touching a low-stress surface, like a doorknob at home, and waiting a few minutes before washing. Over time, they progress to more challenging surfaces, like classroom desks or playground equipment. They notice the anxiety rising, but instead of trying to eliminate it, they stay with the feeling.
Repeated practice teaches the brain that anxiety and discomfort are tolerable, and that the urge to perform a compulsion is not the only option. Over time, children gain confidence in their ability to experience anxious feelings without being controlled by OCD—learning, in essence, “I can feel anxious and still keep going.”
ERP works best when parents are actively involved:
Practicing exposures at home reinforces learning and keeps progress consistent.
Encouraging children to tolerate discomfort without performing compulsions strengthens new, healthier responses.
Supporting children helps them generalize learning to real-life situations, so anxiety has less control over daily life.
Why It Matters
When kids and families engage in ERP, they often notice:
Less anxiety running the show
Fewer compulsions stealing time and energy
More freedom to do the things they value most
A growing sense of “I can handle this”
ERP isn’t about making life perfect or anxiety-free. It’s about helping kids (and families) build resilience, courage, and freedom from OCD’s hold.
Why Mind Chicago
Our team includes clinicians with advanced training through the University of Pennsylvania’s Perelman School of Medicine in ERP.
We are proud members of the International OCD Foundation (IOCDF), and we actively participate in community events like the Midwest OCD Walk—showing our support and helping reduce stigma.
We take evidence-based science seriously, but we also take your family’s experience seriously, too. You won’t just get a therapy plan; you’ll get guidance, encouragement, and a partner in the process.
If you’re wondering whether what you’re seeing in your child could be OCD, or if ERP might help, we’d love to talk. You don’t have to figure this out alone, and you don’t have to wait 7 years.
Reach out at hello@mindchicago.com—we’ll meet you where you are and walk alongside you every step of the way.
