Imaginal Exposures Explained
Written by OCD therapist, Naomi Kaplan, LCSW
Fears of throwing up? Dying? Or worrying that God is mad at you? These kinds of fears can feel impossible to face in therapy—but there’s a proven method designed to help people work through exactly these worries: Exposure and Response Prevention (ERP).
ERP is the gold-standard, evidence-based treatment for Obsessive-Compulsive Disorder (OCD) and other anxiety disorders. It helps people safely face their fears while learning that they can handle discomfort and uncertainty. Over time, this helps reduce the power that OCD-based fears hold, as well as the need to engage in compulsions (the repetitive behaviors or mental acts a person feels driven to do in response to an obsession).
What is exposure?
Most people think of exposure therapy as in-vivo exposures or gradually facing fears directly in real life with the support of a therapist. Examples include:
Riding a train to face a fear of public transportation
Eating a food you fear might cause illness
Performing a ritual “incorrectly” to challenge OCD rules
These experiences allow people to learn new safety information that can help inhibit obsessional fears. By testing out the fear without engaging in compulsions, we gain new safety information: that the feared outcome is less likely or less severe than predicted, or that we can handle it if it does happen… AND we don’t need compulsive behaviors for safety or to handle anxiety. With repetition, these exercises weaken OCD’s grip.
But some fears can’t safely, ethically, or realistically be recreated, like fearing death, harming someone, or disappointing a religious figure. That’s where imaginal exposure comes in.
Imaginal exposure is a type of ERP where you mentally “walk through” feared scenarios in vivid detail. Instead of confronting the fear in real life, you face it in a safe, controlled mental space through imagery and script writing. Like in-vivo exposures, imaginal exposures help clients build new safety information that permanently puts obsessional fears in check.
How does imaginal exposure work?
With your therapist’s support, during imaginal exposures…
You write or record a detailed narrative of the feared scenario in first-person, as if it’s happening right now. Include what you see, feel, and think, and incorporate physical sensations and emotions.
You repeat the scenario multiple times, ideally in different settings, without engaging in compulsions like avoidance or seeking reassurance.
Over time, you may notice that you are able to tolerate the discomfort and uncertainty, and for some people, they may find the fears less dangerous or even feel a decrease in emotional reactivity overall.
Here’s an example:
Imagine someone fears what might happen after death. With their therapist, they create an imaginal exposure script that describes their worst-case scenario in vivid detail: what they see, feel, and think in the first-person.
They then read or listen to this story repeatedly, noticing their distress rise and fall. Over time, the scenario feels different. They may no longer feel the same intense fear and/or feel prompted to engage in compulsions.
You can think of imaginal exposures as deliberate training for your brain’s ability to tolerate discomfort. Each time you practice, fear loses a bit of its influence. Just like a scary movie becomes less alarming after several viewings, repeatedly approaching your worst-case scenario in a safe, structured way teaches your brain something new: “I can have this thought without needing to escape or fix it.” With consistent repetition, the story feels less threatening, the emotional punch weakens, and your anxiety naturally decreases as your brain strengthens a calmer, more confident response.
Why do Imaginal exposures help?
Imaginal exposures allow people to:
Confront fears that can’t happen safely in real life
Practice tolerating uncertainty and discomfort
Reduce avoidance and compulsions
Learn that thoughts and fears don’t require action
It’s especially helpful when paired with in-vivo or interoceptive exposures, creating a fuller, more flexible approach to fear and anxiety.
who can benefit from imaginal exposures?
Imaginal exposure is useful for anyone doing ERP, including individuals with:
Obesssive Compulisve Disorder (OCD) – harm OCD, contamination, responsibility obsessions
Generalized Anxiety Disorder (GAD) – chronic worry about future events
Social Anxiety Disorder – fear of judgment or embarrassment
Other conditions with intrusive thoughts, rumination, or mental images
what to expect.
ERP can be most helpful when you collaborate with a trained ERP clinician who helps provide psychoeducation on OCD and anxiety, can help create and monitor exposures, support accountability of practice at home, and can provide validation and encouragement.
Staying consistent with your exposures—including imaginal work—is one of the most important parts of healing. Every time you show up and practice, even when it’s hard, you’re building real change. The more willing you are to lean into the work of ERP, the more you open the door to its benefits. You’re doing something brave, and it truly pays off.
Through both in-vivo and imaginal exposures, clients learn: you can feel fear and still be okay.
you got this!
Living with OCD and anxiety can feel overwhelming, exhausting, and frightening—but you are not alone. Nearly 10 million Americans live with OCD, yet many go undiagnosed or untreated. The good news is that effective treatment exists, and you don’t have to face this journey on your own. We’re here to support you every step of the way and help you take the first step toward relief.
If you or your child struggles with fears or worries that feel impossible to face, ERP offers a safe, structured way to build confidence, reduce distress, and take back control from OCD. Contact us to connect with an trained ERP therapist.
