What If OCD Therapy Isn’t Working? Common Reasons and Next Steps
Exposure and Response Prevention (ERP) for OCD is simple in theory: Do the thing you’re afraid of, repeat, and it will get easier over time. In practice, however, it’s really hard to do, and there are a lot of hiccups that can happen along the way.
Many of the hiccups I often see at Leap Counseling arise from difficulty getting into the “spirit” of treatment. It is SO counterintuitive to intentionally move towards the things your brain thinks are dangerous. Anxiety is tricky and will do all it can to manipulate you into trying to escape or reduce that feeling. The spirit of ERP is to change your relationship to anxiety and discomfort.
OCD wants us to keep having an “avoidance orientation" to anxiety, where our natural and typical response to anxiety is to avoid it. In ERP, treatment for OCD is not just about doing the exposure, habituating to it, then doing the next exposure, and so on. It’s about building an “approach orientation” to anxiety, uncertainty, and emotional discomfort.
Why Isn’t ERP Working?
Below are common reasons that ERP doesn’t seem to be working and how to get back to the spirit of treatment:
Avoiding exposures or doing them halfway
Doing the easier version
Touching only the cleanest-looking part of the dog
Choosing the nicest-looking employee to speak to
Avoiding the hardest triggers
Refusing the exposures that are most challenging
Refusing exposures for the most difficult fears
Procrastinating or doing them last minute
Completing exposures
Only doing them on “good” days or times of day with less anxiety
Solution: A little thing called opposite action. When doing an exposure, your anxiety will tell you to do things a certain way. It wants you to find ways to feel safer. Figure out what it is that anxiety is saying, and do the opposite.
I once was at a hotel and conference center in Atlanta, Georgia, and it has this glass-walled elevator going 52 stories up in a giant atrium so that you can see all the way down. I rode it all the way up, just for the experience. The higher up it went, the more my anxiety was telling me to back away from the glass and huddle on the floor, the farthest away from the glass. So instead, I stayed standing, put my hands to the glass, leaned my body weight against it, and looked down. It was terrifying. THAT is opposite action.
Treatment is subtly compulsive
Exposures become a compulsion
Attempting to “perfect” exposures
Focusing on doing exposures “right” rather than leaning into the fear
Solution: Lean into the uncertainty that you might be doing your exposure wrong. Exposure work around the fear of not getting better may be needed. For more information and strategies on this issue, see my blog on perfecting treatment.
Neglecting response prevention
During exposures
Allowing yourself to engage in compulsions during or immediately after the exposure
Doing a compulsion much later in the day to “cancel out” the perceived effect of the exposure (e.g., saying a prayer at night to ask for forgiveness for exposures done during the day)
Outside of exposures
Only working on response prevention directly related to exposures
Not working on reducing compulsions overall
Sneakier compulsions might include giving oneself reassurance while doing an exposure
As an online OCD therapist in Wauwatosa, I often remind clients that response prevention is half the treatment! It’s called exposure and response prevention for a reason. Without ritual prevention, we are just doing OCD on purpose. Often, the first thing to examine when exposures don’t seem to be working as they should is whether there are compulsions going on.
Solution: Keep up with tracking compulsions and avoidance. Use mindfulness strategies when compulsions are automatic. This is especially helpful for mental compulsions. Mindfulness can help turn one’s attention back to the trigger. If unwilling to resist compulsions during an exposure, it can sometimes be helpful to switch to a different exposure that someone is willing to do full response prevention with and return to the more challenging exposure later on.
Learning the wrong lesson from an exposure
OCD wants to highlight how bad it felt instead of what you learned
Walking away thinking:
That was unbearable
I barely survived that
Solution: Exposures are a form of an experiment. It’s testing out a belief of some kind. OCD tells us that not doing your compulsions will be catastrophic. Or it will simply convince you that you cannot handle the uncertainty or anxiety. Use the exposures to test out those assertions. Sometimes, if exposures are not planned out, folks are not in the right headspace going in and are only focused on how bad it feels. It can be helpful to decide ahead of time what predictions you have for the exposure and then see if they come true.
Make sure the exposure is set up to test that properly. For example, if you want to test if touching a doorknob will get you sick, it won’t work as well to touch it with one finger, then wipe it off, and try not to use that finger again. To really find out what will happen, touch all over the doorknob, then lick your hand and touch other things with your hand. No matter what the exposure, at the end, you can always ask yourself: But did you die?
Mindset: Goals and expectations
Mindset can be really important in ERP treatment. Often, folks come into OCD therapy with unrealistic expectations or goals that run counter to ERP principles. These can include:
Want to get rid of or calm anxiety
Wanting to get rid of intrusive thoughts
Believing that anxiety should be predictable or controllable
Thinking that setbacks are permanent
Thinking of progress as how you feel instead of what you do
Solution: Bust those myths! It’s impossible to get rid of anxiety. And we know that the more we try to avoid it, the worse it gets. It’s also impossible to remove intrusive thoughts, and trying to suppress them makes them come back stronger. Remember the new goal: develop an approach orientation to anxiety and uncertainty. Finally, redefine progress as what you do in response to your anxiety, not as how much anxiety you experience. Not feeling anxious is not as much of a success as feeling anxious and doing it anyway.
There Is Always Hope: Final Thoughts
There are, of course, many other reasons that treatment might not be working. For example, symptoms of a co-occurring disorder might be getting in the way. Medication management might be needed, or weekly therapy sessions might not be enough. This article outlines some of the first things to examine or rule out, because if we don’t learn to get into the spirit of treatment, progress can be limited.
It’s important to talk to your therapist about reservations with treatment and your feelings about progress. A part of therapy can be learning to redefine progress or to work on being kinder to ourselves. No matter what the hiccups are, there’s always a way around or through them. There is always hope!
Tired of Feeling Stuck With ERP? Try Online OCD Treatment in Wauwatosa
If you’ve tried OCD therapy before and haven’t seen the progress you hoped for, it doesn’t mean treatment can’t work for you. A white paper published in 2025 by the International OCD Foundation revealed that between 81% and 98% of people with OCD have NOT received exposure and response prevention (ERP) therapy, the gold standard empirically-supported treatment for OCD. And that statistic does not even take into account the quality of the ERP treatment received. The good news is that high-quality ERP is an effective treatment for OCD. Sometimes it just takes a more experienced, highly trained, and specialized therapist to see those benefits.
Leap Counseling and Consultation is a Wisconsin-based solo therapy practice led by Dr. Johanna Wood, who specializes in treating OCD and anxiety disorders using evidence-based care. Dr. Wood works collaboratively with clients to identify what may be getting in the way of progress and tailor treatment to better fit their needs. Taking the next step doesn’t have to be complicated:
Take the first step toward improvement and schedule a free 15-minute consultation
Meet one-on-one with an experienced OCD therapist in Wauwatosa, WI
Begin exploring effective strategies to reduce compulsions and move forward with support
Other Services Leap Counseling Offers Online in Wauwatosa, WI, and Beyond
If OCD therapy hasn’t worked the way you expected, it can feel discouraging, but that doesn’t mean meaningful progress isn’t possible. With the right adjustments and evidence-based support, many people discover new strategies that reduce symptoms, strengthen resilience, and restore confidence in the treatment process.
While OCD treatment is a primary focus of my Wisconsin-based online therapy practice, it is not the only area where I provide care. Anxiety conditions often overlap with OCD or show up in different forms. As a licensed online therapist serving Wisconsin and all PSYPACT states, I also offer therapy for Panic Disorder, Agoraphobia, Generalized Anxiety Disorder, Social Anxiety Disorder, and specific Phobias.
No matter where you are in your journey—even if you’re feeling stuck—compassionate, research-informed therapy can help you move forward. I invite you to explore my mental health blog to learn more about OCD, anxiety, and treatment options, and when you’re ready, reach out to schedule an appointment and take your next step toward lasting change.
About the Author
Dr. Johanna Wood is a Wisconsin-based clinical psychologist who specializes in OCD treatment using evidence-based approaches such as Exposure and Response Prevention (ERP). She completed her PhD in Clinical Psychology at Northern Illinois University and her doctoral internship at Rogers Behavioral Health’s OCD and Anxiety Adult Residential Program, later supervising clinical staff in residential treatment settings.
In addition to her professional training, Dr. Wood brings personal insight to her work, having experienced the cycle of intrusive thoughts and anxiety in her own struggle with relationship OCD. When ERP felt challenging in her own therapy, she learned that progress often requires approaching uncertainty as a “leap of faith”—a lesson that now informs how she helps clients who feel stuck or discouraged in treatment. Licensed in Wisconsin with PSYPACT authorization, she is also active in the International OCD Foundation, contributing to education and advocacy efforts related to OCD and scrupulosity.
