How Occupational Therapists Can Help Your OCD

How Occupational Therapists Can Use ERP to Help with Obsessive-Compulsive Disorder (OCD)

Understanding OCD and Its Impact

Obsessive-Compulsive Disorder (OCD) is a mental health condition characterized by unwanted, intrusive thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) aimed at reducing anxiety or preventing a feared outcome. These symptoms can significantly interfere with daily routines, relationships, and quality of life.

Occupational Therapists play a vital role in the treatment of OCD—especially through the use of Exposure and Response Prevention (ERP), one of the most evidence-based treatments for OCD.

What Is Exposure and Response Prevention (ERP)?

ERP is a specialized form of Cognitive Behavioural Therapy (CBT) designed to help individuals gradually face their fears and resist the urge to engage in compulsions. The emphasis on this type of therapy is the behavioural component. Over time, this process helps the brain learn that anxiety naturally decreases without performing the rituals.

For example, someone who fears contamination might work toward touching a doorknob and refraining from washing their hands immediately afterward—under the supportive guidance of their therapist.

How Occupational Therapists Integrate ERP Into Practice

Occupational therapists are uniquely positioned to integrate ERP within the context of a person’s daily life and functional goals. Here’s how Occupational Therapists can effectively support clients with OCD:

1. Functional Assessment of Triggers

Occupational Therapists begin by understanding how obsessions and compulsions affect self-care, productivity, and leisure. For example, an individual might spend hours engaging in compulsions, struggle to complete work tasks due to intrusive thoughts, or avoid social situations out of fear their obsession might come true.

This holistic assessment helps tailor ERP exposures that are person-centered and directly related to meaningful life activities.

2. Graded Exposure Plans

Occupational Therapists collaborate with clients to design graded exposure hierarchies—lists of feared situations ranked from least to most distressing.
Some examples of behavioural exposures:

• Touching an item perceived as “dirty” without immediately washing.

• Leaving home without checking locks multiple times.

• Using public restrooms or touching shared objects.

Through structured ERP sessions, the Occupational Therapist supports the client in approaching anxiety-provoking tasks safely and gradually, helping them regain confidence in everyday occupations. It is important to note that your therapist works through your hierarchy at your pace. Although it may feel challenging it should never be incredibly distressing. Your feedback throughout is important.

3. Response Prevention Strategies

In addition to exposure, Occupational Therapists integrate response prevention—refraining from performing compulsions such as handwashing, checking, or seeking reassurance.
The Occupational Therapist provides emotional regulation tools, grounding techniques, acceptance and mindfulness strategies to tolerate the discomfort that arises during exposure.

4. Building Daily Routines and Coping Skills

ERP alone is most effective when combined with occupational therapy’s focus on functional recovery. Occupational Therapists help clients rebuild balanced routines, improve sleep, eating, and self-care, and engage again in valued activities that OCD may have disrupted.

5. Collaborative, Holistic Care

Occupational therapists often work alongside psychologists, psychiatrists, and family members to ensure a coordinated approach. The Occupational Therapist’s focus on participation, autonomy, and quality of life helps bridge the gap between clinical progress and real-world functioning.

Benefits of ERP With an Occupational Therapist

• Personalized treatment focused on your daily life and goals.

• Supportive, practical guidance during real-world exposures.

• Improved independence in home, work, and social settings.

• Long-term anxiety reduction and increased tolerance for uncertainty.

Key Takeaway

ERP is one of the most effective, research-supported treatments for OCD—and occupational therapists are uniquely equipped to deliver it within the context of everyday living. By addressing both the emotional and functional aspects of OCD, OTs help clients reclaim their routines, relationships, and sense of control.

Frequently asked questions (FAq)

1. What is ERP therapy for OCD?
Exposure and Response Prevention (ERP) is a form of CBT that helps people face their fears and reduce compulsive behaviours by gradually exposing them to anxiety triggers without performing rituals.

2. Can occupational therapists provide ERP for OCD?
Yes. Occupational Therapists trained in mental health can integrate ERP techniques to help clients manage OCD symptoms while improving participation in daily activities.

3. How is ERP with an Occupational Therapist different from ERP with a general therapist?
While both use evidence-based ERP methods, Occupational Therapists focus on function and daily living, helping clients apply ERP skills in real-world contexts such as hygiene routines, work tasks, and social interactions. Its not just talking, we bring therapy to life.

4. How long does ERP treatment take?
ERP is typically delivered over several months to a year or more, depending on symptom severity and readiness for exposure. Progress is gradual but highly effective with consistent participation.

5. Is ERP effective for all types of OCD?
Yes. ERP has strong research support across various OCD presentations, including contamination fears, checking, intrusive thoughts, and symmetry obsessions.

Want more information about therapy for OCD? Check out this past blog post:

When Thoughts Feel Like Threats: Understanding Intrusive Thoughts

In our practice, we often meet people who’ve been carrying a secret fear for a long time, one they rarely speak aloud. It usually begins with a question:

“Why would I think something like that?”

Maybe you’ve had a sudden image flash through your mind. Maybe something violent, inappropriate, or completely unlike you. Or maybe a disturbing question loops through your thoughts all day, no matter how hard you try to stop it. These aren’t signs you’re broken. They’re called intrusive thoughts, and they’re more common, and more treatable than most people realize.

This post explores what intrusive thoughts are, why they happen, how they show up in real life, and how Cedar Tree Therapy helps clients regain peace of mind.

What Are Intrusive Thoughts?

Intrusive thoughts are unwanted mental events: images, ideas, impulses, or doubts that feel jarring and uncomfortable. They show up suddenly, often at the worst times, and tend to focus on taboo or fear-inducing themes. What makes them especially upsetting is that they seem to contradict your values or identity.

Examples Include:

• “What if I swerve my car into traffic?”

• “What if I touched something toxic and didn’t realize it?”

• “What if I accidentally harmed someone?”

• “Do I really love my partner, or is something wrong with me?”

• “What if I’m secretly a bad person?”

These thoughts can feel so out-of-place and intense that people begin questioning their character, morality, or mental stability.

Important Note: Everyone has random thoughts, but for people with OCD or anxiety disorders, these thoughts become distressing obsessions. The brain reacts as though the thought itself is a threat.

Why Are Intrusive Thoughts So Disturbing?

Let’s be clear: intrusive thoughts don’t feel random. They feel dangerous, personal, and urgent. This is where the obsessive-compulsive cycle can take hold.

How It Typically Plays Out:

1. An intrusive thought occurs: “What if I just screamed in this quiet room?”

2. You feel anxiety, guilt, or shame: “What’s wrong with me?”

3. You try to make the thought go away: by checking, avoiding, praying, confessing, or mentally analyzing, engaging in compulsions

4. Temporary relief … until the thought returns

This pattern is exhausting and can make a person feel like they’re constantly at war with their own mind. The real problem isn’t the thought itself, it’s the meaning the brain assigns to it and the desperate effort to make it go away.

Common Themes of Intrusive Thoughts

At Cedar Tree Therapy, we help people work through all kinds of intrusive thought content. While no two experiences are exactly alike, here are some of the most common themes:

1. Harm OCD

• Fears about accidentally or intentionally harming someone

• E.g., “What if I dropped my baby?” or “What if I stabbed someone?”

2. Sexual Intrusive Thoughts

• Disturbing sexual images or fears related to taboo topics

• These thoughts are particularly shame-inducing but don’t reflect desires

3. Religious or Moral OCD (Scrupulosity)

• Obsessions about sinning, being impure, or violating moral rules

4. Contamination OCD

• Fears of germs, illness, or spreading harm through touch or presence

5. Relationship OCD (ROCD)

• Endless doubt about whether you're in the "right" relationship

6. Existential OCD

• Obsessive questioning about life, reality, consciousness, or death

Why Do Intrusive Thoughts Happen?

Intrusive thoughts are a byproduct of a high-functioning, threat-sensitive brain. The human brain constantly scans for danger and sometimes, especially in people with OCD or high anxiety, it over-fires.

• For example: A parent with strong moral values imagines harming their child and feels horrified. Their anxiety goes up, and their brain mistakenly assumes the thought itself is dangerous.

• Result: They avoid being alone with the child, seek reassurance, or mentally review every interaction—just to feel safe.

This reinforces the idea that the thought was dangerous and should be avoided, thus keeping the cycle going.

The Role of Shame

One of the most painful aspects of intrusive thoughts is the isolation they cause. People don’t talk about them, not even with close friends or partners because they’re afraid they’ll be misunderstood.

At Cedar Tree Therapy, we emphasize this truth with our clients:

Intrusive thoughts show you your values—not your desires.

OCD loves to latch onto the things that you value the most. Of course you would want to protect what you value and experience fear, anxiety and distress if those things are threatened by your thoughts. You’re not broken. You’re someone with a brain that’s reacting to stress or trauma.

What Helps: How We Treat Intrusive Thoughts

1. ERP (Exposure and Response Prevention)

ERP is the gold-standard treatment for OCD and intrusive thoughts. In ERP, you practice allowing the thoughts to exist without doing the usual rituals (checking, avoiding, seeking reassurance). ERP is highly structured, and at Cedar Tree Therapy, we deliver it gently, with your full collaboration and consent.

2. Mindfulness and Acceptance-Based Approaches

Mindfulness helps you observe thoughts like passing weather, not personal attacks. Instead of “fixing” every thought, you practice saying:

“There’s that thought again. I don’t have to do anything about it.”

This takes practice, but over time it builds cognitive flexibility—the ability to stay grounded, even when the mind gets loud.

3. Trauma-Informed Care

For clients with past trauma, intrusive thoughts can carry an even heavier emotional load. Our therapists are trained to spot trauma-related patterns and work at a pace that feels safe, respectful, and empowering.

4. Self-Compassion Work

Shame feeds the OCD cycle. Self-compassion helps unwind it. You’ll learn to talk to yourself the way you would talk to a friend in the same situation.

How to Talk About Intrusive Thoughts (Without Fueling Them)

Talking about intrusive thoughts can help—but how you talk about them matters. If you’re constantly seeking reassurance from friends, partners, or Google, you might unintentionally be reinforcing the OCD cycle.

Instead, focus on:

• Naming the thought (“This is an intrusive thought”)

• Noticing the urge to check or neutralize

• Practicing gentle redirection (“I'm choosing not to feed this loop today”)

Building a Safe Container for Healing

Therapy is about more than tools—it’s about relationship. At Cedar Tree Therapy, we don’t just give you coping strategies; we provide a safe, grounded space to explore what these thoughts mean to you, how they’ve impacted your life, and how you want to move forward.

We use a collaborative, non-pathologizing approach. You’ll never be rushed. You’ll never be shamed. You’ll always be treated as the expert on your own experience.

Frequently Asked Questions

Are intrusive thoughts normal?

Yes. Nearly everyone has intrusive thoughts. But for those with OCD or anxiety disorders, they become sticky and distressing.

Do intrusive thoughts mean I want to act on them?

No. In fact, the more distressed you are by a thought, the less likely you are to act on it.

Can therapy really help?

Absolutely. With proper support, clients can reduce the power of intrusive thoughts, develop a healthier relationship with their mind, and regain control of their lives.

Final Words

You are not your thoughts.
You are not alone.
And healing is possible.

If intrusive thoughts have been running your life, it might be time to take back the reins with support that feels steady, respectful, and rooted in understanding. Whether you’re looking for ERP, trauma-informed therapy, or simply someone who gets it, we’re here for you.

Ready to Begin?