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:

The Vicious Cycles of Depression

Depression is a common mental illness that can severely impact a person’s ability to complete the tasks they need and want to do. It is characterized by persistent feelings of sadness, hopelessness, and a lack of interest or pleasure in activities that were once enjoyable. It can affect how a person thinks, feels, impacting one’s ability to engage in their usual daily tasks. These devastating symptoms of depression can lead to significant impairment in functioning at work, school, at home and in their relationships.

Depression can vary in its intensity and duration, from a short episode to a chronic illness that requires ongoing management. Depression is caused by a combination of genetic, biological, environmental, and psychological factors. Understanding these complexities is essential for effective treatment, which involves psychotherapy, medication, or a combination of both. Early intervention and support are crucial in helping individuals navigate their experiences with depression and interrupt the negative cycles that depression can cause.

Low motivation is a common symptom of depression that can significantly impact daily functioning and overall quality of life. Individuals may experience extreme low energy and motivation, making even simple tasks feel overwhelming or impossible. This lack of motivation often leads to disengagement from activities that were once enjoyable to the person, contributing to a cycle of isolation and worsening mood. People may struggle to initiate or complete everyday responsibilities, such as tasks at work or school, engaging in basic social interactions, or struggle with completing simple self-care and hygiene tasks, which can make feelings of worthlessness or guilt worse.

One of the most impactful symptoms of depression is that change that occurs in a person’s behaviour. With low mood, comes decreases to one’s activity level. These changes can have profound impacts and change the person who was once active, engaged and upbeat to someone who is isolated, withdrawn and struggles to take care of themselves.

A vicious cycle is created when these feelings of low motivation and fatigue are paired with decreased activity levels. As your activity level decreases, you start to stop doing the things you once loved and enjoyed, leading to fewer opportunities to experience positive emotions. This, in turn, perpetuates the feelings of depression, allowing the depression to persist and be maintained.

Physical symptoms of depression, such as fatigue and disrupted sleep patterns, also play a significant role. Lack of energy can reduce motivation to engage in self-care or seek help, while poor sleep can worsen mood and clear thinking ability. As a result, individuals may find it increasingly difficult to break out of the cycle. Additionally, people with depression may experience difficulty concentrating or making decisions, leading to decreased productivity at work or school. This decline can trigger feelings of inadequacy or failure, reinforcing negative thought patterns and perpetuating the cycle.

Depression often creates vicious cycles of inactivity that make the person’s mood worse and prolong recovery. One aspect of the treatment of depression that is critical is addressing and interrupting this cycle through increasing activity levels. This evidence based treatment for depression is called Behaviour Activation and comes from the Cognitive Behavioural Therapy model. When we engage in activities that are pleasurable, it increases our chances of experiencing positive emotions, allowing for increased motivation, confidence and energy. This is one of the ways to break out of the vicious cycle of depression.

Understanding these vicious cycles is crucial for addressing depression effectively. Therapy interventions for depression, such as cognitive behavioural therapy (CBT), can help individuals identify and challenge negative thoughts, interrupt the vicious cycles of depression, and gradually re-engage in life again.

About the Author

Dana Etherington is an Occupational Therapist, Psychotherapist and the Owner of Cedar Tree Therapy, a group psychotherapy practice located in Brooklin, Ontario. Dana used cognitive behavioural therapy along with other evidence based treatment modalities to treat anxiety, depression, obsessive compulsive disorder and disorder eating.

Occupational Therapists Apply Psychotherapy to Real Life

October is Occupational Therapy (OT) month! This blog post will cover the role of Occupational Therapists in mental health treatment and why they are the best person to have on your treatment team when seeking support for your mental health challenges. With our unique expertise in promoting independence, Occupational Therapists provide valuable insights and interventions to help you manage and overcome your mental health challenges. Occupational Therapists play a crucial role in supporting individuals with mental health conditions. Read on to learn more.

In Ontario, occupational therapists (OTs) are among the regulated health professionals authorized to practice psychotherapy, as outlined under the Regulated Health Professions Act, 1991 (RHPA). ​

Psychotherapy is considered a controlled act under this legislation, meaning only certain regulated professionals including OTs, psychologists, social workers, nurses, registered psychotherapists and physicians may perform it. Psychotherapy is not an entry level competency for OTs. ​

To become a providers of psychotherapy as an Occupational Therapist, it requires additional training in psychotherapeutic modalities to obtain competence, as well as a minimum of 50 hours of psychotherapy supervision. 

An OT brings something different to the table than standard therapist. OTs believe that healing comes from doing, so we are naturally drawn to concrete, actionable goals. Whether it be engaging in an activity you really used to enjoy again, or working up the courage to order a coffee. Our therapy is based in doing.
One of the primary goals of occupational therapy in mental health treatment is to enhance your ability to engage in meaningful activities and participate in daily life. By focusing on a person's occupations (the things you do every day), occupational therapists can address the physical, cognitive, emotional, and social dimensions of mental health conditions.

An Occupational Therapist will frame your treatment around how your problem is getting in the way of the things you want and/or need to do. The things you want and need to do could be anything, from the little tasks such as getting dressed in the morning, to the bigger tasks of having family over for a dinner party. 

Occupational Therapists are unique practitioners in that goals are set collaboratively with the client and they tend to be concrete and action oriented. Although action orientated goals may sound intimidating, like jumping off the deep end into something you are scared to do, the tasks are always scaled to be just the right challenge. Not too hard and not too easy. We focus on the building up small successes to attain the client’s larger goal. 
To begin the treatment process, Occupational Therapists conduct comprehensive assessments to understand the unique needs and abilities of each individual. These assessments may involve evaluating cognitive and executive functions, analyzing daily routines, and assessing social interaction skills within various contexts.

Based on the assessment findings, occupational therapists collaborate with you to develop personalized treatment plans. These plans may include a variety of interventions, such as:
1. Activity Analysis: Occupational therapists break down daily activities into smaller components to identify potential barriers and develop strategies to overcome them. By modifying activities or adapting the environment, you can build confidence, enhance your coping skills, and restore a sense of accomplishment. This may look like analyzing food related activities such as grocery shopping, meal planning, eating, cooking in order to help manage the anxiety surrounding them for someone with an eating disorder.
2. Skill Training: Occupational therapists provide guidance and support in developing new skills or relearning lost ones. This may involve focusing on self-care activities like dressing, grooming, or cooking, as well as leisure pursuits or work-related tasks. Through skill training, individuals can regain independence and improve their overall well-being. Regaining skills or learning new ones helps in the process of self discovery and exploring self outside of mental illness. An important part in the recovery process is engaging in meaningful activities. 
3. Coping Strategies: Occupational therapists teach you practical techniques to manage stress, anxiety, and other emotional challenges. These may include relaxation exercises, guided imagery, deep breathing techniques, and time management strategies. This could also involve learning cognitive behavioural therapy (CBT), dialectical behavioural therapy (DBT) or other psychotherapy based tools. By equipping you with effective coping mechanisms, occupational therapists empower you to navigate your mental health journey more effectively.
4. Environmental Modifications: Occupational therapists assist you in creating supportive environments that foster positive mental health outcomes. This may involve rearranging living spaces or workstations to optimize functionality, promoting safety, and reducing potential triggers for anxiety or depression.
5. Social Skills Training: Occupational therapists facilitate social skills development teaching assertiveness skills, anger management skills, and boundary setting to name a few. By nurturing healthy relationships and enhancing communication skills, you can increase your social support network, which is vital for mental well-being.

Occupational Therapists in mental health treatment also collaborate closely with other healthcare professionals, such as psychologists, psychiatrists, and social workers, to ensure comprehensive care. This interdisciplinary approach fosters a holistic understanding of your mental health needs and enables a more integrated treatment plan.
Throughout the treatment process, Occupational Therapists regularly evaluate progress and adjust interventions as needed. By providing ongoing support, education, and empowerment, occupational therapists empower you to take an active role in your mental health recovery.
In summary, Occupational Therapists play a fundamental role in mental health treatment by using our expertise in enhancing the functional independence and overall well-being of individuals. Through a range of interventions, we help individuals overcome challenges related to daily activities, develop coping strategies, and create supportive environments, all with the aim of promoting positive mental health outcomes.

ABOUT THE AUTHOR

Dana Etherington OT Reg. (Ont.), Psychotherapist is the owner of Cedar Tree Therapy, a psychotherapy practice for young adults that is located in Whitby, Ontario.