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:

How to Help A Friend In Eating Disorder Recovery

When someone you care about is in recovery from an eating disorder, it’s natural to want to help, but knowing how can be difficult. Eating disorders are complex, deeply rooted struggles that go far beyond food or appearance. As a therapist who works closely with clients in recovery, I’ve seen firsthand how crucial support from friends and loved ones can be. Done well, your support can help reinforce recovery and rebuild trust in connection. Done carelessly, even well-meaning comments can inadvertently trigger shame or setbacks.

If you're wondering how to be a truly supportive friend, here are some guidelines to keep in mind.

1. Educate Yourself

Start by learning about eating disorders and what recovery actually entails. Eating disorders are not choices, they are serious mental health conditions with physical, emotional, and behavioural dimensions. Recovery isn't linear, and it doesn’t end with weight restoration or the ability to eat certain foods again. Understanding this helps you approach your friend with empathy instead of judgment or oversimplified advice.

Local Ontario resources to explore:

• NEDIC (National Eating Disorder Information Centre): Offers information, support, and a toll-free helpline across Canada.

• Body Brave: Based in Ontario, this organization offers virtual support programs for individuals and loved ones.

• Sheena’s Place: A Toronto-based community mental health charity offering free support groups and workshops (virtual and in-person) for people affected by eating disorders.

2. Avoid Talking About Bodies and Food

Even compliments like “You look healthy” or “I’m so glad you’re eating more” can be triggering. You don’t know how your friend interprets these comments, they might equate “healthy” with “gained weight,” which can activate eating disorder thoughts. These comments are unnecessary and perpetuate the faulty idea that the most important thing about a person is their appearance.

Instead:

• Compliment other attributes about them that are not related to their physical appearance. Their kindness, their thoughtfulness, their intellect.

• Focus on how they’re feeling, not how they look.

• Let them set the tone if they want to talk about food or meals.

3. Respect Their Boundaries

Your friend may not want to talk about their eating disorder, and that’s okay. Or they may want to talk, but not all the time. Respect where they are. Ask open questions like, “Do you feel like talking about how things are going?” rather than pushing them to open up.

Also, avoid becoming their therapist. Your job is not to treat them, it’s to be a steady, non-judgmental presence. If you're concerned, encourage them to reach out to a professional rather than trying to take it all on yourself.

4. Offer Support Around Meals (If Invited)

Meal times can be one of the most stressful parts of recovery. If your friend expresses that they’d like support, offer to sit with them during a meal or create a distraction after eating to help them cope with the anxiety.

Avoid watching what they eat or making comments like:

• “Are you sure that’s enough?”

• “I could never eat that much!”

• “You’re doing so well!”

Instead, try being a calming, normalizing presence. You can say:

• “I’m glad we get to enjoy a meal together”

• “Want to watch something after?”

• Offer distracting conversation, unrelated to food or appearance.

5. Be Patient with Setbacks

Relapsing back into disordered eating habits is not uncommon in eating disorder recovery. Don’t treat it as failure. Instead, show your friend that your care for them isn’t conditional on their progress.

You might say:

• “I’m here for you no matter what.”

• “You’re not alone in this. We can take things one day at a time.”

• “Have you talked to your therapist about how you’re feeling?”

It is likely your friend is already feeling a lot of shame. Scolding or lectures from you will only add to it. Instead, your steady, compassionate presence can help reduce it.

Final Thoughts

Your friend’s recovery journey is theirs alone, but your support can make an enormous difference. By listening without judgment, respecting their autonomy, and showing up consistently, you send a powerful message: You are not alone. You are worthy of care. You matter.

That message - more than any advice- might be exactly what they need to keep going.

If you or a loved one is navigating an eating disorder, I invite you to reach out. You don’t have to do it alone. To learn more about therapy for eating disorders or to schedule a virtual consultation, please contact me using the button below.

About the Author

Dana Etherington is an Occupational Therapist, Psychotherapist and the owner of Cedar Tree Therapy, a psychotherapy practice located in Brooklin, Ontario. Dana uses evidence based treatment modalities to treat anxiety, obsessive compulsive disorder (OCD) and eating disorders.

A Compassionate Path to Eating Disorder Recovery

Eating disorders are complex. They are not just about food, weight, or appearance—they are deeply rooted in emotional pain and, often, a need for control or safety. Whether you or someone you love is struggling, know this: eating disorders are rarely simply about the food.

As a therapist who specializes in eating disorder treatment, I’ve had the privilege of walking beside clients through some of their most vulnerable moments. This work has shown me over and over again that recovery is not only real, but transformative. If you’re reading this and wondering whether healing is truly possible, I want you to know: it is.

Understanding Eating Disorders: More Than Meets the Eye

Eating disorders come in many forms and affect people across all ages, genders, body types, ethnicities, and backgrounds. They are not always visible from the outside. People of all body shapes and sizes can experience eating disorders.

Some of the most common eating disorders include:

• Anorexia Nervosa: Characterized by restriction of food intake, intense fear of gaining weight, and a distorted body image.

• Bulimia Nervosa: Involves cycles of binge eating followed by the compensatory behaviour of purging.

• Binge Eating Disorder (BED): Involves recurring episodes of consuming large quantities of food, often rapidly and to the point of discomfort, without compensatory behaviors.

• Avoidant/Restrictive Food Intake Disorder (ARFID): A pattern of eating disturbances often tied to sensory issues or fear of aversive consequences, not driven by body image concerns.

• Orthorexia (not yet officially recognized in the DSM): An unhealthy obsession with "clean" or "healthy" eating that can severely disrupt a person’s life.

While each disorder has unique traits, they all share a common thread: emotional distress expressed through food and the body.

Myths That Get in the Way of Healing

Eating disorders are surrounded by harmful myths that can delay treatment and deepen shame. Let’s dispel a few:

• “You don’t look like you have an eating disorder.” Eating disorders do not have a “look.” People of all sizes can experience eating disorders.

• “It’s just a phase.” Eating disorders are serious mental health conditions that require professional support and are not to be brushed off. They are the most fatal psychiatric illness.

• “If they would just eat, they’d be fine.” Recovery is not just about eating differently, it’s about healing psychologically as well.

• “They’re just doing it for attention.” There is immense shame that comes with an eating disorder and it is a mental illness that no one would willfully choose.

Letting go of these myths opens the door for empathy, intervention, and hope.

What Recovery Really Looks Like

Recovery from an eating disorder is not a straight line. It’s more like a winding path—filled with highs and lows, setbacks and breakthroughs. That’s not a sign of failure. It’s how real, meaningful change works.

Here’s what recovery may involve:

1. Reconnecting with the Body

Many people with eating disorders feel disconnected from their bodies—either ignoring hunger cues or feeling at war with their physical selves. In recovery, we begin to rebuild trust with the body: listening, responding, and caring for it rather than controlling or punishing it.

2. Addressing the Root Causes

Eating disorders often serve a function: numbing emotional pain, providing a sense of control, or coping with trauma, anxiety, or low self-worth. Therapy creates space to explore and heal these underlying issues.

3. Rewriting the Inner Dialogue

The inner critic in eating disorders can be relentless. Part of recovery is learning to challenge that voice and cultivate a new one- one rooted in compassion, curiosity, and self-acceptance.

4. Creating a Life Beyond the Disorder

As healing progresses, clients begin to rediscover who they are beyond the eating disorder - reconnecting with passions, relationships, values, and dreams that may have been buried or put on hold.

What Progress Looks Like (Even When It’s Hard to See)

Recovery looks different for everyone and progress can take many forms. Sometimes, it might look like one of these things:

• Eating in a social setting with friends despite feeling anxious

• Choosing rest instead of compulsive exercise

• Recognizing a trigger before acting on it

• Crying instead of restricting

• Feeling an emotion fully, without numbing

These moments are profound victories. They may seem small, but they are the building blocks of sustainable healing.

For Those Who Love Someone Struggling

If someone you care about is living with an eating disorder, you may feel confused, helpless, or scared. You don’t need to have all the answers but your support makes a difference.

Here’s what can help:

• Listen without judgment.

• Avoid comments about weight, food, or appearance. Take a neutral stance to all bodies and food.

• Educate yourself about eating disorders. Meet with an eating disorder therapist yourself to gain a deep understanding of this psychiatric illness.

• Encourage professional help

• Practice patience. Recovery takes time and there will be ups and downs

Taking the First Step

If you’re considering therapy- or just wondering if your relationship with food and body is something to look at- that curiosity is enough. The first step doesn’t have to be big. It might be a phone call. A journal entry. A conversation.

And if you’re further along in your healing, know that setbacks don’t erase progress. Every part of your story matters. Every part deserves care.

Final Thoughts: You Are worthy of recovery

Eating disorders often leave people feeling like the eating disorder is their safe place for finding their worth, validation and comfort.

Recovery is about coming home to yourself. It’s about learning that you are enough as you are- not because of your weight, your achievements, or your willpower- but simply because you exist. You are worthy.

If you or a loved one is navigating an eating disorder, I invite you to reach out. You don’t have to do it alone. Healing is possible, and you are deserving of it.

Let’s take that first step together.

To learn more about therapy for eating disorders or to schedule a virtual consultation, please contact me using the button below.

The Body Image Course is a wonderful self guided e-course to compliment therapy for people living with eating disorders and their support people. Through powerful video lessons, reflective journaling prompts, and unique guided meditations, you’ll explore the roots of body image struggles, uncover the toxic impact of diet culture, and learn practical tools to build body image resilience.