ERP Therapy for OCD: What to Expect in Virtual Sessions

Exposure and Response Prevention (ERP) therapy is the gold standard treatment for OCD, and virtual sessions are proving to be just as effective—sometimes even more so—than traditional in-person therapy. Here’s everything you need to know about what happens in virtual ERP sessions and how they can help you overcome OCD.

If you’ve been struggling with OCD and are considering therapy, you’ve probably heard about ERP (Exposure and Response Prevention) as the most effective treatment available. But you might be wondering: How does ERP work when it’s done virtually? Can online therapy really be as effective as meeting with a therapist in person?

The answer is a resounding yes. Recent research shows that virtual ERP therapy can lead to meaningful results twice as fast as standard ERP therapy, with participants experiencing an average decrease in OCD symptoms and dramatic improvements in depression, anxiety, stress, and overall quality of life.

Understanding ERP Therapy: The Basics

Before diving into virtual sessions, let’s understand what ERP therapy actually involves.

What is ERP Therapy?

Exposure and Response Prevention (ERP) is a specialized form of Cognitive Behavioral Therapy (CBT) specifically designed to treat OCD. It works by helping you gradually confront intrusive thoughts and triggers that cause anxiety, while learning to resist performing compulsions.

The two core components are:

1. Exposure: Practicing confronting the thoughts, images, objects, and situations that make you anxious and provoke your obsessions
2. Response Prevention: Making a choice not to do a compulsive behavior once the anxiety or obsessions have been “triggered”

How ERP Retrains Your Brain

Think of anxiety as your body’s alarm system. If your fire alarm goes off, it’s there to get your attention and prompt you to take action. But imagine if your fire alarm went off every time you burnt toast or blew out birthday candles?

That’s what happens in OCD. Your alarm system begins to respond to any trigger (no matter how small) as an absolute, terrifying, catastrophic threat. ERP helps retrain your brain to no longer see the object of the obsession as a threat.

For more detailed information about different types of anxiety disorders and how they’re treated, check out our comprehensive guide on understanding anxiety disorders.

Why Virtual ERP Therapy Works So Well

The Home Advantage

One of the most significant benefits of virtual ERP therapy is that it allows your therapist to “go with you” as you face your OCD triggers in real-time. According to Dr. Patrick McGrath, Chief Clinical Officer at NOCD, doing ERP therapy from home can be highly beneficial because it allows “a therapist to work with their members in the settings and situations where their triggers are most likely present—and where obsessions or compulsions are most likely to occur.”

Think about it: If your OCD involves checking behaviors, your therapist can observe you in your home as you resist the urge to repeatedly check that doors are locked or appliances are turned off. This real-time exposure in your actual environment makes ERP therapy more relevant and effective.

Research-Backed Effectiveness

A major peer-reviewed study published in the Journal of Medical Internet Research examined treatment outcomes of virtual ERP therapy for over 3,500 participants. The findings were remarkable:

• 43.4% average reduction in obsessive-compulsive symptoms
• 62.9% response rate among participants
• Results achieved in under 12 weeks and less than 11 total therapist hours
• Long-term success: Improvements maintained at 3, 6, 9, and 12 months

This represents substantial monetary and time savings compared to traditional once-weekly outpatient ERP therapy.

What to Expect in Your Virtual ERP Sessions

Session 1-3: Assessment and Foundation Building

Initial Assessment

Your therapist will conduct a comprehensive evaluation to understand your specific OCD presentation. During these sessions, Laura Davidson at Mental Wellness and Me will explore:

• Your intrusive thoughts, sensations, images, feelings, and urges
• Your mental and physical compulsions
• What you fear will happen if you don’t perform a compulsion
• Any situations, people, thoughts, or objects you avoid to prevent intrusive thoughts

Creating a Safe Space

ERP therapists understand that discussing OCD symptoms can feel intimidating. As one NOCD member shared, their first couple of sessions were where they learned to “vocalize” their fears: “I would be like, ‘I’m scared that I’m going to fade out of reality or just cease to exist.'”

Your therapist will create a non-judgmental space for you to openly share. Remember, ERP therapists have ample experience and have heard it all before.

Psychoeducation

You’ll learn about:

• How OCD works in your brain
• Why compulsions actually strengthen obsessions over time
• How ERP breaks the OCD cycle
• What to expect during treatment

Laura Davidson’s approach at Mental Wellness and Me emphasizes empowerment-based therapy, helping you understand not just what to do, but why these techniques work. Learn more about her background on our About Us page.

Session 4-6: Building Your Exposure Hierarchy

Creating Your Personalized Fear Ladder

One of the essential tools in ERP is the exposure hierarchy—a ranked list of feared situations or thoughts, organized from least to most anxiety-provoking. This collaborative process between you and your therapist involves:

1. Identify Triggers: List all situations, thoughts, or objects that cause anxiety and lead to compulsive behaviors
2. Rate Anxiety Levels: Assign a number to each trigger based on how much anxiety it produces (usually 1-10 scale)
3. Rank Triggers: Organize the list from least to most anxiety-provoking
4. Plan Exposures: Choose the least anxiety-provoking item to start with

Example Hierarchy for Contamination OCD:

• Level 1 (Anxiety: 2/10): Looking at a picture of a public restroom
• Level 3 (Anxiety: 4/10): Touching a clean doorknob without washing hands for 5 minutes
• Level 5 (Anxiety: 6/10): Touching a shopping cart handle
• Level 7 (Anxiety: 8/10): Using a public restroom without excessive cleaning
• Level 10 (Anxiety: 10/10): Eating food after touching a public surface

Session 7-15: Active Exposure Work

Starting with Lower-Level Exposures

You’ll begin with exposures that provoke mild to moderate anxiety. During virtual sessions, your therapist can guide you through these exercises in real-time, providing:

• Immediate support and encouragement
• Real-time coaching on managing anxiety
• Observation of your responses to triggers
• Guidance on resisting compulsions

Types of Exposures in Virtual Sessions

In-Vivo Exposure (Live Exposure) This involves directly confronting feared objects or situations in your real environment. For example:

• If you have contamination fears, touching surfaces in your home without washing hands
• If you have checking compulsions, leaving your house without repeatedly checking locks
• If you have symmetry obsessions, deliberately leaving objects out of place

Imaginal Exposure Your therapist guides you to vividly imagine scenarios that trigger distress. This might involve:

• Describing feared situations in detail
• Mentally placing yourself in anxiety-provoking experiences
• Replaying distressing thoughts without performing mental compulsions

Virtual Reality Exposure Some advanced practitioners use VR technology to simulate real-life experiences in a controlled digital environment when live exposure isn’t practical.

Session 16-20: Advanced Exposures and Independence Building

Working Up Your Hierarchy

As you build confidence with easier exposures, you’ll gradually work up to more challenging situations. Your virtual therapist can:

• Accompany you virtually to different rooms in your house
• Guide you through increasingly difficult scenarios
• Help you practice in multiple environments via video
• Provide ongoing support as anxiety levels increase

Example Virtual Session for Checking OCD:

“Today we’re going to practice leaving your house without checking the stove. I want you to walk to your kitchen, look at the stove once, and then walk directly to your front door. I’ll be right here with you virtually, coaching you through any urges to go back and check.”

Response Prevention Strategies

Your therapist will teach you specific techniques for resisting compulsions:

• Delaying tactics: “Wait 5 minutes before checking”
• Mindfulness techniques: Observing urges without acting on them
• Cognitive strategies: Challenging catastrophic thoughts
• Physical techniques: Progressive muscle relaxation during exposure

What Makes Virtual ERP Sessions Unique

Real-Time Environmental Access

Unlike in-person therapy where you might describe your triggers, virtual therapy allows your therapist to see and guide you through exposures in your actual environment. This means:

• More relevant practice: Working with your actual triggers, not simulated ones
• Immediate application: Skills learned can be used right where you need them
• Enhanced generalization: Exposures happen in the settings where you’ll use these skills daily

Flexible and Convenient Access

Virtual ERP sessions offer several practical advantages:

Accessibility: You can receive treatment from anywhere with an internet connection, making it easier to fit therapy into your life.

Privacy and Comfort: Many people feel more comfortable receiving therapy from their own home, which can lead to more honest and open communication.

Continuity of Care: Whether you’re traveling, have a busy work schedule, or face other life changes, virtual therapy allows you to continue treatment without interruption.

Mental Wellness and Me offers flexible scheduling including evening and weekend options. You can easily book sessions through our Jane App booking system.

Between-Session Support

Virtual ERP platforms often provide additional support between sessions:

• Messaging with your therapist for questions or encouragement
• Digital tools for tracking exposures and progress
• Educational resources to deepen your understanding of OCD
• Peer support communities for connection with others in recovery

Common Concerns About Virtual ERP

“Will online therapy really work for my specific OCD type?”

Virtual ERP has been proven effective for all subtypes of OCD, including:

• Contamination OCD: Working with actual surfaces and objects in your environment
• Checking OCD: Practicing leaving without checking in your real home
• “Pure O”: Using imaginal exposure and mindfulness techniques
• Symmetry OCD: Deliberately creating disorder in your space
• Harm OCD: Processing intrusive thoughts without mental compulsions

For more information about different OCD presentations, read our article about OCD and perfectionism.

“What if I have a panic attack during a virtual session?”

ERP therapists are trained to handle intense anxiety and provide support during challenging moments. Virtual therapy actually offers some advantages:

• You’re in your familiar environment with your usual comfort items nearby
• Your therapist can quickly assess your safety and provide grounding techniques
• Emergency contacts are readily available if needed
• Session pacing can be adjusted immediately based on your responses

“How do I know if I’m doing the exposures correctly?”

Virtual sessions provide excellent opportunities for therapist observation and feedback:

• Real-time guidance: Your therapist can see how you’re responding and adjust accordingly
• Immediate feedback: Corrections and encouragement happen in the moment
• Video recording options: Some platforms allow session recording for review (with consent)
• Progress tracking: Digital tools help monitor your advancement over time

The Role of Homework in Virtual ERP

Between-Session Practice

A crucial component of ERP therapy involves practicing exposures outside of sessions. Your therapist will assign specific homework exercises to reinforce progress:

Exposure Homework Examples:

• Touching designated “contaminated” objects without washing hands for specific time periods
• Leaving the house without checking specific items
• Allowing intrusive thoughts without performing mental rituals
• Deliberately creating mild disorder in specific areas

Digital Tools for Tracking

Many virtual ERP platforms provide tools to support homework practice:

• Exposure hierarchies you can access on your phone
• Distress ratings to track anxiety levels during exposures
• Progress visualization showing improvement over time
• Reminder systems to encourage consistent practice

For guidance on maintaining progress between sessions, check out our article on managing emotion regulation challenges.

Expected Timeline and Outcomes

How Long Does Virtual ERP Take?

Research shows that virtual ERP therapy can produce results faster than traditional approaches:

• Average treatment duration: 11.5 weeks
• Total therapist time: Approximately 10.6 hours
• Session frequency: Often starts with twice-weekly sessions, then transitions to weekly
• Early results: Many people notice improvement within the first few sessions

What Success Looks Like

ERP therapy success isn’t about eliminating all anxiety or intrusive thoughts. Instead, it focuses on:

Reduced Symptom Severity: Obsessions and compulsions become less frequent and intense

Improved Functioning: Better ability to work, maintain relationships, and enjoy activities

Increased Confidence: Growing belief in your ability to handle uncertainty and anxiety

Enhanced Quality of Life: More time and energy available for meaningful activities

Long-term Resilience: Skills that continue to serve you beyond therapy

One research study found that 80% of people with OCD who use ERP experience a reduction in symptoms within eight to 16 weeks.

To understand more about therapy timelines, read our guide on how many therapy sessions you really need.

Virtual ERP at Mental Wellness and Me

Laura Davidson’s Approach

Laura Davidson, MSW, RSW, brings a unique combination of clinical expertise and empowerment-focused therapy to virtual ERP sessions. Her approach includes:

Evidence-Based Treatment: Using proven ERP techniques adapted for virtual delivery

Personalized Care: Tailoring exposures to your specific OCD presentation and life circumstances

Empowerment Focus: Building your confidence and independence in managing OCD

Collaborative Planning: Working together to create exposures that challenge you appropriately

Comprehensive Support: Addressing related concerns like anxiety, depression, or life transitions

Service Features

Virtual Accessibility: Serving clients across Ontario through secure video platforms

Flexible Scheduling:

• Monday-Thursday: 9:00 AM – 8:00 PM
• Friday: 9:00 AM – 4:00 PM
• Weekend options for urgent needs

Insurance Coverage: Most Extended Health Benefit plans accepted

No Referral Required: Direct access to specialized OCD treatment

Secure Platform: Using Jane App for easy, confidential booking and communication

Learn more about Laura’s credentials and experience on our About Us page.

Preparing for Your First Virtual ERP Session

Technical Setup

Equipment Needed:

• Computer, tablet, or smartphone with camera and microphone
• Reliable internet connection
• Headphones (recommended for privacy)
• Private space where you feel comfortable talking

Testing Technology:

• Test your video connection before your first session
• Ensure your camera and microphone work properly
• Have a backup plan (phone number) in case of technical issues
• Download any required apps in advance

Mental Preparation

Before Your Session:

• Write down specific OCD symptoms you want to discuss
• Note situations or objects that trigger your obsessions
• List your most common compulsions
• Think about your goals for therapy

Creating the Right Environment:

• Choose a private space where you won’t be interrupted
• Ensure good lighting so your therapist can see you clearly
• Have tissues and water nearby
• Consider having a comfort item available (but not for compulsive use)

What to Bring Up

Important Topics for Early Sessions:

• Your specific OCD triggers and compulsions
• How OCD impacts your daily life and relationships
• Previous therapy experiences, if any
• Current medications or other treatments
• Questions about the ERP process

Integrating Virtual ERP with Daily Life

Making the Most of Home-Based Treatment

Advantages of Your Home Environment:

• Practice with actual triggers rather than simulated ones
• Immediate application of skills where you need them most
• Family members can observe and learn supportive behaviors
• Natural generalization to daily routines

Family Involvement: Virtual ERP allows family members to participate in sessions when appropriate, helping them:

• Understand how OCD affects you
• Learn how to reduce accommodation of compulsions
• Support your recovery without reinforcing symptoms
• Participate in family-based interventions

For more information about improving family relationships during recovery, read our article on building stronger connections.

Handling Setbacks

What to Expect:

• Initial increase in anxiety when starting exposures
• Temporary worsening of symptoms as you resist compulsions
• Fluctuations in progress from day to day
• Emergence of new obsessions as old ones improve

Virtual Support for Challenges:

• Immediate access to your therapist for crisis support
• Between-session messaging for questions and encouragement
• Video check-ins if you’re struggling with homework
• Rapid scheduling adjustments during difficult periods

Advanced Virtual ERP Techniques

Innovative Approaches

Real-Time Environmental Exposures: Your therapist can guide you to different locations via video, such as:

• Walking through your house while resisting checking
• Going to your kitchen without washing dishes repeatedly
• Entering your bedroom without arranging items perfectly

Technology-Enhanced Practice:

• Screen sharing to review triggering images or videos
• Recording exposure practices for later review
• Using apps to track anxiety levels during exposures
• Virtual reality components for specific phobias

Community Integration: Some virtual platforms offer:

• Peer support groups you can join from home
• Online communities for sharing experiences
• Group ERP sessions with other individuals with OCD
• Family education sessions via video conference

Maintaining Progress After Virtual ERP

Developing Independence

The goal of ERP therapy isn’t to depend on your therapist forever. Virtual treatment helps you become your own therapist by:

Skill Building: Learning to recognize and resist OCD patterns independently

Environmental Mastery: Practicing in your actual living spaces builds real-world competence

Generalization: Skills learned at home naturally extend to other environments

Self-Monitoring: Using digital tools to track your own progress and identify patterns

Long-Term Success Strategies

Relapse Prevention Planning:

• Identifying early warning signs of symptom return
• Creating action plans for managing OCD flare-ups
• Establishing maintenance exposure practices
• Building a support network for ongoing encouragement

Booster Sessions: Many people benefit from occasional check-in sessions to:

• Review and refresh ERP skills
• Address new life stressors that might trigger symptoms
• Update exposure hierarchies for new challenges
• Maintain motivation and accountability

For additional support with related concerns, explore our services for anxiety therapy, depression treatment, and emotion regulation.

Frequently Asked Questions About Virtual ERP

“How effective is virtual ERP compared to in-person therapy?”

Research consistently shows that virtual ERP therapy is just as effective as in-person treatment. A recent study showed that ERP done in live, face-to-face teletherapy is just as effective as in-person ERP therapy. In fact, virtual treatment often produces results twice as fast as traditional therapy.

“What if my internet connection fails during an important exposure?”

Good virtual therapy platforms have contingency plans:

• Phone backup options for continuing sessions
• Immediate reconnection protocols
• Session recording capabilities to review missed content
• Flexible rescheduling policies for technical issues

“Can children and teens do virtual ERP?”

Yes! ERP is delivered almost exactly the same for children and teens as it is for adults with OCD. Therapists simply use age-appropriate language and concepts. Parents are often included in sessions to ensure they’re supporting recovery rather than accommodating OCD symptoms.

“How do I know if virtual ERP is right for me?”

Virtual ERP works well for most people with OCD. It’s particularly beneficial if you:

• Have transportation or mobility challenges
• Live in an area with limited access to OCD specialists
• Prefer the privacy and comfort of your own space
• Want to practice skills in your actual environment
• Need flexible scheduling options

“What happens if I need crisis support between sessions?”

Mental Wellness and Me provides clear protocols for crisis situations:

• Emergency contact information for immediate needs
• Between-session messaging for urgent questions
• Crisis resource referrals for immediate safety concerns
• Expedited scheduling for urgent appointments

If you’re experiencing thoughts of self-harm, always contact:

• Crisis Services Canada: 1-833-456-4566
• Toronto Distress Centre: 416-408-4357
• Emergency Services: 911

Taking the Next Step

Ready to Start Virtual ERP Therapy?

If you’re tired of OCD controlling your life, virtual ERP therapy with Laura Davidson at Mental Wellness and Me could be the solution you’ve been looking for. Virtual therapy offers:

• Evidence-based treatment proven to reduce OCD symptoms significantly
• Convenient access from anywhere in Ontario
• Flexible scheduling that fits your life
• Real-environment practice for maximum effectiveness
• Professional expertise with a compassionate approach

Getting Started

Contact Mental Wellness and Me:

• Email: [email protected]
• Online Booking: Schedule through Jane App
• Website: Mental Wellness and Me

What Happens Next

1. Initial Consultation: Discuss your symptoms and goals with Laura
2. Assessment: Comprehensive evaluation of your OCD presentation
3. Treatment Planning: Collaborative development of your personalized approach
4. ERP Sessions: Regular virtual sessions with homework practice
5. Progress Monitoring: Ongoing assessment and adjustment of treatment
6. Maintenance Planning: Strategies for long-term success and independence

Additional Resources

Educational Materials:

• Understanding Anxiety Disorders: Types, Symptoms, and Causes
• OCD and Perfectionism in Toronto
• Managing Emotion Regulation and Behavioural Challenges

Support Organizations:

• International OCD Foundation: Comprehensive OCD resources
• Anxiety and Depression Association of Canada: Educational materials
• Toronto OCD Support Group: Peer support meetings

Your Recovery Journey Starts Today

Virtual ERP therapy represents a revolutionary approach to OCD treatment that combines the convenience of modern technology with the proven effectiveness of evidence-based therapy. With virtual sessions, you can access specialized care, practice in your real environment, and build lasting skills for managing OCD—all from the comfort and privacy of your own space.

Research consistently shows that virtual ERP can lead to significant symptom reduction, improved quality of life, and lasting recovery. The key is working with a qualified therapist who understands both ERP techniques and how to deliver them effectively in a virtual format.

Laura Davidson at Mental Wellness and Me brings exactly this combination of expertise and innovation to your recovery journey. Her empowerment-focused approach, combined with the convenience and effectiveness of virtual therapy, offers you the best possible chance of overcoming OCD and reclaiming your life.

Remember: OCD is highly treatable, and recovery is possible. The techniques you’ll learn in virtual ERP therapy will serve you for years to come, giving you the tools to handle whatever challenges OCD might present.

Don’t let another day pass with OCD limiting your potential. Take the first step toward freedom by reaching out to Mental Wellness and Me today. Your future self—free from the exhausting cycle of obsessions and compulsions—is waiting.

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Mental Wellness and Me provides virtual mental health services across Ontario, Canada. This guide is for educational purposes and does not replace professional medical advice. If you’re experiencing a mental health emergency, please contact your local emergency services immediately.