ERP at Home and Online: How Telehealth ERP Therapy Works Between Sessions
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ERP at Home and Online: How Telehealth ERP Therapy Works Between Sessions


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If you’re exploring online ERP therapy, you’re likely wondering: Will it work outside a clinic? Can we really do exposures over video? The short answer is yes—done well, telehealth ERP is effective and can be as helpful as in‑person care for many people with OCD (1–3). In fact, practicing in your real spaces often accelerates learning that sticks. In this guide, we’ll show you how telehealth ERP works, what you’ll do between sessions, and how we keep you safe and supported.


🏠 Key takeaway: “ERP works best when we practice in the same contexts where OCD shows up—your kitchen, bathroom, car, inbox, or bedtime routine.” (4,5)

Why ERP Works Well Outside the Office

Bringing exposures into real‑life situations

ERP (Exposure and Response Prevention) helps your brain update what it predicts—and how it copes—when obsessions arise. The modern inhibitory learning model emphasizes varied, surprising, real‑world practice to disconfirm threat expectations (4). Doing exposures in your actual environment can:

  • Recreate real triggers (e.g., your soap, your stove, your front door).

  • Reduce “context mismatch” between office success and home challenges.

  • Build flexible skills you can use throughout your day (4,5).

🔁 Key takeaway: “Varied, ‘in‑context’ exposures teach your brain that feared outcomes are less likely than OCD predicts—and that you can cope if discomfort shows up.” (4)

How telehealth makes “in‑context” practice easier

Telehealth removes commute time and lets us coach you live in the spaces where rituals usually happen—bathroom, bedroom, pantry, mailbox—without needing to recreate them in an office. Recent research shows remotely delivered CBT for OCD (which includes ERP) is effective and, for many, comparable to in‑person care (1–3). Some programs also show strong outcomes with efficient therapist time, which can lower barriers to care (2).


Meet our team and see how we tailor sessions to your goals and schedule.


What Happens in an Online ERP Therapy Session

Assessing OCD patterns and building a hierarchy

We start by mapping obsessions, triggers, rituals, and avoidance, then co‑create a hierarchy—from “a little uncomfortable” to “very challenging.” We’ll choose first steps that are doable but meaningful, and we’ll set clear success metrics (not just “feel less anxious,” but “do X without ritual for Y minutes”).


Designing exposures that use your home environment

Your therapist will coach you through exposures that fit your space and life, such as:

  • Touching “contaminated” items and resisting washing.

  • Leaving doors unlocked for a set time while you stay with uncertainty.

  • Writing and listening to “what if” statements without neutralizing.

  • Placing items out of symmetry and resisting straightening.

  • Sending an email without rereading 10 times.

🧭 Key takeaway: “The goal isn’t to feel nothing—it’s to do life without rituals, even while some discomfort is present.” (4,5)

ERP Homework: Practicing Between Sessions

Turning daily routines into exposure opportunities

Between visits, we’ll turn everyday tasks into “mini‑experiments.” Examples:

  • Morning: Skip the third reassurance text; notice urges, let them pass.

  • Work/School: Submit drafts with one proofread instead of five.

  • Evening: Leave a countertop slightly messy and eat dinner first.

  • Weekend: Drive past a checking spot without turning around.

We’ll right‑size the dose so practice is challenging but safe, and we’ll adjust weekly based on outcomes.


Tracking anxiety and rituals over the week

Expect brief tracking—two or three times a day—to note triggers, urges, rituals, and what you did instead. Many clients like a 0–10 discomfort rating and a one‑line note (“Touched trash can, no handwashing for 10 minutes”). Tracking helps us adapt the plan and aligns with how research teams monitor progress (1,3).

If you’re a data‑lover, our assessment and outcomes approach helps you see what’s changing and where to focus next.


Staying Safe While Doing ERP at Home

What to practice solo vs with therapist support

We’ll flag which items are therapist‑assisted only (e.g., intensive imaginal work, driving exposures for harm OCD) versus solo‑safe practice (e.g., delaying a compulsion, resisting reassurance). You’ll always have clear safety parameters for duration, frequency, and when to stop.


Making a plan for strong spikes or setbacks

Before homework starts, we co‑create a written plan for rough days:

  • Signs to pause an exposure (e.g., panic symptoms above your personal threshold or dissociation).

  • Grounding steps (paced breathing, name‑five‑things, sensory reset).

  • Who to contact (therapist message portal, crisis resources).

  • How we’ll review and revise next session.

🚦 Key takeaway: “Discomfort is expected; danger is not. If your signals say ‘too much, too fast,’ use your plan and reach out.” (4)

Telehealth ERP for ADHD, Autism, and Demand Avoidance

Shorter, structured, or visual supports for EF needs

When ADHD is part of the picture, executive function supports can boost follow‑through: shorter tasks, visual checklists, reminders, and rewards. Research suggests youth with comorbid OCD + ADHD show more EF difficulties and may benefit from added structure (7). We’ll also adapt exposures to be briefer and more frequent, and we may pair ERP with coaching for planning and task initiation.

Curious about these supports? Explore our executive function coaching.


Collaborative planning for PDA‑style demand avoidance

“Pathological demand avoidance” (PDA) is a contested construct—not a formal DSM/ICD diagnosis—but many autistic folks report intense control needs and strong avoidance of demands. Reviews recommend collaborative, autonomy‑supportive planning: clear choices, co‑designed goals, and flexible routes to exposure (6). We integrate these principles while staying OCD‑focused. Individual experiences vary, so we’ll adjust with you (6).


🧩 Key takeaway: “When control needs are high, shared power (choices, pacing, co‑design) reduces pushback and makes ERP possible.” (6,7)

If autism is part of your story, we draw on autism‑adapted CBT/ERP manuals and case‑guided modifications while keeping ERP’s core intact (6).


Getting Started with Telehealth ERP in Tennessee

Tech and privacy basics for virtual sessions

We use HIPAA‑compliant platforms and follow HHS guidance for privacy, security, and online tracking protections in telehealth (8–10). Practically, that means:

  • Using secure video with a Business Associate Agreement (BAA) (9).

  • Avoiding non‑essential tracking pixels on clinical pages (10).

  • Encouraging headphones, private rooms, and a door sign at home.

  • Having a backup phone plan if Wi‑Fi drops.

🔐 Key takeaway: “Your privacy matters—HIPAA‑compliant tools plus simple at‑home steps keep sessions confidential.” (8–10)

How to set up a consultation with ScienceWorks

If you’re considering online ERP therapy in Tennessee, start with a free, judgment‑free call. Share a little about your goals, and we’ll help you decide next steps:


About the Author

Kiesa Kelly, PhD, HSP is a licensed clinical psychologist and the Chief Clinical Officer at ScienceWorks Behavioral Healthcare. She provides affirming care for OCD, trauma, insomnia, and autistic & ADHD neurotypes, with advanced training in ERP, I‑CBT, EMDR, and CBT‑I.


Before opening ScienceWorks, Dr. Kelly spent 16 years as a psychology professor and department chair. She’s passionate about translating rigorous research into practical, kind, real‑life support for clients across Tennessee.

References and Citations

  1. de Pablo, G. S., Pascual‑Sánchez, A., Panchal, U., Clark, B., & Krebs, G. (2023). Efficacy of remotely‑delivered cognitive behavioural therapy for obsessive‑compulsive disorder: An updated meta‑analysis of randomised controlled trials. Journal of Affective Disorders, 322, 289–299. https://doi.org/10.1016/j.jad.2022.11.007

  2. Feusner, J. D., Farrell, N. R., Kreyling, J., McGrath, P. B., Rhode, A., Faneuff, T., et al. (2022). Online video teletherapy treatment of obsessive‑compulsive disorder using exposure and response prevention: Clinical outcomes from a retrospective longitudinal observational study. Journal of Medical Internet Research, 24(5), e36431. https://doi.org/10.2196/36431

  3. Aspvall, K., Andersson, E., Melin, K., et al. (2021). Effect of an internet‑delivered stepped‑care program vs in‑person cognitive behavioral therapy on obsessive‑compulsive disorder symptoms in children and adolescents: A randomized clinical trial. JAMA, 325(18), 1863–1873. https://doi.org/10.1001/jama.2021.3839

  4. Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy, 58, 10–23. https://doi.org/10.1016/j.brat.2014.04.006

  5. Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99(1), 20–35. https://doi.org/10.1037/0033-2909.99.1.20

  6. Jassi, A., Patel, S., Lang, K., Heyman, I., & Fineberg, N. A. (2021). An evaluation of a new autism‑adapted cognitive behaviour therapy manual for obsessive–compulsive disorder in young people: A naturalistic study. Child Psychiatry & Human Development, 52(6), 1116–1128. https://doi.org/10.1007/s10578-020-01066-6

  7. Farrell, L. J., Waters, A. M., Milliner, E. L., & Morgan, H. (2020). Clinical expression and treatment response among children and adolescents with obsessive–compulsive disorder and comorbid ADHD. Journal of Affective Disorders, 266, 292–299. https://doi.org/10.1016/j.jad.2020.01.112

  8. U.S. Department of Health and Human Services. (2024). Privacy and security for telehealth: Laws and policy guidance. https://telehealth.hhs.gov/providers/best-practice-guides/privacy-and-security-telehealth/privacy-laws-and-policy-guidance

  9. U.S. Department of Health and Human Services—Office for Civil Rights. (2023). HIPAA rules for telehealth technology. https://telehealth.hhs.gov/providers/telehealth-policy/hipaa-for-telehealth-technology

  10. U.S. Department of Health and Human Services—Office for Civil Rights. (2024). Use of online tracking technologies by HIPAA covered entities and business associates. https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/hipaa-online-tracking/index.html


Disclaimer

This article is for educational purposes only and is not a substitute for professional advice, diagnosis, or treatment. If you have questions about your mental health or safety, contact a qualified clinician or emergency services in your area.


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