Online ERP Therapy: What Telehealth ERP Actually Looks Like (Between Sessions, Too)
- Ryan Burns
- Feb 23
- 8 min read
Last reviewed: 02/23/2026
Reviewed by: Dr. Kiesa Kelly
Online ERP therapy can feel mysterious at first, especially if you’ve only heard “exposure therapy” described as something extreme. In real life, telehealth ERP is usually structured, collaborative, and designed to help you practice in the places OCD actually shows up, including at home.
In this article, you’ll learn:
The biggest misconception about ERP (and why “exposure” isn’t flooding)
What an ERP session looks like online, step by step
How response prevention is practiced safely (including mental rituals)
What happens between sessions, including homework and handling spikes
How to start ERP therapy for OCD in Tennessee, with a clear next step
The biggest misconception about ERP (and what it really is)
ERP (exposure and response prevention) is one of the most evidence-based treatments for OCD, and it’s recommended in clinical guidelines. [1]
But the way ERP is talked about online can make it sound like you’re supposed to “white-knuckle” your way through terrifying situations. That’s not what good ERP is.
💡 Key takeaway: ERP is a skills-based, paced treatment plan, not a one-time courage test. The goal is learning new responses to uncertainty over time.
“Exposure” isn’t flooding
In ERP, an “exposure” is a planned practice of approaching triggers in a gradual, repeatable way. That might mean touching a “contaminated” surface and delaying washing, reading a short phrase that sparks doubt, or practicing a brief “maybe” statement when OCD demands certainty.
Flooding is when someone is pushed into the hardest feared situation all at once, with little preparation or control. That approach is not the standard for OCD treatment, and it’s not how we think about effective telehealth ERP.
Misconception #1: “ERP means forcing the worst thing to happen.”
What it really means: approaching triggers in a stepwise way so your brain can learn, “I can handle uncertainty, and I don’t have to do rituals to get through this.”
The role of response prevention (dropping rituals safely)
The “RP” part of ERP is what changes the OCD cycle. Exposure brings up the trigger. Response prevention is choosing not to do the compulsion that temporarily lowers anxiety (or trying to do it less and less). [3]
Compulsions are not always obvious. They can be physical (washing, checking, confessing, asking for reassurance) or internal (reviewing memories, mental checking, repeating phrases, rumination). That’s why ERP for intrusive thoughts and ERP for Pure O often focuses heavily on response prevention around mental rituals. [9,10]
Misconception #2: “Pure O means there are no compulsions.”
What it really means: compulsions may be happening internally or through reassurance seeking, avoidance, and rumination. [9]
🔎 Key takeaway: If it’s done to feel certain, neutral, or “safe,” it may be a ritual, even if it happens silently. Naming hidden rituals is often a turning point in ERP.
What online ERP therapy sessions look like
ERP therapy online is usually a mix of planning, practice, and learning from what happened. Research supports the feasibility and effectiveness of delivering ERP through videoconferencing and related telehealth formats for many people. [4–8]
If you’re new to ERP, it can help to think of each erp session as a training session: your therapist is teaching a process you’ll use between sessions.
Planning + practicing + debriefing
A typical online erp therapy session may include:
Checking in on symptoms, stressors, and what got in the way since last time
Reviewing homework (what you did, what you avoided, what rituals showed up)
Picking one or two exposures to practice together on camera
Practicing response prevention in real time (including how to handle urges)
Debriefing: what you learned, what surprised you, and what to repeat this week
Because you’re at home, telehealth ERP can sometimes make practice more “real world.” A session might involve your kitchen sink, front door, phone, laptop, or the exact room where you tend to spiral. Studies of at-home, videoconference-guided ERP highlight this advantage: you can practice where the triggers actually live. [7]
📌 Key takeaway: The goal of an ERP session isn’t to “win” by feeling calm. It’s to practice the skill of doing less ritual, even while anxiety rises and falls.
How therapists tailor ERP to your OCD themes
OCD isn’t one-size-fits-all. A therapist tailors ERP based on your themes and your compulsions, including hidden ones.
Here are examples of how tailoring might look:
Contamination OCD: touching “maybe dirty” surfaces, delaying washing, reducing glove use, and practicing “good enough” hygiene rules
Checking OCD: leaving the house without re-checking locks, practicing a single check, and resisting mental review
Harm/intrusive thoughts: reading feared phrases, holding uncertainty statements (“Maybe I could, maybe I couldn’t”), and dropping reassurance seeking
Scrupulosity: tolerating “not quite right” moral certainty and reducing compulsive confession
ROCD themes: resisting reassurance seeking, stopping relationship “tests,” and practicing uncertainty about feelings
Misconception #3: “A good therapist will reassure me that my fear isn’t true.”
What it really means: ERP focuses on helping you tolerate uncertainty without rituals, not proving the fear false.
What happens between sessions (and how support works)
The “between sessions” part is where change really compounds. Most people improve because they practice repeatedly in daily life, not because the therapist does something magical on video.
This is also why it matters to work with an OCD-trained provider. ERP is structured, and it’s normal to need help spotting subtle avoidance or mental rituals that sabotage practice.
Homework that is structured (not “wing it”)
ERP homework is usually specific and measurable. Instead of “try exposures,” you might get:
A short list of target exposures (often 2–5) with clear instructions
A frequency plan (e.g., 10 minutes daily or 3 short practices per day)
A response-prevention plan (what you will do instead of ritualizing)
A simple way to track practice (notes, a worksheet, or a shared plan)
Example #1 (contamination):
You touch the mailbox, then wait 15 minutes before washing. During the wait, you practice response prevention by noticing urges and returning to what matters (e.g., cooking, texting a friend), instead of Googling disease risk or scanning your body.
Example #2 (Pure O / intrusive thoughts):
You write a two-sentence “uncertainty script” and read it for 2 minutes. Your response prevention target is to stop mental debating, replaying, and reassurance seeking. When the urge to “solve it” hits, you label it as OCD and return to the present task.
✅ Key takeaway: The most effective homework is repeatable and small enough that you actually do it. Consistency beats intensity in ERP.
If you want more OCD-specific education and options at ScienceWorks, you can explore our OCD therapy page and specialized therapy services.
What to do when anxiety spikes
Anxiety spikes are expected in ERP. The question isn’t “How do I make this go away immediately?” It’s “How do I respond without feeding the OCD loop?”
A few therapist-approved moves that often help:
Name what’s happening: “This is an OCD spike. My brain is asking for certainty.”
Practice response prevention: delay the ritual, shorten it, or skip it, based on your plan
Reduce avoidance: gently do the next right action (keep driving, keep cooking, keep writing the email)
Drop mental rituals: notice rumination and return attention to the moment (without arguing with the thought) [10]
Use values-based coping: choose an action aligned with the life you want, even with anxiety present
If you’re in telehealth care, your therapist should explain what between-session support looks like (for example, whether you can send a brief update, and what to do in an urgent situation). It’s okay to ask about this during intake.
When telehealth ERP is a great fit - and when you need extra support
ERP therapy at home can be a great fit when:
You can access a private space for sessions
Your OCD triggers are mostly in daily-life environments (home, phone, relationships, work)
You can practice between sessions with a realistic plan
You have enough stability to tolerate anxiety without using unsafe coping
Telehealth ERP has also been studied in different populations and settings (including at-home formats), with findings supporting feasibility and symptom improvement for many clients. [4–8]
At the same time, ERP doesn’t work for everyone, and many people need careful tailoring, longer treatment, or additional supports. [11]
🧭 Key takeaway: Telehealth expands access, but the “right fit” still depends on severity, safety, and what supports you have between sessions.
Red flags for DIY ERP
Some people try to DIY ERP using social media scripts or random exposure ideas. Guided self-help can be useful for education, but DIY ERP can backfire when it turns into:
Accidental reassurance seeking (“I did the exposure, so I’m safe, right?”)
Hidden rituals that you don’t recognize (especially with Pure O) [9,10]
Flooding yourself with overly intense exposures
Using ERP to “prove” a feared outcome won’t happen
Avoiding key triggers because the plan has no structure
If you notice you’re getting more rigid, spending more time “planning ERP” than doing it, or turning exposures into a new compulsion, that’s a sign to get support.
How to get matched with the right level of care
A quality match usually starts with assessment and a “stepped-care” mindset, as reflected in guidelines: some people do well with outpatient CBT with ERP, while others need more intensive care when symptoms are severe or functioning is significantly impaired. [1]
That matching process often includes:
A clear diagnosis (including OCD themes, compulsions, and comorbid concerns)
A severity and safety check
A recommendation for frequency and intensity (weekly ERP, more frequent sessions, groups, or higher level of care)
If you’d like a starting point, ScienceWorks offers screening resources that can help you clarify what you’re dealing with, including the Y-BOCS self-check and other mental health screening tools.
How to start ERP in Tennessee (step-by-step)
If you’re looking for an ERP therapist Tennessee residents can see via telehealth, a step-by-step process can make it feel less overwhelming.
Intake → goals → treatment plan
Many telehealth ERP starts like this:
Intake: your symptoms, OCD themes, compulsions (including mental rituals), and what you’ve tried
Goals: what OCD is stealing from you (time, relationships, school/work, parenting, sleep)
Treatment plan: an exposure hierarchy, response prevention targets, and a practice schedule
If you want help getting matched, you can also review our clinicians to see who specializes in OCD and related concerns.
Book ERP with ScienceWorks
If you’re ready to explore ERP therapy online with a clinician who understands intrusive thoughts and compulsions, we can help you take the next step.
Learn about our approach on the OCD therapy page
Explore options for specialized therapy
Reach out through our Contact page to request a free consult and ask questions about fit
To recap: online ERP therapy is usually a structured plan of exposures plus response prevention, practiced in daily life with coaching and accountability. If you’ve been avoiding ERP because you pictured flooding or “doing it wrong,” a guided, step-by-step telehealth approach can be a gentler and more effective way to begin.
About ScienceWorks
Dr. Kiesa Kelly is a clinical psychologist and the founder of ScienceWorks Behavioral Healthcare. She provides specialized therapy and assessments for adults and teens, including OCD treatment approaches such as Exposure Response Prevention (ERP), Inference-based CBT (I-CBT), and Acceptance and Commitment Therapy (ACT).
Dr. Kelly earned her PhD in Clinical Psychology with a concentration in Neuropsychology from Rosalind Franklin University of Medicine and Science. Her training includes practica, internship, and postdoctoral work in clinical and neuropsychological settings, and she offers HIPAA-compliant telehealth services.
References
National Institute for Health and Care Excellence (NICE). Obsessive-compulsive disorder and body dysmorphic disorder: treatment (CG31). 2005 (last reviewed 2024). https://www.nice.org.uk/guidance/cg31
Reid JE, Laws KR, Drummond L, et al. A systematic review and meta-analysis of randomised controlled trials of cognitive behaviour therapy with exposure and response prevention for obsessive-compulsive disorder. J Affect Disord. 2021;293:464-478. https://pubmed.ncbi.nlm.nih.gov/33618297/
International OCD Foundation. Exposure and Response Prevention (ERP). https://iocdf.org/about-ocd/treatment/erp/
Vogel PA, Launes G, Moen EM, et al. A pilot randomized controlled trial of videoconference-assisted treatment for obsessive-compulsive disorder. Behav Res Ther. 2014. https://pubmed.ncbi.nlm.nih.gov/25461792/
Goetter EM, Herbert JD, Forman EM, Yuen EK, Thomas JG. An open trial of videoconference-mediated exposure and ritual prevention for obsessive-compulsive disorder. J Anxiety Disord. 2014;28(5):460-462. https://pubmed.ncbi.nlm.nih.gov/24873883/
Fletcher TL, Hogan JB, Keegan F, et al. A pilot open trial of video telehealth-delivered exposure and response prevention for obsessive-compulsive disorder. J Clin Exp Neuropsychol. 2021. https://pmc.ncbi.nlm.nih.gov/articles/PMC10013345/
Voderholzer U, et al. Effectiveness of one videoconference-based exposure and response prevention session at home for obsessive-compulsive disorder: observational study. JMIR Ment Health. 2024. https://pmc.ncbi.nlm.nih.gov/articles/PMC10973968/
Feusner JD, et al. Effectiveness of video teletherapy in treating obsessive-compulsive disorder in children and adolescents: real-world outcomes. 2025. https://pubmed.ncbi.nlm.nih.gov/39869894/
Williams MT, Farris SG, Turkheimer E, et al. The myth of the pure obsessional type in obsessive-compulsive disorder. Depress Anxiety. 2011. https://pmc.ncbi.nlm.nih.gov/articles/PMC3227121/
International OCD Foundation. Ruminating on ruminations: mental compulsions and what to do about them. 2023. https://iocdf.org/blog/2023/02/02/ruminating-on-ruminations-mental-compulsions-and-what-to-do-about-them/
Hezel DM, Simpson HB. Exposure and response prevention for obsessive-compulsive disorder: a review and new directions. Dialogues Clin Neurosci. 2019. https://pmc.ncbi.nlm.nih.gov/articles/PMC6343408/
Disclaimer
This article is for informational and educational purposes only and is not a substitute for professional diagnosis, treatment, or medical advice. If you are in crisis or may be at risk of harm, call 988 in the U.S. or go to your nearest emergency room.
