Does OCD get worse at the start of ERP?
Written by the clinical team at The Lyceum Clinic. Clinically reviewed by Sanah Younis, Founder and Clinical Director, BABCP-accredited (no. 1000792). Published 28 October 2026. Last reviewed 28 October 2026.
Clinical perspective: The Lyceum's specialist therapist in OCD.
How do you explain ERP to someone who is frightened of it?
'Right now, your OCD is a monster that lives in your house, and every time it roars, you feed it a compulsion to make it quiet down. But feeding it just makes it bigger. ERP is the process of starving the monster. Yes, when we stop feeding it, it is going to roar louder than ever for a little while. But if you stand with me and refuse to give it the food (the ritual), the monster will eventually shrink and go to sleep.'
Why can anxiety feel worse early in treatment?
I warn them in session one: 'In week 2 or 3, your anxiety will likely spike. This is called an extinction burst. Your brain is used to getting its way through avoidance. When we block the avoidance, the brain throws a tantrum to force you back into submission. When the spike happens, do not panic; it means the medicine is working.'
For more detail, read about OCD therapy.
What is the hardest part of this treatment, and what do you say to someone standing at the edge of it?
The hardest part is the 'Extinction Burst', the moment in exposure therapy (or behavioural activation) where the anxiety spikes because we have taken away their coping mechanism, and their brain screams that they are in danger. To someone standing on that edge, I say: 'Every cell in your body is telling you to run, to check, to hide. That is just your alarm system firing blindly. The only way out of this cage is through the fire. I am right here with you. Drop the armour, let the anxiety peak, and watch it burn itself out. You are strong enough to hold this.'