Exposure and Response Prevention (ERP) Therapy for Children, Teens, and Adults
Facing fears one step at a time, so they stop running the show.
Evidence-based treatment for OCD, anxiety, intrusive thoughts, phobias, and avoidance.
At SageMind Psychology, we help children, teenagers, and adults overcome anxiety-driven patterns that interfere with everyday life.
Whether your child repeatedly asks for reassurance, your teenager is overwhelmed by intrusive thoughts, or you're an adult struggling with compulsive checking, health anxiety, or avoidance, Exposure and Response Prevention (ERP) can help.
Our therapists offer developmentally tailored ERP and exposure-based cognitive behavioral therapy (CBT) to help people tolerate uncertainty, build confidence, and get back to daily life.
Available in person in Brooklyn Heights and virtually in New York and 40+ additional states, depending on clinician licensure.
What Is Exposure and Response Prevention (ERP)?
Exposure and Response Prevention (ERP) is a specialized form of Cognitive Behavioral Therapy (CBT) and the gold-standard psychological treatment for obsessive-compulsive disorder (OCD).
Exposure-based CBT is also effective for many anxiety disorders and phobias, especially when fear leads to avoidance, rituals, or reassurance-seeking.
When anxiety shows up, it's natural to try to make it go away by avoiding, asking for reassurance, checking, mentally reviewing, or performing a ritual such as washing or counting. These behaviors bring quick relief, but they also teach the brain that the fear was real and the ritual was necessary. Over time, anxiety gets stronger.
ERP breaks this cycle. With your therapist, you gradually face the thoughts, situations, sensations, or uncertainty that trigger anxiety, while practicing not responding with compulsions or avoidance.
With practice, people learn they can handle discomfort and uncertainty without rituals or escape.
The goal isn't to eliminate every anxious thought. It's to help anxiety stop making your decisions.
How Do I Know If I or My Child Might Benefit From ERP Therapy?
Sometimes anxiety looks like worry. Other times it looks like anger, rigidity, perfectionism, or a constant need for reassurance.
Many people reach out because of behaviors they're noticing, not because they already know whether it's OCD, anxiety, or something else.
ERP or another form of exposure-based therapy may be helpful if you or your child:
Ask the same questions or seek reassurance over and over
Experience unwanted, disturbing, or intrusive thoughts
Need things to feel "just right" before moving on
Become extremely distressed when routines change or things feel uncertain
Avoid school, social situations, sleepovers, or separating from caregivers
Repeatedly check locks, appliances, homework, messages, or physical symptoms
Wash, clean, count, repeat, or redo things to relieve anxiety
Fear vomiting, choking, germs, illness, needles, or medical procedures
Struggle with perfectionism or an intense fear of making mistakes
Avoid situations because of embarrassment, judgment, or rejection
Experience panic attacks or fear the physical sensations associated with anxiety
Spend hours researching symptoms or mentally reviewing events
Depend on parents or partners to participate in rituals or help prevent feared outcomes
These behaviors don't automatically mean OCD or any specific diagnosis. Our clinicians look at what is driving them and recommend ERP, exposure-based CBT, parent coaching, or another evidence-based approach.
You don't need to know the diagnosis before reaching out. Helping you understand what's happening is part of our job.
What Conditions Can ERP and Exposure-Based Therapy Treat?
OCD and anxiety take many forms. At SageMind Psychology, ERP and exposure-based treatment may be used for the concerns below.
Obsessive-Compulsive Disorder (OCD)
ERP is a first-line psychological treatment for OCD, including:
Contamination OCD and excessive cleaning or washing
Checking OCD
Harm OCD and fears of causing harm
Scrupulosity and religious or moral obsessions
Relationship OCD (ROCD)
Sexual-orientation-related obsessions
Unwanted sexual intrusive thoughts
Symmetry, ordering, and "just right" compulsions
Mental compulsions, rumination, and reviewing
Reassurance-seeking and intolerance of uncertainty
Anxiety Disorders and Phobias
Exposure-based CBT can be effective for:
Separation anxiety disorder
Social anxiety disorder
Generalized anxiety disorder (GAD)
Panic disorder
Agoraphobia
Specific phobias, including fear of vomiting, needles, blood, animals, heights, flying, storms, and elevators
Illness anxiety disorder and health anxiety
Selective mutism, using developmentally appropriate graduated exposure and behavioral treatment
Other Conditions and Concerns
Exposure-based strategies may also be incorporated into treatment for:
Body dysmorphic disorder (BDD)
Anxiety-related perfectionism and fear of mistakes
Anxiety and OCD symptoms occurring alongside ADHD
Anxiety and OCD symptoms occurring alongside autism
Avoidant/restrictive food intake disorder (ARFID), when fear-based avoidance is present and specialized multidisciplinary care is appropriate
Medical procedure anxiety
Avoidance related to stressful life transitions
Treatment is tailored to each person's diagnosis, age, and needs, so not every concern is treated with the same ERP protocol.
ERP Therapy for Every Age and Stage of Life
Anxiety looks different at age 4, 14, and 40. Treatment should, too.
We tailor exposure-based treatment to each stage of development.
Young children: For our youngest clients, treatment is playful and caregiver-centered. It uses play-based exposure, small separation challenges, and flexibility-building games. For toddlers and very young preschoolers, parent-guided behavioral strategies are often a better fit than traditional ERP. Learn more about our Children’s Center.
School-aged children: Kids learn about anxiety in age-appropriate language and build personalized “fear ladders” to face fears gradually. Parents learn to reduce reassurance and support independence. When anxiety affects school attendance, our School Refusal Program and Child and Teen Intensive Outpatient DBT Program can offer more support.
Teens: ERP helps teens work on intrusive thoughts, social anxiety, checking, perfectionism, and avoidance. Teens help set their own goals, and we balance their independence with family involvement. Teens can also practice skills with peers in our DBT skills groups.
College students and young adults: Treatment targets intrusive thoughts, relationship obsessions, academic and social anxiety, and reassurance-seeking, so young adults can take on new independence with confidence. For those whose anxiety comes with intense emotions or overwhelm, our adult DBT program offers skills for managing hard moments.
Adults: Some adults spend hours mentally reviewing, researching, checking, or avoiding, and it gets in the way of work, parenting, and relationships. ERP helps adults break these cycles and make decisions based on their values rather than on anxiety. For adults who need a higher level of care, we offer an Adult Intensive Outpatient Program.
How Does ERP Therapy Work?
Step 1: Understand the Anxiety Cycle
Your therapist helps you identify triggers, intrusive thoughts, compulsions, avoidance, and reassurance-seeking, and how these patterns keep anxiety going.
Step 2: Build a Personalized Fear Ladder
Together, you build a list of challenges from easier to harder. This fear ladder is your roadmap, and every exposure is planned with you, never sprung on you or forced.
Step 3: Practice Facing Fears
With support, you gradually approach what triggers anxiety. That might mean touching something that feels contaminated, going to a feared social event, practicing time apart from a parent, or leaving home without rechecking the door.
Step 4: Reduce Rituals and Avoidance
Instead of performing a compulsion, escaping, or seeking reassurance, you practice responding differently. Over time, the link between fear and ritual weakens.
Step 5: Build Confidence Through Repetition
Practice happens in sessions and in everyday life. Progress shows up as less anxiety, and also as more independence, flexibility, and participation in the things that matter.
ERP helps you discover that feeling anxious and being capable can exist at the same time.
What Makes ERP at SageMind Psychology Different?
Evidence-based treatment should be both effective and compassionate.
Collaborative: You and your therapist set goals and plan exposures together.
Gradual: Treatment begins with manageable challenges and progresses as skills and confidence develop.
Compassionate: Facing fears takes courage. We offer support, encouragement, and flexibility along the way.
Practical: ERP happens in real life: at home, at school, at work, and wherever anxiety shows up.
Family-inclusive: Parents, caregivers, and partners learn to encourage progress without reinforcing compulsions or avoidance.
Developmentally tailored: Treatment is adapted to each person's age, abilities, and goals, from play-based work with young children to skills-focused treatment for adults.
Integrated when appropriate: Clinicians may add CBT, Dialectical Behavior Therapy (DBT) skills, parent coaching, or family work when helpful.
How Can Parents and Partners Help Someone With OCD or Anxiety?
Supporting someone with anxiety doesn't always mean making the anxiety go away.
When someone we love is distressed, we want to help right away. Parents may reassure a child again and again that nothing bad will happen. Partners may join in checking, answer the same question many times, or change routines to prevent distress.
These responses come from love, but they can keep the anxiety cycle going. ERP helps families offer warmth and encouragement while gradually reducing reassurance and accommodation.
For younger children, caregiver involvement is often central to treatment. For teens and adults, family participation depends on the client's needs and consent.
ERP Therapy in Brooklyn Heights and Online
SageMind Psychology offers ERP therapy in-person ERP at our Brooklyn Heights office and virtually in New York and 40+ additional PSYPACT states.
Virtual ERP lets clients practice skills in the places where anxiety actually happens. Our team works with children, teens, college students, and adults and will help match you with the right clinician.
Frequently Asked Questions About ERP Therapy
What is the best therapy for OCD?
ERP is widely considered the gold-standard psychological treatment for OCD. It helps people face obsessive fears while reducing compulsions, avoidance, and reassurance-seeking. Medication or other treatments may also be recommended.
Is ERP only for OCD?
No. ERP is specifically associated with OCD treatment, but related exposure-based CBT interventions are effective for social anxiety, panic disorder, separation anxiety, specific phobias, and other anxiety-related concerns.
How do I know if my child has OCD or anxiety?
They often overlap. OCD usually involves obsessions and compulsions, while other anxiety disorders involve ongoing worry, fear, and avoidance without the same rituals. A psychological assessment can clarify what's happening and which treatment fits.
My child constantly asks for reassurance. Can ERP help?
Yes, when reassurance-seeking is part of an OCD or anxiety cycle. Treatment can help children tolerate uncertainty while teaching parents how to provide support without repeatedly answering anxiety-driven questions.
Can ERP help a child who refuses to go to school?
Yes, when anxiety-driven avoidance is contributing to school attendance difficulties. Exposure-based interventions may help children gradually return to school-related activities, often alongside parent coaching, school collaboration, and other supports. For children who need additional support, we provide a school refusal program as well.
Can a 3-year-old or 4-year-old receive ERP therapy?
Very young children can benefit from developmentally appropriate exposure-based and parent-guided behavioral interventions. Traditional ERP may not be suitable for every preschooler, so treatment is tailored to the child's age, symptoms, and developmental abilities.
Can ERP help with intrusive thoughts?
Yes. ERP is especially effective for OCD involving unwanted intrusive thoughts, including fears related to harm, morality, relationships, or other distressing themes. Treatment helps clients change their responses to thoughts rather than trying to suppress or neutralize them.
Can ERP help with health anxiety?
Yes. ERP and other CBT strategies can help individuals reduce excessive symptom checking, reassurance-seeking, repeated online researching, and avoidance while maintaining appropriate medical care.
Can ERP help with a fear of vomiting?
Yes. Exposure-based CBT is commonly used to treat emetophobia, or fear of vomiting. Treatment is individualized and may address feared situations, bodily sensations, avoidance, and safety behaviors.
Can someone with ADHD or autism benefit from ERP?
Yes. ERP and exposure-based CBT can be adapted for people with ADHD or autism when appropriate. Therapists may adjust communication, pacing, sensory considerations, reinforcement, and executive-function support. All of our clinicians offer neurodivergent informed therapy.
Will ERP make my anxiety worse?
Exposure exercises can temporarily increase discomfort because they involve approaching feared experiences. Treatment is structured and collaborative, with challenges selected to support learning rather than overwhelm. Over time, many individuals experience reduced interference from anxiety.
Does ERP involve forcing people to face their biggest fears?
No. ERP at SageMind Psychology is collaborative. Therapists and clients work together to create manageable challenges and develop a treatment plan with active client participation.
How long does ERP therapy take?
Treatment length depends on diagnosis, symptom severity, goals, and consistency of practice. Some individuals benefit from a focused course of treatment, while others require longer-term or more intensive support.
Can ERP therapy be done online?
Yes. ERP can be delivered effectively through telehealth for many clients. Virtual treatment can also allow therapists to help individuals practice skills in the environments where anxiety occurs.
Do parents participate in their child's ERP treatment?
Often, yes. Parent involvement is especially valuable when children rely on family members for reassurance or when avoidance affects family routines. The degree of involvement depends on the child's age and treatment needs.
How do I find an ERP therapist for myself or my child?
Look for a licensed clinician trained in ERP or exposure-based CBT for your concern and age group. A free consultation with SageMind Psychology can help match you with the right clinician.
Take the First Step Toward Freedom From Anxiety
Anxiety may be part of your experience, but it doesn't have to make your decisions.
At SageMind Psychology, we help children, teens, and adults face fears, reduce compulsions, build confidence, and participate more fully in their lives.
Whether you're looking for an OCD therapist in Brooklyn, exposure therapy for your child, or virtual ERP treatment for yourself, our team can help you find the right starting point.
You don't have to feel completely ready to begin. You just have to be willing to take the first step.