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Exposure and response prevention (ERP)

ERP is the leading treatment for OCD in children and teens, and a powerful tool for anxiety.

The ERP fear ladder

123456Small steps, easiest firstAn example ladder, for a fear of germs1  Talk about the worry2  Look at a picture of it3  Touch a clean door handle4  Touch a shared surface5  Wait before washing hands6  Skip the ritualWhat happens to anxietypeaktime, without doing the ritual

Your child and I build the ladder together and start at the bottom. At each step, anxiety rises and then falls on its own, so the brain learns the fear can be handled.

In my practice

“Courage is not the absence of fear. It is doing the brave thing with a plan and with someone beside you.”

Pamela Wallberg, RCC

Understanding the approach

Exposure and response prevention is a form of CBT. It teaches children that facing a feared thought or situation, without doing the ritual that usually follows, lets anxiety rise and then fall by itself.

Over time, the brain learns the feared outcome is not coming, and OCD loses its power. It is done gradually and collaboratively. Your child never faces something they have not prepared for, and they help choose the steps. It is not about forcing a child through fear.

Origins and evolution

Exposure and response prevention was pioneered for OCD by psychologist Victor Meyer in the 1960s. It has since become the leading psychological treatment for OCD, with adaptations for children that involve parents and use playful language.

Meyer, V. (1966). Modification of expectations in cases with obsessional rituals. Behaviour Research and Therapy, 4(4), 273–280. link

Read the research

The science

ERP-based CBT is the first-line psychological treatment for OCD in children and adolescents. In the Pediatric OCD Treatment Study, CBT alone and CBT combined with medication both worked better than medication alone, and combined treatment was strongest. Clinical guidelines recommend CBT with ERP as a first-line treatment for mild to moderate OCD.

Geller, D. A., & March, J. (2012). Practice parameter for the assessment and treatment of children and adolescents with obsessive-compulsive disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 51(1), 98–113. link

Öst, L.-G., Riise, E. N., Wergeland, G. J., Hansen, B., & Kvale, G. (2016). Cognitive behavioral and pharmacological treatments of OCD in children: A systematic review and meta-analysis. Journal of Anxiety Disorders, 43, 58–69. link

Freeman, J., et al. (2014). Family-based treatment of early childhood obsessive-compulsive disorder: The Pediatric Obsessive-Compulsive Disorder Treatment Study for Young Children (POTS Jr). JAMA Psychiatry, 71(6), 689–698. link

Peris, T. S., Rozenman, M. S., Sugar, C. A., McCracken, J. T., & Piacentini, J. (2017). Targeted family intervention for complex cases of pediatric obsessive-compulsive disorder: A randomized controlled trial. Journal of the American Academy of Child & Adolescent Psychiatry, 56(12), 1034–1042. link

Pediatric OCD Treatment Study (POTS) Team (2004). Cognitive-behavior therapy, sertraline, and their combination for children and adolescents with obsessive-compulsive disorder. JAMA, 292(16), 1969–1976. link

Kelty Mental Health Resource Centre (BC Children’s Hospital): Obsessive Compulsive Disorder (OCD). link

Read the research

What sessions look like

  • Early sessions. Mostly learning, mapping OCD and building coping skills, before any exposure.
  • Practice sessions. Exposures in session, with homework to practise between sessions.
  • Parent coaching. Parents are included in the plan, since family routines often become tangled up with OCD.

How it works

The steps of ERP.

Every child is different, so the pace and order change. This is the general path.

01

Understand OCD

We learn how OCD works, give it a name and separate it from your child, so they see OCD as the problem, not themselves.

02

Build a fear ladder

Together we list feared situations from least to most scary, and your child helps pick the order.

03

Practise, one step at a time

Starting with easier steps, your child faces the fear without doing the ritual, and notices the worry rise and fall.

04

Support at home

Parents learn how to respond to OCD kindly, without giving reassurance or helping with rituals, and how to celebrate brave steps.

Where this approach helps

ERP is part of care for many concerns. Choose one to see how I work with it.

Related approaches

CBT → Play therapy → Parent coaching →

Common questions

Is ERP too hard for my child?+

It is hard work, but done in small steps at a pace your child helps set. Many children are surprised at how quickly anxiety drops.

Why can’t I just reassure my child?+

Reassurance brings short relief but teaches the brain that the fear needs checking. I show parents warm ways to respond that support your child without feeding OCD.

Is ERP only for OCD?+

It is most closely linked to OCD, but similar exposure methods also help with phobias, panic and other anxiety problems.

Ready to take a first step together?

You do not have to work this out alone. Book a free 15-minute call to talk about your child, your family and whether this approach fits.

Schedule free consultation

Trusted resources

More help for families in B.C.

Free, evidence-informed information from Kelty Mental Health at BC Children’s Hospital. These links open in a new tab.

OCD in children and youth Kelty Mental Health: what OCD is and how it is treated.Cognitive behavioural therapy (CBT) Kelty's overview of CBT.

Information on this page is provided by Pamela Wallberg, MA, RCC, Registered Clinical Counsellor. Last updated October 2026. This page is general information and is not a substitute for individual care.

Related: OCD therapy · CBT · Family and filial therapy