Make room for uncertainty and move toward what matters.
Thoughts keep circling even though you know they aren’t true. It’s frustrating, exhausting, and draining. ERP, exposure and response prevention, is built exactly for that: to approach the thought instead of avoiding it, and stop the checking, reassurance, or avoidance that keeps it going. I’m Nellie Harari, a licensed clinical psychologist with close to 20 years of experience doing this work.
You know the fear isn't real. The urge to respond is still there.
By the time you’re looking into ERP, you’ve probably already tried managing this on your own. Telling yourself the fear isn’t real. Asking for reassurance and checking again. Avoiding whatever sets it off. It works for a bit. Then the doubt comes back and wants another answer.
The stuff that brings relief is usually what keeps you stuck. Reassurance works until the next doubt shows up. Avoidance makes more things feel risky. Checking again settles it for a minute, then you need to do it again. ERP works on changing that.
The doubt won’t stop asking. ERP can change how you answer it.
You already know the fear isn't real. ERP is where that turns into something you can actually do.
ERP may be a good fit if you:
ERP changes what happens after the intrusive thought arrives.
ERP means approaching the thoughts, situations, or feelings that bring up anxiety instead of avoiding them, and sitting with the urge to check, wash, or ask again instead of just doing it. We go at a pace that works for you, and you keep practicing between sessions so it gets easier outside of therapy, too.
Here’s what the work actually involves:
The thought may return. Checking again does not have to follow it.
Hi, I'm Nellie Harari
Direct, warm, and not afraid to push a little.
I ask questions that help you look at familiar thoughts in a different way. I adjust the pace based on what actually works for you. We decide things together, and if something isn’t working, we change it.
I’m a licensed clinical psychologist with close to 20 years of experience, and I’ve worked with a wide range of OCD, from contamination and harm OCD to scrupulosity, relationship OCD, Pure O, and health anxiety. My primary framework is CBT, and I offer in-person sessions in Brooklyn Heights and online therapy throughout New York State.
ERP is the foundation. CBT, ACT, mindfulness, and compassion-focused work get added in when they help.
We don’t start with the hardest thing. We build a plan together and start with something uncomfortable but doable, a thought, an image, a feeling, whatever it is. Then we practice sitting with it instead of trying to fix it right away.
What this can look like in sessions:
After the anxiety kicks in, we practice not going back to check, wash, review, or ask for reassurance. This is usually the hardest part, so we figure out the pace together.
What this can look like in sessions:
You probably already know the feared outcome is unlikely. The hard part is living with the bit of uncertainty that’s left over. ACT helps you sit with that doubt or discomfort instead of checking it away.
What this can look like in sessions:
Intrusive thoughts can bring a lot of shame, especially when the content goes against what you actually care about. Compassion-focused work helps separate having a thought from what it says about you, which makes the whole thing easier to step away from.
What this can look like in sessions:
CBT helps us catch when OCD is making a thought feel bigger, scarier, or more urgent than it actually is. We look at what you believe about responsibility, risk, and what these thoughts mean. That work supports ERP. It doesn’t replace it or turn into another way to chase certainty.
What this can look like in sessions:
OCD can look different from person to person. The thoughts might be different, but the checking, reassurance, avoidance, or replaying it in your head usually feels familiar. These are the ones I see most often.
OCD can mean intrusive thoughts, images, or urges that won’t go away, no matter how hard you try to dismiss them. The content can be about harm, contamination, relationships, religion, health, whatever matters most to you. It usually leads to checking, asking again, avoiding, or replaying it in your head. ERP works on changing what happens after the thought shows up.
Contamination OCD can mean being afraid of germs, substances, surfaces, or touching other people. It’s usually not just about the germs. It’s about what happens if you don’t wash, clean, or avoid it. Checking OCD often shows up here too, washing your hands over and over, or double-checking that you avoided the contamination. Washing feels better for a minute and convinces your brain that the danger was real. ERP works by having you touch what you’re scared of while cutting back on the washing or avoiding.
Harm OCD means unwanted thoughts or images about hurting yourself or someone else. They’re distressing because they go against everything you actually care about. Avoidance, mental checking, and reassurance can start eating up more and more time. ERP works on approaching what you’ve been avoiding and cutting back on the checking and reassurance that’s been keeping it going.
Scrupulosity means intrusive doubts about morality, sin, faith, or whether you did something right. Prayer, confession, reviewing, or reassurance can start feeling forced instead of chosen. ERP works on the doubt itself and the repeated response around it, while still respecting what you actually believe.
Relationship OCD (ROCD) means constant doubts about whether the relationship is right, whether your feelings are strong enough, or whether you should feel more certain by now. You might review conversations, compare feelings, or keep asking for reassurance, even while knowing the relationship is actually good. ERP works on cutting back the reviewing and making room for the uncertainty instead of forcing an answer.
Pure O is a common name for OCD where the compulsions happen mostly in your head. Reviewing, counting, neutralizing, praying, repeating reassurance to yourself- it can look like normal thinking from the outside, which is why it’s harder to catch. ERP starts by noticing those responses and doing something different when the thought shows up.
Health anxiety can mean recurring fears about being sick, symptoms, or how your body feels. Googling it, checking your body, asking a doctor, asking someone else- it brings relief for a bit. Anxiety and panic often show up alongside health anxiety. ERP works on cutting back those checks and making room for not knowing right away.
Body-focused repetitive behaviors like hair pulling and skin picking can happen fast, almost without thinking, especially when you’re tense, concentrating, or uncomfortable. The work focuses on noticing the pattern, figuring out what sets it off, and practicing something different instead.
ERP can sound intimidating before you know what it actually involves. A few core ideas make the treatment easier to understand.
Exposure and Response Prevention is a behavioral therapy used for OCD and related anxiety patterns. It combines gradual exposure to a trigger with practice resisting the ritual, reassurance, or avoidance that would usually follow.
Core Principles and Historical Background of ERP
ERP traces back to the late 1960s, when psychologist Victor Meyer first showed that preventing compulsive rituals while approaching feared situations reduced OCD symptoms in ways that talk therapy alone had not. Research consistently shows that ERP interrupts this cycle of obsession and compulsion more reliably than other approaches.
CBT may involve looking at the thoughts and beliefs that increase anxiety. ERP places more emphasis on approaching triggers and changing the compulsive response that follows. Cognitive strategies can support the work, but they should not become another form of reassurance.
Reassurance can calm the doubt for a moment, which is exactly why it becomes difficult to stop seeking.
Avoidance can bring immediate relief while making the trigger feel more difficult to approach later.
An exposure hierarchy is a list of triggers arranged from less difficult to more difficult. We build it together based on the person’s actual fears and compulsions.
Imaginal exposure is used when a feared outcome cannot be approached directly or when the obsession centers on a thought or image. It may involve writing or listening to a script while practicing response prevention.
The first session is about figuring out what’s been going on and whether ERP makes sense for you. We don’t start exposures on day one.
You don’t need to know exactly where to start, and you don’t need to jump into exposures right away. We use the early sessions to make sense of the pattern and figure out together what a reasonable next step looks like.
You can see the whole plan before you decide whether to start.
We start by exploring what’s going on beneath the surface so we can understand what’s driving your challenges.
Together, we connect the dots between your thoughts, emotions and behaviors to discover the meanings you place on distressing events in your life.
You’ll learn and try out new ways of thinking, feeling, and responding that support lasting,
healthy change.
We focus on deepening your growth and helping you carry what you’ve learned into everyday life with confidence and clarity.
ERP stands for Exposure and Response Prevention. Exposure response prevention therapy is the most effective OCD treatment available and the first-line approach recommended across clinical guidelines. It is a specific behavioral therapy developed to interrupt the cycle that maintains obsessive-compulsive disorder. The exposure component involves deliberately approaching the thoughts, situations, or stimuli that trigger OCD-related distress. The response prevention component involves refraining from the compulsive response that would ordinarily follow. Together, these interrupt the cycle that maintains OCD.
How ERP Differs From Standard CBT: Exposure and Ritual Prevention
Standard CBT combines cognitive and behavioral techniques. ERP is a specific protocol within that framework, using exposure and ritual prevention as the primary mechanism of change. Cognitive work supports the exposure work rather than replacing it.
Yes. ERP is the gold-standard, evidence-based treatment for OCD, supported by decades of research. The goal is not to eliminate every intrusive thought. It is a meaningfully different relationship to them, where they no longer drive compulsive behavior.
How Long Does ERP Therapy Take?
The timeline depends on severity and how consistently the between-session practice is engaged with. Many people see meaningful change over several months of weekly work. We discuss the timeline regularly.
What Happens If ERP Has Not Worked Before?
Worth examining rather than assuming ERP cannot help. Common reasons include insufficient exposure intensity, reassurance built into the exposure process, or avoiding the most distressing hierarchy items.
ERP treats every type of OCD. The content of the thought does not change the treatment approach. What matters is identifying the obsession, the compulsive response, and the avoidance.
OCD Subtypes Treated With ERP
Health Anxiety, OCD, and Medical Reassurance Seeking
Involves intrusive fears about illness, plus the checking, reassurance, and avoidance that follow. Distinguished from general health anxiety by the compulsive quality of the response.
Hair Pulling, Skin Picking, and Body-Focused Repetitive Behaviors
Hair pulling (trichotillomania), skin picking, and body dysmorphic disorder (BDD) share structural features with OCD. The behavior provides brief relief, then the urge returns. ERP-informed approaches address these patterns directly.
Obsessions are intrusive, unwanted thoughts, images, or urges that produce significant distress. They are ego-dystonic, meaning they conflict with the person’s values and wishes rather than reflecting them. Compulsions are repetitive compulsive behaviors or mental acts performed in response to an obsession to reduce distress or prevent a feared consequence. These behaviors reinforce the cycle by providing temporary relief. In ERP, we target both: exposures target the obsessions, response prevention targets the compulsive behaviors.
Mental Compulsions and Pure O
Internal rituals like reviewing, counting, neutralizing, or mentally checking count as compulsions even though they are not visible. Pure O refers to OCD where the compulsions are primarily mental. Treatment is identical: building awareness and practicing, not performing them.
Safety Behaviors and How They Maintain the OCD Cycle
Actions that are not technically compulsions but serve the same function, like carrying a phone in case of an emergency or sitting near an exit. Each one confirms the anxiety’s premise. Dropping them is often central to response prevention.
ERP involves deliberately approaching situations and thoughts that produce real anxiety. That is not a side effect; it is how the treatment works. The distress is real and paced carefully, starting where the anxiety is manageable rather than overwhelming.
What to Do If ERP Makes Anxiety Worse Initially
Some initial increase in distress is expected and part of how ERP works. If anxiety is escalating in a way that feels unmanageable across sessions rather than within them, bring that into the next session.
Panic Attacks and Physical Sensations in ERP
Panic attacks and strong physical sensations can occur during exposures, especially early in treatment. They are uncomfortable but not dangerous. When panic is a primary concern, interoceptive exposure targets the physical sensations directly.
Yes. ERP is used for specific phobias, health anxiety, panic disorder, social anxiety, and emetophobia (fear of vomiting), all of which involve avoidance, maintaining the anxiety. Anxiety and panic therapy Anxiety and panic therapy at this practice draws on the same ERP principles alongside CBT.
ERP for Perfectionism
Perfectionism that takes on an OCD-like quality, where a standard becomes a feared consequence prevented through compulsive checking, responds to ERP. Perfectionism therapy at this practice incorporates ERP when behavioral patterns are maintaining the anxiety.
Acceptance and Commitment Therapy and ERP
ACT addresses cognitive fusion, the tendency to treat intrusive thoughts as literal truths, and builds the willingness to experience discomfort that ERP requires.
The exposure hierarchy, also called the fear ladder, is a ranked list of triggers ordered from least to most difficult. We built it together in the early sessions. Starting at the bottom does not mean starting where it is easy.
Imaginal Versus In-Vivo Exposure
In-vivo exposure means approaching real situations, objects, or people. Imaginal exposure means engaging with feared thoughts or scenarios in the imagination, often using a written script, when the feared consequence cannot be directly approached.
Practice Assignments and Weekly Sessions Between ERP Appointments
Weekly sessions are the structure. Each session ends with a specific practice assignment: a situation to approach, a safety behavior to drop, or a script to engage with. What happens between sessions often matters most.
Habituation and Inhibitory Learning in ERP
Two overlapping mechanisms. Habituation is the natural reduction in anxiety with repeated exposure. Inhibitory learning is the newer model: exposures build new associations that compete with the old fear response. Both require response prevention.
Internal rituals like reviewing, counting, neutralizing, or praying to undo are mental compulsions. They are harder to catch than overt compulsions because they can feel like reasonable problem-solving. The ERP approach is the same: build awareness and practice not performing them.
Reassurance Seeking as a Compulsion in OCD
One of the most common and most maintained compulsions in OCD. It reduces distress temporarily, but the doubt returns stronger. Family members or partners may be involved in reducing how much they accommodate it.
Intolerance of uncertainty is one of the most reliable maintaining factors in OCD. For many people, certainty about a bad outcome would be more tolerable than sustained not-knowing. This drives the checking, reassurance-seeking, and mental reviewing that ERP works with directly.
ERP and ACT: Working With Uncertainty Together
ERP and ACT work well together because ACT directly builds the willingness to experience uncertainty that ERP requires. The goal is not certainty. It is the capacity to tolerate uncertainty well enough to refrain from the compulsion.
ERP is designed for OCD and anxiety conditions where avoidance maintains the fear. Trauma-focused exposures, like Prolonged Exposure for PTSD, are a distinct protocol for a different mechanism. Trauma-focused exposure therapy is not offered at this practice, but co-occurring trauma is part of the early assessment.
ERP for Co-Occurring OCD, ADHD, and PTSD
OCD alongside ADHD is common. ADHD can make consistent practice harder to sustain, so the plan is adjusted. When OCD co-occurs with post-traumatic stress disorder, treatment is typically sequenced rather than combined, since the two require different clinical logic.
Debunking Myths About ERP: Trauma, Complexity, and Effectiveness
A common misconception is that ERP is too traumatic or only works for certain OCD types. Neither is accurate. ERP is paced deliberately and is highly effective across every presentation, producing measurable symptom reduction for most people who engage consistently.
Sessions are typically weekly at the start. Between-session practice is equally important, since ERP works through repeated exposure across many trials, not through understanding alone. People who engage with the practice consistently tend to progress faster.
How Often Sessions Are Needed and Intensive ERP
Depends on the severity and how the work is progressing. Some presentations benefit from more frequent sessions, especially when a concentrated period of exposure work is clinically indicated.
A common concern that deserves a direct answer. Compulsions feel like they are preventing something. They are not. Feared outcomes do not actually depend on the compulsion, and stopping it reduces the anxiety’s influence rather than increasing actual risk.
Answering Patient Concerns: Exposures, Medication, and Past Failures
Feeling afraid of exposure is common and does not disqualify anyone from doing ERP well. Medication combined with treatment is common practice, and the two are not in conflict. Exposures happen in a controlled environment at a collaborative pace, which is how people gain confidence.
Patterns can resurface during periods of high stress or significant life change. What changes through ERP is that the pattern is recognizable earlier, and the tools for responding are available. Returning for booster sessions is a reasonable and common response.
Response Prevention and Long-Term Maintenance Strategies
Involves resisting the urge to perform compulsions independently using the strategies learned in treatment. This gets more automatic over time. Recognizing early warning signs and returning for booster sessions if needed helps build resilience that holds up under stress.
Yes. Online therapy is available for adults anywhere in New York State and follows the same structure as in-person work. Exposures can often happen in the natural environment where triggers occur.
ERP Therapy in Brooklyn, NY, and Midtown Manhattan
In-person sessions are at 26 Court Street, Suite 600, Brooklyn Heights, Brooklyn, NY 11242, near Borough Hall and Court Street Station, served by the 2, 3, 4, 5, N, R, and W trains. Online sessions are available for adults throughout New York State.
How to Find an ERP Therapist Near Me in Brooklyn
The Brooklyn Heights office is steps from Borough Hall and Court Street Station, with Jay Street-MetroTech about 5 minutes away. A free 15-minute consultation is available to discuss fit before committing.
Licensed ERP Therapy Across Brooklyn and the NYC Boroughs
As a licensed therapist trained in ERP, I see people from Brooklyn and the surrounding boroughs, including Manhattan, Queens, the Bronx, and Staten Island, both online and in person. Unlike larger clinics with multiple therapists and clinical directors, this is a solo practice, so every session is with me directly.
Below is current information on fees, insurance, and how to access sessions.
