ERP for Hit-and-Run OCD | Houston OCD Therapy Guide
The Houston OCD Treatment Guide is a resource for adults and teens seeking therapy for obsessive-compulsive disorder (OCD) or currently in treatment. In my practice, I’ve found that using local references, no matter how subtle, helps normalize my clients’ experience, makes them feel less isolated, and encourages them to approach treatment with greater confidence. While many general resources exist for OCD, few, if any, are tailored to Houston. My hope is that this guide bridges that gap by offering local connections that make you feel seen, supported, and empowered in your treatment journey.
It is important to note that these blogs are not a substitute for professional clinical recommendations. Exposure and Response Prevention (ERP) is most effective when undertaken with a trained OCD specialist who can help you navigate treatment safely and effectively.
What Do Hit-and-Run Obsessions Look Like?
If you’ve ever felt terrified that you might have hit someone with your car, even though there’s no evidence, you’re not alone. This experience is often part of a form of OCD known as Hit-and-Run OCD. While there are many great resources out there (like the IOCDF, NOCD, and videos by therapists such as Nathan Peterson), sometimes hearing someone else’s story can make things click in a new way.
In this post, we’ll take a closer look at Sarah’s experience and how OCD impacts her daily life. We’ll also walk through some examples of how ERP helped her, and can maybe help you too.
Meet Sarah
Sarah is 33, married, and the mom of a 6-year-old son. Every morning, she drops her son off at St. Laurence Catholic Elementary School, and every morning, she’s overwhelmed with anxiety.
She explains:
“I just feel like I accidentally ran over a kid during drop-off.”
Even after leaving the school, Sarah doesn’t go home right away. Instead, she waits at a nearby CVS until 8:30 AM, when drop-off ends, so she can go back and check that nothing happened. While she waits, she reviews her dashcam footage and searches the news for things like “St. Laurence student death” just to be sure.
Still, nothing feels like enough.
“Even when I look at the dash cam, I keep thinking I could have missed something,” she says. “If I’m wrong, I could never live with myself knowing I hit a kid and drove off. I’d be in jail, and my son’s life would be ruined because of me.”
When she finally gets home, she checks her car for dents and mentally replays the entire drive, over and over.
What Are the Compulsions?
Sarah is using several compulsions to feel 100% certain nothing bad happened. But despite all this checking, she still feels just as anxious and confused. That’s why the first step in her ERP journey is identifying these compulsions, so she can begin practicing exposures that help her live more flexibly.
Here are some of the compulsions Sarah uses:
Checking dash cam footage after drop-off
Googling news stories to see if an accident occurred
Waiting in the parking lot until drop-off ends
Driving back to retrace her route
Inspecting her car for dents
Replaying the drive in her mind
Mentally reassuring herself that nothing happened
Now, imagine that Sarah reports that letting go of any of these compulsions during drop-off would be a “10/10” on the anxiety scale. That tells us we need to start somewhere else in our exposure hierarchy.
Step-by-Step: Letting Go of Physical Compulsions
Since school drop-off is a 10/10 in anxiety for Sarah, she can begin with easier situations to practice resisting the urge to check or go back.
Sample Exposure Hierarchy:
Drive around a Chick-fil-A parking lot (3/10)
Drive through a Walmart parking lot on a weekday (5/10)
Drive around a Costco parking lot during the weekend (7/10)
Drive around Memorial Park during the weekend when lots of families are out (8/10)
Do the school drop-off without compulsing (10/10)
At each level, Sarah is practicing not going back, not checking, nor seeking reassurance. From her first exposure, she begins building the foundation that will help her successfully drop off her son at school without compulsing.
Step-by-Step: What About Mental Compulsions?
Letting go of physical rituals is crucial, but mental compulsions can be just as sticky. If you continue engaging in mental compulsions during exposures, you may stay anxious longer and slow your progress.
In Sarah’s case, her mental compulsions include:
Replaying the drive in her head
Reassuring herself that nothing happened
Repeatedly reasoning her way out of the fear
Exposure ideas for letting go of mental compulsions:
Read a story about a hit-and-run in another state (4/10 anxiety)
Notice the urge to think, “What if that’s me?” and practice not engaging
Use mindfulness: notice the thought, and let it pass
Practice non-engagement responses to minimize rumination
Read a story about a hit-and-run in Houston (7/10)
Read about someone who didn’t realize they had committed a hit-and-run (9/10)
Combine the mindfulness and cognitive skills with driving exposures (3–10/10) to practice not mentally reviewing
Don’t Skip the Shame
One of the hardest parts of Hit-and-Run OCD is the shame. You might feel like if you stop checking, it means you don’t care, or that you’re okay with being a bad person. But that’s not true. You care deeply. That’s why OCD latched onto this fear in the first place. Working with an OCD specialist can help you recognize shame as just a feeling, not a fact.
Hit-and-Run OCD Therapy Near You
There are a lot of nuances that can’t be captured in a blog post. With that said, I hope reading about Sarah’s case helped show you that you aren’t alone and that successful treatment is possible. If hit-and-run OCD is interfering with your life, we’re here to help. Whether you live in Houston, Dallas, or anywhere in Texas, contact OCD & Anxiety Recovery today to start your journey toward healing and reclaiming your freedom.
