Making OCD Exposures Meaningful | Houston OCD Therapy Guide

The Houston OCD Therapy 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.

ERP Isn’t One-Size-Fits-All

There are many excellent resources explaining ERP (Here, Here, and Here!) and plenty of templates for constructing an exposure list (Here, and Here). However, a common concern among new patients is:

“I’ve seen exposure lists. I don’t understand how they make sense.”

For example, if you have Harm-OCD you may have seen a generic exposure list such as:

• Write the word “stabbing” repeatedly (3/10)

• Record yourself saying, “I am capable of harming someone” (4/10)

• Sit in a café and mentally say to yourself, “I could lose control.” (6/10)

• Writing a detailed script of a feared harm scenario and reading it aloud (9/10)

• Holding a knife in one’s lap with someone in the room while thinking, “What if I stab them?” (10/10)

Understandably, your first thoughts may be, “That sounds terrifying, why would I do that? Even people without OCD don’t do those things!” And to be fair, you’d be right. ERP isn’t about following a one-size-fits-all list of exposures. It’s about designing exposures that help you move toward personally meaningful activities that align with your values.  

How to Make Exposures Meaningful

A useful thought experiment for beginning your exposure list is: “If someone filmed my day and I refrained from engaging in compulsions, what would look different?” In other words, what would you be doing more freely and confidently if OCD were not interfering?

Consider Josh, a sophomore engineering student at Rice University who struggles with Harm-OCD:

What would probably show up on camera is me cooking more. I used to enjoy cooking for others, but now I only buy ready-made meals from H-E-B to avoid using knives in front of people, especially my girlfriend.

You’d probably see me going to more movies with friends. It’s how I made friends during freshman year. Now, I avoid going to the movies because I’m afraid of seeing something violent and ruminating if I’m a murderer all day long.

I’d probably be doing more homework. I’m usually so preoccupied with intrusive thoughts and images that I end up doom-scrolling for hours just to distract myself. Lastly, I’d attend more classes. I sometimes skip class because I feel so anxious about my thoughts.

What does Josh learn about himself from this activity? Well, he learns that he values his relationships and education, and that he used to express those values by cooking, going to the movies, and meeting his academic responsibilities. This means his exposures should help him move toward these important aspects of his life.

Exposures as Training Exercises

A common challenge in ERP is that the most personally disruptive triggers often rank highest in distress, making them feel insurmountable. For instance, Josh may rate cooking in front of his girlfriend with a knife as a 10/10 exposure. Because of its intensity, he might feel that ERP is beyond his reach.

However, exposures don’t need to perfectly replicate the feared situation to be effective. Instead, they can be structured like training exercises that build toward a larger goal.

Think of it like sports training. Basketball players practice dribbling around stationary cones, not because they will face cones in a real game, but because this drill strengthens their ball-handling skills for game time. Similarly, musicians (shoutout to fellow clarinetists!) practice scales to improve their technical skills to play complex compositions.

In Josh’s case, breaking his exposure into smaller, skill-building steps allows him to gradually work toward his goal:

• Hold scissors alone (2/10)

• Practice not relying on avoidance to manage anxiety

• Practice mindfulness to be with distressing thoughts and uncertainty

• Practice acceptance skills to be with the anxious feelings

• Hold a knife alone (4/10)

•  Like the scissors exposure but more challenging

• Use a knife while eating at North Servery (5/10)

• First practice of using a knife in front of others

• Utilize previously learned mindfulness and acceptance skills to accept anxious thoughts and feelings while not compulsing

• Hold sharp scissors while sitting with girlfriend (6/10)

• Like the North Severy exposure, but this time holding a sharp object with someone important to Josh

• Continue to use mindfulness and acceptance skills to be with distressing thoughts and feelings while with someone

• Read about a murder (7/10)

• Practice non-engagement responses to reduce mental compulsions such as rumination

• Read about the Andrea Rodriguez case (8/10)

• A tragic event involving a Rice student that would be more challenging to not mentally compulse after reading

• More practice with non-engagement responses

• Prepare food in front of roommates that requires a knife (9/10)

• Learn to accept and be willing to feel anxious while cooking

• Josh teaches his OCD that he can use knives in front of others while accepting uncertainty

• Cook in front of girlfriend while using a knife (10/10)

• By now, Josh has practiced:

• Mindfulness, acceptance, and willingness skills in multiple contexts

• Accepting uncertainty  while using sharp objects in front of others

• Learned how to use non-engagement responses to reduce mental compulsions.

As you can see, by engaging in exposures that systematically build tolerance to distress and uncertainty, Josh can regain his ability to live according to his values. Although holding scissors alone isn’t something I’m sure Josh plans on doing his whole life, it does help him build confidence to do the harder, more meaningful exposures such as cooking for his girlfriend. Lastly, the skills that Josh used for these exposures can carry over to other areas in his life, such as watching movies or studying!

ERP Therapy Near You

ERP is not about completing an arbitrary list of exposures; it is about reclaiming your life. The most meaningful exposures are the ones that help you move toward the relationships, experiences, and activities that matter most to you. Whether you live in Houston, Dallas, or anywhere in Texas, consider working with a trained ERP therapist to develop a customized exposure plan tailored to your unique challenges and goals.