Exposure and Response Prevention: My Journey, the Evidence, and Why I Built Foothold Now
Table of Contents
Introduction
Quick Summary
What ERP Asks of You
Why I Built Foothold Now
What Actually Decides Whether It Works
References
Introduction
For a long time I thought that spending thirty minutes before bed checking that the items in my room were positioned right, that the lights were really off, and that getting up and back into bed had gone correctly, was just my routine. I thought being hyper-focused on my thoughts was what made me detail-oriented. It did not occur to me that it was costing me anything.
Not until I did ERP—Exposure and Response Prevention—did I understand how much time I could get back, and that exposure was how I could start removing myself from obsessive and compulsive cycles instead of negotiating with them.
Therefore, I wanted to see what exists to support the part of ERP that happens when nobody is watching.
Quick Summary
Topic: What ERP is, why the work that decides the outcome happens between sessions, and what I built.
Key Takeaways:
ERP is the first-line treatment for OCD (American Psychiatric Association, 2007; NICE, 2005), with a large pooled effect against placebo (Song et al., 2022).
The strongest patient-side predictor of whether it works is homework adherence—the exposures you do alone (Simpson et al., 2021). It is also the least supported part.
Almost nobody receives ERP at all. 95–98% of people with OCD never have (International OCD Foundation, 2026).
What ERP Asks of You
ERP was the first cognitive behavioral therapy built for OCD (Meyer, 1966). You and a clinician identify your triggers and compulsions, then work through a hierarchy of exposures—least frightening first—while practicing response prevention: you do not run the ritual that makes the distress go away (Foa et al., 2012).
The point is not to prove the fear is silly. It is to find out that the disastrous consequence does not arrive. For me, the exposure was going to bed once. The response prevention was staying there.
Why I Built Foothold Now
My exposures previously lived in a Google Doc. However, I found it slightly difficult with documents. A doc is a document, not an instrument: you type "65" into a table cell, which is not the same motion as moving a scale and watching it land. It stores the work. It does not help you do the work.
Therefore, I built Foothold Now so I could log my exposures anywhere, at any time, in something that looked and moved like a tool for the thing rather than a file about it. You can check out this tool here.
You build practice ladders: name what you are working toward, break it into steps in your own words, rate each 0–100 by how hard it feels, and repeat a step until it loses its grip. A ladder is an exposure hierarchy; the ratings are SUDS scores, the same scale a clinician uses in session (Foa et al., 2012).
It is a website you can add to your home screen, nothing leaves your browser unless you sign in, and there is no AI talking to you inside it. It is a practice companion, not medical care—if you have a therapist, build your ladders together.
What Actually Decides Whether It Works
Between-session homework is not a supplement to ERP. It is the protocol, and completing it robustly predicts outcomes across delivery formats, in adults and children alike (Wheaton & Chen, 2021).
The sharpest finding I came across: in a trial of 137 adults, researchers tested behavioral, psychological, and biological predictors of remission—down to OCPD traits and BDNF genotype. Homework adherence was the most potent patient factor overall (Simpson et al., 2021).
Therefore, what most determines whether ERP works is what you do alone, in the moment you are least equipped to do it. That is not a discipline failure—avoidance is what the disorder is made of. It is a design problem, and design problems can be worked on. Hopefully Foothold Now can be that design solution for some.
References
American Psychiatric Association. (2007). Practice guideline for the treatment of patients with obsessive-compulsive disorder. https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/ocd.pdf
Foa, E. B., Yadin, E., & Lichner, T. B. (2012). Exposure and response (ritual) prevention for obsessive compulsive disorder: Therapist guide. Oxford University Press.
International OCD Foundation. (2026, April 6). The most effective OCD treatment reaches almost no one: Here's what we can do about it. https://iocdf.org/blog/2026/04/06/the-most-effective-ocd-treatment-reaches-almost-no-one-heres-what-we-can-do-about-it/
Meyer, V. (1966). Modification of expectations in cases with obsessional rituals. Behaviour Research and Therapy, 4(4), 273–280. https://doi.org/10.1016/0005-7967(66)90023-4
National Institute for Health and Care Excellence. (2005). Obsessive-compulsive disorder and body dysmorphic disorder: Treatment (Clinical guideline No. 31). https://www.nice.org.uk/guidance/cg31
Simpson, H. B., Foa, E. B., Wheaton, M. G., Gallagher, T., Gershkovich, M., Schmidt, A. B., Huppert, J. D., Campeas, R. B., Imms, P. A., Cahill, S. P., DiChiara, C., Tsao, S. D., Puliafico, A. C., Chazin, D., Asnaani, A., Moore, K., Tyler, J., Steinman, S. A., Sanchez-LaCay, A., ... Wang, Y. (2021). Maximizing remission from cognitive-behavioral therapy in medicated adults with obsessive-compulsive disorder. Behaviour Research and Therapy, 143, 103890. https://doi.org/10.1016/j.brat.2021.103890
Song, Y., Li, D., Zhang, S., Jin, Z., Zhen, Y., Su, Y., Zhang, M., Lu, L., Xue, X., Luo, J., Liang, M., & Li, X. (2022). The effect of exposure and response prevention therapy on obsessive-compulsive disorder: A systematic review and meta-analysis. Psychiatry Research, 317, 114861. https://doi.org/10.1016/j.psychres.2022.114861
Wheaton, M. G., & Chen, S. R. (2021). Homework completion in treating obsessive–compulsive disorder with exposure and ritual prevention: A review of the empirical literature. Cognitive Therapy and Research, 45(2), 236–249. https://doi.org/10.1007/s10608-020-10125-0
Tags: OCD, ERP, exposure and response prevention, mental health access, Foothold Now