We often hear about the importance of facing our fears—whether in everyday life or in anxiety and OCD treatment. And for good reason: being able to tolerate discomfort, step outside of our comfort zones, and challenge limiting beliefs are all essential skills. They help us grow and show us that we’re often more capable and resilient than we think.
But when it comes to treating Obsessive-Compulsive Disorder—and, honestly, anxiety in general—there’s a piece that’s often overlooked or misunderstood: response prevention.
Facing Fear Isn’t Enough
In OCD treatment, we use Exposure and Response Prevention (ERP). Many people understand the “exposure” part—intentionally facing a fear without avoiding it. But without the second piece, response prevention, exposures lose their power. In fact, exposures without response prevention can actually reinforce the anxiety cycle and leave people feeling more stuck than before.
So what exactly is response prevention?
What Is Response Prevention?
Response prevention means resisting the urge to perform compulsions or safety behaviors after an exposure. Compulsions are the rituals—physical or mental—that people with OCD (and anxiety more broadly) do to try to feel safe or reduce uncertainty. They might bring temporary relief, but they ultimately keep the anxiety cycle alive.
Let’s break this down with an example.
A Real-Life Example: Contamination OCD and the Stomach Bug
Imagine you’re a parent with a very common fear: your child or family getting the stomach bug.
You’re out and overhear someone say their kid just had the stomach bug. Your brain might instantly misinterpret this as a serious, immediate threat. You feel a spike of anxiety and, almost reflexively, start engaging in behaviors to “prevent” the feared outcome:
Avoid going to crowded places like school, birthday parties, or the grocery store.
Start symptom-checking: Do I feel nauseous? Is my child acting off?
Take everyone’s temperature—just to be sure.
Google local outbreaks of norovirus or read message boards about how to avoid it.
Now let’s say no one ends up getting sick. Your brain concludes, “Phew. All that checking, avoiding, researching—it worked! Crisis averted.”
But what you’ve actually done is reinforce the belief that compulsions are necessary to stay safe. You’ve given anxiety exactly what it wants: control.
Yes, it’s wise to practice reasonable hygiene and avoid known illness when possible. But complete avoidance of uncertainty isn’t possible. You can’t know who might become ill tomorrow, or what germs are on the shopping cart handle today. It’s an illusion of control, and chasing it keeps you locked in anxiety.
So How Do We Break the Cycle?
Here’s where response prevention becomes the star of the show.
Let’s say you do an exposure: you go to the grocery store even though it makes you anxious. That’s great! But if you go home and immediately wash your hands ten times, ask your kids if their stomachs hurt, and scroll for updates about norovirus in your area—you’ve undone the progress. The exposure just became another loop in the OCD cycle.
True change happens when you not only face the fear—but also resist the compulsions. That’s response prevention.
Why Is Response Prevention So Important?
If you do an exposure without resisting compulsions, you’re essentially increasing your anxiety for no benefit. You’re still sending the brain the same message: “This is dangerous, and I need to control it.”
When you do resist the compulsion, your brain begins to learn in two critical ways:
Inhibitory Learning – Your brain starts to realize: “I was anxious, didn’t do the compulsion, and the feared outcome didn’t happen—or if it did, I coped.” This creates new learning that inhibits the old fear pathways.
Habituation – Your nervous system starts to settle. Think of it like getting into a cold pool. At first, the water feels unbearable. But if you stay in, your body adjusts. The same is true with anxiety: if you stay with it (without escaping through a compulsion), the intensity naturally comes down.
Response Prevention: The Missing Piece
For many people, response prevention is the missing piece in treatment. You might be doing all the “right” things—going to the places that scare you, facing the thoughts head-on—but still feel stuck. If you’re not pairing exposures with response prevention, the anxiety doesn’t have a chance to shift.
The good news? Once you begin practicing both pieces of ERP—exposure and response prevention—your brain starts to change. It learns that you can tolerate fear. That you don’t have to control everything. That uncertainty, as uncomfortable as it is, doesn’t mean danger.
A Hopeful Note
If you’re struggling with OCD or anxiety and feel like nothing is working, know this: it’s not because you or your family are beyond help. It might just mean that this key ingredient—response prevention—has been missing.
It takes courage to resist compulsions, to lean into uncertainty, and to trust the process. But with support and practice, it absolutely works. Your brain can learn. You can get your life back.
You are not your compulsions. You are not your fear. And you don’t have to do this perfectly—you just have to start.
Barb Shepard is a Licensed Mental Health Counselor and OCD and Anxiety Specialist in Syracuse, New York.
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Please note that Any content on my website or blog is a not substitute for therapy and is for educational purposes only. I cannot provide tailored therapeutic advice unless you are a therapy client. Reading this blog or listening to audio content does not constitute a therapeutic relationship. If you are seeking therapy, visit psychologytoday.com. If you are in crisis, dial 911 or visit your local emergency room.
Barb Shepard, LMHC, PLLC 