Exposure Therapy for Anxiety and OCD: Facing Fears, Safely

Anxiety and OCD Are Common, and Treatable

Anxiety and obsessive-compulsive disorder (OCD) are common, and they respond well to treatment. In 2022, about 1 in 5 U.S. adults (18.2%) reported recent anxiety symptoms, up from 15.6% in 2019 (CDC/NCHS, 2024). OCD affects roughly 1 to 3 percent of people worldwide (StatPearls/NIH Bookshelf, 2024). One of the most effective, evidence-based treatments for both is exposure therapy, including Exposure and Response Prevention (ERP) for OCD (Reid et al., 2021). For generalized anxiety, CBT outperformed usual care across 65 randomized trials (Papola et al., 2024).

Those numbers represent real people in our communities, from students at California State University San Bernardino to healthcare workers in Redlands to families across San Bernardino and Riverside counties. This guide explains what exposure therapy is, what to expect, and how to find care, so you can make an informed decision with a clinician you trust.

How to Get Started with Exposure Therapy in the Inland Empire

Here is a practical path, from your first question to active treatment.

Step 1 - Screen. Ask your primary care provider or our clinic about anxiety and OCD screening and whether ERP is a good fit for you. Common screening tools include the GAD-7, Y-BOCS, and OCI-R.

• Discuss any medical conditions that should be ruled out, along with any other conditions present alongside anxiety or OCD.
• Talk through your motivation and readiness for active, weekly treatment.

Step 2 - Check your coverage. California’s SB 855 requires most private plans to cover medically necessary mental health care, including psychotherapy (CA Dept. of Insurance, 2025; SB 855, 2020). IEHP members have mental health benefits, and IEHP lists phone and video visits as a way to reach a provider (IEHP, 2025; IEHP How to Access Care, 2025).

• Ask about single-case agreements if you need a specialized provider who is out of network.
• Keep documentation of medical necessity in case you ever need to appeal a denial.

Step 3 - Find the right clinician. Choose a therapist trained in ERP. The International OCD Foundation lists providers and training programs (iocdf.org/ocd-treatment-guide/, 2024).

• Ask specifically about their ERP training and experience.
• Ask about their approach and the kinds of outcomes they typically see.
• Make sure the therapeutic relationship feels comfortable to you.

Step 4 - Make a plan together. Work with your therapist to co-create an exposure plan (sometimes called a hierarchy), agree on safety guidelines, and decide together on any practice between sessions.

• Set clear boundaries and expectations up front.
• Agree on a realistic pace, and plan for support between sessions.

Step 5 - Practice. Attend your sessions (usually about once or twice a week, with some intensive programs meeting daily for a couple of weeks) and practice the exercises your therapist assigns between visits.

• Consistent between-session practice tends to predict better outcomes.

Step 6 - Review and adjust. Plan to reassess your progress with your clinician every few weeks, and talk about whether adding medication makes sense if progress stalls (NICE, 2024; Swierkosz-Lenart et al., 2023).

• Tracking progress with standardized measures helps you and your clinician see what is working.
• Your plan can be adjusted, or treatment combined, based on how you respond.

Cost and Access (Redlands and the Inland Empire)

Most ACA-compliant plans cover psychotherapy for anxiety and OCD under parity laws; SB 855 expanded California’s parity protections starting in 2021 (SB 855, 2020; DMHC, 2021).

IEHP (Medi-Cal and Covered California) lists behavioral health as a covered benefit, and many clinics across San Bernardino and Riverside counties accept IEHP and offer telehealth (IEHP, 2025).

If you are paying out of pocket, options that can lower the cost include:

• Sliding-scale clinics, university training clinics, and online therapy platforms.
• Payment plans or reduced fees, which many providers offer.
• Group therapy, which can cost less while adding peer support.

Zoom

Myths vs Facts

Risks, Limitations, and Uncertainties

Common challenges. Some temporary distress during or after sessions is common, and it usually fades with repetition (NICE, 2024). Newer research suggests the fear does not have to fall during a practice for the practice to count; that view is explained in The Fear Learns From What You Do Next.

• This kind of distress is expected and part of how the therapy works, not a sign of harm.
• Your therapist teaches and practices distress-tolerance skills with you.
• Support is available between sessions if you need it.

Dropping out early. A minority of people leave treatment early. Pooled dropout was 16 percent across 46 virtual-reality exposure studies (Benbow and Anderson, 2019), 16 percent across randomized trials of psychological therapies for PTSD (Lewis et al., 2020), and 18 percent in an earlier PTSD meta-analysis (Imel et al., 2013). Rates vary by condition and format.

• Retention is shaped by the therapeutic relationship, your expectations, and practical barriers.
• Motivational support, problem-solving around obstacles, and flexible scheduling can all help.

Adverse events. Harms are not tracked consistently in psychotherapy trials. A systematic review of 85 randomized trials across common mental disorders found that only 60 percent explicitly reported harms. Where they were counted, serious adverse events occurred in more than 1 in 21 participants, though for most reported adverse events the link to the treatment being studied was unclear (Klatte et al., 2025). Ask your therapist how setbacks will be monitored.

• The most common are a temporary rise in anxiety, some sleep disruption, or emotional activation.
• Rarely, new symptoms or a meaningful drop in day-to-day functioning can emerge.
• These are managed by monitoring together, adjusting the pace, and adding support.

Individual Variability

Not every format fits every person. For example, severe co-occurring conditions may call for combined care, and results vary from person to person. In placebo-controlled trials published since 2017, most of them in PTSD, CBT’s edge over placebo treatments was small (Bhattacharya et al., 2023), so a good response is likely but not guaranteed. Factors that can shape how someone responds include:

• Baseline severity, other conditions present, social support, and how much between-session practice gets done.
• A need for an adapted approach in some groups, including children, older adults, and people with developmental disabilities.
• Exposure targets that sometimes need to be adapted to a person’s cultural context.

Other Treatment Options

Medication Options

Medication (SSRIs, and sometimes clomipramine) is a first-line pharmacologic option for OCD and can be combined with ERP for more difficult cases (Swierkosz-Lenart et al., 2023).

• Commonly used agents include sertraline, fluoxetine, fluvoxamine, and paroxetine.
• It often takes several weeks to feel the full effect.
• Medication choices and plans are individualized and decided with your prescriber.
• Combining medication with ERP may improve outcomes for some people.

Therapy Variations

Acceptance and Commitment Therapy (ACT) can be combined with ERP. In a randomized trial of 58 adults with OCD, adding ACT to ERP worked about as well as ERP alone, with no difference in dropout or exposure engagement (Twohig et al., 2018). A 2025 trial found group ACT non-inferior to CBT with ERP (Nielsen et al., 2025).

• It emphasizes psychological flexibility and acting in line with your values.
• It has not been shown to lower dropout compared with ERP alone.
• It can be particularly helpful for people who tend to avoid difficult internal experiences.

Technology-Enhanced Options

Virtual-reality-assisted exposure can be useful when real-life practice is hard to arrange (Carl et al., 2019).

• Applications include specific phobias, PTSD, and social anxiety.
• Advantages include a controlled, graduated environment and easier access.
• Limitations include equipment cost and, for some users, a feeling of motion sickness.

Intensive Formats

Intensive ERP, such as brief multi-day programs, can help when weekly care is not feasible (Mogan et al., 2025).

• These programs typically meet for several hours a day over one to a few weeks.
• Benefits can include a faster response, immersive learning, and high completion in small studies.
• Things to weigh include the time commitment, insurance coverage, and a plan for maintaining gains.

Frequently Asked Questions

Does exposure therapy work without medication?

Yes. ERP and CBT are first-line treatments, and many people improve without medication; SSRIs can be added if needed (NICE, 2024; Swierkosz-Lenart et al., 2023). Many people with OCD respond well to ERP on its own. The decision to add medication depends on severity, your preferences, and how you respond to therapy.

How long does ERP take?

It is tailored to your severity and goals. A typical course often runs over a few months, though some people need fewer sessions and others need more (NICE, 2024). Things that affect how long it takes include:

• Symptom severity and how many areas of life are affected.
• Other conditions present, life stress, and how much between-session practice gets done.

Intensive programs can compress this into a few weeks of more frequent sessions, and occasional booster sessions afterward are common.

Is online ERP effective in California?

Videoconference CBT for anxiety shows outcomes comparable to in-person care in trials (Bouchard et al., 2022; Zandieh et al., 2024). Check whether your plan covers video visits; IEHP lists phone and video visits as one way to reach a provider (IEHP How to Access Care, 2025). Benefits of online ERP include:

• Easier access, especially in rural areas, with less travel time and cost.
• The chance to practice exposures in your own home, and more scheduling flexibility.

It does require a stable internet connection, some exposures may still be better guided in person, and comfort with technology varies from person to person.

Does IEHP cover therapy for anxiety or OCD near Redlands?

IEHP lists mental health services, including psychotherapy, as covered benefits; check your member plan for specifics (IEHP, 2025; IEHP How to Access Care, 2025). A few coverage notes:

• A plan may ask for prior authorization (IEHP How to Access Care, 2025). For IEHP Covered California plans, California parity law says the plan cannot cap medically necessary therapy more tightly than other medical care (SB 855, 2020). SB 855 does not apply to Medi-Cal; for IEHP Medi-Cal, federal Medicaid parity rules set the same kind of limit (42 CFR 438.910).
• Both in-network and out-of-network options exist, and telehealth is widely covered.

To verify your coverage, you can call member services, ask about the relevant CPT codes (90834 and 90837), confirm that ERP is covered as an evidence-based treatment, and get any authorization in writing.

Is ERP safe for intrusive harm thoughts?

Yes. ERP works with distressing thoughts as well as situations, using imagined and real-life exercises with safeguards, and it is guideline-recommended when clinically appropriate (NICE, 2024). For harm-related obsessions specifically:

• Imagined exposure is often used before real-life exposure.
• Clear boundaries are set, and no exercise ever involves actual harm or anything illegal.
• A therapist’s expertise matters especially here, and family education helps reduce accommodation.
• Response prevention focuses on mental rituals and reassurance-seeking.

Harm obsessions tend to respond to ERP as well as other forms of OCD when treatment is done properly. These intrusive thoughts are a symptom of OCD, not a reflection of who you are or what you want.

References

1. CDC/NCHS. Symptoms of Anxiety and Depression Among Adults: U.S., 2019 & 2022. 2024. https://www.cdc.gov/nchs/data/nhsr/nhsr213.pdf
2. NICE. Obsessive-compulsive disorder and BDD: treatment (CG31). Last reviewed 2024. https://www.nice.org.uk/guidance/cg31
3. Reid JE, Laws KR, Drummond L, et al. Cognitive behavioural therapy with exposure and response prevention in the treatment of obsessive-compulsive disorder: a systematic review and meta-analysis of randomised controlled trials. Comprehensive Psychiatry. 2021;106:152223. PMID 33618297. https://pubmed.ncbi.nlm.nih.gov/33618297/
4. Bhattacharya S, Goicoechea C, Heshmati S, Carpenter JK, Hofmann SG. Efficacy of cognitive behavioral therapy for anxiety-related disorders: a meta-analysis of recent literature. Current Psychiatry Reports. 2023;25(1):19-30. PMID 36534317. https://pmc.ncbi.nlm.nih.gov/articles/PMC9834105/
5. Carl E, Stein AT, Levihn-Coon A, et al. Virtual reality exposure therapy for anxiety and related disorders: a meta-analysis of randomized controlled trials. Journal of Anxiety Disorders. 2019;61:27-36. PMID 30287083. https://pubmed.ncbi.nlm.nih.gov/30287083/
6. Papola D, Miguel C, Mazzaglia M, et al. Psychotherapies for generalized anxiety disorder in adults: a systematic review and network meta-analysis of randomized clinical trials. JAMA Psychiatry. 2024;81(3):250-259. PMID 37851421. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2810866
7. Swierkosz-Lenart K, Dos Santos JFA, Elowe J, et al. Therapies for obsessive-compulsive disorder: current state of the art and perspectives for approaching treatment-resistant patients. Frontiers in Psychiatry. 2023;14:1065812. PMID 36873207. https://pmc.ncbi.nlm.nih.gov/articles/PMC9978117/
8. StatPearls/NIH Bookshelf. Obsessive-Compulsive Disorder. 2024. https://www.ncbi.nlm.nih.gov/books/NBK553162/
9. CA Dept. of Insurance. SB 855 parity enforcement update. 2025. https://www.insurance.ca.gov/0400-news/0100-press-releases/2025/release050-2025.cfm
10. IEHP. Covered California and Mental Health Benefits. 2025. https://www.iehp.org/en/browse-plans/covered-california/iehp-covered
11. SB County DBH. Urgent/Crisis lines. 2025. https://wp.sbcounty.gov/dbh/urgentcare-2/
12. RUHS-BH. Crisis Support System of Care. 2024. https://ruhealth.org/behavioral-health/crisis-support-system-care
13. Bouchard S, Dugas MJ, Belleville G, et al. A multisite non-inferiority randomized controlled trial of the efficacy of cognitive-behavior therapy for generalized anxiety disorder delivered by videoconference. Journal of Clinical Medicine. 2022;11(19):5924. PMID 36233791. https://pubmed.ncbi.nlm.nih.gov/36233791/
14. Zandieh S, Abdollahzadeh SM, Sadeghirad B, et al. Therapist-guided remote versus in-person cognitive behavioural therapy: a systematic review and meta-analysis of randomized controlled trials. CMAJ. 2024;196(10):E327-E340. PMID 38499303. https://pubmed.ncbi.nlm.nih.gov/38499303/
15. Klatte R, Strauss B, Flückiger C, Rosendahl J. Adverse events in psychotherapy randomized controlled trials: a systematic review. Psychotherapy Research. 2025;35(1):84-99. PMID 38090772. https://pubmed.ncbi.nlm.nih.gov/38090772/
16. Twohig MP, Abramowitz JS, Smith BM, et al. Adding acceptance and commitment therapy to exposure and response prevention for obsessive-compulsive disorder: a randomized controlled trial. Behaviour Research and Therapy. 2018;108:1-9. PMID 29966992. https://pubmed.ncbi.nlm.nih.gov/29966992/
17. Nielsen SKK, Stuart AC, Winding C, et al. Group acceptance and commitment therapy versus cognitive behavioral therapy/exposure response prevention for obsessive compulsive disorder: a block randomized controlled trial. Psychotherapy and Psychosomatics. 2025;94(3):135-146. PMID 39987908. https://pubmed.ncbi.nlm.nih.gov/39987908/
18. Benbow AA, Anderson PL. A meta-analytic examination of attrition in virtual reality exposure therapy for anxiety disorders. Journal of Anxiety Disorders. 2019;61:18-26. PMID 30646997. https://pubmed.ncbi.nlm.nih.gov/30646997/
19. Lewis C, Roberts NP, Gibson S, Bisson JI. Dropout from psychological therapies for post-traumatic stress disorder (PTSD) in adults: systematic review and meta-analysis. European Journal of Psychotraumatology. 2020;11(1):1709709. PMID 32284816. https://pubmed.ncbi.nlm.nih.gov/32284816/
20. Imel ZE, Laska K, Jakupcak M, Simpson TL. Meta-analysis of dropout in treatments for posttraumatic stress disorder. Journal of Consulting and Clinical Psychology. 2013;81(3):394-404. PMID 23339535. https://pubmed.ncbi.nlm.nih.gov/23339535/
21. Mogan C, Mogan J, Foroughi E, et al. An outcome study of an intensive, out-patient exposure and response prevention therapy for obsessive compulsive disorder. The Cognitive Behaviour Therapist. 2025;18:e21. https://doi.org/10.1017/S1754470X2500008X
22. California Legislature. SB 855, Health coverage: mental health or substance use disorders. Chaptered September 25, 2020. https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200SB855
23. California Department of Managed Health Care. All Plan Letter 21-002: Implementation of SB 855, Mental Health and Substance Use Disorder Coverage. January 5, 2021. https://www.dmhc.ca.gov/Portals/0/Docs/DO/APL21-002-SB-855MHSUDCoverage.pdf
24. IEHP. How to Access Care (Covered California). 2025. https://www.iehp.org/en/browse-plans/covered-california/how-to-access-care
25. U.S. Code of Federal Regulations. 42 CFR 438.910, Parity requirements for financial requirements and treatment limitations (Medicaid managed care). https://www.ecfr.gov/current/title-42/section-438.910

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