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Therapy & Skills

Exposure Therapy for Anxiety and OCD: Facing Fears, Safely

Exposure therapy, including Exposure and Response Prevention (ERP), is a leading, evidence-based treatment for anxiety and OCD. This guide explains what it is, what to expect from a course of care, and how to find a trained clinician in the Inland Empire who accepts IEHP and Medi-Cal.

Originally published November 13, 2025

Last reviewed June 1, 2026

Clinical review: Fady Boules, PMHNP-BC

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.

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; LegiScan SB 855 text, 2021). IEHP members have mental health benefits and telehealth options (IEHP, 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 (LegiScan, 2021; DMHC, 2025).

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.

Myths vs Facts

MythFact
"Exposure therapy is dangerous."When planned and supervised, exposure is safe and guideline-recommended for OCD and anxiety (NICE, 2024). Serious adverse events are very rare, and temporary distress is managed collaboratively.
"ERP means doing the scariest thing first."ERP is graded. You start with easier steps and build up (NICE, 2024). The plan is designed to challenge you without overwhelming you, which supports steady progress.
"Online therapy cannot help anxiety."Videoconference CBT performs as well as in-person care for generalized anxiety in trials (JAMA Psychiatry, 2024). Technology can even add support through apps, virtual reality, and between-session tools.
"If I do not use medication, therapy will not work."Many people improve with ERP alone; medication such as an SSRI is an option if needed (Swierkosz-Lenart et al., 2023). The decision is individual, based on severity, preference, and response.

Risks, Limitations, and Uncertainties

Common challenges. Some temporary distress during or after sessions is common, and it usually fades with repetition (NICE, 2024).

  • 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; meta-analyses suggest roughly 16 to 18 percent in exposure-based trials, varying by condition and format (Benbow et al., 2019; McLean et al., 2022).

  • 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. Serious adverse events are rare in psychotherapy trials, and any that occur are tracked carefully (Linardon et al., 2024).

  • 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. 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) combined with ERP has emerging evidence supporting the integration (Soumee et al., 2025).

  • It emphasizes psychological flexibility and acting in line with your values.
  • It may reduce dropout and improve engagement.
  • 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 (The Cognitive Behaviour Therapist, 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 lower dropout.
  • 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, and many California plans cover telehealth (JAMA Psychiatry, 2024; DMHC, 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 Learning Center, 2025). A few coverage notes:

  • Prior authorization may be required, and session limits vary by plan.
  • 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, et al. CBT with ERP for OCD: systematic review and meta-analysis. Comprehensive Psychiatry, 2021. https://pubmed.ncbi.nlm.nih.gov/33618297/
  4. Bhattacharya S, et al. CBT for anxiety disorders: overview. Curr Treat Options Psychiatry, 2022. https://pmc.ncbi.nlm.nih.gov/articles/PMC9834105/
  5. Carl E, et al. Virtual reality exposure for anxiety: meta-analysis. J Anxiety Disord, 2019. https://pubmed.ncbi.nlm.nih.gov/30287083/
  6. Papola D, et al. Psychotherapies for GAD in adults: umbrella review. JAMA Psychiatry, 2024. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2810866
  7. Swierkosz-Lenart K, et al. Therapies for OCD (SSRIs and CBT/ERP). Pharmacological Reports, 2023. 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

If you or someone you know is in crisis

  • Call 911 or go to your nearest emergency room for any life-threatening emergency.
  • 988 Suicide & Crisis Lifeline — call or text 988, available 24/7. En español: marque 988 y oprima 2. Veterans: 988 y oprima 1, or text 838255.
  • Crisis Text Line — text HOME to 741741.
  • The Trevor Project (crisis support for LGBTQ+ young people) — call 1-866-488-7386, or text START to 678-678.
  • Riverside County — 24/7 crisis line 951-686-HELP (4357); CARES line 800-499-3008.
  • San Bernardino County — DBH Screening/Referral 800-968-2636; DBH ACCESS 888-743-1478 (24/7); Mobile Crisis/CCRT 800-398-0018; crisis text 909-420-0560. Arrowhead Regional Medical Center (ARMC) has a dedicated adolescent psychiatric ER (ages 13–17).
  • NP Fady (non-emergency) — for routine scheduling or questions, call (909) 707-6261. This line is not monitored for emergencies.