I'm really struggling with understanding how ERP works. It seems that many therapists & providers use it differently, so it's really hard to know what I'm supposed to be doing to get better.

Well, I think there are many ways of doing ERP. But we as sufferers tend to be black and white thinkers and we wish for ONE way to tackle the obsession, but in reality you can do it in different ways. I think the problem is that you obsess about the ERP. Choose what to do and stick with that choice.

Here’s an excerpt from the The OCD Workbook: Your Guide to Breaking Free from Obsessive-Compulsive Disorder ($12.00 on Kindle) https://www.amazon.com/dp/1572249218/ref=cm_sw_r_cp_tai_RNsoFbFRGK970 They have a whole self directed program on ERP - Exposure and response prevention treatment utilizes this same process of habituation to help you systematically overcome feelings of fear and dread in situations involving people (the homeless, for example), places (such as airplanes), and, in the case of OCD, even fears of your own thoughts. Through frequent and prolonged confrontation with situations you fear and dread, your nervous system will automatically numb out fear responses, bringing them down to more manageable levels. Here’s a simple example of how habituation works to help overcome fear, in this case the irrational fear, or phobia, of water: The fearful individual first approaches the edge of a swimming pool until his or her fear rises to uncomfortable levels, perhaps several feet away, and then waits there. Over the next several minutes, the person’s original fear gives way, numbing out as nervous system habituation kicks in. When calm, the person then moves closer to the pool, perhaps a few inches away, until the fear once again rises to uncomfortable levels. Again, the person waits until habituation causes the feelings of dread to diminish to manageable levels. The process is repeated in baby steps. Gradually one toe is placed in the pool, then a foot, then both feet, then the legs up to the ankles, and then the legs up to the knees. Then both legs are entirely immersed, and gradually the whole body is immersed with very little fear. Although this example is simplified, the process of overcoming OCD-related fears takes place in a similar manner. In order for this approach to be effective, it’s also necessary to practice response prevention, in other words, to refrain from engaging in compulsive behaviors or responses.

For example, I thought the content of the thoughts didn't matter, that you're supposed to let the intrusive thoughts be there & not do compulsions is the main concept. But I've found that many providers do believe the content matters and it's not just sitting with the thoughts, but actually engaging with the contents of the thoughts until you habituate to it. It's really confusing.

*from my understanding* all together, the content does not matter. Everyone gets intrusive thoughts. Ocd focuses on things you care about. I think when you engage with the thoughts it’s to desensitize you to them.

without compulsions*^^