Getting Creative with OCD Therapy: When to Go Beyond ERP

ERP is the gold standard for OCD. But what happens when it's not enough on its own?

In this episode of Breaking the Rules, Dr Celin Gelgec and Dr Tori Miller explore one of the most important — and least talked about — questions in OCD treatment: when and how to bring in other therapeutic modalities, and how to do it without abandoning the principles that make ERP work.

Tori shares what traditional manualized ERP actually looked like in the early days of her career — rate your SUDS, watch the clock, wait for the anxiety to come down — and how the field has shifted since the inhibitory learning model changed the way we think about exposure. Celin reflects on her experience of always working in an integrated way, and why the principles of ACT have always felt like ERP to her — because they are.

They also get honest about the moments when ERP becomes a battle. When the exposure menu turns into a war. When a client has every reason in the world not to engage — and what to do instead.

Whether you're a clinician looking to expand your toolkit or someone living with OCD who's wondered why their therapist keeps talking about values and mindfulness -

this episode will change how you think about what treatment can look like.

In this episode, you'll learn:

• What traditional manualized ERP actually looked like — and how it's evolved
• Why the inhibitory learning model changed everything about how we approach exposure
• How ACT principles map directly onto ERP — and why urge surfing is response prevention
• The question to ask before bringing in any new modality: is this ERP-friendly?
• What to do when a client refuses to engage with the exposure hierarchy
• How schema therapy, DBT, and imagery rescripting can be woven into OCD work without softening exposure
• Why ERP has a 20% dropout rate — and what that tells us about why integration matters
• When to hold the line and when to shift gears — and how to know the difference
• Why getting your client's life back is always the goal, even when it doesn't look like ERP

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