Beyond ERP: Navigating OCD Maintenance & Relapse Prevention
Written By Dr. Melissa Jermann
“Maintenance in OCD treatment is not about perfection, but about continuing to live with courage, self-trust, and compassion.”
When most people talk about OCD treatment, they discuss facing exposures, resisting compulsions, and tolerating uncomfortable emotions like anxiety and guilt. However, we need to shed more light on the challenges you face during the last phase of treatment: the maintenance stage.
You enter this phase of treatment when you have gone through your entire Exposure and Response Prevention (ERP) hierarchy and your subject unit of distress (SUDs) has decreased significantly. Intrusions and uncomfortable emotions still show up, but you know how to respond to them, and they don’t interfere with your life anymore. You may still need to engage in exposures when something is sticky, but overall, your primary focus is on response prevention.
At this stage, the work also shifts in therapy. It’s less about learning skills and planning exposures and more about cultivating self-trust, flexibility, processing emotions, and acceptance. Here are some of the frequent challenges I notice with clients in my practice and how you can address them!
Perfectionism at the Finish Line
Perfectionism always has a sneaky way of showing up in treatment, especially when you enter the maintenance stage. As I stated earlier, intrusive thoughts may no longer trigger panic, but perfectionism will continue to say, “Shouldn’t these thoughts be gone by now?”
This is the fantasy that perfectionism wants for you, a completely quiet mind. Thoughts that once spiked anxiety now feel annoying, and perfectionism insists the only solution is to get rid of them. However, as we know, trying to eliminate intrusions reinforces them.
This is where acceptance work and cognitive flexibility are important. It’s okay to be frustrated with intrusions; this is part of acceptance. You don’t have to “like” them being there, but you can tolerate their presence. You continue to show that perfectionistic part of your brain that these intrusions can be here AND you can live the life you want.
Perfectionism can also show up in how you respond to OCD. This is where Meta-OCD and the “two-tailed spike” come in. Meta OCD is an obsession about the disorder itself and your OCD recovery. When we add perfectionism into the mix, we then start to search for the “right” way to respond to OCD. So now we are no longer obsessing over our spike theme, but rather how we are engaging in treatment and responding to OCD.
For example, if you have Relationship OCD, and you have an urge to tell your partner you love them. Your brain says, “Wait, do I want to say this because I genuinely feel it in the moment, or is this a compulsion for reassurance? What do I do?” Another example is you have contamination OCD, and you think it would be a good exposure to hold onto the subway pole today. Then your brain says, “Is that an exposure, or am I trying to seek relief? Maybe I’m touching the pole compulsively?”
My OCD mentor, Dr. Steven Phillipson, coined the term “two-tailed spike” to explain this phenomenon. When you feel stuck in a decision around treatment, OCD is telling you you’re damned if you do or damned if you don’t. This ambiguity makes you overanalyze almost every choice, leading to more compulsions and decision paralysis. The thought becomes: “If I just respond the right way, OCD will go away.” But this is really another sneaky OCD compulsion—a disguised attempt to get rid of OCD altogether.
The goal here is not to respond “perfectly,” but to:
Trust yourself, even in the presence of doubt.
Lean into the possibility of getting it wrong, and discover that life still moves forward.
The more consistent you are with self-trust and embracing the idea that you might be ‘getting it wrong,’ the less grip OCD and perfectionism have over you. When you allow yourself to respond imperfectly, you’re no longer chasing the impossible standard of certainty or the ‘right’ way. Instead, you build flexibility, resilience, and a stronger sense of trust in your ability to handle whatever comes next. This shift is what makes room for growth and lasting recovery.
Processing Grief and Anger
As OCD symptoms begin to decrease, you may feel excited and proud to be able to get your life back, but what often comes with that is grief. You may grieve the years that felt consumed by compulsions, the opportunities you couldn’t take, or the relationships that suffered under the weight of OCD. Anger can also rise; anger at the doctors, parents, or teachers who missed the signs, anger at how long it took to get answers, anger at OCD itself for stealing so much time.
These emotions can feel surprising and even confusing, especially if you thought recovery would only bring lightness. It’s important to remember that grief and anger are not signs of slipping back; they are signs of healing. Grief is what shows up when we reclaim our lives and recognize how much we lived without it. Anger surfaces when we finally see the unfairness of what was taken from us. These emotions are normal and valid!
It’s important to make space for these feelings instead of pushing them away. Processing them can look different for everyone: crying, journaling, or simply allowing the feelings to exist without judgment. It’s just as important that your therapist creates room for this too. A supportive therapist will validate these emotions, not rush past them, because honoring grief and anger is part of building a fuller, more honest recovery.
When you allow yourself to feel the weight of what was lost, you also create space to appreciate what’s been regained. This process doesn’t erase the pain, but it can transform it into compassion for your past self.
Rediscovering the Self
OCD feels like the thief of identity. It pulls you away from your values until you no longer feel connected to who you are. When you start to become more skillful with OCD symptoms and the chatter begins to quiet, many people find themselves asking: “Who am I when OCD isn’t steering the wheel?”
This rediscovery can feel disorienting, and sometimes even unsettling. You may realize that parts of your life, your relationships, hobbies, and goals were shaped by OCD rather than by your true desires. That awareness can bring sadness or confusion. At the same time, it can also open up an entirely new sense of possibility. This is a season of exploration: reconnecting with what matters, revisiting old passions, and experimenting with new interests that OCD once overshadowed.
It’s important to give yourself permission to feel both the grief of what was lost and the curiosity of what lies ahead. Rediscovery isn’t about rushing to “fix” who you are; it’s about making space to notice what excites you and what feels meaningful. In this part of treatment, your therapist can hold this space with you, validating the discomfort, encouraging exploration, and reminding you that identity unfolds with time, not pressure.
This stage also means integrating OCD into your story. For many, this can involve choosing to share their experience with others. Speaking openly can reduce shame and create opportunities to educate, breaking stereotypes about what OCD really is. Some find healing in advocacy, whether it’s talking with friends, posting online, or supporting awareness efforts. Others discover comfort and strength in connecting with a community of people who understand the challenges firsthand. Finding a space where you can be seen, validated, and not alone can be a powerful step in turning OCD from a source of isolation into a part of your story that fosters connection and healing.
Recovery doesn’t erase the past, and it doesn’t require you to deny what you’ve been through. Instead, you bring forward the lessons you’ve learned: resilience, courage, compassion for yourself and others. OCD is not your defining feature, but it will always be a part of your history and something that you carry with you. The difference now is that it no longer dictates who you are.
Fear of Relapse
For many, relapse feels like a shadow lurking in the background. When OCD takes over your life, it often feels overwhelming, sometimes even traumatizing. The memory of those darkest moments can make the possibility of symptoms returning feel unbearable. Even in recovery, the fear of being “back at square one” can be heavy and persistent.
This is where trauma-informed care becomes essential. OCD is not just about obsessions and compulsions; it’s a traumatizing experience that can last anywhere from months to years. Individuals feel like they are trapped in their own brain with no way out. A trauma-informed therapist will recognize that OCD flare-ups can also re-activate these old feelings of powerlessness, fear, or shame, and will create a safe space to process these reactions without judgment. Instead of dismissing relapse fears, trauma-informed care validates them, while also guiding you to rewrite your relationship with those memories.
Equally important is recognizing the agency you now carry. Recovery is not about never having symptoms again; it’s about knowing that you have the tools to respond differently when OCD shows up. Exposure and Response Prevention, mindfulness, self-compassion, and values-based living are not skills you “lose” when OCD flares; they are strengths you can return to again and again. A flare-up doesn’t erase your progress; it’s an opportunity to continue to practice what you’ve built. Building this sense of agency is what transforms relapse from a terrifying threat into something manageable. This shift from fear to empowerment is what helps maintenance feel sustainable, grounded, and hopeful.
Acceptance of Living with OCD
This is often the last and most challenging hurdle. Many people enter treatment holding on to the hope for a cure, that OCD will one day disappear altogether. That hope is deeply human and understandable. However, the reality is that OCD does not have a cure, but remission from symptoms that disrupt functioning is possible!
Recovery isn’t about eliminating intrusive thoughts, images, or uncomfortable emotions; it’s about learning to live fully alongside them. Acceptance does not mean resignation, and it doesn’t mean you like or agree with the presence of OCD and what it has to say. Instead, it means recognizing that intrusions can exist without taking control of your life. Acceptance is choosing to reclaim your time, energy, and values while experiencing symptoms.
At first, this can feel unfair, which is, of course, valid. Why should you have to “accept” something that has caused so much pain? Acceptance is not about giving OCD a free pass; it’s about refusing to keep fighting a battle you can’t win. When you stop trying to force intrusions out of existence, you free up space and energy to invest in the things that actually bring you meaning and joy.
Think of it like learning to share the road with an annoying driver. You don’t have to like their presence, but you also don’t let them stop you from reaching your destination. Over time, that “driver” becomes just background noise. Acceptance is active. It takes courage to say: OCD may show up, but I get to decide what I do next. When you embody that agency and lean into your values, relationships, and passions, you discover that OCD no longer defines the path ahead.
Closing Remarks
Maintenance in OCD treatment is not about perfection, but about continuing to live with courage, self-trust, and compassion. Perfectionism may show up, grief and anger may still come in waves, identity may still feel in flux, relapse fears may still linger, and acceptance may feel like an uphill climb. Each of these hurdles also opens the door to continued growth.
You are not the same person you were when OCD first showed up in your life. You now have skills, insights, and values that can ground you when symptoms flare. The journey forward is not about erasing OCD, but about reclaiming your life from it, piece by piece, choice by choice. With each step, you prove that freedom isn’t found in certainty or control, but in your ability to tolerate discomfort and keep moving toward what matters most.
© 2025 Dr. Melissa Jermann Psychology Services LLC - All Rights Reserved - Disclaimer: This site should not be construed as therapeutic recommendations or personalized advice. Interaction with this blog does not constitute a therapeutic relationship. This blog aims to provide general information for educational purposes only. It is not intended or implied to supplement or replace the advice of your mental health professional. This information should not be used to self-diagnose mental health conditions. Consult with your mental health provider before implementing anything read here.
