The behavioural part of CBT focuses on the reactions, rather than beliefs, that keep the cycle going. One key aspect of this is learning about how anxiety works, how it is felt in the body, and why it causes the responses or behaviours that it does. Through this understanding and guidance from the therapist, you can then learn to respond in a new way to anxiety. This has to be a gradual process set at the right pace for you. The goal is not simply to choose a new reaction, but to build one. Exposure and Response Prevention (ERP) works to reverse the OCD vicious cycle. The meaning that OCD attaches to intrusive thoughts causes you to feel anxious and responsible, so you use compulsions to get relief from the anxiety. This relief then reinforces the brain’s assumption that the thoughts are bad, so the anxiety about them keeps getting worse. Through ERP, you practice the opposite – by choosing anxiety instead of running from it, it becomes less intense with time, and the brain re-learns how to respond to it without compulsions. Exposure involves taking part in an action that will bring on the anxiety. Response Prevention means making the active choice to stay anxious instead of doing a compulsion. ERP must be done in a gradual way, because you are learning and practicing a different way of going about life and this takes time. This is called graded exposure and can be done in lots of different ways. You might start off with small things that only bring on a bearable amount of anxiety and then build up from there, or you might only hold back compulsions for a few minutes at the beginning and wait longer and longer each time. Eventually, ERP exercises will involve doing quite scary things and then waiting for the anxiety to go away by itself, without doing any compulsions.