Making Exposure Response Prevention More Trauma-Informed: An Integration with Internal Family Systems

By Rachel Cashman, MSEd., LPC | June 3rd, 2025

Obsessive-Compulsive Disorder (OCD) is more than just intrusive thoughts and rituals-it is a complex condition that connects deeply with a person’s identity and history. Exposure and Response Prevention (ERP), the gold-standard treatment for OCD, helps individuals confront their fears while learning how to resist the urge to do compulsions. Yet for many, especially those with complex trauma, traditional ERP can be destabilizing and it can feel hard to get started.

In most cases, OCD isn’t “random.” When we experience trauma, we develop core fears and beliefs about ourselves, others, and the world. Traumatic events can leave us feeling unsafe, unworthy, and ashamed, and the effects can linger for years after the initial event if not fully processed. Therefore, obsessions shouldn’t be viewed as just clinical symptoms, rather echoes of earlier wounds that need to be handled with care. Compulsions, on the other hand, can be seen as the ways in which we cope with trauma if not given more effective tools. Performing compulsions often gives an individual a false sense of control after having lost it; this can bring temporary relief, however, it also creates a never ending cycle: obsession, anxiety, compulsion, relief, repeat. Without honoring these deeper layers, ERP can reinforce self-blame and cause emotional and physical dysregulation which is the last thing a person trying to recover from a traumatic past needs.

Trauma and OCD: When Intrusive Thoughts Echo the Past

Clients with a history of trauma may find their OCD themes interwoven with their past experiences:

-A survivor of religious trauma may obsess over morality and having “pure” thoughts

-A survivor of abuse and neglect may be consumed with fears of being a bad person or causing harm to others

-Childhood bullying might cause a person to obsess about how they are perceived by others

Traditional ERP tells us to expose and resist, however, when the fear feels existential or shame-based, it’s not always just about habituation, or “getting used to” the trigger, it’s about healing the root cause.

Combining ERP with IFS: Meeting OCD Parts with Compassion

Here’s where IFS becomes a powerful companion to ERP. IFS teaches us that we are made of parts—some carry pain (exiles), and others protect us from feeling that pain (protectors). OCD, through this lens, can be seen not as a malfunction, but as a system doing its best to manage inner distress.

Let’s break it down:

-Obsessions and fears often reflect the voice of exiled parts—young, wounded selves or ego states burdened with shame, fear, or guilt

-Compulsions are protective parts—doing anything they can to keep us from feeling the rawness of those exiles

From this perspective, ERP becomes more than just resisting compulsions—it becomes a way of rebuilding trust within the internal system.

How to Make ERP Trauma-Informed with IFS Principles

1. Befriend the System

Before diving into exposures, help clients map out their parts.

In regards to obsessions and core fears, ask:

- “When might this obsession have started?” Let them share about their past and validate the seriousness of their experience(s.) Encourage them to have compassion for themselves and to send love to the part of them that is afraid.

In regards to compulsions, ask:

-“What part of you is doing this compulsion? What is it afraid would happen if you didn’t?”

This reframes obsessions and compulsions not as irrational, but as purposeful and able to be understood.

2. Use Self-Energy, Not Force, During Exposures

Encourage the client to approach exposures with courage and compassion, not punishment.

-Invite protectors to step back so that you (The Self) can sit with the exiled part while it faces its fear.

For example: If a person is afraid of something bad happening to them or a loved one, ask their “Reassurance” and “Rumination” protectors to step aside because, as much as they are trying to help, the exile needs to face their fear in order to let go of their need for certainty. Imagine The Self gently showing the exile what it is afraid of (maybe through a worse case scenario story or a triggering video) while reminding it that it is not happening now, it is just a thought or image that their brain is creating.

-Empathize with the part: let it know that you understand why they would be afraid of the unknown and how difficult it is to not have control over what happens to us. But remind it that it is strong and able to deal with whatever life throws at them.

3. Show Gratitude

Honor the obsessions and compulsions as strategies that once made sense. This reduces internal conflict. Ask:

“Can we thank this part for working so hard to protect you? Let it know that we have found a better, most sustainable way to deal with our fears and that it is not alone.”

A Gentler ERP

When ERP is guided by the principles of IFS, it becomes, not just a tool to retrain behavior, but a compassionate way of healing the parts of us that are stuck in fear. It’s still evidence-based, but it’s also gentler and more person-centered.

If you’re a therapist consider incorporating parts work into your ERP sessions or if you’re someone with OCD, try asking yourself:

“What part of me is afraid? What part is trying to protect me? And what do they need from me now?”

The goal isn’t to get rid of OCD. It’s to bring your internal system into balance—where every part, even the most scared or stubborn, feels safe enough to surrender.

Keywords: Obsessive Compulsive Disorder (OCD,) Trauma-Informed, Exposure Response Prevention (ERP,) Internal Family Systems (IFS)