Exposure and Response Prevention (ERP) Therapy in London
CBT with ERP at Regal Private Therapy Practice, Harley Street Medical Area
What is ERP?
Exposure and Response Prevention (ERP) is the gold-standard, first-line psychological treatment for Obsessive Compulsive Disorder (OCD), recommended by the National Institute for Health and Care Excellence (NICE) and the American Psychological Association (APA). At Regal Private Therapy Practice, we offer specialist CBT with ERP in London's Harley Street Medical District, delivered by HCPC-registered, BABCP-accredited Clinical Psychologists with doctoral-level training.
BABCP accreditation is the benchmark standard for CBT delivery referenced in NICE guidance — and it is the professional qualification that distinguishes specialist CBT with ERP from more general therapeutic practice.
What is CBT with Exposure and Response Prevention?
OCD is maintained by a cycle: an intrusive thought or trigger generates anxiety, a compulsive behaviour or ritual temporarily relieves that anxiety, and the relief reinforces the cycle. Over time, the cycle becomes more entrenched, triggers multiply, and relief becomes shorter-lived.
CBT with ERP disrupts this cycle directly, through two paired components embedded within a broader cognitive behavioural framework.
Exposure means gradually and safely encountering the situations, thoughts, or triggers that provoke anxiety rather than avoiding them.
Response Prevention means resisting the compulsive or ritualistic behaviour that would typically follow, allowing anxiety to run its natural course without reinforcement.
This is not about forcing distress. ERP is always conducted at a manageable pace, collaboratively, with a structured exposure hierarchy agreed between you and your clinician. The inhibitory learning model (currently the leading scientific account of how exposure therapy works) proposes that new, non-fearful associations are built alongside existing fear responses rather than eliminating them outright. Over time, the new learning comes to dominate.
The practical result is that anxiety reduces, compulsions lose their grip, and individuals regain meaningful control over their lives.
What Can CBT with ERP Treat?
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CBT with ERP is the primary evidence-based psychological treatment for OCD, recommended by NICE as the first-line psychological intervention for both adults and young people. A meta-analysis of 39 randomised controlled trials involving 1,793 participants found ERP to have a definite effect on OCD, with effect sizes significantly superior to placebo and medication alone.
Common OCD presentations treated with CBT with ERP at Regal include:
Contamination fears and washing compulsions
Checking rituals
Intrusive thoughts — including harm OCD, sexual OCD, religious OCD, and relationship OCD
Symmetry, ordering, and "just right" OCD
Reassurance-seeking and mental compulsions
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For anxiety disorders beyond OCD — including generalised anxiety, social anxiety, health anxiety, and panic disorder — the relevant approach is exposure-based CBT, which shares ERP's core mechanism. At Regal, our clinicians deliver both CBT with ERP for OCD and exposure-based CBT for anxiety disorders, and will recommend the most appropriate formulation at assessment.
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Exposure-based CBT is the most effective psychological treatment for specific phobias, with meaningful outcomes often achievable in a focused course of sessions. Common presentations include fear of flying, animals, heights, medical procedures, and vomiting.
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Exposure-based approaches, including food exposure hierarchies and mirror exposure for body image distress, form part of evidence-based treatments for anorexia nervosa and bulimia nervosa. These are delivered within a broader treatment framework and formulated individually at assessment.
A Note on Clinical Accuracy
ERP is a specific, structured protocol developed for OCD. Some providers use the term loosely as a label for all exposure-based work. At Regal Private Therapy Practice, we are precise about this because the correct formulation of a treatment plan matters for outcomes.
Your clinician will recommend the most appropriate approach: CBT with ERP, exposure-based CBT, or a combination, based on a thorough clinical assessment of your presentation.
How CBT with ERP Works at Regal
Detailed Clinical Assessment
Treatment begins with a thorough assessment of your OCD or anxiety presentation: the nature of your obsessions or fears, your compulsive and avoidance behaviours, and the impact on your daily life. This is the foundation of an effective and personalised treatment plan.
Building Your Exposure Hierarchy
Together with your clinician, you develop a structured, step-by-step exposure hierarchy — a graduated plan starting with manageable challenges and working progressively toward more demanding ones. Nothing is forced or rushed.
Guided Exposure Work
You work directly with your clinician through the hierarchy, with active support and coaching. The aim is not to eliminate anxiety in the moment, but to build new learning that reduces its power over time.
Response Prevention Support
Alongside exposure, your clinician will help you identify and reduce compulsive and avoidance behaviours — including less visible mental compulsions such as reassurance-seeking, mental reviewing, and neutralising.
Between-Session Practice
CBT with ERP is most effective when practiced consistently between sessions. Your clinician will provide structured between-session tasks and support you in building a practice that carries beyond the therapy room.
Monitoring Progress
We use validated clinical measures throughout treatment — including the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) — to track symptom change objectively and adapt the approach where needed.
What Does CBT with ERP Look Like in Practice?
For someone with contamination OCD, an exposure hierarchy might begin with touching a low-risk surface and delaying handwashing for a short period, then gradually progressing toward more challenging situations over successive sessions. At each stage, the goal is not to feel comfortable; it is to demonstrate that anxiety reduces on its own and that feared outcomes do not materialise.
For someone experiencing intrusive thoughts, ERP might involve writing out feared thoughts, reading them without engaging in mental neutralising, and systematically reducing the mental rituals that sustain their power.
Each hierarchy is built entirely around the individual. No two courses of CBT with ERP are identical.
Why Specialist Delivery Matters
CBT with ERP requires specialist clinical training to deliver safely and effectively. There is robust evidence that ERP is significantly underutilised in private practice, partly because it can feel counterintuitive for both clients and insufficiently trained clinicians, and partly because incomplete ERP, where exposure is conducted without adequate response prevention, can fail to produce change and in some cases inadvertently reinforce the OCD cycle.
At Regal Private Therapy Practice, CBT with ERP is delivered by doctoral-level Clinical Psychologists who hold BABCP accreditation, the professional standard explicitly referenced in NICE guidance for the delivery of CBT. This is a meaningful distinction in a private therapy market where the term "CBT therapist" covers a wide range of training levels.
Our Clinicians
DClinPsy, PGDip CBT, MSc Developmental Psychology, BSc Psychology | HCPC Registered | BABCP Accredited | BPS Chartered | Associate Fellow of the BPS
Dr. Bradley Powell
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Dr Bradley Powell is Co-Founder and Co-CEO of Regal Private Therapy Practice, and an award-winning Clinical Psychologist based in Harley Street and Chelsea. He specialises in CBT with Exposure and Response Prevention (ERP) for OCD, alongside CBT for anxiety, trauma, panic, and low self-esteem. His academic research has been published in peer-reviewed journals, and he has served as a peer-reviewer for parliamentary briefings. Bradley holds a PGDip in CBT in addition to his Doctorate in Clinical Psychology, making him qualified at both doctoral and postgraduate levels in the delivery of cognitive behavioural approaches.
DClinPsy | BABCP-Accredited CBT Therapist | HCPC Registered | BPS Member
Dr. Ashleigh Powell
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Dr Ashleigh Powell is Co-Founder and Co-CEO of Regal Private Therapy Practice. She completed her doctoral and postgraduate clinical training at Royal Holloway, University of London, and King's College London. She specialises in CBT with ERP, ACT, and Compassion Focused Therapy (CFT), working with adults, adolescents, and children across OCD, anxiety disorders, depression, low self-esteem, trauma, and eating disorders.
Frequently Asked Questions
How many sessions of CBT with ERP will I need?
This varies by presentation and severity. For straightforward OCD, meaningful progress is often achieved within twelve to twenty sessions. Complex, longstanding, or severe OCD may require a longer course. Your clinician will give a clear indication at assessment.
Is ERP uncomfortable?
CBT with ERP involves deliberately encountering feared situations, which can feel challenging. However, it is always conducted gradually, collaboratively, and at a pace agreed with you. Anxiety reduces naturally over the course of treatment — and the short-term discomfort of ERP is consistently reported as preferable to the long-term impact of untreated OCD.
Can CBT with ERP be done online?
Yes. We offer secure video sessions alongside in-person appointments. Research supports the effectiveness of online ERP, which can be particularly useful for OCD involving home-based triggers such as contamination fears or checking rituals.
How is CBT with ERP different from standard CBT?
CBT with ERP is a specific, structured protocol developed for OCD. Standard CBT may address unhelpful thought patterns across a range of presentations. ERP adds a formal, graduated exposure component and a specific focus on response prevention — the structured resistance of compulsions — which is what makes it particularly effective for OCD's compulsive cycle.
Can CBT with ERP be used alongside medication?
Yes, and for moderate to severe OCD this combination is often recommended. Evidence shows ERP combined with medication to be significantly more effective than medication alone, with benefits maintained at follow-up. Where appropriate, we can coordinate care with a prescribing psychiatrist.
Do I need a formal OCD diagnosis to access treatment at Regal?
No formal diagnosis is required to enquire or book a consultation. Your clinician will conduct a thorough assessment and advise on whether CBT with ERP is the most appropriate approach for your presentation.
What is the difference between ERP and CBT-E?
CBT-E (Enhanced Cognitive Behavioural Therapy) is a specialist adaptation of CBT developed specifically for eating disorders. ERP is the OCD-specific protocol. Both fall within the CBT family but are distinct approaches designed for different presentations.
A Discreet Harley Street Setting
CBT with ERP at Regal Private Therapy Practice is delivered within a confidential, specialist clinical environment at 4 Devonshire Street, Marylebone, London W1W 5DT, within the Harley Street Medical District.
We offer:
One-to-one CBT with ERP delivered by HCPC-registered, BABCP-accredited Clinical Psychologists
In-person appointments in Marylebone
Secure online sessions
Flexible scheduling, including some evening availability
Integrated care with psychiatric colleagues, where clinically indicated
