How Does Exposure Response Prevention (ERP/ExRP) for OCD Work?

One of the really frustrating things about living with OCD is that the ways we try to cope with having OCD tend to become the compulsions that make OCD worse. In order words, we struggle to deal with obsessive thoughts that cause anxiety, such as a fear that touching things will make us sick (contamination type OCD), or the uncertainty about whether we might be going to hell (scrupulosity type OCD), or the fear that maybe we hurt someone in the past (harm type OCD). Then we come up with creative ways to deal with the intense fears and uncertainty, like washing our hands after touching something, or saying repeated prayers, or seeking reassurance about our past behavior. But it is exactly those creative ideas that become the compulsions that take up increasing effort and time in our lives, and which edge out more and more of the things that give us pleasure. Also trying to avoid the kinds of experiences that trigger our fears can gradually make our lives smaller. Going to therapy with people who are untrained in working with OCD can also make OCD worse since well-meaning therapists will teach coping skills, offer reassurance, or help analyze and reality-test past experiences using methods like Cognitive Behavioral Therapy (CBT), but those actions can also worsen compulsions or become compulsions themselves.