Intensive Treatment Program

Program Overview

Our Intensive Exposure and Response Prevention (ERP) Program provides focused, evidence-based treatment for individuals experiencing one of more of the following:

Obsessive-Compulsive Disorder (OCD)
Specific Phobias (including Emetophobia)
Social Anxiety Disorder/Social Phobia
Panic Disorder
Illness Anxiety Disorder (Health Anxiety)
Body Dysmorphic Disorder
Generalized Anxiety Disorder (often treated alongside OCD in our intensive program; occasionally treated as primary diagnosis)
Body Focused Repetitive Behaviors (BFRBs would not be treated with ERP; best practice involves treatment with HRT or ComB)

ERP is a specialized form of Cognitive Behavioral Therapy (CBT) that helps individuals gradually face their fears, while learning to resist compulsions and other responses that unintentionally maintain the OCD cycle. For more information on ERP, please visit our website or iocdf.org.

An intensive format offers more frequent, focused opportunities to practice ERP skills and apply them to everyday life. Treatment is individualized to each person's symptoms, goals, and needs.

What Makes This Program Different?

Rather than working with only one clinician throughout treatment, participants work with a coordinated team of 2–3 clinicians, including one designated lead clinician who oversees the program and helps guide treatment.

This team-based approach provides multiple opportunities to practice ERP while maintaining a shared understanding of treatment goals and progress.

Treatment consists primarily of individual sessions. A virtual, weekly treatment group may also be available as an optional addition when clinically appropriate.

Who May Benefit From Intensive ERP?

The program may be a good fit for individuals who:

Experience OCD symptoms that interfere with daily activities, relationships, work, school, parenting, or other meaningful areas of life.
Would benefit from more frequent or focused ERP than traditional weekly outpatient treatment provides.
Continue to experience significant symptoms despite previous treatment.
Want to reduce compulsions, avoidance, reassurance seeking, mental rituals, or other behaviors that maintain OCD.
Are willing to practice responding differently to OCD-related fears and uncertainty, even when doing so feels uncomfortable.

A previous course of ERP is not required. We also typically do not require medication management as a part of this treatment plan. However, we may recommend that you consider medication if indicated. As we do not have a prescriber on our team, we would provide referrals if you determine that medication would be helpful.

We also may ask to communicate with your medical providers as needed to coordinate treatment. This would be discussed with you in advance and would require a signed release of information.

Who May Need a Different Level or Type of Care?

Intensive ERP is not the right fit for everyone. Some individuals may benefit from additional support, stabilization, or a different level of care before beginning this program.

A higher level of care (e.g. residential treatment or PHP) may be recommended if:

There is severe functional impairment. For example, if symptoms are impairing and time-consuming to the point where it would be too difficult to manage attending our outpatient sessions reliably, completing homework, etc.
More frequent support and monitoring is needed. Residential treatment provides a 24-hour therapeutic environment and may be a better fit for folks who are struggling to maintain treatment demands outside of sessions.
There are active or fluctuating safety concerns. Struggles with active suicidal ideation may require partial hospitalization or a psychiatric inpatient stay for more stabilization and monitoring. If you believe you may be experiencing safety concerns, please call 988 or your local Mobile Crisis.
Intensive outpatient doesn’t help. Sometimes, folks try our program to help prepare for another higher level of care or to rule out a higher level of care. If this is the case, we can help adapt your treatment plan to these goals.

A different type of care may be recommended if:

OCD (or a related disorder) isn’t your main treatment target. Though we’re comfortable working with co-occurring disorders, we’re primarily going to focus on OCD and other disorders for which ERP is recommended. If trauma, depression, or another condition is your primary concern, we will likely recommend that you consider other programs better suited to your needs
You need eating disorder support. OCD often impacts eating and if this is the case, we will likely require that you establish support from your medical providers and a dietician. If an eating disorder is the primary concern and/or involves nutritional deficits, we’ll likely recommend that you attain medical stability before participating in our program.
You’re actively struggling with substance use.
You are experiencing impairing symptoms of insomnia that make it difficult to engage in treatment. If this is the case, you may need to consult with a medical professional and consider CBT-I before engaging in intensive ERP therapy.
If we suspect that another medical condition may be causing or interfering with your OCD symptoms.

The intake process helps determine whether the program can appropriately address an individual's needs. If another treatment option appears more suitable, we can discuss recommendations or potential next steps.

For a thorough list of OCD specialty PHP and residential programs, please visit IOCDF.org and view their program directory.

What Does Treatment Look Like?

Individualized Treatment With a Team of Clinicians

Participants work with a team of 2–3 clinicians, with one clinician serving as the lead. The team coordinates treatment around shared goals and an individualized treatment plan.

Sessions are primarily individual and typically last approximately 50 minutes. We sometimes schedule 90-minute sessions when indicated.

Scheduling and Frequency

Sessions are generally scheduled at 9:00am, 10:00am, or 11:00am, depending on availability.

Sessions typically take place 4x per week for 4-8 weeks. After your initial intake appointment, your team lead will propose a draft schedule (for example 4x per week for 5 weeks) based on the assessment results. Your team lead will discuss potentially adding time to your schedule after several weeks of treatment if it is determined that an extension could be helpful for more progress.

Program length is individualized based on clinical needs, treatment goals, progress, and other relevant considerations. The treatment team will discuss anticipated duration and scheduling during the intake process.

Treatment Setting

The program can take place exclusively virtually, in-person in our office in Chapel Hill, or hybrid (a combination of both). When relevant and logistically possible, we may also plan for ERP practice out in the community. Treatment format is discussed during the initial phone consultation as well as throughout the intake process.

For virtual sessions, our clients need to be located in North Carolina.

ERP will only be effective with regular practice. Our expectation is that clients practice homework assignments between sessions, which may involve exposure tasks in the home or out in the community, depending on each person’s needs.

Optional Virtual Treatment Group

A weekly virtual treatment group may be offered as an additional component when appropriate. Participation is optional and is not required for enrollment in the individual intensive program. This group costs $50/week.

What Is Expected of Participants?

Intensive ERP is an active, collaborative treatment process. Participants are expected to:

Attend scheduled sessions consistently and communicate about scheduling needs.
Collaborate with the treatment team to identify goals and develop an individualized treatment plan.
Participate in exposure exercises designed to address their OCD symptoms and treatment goals.
Practice response prevention, including reducing overt compulsions, mental rituals, reassurance seeking, and avoidance as relevant to their symptoms.
Complete practice between sessions to help carry treatment gains into everyday life.
Communicate openly and promptly about challenges, barriers, and questions so the team can adjust treatment as needed.

ERP involves practicing new responses to uncertainty and distress. Participants do not need to feel completely ready or confident before starting, but they should be willing to engage collaboratively in the treatment process.

What Is the Intake Process?

1. Initial contact: Fill out our new patient screener form on our website. Our care coordinator will contact you within 1-2 business days to schedule your phone consultation.

2. Screening or consultation: If you express interest in our Intensive ERP program via the screening form, you will be scheduled for a 15-minute screening call with our program manager, Erin Jones. If it’s determined that the Intensive Treatment Program is a good fit, you’ll be added to the waiting list. If not, we can provide referrals to other services within our group (weekly individual therapy, group therapy, etc.) or to other specialists outside of our group.

3. Initial Intake Appointment: We will reach out via email to schedule an initial intake appointment (50 minutes, $265, virtual or in-office) when space becomes available. You will have some initial paperwork to complete using our online health portal. We cannot see you without this paperwork, so be sure to complete it at least 24 hours before your initial appointment. Your intake appointment will take place with the program manager or a lead clinician. The assessment process explores symptoms, treatment history, goals, and whether intensive ERP is an appropriate fit.

If recommended, we often schedule one follow-up session (50 minutes, $205) for additional assessment and treatment planning before beginning the full intensive ERP program schedule.

4.Receive and confirm schedule: Your lead will send you the draft intensive ERP program schedule including appointment times, clinical team information, course of treatment, and weekly cost. You will also discuss your plans for treatment after the intensive, whether returning to a previous therapist or receiving new referrals for maintenance. Depending on clinician availability and fit, we may or may not be able to offer referrals within our practice.

An initial inquiry does not guarantee enrollment. Recommendations are based on an individualized assessment of treatment needs and program fit.

Additional Information

Cost and insurance:

Initial Intake: $265

All subsequent appointments: $205

Most intensive appointments are 50 minutes @ $205 per session. Once the ~4x weekly sessions begin, we bill weekly, pre-paid session fees every Monday. This schedule will be provided to you when you receive your treatment schedule draft after the initial intake appointment. The average weekly fee for the intensive program is $820/week.

We are private pay and out-of-network with insurance providers. We can issue a superbill for you to submit to your insurance company for out of network benefits. For more information on out of network benefits and gap exceptions, please visit the “Fees” page on our website..

Availability: We tend to have a wait list for our intensive program. The wait list time varies, though it’s not uncommon for it to reach more than 1-2 months. The wait time can and does fluctuate, based on several factors. You’re always welcome to reach out to see if our estimate has changed.

When there’s an upcoming spot available, you’ll receive an email letting you know that there’s space becoming available. This will include the approximate time of day of that availability and we will offer to schedule the initial intake appointment. Please reply to this email as promptly as possible, including if you wish to be removed from the wait list or want us to circle back to you later on. Your prompt reply is appreciated, as we want to be able to offer those spots to someone else on the list as soon as possible.

For a current wait list estimate, please email our intensive ERP program director, Erin Jones at jones@bullcityanxiety.com.

Individual: If you’d like to pursue individual therapy with one of our clinicians 1-2x per week, please fill out our new patient screener form on our website. Starting individual therapy does not exclude you from the Intensive Treatment Program and you’ll still be contacted when space becomes available if you’re on the wait list.

Interested in Learning More?

Contact: Erin Jones, LCMHCS, PMH-C (Intensive Treatment Program Manager)
Email: jones@bullcityanxiety.com
Website: https://www.bullcityanxiety.com/intensive-treatment