ERP, PDA, and Autism: Why Fear of Harm Makes Sense—and Why It Doesn’t Have to Be the End of the Conversation

ERP is a behavioral therapy. That fact alone is enough for many autistic and PDA individuals to feel immediate alarm.

The concern is often:

Will this override my autonomy?
Will I be pushed through distress for someone else’s definition of progress?
Will my nervous system be ignored again?

For PDAers in particular—whose anxiety is often tightly linked to perceived loss of autonomy—the idea of “exposure” can sound indistinguishable from coercion.

And in some settings, unfortunately, that fear has been justified. ERP can be practiced in ways that are rigid, therapist-led, compliance-focused, and dismissive of neurodivergent needs.

When that happens, it does replicate harmful dynamics.

The Critical Distinction: ERP Is a Tool, Not a Philosophy

What often gets lost in these conversations is an important distinction:

ERP itself is not inherently coercive.
The way it is conceptualized and delivered determines whether it is harmful or healing.

ERP does not require:

Forced participation
Ignoring consent
Suppressing autistic traits
Prioritizing normalization
Treating distress as something to be overridden

Those are choices made by providers, not requirements of the model.

Why Avoidance of All Behavioral Treatment Can Also Cause Harm

In response to historical abuse, some communities have understandably swung toward an absolute stance: that any behavioral intervention is unsafe for autistic or PDA individuals.

While protective in intent, this belief can unintentionally:

Cut people off from effective OCD treatment
Leave severe anxiety untreated
Conflate autonomy with avoidance
Frame suffering as inevitable rather than addressable

For individuals with OCD, this is especially consequential. OCD does not resolve through insight, accommodation, or validation alone. Without some form of exposure to feared experiences—and reduction of compulsive responses—symptoms often expand, restrict life, and entrench suffering.

Rejecting ERP wholesale can mean abandoning people to their anxiety, not protecting them from harm.

What Neuroaffirming, PDA-Informed ERP Actually Looks Like

ERP does not have to resemble ABA. When practiced ethically and neuroaffirmingly, it often looks fundamentally different from what many people fear.

Key differences include:

Consent is ongoing, not assumed
Participation is collaborative, reversible, and transparent.
Exposures are co-created, not prescribed
The client defines goals, pacing, and meaning—not the therapist.
Autonomy is protected, not challenged
ERP is framed as increasing choice, not enforcing endurance.
Sensory and nervous system needs are accommodated
Distress is differentiated from harm.
Success is not compliance or normalization
It is access to a fuller, values-aligned life.

For PDAers, this autonomy-preserving stance is often what makes engagement possible at all.

ERP Is Not About “Doing What You’re Afraid Of”

This is another misconception that fuels fear.

ERP, when done well, is not about forcing someone into distress. It is about:

Reducing compulsive patterns that already cause distress
Increasing flexibility where anxiety has narrowed life
Allowing the nervous system to learn that choice still exists

For autistic and PDA individuals, ERP can be reframed as:

“Expanding your range of options—on your terms.”

Not shrinking them.

You Are Not Wrong to Be Cautious

Skepticism toward behavioral treatment is not ignorance—it is lived experience.

But caution does not have to mean closure.

It is possible to:

Acknowledge harm caused by past interventions
Reject coercive, compliance-driven models
Demand neuroaffirming, consent-based care
And still access effective treatment for OCD and anxiety

ERP does not have to be the enemy of autistic liberation. When reclaimed thoughtfully, it can be a tool that supports autonomy rather than undermines it.

A Reframe Worth Considering

The question may not be:

“Is ERP safe for autistic or PDA individuals?”

But rather:

“Who gets to define what ERP looks like—and whose nervous system is centered?”

When autistic and PDA voices are central, when consent is real, and when autonomy is preserved, ERP does not replicate harm.

It becomes something else entirely.