OCD Therapy

What is OCD?

Obsessive-compulsive disorder (OCD) is a mental health condition that involves a cycle of obsessions and compulsions. Obsessions involve unwanted, repetitive, intrusive thoughts, images, or urges that cause significant distress. Compulsions are mental and/or physical actions done in response to the obsessions, aimed at reducing the distress or preventing a feared outcome.

The OCD cycle starts with an intrusive, unwanted thought, causing anxiety. This anxiety can feel unbearable, triggering a compulsive action to try reduce, neutralise or manage the anxiety and distress. This can be an obvious behaviour, such as washing hands, checking the door is locked, or something internal, such as repeating a phrase in your head, counting to a certain number repeatedly, or it may involve complete avoidance of something. Whatever the compulsion, it usually brings some relief, however the relief is only temporary, before another or the same intrusive thoughts pops back up and the cycle repeats itself, again, and again.

Intrusive thought an unwanted thought or image appears Anxiety rises distress builds, urge to act Compulsion a ritual, checking, or avoidance Temporary relief anxiety drops, briefly

OCD's themes vary widely between people. Common presentations include:

  • Contamination fears and washing or cleaning rituals

  • Intrusive doubts about causing harm (to self and/or others)

  • Checking behaviours

  • Taboo, unwanted or forbidden thoughts

  • A need for symmetry, order, or exactness

  • Needing things to feel “just right” or perfectionism

  • Relationship-focused doubts (ROCD) or sexuality-focused doubts

The emotional toll of OCD

OCD is often extremely distressing for people. It causes significant anxiety and distress and can cause debilitating impairment on everyday life and functioning.

OCD commonly brings feelings of shame, guilt and doubt. The content of obsessions can often feel at odds to a person’s values or their sense of self, making the experiencing distressing and confusing.

The cycle of OCD is exhausting and relentless, often leaving people feeling trapped by it. Thankfully, there are a few psychological treatments that can really help.

How is OCD treated?

Exposure and Response Prevention (ERP) is the gold-standard, most extensively researched treatment for OCD, and it's the core of how I work with clients. ERP involves identifying situations, thoughts, or sensations that trigger obsessions, with the goal of exposing ourselves to these thoughts and obsessions, resisting the urge to perform the compulsion. ERP involves learning to sit with the uncertainty, anxiety and distress that come with obsessions, taking away the need to do the compulsions.

ERP is tough, as it asks you to do exactly the opposite of what your OCD wants you to do. Starting ERP therapy can be overwhelming and often comes with a lot of hesitation. The good thing is that ERP can be individualised and adapted to go at a pace that feels manageable.

Acceptance and Commitment Therapy is another approach that has shown effectiveness in supporting people with OCD. Alongside ERP, I often draw on ACT, particularly for clients who get caught in mental battles with their intrusive thoughts, or who find themselves avoiding exposure work because the internal struggle feels too big. ACT offers tools for relating differently to intrusive thoughts: noticing them without immediately buying into their content or urgency, and reconnecting with what matters to you outside of OCD's demands. ACT can be helpful for building the psychological flexibility that makes staying in an exposure, rather than escaping into a compulsion, more achievable.