In my early career as a psychologist, over 20 years ago, the way we view OCD and its treatment was different than today. While we knew that OCD was a treatable condition, the options available and the understanding of the disorder were not as advanced as they are today. Newer approaches, such as Acceptance and Commitment Therapy (ACT), were starting to gain traction, offering a different perspective on managing OCD.
Even back then, some key treatments were emerging as effective:
- Exposure and Response Prevention (ERP): By the early 2000s, ERP was already being recognized as a gold standard for OCD treatment. Research had clearly demonstrated its effectiveness, and it was being implemented in many clinical settings.
- Cognitive Behavioural Therapy (CBT): CBT, especially when combined with ERP, was also gaining recognition as a powerful tool for changing the thought patterns that fuel OCD.
- Medication Advances: Selective serotonin reuptake inhibitors (SSRIs) were proving helpful in reducing OCD symptoms for many individuals.
By the early 2000s, the narrative around OCD was beginning to change. Advocacy organisations, such as the International OCD Foundation (founded in 1986), and mental health campaigns were helping raise awareness about OCD’s treatability. Public figures who spoke openly about their experiences with OCD also reduced stigma, encouraging people to seek help. This shift in mental health were people start to discuss their difficulties openly has had, I believe, and profound effect on treatment, for example, people now come to see me requesting specific approaches, usually ERP, after the read or saw someone talk about their experiences with OCD, this is so encouraging to see, people taking charge of their own mental health. And to help you move forward with your chosen treatment, I want to take this opportunity to discuss what treatment and therapy options are open to you.
Cognitive Behavioural Therapy (CBT): Changing Your Thinking
Cognitive Behavioural Therapy (CBT) is a cornerstone of OCD treatment and recent research1 consistently shows how effective it is. It helps you identify and challenge the unhelpful thought patterns that fuel your anxiety. Imagine learning to reframe those intrusive thoughts, to see them not as threats but as mental events that you can observe without reacting to. CBT equips you with coping strategies to manage anxiety and break free from the cycle of obsessions and compulsions.
For example, if you have a fear of contamination, CBT might help you challenge the thought “If I touch this doorknob, I’ll get sick and die.” You’ll learn to question the likelihood of that outcome and develop healthier ways to manage the anxiety. How this could play out in therapy. If you were in session with me, I would set up as a homework, I could touch something that you consider ‘germy’ can lick my finger, then the important bit – you would have to specifically tell me when I how I will get sick. This is crucial, as I got get a random head cold on the day of your next session and you may misinterpret that as evidence that I got sick from touching something in our last session. I will ask you to name exactly how I will get sick and in what time frame. It’s considered a behavioural experiment and when you next see me in therapy, we can check if I got sick or not.
- You can learn more about CBT here
Exposure and Response Prevention (ERP): Facing Your Fears
ERP is a powerful behavioural therapy, and is aptly referred to as the gold standard for treatment2; it involves gradually confronting your fears and resisting the urge to engage in compulsions. It’s like slowly turning down the volume on your anxiety. By repeatedly exposing yourself to the things that trigger your OCD, you learn that the anxiety will subside naturally, even without performing compulsions.
- Example: If you have a checking compulsion, ERP might involve leaving the house without checking the stove, gradually increasing the time you spend away from home. In my clinical practice, I’ve seen ERP be incredibly effective in helping people overcome OCD and on a personal note I have also used it myself to stop myself from constantly checking doors.
Acceptance and Commitment Therapy
ACT takes a different approach, focusing on accepting your thoughts and feelings without judgment, and committing to actions that align with your values. It’s about learning to live with uncertainty and focusing on what truly matters to you.
For example, instead of trying to eliminate intrusive thoughts, ACT encourages you to observe them without getting carried away, and to focus on engaging in activities that bring you joy and purpose, even if those thoughts are present.
Mindfulness-Based Therapies: Finding Stillness in the Storm
Mindfulness practices, such as meditation and mindful breathing, can be a powerful tool in managing OCD. By learning to observe your thoughts and feelings without judgment, you can reduce the intensity of anxiety and the urge to engage in compulsions. Mindfulness can be integrated into other therapies, such as ACT, or practiced on its own.
Medication
In some cases, medication can be helpful in managing OCD symptoms, particularly when combined with therapy. Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), can help regulate brain chemicals that contribute to anxiety and obsessive thinking. I am a psychologist and we do not prescribe mediation, so it is important to discuss medication options with your doctor or psychiatrist.
Emerging Treatments
Research is constantly evolving, and new treatments for OCD are being explored. These include Deep Brain Stimulation (DBS) for treatment-resistant OCD and Ketamine-Assisted Therapy to rapidly reduce symptoms. While in my clinical experience these are not treatments I have personally used, the research suggests they hold promise for the future of OCD treatment. It’s important to discuss any new or emerging treatment options with a qualified healthcare professional.
Self-Help Strategies for OCD
While professional treatment is essential for many people with OCD, there are also many things you can do on your own to manage your symptoms and support your recovery journey. These self-help strategies can be used alongside therapy or as a first step towards seeking help:
- Mindfulness Exercises: Practice mindful breathing or body scan meditations to observe your thoughts and feelings without judgment.
- Relaxation Techniques: Use techniques like progressive muscle relaxation or guided imagery to manage anxiety.
- Journaling: Track your OCD symptoms, identify triggers, and challenge negative thoughts through journaling.
- Lifestyle Changes: Prioritize healthy sleep, regular exercise, and a balanced diet to support your mental health.
- Support Networks: Connect with online or in-person support groups for OCD to reduce feelings of isolation.
It’s very important to understand that even though OCD comes in all different forms, the treatment stays the same. The different forms are really just differing obsessions or intrusive thoughts such as.
- HOCD, where the focus is on your sexual identity – you can learn more about HOCD in my guide, or
- POCD, which is very difficult for the person involved as the obsessions centre around children; learn more about POCD here,
- or in my Guide to Intrusive Thoughts, I list many different manifestations of OCD.
To reiterate my point, regardless of how OCD is affecting you, you still need to undertake researched based models of therapy like CBT and ERP.
A Personal Note
Creating this website and these resources has been a deeply personal journey for me. [ Briefly share your own experience or motivation for helping others with OCD. This could be a sentence or two about your own journey with OCD or your passion for supporting others.] I believe that everyone deserves access to information and support, and I hope this page helps you find your way forward.