Obsessive Compulsive Disorder (OCD)
OCD is a common but often misunderstood anxiety disorder. Many people think OCD is simply about being tidy or organised, but in reality it can involve persistent, unwanted intrusive thoughts, images, urges or doubts (obsessions) that cause significant distress. To reduce this distress, people often engage in compulsions such as checking, washing, seeking reassurance, mentally reviewing events, or avoiding situations they fear may trigger their anxiety.
OCD can affect every aspect of life, including work, relationships and daily functioning. It can also take many different forms, including contamination fears, checking, intrusive thoughts about harm, sexual or religious obsessions, relationship OCD, health-related obsessions, "Pure O", and perfectionism. Whatever form it takes, OCD is highly treatable with the right approach.
How CBT helps OCD
Cognitive Behavioural Therapy (CBT), incorporating Exposure and Response Prevention (ERP), is the most effective psychological treatment for OCD and is recommended by UK clinical guidelines. Rather than trying to eliminate intrusive thoughts, CBT helps you develop a different relationship with them and break the cycle that keeps OCD going.
Treatment begins by developing a shared understanding of how your OCD operates. Together, we identify the beliefs, behaviours and patterns maintaining the problem before creating a personalised treatment plan. Behavioural experiments are then collaboratively carried out to discover what happens when you don’t respond to intrusive thoughts or carry out compulsions. By disconfirming catastrophic beliefs, we dismantle OCD. The aim is not to stop intrusive thoughts from ever occurring, but to reduce the fear, meaning and compulsions attached to them so they no longer control your life.
Why work with me?
I am an HCPC Registered and BABCP Accredited Counselling Psychologist with extensive experience treating OCD within specialist NHS services. I spent ten years working at South London & Maudsley NHS Foundation Trust, including with Professor David Veale and colleagues the Centre for Anxiety Disorders and Trauma, before joining Oxford Health Specialist Psychological Intervention Centre, where I continue my NHS work with Professor Paul Salkovskis and colleagues.
My clinical practice is dedicated to anxiety disorders, and I have helped many people recover from OCD, ranging from mild symptoms to long-standing and complex presentations. Alongside my clinical work, I provide teaching and supervision to psychologists and CBT therapists at Oxford Cognitive Therapy Centre and have delivered workshops for NHS services and organisations including OCD-UK.
Whether you have recently begun experiencing OCD or have struggled for many years, therapy is tailored to your individual goals and delivered in a collaborative, compassionate and evidence-based way.
Related obsessional problems
The same CBT principles used to treat OCD are also highly effective for a number of related difficulties that involve intrusive thoughts, uncertainty and repetitive safety behaviours.
Health Anxiety
Health anxiety involves persistent worry about having or developing a serious illness, even when medical reassurance suggests there is no significant cause for concern. People often find themselves repeatedly checking their body for symptoms, researching illnesses online, seeking reassurance from family or healthcare professionals, or avoiding situations they associate with illness.
CBT helps you understand how these patterns inadvertently keep anxiety going and supports you in reducing checking and reassurance-seeking behaviours, becoming more comfortable with uncertainty, and responding differently to health-related fears.
Emetophobia
Emetophobia is an intense fear of vomiting or seeing others vomit. It can have a profound impact on daily life, leading people to avoid certain foods, restaurants, public transport, travel, social events, pregnancy, or contact with people who may be unwell.
Treatment focuses on identifying the beliefs and behaviours that maintain the fear and gradually reducing avoidance through carefully planned behavioural experiments and exposure exercises. As confidence grows, people are able to return to activities that OCD or anxiety had previously restricted.
Body Dysmorphic Disorder (BDD)
Body Dysmorphic Disorder (BDD) involves becoming preoccupied with perceived flaws in your appearance that are either not noticeable to others or seem much more significant to you than they do to other people. This can lead to distress, low confidence, and difficulties in work, relationships and everyday life.
People with BDD often spend excessive time checking mirrors, comparing themselves with others, seeking reassurance, grooming, or avoiding social situations. Although these behaviours may reduce anxiety in the short term, they ultimately keep the problem going.
CBT for BDD helps you understand these patterns, reduce unhelpful checking and avoidance, and develop a healthier relationship with your appearance. Because BDD shares many of the same maintaining processes as OCD, specialist CBT is an effective treatment for both conditions.
Other obsessional difficulties
Some people experience obsessional problems that do not fit neatly into a diagnosis of OCD but are maintained by similar processes, such as excessive doubt, intolerance of uncertainty, compulsive reassurance seeking, perfectionism, or repetitive checking and reviewing. Because these difficulties share many of the same maintaining mechanisms as OCD, they often respond well to the same evidence-based CBT approaches.
If you are unsure whether your difficulties would be described as OCD, health anxiety, emetophobia or another obsessional problem, this can be explored during an initial assessment. The focus is not on the label itself, but on understanding the patterns that are keeping your difficulties going and developing an effective treatment plan tailored to your needs.
-
Yes. CBT with Exposure and Response Prevention (ERP) has the strongest evidence base for treating OCD and is recommended as the first-line psychological treatment. Most people experience significant improvement when they engage consistently with therapy.
-
CBT for OCD is about more than just exposure exercises. Once we have developed a shared understanding of your OCD, the aim is to help you carry out behavioural experiments to test your beliefs and behaviours, and make changes that start to dismantle your OCD. Experiments that include ERP, to test your beliefs about what happens if you don’t carry out compulsions, are a key component of effective treatment. Good CBT is always collaborative. We agree each experiment together and work at a manageable pace. You will never be forced to do anything you are not prepared for, have not agreed to, or don’t understand.
-
No. Everyone has intrusive thoughts they dislike, including violent, sexual, blasphemous, or other unpleasant thoughts. Intrusive thoughts of this kind are extremely common and are not an indication that you are strange, dangerous, or want to act on them. A central part of OCD treatment is learning to understand that intrusive thoughts are just thoughts, and that not all thoughts are meaningful, important, accurate, or true. What is important is how your respond to them. Treatment will help you respond differently to these thoughts so they lose their power.
-
Absolutely. Many people seek treatment after living with OCD for years or even decades. Effective treatment focuses on the processes maintaining OCD now, rather than how long you have experienced it.
-
Yes. Research has shown that CBT for OCD can be delivered effectively via secure video appointments, with outcomes comparable to face-to-face therapy for many people.
-
The number of sessions varies depending on the severity and complexity of your OCD, your treatment goals, and the amount of practice you are able to complete between sessions. During the initial assessment, we will discuss a personalised treatment plan and likely timescale.
-
I work with the full range of OCD presentations, including contamination fears, checking, intrusive harm thoughts, sexual and religious obsessions, relationship OCD, health-related OCD, responsibility OCD, "Pure O", perfectionism, and compulsive reassurance seeking.
-
As my expertise is in working with adults, I do not see people under 18.
For help for children and adolescents, contact Dr Sasha Walters - www.theocdpsychologist.com
Useful websites
OCD UK – A national OCD charity, run by, and for people with OCD, providing evidence-based information, advice and support.
OCD Action – The UK’s largest OCD charity, providing support and information to anybody affected by OCD.
Recommended reading
Break Free from OCD: Overcoming OCD with CBT | Fiona Challacombe, Victoria Bream, and Paul Salkovskis – An extensive and practical guide to overcoming OCD through cognitive behavioural therapy from three leading psychologists and experts in OCD and anxiety disorders.
“My number one recommendation OCD self-help book”, Ashley Fulwood, CEO, OCD-UK.
Podcasts
The OCD Stories – A UK show that aims to offer hope and inspiration. Host Stuart Ralph interviews some of the best minds in OCD treatment and recovery.
OCD Family Podcast – An educational and support-focused US show, hosted by Nicole Morris, a Licensed Marriage and Family Therapist (LMFT) and an OCD specialist, that aims to help parents, partners, adult children, and loved ones of individuals suffering from OCD and related conditions.
Other resources
OCD - Too Careful, Too Nice, and Trying Too Hard | Prof Paul Salkovskis