Which therapy helps with OCD?

The therapy with the strongest evidence for obsessive-compulsive disorder (OCD) is cognitive behavioural therapy (CBT) that includes exposure and response prevention (ERP), and this is what NICE guidance recommends. For some people, depending on how much OCD is affecting their life, medication prescribed through a GP is also offered, either on its own or alongside therapy. Other approaches can be helpful alongside this, particularly for the shame, self-criticism and relationship strain that often come with OCD.

Key points

• OCD involves obsessions (unwanted, distressing thoughts, images or urges) and compulsions (things done to reduce the distress).
• Compulsions are not always visible: mental reviewing, checking and reassurance-seeking count too.
• NICE recommends CBT including ERP, and in some cases medication via your GP.
• Other approaches can help with shame, self-compassion and relationships, but are best seen as additions rather than replacements.
• Charities such as OCD-UK and OCD Action, and the BABCP register, can help you find support.

What is OCD?

OCD is a common mental health condition made up of two parts. Obsessions are unwanted and intrusive thoughts, images, doubts or urges that cause intense anxiety, disgust or a sense that something is "not right". Compulsions are the actions, rituals or mental acts a person feels driven to do to ease that distress or prevent something bad from happening.

Some compulsions are easy to see, such as washing, checking or arranging. Many are not. People with OCD often carry out mental compulsions, such as replaying events, mentally checking, counting, praying in a particular way or trying to "neutralise" a thought with another one. Reassurance-seeking, whether asking others, searching online or checking your own feelings, is also very common and can quietly keep the cycle going.

The themes of OCD vary widely: contamination, harm, responsibility, sexual or religious thoughts, relationships, health, symmetry and more. The content of the thought is not the problem in itself. What keeps OCD going is the cycle of anxiety, compulsion, brief relief and then the doubt returning, often stronger.

What does NICE recommend for OCD?

NICE (the National Institute for Health and Care Excellence) recommends CBT that includes exposure and response prevention as the main psychological treatment for OCD. The intensity of support offered depends on how much OCD is affecting someone's life. For some people, particularly where OCD is more severe, medication (usually a type of antidepressant) may be offered by a GP or psychiatrist, either alone or alongside CBT.

Medication is a decision to make with your GP, who can talk through the options, benefits and possible side effects with you. As a psychotherapist, I do not prescribe or advise on medication.

How does exposure and response prevention work?

In plain terms, ERP helps you gradually face the thoughts and situations that trigger your OCD (the exposure) while choosing not to carry out the compulsion (the response prevention). Over time, this teaches your brain that you can tolerate the anxiety and uncertainty without the ritual, and that the feared outcome does not depend on it.

ERP is done collaboratively and step by step. A therapist will usually work with you to:

1. Understand your particular OCD cycle, including the hidden mental compulsions and reassurance-seeking.
2. Build a list of triggers, from mildly to very uncomfortable.
3. Start with manageable steps and practise staying with the discomfort without the compulsion.
4. Repeat the practice between sessions, gradually moving up the list.
5. Notice what you learn, and reduce the ways you have been avoiding life.

ERP is not about forcing yourself into overwhelming situations, and a good therapist will not push you faster than you can manage. It can feel daunting, and that is understandable. Many people find it helps to know the reasons behind each step.

What can other approaches add?

OCD rarely exists in isolation. People often carry a great deal of shame about their thoughts, fear of being judged, and years of hiding what they experience. Other therapeutic approaches can be valuable alongside ERP-based work.

• Person-centred approaches offer a space where you can say the thoughts out loud without being judged, which can ease shame and make it easier to engage with treatment.
• Psychodynamic ideas can help explore how early experiences, family patterns or a strong sense of responsibility may have shaped the way you relate to doubt and danger.
• ACT-informed work (acceptance and commitment therapy) focuses on making room for uncomfortable thoughts and feelings while moving towards what matters to you, which fits well with the spirit of ERP.
• Self-compassion can soften the harsh self-criticism that often comes with OCD.
• Work on relationships can help when partners or family have become involved in rituals or reassurance, which is very common and nobody's fault.

These approaches can support recovery, but on their own they are not the recommended first-line treatment for OCD. It is worth being cautious about any therapy that encourages lengthy analysis of the content of obsessive thoughts, as this can sometimes turn into another form of reassurance.

Where can I find help for OCD?

• Your GP can talk through treatment options, including medication, and refer you to local services.
• NHS Talking Therapies (in England) accepts self-referrals and offers CBT for OCD.
• OCD-UK and OCD Action are UK charities offering information, support groups and guidance on finding treatment.
• The BABCP (British Association for Behavioural and Cognitive Psychotherapies) keeps a register of accredited CBT therapists, which you can search for someone with OCD experience.

How I work with OCD

As an integrative psychotherapist registered with the BACP, I work with people experiencing OCD and anxiety, helping them understand the patterns that keep them stuck and find different ways of responding to their thoughts and feelings. I draw on Cognitive Behavioural Therapy (CBT), including Exposure and Response Prevention (ERP) where appropriate, alongside other therapeutic approaches tailored to your individual needs. You can read more on my OCD therapy page.

If you are in crisis, call 999, go to A&E, call NHS 111, or contact Samaritans on 116 123 (free, 24/7).

If you would like to talk about whether working together might help, you are welcome to get in touch and book an initial consultation. There is no pressure, and you do not need to explain everything in that first conversation.