Treatment Options

There are many different types of Cognitive Behavioural Therapy, which have been designed to work with different conditions or situations. The main goal in CBT is to get to know your personal patterns and slowly change them through practice. The idea is that our thoughts, actions, and emotions all impact on each other, so practicing new ways of thinking about things (cognitive) and new reactions (behavioural) can help to build new patterns that don’t revolve around anxiety.

Exposure and Response Prevention is a key part of treating OCD. Without it, therapy is much less likely to help.

One of the main issues that keeps people stuck in OCD is that the anxiety and doubt feel like they will go on forever, so the brain’s automatic reaction is to try to get rid of them. Unfortunately, this just makes them bigger and scarier as time goes on. When doing an ERP exercise, you would bring on anxiety on purpose so that you can practice not doing a compulsion.

At first you will start with tiny steps, like doing something that’s not too scary or just delaying a compulsion instead of skipping it altogether. Like with any other type of exercise, though, you will get stronger and better at it with practice, and intrusive thoughts will cause less and less anxiety as you go on.

Because this type of therapy is so hands-on, it acts quite quickly. Once you have started doing ERP exercises, you should start noticing a change after a few sessions.

The goal of the therapy is not necessarily for you to be completely free of OCD by the time you finish. Most of the time, successful therapy means that you have made enough progress and learned enough about the strategies that you can continue to work on your long-term goals independently.

Depending on the person, this usually takes between 8 and 20 sessions.

Doing ERP is a bit like going to the gym. It’s hard work, and you will probably not see results at first, so it can be tough to stick to. This is why working on it with a therapist who can guide you through it is often better than doing it on your own.

A therapist can also help you work towards doing ERP if you’re not quite ready for it. Most people have at least a few sessions at the start that are just about ‘psychoeducation’ – this means learning about your OCD and how the therapy will help you.

If ERP is just too hard, CBT techniques that focus on the way you think about things can help you work up to it. Everyone is different, so your therapist should be adapting what you do in therapy to what your strengths and needs are.

…my childhood / parents / past.

CBT with ERP focuses on what is happening right now and how to change it. You might explore some of your inner beliefs to help you understand the way you think about intrusive thoughts, but the focus should not be on your past. Finding the ‘root cause’ of OCD isn’t always possible, and luckily it’s not a part of what is needed to change it.

…my most scary intrusive thoughts

OCD is secretive by nature and can often pick topics that are embarrassing or taboo. There might be some parts of your condition you don’t feel able to tell a stranger about.

You don’t need to tell your therapist everything straight away. As you get to know them, you should feel more and more confident that they understand the nature of OCD and will see all your intrusive thoughts in the same way. If you are struggling to tell them about something, you can also say so – part of their job is to help you feel safe enough to open up. They shouldn’t respond by forcing you to tell them, but rather by looking at what is holding you back.

These tablets are often called ‘anti-depressants’, because they can also help with low moods and are prescribed for depression.

At high doses, though, SSRIs and Clomipramine are actually even better at helping to take the edge off of obsessive thinking, making the thoughts less ‘sticky’. When they are being used to help with OCD or related conditions, the tablets are called ‘anti-obsessional’.

About 60% of people who try this medication find that it helps them with their OCD symptoms. Some people find that medication is the main thing that helps them get their life back, while other people use the ‘boost’ to help them work harder in therapy.

You might find that your mood and anxiety start to get better after a few weeks, but the full anti-obsessional effects can take up to 12 weeks to kick in, so you might need to be patient with the results.

Every person is different, so the first tablet you try might not be the right match for you. If the side effects are too strong or the medication isn’t helping after 12 weeks, you might find that a different tablet, or sometimes a combination, works much better for you. This should always be discussed with your doctor.

Not knowing exactly how you will feel when you are taking medication can be worrying. You can speak to your doctor about what the most common side effects are for the type of medication you are trying out. It’s important to keep in touch with your doctor and let them know how you are feeling, especially during the first few weeks of taking a new tablet.

Most of the time, side effects are a result of your body adjusting to the changes, so they will fade or even go away completely after a few weeks. If they’re unbearable, though, or last a very long time, it might be that a different tablet would suit you better.

Many people worry that taking medication will change who they are. Really, when you find the right medication for you, it should help you feel more like yourself, because you’ll be less distracted and controlled by the OCD.

Any medication you take should be reviewed regularly with your doctor to see if it’s still the right thing for you. Whether you keep taking it is up to you, and will probably be based on how much it’s still helping.

The guidelines for treating OCD recommend to keep taking medication for at least a year, so that the positive changes get a good chance to sink in and stick around in the long run.

Some people take medication short-term to help while waiting for therapy and during the therapy itself, while other people take it for a much longer time because they find it really helps them and improves their quality of life.

Anxiety medication works in the moment by reducing the physical symptoms of anxiety, like heart palpitations or tense muscles. While this can be a huge relief, it doesn’t actually change the obsessive thinking that is happening on the inside. Because these types of tablet are very addictive, they’re not considered a safe or reliable way of managing the symptoms of OCD.

Unfortunately, you will likely have to wait some time for therapy if you are going through the NHS. We hear from a lot of people that this makes them hold back from asking for help, but it’s usually still going to be worth it to do so. You can do other things to help yourself while you wait, and when the time comes the therapy will help with wherever you in your recovery.

You can read our resource about Taking care of yourself, and learn about What support your university can offer.

You can contact mental health teams, either directly or through your GP, to find out about their waiting times. This can help you make a decision about where you are likely to be and where you want to get a referral to.

This level is for people with mild to moderate symptoms, and most patients start out here if they haven’t tried therapy yet.

You might be offered low-intensity therapy or guided self-help, but for OCD it’s usually more appropriate to receive high-intensity therapy.

In England, therapy at this level is offered by IAPT centres, which you can also self-refer to. Outside of England, it changes depending on where you live, so you can find information online or through your GP.

This level is for more complex situations that need a more specialised professional or team. Your GP should consider referring you to this step if:

• You had therapy at primary level and it wasn’t enough
• You have more than one condition or diagnosis (or think you might)
• Your symptoms are having a very severe impact on your day to day life and mental health

There are 6 services in the UK that specialise in treating adults with OCD and related conditions. There are also other, more general, services at this high level that can also offer OCD treatment. Usually, you will need a referral from a psychologist or psychiatrist to access this level of treatment, because it is specifically for people who have very hard-to-treat symptoms.

Different specialist centres offer different treatment options, including weekly sessions, intensive week-long therapy, and inpatient support. A specialist assessment is used to work out which option is best for each person.

There are plenty of websites where you can look for a therapist or a psychologist to work with. Unfortunately, these often include lots of professionals who say they can help with OCD but don’t realise that there is a specific therapy for it.

The easiest way to make sure someone has the right training in the right type of therapy is to look for registration with the BABCP, which is the regulating body for CBT therapists in the UK. Seeing the BABCP logo on a therapist’s website means that they have had good-quality training in CBT and have kept up their learning since then.

Be weary of therapists who claim they can help with everything! Not everyone who studies CBT knows how to treat OCD. You can check their website or get in touch with them to find out how much they know about OCD and ERP.

You might choose to see a psychiatrist if you need a formal medical diagnosis or your medication needs are quite complex. Your GP can refer you for this through the NHS if it is needed, or can write you a referral to show a private practitioner. A referral isn’t necessary for a private psychiatrist but it’s usually preferred.

When looking for a psychiatrist, we recommend choosing someone who is registered with the Royal College of Psychiatrists (RCPsych). You will know that they are if they have the letters MRCPsych (Member of the Royal College of Psychiatrists) or FRCPsych (Fellow of the Royal College of Psychiatrists) after their name.

This page has given you a snapshot of the treatments for OCD and how to access them. If you want to learn more about any of the topics mentioned on this page, you can also find more in-depth information on Our Resources Page.

We have factsheets about all the different topics covered on this page, as well as information about your legal rights, advocating for yourself, and making the most of treatment.

The helpline offers a listening ear and expert knowledge on all of our information. Our volunteers receive in-depth training, and most of them have personal experience of living with, and recovering from, OCD or a related condition.

If you have read through our factsheets and have any questions, or if you’d rather talk through how to get help instead of reading about it, get in touch!

You can call on 0300 636 5478

You can email on support@ocdaction.org.uk

You can read more about the service and request a call or email Here

If you are about to start therapy and are feeling nervous about it, you might be interested in signing up for some support alongside your treatment.

Through Next Steps, you will be paired up with a volunteer from the helpline, who you will speak to over 4 or 5 calls throughout your course of therapy. The volunteer is there to support you through CBT with ERP in 3 main ways:

• Help you to know what to expect, so you can be sure you are getting the right help
• Help you be honest with your therapist by providing a space to talk through the things you’re having trouble opening up about
• Encouragement – this might be reminding you how far you’ve come, cheering you on, or talking through your worries or frustrations

You can find out more about the service and sign up to it (once your therapy is about to start) Here.

Alongside working towards treatment, a lot of people find it helpful to join one of our support groups. These groups are not therapy, but rather a space to talk and hear about people’s experiences with OCD.

Living with OCD can bring a lot of feelings of shame, isolation, and not being understood – these groups exist to combat this. No matter where you are on your path to treatment or recovery, feeling less alone in your experience can be valuable support.

We run dozens of groups that meet over the phone or online through Skype or Zoom. Some are general groups for people with OCD, others are for particular experiences. You can find a list of our groups and sign up for one Here.

We also work with individuals across the country who run independent, face-to-face support groups for OCD, related conditions, or anxiety. You can find a map of face-to-face support groups Here.