Treatment
OCD treatment: CBT with exposure and response prevention
The NHS says OCD is unlikely to get better on its own. It also says treatment and support can help you manage your symptoms and improve your quality of life. Therapy for OCD is usually a type of cognitive behavioural therapy (CBT) that includes exposure and response prevention (ERP).
We offer CBT with ERP online, one to one. Sessions are with a clinical psychologist who specialises in OCD and is registered with the Health and Care Professions Council (HCPC). This page explains what NICE guidance recommends, how ERP works and what sessions with us look like.
Recommended treatments
What NICE guidance recommends for OCD
The main treatments for OCD are talking therapy and medicine. Current NICE guidance (CG31) for adults suggests which to offer based on how much OCD affects your daily life. NICE is updating this guidance, and the new version is due in 2027.
CBT with ERP
A talking therapy that helps you face your fears without doing compulsions. NICE says adults whose OCD has a mild effect on daily life, or who prefer it, should first be offered a low-intensity therapy. This can include ERP, and involves up to 10 hours with a therapist. For moderate OCD, one option is more intensive CBT with ERP, with more than 10 hours with a therapist.
SSRI medicine
A type of antidepressant called a selective serotonin reuptake inhibitor (SSRI), prescribed by a doctor. For adults with moderate OCD, NICE says you should be offered a choice: an SSRI, or more intensive CBT with ERP. It says they appear to work about as well as each other.
Both together
For adults whose OCD has a severe effect on daily life, NICE recommends an SSRI combined with CBT with ERP. The NHS says more severe OCD may need a longer course of treatment.
How ERP works
How exposure and response prevention works
In ERP, you gradually face the things you fear without doing your usual compulsions, and wait for the anxiety to settle. Over time, you can learn that you are able to cope without them.
Understand your OCD together
In the first sessions, you and your psychologist work out how your OCD works and what keeps it going. This includes why compulsions only bring short-term relief. You agree your goals together.
Build a ladder of feared situations
You list the situations or thoughts you fear, from the least frightening at the bottom to the worst at the top. This becomes your plan.
Face your fears step by step, without compulsions
You start with the easiest step. You stay with the situation without doing a compulsion and let the anxiety settle. Then you move up, one step at a time.
Practise between sessions
ERP tends to work best with frequent practice. You will have exercises to do between sessions, ideally where OCD affects you most, such as at home.
Cut down reassurance and avoidance
Asking for reassurance and avoiding triggers can work like compulsions. Reassurance may feel helpful at the time, but in the long term it can make OCD harder to overcome. Where it helps, and if everyone agrees, family members can learn to respond differently.
Plan for setbacks
Towards the end of treatment, you make a plan for using what you have learned if the same or new symptoms come back. Setbacks can happen, and a plan helps you know what to do.
Resist the compulsion, not the thought
The NHS says ERP may be hard work. It also says many people find that when they confront their obsessions, the anxiety eventually improves or goes away.
The Royal College of Psychiatrists advises resisting the compulsion, but not the obsessional thought itself. NHS inform explains that the harder you try not to think about something, the more likely you are to think about it.
Treatment with us
What online OCD therapy with us looks like
Treatment is one to one and built around CBT with ERP. You can book directly, without a referral or a diagnosis. You can start with an Initial Consultation to talk through your concerns and get a personalised treatment plan.
- No referral needed
- HCPC-registered psychologist
- From home, via Zoom
The treatment may be hard work, but many people find that when they confront their obsessions, the anxiety eventually improves or goes away.
The NHS, on CBT with ERP for OCD
- Where
- Online via Zoom
- Session length
- 50 minutes
- How often
- Twice weekly, weekly or fortnightly, whichever suits you
- Who you’ll see
- An HCPC-registered clinical psychologist who specialises in OCD
- Between sessions
- Exercises to practise at home. OCD-UK says much of the real work of therapy happens between sessions.
- How long treatment takes
- It varies. The NHS says people with fairly mild OCD usually need about 8 to 20 sessions. More severe OCD may need longer.
- Regular times
- The same day and time each week if you need it, by agreement and subject to availability
- Cost
- Prices are on our fees page. You get a discount when you book four or more sessions in advance.
- 30-minute Initial Consultation
- Online via Zoom
- No diagnosis needed
How we work
Our approach to OCD treatment
CBT with ERP is at the centre of our treatment. Dr Craig Govan, our founder and Clinical Director, is a clinical psychologist, not a medical doctor. Where it fits your needs, he can also draw on acceptance and commitment therapy (ACT) and on family and systemic work.
At the centre
ERP within the wider CBT approach
ERP sits within CBT. CBT also looks at how you make sense of intrusive thoughts and respond to them. OCD-UK says it is not the thought itself that is the problem, but the way you interpret and deal with it. It believes ERP is more likely to work as part of the full CBT package than on its own.
Added where it fits
Acceptance and commitment therapy (ACT)
ACT is another type of talking therapy. If it suits you, Dr Govan can bring ideas from ACT into your treatment.
Added where it helps
Family and systemic work
OCD often affects the people you live with. Family members can get drawn into checking, reassurance or avoidance without meaning to. Where it helps and everyone agrees, we can involve them in your treatment. The aim is to help them step back from this in a supportive way.
Medication
Medication for OCD
Dr Govan is a clinical psychologist, not a medical doctor, so we do not prescribe medicine. If you would like to talk about medication, speak to your GP or a psychiatrist.
The medicine usually offered for OCD is a type of antidepressant called an SSRI. The NHS says medicine may be needed if talking therapy has not helped or if OCD is fairly severe.
Up to
12 weeks
For an SSRI to start working for OCD, says the NHS
At least
12 months
How long NICE recommends taking an SSRI, if it helps
Things to know about SSRIs
- The NHS says they can take up to 12 weeks to start working for OCD, but most people will eventually benefit.
- If an SSRI helps, NICE recommends taking it for at least 12 months.
- Do not stop taking an SSRI suddenly. Speak to your doctor first, as stopping suddenly can cause unpleasant side effects.
- There is a very small chance that SSRIs could cause suicidal thoughts or urges to self-harm. If this happens, contact a GP or go to A&E. See where to get urgent help.
- For children and young people, NICE says an SSRI should only be prescribed after assessment and diagnosis by a child and adolescent psychiatrist.
Children and young people
Treatment for children and young people
Current NICE guidance (CG31) says CBT with ERP is the treatment of choice for children and young people with moderate to severe OCD. It should involve the family or carers and be adapted to the child’s age and stage of development. The same applies to milder OCD if guided self-help has not worked or was not wanted.
- Your child
- Family or carers
- School staff
It is very common for children with OCD to involve family members in their rituals. Going along with this is a normal parental response, and parents are not to blame. NICE says treatment should help families step back from this in a sensitive and supportive way. It may also help to involve school staff, such as teachers.
Dr Govan works with children and adults. Read our guide to OCD in children and young people.
When we may not be the right service
We want you to get the right help, even if that is not with us.
- If you are in crisis: we are not an emergency service. If you feel you cannot keep yourself safe, call 999 or go to A&E now. For other urgent support, see where to get urgent help.
- If your OCD is severe, long-lasting and hard to treat: the NHS says some people with OCD like this may be referred to a national specialist NHS OCD service.
Treatment for OCD is also available on the NHS. In England, you can refer yourself to an NHS talking therapies service if you are 18 or over (16 or 17 in some areas). You can also see a GP. Elsewhere in the UK, start by speaking to your GP.
If you are worried about a child or young person, speak to a GP, teacher or school nurse. They can put the young person in touch with local NHS children and young people’s mental health services.
If you are not sure, you can book an Initial Consultation. It gives you a clinical opinion and advice about the right next step.
Frequently asked questions
Can ERP therapy be done online?
Yes. The Royal College of Psychiatrists says ERP with a professional can take place face to face, by phone or by video link.
All our sessions are on Zoom, so you can join from home. They follow the steps of ERP: you build your ladder with your psychologist, face each step without doing compulsions, and practise between sessions.
How many ERP sessions will I need?
It depends on you and how much OCD affects your life. The NHS says people with fairly mild OCD usually need about 8 to 20 sessions. It says more severe OCD may need a longer course, and it can take several months before you notice the benefit.
You can have sessions twice weekly, weekly or fortnightly. At your Initial Consultation, we make a personalised treatment plan with you.
Will ERP make my anxiety worse?
It may, for a while. NHS inform says that when you start cutting down rituals and reassurance, your distress is likely to get worse at first. It says this is temporary.
That is why ERP starts with the easiest steps and builds up gradually. The NHS says many people find that when they confront their obsessions, the anxiety eventually improves or goes away.
You can say no to, or stop, treatment at any point.
Do I need an OCD diagnosis to start treatment?
No. You do not need a diagnosis or a referral to book treatment with us. Everyone is welcome.
If you would like a diagnosis, you can book our optional Assessment & Diagnosis. It is a one-off, 90-minute online session. If you are diagnosed with OCD, you get an official letter from a registered clinical psychologist. If not, we still give you recommendations and tell you what we think is going on.
Not sure if it is OCD? Read our guide to what OCD is.
Sources
- NHS — Overview - Obsessive compulsive disorder (OCD) (opens in a new tab)
- NHS — Symptoms - Obsessive compulsive disorder (OCD) (opens in a new tab)
- NHS — Treatment - Obsessive compulsive disorder (OCD) (opens in a new tab)
- NHS — Talking therapies (opens in a new tab)
- NHS — Find NHS talking therapies for anxiety and depression (opens in a new tab)
- NHS — Children and young people's mental health services (opens in a new tab)
- NHS — Where to get urgent help for mental health (opens in a new tab)
- NHS inform — Obsessive compulsive disorder (OCD) (opens in a new tab)
- NHS inform — Obsessive compulsive disorder (OCD) self-help guide (opens in a new tab)
- NHS inform — What is psychological therapy? (opens in a new tab)
- NICE — Overview | Obsessive-compulsive disorder and body dysmorphic disorder: treatment (CG31) (opens in a new tab)
- NICE — Recommendations | Obsessive-compulsive disorder and body dysmorphic disorder: treatment (CG31) (opens in a new tab)
- NICE — Obsessive-compulsive disorder: core interventions in the treatment of obsessive-compulsive disorder and body dysmorphic disorder (CG31 full guideline) (opens in a new tab)
- NICE — Project information | Obsessive-compulsive disorder and body dysmorphic disorder: assessment and management (GID-NG10435) (opens in a new tab)
- Royal College of Psychiatrists — Obsessive-compulsive disorder (OCD) (opens in a new tab)
- OCD-UK — Introduction to Obsessive Compulsive Disorder (opens in a new tab)
- OCD-UK — What are obsessions? (opens in a new tab)
- OCD-UK — OCD Treatment – An Overview (opens in a new tab)
- OCD-UK — The Importance of Working at Therapy (opens in a new tab)
- OCD-UK — Getting the most from therapy (opens in a new tab)
- OCD-UK — Finding a Private Therapist (opens in a new tab)
- OCD Action — Good Quality CBT with ERP (opens in a new tab)
- Mind — How to help someone who has OCD (opens in a new tab)
- Sussex Partnership NHS Foundation Trust — Obsessive Compulsive Disorder (OCD) – CAMHS resources (opens in a new tab)
- HCPC — What you should expect from your health and care professional (opens in a new tab)
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