What is OCD? Understanding Obsessive-Compulsive Disorder and How Therapy Can Help

How OCD can affect people

Many of us engage in behaviours that can resemble aspects of OCD, even though this is very different from having Obsessive-Compulsive Disorder (OCD). British culture is full of superstitions such as knocking on wood, crossing our fingers for luck, or avoiding saying something "just in case." These behaviours often help us feel a little more certain when facing anxiety-provoking situations or uncertainty about the future. Psychologists sometimes refer to these as neutralising rituals, driven by magical thinking, the belief that our thoughts or actions can influence events even when there is no logical connection. For most people these behaviours are occasional and harmless, but for someone with OCD they can become much more frequent, distressing and difficult to resist.

Obsessive-Compulsive Disorder (OCD), however, is a common but often misunderstood mental health condition. It is characterised by recurring intrusive thoughts (obsessions) and repetitive behaviours or mental rituals (compulsions). People with OCD often feel compelled to carry out these behaviours because they fear that, if they do not, something bad might happen or their anxiety will become unbearable. Although these rituals may provide temporary relief, they unintentionally reinforce the belief that the ritual was necessary, maintaining the cycle of anxiety over time.

Obsessions can involve many different themes, including fears of contamination, accidentally harming someone, making mistakes, unwanted sexual or violent thoughts, religious or moral concerns, relationship doubts, or a need for things to feel "just right." However, these thoughts are not a reflection of a person's character or intentions. They are intrusive, unwanted and often deeply distressing, frequently being completely at odds with the person's values and beliefs. This is what distinguishes obsessions from the ordinary thoughts that most of us experience every day and are able to dismiss without much concern.

Compulsions are the behaviours or mental rituals used to try to reduce the anxiety caused by these intrusive thoughts. These may include excessive washing, checking, counting, repeating actions, arranging items, mentally reviewing events, or repeatedly seeking reassurance from others (Seif & Winston, 2020). Although compulsions can provide short-term relief, they prevent the person from learning that the feared outcome was unlikely to happen anyway. Instead, the brain mistakenly credits the ritual with keeping them safe, strengthening the OCD cycle and making the obsessions more persistent over time.

Within my practice, I often see clients when OCD has begun to have a profound impact on their lives often affecting work, education, relationships and everyday life. Many people spend hours each day caught in a cycle of obsessions and compulsions, leaving them exhausted, frustrated and isolated. It is important to remember that OCD is not simply about being tidy, organised or liking things a certain way; it is a recognised mental health condition that can cause significant distress. The good news is that OCD is highly treatable, and with the right support many people learn to manage their symptoms, break free from the cycle of obsessions and compulsions, and regain their quality of life again.

How I can help

Through many years of experience in treating individuals living with different types of OCD, I offer evidence-based CBT/integrative therapy in a supportive, compassionate and non-judgemental way. We work together to understand how OCD operates within your life, identify the patterns that keep it going, and gradually build up resilience and confidence so you have the confidence to respond differently.

My approach includes:

The way I work with clients is often using Exposure and Response Prevention (ERP), the gold-standard psychological treatment for OCD and Cognitive Behavioural Therapy (CBT) to help you understand the thoughts, feelings and behaviours that maintain OCD.
I have also found EMDR helpful for OCD as well, with EMDR being increasingly used to effectively treat this condition. This is because OCD often originates from a negative experiences in the past that eventually leads to neutralising rituals and magical thinking to reduce anxiety and uncertainty.

The main aim for therapy is about learning to tolerate uncertainty and reduce the need for compulsions or reassurance. Understanding why intrusive thoughts occur and recognising that they do not define who you, builds confidence, resilience and self-compassion throughout the recovery process. Whether your symptoms are mild or severe, treatment is tailored to your individual needs and carried out at a pace that feels manageable (and within your comfort zone), while still helping you make meaningful progress.

Example

Sarah repeatedly has the thought, "What if I left the front door unlocked and someone breaks in?" Even after checking the lock several times, she continues to doubt herself. Before leaving home, she finds herself checking the door again and again, sometimes for over thirty minutes. She knows the behaviour is excessive, but the anxiety feels overwhelming if she tries to stop doing this safety behaviour. During therapy, Sarah gradually learns to resist the urge to repeatedly check the door and with support through Exposure and Response Prevention (ERP), she begins to be able to check the door just once before leaving the house. Although her anxiety initially increases, she discovers that it naturally decreases over time without performing additional checks.

As therapy progresses, she becomes more comfortable living with uncertainty and no longer feels controlled by the obsessive thought. Eventually, leaving the house becomes much quicker and far less distressing, allowing her to regain time, confidence and independence. One effective suggestion from Seif & Winston (2020) is their recommendation of a mindfulness and cognitive-behavioral acronym used to help individuals deal with, and tolerate, uncertainty thus overcoming compulsive checking or reassurance-seeking. This is a four step process they call 'The DEAF Model':

The DEAF Model
D - Distinguish doubt from danger
E - Embrace uncertainty
A - Avoid reassurance (or avoidance)
F - Float above the physical discomfort or feeling while time passes

Through using The DEAF model it is possible to tolerate intrusive thoughts and avoid compulsions, reducing OCD through the realisation that life is ok without giving in to these thoughts or acting on them, and thus not being at the mercy of OCD.

Outcome

With OCD, the goal of therapy here is not to eliminate every intrusive thought that might pop up as everyone experiences unwanted thoughts from time to time. Instead, therapy enables you to change how you respond to these thoughts so that they no longer have the same power over your life. As treatment progresses, many people find they spend far less time caught in the 'reassurance trap' of obsessive thinking and compulsive behaviours. Anxiety then gradually becomes more manageable, confidence grows, and everyday activities that once felt overwhelming become much easier. Thus, rather than seeking constant certainty or reassurance, you learn to tolerate uncertainty and trust yourself again. Many clients tell me that after the therapy process they feel as though they have "got their life back." They are able to focus more on their relationships, work, family and hobbies instead of being controlled by OCD. And, although recovery is different for everyone, effective treatment can lead to lasting improvements in both mental well-being and quality of life.