Treating Obsessive and Compulsive Disorder (OCD)
What is OCD?
Obsessive-compulsive disorder (OCD) is a common mental health condition that affects around 1–2% of the population (Veale & Roberts, 2014). It is characterised by the presence of obsessions, compulsions, or both. Obsessions are intrusive, unwanted thoughts, images, or urges that cause distress and anxiety. Compulsions are repetitive behaviours or mental acts that a person feels driven to perform in order to reduce this distress or to prevent a feared outcome. Sometimes the link between the obsession and the compulsion is clear (e.g., repeated handwashing after thoughts of contamination), while in other cases the rituals may appear unrelated (e.g., avoiding cracks in the pavement to protect family members).
The common thread across all forms of OCD is anxiety or discomfort, which fuels the cycle of obsessions and compulsions. Some individuals experience obsessions without outward rituals, relying instead on mental checking, distraction, or avoidance. Others may primarily engage in compulsive behaviours without strong obsessional thoughts.
Although most people with OCD recognise that their fears and behaviours are irrational, they often feel unable to stop. This can lead to shame, secrecy, and significant disruption in daily life, relationships, work, or study. Health consequences may also arise, such as skin problems from excessive washing or delays in seeking medical care due to contamination fears.
OCD often begins in childhood or adolescence, and if untreated, it can prevent young people from socialising or living independently. Because of its impact on quality of life and functioning, the World Health Organisation ranks OCD among the most disabling conditions worldwide (Bobes et al., 2020).
Cognitive-Behavioral Therapy in the Treatment of OCD
Cognitive-behavioral therapy (CBT) is the one of most effective psychological treatment for obsessive–compulsive disorder, with decades of research showing strong and lasting benefits. The core behavioural method used in CBT for OCD is exposure and response prevention (ERP). This approach directly targets the cycle that maintains OCD: intrusive thoughts create anxiety or discomfort, and rituals temporarily relieve that distress. Because this relief feels rewarding, the ritual is reinforced and becomes harder to resist.
ERP works by gradually exposing individuals to feared thoughts, images, or situations while preventing the usual ritual or mental strategy that reduces discomfort. For example, someone worried about contamination might be guided to touch a “dirty” surface without washing their hands afterwards. At first, this exposure creates a rise in anxiety, but over time the distress plateaus and then diminishes. Repeated sessions show that the initial anxiety response becomes weaker and settles more quickly, breaking the cycle of fear and ritualising.
The same principles apply to obsessional thoughts that do not have obvious outward rituals. Instead of behavioural checking or washing, people may use mental rituals - such as praying, suppressing images, or self-reassurance - to neutralise their thoughts. Treatment here involves deliberately focusing on the intrusive thought without using these mental “safety behaviours,” until the thought loses its emotional intensity and becomes just another passing idea.
CBT also incorporates cognitive therapy (CT), which helps individuals identify and challenge the unhelpful beliefs that drive OCD - such as inflated responsibility (“If I don’t check, something terrible will happen”), over-importance of thoughts, or perfectionistic standards. By learning to appraise thoughts differently, sufferers can reduce the power of obsessions and the urge to respond with compulsions.
Research highlights that while ERP and CT are highly effective, treatment must be structured, systematic, and tailored to each individual. Progress is often gradual, requiring motivation, consistency, and collaboration with a therapist to overcome challenges. Symptom dimensions also differ - contamination fears, checking, ordering, or intrusive images may each respond differently to treatment, and some may require longer or more intensive therapy. Despite these complexities, CBT with ERP remains the gold standard first-line treatment, helping individuals regain control over their symptoms and significantly improve quality of life.
Article written by Catherine Yu, Psychologist and Clinical Psychology Registrar
References
Bobes, J., González, M. P., Bascarán, M. T., Arango, C., Sáiz, P. A., & Bousoño, M. (2001). Quality of life and disability in patients with obsessive-compulsive disorder. European Psychiatry, 16(4), 239–245. https://doi.org/10.1016/s0924-9338(01)00571-5
Veale, D., & Roberts, A. (2014). Obsessive-compulsive disorder. BMJ, 348(apr07 6), 2183–2183. https://doi.org/10.1136/bmj.g2183