There are various therapies and other types of help available to those with OCD.

Cognitive Behavioural Therapy (CBT)

This is a treatment that helps you change the way you think and behave so you can feel better and get on with your life.

There are two types of CBT used to treat OCD – Exposure and Response Prevention (ERP) and Cognitive Therapy (CT).

Exposure and response prevention (ERP)

This is a way to stop compulsive behaviours and anxieties from strengthening each other. We know that if you stay in a stressful situation long enough, you gradually become used to it and your anxiety goes away13. So, you gradually face the situation you fear (exposure) but stop yourself from doing your usual compulsive rituals, checking or cleaning (response prevention), and wait for your anxiety to go away.

It's usually better to do it in small steps:

make a list of all the things you fear or avoid at the moment;

put the situations or thoughts you fear the least at the bottom, the worst ones at the top;

then start at the bottom and work up, tackling one at a time. Don't move onto the next stage until you have overcome the last one.

This will work best if you practice it often, several times every day, for at least one or two weeks. Each time, you do it for long enough for your anxiety to fall to less than half what it is at its worst – this may take between 10 and 90 minutes to start with. It can help to write down a measure of how anxious you are every 5 minutes, for example, from 0 (no fear) to 10 (extreme fear). You will see how your anxiety rises, then falls.

You may practice some of the steps with your therapist, but most of the time you will be doing it on your own, at a pace you feel comfortable with. It is important to remember that you do not need to get rid of all your anxiety, just enough to manage it better. Remember that your anxiety:

is unpleasant but won't do you any harm.

will go away eventually.

will be easier to face with regular practice.

There are two main ways of trying ERP:

Guided self-help – You follow the guidance in a book or DVD or use a software programme on a computer, tablet or smart phone app. You also have occasional contact with a professional for advice and support. This approach may be suitable if your OCD is mild, and you have the confidence to try out ways of helping yourself.

– You follow the guidance in a book or DVD or use a software programme on a computer, tablet or smart phone app. You also have occasional contact with a professional for advice and support. This approach may be suitable if your OCD is mild, and you have the confidence to try out ways of helping yourself. Direct regular contact with a professional, on your own or in a group – This can be face-to-face, over the phone or by video link. This usually happens every week or two weeks at first, and can last for between 45 and 60 minutes at a time. Up to ten hours of contact is recommended to start with, but you may need more.

Here's an example:

John could not leave the house on time for work every day, because he had to check so many things in the house. He worried that the house might burn down, or he might be burgled if he did not check certain things five times each. He made a list of what he was checking, starting with the easiest to tackle. It looked like this:

The cooker (least feared) The kettle The gas fire The windows The doors (most feared)

His first step was to deal with the cooker, as this was his least-feared issue. Instead of making sure that the cooker was switched off several times, he checked it only once (exposure). At first, he felt very anxious. He stopped himself from going back to check again. He agreed not to ask his wife to check everything for him as well, and not to ask her for reassurance that the house was safe (response prevention). His gradually felt less fearful over the next two weeks.

He then moved on to step two (the kettle) and so on. Eventually, he was able to leave the house without any of his checking rituals. He could now get to work on time.

Effectiveness

About 3 out of 4 people who complete ERP are helped a lot17. Of those who get better, about 1 in 5 will develop symptoms in the future, and will need extra treatment18. However about 1 in 4 people refuse to try ERP, or else do not finish it19. They may be too fearful, or feel too overwhelmed to do it.

Cognitive therapy (CT)

Cognitive therapy is a psychological treatment which helps you to change your reaction to the thoughts, instead of trying to get rid of them. This can be helpful if you have worrying obsessional thoughts, but do not perform any rituals or actions to make yourself feel better. It can also be added to exposure treatment (ERP) to help overcome OCD.

Cognitive therapy helps you to:

Stop fighting the thoughts

We all have odd thoughts at times, but that is all they are. They do not mean you are a bad person or that bad things are going to happen – and trying to get rid of such thoughts just doesn't work. Cognitive therapy can help you to feel better, even relaxed, while you are having such thoughts. You can learn to treat them with mild curiosity or amusement. If even more unpleasant thoughts happen, you learn not to resist them, to just let them happen, and to think about them in the same way. Such thoughts will often fade away when you stop trying to make them go away.

Change your reaction to your thoughts

You learn to notice when you are having upsetting 'thoughts about thoughts' such as 'I'm a bad person for thinking like this.' You can keep a diary of these unhelpful ways of thinking, then challenge them by asking yourself:

What is the evidence for - and against - this idea being true?

How useful is this thought? What's another way to look at this?

What's the worst/best/most realistic outcome?

How would I advise a friend who had my problems? If my advice to them is different from the advice I give myself, why?

Deal with responsibility and blame

You tackle unrealistic and self-critical thoughts These can include:

placing too much importance on your thoughts (they are 'just' thoughts);

overestimating the chances of something bad happening;

taking responsibility for bad things happening, even when they are out of your control;

trying to get rid of all risk in the lives of your loved ones.

Test out unhelpful beliefs

A common fear in OCD is that 'thinking it will make it happen'. Try looking out of the window at a building and think about it falling down. Get a really strong picture in your mind. What happens? Another upsetting belief is that 'having thoughts is as bad as carrying them out'. Imagine your neighbour is unwell and needs some shopping done. Just think about doing it. Does that make you a good person? Not really. In order to be helpful, you have to do the action. The same is true for 'bad' thoughts. It is important to remind yourself that a person with OCD does not carry out their obsessional thoughts.

A cognitive therapist will help you to decide which of your ideas you want to change, and will help you to build new ideas that are more realistic, balanced, and helpful.

Most meetings with a therapist take place at your local GP practice, a clinic or sometimes a hospital. You might be able to have CT over the phone, or in your own home if you can't leave your house.

Antidepressant medication

SSRI (Selective Serotonin Reuptake Inhibitors) antidepressants can help to reduce obsessions and compulsions, even if you are not depressed. Examples include sertraline, fluoxetine, paroxetine, escitalopram and fluvoxamine.

They are generally safe, but may cause side-effects in the first few days like restlessness, a headache, dry mouth or feeling sick14. SSRIs can be used alone, or with CBT, for moderate to severe OCD. Higher doses often work better for OCD15.

If treatment with an SSRI has not helped at all after 3 months, the next step is to change to a different SSRI or a medication called clomipramine. It is best to continue medication for at least 12 months, if it is helping. These medications are not addictive16, but should be cut down slowly over several weeks before stopping.

Effectiveness

About 6 out of 10 people improve with medication20. On average, their symptoms reduce by about one third. Anti-obsessional medication does help to prevent OCD coming back for as long as it is taken, even after several years21. But - about 1 in 3 of those who stop medication will get symptoms again in the months after stopping it. This is much less likely to happen if the medication is combined with CBT22.