Expert Treatment for Obsessive Compulsive Disorder - Accredited CBT Specialists for OCD

Problems with intrusive thoughts, obsessional worry or doubt and compulsive checking behaviours, are normally strong clinical indicators for Obsessive Compulsive Disorder (OCD). On this page you can learn about OCD, explore the different OCD subtypes and find out what causes OCD to develop.

In spite of the confusing and often contradictory information available on the web, the recommended treatment of choice for OCD spectrum related problems is Cognitive Behavioural Therapy (CBT). In addition to mainstream CBT, special forms of Cognitive Behavioural Therapy known as Acceptance and Commitment Therapy (ACT), Metacognitive Therapy and Inference Based Therapy have been found to be particularly effective in the treatment of OCD. Exposure Response and Prevention (ERP) also forms an integral part of the CBT treatment process, providing a well established behavioural strategy for reducing OCD compulsions. 

We specialise in Obsessive Compulsive Disorder and all recognised OCD subtypes. This includes contamination OCD, harm and checking OCD, primarily obsessional OCD, orderliness and symmetry OCD and the related problem of compulsive hoarding. We are fully qualified and professionally accredited by the British Association for Behavioural and Cognitive Psychotherapy - BABCP, which is the recognised UK professional body for Cognitive Behavioural Therapy.  To talk to one of our OCD specialists, email This email address is being protected from spambots. You need JavaScript enabled to view it. or complete our contact form

The OCD Cycle

All forms of OCD follow the same basic three-step process, involving triggers or intrusions, obsessional doubts and compulsive or avoidance behaviours.

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Contamination OCD

Contamination based OCD involving obsessional worry about germs and other forms of physical or mental contamination. This can be linked to health obsessions and frequently leads to superstitious or magical thinking, excessive checking and cleaning behaviours.

Harm OCD

Harm based OCD involving intrusive or disturbing thoughts about causing or being responsible for preventing harm to others. This frequently involves highly distressing worry, self-doubt and patterns of avoidance and reassurance seeking behaviours. This can also include specific worry about harm or danger to children.

Pure "O"

Primarily Obsessional OCD, also referred to as Pure “O”. This is mainly an internal mentalised form of OCD involving excessive worry, rumination and self-doubt. Whilst it is commonly assumed that this form of OCD does not involve compulsions, Pure “O” also includes internal attempts to stop, avoid, neutralise or control obsessional thoughts. The OCD compulsions still exist, but in an internalised form.

Relationship OCD

Relationship OCD involves excessive worry and doubt about relationship commitment and compatibility. Like other  OCD presentations, the individual’s attachment experiences and irrational beliefs about relationships can profoundly influence ROCD obsessions and compulsive behaviours. ROCD frequently leads to relationship difficulties and breakups, causing significant distress for the sufferer and their partner.

Real Event OCD

Real event OCD has more recently been used to describe obsessional worry and rumination about past events or memories. This can involve an obsessional fixation with past mistakes, or continuous attempts to replay, interrogate or test memories. In addition to high levels of anxiety, real-event OCD can be linked to guild or shame and significantly influenced by early maladaptive schema or personal rules and beliefs. 

Sensorimotor OCD

Sensorimotor and hyperawareness OCD are a physicalised form of Obsessive Compulsive Disorder. Sensorimotor typically involves an obsessional focus on body sensations or physiological functions and hyperawareness OCD is linked to testing external senses such as sounds, visual stimuli or smells. Hyperawareness OCD can also be confused with hyperacusis and Misophonia, so it’s important to obtain an accurate diagnosis and treatment.

Scrupulosity OCD

Scrupulosity OCD involves obsessional worry  about sins and violations of religious or moral rules. As worry is focused on faith or ethical issues, the obsessions are impossible to test or disprove , leading to excessive praying, mental or physical purification, reassurance seeking and acts of self-sacrifice to neutralise the worry.

Sexuality OCD

Sexuality OCD involves worry and self-doubt about one’s sexuality or attraction to others outside the individual’s known sexual preferences. This frequently involves self-checking and worry about arousal.

Orderliness and Simitry OCD

   Orderliness and Symmetry OCD, also known as “Just So” OCD involves anxiety and discomfort when things are out of sequence, symmetry or balance. This is characterised by intrusive and obsessional thoughts about disorder and compulsive arranging, organising or visual alignment behaviours.

Existential OCD

 Existential OCD is similar in nature to Scrupulosity OCD and involves obsessional thoughts about theoretical, hypothetical or philosophical questions that cannot possibly be answered. This frequently involves attempts to disprove or figure out doubts about consciousness, life, meaning or existence itself. 

Magical Thinking OCD

Magical Thinking OCD involves intrusive and obsessional thoughts about superstitious or fatalistic worries and compulsive behaviours in an attempt to prevent or neutralise future possible harm, negative events or bad luck. 

Pedophhilia OCD

Pedophilia OCD also known as POCD, involves obsessional worry avoidance, checking and reassurance seeking behaviours relating to worries about being attracted to children. This is a highly distressing form of OCD linked to repugnant intrusive doubts about the shame and stigma of opposite and inappropriate attraction. 

What Causes OCD?

Contemporary research has identified a number of genetic, neurobiological, environmental, cognitive and behavioural factors involved in the development and maintenance of OCD symptoms. The research indicates that whilst some genetic and biological differences may exist, cognitive and behavioural factors are known to directly influence OCD brain function through the processes of normalization and neuroplasticity. 

This means that whilst the direct causes of OCD are difficult to pin down, changing thinking and behavioural patterns directly alters the brain structures that maintain OCD symptoms. OCD Precursors and Developmental Risks Whilst the causes of OCD are complex, we have summarized some of the contemporary research on the precursors and developmental risk factors that may contribute to OCD symptoms. 

Genetics and Heritability 

Genetics is thought to play a potential role in developing a vulnerability to OCD. 25%of Individuals with OCD have another family member with OCD symptoms. Research into twin studies also shows that identical twins have a statistically higher prevalence than non-identical twins, indicating the potential role of shared genetic risk factors. DNA studies may also point to a variation in the serotonin transporter gene (HSERT), which may explain differences in inhibitory brain functions. Overall, the research does not point to a direct genetic cause of OCD, but indicates that genetic differences may be a risk factor or vulnerability in the development of OCD. Genetics do not cause OCD, but may make individuals more susceptible to future triggers, traumas or environmental factors. 

Brain Function and Neurobiology 

Neurobiological factors are complex and not fully understood. Research has however identified a problem with an important feedback loop between the Orbital Frontal Cortex, the Basal Ganglia and the Thalamus. This is referred to as the Cortical-striatal–Thalamic-cortical loop (CSTC). This loop has two modes, a direct activation or excitability function and an indirect inhibitory or self-regulating function. Increased activity in the Orbital Frontal Cortex is associated with the assessment of potential dangers or concerns, as well as decision making and reward responses. When the Orbital Frontal Cortex is activated, it communicates with the Basal Ganglia causing activation of the direct pathway leading to action to alleviate the perceived threat or concern. In healthy individuals, this is followed by activation of the indirect inhibitory pathway, returning attention and behaviour to a normal state. In OCD, however, the direct pathway is over excitable, dominating the inhibitory or self-regulatory function of the indirect pathway. 

This explains why individuals with OCD experience difficulties shifting focus and changing behaviour in response to perceived threats or problems. Overactivity in this brain circuit has been found to be “neuroplastic”, causing structural and architectural changes in this and other associated areas of the brain over time. The key point to note, is that these brain functions are not static. The interaction of changes in behaviour, cognition and the corresponding neuroplastic changes in the brain means that the OCD brain circuitry can also be normalised through the process of inhibitory learning in specialist CBT treatments. 

Neurotransmitters 

Neurotransmitters and brain biochemistry also play a part in the maintenance of OCD symptoms. Whilst the neurochemical pathways are complex, the serotonin, dopamine, Glutamate and Gamma-aminobutric Acid (GABA), activation and inhibition relationships can be out of balance. Research into the biochemical factors in OCD indicates over activity in the Dopamine and Glutamate systems in the frontal-striatal pathways and diminished activity in the Serotonin and GABA pathways in the frontal-limbic system. This  contributes to over-activation of excitatory pathways and under-performance  of the inhibitory functions leading to problems with decision making, behaviour and emotional regulation. These neurochemical imbalances have been identified in individuals with OCD symptoms. As with changes in brain structures and functioning, these complex neurochemical imbalances can be altered by changes in behaviour, cognition and the use of psychotropic medications.

PANDAS and PANS 

Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus (PANDAS ) develops suddenly in response to a childhood infection and often causes the immediate onset of OCD and tic related symptoms. This is caused by the child’s immune system attacking the basal ganglia in the brain rather than the streptococcal  or related infection. This in turn affects the function of the CSTC brain circuit leading to OCD and other compulsive behaviours. PANDAS and PANS can be effectively targeted and treated using a combination of antibiotic medication and Cognitive Behavioural Therapy. It is crucial that CBT is delivered by a qualified pediatric therapist. 

Stress and Trauma 

Whilst some psychotherapy models including psychodynamic and psychoanalytic therapy emphasise the important of unresolved trauma and early life experiences in the development of OCD, there is no evidence to show that trauma and stress cause OCD itself. It is however likely that trauma and other environmental factors may act as a trigger, which when combined with genetic and biological vulnerabilities, lead to the development of OCD symptoms. 

Cognitive and Behavioural Causes 

Whilst the cause and affect mechanisms that maintain OCD involve complex interactions between biological and psychological factors, the fundamental role of behaviour and cognitive processes in the development and maintenance of OCD is well documented. This means that the way that we act and think in response to perceived difficulties and threats, is hardwired to our neurological and biochemical brain functions through the process of neuroplasticity. Altering behaviour and cognition directly changes the feelings, perceptions and physiological reactions associated with OCD symptoms. Cognitive Behavioural Therapy strategies including Exposure and Response Prevention (ERP),Cognitive Reappraisal, Metacognitive Therapy, Inference Based Therapy (IBT) and Acceptance and Commitment Therapy  (ACT), directly undermine and alter the patterns that lead to OCD. The research shows that approximately 75% of individuals undertaking CBT, reach clinical recovery and go on to live normal healthy lives. 

To organise a free initial call to discuss specialist Cognitive Behavioural Therapy for OCD, you can complete our contact form or email This email address is being protected from spambots. You need JavaScript enabled to view it.

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How Is OCD Effectively Treated?

In our section on the causes of Obsessive Compulsive Disorder,  we outlined the different factors that predispose, trigger and maintain OCD symptoms. Whilst there are complex interactions between neurobiological, environmental, cognitive and behavioural factors, it is important to recognize that OCD is a psychological disorder, not a “medical” disease, injury or disability. As OCD symptoms are mediated and altered by changes in behaviour and cognition, it’s therefore important that psychological therapy targets the thinking and behavioural patterns that maintain the problem. What Works and 

What Works and What Doesn’t Work? 

The National Institute of Health and Clinical Excellence (NICE), recommends Cognitive Behavioural Therapy as the first line treatment for Obsessive Compulsive Disorder. SSRI medication is also recommended as a stand-alone treatment or adjunct to CBT. Where SSRI medications are ineffective for some individuals, other medications including Neuroleptics can be prescribed usually by a psychiatrist. 

Talking therapies including Psychodynamic, Psychoanalytic, existential, Interpersonal counselling, NLP, The Human Givens approach and other “complementary” therapies are inappropriate treatments for OCD. 

Mainstream Cognitive Behavioural Therapy (including ERP and cognitive reappraisal), Metacognitive Therapy, Acceptance and Commitment Therapy and  Inference Based Therapy have been found to provide highly effective treatments for Obsessive Compulsive Disorder. These therapies can provide  recovery rates in excess of 75%. These approaches are briefly outlined below: 

Cognitive Behavioural Therapy (CBT) 

A number of evidence based Cognitive Behavioural Therapy protocols have been developed over the last 40 years or so. In addition to Exposure and Response Prevention (ERP), which is normally integrated into most CBT models, cognitive factors play a critical role in the treatment of OCD symptoms. 

Cognitive is an umbrella term used to describe the content and processes of thinking including beliefs, rules, assumptions, perceptions, distortions and attentional biases. These cognitive factors play a major role in the maintenance of OCD. 

The behavioural aspects of CBT treatment usually involve systematic exposure and behavioural change to encourage habituation, normalization and a process known as Inhibitory Learning. In CBT, cognitive and behavioural strategies are combined to help clients reappraise and normalise intrusive and obsessional thoughts, whilst breaking down and eliminating compulsive behaviours and patterns of avoidance. 

Experienced Cognitive Behavioural Psychotherapists should normally be familiar with the work of psychological luminaries such as Clarke, Purdon, Rachman, Salkovskis, Wilhelm & Steketee, Wells and Veale. These names can provide a helpful check-list when talking to potential therapists about their knowledge and approach. 

Metacognitive Therapy 

This approach was developed by Adrian Wells in 2009 and involves strategies to target the cognitive processes involved in the interpretation, monitoring and control of OCD thoughts. In OCD the concept is that intrusive thoughts activate “Metacognitive Knowledge”, which includes beliefs about the individual’s thoughts and thinking processes. This in turn activates maladaptive cognitive processing such as excessive worry, leading to high levels of distress and compulsive checking or avoidance behaviours. In OCD individuals become entangled in the internal interpretation of their thoughts, what this might mean and the intensive processes of worry,  rumination and doubt In Metacognitive Therapy, the focus is on evaluating and altering these internal processes of thinking rather than externally testing the content of thoughts themselves. 

MCT strategies are aimed at helping clients to update and reinterpret their “Metacognitive Knowledge” and modify their metacognitive control strategies so that they can view their thoughts from a less threatening and more realistic perspective. 

Experienced CBT specialists will have a strong knowledge of the Metacognitive model and the ability to help their OCD clients to identify and change the internal maladaptive thinking processes that maintain the OCD. 

Inference Based Therapy 

Inference Based Therapy(IBT) was specifically developed for the treatment of Obsessive Compulsive Disorder and primarily involves a cognitive based approach. 

IBT primarily focuses on the process of inferential confusion, which leads to an overinvestment in remote possibilities at the cost of externally verifiable data or the individual’s own common sense. Inference Based Therapy makes the distinction between external testable doubt and internal OCD-related doubts, which are internally generated aspects of the individual’s own imagination. 

The client is first taught how to identify and describe the internal thinking “devices” responsible for maintaining the OCD narrative. They are then encouraged to test and compare this against their external common sensical observations, which they are finally supported to act upon. 

The IBT protocol shares some conceptual similarities with other process based forms of CBT and can be used by a skilled OCD specialist either as a distinct treatment protocol or on an integrated  basis. 

Acceptance and Commitment Therapy 

Acceptance and Commitment Therapy (ACT) is another process based approach to CBT, which has also been found to be highly effective in the treatment of OCD and other related psychological disorders. The main approach in ACT is to treat OCD thoughts as thoughts rather than literal interpretations or facts, to reduce emotional resistance and to encourage meaningful action. 

Clients are encouraged to flexibly draw on six core processes involving improved present moment attention, acceptance, cognitive defusion, perspective taking, personal values and committed action. Clients learn how to shift attention to the now, reduce the struggle with distressing feelings such as anxiety or disgust, to unhook from or “deliteralise” intrusions and obsessions , to alter their perspective on the nature of OCD beliefs and to act in the service of their personal values over their OCD vulnerabilities. 

ACT is focused on improving psychological flexibility in the service of engaging in a more purposeful life, rather than trying to avoid or control what we fear. The ACT treatment approach for OCD can be delivered on an individual basis or integrated alongside other strategies including ERP, cognitive reappraisal and metacognitive therapy. 

In all of the above approaches, there is a fine balance between drawing on a variety of tools and techniques and maintaining a clear and straight forward treatment plan. An experienced OCD therapist can integrate different evidence based approaches to create and deliver a tailored treatment plan to meet the specific needs of their client. 

Always work with a BABCP accredited CBT specialist with expertise in the treatment of OCD and related disorders.  

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