Obsessive-Compulsive Disorder

Overview

OCD is maintained by the compulsion, not the thought. Treatment that reduces compulsions (overt and mental) breaks the cycle and lets new safety learning form. Medication (SSRIs at higher-than-depression doses) often adjuncts therapy in moderate-to-severe cases.

First-line treatments

• ERP — Exposure and Response Prevention (for OCD)

  Gold-standard treatment — graded exposure to obsessions while preventing rituals.

Also consider

• ACT

  Acceptance + values reduce experiential avoidance and increase ERP tolerability.

• CBT

  Cognitive interventions for overvalued beliefs (responsibility, thought-action fusion).

• MBCT

  Mindfulness skills support tolerating uncertainty and resisting mental compulsions.

Cautions

• Reassurance from the therapist functions as a compulsion — avoid answering 'is this normal?' loops.
• Pure-O presentations rely heavily on mental rituals; identify and target them explicitly.

Worked cases

• Obsessive-compulsive disorder, contamination subtype

  Contamination OCD with 4-hour daily ritual time; reassurance-seeking from family; minimal insight at intake.

• OCD, moral/religious scrupulosity subtype

  Compulsive confession, mental review, and reassurance-seeking from clergy; misframed by past providers as 'spiritual struggle.'

Related tools

• Assessments

Related worksheets

• The OCD Cycle
• ERP Exposure Ladder
• Sitting with the Urge
• Worry Time