Edinburgh Therapy Service specialises in OCD therapy, providing the gold standard treatment for OCD: cognitive-behavioural therapy with exposure and response prevention (CBT with ERP). Our priority is to create a safe, non-judgmental space where you can openly discuss your thoughts and compulsions at a pace that suits your comfort. Let’s work together!
Obsessive-compulsive disorder (OCD) is a mental health condition characterised by the presence of distressing and persistent intrusive thoughts (see examples of obsessions) and repetitive behaviours or mental acts (compulsions) aimed at alleviating the anxiety or discomfort caused by these thoughts.Â
Obsessions are intrusive, distressing thoughts, images, or urges that frequently enter a person’s mind. These thoughts can encompass a wide range of concerns, such as fears of contamination, worries about harm befalling loved ones, or a need for symmetry and order. While most people experience sometimes intrusive thoughts with similar content to the obsessions in OCD, for people who develop OCD, the intrusive thought becomes an obsession when it is evaluated as bad, unacceptable, or dangerous, leading to excessive worry and distress. Unlike most people who may briefly notice and dismiss such thoughts, individuals with OCD often give them undue importance and meaning.
Compulsions, on the other hand, are repetitive behaviours or mental acts performed in response to obsessions. The primary purpose of compulsions is to reduce the anxiety or discomfort caused by these intrusive thoughts or prevent the feared consequence. There are various types of compulsions, including checking and rechecking, excessive hand washing, counting, repeating actions, or seeking constant reassurance. Compulsions can take many forms, but they all serve the same purpose: alleviating the distressing feelings triggered by obsessions.
Over time, compulsions can become a habitual coping mechanism for individuals with OCD. These rituals temporarily provide relief, reinforcing the belief that performing them is necessary to prevent harm or discomfort. However, this reliance on compulsions can exacerbate the condition, making it even more challenging to break free from the cycle of obsessions and compulsions. This cycle can significantly disrupt daily life, and those affected with OCD often find it challenging to control or manage these patterns of thinking and behaviour.
If you or someone you know is struggling with OCD, it’s important to consider seeking help when the symptoms begin to interfere significantly with daily life, work, or relationships. Common signs that it’s time to reach out to a counsellor/therapist include:
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Persistent emotional distress: People dealing with this problem may feel stuck in an ongoing cycle of emotional distress that affects their mental well-being. This continuous struggle can lead to increased anxiety, sadness, growing frustration, and a feeling of being powerless. This lasting distress is a sign that seeking counselling for OCD is a good idea.
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Impact on daily functioning: When OCD symptoms start to interfere with everyday tasks such as work, school, or even simple personal hygiene, it’s time to seek assistance. Clients may notice that they’re spending an excessive amount of time on rituals or mental compulsions, which can disrupt their routines.
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Strained relationships: OCD can affect relationships with family, friends, and colleagues. When the condition starts impacting these connections, causing misunderstandings, conflicts, or social isolation, it’s an important reason to consider therapy.Â
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Risk of safety concerns: In some cases, OCD can lead to behaviours that pose safety risks. For example, someone with contamination-related OCD may excessively wash their hands to the point of skin damage or infection. When these compulsions endanger physical well-being, professional intervention is critical.
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Lack of control: People with the disorder often describe a lack of control over their thoughts and behaviours. They may recognize the irrationality of their actions but find it extremely difficult to stop. This feeling of being trapped can lead to frustration and despair, prompting the need for therapeutic support.
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Failed self-help attempts: While there are self-help strategies and resources accessible, not everyone can successfully manage OCD independently. If you have attempted self-help methods without experiencing improvement, it strongly suggests the need for therapy.
In the realm of OCD treatment, two primary approaches have emerged as the recommended courses of action: cognitive-behavioural therapy (CBT) with exposure and response prevention (ERP), and medication.Â
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CBT with ERP is widely regarded as the gold standard for treating OCD. This treatment method not only aligns with professional consensus but also finds endorsement in the guidelines set forth by the National Institute for Health and Care Excellence (NICE). NICE guidelines provide evidence-based recommendations to ensure the highest standards of care for people with OCD.
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Cognitive therapy within the context of OCD treatment aims to address and modify the beliefs that sustain the OCD cycle, helping individuals recognize that their reactions often stem from uncertainty rather than genuine danger. Specifics of cognitive therapy will vary from person to person, as it’s tailored to personal experiences.
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At the onset of therapy, you and your therapist collaborate to identify your unique thought patterns and triggers. Your therapist may provide psychoeducation, which involves explaining how the brain functions and shedding light on the underlying processes that contribute to OCD symptoms. This knowledge helps you gain a better understanding of what’s happening in your mind.
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Your therapist might introduce various cognitive strategies to challenge the thoughts that feed the fear, although the exact approach will be customised to your needs. Although the therapeutic requirements vary widely from person to person, the core objective of cognitive work is to reshape the context that gives OCD its overwhelming influence.
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Moreover, the cognitive component of CBT for OCD can help clients engage in exposure and response prevention (ERP), the behavioural aspect of the treatment. ERP can be difficult and demands a considerable commitment. In cases where it is needed, cognitive work can serve as a preparatory phase, equipping you with the skills and mindset needed to effectively engage in ERP.
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Behavioural element
The behavioural aspect of OCD treatment, known as exposure and response prevention (ERP), places a spotlight on compulsions. In OCD, compulsions are the actions taken in response to anxiety-triggering thoughts. An essential component of this phase involves understanding the nature of anxiety, how it manifests in the body, and the reasons behind the behaviours it prompts.
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With the guidance of a therapist, you develop a new approach to anxiety, one that doesn’t rely on compulsive behaviours for relief. This process is gradual and adapted to your individual needs, ensuring it progresses at a pace that feels comfortable for you.Â
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ERP stands as a pivotal component in breaking the cycle of OCD. OCD assigns specific meanings to intrusive thoughts, generating anxiety and a sense of responsibility. In response, compulsions are employed to alleviate this anxiety. Paradoxically, the relief derived from compulsions reinforces the belief that these thoughts are inherently harmful, perpetuating the cycle of anxiety. ERP introduces a different approach – deliberately choosing to confront and experience anxiety rather than evade it. Over time, this process reduces the intensity of anxiety, allowing the brain to relearn how to respond without resorting to compulsions.
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Exposure involves immersing oneself in activities or situations that trigger anxiety, while response prevention entails an active decision to endure anxiety without engaging in compulsions. ERP is an incremental process because you’re essentially relearning how to navigate life without compulsions. This gradual approach, known as graded exposure, offers flexibility. It may start with manageable anxiety-inducing situations and progressively escalate in intensity. You might initially delay compulsions for brief periods and gradually extend these intervals. This process, though challenging, is an integral part of reclaiming control from OCD.
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>> Read more about CBT and ERP for OCD.
We adhere to the established gold standard for treating OCD, which is cognitive-behavioral therapy with exposure and response prevention (CBT with ERP), under the recommendations outlined by NICE guidelines. However, we recognize that each individual’s journey to recovery is unique, and there are instances where additional therapeutic approaches like acceptance and commitment therapy (ACT) or compassion-focused therapy (CFT) may prove beneficial based on specific barriers and individual needs.
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These complementary approaches can serve various purposes within the treatment process. They may be employed to enhance a client’s readiness for CBT with ERP, address particular challenges, or offer additional support during the exposure and response prevention phase. Our commitment to personalised care ensures that treatment is tailored to meet the distinct requirements of each individual, providing the most effective and comprehensive support on their path to overcoming OCD.
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Moreover, we recognize that many people with OCD can feel judged. That’s why it is so important to us to create a safe and supportive space where you can feel secure, and free from judgement, an empathetic space to discuss intrusive thoughts openly without fear.
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Obsessive-compulsive disorder can manifest in various forms, often referred to as “types” or “subtypes.” These subtypes represent different themes or areas of focus for obsessions and compulsions. Some common types include:
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Contamination OCD: Individuals with this subtype are consumed by fears of contamination from germs, dirt, or toxins. They may engage in excessive cleaning, handwashing, or avoidance behaviours to reduce their anxiety.
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Checking OCD: People affected experience intrusive doubts and fears, such as whether they locked the door or turned off the stove. They engage in repetitive checking behaviours to alleviate these doubts.
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Pure-O (Pure Obsessional) OCD: Pure-O is characterised by primarily mental obsessions without noticeable outward compulsions. Clients experience distressing and intrusive thoughts, often of a violent, sexual, or blasphemous nature, which can lead to mental rituals or excessive rumination.
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Symmetry and ordering OCD: Individuals with this subtype are preoccupied with achieving perfect symmetry or maintaining precise order. They may spend excessive time arranging and aligning objects to reduce discomfort.
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Harm OCD: People with this subtype have distressing obsessions related to causing harm to others or themselves. These intrusive thoughts can be highly distressing, and individuals may engage in mental or behavioural rituals to prevent harm.
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Scrupulosity: Scrupulosity OCD involves obsessive concerns about religious or moral purity. Someone with this subtype may experience intrusive thoughts related to sin, blasphemy, or moral transgressions and may engage in religious rituals to seek reassurance or relief.
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Sexual orientation OCD: Characterised by obsessions related to one’s sexual orientation or identity. Clients may experience distressing doubts about their sexual preferences and may engage in mental compulsions or reassurance-seeking behaviours.
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Relationship OCD: Involves obsessions and doubts about one’s romantic relationship. Individuals may question the authenticity of their feelings, causing distress and uncertainty in their relationships.
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These are just a few examples of OCD subtypes, and it’s essential to remember that OCD can be highly individualised, with some individuals experiencing a combination of these themes. We can provide a personalised treatment based on your specific subtype and needs. Contact us for more information!
OCD primarily revolves around two main components: obsessions and compulsions. These are the hallmark symptoms of the disorder:
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Obsessions: Obsessions are distressing, intrusive, and persistent thoughts, images, or urges that repeatedly enter an individual’s mind. These thoughts are unwanted and often cause significant anxiety, discomfort, or distress. Obsessions can take various forms, depending on the type of OCD an individual has. Here are some examples:
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‣ Contamination obsessions
‣ Harm obsessions
‣ Doubt obsessions
‣ Taboo thoughts
‣ Perfectionism obsessions
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Compulsions: Compulsions are repetitive behaviours or mental acts performed in response to obsessions. These behaviours are aimed at reducing anxiety or preventing a feared event associated with the obsessions. Compulsions can also vary depending on the type of OCD. Here are some examples:
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‣ Cleaning and washingÂ
‣ CheckingÂ
‣ Counting and repeatingÂ
‣ Ordering and arrangingÂ
‣ Mental rituals
The precise causes of obsessive-compulsive disorder remain a subject of ongoing research and are not entirely clear. As with many mental health conditions, it appears to be the result of a complex interplay between genetic predispositions, psychological factors, and life experiences.
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Genetic factors: There is evidence to suggest that genetics plays a role in the disorder. Individuals with a family history of OCD or related disorders may be at a higher risk. There may also be abnormalities in certain brain structures or neurotransmitter systems, particularly the serotonin system, that are associated with the problem.
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Environmental factors: Traumatic or highly stressful life events, such as illness, abuse, or loss, can trigger or exacerbate OCD symptoms.Â
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Psychological factors: Some psychological factors, such as high levels of anxiety, perfectionism, or a tendency to worry excessively, may increase the risk of developing the condition.Â
Edinburgh Therapy Service offers both in-person OCD counselling in Edinburgh (United Kingdom), and online therapy accessible worldwide. You can find our exact location here. We specialise in therapy for OCD, offering CBT with ERP as the main treatment option.Â
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Foa E. B. (2010). Cognitive behavioral therapy of obsessive-compulsive disorder. Dialogues in clinical neuroscience, 12(2), 199–207.Â
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SHoaakazemi, M., Javid, M. M., & Tazekand, F. E. (2014). The Effect of Cognitive Behavioral Therapy on Reduction of Obsessive-compulsive Disorder Symptoms in Girl Students. Procedia – Social and Behavioral Sciences, 159, 738–742.Â
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van Oppen, P., van Balkom, A. J., de Haan, E., & van Dyck, R. (2005). Cognitive therapy and exposure in vivo alone and in combination with fluvoxamine in obsessive-compulsive disorder: a 5-year follow-up. The Journal of clinical psychiatry, 66(11), 1415–1422
The Edinburgh Therapy Service is a psychotherapy and counseling practice based in Edinburgh, Scotland (United Kingdom). We offer therapy both in-person in Edinburgh and online, available in English and Spanish.
Contact us for more information or to book your first appointment: [email protected]