​Obsessive-Compulsive Disorder (OCD) is often misunderstood. It is sometimes portrayed as being very tidy, organised or particular about how things are done. In reality, OCD can be a distressing and exhausting condition that can significantly affect everyday life.

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OCD can involve unwanted thoughts, images, urges or doubts that feel difficult to dismiss. These experiences can lead to anxiety, guilt, disgust or a strong sense that something is not quite right. You may then find yourself doing things repeatedly, either physically or mentally, to try to reduce the distress or gain certainty.

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At Jodie Schallhorn Psychotherapy Ltd, I provide evidence-based Cognitive Behavioural Therapy (CBT) to help adults understand and overcome OCD, allowing them to regain confidence and enjoy life more fully.

 

 

 

 

What are obsessions?

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Obsessions are unwanted and intrusive thoughts, images, urges or doubts that repeatedly enter your mind.

They can feel frightening, upsetting or completely at odds with your values and the person you believe yourself to be.

 

Examples might include:

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• What if I accidentally hurt someone?

• What if I become contaminated or make somebody else ill?

• What if I left the door unlocked or an appliance switched on?

• What if I said or did something inappropriate?

• What if this thought means something terrible about me?

• What if I don't really love my partner?

• What if I lose control and do something I don't want to do?

• What if I can never be completely certain?

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Having an intrusive thought does not mean that you want it to happen or that you are likely to act on it. Intrusive thoughts are common. With OCD, however, the thought can become particularly significant because of the meaning attached to it.

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What are compulsions?

 

Compulsions are things you feel driven to do to reduce anxiety, prevent something bad from happening or achieve a sense of certainty.

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Some compulsions are visible, such as:

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• Repeatedly checking doors, appliances, emails or messages

• Excessive washing or cleaning

• Avoiding certain objects, people, places or situations

• Repeating actions until they feel “right”

• Asking other people for reassurance

• Confessing things repeatedly

• Following particular routines, numbers or rules

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Other compulsions happen entirely inside the mind and can therefore be much harder to recognise.

 

These might include:

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• Mentally reviewing past events

• Checking your memory

• Replaying conversations

• Analysing what a thought “really means”

• Trying to replace a bad thought with a good one

• Repeating words or phrases internally

• Testing your feelings

• Trying to prove to yourself that something didn't happen

• Constantly searching for certainty

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These strategies may provide temporary relief, but that relief can unintentionally reinforce the OCD cycle.

 

Understanding the OCD cycle

 

OCD can create a powerful cycle:

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Intrusive thought, image, urge or doubt → threatening interpretation → anxiety or discomfort → compulsion, reassurance or avoidance → temporary relief → increased importance of the intrusive thought

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For example, you might have the thought:

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“What if I didn't lock the door?”

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You feel anxious and go back to check.

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For a moment, you feel relieved. But your brain may learn:

 

“Checking kept me safe. I need to check whenever I have this doubt.”

 

The next time the doubt appears, the urge to check can become even stronger. CBT for OCD aims to help you gradually break this cycle rather than simply trying to eliminate intrusive thoughts.

 

OCD isn't always about contamination or checking

 

OCD can attach itself to almost anything that matters to you.

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Some common presentations include:

 

Contamination OCD

 

Fears about germs, illness, bodily fluids, chemicals or contamination. This can involve washing, cleaning, avoidance or seeking reassurance.

 

Checking OCD

 

Repeated checking because of fears about responsibility, mistakes, accidents or harm. This might involve doors, appliances, work, emails, driving or memories.

 

Harm OCD

 

Unwanted thoughts, images or impulses involving harm coming to yourself or another person. These thoughts can be particularly distressing because they are often completely inconsistent with the person's values.

 

Relationship OCD

 

Persistent doubts about your relationship, attraction or feelings, often accompanied by checking feelings, comparing relationships, seeking reassurance or repeatedly analysing whether the relationship is “right”.

 

Sexual intrusive thoughts

 

Unwanted sexual thoughts or images that cause significant distress and lead to checking, avoidance, reassurance seeking or attempts to determine what the thoughts mean.

 

Religious or moral OCD

 

Sometimes called scrupulosity, this can involve intense fears about morality, religion, wrongdoing, offending others or being a “bad” person.

 

Responsibility OCD

 

Feeling excessively responsible for preventing harm or believing that failing to take particular precautions could make you responsible if something bad happened.

 

“Just right” OCD

 

A strong feeling that something must look, feel or be done in a particular way before you can move on.

These are not separate diagnoses. They are different ways in which the same underlying OCD processes can appear.

 

Why does reassurance make OCD worse?

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When you are frightened, asking someone for reassurance can feel completely natural. You might ask:

 

“Are you sure I didn't do anything wrong?”

 

“Do you think this thought means anything?”

 

“Are you certain I locked the door?”

 

Reassurance often works — but only temporarily!

 

The anxiety reduces, but another doubt eventually appears. You may then need reassurance again. Over time, this can teach your brain that uncertainty is dangerous and that you need reassurance before you can feel safe.

Therapy therefore focuses on developing a different relationship with uncertainty rather than repeatedly trying to obtain absolute certainty.

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Why can't I just stop thinking about it?

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Trying very hard not to think about something can actually make the thought more noticeable. OCD treatment is therefore not about forcing thoughts away or proving that they are untrue. Instead, therapy can help you recognise intrusive thoughts for what they are, reduce the importance you give them and gradually change the behaviours that keep the OCD cycle going.

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The goal isn't to achieve 100% certainty. It is learning that you can tolerate uncertainty without having to respond to every doubt.

 

How can CBT help OCD?

 

Cognitive Behavioural Therapy (CBT), including Exposure and Response Prevention (ERP), is an evidence-based psychological treatment for OCD. Therapy begins by developing an individual understanding of how OCD operates for you.

 

Together, we may explore:

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• Your intrusive thoughts, images, urges and doubts

• What you fear these experiences mean

• Situations that trigger your OCD

• Compulsions and mental rituals

• Reassurance seeking

• Avoidance and safety behaviours

• Beliefs about responsibility, danger and uncertainty

• The impact OCD is having on your everyday life

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Understanding your individual OCD cycle gives us a starting point for changing it.

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What is Exposure and Response Prevention (ERP)?

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ERP involves gradually approaching situations, thoughts or feelings that trigger OCD while reducing the compulsions you would normally use to feel safe or certain. This doesn't mean being forced into your biggest fear. Exposure should be collaborative, planned and purposeful.

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For example, someone who repeatedly checks a door may practise gradually reducing their checking.

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Someone who repeatedly seeks reassurance may practise allowing a doubt to remain unanswered.

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Someone experiencing intrusive thoughts may practise allowing the thought to be present without analysing, neutralising or trying to prove what it means.

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Over time, you can learn:

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“I can experience uncertainty without having to perform a compulsion.”

 

That learning is an important part of weakening the OCD cycle.

 

What happens during therapy?

 

Treatment is tailored to you rather than simply following a generic set of exercises. We will work together to understand your difficulties and develop a shared formulation of what may be maintaining them.

 

Therapy may include:

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• Learning how OCD works

• Identifying compulsions that may have become automatic

• Recognising less obvious mental rituals

• Exploring the meaning you attach to intrusive thoughts

• Reducing reassurance seeking

• Gradually reducing avoidance

• Behavioural experiments

• Exposure and Response Prevention

• Learning to tolerate uncertainty

• Developing strategies to maintain progress after therapy

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Therapy moves at a collaborative pace, while also helping you gradually challenge the patterns that are keeping OCD going.

 

You don't need to be embarrassed by your intrusive thoughts

 

People experiencing OCD can sometimes delay seeking help because they are frightened about what a therapist might think of their intrusive thoughts. OCD frequently targets the things that matter most to us, which is one reason intrusive thoughts can feel so disturbing. You can talk openly about intrusive thoughts in therapy without judgement.

 

Understanding the difference between an unwanted intrusive thought and genuine intention is an important part of

appropriately assessing and treating OCD.

 

Online CBT for OCD

 

I offer online CBT for adults experiencing OCD, including intrusive thoughts, checking, reassurance seeking, avoidance and mental compulsions. Online sessions allow us to work with OCD in your everyday environment, where many of your triggers and compulsions naturally occur.

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As a BABCP Accredited Cognitive Behavioural Psychotherapist, I use evidence-based CBT approaches tailored to your individual difficulties rather than assuming everyone's OCD looks the same.

 

Ready to take the next step?

 

If OCD is taking up increasing amounts of your time, affecting your relationships or making everyday decisions feel exhausting, therapy can help you understand and begin changing the cycle.You  don't need to wait until OCD becomes completely unmanageable before seeking support.

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Book a free 20-minute consultation to discuss what you are experiencing, ask questions about therapy and explore whether CBT for OCD might be right for you.​

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