Evidence-based treatment for intrusive thoughts, compulsions
Understanding Obsessive-Compulsive Disorder (OCD)
OCD is often misunderstood. It's not about being overly tidy, quirky, or simply "liking things a certain way." Obsessive-Compulsive Disorder (OCD) is a mental health condition characterised by unwanted, distressing thoughts (obsessions) and repetitive behaviours or mental acts (compulsions) carried out to try to reduce distress or prevent feared outcomes.
For those living with OCD, the condition can be exhausting and debilitating. It creates a cycle of fear, doubt, and ritualised coping that can significantly interfere with daily life, relationships, and self-esteem.
Living with OCD can be incredibly isolating. You might find it difficult to explain what you’re experiencing to others, especially when the thoughts feel disturbing or irrational. You may also experience:
- Constant mental exhaustion from internal battles
- Struggles to focus on work or studies due to rumination
- Avoidance of social situations or relationships
- Guilt, shame, or fear of being “found out”
- A need to hide rituals or avoid triggering topics
Over time, this can lead to low mood, loss of confidence, and a reduced sense of identity. It can feel like your life is being run by fear rather than your values or choices.
What Are Obsessions and Compulsions?
Obsessions are intrusive, repetitive thoughts, images, or urges that feel disturbing, inappropriate, or frightening. They often go against your values and can leave you feeling ashamed, guilty, or confused. Common themes include:
- Fears of contamination or illness
- Fears of harming others (physically or emotionally)
- Sexual or violent intrusive thoughts
- Religious or moral doubts (also known as "scrupulosity")
- Relationship doubts (ROCD)
- Perfectionism or fear of making mistakes
- Fear of acting on impulses that contradict your identity.
Compulsions are actions (physical or mental) performed to reduce the anxiety caused by obsessions or to prevent something bad from happening. These may include:
- Excessive cleaning or handwashing
- Checking doors, appliances, or personal belongings repeatedly
- Repeating words, numbers, or phrases mentally
- Seeking reassurance from others
- Avoiding situations or people
- Mentally reviewing past events or "confessing" perceived wrongdoings
While compulsions can bring short-term relief, they reinforce the cycle over time, keeping anxiety alive and preventing new learning.
Why OCD Feels So Distressing
One of the most painful aspects of OCD is the way it targets what you care about most. The intrusive thoughts feel intensely real and often contradict your core values—leaving you feeling frightened, ashamed, or "not yourself." You may think:
- “What if this thought means I’m a bad person?”
- “Why do I keep thinking these things when I don’t want to?”
- “What if I lose control and hurt someone?”
- “I can’t relax unless I’m 100% sure I haven’t done something wrong.”
It’s important to know: having intrusive thoughts does not mean you agree with them. In fact, the very distress they cause is evidence of your values. OCD is a disorder of overactive threat detection—not a reflection of who you are.
Intrusive thoughts are part of the human experience—most people experience them occasionally. However, in OCD, the brain misinterprets these thoughts as meaningful or dangerous, triggering a cascade of anxiety and compulsions.
Trying to neutralise or suppress the thoughts (through reassurance-seeking, rumination, or rituals) gives them more power. Over time, your brain learns that the only way to feel safe is to perform the compulsion—thus reinforcing the obsession and keeping you trapped.
This is why reassurance from others, although well-intended, rarely helps in the long run. It may bring momentary relief, but it prevents the brain from learning that uncertainty is survivable and that the feared outcome is unlikely to happen.
Types of OCD
OCD can present in many different ways. Some of the more common types include:
- Contamination OCD – fear of germs, illness, or spreading contamination
- Harm OCD – fear of harming others or yourself, even accidentally
- Sexual Orientation OCD (SO-OCD) – intrusive doubts about sexual identity
- Relationship OCD (ROCD) – constant questioning of whether a relationship is “right”
- Religious or moral OCD (scrupulosity) – obsessive guilt about sin, morality, or religious rules
- Pure-O or “Pure Obsessional OCD” – where compulsions are largely internal and invisible (e.g. mental reviewing or thought neutralisation)
Regardless of the theme, the cycle of obsession, anxiety, compulsion, and temporary relief remains the same.
Effective Treatment
The most effective treatment for OCD is a specialised form of Cognitive Behavioural Therapy known as Exposure and Response Prevention (ERP). ERP helps you gradually face the thoughts and situations you fear—without performing compulsions—so that your brain can learn a new, more realistic response.
In therapy, we will:
- Map out your unique OCD cycle and triggers
- Identify both visible and subtle compulsions (including mental rituals and avoidance)
- Develop a personalised ERP plan
- Learn to tolerate uncertainty and emotional discomfort without responding to it
- Build tools for resilience, emotional regulation, and values-based action
- Foster self-compassion and reduce shame about your experience
I also integrate approaches such as:
- ACT (Acceptance and Commitment Therapy) – to help you relate differently to your thoughts and take action towards what matters
- Compassion Focused Therapy (CFT) – to address shame, self-criticism, and internal fear
- Mindfulness-based techniques – to support grounding and reduce over-identification with intrusive thoughts
Next steps
If you’re struggling with OCD, please know: you are not broken. You are not dangerous. You are not your thoughts. Your mind has developed patterns of protection that are now causing harm—and with support, those patterns can change.
I offer confidential, compassionate therapy for OCD both in-person at my London practice (Peckham Levels) and online. Sessions are tailored to your needs, and I welcome people of all backgrounds, identities, and experiences.
Freedom from OCD doesn’t mean never having intrusive thoughts. It means they no longer control your life.
Get in touch to book a free 30-minute consultation and take the first step towards reclaiming your life from OCD.