Exposure and response prevention (CBT) therapy for OCD

Obsessive compulsive disorder (OCD) is an anxiety disorder that is characterised by obsessions (intrusive thoughts or images) and compulsions (actions or rituals).

OCD is a common anxiety disorder and can cause a lot of distress and impairment for sufferers.

OCD affects people of all ages, across the lifespan – from young children all the way through to the elderly.

OCD, like many other anxiety disorders and mental health issues, is a treatable condition. If you’re suffering with this right now, please try to have hope as there are OCD professionals, medications, and widely available information that can help!

Clinical Psychologists are trained and have special skills to help sufferers to cope with, and recover from, OCD.

Sometimes, people with OCD can benefit from medication, in addition to therapy.

Please reach out to us if you need assistance. In the meantime, below is some brief information that may be of help:

Obsessions are intrusive, unwelcome, and persistent thoughts AND/OR images that are accompanied by feelings of anxiety, discomfort or disgust.

Common themes for obsessions are:

  • fear of contamination, germs or dirt
  • doubt about whether you have done something properly eg. turning the stove off or locking the door properly
  • fear of harm to self or others
  • aggressive or sexual thoughts
  • images of disasters
  • fear of losing of control
  • a need for exactness or symmetry

Many people who experience OCD also engage in rituals or compulsions. Compulsions are defined as persistent needs or urges to perform certain behaviours in order to reduce anxiety or discomfort. There is often no pleasure in carrying out the rituals, only temporary relief from the discomfort cause by the obsession. Compulsions tend to be very time consuming.

Some examples of compulsive behaviours are listed below:

  • washing things over and over eg. your hands or cutlery
  • checking things repeatedly eg. the stove is turned off or the door is locked
  • ordering or arranging things
  • having to do things in a certain order eg. dressing or locking the door
  • doing something a certain number of times eg. tapping the table 4 times
  • hoarding or collecting things

Often the compulsions are associated with the obsession. For example, intrusive thoughts about contamination may lead the sufferer to engage in washing rituals. For other people, there is no apparent connection between the obsession and the compulsion, for example, not stepping on cracks in the sidewalk in order to prevent family members being harmed. Sometimes, OCD is mainly in the mind. An example of this is ego dystonic thoughts – where abhorrent, unwanted and intrusive thoughts become ‘stuck’ repeating over and over in the mind and causing much distress.


Cognitive behaviour therapies (CBT; including Acceptance and Committment Therapy) is the psychological treatment of choice for children, adolescents and adults with OCD. CBT is actually the combination of two types of therapy – behaviour therapy and cognitive therapy.

Exposure is based on the fact that anxiety usually goes down after long enough contact with something feared. Thus people with obsessions about germs are told to stay in contact with “germy” objects (eg., handling money) until their anxiety is extinguished. The person’s anxiety tends to decrease after repeated exposure until he/she no longer fears the contact. Prior to commencing exposure therapy, the therapist will have provided scaffolding strategies so that the person feels ready for this part of the treatment.

For exposure to be of the most help, it needs to be combined with response prevention (RP). In RP, the person’s rituals or avoidance behaviours are blocked. For example, those with excessive worries about germs must not only stay in contact with “germy things”, but must also refrain from ritualized washing.

Exposure is generally more helpful in decreasing anxiety and obsessions, while response prevention is more helpful in decreasing compulsive behaviours. Despite years of struggling with OCD symptoms, many people have surprisingly little difficulty tolerating E/RP once they get started.

Cognitive therapy (CT) is the other component in CBT. CT is often added to E/RP to help reduce the catastrophic thinking and exaggerated sense of responsibility often seen in those with OCD. For example, a woman with OCD may believe that her failure to remind her husband to wear a seat belt will cause him to die that day in a car accident. CT can help her challenge the unhelpful assumptions in this obsession. Armed with this proof, she will be better able to engage in E/RP, for example, by not calling her husband at work to make sure he arrive safely.

People react differently to treatment, just as they do to medicine. CBT is relatively low on the scale of side effects, but all patients will have some anxiety during treatment. Overall, CBT has been shown to be very effective in treating OCD.

Most people with OCD benefit from professional support from someone with special skills in treating OCD. The following resources are not intended in any way to replace such professional support, but are suggested as an adjunct to treatment.

Some good OCD books are:

There are also some good Instagram accounts around, including:

  • @anxietyocdtreatment
  • @ocdwhisperer
  • @christinacounsels
  • @jenna.overbaugh

And some good podcasts that might help:

  • All the Hard Things by Jenna Overbaugh
  • The OCD Whisperer Podcast
  • Your Anxiety Toolkit
  • The OCD Stories

You may also like to look at this website (OCD Australia) – https://www.ocdaus.org/

and the self help program at https://thiswayup.org.au/

Please don’t hesitate to reach out to us if you would like some help. To enquire about an appointment at Moving Forward Clinical Psychologists, please complete our Online Contact Form, and a member of our team will be in touch shortly. Alternatively, please call us on 1300 133 013. Our experienced Clinical Psychologists are located in Terrigal (10 minutes from Erina) on the beautiful NSW Central Coast. We are also available Australia wide, via Telehealth.