Evidence-Based OCD Treatment & Assessment in the UK

Obsessive compulsive disorder (OCD) can be a persistent and distressing condition, but effective, evidence-based OCD treatment is available in the UK.

This page outlines how OCD is understood and treated, including cognitive behavioural therapy (CBT) with exposure and response prevention (ERP), medication where appropriate, and how to access specialist assessment and care.

Much of the information included on this page is taken from our book Overcoming Obsessive Compulsive Disorder.

Obsessive compulsive disorder (OCD) is a condition consisting of obsessions or compulsions, or more commonly both.

Obsessions are recurrent thoughts, images or urges that you may regard, at least initially, as intrusive and senseless. They are often distressing and may lead to feelings of anxiety, guilt or responsibility. You may find it difficult to ignore them or distract yourself from them.

Common obsessions include fears of contamination from germs, dirt or disease, or fears of causing harm, accident or misfortune. For example, you may worry that you have left doors unlocked or appliances on, leading to repeated checking. Obsessions may also involve intrusive thoughts about violence, sex, religion or causing offence, which can be particularly difficult to describe and may lead to avoidance of certain situations.

Compulsions are actions or mental rituals performed to reduce discomfort or prevent a feared outcome. Although they are carried out voluntarily, you may feel driven to perform them. Common compulsions include checking, excessive cleaning or hand washing, seeking reassurance, counting, repeating actions, or arranging things in a particular way.

Some compulsions take place mentally, such as repeating phrases or reviewing events in your mind. These are often referred to as ruminations or mental rituals.
OCD is maintained by a cycle in which individuals overestimate the likelihood of harm and their responsibility for preventing it.

This is often combined with a tendency to catastrophise and a need for certainty. While compulsions and avoidance may reduce anxiety in the short term, they tend to perpetuate the problem over time.

There are two main treatments that have been shown to be effective for OCD: cognitive behavioural therapy (CBT) and medication. Current NICE guidelines recommend CBT that includes exposure and response prevention (ERP) as the first-line, evidence-based OCD treatment in the UK.

Cognitive behavioural therapy (CBT) with exposure and response prevention (ERP)

CBT with ERP is based on a psychological understanding of what keeps OCD going.

Individuals with OCD often have an over-inflated sense of responsibility, they overestimate the likelihood of harm, and feel a strong need for certainty that a feared event will not occur. Treatment focuses on addressing these beliefs and the behaviours that maintain the problem.

When ready, patients are supported to confront feared situations (exposure) without performing compulsions or rituals (response prevention). This may involve gradually facing situations that trigger anxiety, while resisting checking, reassurance-seeking or avoidance.

Although this can lead to increased anxiety in the short term, repeated exposure without carrying out compulsions allows anxiety to reduce over time. Patients learn that feared outcomes do not occur, or can be tolerated, and that the need for rituals diminishes.

Treatment is usually approached in a gradual and structured way, beginning with less difficult situations and progressing to more challenging ones. Of those who adhere to the programme, around 75% experience a significant improvement. There is a risk of relapse, and some individuals may require further treatment.
There is no evidence that psychodynamic or analytical therapy or hypnotherapy is of benefit in OCD.

Medication for OCD

Medication may also play a role in OCD treatment, either on its own or alongside CBT.

The most commonly used medications are selective serotonin reuptake inhibitors (SSRIs), including fluoxetine, sertraline, fluvoxamine, paroxetine and citalopram. Clomipramine, an older medication, may also be used but is more likely to produce side effects.

Medication can be helpful in reducing symptoms and may improve motivation to engage with psychological treatment, particularly where anxiety or depression is significant.
To assess whether medication is effective, it is usually necessary to take an adequate dose for at least 12 weeks. Around 60% of patients experience improvement, although relapse is common after stopping medication. The risk of relapse can be reduced by combining medication with CBT.

A detailed assessment is an essential first step in identifying the nature of OCD and determining the most appropriate treatment approach.

The assessment focuses on understanding the types of obsessions and compulsions present, how they are maintained, and the degree to which they interfere with daily life. It will also consider any related difficulties, such as body dysmorphic disorder (BDD), health anxiety or emetophobia, as well as symptoms of depression.

Where relevant, previous treatments and responses to therapy or medication are reviewed. This helps inform recommendations about the most appropriate evidence-based OCD treatment in the UK.

Assessments can be carried out either remotely by video or face-to-face in London. Following assessment, recommendations are made regarding treatment options and next steps, which may include referral to a specialist therapist for cognitive behavioural therapy (CBT) with exposure and response prevention (ERP), and consideration of medication where appropriate.

THere is also the option for intensive CBT over 4 days with the same number of hours as delivered weekly.

Following assessment, patients are guided towards the most appropriate evidence-based OCD treatment in the UK.

In many cases, this involves referral to a specialist cognitive behavioural therapist with expertise in OCD and related disorders, particularly in the use of exposure and response prevention (ERP). Access to therapists with specific experience in OCD is important, as treatment requires a structured and consistent approach.

I work closely with a network of experienced therapists and services specialising in OCD. This allows patients to be directed towards appropriate care based on their individual needs and circumstances.

Where indicated, medication may be recommended either alongside therapy or as part of the overall treatment plan. Ongoing input may also be provided to review progress and adjust treatment where necessary.

The aim of this approach is to ensure that patients receive evidence-based OCD treatment that is appropriate, coordinated and delivered by clinicians with relevant expertise.

I am a Consultant Psychiatrist with over 30 years’ experience in the assessment and treatment of obsessive compulsive disorder and related conditions.

I have contributed to national and international research in OCD and was involved in the development of NICE guidelines for the treatment of OCD and body dysmorphic disorder. I have published widely in this field and am co-author of the book Overcoming Obsessive Compulsive Disorder.

I am affiliated with King’s College London and have previously led the specialist OCD services at the Maudsley and Bethlem Royal Hospitals, the leading centres for the treatment of OCD in the UK.

If you are seeking evidence-based OCD treatment in the UK, a detailed assessment is the first step in identifying the most appropriate approach.

An assessment provides an opportunity to understand the nature of the problem, including the specific patterns of obsessions and compulsions, and to receive recommendations for treatment based on current NICE guidance.

Appointments can be arranged via my PA, Natalie Fisher, on 020 3137 9911 or by email here. Consultations are available by video or face-to-face in London.