Most people who arrive on this page are looking for therapy or treatment for obsessive-compulsive disorder (OCD). You may already have tried counselling, read about Exposure and Response Prevention (ERP), or searched online for answers, but OCD is a complex condition that needs a very specific, evidence-based approach to truly improve.
Before we go any further, I want to show you what actually works for OCD, what doesn’t, and why — because some approaches can unintentionally make the problem worse. This isn’t just opinion. I’m a Chartered Psychologist trained to doctoral level, and part of that training involved studying the international research and clinical guidelines that define which types of therapy are proven to help, and which ones have been shown to maintain or worsen symptoms.
Many people seeking help for OCD aren’t aware of this difference, so I’ll start by explaining how to recognise effective therapy and the kind of treatment that leads to recovery, before we look more closely at the psychology and brain science behind OCD itself.
Table of contents
When Therapy Makes OCD Worse — and How to Fix It
Most therapy talks about your thoughts. In order to recover from OCD you need to retrain the pattern that drives those thoughts. Just talking about them, can in fact, feed your OCD and make things worse, especially if you keep asking in therapy questions like, but how do you know something won’t happen, how do you know it clean, as this is in fact reassurance seeking and keeps you firmly stuck in OCD.
If you’ve already tried counselling that focused on talking about your thoughts, you’ll know it doesn’t work for OCD. In fact, it can make things worse. Every time you analyse, confess, or look for reassurance, your brain rehearses the same loop that keeps you stuck. That’s why general counselling fails — it feeds the pattern instead of fixing it.
To recover, you have to change what your brain does, not what you think about it. That means meeting the fear head-on, resisting the ritual, and retraining the part of your brain that keeps firing the alarm. That’s exactly what I teach — step by step, in clear, practical language, so you can finally stop rehearsing OCD and start rewiring it.
I’m Dr Elaine Ryan, Chartered Psychologist. I specialise in anxiety and OCD, that is all I work with; combining over twenty years of clinical experience with personal insight from living through OCD and anxiety myself. My approach doesn’t keep you talking about the thoughts — it teaches you how to change the brain pathways that create them.
Start ERP for OCDWhat Effective OCD Therapy Looks Like
You might not have come across what effective OCD therapy is meant to do. It’s not long conversations about how you feel — it’s structured, practical, and measurable. Effective therapy teaches your brain a new response to intrusive thoughts until the old loop fades.
Effective OCD therapy:
- Focuses on actions, not analysis. Talking about thoughts keeps the loop alive. Recovery starts when you change what you do, not what you think.
- Teaches you to face the thought and do nothing. That’s how your brain learns there’s no danger.
- Measures progress by behavioural change, not by minutes spent talking. You’ll know it’s working when rituals reduce and freedom returns.
- Uses Exposure and Response Prevention (ERP) — the gold-standard, neuroscience-based approach for OCD.
- Works because it rewires your brain’s alarm system, not just your insight.
If therapy in the past left you analysing your thoughts, that’s why it didn’t work.
OCD recovery isn’t a conversation — it’s a retraining process.
In order to fully recover from OCD, or any mental health condition for that matter, you first need to fully understand the condition, and, as I said at the beginning of this article, I want to now talk about more psycho-educational material to help you understand what is going on for you.
What is OCD? Understanding Obsessions and Compulsions
OCD stands for Obsessive-Compulsive Disorder and consists of having both obsessions and compulsions that affect your quality of life. Obsessive-Compulsive Disorder is a treatable condition, and whether you choose individual therapy or my online OCD course.
What are obsessions?
A key element of Obsessive-Compulsive Disorder is having obsessions. Obsessions are all the anxiety-provoking thoughts and images that pop into your head. In OCD, these obsessions often are contrary to who you are as a person and the values you live your life by.
Some examples of obsessions that occur within OCD are
- thinking you could harm someone or yourself
- you saying something unthinkable out loud in Church
- Fearing that you did not clean something correctly and may make yourself or the people you love ill.
A simple way to tell obsessive thoughts from other thoughts is that it is tough to dismiss them, as they frighten, disturb or disgust you so much.
What are compulsions?
Compulsions are the things you do to help you cope and can include;
- washing
- repeating or counting
- checking
- reassurance seeking
A compulsive behaviour within OCD differs from other behaviours you have, as you have to carry out these compulsions. They are hard to resist.
The following video taken from my online course for OCD explains some obsessions and compulsions.
Types of OCD
I find it easier to break this down into
- People who check
- People who hoard
- People who worry about contamination and germs
OCD and Checking
People check;
- Door, windows, locks
- Emails – were they sent properly or checking that they are perfect before you send them.
- Turning off cookers, curling tongs, electrical appliance
- Sending loads of texts to make sure someone is okay, that they got home okay, that they are alright with you
- The route (thoroughly) before you travel
OCD concerning doing something wrong – e.g. did I send that email to the right person?
If you don’t have this, you probably hit ‘send’ without doing a basic spell-check. If you always worried that you might do something wrong, emailing is a long and challenging thing.
The obsession might start with something simple like “have I got the email address right”, and behind this thought is a fear of not wanting to do something wrong or a fear of making mistakes.
The fear that you might get the email address wrong will lead you to carry out a compulsion – check the email address, but if only your compulsions were that short! You might also have to carry out the following if you have a fear of making a mistake;
- checking the email address many times
- proofreading the email many times
- not sending it after you have done the above, as you may have missed something
- Once you send the email, the anxiety can start, and you have to go into your ‘sent items’ and start checking again.
OCD and Hoarding
This is what it sounds like – you can’t get rid of anything. You keep everything just in case you need it, and it is too anxiety-provoking to consider getting rid of anything. The anxiety spike is so intense that it is just easier to keep everything, even though it is making your life difficult.
OCD and Contamination – OCD and Cleaning
If you have contamination OCD, somewhere in the back of your head (and it could be there and you don’t know it yet) is a fear of harming yourself or other people.
Because OCD and cleaning have been the subject of many television programs, it looks like the cleaning became the focal point instead of the actual fear and anxiety behind it.
If I had this, and somewhere in my mind, I thought I could inadvertently harm people I care about or myself through germs, yes, it is better to clean, just in case it is true.
The contamination fear can cause cleaning,
- Yourself – before you get in the shower, cleaning your products before and after you use them, cleaning the shower before you get out, and if you touch something or it doesn’t feel right, you start again.
- Objects or surfaces around you.
You may avoid many public places or crowds because of fear of contamination. It can be challenging to use the loo outside your own home, and many people don’t. You may not touch many things you have not made sure are clean and probably carry disinfectant gel with you.
The cleaning, especially of yourself, can be challenging, as your skin can hurt and burn.
Obsessions and compulsions concerning cleaning
If you have this, you might have come across contamination OCD, I am not big into labels, so I shall explain how this works.
Let’s say you were about to prepare dinner, and you had the thought, “is my kitchen counter clean?” This is the obsession.
More often than not, what is behind this obsession is a fear that you could cause harm to either yourself or others. You, not cleaning something correctly, could, for example, result in the spread of germs and make someone you care about ill, or worse.
This thought you could make someone ill will cause you to carry out your compulsion – the cleaning as you will not risk harming someone you care about.
Read more on contamination OCD.
Intrusive Thoughts – Pure O
Many people see this as only having obsessions without compulsions, but I often find that the compulsions are there if you look hard enough.
Typical intrusive thoughts are concerns relating to your sexuality, relationship, faith, and concerns that you could cause harm to yourself and other people.
The recommended treatment for OCD is Cognitive Behavioural Therapy – CBT, using Exposure Response Prevention – ERP. This page discusses all reputable models of therapy used to treat OCD to make an informed decision on what will work best for you.
Self-help and Treatment for OCD
Cognitive Behavioural Therapy for OCD
CBT is the traditional treatment for OCD as recommended by NICE guidance and comprises
Looking at your thoughts -and the meaning you place on your thoughts. For example, you probably take personal responsibility for having the thoughts first and think they must mean something about you as a person.
CBT will help you break this down and help to rational your thoughts.
It also has what we call a behavioural component. You are taught how to change your behaviours; with OCD, this would guide you to reduce and eventually eliminate your compulsions.
Acceptance and Commitment Therapy – ACT for OCD
At its most basic level, Acceptance and Commitment Therapy – ACT teaches you to accept your thought for what it is (just mental activity in your head) and commit to doing something else, i.e. not a compulsion.
This is such an essential part of recovering from OCD. As I have already stated, the compulsions you carry out only help short term, but long term, they keep your OCD going.
Exposure Response Prevention (ERP) for OCD
ERP should be carried out as part of Cognitive Behavioural Therapy. ERP is a highly effective therapy for OCD. Learn more about ERP therapy and how it can help you manage symptoms.
Why Choose Therapy with Dr Elaine Ryan?
- Personalised support in Dublin or online across Ireland and the UK.
- Expertise in treating OCD with over 20 years of experience.
- Evidence-based therapies tailored to your needs (CBT, ERP, ACT).
FAQ’s
ERP involves gradually exposing yourself to feared situations without performing compulsions, helping to reduce anxiety over time.
You’ll receive a personalised plan tailored to your needs, using evidence-based therapies like CBT and ERP to help you manage OCD symptoms effectively.
The course includes video modules, practical exercises, and step-by-step strategies to help you reduce obsessions and compulsions
The most effective treatments for OCD are Cognitive Behavioural Therapy (CBT) and Exposure and Response Prevention (ERP).
See Also HSE
