There are two main treatments for OCD - Cognitive Behaviour Therapy (CBT) and Anti-Obsessional Medication. CBT and medication can be used alone or in combination with one another.

Your first step is to consult your GP. Then CBT is often recommended as a first line treatment, medication as a second line of treatment when an individual fails to make progress with CBT, or if an individual has severe problems, or is significantly depressed. However, there are often long waiting lists for CBT on the NHS and you may be offered medication as a first treatment by your GP or Consultant. The choice, however, is yours.

Cognitive Behaviour Therapy (CBT)
CBT is based on a programme of structured self-help. Behaviour Therapy began in the late 1960's and is the most researched psychological treatment for OCD. It involves repeatedly confronting feared situations that are avoided (a process called "exposure"). For the treatment to be successful, the exposure needs to be long enough for the anxiety to subside. The fear needs to be constant and the exposure should be repeated often. Exposure needs to be done without performing a compulsion (a process called "response prevention") and to therefore learn to tolerate the discomfort that occurs. If you do perform a compulsion, then you should repeat the exposure to "undo" the compulsion.

As time goes on the level of anxiety drops dramatically.

Each individual has a personal hierarchy. This means that each person starts by confronting easier situations and then gradually works up to more difficult ones. Facing up to each fear becomes easier and easier and the anxiety gradually subsides. The short-term side effects consist of anxiety and distress, but these will gradually decrease and, in the long-term, the fear will subside. No one is forced to confront their fears but the sufferer is encouraged to take responsibility to devise their own programme. A therapist does not have to be present, although it may help some individuals at the start of their treatment programme. Tasks need to be challenging but not overwhelming.

There are a number of excellent self-help books (For example 'When once is not enough' by Gail Steketee - Visit the OCD Shop page for more self help books') which explain such programmes in more detail. There are also self-help computer programmes such as BTSteps.

In research trials, about 25% of patients either refuse to take part in a programme of exposure and response prevention or fail to adhere to a programme. Of those that do adhere, about 75% are helped significantly after 10-20 sessions as an out-patient. The risk of relapse after treatment is about 25% when you may require additional treatment. More severe cases (especially washers) may be helped by a more intensive programme as an in-patient or at home. Due to the high drop out rate and partial success with exposure and response prevention, research is being carried out to make it better. One approach is adding cognitive therapy.

Dr Isobel Heyman and OCD sufferer during a Cognitive Therapy session. (All children featured are child actors).

Cognitive therapy suggests that OCD results when an individual misinterprets intrusive thoughts or urges as a sign that not only harm will occur, but that they may be responsible for it through what they do or what they fail to do. Therapy seeks to help the individual understand that their problem is one of anxiety rather than danger and to react accordingly. Individuals with OCD are therefore trying too hard to prevent harm. The solution becomes the problem. For example, a mother may try to suppress or neutralise intrusive thoughts about stabbing her baby. This has the effect of increasing the frequency of intrusive thoughts. The problem is not the intrusive thoughts but the meaning the individual with OCD attaches to them; for example "having such thoughts means I might act upon them" or "I shouldn't be having such thoughts".

This has the effect of increasing the degree of threat and responsibility and will lead the person to avoid having knives around their kitchen or being alone with their baby. This will further maintain their fear and prevent them from demonstrating they are just 'thoughts'. Cognitive therapy will also try to help the person overcome the need for certainty and to alter the criteria they may use to terminate a compulsion (e.g. when "I feel comfortable" or "just right" - beliefs that will tend to maintain a compulsion.)

When you are receiving CBT, the most important ingredient is the homework that you do between the sessions. The therapist can only act as a guide or teacher and the more you practice on your own, the quicker you get better. When patients have completed a successful course of treatment for OCD, most experts recommend follow-up visits for at least 6 months to a year.

Cognitive Behaviour Therapists come from a variety of professional backgrounds but are usually psychologists, nurses or psychiatrists. A directory of accredited cognitive behaviour therapists in the UK can be obtained from the British Association of Behavioural and Cognitive Psychotherapy (BABCP), PO Box 9, Accrington, BB5 2GD, enclosing a cheque for £3 made payable to 'BABCP'. The BABCP telephone number is +44 (0) 1254 875277. Alternatively you may find a therapist by searching the web-site www.babcp.org.uk under 'Find a Therapist'.

Further information about private treatment may be obtained from the British Psychological Society in Leicester by telephoning +44 (0) 116 254 9568. A GP can refer you to a cognitive behaviour therapist on the NHS or it is usually possible to refer yourself to a private therapist. Cognitive behaviour therapists do not need to be accredited by the BABCP and many do not bother, but it does guarantee certain minimum standards of training.

Getting the most from your therapist
At the recent OCD Conference in London, Professor Paul Salkovskis addressed delegates advising them how they can get the most from their therapist. We are lucky enough to have the audio recording on the Conference website, under the 'Recorded Highlights' section. You will not require any special software or plug-in to view and listen to these presentations.

Self - Help
If the OCD is not severe sufferers can start their own self - help programme. A number of books setting out self - help programmes are available from our OCD Shop. (Examples are 'Understanding obsessions and compulsions: A self - help manual' by Frank Tallis and 'Living with Fear' by Isaac Marks).

It is important to set aside time to follow a programme and to follow a programme consistently. The family can help by providing encouragement for the sufferer and praise when changes are achieved.

If the problem is more severe or complicated, the sufferer will benefit from seeking professional help. The GP may make a referral to a specialist for behaviour therapy.

Support groups
Support groups can potentially be a useful part of treatment. These groups provide a forum for mutual acceptance, understanding and setting of goals. People new to OCD can talk to others who have learned successful strategies for coping with the illness. It is important to remember, however, that support groups are not suitable for everyone.

UK Support Groups

Pharmacological Treatments

Source: OCD Action 2002