Over the last 15 years or so the treatments available for OCD have improved dramatically. These usually include:-

(1). Cognitive Behavioural Therapy (CBT) which now specifically includes a form of treatment called Exposure and Response Prevention Therapy, (more commonly referred to as ERP).

(2). Medication in the form of Selective Serotonin Reuptake Inhibitors (SSRI's). 

(3). A cobination of CBT and Medication.

(4). Acceptance Commitment Therapy.

(5). Other help for OCD.

(1). Cognitive Behavioural Therapy and ERP

A person who has OCD will suffer considerably with cognitive distortions and the inability to interpret reality accurately. Cognitive Behavioural Therapy and ERP helps a person with OCD to challenge this faulty way of thinking and break the cycle of both obsessions and compulsions. This in turn helps to build a more positive and more accurate view of the world. 

Exposure and Response Prevention Therapy helps a person with OCD to face their fears by accepting the obsessive thoughts without trying to rectify them or perform compulsions to neutralise them. The therapist will work with the client to put in place strategies that will help them to resist doing the compulsions and thus break the endless cycle that has kept them stuck. The client will also see that by not engaging in the compulsions any anxiety caused by the obsessive thoughts will subside naturally. 

One example of how this might work is as follows:-

A person with OCD might have a fear that if they don't check the taps on the sink 20 times then the tap will accidentally get left on and flood the house. Only after 20 times will they feel that the tap is off and that the anxiety has reduced. However, this relief is usually very short lived and they may then have to return to the tap again and check another 20 times.

When doing ERP the client could agree with the therapist that instead of checking 20 times, they will only check 15 times for the first week. They would have to agree to sit with any increased anxiety caused by doing this until the anxiety levels subsided. This would show them that they could tolerate the anxiety and uncertainty caused by only checking 15 times. Then the next week they could perhaps reduce it to 10 times and then 5 times and so on.

The above is just one example but when starting ERP with a therapist, an exposure hierarchy will most likely be drawn up by the client. This can then be worked on with the therapists guidance. Exposures need to be carefully thought out and specifically tailored for each person. A hierarchy will include all the different situations in a persons life, that trigger the obsessions and compulsions. The client will then rate each one with a number between 1-10, with 1 being the easiest and 10 the most difficult. Then when starting therapy, they will most likely start with one that has been rated as 3 or a 4. This is because if they started with one that was too easy then the benefit would be minimal. On the other hand if they started with one that was too difficult and they felt that they had failed, then this may well discourage them from continuing with therapy.

ERP is the recommended treatment for OCD and it most certainly helps to reduce OCD symptoms significantly. However, it should be noted that ERP is very challenging and that the client will need to be very committed, to the treatment, in order to see positive results. There is no doubt that doing ERP on a daily basis is exhausting. Some days will be better than others. Some days the client may feel more compelled to engage in rituals whilst on other days they find doing the ERP much easier

On days when a client wants to challenge their OCD compulsions they might try 'delaying' doing the ritual. As with the previous example, a person could be worried that they had not turned off the bathroom tap and that the house would be flooded. To check, they may have to put their hand under the tap to make sure that it is turned off. On a bad day they may have to do this compulsion straight away. However, on a better day they could delay that check by a minute and then the next time 'delay' their check by 2 minutes. Another strategy that can be used to combat compulsions is to 'change' the ritual slightly; therefore rather than putting the whole hand under the tap to check they could just put one finger under the tap. By changing the rituals slightly or by delaying them, the person is still doing some ERP work towards their recovery, even if they can't refrain from doing the whole compulsion.

Many people who have OCD will have at some point worried for days about something that they think they have done in the past or that might happen in the future. For example, somebody with 'Harm' OCD might think that they ran over somebody on the way home from work. Logically they know in their mind that this is not true but it just 'feels' like they did. In response to this fear they might try to run through the journey home over and over again in their mind. Often the next step from this is to check 'online' for any accidents that might have occurred or they may even drive back along the road to check. The person may think about this for days or even weeks sometimes before being able to let go of this OCD thought.

Another ERP strategy that could be used in this situation is for the person with OCD to agree with themselves that they are not going to worry about this issue throughout the day; however at the end of the day they will give themselves just half an hour to do compulsions or to think about this. Giving themselves this time at the end of the day can help dramatically to reduce the number of compulsions that are engaged in throughout the day.

(2). Medication

As mentioned earlier, prescribed medication, (SSRI's) can be of some benefit in reducing OCD symptoms. How much of a benefit is strongly debated. Some people feel that they help significantly whilst others find any benefit minimal. In the early days when I first started on medication for OCD I felt that it reduced my symptoms by about 30%. However, as I have got older, I have noticed that any benefits from the medication has reduced down to about 10%. 

Before taking any medications it is important to consult your G.P. There are many different SSRI's that can be tried and it may well take some time to find the right SSRI for you. It is also just as important to consult your G.P. before withdrawing from any medication as the side effects from withdrawl can often be quite troublesome.

SSRI's work by inreasing the levels of serotonin, (a neurotransmitter), in the brain. People who have OCD are, for some reason, believed to have a lack of serotonin in the brain. Your G.P. will most likely start you on a low doseage of an SSRI and possibly increase the doseage when and if it is required. A list of some SSRI's are as follows:- fluoxetine, sertraline, citalopram, paroxetine and escitalopram. This is not an exhausive list.

When you first start on medication you will most likely notice some side effects which may last for a few weeks before they start to subside. Some common side effects may include, headache, nausea, vomitting, feeling drowsy, dizziness, anxiety, and sexual dysfunction. I myself tried several different SSRI's before I found one that suited me best. Every person is different and an SSRI that suits one person might not suit another. It often takes around about four weeks to start feeling the benefit of these medications.

It also might take several attempts to find the right medication and this is why it is so important to have a good patient/doctor relationship with a GP. More recently, I have been started on an antipsychotic medication to help increase the affectiveness of the SSRI that I am on. However, it should be noted that this is usually more of a last resort. I am currently on olanzapine having already tried quatiapine and risperidone. Always work with your GP to find the right medications that suit you.

(3). CBT + ERP and Medication

Often a combination of ERP and medication can be beneficial when treating OCD. Always consult your G.P. to discuss your options. Sometimes a low dose of an SSRI might initially help the client to engage with CBT and the process of ERP. Ultimately, a combination of both may help to improve the overall outcome of therapy.

(4). Acceptance Commitment Therapy (ACT).

Acceptance Commitment Therapy (ACT) can be used in conjunction with ERP. Like the practice of meditation and mindfulness, it very much concentrates on the present, the here and now. It looks at what is going on in an individual's life right at this moment, what thoughts, feelings or experiences a person is having and asks that these be looked upon  without judgement. Self-Compassion is therefore central to the Acceptance Commitment Therapy model and through various techniques and strategies the individual learns to practice self-compassion. With OCD the bad thoughts and feelings can often feel overpowering and all consuming but through Acceptance Commitment Therapy the individulal can learn to change their reaction to them; to accept them for what they are and show themselves greater compassion in doing so.

(5). Other help for OCD.

When recovering from severe OCD symptoms it is also important that a balance between psychological and physical wellbeing is maintained. For example, some people find meditation extremely useful. They may meditate twice a day for about 10 minutes, once in the morning when they wake up and once in the evening, to wind down after a busy day. Others may meditate just once a day. There are quite a few good meditation Apps available which can help to build up a daily plan of meditation exercises. As-well as this, daily physical exercise is extremely important. Just going for a brisk walk each day can be hugely beneficial. Participating in different sports that you are interested in can also be extremely helpful. Partaking in a hobby that you are intrested in can also help to maintain this balance.