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From obsessional loop to deliberate response — exposure and response prevention
Obsessive-compulsive disorder affects 2–3% of the population and is characterized by intrusive, distressing thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) performed to reduce anxiety. Dr. Ruja's clinic specializes in exposure and response prevention (ERP), the gold-standard psychotherapy for OCD. Unlike generic anxiety management, OCD requires targeted interventions that break the obsession-compulsion cycle through deliberate, sustained exposure to the feared stimulus without performing the ritual.
Kathmandu Neurology Clinic & Cognitive Center
Authored and reviewed by Dr. Ruja Shrestha (MBBS, MD (Psychiatry), NMC 19766). Evidence-based, no fabricated outcomes.
Obsessive-compulsive disorder affects 2–3% of the population and is characterized by intrusive, distressing thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) performed to reduce anxiety. Dr. Ruja's clinic specializes in exposure and response prevention (ERP), the gold-standard psychotherapy for OCD. Unlike generic anxiety management, OCD requires targeted interventions that break the obsession-compulsion cycle through deliberate, sustained exposure to the feared stimulus without performing the ritual.
Reviewed by Dr. Ruja Shrestha, MBBS, MD — Consultant Psychiatrist & CBT Therapist (NMC 19766), Kathmandu Neurology Clinic. For evaluation, book an appointment.
OCD assessment includes the Y-BOCS (Yale-Brown Obsessive Compulsive Scale) for severity, detailed obsession and compulsion inventory, and functional analysis of the maintenance cycle. Common obsessions: contamination, harm (to self or others), symmetry/order, forbidden thoughts (sexual, religious, aggressive). Common compulsions: washing, checking, ordering, counting, mental rituals, reassurance-seeking. Body dysmorphic disorder, hoarding disorder, and trichotillomania are related but distinct conditions.
Exposure and response prevention involves: (1) building an obsession hierarchy (0–100 SUDS), (2) graded exposure to feared stimuli, (3) deliberate prevention of the compulsive response, (4) habituation and learning that anxiety decreases without ritualizing. Treatment typically runs 12–20 sessions, with intensive daily sessions for severe cases. Medication (SSRIs at higher doses than for depression, or clomipramine) may be combined with ERP for moderate-to-severe OCD.
Guidelines referenced:
Foa EB, Yadin E, Lichner TK. Exposure and Response Prevention (ERP) for Obsessive Compulsive Disorder. Oxford University PressNICE CG31 — Obsessive-compulsive disorder: core interventions in the treatment of obsessive-compulsive disorderSkapinakis P et al. Pharmacological and psychotherapeutic interventions for management of obsessive-compulsive disorder in adults: a systematic review and network meta-analysis. Lancet PsychiatryContent on this website is for general educational purposes only and does not constitute medical advice, diagnosis, or treatment. It is not a substitute for evaluation by a qualified healthcare professional. Always seek the advice of your physician or other qualified provider with any questions regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have read on this website. In case of a medical emergency, contact emergency services immediately. No doctor–patient relationship is established by use of this site or by contacting the clinic through the site.