How OCD works
OCD operates in a cycle: an obsession (intrusive thought, image, or urge) creates intense anxiety or distress, leading to a compulsion (behaviour or mental ritual) that temporarily reduces the distress. Over time, the compulsion reinforces the obsession, making it return stronger. Common obsessions include fears of contamination, harm, doubt, or taboo thoughts. Common compulsions include washing, checking, counting, reassurance-seeking, and mental rituals.
OCD is not about being neat or organised — it is a condition where the brain misfires, generating false alarm signals that feel extremely real. People with OCD often understand that their fears are irrational, but the distress is genuine and difficult to resist without support.
- Obsessions: intrusive, unwanted thoughts causing distress
- Compulsions: repetitive behaviours to reduce anxiety temporarily
- Cycle reinforcement: compulsion strengthens obsession over time
- Common themes: contamination, harm, doubt, symmetry, taboo thoughts
- Time-consuming — can take hours each day and impair functioning
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Evidence-based treatment for OCD
The first-line treatment for OCD combines Exposure and Response Prevention (ERP) with SSRI medication. ERP is a specialised form of CBT where you gradually face feared situations (exposure) while resisting the urge to perform compulsions (response prevention). Over time, anxiety naturally decreases without the compulsion, breaking the OCD cycle.
SSRIs (such as fluoxetine, fluvoxamine, or sertraline) are typically used at higher doses for OCD than for depression, and may take 8–12 weeks to show full benefit. Dr. Shrestha combines ERP with pharmacotherapy for moderate to severe OCD, and provides clear psychoeducation about the treatment process and expected timeline.
| Treatment | How it helps | Typical duration |
|---|---|---|
| ERP (Exposure & Response Prevention) | Breaks the obsession-compulsion cycle | 16–20 sessions |
| SSRI medication | Reduces obsessive thoughts and compulsive urges | 8–12 weeks to full effect |
| Combined ERP + SSRI | Best outcomes for moderate-severe OCD | 20+ sessions with ongoing medication |
What to expect during ERP
ERP begins with building an understanding of your OCD cycle, identifying obsessions and compulsions, and creating a fear hierarchy (ranking feared situations from least to most distressing). You then systematically work through the hierarchy, starting with easier exposures and progressing to more challenging ones.
During exposure, you will experience anxiety initially — this is expected and necessary for the process to work. Over time, without performing the compulsion, anxiety decreases naturally (habituation). Dr. Shrestha guides you through each step, providing support and techniques to manage distress. Homework between sessions is essential for progress.
- Fear hierarchy created collaboratively at the start
- Exposures start easy and progress to more challenging
- Anxiety decreases naturally without compulsion (habituation)
- Between-session homework is critical for progress
- Progress is tracked and treatment adjusted as needed