Therapy for OCD. Symptoms, Causes, and Tips That Help.
What Is Obsessive-Compulsive Disorder (OCD)?
OCD is when your brain gets stuck in a loop.
Obsessions are unwanted thoughts, images, urges, or doubts that pop up and feel hard to shake.
Compulsions are the things you do (out loud or in your head) to try to feel safe, certain, or “back to normal.”
A lot of people hear “OCD” and think “super clean” or “very organized.” But OCD is usually not about being tidy. It is more like a false alarm system that keeps going off, even when you know the risk is low.
If you’ve ever thought, “Why am I doing this, I know it doesn’t even make sense,” you are not alone. That tug-of-war is a common OCD experience.
What are the symptoms of OCD?
OCD symptoms often come in pairs: an obsession that spikes anxiety, followed by a compulsion that tries to bring anxiety down. The relief usually does not last, so the cycle keeps going.
Obsessions
Obsessions can sound like:
“What if I hurt someone by accident?”
“What if I’m a bad person?”
“What if I didn’t lock the door and something happens?”
“What if I get sick and it’s my fault?”
“What if I don’t really love my partner?”
“This feels wrong unless it’s perfectly clean, even, or ‘just right.’”
Common themes include contamination fears, harm fears, “just right” feelings, taboo intrusive thoughts (sexual, violent, or religious), intense doubt, and fear of mistakes.
One important reminder: intrusive thoughts are not intentions. Having a scary thought does not mean you want it, agree with it, or will act on it.
Compulsions
Compulsions are the “fix it” behaviors. They can be visible or totally hidden.
Examples include:
Washing, cleaning, showering, sanitizing
Checking locks, ovens, appliances, messages, homework, work tasks
Repeating steps until it feels “right”
Counting, tapping, arranging, lining things up
Mentally replaying conversations to “prove” you did nothing wrong
Googling symptoms for reassurance
Asking people to confirm things over and over (“Are you sure I didn’t mess that up?”)
Compulsions can steal time and energy. Many people also start avoiding triggers, canceling plans, and shrinking their world just to keep anxiety down.
What causes OCD?
There is no one single cause, but big medical sources agree on a few pieces:
OCD is linked to differences in brain circuits that involve habits and checking for danger.
Stress and major life changes can make OCD louder.
OCD can run in families, so genetics can play a role.
In a small number of kids, symptoms may show up suddenly after an infection (often called PANDAS or PANS).
None of this means you “did this to yourself.” OCD is not a lack of willpower.
How is OCD different from anxiety?
OCD and anxiety can look similar, but here is a simple way to think about it.
Anxiety often worries about real-life problems, like money, health, work, or relationships.
OCD demands certainty. It pushes you to do rituals, checking, mental reviewing, reassurance seeking, or avoiding to get relief.
Many people have both anxiety and OCD, and that can make it confusing. A trained therapist can help sort out what is what.
Diagnosis
OCD diagnosis is mostly about getting a clear picture of your patterns, not “passing” a test.
A provider will usually ask about:
What thoughts show up
What behaviors or mental rituals you do to calm the thoughts
How much time it takes each day (often an hour or more)
What you avoid
How it affects sleep, work, school, parenting, and relationships
Sometimes a physical exam is used to rule out other medical issues. A clinician may also use a short rating tool to track severity and progress.
Diagnostic challenges
OCD is easy to miss because:
People feel ashamed and keep it private
Compulsions can be mental, so nobody sees them
OCD can look like perfectionism, generalized anxiety, depression, ADHD, trauma responses, or postpartum anxiety
Many people have OCD plus something else, which blurs the picture
If you’ve been told “it’s just anxiety” but something still feels off, that is worth revisiting.
Treatment
OCD is treatable. Most plans include therapy, sometimes medication, and always practical supports that help you stay steady between sessions.
Psychotherapy
The most research-backed therapy for OCD is CBT, especially a specific kind called Exposure and Response Prevention (ERP).
Here’s what ERP looks like in real life:
You and your therapist pick a trigger to practice with.
You face it in a planned, supported way.
You practice not doing the compulsion afterward.
Over time, your brain learns, “I can handle this feeling, and I do not need rituals to be safe.”
Good ERP is not a surprise attack. It is paced, collaborative, and built around your goals. Many people also use ACT or other skills to help them stop wrestling with intrusive thoughts all day.
Other healpful forms of theraoy include IFS, in which you and your therapist can explore the ways in which your internal OCD emotional part is trying to help you, and work to retrain that part to be more helpful, regulated and balanced (yes, there are good parts of your OCD too). EMDR can also help your brain to reprocess OCD emotional triggers and form new healthier neural networks that can help you to overcome OCD fears and reframe your thinking processes to more healthy ones.
Medicines
Medication can lower the volume on OCD symptoms, especially when things feel relentless. The most common options are SSRIs, and sometimes clomipramine.
A few helpful expectations:
OCD often needs higher doses than depression.
It can take 8 to 12 weeks to see the full effect.
Stopping suddenly can cause withdrawal-like symptoms and OCD flare-ups, so changes should be done with a prescriber.
Medication is not a shortcut or a failure. For some people, it creates enough breathing room to do the real work in therapy for OCD.
Other treatment
If OCD is severe and standard treatment has not helped enough, a specialist may discuss:
Intensive outpatient or residential OCD programs
TMS (a non-surgical brain stimulation option used for some treatment-resistant OCD cases)
DBS (a surgical option used rarely for severe, treatment-resistant OCD)
Lifestyle and home remedies
These do not replace therapy for OCD, but they can make treatment easier.
Try a few of these:
Name the cycle: “This is OCD, not me.”
Track time, not content: notice how many minutes OCD steals each day.
Practice small delays: delay a compulsion by 2 minutes, then 5.
Reduce reassurance slowly: reassurance feels good fast, but it usually feeds the loop.
Protect the basics: sleep, food, movement, hydration.
Quick experiment for this week: pick one small compulsion you do every day. Set a timer for 60 seconds and wait before doing it. While you wait, take five slow breaths and notice the urge rise and fall. If you still do the compulsion, that is okay. The win is practicing the pause with kindness today.
If symptoms feel intense, do not try big exposures alone. Get support and a plan.
Coping and support
OCD can be isolating. Therapy is a place where you do not have to hide.
A few supportive moves:
Tell one safe person, “My brain gets stuck in loops, and I’m working on it.”
Look for an OCD support group or trusted resources.
Ask loved ones to help you resist reassurance, like “Can you sit with me while I ride this out?”
Celebrate small wins, like delaying a ritual or showing up for therapy.
Preparing for your appointment
What you can do
Before your first session, it can help to jot down:
Your most common obsession themes
What compulsions you do, including mental rituals
What you avoid
Roughly how much time OCD takes each day
What you want back (sleep, routines, parenting calm, focus, time)
Notes in your phone are perfect.
What to expect from your therapist
A good OCD therapist will:
Use plain language
Ask about both obsessions and compulsions (including the hidden ones)
Explain a clear plan for OCD treatment, not just “let’s talk about it”
Help you build practice steps between sessions
At Emberly Counseling, our style is warm, down-to-earth, and evidence-based. We work with teens and adults in Pennsylvania, and we support concerns like OCD, anxiety, trauma, depression, relationship stress, and pregnancy or postpartum challenges.
When should I see my healthcare provider?
Consider reaching out if:
OCD takes more than an hour a day
You are late, stuck, or exhausted because of rituals
You are avoiding life to avoid triggers
You feel ashamed and alone with your thoughts
Your mood is dropping, or you feel hopeless
You do not have to wait until you are at your breaking point.
Outlook / Prognosis
Many people improve a lot with the right plan, especially therapy for OCD that includes ERP. Progress is not perfect or linear. The goal is getting your time, energy, and choices back.
FAQ: Therapy for OCD
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Yes. ERP, which is a type of CBT, is considered a gold standard treatment for OCD. Many people have fewer obsessions, less time spent on compulsions, and more freedom in daily life after a good course of ERP. This paired with EMDR and IFS can be especially helpful.
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It varies. Some people notice changes within a few weeks. Many structured ERP plans last around 12 to 20 sessions, sometimes longer if OCD is severe or there are other conditions like trauma or depression.
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Not always. Some people do well with therapy alone. Others find that medication plus therapy for OCD works best, especially when symptoms are intense. A prescriber can talk with you about risks, benefits, and options.
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Yes. OCD and anxiety are core focus areas for Emberly Counseling. We use approaches like ERP, IFS, EMDR, and CBT for OCD, combined with trauma informed care and relational therapy when that fits your story.
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You might be a good fit if you are looking for a therapist who understands OCD, trauma, and anxiety, and who offers a mix of practical tools and warm, human connection. If you are unsure, you can reach out, ask questions, and see how it feels.
