Evidence-Based OCD Treatment

Serving NV, CA, OR, AZ & PsyPACT States

Overcoming Obsessive-Compulsive Patterns

Obsessive-Compulsive Disorder (OCD) is often misunderstood as simply being overly neat, organized, or particular. In reality, OCD involves unwanted, intrusive thoughts, images, or urges (obsessions) and repetitive behaviors or mental acts (compulsions) performed to reduce distress, gain certainty, or prevent a feared outcome.

Compulsions may provide temporary relief, but over time they can reinforce the cycle of obsessions, uncertainty, and compulsive responding.

Common OCD Themes

OCD can involve many different themes, sometimes informally described as “types of OCD.” Common presentations I treat through telehealth include:

  • Harm OCD & Intrusive Thoughts: Unwanted fears, thoughts, or images involving accidentally or intentionally causing harm to yourself or others.

  • Relationship OCD (ROCD): Persistent doubts about relationships, attraction, compatibility, or feelings, often accompanied by checking, analyzing, comparing, or reassurance seeking.

  • Pedophilia-Themed OCD (P-OCD): Unwanted, distressing thoughts or doubts about being sexually attracted to children, often accompanied by checking reactions, reviewing past interactions, avoidance, or reassurance seeking.

  • Sexual Orientation OCD (SO-OCD): Intrusive doubts or uncertainty about sexual orientation, often accompanied by checking thoughts, feelings, attraction, or bodily responses.

  • Gender Identity OCD (GI-OCD): Persistent, unwanted doubts or fears about one's gender identity, often accompanied by repeatedly analyzing feelings, checking reactions, comparing experiences, or seeking reassurance to achieve certainty.

  • “Pure O” / Primarily Obsessional OCD: OCD in which compulsions are less visible and may include rumination, mental reviewing, analyzing, checking feelings, reassurance seeking, or attempts to resolve intrusive thoughts internally.

  • Moral & Real-Event OCD: Persistent doubt or guilt about past actions or what they might mean about you, often accompanied by mental review, confession, checking, or reassurance seeking.

  • Contamination & Health-Related OCD: Persistent fears involving contamination, illness, germs, toxins, or other perceived threats to physical health.

  • Checking & Responsibility OCD: Fears of making a mistake, causing harm, or failing to prevent something bad, often leading to repeated checking or reassurance seeking.

  • “Just Right” OCD: A need for actions, thoughts, sensations, or surroundings to feel correct, complete, even, or certain.

The particular content of OCD can vary considerably, and themes can change or overlap over time. Treatment focuses less on what OCD happens to be about and more on the patterns of avoidance, compulsive responding, and attempts to obtain certainty that keep the problem going.

My Clinical Approach: ACT-Informed OCD Treatment

Exposure and Response Prevention (ERP) is a form of cognitive behavioral therapy and one of the best-supported psychological treatments for OCD (Steele et al., 2025). ERP involves intentionally approaching feared thoughts, sensations, situations, or uncertainty while reducing the compulsions and avoidance that ordinarily follow. It is an active, experiential treatment: we develop structured exercises that give you repeated opportunities to practice approaching discomfort and uncertainty without responding in the ways OCD demands. In some ways, ERP is a bit like deliberately watching a scary movie over and over again: the goal isn't to convince yourself that nothing feels scary, but to practice experiencing fear and uncertainty without escaping, checking, or doing something to make the feeling go away.

ERP is the foundation of my approach. I also draw heavily from Acceptance and Commitment Therapy (ACT) to help clients change how they respond to intrusive thoughts and uncomfortable internal experiences.

Rather than spending therapy trying to prove that an intrusive thought is false, eliminate uncertainty, or make anxiety disappear, ACT emphasizes learning to make room for unwanted thoughts and feelings while choosing behavior based on what matters to you.

Importantly, I don't view ACT as a replacement for ERP or assume that adding ACT somehow makes ERP more effective. Research comparing ERP with ACT-integrated ERP has found substantial improvement with both approaches (Twohig et al., 2018). I use ACT because it provides a useful framework for practicing willingness, stepping back from thoughts, and moving toward meaningful activities even when OCD is demanding certainty.

In ACT-Informed ERP, We May Also Work On:

  • Stepping Back from Intrusive Thoughts: Learning to notice thoughts as mental events rather than automatically treating them as facts, threats, or instructions that require a response.

  • Making Room for Uncertainty: Practicing willingness to experience anxiety, doubt, or discomfort without relying on compulsions to make those experiences go away.

  • Moving Toward What Matters: Redirecting time and energy toward relationships, work, school, interests, and other personally meaningful activities rather than organizing life around OCD.

Frequently Asked Questions

  • Yes. Research supports delivering ERP through videoconferencing, although the evidence base for telehealth ERP is smaller than the broader literature supporting ERP itself (Vogel, 2014). Telehealth can also have a practical advantage for ERP: we can work with triggers, compulsions, and avoidance in the environments where they actually occur rather than limiting exposure practice to a therapist's office.

  • ERP is one of the most effective treatments available for OCD. Across studies, about 60% to 85% of people who complete ERP show a meaningful reduction in OCD symptoms (Ponniah et al., 2013; Rosa-Alcázar et al., 2008). However, improvement is not the same thing as complete remission, and outcomes vary considerably from person to person.

    Researchers usually distinguish between response and remission. Response means OCD symptoms have improved substantially. Remission is a higher bar and generally means symptoms have become relatively minimal. Most people who complete ERP respond, but in “difficult-to-treat-OCD,” some people benefit from a longer course of treatment (Simpson et al., 2021).

  • ERP is itself a form of cognitive behavioral therapy and remains central to my treatment of OCD. ACT differs primarily in emphasis. Rather than trying to determine whether an intrusive thought is true, rational, or likely, ACT focuses on noticing thoughts without automatically responding to them, allowing room for uncertainty and discomfort, and choosing behavior based on your values.

    In my approach, ACT complements ERP rather than replacing it.

  • ERP takes work, and some people stop treatment early. Across studies, dropout rates appear to be around ~19% (Ong et al., 2016), though some estimates range higher. ERP should be challenging, but treatment doesn't mean being thrown into your worst fear on day one. We work collaboratively to develop exposures that are challenging enough to promote learning while still being realistic and doable.

    It’s also not always the right time to start an intensive or demanding course of ERP. Major life stressors, other mental health concerns, or simply not having enough time or energy to practice between sessions can make it reasonable to address other issues first. In some cases, I would rather someone intentionally postpone or pause ERP and return when they’re better able to engage with it than push through treatment and walk away believing that ERP “didn’t work” for them.

  • Improvement is usually gradual rather than immediate. Some people notice meaningful changes within several weeks; for others it takes a few months. Progress also isn't always linear. OCD symptoms can fluctuate with stress, major life changes, illness, sleep, and how consistently you're able to practice between sessions. The goal isn't necessarily to eliminate every intrusive thought or uncomfortable feeling. It's to reduce the extent to which OCD controls what you do.

  • Research protocols commonly involve around 12 to 20 sessions, and a well-studied ERP protocol consists of 17 sessions: two introductory/planning sessions followed by 15 exposure-focused sessions.

    But that's a research protocol, not an expiration date. Some people need fewer sessions and some need considerably more. Treatment may take longer if your OCD is severe or complex, we're working on several problems at once, you're dealing with significant life stressors, or there are other concerns we need to address alongside OCD.

    I generally think of the research averages as a useful starting point rather than a deadline for treatment.

  • Standard outpatient sessions are usually around 45-55 minutes, although individual exposures may be much shorter and some intensive ERP programs use longer or more frequent sessions. Much of the actual work of ERP happens outside the therapy hour.

    Between-session practice is therefore an important part of treatment. Traditional research protocols have sometimes prescribed 90 minutes or more of daily practice, but we'll develop a plan that fits your symptoms, goals, schedule, and what is realistically sustainable. The important part is practicing regularly. Better adherence to ERP homework is associated with better outcomes and, in one study, was the strongest measured patient factor associated with eventually reaching remission (Simpson et al., 2021).

Trying To Find a Las Vegas Therapist or Online Therapy?

You can learn more about my background and credentials on my About Me page. I serve Las Vegas, NV, and Nevada statewide as well as Portland, OR, and all of Oregon statewide (California and 40+ PsyPACT states) via teletherapy. You may call me at (702) 530-6134, schedule an initial consultation, or use the contact form to take the first step.