OCD: the eight-step exposure programme

This programme supports care, it does not replace it. Obsessive-compulsive disorder is treatable, and treatable well: the work described here has the strongest evidence base available. It is demanding, however, and it is markedly more effective with a trained professional alongside — section 9 explains when that support is not optional. If you are having suicidal thoughts, if you are harming yourself, or if your thoughts are no longer experienced as absurd and alien but as intentions you wish to act on, this text is not the right answer: contact your doctor or your local emergency services today. Allow forty-five minutes to read, and twelve weeks to practise.

1. Before you start

You have gone back three times to check the door. You know it is locked — you saw it locked — and you go back anyway. You wash your hands until the skin splits. You reread the same email eleven times to be certain you have not hurt anyone. Or there is nothing to see from outside, and inside an unbearable image has come back every twenty minutes for years, and you have never told anyone because you are convinced that what you think makes you dangerous.

You know it is excessive. That is one of the features of the disorder: most people who suffer from it find their own rituals absurd, and perform them anyway. OCD is not a failure of logic. It is an alarm going off with nothing there, and a security system that gets stronger every time you obey it.