Obsessive Compulsive Disorder Clinic

What is OCD?

Obsessive Compulsive Disorder (OCD) is a condition where people experience unwanted, intrusive and unpleasant thoughts and/or compulsive behaviours.

This experience can often, but not always, be applied to an OCD cycle such as below. Here, people experience intrusive thoughts or feelings, which can become obsessive thoughts through applying an inflated sense of importance: this causes the individual to feel distressed. There are lots of examples of obsessive thoughts  - please see ‘Obsessive thoughts’ below for more information. As a response to this feeling, individuals may carry out mental and physical compulsions, please see ‘compulsions’ below for more information. Although these may bring individuals temporary relief, this causes the cycle to be quickly repeated. 

Obsessive thoughts are repeated and unpleasant intrusive thoughts, images or urges that pop into our minds involuntarily. Everyone experiences intrusive thoughts, but people with OCD can become preoccupied with these thoughts. This is because worry and attention can make these thoughts feel meaningful. Obsessive thoughts are always around things that you do not want to happen, or are fearful of happening. You may feel responsible for causing or preventing these things from happening, and you may engage in compulsions to reduce this anxiety. Intrusive thoughts are usually thoughts, but they can also be sounds, images, smells or sensations. For some examples of compulsions you may be experiencing, please see this table. *Link to table*

Compulsions are the things we do to try and stop obsessive thoughts from coming true and to get relief from the anxiety we may feel. These compulsions are often repeated many times and can take several hours each day. Common examples of compulsions can include checking (e.g. checking doors, electrical equipment) and cleaning (e.g. hand washing), asking for reassurance, and avoiding situations. For some examples of compulsions you may be experiencing, please see this table. *Link to table*

Avoidance is something you may find yourself doing to reduce exposing yourself to potential triggers. For example, if your obsessions are around the thought that you might hit a person with your car, you may avoid using your car or leaving your house. 

The OCD Cycle

You may find it helpful to refer to the image of the cycle above.

The OCD cycle is an attempt to explain what is happening when a person with OCD experiences an intrusive thought. Not everyone experiences OCD in the same way: those with Pure O for example will only experience obsessions. For more information on this, please see the definitions and examples tab. *Insert link*

First, the person will encounter a trigger. These triggers will be different for everyone. For example, some people may be triggered by touching something, going outside or getting in their car. The person will then experience an intrusive thought, image or urge. Examples and more information can be found here. *Link to page*

Lots of people without OCD experience intrusive thoughts. Clark and Purdon (1992, insert link) for example, found around 50% of people have thoughts that they have hit an animal or person with their car. However, those with OCD give these thoughts important meanings, and will experience unpleasant feelings such as guilt, anxiety and uncomfortableness. 

As sitting with these feelings are uncomfortable, you may have urges to carry out certain behaviours to either stop the bad thought from coming true or to soothe how you are feeling. These behaviours are called compulsions. Here, we can see how the distressing obsessions can lead to compulsions. Carrying out these compulsions stops us from finding out if the meanings we have given the intrusive thoughts are true. For more information on this including examples, please see here. *Insert link*. Carrying out these behaviours will give the individual temporary relief which, due to negative reinforcement, will increase their want to do it again. 

Additionally, the person may avoid triggers to avoid the unpleasant feelings. For more examples and information please here. *Insert link*.

Below is a video of Sophie Ward, a psychological wellbeing practitioner, explaining the OCD cycle in more depth.

The OCD Clinic, established in 2013, is for adults experiencing difficulties with OCD, whether the problem is mild or very severe. We offer high-quality evidence-based help, according to each person's need, based on the latest research and NHS guidelines. 

Therapies on offer include supported self-help using Cognitive Behavioural Therapy (CBT) principles and workshops.

The OCD Clinic is part of the adult primary care mental health services in East Sussex (Health in Mind) and in Brighton and Hove (Brighton and Hove Wellbeing Service). The service also operates in some, but not all, of the Assessment and Treatment Services (ATS) in Sussex Partnership NHS Foundation Trust. If you are currently receiving care in an ATS in Sussex and are interested in accessing the OCD Clinic please speak to your Lead Practitioner to see if it would be possible to access through the psychological therapy service within the ATS

Although CBT is helpful for the majority of people who have OCD, not everyone will benefit. A third to a half of people find that CBT does not help to address their OCD symptoms. To improve care for people with OCD we are involved in a number of research projects. Clients attending the clinic will be offered the opportunity to take part in these projects if they wish to, however, this is entirely optional.

The OCD Clinic was established by Professor Clara Strauss, consultant clinical psychologist working in the Research and Development department at Sussex Partnership NHS Foundation Trust. 

What support is available?

Up to one million people in the UK live with some form of OCD. Although most people with OCD know that their compulsions can be excessive, they nonetheless feel unable to control their thoughts or their behaviour. Fortunately, there are well-established and effective ways of helping. The National Institute of Health and Care Excellence (NICE) recommends cognitive behaviour therapy (CBT) for OCD. At the OCD Clinic, the particular type of CBT we use to tackle OCD is known as Exposure and Response Prevention (ERP).

How does Exposure Response Prevention work?

ERP is an evidence-based therapy which is aimed at breaking the cycle of obsessive thoughts and compulsions which make up OCD. During ERP, you will expose yourself to a range of different situations which bring on your obsessive thoughts or compulsions, whilst at the same time resisting the urge to carry out your compulsions. Over time, your anxiety will reduce naturally without the compulsion: this reduces the strength of the link between your obsessive thoughts and your compulsions. Whilst ERP exercises can be difficult, they generally become easier the more you do them and you will be allowed to build up your confidence throughout the process. Your ERP will also be undertaken with the support of a trained practitioner, who will help you to devise a plan and carry out the exercises in a systematic way.

The OCD Clinic is for adults experiencing difficulties with OCD that live within Brighton and Hove, and East Sussex. We offer high quality evidence-based help based on the latest research and NHS guidelines. 

You might find our resources page helpful.

Please also look at our information for people who are experiencing OCD and need support.

Unfortunately, at the moment the OCD Clinic isn’t open to those under the age of 18. If you, or someone you know is under the age of 18 and requires OCD support, we encourage you to contact your GP. Alternatively, you may be able to contact a wellbeing or counselling service at your school if appropriate and available. 

• OCD UK have released an OCD guide, including different types of OCD, what treatment is available, experiences of OCD from other young people, and a guide to abbreviations that you might see when you are looking at OCD resources. It is available here. 
• Young  Minds have made a guide for OCD, for young people.
  It includes information such as what OCD is, things that can help and how to access treatment.
  https://www.youngminds.org.uk/young-person/mental-health-conditions/ocd/

The OCD Clinic is part of Sussex Partnership's adult primary care mental health services in Health in Mind (East Sussex), Brighton and Hove Wellbeing Service and Brighton and Hove Assessment & Treatment Service.

If you are experiencing OCD difficulties and would like help please speak to your GP about a referral to the OCD Clinic.

You are also very welcome to refer yourself directly to the OCD Clinic, please see below on how to do this based on location.

East Sussex (Health in Mind)

If you live in East Sussex you can refer yourself directly via Health in Mind, a free NHS Service for those experiencing emotional or psychological difficulties. Self-referrals can be made through telephone: call 03000 030 130 and ask to be referred to the OCD clinic.

Alternatively, you can complete an online self-referral form on the Health in Mind website: click here to access the self-referral form. On the form it will ask you to state “What are your current difficulties as you see them?” In this box please state that you would like to be referred to the OCD clinic

Brighton & Hove (Brighton & Hove Wellbeing Service)

If you live in Brighton and Hove you can also refer yourself directly via the Brighton & Hove Wellbeing Service. Simply complete an online self-referral form and state that you would like to be referred to the OCD clinic: click here for the self-referral form.

Brighton and Hove Assessment and Treatment Service (ATS)

Whilst there isn’t a self-referral option for those trying to access the OCD Clinic through the Brighton and Hove ATS, those who are open to the service and who are interested in accessing support should speak to a clinician working in this service who is directly involved in their care. A clinician will then be able to make a referral to the OCD Clinic on your behalf.

West Sussex

We do not currently offer a service for West Sussex. If you are in West Sussex and feel you need support, please contact your General Practitioner.

Young people and children

Unfortunately, at the moment the OCD Clinic isn’t open to those under the age of 18. If you, or someone you know is under the age of 18 and requires OCD support, we encourage you to contact your GP. Alternatively, you may be able to contact a wellbeing or counselling service at your school if appropriate and available. 

• OCD UK have released an OCD guide, including different types of OCD, what treatment is available, experiences of OCD from other young people, and a guide to abbreviations that you might see when you are looking at OCD resources. It is available here. 
• Young  Minds have made a guide for OCD, for young people.It includes information such as what OCD is, things that can help and how to access treatment.https://www.youngminds.org.uk/young-person/mental-health-conditions/ocd/

Assessment

When you are referred to the clinic we will offer you an assessment meeting with an expert clinician. At this meeting we will discuss your difficulties with OCD and we will agree on the best treatment plan together. You will also be offered the opportunity to sign up to the Research Network, which offers you a chance to find out about the research happening in the clinic.

Treatment

The treatments for OCD currently recommended by the National Institute for Health and Care Excellence (NICE) are Cognitive-behavioural therapy (CBT) and medication.

CBT is a type of therapy which aims to look at what you think (cognition) and what you do (behaviour). For example, a person with OCD may believe that their furniture at home is contaminated with germs which will infect them and make them ill (cognition). As a response to this, they may avoid touching any surfaces at home, wash their hands very often, and clean their house many times a day (behaviour). In CBT you will examine, reflect on, and challenge these patterns of cognition and behaviour in order to explore alternative ways of thinking and behaving.

At the OCD Clinic, the particular type of CBT we use to tackle OCD is known as Exposure and Response Prevention (ERP). For information on how ERP works, you can find this under the heading ‘‘What is the OCD Clinic and what support is available?’. First, you will typically have sessions explaining the OCD cycle, and how ERP works. You will then move to completing ERP tasks both in sessions and at home. You will first make a list of challenging tasks with your therapist. Together you will choose approximately  2-3 of these ERP tasks to do at least once a day. You will discuss learning from these tasks with your therapist. It is important to note that you will need to drop all compulsive and avoidance behaviours, including mental compulsions, your therapist can support you with this. It is also important to remember that you have unpleasant feelings, such as anxiety, disgust and shame: this is a good thing as it means that the treatment is working.  

The recommended treatment in the OCD clinic is group therapy. This is because having group therapy reduces drop-out rates, and many people find it can be helpful to learn from each other's experiences with ERP. There is also a level of stigma reduction and solidarity between the group, which importantly can encourage home task completion. Group therapy is not suitable for everyone, for example those with autism may find 1:1 support more helpful. You will discuss this in your initial assessment. 

Perinatal OCD

Perinatal OCD (PNOCD) is estimated to impact 6.2% to 7.8% of individuals during pregnancy, and 14% to 16.9% postnatally (Fairbrother & Al, 2021; Miller et al., 2022). It consists of obsessions and compulsions most commonly around contamination and deliberate or accidental harm coming to the baby/foetus (Abramowitz et al., 2003). Medication and ERP-CBT have found to be effective for PNOCD (Challacombe et al, 2011). Despite this, PNOCD is often under-recognised and under-diagnosed (Sharma and Mazmanian, 2021). Support and information can be found by contacting your health visitor, midwife, or perinatal mental health team. Or can be found at https://maternalocd.org/ or https://ocdaction.org.uk/

OCD for Young people

Unfortunately, at the moment the OCD Clinic isn’t open to those under the age of 18. If you, or someone you know is under the age of 18 and requires OCD support, we encourage you to contact your GP. Alternatively, you may be able to contact a wellbeing or counselling service at your school if appropriate and available. 

OCD UK have released an OCD guide, including different types of OCD, what treatment is available, experiences of OCD from other young people, and a guide to abbreviations that you might see when you are looking at OCD resources. It is available here. 

Young  Minds have made a guide for OCD, for young people.
It includes information such as what OCD is, things that can help and how to access treatment.
https://www.youngminds.org.uk/young-person/mental-health-conditions/ocd/

If you are experiencing symptoms of OCD and would like help, please speak to your GP in the first instance. If you live in Brighton & Hove or East Sussex, you can also refer yourself directly - see here. You may not realise you have OCD until you talk to a mental health professional/  you may not realize things that are obsessions or compulsions because you have been doing them for so long. 

If you feel unable to keep yourself safe, please visit the red ‘Need help urgently’ button at the top right of the Trust home page, or call 999 and ask for an ambulance.

If you feel you are experiencing OCD and would like support, please speak to your GP and explain your experience and how it affects you. If you are worried about talking to your GP, you might find the following resources useful:

• OCD UK GP Icebreaker. This involves a checklist of items for you to fill out in preparation for your appointment, which may be useful for starting conversations about what your OCD looks like, how it affects you and how you need to be supported.

• OCD Action information on how to prepare for a GP appointment: Preparing for a GP Appointment - OCD Action

You can also access help through the following:

For urgent support: https://www.mind.org.uk/need-urgent-help/

Sussex Mental Healthline – 0800 0309 500

24/7 mental health telephone support and information service.

The Sussex Mental Healthline offers listening support, advice, information and signposting to anyone experiencing difficulties, or who may be in crisis and in urgent need of help, with their mental health. The service is free and is available to anyone concerned about their own mental health or that of a relative or friend.

OCD Action helpline

“The helpline is mostly run by volunteers, who have a strong understanding of OCD and what impact it can have on your life. They undergo an in-depth training and are able to talk you through any of their information. Most of their volunteers are people with personal experience of OCD who now feel strong enough to provide help and support to others. The team also includes family members and loved ones of people with OCD.

You can call them on: 0300 636 5478
Calls are charged at the same rate as a normal landline.

You can email them on support@ocdaction.org.uk
 

OCD UK

“Please note our support services are only available (Mon-Fri) and for UK residents. Please check our contact page for details of the helpline availability. We only offer advice/support, and are unable to offer therapeutic or crisis support”

You can call them on 01332 588112 9am - 12pm

You can email them: support@ocduk.org

Samaritans:

For someone to talk to, the Samaritans are open 24 hours a day, 7 days a week. You can call them on 116 123 (Freephone) or email jo@samaritans.org

Someone may not realise they have OCD until they talk to a mental health professional/ they may not realize things that are obsessions or compulsions because they have been doing them for so long.

If you feel concerned about someone who you think may be struggling with OCD, please encourage them to look at some of the resources, which are provided on this website. You should also encourage them to speak to their GP, or see the page on how to access support from the clinic.

Although CBT is helpful for the majority of people who have OCD, not everyone benefits. To improve care for people with OCD we are involved in a number of research projects. People attending the clinic will be offered the opportunity to take part in these research projects if they so wish. Taking part in these projects is optional.

You are welcome to join our Research Network to find out about research studies taking place at Sussex Partnership NHS Foundation Trust.

Below is a summary of four recent research papers from the OCD Clinic.

To access these papers, please see the following:

Participant perspectives on the acceptability and effectiveness of mindfulness-based cognitive behaviour therapy approaches for obsessive compulsive disorder. PLOS ONE. 15. 10.1371/journal.pone.0238845. 
Leeuwerik, T., Strauss, C., Cavanagh, K. et al (2020)

Patient Adherence to Cognitive Behavioural Therapy for Obsessive-Compulsive Disorder: A Systematic Review and Meta-analysis. Journal of Anxiety Disorders. 68. 102135. 10.1016/j.janxdis.2019.102135.
Leeuwerik, T., Cavanagh, K., Strauss, C. (2019)

You can also find other recent research papers here:

Mindfulness-based exposure and response prevention for obsessive compulsive disorder: Findings from a pilot randomised controlled trial. Journal of Anxiety Disorders. 57. 10.1016/j.janxdis.2018.04.007.

Strauss, C., Lea, L., Hayward, M. et al (2018)

A meta-analytic review of the relationship between family accommodation and OCD symptom severity. Journal of Anxiety Disorders. 33. 10.1016/j.janxdis.2015.05.006.

Strauss, C, Hale, L., Stobie, B. (2015)

• Clinic workshops:

• Ward, PWP, Health in Mind:

• Workshop 1 Part 1 - What is OCD? https://youtu.be/OmovEGRFYcY

• workshop 1 Part 2 What is OCD: https://youtu.be/jQKL7noB_GY

• Workshop 1 Part 3 The Vicious Cycle of OCD https://youtu.be/6QacNGj7A4s           

Access our OCD clinic Youtube Series here: OCD Clinic - YouTube

• ​​​​​​​​​​​OCD-UK
• ​​​​​​​OCD Action

Since opening in 2013, the clinic has helped hundreds of people experiencing symptoms of OCD.

A story from an individual describing how Leanda, their CBT therapist supported them through the OCD Clinic

I referred myself for a second course of CBT with Health in Mind after an initial course with a different therapist which unfortunately I did not find to be very beneficial.

This time, I was lucky enough to be allocated to Leanda. From the very first session with her, I knew that this course of CBT was going to be completely different. I remember coming away from that session (and sessions to come) thinking to myself, and telling close family “If I can’t beat OCD with the support of a professional like Leanda then I won’t be able to do it with anyone. She is 100 percent my best chance.”

She instantly put me at ease with her professional, yet kind, caring and empathetic persona. She introduced herself and made it clear that this therapy was a partnership and we would be going on the journey together. Straight away I felt supported and felt a connection. She took the time to let me talk and to get to know me. I felt completely listened to and that I always had her full attention (this was something I continued to feel throughout every session of the course). She recognised that I needed time to build up my understanding of OCD and how it had taken hold of my life. She also knew I needed time to build some tools and skills to use (for example, the vicious flower, theory A/B, responsibility pie, values, ACT) before embarking on any ‘behavioural experiments’. I really appreciated this as it built my confidence and gave me a real purpose for carrying out behavioural experiments and ultimately overcoming the OCD.

Every week, Leanda was so professional, ensuring the session followed a clear structure which made me feel really safe and reassured. In the session, we revisited the session before/ home learning, set goals together and then reviewed at the end. Leanda also made sure she recorded notes when I wanted her to and sent them to me promptly, along with some really helpful links to reading/ resources. A particularly wonderful resource she recommend and helpfully referred to in our sessions was ‘Break Free From OCD’ which I will continue to use to in time to come.

I felt that Leanda made the therapy truly personalised for me. I felt the pace of each session was just right. She was kind and gentle, refocusing things if I went off on tangents, never dismissing things I had to say but instead, acknowledging them and then bringing them in at appropriate times which helped me make sense of things. During our behavioural experiments she was so patient with me but she was also insightful and assertive enough to encourage me to take things a bit more quickly when she knew it was in my interest to. She was also always ready to do the experiment with me which I found hugely supportive and reassuring. It was extremely emotional and I can only describe the moment as feeling like an enormous weight had been lifted and Leanda was giving me my life back.

Whilst I know I am not fully cured of OCD, the progress I have made with Leanda’s support has been huge and I know I am so much further along in my journey. I have learnt so much from her and I know that I now have the skills and tools to use to continue my journey alone.

From an individual who was supported through the OCD Clinic
'Treatment for OCD was challenging however my therapist was confident, friendly and professional and helped me work through my goals and challenge ingrained unhelpful thoughts and beliefs. By no means is the journey over but it has been a breakthrough for me to be able to talk about this for the first time, with others, and this has had a positive impact on my life. It feels scary when your sessions come to an end and I think a follow up session could be offered E.g. 6 - 8 weeks after treatment, to bridge that gap and help with accountability. Many thanks to this service, we're lucky to have it on the NHS.'

A story from Penelope, who was supported through the OCD clinic
"I have suffered from OCD since a very young age. I cannot remember a time that I had not had intrusive thoughts and had to ‘do things’ to stop bad things from happening. Last year I was unable to leave the house for several months. I found each day highly distressing and honestly, unbearable, so I reached out for help. I was offered ERP therapy, which I had never heard of before. I hoped ERP may help a little and even a little bit of help would have been amazing. It is now months down the line and I am at the end of therapy. I cannot express enough how life changing ERP therapy has been for me. My journey was filled with highs and lows, sometimes the process was extremely tough, but I am so glad I stuck with it, as it was worth every minute. I can finally breathe and live my life, as OCD is no longer in control, I am."

Below are the results from our patient experience questionnaire. We asked people who have been through our clinic to give feedback on their experience receiving treatment. 

• 89.4% of people who filled out a feedback questionnaire for the OCD Clinic felt that they were listened to all of the time
• 100% of respondents reported that they would recommend the OCD Clinic to a friend
• 45% of respondents said there was nothing the clinic should do to improve. 
• Time with the clinic was labelled as "life changing", "invaluable" and 'confidence building'.
• Anxiety of meeting people in person dissipated by use of online platforms for sessions
• People using the clinic felt involved in picking the tasks to complete between sessions
• Group therapy allowed for "OCD sufferers to help each other"

We work hard to make sure that patient and public involvement (PPI) is embedded within all of our research, and are always looking for people with lived experience of mental health difficulties to join our Lived Experience Advisory Panels (LEAP). 

By sharing your experiences, you will help to make our research more relevant and improve the quality of treatment and care. We believe that if you ask people who have used or will be using the services/treatments you are testing, you will get a better result.
You will be invited to meetings which are relaxed and friendly and we’ll ask your opinion on how a research study should work. For example, we may look at the wording of the information or how we should explain the research study to people or what it is asking people to do. You will be paid £17.69 per hour  for your time.

We hold Lived experience advisory panel meetings, where friends and family members with lived experience of OCD get involved with shaping research happening in the clinic, as well as how the clinic functions. Some people get involved with lots of different meetings and pieces of work and others just a little. If you do join us, there is no expectation of you doing more work with us than you are happy to do.

If you are interested in joining the OCD Clinic's Lived Experience Advisory Panel, please email: involvementinresearch@spft.nhs.uk

• Email: SPNT.OCDClinic@nhs.net 
• Telephone: 0300 0030 130
• Address: OCD Clinic, Research and Development, Sussex Education Centre, Mill View Hospital Site,
  Nevill Avenue, Hove BN3 7HZ.