OCD clinic

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

Obsessive thoughts are repeated and unpleasant intrusive thoughts, images or urges that pop into our mind involuntarily. Everyone experiences intrusive thoughts, but people with OCD can become preoccupied with these thoughts.

Compulsions are the things we do to try and stop obsessive thoughts from coming true. These compulsions are often repeated many times and can take several hours each day. Common examples of compulsions include checking (e.g. checking doors, electrical equipment) and cleaning (e.g. hand washing).

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) recommend cognitive behaviour therapy (CBT) for OCD. 

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 Assessment and Treatment Services (ATS) across Sussex. During their time in the clinic all patients will continue to receive their usual care from their ATS team. 

Who works in the OCD Clinic?

The OCD Clinic is for adults experiencing difficulties with OCD, whether the problem is mild or very severe. We offer a high-quality evidence-based help based on the latest research and NHS guidelines. We provide care and treatment according to each person’s need. Therapies on offer include supported self-help using Cognitive Behavioural Therapy (CBT) principles and a CBT for OCD course. All our services are based on best practice guidelines. 

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 Dr Clara Strauss who is an experienced consultant clinical psychologist working in the Research and Development department at Sussex Partnership NHS Foundation Trust. 

The clinic is also supported by clinic assistants Molly Heeger & Guan Mao who support the day-to-day activities within the clinic and can offer additional Exposure and Response Prevention (ERP) support sessions under supervision. 

Lucy Walsh is the patient and public involvement coordinator supporting the clinic. Lucy is involved in organising and facilitating our Lived experience and advisory panel (LEAP) meetings and supports public and patient involvement within the clinic.

The clinicians delivering the OCD clinic interventions are imbedded in the clinical teams we work with and are supervised by Clara Strauss to deliver OCD clinic interventions.

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 the best treatment plan together. You will also be offered the opportunity to sign up to the Research Network. This network offers you a chance to find out about the research happening in the clinic. 

Treatment

In the last 20 years the treatment of OCD has greatly improved, and most people do make a good recovery. 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). 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 part of Sussex Partnership Trust's adult primary care mental health services in:

• East Sussex - Health in Mind

• Brighton and Hove - Brighton and Hove Wellbeing Service and Brighton and Hove Assessment & Treatment Service

"I am experiencing OCD and want some help"

If you are an adult and live in Brighton & Hove or East Sussex you can refer yourself directly, or if you prefer, you could speak to your GP first who can also refer you:

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 & Hove Assessment and Treatment Service (ATS)

Whilst there is not a self-referral option for those trying to access the OCD clinic through the ATS services, those who are open to the service and who are interested in accessing support should speak to a clinician within the service who is involved in their care. This clinician will then be able to make a referral to the OCD clinic on your behalf.

"I am concerned about someone I know with OCD"

If you feel concerned about someone who you think may be struggling with OCD, encourage them to look at some resources e.g. this website and others listed below. You should also encourage them to speak to their GP, or to contact us using one of the methods above.

Who is eligible?

Treatment through the clinic is available to anyone over the age of 18.

Since its launch in November 2013 the clinic has helped hundreds of people experiencing symptoms of OCD. Below is a story from Penelope, who was recently 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.”

Our Research

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

This study interviewed participants in two Mindfulness-based courses for OCD about their experiences. Mindfulness helped many participants to relate differently to their obsessional intrusions and compulsions, for example through "coming back to the present", "observing and allowing", "giving less meaning to intrusions" and "calm and relaxation". Participants reported benefits from their course including reduction in OCD symptoms; increased awareness of, and ability to manage OCD; and reduced anxiety. Overall, the interviews found that most participants in the courses were satisfied with their course and considered it an acceptable treatment for OCD.

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

It is often suggested that poor adherence to CBT for OCD could reduce the benefits patients receive from the therapy. Non-adherence includes refusing therapy, dropping out of therapy, poor attendance, and not adhering to the tasks recommended as part of the therapy. This paper reviewed previous studies with a focus on patient adherence to CBT for OCD. It found refusal rates of 15.6% and dropout rates of 15.9%: so over 30% of patients who are recommended CBT for OCD fail to start or complete their treatment. It also found that Group CBT had significantly lower dropout rates than individual CBT. Apart from this, no other significant factors linked to refusal were found.

Mindfulness-based exposure and response prevention for obsessive compulsive disorder: Findings from a pilot randomised controlled trial. Journal of Anxiety Disorders. Strauss, C., Lea, L., Hayward, M. et al (2018) .57. 10.1016/j.janxdis.2018.04.007.

This randomised controlled trial compared a group Mindfulness-based approach to ERP with standard ERP alone. It found that both groups improved in OCD symptom severity after attending their respective therapy. However, the mindfulness-based approach did not lead to clinically important improvements in symptom severity, whereas the standard ERP did. All measures of depression, wellbeing and OCD-related beliefs were in favour of standard ERP in comparison to Mindfulness-based ERP. However, there was evidence that Mindfulness-based ERP has potential to improve mindfulness in comparison to standard ERP.

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).

Family accommodation is when family members support OCD maintaining processes. This could include performing compulsive rituals for the person such as checking and cleaning, providing reassurance, and modifying routines. Theories of OCD suggest that family accommodation worsens the symptoms of OCD. Using meta-analysis of previous studies, this paper supported this theory by finding that there was a significant relationship between family accommodation and OCD symptoms. It found no differences between children and adults.

The Effectiveness and Acceptability of Mindfulness-Based Therapy for Obsessive Compulsive Disorder: A Review of the Literature. Mindfulness. Hale, L., Strauss, C., & Taylor, B.L. (2013). 4. 10.1007/s12671-012-0137-y. 

CBT (ERP) is the recommended psychology therapy for OCD. However, it is not without problems: it only has only moderate response rates, and relatively high drop-out rates. A mindfulness-based approach could help in treatment of OCD, by enabling people to notice intrusive thoughts without attaching significance and meaning to them. This literature review found four empirical studies investigating mindfulness techniques in the treatment of OCD. All of the studies reviewed found positive effects of mindfulness on symptoms of OCD. This provides an early indication that mindfulness-based therapy could be promising as an intervention for OCD.

Lived Experience shaping the OCD Clinic

We work hard to make sure that patient and public involvement (PPI) is embedded within all of our research. We 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 for your time.

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.

You can also join the LEAP if you have a friend or family member with OCD. You do not have to live in Sussex to join, nor do you need to have used the OCD Clinic's services.

If you are interested in joining the OCD Clinic's Lived Experience Advisory Panel, please contact
Lucy Walsh (Coordinator of Service User and Carer Involvement): Lucy.Walsh@sussexpartnership.nhs.uk

or send an email to the OCD Clinic mailbox:
SPNT.OCDClinic@nhs.net

The OCD Clinic's Lived Experience group will be holding our first meeting of the year on Zoom, on Monday 17th of January, 1-2:30pm. Please email us for  a link to join us.

Resources

How we can help and support you: A Guide for Obsessive Compulsive Disorder (OCD)

Obsessions and compulsions: a self-help guide

OCD-UK | A national OCD charity, run by, and for people with lived experience of OCD (ocduk.org)

What is OCD? | Mind, the mental health charity - help for mental health problems

For further information, please contact:

E: SPNT.OCDClinic@nhs.net

T: 03000 030 130

Address: OCD Clinic, Research and Development, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Mill View Hospital Site, Nevill Avenue, Hove BN3 7HZ.