Dr Sasha's Blog

Exposure and Response Prevention, or ERP, is one of the most important and best-supported treatments for obsessive-compulsive disorder. I use ERP extensively in my work as an OCD specialist in London. At the same time, after many years of clinical practice, I have become increasingly interested in what sits around the obsessive-compulsive cycle: particularly self-criticism, shame, excessive responsibility, withdrawal and the tendency to become trapped inside one's own interna

Exposure and Response Prevention, or ERP, is an important part of OCD treatment and one that I use regularly. Learning to step away from compulsions, tolerate uncertainty and practise different responses is valuable. But in clinical work, particularly with more severe or complex OCD, there is often much more going on than the compulsion itself. There may be intense physiological activation, shame, urgency, mental narrowing, habitual automatic responses, self-criticism and a s

Many people assume that OCD is driven purely by anxiety. Anxiety is certainly part of the picture, but in my experience it is often not the deepest emotion involved. Beneath the anxiety there is frequently shame—a painful belief that "there is something wrong with me," "I am bad," "I am defective," or "I am somehow responsible." This is particularly obvious in forms of OCD such as scrupulosity, responsibility OCD, relationship OCD and moral OCD, where the person's mind become

Living with OCD can feel overwhelming, exhausting and isolating. Many people spend years trying to understand why certain thoughts, fears or behaviours feel so difficult to control. They may recognise that their experiences are connected with OCD, yet still feel trapped in repetitive cycles of anxiety, checking, reassurance seeking, avoidance, mental rituals or intrusive thoughts. I am Dr Sasha Mitrofanov, PhD, an OCD and anxiety specialist with over 17 years' experience in p

If you've been finding your OCD noticeably harder to manage during this summer's heatwave, you're not imagining it. Here in the UK, we've experienced periods of unusually high temperatures. Around the world, many countries are seeing hotter summers that last longer than they used to. In Britain, there's an added challenge: many of our homes, especially Victorian houses, were built to keep heat in during winter, not to keep it out during summer. As an OCD therapist, I've notic

My Approach to Treating OCD Most OCD treatment focuses on symptoms. I work with the whole system that produces them. My approach combines nervous system regulation, trauma work, cognitive clarity, and carefully paced exposure, so that change is not just temporary, but lasting. 1. Regulation comes first Before we challenge OCD, we stabilise the system. You learn how to: Reduce anxiety and overwhelm in real time Stay present with difficult emotions Build internal steadiness rat