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 internal world. One...

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 sense that the...

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 becomes preoccupied...