"I can't stop checking whether I locked the door." "I know washing my hands 20 times makes no sense, but the anxiety won't let me stop." "I have horrible thoughts that make me feel like a terrible person." If any of these thoughts sound familiar, you may be experiencing obsessive-compulsive disorder (OCD), a disorder that can be deeply disabling but has effective treatment. And the good news is that online OCD therapy has been shown to be just as effective as in-person therapy.
What is Obsessive-Compulsive Disorder (OCD)?
OCD is a mental health disorder characterized by the presence of two main components: obsessions and compulsions. It affects approximately 2-3% of the world's population and usually appears between late childhood and the start of adulthood, although it can begin at any age.
Obsessions are intrusive, unwanted, and recurring thoughts, images, or impulses that produce intense anxiety. They are not normal worries about everyday problems: they are thoughts the person recognizes as irrational or exaggerated, but cannot control or ignore.
Compulsions are repetitive behaviors (washing, checking, ordering) or mental acts (counting, praying, repeating words) that the person performs in an attempt to reduce the anxiety caused by obsessions or to prevent a feared event. The problem is that this relief is temporary and reinforces the obsessive-compulsive cycle.
The OCD cycle: why compulsions worsen the problem
Understanding the OCD cycle is essential to grasp why treatment works the way it does:
- Obsession: an unwanted intrusive thought appears ("my hands are contaminated")
- Intense anxiety: the thought generates distress that is hard to bear
- Compulsion: the person performs an action to reduce the anxiety (washing hands)
- Temporary relief: anxiety decreases briefly
- Reinforcement: the brain learns that the compulsion "works" to calm itself
- Return of the obsession: the thought comes back stronger, starting a new cycle
Each time a compulsion is completed, the brain receives the message that the obsession was really dangerous and that the compulsion was necessary. In this way, the cycle strengthens session by session, day by day.
The most common types of obsessions and compulsions
Contamination and washing
Fear of being contaminated by germs, dirt, chemicals, or bodily fluids. Compulsions include excessive handwashing (to the point of skin damage), compulsive home cleaning, and avoidance of touching public surfaces, doors, or money.
Checking and verifying
Fear that something bad will happen due to one's own negligence: not having locked the door, not having turned off the stove, not having unplugged an appliance. Compulsions include checking repeatedly (sometimes for hours) doors, windows, appliances, and locks.
Intrusive thoughts of harm
Unwanted thoughts or images of harming a loved one, pushing someone, hurting a baby, or causing an accident. These thoughts are egodystonic, meaning completely opposed to the person's values, which multiplies the suffering. Compulsions are usually mental: praying, repeating phrases, or seeking reassurance that "I would never do that."
Symmetry and order
Intense need for things to be symmetrical, ordered, or "just right." The person experiences intense distress when something is "out of order" by their own criteria. Compulsions include arranging, aligning, touching objects a specific number of times, or repeating actions until they feel "right."
Sexual or religious obsessions
Unwanted intrusive thoughts of sexual content (often about sexual identity, pedophilia, or forbidden relationships) or obsessive blasphemies and religious doubts. They are especially distressing because they attack the person's deepest values. The treatment is the same: ERP adapted to the theme.
Relationship OCD
Obsessive doubts about the partner: "Do I really love them?", "What if they're not the right person?", "What if I'm attracted to someone else?". The person constantly reviews their feelings, compares their relationship to others', and seeks reassurance. Compulsions include compulsively analyzing feelings and asking the partner or friends for confirmation.
Online OCD treatment: ERP by video call
Exposure with Response Prevention (ERP) is the first-line treatment for OCD, supported by dozens of scientific studies with effectiveness rates of 60-80%. Recent research has shown that ERP by video call is just as effective as in-person ERP, opening the door to specialized treatment that is accessible from anywhere.
How does online ERP work?
ERP consists of gradually exposing yourself to situations that trigger obsessions without performing the compulsion. Over time, the brain learns that anxiety decreases on its own (habituation) and that obsessive thoughts are not dangerous. By video call, the process follows the same phases:
- Psychoeducation: understanding the OCD cycle and how ERP breaks it
- Exposure hierarchy: creating a personalized scale of situations, from least to most anxiety-producing
- Guided exposures: the psychologist accompanies exposures live by video call
- Response prevention: not performing the compulsion and allowing anxiety to come down on its own
- Between-session tasks: practicing exposures independently to consolidate progress
Advantages of ERP in online format for OCD
Online OCD therapy offers unique advantages that, in many cases, make it superior to in-person therapy:
- Exposures in real context: contamination, checking, or ordering exposures take place in the patient's own home, where the real symptoms occur
- Less avoidance: people with contamination OCD who would avoid going to a clinic for fear of contamination can access therapy from home
- Access to specialists: OCD requires a specialization that not all psychologists have; the online format gives access to specialized professionals regardless of location
- Treatment continuity: with no commute, it is easier to maintain the weekly consistency the treatment requires
- Schedule flexibility: it makes it easier to combine treatment with work and family obligations
Cognitive techniques in online OCD treatment
In addition to ERP, cognitive therapy works on the dysfunctional beliefs that maintain OCD:
Restructuring metacognitive beliefs
OCD is maintained by beliefs such as:
- Thought-action fusion: "If I think about hurting someone, it means I really want to do it" or "If I think something bad will happen, it's more likely to happen"
- Inflated responsibility: "If I don't check 10 times, and something happens, it will be my fault"
- Intolerance of uncertainty: "I have to be 100% sure there is no danger, otherwise I can't stop"
- Overestimation of danger: calculating the real probability of what is feared actually happening
In online sessions, we work to identify and challenge these beliefs, which reduces the need to perform compulsions.
Cognitive defusion and mindfulness
Learning to observe obsessive thoughts as simple "products of the mind" without needing to react to or analyze them. Techniques such as labeling thoughts ("That's my OCD talking"), full-presence meditation, and radical acceptance help reduce the struggle against obsessions, which paradoxically keeps them alive.
Myths about OCD: what you should know
- Myth: "OCD is being very clean or tidy" → Reality: OCD can take infinite thematic forms: harm, relationships, sexuality, religion, health, symmetry, and many more. Cleanliness and order are just one subtype
- Myth: "If I have intrusive violent or sexual thoughts, I'm a bad person" → Reality: 90% of the population has intrusive thoughts. In OCD, the person gives them excessive importance. Having a thought does not mean wanting it or being capable of acting on it
- Myth: "It can be overcome with willpower" → Reality: OCD is a neurobiological disorder that requires professional treatment. Trying to resist compulsions through willpower alone, without the right strategies, can worsen anxiety
- Myth: "OCD has no treatment" → Reality: ERP has an effectiveness rate of 60-80%, and the combination of ERP with medication (SSRIs) reaches even higher rates in moderate-to-severe cases
- Myth: "Online therapy can't work for OCD" → Reality: Studies published in journals such as Behaviour Research and Therapy show that online ERP is just as effective as in-person ERP, with the added benefit of doing exposures in real context
When should you seek professional help for OCD?
Consider seeking specialized help if:
- You spend more than 30 minutes a day on obsessions or compulsions
- Obsessions cause significant distress that affects your mood
- You avoid situations, places, or people for fear of triggering obsessions
- Rituals interfere with your work, studies, relationships, or daily routine
- You feel you cannot control intrusive thoughts despite knowing they are irrational
- Compulsions take more and more time and become more elaborate
- You have started involving people around you in your rituals (constantly asking for reassurance)
OCD rarely improves on its own. Without treatment, it tends to become chronic and worsen over time. Early intervention significantly improves the prognosis.
What is an online OCD therapy session like?
A typical session of online OCD treatment lasts between 50 and 60 minutes and follows this structure:
- Review: we go over how the week went, the exposures done between sessions, and anxiety levels
- Cognitive work: we identify and challenge the beliefs that maintain OCD
- Guided exposure: we conduct a live exposure, with professional support and guidance
- Processing: we analyze the experience and what has been learned from the exposure
- Planning: we set the exposure tasks for the coming week
All you need is a device with a camera (computer, phone, or tablet), a stable internet connection, and a private space where you can talk peacefully.
OCD and anxiety: a complex relationship
OCD was classified for years within anxiety disorders, and although it now has its own diagnostic category, anxiety remains a central component. Obsessions generate anxiety, and compulsions are the (failed) attempt to reduce it. For this reason, anxiety therapy and OCD therapy share some techniques, such as breathing, mindfulness, and exposure, but treating OCD requires additional specialization in ERP.
Take the first step
If OCD is limiting your life — if obsessions are stealing your time and energy, if compulsions have taken over your routine, if you feel trapped in a loop of thoughts that won't stop — you should know that treatment works and that you can access it from anywhere. As a licensed health psychologist specialized in OCD, I will accompany you through the process via online therapy, at your own pace and with the tools that scientific research has shown to work. Contact me for a first informational consultation.