What non-pharmacological interventions are recommended for patients with OCD, and how can I implement them in practice?

Recommended non-pharmacological interventions for patients with obsessive-compulsive disorder (OCD) include cognitive-behavioural therapy (CBT) with exposure and response prevention (ERP), cognitive therapy adapted for OCD, and guided self-help approaches.

For adults with mild functional impairment, low-intensity CBT including ERP is recommended, which can be delivered as brief individual CBT with structured self-help materials, brief individual CBT by telephone, or group CBT including ERP. These low-intensity treatments typically involve up to 10 therapist hours per patient and can be accessed via referral or self-referral to NHS Talking Therapies.

Adults with moderate functional impairment should be offered intensive CBT including ERP (more than 10 therapist hours) or an SSRI, with the choice guided by patient preference and clinical judgement. For severe functional impairment, combined treatment with an SSRI and CBT including ERP is advised.

CBT should be adapted to the individual’s needs, and for adults living with family or carers, involving them as co-therapists in ERP is recommended where appropriate and acceptable. For those with severe impairment who are housebound or reluctant to attend clinics, home-based CBT or CBT by telephone may be considered.

For adults who refuse or cannot engage with ERP, individual cognitive therapy specifically adapted for OCD may be considered as an alternative.

For children and young people, psychological treatments should be collaborative and involve family or carers. Guided self-help may be considered for mild impairment, while moderate to severe cases should be offered CBT including ERP involving family or carers and adapted to developmental age.

Healthcare professionals delivering these psychological interventions should have appropriate training and ongoing clinical supervision.

Towards the end of treatment, patients should be informed about how to apply the principles learned to manage future symptoms.