PhD, ABPP, CPsychol
Specialist treatment for OCD and anxiety in adults, teenagers and children
I am a clinical psychologist in Nottinghamshire. I treat OCD and anxiety with CBT and exposure and response prevention (ERP), in person in Nottinghamshire, in your own home or at my office in Ravenshead, and online anywhere in the UK.
- HCPC-registered Clinical Psychologist
- Chartered Psychologist (BPS)
- Board certified in behavioural and cognitive psychology (ABPP)
- PhD, University of Washington
- Recognised by BUPA, AXA Health, Aviva, Vitality & WPA
Interactive
How treatment works
Four short steps: why anxiety and OCD keep going, what one practice looks like, what changes with repetition, and what the research says is happening in the brain. Choose the example closest to yours.
Why it keeps going
A compulsion is anything you do to make the anxiety or the doubt go away, such as washing, checking, or asking someone to reassure you. It brings relief, usually within seconds, and anything that brings relief that quickly becomes more likely to happen again next time. The relief also teaches something that is not true, that the danger was real and you only avoided it because you acted. Because the compulsion ends the situation early, you never get the chance to learn that you could have handled the anxiety and the doubt without it.
- 1
- 2Without the compulsion, the anxiety rises higher and stays up for a while. This is expected, and you know it is coming because we plan each step together beforehand.
- 3
- 4
One practice, up close
Exposure means meeting the thing that sets off the OCD on purpose, in small steps that you choose and agree with me beforehand, and then not doing the compulsion. You start with a step that feels manageable rather than the one you fear most, and the first practices can happen in the session with me there. Without the compulsion to bring it down, the anxiety usually rises higher than it would have and stays up for a while. This is planned for, and it gets easier each time you know what is coming.
Anxiety often comes down on its own, but it does not have to for the practice to count. What you are learning is that you can handle the anxiety, and not knowing for certain, without doing the compulsion. Sometimes you also see that the feared thing did not happen, which helps, but with OCD the fear is often about something that cannot be checked, such as whether you are a bad person or whether something will go wrong years from now. That is why the aim is to get better at carrying the doubt rather than to prove it wrong. Doing the compulsion would have brought the anxiety down sooner, but you would not have found out that you can manage without it. The green line is the same trigger after repeated practice: the anxiety rises a little and passes on its own, without an urge that needs answering.
- Your ability to tolerate anxiety
- Your overall anxiety, day to day
- How high the anxiety went during that practice
What repetition changes
Across practices the anxiety still rises each time, though it tends to peak lower and settle more easily. The most important changes are in the two lines: your ability to handle the anxiety and discomfort without needing to fix it, and your overall anxiety from day to day. Real progress is less smooth than this, and a harder week is normal rather than a setback.
Research suggests that exposure does not delete the old fear but rather builds new learning that competes with it. That is why practice is varied, across different places, times and versions of the trigger, so the new learning holds, and why an old fear can flare after stress or a long gap without meaning treatment has failed.
What is happening in the brain
Brain-imaging studies find differences in OCD in circuits that link the front of the brain, the orbitofrontal and cingulate cortex, with deeper structures, the striatum and thalamus. These are associations: they show the circuits behave differently, not that they cause OCD on their own.
Research on how fears are unlearned, much of it in animals and supported by human imaging, suggests the ventromedial prefrontal cortex (vmPFC) helps to calm the amygdala’s alarm response, with the hippocampus tying that new learning to the situations it happened in. The alarm is not removed; the new learning sits alongside it. When people improve with CBT and ERP, activity in the OCD circuits tends to shift towards more typical levels, as it also does with medication. The effects are modest and many studies are small, so this shows how learning fits with the brain rather than proving that treatment rewires it.
Step 1 of 4
An illustration, not a measurement and not a diagnosis. Real courses vary from person to person, and exposure is planned and paced with a clinician. NICE recommends CBT that includes ERP for OCD (guideline CG31, currently being updated). In research studies, around half to two thirds of people who complete ERP respond, fewer recover fully, and many still have some symptoms (Öst and colleagues, 2015).
Sources
- Salkovskis, P. M. (1985). Obsessional-compulsive problems: a cognitive-behavioural analysis. Behaviour Research and Therapy, 23(5), 571-583. doi
- Craske, M. G., Kircanski, K., Zelikowsky, M., Mystkowski, J., Chowdhury, N., & Baker, A. (2008). Optimizing inhibitory learning during exposure therapy. Behaviour Research and Therapy, 46(1), 5-27. doi
- Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: an inhibitory learning approach. Behaviour Research and Therapy, 58, 10-23. doi
- Craske, M. G., Treanor, M., Zbozinek, T. D., & Vervliet, B. (2022). Optimizing exposure therapy with an inhibitory retrieval approach and the OptEx Nexus. Behaviour Research and Therapy, 152, 104069. doi
- Bouton, M. E. (2004). Context and behavioral processes in extinction. Learning & Memory, 11(5), 485-494. doi
- Milad, M. R., & Quirk, G. J. (2012). Fear extinction as a model for translational neuroscience: ten years of progress. Annual Review of Psychology, 63, 129-151. doi
- Stein, D. J., et al. (2019). Obsessive-compulsive disorder. Nature Reviews Disease Primers, 5, 52. doi
- van der Straten, A. L., Denys, D., & van Wingen, G. A. (2017). Impact of treatment on resting cerebral blood flow and metabolism in obsessive compulsive disorder: a meta-analysis. Scientific Reports, 7, 17464. doi
- Öst, L.-G., Havnen, A., Hansen, B., & Kvale, G. (2015). Cognitive behavioral treatments of obsessive-compulsive disorder: a systematic review and meta-analysis. Clinical Psychology Review, 40, 156-169. doi
What I treat
OCD and anxiety in adults, teenagers and children.
For adults
Treatment for adults
The treatments with the best evidence for adult OCD and anxiety are CBT and ERP, carried out at a pace we agree together.
- OCD in adults
- Types of OCD, including “Pure O”
- Generalised anxiety and worry
- Health anxiety
- Social anxiety
- Panic and agoraphobia
- Phobias
- Body dysmorphic disorder, skin picking and hair pulling
For parents, children and teenagers
Treatment for children and teenagers
Childhood OCD and anxiety often draw the whole family in, through repeated reassurance, changed routines and arguments before school, so parents are often part of the treatment.
- OCD in children and teenagers
- Anxiety and worry in children
- School refusal and school avoidance
- ARFID and food-related anxiety
The forms OCD takes
OCD can attach to almost any fear. The theme changes, but the pattern of unwanted doubt and a compulsion to settle it is the same, and so is the treatment.
- Contamination Germs, dirt, illness or chemicals, and the washing, cleaning and avoiding that follow.
- Checking Checking doors, hobs, emails or the road behind you, to make sure nothing bad happens because of you.
- Just right and symmetry Things have to look, feel or be done a certain way, and be redone until they feel right.
- Harm Unwanted thoughts or images of hurting someone, very often the person you love most.
- Sexual intrusive thoughts, including about children Sometimes called POCD. Unwanted and horrifying to the person having them. They are obsessions, not desires, and not a sign you would act on them.
- Sexual orientation Repeated doubt about your own orientation, with checking your reactions and reviewing your past.
- Relationship (ROCD) Constant doubt about whether you love your partner, or whether they are the right person.
- Religious and moral Fear of having sinned or of being a bad person, with praying, confessing or going over what you did.
- Pure O Compulsions that happen in your head, such as reviewing, arguing with a thought or checking for a feeling.
- Existential Whether anything is real, whether you are conscious, what happens after death.
- Something else OCD can attach to almost anything. The pattern of doubt and compulsion matters more than the theme.
How it works
Three steps to treatment
- A free introductory call
You tell me what is going on and I tell you whether I can help. The call is free and there is no obligation to book.
- A first session
We map the problem: what triggers it, what keeps it going, what has been tried. By the end we talk about what I would recommend and what happens next, where that is already clear. Sometimes further assessment is needed first.
- Treatment, with the end in view
CBT and ERP are active and time-limited. We agree goals, keep track of progress towards them, and plan each step together.
About Dr O’Rourke
Trained at one of the leading US clinical psychology programmes
My PhD is from the University of Washington, which has one of the top-ranked clinical psychology programmes in the United States. My pre-doctoral internship was at Seattle Children’s Hospital and Harborview Medical Center, and my postdoctoral fellowship was at the Evidence Based Treatment Centers of Seattle, and Assistant Director, Child Anxiety Center (Seattle). I am registered with the HCPC, chartered with the British Psychological Society, and board certified in Behavioural and Cognitive Psychology by the American Board of Professional Psychology (ABPP), a United States board certification.
I work online across the UK and in person in Nottinghamshire, usually in your own home, which is where the problem tends to show up, or at my office in Ravenshead.
Every session is £120 for 60 minutes. I am recognised by BUPA, AXA Health, Aviva, Vitality and WPA.
Screens, gaming and phones
A course I developed for parents
As well as my clinical work, I developed the Screen Balance Program with my colleague Dr Jennifer Tininenko, a clinical child psychologist licensed in the United States. It is an online course for parents of children of any age, from toddlers to teenagers. You assess your child, write a screen plan that fits your family, and practise the situations parents find difficult, such as what to say when screen time ends, which parental controls to use, gaming, and a first phone and social media.
Commercial disclosure: I co-own the Screen Balance Program and earn money when it is bought. It is sold by Elevating Parenthood LLP, a United States business that is separate from Anxiety CBT Ltd, in US dollars and under its own terms and privacy policy. It is education for parents, not psychological treatment, and you never need to buy it to be seen by me.
Free 20-minute call
Not sure whether this is the right fit?
Start with a free 20-minute call. We talk through what is going on, I answer any questions you have, and I tell you whether I think I can help. If I cannot, I will try to point you to someone who can. The call is free and there is no obligation to book.
Weekdays, 9am to 5pm. No GP referral needed.