What’s best practice for treating anxiety and obsessive-compulsive disorder?
Individuals suffering from anxiety and obsessive-compulsive disorder can benefit from evidence-based treatments.
Obsessive-compulsive disorder (OCD)
I frequently treat OCD in my practice, and I see how misunderstood and debilitating this condition can be. Popular culture often portrays OCD as a preference for neatness, but in reality, OCD involves intrusive thoughts and compulsive behaviours that can severely disrupt daily life.
As a psychotherapist specialising in anxiety and related disorders, I guide clients to break down this cycle and develop resilience using precise, evidence-based treatments. Although the journey can feel difficult, clients can absolutely move from the grip of OCD to meaningful recovery.
The origins and experience of OCD
OCD is defined by the presence of obsessions, compulsions, or both. It is a disorder where the brain gets "stuck" in a loop, a cycle that can feel impossible to escape without intervention.
The origins of OCD lie within a convergence of factors.
Brain biology and function: Research shows abnormalities in brain circuits that govern planning, decision-making, movement, and emotional processing. Regions such as the orbitofrontal cortex, cingulate gyrus, and striatum function differently, creating a “short circuit” that prevents smooth transitions between thoughts and actions. Serotonin and dopamine also play significant roles.
Genetics: OCD often runs in families, highlighting a strong hereditary component.
Environmental triggers: Stressful life events, trauma, or in rare cases, certain infections like PANDAS (Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections), can sometimes trigger or exacerbate the onset of OCD symptoms.
Obsessions and compulsions: the lived experience
Obsessions are persistent, unwanted thoughts, images, or urges that cause distress. They often involve contamination, harm, taboo themes, or the need for symmetry. People recognize these thoughts as irrational but cannot stop them.
Compulsions are repetitive behaviours or mental rituals performed to reduce distress or prevent a feared event. These actions temporarily relieve anxiety, which reinforces and strengthens the OCD cycle.
People with OCD experience a constant internal battle: the brain signals danger (the obsession) and the person performs a ritual (the compulsion) to neutralize it. This loop grows stronger over time.
Expert treatment for OCD: breaking the cycle
Treating OCD requires more than traditional talk therapy. I rely on the gold-standard psychological treatment—Exposure and Response Prevention (ERP)—as the foundation of care.
Exposure and Response Prevention (ERP)
ERP gradually and safely exposes clients to triggers while preventing compulsive responses. Through repeated exposure without ritualizing, clients learn that their anxiety dissipates naturally and that feared outcomes do not occur.
Treatment example: Fear of contamination
Increasing exposure: A client has an intense fear of germs on public restrooms and compulsively washes their hands until they bleed. We collaboratively build a hierarchy. We might start with me touching a clean surface in my office and the client gently touching their finger to that same surface. Later sessions might involve touching a doorknob in a public place, and eventually, touching a toilet seat in a public restroom.
The crucial part is that after touching the "contaminated" item, the client is prevented from washing their hands immediately. They must sit with the anxiety until it habituates and decreases naturally. We use journaling and mindfulness techniques during this time to manage distress. Over repeated sessions, the brain learns that the feared outcome (getting sick) doesn't happen, and the anxiety response weakens.
Cognitive therapy
Cognitive therapy complements ERP by addressing catastrophic thinking and risk overestimation. It helps clients challenge irrational beliefs and release the idea that compulsions keep them safe.
Treatment example: fear of harming others
A client experiences intrusive thoughts about pushing someone onto train tracks. We target “thought-action fusion”—the belief that thinking something equals doing it. Together, we examine evidence from their past behaviour to reinforce their identity as a safe person.
Acceptance and Commitment Therapy (ACT)
ACT helps clients accept intrusive thoughts without trying to eliminate them and commit to valued actions. It often improves compliance with ERP. Living with OCD feels exhausting, but it is not permanent. With ERP and specialised therapy, clients can break the OCD loop and live according to their values rather than their fears.
Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs serve as first-line medications for OCD and often accompany cognitive therapy. They increase serotonin levels by blocking its reuptake in the brain, helping regulate the circuits associated with OCD. They are prescribed by medical practitioners.
Typical effects of SSRIs
Up to 60 percent of patients experience significant symptom reduction.
Higher doses often produce better results but may increase side effects.
Clients typically need 8–12 weeks—at higher doses—to notice improvement.
Many clients benefit from at least 1–2 years of ongoing treatment to prevent relapse.
SSRIs approved by the Australian Therapeutic Goods Administration for treating OCD
Citalopram
Escitalopram
Fluoxetine (brand names Prozac, Lovan)
Fluvoxamine (brand names Luvox, Movox)
Paroxetine (brand names Aropax, Paxtine)
Sertraline (brand name Zoloft)
OCD Resources
Medical and pharmaceutical resources: For medication-specific questions, you can call 1300 MEDICINE (1300 633 424) to speak with a pharmacist. Healthdirect is an Australian government-funded, 24/7 virtual health service that provides free health information and advice to help people manage their health and access the right care. It is a government-owned organization that offers a website, app, and helpline.
For medical advice or diagnosis, consult a healthcare professional.
Educational resources: See International OCD Foundation brochures and fact sheets.
Anxiety disorders
Anxiety disorders are among the most common mental health conditions globally, affecting approximately one in four people at some point in their lives. They are more prevalent in women than men, tend to emerge early in life, and have high rates of comorbidity with other mental disorders.
Specific phobias are the most common type, followed by social anxiety disorder and generalised anxiety disorder. Anxiety disorders arise from a combination of biological, psychological, and environmental factors.
Origins of Anxiety
Genetics
A family history of anxiety increases an individual’s risk.
Brain chemistry and structure
The amygdala triggers the fight-or-flight response when it perceives threat. Neurotransmitters such as serotonin and GABA (gamma-aminobutyric acid) may function differently in people with chronic anxiety.
Psychological and Environmental Factors
Trauma
Events like abuse, loss, or major transitions often activate anxiety disorders.
Learned behaviours
Children may model anxious responses they observe in caregivers.
Personality traits
High neuroticism or behavioural inhibition increases vulnerability.
The Experience of Anxiety
Anxiety extends beyond worry. It affects the entire body and mind. Physical symptoms may include rapid heart rate, shortness of breath, trembling, sweating, tension, digestive issues, or sleep problems.
Cognitive symptoms often involve catastrophising and persistent “what-if” thinking.
Behavioural avoidance offers temporary relief but ultimately strengthens anxiety’s grip.
Treating anxiety
Effective treatment requires a tailored, comprehensive plan supported by strong evidence. I rely heavily on interventions with robust research support.
First-line treatments
Cognitive Behavioural Therapy (CBT)
SSRIs and SNRIs (by medical practitioners)
Cognitive Behavioural Therapy (CBT)
CBT remains the gold standard for treating anxiety. It helps clients identify, challenge, and change unhelpful thought patterns and behaviours.
Treatment example: Fear of Public Speaking
Cognitive restructuring: We challenge beliefs such as “If I stutter, everyone will think I’m an idiot,” replacing them with more balanced thoughts.
Exposure ladder: We build an exposure ladder—from practising in front of a mirror to presenting to a small group—until fear becomes manageable.
Selective Serotonin Reuptake Inhibitors (SSRIs)
Selective Serotonin Reuptake Inhibitors (SSRIs) treat anxiety by increasing the amount of available serotonin in the brain, which helps brain cells communicate and can improve mood.
They work by blocking the reuptake (reabsorption) of serotonin after it has been released between brain cells, making more of it available in the synaptic cleft to send signals. This helps alleviate anxiety symptoms over time, though it can take several weeks to experience the full therapeutic effect.
SSRIs approved in Australia for anxiety include citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline. They are prescriber by medical practitoners.
How SSRIs work
Blocking serotonin reuptake: After a brain cell releases serotonin to carry a signal, it is normally reabsorbed back into the cell. SSRIs block this reabsorption process by inhibiting the serotonin transporter protein.
Increasing serotonin availability: By blocking the reuptake, SSRIs leave more serotonin in the space between brain cells (the synaptic cleft).
Modulating brain signalling: This increase in available serotonin helps modulate brain signalling, leading to a gradual improvement in anxiety symptoms.
other treatments
Mindfulness-based interventions
ACT, depending on client needs
Somatic therapy
Mindfulness-Based InterventionS
Mindfulness teaches clients to observe anxious thoughts without reacting. This reduces rumination and physiological arousal.
Treatment example: Managing a Panic Attack
I teach the three-minute breathing space: pause, observe the feelings, focus on breathing, and expand awareness to the body and environment. This helps ground and calm the nervous system.
Acceptance and Commitment Therapy (ACT)
ACT helps clients accept anxiety and move toward values-driven action.
Treatment example: Overcoming Social Anxiety
A client who values connection avoids social gatherings due to fear. We work on accepting the anxiety while still attending events aligned with their values.
Somatic therapy
The science of trauma and somatics proposes that anxiety related to traumatic experiences is a physiological response resulting from a dysregulated nervous system, where the body remains in a persistent state of "fight, flight, freeze or fawn" even after the actual threat has passed.
Integrating somatic practices with traditional talk therapy (often called a "bottom-up" and "top-down" approach) provides a comprehensive path to healing from trauma and anxiety.
A growing body of research, while still preliminary for some specific somatic modalities compared to first-line treatments like trauma-focused Cognitive Behavioural Therapy (CBT), supports the integration of somatic practices with traditional talk therapy.
The evidence highlights that this combined "top-down" (cognitive) and "bottom-up" (body-based) approach can be highly effective for treating trauma and anxiety.
This is how I approach the treatment of anxiety. For more information, see my related article titled, A holistic approach to treating anxiety rooted in trauma for a comprehensive explanation of this treatment approach.
Apps for anxiety
You can access free apps and audio guides for anxiety through options like Insight Timer, which has over 100,000 free meditations, and the Dare app, which offers free audio guides for daily anxious situations. Other valuable free resources include Smiling Mind, the Black Dog Institute's myCompass, and Calm, which provides a free version with a limited selection of content.
Insight Timer: This app offers a vast library of over 100,000 guided meditations, and many are completely free, without a subscription.
Dare: Anxiety & Panic Attacks: Provides free audio guides designed to help you cope with daily anxiety, panic attacks, and worry in various situations like driving, eating out, or public speaking.
Smiling Mind: A free, evidence-based mindfulness and meditation app developed for all ages, with programs to help you build essential life skills.
myCompass: Developed by the Black Dog Institute, this is a free, 14-module online program that uses Cognitive Behavioural Therapy (CBT) techniques to help manage mild to moderate symptoms of depression, anxiety, and stress.
Apps with a free version or limited free content
Calm: Offers a free version that includes a selection of guided meditations, sleep stories, and other features for managing stress and improving sleep. A subscription is required to unlock the full library.
Headspace: Provides free content, including a beginner's series of meditations, to help you build a mindfulness practice. A paid subscription is required for the full library of content.
MindShift: This app helps adolescents and young adults manage anxiety by teaching them basic skills and allowing them to choose and "favorite" coping strategies that work for them.
Other apps to explore
Self-Help Anxiety Management: Focuses on mindfulness and self-awareness to help users understand and monitor their anxious thoughts and behaviors.
ReachOut WorryTime: An app that helps you manage the time you spend worrying.
Medito: A completely free alternative to apps like Calm that offers meditation courses and sleep sounds.
Conclusion
Anxiety and OCD can feel overwhelming, but evidence-based treatments such as CBT, ERP, mindfulness, ACT, and medications like SSRIs make meaningful recovery possible. With the right support, individuals can shift from merely coping to genuinely thriving.
If you are ready to experience the benefits of an evidence-based approach to anxiety or OCD in your life, please visit the contact page and make an enquiry or booking today.
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