11 Changes in OCD Treatment: From Misconceptions to Therapy

Introduction – A Story from My Clinic

You won’t believe this, but just last week a client sat in my therapy room and whispered, “Federico, I feel like I’m going crazy. I know these thoughts aren’t real, but they feel so real.”

And I just looked at them with a smile and said, “You’re not going crazy. You’re experiencing OCD. And you’re definitely not alone.”

Hi, I’m Federico Ferrarese, a CBT therapist based in Edinburgh specialising in OCD treatment. Today, I want to take you through a journey. A journey from when OCD was seen as some kind of demonic possession or moral failing, to today – where we have science-backed therapy approaches like ERP that actually work.

Here’s what I think… understanding how OCD research and treatment have evolved helps us see hope. It shows us that things can, and do, get better.

So, grab a cup of tea, and let’s dive into how OCD treatment went from medieval misconceptions to modern, empowering therapy.

What Exactly Is OCD?

Breaking Down the Basics

First, let’s keep it simple. OCD (Obsessive Compulsive Disorder) is a mental health condition where a person has:

• Obsessions: Unwanted, distressing thoughts, images or urges.

• Compulsions: Repetitive behaviours or mental rituals done to reduce anxiety from the obsessions.

Imagine thinking, “What if I accidentally harmed someone?” and then checking the gas stove 20 times to ‘make sure’ you didn’t cause an explosion. That’s OCD in a nutshell.

Quick Stats You Should Know

• Around 1.2% of the UK population experiences OCD at any one time (NHS Digital, 2016).

• That’s over 750,000 people just in the UK.

• It often starts in childhood or adolescence (Fineberg et al., 2013).

Can you imagine that? So many people are suffering in silence because of myths and a lack of proper understanding.

OCD in Ancient Times – The Spiritual Lens

When OCD Was Called ‘Religious Melancholy’

Here’s something most websites won’t tell you.

Back in the Middle Ages, people with OCD symptoms were thought to have “religious melancholy” or were seen as possessed. Their intrusive, blasphemous thoughts? Blamed on demons. Their compulsive praying? Seen as moral devotion or spiritual punishment.

Imagine having distressing thoughts and being told it’s the devil inside you. Terrifying, right?

Early Mentions in Medical Texts

In the 1600s, physicians like Robert Burton described ‘religious fears’ in The Anatomy of Melancholy. But no one really knew what it was. There was zero understanding of OCD as a mental health condition.

19th Century – OCD as ‘Obsessive Neurosis’

The First Steps Toward Understanding

Fast forward to the 19th century, French psychiatrist Esquirol described patients with “folie du doute” – meaning “madness of doubt.” Finally, someone noticed it wasn’t demonic. It was psychological.

Then Pierre Janet introduced the term ‘psychasthenia’ for conditions like OCD, describing the constant doubt, checking, and need for certainty.

Freud’s Influence – The Wrong Turn?

You might know Sigmund Freud as the father of psychoanalysis. But his theories on OCD weren’t that helpful for treatment.

Freud thought OCD was due to unresolved unconscious conflicts, particularly around sexuality. So, people spent years in psychoanalysis trying to resolve their childhood. But OCD symptoms remained stubborn.

What do you think about that? Personally, I’m glad we moved on from purely psychoanalytic interpretations.

Mid-20th Century – Biological Explanations Emerge

The Rise of Neurochemistry

Then, researchers noticed something interesting. Certain medications for depression reduced OCD symptoms. This led to the serotonin hypothesis – the idea that OCD involves dysregulation of serotonin in the brain (Zohar & Insel, 1987).

Imagining the OCD Brain

In the 1990s, PET scans and MRI studies showed hyperactivity in the orbitofrontal cortex and caudate nucleus in OCD sufferers (Saxena et al., 1998). Simply put, the ‘worry loop’ was stuck in overdrive.

Imagine seeing on a scan that your brain is physically stuck in a loop. Validating, right?

The Birth of Behaviour Therapy for OCD

ERP – The Gold Standard Emerges

Here’s the game-changer.

In the 1960s and 70s, psychologists like Victor Meyer introduced Exposure and Response Prevention (ERP).

What’s ERP?

• Exposure: Facing your feared thought, image, or situation.

• Response Prevention: Resisting the urge to do the compulsive behaviour.

Sounds simple, but it’s powerful. Because by doing this, your brain learns the obsession isn’t dangerous, and anxiety reduces over time.

Why ERP Works

Imagine being terrified of contamination, touching a ‘dirty’ door handle, and then not washing your hands. Over time, your anxiety peaks and falls on its own. That’s ERP.

Studies show ERP has up to 80% efficacy for OCD treatment (Foa et al., 2005). That’s massive.

Modern CBT Approaches – Beyond ERP

Adding Cognitive Restructuring

CBT for OCD today often combines ERP with cognitive restructuring – identifying and challenging distorted beliefs about thoughts.

For example, the belief: “If I think it, it will happen.”

We help clients see that thoughts aren’t facts. They’re just mental events. Nothing more.

Mindfulness-Based CBT

Recently, therapies like Mindfulness-Based Cognitive Therapy (MBCT) are used to help people ‘observe’ thoughts rather than engage with them (Hertenstein et al., 2012).

Imagine just noticing an intrusive thought without judging or fighting it. Freedom, right?

Misconceptions That Still Exist

‘OCD Is Just About Cleaning’

This one drives me nuts. OCD is not just about cleaning or organising. It includes:

• Violent intrusive thoughts

• Sexually intrusive thoughts

• Religious or moral obsessions

• Health and contamination fears

• Relationship OCD

So, it’s far more than a ‘quirky cleaning habit’.

‘People With OCD Are Dangerous’

Absolutely false. In fact, research shows people with OCD are less likely to act on intrusive violent thoughts than the general population because these thoughts are ego-dystonic (Abramowitz et al., 2009).

Medication for OCD – Where Do We Stand?

SSRIs as First-Line Treatment

Medications like fluoxetine, sertraline, and fluvoxamine are first-line pharmacological treatments. They can reduce symptoms, especially when combined with therapy (NICE, 2005).

The Role of Clomipramine

Clomipramine, a tricyclic antidepressant, was one of the first drugs to show efficacy in OCD treatment in the 1960s and 70s (Marks et al., 1980). Still used today if SSRIs aren’t effective.

Cutting-Edge Research – What’s New?

Deep Brain Stimulation (DBS)

For severe, treatment-resistant OCD, Deep Brain Stimulation is showing promise. Electrodes implanted in the brain modulate circuits involved in OCD (Greenberg et al., 2006).

Virtual Reality ERP

Can you imagine doing ERP in virtual reality? Well, researchers are testing VR exposure therapy for contamination OCD and fear of harm (Kim et al., 2020). Early results look positive.

Genetics and OCD

Studies show 40-50% heritability in OCD. Scientists are investigating specific genes involved in serotonin and glutamate regulation (Pauls et al., 2014).

My Approach to Treating OCD

Using ERP in Therapy

In my clinic in Edinburgh, I use ERP therapy for OCD because it’s the gold standard. But I combine it with:

• Psychoeducation: Understanding what OCD is.

• Cognitive therapy: Challenging unhelpful beliefs.

• Mindfulness: Accepting thoughts without fighting them.

Because here’s the thing. ERP alone is powerful, but addressing beliefs around the need for certainty takes treatment further.

How I Can Help You

If you’re struggling with OCD, know this. You’re not broken. You’re not alone. Modern therapy works.

As a CBT therapist specialising in OCD treatment here in Edinburgh, I’ve seen clients go from spending 8 hours a day doing compulsions to living their life again.

And honestly? That’s why I love this job.

Final Thoughts – From Misconceptions to Empowerment

The Journey We’ve Taken

So, we’ve gone from:

• Demonic possession in the Middle Ages

• To moral weakness in the Victorian era

• To psychoanalysis in the early 20th century

• To ERP and CBT today – therapies that truly work

There’s Hope

We’ve come a long way. And research is still evolving, with exciting avenues like VR therapy and neuromodulation on the horizon.

Conclusion – What Do You Think?

Well, that’s our journey through the history of OCD research and treatment. From misconceptions to modern therapy.

I hope this gives you hope and clarity.

So, here’s my last question for you today:

If therapy has come this far in 50 years, where do you think it will take us in the next 50?

References:
Abramowitz, J. S., et al. (2009). The nature, assessment, and treatment of obsessions. Cognitive Behaviour Therapy, 38(3), 137-154.

Fineberg, N. A., et al. (2013). Clinical advances in obsessive-compulsive disorder: a position statement. World Psychiatry, 12(3), 205-206.

Foa, E. B., et al. (2005). Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder. American Journal of Psychiatry, 162(1), 151-161.

Greenberg, B. D., et al. (2006). Deep brain stimulation of the ventral internal capsule/ventral striatum for obsessive-compulsive disorder. Neuron, 52(3), 559-560.

Hertenstein, E., et al. (2012). Mindfulness-based cognitive therapy in obsessive-compulsive disorder: A qualitative study. Journal of Behavior Therapy and Experimental Psychiatry, 43(4), 1044-1049.

Kim, K., et al. (2020). Virtual reality for obsessive-compulsive disorder: past and future. Psychiatry Investigation, 17(1), 29-38.

Marks, I., et al. (1980). Clomipramine in obsessive-compulsive disorder. Archives of General Psychiatry, 37(11), 1361-1365.

NHS Digital. (2016). Adult Psychiatric Morbidity Survey.

NICE. (2005). Obsessive-compulsive disorder: Core interventions in the treatment of obsessive-compulsive disorder and body dysmorphic disorder.

Pauls, D. L., et al. (2014). The genetics of obsessive-compulsive disorder: a review. Dialogues in Clinical Neuroscience, 16(3), 301-311.

Saxena, S., et al. (1998). Functional neuroimaging and the neuroanatomy of obsessive-compulsive disorder. Psychiatric Clinics, 21(3), 385-402.

Zohar, J., & Insel, T. R. (1987). Obsessive-compulsive disorder: psychobiological approaches to treatment. Psychopharmacology Bulletin, 23(3), 358-364.