IOCDF BTTI Training: Transforming My OCD Therapy Journey
I remember logging off on 24 February, the session window finally closed, my desk still scattered with notes and half-drunk coffee. Four days earlier, I’d clicked into the International OCD Foundation’s Behaviour Therapy Training Institute from my home office in Edinburgh, excited but a bit nervous. By the end of 20–24 February 2025, something had clicked. The training didn’t just add tools to my kit. It shifted how I think, how I plan treatment, and how I show up in the therapy session. Sounds dramatic, I know. But that’s what happens when you spend a week immersed—albeit virtually—in exposure and response prevention with people who’ve shaped the field, and you close your laptop with your certificate in hand and a sharper, steadier approach for the next person who asks, “Can OCD really get better for me?”
IOCDF BTTI Training: So, why does it matter?
Well, the BTTI is designed to train clinicians in ERP, the first-line, evidence-based psychological treatment for OCD, and to deepen practical skills across OCD-related conditions. It’s intensive by design, and the 2025 calendar offered general and paediatric tracks that kept the focus firmly on doing the work, not just talking about it.
Even virtually, the atmosphere is hands-on. You’re not just a passive observer; you practise case formulation, exposure design, response-prevention rules, and troubleshooting, all with live faculty feedback. The real-time interactivity—breakout rooms, role-plays, Q&A with the faculty—made it easy to forget I wasn’t in the same physical room. Finally, the teaching links directly to what helps in UK practice, where our public guidance also points to CBT that includes ERP as the recommended therapy.
A quick word about who’s talking
I’m Federico Ferrarese, a CBT therapist based in Edinburgh specialising in OCD treatment. I’ve worked with people across the UK who are fed up with being told to “think positive” when what they need is structured, compassionate, head-on work with OCD. The BTTI consolidated exactly that.
What I learned from Dr C. Alec Pollard: a cleaner way to think about barriers
Dr Pollard is famous for keeping things practical. One of the biggest lessons I brought home was how to manage treatment-interfering behaviours without shaming the person or getting stuck. He frames “treatment-interfering behaviour” as anything, intentional or not, that gets in the way of effective participation in therapy. It can look like missed sessions, homework avoidance, or endless debate in sessions, but the key is function: if it blocks change, we address it directly and kindly.
He proposes adjusting our strategy to the level of engagement: if someone’s ready, treat OCD; if ambivalent, treat OCD while managing the interference; if resistant, focus on those behaviours first, then return to ERP once readiness improves. That clearer map has already saved me and my clients time and frustration.
Next, Pollard refreshed my thinking about the core fear. We’re not just reducing anxiety in the session; we’re helping someone learn safety in the presence of triggers. He emphasised that recovery is about learned safety that becomes strong enough to inhibit old danger learning, which is why exposures must be varied across contexts and reinforced over time. That’s not just theory; it’s the blueprint for preventing relapse.
Then, there was his elegant case-formulation template: trigger, the ritual you’d do if you could, and the catastrophe you fear if you don’t. It’s deceptively simple, but it keeps exposure and response-prevention honest. We expose to the trigger, we specify what not to do, and we define what the person needs to learn. If the feared outcome can’t be disconfirmed, we name that and recalibrate the plan. That clarity has made my sessions tighter and my clients’ progress faster.
What I learned from Dr Robert Hudak: medication, ERP, and a calm algorithm
Dr Hudak’s sessions gave me a steadier hand with medication conversations. His algorithm was simple and humane: many moderate to severe cases do better with both medication and ERP; milder cases may do well with ERP alone.
For pharmacotherapy, selective serotonin reuptake inhibitors are the first choice, with clomipramine a tried-and-tested option; and he stressed what constitutes a real trial: maximum tolerated dose for twelve to sixteen weeks before calling it.
He also addressed what to do when progress stalls, from ensuring adequate doses and duration, to adding ERP, to switching or augmenting with agents such as memantine or, with caution, antipsychotics for defined use cases like co-occurring tics. The tone was steady: go stepwise, verify trials, prioritise ERP augmentation, and avoid polypharmacy creep.
Then he covered discontinuation. Stop too fast and relapse risk spikes; taper slowly, ideally with ERP in place to preserve gains. It’s the kind of guidance that helps families plan with less fear and more foresight, and it dovetails with how we do shared decision-making in the UK.
What I learned from Dr Martin E. Franklin: paediatric OCD, families, and how change sticks
Dr Franklin’s work on children and adolescents reminded me that young people can do powerful ERP when we pitch it right. He laid out how OCD shows up in kids, how they lean on reassurance more, and how family accommodation quietly fuels the cycle. Crucially, he emphasised mapping symptoms with child-friendly language, building hierarchies they understand, and involving parents to withdraw accommodation and support exposures between sessions.
He walked through validated measures like the CY-BOCS so we can track severity properly and define “excellent responder” thresholds rather than relying on vibes. And he showed the data: CBT with ERP delivers robust symptom reduction in paediatric OCD, and the gains can last—especially when families are coached to support response prevention at home.
He also highlighted developmental tweaks. With younger children, we get creative with metaphors, games, and rewards, but we don’t hide the straightforward message: we’re choosing to be anxious on purpose so the fear system can learn something new. With adolescents, we collaborate more on exposure selection and talk plainly about risk and feared consequences. That balance—clear rationale plus developmental fit—makes treatment feel doable rather than punitive.
What this means for you if you’re living with OCD in the UK
First, ERP works. Meta-analyses show ERP beats medication alone, and that combining ERP with medication can outperform medication by itself. UK-relevant guidance from the NHS and major charities lines up with this: CBT that includes ERP is the recommended talking therapy for OCD.
Next, ERP is not endless suffering. It’s uncomfortable on purpose, yes, but it’s structured. We plan exposures to your triggers, we agree on the rituals we’ll hold back, and we stick with the discomfort—whether in a virtual session or your real-life environment—long enough for your fear to be activated and for new safety learning to take root.
Then, medication is a tool, not a verdict. If we use it, we’ll talk about proper trials, common side effects, and a tapering plan. And we’ll keep ERP central, because even when medicines help a lot, ERP locks in the skills that stay with you when doses change.
What most websites don’t tell you about ERP, but the BTTI hammered home
They don’t talk enough about treatment-interfering behaviour. We all have it. It’s not a character flaw. It’s just the stuff that gets in the way when change is hard. Naming it early, setting readiness goals, and addressing it directly can double the speed of real progress. Sometimes we temporarily shift the therapy focus from OCD to readiness, agree on concrete behaviours, and then return to ERP once those are in place.
They also skim the difference between danger learning and safety learning. You don’t need your anxiety to plummet during a session for exposure to “work.” What you need is repeated, well-designed contact with triggers without the old escapes, across varied settings, until the new learning becomes accessible when you need it. That’s why we sometimes avoid distraction during exposures; it may blunt the learning. And that’s why we take exposures outside the therapy frame—even virtually—into your day-to-day life.
Finally, they rarely show how paediatric ERP depends on family behaviour. If reassurance and rituals have become family habits, we’ll gently teach parents how to step back without stepping away, replacing short-term rescue with long-term recovery.
A quick story from the (virtual) clinic
A student came in with checking rituals that swallowed their evenings. They’d tried “CBT” before, which mostly meant thought-challenging worksheets, and they felt like a failure.
We used Pollard’s formulation to pin down the core fear: if I don’t check lights and locks “just right,” I’ll cause a fire and hurt someone, and I’ll be to blame.
Next, we wrote response-prevention rules informed by Hudak’s common-sense algorithm: carry on with ERP regardless of medication shifts, and if we do adjust meds, we’ll do it deliberately, not reactively.
Then we used Franklin’s structure to map a simple, graded plan and pulled parents in—not to nag, just to stop accommodating.
After that, we did exposures where the OCD lives: in the hallway, in the kitchen, at the front door. And finally, we added variety so safety learning stuck. Two months later, they were going to bed on time.
That’s not a miracle. That’s planned, repeated learning—done via a mix of virtual guidance and real-world practice.
How my BTTI certificate changes what you get from me
It sharpens the plan. You get clearer ERP rationales, cleaner response-prevention rules, and faster adjustments when we hit a snag. It expands the toolkit for kids and teens, including family-based strategies that make the gains last. It makes medication conversations calmer, because we’re following a sensible ladder, not chasing shiny objects. And it reinforces the culture of steady, compassionate practice that gets the job done in real lives in Edinburgh, Glasgow, Aberdeen, and anywhere else in the UK you happen to be reading this from.
Let’s talk UK-specific access
If you’re in England or Wales, NHS guidance points you toward CBT with ERP, and charities like OCD-UK and OCD Action give practical steps for navigating the system and, if needed, choosing a private therapist who is trained in ERP rather than generic CBT. In Scotland, similar pathways apply through NHS boards, but the same principle holds: ask directly about ERP, about how exposures will be planned, and about how rituals will be prevented in session and at home.
The evidence, simplified
You don’t need to wade through journals to trust ERP. Reviews show ERP is effective and often superior to control conditions and cognitive-only approaches for OCD; adding ERP to medication outperforms medication alone; and delivering ERP flexibly, including via telehealth, can be effective too, which matters across the UK where access varies. That’s the backbone behind everything I learned in February.
How we’ll work together, step by step
Next, we’ll map your triggers and the feared consequence. Then, we’ll write response-prevention rules so you know exactly what you’re not going to do and what you’ll do instead. After that, we’ll build a simple hierarchy, but we won’t be slaves to it; sometimes we’ll mix it up to help learning generalise. Finally, we’ll plan homework, involve family or partners wisely, and track outcomes with clear measures so you can see progress on paper, not just feel it.
If you’ve been burned by therapy before
Well, that happens, and it’s heartbreaking. Many people in the UK try generic CBT that focuses on thinking differently without changing behaviour in the presence of triggers. ERP is different. It asks more of you, but it gives more back. And if something keeps getting in the way—avoiding sessions, not doing homework—we won’t pretend it isn’t happening. We’ll name it, treat it, and keep going. That’s how we get you your life back.
About me and how I can help with ERP
I’m Federico Ferrarese, a CBT therapist based in Edinburgh, specialising in OCD treatment. Day to day, that means designing an ERP you can actually do, helping you and your family step out of accommodation, coordinating sensibly with GPs or psychiatrists when medication is on the table, and teaching you skills you keep. If you’re ready to try again, or to try properly for the first time, I’d be honoured to help.
Frequently asked questions
Is ERP safe?
Yes, ERP is challenging but safe when delivered by a trained clinician and paced appropriately. We agree the plan, we practise in session, and we build towards the harder steps. You’ll never be asked to do anything dangerous, only to stay present with discomfort so your brain can update its predictions.
Will I have to stop medication to do ERP?
No. Many people do ERP while staying on medication. If you and your prescriber decide to adjust meds, we’ll time that sensibly and use ERP to hold the gains as doses change.
Does ERP work for children and teens?
Yes. With the right developmental tweaks and family involvement to reduce accommodation, children and adolescents can do ERP very effectively, and results can last.
How long does treatment take?
It varies. Some people notice shifts within weeks; others take longer, especially if OCD has entwined itself with daily routines or if treatment-interfering behaviours need attention first. The point isn’t speed for its own sake; it’s building learning that sticks.
I tried CBT, and it didn’t help. Should I still try ERP?
If your CBT didn’t include structured exposure and response prevention, you haven’t really tried the recommended treatment for OCD. It’s absolutely worth trying a proper ERP with someone trained specifically in it.
The bottom line
The BTTI week in February wasn’t just a course. It was a reset. It gave me a cleaner map for when to push, when to pivot, and how to make ERP stick for adults, teens, and families here in the UK. If OCD has made your world small, I know the path back gets steep in places, but I also know it’s walkable with good company and the right plan; want to take the first step together?
References:
Franklin, M. E. (2025). Treating children and adolescents with OCD [Conference slides]. IOCDF BTTI.
Hudak, R. (2025). Medication protocols for obsessive-compulsive disorder [Conference slides]. IOCDF BTTI.
International OCD Foundation. (n.d.). Exposure and response prevention (ERP). https://iocdf.org/about-ocd/treatment/erp/
International OCD Foundation. (n.d.). IOCDF training institute. https://iocdf.org/professionals/training-institute/
Mao, L., Wang, M., Jiang, F., et al. (2022). The effectiveness of exposure and response prevention in the treatment of obsessive–compulsive disorder: A meta-analysis. Frontiers in Psychiatry, 13, 917270. https://doi.org/10.3389/fpsyt.2022.917270
McLean Hospital. (2025, March 14). What is ERP therapy? A guide to OCD’s leading treatment. https://www.mcleanhospital.org/essential/erp
Mind. (n.d.). Treatment for OCD. https://www.mind.org.uk/information-support/types-of-mental-health-problems/obsessive-compulsive-disorder-ocd/treatment-for-ocd/
NHS. (n.d.). Treatment – Obsessive-compulsive disorder (OCD). https://www.nhs.uk/mental-health/conditions/obsessive-compulsive-disorder-ocd/treatment/
OCD-UK. (n.d.). What is exposure and response prevention (ERP)? https://www.ocduk.org/overcoming-ocd/accessing-ocd-treatment/exposure-response-prevention/
Pollard, C. A. (2024). An integrative cognitive-behavioral approach to managing treatment-interfering behaviour [Conference slides]. IOCDF BTTI.
Pollard, C. A. (2024). Cognitive behavioral treatment of obsessive-compulsive disorder [Conference slides]. IOCDF BTTI.