My Approach to Treating OCD: Evidence-Based CBT, ERP & Inference-Based Therapy

This article is for adults living with obsessive compulsive disorder (OCD) who want specialist, evidence-based treatment, and who may be worried about choosing the wrong kind of support.

Obsessive Compulsive Disorder (OCD) can feel like a relentless cycle of anxiety, intrusive thoughts, and compulsive behaviours that slowly erode your time, energy, and peace of mind. Many people with OCD describe feeling trapped in doubt, constantly scanning for certainty, reassurance, or safety.

If you’re reading this, you may be looking for a therapist who truly understands OCD and can offer treatment that goes beyond symptom management to address what keeps the disorder going.

Why specialist OCD treatment matters

OCD is not a condition that responds well to general counselling alone.

Effective treatment requires specialist training in Cognitive Behavioural Therapy with Exposure and Response Prevention (CBT-ERP), delivered through postgraduate Masters level training, close supervision, and substantial clinical experience.

When OCD is treated without this specialist understanding, therapy can unintentionally:

• reinforce reassurance-seeking

• increase mental checking or rumination

• strengthen compulsions rather than reduce them

  
  

This is also why self-directed advice, online forums, and AI tools can sometimes worsen OCD symptoms despite good intentions.

My clinical approach to OCD

I specialise in working with OCD using a structured, compassionate, and evidence-based approach, drawing from:

• CBT with Exposure and Response Prevention (ERP)

• Inference-Based CBT (I-CBT)

• EMDR, where clinically appropriate

  
  

I completed specialist CBT-ERP training at King’s College London, one of the UK’s leading centres for OCD treatment and research. During this training, I worked across multiple OCD subtypes, recognising that OCD can present very differently depending on the underlying fears, beliefs, and reasoning patterns involved.

In February, I am undertaking specialist training in Inference-Based CBT (I-CBT) — an evidence-based approach increasingly recognised for its effectiveness in certain presentations of OCD, particularly those dominated by doubt, rumination, and mental compulsions.

CBT-ERP: addressing fear and avoidance

ERP remains the gold-standard treatment for OCD and is a core part of my work.

Through ERP, we:

• gradually and carefully face feared thoughts, sensations, or situations

• reduce reliance on compulsions and safety behaviours

• build tolerance for uncertainty rather than chasing certainty

  
  

ERP is collaborative and carefully paced. Over time, anxiety reduces not because it is eliminated, but because it no longer dictates your choices or behaviour.

Inference-Based CBT (I-CBT): working with doubt and reasoning

While ERP is highly effective for many people, some individuals with OCD find that their symptoms are driven less by fear of situations and more by persistent doubt, over-analysis, and imagined possibilities.

Inference-Based CBT focuses on:

• how OCD creates doubt through imagined narratives

• the point where reasoning shifts from reality-based to OCD-based

• strengthening trust in lived experience rather than hypothetical threats

  
  

I-CBT can be particularly helpful for:

• “pure O” presentations

• obsessive doubt and mental checking

• moral, responsibility, or contamination-based OCD

• clients who struggle to engage fully with exposure alone

  
  

Rather than focusing solely on anxiety reduction, I-CBT works with the thinking process that gives OCD its grip.

What if trauma is part of the picture?

For some people, OCD is complicated by past trauma or adverse experiences. Where appropriate, I may integrate EMDR (Eye Movement Desensitisation and Reprocessing) to address trauma memories that:

• intensify OCD symptoms

• block progress in CBT-based work

• keep the nervous system in a heightened state of threat

  
  

EMDR does not replace ERP or I-CBT. It is used selectively, following stabilisation work, to support the overall therapy process safely and effectively.

My therapeutic stance

OCD is often misunderstood, even within mental health settings.

My approach is:

• validating and non-judgemental

• clear and honest about what works

• grounded in evidence rather than reassurance

  
  

You will never be judged for your thoughts or rituals. At the same time, I will not collude with OCD or offer false certainty. Therapy is a collaborative process, and my role is to support change with clarity, compassion, and clinical integrity.

Working together

I offer:

• one-to-one OCD therapy

• CBT-ERP and I-CBT-informed work

• EMDR-integrated therapy where appropriate

• EMDR intensives for those seeking focused therapy blocks

  
  

I am a:

• BABCP-accredited CBT therapist

• Registered Mental Health Nurse

• Qualified EMDR therapist (EMDR Association UK), working toward full accreditation

  
  

If you’re considering working with me, therapy begins with a clear, structured booking process designed to ensure the work is appropriate and well-paced.

Step 1: Paid clarity call (including suitability assessment) The first step is a paid clarity call. This is a focused therapeutic consultation where we explore what you’re seeking support for, assess suitability, and consider the most appropriate way of working (for example CBT-ERP, inference-based CBT, EMDR-informed work, or structured therapy blocks).This is not an introductory chat, but part of the therapy process.

Step 2: Therapy begins If we decide to proceed, we agree a therapy plan and next steps. This may involve weekly sessions, structured blocks of therapy, or focused intensives, depending on your needs and circumstances.

You can view current availability and book a paid clarity call here:👉 Home - Client Bookings Zanda

Further information about fees, location, location, and ways of working is available on my website:👉 www.beckygracetherapy.co.uk

About the author

Becky Grace is a BABCP-accredited CBT and EMDR therapist specialising in OCD, eating disorders, neurodiversity, and complex trauma. She works with adults who feel stuck in cycles of anxiety, doubt, self-control, and shame, and offers in-person therapy in Norwich alongside UK & International online therapy.