OCD Therapy: Treatment in Providence

Understanding Obsessive Compulsive Disorder

If you’re struggling with OCD, you already know how it feels to be caught in an exhausting cycle you can’t seem to escape—intrusive thoughts that won’t leave you alone, rituals that take over your day, and the constant fear that something terrible will happen if you don’t give in to the compulsions. Obsessive-Compulsive Disorder affects millions of people, creating patterns where unwanted thoughts (obsessions) trigger overwhelming anxiety, and repetitive behaviors or mental rituals (compulsions) temporarily reduce that anxiety—only to start the cycle all over again. What makes OCD so challenging is how logical your brain makes these patterns feel, even when part of you knows they don’t make sense. You might spend hours checking, cleaning, counting, or seeking reassurance, all while wondering why you can’t just stop. The good news? OCD is one of the most treatable mental health conditions when you work with therapists who understand its specific mechanisms.

An accurate diagnosis is essential, as many mental health conditions can present with similar symptoms, such as anxiety disorders or other related conditions. Distinguishing OCD from these similar symptoms is crucial for selecting the most effective, personalized treatment. Many patients also feel a sense of relief upon receiving an accurate diagnosis of OCD, as it validates their experiences and provides a clear path forward.

At the Providence Therapy Group, we use specialized approaches including Exposure and Response Prevention (ERP), Acceptance and Commitment Therapy (ACT), and Inference-Based Cognitive Behavioral Therapy (I-CBT)—evidence-based treatments that help you break free from OCD’s grip. Organizations like the International OCD Foundation provide additional resources for understanding and managing OCD. With the right therapeutic approach—one that targets how OCD actually works in your brain—you can reclaim the time and mental energy OCD has stolen and build a life no longer controlled by obsessions and compulsions.

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How OCD Shows Up in Daily Life

OCD isn’t just “being neat” or “liking things organized”—it’s an exhausting mental health condition that consumes hours of your day and makes normal functioning incredibly difficult. For some people, OCD centers around contamination fears: washing hands until they’re raw, avoiding doorknobs or public spaces, showering for hours, or refusing to touch anything that might be “dirty.” For others, it’s about harm obsessions: intrusive thoughts about hurting someone (even though you’d never want to), repeatedly checking that doors are locked or appliances are off, or needing to mentally review every interaction to make sure you didn’t say or do something wrong. Some people experience religious or sexual obsessions—disturbing intrusive thoughts that feel completely contrary to their values, creating intense shame and distress. Others struggle with symmetry and ordering compulsions, needing everything arranged “just right” or feeling unable to move forward until certain compulsive rituals are completed perfectly. What all forms of OCD share is the pattern: intrusive thought → anxiety spike → compulsion to reduce anxiety → temporary relief → the cycle starts again, often more intensely. Many people with OCD also develop elaborate avoidance patterns, structuring their entire lives around preventing triggers. Living with untreated OCD often means spending hours each day on compulsive rituals, avoiding important activities, struggling with relationships when partners don’t understand the compulsions, and experiencing significant depression or anxiety alongside the OCD. The isolation compounds the problem—many people are too embarrassed to tell anyone about their intrusive thoughts, suffering in silence while OCD progressively takes over more of their life.

Evidence-Based Treatment Approaches for OCD

When it comes to treating OCD effectively, three specialized approaches that we use at the Providence Therapy Group have strong research support: Exposure and Response Prevention (ERP), Acceptance and Commitment Therapy (ACT), and Inference-Based Cognitive Behavioral Therapy (I-CBT). While all three are highly effective, they work in different and complementary ways to address different aspects of how OCD operates in your brain. There are a range of treatment options available, and a personalized approach is key to help manage symptoms and reduce symptoms over time.

Exposure and Response Prevention (ERP) works by helping you become gradually exposed to the situations, objects, or thoughts that trigger your obsessions—while simultaneously preventing the compulsive responses you’d normally use to reduce anxiety. The key insight behind ERP is that anxiety naturally decreases on its own when you stay with it long enough, without performing compulsions. Over time, your brain learns that the feared outcome doesn’t actually happen, and that you can tolerate the anxiety without ritualizing. ERP involves creating a hierarchy of fears (from least to most anxiety-provoking) and systematically working through exposures while resisting compulsions. This behavioral approach has decades of research demonstrating its effectiveness, though some people initially find the idea of deliberately triggering their anxiety quite daunting. ERP is a specific type of cognitive-behavioral therapy (CBT) and is proven to be the most effective first-line therapy for OCD. Approximately 65% to 80% of patients who complete ERP experience significant symptom reduction, and research has shown that ERP can be more effective and longer-lasting than medication alone. Combining ERP with medication produces the best outcomes for patients with OCD. ERP requires courage and commitment from the patient, and it is shown to be highly effective in as little as a few months.

Acceptance and Commitment Therapy (ACT) is a psychological treatment that focuses on increasing psychological flexibility—the ability to be present with difficult internal experiences (thoughts, feelings, sensations) while taking action guided by personal values rather than by attempts to control or avoid these experiences. Unlike traditional cognitive behavioral therapy that aims to change or challenge the content of thoughts, ACT teaches patients to change their relationship with their thoughts and feelings. Evidence from multiple randomized controlled trials demonstrate significant reductions in OCD symptoms using ACT.

ACT is based on six core processes that work together to build psychological flexibility: acceptance (willingness to experience unwanted thoughts and feelings), cognitive defusion (seeing thoughts as just thoughts rather than facts), present moment awareness, self-as-context (observing oneself from a broader perspective), values clarification, and committed action. ACT addresses the experiential avoidance that maintains OCD symptoms and reframes exposure to anxiety provoking experiences as a values-based action.

Inference-Based Cognitive Behavioral Therapy (I-CBT) takes a different approach by targeting the reasoning processes that fuel OCD. Rather than focusing on anxiety reduction through exposure, I-CBT helps you understand how OCD tricks you into trusting obsessional doubts over reality. The therapy teaches you to recognize “inferential confusion”—when you give more weight to imagined possibilities than to what you actually perceive with your senses. For example, you might see that the door is locked but still feel like it might not be, leading to checking compulsions. I-CBT helps you learn to trust your senses and reality-based reasoning over the “remote possibility” thinking that OCD generates. This approach can be particularly helpful for people who struggle with the exposure component of ERP or who have primarily mental compulsions rather than behavioral ones.

Other treatment options include cognitive therapy, which can be used as an adjunctive or alternative approach. Cognitive therapy focuses on changing thought patterns and is often used to help manage symptoms by addressing the beliefs and interpretations that drive obsessions and compulsions. Acceptance and Commitment Therapy (ACT) is another evidence-based approach that focuses on accepting intrusive thoughts without judgment and helps build psychological flexibility, supporting individuals in responding differently to their OCD symptoms.

Many therapists integrate the three approaches, using I-CBT to address the faulty reasoning that maintains OCD while incorporating ERP elements to build tolerance for uncertainty and anxiety and bringing in ACT to help clients feel grounded in their values while engaging in treatment. Medication, particularly SSRIs, can also support therapy by reducing the intensity of obsessions and making it easier to resist compulsions. The goal isn’t to eliminate all anxiety—that’s impossible and unhealthy—but to help you respond to intrusive thoughts differently, without getting pulled into the compulsive cycle that makes OCD so debilitating.

What is OCD Treatment?

OCD treatment is specialized therapeutic work designed to help you break the patterns that keep obsessions and compulsions locked in place. Unlike general anxiety treatment, OCD therapy uses specific techniques that target how obsessive-compulsive disorder operates in your brain. The most effective treatments—Exposure and Response Prevention (ERP), Acceptance and Commitment Therapy (ACT), and Inference-Based CBT (I-CBT)—help you respond differently to intrusive thoughts, resist compulsions, and rebuild trust in your own perception of reality. Accurate diagnosis is essential, as OCD can share similar symptoms with other conditions, making it important to differentiate between them. Working with a multidisciplinary care team ensures that your OCD treatment plan is comprehensive and personalized, drawing on the expertise of various mental health professionals to address your unique needs. An OCD specialist understands that you’re not being irrational or weak—you’re dealing with a neurobiological condition that hijacks your reasoning and creates false alarms in your brain. Treatment provides you with tools to recognize these false alarms, resist the compulsive responses OCD demands, and gradually reclaim the parts of your life OCD has taken over. The therapeutic relationship itself matters enormously—you need a therapist who creates enough safety that you can discuss even your most disturbing intrusive thoughts without judgment or shame.

Meet the Providence Therapy Group's OCD Therapy Expert

Jennifer McMillan, M.S., LMHC
Licensed counselor
OCD Specialist in Providence

Jennifer has specialized training in treating OCD using Exposure and Response Prevention, ACT, and cognitive approaches that address the thought patterns maintaining obsessions and compulsions. She recognizes that intrusive thoughts can feel deeply shameful—whether they involve harm, contamination, sexual content, or religious themes—and works to create a therapeutic environment where you can discuss these thoughts openly without fear of judgment. Jen understands that the content of obsessions often feels completely contrary to your actual values, which creates enormous distress on top of the anxiety itself. She uses evidence-based techniques while pacing treatment in ways that feel challenging but not overwhelming, helping you build confidence as you resist compulsions and discover that feared outcomes don't actually occur. Before joining Providence Therapy Group, Jen worked at Brown University Medical School and Keypoint Health Services in Maryland, building expertise in anxiety disorders and OCD treatment. She is also part of a professional consultation group that meets regularly to discuss emerging treatments in OCD and continue to keep their treatment skills fresh.

Benefits of OCD Treatment

Engaging in specialized OCD treatment can transform your daily life in ways that might feel impossible right now:

• Freedom from time-consuming rituals: Reclaim the hours currently spent on compulsions for activities that actually matter to you.

• Reduced distress from intrusive thoughts: Learn that disturbing thoughts are just thoughts—they don't require any action or mean anything about who you are.

• Ability to tolerate uncertainty: Build capacity to live with the normal uncertainty of life without needing constant reassurance.

• Improved relationships: Stop involving others in reassurance-seeking or avoiding social situations due to OCD triggers.

• Better quality of life overall: Reengage with work, school, hobbies, and relationships without OCD interfering.

• Decreased avoidance patterns: Go places and do things you've been avoiding without elaborate rituals or planning.

• Relief from shame and isolation: Understand that OCD is a recognized condition with effective treatment, not a personal failing.

• Skills that last: Learn strategies that continue working long after therapy ends, reducing relapse risk.

We Provide Specialized OCD Treatment in Providence

At the Providence Therapy Group, our therapists have specific training in treating obsessive-compulsive disorder using evidence-based approaches. We understand that OCD is fundamentally different from generalized anxiety and requires specialized treatment techniques. A thorough OCD diagnosis is a crucial first step, as our care team works together to ensure an accurate diagnosis by carefully evaluating symptoms and distinguishing OCD from other conditions with similar symptoms. Our therapists use Exposure and Response Prevention (ERP)—the behavioral approach with the longest research track record—as well as Acceptance and Commitment Therapy (ACT) and Inference-Based Cognitive Behavioral Therapy (I-CBT), which addresses the reasoning distortions that fuel OCD. This combination allows us to personalize treatment to what works best for your specific OCD presentation.

OCD manifests in countless ways: contamination fears and washing rituals, harm obsessions and checking behaviors, intrusive sexual or religious thoughts, need for symmetry and ordering compulsions, relationship obsessions, and many other patterns. Regardless of the content of your obsessions, the underlying mechanism is similar—and that’s what we target in treatment. We also address co-occurring conditions like depression, generalized anxiety, and relationship difficulties that often develop alongside OCD. Research consistently shows that with proper treatment, most people achieve significant reduction in OCD symptoms and meaningful improvement in daily functioning. Our goal is to help you get to that point.

What to Expect in OCD Treatment:

• Comprehensive assessment to understand your specific OCD patterns and how they impact your life.

• Collaborative development of treatment goals that matter to you, not just symptom reduction.

• Evidence-based techniques including ERP, ACT, and I-CBT adapted to your needs and comfort level.

• Gradual progression through treatment at a pace you can manage while still making progress.

What to Expect in OCD Treatment Sessions

Beginning OCD treatment means working with a therapist who specializes in obsessive-compulsive disorder and understands its particular mechanisms. Your therapist will help you understand how OCD operates in your brain, why compulsions maintain the problem even though they feel like the solution, and how to gradually change your response to obsessions. Treatment typically involves weekly sessions initially, with the possibility of spacing out as you build skills. In many cases, it is also important to consult a doctor to discuss medication options, including the risks and benefits, as part of your overall treatment plan. Certain psychiatric medicines, especially antidepressants, are commonly used to help control the obsessions and compulsions of OCD. FDA-approved SSRIs for OCD include fluoxetine, sertraline, and fluvoxamine. These SSRIs are often prescribed at higher doses for OCD than for depression, and it can take two to three months to notice a difference. For individuals who do not respond to first-line treatments, other medications such as clomipramine (a tricyclic antidepressant) or antipsychotics may be added as adjunctive options to improve outcomes.

Here’s what the treatment process involves:

• Understanding OCD’s patterns: Learn how the obsession-compulsion cycle works and why your current coping strategies strengthen OCD rather than reducing it.

• Maintaining motivation for treatment through values: Using, ACT your therapist reframes the purpose of exposure exercises as values-based actions rather than anxiety reduction exercises.

• Creating your exposure hierarchy: If using ERP, you’ll work with your therapist to list situations from least to most anxiety-provoking, providing a roadmap for treatment.

• Addressing reasoning distortions: If using I-CBT, you’ll learn to recognize when you’re trusting obsessional doubts over actual reality and how to strengthen reality-based reasoning.

• Practicing between sessions: The work you do outside therapy sessions is where real progress happens—gradually exposing yourself to triggers while resisting compulsions.

• Building distress tolerance: Developing ability to sit with anxiety and uncertainty without immediately trying to eliminate the discomfort.

• Preventing relapse: Learning to recognize warning signs and maintain gains long after therapy ends.

OCD vs. OCPD: Understanding the Difference

Despite similar names, Obsessive-Compulsive Disorder (OCD) and Obsessive-Compulsive Personality Disorder (OCPD) are fundamentally different conditions that require different treatment approaches. OCD involves unwanted, distressing intrusive thoughts (obsessions) paired with compulsive behaviors or mental rituals aimed at reducing anxiety. People with OCD typically recognize their obsessions and compulsions as excessive or irrational—they don’t want these thoughts or feel compelled to do these behaviors, but they feel unable to resist. The experience is dystonic, meaning it conflicts with their sense of self.

OCPD, in contrast, is a personality pattern characterized by rigidity, perfectionism, need for control, and preoccupation with rules and order—but without the intrusive thoughts and anxiety-driven compulsions of OCD. People with OCPD often view their traits as reasonable and appropriate rather than problematic. They may be inflexible about how tasks should be completed, overly devoted to work at the expense of relationships, or unable to delegate because others won’t do things “correctly.” While this creates significant problems in relationships and functioning, it doesn’t involve the acute distress and recognized irrationality of OCD.

Because OCD and OCPD can share similar symptoms with other mental health conditions, an accurate diagnosis is essential to distinguish between them and ensure you receive the most effective, personalized treatment.

Treatment differs accordingly: OCD responds best to specialized behavioral interventions like ERP and I-CBT, sometimes combined with SSRIs, while OCPD typically requires longer-term psychodynamic therapy or schema-focused approaches that address core personality patterns and relationship dynamics. If you’re uncertain which condition better describes your experience, a thorough evaluation with a mental health professional can clarify the diagnosis and point toward the most effective treatment approach.

Lifestyle Changes for Managing OCD

Living with obsessive compulsive disorder (OCD) can feel like walking through a psychological minefield—but making intentional lifestyle changes can play a powerful role in managing OCD symptoms and supporting your overall mental health. While therapy—especially cognitive behavioral therapy (CBT) and exposure and response prevention (ERP) therapy—remains the cornerstone of effective OCD treatment, the choices you make in your daily life can help reinforce the progress you make in sessions and bring symptoms under better control.

Here are some lifestyle strategies to consider as part of your treatment plan:

• Establish a Consistent Routine: Structure and predictability can help reduce anxiety and make it easier to follow through with exposure and response prevention (ERP) exercises. Try to keep regular sleep, meal, and activity times to support your mental health and daily functioning—think of routine as your psychological anchor.

• Prioritize Self-Care: Taking care of your body and mind is essential. Aim for adequate sleep, balanced nutrition, and regular physical activity—all of which can help regulate mood and reduce stress, making OCD symptoms less intense. (Your brain needs fuel to fight back against obsessive patterns.)

• Practice Mindfulness and Stress Reduction: Techniques like mindfulness meditation, deep breathing, or gentle yoga can help you become more aware of obsessive thoughts without immediately reacting to them. These practices can also build your ability to tolerate discomfort during ERP therapy—turning down the volume on your brain's alarm system.

• Limit Avoidance and Safety Behaviors: While it's natural to want to avoid triggers, gradually facing them (with the support of your therapist) is key to response prevention. Try to resist the urge to create "safe zones" or routines that reinforce compulsive behaviors—those comfort zones can become psychological prisons.

• Stay Connected: Isolation can make OCD symptoms worse. Reach out to supportive friends, family members, or join OCD support groups—either in person or online. Sharing your experiences can reduce shame and help you feel less alone. (Community cushions the stress and offers fresh perspective.)

• Monitor Triggers and Progress: Keeping a journal of your OCD symptoms, triggers, and successes can help you and your therapist fine-tune your treatment plan. Noticing patterns can also empower you to anticipate and manage challenging situations—think of it as collecting evidence about what works.

• Limit Substances That Increase Anxiety: Reducing or avoiding caffeine, alcohol, and recreational drugs can help stabilize your mood and make it easier to engage in therapy. (Your nervous system is already working overtime—don't give it extra fuel for the fire.)

• Be Patient with Yourself: Managing obsessive compulsive disorder is an ongoing process. Progress may be gradual, and setbacks are normal. Celebrate small victories and remember that every step forward counts—even when it feels like you're moving through psychological molasses.

Integrating these lifestyle changes with your ongoing therapy—whether that's cognitive behavioral therapy, ERP therapy, or medication—can make a meaningful difference in your daily life. By taking an active role in your treatment and making choices that support your mental health, you can reduce the impact of OCD symptoms and reclaim more of the life you want to live. Start with self-kindness and remember: managing OCD isn't retreat—it's smart strategy.

Getting Started with OCD Treatment

Beginning treatment for OCD requires working with a care team to ensure an accurate diagnosis and to develop a personalized treatment plan. It’s important to find a therapist with specific training in evidence-based approaches for obsessive-compulsive disorder—not just general anxiety treatment. Look for therapists who explicitly mention ERP, I-CBT, ACT, or OCD specialization, as many well-meaning therapists lack the specific training needed for effective OCD treatment. Educate yourself about how OCD works and why certain treatment approaches are effective. Understanding the rationale behind ERP, ACT, or I-CBT makes the sometimes-difficult process of therapy feel more manageable and purposeful. Build a support system that understands OCD. Whether that’s family members, friends, support groups (online or in-person), or online communities, having people who understand what you’re dealing with reduces isolation and provides encouragement during difficult points in treatment.

There are a range of treatment options available for OCD. First-line therapies include ERP and I-CBT, often combined with medication such as SSRIs to help manage symptoms. For severe, treatment-resistant OCD, advanced options are available. Transcranial magnetic stimulation (TMS) offers a non-invasive method for treating severe OCD by using magnetic fields to target specific brain regions involved in obsessive-compulsive symptoms. TMS is FDA-approved for OCD and is typically reserved for cases that have not responded to standard therapies. Deep brain stimulation (DBS) is another advanced treatment option for severe, treatment-resistant OCD. DBS is a surgical procedure that is also typically reserved for individuals who do not respond to other treatments. Both TMS and DBS have potential benefits for those with severe OCD, but these emerging treatments are still being researched to better understand their long-term effectiveness and safety.

Prepare yourself emotionally for the reality that effective OCD treatment involves experiencing discomfort in the short term to achieve freedom in the long term. ERP involves deliberately triggering anxiety and sitting with it; I-CBT involves learning to tolerate uncertainty rather than seeking the reassurance OCD demands. This is uncomfortable work—but it’s time-limited and leads to lasting improvement, unlike the endless cycle of compulsions that keeps you stuck. Consider whether medication might support your therapy. While not required for everyone, SSRIs can reduce the intensity of obsessions and make it easier to resist compulsions, potentially speeding progress in therapy. This is something to discuss with your therapist and potentially a psychiatrist.

If you are seeking specialized programs, Butler Hospital offers an OCD Outpatient Clinic and an Intensive OCD and Anxiety Outpatient Program.

Commit to doing the between-session work. The therapy session itself is where you learn concepts and plan exposures, but the real change happens in your daily life as you practice resisting compulsions and applying new reasoning skills. Finally, be patient with the process. Most people see meaningful improvement within 12-20 sessions, but complex OCD or co-occurring conditions may require longer treatment. Progress isn’t linear—you’ll have better and worse weeks—but the overall trajectory should be toward greater freedom and reduced OCD interference in your life.