Structured, evidence-based therapy for adults with OCD, in Gosford, Hornsby, or via telehealth across Australia.
Structured, evidence-based therapy for adults with OCD, in Gosford, Hornsby, or via telehealth across Australia.
The CANMAT/ICOCS 2025 international guidelines (published 2026) recommend CBT, delivered as ERP or cognitive therapy, as the first-line psychotherapy for OCD (Level 1), noting that the most evidence exists for individual, in-person CBT that emphasises ERP3. The NICE guideline (2005, last reviewed 2024, update expected 2027) recommends that adults with moderate functional impairment be offered a choice of an SSRI or more intensive CBT including ERP (more than 10 therapist hours), on the basis that the two appear comparably efficacious; NICE does not use the term first-line for adults6.
The Australian Psychological Society's 2024 review classifies CBT with ERP at NHMRC Level I (a meta-analysis or systematic review of RCTs) for adult OCD, with ACT and self-guided digital interventions also at Level I; it is an evidence classification, not a guideline, each Level I rating rests on the single best-ranked article for that intervention, and the review rates the ACT meta-analysis at high risk of bias and records the self-guided digital evidence as very low quality4. The CANMAT/ICOCS Key Points describe only limited evidence for ACT and EMDR, and the guideline's synthesis states that stress and anxiety management therapy, progressive muscle relaxation and mindfulness-based cognitive therapy do not appear effective for OCD3.
Across 36 RCTs (n = 2,020, adults and children), CBT with ERP reduced end-of-trial Y-BOCS more than the pooled control conditions, Hedges g 0.74 (95% CI 0.51 to 0.97; adult-only trials g 0.60, 95% CI 0.35 to 0.84), with g 1.27 versus waitlist and g 1.13 versus psychological placebo; only 8 of 36 trials were at low risk of bias7. Wang 2024's broader analysis of 48 trials of psychological treatments (55 comparisons, adults and young people pooled) found g -1.14 (95% CI -1.31 to -0.97; negative values favour treatment; adult-only g -1.10) versus control conditions, mostly waitlist, and a smaller g -0.82 versus psychological placebo (16 comparisons), with 87% of trials rated at high risk of bias8. Against other active psychological treatments the difference is small or absent: g -0.05 (95% CI -0.27 to 0.16) in eight head-to-head RCTs, and g 0.15 (efficacy trials) to 0.29 (routine-care trials) in Öst 2022, where every routine-care comparator was itself another CBT variant7, 9.
Across 29 effectiveness studies (1,669 adults treated in routine settings, 8 of the studies RCTs), the within-group before-after improvement was g 2.12 at post-treatment (not comparable with controlled effects; trim-and-fill 1.57; a large share of studies at high risk of bias), 59.2% met their study's remission criterion at post-treatment and 56.5% (95% CI 47.6 to 65.0) at follow-up averaging about 15 months (remission reported by 24 and 19 of the 38 treatment conditions), with 15.2% dropout after starting and 11.1% of eligible patients declining treatment9. Remission was defined per study: 13 conditions used Jacobson-Truax clinically significant change, four used a 35% reduction plus Y-BOCS 12 or below, and Y-BOCS cut-offs ranged from 7 to 169. Definitions matter: the CANMAT/ICOCS guideline itself sets remission at Y-BOCS 10 or below and full response at a 35% reduction plus CGI-I 1 or 2, so guideline-defined and Öst-defined rates are not interchangeable3.
In follow-up studies averaging about two and a half years (47 studies, 2,817 treated participants, follow-up 1 to 11 years), improvements were generally maintained, before-after in treated samples, with mean adult Y-BOCS roughly halving from about 25 to about 13 and staying near that level; at follow-up 65.0% of adults met their study's response criterion (usually a 35% or greater Y-BOCS reduction) and 47.2% its remission criterion (most often Y-BOCS 12 or below), among the 75% of starters assessed, with adult attrition of 14.2%5. Controlled long-term evidence is more limited: pooled controlled effects lost statistical significance at 3 to 6 and 6 to 12 months in Wang 2024 (6 and 5 comparisons), and the guideline states that for some patients the benefit of CBT wanes8, 3. (Öst 2022 and Öst 2026 share a lead author; the controlled efficacy figures come from independent meta-analyses, Reid 2021 and Wang 2024.)
Pooled across 123 studies (5,627 participants), 15.6% of eligible patients refused CBT for OCD and 15.9% of those who started dropped out (abstract-level figures with separate denominators, mostly trial samples); adult attrition in the long-term follow-up set was 14.2%10, 5. The guideline notes that dropout in clinical settings may be higher than in trials, that ERP is by nature distressing, and that early distress usually emerges before improvement, although the routine-care meta-analysis above found 15.2% dropout, not significantly different from efficacy trials3, 9.
CANMAT/ICOCS rate first-line psychological and pharmacological treatments as comparably efficacious in the short term (Level 1), find combination better than SRI monotherapy but no better than CBT alone and rank CBT monotherapy above combination (Level 1), recommend continuing a well-tolerated SRI for at least 12 months and possibly indefinitely (Level 4), and do not recommend CBT as protection against relapse after SRI withdrawal (Level 3, negative)3. The severity-based combination advice comes from NICE 2005 (combined SSRI and CBT including ERP for severe functional impairment) and the ICOCS 2020 position statement, which itself notes the supporting evidence is largely augmentation in patients still symptomatic on medication6, 11. In the key adult RCT as summarised by the guideline (Foa 2005, N = 122, Level 2), ERP alone was not significantly different from ERP plus clomipramine at week 12, with clomipramine rather than an SSRI as the drug comparator; a small pilot RCT (Fineberg 2018, N = 44 randomised, 23 completers, Level 3) found combination reduced Y-BOCS more than either alone while sertraline alone appeared more cost-effective; and 64% of the 36 ERP trials in Reid 2021 permitted concurrent medication, so much of the efficacy evidence is de facto combined treatment3, 7. Prescribing decisions sit with the referrer.
Pooled across help-seeking clinical samples, the interval from onset to first help-seeking was 6.97 years (95% CI 5.69 to 8.24) and the duration of untreated illness to first adequate treatment, defined mostly as adequate medication, was about 80 months (95% CI 69 to 92); study quality was low to moderate with high heterogeneity, and these samples exclude people who never present, so they likely understate delay12. A scoping review found non-recognition of symptoms as a disorder, stigma and lack of information the factors most often reported across studies, and the guideline names secretiveness and shame as a frequent barrier to seeking help13, 3. Longer untreated illness is linked in some studies with poorer response to serotonergic medication, with a null and a trend-level finding in others, and the guideline nonetheless treats a longer untreated period as a negative prognostic factor; the delay-to-outcome evidence does not concern CBT, and Pellegrini 2025 records, without study detail, that the first dedicated early-intervention program (Brakoulias 2021) was not found effective, so early-intervention evidence is thin3, 12.
NICE 2005 states that intrusive sexual, aggressive or death-related thoughts are common in people with OCD at any age and are often misinterpreted as indicating risk, while still requiring assessment of self-harm and suicide risk, especially with comorbid depression6. Stakeholders in NICE's 2019 surveillance, asked about ego-dystonic violent or paedophilic thoughts, advised that aggressive obsessions should always be fully assessed but should not be used as evidence of increased risk of enacting harm, since inappropriately attributing risk can reinforce the fear and act as a barrier to treatment14. NICE also recommends routinely asking direct questions about OCD symptoms in people presenting with depression, anxiety, alcohol or substance misuse, body dysmorphic disorder or an eating disorder6.
The pooled RCT evidence (Salazar de Pablo 2023, 22 trials, adults and young people) covers internet, computerised, app-based, telephone and bibliotherapy CBT with varying therapist support; only two small videoconference pilots were included, both versus waitlist15. Against face-to-face CBT (8 trials, n = 530, none videoconference) the pooled difference was g -0.10 (95% CI -0.39 to 0.18), a non-significant difference rather than demonstrated non-inferiority, dropout did not differ significantly, and in an underpowered meta-regression higher baseline severity reduced the relative efficacy of remote CBT15. CANMAT/ICOCS place individual in-person CBT first, with group, remote one-to-one video or phone, or therapist-assisted self-guided CBT as the next options, and recommend in-person treatment for higher symptom severity (Level 2); in the child and adolescent network meta-analysis (Cervin 2023), therapist-assisted webcam or telephone CBT did not differ significantly from in-person CBT (MD 0.85, 95% CI -2.51 to 4.21, each remote format resting on a single non-waitlist trial, so not evidence of equivalence) whereas internet CBT was less efficacious than in-person (MD 3.95, 95% CI 0.42 to 7.49)3.
CANMAT/ICOCS describe a standard initial course of ERP as 12 to 14 sessions (range 5 to 23; Level 4, expert opinion) and state that both first-line modalities need at least 12 weeks at adequate dose before a signal of efficacy can be judged3. Research courses averaged 14.5 sessions over about 14 weeks, roughly 20 therapist hours, most often individual and therapist-delivered; routine-care courses also averaged 14.5 sessions with a very wide spread, and neither session number nor treatment hours was a significant moderator of outcome after correction5, 9.
In the ABS National Study of Mental Health and Wellbeing 2020-2022, 3.6% of Australians aged 16 to 85 had 12-month OCD, meaning they met ICD-10 criteria at some time in their life and had sufficient symptoms in the 12 months before interview (WHO CIDI 3.0, face-to-face survey run during COVID-19 restrictions, no confidence interval or lifetime OCD figure published)16. Unwanted intrusive thoughts are near-universal: 94.3% of 683 university students across 15 sites in 13 countries, including Melbourne, reported at least one in the previous three months (students only, three-month recall)1.
Living with OCD can feel exhausting: intrusive thoughts, mental rituals, checking, or the constant need to "make things feel right" can take up far more time and energy than you'd like. Many people describe feeling stuck in a loop they can't break free from, even when they recognise the thoughts or behaviours don't make sense.
OCD responds well to treatment. Most people who complete a course of therapy improve3, 5.
Although based in Gosford, I support adults with OCD from across the Central Coast and in Hornsby, providing structured treatment grounded in cognitive-behavioural therapy, including Exposure and Response Prevention (ERP), the first-line psychological treatment for OCD in current international guidelines3.
OCD sits alongside the anxiety conditions in Australia's national mental health survey16, so if you'd like an overview of how anxiety presents more generally, you can read more about understanding anxiety.
OCD is not a lack of willpower. Rituals can bring brief relief, which makes them feel necessary the next time a doubt appears2, 17, 18. Explore the cycle, then see how treatment helps you practise a different response.
Brief relief can bring you back to the same doubt. Follow the arrows to see how.
Follow one checking example to see how brief relief can keep OCD going.
An unwanted thought, image, urge or doubt appears. With OCD, it can feel important and difficult to leave alone.
You have locked the door, but a doubt appears: “What if it is not locked?”
The doubt is the starting point. What happens next can keep it going.
The thought is given an alarming meaning. It can feel as though you must remove every doubt, prevent harm or get things exactly right.
“I must be completely sure. If anything happened, it would be my fault.”
A possibility starts to feel like something you must resolve.
Anxiety, guilt, disgust or a “not right” feeling can rise, along with a strong urge to do something to settle it.
You feel uneasy and pulled back towards the door, even though you have already locked it.
The feeling creates urgency. The ritual promises a way to ease it.
Compulsions are actions or mental rituals used to reduce distress or prevent a feared outcome. They can include checking, mental review, reassurance and avoidance.
You check the lock again, replay locking it in your mind, or ask someone to confirm it.
The ritual aims to bring certainty or relief.
A ritual may ease distress for a while. That relief can make the ritual feel necessary the next time doubt appears, keeping the cycle going.
You feel better briefly, but another “what if” brings the urge to check again.
Short-term relief can make the same response more likely next time.
The new path leaves out the ritual. Doubt and discomfort may still be there.
Exposure and response prevention (ERP) pairs facing uncertainty with practising a different response.
With your therapist, you plan to approach situations, thoughts or uncertainty that OCD asks you to avoid. The steps are agreed together.
You practise leaving home after your ordinary locking routine, allowing the doubt to be there.
Exposure and response prevention work together. The next steps show the response you practise.
The demand for certainty may still appear. You practise noticing that demand without having to settle the thought or work out what it means.
The thought “I must be completely sure” is there, and you practise leaving it unresolved.
You do not need a perfectly reassuring answer before taking the next step.
Distress and the urge to check may still be present. Treatment helps you practise responding differently while those feelings are there.
You notice the uneasy feeling and the pull to return to the door.
Feeling calm straight away is not the test of whether the practice counts.
You practise leaving out the compulsions that usually follow the doubt. This includes hidden rituals, such as mental checking or seeking reassurance.
Following the plan agreed with your therapist, you leave out the repeat check, mental replay and reassurance.
The practice is changing your response to uncertainty, with support.
You practise continuing with your day without resolving every doubt first. Repeated practice can help OCD take up less time and attention.
You head to meet a friend, even if some uncertainty comes with you.
The thought may return. You can keep practising a different response.
One example of a common OCD pattern. Treatment is planned together and adapted to the person.
Based on the cognitive-behavioural model of OCD (Salkovskis 1999)2, 3. The treatment view illustrates practising new responses through exposure and response prevention. Its explanation draws on inhibitory learning (Craske 2014; Jacoby and Abramowitz 2016), one current account of how exposure works. The precise mechanisms are still being studied20, 19, 3.
Your first sessions focus on understanding your own pattern and building a plan together.
OCD varies widely from person to person. You may experience some, all, or only one cluster of symptoms.
If you're unsure what intrusive thoughts mean or why they happen, you can read a detailed explanation here: Why do I keep having disturbing intrusive thoughts?
A study of university students in thirteen countries, including Australia, found unwanted intrusive thoughts, including thoughts about harm, contamination, sex or religion, in almost all of the people asked1, 6.
Treatment begins by understanding exactly how your OCD operates: your specific obsessions, compulsions, triggers, and what maintains the cycle over time. Many people feel relief simply having clarity and a clear plan.
Many people with OCD notice improvements such as:
You do not need to eliminate intrusive thoughts to get better; the goal is reducing their power over your behaviour and wellbeing2, 17.
I support adults experiencing all forms of OCD, including:
Intrusive thoughts about harm, sex or religion are common in OCD6, 17, and the NICE guideline notes that violent and sexual thoughts of this kind are often mistaken for a sign of risk6. They are often hard to say out loud, so part of the first session is understanding them properly, without judgement.
If your OCD is mostly in your head, with no visible rituals, it is still OCD and the same treatment applies. The rituals are usually mental, such as reviewing, neutralising or reassuring yourself, and exposure can be to the thoughts themselves6, 17, 2.
If you're unsure whether what you're experiencing is OCD, we can explore this together in a supportive and structured way.
Many people wait years before seeking help for OCD, often because of shame about the thoughts, or not realising it is a recognised and treatable condition12, 3, 13. Current guidelines describe early identification as important, and there is no need to wait until things are severe before getting help3.
If you're not sure where to start, you're welcome to get in touch or simply book a first appointment.
In this video, I explain how OCD is understood in therapy, how treatment targets obsessions and compulsions, and what you can expect.
James Wightman is the Principal Psychologist and Clinical Psychology Registrar providing therapy for adults on the Central Coast and in Hornsby. He offers a warm, collaborative, and evidence-based approach, helping clients build practical strategies that support meaningful and lasting change.
He has worked across Queensland Health, Aurora Healthcare, Griffith University Psychology Clinic, and private practice in Sydney, the Gold Coast, and the Central Coast.
His postgraduate research focused on what makes exposure therapy (the basis of ERP) more effective for anxiety. He is also a Professional Member of the International OCD Foundation (IOCDF).
Good therapy should be structured, respectful, and supportive in a way that helps you move forward. You'll leave sessions with something practical to try, and we'll work at a pace that feels manageable for you.
Learn more about James's approach →In the model that guides treatment, what sets OCD apart is not the intrusive thought itself, which nearly everyone has, but how it is interpreted and what you do about it1, 2, 3.
The CANMAT/ICOCS 2025 international guidelines, published in 2026, recommend cognitive-behavioural therapy, delivered as exposure and response prevention or cognitive therapy, as the first-line psychological treatment for OCD, and the Australian Psychological Society's 2024 review classifies CBT with ERP at Level I, the highest level in the evidence hierarchy it uses3, 4.
Most people who complete a course of treatment improve, a proportion do not, and some find exposure hard and stop early3, 5.
In follow-up studies averaging about two and a half years, improvements were generally maintained, although controlled long-term evidence is more limited and for some people the benefit fades5, 3.
Psychological treatment and medication are rated as comparably effective in the short term, and any medication decision sits with your GP or psychiatrist3.
Evidence reviewed September 2026.
Seeing a psychologist for the first time can feel daunting, especially if you're unsure how OCD treatment works or whether it'll be the right fit. The early sessions are simply about understanding your experience and building a clear, structured plan.
We begin by understanding how your OCD operates: your specific intrusive thoughts, the rituals or mental behaviours you use, what triggers the cycle, and what maintains it over time.
Many people feel relief simply understanding why OCD feels so powerful and why it's been difficult to break.
Towards the end of this session (or early in the second), we usually introduce the first practical strategies so you have something useful to take away early on.
Together, we build a personalised treatment plan using Exposure and Response Prevention (ERP) and cognitive strategies tailored to your specific OCD themes.
ERP is planned carefully and collaboratively; you'll never be pushed into exercises before you feel ready. We move at a pace that feels manageable and aligned with your goals.
Exposure is uncomfortable at first, and that discomfort usually shows up before the improvement does3. Some people stop at that point, which is understandable, and it is one reason the steps are planned with you and paced to what you can manage5.
You'll leave each session with practical tools to use throughout the week: response prevention techniques, ways to interrupt rumination, and structured exposure plans.
MindSure Psychology is based in Gosford CBD (Suite 112, 159 Mann St, inside John's Place), making it easy to access from across the Central Coast.
Many clients travel from nearby suburbs, including:
People often search for OCD support in their own suburb, for example, 'OCD psychologist Erina', 'OCD therapy Terrigal', or 'OCD treatment Woy Woy'. Many clients choose Gosford because it's centrally located with flexible appointment times.
Gosford appointments: Wed–Fri 11:30am–7:30pm
In-person sessions are also available at our Hornsby clinic, serving clients across the Upper North Shore including Wahroonga, Waitara, Asquith, Normanhurst, and Thornleigh.
Telehealth available anywhere in Australia
Secure video sessions are available across NSW and Australia and can be a good option if you prefer the convenience and privacy of attending from home. In trials, remotely delivered CBT for OCD worked better than waiting and, on average, was not significantly different from face-to-face treatment15. Current guidelines support it, with in-person sessions preferred where symptoms are more severe3.
$138.45 per session
Out-of-pocket cost with a Medicare rebate
Full session fee is $240 per 50-minute appointment. A Medicare rebate of $101.55 applies with a GP Mental Health Treatment Plan.
Questions people commonly ask before starting OCD treatment at MindSure Psychology.
Yes. Exposure and Response Prevention (ERP) is a first-line psychological treatment for OCD in current international guidelines, and it is a core part of how I work3. ERP involves gradually facing triggers while reducing compulsions, in a structured and collaborative way3. Cognitive strategies sit alongside it. We move at a pace that is manageable and aligned with your goals.
You do not need to be on medication to start therapy, and therapy works alongside medication if you are already taking it3. Current guidelines rate psychological treatment and SSRI medication as comparably effective in the short term, and suggest combining them where OCD is causing severe impairment3, 6. Any medication decision, including any change to what you take, sits with your GP or psychiatrist, and I work alongside them.
I support adults experiencing a wide range of OCD presentations, including contamination fears, checking OCD, intrusive thoughts (such as harm, sexual, or religious themes), "just right" symptoms, relationship OCD, moral or scrupulosity concerns, and mixed presentations.
No. The first session focuses on understanding your symptoms and mapping the OCD cycle. ERP is planned carefully and collaboratively, and you will never be forced into exercises before you understand the rationale and feel ready. Many people find relief simply having clarity and a clear plan.
It varies. Current international guidelines describe a standard initial course of ERP as around 12 to 14 sessions, with a wide range either side3. That figure is expert guidance rather than a fixed rule, and research courses have averaged a similar number3, 5. Your plan depends on your presentation, your goals and how the early sessions go. Medicare rebates apply to up to ten sessions a calendar year, so some courses run past the rebated sessions.
Yes. In trials, remotely delivered CBT for OCD worked better than waiting and, on average, was not significantly different from face-to-face treatment, though most of those trials used online programs or telephone sessions rather than video, so the evidence for video specifically is still thin15. Current guidelines support remote delivery and prefer in-person sessions where symptoms are more severe3. I offer secure video sessions Australia-wide and in-person sessions in Gosford and Hornsby. Where OCD is severe, or the exposure work is tied to a particular place, I will usually suggest in-person sessions where that is practical.
No. You can self-refer and book an appointment without a referral. A GP Mental Health Treatment Plan is only required if you would like to claim Medicare rebates.
No. Your Mental Health Treatment Plan doesn't expire, so you can start using it at any time, even if it was written a while ago. Medicare rebates are capped at 10 sessions per calendar year, and the cap resets each January. You can read more on healthdirect.
Yes, that's completely fine. If you have a valid GP Mental Health Treatment Plan, you can still attend sessions at MindSure Psychology and claim Medicare rebates, even if the referral is addressed to a different psychologist or practice. This is very common.
The online booking portal shows live availability, so the soonest open appointment is always shown there before you book. You can book online anytime, or call (02) 4313 1656.
Yes. Everything you share in therapy is confidential, with only rare legal or safety-related exceptions. Records are stored securely in line with Australian Privacy Principles.
Your first session focuses on understanding your OCD patterns (obsessions, compulsions, reassurance seeking, and avoidance), how they affect your life, and what you want to change. You'll leave with a clear, evidence-based plan tailored to your symptoms and goals. If you have a GP referral or Mental Health Treatment Plan, please bring it to your first session.
Have a question that isn't covered here? See our full FAQs.
If OCD is interfering with your life, effective, evidence-based treatment is available. You don't need a referral to get started.
Sources for the numbered citations on this page. Evidence reviewed September 2026.
