Comparison of focused cognitive behavioural therapy and treatment as usual in the treatment of obsessive compulsive disorder

Plain English summary of protocol

Background and study aims
Obsessive compulsive disorder (OCD) is a severe mental health condition that affects around 2.3% of the population. OCD can cause high levels of distress, make it harder for people to cope in their day-to-day lives, and lead to significant healthcare costs. People with OCD repeatedly experience unwanted and distressing thoughts/images (known as obsessions) and engage in repetitive behaviours (known as compulsions) to reduce their anxiety, which leads to significant distress. Individuals with OCD rarely get better on their own, indicating the need for effective treatments.

The cognitive model of OCD suggests that intrusive thoughts are common to everyone, but in OCD they are appraised as highly threatening and personally significant. Individuals with OCD tend to overestimate responsibility for preventing harm, leading to intense anxiety. Compulsive behaviours are used to neutralise perceived danger and responsibility, but these safety-seeking behaviours prevent learning that the feared outcome would not occur, thereby maintaining OCD symptoms. NICE Guidelines recommend cognitive behavioural therapy (CBT) as the first-line treatment for OCD. Numerous research papers support the use of CBT, with clinical studies indicating that CBT is more effective than no intervention (waitlist control) and drug interventions. Despite the availability of effective treatments, symptoms often go untreated for several years, with only a minority of obsessional patients receiving appropriate CBT.

National Health Service Talking Therapies (NHSTT) services (formerly known as Improving Access to Psychological Therapies (IAPT)) were developed to address health inequalities and increase access to evidence-based psychological interventions in line with NICE recommendations. Through a stepped-care model, patients with ‘mild to moderate’ OCD symptoms are initially offered with Step Two (low-intensity) interventions (computerised (c)CBT) or guided self-help (GSH), while patients with ‘severe’ OCD are offered Step Three (high-intensity) interventions. NHSTT services currently report reliable improvement rates of 53%, with recovery rates likely to be around 30%, which is significantly lower than those reported clinical studies.

This study aims to improve OCD recovery rates by training Psychological Wellbeing Practitioners (PWPs) in two NHSTT services to deliver a new low-intensity intervention for OCD, termed ‘focused CBT’. The focused CBT sessions are supported by workbook modules, with treatment involving the development of a shared understanding of their OCD difficulties and the introduction of cognitive and behavioural strategies aimed at addressing factors maintaining OCD symptoms. The secondary aim of the study is to compare groups on general mental health outcomes (anxiety, depression, and general functioning).

Who can participate?
Qualified psychological wellbeing practitioners (PWPs) working at the two participating NHSTT services. Adult patients aged 18 years and over with OCD as their main problem accepted in two NHSTT services.

What does the study involve?
Invites for participation will be sent to the PWPs from the service leads. Therapists will express their interest in the trial and provide informed consent via an online form before being randomly allocated (by chance) to deliver either treatment as usual (TAU) or focused CBT. Those in the focused CBT condition will receive training on how to deliver this treatment.

Patient referrals to the services will be assessed using their standard triage and assessment procedures, where a main problem description is identified by the assessing clinician. Participants (people with OCD as their main difficulty) will be allocated to a treatment condition randomly (by chance) and have treatment sessions with PWPs. Random allocation will be completed on a 1:1 ratio in blocks of four using an online system such as Sealed Envelope.

What are the possible benefits and risks of participating?
The present study may help to improve OCD recovery rates in local NHSTT and psychological treatment for OCD. This could significantly impact the lives of patients accessing NHSTT for OCD.The present trial is not anticipated to cause any harm, with all participants receiving an active intervention (focused CBT or TAU). Services will manage risk (e.g. safeguarding and self-harm concerns) according to standard NHS talking therapy policies. In line with routine clinical care, clinical treatment notes will be recorded on participants’ electronic NHS care records, and consent forms will be uploaded.

Where is the study run from?
This study is being conducted at two NHS Talking Therapy services.

When is the study starting and how long is it expected to run for?
June 2026 to September 2027.

Who is funding the study?
Oxford NIHR Biomedical Research Centre, UK.

Who is the main contact?
1. Roberta McGuinness, roberta.mcguinness@newc.ox.ac.uk
2. Professor Paul Salkovskis, paul.salkovskis@hmc.ox.ac.uk
3. Dr Saarim Aslam, saarim.aslam@psy.ox.ac.uk

Contact information

Study information

Eligibility

Locations

Countries of recruitment

• United Kingdom
• England

Study participating centre

Results and Publications

Editorial Notes

05/05/2026: Study's existence confirmed by Health Research Authority (HRA) (UK).