What is the best treatment for OCD? Registered Psychotherapist and CAC member, Noah Tile, shares how he helps patients with obsessive-compulsive disorder (OCD) find relief.
What if your mind constantly planted doubts that you could harm the people you love, even though you knew it wasn’t true? For people with OCD, these intrusive thoughts can feel overwhelming, shaping many aspects of their lives.
OCD treatment offers evidence-based approaches, including exposure and response prevention (ERP) therapy, cognitive therapy, and inference-based therapy (I-CBT). Therapists often complement these with modalities like dialectical behaviour therapy (DBT) and acceptance and commitment therapy (ACT).
In this blog, I’ll share how I help people recover from OCD by going beyond the treatment manuals.
My name is Noah Tile, and I am a Registered Psychotherapist in Toronto, Canada. I aim to help clients recover from OCD and live more meaningful, connected lives. Let me illustrate my approach with a case study.
Case Study: Erica’s Story
Erica, a 26-year-old high school teacher, loves her job. However, she has struggled with debilitating intrusive thoughts centered on violence and harm to others.
These obsessions are most intense around ledges and platforms with dangerous drops. In the past, whenever Erica was near these areas, she experienced terrifying thoughts and images of herself deliberately inflicting harm.
During her subway commute, she developed elaborate rituals to feel safe. She stood far from the platform, closed her eyes to avoid looking at the tracks, and listened for the train to arrive. If she saw someone near the edge, she had to stare at them until she neutralized her fear with a positive thought of them being safe. She also repeated to herself, “I am not a monster,” and sought reassurance from her partner.
At home, Erica avoided her balcony, even though she once loved mornings there with her partner. Her avoidance extended to skipping the subway entirely, relying on costly Uber rides, and sometimes staying at her parents’ bungalow to escape the challenges of her high-rise apartment.
Now in therapy, Erica is working to reclaim her life. Together, we are addressing her fears and helping her move toward greater freedom and connection.
Values and Goals
I begin OCD-specific therapy by exploring how Erica’s symptoms negatively affect her life and creating a shared vision for her future. Using ACT therapy and values work, we identify what matters most to her.
Erica shares that she wants to ride the subway without fear and enjoy morning coffee on her balcony with her partner. She hopes to spend her evenings engaged in activities she loves—reading, cooking, music, writing, and meaningful conversations with loved ones.
This values-based focus not only provides motivation but also ensures that therapy is aligned with her vision of a fulfilling life.
Cognitive Therapy
With Erica’s goals clear, we use cognitive therapy to develop healthier core beliefs and thinking patterns. She documents her insights in a notes app and reviews them regularly.
Early on, Erica identifies her core fear: losing control of her body and harming someone, which she believes would leave her with overwhelming guilt and dread forever. Together, we challenge these distorted beliefs.
Erica recognizes that her OCD is rooted in unrealistic fears. She articulates that the chances of her harming anyone are nearly zero and begins to internalize that her worries exist in the realm of imagination, not reality.
She also learns to accept risk and uncertainty, even if she cannot 100% prove that she would not lose control and do something horrendous. Over time, she deepens her understanding that intrusive thoughts do not define her character or predict her actions. She begins to trust that she is a good person, regardless of the thoughts that cross her mind.
Exposure and Response Prevention Therapy (ERP)
Once Erica has developed a strong foundation through cognitive therapy, we transition to ERP. This phase helps her build the courage to face her fears by stopping rituals and avoidance. ERP allows her to confront her core fears head-on without neutralizing her thoughts or seeking reassurance.
My ERP approach is values-focused. We prioritize addressing compulsions and avoidance behaviours that most disrupt her quality of life, mapping out the specific triggers she encounters daily—what is often called lifestyle exposure.
For instance, during one virtual session, Erica and her partner joined me via video and walked onto their balcony together.
They shared a coffee and even leaned against the railing, demonstrating a significant step forward. She then committed to practicing this every day, regardless of her anxiety and intrusive thoughts. She learns, using a DBT phrase, to trust her wise mind.
We also incorporated deliberate exposures to provoke obsessions and practice non-compulsive responses. In one session, Erica practiced walking progressively closer to the yellow lines at the subway station without boarding a train. This exercise was a stepping stone toward resuming her daily subway commute.
Deliberate exposures are like training grounds, preparing the mind and body for real-life challenges. Throughout ERP, Erica practiced staying present, engaging her senses and tuning into the world around her instead of dissociating or ruminating.
Mental Health Tools for OCD
Throughout therapy, I also equipped her with distress tolerance, mindfulness and emotion regulation tools from DBT. We also incorporate skills from ACT therapy, to allow her to defuse, or disengage from intrusive thoughts, while accepting difficult emotions.
Progress and Reflection
Over time, Erica learned to trust herself, her senses, and the world around her. Her faith in God deepened as she released the belief that she was a monster. She gained confidence in her ability to manage anxiety triggers and intrusive thoughts.
Sometimes, Erica, like all human beings, engages in safety behaviours and rituals that make her feel better, which is her choice. She now knows she doesn’t need to do these things. What matters most is that OCD is not causing her dysfunction or preventing her from living her best life.
The heart of OCD therapy is fostering agency—the ability to choose not to cope through compulsions and to see that life can be brighter on the other side. This is my hope and prayer for every person I am privileged to help.
Thank you to Noah Tile of our CAC for this insightful article on OCD treatment.
Read Noah Tile’s next blog post on treating Faith-Based OCD.