Depression is complex and it isn't realistic to identify a correct causal pattern with every person. Conversely focusing on a single solution does not always help. Although CBT remains one of the most evidence-based treatments, there’s growing interest in whether supplements can help with treating depression.
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Supplements are not a replacement for therapy or medical treatment. But some supplements can be helpful when used correctly.
This article cuts through the noise and focuses on supplements with actual evidence behind them. Don't however forget that supplements don't replace Cognitive Behavioural Therapy. You can book therapy in Richmond and remote based with me.

Omega-3s—particularly EPA (eicosapentaenoic acid)—have one of the strongest evidence bases among supplements aimed at treating depression.
Considerations to keep in mind:

• EPA-heavy formulations appear more effective than DHA alone
• May reduce inflammation linked to depressive symptoms
• Particularly helpful in mild-to-moderate depression

Takeaway: Look for a supplement with at least 1,000 mg of EPA daily, ideally with a higher EPA-to-DHA ratio.

Low vitamin D levels have been repeatedly associated with depression, especially in countries that enable less sunlight exposure.
Why it matters:

• Vitamin D plays a role in brain function and mood regulation
• Deficiency is widespread in the UK and Northern Europe
• Supplementation may improve mood in certain individuals

Practical takeaway: If you aren't exposed to much sunlight, supplementation can often be beneficial. Blood testing is ideal, but many people benefit from 1,000–2,000 IU daily.

​Magnesium is involved in many biochemical processes, including those that regulate stress and mood.
What it may help with:
    • Anxiety and irritability
    • Sleep quality
    • Nervous system regulation
Evidence:
Some trials find that magnesium supplementation can reduce mild depressive symptoms, particularly where a deficiency exists.
Practical takeaway: Forms like magnesium glycinate or citrate tend to be better absorbed and gentler on the stomach.

 Saffron is one of the more surprising entries—but also one of the most promising.
Research highlights:

• Several studies suggest saffron can be as effective as SSRIs in mild-to-moderate depression
• May influence serotonin levels
• Fewer side effects compared to antidepressants

Practical takeaway: Typical doses range from 28–30 mg daily (standardised extract).

B vitamins are essential for brain function and neurotransmitter production.
Key points:

• Low B12 and folate levels are linked to depression
• Supplementation may improve response to antidepressants
• Vegans and vegetarians are at higher risk of deficiency

Practical takeaway: Consider a high-quality B-complex or targeted supplementation if deficiency is suspected.

An adaptogenic herb often used for stress and anxiety.
Potential benefits:

• Reduces cortisol (stress hormone)
• May improve resilience to stress
• Indirectly supports mood

Evidence: More robust for anxiety than depression, but useful where stress is a major driver of symptoms.

Not all “natural” supplements are safe or effective.
Use caution with:

• St John’s Wort – can interact dangerously with antidepressants and other medications
• 5-HTP – may increase risk of serotonin syndrome when combined with SSRIs.
• High-dose or poorly regulated products bought online

Always check with a GP if you’re taking medication.

Even when supplements help, they don’t address the psychological mechanisms that maintain depression.
From a CBT standpoint, depression is often driven by:

• Negative thinking patterns about the future, oneself and one's environment. For severely depressed clients this can be the default state.
• Behavioural withdrawal and other unhelpful behavioural patterns which keep clients stuck.
• Avoidance cycles
• Low reinforcement from the environment

Supplements may improve your baseline—but they may not change everything that needs to be addressed.
That’s where structured therapy can become helpful.
If you’re struggling with persistent low mood, booking a session will help you find  a way forward.

Think of supplements as part of a broader system, not a solution in isolation:

• Therapy → addresses thought patterns and behaviour
• Lifestyle → sleep, exercise, routine
• Supplements → support underlying biology

Used together, they can be powerful.

There is no “magic supplement” for depression. But there are evidence-based options that can support recovery—especially when used alongside therapy and lifestyle changes.
If you’re considering supplements:

• Focus on those with real evidence (Omega-3, Vitamin D, Magnesium, Saffron)
• Avoid stacking too many at once
• Track your response over time

And most importantly: if your depression is ongoing, don’t try to solve it alone.
You can find structured, evidence-based support through by booking a therapy session with me, or explore therapist matching options via seekapsych.com.

This article is for informational purposes and does not replace medical advice.

Remote work as been increasingly common in recent years. While working from home can have many advantages, many are noticing psychological costs to working from home. From blurred boundaries to the problems that go with increased isolation, home-based work can negatively influence your mental health. Many clients that I treat find that their mood decreases and that they worry more when they have spent extended periods of time alone.
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From a cognitive behavioural perspective, one's environment has the potential to influence mood, behaviour and stress levels. Renting office space — whether a private consulting room, a serviced office, or shared workspace can provide numerous mental health benefits. We will now explore the reasons for this.

Humans are wired for connection. Even brief social interactions like greeting someone in the morning or chatting over coffee, can have a positive influence on mood.
When working from home, opportunities for spontaneous interaction are reduced. Over time, this can contribute to loneliness, low mood and heightened anxiety. If someone is already a bit socially anxious, withdrawal from others can often make their anxieties worse.
A rented workspace introduces light but beneficial social contact, which research consistently links to improved resilience and also reduced stress.

One of the most powerful mental health benefits of office space is separation from settings that are meant to provide a different function.
When your kitchen table doubles as your desk, it becomes difficult to “switch off.” This blurred boundary can lead to:

• Persistent stress
• Difficulty relaxing
• Sleep disruption
• Gradual burnout

Physically leaving a workspace reinforces a behavioural cue: work has ended and makes it easier to relax in your home environment. In CBT terms, this supports stimulus control and reduces rumination outside of working hours.

Home environments often contain competing stimuli — chores, family members, deliveries, screens and other kinds of distractions.
Your own office space signals to the brain that it is time for focused work. This environmental cue can cause:

• Enhances concentration
• Reduces procrastination
• Lowers deadline-related stress
• Improves task completion satisfaction

In CBT, we explore how environmental structure supports behavioural activation and therefore an increase in mood. A clear workspace supports intentional and goal-directed behaviour.

A healthy routine helps stabilise mood. It reduces uncertainty and decision fatigue.
Commuting (even a short walk), arriving at a workspace and finishing at a set time provides predictable structure. This predictability can:

• Reduce anxiety
• Improve motivation
• Enhance sleep patterns
• Support emotional regulation

Without structure, work can gradually expand to fill all available time. This causes exhaustion and leads to reduced recovery.

Your own environment shapes how you see yourself.
Working in a professional setting reinforces a healthy identity and a sense of competence that is partially driven by the direct interaction with others. For therapists, consultants, and independent professionals in particular, having a dedicated office can:

• Increase confidence
• Strengthen boundaries with clients
• Support professionalism
• Reduce imposter feelings

Physical space therefore has a big influence on our lives.

 Burnout often develops gradually. Warning signs include:

• Emotional exhaustion
• Cynicism or detachment
• Reduced productivity
• Irritability
• Persistent fatigue

When work and home merge, recovery time can shrink. Renting office space restores psychological distance, which is essential for sustainable performance. It is therefore also important for you to design your home life that also resembles the psychological components that drive and enable helpful rest and downtime. This means avoiding escapist behaviours whilst also pursuing meaningful activities.

Not everyone needs in person office space for them to attend. Some people can make the most of and benefit from a hybrid approach — working from home part-time while using a rented office or their employers office.
If you notice:

• Difficulty switching off
• Increased irritability
• Reduced motivation
• Feeling isolated
• Blurred boundaries

Your environment could well be contributing to your stress levels.

At Klein CBT, I understand that mental well-being is shaped not only by thoughts but by behaviours and / or  the environments we shape and live in.
Small structural changes — such as separating work and home — can significantly improve mood, clarity and resilience. It can even enable experiencing a sense of purpose.
If you are experiencing stress, anxiety, burnout, or low mood professional support can help you identify  changes that may improve your mental health.

If work stress, burnout, or anxiety are affecting you, I offer a free 15-minute introductory call to see whether my style of CBT would be a good fit for you.
You can learn more about my therapy services here:
👉 Online and Phone Based Therapy
👉 Therapy in Richmond
👉 Mental Health Assessments

Exposure and Response Prevention (ERP) is the psychological treatment for Obsessive‑Compulsive Disorder (OCD) with the strongest research backing. ERP is a core part of how I help clients recover from OCD which includes Pure O and other forms where compulsions are largely mental (internally based) rather than visible.
This client guide explains how ERP can be applied for Pure O and other types of OCD presentations and why a strong emphasis is on acceptance based approaches compared to traditional thought challenging.

​“Pure O” is an informal term used to describe OCD where obsessions are prominent and compulsions mostly play out inside of someone’s head. OCD always involves compulsions but they are not always obvious.
OCD often revolves around types and themes such as scrupulosity or cleanliness (there are infinite variations when it comes to OCD. Not all are “officially” listed.) Common Pure O themes include:
    • Harm OCD
    • Sexual OCD
    • Relationship OCD (ROCD)
    • Religious or moral OCD (scrupulosity)
    • Existential OCD
Mental compulsions often include:
    • Reassurance seeking (from yourself or others)
    • Mental checking
    • Analysing or problem-solving thoughts
    • Neutralising thoughts with “good” thoughts
    • Reviewing past events
    • Googling or researching for certainty
When working with me, ERP for Pure O focuses on identifying and reducing these internal responses, rather than trying to control or eliminate uncomfortable thoughts.

​ERP has two essential components:
    1. Exposure – intentionally allowing feared thoughts, images, feelings or uncertainty to be present (sometimes a mixture of all of these things.)
    2. Response Prevention – choosing not to engage in compulsions (including mental ones). An important point her is to keep response prevention simple. Over-planning on how to work on your OCD can become a compulsion in itself.
The goal of ERP is not short term relief. Instead, it helps retrain the brain to learn that:
    • Intrusive thoughts are not dangerous
    • Anxiety is uncomfortable but tolerable
    • Feelings rise and fall without needing to be fixed
    • Certainty is not required to live a meaningful life
Over time, this weakens the OCD cycle as the sense of threat associated with triggers and / or obsessions lessens.

​Many people come to therapy having tried to argue with or logically challenge their intrusive thoughts:
    • “That would never happen.”
    • “I know I would never do that.”
    • “This thought makes no sense.”
While cognitive restructuring can be useful in other difficulties, in OCD it can often run the risk of keeping the problem going.
From a clinical perspective, thought challenging:
    • Keeps attention locked on the obsession
    • Treats the thought as meaningful or dangerous
    • Becomes another form of reassurance
    • Fuels the need for certainty
OCD is not persuaded by logic. When seeking therapy with me, ERP is designed to help clients step out of the mental debate altogether.

Rather than trying to change or disprove thoughts, acceptance based ERP focuses on changing your response to them. Ideally you will end up doing less and not more.
This approach draws on both ERP and Acceptance and Commitment Therapy (ACT) and is effective for Pure O and other forms of OCD.
Key principles include:

• Allowing intrusive thoughts to be present without fixing them
• Making room for anxiety instead of resisting it
• Letting uncertainty exist without resolving it.
• Letting go of control.
• Choosing behaviour based on values, not fear

This does not mean liking thoughts or agreeing with them. It means learning that you can live well even while they are there.

​1. Identifying Mental Compulsions
The first step in effective ERP is helping clients clearly identify what they do in response to intrusive thoughts.
In therapy, we explore questions such as:
    • What do you do to try to feel safe or certain?
    • What mental actions follow the thought?
    • What are you hoping will happen if you think this through?
ERP targets the stuff people do to get some sense of control and short term relief. This could be something visible or something they do in their own head.

2. Designing Meaningful Exposure Exercises
For Pure O, exposures often involve intentionally allowing thoughts, images or uncertainty without doing anything about them. Keep it simple!
Examples may include:
    • Deliberately bringing on feared thoughts
    • Reading or writing triggering statements
    • Imaginal exposure to feared scenarios
    • Allowing doubt to remain unresolved
The exposure is allowing these experiences without correcting, neutralising, or analysing them.

3. Response Prevention Through Non Engagement
Response prevention means learning to notice urges to analyse, reassure, or check — and choosing not to follow them.
Instead of thought challenging, clients are supported to practise noticing their triggers and / or obsessions whilst not taking the bait of engaging with them.

4. Allowing Anxiety to Rise and Fall
A key part of ERP is learning that anxiety is self limiting.
When compulsions stop or are done less:
    • Anxiety often increases at first
    • Urges to gain certainty may feel strong
    • The mind may insist something must be done
In therapy, we focus on staying present and allowing anxiety to run its course, rather than trying to calm it.
With repetition, the nervous system learns that anxiety does not need to be controlled and often the anxiety itself lessens.
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5. Living Life Alongside OCD
Some of the most powerful ERP work happens in everyday life.
This includes:
    • Making decisions without full certainty
    • Continuing relationships, work or activities despite being anxious
    • Allowing intrusive thoughts during valued actions
Recovery is not about feeling confident — it is about acting without waiting for confidence first.

• Using acceptance language as subtle reassurance
  
• Mentally analysing while appearing calm
  
• Waiting to feel better before moving on
  
• Measuring success by how little anxiety is felt
  
• Constantly over-planing or reminding oneself of suitable ERP methods.
  
• Often stopping all compulsions at once can be too challenging and risky. Graded exposure can often help (exceptions exist)
  

If a strategy is designed to make anxiety disappear, OCD is usually still in control.

ERP is a structured but flexible treatment.
Clients often notice:

• Early changes in how they respond to thoughts
  
• Gradual reductions in distress and rumination
  
• Increased confidence in handling uncertainty
  

Progress is rarely linear, and setbacks are a normal part of recovery.

ERP for Pure O and other forms of OCD is most effective when it moves away from thought challenging and toward acceptance, willingness and behaviour change.
If you are struggling with Pure O or another form of OCD, I offer specialist, evidence based treatment using ERP and acceptance based approaches.
Therapy is available in Richmond, London, online and over the phone. A free initial consultation is available to discuss whether this approach is the right fit for you.

Christmas. A magical time of lots of family. The thought of navigating the holiday season with your children and parents can spark both joy and mild panic in equal measure (approach/avoidance). So here’s a little guide to help you keep your sanity while still enjoying the festivities.

Let’s start with your expectations. Not every gift exchange will be heartwarming, every meal exceptional and emotive, and every family game a laugh-filled success. For many there will be burnt turkey, awkward silences and someone inevitably arguing.
Tip: Try to let go of perfection. In CBT terms, notice your expectations, label them as and ask yourself: Does this expectation help me enjoy the day, or just set me up for stress? The more you let go, the more stuff you can do without feeling like all has failed.

Have some structure and realistic scheduling. This is however not a work environment so the festive season should not only be consisting of tasks.

• For kids: Plan a few activities, but keep them short and sweet — little wins help build up momentum.
  
• For parents: Build in quiet moments. Even a short coffee break or a stroll can keep tempers cool.
  

Misunderstandings multiply around the table. Here’s a simple framework:

• Express, don’t explode. When you’re rushed or forcing yourself to be in a good mood, delaying responses to your anger and frustrations may help.
• Set gentle boundaries. It’s okay to say: “I’ll help with the kids for an hour, then I need a break.”

Family members often have different values or opinions. Instead of rolling your eyes, try curious observation. Ask questions, listen actively and notice when you get triggered without having to then engage in a battle (I disagree but I don’t have to force my opinion onto others).
CBT twist: notice your internal reactions, label them, and choose a response that works for you. It’s a tiny exercise in emotional regulation — and it works wonders over Christmas dinner.

Christmas with children and parents doesn’t have to be a minefield. With flexible expectations, structured time, gentle boundaries, curiosity and humour, you can survive — and maybe even enjoy — the holidays.

Obsessive-compulsive disorder (OCD) is typically treated with SSRIs and Cognitive Behavioural Therapy. Many patients are interested how they can make use of supplements as an adjunct to conventional treatment approaches. Research on supplements is still somewhat limited but growing.
See below summary for supplements that have some clinical evidence. For each supplement we note what the treatment mechanism is and what trials show. Always discuss supplements with your doctor as they can interact with medication and have side effects. This is not medical advice.

NAC is an antioxidant that is derived from cysteine. It modulates glutamate neurotransmission. In OCD trials (typically over 12 weeks using 2.4–3.0 g/day), NAC has reduced symptom severity. A systematic review found NAC “reduces the severity of symptoms, with a good tolerability profile”. It may help with compulsions and is often studied as an add-on to SSRIs. Typical dosage is 2–3 g/day (split AM/PM).

• Mechanism: Increases brain glutathione (antioxidant) whilst regulating glutamate, which may calm overactive brain circuits that are linked to OCD.
  
• Evidence: Several small trials/case reports indicate a beneficial effect. For example, one trial showed significantly lower Yale–Brown OCD scores on NAC vs placebo. (However, studies are small and more research is needed.)
  
• Safety: Well-tolerated; common side effects include mild nausea, rash, constipation or gas. It has a sulfurous odor (odorless formulations exist). No major drug interactions noted, but always check with your doctor.
  
• Caveat: NAC is NOT to be seen as a replacement for standard OCD treatments. It’s an adjunct (often used with medication/therapy).
  

Myo-inositol (MI) is a nutrient that is in involved in cell signaling (including serotonin and glutamate pathways). In one placebo-controlled trial, 18 g/day of MI (monotherapy) improved OCD symptoms. However, adding MI to an SSRI offered no additional benefit over SSRI alone. This suggests MI might help some patients if used instead of (not with) medication. Research is limited.

• Mechanism: Influences inositol-related signaling in neurons. This could be affecting neurotransmitters involved in OCD.
• Evidence: One study with a small sample size found that MI alone reduced OCD severity. But the evidence is quite sparce.
• Safety: High doses (15–18 g) are required and side effects are mostly GI (bloating, gas, diarrhea). These usually lessen over time.
• Note: MI is generally safe but high-dose powders are bulky.

Omega-3s (fish oil) have many anti-inflammatory and neuroprotective effects. However, one small trial (11 OCD patients that were on a stable course of SSRIs) added 2 g/day EPA and found no significant improvement that was beyond placebo. The current state of evidence does not support omega-3s for OCD specifically. However, omega-3 supplements are generally safe and may infer benefits for mood and heart health.

• Mechanism: Omega-3 is thought to modulate neuronal membranes, inflammation and neurotransmission. The exact effect on OCD is unclear.
  
• Evidence: Only one published OCD trial (EPA vs placebo) which showed no benefit. Meta-analyses have found a beneficial impact of omega-3s with depression/anxiety. Trials focused in treating OCD are however lacking.
  
• Safety: Side effects are mild (heartburn and nausea). Beware that high doses can thin blood.
  
• Caveat: Omega-3s can be used for general health, but are not a replacement for OCD therapy.
  

St. John’s Wort is an herbal antidepressant with mixed results for treating OCD. An early open-label study showed symptom improvement, but a subequent trial found no benefit over placebo. In general, SJW appears to be ineffective for treating OCD.

• Mechanism: May increase serotonin (among other neurotransmitters), but its effect on OCD circuits is unproven.
• Evidence: Only two small studies exist. The controlled trial failed to show an improvement. SJW may help with treating comorbid depression, but not OCD.
• Safety: Side effects can include insomnia, headache and GI upset but are usually mild. Important: SJW strongly interacts with many medications (SSRIs, birth control, anticoagulants) and it can make sense to avid taking it when taking other drugs.
• Caveat: Due to a lack of benefit and potential drug interactions, SJW is generally not recommended for treating OCD.

These herbal remedies have one small trial each for managing OCD (from the same research group out of Iran).

• Borage: An Omega-6 source thought to affect serotonin transport. A 4–6 week trial reported reduced OCD and anxiety symptoms with borage extract. However, this is preliminary. Use only PA-free (pyrrolizidine alkaloid-free) borage products to avoid toxicity.
• Milk Thistle (Silybum marianum): Traditionally a liver tonic. One trial (6 weeks) found results that are comparable to fluoxetine in OCD. But this is a single study and unreplicated.
• Caveat: Because the available data is weak, borage and milk thistle remain unproven. Discuss liver enzymes and pay attention to quality if considering them.

These are natural serotonin precursors. No controlled studies show any benefit for treating OCD. High doses can cause fatigue, headache and nausea. Combining them with SSRIs can trigger serotonin syndrome (overload of serotonin). Due to lack of proof and safety concerns, tryptophan/5-HTP are not recommended supplements.

Some nutrients have been studied: OCD patients often have low vitamin D and occasionally low B12 or folate.

• Vitamin D: Studies find most OCD patients are vitamin-D deficient and low vitamin D correlates with worse OCD symptoms. No large trials have tested high-dose vitamin D in OCD, but correcting a deficiency is wise for overall brain health which may help boost mood. It is recommended to use standard doses and avoid exceeding safe upper limits.
  
• B Vitamins: Low B12 (and sometimes low folate) have been observed in OCD cohorts. While supplementing a deficiency is important, there’s no strong data that extra B12/folate meaningfully reduces OCD symptoms.
  
• Other Minerals: Magnesium and zinc can support general nervous system function. No specific OCD trials exist.
  

Supplements can be a useful aid alongside standard OCD treatments, but they are not replacements for medication or cognitive-behavioural therapy. Always talk to a doctor before starting any supplement. Reliable brands are recommended in order to ensure quality.

Cognitive Behavioral Therapy (CBT) in Richmond is common and represents an effective set of approaches that are effective for the treatment for a variety of mental health conditions. These include anxiety, depression and obsessive-compulsive disorder. Third-wave CBT approaches such as mindfulness-based cognitive therapy (MBCT), acceptance and commitment therapy (ACT) and dialectical behaviour therapy (DBT) differ from Beckian Cognitive Therapy by incorporating concepts like mindfulness, acceptance and emotional regulation. Third wave approaches often don’t focus on challenging thoughts. An emphasis is on changing behaviours. These more modern approaches have measurable effects on the brain. Understanding which areas of the brain are impacted by third-wave CBT can provide insight into how these therapies facilitate psychological change.

Third-Wave CBT: An OverviewThird-wave CBT approaches lay an emphasis on acceptance and the relationship individuals have with their thoughts and emotions. Unlike traditional Beckian Cognitive Therapy, which focuses on identifying and restructuring distorted thoughts, third-wave therapies help individuals change the relationship with relevant internal experiences by observing thoughts, accepting discomfort whilst engaging in a direction that is in line with one’s values. Mindfulness meditation, defusion (observing internal experiences) and emotional regulation represent important elements.

Key Brain Areas Impacted by Third-Wave CBT1. Prefrontal Cortex (PFC): Enhancing Executive ControlThe prefrontal cortex is responsible for executive functions such as decision-making, impulse control and emotional regulation. Mindfulness-based approaches like MBCT strengthen the PFC by improving self-awareness and cognitive flexibility.

• Impact of Mindfulness and ACT: Regular mindfulness practice is an element of third-wave therapies which increases activity in the PFC. This enhanced activation allows individuals to pause and respond to situations rather than reacting impulsively.
• Emotional Regulation: By strengthening the PFC, third-wave CBT helps clients manage emotions and reduce rumination.

The PFC may be underactive in problems such as anxiety and depression. Third wave therapies restore balance and improve mental clarity.

2. Amygdala: Reducing Emotional ReactivityThe amygdala is a small almond-shaped structure deep in the brain and plays a role in processing emotions, particularly fear and stress responses. With anxiety, PTSD, or depression, the amygdala is often hyperactive which can lead to heightened emotional reactivity and a subsequent exaggerated stress response.

• Impact of Mindfulness-Based Techniques: Mindfulness meditation, a central component of third-wave CBT, reduces amygdala activation. Regular mindfulness practice helps individuals observe emotions without these controlling their life.
• Cognitive Defusion in ACT: Cognitive defusion as used in ACT, allows clients to learn to see thoughts as mental events rather than absolute truths. This also helps to reduce emotional reactivity. By learning to observe distressing thoughts, the amygdala's stress response gets less.

This change allows individuals to manage situations with greater calm.

​3. Anterior Cingulate Cortex (ACC): Improving Attention and AwarenessThe anterior cingulate cortex (ACC) is involved in attention regulation and emotional awareness. Third-wave therapies, particularly mindfulness-based interventions, strengthen the ACC’s role in maintaining focus whilst minimising mental interference.

• Mindfulness and Focus: MBCT and DBT help people focus on the present, improving the ACC’s ability to sustain attention.
• Reducing Rumination: By enhancing the ACC’s function, third-wave CBT helps individuals break free from patterns of overthinking and rumination which is common in depression and anxiety disorders.

Strengthening the ACC supports a more balanced response towards daily stressors.

4. Insula: Increasing Interoceptive AwarenessThe insula is a region of the brain related to the awareness of bodily sensations such as the heartbeat, breathing and emotional states. Third-wave CBT approaches, particularly mindfulness and ACT, emphasise body awareness.

• Mindfulness Meditation: Practices like body scans activate the insula, thereby increasing awareness of bodily sensations and their connection towards emotional states.
• Emotional Acceptance: By improving interoceptive awareness, third-wave CBT helps clients accept discomfort and respond to emotions in a better way.

This heightened connection between body and mind fosters helps in many ways.

Neuroplasticity: The Brain’s AdaptabilityThird-wave CBT impacts the brain in ways that lead towards neuroplasticity, the brain’s ability to reorganize itself by creating novel neural connections. The regular practice of mindfulness, acceptance and emotional regulation related techniques strengthens connections between the prefrontal cortex, amygdala and other relevant regions.

Perfectionism can sometimes lead to excessive self-criticism and an unhealthy pursuit of unattainable standards. While striving for high standards can be positive, some types of perfectionism can bring significant emotional and mental distress. Types of distress that are common include anxiety, procrastination and burnout. Cognitive Behavioural Therapy (CBT) is an approach that helps address the harmful effects of perfectionism. This is how CBT can help you take practical steps toward finding balance:

1. Understand Yourself:
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First you need to understand what perfectionism looks like for yourself. Some for example engage in a critical self focus which keeps them stuck by preventing them from expanding their behavioural repertoire.


2. Unrealistic Standards:

Perfectionism can make people set unattainable goals whilst feeling defeated when they’re not met. Not feeling good enough deep down can make people always want to change their current state, whilst pursuing the futile quest of chasing unrealistic goals.

Perfectionism can make people view outcomes as either total successes or absolute failures.

Fear of Failure: Some people procrastinate because of the fear of not meeting their unrealistic standards.

The first step in overcoming perfectionism is understanding these patterns and recognizing how they contribute to stress, procrastination and maintain low self-esteem.

3. Be aware of Perfectionist Thinking:

CBT helps individuals identify and manage unhelpful thoughts. This includes:
Write down perfectionistic thoughts like, “If I don’t do this perfectly, I’m a failure,” and try to understand how this fits within the overall presentation of yourself. Being aware when these thoughts play out AS THEY OCCUR will help you not recognise that you are not your thoughts and you have far more control of what and how you do what you do in your life.


4. Defining Goals:

Set goals that are beneficial for yourself. It is crucial to avoid the trappings of over extending yourself after you have met predefined goals. Have a baseline that you want to cover and do not indulge in self criticism if you do not regularly exceed that baseline. Over extending yourself can become an addiction.

Focus on Progress: Shift the emphasis from achieving perfection to making consistent progress that is not black and white (do not do a lot one day and very little the other).

By adopting a more realistic approach, you’ll find tasks less daunting and more attainable.


5. Embrace Imperfection

Intentional Imperfection: Try completing a task to a “good enough” standard rather than a perfect one. For example, send an email without endlessly reviewing it.

Reflect often: Look back at your behavioural patterns and reflect how these interacted with aspects of your environment. If you know what drives your perfectionism and other problems then you will learn how so many helpful things such as understanding what prevents the snowball from getting bigger.

Overcoming Procrastination: Break tasks into smaller, actionable steps.

Balance Rest and Work: Schedule regular breaks and set boundaries to avoid burnout. Remind yourself that rest is essential for productivity.

By addressing these patterns, you can establish healthier routines and reduce stress.

6. Build Resilience to Criticism

A common fear among perfectionists is external judgment or criticism. CBT equips individuals with tools to cope:

Reframe Criticism: View feedback as an opportunity to grow rather than a personal attack.
Role-Playing: Practice responding to imagined criticisms in a therapy session to build confidence for handling real-life situations.
Learning to accept constructive feedback without equating it to failure will help you overcome perfectionism.

There are many ways to work on perfectionism and what is best for some may not be a good solution for others. In order to understand how you can best work on your own perfectionist tendencies, you need to understand yourself and then make use of that understanding in the best way you can. It does not make a difference whether you try and use CBT for perfectionism through in person sessions, online therapy or over the phone. Research has shown that all of these mediums are effective in treating perfectionism.

Obsessive-Compulsive Disorder (OCD) is a mental health condition in which individuals experience intrusive thoughts (obsessions) and short term reward behaviours (compulsions) which aim to reduce the anxiety caused by these thoughts. Brain imaging studies have provided valuable insights into the affected brain areas that underpin OCD. Repeat research has highlighted specific brain areas that play a significant role in the disorder. The key brain regions related to OCD include:

1. Orbitofrontal Cortex (OFC): The OFC is involved in decision-making and the processing of rewards and punishments. Sufferers of OCD experience that this region is often overactive. This is seen as a contributing factor to the excessive anxiety and doubt that is often experienced by individuals. This overactivity leads to the repetitive thoughts (obsessions) that drive compulsive behaviors.
2. Striatum: The striatum is a part of the basal ganglia and is responsible for the formation of habits and motor control. In OCD, there is a dysfunction in the cortico-striato-thalamo-cortical loop, which leads to the persistence of compulsions. The striatum can reinforce compulsive behaviour when it is overactive.
3. Thalamus: The thalamus acts as a relay station for sensory information. It is believed that in OCD, abnormal thalamic function may contribute to the loop of repetitive thoughts and behaviours. Dysfunctional communication between the thalamus and the OFC leads to the persistence of obsessive thoughts.

These brain areas work together in a feedback loop that perpetuates the cycle of obsessions and compulsions in OCD.

Cognitive Behavioural Therapy (CBT) is widely regarded as one of the most effective treatments for OCD. Many styles of CBT aim to address the reinforcing cycle of obsession and compulsion. Since the pandemic, online CBT for OCD, such as those offered by therapists in London or through online platforms, has become increasingly popular, as it provides flexible access to treatment. Many individuals specialised in working with OCD may work further away.

CBT focuses on exposure and response prevention (ERP), a key technique in which individuals often gradually expose themselves towards feared situations or thoughts (exposure) whilst reducing, or stopping the performing of compulsive rituals (response prevention). This process helps to reduce the anxiety associated with their obsessions over time whilst consequently disrupting the compulsive behaviours that reinforce obsessive thoughts.

UCL Case Formulation ModelThe UCL Case Formulation Model of CBT offers a structured framework for understanding and treating OCD and was devised by the founder of ERP. This model places significant emphasis on understanding the individual's unique cognitive and other internal and external processes that contribute to the development and maintenance of OCD. By working with an OCD therapist online​, over the phone or in person, individuals can identify their respective factors that lead to compulsive behaviours. This allows for more tailored interventions.

The UCL model encourages clients to explore their own individual circumstances and contributing factors. Common elements can be the overestimation of the risk of harm or an excessive need for certainty, which can fuel obsessive thoughts.

Acceptance and Commitment Therapy (ACT)ACT, is a form of therapy that falls within the third wave of CBT, is often used in the treatment of OCD. ACT focuses on acceptance of intrusive thoughts rather than trying to eliminate them. It teaches individuals to view their obsessions as thoughts that do not necessarily require action. By further developing mindfulness skills, they also train impulse controls which fuels psychological flexibility and helps with OCD. ACT helps clients develop the ability to engage in values-based actions even in the presence of distressing thoughts.
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ACT can be particularly effective for those who struggle with the overwhelming anxiety that accompanies their obsessions, as it encourages acceptance of discomfort without resorting to compulsive behaviours. One can make use of it when pursuing therapy online, making it accessible for those looking for online options for treating their OCD through therapy. These often include phone therapy or video sessions.

How Different Forms of CBT Address Brain Areas Affected by OCDCBT works to address the brain regions associated with OCD by managing how individuals respond to intrusive thoughts and by reducing the overactivity in the regions responsible for compulsive behaviours.

• Orbitofrontal Cortex (OFC): CBT helps to recalibrate the overactive OFC by helping individuals tolerate anxiety and uncertainty whilst stopping compulsive actions from reinforcing obsessive thoughts.
• Striatum: The practice of ERP means that individuals can weaken the habit formation processes in the striatum by reducing the compulsive behaviours that this brain area promotes. ACT further reinforces this by encouraging individuals to engage in behaviours that are aligned with their values, even when impulses want to tell them otherwise. This breaks the automatic response loop.
• Thalamus: The communication between the thalamus and other brain regions is also addressed. By having a lessened need for compulsive responses, CBT and ACT help to interrupt the cycle that keeps obsessive thinking and compulsive behaviour going.

The Rise of Online Therapy for OCDAs many competent therapists that specialise in OCD are hard to find, pursuing therapy over the phone or online can provide a big benefit for many clients. Many therapists and clients also find the it easier to talk about intrusive thoughts they find embarrassing remotely or through the telephone.
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Whether through phone therapy, video call, or online CBT programs, doing CBT remotely offers the flexibility to engage in treatment that is evidence based. Especially with something as uncommon as the UCL Case Formulation Mode. OCD therapists that work online are trained to be able to work remotely and / or face to face.

Obsessive-Compulsive Disorder (OCD) is a mental health condition in which people experience unwanted thoughts (obsessions) and repetitive behaviours (compulsions). Compulsions are performed in order to reduce anxiety. Although our understanding of OCD has evolved significantly over time, treatment approaches have developed from rudimentary practices to sophisticated and evidence based therapies. This article explores the history of treating OCD around the world. How treatments have changed and how individual and group settings differ in addressing the disorder will be covered.

Ancient and Pre-Modern Understanding of OCD

The first widely known evidence detailing obsessive-compulsive symptoms can be traced back to ancient Greece. Hippocrates described symptoms resembling what we now understand to be OCD, even though there was little understanding of how to view OCD from a psychological paradigm. OCD, like most ailments, was often attributed to an imbalance of bodily humors.
Ancient cultures had a tendency to see obsessive behaviours through either spiritual or moral lenses. In some cultures throughout the world, people who displayed unusual rituals or compulsions were thought to be possessed by evil spirits or under some kind of divine influence.

During the Middle Ages in central Europe religious explanations tended to dominate. Obsessive behaviours were often viewed as sins or moral failings. People exhibiting these symptoms were sometimes subjected to harsh punishment or exorcisms in order to ‘cleanse’ them. The Renaissance and enlightenment provides the intellectual soil for the rise of early psychological thought. The first inclinations towards a more scientific understanding emerged. However, mental disorders were still often seen through a theological lense.

The Rise of Modern Psychiatry and Early Treatments

The 19th century experienced the emergence of psychiatry as a medical discipline. This laid the foundation for a more structured understanding of mental disorders. French psychiatrist Jean-Martin Charcot and his student Sigmund Freud made early contributions to the understanding of neurosis, including obsessive symptoms. Freud’s psychoanalytic theory linked OCD to unconscious conflicts, particularly those stemming from childhood experiences and repressed desires. This paradigm guided early approaches towards treating OCD. Treatments focused on uncovering repressed emotions through techniques such as free association and dream analysis.

Treatment options during the early 20th century were still largely experimental and often did not result in any meaningful reduction in symptoms. Interventions included methods like electroconvulsive therapy (ECT) and lobotomies. These were sometimes used for severe cases of mental illness. While these treatments had varying degrees of success, they were also often harmful.

The Birth of Cognitive Behavioural Therapy (CBT)

The landscape of OCD treatment began to change in the mid-20th century with the development of Cognitive Behavioural Therapy (CBT). Researchers such as Dr. Victor Meyer started to pioneer behavioural techniques specifically targeting the avoidance and compulsions associated with OCD through the development of ER. This entails exposing individuals to the situations that trigger their obsessions while preventing them from engaging in their usual compulsive behaviours. ERP has become a cornerstone in the treatment of OCD.

By the 1980s, CBT became recognised as the most effective non-medical treatment for OCD. The development of selective serotonin reuptake inhibitors (SSRIs) which are a type of of antidepressants which helped regulate serotonin levels in the brain also emerged as a very effective treatment option. SSRis and CBT to this day represent the most effective combination when addressing OCD.

Global Variations in OCD Treatment

To this day different regions of the world treat OCD differently. A uniform approach has not yet been implemented.
In Western countries, CBT with ERP is the gold standard for treating OCD.
In Eastern countries, particularly in parts of Asia, OCD treatment is heavily influenced by traditional beliefs. In countries like Japan and China, OCD symptoms may have been interpreted as a form of moral or spiritual imbalance. While modern CBT approaches are becoming more widespread, traditional forms of therapy such as acupuncture, herbal treatments, and spiritual counselling are sometimes still integrated into the treatment process. However, cognitive-behavioral interventions are gaining more and more recognition as the most effective treatment for OCD.

Commonalities

Third wave therapies often focus on a behavioural approach to treating mental health conditions. These include OCD, depression, anxiety and more. Common therapies include Acceptance and Commitment Therapy (ACT), Mindfulness-Based Cognitive Therapy (MBCT), and Dialectical Behavior Therapy (DBT).

A common focus, although worded differently, is on mindfulness, acceptance and value-driven behaviour changes. They have in common with first wave therapies that they focus on the benefits of changing behaviours. Third wave therapies represent an effective treatment option. Today we will discuss how third wave therapies work and their application to treating many mental health conditions.

Acceptance and Commitment Therapy (ACT) is particularly effective in treating many conditions. It often helps patients accept their intrusive thoughts without judgement whilst exploring how they can commit to actions that align with their values.

Mindfulness-Based Cognitive Therapy (MBCT) combines Beckian cognitive therapy with modern mindfulness related methods. MBCT offers techniques to stay present and reduce engagement with intrusive thoughts. A psychotherapist can teach patients mindfulness practices that often accompany effective behavioural change.

​Depression is a serious mental health problem. Research has shown that it benefits significantly from third wave therapies. MBCT has been shown to effectively prevent relapse in individuals with recurrent depression. This is done through developing a mindful awareness of their thoughts and feelings.

Dialectical Behavior Therapy (DBT) is focused on treating Borderline Personality Disorder (BPD). DBT focuses on building skills that help manage stressful situations, emotion regulation, interpersonal effectiveness and mindfulness. DBT is delivered in a very structured format and focuses on delivering DBT based skills training.

ACT has proven to effectively treat many types of anxiety disorders. It focuses on helping clients accept their anxiety symptoms whilst committing to actions that reflect their values. It does not emphasise trying to eliminate anxiety altogether. This approach can aid in reducing the impact of anxiety and it’s impact on daily functioning.

Many mental health conditions are often addressed by using a combination of evidence-based treatments. Third wave therapies offer a flexible approach that is independent to commonly practised treatment approaches for various conditions.

Third wave therapies represent an advancement in the treatment of mental health conditions that in some ways goes back to the success of first wave therapies. The common focus on mindfulness, acceptance and value-driven actions provides an effective approach that can be effectively pursued. No matter if a therapist is dealing with OCD, depression, anxiety or BPD, third wave therapies offer a menu of effective treatment.

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