Finding clear, trustworthy information about OCD, emetophobia (vomit phobia), Body Dysmorphic Disorder (BDD), health anxiety and related difficulties can feel overwhelming, especially when intrusive thoughts, shame or uncertainty make it hard to ask. This FAQ hub gathers the questions people (and parents) most often raise in early consultations. I integrate evidence based approaches including Cognitive Behavioural Therapy (CBT), Exposure and Response Prevention (ERP), Compassion Focused Therapy (CFT), and Eye Movement Desensitisation & Reprocessing (EMDR) where clinically appropriate. This information is educational and not a substitute for personalised medical or psychiatric advice. If you are in crisis or concerned about immediate safety, contact emergency services (999 in the UK), your GP, or a crisis line.
Quick Navigation
• Understanding Conditions
• Treatment Approaches
• Working Together
• Practicalities
• Recovery & Progress
• Additional & Safety
Understanding Conditions
Obsessive Compulsive Disorder involves intrusive, unwanted thoughts, images, urges or doubts (obsessions) plus mental or physical behaviours (compulsions) performed to reduce distress or prevent a feared outcome. People with OCD usually recognise the thoughts are excessive or inconsistent with their values, yet still feel compelled to act. OCD is more than liking order; it can centre on contamination, harm, responsibility, morality, sexuality, religious themes, symmetry, “just right” sensations and more. Specialist support through OCD Therapy in London can help address these patterns using evidence-based methods.
Health anxiety (also known as illness anxiety) centres on fear of having or developing a serious illness, leading to body checking, reassurance seeking, scanning symptoms or repeated online research. OCD requires obsessions plus compulsions driven by a wide range of feared meanings (e.g. “What if thinking this means I’m dangerous?”). Some people have elements of both; assessment clarifies the maintaining cycles so treatment targets the right behaviours.
Intrusive thoughts are automatic, involuntary mental events, thoughts, images or impulses, that feel alien, disturbing or taboo (e.g. an aggressive image, a blasphemous idea, a fear of acting inappropriately). They are common in the general population. In OCD and related disorders, the meaning attributed to them (“What if this means I’m unsafe?”) plus attempts to suppress, neutralise or check them fuels the cycle. Intrusive thoughts do not reflect intent or character. For a deeper overview of how to manage them, see this Intrusive Thoughts Guide.
Emetophobia is an intense fear of vomiting, seeing or hearing someone else vomit, or feeling nausea. It can lead to restrictive eating, avoidance of restaurants, social events, transport, pregnancy concerns, scanning body sensations and carrying “safety” items (mints, anti nausea products). It is treatable with graded, well planned exposure and reduction (CBT and ERP) of safety behaviours, sometimes supported by CFT strategies to address shame or self criticism. Many people benefit from structured Emetophobia Treatment in London to gradually reduce avoidance and regain daily confidence.
BDD involves a persistent preoccupation with perceived flaws or defects in appearance (skin, hair, nose, shape, symmetry) that others see as minor or unnoticeable. Repetitive behaviours—mirror checking, comparing, grooming, camouflaging, seeking reassurance—consume time and lead to distress or avoidance. High self criticism and shame often accompany BDD, so integrating CFT and behavioural experiments is helpful. Specialised BDD Therapy in London focuses on reducing preoccupation and developing a healthier relationship with appearance concerns.
Yes. OCD frequently emerges in late childhood or adolescence. BDD can also appear during early teen years when appearance evaluation becomes more salient. Early, specialist intervention helps prevent patterns of avoidance and compulsions from becoming entrenched.
Both reduce anxiety temporarily. Compulsions in OCD often feel rule bound or ritualistic (“I must repeat until it feels right”). Safety behaviours can be subtler: carrying ginger sweets (emetophobia), mirror scanning (BDD), seeking constant reassurance, avoidance planning. Both maintain anxiety by preventing corrective learning. Therapy helps identify and gradually reduce these responses.
No. Thoughts are mental events, not intentions. People distressed by taboo intrusive thoughts are statistically among the least likely to act on them. Treatment focuses on changing your relationship with the thought (allowing, observing) rather than endlessly proving it false.
Treatment Approaches
Exposure and Response Prevention (ERP) involves systematically approaching feared thoughts, sensations, images or situations while refraining from the usual compulsion or safety behaviour. Through repeated practice your nervous system learns anxiety can rise and then fall naturally (habituation) and your brain updates its threat predictions (inhibitory learning). Confidence grows as you discover you can cope without rituals.
CBT is a structured umbrella approach examining the interaction of thoughts, emotions, behaviours and bodily responses. ERP is a specialised behavioural method within CBT specifically designed to dismantle OCD and related anxiety cycles by removing compulsive reinforcement. CFT targets shame, self criticism and an over active threat system, cultivating compassion, safeness and soothing which supports behavioural change. EMDR is a trauma processing therapy helping the brain reprocess distressing memories or “stuck” images so they become less activating in the present. I may integrate EMDR if a past event (e.g. severe vomiting episode, appearance related bullying, medical scare) continually spikes anxiety and obstructs ERP or CBT progress.
EMDR does not replace ERP for OCD. However, if a specific unprocessed memory repeatedly re triggers physiological arousal (e.g. a humiliating incident fuelling BDD, a frightening nausea event driving emetophobia, or a contamination incident reinforcing obsessive fears), reducing its emotional charge with EMDR can make subsequent exposure and behavioural work more manageable. Some clients also explore EMDR for Anxiety and Trauma as part of an integrated treatment plan.
EMDR is strongly evidence based for Post Traumatic Stress Disorder (PTSD). Research into its adjunctive use for OCD, emetophobia and BDD is also present. Clinical reasoning guides selective use when a trauma memory (large “T” or cumulative “small t”) clearly maintains present avoidance, compulsions or intense distress.
If the core maintaining loop is obsession → compulsion → short term relief → stronger cycle, we usually begin with ERP/CBT. If a highly charged memory repeatedly derails exposures or evokes overwhelming panic, we may process that memory early with EMDR then resume ERP. The decision is collaborative and formulation driven.
After thorough assessment and preparation (stabilisation, resourcing, consent), we identify a target memory (snapshot image, negative belief, emotions, bodily sensations). You hold aspects in mind while engaging in sets of bilateral stimulation (commonly guided eye movements, taps or tones). Processing tends to shift the memory from “live and raw” to “past and integrated,” reducing distress and changing associated beliefs.
Yes. When a discrete, recurrent image or memory (e.g. a vivid moment of near vomiting in public, a mirror image snapshot, a bullying episode) triggers intense reactivity, EMDR can reduce its charge so present focussed exposures feel safer.
Shame or self attack can undermine both exposure and trauma processing. CFT builds a compassionate, stabilising internal stance, supporting emotional regulation during EMDR and encouraging consistent ERP participation.
No. Not every difficult experience requires targeted trauma processing. If a memory no longer drives present avoidance or arousal, we focus on current maintenance factors (compulsions, safety behaviours, cognitive loops). Minimal effective intervention is the principle.
Mild to moderate presentations often respond across 12–20 sessions. A focused EMDR phase for one or two key targets might take 2–6 sessions within that. Complex, longstanding issues or multiple trauma targets can extend the work. Progress is reviewed regularly.
- ERP/CBT: brief check in → review previous practice → refine hierarchy or behavioural experiment → run an in session exposure → debrief learning and inhibitory signals → plan between session tasks.
- EMDR (when indicated): check safety/resources → select target → assess image, belief, emotion, body sensations, distress rating (SUD) → bilateral stimulation sets → periodic checks → closure and grounding.
Yes. Between session practice (graded exposures, behavioural experiments, compassion exercises, grounding or resourcing when relevant) consolidates change. We co design tasks so they are challenging enough to promote learning while remaining achievable.
For ERP/CBT: symptom scales (e.g. OCI style measures), subjective distress ratings (0–10), time spent on compulsions, avoidance reduction, functional improvements (work, school, social). For EMDR targets: shifts in Subjective Units of Distress (SUD), changes in negative vs adaptive belief about the memory, and downstream impact on exposure tolerance.
No. As a psychotherapist I do not prescribe. Many clients improve with therapy alone. Some may benefit from concurrent medication (e.g. SSRI). With consent I can liaise with your GP or psychiatrist.
Working Together
We clarify your main concerns, history, patterns of obsessions/compulsions or avoidance, triggers, current coping strategies, strengths, goals and any risk factors. You can ask questions. By the end we usually outline a preliminary formulation (how the cycle maintains itself) and propose an evidence based plan.
You do not need perfect confidence, willingness to experiment is enough. We begin with lower intensity steps to build efficacy. Confidence grows as you discover you can tolerate uncertainty without rituals.
Readiness includes: basic emotional regulation capacity, ability to remain grounded while recalling distressing material, and willingness to notice internal experiences without immediately avoiding. We develop these stabilisation skills first if required.
Yes— ten minute walk from Harley street, convenient for Baker Street and Marylebone stations. In person sessions can facilitate guided exposures (e.g. transport nausea triggers, mirror tasks) where needed.
Yes. Structured CBT/ERP delivered via secure video is evidence based. Online work can leverage real environments (kitchen, bathroom, wardrobe, travel planning) for ecological exposures. EMDR can also be delivered online using validated bilateral stimulation methods.
We use age appropriate explanations, concrete behavioural experiments, visual tools, and involve parents to support (not enable) progress. We clarify confidentiality boundaries to maintain trust while ensuring safeguarding.
Session content is private unless there is a safeguarding concern or explicit consent to share. Parents may receive general progress themes and guidance on supporting exposures without accommodating compulsions.
You can begin with general descriptions (“a harm thought”) before specifics. Shame usually lessens as intrusive phenomena are normalised. Using CFT we externalise self criticism and develop compassionate perspectives, reducing avoidance of disclosure.
Practicalities
Use the contact form, booking link or phone to arrange a brief introductory call. We confirm suitability and availability, then schedule an assessment.
These range from £170-£250. Fees are discussed transparently before booking. I do not work with insurers but invoices or receipts can be provided for insurance where applicable.
A common structure: sessions cancelled with less than 48 hours’ notice are chargeable because the time is reserved exclusively for you. All sessions are pre paid within 48 hours of scheduling.
Limited early evening slots may be available; please enquire.
Yes, subject to scheduling. Some people start online and add periodic in person sessions for particular exposure exercises.
Yes. Treatment can be modular: begin with ERP, insert a short EMDR block for a blocking memory, then resume ERP; or process a critical memory first then build exposures. Decisions are formulation based.
Recovery & Progress
Many people achieve substantial, lasting reductions in distress and time spent on compulsions, regaining valued activities. Residual intrusive thoughts are normal human phenomena; success is measured in freedom and flexibility, not perfection or zero thoughts.
Periodic spikes during stress are common. You will have a relapse prevention plan: early warning signs, booster exposure steps, self compassion scripts and criteria for seeking a refresher session.
A short term rise in anxiety is expected—your nervous system is encountering triggers without the old ritual. With repetition and correct pacing, distress typically levels and drops, and confidence grows.
Emotional activation is part of reprocessing, but we pace the work and maintain stabilisation tools (breathing, grounding, compassionate imagery, containment). You retain choice at every stage and can pause.
Additional & Safety
Yes. Assessment clarifies patterns. Accurate formulation guides intervention even before a formal diagnostic label is finalised.
If you are at imminent risk, contact emergency services (999), attend A&E, reach your GP, or a crisis line (e.g. Samaritans: 116 123). Therapy sessions and email are not emergency services.
Specialist training means hearing intrusive and taboo thoughts is routine. Non judgement underpins effective work; focus is on process, not moral evaluation.
Yes. Overlaps are common. We prioritise maintaining mechanisms (avoidance, compulsions, rumination) and integrate strategies accordingly.
Ready to explore a structured, compassionate approach—whether you need ERP, integrative CBT/CFT, targeted EMDR for a blocking memory, or a blended plan? Book a brief introductory call (in person Marylebone or online) to map your next step.
Contact
To explore answers to common questions about OCD, emetophobia, BDD & anxiety or to see how our Integrative CBT, ERP, CFT & EMDR approaches might work for you, schedule an assessment with a fully‐licensed private CBT Therapist in London (in-person or online). You can also reach out via email: info@homebasedtalkingtherapy.com.
Short Disclaimer: Information here is educational and not a substitute for personalised medical or psychiatric advice. Seek urgent help if concerned about immediate safety.