Why clarity matters: inside our new OCD series with Professor Roz Shafran

When Professor Roz Shafran joined the Psychology Tools team to review our new OCD resources, the plan was straightforward: to gather her reflections on the finished collection ahead of its release.

As we worked through the materials, the discussion quickly became much broader than individual worksheets or workbooks. Again and again, it returned to the same question: what helps people understand OCD well enough that they’re willing to do something challenging to address it?

Professor Shafran’s answer came without hesitation. “If I had to use one word,” she said, looking at the OCD vicious cycle formulation diagram, “it would be clarity.”

It’s a simple answer, and one that seemed to capture the thinking behind the whole project: creating resources that are designed to help therapists explain OCD more clearly, help clients understand their experiences better, and make one of the most effective treatments for OCD understandable and achievable.

Making sense of OCD

One of the first resources we reviewed was a visual formulation of the vicious cycle that maintains OCD. It’s a familiar cognitive behavioral model, but presented in a way that explains not only why OCD persists, but also where therapy can help.

“I think it’s both explanatory and treatment-guiding,” explained Professor Shafran. “It helps explain to clients why it’s so hard to break out of the cycle in a clear way. But equally, it highlights places where therapists can intervene, break the cycle, change behaviors, and help people move into a more positive spiral.”

As she described the model, it became clear that the emphasis should be on helping people make sense of an experience that often feels confusing and contradictory rather than just presenting theory for its own sake.

“If you’re experiencing OCD, you know, rationally, that your thoughts or behaviors don’t make sense, and yet you still can’t stop. That often leads to a lot of self-criticism and frustration. People think they just need more willpower.”

One of the aims of the new resources is to replace self-blame with understanding. “Recognizing that there are mechanisms maintaining the disorder – that it isn’t simply a lack of willpower – is enormously important. It helps people understand that it isn’t their fault, and it gives them hope that things can change.”

Why understanding matters before exposure and response prevention (ERP)

The same principle runs through the new exposure and response prevention (ERP) resources. ERP is the recommended psychological treatment for OCD, but it’s also one of the hardest treatments to engage in. By definition, it asks people to move towards the situations, thoughts, and feelings they’ve tried to avoid. It’s understandable that many people feel hesitant about it.

For Professor Shafran, that’s why a good explanation is so crucial. “It isn’t enough simply to tell somebody to stop doing their compulsions. You need to give people a rationale. You need to help them understand why they’re doing something difficult.”

The resources explain how compulsions unintentionally keep OCD going, why exposure works, and what people can expect as treatment progresses. “Breaking it down into different components makes it seem much more manageable,” she said. “People are much more likely to walk with you if you’ve given them a reason, even if the path is difficult.”

Dr Matthew Whalley, the founder of Psychology Tools, sees formulation as central to that process: “before we ask someone to do something challenging, we need to help them make sense of what’s happening. A good formulation gives people a story that explains their experiences and makes sense of the treatment they’re about to undertake.”

Professor Shafran highlighted an interesting distinction. “Whether or not a formulation is ultimately the truth, it’s about giving people a coherent story that makes sense of their experiences. It helps them understand what’s happening and why it’s important to do something challenging.”

Good design isn’t just for clients

As the discussion turned to the illustrated handouts describing common obsessions and compulsions, Professor Shafran reflected on the realities of modern clinical practice. “Therapists are overwhelmed,” she said. “They’ve got huge workloads, very little time, and they’re moving quickly from one thing to another.”

That has implications for how resources should be designed. “I don’t think the first thing clinicians do is read every word. They scan it. They’re searching for what they need.” To explain what she meant, she described two branches of the same clothing shop that her daughter visits. Both sell essentially the same products, but one is organized intuitively, so it’s easy to find what you’re looking for. In comparison, the layout of the other store is confusing and much harder to navigate . “The content has to be there,” said Professor Shafran, “but the layout makes it accessible.”

It’s an apt analogy. The science matters, of course, but so does reducing the effort required to find, understand, and use it. Good design isn’t simply about making resources attractive; it’s about reducing cognitive load so that therapists and clients can focus on the work they’re trying to do.

Professor Shafran also pointed out that good design helps information stick. “Different people absorb information in different ways,” she said. “Clients forget a lot of what we say in therapy. We’d like to think they remember every word of wisdom, but they don’t.”

Combining concise explanations with illustrations makes ideas more memorable, and gives clients something they can return to between sessions. It also helps normalize people’s experiences and recognize they’re not alone.

Supporting therapists to deliver evidence-based OCD treatment

One question that arose during the discussion was whether experienced therapists would find structured resources useful, or whether they’re mainly aimed at clinicians earlier in their careers.

Professor Shafran’s answer challenged the idea that clinical resources are just for inexperienced therapists. “It’s often the case that the more experienced you become, the easier it is to drift from the evidence-based protocol,” she said. “Experience brings confidence and flexibility, which are valuable qualities, but it can also mean we start doing things a little differently.”

That’s one reason she sees structured resources as valuable – they help therapists stay grounded in the core principles of evidence-based treatment. “If you want to implement the treatment consistently, it helps to have something that brings you back to basics.”

She compared the workbook to a behavioral experiment record sheet. An experienced therapist could conduct a behavioral experiment without a record sheet, but it’s usually better to use one.

From a workbook to a sequenced treatment program

The project began with a much narrower aim: to create a workbook to support ERP for OCD.

As work progressed, however, it became clear that a workbook couldn’t stand on its own. Before people engaged in ERP, they needed to understand OCD, develop a shared formulation of their experiences, learn why exposure works, and have practical tools to support their treatment along the way. One by one, additional resources were developed to support these conversations.

Looking at the completed collection, it was more like a structured treatment program with each resource building on the last, rather than a workbook with a handful of accompanying handouts.

Dr Whalley reflected on what had made the project different from developing individual resources: “It’s relatively straightforward to create a good worksheet or a good formulation. What’s much harder is bringing everything together into one coherent sequence, making sure every stage builds naturally on the previous one, and that nothing important gets left out.”

That sequencing was an important part of the collaboration. Professor Shafran brought decades of clinical and research expertise to the content, while the Psychology Tools team focused on how key ideas should be introduced and connected to make them as intuitive as possible for therapists and clients alike.

Reflecting on the process, Professor Shafran commented, “Whenever the team suggested changing the order of something, it always felt like an improvement. Psychology Tools has a feel for what’s going to make it intuitive for the user, whether that’s the therapist or the client.”

Clearly, evidence-based treatment isn’t just about having the right ingredients. It’s also about presenting them in the right order, so that therapists can deliver treatment consistently, and clients can understand where they are in therapy and what comes next.

A shared goal

By the end of the conversation, it was striking how little time we’d spent discussing individual products, and how much time we’d spent discussing understanding. Helping people change begins by helping them understand why OCD persists, why ERP works, and why doing something difficult is worthwhile. The same principle applies to therapists. Resources are most useful when they make complex ideas easier to understand, easier to personalize, and easier to put into practice.

The new collection of Psychology Tools OCD resources includes visual formulations, psychoeducation guides, illustrated handouts, practical worksheets, and a comprehensive workbook. Together, they support collaborative, evidence-based therapy from the very first conversation about OCD through to relapse prevention.

At the beginning of our discussion, Professor Shafran summarized the collection in a single word. After hearing the thinking behind the project, it’s difficult to think of a better one.

“Clarity.”

About Professor Roz Shafran

Professor Roz Shafran is Senior Scientific Advisor to Psychology Tools and Emeritus Professor of Translational Psychology at the UCL Great Ormond Street Institute of Child Health. She is a leading clinical researcher with particular expertise in obsessive compulsive disorder, as well as the development and implementation of evidence-based psychological treatments.