Relapse prevention plan: OCD
A plan for keeping OCD gains after therapy: what you learned about intrusions and rituals, your own warning signs, a weekly self-ERP plan, and steps for setbacks. Based on Salkovskis (1999), exposure and response prevention, and the relapse prevention approach of Larimer, Palmer and Marlatt (1999): adds OCD warning signs, self-ERP and setback steps.
Written by Tarun Vermani, Trainee Clinical Psychologist Updated
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Relapse prevention plan: OCD
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What I've learned in therapy
Write this in your own words. For the thoughts, a word or two is enough: you do not need to write them out in full.
Situations to watch out for
OCD often gets louder at times of stress, change or extra responsibility. Planning for these times ahead helps.
My early warning signs
Having an intrusive thought is not a warning sign on its own. The signs to watch for are the old responses coming back. Tick the ones that fit you.
My coping toolkit
List the ways of responding to OCD that have worked for you, such as naming a thought as OCD, letting the doubt be there, or putting off a ritual. Leave out anything that has quietly become a new ritual or a way of getting certainty. Rate how well each works for you: 0 is not at all, 10 is very well.
| # | What I do | When to use it | Works for me (0 to 10) | Actions |
|---|---|---|---|---|
| 1 | ||||
| 2 | ||||
| 3 |
Keeping my own ERP going
The gains from ERP tend to last best when you keep practising, especially in the first months after therapy ends. Each week, do at least one planned exposure without the ritual, and respond to everyday intrusions the way you have practised. If in doubt, lean into it: choose the step that lets the doubt stay rather than the one that settles it.
Choose exposures you have practised or planned with your therapist. Your therapist can share sheets for building an ERP ladder and recording practice.
Only practise steps you have agreed with your therapist, and leave out anything that would put your health or safety at real risk.
| # | Exposure I will practise | Ritual or habit to drop | How often | Actions |
|---|---|---|---|---|
| 1 | ||||
| 2 |
My action plan for setbacks
A setback is not a relapse. Rituals or old worries coming back for a while is common, especially under stress. It does not mean you are back to square one: you still have the skills, and you can use them again.
My support network
If family or friends used to help with rituals or answer reassurance questions, agree with them now how they will respond if OCD comes back. Your therapist can share a sheet for people supporting someone with OCD.
| # | Name | Relationship | How they can help | Contact details | Actions |
|---|---|---|---|---|---|
| 1 |
My commitment
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When to use ‘Relapse prevention plan: OCD’
‘Relapse prevention plan: OCD’ is an interactive cognitive behavioural therapy (CBT) worksheet, most often used in CBT for obsessive-compulsive disorder (OCD).
It is designed to be used within therapy rather than as a standalone self-help tool: a therapist introduces it, works through it collaboratively, and helps make sense of what it surfaces. You can preview the full worksheet above, then assign it digitally for clients to complete between sessions on any device or download it as a print-ready PDF.
How it works
Most people work through it in around 20 minutes. It moves through six short steps:
- What I've learned in therapy: Write this in your own words. For the thoughts, a word or two is enough: you do not need to write them out in full.
- Situations to watch out for: OCD often gets louder at times of stress, change or extra responsibility. Planning for these times ahead helps.
- My early warning signs: Having an intrusive thought is not a warning sign on its own. The signs to watch for are the old responses coming back. Tick the ones that…
- My coping toolkit: List the ways of responding to OCD that have worked for you, such as naming a thought as OCD, letting the doubt be there, or putting off a…
- Keeping my own ERP going: The gains from ERP tend to last best when you keep practising, especially in the first months after therapy ends. Each week, do at least…
- My action plan for setbacks: A setback is not a relapse. Rituals or old worries coming back for a while is common, especially under stress. It does not mean you are…
Completed on the Formulate platform, your client's answers are saved automatically and shared straight back to you, so you can review them before the next session rather than waiting for a paper copy to come back.
The CBT approach behind it
In common with other CBT methods, ‘Relapse prevention plan: OCD’ works by gradually and safely facing avoided situations so anxiety can subside (exposure). The aim is not positive thinking but a clearer, shared understanding of what keeps a difficulty going and practical, testable ways to change it.
Because it is a CBT tool it stays focused on the here-and-now links between thoughts, feelings, the body and behaviour, and it works best as one part of a wider course of therapy rather than as advice or a diagnosis.
Evidence & sources
This worksheet is grounded in established cognitive behavioural therapy theory and practice. Key sources include:
- Salkovskis, P.M. (1999). Understanding and treating obsessive-compulsive disorder. Behaviour Research and Therapy, 37(Suppl. 1), S29-S52. doi:10.1016/S0005-7967(99)00049-2
- Law, C., & Boisseau, C.L. (2019). Exposure and response prevention in the treatment of obsessive-compulsive disorder: Current perspectives. Psychology Research and Behavior Management, 12, 1167-1174. doi:10.2147/PRBM.S211117
- Hiss, H., Foa, E.B., & Kozak, M.J. (1994). Relapse prevention program for treatment of obsessive-compulsive disorder. Journal of Consulting and Clinical Psychology, 62(4), 801-808. doi:10.1037/0022-006X.62.4.801
- Larimer, M.E., Palmer, R.S., & Marlatt, G.A. (1999). Relapse prevention: An overview of Marlatt's cognitive-behavioral model. Alcohol Research & Health, 23(2), 151-160.
For use alongside professional support
Formulate provides educational CBT resources for use with a qualified therapist. They are not a substitute for professional assessment, diagnosis, or crisis care.
If you need urgent help now:
- Emergency services: 999 — if you or someone else is in immediate danger
- NHS 111 (NHS 24 in Scotland): 111 — choose the mental health option for urgent help, in England, Scotland and Wales (in Wales, press 2)
- Lifeline: 0808 808 8000 — for urgent help in Northern Ireland, free, day or night
- Samaritans: 116 123 — free, day or night, 365 days a year
- Shout: 85258 — text SHOUT, free, day or night
- SANEline: 0300 304 7000 — 4pm–10pm, every day
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OCD formulation (Salkovskis)
A formulation based on Salkovskis' cognitive model of OCD, mapping intrusions, responsibility appraisals, distress, and neutralising behaviours.
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ERP hierarchy builder
Plan exposure and response prevention (ERP) for OCD with your therapist: a ladder of steps, what you fear at each, how likely it feels, how upsetting it would be and the rituals you will not do. Based on Foa, Yadin and Lichner (2012): a rating of how likely the fear feels is added, from Craske et al. (2014).
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OCD monitoring diary
Record OCD episodes (the trigger, the unwanted thought, what it meant to you, what you did and how long it took) to spot patterns and track progress. Based on Salkovskis (1985): a diary of each episode, with belief and distress ratings added.
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ERP practice record
Record each exposure and response prevention (ERP) practice: what you feared would happen, your distress and urge ratings, whether you held back from the ritual, and what you learned. Based on Craske et al. (2014): it adds a re-rating of the fear, distress and urge ratings and a record of rituals, and leaves out "How do you know?".
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Responsibility appraisal worksheet
Look at inflated responsibility beliefs that often keep OCD going. You rate how responsible you feel, test the belief, share out the responsibility, and re-rate. Based on Salkovskis (1985), with the responsibility pie from Greenberger and Padesky (2016): it adds before and after ratings, and uses the pie for a feared outcome rather than a past event.
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Thought-action fusion experiment
Test the belief that having a thought makes it more likely to happen, or that having a bad thought is as wrong as doing it. Based on Wells (2009) and Salkovskis (1985): an experiment testing whether thinking about an event makes it happen, without neutralising; the moral question and belief ratings are added.
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