Niles Cook, PsyD
Co-Founder & Clinical Director of Red Elm Psychotherapy
Clinical Psychologist Specializing in OCD & ERP
Specialized, evidence-based OCD treatment for people caught in cycles of fear, uncertainty, avoidance, and compulsive responding.
OCD Treatment for When You Feel Stuck
I’m Niles Cook, PsyD, Co-Founder and Clinical Director of Red Elm Psychotherapy. I specialize in OCD treatment and Exposure and Response Prevention (ERP), helping people who feel caught in cycles of fear, uncertainty, avoidance, and compulsive responding.
OCD doesn't always look the way people expect. It can involve checking, reassurance seeking, avoidance, endless analyzing, mental reviewing, or feeling driven to solve questions that never seem to have a satisfying answer.
The goal isn't to help you find perfect certainty. It's to help you respond differently when OCD asks you to keep searching for it.
We'll work together to understand the patterns keeping you stuck and develop an approach that helps you move forward with greater flexibility and freedom.
Meet Niles Cook, PsyD
People often come to therapy after spending months or years trying to solve anxiety through logic, research, reassurance, or self-analysis.
OCD can make uncertainty feel like a problem that has to be solved before you can move forward. You may find yourself repeatedly asking What if?, reviewing what happened, searching for the right answer, or trying to make absolutely sure you've made the right decision.
My approach to therapy is collaborative, practical, and grounded in evidence-based OCD treatment. I believe therapy should give you a place to understand what's happening without judgment, while also helping you make meaningful changes in the patterns that keep you stuck.
You don't have to figure everything out before you begin. We can start by understanding what's happening and work from there.
Why Work With Niles Cook, PsyD?
OCD treatment requires specialized training and experience. Effective ERP is more than following a set of techniques—it requires understanding how OCD can present in different ways, recognizing subtle compulsions, and tailoring treatment to the person in front of you.
Before co-founding Red Elm Psychotherapy, I served as Director of Training at Portland Anxiety Clinic, where I led a psychology practicum training program and supervised clinicians in Exposure and Response Prevention (ERP). I have also taught doctoral psychology students and developed and taught doctoral-level coursework in basic clinical skills, diagnosis, and treatment planning.
That background in clinical training and education continues to shape how I practice today. I bring a strong emphasis on evidence-based treatment, thoughtful case conceptualization, and individualized care.
My approach to ERP is collaborative, practical, and compassionate. The work can be challenging, but you should never feel like you're doing it alone.
What Is ERP Therapy?
Exposure and Response Prevention (ERP) is the most well-supported psychological treatment for OCD.
ERP is based on two components:
Exposure
Gradually approaching thoughts, situations, feelings, or uncertainties that OCD has taught you to fear.
Response Prevention
Learning to reduce compulsive behaviors and reassurance-seeking patterns that temporarily relieve anxiety but keep OCD going over time.
ERP is not about forcing yourself to stop having intrusive thoughts.
Everyone experiences unwanted thoughts.
Instead, ERP helps you learn:
“I can experience uncertainty without needing to solve it.”
“I can feel anxiety without responding with compulsions.”
“A thought does not have to control my actions.”
OCD Presentations I Treat
OCD can look very different from person to person. While the themes may vary, many forms of OCD involve the same underlying cycle:
Intrusive thought → anxiety → compulsion → temporary relief → stronger OCD cycle
I provide treatment for many OCD presentations, including:
Harm OCD
Harm OCD involves unwanted intrusive thoughts about causing harm to yourself or others.
These thoughts often feel deeply disturbing because they conflict with a person’s values. People may respond by checking, avoiding, seeking reassurance, or analyzing what the thoughts “mean.”
Relationship OCD (ROCD)
Relationship OCD involves persistent doubts and uncertainty about romantic relationships.
People may repeatedly analyze their feelings, their partner, or whether they have made the “right” choice — searching for a level of certainty that never feels complete.
Existential OCD
Existential OCD involves distressing, repetitive questions about existence, consciousness, reality, meaning, or purpose.
Rather than being a curiosity or philosophical interest, these questions become urgent and difficult to disengage from.
Scrupulosity OCD
Scrupulosity involves obsessions related to morality, guilt, responsibility, religion, or being a “good” person.
People may feel driven to confess, review past actions, seek reassurance, or repeatedly analyze whether they have done something wrong.
Contamination OCD
Contamination OCD involves fears related to illness, germs, contamination, or feeling unsafe.
Compulsions may include excessive cleaning, washing, avoidance, or repeated attempts to achieve certainty about safety.
“Just Right” OCD and Perfectionism
“Just Right” OCD involves feeling that something is incomplete, incorrect, or not quite right.
This may lead to repeating behaviors, adjusting things repeatedly, or feeling unable to move forward until things feel resolved.
Location & Telehealth Availability
Dr. Cook provides specialized OCD therapy and Exposure and Response Prevention (ERP) through in-person appointments in Vienna, Virginia, and secure telehealth in Virginia and additional PSYPACT-participating states.
Frequently Asked Questions
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No. Many people begin therapy because they recognize patterns of obsessive thinking, compulsive behaviors, avoidance, or overwhelming anxiety before receiving a formal diagnosis.
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Many people with OCD feel shame or fear about their intrusive thoughts. These experiences are common in OCD treatment, and therapy provides a supportive, nonjudgmental space to discuss them.
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ERP includes exposure, but the goal is not simply to face fears. The focus is learning that you can tolerate uncertainty and discomfort without relying on compulsions.
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If you find yourself repeatedly checking, analyzing, researching, avoiding, or seeking reassurance in an attempt to feel certain, ERP may be a helpful treatment approach.
Get Started
If you’re looking for structured, evidence-based treatment for OCD or anxiety, you can reach out to schedule a consultation.