AHT Protocol: Clinical Documentation
Overview
AHT (Advanced Healing Training) is a structured 9- to 12-week clinical protocol for the treatment of Obsessive Compulsive Disorder, delivered by Cromunity under the direction of an RCI-registered clinical psychologist.
The protocol integrates Exposure and Response Prevention (ERP), Cognitive Behavioural Therapy (CBT), Acceptance and Commitment Therapy (ACT), Solution-Focused Brief Therapy (SFBT), Cognitive Defusion Techniques (CDT), and Jacobson’s Progressive Muscle Relaxation (JPMR), alongside brain priming techniques developed at Cromunity.
Clinical Supervision and Delivery
AHT, or Advanced Healing Training, is a therapist-guided treatment protocol for OCD. It is delivered by Namrata Upadhyay, Clinical Psychologist, registered with the Rehabilitation Council of India (RCI Registration No.
A51015).
AHT combines structured therapeutic material, assigned according to your presentation, with live one-to-one sessions with Namrata Upadhyay.
Your first consultation is a live one-to-one video session with Namrata, in which your history is taken and your Y-BOCS score recorded.
During treatment, you work through structured therapeutic modules selected for your specific OCD subtype and severity. This is where the exposure and response prevention work is done, and it is done daily rather than once a week.
Each week you have a live session with Namrata to review the week's work, address obstacles, and set and adjust the following week's tasks.
Y-BOCS is administered again at completion.
This is a guided model, not a self-directed course. The material is not worked through alone; progress is reviewed every week by Namrata Upadhyay, and the plan changes based on what the review finds.
The same clinician handles your case from the first consultation to the final Y-BOCS assessment. You are not reassigned, and you do not repeat your history to someone new part-way through.
Internet-delivered CBT for OCD has been evaluated in a 2023 systematic review and meta-analysis of 15 studies covering 552 adults, which found large reductions in Y-BOCS severity from pre-treatment to post-treatment, maintained at follow-up. Therapist guidance was associated with lower dropout.
Clinical Model
OCD is maintained by a self-sustaining cycle. An intrusive thought triggers a threat appraisal disproportionate to the actual situation. This produces anxiety or physical distress. The person performs a compulsion, avoidance behaviour, or seeks reassurance in order to reduce that distress. Relief is temporary, and each repetition strengthens the underlying association.
Neuroimaging research links OCD to altered activity across the orbitofrontal cortex, anterior cingulate cortex, and striatum—a circuit involved in error detection and the sense of task completion.
AHT targets this maintenance cycle rather than the surface behaviour alone.
Protocol Components
Exposure and Response Prevention (ERP)
ERP is the most evidence-supported psychological treatment for OCD and forms the behavioural core of AHT. Clients are systematically exposed to feared triggers while compulsions and safety behaviours are prevented, allowing corrective learning to occur.
Cognitive Behavioural Therapy (CBT)
Addresses the appraisals that maintain OCD, including inflated responsibility, intolerance of uncertainty, thought-action fusion, and overestimation of threat.
Acceptance and Commitment Therapy (ACT)
Supports engagement with exposure work before anxiety reduces, through willingness, defusion, and values-based action.
Solution-Focused Brief Therapy (SFBT)
Used in the early phase to build motivational readiness and establish a clear picture of life without compulsions.
Cognitive Defusion Techniques (CDT)
Help clients relate to intrusive thoughts as mental events rather than instructions or facts requiring action.
Jacobson’s Progressive Muscle Relaxation (JPMR)
Supports physiological regulation during high-distress exposure work.
Brain priming (cognitive preparation)
Brain priming is our term for the cognitive preparation phase that precedes exposure work. It addresses four things: Inflated responsibility — the belief that you are uniquely responsible for preventing harm, and that failing to act is equivalent to causing it. This is a core cognitive feature of OCD and a primary target in cognitive models of the disorder. Moral thought-action fusion — the belief that having a thought is morally equivalent to carrying it out. Common in religious and harm presentations. The importance and control of thoughts — the belief that an intrusive thought is significant because you had it, and that you ought to be able to stop it. Distinguishing intrusive thoughts from OCD. People without OCD report the same intrusive thoughts as people with it. The difference is not the thought but what is made of it. Most clients have never been told this, and it is often the single most useful thing they learn. Alongside this, triggers are mapped through functional analysis, which is what the exposure hierarchy is then built from. These are established cognitive targets in the OCD literature. What AHT does is sequence them deliberately before exposure begins, rather than addressing them as they arise.
Narrative therapy
Used as an integrated therapy to support the results of other therapies.
AHT-Advanced Healing Training Program Structure
Weeks 1–2 Clinical assessment (Y-BOCS), case formulation, psychoeducation, motivational groundwork
Weeks 3–5 Cognitive restructuring, behavioural experiments, brain priming
Weeks 6–8 Graded exposure with response prevention, defusion and acceptance work
Weeks 9–12 Consolidation, relapse prevention, reassessment (Y-BOCS)
Duration varies between 9 and 12 weeks depending on presentation and severity.
How Outcomes Are Measured In AHT
Every client is assessed using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the standard clinician-administered instrument for OCD severity, scored 0–40 across obsessions and compulsions.
0–7 Subclinical
8–15 Mild
16–23 Moderate
24–31 Severe
32–40 Extreme
Assessment is conducted at intake, before treatment begins, during and again on completion.
Family Involvement
Family accommodation — reassurance-giving, participation in rituals, and avoidance arranged around the person’s OCD — is a recognised maintaining factor. Where appropriate, parents and caregivers receive structured guidance on reducing accommodation without increasing distress. The family is only involved when the patient requires it or wants to involve otherwise in AHT we keep it discreet for the patient.
Presentations Treated
Contamination and washing · Checking · Harm OCD · Relationship OCD · Scrupulosity (religious OCD) · Symmetry and “just right” presentations · Primarily obsessional OCD (Pure O) · Health-related OCD · Perfectionism
Who AHT Is Not Suitable For
AHT is not appropriate as a sole intervention where there is active suicidal ideation, untreated psychosis, active substance dependence, or an eating disorder requiring primary treatment. In these cases, we refer to appropriate specialist care.
AHT does not replace psychiatric medication. Clients taking prescribed medication should remain under their prescriber’s care. AHT is delivered alongside pharmacological treatment, not instead of it.
A minimum level of insight into the nature of OCD symptoms is required for ERP-based work to be effective.
How AHT Is Delivered
AHT is not a self-directed course. The material is not worked through alone —progress is reviewed every week by your psychologist, and the plan is adjusted based on that review. It is not delivered in group cohorts, and it is not delivered by non-clinical coaching staff. Every client's case is handled by Namrata Upadhyay, Clinical Psychologist, RCI No. A51015.
each session.
Clinical FAQ
Does AHT replace ERP?
No. ERP is the most evidence-supported psychological treatment for OCD and forms the behavioural core of AHT. The protocol sequences ERP alongside cognitive, acceptance-based, and physiological components, with preparatory work intended to improve engagement and adherence — a recognised limitation in routine ERP delivery.
I’m already taking medication. Can I do AHT?
Yes. AHT is delivered alongside pharmacological treatment, not instead of it. Clients on prescribed medication should remain under their psychiatrist’s care throughout. Decisions about medication are made by the prescribing doctor, not by Cromunity.
I’ve already tried therapy, and it didn’t work. Why would this be different?
This is the most common presentation we see. In many cases, previous treatment was not OCD-specific, did not include structured ERP, or ended without formal reassessment. The first consultation establishes what was previously attempted and in what form, which informs how we sequence the protocol.
How is progress tracked between the two Y-BOCS assessments?
Through session-by-session review of between-session tasks, subjective distress ratings during exposure work, and documented changes in compulsion frequency. Y-BOCS provides the formal measurement at intake and completion; weekly review provides the clinical picture in between.
What if I don’t improve?
Non-response is addressed clinically rather than by continuing unchanged. If there is no measurable change by the mid-point, the formulation is revisited — common reasons include insufficient exposure dose, undisclosed covert compulsions, family accommodation, or an untreated comorbidity. Where the presentation falls outside what AHT can appropriately address, we refer on.
Is nine weeks long enough for OCD?
Nine to twelve weeks is consistent with the duration of structured ERP protocols in the clinical literature. Treatment length is driven by protocol completion rather than a fixed number of sessions, and some presentations require the longer end of that range.
How much work is required outside sessions?
Substantial. Between-session exposure practice is the primary mechanism of change in ERP, and adherence outside the session is the strongest predictor of outcome. Clients unable to commit to daily practice are unlikely to benefit.
Why daily work rather than one session a week?
In Exposure and Response Prevention, the practice done between sessions is the active ingredient. Adherence to between-session tasks is the strongest predictor of outcome in the research — and it is also the most common point of failure in routine delivery, because the tasks are set in a weekly session and then carried out alone, often without structure or follow-up. AHT provides structured daily work matched to your presentation, and reviews it every week with your psychologist. The aim is to make the between-session practice actually happen, because that is where OCD changes.
Will my information remain confidential?
Yes. Clinical records are confidential and are not disclosed without explicit written permission. Anonymised outcome data is used only in aggregate and only with consent.
What happens if I have a setback or a crisis part-way through?
The protocol is sequenced, not fixed to a calendar. Your weekly session is where that gets decided. If something has happened in your life, or an exposure step is too much at that point, the plan for the coming week changes— the hierarchy can be adjusted, a step can be repeated, treatment can be paused, or the protocol can run beyond twelve weeks. Progression is based on where you actually are, not on which week you are in.
Case Examples
Published with written consent. Identifying details removed.
Case 1 — Male, 34, contamination presentation with extensive washing and avoidance. Y-BOCS 28 at intake (severe range). Previous treatment: two years of general counselling without structured ERP. After AHT, Y-BOCS 13 at week 8.
Case 2 — Female, 27, primarily obsessional presentation with mental review and reassurance-seeking. Y-BOCS score 30 at intake. Previous treatment: medication alone. After AHT, the Y-BOCS score was 10 at week 12
Case 3 — Male, 19, checking and symmetry presentation with significant family accommodation. Y-BOCS 22 at intake. Parental guidance formed part of treatment. After the AHT, Y-BOCS score was 9 at week 9.
Case 4 — Male, 23, pure OCD presentation with thoughts about harming in the dark, anxiety, and panic when alone. Y-BOCS score: 34 at intake. After 8 weeks of AHT, current Y-BOCS score is 5
These are individual cases and are not representative of average outcomes. Outcomes are mostly dependent upon the involvement of the patient and their efforts on the therapies too.
When Treatment Does Not Progress
Not every client responds at the same rate, and some do not respond within the standard protocol duration.
If there is no measurable change by the mid-point assessment, the case formulation is reviewed rather than simply continuing the protocol. Common factors examined include: exposure tasks not being completed at sufficient frequency, covert or mental compulsions not identified at intake, ongoing family accommodation, an undiagnosed comorbidity affecting engagement, or a presentation requiring psychiatric input alongside psychological treatment.
Depending on what is identified, treatment may be extended, the hierarchy adjusted, family work introduced, or referral made to psychiatric or specialist services.
Where AHT is not the appropriate intervention, we say so and refer on.
About Namrata Upadhyay
Clinical Psychologist
RCI Registration No. A51015
[Degree], AIBHAS, AMITY University, 2012-2014
Registered with the Rehabilitation Council of India since 2016, Namrata Upadhyay has practised for fifteen years, working exclusively with Obsessive Compulsive Disorder. She is the lead developer of the AHT protocol and conducts the initial clinical assessment for every client personally.
[Professional memberships, supervision credentials, teaching or training roles, conference presentations]
Development of the Protocol
AHT was developed at Cromunity over [period], in response to a pattern seen repeatedly in clients presenting for treatment: people who had been in therapy for years, often without OCD-specific intervention, without structured exposure work, and without any formal measurement of whether their symptoms had changed.
The protocol was built around three principles. Treatment should target the maintenance cycle rather than surface behaviour. It should have a defined endpoint rather than continuing indefinitely. And it should be measured at both ends using a standard instrument, so that progress is established rather than assumed.
References
Abramowitz, J. S., Franklin, M. E., & Cahill, S. P. (2003). Approaches to common obstacles in the exposure-based treatment of obsessive-compulsive disorder. Cognitive and Behavioral Practice, 10(1), 14–22.
Salkovskis, P. M. (1999). Understanding and treating obsessive-compulsive
disorder. Behaviour Research and Therapy, 37, 29–52.
Polak, M., et al. (2024). Internet-based cognitive behavioural treatments for obsessive-compulsive disorder: A systematic review and meta-analysis. Clinical Psychology & Psychotherapy. doi:10.1002/cpp.2989 Andersson, E., et al. Internet-based cognitive behaviour therapy for obsessive-compulsive disorder: A randomized controlled trial. Psychological Medicine.
Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy, 58, 10–23.
Foa, E. B., Liebowitz, M. R., Kozak, M. J., et al. (2005). Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder. American Journal of Psychiatry, 162(1), 151–161.
Goodman, W. K., Price, L. H., Rasmussen, S. A., et al. (1989). The Yale-Brown Obsessive Compulsive Scale: Development, use, and reliability. Archives of General Psychiatry, 46(11), 1006–1011.
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change. Guilford Press.
National Institute for Health and Care Excellence. (2005). Obsessive-compulsive disorder and body dysmorphic disorder: Treatment (Clinical guideline CG31).
Olatunji, B. O., Davis, M. L., Powers, M. B., & Smits, J. A. J. (2013). Cognitive-behavioral therapy for obsessive-compulsive disorder: A meta-analysis of treatment outcome and moderators. Journal of Psychiatric Research, 47(1), 33–41.
Twohig, M. P., Abramowitz, J. S., Bluett, E. J., et al. (2015). Exposure therapy for OCD from an acceptance and commitment therapy (ACT) framework. Journal of Obsessive-Compulsive and Related Disorders, 6, 167–173.
Machado-Sousa, M., Moreira, P. S., Costa, A. D., Soriano-Mas, C., & Morgado, P. (2023). Efficacy of internet-based cognitive-behavioral therapy for obsessive-compulsive disorder: A systematic review and meta-analysis. Clinical Psychology: Science and Practice, 30(2), 150–162. doi:10.1037/cps0000133