The Truth About CBT for Obsessive Compulsive Disorder

When it comes to treating obsessive-compulsive disorder (OCD), not all forms of therapy are equally beneficial. There are many types of therapy available, and it can be challenging to figure out how to treat OCD. 

The gold standard of treatment for OCD is exposure and response prevention (ERP) therapy, a type of cognitive behavioral therapy (CBT). However, not all forms of CBT are suited or beneficial for OCD. In fact, some may be counterproductive. Here’s what you need to know about how to ensure you’re receiving the best possible treatment for your OCD.

What is cognitive behavioral therapy and how does it work?

CBT is an umbrella term for different forms of evidence-based therapies based on the idea that the way someone thinks and behaves impacts their emotions and that all three of these facets impact one another in a cyclical fashion. CBT is used to treat various mental health conditions, including but not limited to depression, anxiety, stress and eating disorders. The treatment focuses on a person’s present experience and is intended to be short-term. During CBT, a patient will learn practical skills to manage their anxiety and examine the core beliefs driving their decisions. CBT gives the patient practical skills to deal with their circumstances more productively. The goal is to learn how to change one’s thoughts and behaviors and provide necessary skills so that  the patient can eventually become their own therapist.

Here’s an example of how these techniques are used in therapy. Someone may feel it’s unsafe to let anyone into their apartment. During CBT, the focus would be to examine this belief in order to overcome it. A therapist may ask, “What do you think will happen if you have a guest over?” or, “How likely do you think something bad will happen?” or, “Since nothing bad has happened in the past, do you think it’s reasonable to assume nothing bad will happen in the future?” Here’s where things might become tricky for someone with OCD.

These are all reasonable questions, and for someone with a different condition, they may be helpful. However, when it comes to OCD, this treatment can actually encourage compulsions by providing reassurance. Many people with OCD seek reassurance to gain relief from the anxiety of their intrusive thoughts. When reassurance is used as a compulsion, the patient will find temporary relief but will not be working to treat their OCD in the long term.

Some of the techniques used in CBT to help people challenge their thoughts or manage uncomfortable emotions can become compulsive rituals for people with OCD. For example, a therapist may encourage this patient to repeat to themselves, “I am safe,” every time they feel anxious about contamination. For someone with OCD, this can easily become a compulsion used to relieve the stress of their intrusive thoughts.

What makes ERP the best treatment for OCD?

ERP therapy is the gold standard of treatment for OCD because it takes a targeted approach to address your obsessions and compulsions. In the example above, an ERP therapist would not reassure this patient by providing logical explanations against their fears of contamination. For someone with OCD, it’s likely they are already aware of every logical explanation and have tried to talk themselves out of their fears unsuccessfully.

ERP therapy takes the opposite approach. Instead of trying to stop your obsessive thoughts with reassurance, you welcome them. The idea behind ERP therapy is that exposure to these thoughts is the most effective way to treat OCD. When you continually engage in  compulsions like reassurance, it only strengthens your need to complete them in the future. In this example, a patient may feel better after a CBT session, but become dependent on the therapist’s reassurance or may quickly spiral into another cycle of obsession and compulsion when the doubt commonly experienced with OCD kicks in– but what if? On the other hand, when you prevent yourself from engaging in your compulsions, you teach yourself a new way to respond, provide yourself with the opportunity to learn that the feared outcome won’t occur or that you can handle it if it does, and will very likely experience a noticeable reduction in your anxiety. 

During ERP therapy, you’ll work with a therapist to develop a hierarchy of anxieties and related exposures and gradually work your way through them. In the previous example, the patient may start by bringing a new object into their home and sitting with the anxiety that arises. Eventually, they will work up to being able to host a friend. 

ERP therapy can be challenging because it involves facing your fears and putting yourself in situations you’ve been avoiding. However, ERP therapy has a proven track record of helping people with OCD. It has been found effective for 80% of OCD patients, and the majority of patients experience results within 12-20 sessions.

If you’re interested in learning about ERP, you can schedule a free call with the NOCD clinical team to find out how this type of treatment can help you. All of our therapists specialize in OCD and receive ERP-specific training and ongoing guidance from our clinical leadership team. Many of them have dealt with OCD themselves and understand how crucial ERP therapy is.