Obsessive compulsive disorder - OCD treatment and therapy from NOCD

Why general talk therapy isn’t effective for treating OCD

Mar 27, 202410 minute read

Whether you’ve tried it or not, you probably have some associations with talk therapy. There’s the classic picture that comes to mind: therapist sitting across the room from you, you in a chair or reclined on a couch, with a box of tissues beside you.

Make no mistake, there are benefits to talk therapy—but generally not when it comes to obsessive-compulsive disorder (OCD). When I first share this with people who are struggling with OCD, they can feel a bit discouraged, but it’s actually very good news. Though traditional talk therapy doesn’t work for OCD, there’s a specialized form of therapy that’s helped people regain their lives from the condition for decades.

What is talk therapy?

Talk therapy is a method of therapy where you discuss your thoughts and feelings with a licensed mental health professional to understand and resolve emotional and psychological issues. While talk therapy can help people dealing with a range of issues—for instance, depression, relationship issues, and anger management, to name a few—it’s not only ineffective for OCD, but it can actually make symptoms worse.

You might be wondering: Why haven’t I heard about this before? Well, one reason is that as a society, we’ve gotten very used to talking about potential negative consequences associated with medication. When a doctor hands you a script, you’re almost always informed about the side effects of the drug that may actually make your circumstances worse, not better. But very rarely do people treat therapy with the same caution—and that’s a mistake, especially when it comes to a condition like OCD. 

After all, OCD is cunning and cruel. It will do whatever it can to keep you trapped in a cycle of obsessions, fear, and compulsions—and it keeps getting worse over time. If you apply the wrong kind of therapy to this condition, the results can be debilitating. That’s why it’s so critical to know that there are some treatments that are not likely to result in any benefit, and may even be harmful to you. Let’s explore why talk therapy is ineffective, and learn about specialized treatment you can try instead.

5 reasons why talk therapy for OCD backfires (and what specialized treatment does differently)

1. In talk therapy: You analyze your thoughts.
In specialized therapy for OCD: You learn to understand that a thought is just a thought, and it doesn’t have to mean anything.

When someone with OCD goes to a talk therapist to discuss intrusive thoughts, their therapist will likely try to work with them to understand the thoughts or try to make sense of thoughts. They may focus on the content of the thoughts and dig into why they may have had that thought, even looking into how their past may have contributed to it. (It’s the classic, “So tell me about your mother/father discussion.”) For someone with OCD, this approach—analyzing every intrusive thought—is ineffective. That’s because what’s required to manage OCD effectively is an ability to realize that a thought is just a thought. The thought is neither good nor bad and it doesn’t have to mean anything. Searching for the deeper meaning of your intrusive thoughts is therefore futile. 

As OCD specialists, we teach people that their intrusive thoughts, images, or urges—known as obsessions—are not actually a problem. It’s labeling these thoughts as “bad” and—the behaviors they engage in to squash the feelings of discomfort—that leads to suffering. 

2. In talk therapy: You rely on reassurance from your therapist, which makes your fears stronger over time.
In specialized therapy for OCD: You avoid reassurance-seeking behaviors, which provides long-term relief.

While seeking reassurance isn’t a bad thing, people with OCD might do it in excess because they have trouble tolerating their discomfort. They may want someone to constantly quell their doubts or uncertainties, or tell them that a certain outcome they fear won’t occur. A talk therapist may naturally want to help you alleviate your distress by providing this reassurance, but it only serves to perpetuate OCD behaviors and thoughts. That’s because reassurance only provides, at best, momentary relief while causing more long-term harm.

Specialized OCD treatment, on the other hand, acknowledges that reassurance-seeking only perpetuates the fear. And a more effective, long-term solution is avoiding the compulsion to ask for reassurance—whether it’s from a loved one or, yes, a therapist.

3. In talk therapy: There’s no set time frame for recovery.
In specialized therapy for OCD: You can start to see results in weeks, not years.

In talk therapy, people heal and change at a different pace. It’s not unheard of to see a talk therapist for many years or even decades—as they say, there’s always another “layer of the onion” to pull back and analyze. For someone with, say, chronic anxiety or depression, this “it takes what it takes” approach may work just fine for ongoing management of their condition. But for OCD, let’s face it: Every day that goes by where the condition is untreated is another day spent in a debilitating cycle of OCD symptoms. That’s why people are so relieved when I tell them the evidence we have seen at NOCD. 

“We published the largest study on OCD at NOCD, and we found that people were receiving significant reductions in OCD symptoms in 12 to 14 therapy hours,” says Patrick B. McGrath, PhD. “So it can happen very quickly once people go through the treatment and do the therapy. You can see very significant change very, very fast if you allow yourself to not give in to compulsions.” 

4. In talk therapy: You may engage in verbal rumination.
In specialized therapy for OCD: You learn to stop engaging in all compulsions, including rumination.

When you ruminate, you direct a lot of your attention to a particular thought. We hear a lot about mental rumination—the kind you do in your head — but there’s also verbal rumination. Often, for people with OCD, talk therapy sessions can become opportunities to ruminate verbally—or continuously think about the same thoughts and feelings, often far more than is useful, which can also be a compulsion. They’ll run over a thought over and over again, in an effort to figure it out or rationalize it, without necessarily implementing a solution. 

This actually reinforces the message to your brain that an intrusive thought is dangerous (spoiler alert: it isn’t). People who are trained specialists in treating OCD recognize that rumination is a compulsion, and they’ll work with you to help you stop engaging in the behavior. “Many people ruminate on problems they think they’re having in an attempt to solve them,” notes Stacy Quick, LPC. “The issue here is that with OCD, the alarm isn’t responding to a real problem or danger. Choosing to ruminate only strengthens the false alarm system OCD creates.”

5. In talk therapy: You allow the therapy session to “go where it goes.”
In specialized therapy for OCD: You follow a structure in order to practice confronting the thoughts that cause distress and provoke obsessions.

Often, there’s no specified structure to guide talk therapy sessions. Instead, talk therapy relies on a patient communicating past or current experiences, traumas, and underlying thoughts. A therapist engages in active listening and helps the patient see the relationship between emotions, behaviors, and thoughts. Specialized therapy for OCD—known as exposure and response prevention (ERP) therapy—is highly personalized for each individual and their needs, but the foundation is a consistent formula that works.

Why does talk therapy make me feel better for a little bit?

After a talk therapy session, some people may feel that their session was cathartic or that they experienced an emotional release. That may be true, but likely, their OCD symptoms themselves have not been addressed. Sooner or later, they’ll likely begin to doubt everything they ruminated on and received reassurance for in their session. They’ll realize that little has changed. 

That’s because they didn’t take any action to implement change, which is necessary for OCD recovery. To effectively manage OCD long-term, it’s crucial to challenge OCD fears, accept uncertainty, sit with the resulting discomfort, and reduce or resist compulsive behaviors, such as avoidance and other mental or physical rituals. OCD uses these compulsions to keep you trapped, so resisting them is a necessary part of recovery.

Let’s consider an example: someone begins having intrusive thoughts that they will hit a person when driving. After some time, they may even start to fear that this did happen in the past but they can’t remember it, and they begin to feel extremely guilty.

In talk therapy, they might focus on how this is simply logically untrue: “You didn’t hit anyone. Is there blood on your car?”  “Did you see anyone injured?” “It’s ok. You’re fine; everything’s fine.” That will likely feel good for the moment—they’re able to ruminate on their worries and their therapist provides reassurance—but before long, OCD creeps back. Each piece of reassurance also gives OCD a fresh “But what if…?” question, leaving them feeling even less certain than before.

Eventually, their fear of the possibility that they hit someone or might hit someone has become so great that they no longer feel safe driving, and they begin avoiding it altogether. They may continue to discuss this with their talk therapist, but they make little progress, and they may stop driving altogether. 

That’s why using logic alone doesn’t work for treating OCD: even if someone logically understands that their rituals are irrational, their fear can be so great that they still engage in their compulsions “just in case” or “just to be sure.” To truly overcome OCD, it’s important to learn to live with uncertainty and implement techniques that are focused on retraining thinking and behavior patterns.

What type of therapy works for OCD?

The key to treating OCD effectively is by seeing a licensed therapist who specializes in OCD and who has received specialized training in exposure and response prevention (ERP) therapy. ERP is a form of therapy that was specifically developed to treat people with OCD, and countless studies have shown that ERP is the most effective form of treatment for OCD

This unique therapy is specifically designed to help you face your obsessions and resist compulsions in healthy and productive ways. It’s much more active than traditional talk therapy: you’ll collaborate with your therapist to carefully approach the thoughts, places, or situations where OCD impacts you most, then practice resisting compulsions. You’ll keep working step by step, teaching your brain that compulsions aren’t actually making you feel better, and that you’re capable of dealing with your fears and uncertainties.

The goal of ERP is to free individuals from compulsions by teaching them how to accept worry, doubt, or uncertainty so they can live life on their own terms, not according to OCD’s rules and demands. ERP can help you learn that while your fear or anxiety is not pleasant, you can tolerate it without resorting to compulsions. That’s the way to achieve freedom from OCD.

How can you find a therapist who truly specializes in OCD? 

The most important thing to look for when you’re seeking a therapist who specializes in ERP is whether or not they have specific training in treating OCD. They will know what to anticipate when you describe your thoughts and behaviors, and how to tailor treatment to your unique needs. Their expertise is in teaching you how to manage your OCD so you don’t feel stuck trying to “get rid of” the unpleasant feelings caused by disturbing thoughts. For more in-depth information, read our complete guide on what to know when finding an OCD specialist.

Remember, talk therapy can be helpful in many ways, but for OCD, specialized treatment is needed to get better—and the wrong form of treatment can make things worse. With the right type of therapy, you’ll be on the road to conquering OCD.

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