I offer CBT for OCD for adolescents and adults, both virtually and in person. Cognitive-behavioral therapy for OCD is considered a cornerstone treatment, given its effectiveness. This post goes over how I use CBT for obsessive-compulsive disorder, with an example and some alternatives.
This post is designed to help you become an informed and educated consumer of these services, whether you pursue treatment with me or not. I would be happy to talk with you about any of this. Please feel free to contact me or schedule a consultation any time.
What is CBT?
CBT, or Cognitive Behavioral Therapy, is a type of psychotherapy that focuses on changing negative thought patterns and behaviors. It is based on the concept that our thoughts, feelings, and behaviors are interconnected and that changing negative thoughts and behaviors can improve mood and functioning. I provide CBT as a core service in my practice.
CBT is typically short-term and goal-oriented, and it involves techniques such as:
1. Identifying Negative Thoughts: Recognizing and challenging irrational or unhelpful thoughts.
2. Cognitive Restructuring: Reframing negative thoughts in a more positive or realistic light.
3. Behavioral Activation: Encouraging activities that bring pleasure or a sense of accomplishment.
4. Exposure Therapy: Gradually facing feared situations in a controlled way to reduce anxiety.
5. Skill Training: Developing coping skills like problem-solving and stress management.
CBT is used to treat a variety of mental health conditions, including depression, anxiety disorders, phobias, and post-traumatic stress disorder (PTSD). It is evidence-based and is effective in numerous studies.
What is OCD?
Obsessive-Compulsive Disorder (OCD) is a mental health condition characterized by persistent, unwanted thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) that an individual feels driven to perform. These obsessions and compulsions can interfere significantly with daily functioning and cause distress.
Key Features of OCD
1. Obsessions: Intrusive and unwanted thoughts, images, or urges that cause distress or anxiety. Common themes include:
– Fear of contamination or germs
– Aggressive or horrific thoughts about harming oneself or others
– Doubts about having done something correctly (like locking the door)
– Unwanted, forbidden, or taboo thoughts involving sex, religion, or harm
2. Compulsions: Repetitive behaviors or mental acts that a person feels compelled to perform in response to an obsession or according to rules that must be applied rigidly. These behaviors aim to reduce distress or prevent a feared event, but they are not realistically connected to what they are intended to prevent or are clearly excessive. Common compulsions include:
– Washing and cleaning
– Checking (e.g., ensuring the stove is off multiple times)
– Counting
– Ordering and arranging
– Repeating actions a certain number of times
CBT for OCD is a great fit since they are both rooted in automatic, irrational, and exaggerated thinking. OCD involves having these thoughts, while CBT aims to help you reduce or eliminate them. Cognitive-behavioral therapy for Obsessive-compulsive disorder truly works and is, therefore, often the first treatment I use.
CBT for OCD Process
While the process of CBT for OCD can vary, here is a general look at the steps:
CBT for OCD Psychoeducation
We start CBT for obsessive-compulsive disorder with education. The goal is to educate you or your child about OCD, including its symptoms, causes, and the principles of CBT. Some people start to experience relief after this initial step since it clarifies the causes of the symptoms and what is maintaining them. Once you start to see that your symptoms are not “real,” yet there are real reasons why they are happening, it helps you separate yourself from the disorder.
Exposure and Response Prevention (ERP)
ERP is a core component of CBT for OCD. It involves deliberately exposing oneself to situations that trigger obsessions (exposure) while refraining from compulsive behaviors (response prevention). Over time, this helps you learn that your anxiety decreases on its own without needing to perform compulsions. Of course, we go at a pace you are comfortable with, often starting with merely trying to delay responding if you can’t choose not to respond at all.
Cognitive Restructuring
This involves identifying and challenging irrational thoughts (cognitions) related to OCD. Through techniques such as cognitive restructuring, you learn to replace these irrational thoughts with more realistic and balanced ones. I’ll often assign homework exercises to reinforce the cognitive restructuring skills learned in therapy and encourage you to practice these skills. Many people find that CBT for obsessive-compulsive disorder helps them hear the thoughts that they had previously been unaware of. This in itself can be eye-opening and powerful.
Cognitive-Behavioral Therapy for OCD Behavioral Experiments
These involve testing the validity of one’s beliefs related to OCD through structured experiments. This can help you gather evidence that challenges their OCD-related beliefs and assumptions. I’ll guide you on how to do these, and you’ll do them as homework outside the sessions. These experiments are enjoyable and even sometimes fun. Some people choose to have trusted people in their life join them, both for enjoyment and so the other person understands what it’s like to have the disorder.
Mindfulness in CBT for Obsessive-Compulsive Disorder
Mindfulness techniques can help you increase awareness of your thoughts and feelings without judgment. Acceptance and Commitment Therapy (ACT), which incorporates mindfulness and acceptance strategies, can also be helpful as an adjunct to CBT for OCD. Mindfulness can help in so many other ways as well, and many clients who have had cognitive-behavioral therapy for OCD continue to use mindfulness techniques to help in other areas of their lives even after their symptoms subside.
CBT for OCD Relapse Prevention
Once significant progress has been made, our focus shifts to maintaining gains and preventing relapse. This involves developing strategies to cope with any future OCD symptoms that may arise, and thus having a CBT for OCD toolkit you can use going forward.
Cognitive-Behavioral Therapy for OCD Example
Here’s an example of how CBT might be applied in the treatment of OCD:
CBT for OCD Assessment and Treatment Planning
Julie came in with symptoms of OCD since a recent promotion and the birth of her first child. She has been finding herself having increased compulsions to do unnecessary or repetitive tasks to reduce her anxiety at home and work.
We start this course of CBT for OCD by conducting a thorough assessment to understand Julie’s specific OCD symptoms, triggers, and the impact on her daily life. I provide psychoeducation about OCD, explaining how obsessions and compulsions work and why she is likely experiencing them now during these stressful, even if positive, life transitions. We also discuss the principles of CBT for obsessive-compulsive disorder as an effective treatment approach.
Next, we set treatment goals. Together, we establish clear, measurable treatment goals. These goals include reducing the frequency and intensity of obsessions and compulsions, enhancing her overall contentment and quality of life, and developing more positive stress management methods.
CBT for Obsessive-Compulsive Disorder Process
It is now time to dive in and begin the process of cognitive-behavioral therapy for OCD. The cornerstone approach will be Exposure and Response Prevention (ERP). I work with Julie to help her identify their specific triggers for obsessions and compulsions. We then collaboratively develop a hierarchy of feared situations or triggers, ranging from least to most anxiety-provoking.
Outside of sessions, Julie will start with exposures to less distressing triggers and gradually progress to more challenging ones while refraining from engaging in compulsive behaviors. For example, since one of her obsessions and compulsions is about germs and contamination, she will start by touching mildly dirty objects and refraining from washing her hands immediately afterward.
We will start working on cognitive restructuring once Julie has succeeded with some ERP. I help her identify and challenge her irrational beliefs related to OCD. For instance, she believes touching a doorknob without washing her hands could lead to illness. I help her evaluate the evidence for and against this belief so she can develop a more balanced perspective.
Cognitive restructuring leads to the next phase of Julie’s cognitive-behavioral therapy for OCD: Behavioral Experiments. I guide her in conducting experiments to test the accuracy of her OCD-related beliefs. This involves intentionally exposing herself to situations they fear will trigger obsessions but refraining from performing compulsions. When she touches a doorknob, she will see how long she can hold out from washing her hands, and we will go over the consequences (or lack thereof) of doing this.
Throughout this cognitive-behavioral therapy for OCD, I will introduce mindfulness techniques to help Julie develop greater awareness of her thoughts and emotions without judgment. She will practice mindfulness exercises during therapy sessions and as part of homework assignments to cultivate acceptance of uncertainty and discomfort.
Throughout the CBT for obsessive-compulsive disorder treatment process, I provide guidance, support, and encouragement while also fostering Julie’s independence and self-efficacy. CBT for OCD treatment sessions are collaborative, with the two of us working together as a team to achieve the established goals. She’ll leave therapy without symptoms and with a toolkit to manage daily stress.
Summary and My Work
I offer cognitive-behavioral therapy for OCD as a virtual treatment and in person. CBT for OCD is usually conducted over a series of regular weekly individual therapy sessions, with a length of time determined by your progress and the severity of symptoms. The specific treatment plan is tailored to your needs and may involve variations of the abovementioned techniques. CBT for obsessive-compulsive disorder can even be done in a couples therapy or family therapy framework where the other people are there to help with some of the skill-building, cognitive psychology experiments, and exposure methods.
Please feel free to contact me or schedule a consultation anytime to discuss CBT for OCD and how it could help you or your child.
