Cognitive Behavior Therapy

Cognitive Behavior Therapy (CBT) is the “gold standard,” or the treatment of choice, for OCD. It makes use of two evidence-based techniques – Exposure and Response Prevention therapy (ERP) and Cognitive Therapy (CT).

Your college or university student health center or counseling center should be able to help you find a cognitive behavior therapist who treats individuals with OCD. If there is no one on staff with cognitive behavior therapy credentials, ask to be referred to a therapist in a nearby city or town.

Keep in mind that psychoanalysis and talk therapies that focus on family dynamics, early childhood trauma or issues of self-esteem are not effective treatments for OCD. Moreover, there is insufficient evidence at this time to support the use of treatments such as hypnosis, herbal or homeopathic remedies, relaxation therapy, eye movement desensitization reprocessing (EMDR) or dietary changes. Certain forms of therapy, such as family and marriage counseling, can help with relationship problems and other difficulties that frequently accompany OCD. Similarly, there are a number of excellent tools for reducing anxiety that may be used to supplement CBT and medication, including yoga, exercise and meditation. It’s important to note, however, that CBT and medication represent the cornerstone of treatment for OCD.

OCD won’t go away by itself.

How Does CBT Work?

Exposure and Response Prevention

With Exposure and Response Prevention, a mental health professional trained in CBT conducts a series of controlled ERP sessions with you. During these sessions, the therapist gradually exposes you to the situations that trigger your obsessions and compulsions. Over time, you learn to respond differently to these triggers, leading to a decrease in the frequency of compulsions and the intensity of obsessions. OCD symptoms often become so mild that they’re easily ignored; sometimes they disappear.

The first step in ERP is for you to provide your therapist with a detailed description of your obsessions and compulsions, which are then ranked from the least bothersome to the most difficult. Then, beginning with the easiest symptoms, the therapist designs “exposures,” or challenges, that put you in situations that trigger obsessions. During these exposures, you avoid performing compulsive behaviors (“response prevention”) for increasingly longer periods of time. Through repeated exposures, you realize that when you avoid performing rituals, your anxiety increases temporarily, peaks and then decreases.

In cases where creating the actual situation that triggers a compulsion is impossible, therapists can use imagined exposures, visualizations and recordings that can effectively increase anxiety levels for ERP exercises.

When therapeutic exposures are repeated over time, the associated anxiety decreases until it is barely noticeable or actually fades entirely. You can then take on more challenging exposures until they, too, become manageable. Effective ERP leads to “habituation,” which means you learn that nothing bad happens when they stop performing rituals.

If you have an obsessive fear of germs, for example, a therapist conducting ERP therapy may work with you to encourage you to touch the top of a desk – which you believe is contaminated – and then wait longer and longer periods of time to wash your hands. Over time, this gradual exposure and delayed response would help you learn to respond differently to the fear or thoughts about germs, which, in turn, would actually lead to a decrease in the frequency and intensity of the obsession.

Cognitive Therapy

Cognitive Therapy, the second technique involved in CBT, helps you identify and modify patterns of thought that cause anxiety, distress or negative behavior. In other words, CT helps you understand that the brain is sending “error” messages. Through Cognitive Therapy, you learn to recognize these errors and confront the obsessions by responding to them in new ways.

For example, a new mother standing by a window may have the thought, “Would I be capable of throwing my baby out the window?” Most people would easily dismiss this thought with something like “That’s a strange thought; where did that come from?” But some people hold fast to certain beliefs, such as the belief that thoughts are always important, or that having a thought is morally equivalent to actually doing it. Therefore, a mother with OCD may react to the thought of harming her baby by thinking “I’m a horrible mother for having such a thought! What’s wrong with me to think like that?”). Research shows that attempting to control your thoughts – or believing you should be able to control them – actually leads to more horrific images and frightening or repugnant thoughts.

Using Cognitive Therapy, this mother might be asked to challenge her thoughts and would be taught a more suitable alternative to her current way of thinking: “I’ve held a number of babies before, and I have never hurt any of them.” Strategies such as self-talk, learning to separate oneself from the disorder, and analyzing the realistic chances or probability of a catastrophe’s occurrence are also part of Cognitive Therapy.

Most CBT treatment is conducted on an outpatient basis once a week with “homework” consisting of daily exposures to be completed between therapy sessions. In severe cases, people may require more frequent sessions or even residential treatment.

This treatment may seem unusual; you may even think it wouldn’t work. Or perhaps you’ve already tried to resist compulsions, without much success. But with the right therapist and sufficient time and support, Cognitive Behavior Therapy has helped thousands of people control their OCD. In fact, some studies show that more than 85% of the people who complete a course of CBT experience a significant reduction in OCD symptoms.

Imagining life with more free time and without crippling anxiety helps many people with OCD stay motivated to stick with ERP until the end of treatment. Following therapy, you can look forward to resuming studies without the interference of OCD, engaging in social activities, and enjoying the company of those you’ve missed when OCD had control of your life.

That Seems Easy Enough — Why Can’t I Try This ERP Therapy On My Own?

It’s not that simple. To be effective, exposure and response prevention sessions must be planned and conducted by a trained cognitive behavior therapist. This type of professional would know the proper way to design a program for your particular set of symptoms that will bring you relief in the shortest amount of time.

The sessions may be conducted outside of the therapist’s office if the obsessions and compulsions are at their worst outdoors, or in a public place. Some CBT therapists will conduct sessions by phone, online, or via webcam technology such as Skype, if needed. They will also design homework exercises for you to do between sessions. Although there are self-help books on CBT, it is highly recommended that you work with a trained professional to get the most effective treatment.

How Do I Know CBT Really Works?

You can read what others have found out about CBT and living with OCD in the Personal Stories section of this web site. CBT requires real effort and commitment on your part, but the good news is that it really DOES work.

How Do I Find A Therapist?

CBT is the only form of behavior therapy strongly supported by research for the treatment of OCD. Therefore, it’s extremely important to find a cognitive behavior therapist who has training and experience in treating OCD – usually a psychologist with a Ph.D., Psy.D., M.A. or M.S. degree, or a specially-trained social worker. If your student health center or counseling service is unable to help you find a cognitive behavior therapist, Beyond OCD can help you find a treatment provider in the Chicagoland area, or check the International OCD Foundation web site to find a cognitive behavior therapist close to where you are.

What About Medication — Do I Need That Too?

Sometimes medication is prescribed in combination with CBT. If your cognitive behavior therapist thinks you would benefit from medication, he or she will refer you to a psychiatrist who will prescribe it.

Sometimes a doctor on campus at the student health center or in private practice will prescribe a medication that reduces general anxiety without suggesting CBT. If you really have OCD, medication alone generally is not as effective as medication AND CBT. In fact, with medication, you don’t learn how to think differently or how to control the obsessions and compulsions. Medications intended to decrease anxiety may make it easier for you to be successful in CBT, but they don’t take the place of CBT. And, sadly, when people who have only used medication stop taking the meds, they generally find that the symptoms come back.