CBT For OCD: How It Works

Reviewed by Melinda (Santa) Gladden, LCSW

Published 06/27/2022

Cognitive-behavioral therapy (CBT) is an evidence-based treatment used for countless mental health conditions, including obsessive-compulsive disorder (OCD). In this article, you will learn why a type of CBT called exposure and response prevention (ERP) is highly recommended for people with OCD and what you should expect from it.

What Is Cognitive-Behavioral Therapy?

Cognitive-behavioral therapy is a form of psychotherapy that can help people change negative thinking and behavioral patterns that lead to stress and other mental health issues into ones that are positive and productive, and in turn, this changes the way the individual feels.

The primary principle of CBT is that our thoughts, feelings, and behaviors are all intertwined and are influenced by each other.

CBT typically begins by helping people identify the dysfunctional thought patterns that are causing them to feel the way that they do, and once they do, they can find ways of coping with them, which involves changing their behaviors.

Our thoughts are formed by our core beliefs, which are how we perceive ourselves and the world around us, and this leads to the development of rules and assumptions, which are ideas of how we believe things are supposed to be, and naturally, this affects how we think and feel about things. [1]

In OCD, obsessive thoughts are influenced by these core beliefs, rules, and assumptions and the behaviors are the compulsions that people carry out in response to their obsessions. This is why OCD feels like it presents thoughts that we feel are disturbing, disgusting, and even morally wrong, and it seems like it is attacking our personal character.

Once people recognize their obsessions, look at them objectively, and learn how to stop using compulsions, their feelings and emotions will naturally follow suit, and they will experience less stress and anxiety because their thoughts do not bother them as much.

Aaron Beck first developed Cognitive-behavioral therapy in the 1960s, and the philosophy behind it has led to many other methods being developed using the CBT-model. Since then, CBT has become somewhat of an umbrella term that includes therapies such as:

  • Dialectical Behavioral Therapy
  • Cognitive Processing Therapy
  • Stress Inoculation Training

One CBT-based method in particular that has shown tremendous success in helping people with OCD is known as exposure and response prevention (ERP), and in the next section, you will learn more about what this cognitive behavioral therapy for OCD strategy entails and how it works.

Exposure & Response Prevention

Exposure and response prevention (ERP) is the gold standard when it comes to helping people challenge their obsessive thoughts and defeat their compulsions and start feeling better about themselves.

As you would expect by reading the name of this psychotherapy technique, patients with OCD are required to gradually expose themselves to the source of their fears and obsessions and learn how to not respond to them with compulsions.

The compulsions are what cause the obsessions to be so powerful and persistent. Even though they can provide a sense of relief, continually performing compulsions places great importance on these thoughts and will make them constantly appear in your head.

ERP therapy for OCD can sound terrifying and very stressful for those who are unfamiliar with the process but rest assured, it is very safe and will be done under the supervision of a therapist who is familiar with treating people with OCD by using ERP. Your therapist will not require you to jump into things headfirst right away, and recovery can be a gradual process.

Nonetheless, when you are confronting your obsessive thoughts, you will also be instructed not to respond with a compulsion for as long as you can. Starting out, you will most likely have strong urges, and that is completely normal because you have OCD. [2]

However, over time, and by practicing refraining from using compulsions, your fear, stress, and anxiety towards the obsession will start to diminish, and eventually, it won’t have a hold on you anymore.

Of course, not everyone is able to directly confront their obsessions because they cannot be recreated or it is impractical, but there is still an effective option for those who have OCD obsessions that they cannot actually be exposed to.

For these individuals, imagined exposure is recommended, and it can be very effective. The process is the same as in-vivo exposure (direct exposure) as well, except you will try to vividly imagine the thoughts that bother you so that it provokes stress and anxiety. [3]

It can also be a very useful tool to help people work up to in-vivo exposure, too, for those who are not quite ready to directly confront the source of their obsessions. Later on, they can sometimes be used in combination with each other.

Nonetheless, regardless if you choose to use in-vivo or imagined exposure, the most important thing is not responding to the obsessions with compulsions. This also involves not trying to find reassurance from the therapist or trying to distract yourself with neutralizing thoughts.

Your brain will keep trying to tell you that you are in danger, and you might even experience the sensations associated with the fight-or-flight response, but the goal is to change the way you think and behave so that this does not happen.

Starting ERP therapy is not easy, but it is necessary in order to overcome OCD and take control of your life again by reducing the impact these thoughts have on your well-being by not responding to them.

What Happens If And When Your Thoughts Change

Many people with OCD will have the same intrusive thoughts and behaviors for years, but once you deal with them with the help of a therapist, the battle is not necessarily over.

OCD is a condition that can evolve with time, and a person’s obsessions can change, especially if you learn how to address one. Essentially, OCD can find something else to latch onto once one obsession is beaten.

The truth is, managing OCD is a lifelong endeavor, and you will need to utilize the skills you learn in therapy to cope with every potential intrusive thought that arises in the future.

Everyone has intrusive thoughts, but the difference between someone who has OCD and someone who does not is that the latter does not respond to the thoughts and just lets the thoughts pass.

Whatever comes up, do not respond with compulsions, as this can turn a simple but bizarre thought into a full-blown obsession again.

However, if you cannot resist the urge to perform compulsions, it is not the end of the world; just use what you have learned in therapy and try not to respond next time as this will make this new obsession powerless, just like what happened with the old ones.

How to Find a Therapist for OCD

Because CBT is one of the most popular psychotherapy methods available, finding a professional who knows how to treat OCD is quite easy, and an online search can yield many results.

People can benefit from working with a therapist in-person, or they can try online therapy as well. The skills you need to overcome OCD can be learned in both and can be used for the rest of your life.

If you have not been diagnosed yet, meeting with a mental health professional can help you in that regard if you have been showing signs and symptoms of OCD for any amount of time.

You can also take this free OCD test if you are uncertain if you have the condition or, and you can share the results with your therapist if you wish.

Getting a diagnosis is also important for receiving prescription medication; however, your therapist will most likely need to refer you to a doctor or psychiatrist who can because most psychotherapists are not licensed to prescribe medication.

Medication can be helpful in controlling some of the symptoms of OCD, and therefore, can make your ERP sessions much more bearable, especially in the early stages of your treatment, and it can help ensure your success.

Nonetheless, if you choose not to take medication, it is completely normal and acceptable, and it is not essential in beating OCD, but it can certainly help.

What is most important is that you find a therapist who will assist you with your exposure therapy for OCD, and with the right guidance, attitude, effort, and commitment, anyone can overcome the disorder.

Conclusion

I hope that by reading this article, you have a much better understanding of cognitive behavioral therapy techniques and what it takes to treat OCD. Through OCD CBT, particularly exposure and response prevention, people can have what it takes to face their fears and stop using compulsions and start taking their lives back from their obsessive and intrusive thoughts that limit and reduce a person’s quality of life.

References

  1. Dorter, G. (2020, October 22). Core Beliefs in Cognitive Behavioral Therapy (CBT). Retrieved from https://www.guelphtherapist.ca/blog/core-beliefs-in-cognitive-therapy-cognitive-behavioural-therapy-cbt/
  2. International OCD Foundation. (2018, July 23). Exposure and Response Prevention (ERP). Retrieved from https://iocdf.org/about-ocd/ocd-treatment/erp/
  3. Thompkins, M. A. (2018, April 11). Details of Imaginal Exposure. Retrieved from http://sfbacct.com/from-ocd-to-anxiety/nuts-and-bolts-of-imaginal-exposure/