Category Archives: OCD

Cognitive Behavioral Therapy for Treating Obsessive Compulsive Disorder


Obsessive Compulsive Disorder

Obsessive-compulsive Disorder (OCD) is an anxiety disorder that involves the client experiencing obsessive thoughts and/or compulsive thoughts and/or behaviors. Obsessive thoughts, or up sessions, are intrusive thoughts that enter one’s mind involuntarily. While most people experience intrusive thoughts, it is someone who is diagnosed with obsessive-compulsive disorder who becomes pretty occupied with these thoughts and harps on then to the extent that these thoughts now adaptively control his life. Compulsions are thoughts and/or behaviors that are meant to compensate for obsessions and get rid of anxiety. People engage in compulsive behaviors, such as hand washing, checking, engaging in rituals or ordering things to temporarily relieve anxiety that is caused by obsessive thoughts. Compulsions may also be phrases people say to themselves in their own heads to counteract the excessive thoughts, such as praying or counting to oneself.

Cognitive Behavior Therapy

Cognitive Behavior Therapy (CBT) is an empirically supported approach to treat obsessive-compulsive disorder. Cognitive behavioral therapists analyze specific components that play a role in a client’s disorder. The first component is the situation (sometimes called activating event) which is usually beyond the clients control. It is an external factor, such as someone shaking your hand or another person saying something negative about a family member of yours. The second component is the person’s thoughts or cognitions about the situation. People with excessive compulsive disorder tend to have rigid and persistent thoughts about a situation. For example someone may repeatedly think about how the germs from the person’s hand who they just shook may contaminate them and everything they touch. Obsessions are involuntary and unwanted thoughts, so a person with obsessive compulsive disorder tries to rid themselves of these intrusive negative thoughts. One way someone with excessive compulsive disorder may rid themselves of these thoughts is by engaging in a compulsion. For example, they may wash their hands in order to stop the thought that they have been contaminated. The last prominent component of obsessive-compulsive disorder is the anxiety factor. Obsessive thoughts cause anxiety, which in turn lead the clients to engaging compulsions to rid themselves of the anxiety. However, it is this technique of avoidance that only perpetuates the disorder and mixed things worse for the client.

Exposure and Response Prevention

Cognitive behavioral therapists often practice a technique called exposure and response prevention when treating people with obsessive compulsive disorder. Exposure involves having the client face his or her fears and not allowing them to escape or avoid them with compulsions. Using the example from above, someone with obsessive-compulsive disorder who has a fear of contamination may engage in an exposure session in which the therapist has the client get his hands dirty (exposure) and prevents him from washing his hands (response prevention). Exposure therapy is done over a number of sessions and has been shown effective in alleviating ones up sessions and compulsions.  Exposure with response prevention is often referred to as ERP.

Cognitive behavioral therapists also teach their clients to relate to their thoughts differently. People with obsessive compulsive disorder know that in reality their thoughts are realistic. However, when in a moment of upset saying they believe with certainty that these thoughts are true. Cognitive behavioral therapy has helped clients to distance themselves from these thoughts and recognize that the compulsions they engage in only perpetuate the up sessions. One technique used is to teach the client to postpone obsession time. A cognitive behavioral therapist may teach the client to postpone worrying about up sessions for five minutes. This technique allows the client to see that he actually has control over his thoughts, rather than the thoughts having control over him. Cognitive behavioral therapists practice exposure therapy in the session and also assign homework assignments to allow the client to practice exposure on his own for increased benefit.

Cognitive Behavioral Therapy and Anxiety

CBT and Anxiety

Cognitive Behavioral Therapy and Anxiety

Anxiety is a mental health disorder that ranges from mild to severe and includes cognitive, emotional and behavioral problems. Anxiety can affect one’s functioning in various life domains, including social, familial and occupational. There are several types of anxiety disorders, including the following

Generalized Anxiety Disorder

GAD involves excessive worrying most of the time about various aspects of one’s life (e.g., health, occupation, family, etc.).

Panic Disorder with or without Agoraphobia

Panic Disorder involves recurrent panic attacks. Panic attacks are brief periods of intense anxiety that involve physiological symptoms, such as shortness of breath, increased heart rate, sweating and dizziness, and may also include thoughts that one is going crazy or is going to die. Panic Disorder involves recurrent panic attacks and worry about having another panic attack. Panic Disorder may become so severe that one does not leave his/her house and develops Agoraphobia, which is the fear of being in a place where it is hard or impossible to escape. For example, a person with Panic Disorder may have an intense fear of having a panic attack in a place where he/she cannot escape, like on a train or at a rock concert, so he/she avoids these types of places.

Specific Phobia

Phobias an intense fear of something specific, such as a place or thing. Specific Phobias are broken up into categories, including blood/injection phobia, heights or animals.

Post-traumatic Stress Disorder (PTSD)

PTSD is an anxiety disorder that develops after a person is exposed to a traumatic event in which he/she faces a near-death experiences or observes someone else in a near death experience or in which the person’s integrity is significantly compromised. PTSD includes symptoms of the traumatic event recurring, such as in flashbacks or nightmares, physiological and/or psychological reactivity upon exposure to cues that resemble the traumatic event, avoidance of cues of the event and increased arousal (e.g., exaggerated startle response, hypervigilence).

Obsessive Compulsive Disorder (OCD)

OCD involves the presence of obsessions (e.g., intrusive thoughts) and/or compulsions (e.g., behaviors and/or thoughts).

Anxiety Disorder NOS

Anxiety Disorder NOS exists when an individual does not meet diagnostic criteria for any specific anxiety disorder but has significant impairment due to anxiety. People who have anxiety and depression may fall into this category.

Cognitive Behavioral Therapy for Anxiety

CBT has been shown to effectively treat anxiety disorders. It is am empirically-based treatment for these disorders. CBT is an umbrella term that is used to describe a type of psychotherapy that focuses on changing the patient’s thoughts and thereby changing his/her negative emotions and behaviors. There are different types of CBT that have been effective in treating anxiety, including Beck’s Cognitive Therapy, Albert Ellis’s Rational Emotive Behavior Therapy and Exposure Therapy with Response Prevention.

Exposure Therapy

Exposure therapy is a type of behavior therapy that involves exposing the patient to the anxiety-provoking stimulus and preventing the person from escaping. For example, a dog phobic would slowly be exposed to a dog until the anxiety ameliorates. There are two types of exposure therapy: in vivo and imaginal. In vivo involves exposing the patient to the actual feared stimulus in real life, such as actually flying on an airplane with a flight phobic. However, there are times when in vivo exposure is not feasible and in which cases imaginal exsosure is used instead. Imaginal exposure involves having that patient imagine the feared stimulus while the therapist narrates a scene.

Cognitive Therapy

Cognitive Behavior Therapy involves analyzing the patient’s thoughts that are causing the anxiety and restructuring these thoughts, thereby decreasing the anxiety. For example, if a person’s cognitions are, “What if I fail the test? That would be awful. That would mean I’m a failure,” she will likely feel anxious. But is those thoughts are modified to, “If I fail one test that is no big deal,” the emotion that follows will likely not be anxiety.

Systematic Desensitization

Systematic Desensitization involves pairing relaxation with the anxiety-provoking stimulus, which will decrease one’s arousal. This type of psychotherapy is based on the premise that a person cannot be aroused and relaxed at the same time.

Progressive Muscle Relaxation

PMR involves guiding the client through exercises aimed a relaxing body muscles one at a time. The patient is to tense a muscle and then relax that same muscle, paying particular attention to the differences between the physiological feelings between tension and relaxation.

Diaphragmatic Breathing

Breathing from one’s abdomen instead of chest has been shown to decrease arousal and provide a calming response. The therapist walks the client through the breathing exercises.