CBT for OCD
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.