CBT for Obsessive-Compulsive Disorder (OCD)

Treating obsessive-compulsive disorder can be challenging, and choosing the right therapy is essential to ensure a proper and effective remedy. Exposure and response prevention therapy is a type of cognitive behavioral therapy (CBT) for OCD that is considered the gold standard of treatment. Here, we will explore how this type of therapy works, the techniques used, and how effective it is in treating OCD.

What is CBT?

CBT is a multifaceted therapeutic approach that encompasses different types of evidence-based therapies focusing on the interconnectedness of thoughts, emotions, and behaviors. These facets are related to and impact one another. CBT puts forth that dysfunction in one facet can be addressed by adjusting the other areas and that changing thought patterns and behaviors can improve negative feelings.

CBT is used to treat a wide range of mental health conditions, including (but not limited to) depression, anxiety disorders, eating disorders, substance use problems, and other mental illnesses [*]. This treatment focuses on the individual’s present experience and is typically short-term. During cognitive behavioral therapy, people will gain practical skills to manage their obsessions and compulsions and examine the core beliefs that drive their decision-making.

This type of therapy allows individuals to deal with their situation more productively by learning to change their thoughts and behaviors with the help of a therapist and, eventually, by themselves.

How Does CBT Work for OCD?

There are often some confusions between OCPD and OCD, but these two conditions are very different. We will be focusing on OCD in this article.

Individuals with OCD struggle with obsessive thoughts that cause severe distress. As a result, they engage in compulsions or repetitive behaviors to experience temporary relief. Cognitive behavioral therapy for OCD works by breaking the connection between obsessive thoughts and compulsive behaviors. CBT also works by helping the person avoid turning to ritualizing whenever they feel anxious.

CBT Techniques for OCD

There are several CBT techniques that work for treating OCD.

Exposure and Response Prevention Therapy (ERP)

The most effective CBT technique that is used to treat OCD is exposure and response prevention therapy, or ERP. This process entails exposing the patient to some degree of the stress-inducing obsessive thought without allowing them to do the compulsive behavior.

ERP works by preventing individuals from feeling the temporary relief associated with the compulsion. This technique allows the patient to face their anxiety until the anxiety fades, thereby desensitizing them to it.

ERP is often considered the gold standard for treating the condition, whether it’s OCD in adults or OCD in children.

Inference-Based CBT

Inference-based CBT (I-CBT) is another treatment designed specifically for OCD. In this type of CBT treatment for OCD, the assumption is that people with OCD confuse reality with imagination when they are distressed. Thus, the individual with OCD learns the connection between obsessional doubts and faulty reasoning. Therapy allows patients to practice alternative narratives that are not grounded in obsessional doubts but in common sense.

I-CBT does not challenge the content of obsessional doubts but, rather, the doubting process. I-CBT emphasizes that faulty reasoning (the doubting process) is responsible for maintaining the OCD symptoms. Without the doubting process, it is thought that the OCD symptoms will subside.

Deep Breathing Exercises

Breathwork exercises are helpful techniques to manage the anxiety related to OCD. This method is especially beneficial when administering the ERP technique.

There are many breathing exercises that can be used. As long as it allows the person’s heart rate and breath to slow down to create a calming effect, then it can be effective as part of the treatment of OCD.

Cognitive Restructuring

Cognitive restructuring focuses on changing negative thought patterns.

People who tend to overgeneralize, assume the worst will happen, or place too much importance on minor details all have some type of negative thinking pattern. Thinking this way can affect their behaviors and even become a self-fulfilling prophecy.

During CBT, your therapist may ask you to detail your thought process so that you can identify negative patterns. Once you are aware of them, you can reframe those thoughts into more positive and productive ones. For instance, saying “I messed up during the presentation because I’m completely useless” can be rephrased as “That presentation wasn’t my best work, but I am a valuable employee and still contribute in many ways.”

Cognitive restructuring can help especially with OCD in teens, as many adolescents are prone to developing negative thought patterns as they develop into young adults.

Behavioral Experiments

Behavioral experiments are usually used for OCD that involves catastrophic thinking.

It works by asking an individual to predict what will happen if an obsessive thought occurs. Later on, they will discuss whether the prediction came true. Over time, it is easier to see that the predicted catastrophe is actually very unlikely to occur. Therapists will help patients start with lower-anxiety situations and build up from there.

Is CBT Effective for Treating OCD?

More than 40 years of published research has led to a wide consensus among clinicians and researchers that CBT is an effective treatment for OCD [*]. This is particularly true for exposure-based treatments, which have the largest evidence base in support of effectiveness for OCD.

How Long Does CBT Treatment for OCD Last?

Patients who complete CBT report as much as a 50% to 80% reduction in OCD symptoms after 12-20 sessions. People with OCD who respond to CBT have been found to stay well, often for many years [*]. This is especially important in young people like adolescents with OCD, for whom CBT for teens can work effectively and have lasting effects.

Is CBT for OCD Suitable for All Types of Obsessions and Compulsions?

CBT can apply to different obsessions and compulsions, including fear of germs and illness, constant checking, harm OCD, and others.

Are There Risks and Side Effects Associated with CBT for OCD?

Currently, there are no major risks that CBT can have on treating OCD. Perhaps the only downside is that it may not be effective for everyone who receives the treatment. Research has shown that CBT with exposure and response prevention is an effective modality that avoids side effects and reduces relapse once treatment is over [*].

The Bottom Line

Ultimately, if you are considering a way to manage your OCD, CBT is the best choice; OCD and CBT go hand-in-hand. This is recommended for various age groups, with CBT for kids being an excellent option for younger individuals with the condition. With the guidance of a skilled mental health professional, individuals struggling with OCD can achieve long-term wellness and improved mental well-being.

Browse our collection of CBT worksheets for resources that can supplement CBT treatment or provide support for those looking to better manage their thoughts and emotions.

References:

1. American Psychological Association. What is Cognitive Behavioral Therapy? 2017.
2. Foa, E. Cognitive behavioral therapy of obsessive-compulsive disorder. 1 April 2022.
3. University of Florida Department of Psychiatry. Psychotherapy for OCD.
4. Van Noppen B, Sassano-Higgins S, Appasani R, et al. Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder: 2021 Update. 5 November 2021.