Cognitive Behavioural Therapy For OCD

  • Dana Visnitchi MSci, Neuroscience with Psychology, University of Aberdeen, Scotland
  • Helen McLachlan MSc Molecular Biology & Pathology of Viruses, Imperial College London

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Did you know that cognitive behavioural therapy (CBT) has been established over the years as an effective therapy for obsessive-compulsive disorder (OCD)?1 The breakthrough that OCD could be treated didn’t come until the 1960s, and since then, research has been focused on finding the most efficient treatment for this disorder. 

CBT includes different therapeutic techniques which are scientifically proven to be beneficial for dealing with OCD, including exposure and response prevention (ERP) and cognitive strategies.

This article aims to explain CBT and OCD, and dive further into the techniques that this type of therapy encompasses to overcome this behaviour. Keep reading to find out more!

What is OCD?

Obsessive-compulsive disorder is a chronic mental health issue in which an individual experiences intrusive and recurring thoughts (obsession) and performs repetitive behaviours (compulsion) to alleviate them.2

If you have OCD, you might be experiencing obsession, compulsion or both. 

  • Obsessions are unwanted thoughts, urges or impulses that come to your mind repeatedly, and cause you stress and anxiety. Consequently, you either try to ignore these thoughts or you seek comfort by doing something to stop them (compulsion)2
  • Compulsions are repetitive and excessive behaviours or mental actions that you perform to deal with the unease the obsessions cause you2

Common obsessive and compulsive behaviours2 that are seen include:

  • Worry about contamination or germs, followed by excessive cleaning or (body) washing
  • Worry and fear of harm, followed by constant checking (e.g. checking if doors are closed, oven is off, iron is unplugged)
  • Intrusive, aggressive and unwanted thoughts about religion or sex, followed by praying or silently repeating words
  • Desire to have things in order and symmetrical, followed by ordering, arranging items in a certain way, and counting compulsively

Experiencing intrusive thoughts and repeating behaviours is normal and part of our development, however, if you are suffering from OCD, they are time-consuming (more than an hour per day).2 This may interfere with your life and cause you distress, but there are treatments which could help you control it, like CBT. 

What is cognitive behavioural therapy?

Cognitive behavioural therapy is a psychotherapeutic approach which considers that your thoughts, feelings and behaviours are interconnected, therefore, changing your thinking and behavioural patterns can help you deal with negative feelings, emotions and situations.3

CBT aims to give you the necessary tools, so you can transform your negative thoughts into more neutral and positive patterns and be able to deal with challenging situations, without feeling overwhelmed. 

How does CBT work to treat OCD?

CBT is used to treat a wide array of disorders, by having you go to timed sessions, and using a goal-oriented approach to address your problem. Psychotherapists practising CBT want to help you break the automatic response between obsessive thoughts and compulsive behaviours. 

Common techniques used in CBT for OCD

These are the techniques that CBT uses to treat OCD:2,3

  • Exposure and response prevention (ERP): patients are gradually exposed to the stress-inducing obsession with instructions to avoid engaging in their compulsive behaviour. This way, the patient faces the anxiety and uncomfortable feeling caused by their obsessive thoughts, until they eventually become desensitised
  • Mindfulness-based CBT (MCBT): patients practise mindfulness meditation where they become aware of their environment, as well as the sensations they are experiencing, without any judgement. So rather than trying to fight their compulsion, they become aware of the obsession that triggers them, accept their unease, and try to resist fighting it with compulsive behaviours4
  • Cognitive restructuring: patients are taught to identify their obsessive thoughts and replace them with a rational thinking pattern
  • Breathing exercises: patients are encouraged to take deep breaths to deal with the anxiety induced by their OCD, especially during the ERP or MSBT techniques. Doing these breathing exercises can help them relax and remain calm 

Challenges in CBT for OCD

In some cases, patients fail to respond to CBT treatment. This could be for a variety of reasons2, such as: 

  • The OCD is more severe than initially predicted 
  • They suffer from other comorbid conditions, like depression, social anxiety disorder or agoraphobia
  • Low adherence to treatment and resistance to change
  • Unwillingness to experience unpleasant sensations 
  • Resources might not be physically available in their area or they could be too expensive
  • Familial history of OCD
  • Social stigma 

In these cases, a combination of CBT and medical therapy might be worth considering. 

Effectiveness of CBT for OCD

There is plenty of research that has indicated the efficacy of CBT for treating OCD.1 In addition, it appears that intensive CBT therapy has faster effects on patients’ improvement, compared to regular CBT.1 Furthermore, a study indicated that even online CBT decreased OCD and depressive symptoms, and improved patients’ quality of life over 10 weeks of therapy.5 Therefore, even if CBT does not completely cure OCD, it can be seen that it is mostly effective, and using it will be beneficial for your well-being.

The therapeutic process

Knowing what to expect during this process is important as it can help you feel less nervous about the situation. OCD is a health issue like any other, and since it is nothing to be ashamed of, it is important you seek professional help to reduce your distress. Here are some tips that might be useful:

  • Do your research before starting CBT. Pick the therapist that you think will work better for you. Moreover, if after some sessions you feel that you are not getting results or that you are not connecting with your doctor, don’t be afraid to look for other options
  • Consider also joining a support group for OCD, for information and advice
  • Get psychoeducation about OCD and CBT from a professional, including your friends and family. This can address all your concerns, and it can help your loved ones understand better what you are going through
  • Build a therapeutic alliance, which will allow you to set your goals along with your doctor, and achieve them through homework and agreed tasks
  • Be aware of your progress and be open-minded to any suggested interventions that might be beneficial for you
  • Finally, don’t try to rush through this process. It is important to take your time to achieve optimal results 

FAQ’S

How common is OCD?

In the UK, 1 in every 50 people have OCD, with assigned female at birth (AFAB) and assigned male at birth (AMAB) being affected equally.

How long will CBT take?

This will mostly depend on the patient. While CBT tends to show results after 12 weeks, this will also depend on how intense the OCD is, the frequency of your CBT sessions, and whether you are also experiencing other disorders or health issues. Have an open mind and trust your therapist. 

Will I have to take any medications during CBT?

CBT is based on changing negative thoughts and behaviours to positive patterns through talking and tools or exercises, but it does not involve any type of drugs. However, your therapist might suggest combining CBT with selective serotonin reuptake inhibitors (SSRIs) - prescribed by a psychiatrist- for the treatment to be more effective. 

Will CBT make my OCD disappear completely?

While in some situations this might be the case, in others, CBT may not make the disorder go away completely. Still, it will help you cope with it in a better way, reduce the frequency you act compulsively, and overall, ensure OCD does not interfere and cause you as much distress. This shouldn’t discourage you from seeking help and pursuing the treatment. 

How long is a CBT session and how much does it cost?

This will vary. Different practitioners will set the time of the sessions and their prices, so you should focus on finding the one that is more suitable for you. 

Summary

Cognitive behavioural therapy is often used to treat obsessive-compulsive disorder. Experiencing obsessive thoughts which are only relieved by compulsive behaviours, can cause you distress, hence why seeking help is important. CBT is a multifactorial therapeutic approach that consists of changing your thought pattern and behaviour to transform negative feelings into positive experiences. For OCD, CBT uses several techniques, including exposure and response prevention, mindfulness-based CBT, cognitive restructuring and breathing exercises. These methods aim to teach you how to control your compulsions when obsessive thoughts arise, and overall improve your life. Sometimes CBT for OCD might not be completely effective due to different reasons like socioeconomic status or poor adherence to treatment. However, science is constantly evolving, and CBT and OCD are a topic of interest, thus, new advances can appear in the future.

References

  • Jónsson H, Kristensen M, Arendt M. Intensive cognitive behavioural therapy for obsessive-compulsive disorder: A systematic review and meta-analysis. Journal of Obsessive-Compulsive and Related Disorders [Internet]. 2015 Jul 1 [cited 2024 Jan 15];6:83–96. Available from: https://www.sciencedirect.com/science/article/pii/S2211364915000408
  • Stein DJ, Costa DLC, Lochner C, Miguel EC, Reddy YCJ, Shavitt RG, et al. Obsessive–compulsive disorder. Nat Rev Dis Primers [Internet]. 2019 Aug 1 [cited 2024 Jan 16];5(1):1–21. Available from: https://www.nature.com/articles/s41572-019-0102-3
  • Chawathey K, Ford A. Cognitive behavioural therapy. InnovAiT [Internet]. 2016 Sep [cited 2024 Jan 16];9(9):518–23. Available from: http://journals.sagepub.com/doi/10.1177/1755738016647752
  • Key BL, Rowa K, Bieling P, McCabe R, Pawluk EJ. Mindfulness-based cognitive therapy as an augmentation treatment for obsessive-compulsive disorder. Clin Psychol Psychother. 2017 Sep;24(5):1109–20.
  • Patel SR, Wheaton MG, Andersson E, Rück C, Schmidt AB, La Lima CN, et al. Acceptability, feasibility, and effectiveness of internet-based cognitive-behavioral therapy for obsessive-compulsive disorder in new york. Behav Ther. 2018 Jul;49(4):631–41.

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This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Dana Visnitchi

MSci, Neuroscience with Psychology, University of Aberdeen, Scotland

I’m an early career with a degree in Neuroscience with Psychology, who is passionate about mental health, and aims to promote it to a large audience without a scientific background. I’m also interested in skincare and cardiovascular health, and always keen to expand my knowledge. I have previous experience in literature search, creating content for different audiences, and making contributions to a published research paper about Gender Dysphoria. I’m currently focused on exploring medical communications to have a significant impact on the healthcare community.

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