Treatment for Obsessive-Compulsive Disorder

Our treatment for OCD is cognitive behavioral therapy. You can learn more about cognitive behavioral therapy here and more about OCD in general in our education handout.

Cognitive Behavioral Therapy

Research shows that cognitive behavioral therapy (CBT) is the most effective treatment for OCD. CBT is a blend of two types of therapies: cognitive therapy and behavioral therapy and can be delivered in an individual or group format. Family members can also be involved in the treatment and can help reinforce treatment concepts. CBT starts with a thorough assessment of symptoms. Using information from the assessment, the therapist will then provide education about OCD and tailor it to the person’s specific symptoms. Specifically, the therapist will address how obsessions develop and are maintained, and how OCD behaviors (compulsions, reassurance-seeking, and avoidance) feed into the OCD cycle.

The cognitive therapy component of CBT focuses on a person’s thoughts and beliefs and is often used to help people with OCD change how they think about their obsessional thoughts. For example, if a person believes that they will act on their disturbing obsessional thoughts, the therapist will help them see that having a thought about sex or violence is not the same thing as acting immorally or violently.

The behavioral component of CBT, exposure and response prevention (ERP), is a key component of treatment. This intervention involves helping people to gradually confront what they are afraid of, such as leaving their home unlocked, and then helping them resist the urge to engage in the compulsion, in this case repeatedly checking the lock. Exposures can be done in the actual situation (in vivo) and/or through imagination. ERP can be very uncomfortable and anxiety-producing. However, with repeated exposure to feared thoughts and situations, combined with resisting compulsive behaviors, people learn that they can tolerate the anxiety and distress and will eventually experience a decrease in OCD symptoms. To get more practice doing exposures, people are often instructed to do exposure between sessions as therapy homework.

Many people with OCD ask others for reassurance (e.g., asking family members if they have locked the door or if they are a bad person). In CBT, the person will learn about how reassurance contributes to the OCD cycle. They will be asked to refrain from reassurance-seeking so they can learn to tolerate their anxiety.