Cognitive Therapy For Obsessive-Compulsive And Related Disorders

Discover how cognitive behavioral therapy for OCD could help you learn skills and techniques to relieve your symptoms.

If you’re living with OCD (obsessive-compulsive disorder), it might feel like a never-ending struggle. Intrusive thoughts, obsessions, and compulsive rituals can disrupt everyday life. These symptoms may cause significant psychological distress and impact your ability to function in a variety of contexts.

Learn about OCD’s complexities and explore how the scientifically-backed treatment, cognitive behavioral therapy (CBT), could help you.

Key Facts

• OCD is characterized by obsessions and compulsions.
• A combination of SSRIs and CBT provides the best outcome.
• CBT allows you to take a step back from obsessions and compulsions and reduce their intensity.

Quick Overview of Cognitive Behavioral Therapy for OCD

Seeking treatment for OCD can significantly reduce the negative impact symptoms have on your life. Three types of treatments are used for managing this disorder, including selective serotonin reuptake inhibitors (SSRIs), CBT, and neurosurgery. According to the American Psychiatric Association, a combination of SSRIs and CBT is the best treatment for OCD — especially if symptoms are severe. [1]

What Happens During a CBT session for OCD?

If you’re considering attending CBT sessions to help with OCD symptoms, here’s what to expect:

• Assessment and intention setting: You and your therapist discuss the symptoms you’re struggling with and work together to set intentions for treatment.
• Education: The therapist teaches you about OCD from a behavioral science perspective and explains how CBT can help.   
• Exposure and response prevention (ERP): ERP consists of three parts. The first is real-life exposure, where you’re placed in the presence of something you fear over several sessions. Next is imaginal exposure, which involves visualizing your fears and the unwanted outcomes. [2] Finally, during ritual prevention, you learn how to stop responding to the obsessive fear with a ritualistic compulsion and find new, healthy ways of coping. [3]
• Cognitive therapy: Cognitive therapy is another core component of CBT for OCD, helping you learn how to step back from obsessive thoughts and reduce their intensity. Research shows that overemphasizing the importance of negative thoughts and taking active steps to push them out (as you may during the obsession-compulsion cycle) is counterproductive. [2]
• Homework: Many studies highlight that participants who complete homework sessions and involve family members have better outcomes. [4]

Understanding OCD

OCD is characterized by obsessions and compulsions.

• Obsessions: These are repetitive, unwanted urges, thoughts, or images that typically cause significant distress. You may feel compelled to use another thought or action to replace or prevent the obsession.
• Compulsions: Compulsions are behaviors or psychological reactions you feel driven to act out because of the obsession. However, instead of being rational and proportionate to the subject of the obsession, the behavior you use to reduce distress is either excessive or entirely unrelated to the trigger. [5]

Let’s look at some examples of obsessive and compulsive thoughts and behaviors:

• Completing a ritual according to highly specific rules, often repeatedly, to prevent an obsession, such as flicking a light switch 20 times to prevent harm from coming to your family
• Doing something over and over again, such as making sure the oven or tap is switched off even though you rationally know you already did it
• Feeling strong urges to repeat words aloud or in your head to feel relief from an obsession, such as an obsession that people can’t understand you properly, forcing you to repeat words to make sure they do [5]  

Core Components of CBT for OCD

CBT works for OCD because it helps you learn how to cope with thoughts without completing any ritualistic behaviors in a safe, supervised environment. [6]

The Cognitive Aspect

Obsessions and compulsions are underpinned by cognitive distortions you might hold without knowing. One model of OCD suggests there are five distortions common in people with OCD:

1. Thoughts and actions are the same.
2. Failing to prevent harm is the same as causing it.
3. The individual has an exaggerated sense of responsibility. 
4. Failing to complete a ritual is the same as wanting the obsession to manifest.
5. You must control your thoughts.

During active OCD, you try to erase those maladaptive beliefs via compulsions. You might also have an inner dialogue that’s constantly trying to “oppose” your cognitive distortions, but this only feeds the OCD cycle.

If you have OCD, repeating to yourself that “nothing bad will happen” might feel like positive thinking, but it’s a compulsion rather than a rationalization. During cognitive restructuring, you learn to rephrase it to something like, “I can’t say this with certainty, but based on my knowledge and experience, it’s unlikely these thoughts will result in me hurting someone.” This process is called cognitive restructuring. [4] 

Exposure and Response Prevention (ERP)

ERP programs involve a process called habituation, reducing your urge to complete compulsive behaviors through exposure. Gradually, with time, practice, and expert guidance, your brain learns that exposure to your obsessions doesn’t lead to your feared outcomes. Many people experience an initial anxiety spike with ERP, but commitment to the process makes it likely you’ll experience a significant reduction in symptoms. [3]  

Personalizing CBT for Individual Needs 

CBT is typically customized depending on the type of OCD you have, your history, and any co-occurring mental health issues. Additionally, demand for telehealth protocols means you can seek CBT therapy at home, while digital tools can make homework more fun and engaging. [7]

Patient Education and Support Networks

Remember, cognitive behavioral therapy for OCD works best for individuals who fully engage with and understand the therapeutic process. The better you understand why you’re going through ERP, the more motivated and likely you are to complete treatment. [8]

Having a strong support network is another huge advantage when it comes to coping with and completing CBT for OCD. Ideally, you have supportive family and friends to help you through, but if not, consider joining a support network that offers the same benefits. [9]

Special Considerations in CBT for OCD

OCD can present in a variety of ways, depending on your background and experiences. As such, it’s a good idea to seek tailored treatment based on factors such as age, culture, and any dual diagnosis. In addition to individual therapy, group therapy can help you understand yourself and the illness from various perspectives. 

Find a treatment provider specializing in CBT with ERP, and look for those who mention mindfulness and acceptance techniques. The former focuses on being present in the moment so you can get better at noticing and diverting your thoughts, while the latter means accepting negative thoughts instead of trying to control them. 

FAQs About CBT for OCD

Does CBT Work for Long-Standing OCD?

CBT and ERP can be effective treatments for OCD no matter how long you’ve experienced symptoms, provided you’re consistent and committed. 

How Long Does CBT for OCD Last?

CTB is a short-term treatment that typically lasts for 3 to 6 months. Ideally, you attend one session per week and regularly practice between appointments. 

Does CBT Work for Children and Adolescents?

CBT for OCD can be adapted to suit children and adolescents. 

Additional Resources

Here are some resources relating to obsessive-compulsive disorder and cognitive behavioral therapy:

• International OCD Foundation
• Association for Behavioral and Cognitive Therapies
• Obsessive Compulsive Disorder: When Unwanted Thoughts or Repetitive Behaviors Take Over
• BeyondOCD.org