Cognitive Behavioral Therapy (CBT) encompasses a broad range of therapeutic techniques proven highly beneficial in treating obsessive compulsive disorder (OCD), including Exposure Therapy and Cognitive Therapy. OCD is a condition in which the individual suffers from recurring obsessive thoughts and feels compelled to carry out a certain behavior, or a compulsion, in order to experience temporary relief from these thoughts.
Treatment of OCD is usually short-term, with lasting therapeutic benefits. CBT generally consists of weekly, 1-hour therapy sessions lasting approximately 6 months, depending on the severity of symptoms. Most patients who undergo intensive treatment using CBT methods for OCD start noticing improvement within weeks. As with most diagnoses treated through CBT, the client is required to do work outside of the therapy session to get the most benefit.
If you’re ready to connect with a therapist experienced with OCD and trained in CBT, take a look at the Choosing Therapy directory. Review the video introductions from the OCD specialists and, once you’ve found a good fit, book your first session online in minutes. If you’d like to speak with one of Choosing Therapy’s Client Navigators to get free, confidential help selecting a therapist, click here to schedule a consultation.
How Can CBT Help With OCD?
The nature of Obsessive Compulsive Disorder is to engage in specific compulsions to experience temporary relief from the obsessive thoughts that cause severe distress to the individual. Cognitive Behavioral Therapy works to break the automatic bond between the obsessive thought and the ritualistic compulsive behavior. CBT also trains the individual to avoid ritualizing when anxious.2
Common CBT Techniques for OCD
The following are common techniques used in CBT to help treat patients with OCD. Exercises like deep breathing and progressive muscle relaxation can be done alongside therapy sessions.
Exposure/Response Prevention Therapy (ERP)
Perhaps the most helpful tool in the CBT workbook when treating OCD is Exposure/Response Prevention Therapy (ERP). This process involves exposing the patient to the stress-inducing obsessive thought without allowing them to engage in the compulsive behavior. Doing so prevents them from experiencing the temporary relief associated with the compulsion and forces them to face their anxiety until the anxiety fades and they become desensitized to it.
Components of ERP include:2
- In vivo exposure: “Real-life exposure” in which one is repeatedly placed in the presence of a feared stimulus over a prolonged period of time
- Imaginal exposure: The mental visualization of a feared stimulus and subsequent consequences of being exposed to the stimulus
- Ritual prevention: Refraining from the ritualistic behavior
Deep Breathing Exercises
These are exceptionally helpful for managing anxiety related to OCD, and can be beneficial for use during ERP. There are many different types of deep-breathing exercise, but they all serve the purpose of slowing breathing and heart rate, thus creating a calming effect.
Progressive Muscle Relaxation
This is a process that allows the individual to physically tighten and release tension throughout their body. When we are stressed or anxious, our bodies can enter into the fight-or-flight response and this often leads to tension throughout the body. Training the body to disengage from this response is an important component of stress management.
Cognitive Restructuring
Cognitive restructuring involves challenging one’s irrational thoughts or thinking patterns and replacing them with rational and fact-based alternative thoughts. The aim is to use facts to challenge thoughts based on emotional responses.
Scenarios of CBT for OCD
Obsessive Compulsive Disorder is characterized by obsessions with or without compulsions. The obsessions and compulsions related to OCD are irrational and highly distressing, having an impact on the individual’s quality of life.3
Here are a few examples of the way OCD manifests differently based on the individual:
1. Angie
Angie, a 46-year-old stay-at-home mom, worries constantly about falling ill and not being able to care for her children. Her fear drives her to take extreme precautions toward avoiding exposing herself to germs. She spends hours every day disinfecting her home while her children are at school. Any time she comes into contact with surfaces she believes are unclean, she feels compelled to immediately shower or wash her hands. Because of her excessive hand-washing, she has extremely dry, red, chapped and cracked skin on her hands and arms.
2. Tony
Tony recently moved into his first apartment on his own and is starting college. Before he leaves his apartment, he checks the stove to make sure it is turned off. He then walks to the bathroom and checks that the water is not running in the sink. He turns the water on and off making sure the handle is turned all the way to the off position. He does this 8 times. He then returns to check the stove again, ensuring that it is turned off. He goes out his front door and locks it. He immediately worries that the stove is on and returns 2 more times to check it. He locks his front door and twists the handle 8 times ensuring that it is locked and won’t open.
3. Sam
Sam is a freshman in high school. She fears that if she touches a person first that they will somehow come to serious harm. Because of this fear she avoids social interactions and physical touch. If she accidentally touches someone she believes that the only way to prevent them from being hurt is to hurt herself. She carries a razor blade with her at all times and makes small cuts to her arms and legs whenever she is unsuccessful in avoiding contact.
CBT for Angie, Tony, & Sam
Though each case is unique and distinct, treatment using CBT is relatively similar with each case:
A CBT therapist would prescribe some form of exposure therapy where they ask the individual not to engage in the compulsive behavior. Through continued exposure to the obsession, anxiety is heightened at first, but with the passage of time the anxiety attenuates.
When the anxiety decreases so that the individual loses the urge to engage in the compulsion, the exposure therapy session is over. With repeated sessions, the severity of the anxiety and the amount of time the anxiety lasts begins to decrease. With continued practice, the need to engage in the compulsion to relieve the anxiety starts to go away altogether.
Is CBT Effective for OCD?
Yes, Cognitive Behavioral Therapy has been proven to help thousands of people learn to control the Obsessive Compulsive Disorder. In fact, CBT is one of the only research-proven methods for effectively treating OCD.4 According to an article by OCDUK.org, research shows that as many as 75% of patients who seek CBT as treatment for OCD find it to be effective in treating the disorder.
CBT is considered the treatment of choice for OCD by many national health organizations, including the National Institutes of Health in the U.S. and the National Institute for Health and Clinical Excellence in the U.K.5,6
How to Find a CBT Therapist
Because of its high success rate, many providers are certified to practice Cognitive Behavioral Therapy. An easy way to find a CBT therapist is using on online directory, as it allows you to narrow your search by location, type of therapy, and whether or not they offer CBT telehealth sessions. These searches also provide a list of other factors you may want to consider, such as whether the providers accept insurance or if they are private pay, and, if so, what is the hourly rate.
When searching for a CBT provider, you may want to ask about their CBT training and educational background, as well as how experienced they are with treating OCD.
At-Home CBT Exercises for OCD
While there are many different exercises related to treating OCD that can be done at home, it is important to consider having the consultation and guidance of a qualified CBT therapist when starting treatment for any mental health issue, including treatment for OCD. With that in mind, many individuals struggling with OCD can benefit from different relaxation exercises that can be easily done at home.
Deep Breathing Exercise
There are an abundance of simple deep breathing exercises that can be performed at home.
To do a deep breathing exercise at home:
- Breathe in through your nose for 5 seconds
- Hold your breath in your lungs for 5 seconds
- Breathe out through your mouth for 5 seconds
- Repeat
Grounding Exercise
While a grounding exercise can be done to stay focused on the present by seeking out sensory inputs in your current environment, this imagery-guided grounding exercise can also be used as a way to calm anxiety:
To begin, think of a place you find comforting: somewhere in your house, a favorite spot in the park, a beach, or a memory from your childhood. Now spend 5-10 minutes visualizing this place that you have conjured in your mind.
Use your senses to help you:
- What do you see? Look around and take in your surroundings in this space. What can you see in the distance? What do you see close to you? Try to notice small details that you might normally miss?
- What do you hear? Listen closely to the noises around you. Are the noises you hear soft or loud? Do they sound close by or far away?
- What do you taste? Are you eating or drinking something? If so, what does it taste like? Is it sweet or savory?
- What can you feel? Is it warm or cool? Is there a breeze? Is the sun shining on you warming your skin? Or are you bundled up in a soft blanket? Concentrate on how everything feels.
- What can you smell? What does the air smell like here? Is the scent strong or faint? Focus on the scents you smell and appreciate them.
Use this exercise to relax your mind when you are feeling anxious or stressed. Spend as long as you need visualizing your comfortable space. Allow yourself to feel calm and safe.
Exposure Therapy
While intensive exposure therapy should be administered by a trained professional, you can practice exposure at home under the right conditions. To do so, simply deny acting on the compulsive behavior, which provides temporary relief from the anxiety felt in relation to obsessive thoughts.
The longer you are able to deny the compulsion, the more likely it is that the anxiety will begin to ebb. Continue doing so until the anxiety is gone. Repeat this practice each time you feel the need to engage in the compulsive behavior. You can combine this practice with a deep-breathing or grounding exercise.
Additional Resources
- Mental Health America
- National Alliance on Mental Health
- MentalHealth.gov
- Online Therapist Directory: Sort therapists by specialty, cost, availability and more. Watch intro videos and see articles written by the therapists you’re considering working with. When you’ve found a good match, book an online therapy appointment with them directly.
Are you ready to connect with a therapist but feel a little overwhelmed by all your options? Speak with one of Choosing Therapy’s Client Navigators. Client Navigators are mental health professionals who will listen to what you’re looking for in a therapist and help pair you with the best possible fit. Getting started is free, easy, and confidential.
