Cognitive behavioral therapy (CBT) encompasses a range of therapy techniques that are highly beneficial in treating obsessive compulsive disorder (OCD), including exposure and response prevention and cognitive restructuring. Most people who receive CBT treatment for OCD start noticing improvements within weeks.
CBT generally consists of weekly, one-hour therapy sessions lasting approximately six months, depending on the severity of someone’s OCD symptoms. As with most diagnoses treated through CBT, the client is required to do work outside of the therapy session to get the most benefit.
What is the best therapy for OCD? Exposure And Response Prevention Therapy (ERP) – Do live video sessions with a therapist specialized in ERP, the gold standard treatment for OCD. Treatment from NOCD is covered by many insurance plans. Start With A Free 15 Minute Call
What Is Cognitive Behavioral Therapy?
Cognitive behavioral therapy (CBT) is a multifaceted therapy approach that focuses on the interconnected nature of thoughts, feelings, and behaviors. CBT proposes that dysfunction in one area can be well-managed by making adjustments to the others. By changing thought patterns and behavioral habits, CBT can improve negative feelings.
How Does CBT for OCD Work?
People with obsessive compulsive disorder engage in specific compulsions to experience temporary relief from the obsessive thoughts that are causing them severe distress. Cognitive behavioral therapy works to break the automatic bond between the obsessive thought and the ritualistic compulsive behavior. CBT also trains the person to avoid ritualizing when they’re feeling anxious.2
Techniques Used in Cognitive Behavioral Therapy 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 to help improve someone’s anxiety.
Here are four CBT techniques that are commonly used to treat OCD:
1. Exposure & Response Prevention Therapy (ERP)
Perhaps the most helpful CBT tool for treating OCD is exposure and 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. ERP is the gold standard treatment for OCD.
Components of ERP include:2
- In vivo exposure: “Real-life exposure” in which someone 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 the consequences of being exposed to the stimulus
- Ritual or response prevention: Refraining from the ritualistic behavior after having been exposed to the feared stimulus
2. Inference-Based CBT
Inference-based CBT (I-CBT) is an evidence-based treatment specially designed for OCD.12 Through I-CBT, the person with OCD learns the connection between obsessional doubts and creation of faulty reasonings. I-CBT presumes that people with OCD confuse reality with imagination when they are distressed. Through therapy, they learn to practice alternative narratives which are grounded in common sense rather than obsessional doubts.
It is important to point out that I-CBT does not challenge the content of obsessional doubts. Rather, it challenges the doubting process. I-CBT presumes that it is the faulty reasoning, or doubting process, which keeps OCD symptoms around. Without the doubting process, the idea is that OCD symptoms will subside.
3. Deep Breathing Exercises
Breathwork exercises 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 exercises, but they all serve the purpose of slowing down the breath and heart rate, creating a calming effect.
4. Progressive Muscle Relaxation
Progressive muscle relaxation is a process that allows the person 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, often leading to tension throughout the body. Training the body to disengage from this response is an important component of stress management.
5. Cognitive Restructuring
Cognitive restructuring involves challenging irrational thoughts or thinking patterns and replacing them with rational thoughts that are based in reality. The aim is to use facts to challenge thoughts based on emotional responses.
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Is Cognitive Behavioral Therapy for OCD Effective?
Cognitive behavioral therapy has been proven to help thousands of people learn to manage obsessive compulsive disorder. In fact, ERP (a subset of CBT) is one of the only proven methods for effectively treating OCD.4 Research shows that as many as 75% of patients who seek ERP as treatment for OCD find it to be effective in treating the disorder.5
- In a randomized control trial comparing CBT and EMDR, it was found that both were statistically significant in improving OCD symptoms post-study and at a follow up six-month mark.6
- In a study aimed at adults aged 18 years or older with OCD living in England, it was found that a 12 week course of group CBT led to improvements in OCD and co-occurring depression.7
- In another study aimed at the use of CBT after deep brain stimulation (DBS) for those with severe OCD, CBT was found to be effective in conjunction with DBS for severe OCD symptom management and treatment.8
- In another study of CBT for OCD, it was found that even virtual CBT interventions over a 10 week period yielded improvements of both depression symptoms and quality of life, as well as decrease of overall OCD symptoms.9
Are There Any Risks?
There are no specific risks of CBT for OCD, with the exception that it may not be effective for everyone who receives CBT as a treatment option.10 CBT, when compared with no treatment, does effectively decrease the severity of OCD symptoms. In addition, CBT also improved the overall level of functioning and reduced the risk associated with OCD.
How Long Will CBT Take?
The standard treatment model of CBT for OCD is about 12 weeks with one hour-long session a week. However, CBT’s effectiveness can take time depending on other mental health issues the individual is dealing with, or other traumatic histories. The key to success in therapy is trust between the therapist and the client, and willingness to follow through on homework and directives.11
How to Find a CBT Therapist
Many therapists are certified to practice cognitive behavioral therapy, so it shouldn’t be too difficult to find one in your area. An easy way to start finding a therapist is using an online therapist directory, as it allows you to narrow your search by location, type of therapy, and whether or not they offer CBT online. These searches also provide a list of other factors you may want to consider, such as whether they accept insurance and their 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.
How Much Does CBT Cost?
CBT for diagnosed OCD is typically covered by insurance. While most insurances cover CBT, there is still usually a copay for mental health services, which can range from $10 and upwards of $100 depending on the network. Looking at “in-network” providers might be able to help with the out-of-pocket costs with copays and keep it on the lower end.
Out-of-network providers or those who do not accept insurance may charge anywhere from $80 to $200 a session, which is similar to the cost of therapy in general. Some may have a sliding scale option for those clients who qualify. It’s important to consider therapists and practices which may offer sliding scale prices for sessions to ensure you are able to attend the full course of treatment.
Finding Online CBT for OCD
CBT is going to be one of the most widely-available treatments in-person and online. Trying online CBT can provide a person with great benefit from the comfort of their home. Many local treatment providers will offer online CBT with national groups providing services across the country. A quick online search can unveil many options, and the International OCD Foundation outlines some available programs.
What is the best therapy for OCD? Exposure And Response Prevention Therapy (ERP) – Do live video sessions with a therapist specialized in ERP, the gold standard treatment for OCD. Treatment from NOCD is covered by many insurance plans. Start With A Free 15 Minute Call
How to Get the Most Out of CBT for OCD
CBT is a great option for OCD treatment, but every person may not receive the same benefit. Here are several tips to maximize the wanted impact of CBT for OCD:
- Acknowledge the impacts of OCD: Some people struggle to acknowledge the negative aspects of OCD. Be sure to review the harmful and damaging effects of OCD on your life and others.
- Explore a range of treatment levels: Standard outpatient treatment may not offer enough assistance, so intensive outpatient, partial hospitalization, or inpatient setting could be a better fit.
- Explore a range of treatment modalities: Similarly, individual therapy may be helpful, but perhaps family or group sessions offer greater benefit.
- Do your homework: Often, CBT for OCD uses homework to extend treatment between appointments. Being engaged in sessions and completing this homework will help accomplish treatment goals even faster.
- Trust your team: CBT for OCD may seem uncomfortable or too challenging, so having trust in your treatment team is essential. Without trust, it could be too scary to attempt the interventions.
Examples of Cognitive Behavioral Therapy 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 a person’s quality of life.3
Here are a few examples of the way OCD manifests differently, and the treatment plan for OCD using CBT in each situation:
1. CBT for Fear of Germs & Illness Anxiety
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.
The therapist will explore early experiences related to illness, cleanliness, and availability and health of caregivers when Angie was ill. They will determine when these obsessive thoughts began and what was happening at that time, discussing Angie’s perceived benefits of these obsessive thoughts and what she gets out of them.
Then, the therapist will use exposure to a used utensil or item and identify Angie’s intrusive thoughts. They will work to challenge these thoughts, using concrete reasons to understand how her behavior is detrimental (i.e. losing hours in a day, dry and damaged hands). Angie will work to understand these real consequences versus the perceived benefits of her compulsions, using these new thought patterns to guide behaviors moving forward.
2. CBT for Constant Checking
Tony recently moved into his first apartment on his own and is starting college, and lives with checking OCD behaviors. 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.
The therapist will role play Tony’s routine of leaving his apartment and challenge him to not recheck something, helping to identify intrusive thoughts. The therapist will explore with Tony why he questions himself and dissect these thoughts to reprogram them so he can challenge them as they arise. Tony and his therapist will work through what is found when uncovering the underlying issues related to these obsessive thoughts and coping methods to move forward without obsession.
3. CBT for Harm OCD
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.
The therapist will explore where these fears come from, when they started, and what occurred in her childhood that could be a contributing factor. They will also discuss when this started and a history of her physical encounters beforehand to get an understanding of any history of trauma.
The therapist will discuss the likelihood of an accidental bump causing harm to another and Sam’s current perceived benefits of self-harm. The therapist will role play with Sam in sessions to identify intrusive thoughts and potentially uncover any underlying depression, anxiety, post-traumatic stress disorder (PTSD), or another mental health issue that may be a contributing factor, as well as an assessment of her home situation. Sam will work to challenge these behaviors and keep a log of when these thoughts begin, where she is, and what her response is, and she will continue to keep a thoughts journal that she brings to therapy to work through.
The therapist may also work with Sam to come up with a hierarchy of anxieties and gradually work their way through them through exposure. Doing graduated exposure can help Sam learn that she can tolerate not knowing what will happen as well as the discomfort associated with the thoughts, without performing compulsions such as cutting herself.
What is the best therapy for OCD? Exposure And Response Prevention Therapy (ERP) – Do live video sessions with a therapist specialized in ERP, the gold standard treatment for OCD. Treatment from NOCD is covered by many insurance plans. Start With A Free 15 Minute Call
At-Home CBT Exercises for OCD
While it is important to consider having the guidance of a qualified CBT therapist when starting treatment for OCD, there are also some exercises that you can do on your own to help manage symptoms.
Here are a few relaxation exercises that can be easily done at home to help with OCD symptoms:
Deep Breathing Exercise
There are an abundance of simple deep breathing exercises that can be performed at home.
Here’s a deep breathing exercise you can try when you’re feeling anxious:
- 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 five 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?
- What can you smell? What does the air smell like here? Is the scent strong or faint? Do you smell any flowers, or a scent wafting from your beverage?
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 for OCD should be done with a trained professional, you can practice exposure at home under the right conditions. To do so, simply deny acting on your compulsive behavior that provides you 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 compulsive behavior. You can combine this practice with a deep-breathing or grounding exercise to lessen the anxiety you might feel when denying the compulsion.
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What to know when finding a therapist for OCD With so much information out there regarding providers and treatment options for obsessive compulsive disorder, it can be hard to know exactly where to start—especially when you have to consider everything from the type of provider to the different treatment methods, as well as how you’ll fit it into your busy schedule. Can OCD make it hard to make decisions? From choosing what to wear in the morning to picking what to eat for dinner, decision-making is a part of everyone’s daily routine. But for millions of people with Obsessive-Compulsive Disorder (OCD), making any choice can feel like a daunting, sometimes impossible task.