Cognitive-Behavioral Therapy for OCD


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There are also no limits to how many times you can try CBT. In many cases, CBT alone is highly effective in treating OCD, but for some a combination of CBT and medication is a more effective treatment package, especially if there is co-morbidity like depression. Medication can be helpful in reducing anxiety enough for a person to start, and eventually succeed, in therapy.

Cognitive Behavioural Therapy helps the patient explore and understand alternative ways of thinking and challenging their beliefs through behavioural exercises, Dr Victoria Bream explains…. CBT makes use of two evidence-based behaviour techniques, Cognitive Therapy C that looks at how we think, and Behaviour Therapy B which looks at how this affects what we do.

In treatment we consider other ways of thinking C , and how this would affect the way we behave B. The principal aim of this therapeutic approach is to enable the person to become their own therapist and to provide them with the knowledge and tools to continue working towards complete recovery from OCD. What we know from research is that almost everyone has intrusive thoughts that are either non-sensical or alarming. CBT helps us understand the fears we associate with our thoughts, which as mentioned in the types of OCD page, can often be difficult to recognise.

A good way of understanding how different responses to thoughts can affect the way we behave can be demonstrated in the example below. What this example shows is that the same event can make people feel completely different emotions angry, happy, anxious and result in them behaving in very different ways, due to their different beliefs about the event. CBT is based on this intuitive understanding of how we think effecting how we behave.

How Does CBT Work?

So how does this help us understand how to treat OCD? We believe that OCD works in exactly the same way:. In treatment for OCD, one of the first things a person will be asked to do is to think of a recent specific example of when their OCD was really severe. They will be asked to go into a lot of detail, and try and understand what thought s or doubts, images or urges popped into their head at this time.

For example some intrusive thoughts obsessions might be:. People with OCD often ask if treatment can help them get rid of these intrusive thoughts, as they are so distressing and horrible. But if you instead consider whether all intrusive thoughts are always horrible you will see that they are not. It is also worth remembering that everyone has all sorts of intrusive thoughts — including the nasty ones: thoughts of harm coming to people, images of violence, urges to check things, doubts about whether they have done something.

The difference with other people is that their intrusive thoughts do not become bothersome and stick. The idea and reason behind this is that if we can understand the factors that keep a problem alive, we can then take the next step, which is to think about alternative ways of viewing the problem and what we can then do to change it. Therefore CBT looks at how OCD convinces you that the rituals and compulsions performed are necessary, in order to prevent something bad happening. If such a bad outcome were to be true as a result of the thought, the sufferer would be convinced it was entirely their fault and responsibility.

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We also look at the possibility that OCD is a liar. Even if they provide temporary relief from anxiety, the rituals make the meaning attached to the intrusive thoughts, images, urges and doubts feel even stronger, therefore becoming necessary for the sufferer to keep doing the rituals continuously. Ultimately making the thoughts seem even more real, and like there is even more truth in them. So in CBT, people are asked to consider doing the opposite to avoiding the situation. So for example if OCD has made a person believe that they are at risk of dying from contamination from germs on a toilet — in treatment the therapist and patient might put their hands down the toilet.

This behavioural experiment allows the person to find evidence for themselves about whether OCD has been lying and whether they have been needlessly avoiding situations for no reason at all. Of course, this is not straight forward, and the therapist will work with the patient to help them understand their worries and fears, to be able to approach such a challenging behavioural exercise. Trying to not have certain thoughts is another common example of avoidance.

However, the more we try and avoid and ignore unwanted intrusive thoughts, the stronger the frequency becomes. For example, a person might have a blasphemous thought at any time or place. This thought may cause them distress. With imaginal exposure, the blasphemy can be imagined repeatedly, without trying to eliminate it or neutralize it with a ritual. Imaginal exposure may also be used to make subsequent in vivo exposure practices easier for you.

The decrease in your distress during imagery will carry over to the actual exposure. When people with OCD encounter their feared situations or have obsessional thoughts, they become anxious and feel compelled to perform ritualistic behaviors to reduce the distress. Exposure practices can cause this same distress and the same urges to ritualize. Ritual prevention requires that you stop ritualizing, even though you are still having urges to do so.


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In short, rituals are difficult to stop because they bring relief from anxiety or discomfort. However, you are receiving treatment because these rituals are interfering with your ability to function. Through ritual prevention, your therapist will teach you how to stop rituals and you will learn more effective ways of coping with and managing your discomfort. Perhaps you are asking yourself, "Why should I suffer the distress of confronting feared situations on purpose without doing some rituals to get relief?

The first is the connection between distress and the objects, situations, or thoughts that trigger distress. The second connection is between ritualizing and relief from distress. In addition to weakening connections, this treatment program is designed to help correct mistaken ideas that are common in OCD and cause considerable distress. The first mistaken idea commonly seen in OCD is that it is necessary to avoid or ritualize in order to prevent harm.

Most people can think of potential disasters that might happen to them or others when they carry out necessary daily activities such as driving a car. However, because they can think about the risk without disabling distress, they can see that the actual risk is so low that it should be ignored. Many people with OCD become overwhelmed with distress when they think about certain potential disasters that might happen to them or others. For example, individuals with OCD might become intensely anxious about the thought of their house catching fire, being possessed by the devil, or contracting AIDS.

The intense anxiety prevents them from making rational and informed judgments about how risky a situation really is and what they can do to protect themselves or others. To be on the safe side, the person with OCD will avoid or ritualize to prevent even the most remote possibility of harm.

Cognitive Behavior Therapy

Consequently, the individual does not have the opportunity to learn that the feared situation is actually quite safe. Exposure works against this type of mistaken idea. Thus, you recognize that the risk is remote and you learn to ignore it. For example, Stacy was afraid that her house would catch fire, so she refused to use her central heating even in cold weather.

For therapy, she practiced starting the heater and leaving it on while she was away from home. After 24 hours, the house was comfortably warm inside, but did not catch fire and Stacy learned that her fear was unfounded. The second mistaken idea people with OCD tend to have is the belief that they must avoid the distressing situation or they will be distressed forever. This leads them to avoid many situations or to ritualize if they can not avoid them.

However, during prolonged exposure, intense anxiety gradually decreases.

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If someone confronts a distressing situation for a prolonged period of time such as hours , the individual will experience a gradual decrease in distress until the distress is gone. As the distress drops, it becomes easier to see whether or not a situation is actually dangerous. When the same or similar situation arises later, there will be far less distress than experienced previously. For his therapy, Ray purposely disordered his office and bedroom and did not put things back in order even though he became distressed.

Instead, his discomfort eventually decreased and he did not lose his mind.


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He learned that anxiety did not produce insanity. A program that involves prolonged exposure is designed to help you, whether you are afraid of contracting a disease from public bathrooms, causing automobile accidents, discarding something important, saying inappropriate things, or hurting someone with a knife. When you first confront a feared situation, you will become distressed. However, if you remain long enough in the situation, and do so repeatedly, the distress will diminish. For in vivo and imaginal exposure to be helpful, you must become emotionally involved during the exposure exercises.

Specifically, the exposure situation must evoke the same kind of obsessional distress that you experience in your daily life. To promote emotional involvement, we will develop exposure exercises that are a good match to the real-life situations that provoke your obsessions and urges to ritualize.

Treatments for OCD | Anxiety and Depression Association of America, ADAA

For example, if you are distressed by contamination related to cancer and you visit a hospital with no cancer ward, the exercise will not be helpful. The situation does not match your fear. Thus, it will be hard for you to become emotionally involved when your exercises are not matched to your obsessions.

During the exposure exercises that are matched to your obsessions, you must involve yourself emotionally.

Tools to Treat OCD - Sarosh J. Motivala, PhD - UCLA Health

This means that you must pay attention to the distressing aspects of the exposure situation, rather than trying to ignore them. This is true for both imaginal and actual exposure. For example, if you pretend that a cancer ward is really a cardiac unit in order to reduce your distress, the exercise will be less effective. Therefore, during exposure you should think about the potential harm that concerns you.

For example, you are afraid of using public restrooms and you go to a public restroom as an exposure exercise.

Cognitive-Behavioral Therapy for OCD Cognitive-Behavioral Therapy for OCD
Cognitive-Behavioral Therapy for OCD Cognitive-Behavioral Therapy for OCD
Cognitive-Behavioral Therapy for OCD Cognitive-Behavioral Therapy for OCD
Cognitive-Behavioral Therapy for OCD Cognitive-Behavioral Therapy for OCD
Cognitive-Behavioral Therapy for OCD Cognitive-Behavioral Therapy for OCD
Cognitive-Behavioral Therapy for OCD Cognitive-Behavioral Therapy for OCD

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