Psychotherapy for Treating OCD

Psychotherapy is often used to reduce the frequency and intensity of obsessive-compulsive disorder (OCD) symptoms by changing thoughts (which are sometimes referred to as cognitions) and behaviors.

An overview of psychotherapy treatment for OCD

Cognitive and behavioral therapy has been shown to sometimes be even more effective for children and adults with OCD than medication. However, in some cases, the best results come from combining behavioral and cognitive therapy with medication.

Behavioral therapy

Most behavioral therapies used to treat OCD will expose patients to the things they fear the most. Exposure and response prevention (ERP) therapy is one of the more effective and widely used types of behavioral therapy used in OCD treatment. In ERP, patients are exposed to the anxiety brought on by their obsessions and then are prevented from using the rituals that usually reduce their anxiety. This cycle is repeated until the obsessions and/or compulsions no longer trouble the patient.

ERP treatment usually involves 15 to 20 exposure sessions that typically take place in the therapist’s office and last about 90 minutes. Patients will likely be asked to practice ERP at home by completing specific homework assignments.

Depending on the psychiatrist's preferred method, ERP may begin by exposing patients to their worst fear right away, which is known as “flooding,” or the therapist may choose to begin more gradually. ERP can begin with something as mild as simply thinking about being exposed to one's worst fear.

It is highly effective for many people who complete behavior therapy for OCD, but it may not be as effective for patients who primarily experience obsessions without compulsions.

Cognitive therapy

Cognitive psychotherapy for OCD is based on the idea that harmful obsessions and compulsions are caused and maintained by distorted thoughts or cognitions. For example, many people say they experience intrusive thoughts every day, but people with OCD may overestimate the importance or danger of their intrusive thoughts. Because of their OCD, they may even believe that having intrusive thoughts makes it more likely that the thought, event, or action they fear will take place or be true.

In cognitive therapy, the patient and the psychiatrist will work together to examine harmful thought patterns and develop alternative thoughts that are more plausible, realistic, and less threatening. Patients may be unaware of some of the distortions in their thinking. This is not uncommon, and the therapist can help the patient by pointing out these distortions and making them more aware of them.

There is often some overlap between cognitive therapy and behavior therapy. For example, a psychiatrist may suggest exposure therapy so that the patient can try out some of the alternatives they came up with together.

Cognitive therapy is usually done throughout 15–20 sessions that last 50–60 minutes each. The most common homework for cognitive therapy is to keep a thought journal and track whether one's worst fears have come true.