Dialectical Behavior Therapy for Obsessive Compulsive Disorder

Another Alternative When Exposure Therapy Doesn't Work

Women hugging at group therapy session
Dialectical behavioral therapy (DBT) and skill sets can be helpful for some people with obsessive compulsive disorder (OCD). Martin Barraud/Getty Images

Your therapist may have recommended that you pursue dialectical behavior therapy for your obsessive compulsive disorder (OCD). What type of therapy is this and how does it compare with other therapies for OCD?

Cognitive Behavioral Therapy for Obsessive Compulsive Disorder

Cognitive behavioral therapy (CBT) is a type of psychotherapy which focuses on how thoughts and feelings can lead to behaviors. It has been found to be very helpful in both the short term and long term for people living with OCD.

A type of cognitive behavior therapy called exposure-response prevention therapy (ERP) has been considered the gold standard for treating OCD. Yet for those who find that exposure-response prevention therapy does not work for them, dialectical behavior therapy may be an option.

What is Dialectical Behavior Therapy?

Dialectical behavior therapy (DBT) is form of cognitive behavior therapy which focuses on mindfulness, acceptance, validation, and building trust. It was originally intended for people with borderline personality disorder, but has since been looked at for people with a wide range of mental health concerns. One of the biggest differences between DBT and other forms of therapy is the concept of acceptance. No matter your thoughts, they are not good or bad.

Dialectical Behavior Therapy's History

Dialectical behavior therapy (DBT) was developed by Marsha Linehan in the late 1970s at the University of Washington.

Linehan worked with patients who had chronic suicidal thoughts, suicide attempts and self-harming behaviors that are often the result of deep wounds from childhood abuse and/or neglect. Many people who have these traits are diagnosed with borderline personality disorder (BPD), while others may be suffering from posttraumatic stress disorder (PTSD).

At the time that DBT was developed, cognitive behavioral therapy (CBT) had been identified as the treatment of choice for pretty much every mental illness. Linehan, however, realized that the patients she worked with were unable to benefit from CBT due to the direct nature of the work and the constant focus on change. These patients felt CBT was judgmental, confrontational and invalidating. Linehan wisely adapted traditional CBT to make the approach more validating. Since that time, DBT has been proven effective for a wide array of other mental health problems, particularly mood and anxiety disorders.

Dialectical Behavior Therapy (DBT) Skill Sets

DBT has four primary skill sets (discussed further below) that people can learn to apply to their lives. These include:

DBT is generally taught in groups that accompany individual therapy sessions. People who are learning to used DBT skills document how well and how often they apply the skills between group sessions and discuss this in depth with the individual therapist.

DBT for OCD and Anxiety: Acceptance and Non-Judgment

DBT skills are used to cope with the pain and fears associated with everyday life.

DBT draws heavily on the Buddhist concepts of acceptance, non-judgment, and mindfulness. These have been found to be very useful skills for managing OCD.

Unlike CBT, where the focus is on making and measuring changes in behavior, DBT is focused on acceptance and non-judgment. The therapeutic relationship is critical as people learn to be honest about their behavior and emotions without shame or feeling like they have failed. It is the validation of their efforts to show up and talk about their progress (or lack thereof) that is important for many people. Once trust with the therapist is established, people tend to take more risks in therapy.

This step is often necessary before they are ready to make changes.

Studies have found that DBT can improve quality of life and self-control as well as reduce hopelessness in people with personality disorders such as OCD.

How to Apply DBT Skills to OCD

If you're wondering how you may be able to used DBT skills with your OCD, here are examples of how these skills are used:

Distress Tolerance: These skills are used to either distract or self-soothe when faced with disturbing thoughts or emotions.

Emotional Regulation: By learning skills to manage the anxiety related to obsessions and/or fear, you will begin to realize that your anxiety will lessen with time without having to give in to the usual compulsion or reassurance.

Interpersonal Effectiveness: This set of skills helps you manage your feelings related to interactions with others, which might include needing to seek reassurance.

Mindfulness: The skill of mindfulness helps you to be more present in the moment. Being mindful includes not hanging on and attaching to distressing thoughts, practicing being non-judgmental (realizing that your thoughts are neither right nor wrong,) and redirecting your thoughts to the present moment when intrusive, repetitive thoughts occur.

DBT Is an Alternative to ERP

DBT does not directly address obsessions and compulsions as does exposure-response prevention therapy (ERP). DBT skills are used to cope with the anxiety associated with fearful thoughts or obsessions that result in compulsive behaviors. 

Additional Treatment May Be Needed

There are a number of treatments that may be considered for OCD. Most people need medication in addition to therapy to manage OCD. An evaluation by a psychiatrist is recommended to determine if medication might be helpful in your treatment plan.

Bottom Line on Dialectical Behavior Therapy for OCD

Dialectical behavior therapy is a type of cognitive behavior therapy that may be effective for some people with OCD. In particular, those who have found exposure-response prevention therapy, the gold standard for OCD, ineffective. It can be frustrating to live with OCD, but therapy and sometimes medications may greatly improve your symptoms and decrease your distress related to the disorder.

Sources:

Conrad, A., Sankaranarayanan, A., Lewin, T., and A. Dunbar. Effectiveness of a 10-Week Group Program Based on Dialectical Behavior Therapy Skills Among Patients with Personality and Mood Disorders: Findings from a Pilot Study. Australas Psychiatry. 2017 Jun 1. (Epub ahead of print).

Fassbinder, E., Schweiger, U., Martius, D., Brand-de-Wilde, O., and A. Arntz. Emotion Regulation in Schema Therapy and Dialectical Behavior Therapy. Frontiers in Psychology. 2016. 7:1373.

Neacsiu, A., and Tkachuck. Dialectical Behavior Therapy Skills Use and Emotion Dysregulation in Personality Disorders and Psychopathy: A Community Self-Report Study. Borderline Personality Disorder and Emotion Dysregulation. 2016. 3:6.

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