Psychological Therapy for OCD

How effective is it?

Psychiatrist holding a mobile phone with a patient lying on the bed
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Psychological therapy is recognized by both researchers and healthcare providers as an effective treatment for reducing the frequency and intensity of OCD symptoms. Effective psychological therapy for OCD stresses changes in behavior and/or thoughts, sometimes referred to as cognitions.

Overall, cognitive and behavioral therapies appear to be even more effective than medications in both adults and children with OCD.

When appropriate, behavioral and cognitive therapy for OCD can be combined with medications for the best result.

Behavioral Therapy

Although there are a variety of behavioral therapies for treating OCD, most of these focus on exposing you to those things that you fear most. This exposure provides you with an opportunity to gain new information in hopes of disconfirming your worst fears.

Exposure and Response Prevention

One of the most popular and effective forms of behavioral therapy for OCD is exposure and response prevention (ERP). ERP involves exposing you to the anxiety that is provoked by your obsessions and then preventing the use of rituals to reduce your anxiety. This cycle of exposure and response prevention is repeated until you are no longer troubled by your obsessions and/or compulsions.

How Long Does It Take?

ERP usually involves 15 to 20 exposure sessions that last about 90 minutes.

These sessions usually take place at a therapist’s office, although you are usually asked to practice ERP at home.

While some therapists prefer to begin with exposure to the most feared stimuli (called flooding), others prefer to take a more gradual approach. For example, it is not uncommon to have people begin ERP by simply thinking about being exposed to the things they fear most.

Drawbacks

Although behavior therapy is highly effective for about two-thirds of people who complete treatment, there are drawbacks, including:

  • Behavior therapy involves facing your worst fears. Many patients dropout before treatment is complete.
  • Behavior therapy is hard work and requires completing homework in between sessions.
  • Behavior therapy may not be that effective for people who experience primarily obsessions without compulsions.
  • Behavior therapy can be expensive, although insurance plans may cover all or part of the cost.

Cognitive Therapy

Cognitive therapy for OCD is based on the idea that distorted thoughts or cognitions cause and maintain harmful obsessions and compulsions. For example, although the majority of people report experiencing intrusive, and often bizarre, thoughts on a daily basis, if you have OCD you may over inflate the importance or danger associated with such thoughts. You may even believe that by having such thoughts, you increase the likelihood of the feared thought, event, or action taking place or being true.

Magical Thinking

If you have OCD, you might dramatically overestimate the degree to which you are responsible for a catastrophic event taking place and feel you have to take actions to prevent it.

For instance, you might experience an uncontrollable urge to count or order a particular object to prevent a plane crash. Of course, counting or ordering a particular object couldn’t possibly have any impact on whether a plane crashes or not. This illogical thought pattern is often called magical thinking.

Cognitive therapy involves examining these harmful thought patterns and coming up with plausible alternatives that are more realistic and less threatening. It is not uncommon for you to be unaware of some of the distortions that are present in your thinking, and the therapist may help to point these out.

Also, cognitive therapy often integrates elements of behavior therapy. For example, your therapist may have you test out some of the plausible alternatives you have come up with through exposure therapy.

How Long Does It Take?

Like ERP, cognitive therapy is usually done over the course of 15 to 20 sessions, although the cognitive therapy sessions are often shorter in duration, lasting 50 to 60 minutes. As with ERP, you are often asked to do homework, which usually comprises of keeping a daily journal of your thoughts as well as keeping track of whether your worst fears actually came true.

Considerations

Deciding to engage in behavioral or cognitive therapy for OCD is a decision that should be made in consultation with your family doctor, psychiatrist, or psychologist as part of your overall treatment plan. In controlled research studies, behavioral and cognitive therapy seem to be equally effective. However, in practice they are often combined for maximum effect. This is referred to as cognitive-behavior therapy.

Before engaging in psychotherapy, it may be helpful to ask yourself the following questions:

  • Am I willing to try facing the very things I fear most?
  • Will I be able to finance this on my own or will my insurance cover the costs?
  • Am I willing to put in the time required to participate in weekly sessions for up to 20 weeks?
  • On top of going to a weekly session, am I willing to complete homework assignments in between sessions?

A Word From Verywell

Research shows that the people who have good results with psychotherapy are those who are highly motivated to change and willing to try and put in the commitment required. If you have questions about your readiness to participate in psychotherapy, talk to your doctor or psychologist.

If you do decide to include psychotherapy as part of your overall treatment plan, make sure you are comfortable with your therapist. If you feel something is preventing you from having a good working relationship, don’t be afraid to bring it up in therapy.

A good therapist will be happy that you have brought this to his or her attention and will try to work through these issues with you. If you don't have a therapist or aren't happy with the therapist you are seeing, check out these tips on how to find an OCD therapist who is right for you.

Since online therapy (or telephone therapy) is becoming more common, researchers have analyzed whether this can be as effective as in-person therapy. So far, studies suggest that the answer is yes, but keep in mind that distant therapy is more difficult as both the client and therapist lack the ability to interpret body language and other factors. However, it is still a good option for those who live quite a distance from a good therapist.

Sources:

Ost, L., Havnen, A., Hansen, B., and G. Kvale. Cognitive behavioral treatments of obsessive-compulsive disorder. A systematic review and meta-analysis of studies published 1993-2014 Clinical Psychology Review. 2015. 40:156-69.

Ost, L., Riise, E., Wergeland, G., Hansen, B., and G. Kvale. Cognitive Behavioral and Pharmacological Treatments of OCD in Children: A Systematic Review and Meta-Analysis. Journal of Anxiety Disorders. 2016. 43:58-69.

Wootton, B. Remote Cognitive-Behavior Therapy for Obsessive-Compulsive Symptoms: A Meta-Analysis. Clinical Psychology Review. 2016. 43:103-13.

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