Managing OCD with CBT

OCD cannot yet be cured, but it can be managed. This means that, while your symptoms probably won't go away entirely, they may diminish to the point that they are no longer a big problem. No one really knows why OCD doesn't go away completely; we just know that, at least for now, that's the way it is. However, a significant decrease in your OCD symptoms can make a big difference in your quality of life!

Medication and CBT (especially in concert) have so far demonstrated the best results. Neurofeedback (brain-based biofeedback) is becoming increasingly well known and more widely used in treating OCD, as well. Other symptom-management choices include meditation, visualization, alternative therapies such as acupuncture, and herbal preparations. These don't necessarily diminish OCD per se, but they can help reduce the anxiety that is such a large part of it.

Why Cognitive Behavioral Therapy (CBT)?

A journey of a thousand miles must begin, according to ancient wisdom, with a single step. That is exactly the way treatment for OCD begins. Let's take a look at cognitive behavioral therapy, or CBT. Cognitive therapy differs from traditional or “talk” therapy in that it is an “action-oriented” therapy that employs suggestions for specific changes in behavior. That is, the patient is encouraged to look at the entrenched, illogical aspects of her thinking and to work to correct them.


It may surprise you to know that, prior to the 1970s and even the 1980s, before the advent of CBT and the widespread use of medication for OC symptoms, OCD was considered largely incurable.

A good example of illogical or irrational thinking is the classic OC idea that danger lies in wait virtually everywhere. While a traditional therapist might help the patient to arrive at a useful insight, a cognitive therapist will strive to help her see the fallacies in her idea. Generally, cognitive behavioral therapists place far less emphasis on discovering the origins of problematic behaviors, focusing instead on how to change them. This structured type of therapy is used to treat many conditions, including the spectrum of anxiety disorders (OCD, trauma, body dysmorphic disorder, simple phobias) as well as depression.

The chief component of CBT, when used to treat OCD, is a technique called exposure and response prevention (ERP) sometimes called “exposure and ritual prevention.” This technique, which involves gradually exposing the patient to the thing or things he fears, can be practiced on one's own or with a therapist.

(Working with a qualified therapist is strongly recommended, however. As you might imagine, ERP can be difficult to practice alone. It is often difficult even with a therapist, but having specific techniques and supportive help as you confront your fears can make all the difference.)

What to Expect from CBT

You might initially work with your therapist on creating a “hierarchy,” or ordered list, of feared things or situations. You will probably also spend time working together on learning and practicing techniques for anxiety reduction so that you can put these skills into practice as you confront your fears. Only after your anxiety has significantly abated will you be encouraged to move on to the next step.


If you suffer from agoraphobia or another condition that prevents you from going to see a therapist, you may find a therapist who will be willing to come to you, at least for the first several sessions. Together, you will work on overcoming your highway, driving, or leaving-home fears.

Although CBT techniques will not expose you to actual danger, of course, they will help acclimate you to relatively harmless but anxiety-inducing situations (anxiety inducing for you, that is). The idea is gradually to reduce your level of discomfort in situations that now cause you a lot of stress and may even, in some instances, impede your ability to function. Therapists sometimes use a technique called “habit reversal training” (HRT) for people who have specific behavioral disorders, such as trichotillomania, or compulsive hair pulling. (Trichotillomania was once considered rare. It is now believed to affect slightly more people that OCD itself. More women than men — perhaps almost a three-to-one ratio — suffer from this condition.)

Let's say you have a fear of driving over bridges. Perhaps it's not so bad now, but you find yourself taking other routes, when possible, so that you won't have to travel over water. Or maybe you make excuses, declining invitations that would require you to drive over any bridges. A cognitive behavioral therapist might encourage you first to imagine driving over a bridge, and then to try actually driving over one very low, or short, bridge. You would then progress to longer or higher ones, until the situation gave you virtually no discomfort. Or you might have to start by just driving near a bridge or walking to the edge of one, until you were able to tolerate the anxiety this provoked.

In time, you should become acclimated enough that driving over even high or long bridges gives you no real difficulty. Remember: Your symptoms probably developed gradually. Gradual increments are the key to overcoming them, as well.


Confronting a feared object or situation produces anxiety, but that discomfort can be tolerated. In fact, CBT is based partly on the knowledge that anxiety will not increase without end; eventually, it will subside. “Habituation” will occur, albeit at the cost of some uneasiness.

One benefit of CBT is that it carries no risk of side effects. Another is that its gains are believed to be lasting. That is, once you finish treatment, you should not have a recurrence of OC symptoms. Not true of medication, which, once discontinued, may stop working. The occasional flare-up, or return of symptoms under stress, is not unexpected, however, and can be managed by once again implementing the CBT strategies you've learned and incorporated. A therapy “tune-up” session or two is sometimes not a bad idea, either.

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