What to Expect in CBT Treatment Series: Obsessive Compulsive Disorder (OCD)
Written by: Dr. Hillary Gorin, PhD, LCP
This blog series will help you understand what to expect in Cognitive Behavioral Treatment (CBT) for a variety of different anxiety disorders, OCD, and PTSD. No matter what you are seeking help for, it can be very scary to start treatment. I assume most of my patients enter their first appointment with me with anxiety. I assume this for several reasons. 1. You are taking a big first step in your life to change something that may feel impossible to change; 2. Most of my patients experience an abundance of anxiety on a daily basis and new experiences make us all feel anxiety.
My hope is that this blog series helps you to have a better sense of what to expect in your treatment if you choose exposure-based CBT interventions. First and foremost, the first appointment will be a lot of data collection. In order to determine how I can be helpful, I must determine what your problem looks like. You can plan on me asking you a ton of questions. My goal is to determine what diagnoses you meet criteria for (to ensure I can treat those diagnoses) and to instill some hope in you that I can help you. Just like we would hope our doctors would evaluate what is broken before treating a broken bone and then tell us how they can be helpful, I want to use a scientific approach in my practice and give you some hope that the science works. Although a one size fits all approach does not work for everyone, I apply all evidence-based techniques or techniques that have been supported by ongoing research. In this series, you will find the general what’s and why’s of treatment with me. Also, if you are struggling with the motivation to get started, I include some information on why it may be worth it to take a chance on this treatment.
What is OCD?
I describe OCD to my patients as having “sticky brain” or “itches” that need to be scratched or something bad will happen. If we look at our diagnostic manual, obsessions are defined as thoughts, images, or impulses that reoccur and are intrusive in a way that causes anxiety/ distress (American Psychiatric Association, 2013). Compulsions are defined as actions or mental acts that take place in response to the obsession. In other words, OCD consists of having an intrusive thought and feeling the urge to undo or prevent the thought from coming true through some sort of mental or physical act.
What will we work on?
Exposure and response prevention entails learning that our thoughts are not as powerful as they feel. In treatment, you will learn to “sit with” intrusive thoughts without doing anything to neutralize or get rid of them (Foa et al., 2012). In addition, you will learn to do things and confront stimuli that make you feel anxious and distressed so that you can see it is not actually dangerous to do that thing or be around that object. For instance, some people with OCD think that they will run someone over if they drive a car. By driving a car over and over again, without going back to check to see if they hit anyone, they will see their intrusion was not accurate and fear will diminish. I will assist with both exposure to intrusions/ feared situations and also with preventing a response afterwards. The goal of this therapy is to learn that anxiety/ distress/ an “itch” to ritualize does not last forever and decreases eventually. In addition, you will learn that the anticipated consequence of having an intrusion are not very realistic. I often tell my patients that I would not ask you to do anything that I myself would not do or that most people would not do. I will instead ask you to engage in behavior that could have risks but risks that most of us are willing to or required to accept.
Why Engage in this Treatment?
Consider the ways your life has been negatively impacted by your OCD. Consider the time you have lost to getting stuck on thoughts or doing compulsions (Grayson, 2014). Logically, do your compulsions 100% prevent the bad thing from happening? Does your OCD interfere with spending time with loved ones? Does your OCD make you late for things? Does it impact your ability to enjoy your life? If so, you may want to give treatment a try.
Why this treatment works?
A natural way to reduce fear is to do the thing your fear over and over again, until the discomfort or fear fades (Foa et al., 2012). We see this with driving a car. We are all terrified when we begin but over time, we learn that we can do it. Exposure and response prevention follows this logic but also science. Over time, the threat brain (known as the amygdala) stops activating every time you have an intrusion and stops directing you to a compulsion. As you desensitize yourself to a fear, our rational brains take over and we no longer feel fear.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Foa, E. B., Yadin, E., & Lichner, T. K. (2012). Exposure and Response Prevention for Obsessive-Compulsive Disorder: Therapist Guide (2nd ed.). Oxford University Press.
Grayson, J. G. (2014). Freedom from Obsessive-Compulsive Disorder: A personalized recovery program for living with uncertainty. Berkley Books.
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