OCD and Cognitive Behavior Therapy
By Adrian Sparrow
It’s natural to experience doubts about your job performance, experience concerns about your family’s well-being, or even have the occasional intrusive thought. OCD, however, is made up of obsessive thoughts, impulses, images, and compulsions that are distressing and difficult to suppress. It’s currently estimated that 1 in 40 adults in the US, and 1 in 100 children, have obsessive-compulsive disorder (OCD).
What is OCD?
You may have seen a character portrayed in movies or TV as having OCD. Still, the media often exaggerates and ridicules OCD symptoms. OCD isn’t the enjoyment of a clean and organized room but a disorder characterized by intrusive thoughts and repetitive behaviors. Many people would be uncomfortable in a messy room and tidy up. Still, the person with OCD may clean until their hands are raw in a perceived effort to prevent contamination or, in reality, soothe their obsessive thoughts of germs.
Negative thoughts are a normal part of the human experience; sometimes, they can be uncomfortable, but most people can filter out these disturbing thoughts. People who have OCD lack that filter and feel urged to perform repetitive actions, called compulsions, to relieve the distress and anxiety of these negative thoughts. For example, somebody with OCD who’s obsessed with germs may wash their hands in a precise way, bathe excessively, or even avoid public spaces out of fear of contamination. Compulsions and rituals may temporarily soothe symptoms but reinforces the obsession and continue the worsening cycle.
Ultimately, these behaviors either take excessive amounts of time or interfere with a person’s daily functioning, relationships, or everyday routine.
Although OCD has been established as having a neurological basis, researchers haven’t found a clear cause of OCD. The current belief is that OCD results from several factors, such as genetic, cognitive, behavioral, cognitive, or environmental factors.
Obsessions and Compulsions
Common obsessions in OCD may be related to germs and contamination; fear of losing control of themselves, fear of harming others; concerns about exactness or perfection; unwanted or perverse sexual thoughts; and excessive religious or moral concerns. People with OCD often recognize that their obsessions are irrational.
Sometimes, the nature of the obsessions shapes the compulsions. For instance, obsessive fears of contamination may lead to compulsive handwashing. Other times, compulsive behavior is completely unrelated to the obsession. A person might tap their desk multiple times to keep their family from getting sick. The compulsion responds to sensory stimuli in other cases- making something look, sound, or feel “just right.” In most cases, patients would rather not perform these time-consuming behaviors. Compulsive behavior occurs when the person feels an intense need to escape the obsession or reduce their anxiety.
Common compulsions can include cleaning household objects excessively or ‘checking’ behaviors like repeatedly checking that the oven is off. Other compulsions include rewriting words or repeating routine activities such as walking in and out of doors and counting while performing tasks to end on a “good” number. People with OCD might also seek constant reassurance that they completed a task perfectly or didn’t make a mistake, and avoid situations that might trigger obsessions.
Treatment for OCD includes psychotherapy and/or medication. Anti-anxiety and antidepressant medicines might be prescribed, although medications don’t work for nearly 1 in 3 people with OCD.
Cognitive behavior therapy (CBT) is a psychological treatment based on evidence and is the preferred treatment for OCD. CBT utilizes two evidence-based techniques: exposure and response prevention (ERP) and cognitive therapy (CT). One of the goals of CBT is to change damaging thinking patterns and learn better coping skills to alleviate symptoms.
Exposure and Response Prevention (ERP)
A mental health professional gradually exposes the patient to situations that trigger their obsessions and compulsions. Throughout a series of controlled sessions, the person with OCD learns to respond differently to their obsessions. By replacing the harmful compulsive behavior with positive actions (no longer reinforcing the obsession), the patient may see a decline in compulsive behavior and intensity of obsessions.
Cognitive Therapy (CT)
Cognitive therapy helps the patient understand and identify patterns of thought that lead to anxiety, distress, or harmful behavior. The patient may then challenge their negative thoughts and learn a more suitable way of thinking. Cognitive therapy involves self-talk, learning to separate from their disorder, and analyzing realistic chances of catastrophe.