cbt ocd homework

Obsessive Compulsive Disorder (OCD) including Body Dysmorphic Disorder (BDD)

Resource type

Therapy tool.

"Should" Statements

Information handouts

Am I Experiencing Obsessive Compulsive Disorder (OCD)?

Approval-/Admiration-Seeking

Avoidance Hierarchy (Archived)

Behavioral Experiment

Behavioral Experiment (Portrait Format)

Catastrophizing

Checking Certainty And Doubt

Cognitive Behavioral Model Of Body Dysmorphic Disorder (BDD: Veale, 2004)

Cognitive Behavioral Model Of Intolerance Of Uncertainty And Generalized Anxiety Disorder Symptoms (Hebert, Dugas, 2019)

Cognitive Behavioral Treatment Of Childhood OCD: It's Only A False Alarm: Therapist Guide

Treatments That Work™

Cognitive Behavioral Treatment of Childhood OCD: It's Only a False Alarm: Workbook

Cognitive Distortions – Unhelpful Thinking Styles (Common)

Cognitive Distortions – Unhelpful Thinking Styles (Extended)

Defectiveness

Disqualifying The Positive

Embracing Uncertainty

Emotional Inhibition

Emotional Reasoning

Exposure And Response (Ritual) Prevention For Obsessive Compulsive Disorder (Second Edition): Therapist Guide

Exposure And Response Prevention

Exposure Practice Form

Exposure Session Record

Facing Your Fears And Phobias

Fear Ladder

Habituation

Intolerance Of Uncertainty

Intrusion Record

Intrusive Memory Record

Intrusive Thoughts Images And Impulses

Jumping To Conclusions

Maximizing The Effectiveness Of Exposure Therapy

Obsessive Compulsive Disorder (OCD) Formulation

OCD Hierarchy

Personalizing

Recognizing Obsessive Compulsive Disorder (OCD)

Self-Monitoring Record (Universal)

Theory A / Theory B

Theory A / Theory B (Archived)

Therapy Blueprint (Universal)

Therapy Blueprint For OCD

Thought Suppression And Intrusive Thoughts

Thought-Action Fusion

Treating Your OCD With Exposure And Response (Ritual) Prevention (Second Edition): Workbook

Uncertainty Beliefs – Experiment Record

Understanding Body Dysmorphic Disorder

Understanding Obsessive Compulsive Disorder (OCD)

Unhelpful Thinking Styles (Archived)

Urges – Self-Monitoring Record

What Is Body Dysmorphic Disorder (BDD)?

What Is Exposure Therapy?

What Keeps Body Dysmorphic Disorder (BDD) Going?

What Keeps Obsessive Compulsive Disorder (OCD) Going?

Your Stone Age Brain

Links to external resources.

Psychology Tools makes every effort to check external links and review their content. However, we are not responsible for the quality or content of external links and cannot guarantee that these links will work all of the time.

Scale Download Primary Link Archived Link
Obsessive Compulsive Cognition Working Group. (2001). Development and initial validation of the Obsessive Beliefs Questionnaire and the Interpretation of Intrusions Inventory. Behaviour Research and Therapy, 39, 987–1006.
Obsessive Compulsive Inventory (OCI) scoring grid Download Primary Link
Relationship Obsessive Compulsive Inventory (ROCI) Download Primary Link Archived Link
Partner Related Obsessive Compulsive Symptom Inventory Download Primary Link Archived Link
OCD Trauma Timeline Interview (OTTI) | Wadsworth, Van Kirk,August, MacLaren Kelly, Jackson, Nelson & Luehrs | 2023 Download Primary Link Archived Link
Vancouver Obsessional Compulsive Inventory (VOCI) Download Primary Link Archived Link

Guides and workbooks

What you need to know about OCD | International OCD Foundation (IOCDF) Download Primary Link
Managing obsessive compulsive disorder | Simon Enright Download Primary Link Archived Link
Obsessive compulsive disorder: patient treatment manual | Clinical Research Unit for Anxiety and Depression (CRUfAD) Download Primary Link Archived Link
OCD: An OCD-UK Information Guides For People Affected By Obsessive Compulsive Disorder | OCD-UK Download Archived Link
Self-Help: Managing Your OCD At Home | Anxiety Canada Download Primary Link Archived Link

Information Handouts

"Just Right" OCD Symptoms | IOCDF | 2009 Download Primary Link
What are postpartum and perinatal OCD? | IOCDF Download Primary Link

Information (Professional)

Scrupulosity and OCD: information packet for faith leaders | IOCDF, ADAA Download Primary Link Archived Link

Presentations

Cognitive behavioral therapy for OCD | Sabine Wilhelm Download Primary Link Archived Link
New directions in implementing exposure and response prevention: an inhibitory learning perspective | Jonathan Abramowitz | 2018 Download Primary Link Archived Link
Cognitive Therapy for Contamination-Related OCD: ERP and Beyond | Adam Radomsky | 2011 Download Archived Link
Interoceptive exposure: an underused weapon in the arsenal against obsessions and compulsions | Jonathan Abramowitz | 2018 Download Primary Link Archived Link
Family affair: involving a partner or spouse in exposure and response prevention for OCD | Jonathan Abramowitz | 2018 Download Primary Link Archived Link
A couple-based approach to CBT for BDD | Lillian Reuman, Jonathan Abramowitz | 2016 Download Primary Link Archived Link
Body dysmorphic disorder | David Veale | 2017 Download Primary Link Archived Link

Treatment Guide

NICE Guidelines For OCD and BDD | NICE | 2005 Download Primary Link
Treatment of patients with OCD | American Psychiatric Association (APA) | 2007 Download Primary Link
Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders (2014) | Katzman et al | 2014 Download Primary Link Archived Link
A psychological perspective on hoarding – DCP good practice guidelines | Holmes, S., Whomsley, S., Kellet S. | 2015 Download Archived Link
Treatment Manual For OCD | Clinical Research Unit for Anxiety Disorders (CRUFAD) | 2010 Download Primary Link Archived Link

What Is Obsessive Compulsive Disorder?

Signs and symptoms of ocd.

People with OCD experience obsessional thoughts, images, urges, and doubts. They often feel compelled to act or think in certain ways.

Obsessions are intrusive thoughts—thoughts that are unwanted and unacceptable, and which pop into our minds unbidden. Obsessions can be thoughts in the form of words, but also of images (pictures in our minds), urges or impulses, or feelings of doubt. Obsessive thoughts are experienced as unacceptable, disgusting, or senseless, and people with OCD find it hard not to pay attention to them. Examples of obsessions include:

thoughts such as ‘My hands have been contaminated with germs’ or ‘Perhaps I am a pedophile’
images of my family being murdered
doubts such as ‘Have I left the stove on?’
urges such as wanting to shout profanities

Compulsions follow from the way in which the individual interprets the intrusive thoughts. Compulsions are the reactions or mental actions that a person does in order to neutralize or ‘make safe’ following an obsession. People with OCD typically carry out compulsions in order to prevent a harm from happening for which they might be responsible, and/or to reduce any strong emotion which they feel. Exactly what someone with OCD may feel compelled to do will depend upon the meaning their intrusions have for them. Examples of compulsions might include:

carefully washing food after having an intrusive thought about germs;
calling family members to check they are OK after having an intrusive image about their deaths;
going back to the house to check after doubting whether the stove was turned off;
avoiding a public place after having an urge to shout profanities.

Prevalence of OCD

The lifetime prevalence rate of OCD in the United States is estimated to be 2.3% in adults (Kessler et al., 2005), and 1% to 2.3% in children and adolescents (Zohar, 1999).

Psychological Models and Theory of OCD

The cognitive behavioral theory of OCD proposes that when someone experiences an intrusive thought it is the appraisal—what they make of having the thought—that is most important (Salkovskis, Forrester, & Richards, 1998). Intrusive thoughts, even very unpleasant ones, are common and entirely normal . What seems to happen in OCD is that the fact of having intrusive thoughts is interpreted as being especially significant and, as a result, is especially anxiety-provoking. People with OCD are more likely to feel especially responsible for any potential harms and may feel especially strong emotion should they have intrusive thoughts about harm occurring. Compulsions are understood to be an active attempt to reduce harm. According to the cognitive model of OCD targets for intervention include:

understanding and addressing the meaning of the intrusions;
targeting compulsions and safety-seeking behaviors;
modifying attentional biases.

Evidence-Based Psychological Approaches for Working with OCD

Cognitive behavioral therapy (CBT) is an evidence-based psychological treatment for OCD. Historically, CBT for OCD has involved the behavioral approach of exposure with response prevention (ERP). More cognitive approaches within CBT attempt to understand the patient’s appraisal of their intrusions and to find ways of exploring the validity and consequences of these appraisals.

Resources for Working with OCD

Psychology Tools resources available for working therapeutically with OCD may include:

psychological models of obsessive-compulsive disorder (OCD)
information handouts for obsessive-compulsive disorder (OCD)
exercises for obsessive-compulsive disorder (OCD)
CBT worksheets for obsessive-compulsive disorder (OCD)
self-help programs for obsessive-compulsive disorder (OCD)
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry , 62 (6), 593–602.
Salkovskis, P. M., Forrester, E., & Richards, C. (1998). Cognitive–behavioral approach to understanding obsessional thinking. The British Journal of Psychiatry , 173 (S35), 53–63.
Zohar, A. H. (1999). The epidemiology of obsessive-compulsive disorder in children and adolescents. Child and Adolescent Psychiatric Clinics of North America , 8 (3), 445–460.
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Sending Homework to Clients in Therapy: The Easy Way

Successful therapy relies on using assignments outside of sessions to reinforce learning and practice newly acquired skills in real-world settings (Mausbach et al., 2010).

Up to 50% of clients don’t adhere to homework compliance, often leading to failure in CBT and other therapies (Tang & Kreindler, 2017).

In this article, we explore how to use technology to create homework, send it out, and track its completion to ensure compliance.

Before you continue, we thought you might like to download our three Positive Psychology Exercises for free . These science-based exercises will explore fundamental aspects of positive psychology including strengths, values, and self-compassion, and will give you the tools to enhance the wellbeing of your clients, students, or employees.

This Article Contains:

Is homework in therapy important, how to send homework to clients easily, homework in quenza: 5 examples of assignments, 5 counseling homework ideas and worksheets, using care pathways & quenza’s pathway builder, a take-home message.

Cognitive-Behavioral Therapy has “been shown to be as effective as medications in the treatment of a number of psychiatric illnesses” (Tang & Kreindler, 2017, p. 1).

Homework is a vital component of CBT, typically involving completing a structured and focused activity between sessions.

Practicing what was learned in therapy helps clients deal with specific symptoms and learn how to generalize them in real-life settings (Mausbach et al., 2010).

CBT practitioners use homework to help their clients, and it might include symptom logs, self-reflective journals , and specific tools for working on obsessions and compulsions. Such tasks, performed outside therapy sessions, can be divided into three types (Tang & Kreindler, 2017):

Psychoeducation Reading materials are incredibly important early on in therapy to educate clients regarding their symptoms, possible causes, and potential treatments.
Self-assessment Monitoring their moods and completing thought records can help clients recognize associations between their feelings, thoughts, and behaviors.
Modality specific Therapists may assign homework that is specific and appropriate to the problem the client is presenting. For example, a practitioner may use images of spiders for someone with arachnophobia.

Therapists strategically create homework to lessen patients’ psychopathology and encourage clients to practice skills learned during therapy sessions, but non-adherence (between 20% and 50%) remains one of the most cited reasons for CBT failure (Tang & Kreindler, 2017).

Reasons why clients might fail to complete homework include (Tang & Kreindler, 2017):

Internal factors

Lack of motivation to change what is happening when experiencing negative feelings
Being unable to identify automatic thoughts
Failing to see the importance or relevance of homework
Impatience and the wish to see immediate results

External factors

Effort required to complete pen-and-paper exercises
Inconvenience and amount of time to complete
Failing to understand the purpose of the homework, possibly due to lack of or weak instruction
Difficulties encountered during completion

Homework compliance is associated with short-term and long-term improvement of many disorders and unhealthy behaviors, including anxiety, depression, pathological behaviors, smoking, and drug dependence (Tang & Kreindler, 2017).

Greater homework adherence increases the likelihood of beneficial therapy outcomes (Mausbach et al., 2010).

With that in mind, therapy must find ways to encourage the completion of tasks set for the client. Technology may provide the answer.

The increased availability of internet-connected devices, improved software, and widespread internet access enable portable, practical tools to enhance homework compliance (Tang & Kreindler, 2017).

Clients who complete their homework assignments progress better than those who don’t (Beck, 2011).

Having an ideal platform for therapy makes it easy to send and track clients’ progress through assignments. It must be “user-friendly, accessible, reliable and secure from the perspective of both coach and client” (Ribbers & Waringa, 2015, p. 103).

In dedicated online therapy and coaching software, homework management is straightforward. The therapist creates the homework then forwards it to the client. They receive a notification and complete the work when it suits them. All this is achieved in one system, asynchronously; neither party needs to be online at the same time.

For example, in Quenza , the therapist can create a worksheet or tailor an existing one from the library as an activity that asks the client to reflect on the progress they have made or work they have completed.

The activity can either be given directly to the client or group, or included in a pathway containing other activities.

Here is an example of the activity parameters that Quenza makes possible.

A message can be attached to the activity, using either a template or a personally tailored message for the client. Here’s an example.

Once the activity is published and sent, the client receives a notification about a received assignment via their coaching app (mobile or desktop) or email.

The client can then open the Quenza software and find the new homework under their ‘To Do’ list.

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Quenza provides the ability to create your own assignments as well as a wide selection of existing ones that can be assigned to clients for completion as homework.

The following activities can be tailored to meet specific needs or used as-is. Therapists can share them with the client individually or packaged into dedicated pathways.

Such flexibility allows therapists to meet the specific needs of the client using a series of dedicated and trackable homework.

Examples of Quenza’s ready-to-use science-based activities include the following:

Wheel of Life

The Wheel of Life is a valuable tool for identifying and reflecting on a client’s satisfaction with life.

You can find the worksheet in the Positive Psychology Toolkit© , and it is also included in the Quenza library. The client scores themselves between 1 and 10 on specific life domains (the therapist can tailor the domains), including relationships, career development, and leisure time.

This is an active exercise to engage the client early on in therapy to reflect on their current and potential life. What is it like now? How could it look?

The wheel identifies where there are differences between perceived balance and reality .

The deep insights it provides can provide valuable input and prioritization for goal setting.

The Private Garden: A Visualization for Stress Reduction

While stress is a normal part of life, it can become debilitating and interfere with our everyday lives, stopping us from reaching our life goals.

We may notice stress as worry, anxiety, and tension and resort to avoidant or harmful behaviors (e.g., abusing alcohol, smoking, comfort eating) to manage these feelings.

Visualization is simple but a powerful method for reducing physical and mental stress, especially when accompanied by breathing exercises.

The audio included within this assignment helps the listener visualize a place of safety and peace and provides a temporary respite from stressful situations.

20 Guidelines for Developing a Growth Mindset

Research into neuroplasticity has confirmed the ability of the adult brain to continue to change in adulthood and the corresponding capacity for people to develop and transform their mindsets (Dweck, 2017).

The 20 guidelines (included in our Toolkit and part of the Quenza library) and accompanying video explain our ability to change mentally and develop a growth mindset that includes accepting imperfection, leaning into challenges, continuing to learn, and seeing ‘failure’ as an opportunity for growth.

Adopting a growth mindset can help clients understand that our abilities and understanding are not fixed; we can develop them in ways we want with time and effort.

Self-Contract

Committing to change is accepted as an effective way to promote behavioral change – in health and beyond. When a client makes a contract with themselves, they explicitly state their intention to deliver on plans and short- and long-term goals.

Completing and signing such a self-contract (included in our Toolkit and part of the Quenza library) online can help people act on their commitment through recognizing and living by their values.

Not only that, the contract between the client and themselves can be motivational, building momentum and self-efficacy.

The contract can be automatically personalized to include the client’s name but also manually reworded as appropriate.

The client completes the form by restating their name and committing to a defined goal by a particular date, along with their reasons for doing so.

Realizing Long-Lasting Change by Setting Process Goals

We can help clients realize their goals by building supportive habits. Process goals – for example, eating healthily and exercising – require ongoing actions to be performed regularly.

Process goals (unlike end-state goals, such as saving up for a vacation) require long-lasting and continuous change that involves monitoring standards.

This tool (included in our Toolkit and part of the Quenza library) can help clients identify positive actions (rather than things to avoid) that they must carry out repeatedly to realize change.

We have many activities that can be used to help clients attending therapy for a wide variety of issues.

In this section, we consider homework ideas that can be used in couples therapy, family therapy, and supporting clients with depression and anxiety.

Couples therapy homework

Conflict is inevitable in most long-term relationships. Everyone has their idiosyncrasies and individual set of needs. The Marital Conflicts worksheet captures a list of situations in which conflicts arise, when they happen, and how clients feel when they are (un)resolved.

Family therapy homework

Families, like individuals, are susceptible to times of stress and disruptions because of life changes such as illness, caring for others, and job and financial insecurity.

Mind the Gap is a family therapy worksheet where a family makes decisions together to align with goals they aspire to. Mind the gap is a short exercise to align with values and improve engagement.

How holistic therapist Jelisa Glanton uses Quenza

Homework ideas for depression and anxiety: 3 Exercises

The following exercises are all valuable for helping clients with the effects of anxiety and depression.

Activity Schedule is a template assisting a client with scheduling and managing normal daily activities, especially important for those battling with depression.

Activity Menu is a related worksheet, allowing someone with depression to select from a range of normal activities and ideas, and add these to a schedule as goals for improvement.

The Pleasurable Activity Journal focus on activities the client used to find enjoyable. Feelings regarding these activities are journaled, to track recovery progress.

Practicing mindfulness is helpful for those experiencing depression (Shapiro, 2020). A regular gratitude practice can develop new neural pathways and create a more grateful, mindful disposition (Shapiro, 2020).

Each activity can be tailored to the client’s needs; shared as standalone exercises, worksheets, or questionnaires; or included within a care pathway.

A pathway is an automated and scheduled series of activities that can take the client through several stages of growth, including psychoeducation , assessment, and action to produce a behavioral change in a single journey.

How to build pathways

The creator can add two pathway titles. The second title is not necessary, but if entered, it is seen by the client in place of the first.

Once named, a series of steps can be created and reordered at any time, each containing an activity. Activities can be built from scratch, modified from existing ones in the library, or inserted as-is.

New activities can be created and used solely in this pathway or made available for others. They can contain various features, including long- and short-answer boxes, text boxes, multiple choice boxes, pictures, diagrams, and audio and video files.

Quenza can automatically deliver each step or activity in the pathway to the client following the previous one or after a certain number of days. Such timing is beneficial when the client needs to reflect on something before completing the next step.

Practitioners can also designate steps as required or optional before the client continues to the next one.

Practitioners can also add helpful notes not visible to the client. These comments can contain practical reminders of future changes or references to associated literature that the client does not need to see.

It is also possible to choose who can see client responses: the client and you, the client only, or the client decides.

Tags help categorize the pathway (e.g., by function, intended audience, or suggested timing within therapy) and can be used to filter what is displayed on the therapist’s pathway screen.

Once designed, the pathway can be saved as a draft or published and sent to the client. The client receives the notification of the new assignment either via email or the coaching app on their phone, tablet, or desktop.

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Success in therapy is heavily reliant on homework completion. The greater the compliance, the more likely the client is to have a better treatment outcome (Mausbach et al., 2010).

To improve the likelihood that clients engage with and complete the assignments provided, homework must be appropriate to their needs, have a sound rationale, and do the job intended (Beck, 2011).

Technology such as Quenza can make homework readily available on any device, anytime, from any location, and ensure it contains clear and concise psychoeducation and instructions for completion.

The therapist can easily create, copy, and tailor homework and, if necessary, combine multiple activities into single pathways. These are then shared with the click of a button. The client is immediately notified but can complete it at a time appropriate to them.

Quenza can also send automatic reminders about incomplete assignments to the client and highlight their status to the therapist. Not only that, but any resulting questions can be delivered securely to the therapist with no risk of getting lost in a busy email inbox.

Why not try the Quenza application? Try using some of the existing science-based activities or create your own. It offers an impressive array of functionality that will not only help you scale your business, but also ensure proactive, regular communication with your existing clients.

We hope you enjoyed reading this article. Don’t forget to download our three Positive Psychology Exercises for free .

Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond . Guilford Press.
Dweck, C. S. (2017). Mindset: The new psychology of success. Robinson.
Mausbach, B. T., Moore, R., Roesch, S., Cardenas, V., & Patterson, T. L. (2010). The relationship between homework compliance and therapy outcomes: An updated meta-analysis. Cognitive Therapy and Research , 34 (5), 429–438.
Ribbers, A., & Waringa, A. (2015). E-coaching: Theory and practice for a new online approach to coaching . Routledge.
Shapiro, S. L. (2020). Rewire your mind: Discover the science and practice of mindfulness. Aster.
Tang, W., & Kreindler, D. (2017). Supporting homework compliance in cognitive behavioural therapy: Essential features of mobile apps. JMIR Mental Health , 4 (2).

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Psychological Therapy for OCD

Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.

Alain SHRODER / ONOKY / Getty Images

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.

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

Behavior therapy involves facing your worst fears. Many patients drop out 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 harmful thought patterns and coming up with plausible alternatives that are more realistic and less threatening. It is not uncommon to be unaware of some of the distortions 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 .

No matter what type of therapy you choose to pursue, it's most helpful when you actively engage in an open discussion with your doctor or mental health professional—one in which you are honest about your symptoms, feelings, thoughts, and anything else that comes to your mind. This will help to form a full picture of what you require to move forward and progress.

OCD Discussion Guide

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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?

Get Help Now

We've tried, tested, and written unbiased reviews of the best online therapy programs including Talkspace, BetterHelp, and ReGain. Find out which option is the best for you.

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 their attention and will try to work through these issues with 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.

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Ryan RM, Lynch MF, et al. Motivation and Autonomy in Counseling, Psychotherapy, and Behavior Change: A Look at Theory and Practice . The Counseling Psychologist . 2011;39(2):193–260. doi:10.1177/0011000009359313

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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.

By Owen Kelly, PhD Owen Kelly, PhD, is a clinical psychologist, professor, and author in Ontario, ON, who specializes in anxiety and mood disorders.

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OCD Treatment: Cognitive-Behavioral Therapy

For many years, the treatment of OCD was thought to be exceptionally difficult. Traditional psychoanalysis consistently had little impact on the disorder, and other psychotherapies were equally unsuccessful. However, over the past fifteen years, developments in Cognitive-Behavioral Therapy (CBT) have resulted in an OCD treatment protocol that is especially beneficial for individuals with this condition. In fact, numerous clinical studies conducted over the past fifteen years have conclusively found that CBT, either with or without medication, is dramatically superior to all other forms of treatment for OCD.

Compared to traditional psychotherapy, in which sessions are spent merely discussing the client’s problems, CBT treatment for OCD is far more proactive. Working together, both the client and the therapist take active roles in assessing the problem, and in devising concrete, active steps towards alleviating the symptoms. Using the Yale-Brown Obsessive Compulsive Scale (YBOCS) and numerous other assessment tools, the therapist helps the client create a detailed list of his or her symptoms. This symptom list is then used as the primary tool in a form of CBT treatment called Exposure and Response Prevention (ERP) , or “exposure therapy”.

Additionally, a variant of ERP called imaginal exposure is frequently used in the treatment of OCD, OC Spectrum Disorders, and related anxiety disorders. Imaginal exposure involves writing short stories based on the client’s obsessions. These stories are used as ERP tools, allowing the client to experience exposure to their fearful thoughts. This form of exposure therapy is particularly beneficial for obsessions that cannot be experienced through traditional ERP (e.g., killing one’s spouse or molesting a child). When combined with standard ERP, and other cognitive-behavioral techniques, imaginal exposure stories can help to greatly reduce the frequency and magnitude of these intrusive obsessions, as well as the individual’s sensitivity to unwanted thoughts and mental images. To learn more about imaginal exposure, click here .

One of the most effective CBT developments for the treatment of Obsessive-Compulsive Disorder (OCD) and related conditions is Mindfulness-Based Cognitive-Behavioral Therapy. The primary goal of Mindfulness-Based CBT is to learn to non-judgmentally accept uncomfortable psychological experiences. From a mindfulness perspective, much of our psychological distress is the result of trying to control and eliminate the discomfort of unwanted thoughts, feelings, sensations, and urges. In other words, our discomfort is not the problem – our attempt to control and eliminate our discomfort is the problem. For an individual with OCD or a related anxiety-based condition, the ultimate goal of mindfulness is to develop the ability to more willingly experience their uncomfortable thoughts, feelings, sensations, and urges, without responding with compulsions, avoidance behaviors, reassurance seeking, and/or mental rituals. To learn more about Mindfulness Based CBT, click here .

Following a structured CBT protocol, the client gradually challenges all of his or her symptoms, and learns new, more productive methods of coping with anxiety. Over time, the individual becomes de-sensitized to previously anxiety-provoking situations and thoughts, and the obsessions and compulsions are eliminated, or significantly reduced in frequency and magnitude. Using this treatment approach, most clients make dramatic improvement by meeting with their therapist on a weekly basis over a period of just 4-6 months, followed by two or three “booster sessions”. Some clients may also benefit by having a small number of family or couples therapy sessions to address the impact OCD is having on their relationships. And a minority of clients may require a more intensive approach that includes 2-3 sessions per week or even home visits.

CBT Combined with Medication for the Treatment of OCD and Anxiety Conditions

Some individuals with OCD, OC Spectrum Disorders, or related anxiety disorders, may also benefit from combining CBT treatment with one or more medications that are sometimes prescribed for these conditions. The goal of medication, or “pharmacotherapy,” is to reduce obsessional anxiety, thereby increasing the individual’s ability to utilize and benefit from CBT treatment. This is particularly helpful with clients for whom the prospect of exposure therapy is so anxiety-provoking that they are initially unwilling to try CBT. For these individuals, after the medication has begun to reduce their obsessions, it is recommended that they complete a regimen of CBT while continuing the pharmacotherapy. Medication may also be beneficial for individuals experiencing depression, which is sometimes present in those with OCD and related disorders, or with other psychiatric conditions.

But it is important to stress that CBT is the primary treatment for OCD. Numerous research studies completed over the past twenty years have concluded that CBT is the most effective treatment for OCD. In fact, in 1997, the Journal of Clinical Psychiatry surveyed over sixty OCD researchers and treatment specialists from across the world in order to determine the best treatment for OCD. The resulting publication, entitled Expert Consensus Treatment Guidelines for Obsessive-Compulsive Disorder , described CBT as “the psychotherapeutic treatment of choice for children, adolescents and adults with OCD” and noted that it is “the key element of treatment” .

Despite this endorsement, many clients are tempted to rely on medication alone. But four facts provide a compelling case against the “medication-only” route. First, analyses of numerous studies comparing CBT and pharmacotherapy have concluded that CBT treatment for OCD is more effective in both the short and long-term. Second, the potential short-term side-effects of these medications are well-documented and include anxiety, insomnia, nausea, diarrhea, difficulty concentrating, and sexual dysfunction. Conversely, CBT has no side-effects. Third, many of these medications have not been fully studied over an extended period of time, and many researchers and clinicians are concerned about the possibility of long-term side-effects, particularly for children, and for pregnant or breast-feeding women. And finally, studies have shown that when individuals treating OCD exclusively with pharmacotherapy discontinue the medication, as many as 90% may experience a complete return of their OCD symptoms. Conversely, those who complete a course of CBT treatment for OCD usually have a far lower rate of relapse. With CBT, the techniques you learn are always with you and provide a set of tools that can immediately be utilized if and when symptoms return.

Group Cognitive Behavioral Therapy (CBT) for OCD and Anxiety

In addition to individual therapy, the OCD Center of Los Angeles also currently offers five weekly therapy/support groups for adults , all of which are conveniently scheduled on weekday evenings or Saturdays. Research has shown that group Cognitive-Behavioral Therapy can be extremely helpful in the treatment of OCD (including Pure Obsessional OCD and Postpartum OCD) and related anxiety conditions, including Body Dysmorphic Disorder (BDD), Hypochondria (health anxiety), Panic Disorder, Social Anxiety, Phobias, Trichotillomania (hair pulling disorder), and Dermatillomania (skin picking disorder). All of our groups are lead by our professional staff therapists, and use the same treatment protocol as our individual Cognitive-Behavioral Therapy program. To learn more about our weekly groups for adults with OCD and related conditions, click here , or call us at (310) 824-5200 (ext. 4).

Online Cognitive Behavioral Therapy (CBT) for OCD and Anxiety

The OCD Center of Los Angeles also offers webcam-based online therapy and telephone therapy to clients around the world. Our telephone and online therapy program uses the same Cognitive Behavioral Therapy treatment protocol that we use with our face-to-face clients. Telephone and online therapy are cost-effective options for clients who have physical and/or psychological limitations that restrict their ability to come to our office, and for those in remote areas who cannot find specialized OCD and anxiety treatment close to their home. Telephone and online therapy have repeatedly been found to be safe and effective in numerous research studies, and have been legal in California since 1997. If you would like to learn more about our telephone and online therapy program for Obsessive Compulsive Disorder (OCD) and related anxiety based conditions, please click here .

Intensive Cognitive Behavioral Therapy (CBT) for OCD and Anxiety

We also offer an intensive treatment program for adults, adolescents, and children with OCD and related anxiety conditions. This program utilizes the same Cognitive Behavioral Therapy that we use in our standard outpatient program, and is designed to provide specialized intensive treatment to individuals for whom traditional outpatient therapy is either unavailable or insufficient. Our intensive outpatient program is ideal for clients from other states or countries who cannot find effective treatment near to their homes, and for those whose symptoms require a more rigorous treatment protocol. To learn more about intensive outpatient treatment for OCD and related anxiety conditions, click here .

About the OCD Center of Los Angeles

The OCD Center of Los Angeles is a private outpatient treatment center specializing in CBT for the treatment of OCD and related anxiety based conditions. We have 13 therapists on staff, all of whom are either licensed or registered, and all of whom specialize in CBT. We treat adults, adolescents, and children, and offer services six days a week, including evenings and Saturdays.

If you would like more information regarding Cognitive-Behavioral Therapy (CBT), or would like to discuss individual therapy, group therapy, telephone or online therapy, or intensive treatment for OCD or a related anxiety based condition, you can call the OCD Center of Los Angeles at (310) 824-5200 (ext. 4), or click here to email us .

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Cognitive Behavioral Therapy for OCD: Effective Techniques

Fact Checked

Written by:

Eliana Galindo

Reviewed by:

Bahadir Bozoglan, PsyD

published on:

September 29, 2023

Updated on:

October 26, 2023

Obsessive-compulsive disorder (OCD) is a mental health condition characterized by intrusive thoughts , images , or impulses (obsessions) and repetitive behaviors aimed at reducing the anxiety caused by these obsessions (compulsions).

OCD can significantly impact an individual’s daily life, making effective interventions for this often debilitating disorder.

One evidence-based approach for treating OCD is cognitive-behavioral therapy (CBT) , widely recognized for its efficacy in reducing OCD symptoms and improving overall functioning.

Role of Cognitive Behavioral Therapy in OCD

Cognitive Behavioral Therapy (CBT) has emerged as a prominent and effective treatment for individuals suffering from Obsessive-Compulsive Disorder (OCD) .

This form of therapy aims to address the dysfunctional thought patterns and behaviors that characterize OCD by using a combination of cognitive and behavioral strategies .

The primary goal of CBT for OCD is to help individuals recognize , challenge , and change their maladaptive beliefs and behaviors.

This is achieved through various techniques, such as identifying problematic thoughts , evaluating the evidence for these thoughts , and implementing behavioral exercises to modify existing patterns.

As a result, individuals can develop new, healthier ways of coping with their OCD symptoms.

Exposure and Response Prevention Therapy

Exposure and Response Prevention (ERP) therapy is an essential component of cognitive-behavioral therapy (CBT) for individuals suffering from obsessive-compulsive disorder (OCD).

ERP effectively reduces OCD symptoms through a systematic process that focuses on breaking the cycle of obsessions and compulsions. Exposure works to challenge flawed thought .

When you repeatedly confront a feared situation without performing a ritual, you realize that no harm occurs. Consequently, you recognize that the risk is minimal and learn to disregard it.

Exposure Exercises

The primary goal of ERP therapy is to help individuals with OCD confront their fears and anxieties without resorting to their rituals or compulsions. In this process, the therapist designs specific exposure exercises.

These exercises gradually expose the person to their feared objects or situations while preventing them from engaging in compulsive behaviors.

Controlled Environment

During ERP therapy, individuals are gradually exposed to their obsessions in a controlled and supportive environment.

As they confront their fears without performing their rituals, they learn to tolerate the anxiety that arises.

Over time, their anxiety levels decrease, and they gain confidence in managing their OCD symptoms.

Tailored Exercises

It is important to note that exposure exercises are specifically designed to match the individual’s unique obsessions and compulsions.

For example , a person with contamination-related OCD may be asked to touch a doorknob without washing their hands afterward.

The therapist monitors and supports individuals throughout each exposure exercise to ensure their safety and progress.

Cognitive Restructuring and Visualization Techniques

Cognitive behavioral therapy (CBT) for obsessive-compulsive disorder (OCD) often involves two key components : cognitive restructuring and visualization techniques.

These methods help individuals identify and change unhealthy thought patterns and beliefs contributing to their OCD symptoms.

This section will briefly outline these techniques and their application in treating OCD.

Cognitive Restructuring

Cognitive restructuring (CR) refers to a psychotherapy approach aimed at acquiring the ability to recognize and challenge flawed or maladaptive thinking, sometimes called cognitive distortions .

Cognitive restructuring is a process in which patients learn to challenge and replace irrational beliefs and thought patterns with more rational alternatives.

For example, people with OCD may believe that their compulsions will prevent harm to themselves or others.

They can learn to recognize these thoughts as irrational and replace them with healthier, more accurate beliefs through cognitive restructuring.

This can help reduce the frequency and intensity of obsessions and compulsions over time.

Visualization Techniques

Visualization techniques are often combined with cognitive restructuring for added effectiveness.

These methods involve using mental imagery to practice confronting and reducing OCD symptoms.

For instance, patients may visualize themselves performing daily tasks without engaging in compulsive behaviors or imagine successfully managing anxiety-provoking situations.

This helps build confidence in their coping skills and reduces reliance on compulsions to manage anxiety.

Homework Tasks

In CBT for OCD, therapists often assign homework tasks to further practice cognitive restructuring and visualization skills.

These assignments may include monitoring obsessive thoughts, applying restructuring techniques, and engaging in visualization exercises.

Regular practice helps solidify these skills and promotes long-lasting improvements in managing OCD symptoms.

Treatment Planning and Efficacy Evaluation

Cognitive behavioral therapy (CBT) has effectively treated obsessive-compulsive disorder (OCD), focusing on helping individuals identify and modify their irrational thoughts and behaviors.

Treatment planning often involves creating a personalized case conceptualization and tailoring interventions to the individual’s needs.

Empirically Supported Assessment Tools

A crucial element of CBT for OCD is the use of empirically supported assessment tools such as the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) .

This instrument aids in evaluating the severity of the disorder and tracking treatment progress.

It also informs clinicians’ decisions regarding adjustments to the treatment plan.

Case Examples

Case examples can be beneficial in learning about the practical applications of CBT for OCD.

By examining real-life scenarios, therapists gain insights into how individual patients respond to treatment and can adopt a more flexible approach .

Evidence-Based Techniques

CBT for OCD also involves evidence-based techniques such as progressive muscle relaxation and systematic relaxation .

These methods help patients manage their anxiety and develop coping skills to counter their obsessions and compulsions.

Behavioral Contingencies

To achieve optimized treatment outcomes, behavioral contingencies enable patients to practice new habits, eliminate maladaptive behaviors, and sustain progress.

It’s essential to continuously assess the efficacy of CBT throughout the treatment process and make necessary modifications to the treatment plan based on the patient’s needs and progress.

Frequently Asked Questions

What are the main components of a typical cbt treatment plan for ocd.

A typical CBT treatment plan for OCD consists of several components , often tailored to the individual’s unique needs.

Core components generally include :

Psychoeducation: Educating individuals about OCD, including its symptoms and the rationale behind using CBT as a treatment.
Cognitive restructuring: Identifying, challenging, and reframing distorted thoughts linked to obsessions and compulsions.
Exposure and response prevention: Gradual exposure to feared situations while resisting the urge to engage in compulsive behaviors.
Skills training: Developing healthy coping strategies, such as relaxation techniques and time management, to improve overall functioning.
Relapse prevention: Reinforcing new skills and coping mechanisms to maintain progress and prevent relapse.

How does exposure and response prevention compare to CBT for OCD?

Exposure and Response Prevention (ERP) is a fundamental component of CBT for OCD.

ERP exposes the individual to their feared situation or obsession without engaging in compulsive behaviors.

This repeated exposure assists in reducing anxiety and breaking the cycle of obsessions and compulsions.

How to find a CBT therapist specializing in OCD?

To find a CBT therapist who specializes in treating OCD, consider the following steps:

Consult your primary care physician or a mental health professional for recommendations.
Search online directories, such as Find-a-therapist and Psychology Today , which offer lists of therapists by specialty and location.
Search online therapy platforms such as BetterHelp , Online-Therapy.com , or Calmerry .
Ask for recommendations from friends, family members, or support groups.

It is essential to choose a therapist you feel comfortable with and who has experience in treating patients with OCD using CBT methods.

Remember that finding the right therapist may take time , but the effort can be a crucial step in your journey toward recovery.

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About the author

Cognitive behavioral therapy of obsessive-compulsive disorder

Terapia cognitivo conductual del trastorno obsesivo compulsivo, thérapie cognitivocomportementale des troubles obsessionnels compulsifs, edna b. foa.

Center for the Treatment and Study of Anxiety, University of Pennsylvania, Philadelphia, Pennsylvania, USA

Until the mid-1960s, obsessive-compulsive disorder (OCD) was considered to be treatment-resistant, as both psychodynamic psychotherapy and medication had been unsuccessful in significantly reducing OCD symptoms. The first real breakthrough came in 1966 with the introduction of exposure and ritual prevention. This paper will discuss the cognitive behavioral conceptualizations that influenced the development of cognitive behavioral treatments for OCD. There will be a brief discussion of the use of psychodynamic psychotherapy and early behavioral therapy, neither of which produced successful outcomes with OCD. The main part of the paper will be devoted to current cognitive behavioral therapy (CBT) with an emphasis on variants of exposure and ritual or response prevention (EX/RP) treatments, the therapy that has shown the most empirical evidence of its efficacy.

Hasta mediados de la década de 1960 se consideró que el trastorno obsesivo compulsivo (TOC) era resistente al tratamiento, ya que tanto la psicoterapia psicodinámica como la medicación habían sido ineficaces en la reducción significativa de los síntomas del TOC. El primer avance real ocurrió en 1966 con la introducción de terapia de exposición y la prevención de rituales. En este artículo se discuten los conceptos cognitivo conductuales que influyen en el desarrollo de los tratamientos cognitivos conductuales para el TOC. Se efectúa una discusión breve acerca del empleo de la psicoterapia psicodinámica y las primeras terapias conductuales, a pesar que ninguna de ellas produjo un resultado exitoso en el TOC. La parte central del artículo está dedicada a la terapia cognitivo conductual actual, con un énfasis en las variantes de los tratamientos de exposición y prevención de rituales o respuestas, terapia que ha mostrado la mayor evidencia empírica de eficacia.

Jusqu'au milieu des années 60, les TOC (troubles obsessionnels compulsifs) étaient considérés comme résistant à la fois aux psychothérapies psychodynamiques et aux traitements médicamenteux qui n'avaient pas montré de diminution significative de leurs symptômes. La première réelle avancée a pris place en 1966 avec l'introduction de la thérapie par l'exposition et de la prévention des rituels. Cet article analyse les conceptualisations cognitivocomportementales qui influent sur le développement des traitements cognitivo-comportementaux des TOC. La psychothérapie psychodynamique et les premiers traitements comportementaux sont brièvement passés en revue, n'ayant eu ni l'un ni l'autre de résultats probants avec les TOC. L'article se consacre principalement aux thérapies cognitivocomportementales (TCC) actuelles en insistant sur les différents traitements par exposition et prévention de la réponse et du rituel (EX/PR), méthode qui a montré la meilleure efficacité empiriquement.

Obsessive-compulsive disorder (OCD) was considered until the mid-1960s to be resistant to treatment with both psychodynamic psychotherapy and medication. The first significant breakthrough came in the form of exposure and ritual prevention. This, along with other forms of cognitive behavioral therapy (CBT), and earlier behavioral therapy, will be discussed below.

Cognitive behavioral conceptualization of OCD

Several cognitive behavioral theories about the development and maintenance of OCD symptoms have been put forward. Dollard and Miller 1 adopted Mowrer's twostage theory 2 , 3 to explain the development and maintenance of fear/anxiety and avoidance in OCD. Mowrer's theory maintains that a neutral event stimulus (conditioned stimulus, CS) comes to elicit fear when it is repeatedly presented together with an event that by its nature causes pain/distress (unconditioned stimulus; UCS). The CS can be a mental event, such as a thought, and/or a physical object, such as a bathroom or trash cans. After fear/anxiety/distress to the CS is acquired, escape or avoidance behaviors are developed to reduce the anxiety. In OCD, the behavioral avoidance and escape take the form of repeated compulsions or rituals. Like other avoidance behaviors, compulsions are maintained because they indeed reduce the distress. Not only does Mowrer's theory adequately explain fear acquisition, 4 it is also consistent with observations of how rituals are maintained. In a series of experiments, Rachman and colleagues demonstrated that obsessions increase obsessional distress and compulsions reduce this distress. 5 , 6 This conceptualization of a functional relationship between obsessions and compulsions influenced the definitions of OCD in DSM-III 7 and its successors.

Foa and Kozak 8 proposed that OCD is characterized by erroneous cognitions. First, OCD sufferers assign a high probability of danger to situations that are relatively safe. For example, an individual with OCD will believe that if he or she touches a public doorknob without washing his or her hands thoroughly, the germs on the doorknob will cause serious disease to him or her and/or to people whom he or she touched with dirty hands. Second, individuals with OCD exaggerate the severity of the bad things that they think can happen. For example, contracting a minor cold is viewed as a terrible thing. Foa and Kozak also pointed out that individuals with OCD conclude that in the face of lack of evidence that a situation or an object is safe, it is dangerous, and therefore OCD sufferers require constant evidence of safety. For example, in order to feel safe, an OCD sufferer requires a guarantee that the dishes in a given restaurant are extremely clean before eating in this restaurant. People without OCD, on the other hand, conclude that if they do not have evidence that a situation is dangerous, then it is safe. Thus, a person without OCD would eat from the dishes in the restaurant unless he or she has clear evidence that they are dirty.

Salkovskis 9 offered a cognitive theory of OCD. He proposed that five assumptions are characteristic of OCD: (i) thinking about an action is the same as doing it; (ii) failing to prevent harm is morally equivalent to causing harm; (iii) responsibility for harm is not diminished by extenuating circumstances; (iv) failing to ritualize in response to a thought about harm is the same as an intention to harm; and (v) one should exercise control over one's thoughts (p 579). Therefore, while the patient may feel their obsessions are unacceptable, the compulsions used to reduce the anxiety are deemed acceptable.

Traditional psychotherapy

OCD was initially viewed as intractable. Psychoanalytic and psychodynamic theories of unconscious drives and wishes produced several formulations of OCD and descriptions of case studies, but did not lead to treatments that reliably resulted in significant reduction of OCD symptoms. Nonetheless, due to lack of alternatives, psychodynamic psychotherapy continued to be administered to patients with OCD despite limited clinical benefit. 10 Salzman and Thaler 11 in their review of the literature concluded that the traditional approaches to the treatment of OCD “require drastic revision because they have added nothing to the comprehension or resolution of these disorders.” The authors proposed that treatment should be focused on the here and now, and refrain from using psychodynamic interpretations of past experiences. In his 1983 psychiatric review of OCD, Jenike 12 lamented that psychology had little to offer people suffering from OCD. He noted that “OCD is generally easy to diagnose but extremely difficult to treat successfully. The abundance of therapeutic approaches available suggests that none is clearly effective in the majority of cases. Psychotherapy and electroconvulsive therapy are ineffective treatments for pure OCD.” 12

At present it is widely recognized that, for OCD, psychodynamic approaches have little evidence base to justify their use. With regard to psychodynamic therapy and psychoanalysis, one of the most current expert guidelines notes that “there is doubt as to whether it has a place in mental health services for OCD” at all. 13

Early behavior therapy

Several behavioral interventions were developed to alleviate OCD-related distress, with varying degrees of success. The goal was to reduce obsessional anxiety/distress by exposing the patient to the very events that evoked that distress - and are therefore avoided - until the patient adapted, or habituated, to the situation. Systematic desensitization, developed by Wolpe, 14 for phobias, was applied in the treatment of OCD. This approach involved applied relaxation during gradual exposure to feared items and situations. The goal of desensitization was to eliminate the patient's obsessional anxiety, which in turn was thought to eliminate compulsions or rituals. The important components of treatment are to create a hierarchy of anxiety-provoking stimuli, to train the patient in relaxation techniques, and to present items from the hierarchy to the patient while in a relaxed state. The theory was that the presentation of the fear stimuli together with relaxation will dissipate the fear. Compulsions are not addressed directly because, according to the theory, once the anxiety dissipates, the patient will not need to perform the rituals. Systematic desensitization had only limited success with OCD and its use with this disorder has been extensive.

Aversion therapy, another behavioral therapy that was used in OCD, consists of punishment for an undesirable response. The idea behind this therapy is that an activity that is repeatedly paired with an unpleasant experience will be extinguished. Aversive experiences that have been used to change behaviors include drugs that induce nausea (eg, disulfiram for alcohol dependence, electrical shocks for paraphilias or addictions), or any other stimuli aversive to the patient. The most common application of aversive therapy in OCD has been the “rubber-band snapping technique,” whereby the patient wears a rubber band on the wrist and is instructed to snap it every time he or she has an obsessive thought, resulting in a sharp pain; thus the pain and obsession become connected. 15 This method was not very effective. 16 A variant of aversive therapy is thought-stopping, in which the therapist or patient shout “Stop” immediately after an obsessional thought had been elicited, but this was also not effective in reducing OCD symptoms. 17

The breakthrough: exposure and ritual prevention

As noted above, systematic desensitization, as well as operant-conditioning procedures aimed at blocking or punishing obsessions and compulsions, were used in OCD with limited or no success. The first real breakthrough came in 1966, when Meyer described two patients successfully treated with a behavioral therapy program that included prolonged exposure to distressing objects and situations, combined with strict prevention of rituals - exposure and ritual prevention (EX/RP). 18 Meyer and his colleagues continued to implement EX/RP with additional OCD patients, and found that the treatment program was highly successful in 10 of 15 cases, and partially effective in the remaining patients. Moreover, 5 years later, only two of the patients in the case series had relapsed. 19 All patients were hospitalized during their EX/RP treatment.

Description of EX/RP components

As noted above, treatment programs vary with respect to the components that they include. For example, Meyer and colleagues included exposure in vivo and ritual prevention only. Foa and colleagues include imaginal exposure, in vivo exposure, ritual prevention, and processing. Below are descriptions of each component.

Exposure in vivo (ie, exposure in real life), involves helping the patient confront cues that trigger obsessive thoughts. Cues include objects, words, images, or situations. For example, touching water faucets in a public restroom might trigger germ obsessions. Cues were presented in a hierarchical manner, beginning with the moderately distress-provoking ones and progressing to more distressing cues.

Imaginal exposure involves asking the patient to imagine in detail the distressing thoughts or situations. It is used primarily to help patients confront the disastrous consequences that they fear will happen if they do not perform the rituals. For example, imaginal exposure may involve the patient imagining contracting a sexually transmitted disease because they did not wash their hands sufficiently after using a public bathroom and consequently being shunned by friends and family. Obviously these feared consequences cannot and should not be created in reality.

Ritual prevention involves instructing the patient to abstain from the ritualizing that they believe prevents the feared disaster or reduces the distress produced by the obsession (eg, washing hands after touching the floor and fearing contracting a disease). By practicing ritual prevention the patient learns that the anxiety and distress decrease without ritualizing and that the feared consequences do not happen.

Processing involves discussing the patient's experience during or after exposure and response prevention, and how this experience confirms or disconfirms the patient's expectation (eg, you touched the floor and you did not wash your hands for about 1 hour; is your level of distress as high as in the beginning of the exposure? How strong are your urges to wash? Are they as strong as you expected? If not, what have you learned from this experience?)

The efficacy of EX/RP

The successful outcome described by Meyer and his colleagues, 19 prompted clinical researchers to conduct controlled studies, which indeed lent support to Meyer's case reports.

In 1971, Rachman et al 20 conducted a controlled treatment study of 10 inpatients with chronic OCD. All patients received 15 sessions of relaxation control treatment prior to EX/RP. The patients were then assigned randomly to intensive treatment of 15 daily sessions of either modeling in vivo or flooding in vivo. Results indicated significantly more improvement in OCD symptoms in EX/RP compared with the relaxation treatment, and the patients maintained their gains at 3 months' follow-up. At a 2-year follow-up with the 10 original and 10 additional patients, three quarters of the 20 patients were much improved. 21

Influenced by the research of Rachman, Marks, and Hodgson, Foa and Goldstein 22 studied a series of OCD patients, using a quasi-experimental design. Patients' OCD symptom severity was assessed before and after 2 weeks, in which the therapists collected information about their OCD, history, and type of symptoms, but no treatment was conducted. Patients were then treated with EX/RP and their symptom severity was assessed again. This treatment differed in several ways from previous studies. First, for the majority of patients, treatment was conducted as outpatients rather than as inpatients. Second, exposure and ritual prevention involved 10 rather than 15 daily sessions. Third, influenced by reports about the efficacy of imaginal exposure with phobias (see ref 23). Foa and Goldstein 22 included imaginal exposure in addition to in-vivo exposure in the EX/RP treatment. During imaginal exposure, therapists described the patients' feared “disasters” that might result from not performing the rituals and asked them to immerse themselves in imagining the scenario described. The treatment program proved quite effective. During the information-gathering stage, no improvement was evident. In contrast, during the 2-week EX/RP, a marked and highly significant improvement was found. At follow-up, 66% of patients were very much improved and 20% partially improved. Only three patients did not benefit from the treatment program, which was attributed to overvalued ideation, ie, poor insight. The treatment program in this study, as well as in all the treatment studies by Foa and colleagues to date, comprised the components described below.

The bulk of the treatment program involves the practice of exposure and ritual prevention exercises, both in session and as homework assignments, working through more difficult exposures as treatment progresses. During the last few sessions, emphasis is placed on relapse prevention and future maintenance of gains. These sessions can be conducted either once a week, twice a week, or daily in an intensive treatment program, depending on symptom severity and logistical considerations.

The relative efficacy of EX/RP treatment components

After the efficacy of EX/RP and its durability in reducing OCD symptom severity had been established, Foa and colleagues embarked on investigating the relative contribution of the different components of the treatment program. To this end, they conducted a series of dismantling studies to ascertain the separate effects of: in-vivo exposure, imaginal exposure, and ritual prevention.

Imaginal exposure compared with in-vivo exposure and their combination

In order to examine the effect of adding imaginal exposure to EX/RP, Foa et al 24 conducted a study that included OCD outpatients with checking rituals who were randomized to two treatments. The first consisted of 10 sessions of a 90-minute uninterrupted imaginal exposure, which focused on the patients' feared consequences if they did not perform their checking rituals; this was followed by a 30-minute in-vivo exposure to situations which give rise to an urge to perform checking rituals. The second treatment consisted of 120-minute invivo exposure; no imaginal exposure was conducted. Both groups were asked to refrain from performing checking rituals. At the end of treatment both groups showed equal improvement, but at follow-up those who received only the in-vivo exposure showed some relapse, whereas those receiving both imaginal and in-vivo exposure maintained their gains. Thus, imaginal exposure seemed to contribute to the maintenance of treatment gains.

In a second study, Foa et al 25 compared the efficacy of imaginal exposure with that of in-vivo exposure. OCD outpatients with checking rituals were randomly assigned to one of two treatment conditions: imaginal or in-vivo exposure. Ritual prevention was not included in the treatments. Both treatments involved 15 120-minute sessions over 3 weeks, and two home visits in the fourth week. Patients improved significantly in their OCD symptoms and continued to improve at follow-up (an average of 10 months post-treatment). No significant differences between treatments emerged at post-test or follow-up. The authors concluded that both imaginal and in-vivo exposure offered clinically significant and lasting benefits to patients with OCD.

In sum, although imaginal exposure does not appear essential for immediate outcome, it may enhance longterm maintenance and can be used as an adjunct to invivo exposure for patients who manifest fear of “disastrous consequences” such as burglary in the absence of checking door locks and windows.

The relative effects of exposure and ritual prevention

To examine the relative effects of exposure and ritual prevention, Foa et al 26 randomly assigned patients with contamination obsessions and washing rituals to treatment by exposure only (EX), ritual prevention only (RP), or their combination (EX/RP). Each treatment was conducted intensively (15 daily, 120-minute sessions conducted over 3 weeks) followed by a home visit. Patients in all conditions improved at both post-treatment and follow-up. However, patients in the EX/RP treatment (combining EX and RP) showed superior outcome on almost every symptom measure compared with EX-only or RP-only treatments. This superior outcome of the combined treatment was found at both post-treatment and follow-up. When comparing the outcome of EX only with that of RP only, patients who received EX reported lower anxiety when confronting feared contaminants than patients who had received RP, whereas the RP group reported greater decreases in urges to ritualize than did the EX patients. Thus, it appeared that EX and RP differentially affected OCD symptoms. The findings from this study clearly suggest that exposure and ritual prevention should be implemented concurrently; treatments that do not include both components yield inferior outcome.

The relative efficacy of medication, EX/RP, and their combination

Parallel to the development of effective cognitive behavioral therapy for OCD, there was a development of medication treatment for the disorder. Clomipramine was the first medication that showed efficacy in reducing OCD symptoms. 27 While it is outside of this article's scope to discuss the literature on the efficacy of pharmacotherapy on OCD symptoms, the relative effects of medication, EX/RP, and their combination will be described, as well as the effect of augmenting the benefit from medication by adding EX/RP.

Several studies examined the effects of medication, EX/RP, and their combination. The first study that used a straightforward design to compare the relative and combined efficacy of clomipramine, intensive EX/RP, their combination, and placebo (PBO) was a two-site study conducted by Foa et al and Leibowitz et al. The EX/RP program included an intensive phase (15 2-hour sessions conducted over 4 weeks) and a followup phase (6 brief sessions delivered over 8 weeks). EX/RP alone was compared with 12 weeks of CMI alone, combination of EX/RP+CMI, and PBO. At posttreatment all three active treatments were superior to placebo, and EX/RP was found to be superior to CMI. EX/RP+CMI was superior to CMI alone, but the combined therapy did not enhance outcome achieved by EX/RP alone. 28 Moreover, rate of relapse was higher following the discontinuation of CMI treatment compared with that of EX/RP alone or the combined treatment. 29

Augmenting medication treatment with EX/RP

Most OCD patients who seek EX/RP treatment are already taking medication, primarily a serotonin uptake inhibitor (SRI). However, as noted earlier, most patients suffer from residual OCD symptoms even when treated with an adequate dose of medication; they seek psychological intervention to further reduce their symptoms. To examine the augmenting effects of EX/RP, Foa et al and Simpson et al conducted a two-site randomized control trial (RCT). Patients on a stable and therapeutic dose of SRI medication, but who experienced only partial response, were randomized to either EX/RP or stress management training (SMT) while continuing with their medication. At of the 8-week acute treatment phase, EX/RP was significantly superior to SMT in further reducing symptoms in OCD patients who are on medication. 30

Results from numerous studies demonstrate the efficacy of EX/RP in reducing OCD symptoms; moreover, most patients maintain their gains following treatment. A number of RCTs have found that EX/RP is superior to a variety of control treatments, including placebo medication, relaxation, and anxiety management training. Furthermore, recent studies have indicated that these successful outcomes for EX/RP are not limited to highly selected samples of OCD patients. 31 , 32

Abramowitz 33 conducted a meta-analysis to determine the degree of symptom improvement associated with four different variations of EX/RP. The meta-analysis revealed that therapist-supervised exposure was more effective than self-exposure. Complete response prevention during exposure therapy yielded superior outcome to that of partial or no response prevention. The combination of in-vivo and imaginal exposure was superior to in-vivo exposure alone in reducing anxiety. There was no significant difference between treatments that included gradual exposure and those that included flooding.

With regard to the effects of combining medication to EX/RP treatment, two studies failed to detect an enhanced reduction in OCD symptoms by adding medication to EX/RP, two studies found a small but temporary effect, and one study found an advantage for combined treatment over EX/RP alone on obsessions but not on compulsions. On the other hand, the addition of EX/RP to medication enhances the efficacy of the medication and OCD symptoms can be reduced further by adding EX/RP to medication treatment.

Cognitive therapy

OCD patients are distressed about their thoughts, or obsessions, because they interpret them as warnings of events that are dangerous and likely to occur. Cognitive therapy (CT) is designed to help patients identify these automatic unrealistic thoughts and change their interpretations of the meaning of the thoughts, resulting in decreased anxiety and decreased compulsions.

In the first stage of CT, patients are taught to develop an awareness of their worries as obsessions and their rituals as compulsions. The patient keeps a daily diary of obsessions, called a thought record. In the thought record, patients write down their obsessions and the interpretations associated with the obsessions. Important details to record may include what the patient was doing when the obsession begin, the content of the obsession, the meaning attributed to the obsession, and what the patient did in response to the obsession (usually a compulsion).

The therapist will review the thought record with the patient and how the obsession was interpreted. Using gentle reasoning and Socratic questioning, the therapist will verbally challenge an unrealistic belief. This helps the patient to identify the cognitive distortion, typically a faulty assessment of danger, an exaggerated sense of responsibility, or fears that thinking something negative will make it come true (thought-action fusion).

Once patients are able to quickly identify their obsessions and compulsions as symptoms of OCD, the therapist will initiate a few behavioral experiments to disprove errors in thinking about cause and effect. For example, if a patient believes that smoking four cigarettes will prevent her family from being harmed in an auto accident, the therapist may instruct the patient to smoke only three cigarettes and then wait to see if family members are actually harmed that day in an auto accident. The therapist may then use the results of this experiment as material for discussion about other types of magical thinking. Over time, patients learn to identify and re-evaluate beliefs about the potential consequences of engaging in or refraining from compulsive behaviors and subsequently begin to eliminate compulsions (see ref 34).

Cognitive therapy compared to in-vivo exposure with ritual prevention

Van Oppen et al 35 conducted a treatment study comparing CT with EX/RP. Seventy-one Dutch OCD patients were randomly assigned to either CT or in-vivo exposure. Sixteen 45-minute sessions were administered. In the CT condition, treatment focused on “overestimation of danger and inflated personal responsibility,” and after session 6, behavioral experiments were included to test the basis of unrealistic beliefs. The exposure condition consisted of EX/RP working up a hierarchy of feared and avoided situations, with no discussion of feared consequences until after session 6. Patients in both groups improved significantly. No differences between the two treatments emerged. It should be noted that the behavioral experiments in the CT condition introduced in-vivo exposure and ritual prevention. On the other hand, the processing component of EX/RP was omitted. Thus, it is difficult to interpret the results of the study.

Cottraux et al 36 conducted a study involving 62 French patients who received 20 sessions of CT or EX/RP for OCD. Treatment included 4 weeks of intensive treatment (16 hours) and 12 weeks of maintenance (4 hours). EX/RP and CT produced equal improvements in OCD symptoms after 4 weeks, although EX/RP patients showed greater improvement on a measure of intrusive thoughts and CT patients were more improved in anxiety and depression. By week 52, most of the differences had disappeared, but the EX/RP group had lower OCD symptoms and the CT group had lower depression. Notably, here too CT included some in vivo exposure in the form of behavioral experiments to test unrealistic fears and cognitive schemas; no processing of cognitive techniques were included in EX/RP.

In another dismantling study of CT and exposure for OCD, 37 patients with OCD were randomly assigned to receive exposure plus relaxation, exposure plus cognitive therapy, or waitlist. The CBT portion of the treatment consisted of 2-hour sessions held twice a week for 6 weeks using EX/RP along with either CT or relaxation; this was followed by 10 more sessions of in-vivo and/or imaginal exposure. The two CBT treatments were equally effective, and patients showed significant improvement post-treatment and through 12-month follow-up.

A meta-analysis by Eddy et al 38 examined data from 15 clinical trials. Treatments included EX/RP, CT, and active and passive control conditions. Overall, approximately two thirds of the patients who completed treatment improved, but only a third met recovery criteria. Among the intent-to-treat sample, which included dropouts, about one-half of patients improved and only a quarter recovered. Findings were stronger for EX/RP than CT, and individual therapy was more effective than group therapy.

Rosa-Alcazar et al 39 conducted a meta-analysis examining data from 19 controlled psychotherapy studies for OCD. EX/RP and CT as well as their combination were found to be highly effective, with no significant differences between treatments. The authors noted that the similarity of the findings for EX/RP and CT may have been due to the fact that both treatments included the same techniques. For example, CT most often included behavioral experiments that involved in vivo exposure to obsession-evoking situations to challenge irrational thoughts, thereby incorporating in-vivo exposure and ritual prevention. On the other hand, the application of EX/RP involves processing that help patients question their unrealistic beliefs and irrational thoughts. It is possible that EX/RP is more effective than CT, but the studies that compare EX/RP with CT have taken special care to avoid the use of cognitive elements in EX/RP, resulting in an incomplete application of EX/RP, whereas CT in research studies usually includes elements of exposure. 39

Over 40 years of published research has led to the wide consensus among researchers and clinicians that CBT is an effective treatment for OCD. 13 , 40 , 41 Exposure-based treatments have the largest evidence base to support their use for OCD. EX/RP which includes processing appears to be most effective, whereas exposure without processing and CT produced equivalent improvement. Based on the large empirical evidence for EX/RP it is recommended as the first-line treatment for OCD, with CBT as an alternative.

While EX/RP has strong support for its efficacy in reducing OCD symptom severity, 20% of patients drop out prematurely. Although about 80% of patients respond well to EX/RP, 20% do not; therefore about 40% of patients with OCD are not helped by existing treatments. 42 Clinical researchers should continue to refine CBT programs to maximize improvement and make treatment more palatable to those in need of help. It is difficult to determine the usefulness of psychological interventions other than EX/RP and CBT because of lack of control studies. There has been one published RCT on an alternative therapy, yogic meditation, in the treatment of OCD, 43 but no RCTs have been published on any other psychological interventions, such as hypnosis, virtual reality therapy, homeopathy, or an integrated psychological approach. Furthermore, no welldesigned single case studies have been published on interventions other than CBT 13 Further work is needed to validate alternative treatments for OCD.

More work also needs to be done to determine how to best tailor treatment to individual needs. Most studies do not have sufficient power to break down treatment response by OCD subtype such as “washers,” “checkers,” “orderers,” and “hoarders.” Some subtypes have been studied more than others, and some subtypes are typically excluded from RCTs. Most OCD sufferers have comorbid disorders, but studies typically exclude participants with substance abuse, psychosis, or bipolar disorder; thus we do not know how effective treatments are for comorbid populations.

Acknowledgments

The author wishes to acknowledge the excellent contribution of Samantha G. Farris to this paper by careful reading of the manuscript and putting together the references. Many thanks also to numerous colleagues with whom I coauthored many papers and chapters over the years; their work is summarized in this paper.

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Discover Relief: How DBT for OCD Transforms Lives

Published By: Counseling Center Group
Post Modified: February 25, 2024 | Originally Posted: February 15, 2024

Peeling back the layers of DBT for OCD reveals a promising approach to managing this complex condition. Dialectical Behavior Therapy (DBT), originally designed for borderline personality disorder, has found its way into the toolbox for treating Obsessive-Compulsive Disorder (OCD). Embarking on this exploration, you’ll find out that the essence of DBT—mastering distress tolerance, regulating emotions, practicing mindfulness, and enhancing social skills—presents innovative methods for managing OCD’s challenging symptoms. Explore the effectiveness of mindfulness for remaining grounded in the now, even amidst unwelcome thoughts, and delve into why individuals may prefer DBT over conventional CBT on their path to managing OCD.

Understanding DBT for OCD

Merging cognitive-behavioral strategies with mindfulness exercises, Dialectical Behavior Therapy has become a hopeful method for addressing the complexities of Obsessive-Compulsive Disorder. Developed in the 1970s by Marsha Linehan, DBT was initially aimed at managing borderline personality disorder but has since shown its effectiveness across a range of mental health conditions, including OCD.

Navigating the complexities of Obsessive-Compulsive Disorder, which touches approximately 2.5% of individuals over their lifespan, unveils challenges that stretch considerably deeper than the common perception of an obsession with tidiness or precision might suggest. It’s not just about cleanliness or orderliness—OCD encompasses a wide array of obsessions and compulsions that can significantly impact daily functioning and quality of life.

What is DBT?

An integral part of understanding how DBT helps those with OCD involves delving into its core components: distress tolerance, emotional regulation, interpersonal effectiveness skills, and mindfulness. By mastering these abilities, people can more effectively control their worry, curtail their compulsive actions, and enhance their mental health equilibrium.

The unique aspect here lies within DBT’s emphasis on both acceptance and change—a dynamic duality encapsulated in the term “dialectical.” This approach encourages patients to accept themselves fully while working diligently towards changing unhealthy behaviors related to their OCD symptoms.

The Prevalence of OCD

Facing facts head-on reveals that millions worldwide are grappling with this often misunderstood condition. Recognizing the prevalence of OCD underscores the critical need for effective treatments like DBT which offer hope through scientifically-backed methodologies tailored specifically towards addressing both obsessive thoughts and compulsive actions characterizing this complex disorder.

Core Components of DBT for OCD

Through Dialectical Behavior Therapy, individuals battling Obsessive-Compulsive Disorder gain access to crucial skills such as enduring psychological discomfort, managing their emotions, enhancing their social interactions, and practicing present-moment awareness. Diving into the intricacies, we explore how these elements function in concert to aid those battling Obsessive-Compulsive Disorder.

Distress Tolerance Techniques

OCD can thrust individuals into a whirlpool of intense discomfort. Distress tolerance techniques provide the tools needed not just to survive this storm but navigate through it without resorting to compulsions. Incorporating methods such as calming oneself and embracing the truth of one’s circumstances fortifies individuals against the escalating tempests of OCD symptoms.

Mastering the art of enduring discomfort in challenging times, without hastily seeking alterations, is pivotal for those aiming to escape the relentless whirlwind of obsessive contemplations and compulsory actions.

Emotional Regulation Skills

If emotions were weather patterns, for someone with OCD, it might feel like living in a perpetual hurricane season. Emotional regulation skills taught in DBT act as advanced forecasting systems that let individuals identify emotional storms early on and employ strategies that prevent them from spiraling out of control.

This component involves understanding what triggers one’s emotions and applying techniques such as opposite action or problem-solving to reduce vulnerability to emotion mind—essential for diffusing the intensity often found at the core of obsessions.

Mindfulness Skills

Mindfulness teaches staying present amidst chaos—an invaluable tool for someone whose mind is constantly bombarded by intrusive thoughts. By practicing mindfulness, a person learns not only how to observe their thoughts without judgment but also how to stay grounded in the present moment. By dialing down the noise of intrusive thoughts, we carve out room for tranquility within ourselves. Mindfulness is more than just being present; it’s about being aware without getting caught up in the story of our mind. Experts from Marsha Linehan, founder of DBT, explain it as a way to be more than just present, but to be aware without getting caught up in the story of our mind.

Key Takeaway:

DBT gives those battling OCD a set of skills to manage distress, regulate emotions, improve relationships, and stay present. These tools help navigate the challenges of OCD by teaching how to handle intense discomfort without compulsions, understand and control emotional turmoil, and remain grounded amidst intrusive thoughts.

The Role of Mindfulness in Managing OCD

Explore how mindfulness practices within DBT can help individuals with OCD stay present and reduce the intensity of obsessive thoughts.

Mindfulness Skills for OCD

Mindfulness , a cornerstone skill within Dialectical Behavior Therapy (DBT), offers a powerful approach for individuals grappling with Obsessive-Compulsive Disorder (OCD). Cultivating present-moment awareness through mindfulness techniques can significantly lessen the severity and occurrence of persistent, unwelcome thoughts often associated with OCD.

The Practice of Non-Judgment

At its core, mindfulness in DBT emphasizes observing one’s thoughts and feelings without judgment. This practice is crucial for those with OCD who often battle overwhelming obsessive thoughts. Instead of engaging or fighting these intrusions, mindfulness teaches acceptance and observation, creating space between the individual and their reactions to these obsessions.

Transforming the Relationship with Obsessions

Integrating mindfulness into everyday habits can lead to profound changes. Simple practices like focused breathing or mindful walking enable individuals to anchor themselves in the now—a state where compulsions hold less power. The goal isn’t to eliminate obsessive thoughts but to change one’s relationship with them. Through consistent practice, people find they can reduce emotional reactivity towards their triggers.

Enhancing Overall Well-being

Fundamentally, mastering mindfulness skills from DBT does more than just manage OCD symptoms; it enhances overall well-being by improving one’s ability to stay present amidst life’s challenges. As part of a comprehensive treatment plan including behavior therapy techniques such as exposure-response prevention (ERP), dialectical behavioral therapy stands out not only for its effectiveness but also for its holistic approach towards mental health conditions like obsessive-compulsive disorder.

Comparing CBT with DBT for OCD Treatment

Dialectical Behavior Therapy (DBT) and Cognitive Behavioral Therapy (CBT) are both celebrated champions in the mental health arena, especially when it comes to tackling the persistent and often debilitating symptoms of Obsessive-Compulsive Disorder (OCD). While CBT is considered the gold standard for OCD treatment , some individuals find DBT’s unique approach more suited to their needs.

Understanding the Core Differences

The main fork in the road between DBT and CBT lies in their methodologies. CBT zeroes in on recognizing and altering detrimental thought cycles that culminate in unhelpful actions, striving to substitute these with more beneficial alternatives. It employs techniques like cognitive restructuring and exposure-response prevention, directly confronting obsessive thoughts and compulsions head-on.

Whereas CBT tackles the challenge by altering negative thought circuits and maladaptive actions, DBT shifts the focus towards mastering emotional equilibrium and enhancing one’s ability to endure distress as a strategy for navigating OCD symptoms. Originally developed by Marsha Linehan for treating Borderline Personality Disorder, its principles have proven effective for a wider range of conditions including anxiety disorders like OCD. Mastering the art of enduring stress without succumbing to repetitive actions empowers people to manage their responses more effectively.

Why Some Prefer DBT for OCD Over CBT

A critical advantage that makes some lean towards DBT over CBT is its holistic focus on improving an individual’s quality of life beyond just symptom management—integrating mindfulness practices into daily routines helps stay present and reduce intrusive thoughts’ intensity.

Moreover, the application of mindfulness within DBT therapy sessions fosters a non-judgmental awareness, enabling patients not only to combat but also to understand deeply rooted emotions driving obsessive-compulsive tendencies.

While both therapies offer robust frameworks for dealing with OCD’s challenges effectively, your personal preference should ultimately guide which path you embark upon towards recovery.

Emotion Regulation vs Compulsion

Understanding emotional dysregulation.

Grasping the essence of emotional dysregulation is key in navigating the intricate ballet between mastering one’s feelings and succumbing to compulsions. It’s like having a car with an unreliable gas pedal; you either floor it or come to a halt without much in-between. For those grappling with OCD, this lack of control over emotional responses can drive compulsive behaviors as attempts at self-soothing.

Living with OCD is akin to being ensnared by one’s own thoughts, as the disorder flourishes amidst ambiguity and unease. The need to reduce distress through repetitive actions is often a direct result of failing to regulate emotions effectively. Acknowledging these cycles allows us to establish a foundation for innovative approaches aimed at addressing the twin challenges of obsessive ideations and compulsive actions.

Strategies for Emotion Regulation

Dialectical Behavior Therapy (DBT) shines brightly here by offering tools designed not just to cope but to thrive amid emotional turmoil. At its core, DBT emphasizes learning DBT skills such as mindfulness which aids individuals in staying present rather than being hijacked by intrusive thoughts or overwhelming feelings.

Apart from mindfulness, DBT introduces other skill sets crucial for managing OCD: distress tolerance techniques help endure painful emotions without resorting back to compulsions; while effective emotion regulation skills enable one to manage intense feelings more constructively—ultimately reducing the impulse towards obsessive-compulsive behavior.

The journey towards mastering these skills isn’t solitary—it unfolds within therapeutic relationships grounded in trust and mutual respect. Read more about how DBT enhances treatment outcomes for OCD. Through individual therapy sessions focused on dialectical behavioral strategies alongside group therapy environments fostering support and shared experiences, people learn healthy ways of tolerating distress—making significant strides toward reclaiming their lives from OCD’s grasp.

The Significance of the Therapist-Client Relationship in DBT for OCD

When it comes to tackling the complex world of Obsessive-Compulsive Disorder (OCD) with Dialectical Behavior Therapy (DBT), few things are as critical as the bond between you and your therapist. This isn’t just about having someone to chat with about your day. It’s about building a trust that can quite literally change your brain.

In DBT, forging this connection isn’t merely crucial; it serves as the bedrock of the entire approach. Why? Because managing OCD symptoms—those persistent obsessive thoughts and compulsive behaviors—is no small feat. At this juncture, the transformative process unfolds. when clients feel understood and supported by their OCD therapists , they’re not only more likely to stick with therapy but also to dive deep into those challenging dbt skills like distress tolerance and emotion regulation.

This therapeutic alliance allows for real talk on tough topics like intrusive thoughts or unwelcome rituals without judgment, creating a safe space where healing begins. Remember, we’re talking about techniques that help you stay present (hello mindfulness.) amidst anxiety whirlwinds, tolerate discomfort without resorting back to compulsions, regulate overwhelming emotions effectively, and improve relationships both with yourself and others—all cornerstone elements of DBT aimed at helping individuals manage their mental health condition in healthier ways.

Integrating Distraction Techniques with ERP Work

Dialectical Behavior Therapy (DBT) offers a suite of tools that can make tackling Obsessive-Compulsive Disorder (OCD) more manageable. Among these, healthy distraction techniques stand out for their ability to temporarily divert attention from distressing thoughts or urges. However, melding these with Exposure Response Prevention (ERP), a robust approach for tackling OCD on its own, elevates the efficacy of treatment considerably.

ERP work involves gradually exposing individuals to triggers that cause anxiety or compulsive behaviors while teaching them not to engage in their usual responses. Facing fears directly, rather than dodging them, gradually diminishes their influence over our lives. Yet, diving into such exposure exercises without any cushioning could be overwhelming for some; this is where DBT’s distraction strategies come into play.

Avoidance isn’t the goal here—rather it’s about finding a balance between facing one’s fears and having the means to cope with heightened anxiety during ERP sessions. Healthy distractions are employed as temporary measures: they’re there when you need a breather but aren’t meant as permanent escapes from reality. Learning how mindfulness practices within DBT help focus on the present moment can also reinforce efforts in ERP by anchoring individuals amidst potential turmoil triggered by exposures.

The key lies in knowing when and how to use these distractions effectively so they complement rather than detract from the primary goals of ERP therapy—a skillful blend requiring guidance under experienced therapists who understand both modalities well. This approach weaves together a comprehensive journey for individuals battling OCD, paving the path toward diminished anguish and enhanced mastery over pervasive thoughts and compulsive behaviors.

Self-validation Techniques in Managing Intense Emotions Related to OCD

For those wrestling with the grip of obsessive-compulsive disorder (OCD), intense emotions like anxiety or guilt often accompany their daily experiences. Self-validation is a cornerstone skill within Dialectical Behavior Therapy (DBT) that can shine a light on managing these overwhelming feelings.

Understanding Self-Validation vs. Self-Reassurance

Fundamentally, self-validation is about embracing your inner journey without casting any shadows of judgment upon it. This means recognizing your thoughts and feelings as valid, regardless of whether they are pleasant or not. It’s different from self-reassurance, which might involve telling yourself everything will be okay to mitigate discomfort temporarily.

Understanding this difference is crucial, as it sheds light on the reality that compulsive actions are often undertaken in a bid to govern or dodge unsettling thoughts and feelings. Self-validation teaches folks to be present with their feelings instead of impulsively reacting, paving the way to interrupt OCD’s repetitive patterns.

Navigating Intense Emotions Through DBT Skills

Mindfulness practices within DBT, for instance, help bring attention back to the present moment, reducing the intensity of obsessive thoughts that fuel emotional turmoil. On the flip side, mastering how to adjust one’s connection with challenging feelings through emotional regulation can prevent these emotions from steering behavior.

In essence, integrating techniques such as mindful awareness and emotion regulation, alongside other components like interpersonal effectiveness and distress tolerance skills taught in DBT sessions could significantly improve how individuals manage OCD-related anxieties without resorting to compulsions.

Considering DBT for OCD? Contact the Counseling Center Group today to learn more!

DBT for OCD isn’t just another acronym. It’s a lifeline to managing the whirlwind of obsessions and compulsions.

Distress tolerance equips you with the strength to confront your fears head-on, resisting the urge to surrender. Emotional regulation keeps your reactions in check, while mindfulness roots you firmly in the now. Interpersonal effectiveness? That’s all about navigating relationships with grace, even amidst chaos.

If there’s one thing to take away, let it be this: DBT arms you with tools not just to cope but to thrive despite OCD’s challenges.

In essence, mastering DBT techniques through daily application can revolutionize how you navigate life’s unpredictable challenges. The journey might be long but mastering these techniques is a game-changer.

FAQs - Dialectical Behavior Therapy for OCD

Obsessive Compulsive Disorder, OCD, is a mental health condition characterized by recurring and unwanted thoughts (obsessions) that lead to repetitive behaviors (compulsions). These compulsions are performed in an attempt to alleviate the anxiety caused by the obsessions.

Dialectical Behavior Therapy, DBT, for OCD, is an effective treatment approach that blends cognitive-behavioral techniques with mindfulness practices.

DBT aims to provide individuals with skills in:

Mindfulness
Distress tolerance
Emotion regulation
Interpersonal effectiveness

This therapeutic method helps those with OCD manage their intrusive thoughts and compulsive actions more effectively, by teaching them to tolerate distress, regulate their emotions, and maintain awareness of the present moment in a non-judgmental way.

Dialectical Behavior Therapy for OCD not only targets the symptoms directly associated with the disorder but also enhances overall emotional well-being and improves relationships by providing a holistic approach to managing OCD.

Dialectical Behavior Therapy for OCD addresses the prevalent symptoms of Obsessive-Compulsive Disorder (OCD), which are:

Obsessions : These are intrusive, distressing thoughts or impulses focusing on themes like contamination, harm, or the need for perfection, leading to considerable anxiety.

Compulsions: Defined as repetitive behaviors or mental acts undertaken to alleviate the distress caused by obsessions, these actions, such as excessive cleaning, checking, or following rigid rituals, often lack a realistic connection to the outcomes they aim to prevent.

Avoidance: The deliberate avoidance of situations, locations, or items that may trigger obsessive thoughts or compulsive behaviors.

Distress: Significant emotional distress or disruption in social, work, or other vital areas of life, stemming from the obsessive-compulsive patterns or the anxiety they generate.

Insight Variation: The degree of awareness individuals with OCD have about the irrational nature of their obsessions and compulsions can vary, with some fully recognizing their unreasonableness and others being deeply convinced of their fears’ legitimacy.

These symptoms, often troublesome and disruptive, can severely impact daily functioning and overall well-being, highlighting the need for effective interventions like Dialectical Behavior Therapy for OCD.

Dialectical Behavior Therapy for OCD incorporates an all-inclusive approach designed to address the complex nature of OCD through its core components. These components are tailored to provide individuals with the necessary skills to manage their symptoms effectively and improve their quality of life:

Mindfulness: Central to Dialectical Behavior Therapy for OCD, mindfulness encourages individuals to live in the present moment and observe their thoughts and feelings without judgment. This practice helps reduce the power of obsessive thoughts and the urge to engage in compulsive behaviors.
Distress Tolerance: This component focuses on enhancing an individual’s ability to tolerate uncomfortable emotions without resorting to OCD behaviors. Techniques like distraction, self-soothing, and improving the moment are taught to help manage acute distress.
Emotion Regulation: Emotion regulation skills help individuals understand, accept, and better manage their emotions. For those with OCD, this means learning strategies to reduce vulnerability to emotion mind and increasing positive emotional experiences.
Interpersonal Effectiveness: This aspect of DBT for OCD aims to improve relationships and interpersonal skills, which can often be strained by the symptoms of OCD. It teaches how to assert needs, set boundaries, and handle conflict in a way that is effective and maintains self-respect.

By integrating these core components, Dialectical Behavior Therapy for OCD provides a comprehensive toolkit for individuals to combat the intrusive thoughts and compulsive actions characteristic of OCD.

This approach not only addresses the symptoms directly but also works to enhance overall emotional resilience and interpersonal relationships, offering a path toward a more balanced and fulfilling life.

Dialectical Behavior Therapy (DBT) offers many benefits for treating OCD, making it an effective therapeutic approach for managing the condition’s complex symptoms. Here are the key advantages of Dialectical Behavior Therapy for OCD:

Enhanced Emotional Regulation
Improved Distress Tolerance
Increased Mindfulness
Strengthened Interpersonal Relationships
Reduction in Compulsive Behaviors
Greater Life Satisfaction
Skills for Long-Term Management

DBT’s comprehensive approach, focusing on the psychological, emotional, and practical aspects of OCD, provides a robust framework for individuals seeking to overcome the challenges of Obsessive-Compulsive Disorder.

Choosing between Dialectical Behavior Therapy (DBT) and other therapy methods for treating OCD involves considering the unique features, benefits, and focus areas of each approach. Here’s a comparison to help guide the decision:

DBT for OCD:

Emotional Regulation: DBT places a strong emphasis on teaching individuals how to regulate their emotions, which is beneficial for those whose OCD is closely linked to emotional dysregulation.
Distress Tolerance: It offers specific strategies for tolerating the anxiety and distress that trigger OCD symptoms, without resorting to compulsions.
Mindfulness: The mindfulness component of DBT helps individuals with OCD stay present and reduce the impact of intrusive thoughts.
Interpersonal Effectiveness: DBT can be particularly helpful for individuals whose OCD symptoms affect their relationships, as it provides tools to improve communication and assertiveness.

Other Therapy Methods for OCD:

Cognitive Behavioral Therapy (CBT)
Psychodynamic Therapy
Acceptance and Commitment Therapy (ACT)

Choosing Dialectical Behavior Therapy for OCD might be particularly effective for individuals who struggle with emotional regulation, those who experience significant distress related to their OCD symptoms, or when OCD symptoms are intertwined with interpersonal issues. DBT offers a comprehensive approach that addresses not just the symptoms of OCD but also the emotional and interpersonal aspects that accompany the disorder.

Ultimately, the choice between DBT and other therapy methods for OCD should be based on individual symptoms, treatment goals, and personal preferences, and also guided by a mental health professional’s assessment and recommendations.

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CBT for OCD: How It Works, Examples & Effectiveness
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CBT for OCD, Obsessive Compulsive Disorder
Cognitive Behavioral Therapy Worksheet Template & Example
Question Your OCD Worksheet ERP Worksheet CBT Exercise

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The Homework of CBT Cognitive Behavioral Therapy
Myths about OCD
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Module 1 of I-CBT: When OCD begins

COMMENTS

CBT Techniques: 25 Cognitive Behavioral Therapy Worksheets
Cognitive-Behavioral Therapy Worksheets (PDFs) To Print and Use. If you're a therapist looking for ways to guide your client through treatment or a hands-on person who loves to learn by doing, there are many cognitive-behavioral therapy worksheets that can help. 1. Coping styles worksheet.
OCD
Psychological Models and Theory of OCD. The cognitive behavioral theory of OCD proposes that when someone experiences an intrusive thought it is the appraisal—what they make of having the thought—that is most important (Salkovskis, Forrester, & Richards, 1998). Intrusive thoughts, even very unpleasant ones, are common and entirely normal.
PDF Overcoming Your OCD
OCD-driven thoughts trick them into believing will alleviate their anxiety—behavior that, paradoxically, only serves to strengthen it. This workbook will help you explore and assess the role OCD plays in your world so that you can take back your thoughts and live the life you desire. You will gather your personal strengths,
How to Design Homework in CBT That Will Engage Your Clients
Practitioners looking to support these clients using homework might start by sending their clients one or two audio meditations via Quenza, such as the Body Scan Meditation or S.O.B.E.R. Stress Interruption Mediation. That way, the client will have tools on hand to help manage their anxiety in stressful situations.
CBT for OCD: How It Works, Examples & Effectiveness
Cognitive behavioral therapy (CBT) encompasses a range of therapy techniques that are highly beneficial in treating obsessive compulsive disorder (OCD), including exposure and response prevention and cognitive restructuring. Most people who receive CBT treatment for OCD start noticing improvements within weeks. CBT generally consists of weekly, one-hour therapy sessions lasting approximately ...
OCD Exposure Hierarchy Packet
This OCD worksheet packet includes a blank exposure hierarchy template, and an exposure therapy homework form. The homework form provides a professional way for you to record your client's weekly exposure homework, and it gives your clients a nice place to keep track of their progress. To learn more about implementing these tools, check out our ...
Assigning Homework in Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) is known to be a highly effective approach to mental health treatment. One factor underlying its success is the homework component of treatment. It's certainly ...
Sending Homework to Clients in Therapy: The Easy Way
Homework is an essential part of Cognitive-Behavioral Therapy (CBT; Beck, 2011; Mausbach, Moore, Roesch, Cardenas, & Patterson, 2010). ... Homework ideas for depression and anxiety: 3 Exercises. The following exercises are all valuable for helping clients with the effects of anxiety and depression.
Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder: 2021
Cognitive-behavioral therapy (CBT) remains one of the most effective treatments for obsessive-compulsive disorder (OCD). In this update of a previous article (), we define CBT, review the evidence for the efficacy of CBT for OCD, provide a case example and sample treatment plans, and discuss family factors that affect treatment outcome.In addition, we discuss group and family-based modalities ...
Cognitive-Behavioral Therapy for Obsessive- Compulsive Disorder ...
Focus 2021; 19:430-443; doi: 10.1176/appi.focus.20210015. Cognitive-behavioral therapy (CBT) remains one of the most effective treatments for obsessive-compulsive disorder (OCD). In this update of a previous article (1), we define CBT, review the evidence for the ef cacy of CBT for OCD, fi. provide a case example and sample treatment plans ...
Psychological Therapy for OCD
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.
OCD Treatment Overview
1. Recurrent and persistent thoughts, urges, or impulses, that are experienced at some time during the disturbance as intrusive and unwanted, and often cause anxiety. 2. The individual attempts to ignore or suppress these thoughts, urges, or images, or to neutralize them with another thought or action. Compulsions.
The New "Homework" in Cognitive Behavior Therapy
By Judith S. Beck, Ph.D., and Francine R. Broder, Psy.D. Judith S. Beck, Ph.D. We've stopped using the word "homework" in CBT. Too many clients take exception to that term. It reminds them of the drudgery of assignments they had to do at home when they were at school. So in recent times, we've switched. "Homework" is now called the ...
CBT for OCD and Anxiety
Regular "homework" assignments are given so that the client can continue to challenge symptoms between therapy sessions. These homework assignments are specifically designed for each individual client, and are an essential part of treatment for OCD and related anxiety conditions, including Body Dysmorphic Disorder (BDD), Hypochondria ...
Cognitive Behavioral Therapy for OCD: Effective Techniques
Cognitive Behavioral Therapy (CBT) has emerged as a prominent and effective treatment for individuals suffering from Obsessive-Compulsive Disorder (OCD). This form of therapy aims to address the dysfunctional thought patterns and behaviors that characterize OCD by using a combination of cognitive and behavioral strategies .
Supporting Homework Compliance in Cognitive Behavioural Therapy
Homework Non-Compliance in CBT. Cognitive behavioral therapy (CBT) is an evidence-based psychotherapy that has gained significant acceptance and influence in the treatment of depressive and anxiety disorders and is recommended as a first-line treatment for both of these [1,2].It has also been shown to be as effective as medications in the treatment of a number of psychiatric illnesses [3-6].
Clinical Practice Guidelines for Cognitive-Behavioral Therapies in
Efficacy of cognitive behavioral therapy in obsessive-compulsive disorder. CBT involving ERP has been consistently shown to be efficacious in the treatment of OCD. All treatment ... absence of comorbidities, more intensive CBT, and better homework compliance predict long-term success. A plan for relapse prevention plan is imperative before ...
CBT Worksheets
The Cognitive Triangle. worksheet. The cognitive triangle illustrates how thoughts, emotions, and behaviors affect one another. This idea forms the basis of cognitive behavior therapy (CBT). Perhaps most important to CBT, when a person changes their thoughts, they will also change their emotions and behaviors.
CBT for OCD: What is it & How Does it Work?
Understanding how your OCD works: CBT helps you to understand what is going on in your mind, giving you a clearer perspective of how your OCD works. Relief from symptoms: CBT can help you to overcome intrusive and obsessive thoughts, as well as compulsive behaviours. Giving you control back: Despite OCD revolving around trying to gain control ...
Cognitive behavioral therapy of obsessive-compulsive disorder
Cognitive behavioral conceptualization of OCD. Several cognitive behavioral theories about the development and maintenance of OCD symptoms have been put forward. Dollard and Miller 1 adopted Mowrer's twostage theory 2, 3 to explain the development and maintenance of fear/anxiety and avoidance in OCD. Mowrer's theory maintains that a neutral ...
CBT WORKSHEET PACKET
Beck Institute for Cognitive Behavior Therapy • One Belmont Ave, Suite 700 • Bala Cynwyd, PA 19004 • beckinstitute.org 7. STRENGTH-BASED COGNITIVE CONCEPTUALIZATION DIAGRAM QUESTIONS Name: Date: RELEVANT LIFE HISTORY (including accomplishments, strengths, personal qualities and resources
Discover Relief: How DBT for OCD Transforms Lives
These compulsions are performed in an attempt to alleviate the anxiety caused by the obsessions. Dialectical Behavior Therapy, DBT, for OCD, is an effective treatment approach that blends cognitive-behavioral techniques with mindfulness practices. DBT aims to provide individuals with skills in: Mindfulness. Distress tolerance.