Psychotherapy for Obsessive-Compulsive Disorder

Early Treatments

At one time, obsessive-compulsive disorder (OCD) was thought of as a "neurotic" disorder. Sigmund Freud, the father of psychotherapy, devoted considerable attention to OCD, and believed that OCD existed on a spectrum ranging from obsessive-compulsive personality to psychosis. His treatment of choice was psychoanalysis, and this was the accepted treatment of the disorder for many decades. Because this approach was met with no success, OCD was considered a rare and intractable disorder.

Even today, the most popular forms of psychotherapy include psychoanalysis, and its successor, psychodynamic therapy. The goals of these forms of therapy are uncovering hidden motivations and gaining insight — which is why they are often referred to as "insight-oriented therapy." The use of Freudian psychoanalysis has declined over the years in favor of psychodynamic psychotherapy because of its quick effectiveness. Traditional psychoanalysis can be a lengthy process, because it involves a neutral (non-directive) therapist, waiting for clients to reach an epiphany on their own. This process takes years, making it inaccessible for all but the wealthy.

Modern psychodynamic treatments, while having similar insight-oriented approaches, involve a more interactive approach by the therapist, with short-term therapy usually being less than 25 sessions. People who suffer from OCD usually have at least some insight into their behaviors, making the ultimate goal of insight less useful; insight alone is not enough to "cure" OCD. We now understand that OCD has, in large part, a biological causation (meaning, for example, that OCD behavior is not simply caused by a bad relationship with your mother), and it tends to run in families. Because of the failure of traditional psychological treatments for OCD, cognitive-behavioral treatments are now used in the treatment of the disorder, with very high rates of success.

Modern Treatments

Cognitive-behavioral therapy (CBT) is a category of psychological treatments that are used effectively to treat obsessive-compulsive disorder (OCD). Although there is no cure, CBT is the best way to permanently reduce OCD symptoms. CBT is powerful and scientific studies show that it can actually change the activity in a person's brain — in a sense "retraining" the brain.

Mild cases of OCD can be treated with self-help techniques. The book Brain Lock: Free Yourself from Obsessive Compulsive Behavior is a recommended resource for people looking for a way to combat OCD on their own.

More self-help books for OCD...

The goal of CBT is two-fold: to change thoughts and behaviors. The cognitive portion involves the identification and analysis of irrational thoughts, which are then challenged. In the behavioral portion, the therapist and client work together to change the compulsive behaviors. This typically includes techniques such as Exposure and Response Prevention, also called Exposure and Ritual Prevention (ERP or EX/RP), Flooding (where a person repeatedly exposes themselves to their fears), Systematic Desensitization (where a person faces their obsessions in a systematic order), and many others.

Exposure and response prevention is successful 75 to 80 percent of the time in reducing symptoms, making it the most effective treatment for OCD. A person suffering from OCD feels obsessions, which cause extreme anxiety, and is then driven to perform compulsions, which momentarily relieve the anxiety. The goal of ERP is to expose the OCD sufferer directly to their anxiety-causing obsessions, and then prevent them from performing a ritualistic compulsion to relieve the anxiety. ERP is a hierarchical process. The therapist has the patient rank their fears from most distressing to least distressing. After the fears are ranked, the patient will then be exposed to each fear as they are ready for them. The therapist cannot make their client do anything the client does not want to do, so great care is taken to be sure the client is ready for the next step — and because of that the process takes time. The OCD patient eventually learns that the anxiety in itself is not harmful.

Because even the thought of confronting ones fears can prevent many patients from seeking CBT, many wonder if it is possible to bypass the behavioral portion of the therapy. Cognitive therapy alone can be helpful if a patient is unable to participate in the behavioral exercises, but the behavioral part of the treatment is the real key to success.

The therapist will typically assign homework and take periodic ratings of symptoms to be sure the patient is improving. The therapist will push the patient somewhat, because ultimately most people need someone to drive them at least a little for effective treatment, but not more than they can handle. It is a difficult process, but very effective and rewarding. CBT is also effective for most anxiety disorders and many OC spectrum disorders.

Finding a Therapist

As many therapists are not trained in behavioral techniques, people with OCD should carefully screen their mental health professional before starting a program of treatment. Ask specifically about experience using behavioral techniques to treat anxiety disorders. It is not uncommon to find people with OCD stuck in years of ineffective talk therapy, with no improvement. In fact, these types of therapies can make the OCD worse. Even a cognitive therapist with no behavioral training should be avoided.

People getting appropriate treatment for their OCD should start to see some improvements after only a few sessions of CBT. If you are unable to find a qualified behavioral therapist in your area, please see our resources page for links to organizations that can offer you a referral. The Association for Behavioral and Cognitive Therapies has an online list of therapists in your area. You can also talk to online therapist for anxiety and compulsive behaviors for help or advice, but it is not yet known how effective online therapy is compared to treatments in-person.

With appropriate treatment, people with OCD can and do get better.

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Credits: Article written by M. Jahn & reviewed M. Williams, Ph.D. for www.brainphysics.com.

A combination of drugs and cognitive-behavior therapy can be a very effective treatment for OCD.