CBT for OCD (A complete guide)

In this blog, we will answer the questions of How does CBT help with  OCD?”, and also learn about CBT and its techniques in dealing with OCD

How does CBT help with OCD?

CBT is one of the leading therapies that help in dealing with Obsessive Compulsive disorder by tackling the dysfunctional thought process that contributes to the development of the disorder by utilizing various techniques.

What is OCD?

Obsessive-compulsive disorder or OCD is a disorder wherein the patient is bombarded with intrusive thoughts, images, and urges that compel the person to perform either repetitive or ritualistic behaviors to assuage those thoughts. DSM-5 has a category called obsessive-compulsive disorders

Symptoms of OCD

Obsessive-Compulsive Disorder is a disorder with a set of repeated behaviors caused by intrusive thoughts. These obsessive behaviors or compulsions are acted upon to assuage the unwanted thoughts and urges that compel the person to perform those ritualistic behaviors.

• Phobia of contamination or dirt.
• Excessive cleanliness
• Intolerance towards uncertainty
• Need things to be coordinated by color, shape, and size. 
• Preferring symmetry in the objects
• Aggressive or horrific thoughts about losing control and harming yourself or others
• Unpleasant and violent thoughts about causing harm to self or others.
• Unwanted thoughts, including aggression, or sexual or religious subjects
• Unwanted thoughts that are sexual and unethical

Examples of obsession signs and symptoms include:

• Fear of being contaminated by touching objects others have touched
• Doubts that you’ve locked the door or turned off the stove
• Intense stress when objects aren’t orderly or facing a certain way
• Images of driving your car into a crowd of people
• Thoughts about shouting obscenities or acting inappropriately in public
• Unpleasant sexual images
• Avoidance of situations that can set obsessions and compulsive behaviors such as touching a used object.

Compulsion symptoms

OCD compulsions are behaviors that are repetitive, maladaptive, and are compelling to be enacted. The enactment or engagement in these behaviors ensures that the person would not experience anxiety or intrusive thoughts related to their obsessions. But this relief from anxiety is only temporary and the person has to engage in these repetitive behaviors constantly to maintain a mental state of calm

The rituals, repetitive behaviors, or compulsions are a type of coping mechanism for the person to deal with obsessive thoughts. These compulsions are not related to the problem that needs to be fixed and are often excessive and unrealistic in nature. Follow are a few examples of ritualistic behavior.,

• Constant and excessive cleaning
• Inspecting and Checking
• Counting
• Tidiness
• Acting as per the schedule
• Constantly asking for reassurance

Examples of compulsion signs and symptoms include:

• Washing hands until the skin on the hands is rubbed raw.
• Checking doors and locks repeatedly to make sure they’re locked
• Checking the stove repeatedly to make sure it’s off
• Counting in certain order and manner
• Repeating a word, phrase constantly
• Arranging objects in a particular order.

Causes of OCD

The causes of obsessive-compulsive disorder are as follows. 

Biological 

OCD can be caused due to the chemical changes occurring in our body and our brain. These changes might trigger the onset of OCD.  

Genetical

OCD can be hereditary and passed on from previous generations to the next generation. The genes associated with the transmigration of OCD are yet to be identified. 

Modeled behavior. 

OCD can be developed by observing family or people suffering from the disorder. The traits, compulsions, and observations can be picked up and imitated. 

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CBT for OCD

Cognitive-behavior therapy helps individuals cope with and change maladaptive thoughts, behaviors, and emotions by replacing them with adaptive thoughts and behaviors. It is utilized for the treatment of many disorders that produce problematic behaviors and actions. It has been proven to be particularly effective with obsessive-compulsive disorder (OCD). A specialized treatment plan for the treatment of OCD is developed called Exposure and Ritual Prevention. This treatment is designed to deal with intrusive thoughts that cause distress and also the ritualistic behavior that is compelled by these thoughts. The treatment works by breaking the automatic bond between feelings of anxiety and ritual behaviors. It also helps the client to refrain from engaging in ritualistic behavior. 

3 major treatment methods to deal with OCD

In Vivo Exposure: 

For this method, the client is exposed to the real perceived threat. Whether it be a situation or an object they fear they are made to confront it. They are made to be in the presence of their feared object or situation that produces distress or anxiety in them for a longer duration of time.

The constant and consistent exposure to our fears brings about a marked decrease in our fear of them. Over time our perceived feelings of threat towards them get diminished and we can face them without them causing us distress or anxiety.

Imaginal Exposure: 

In this treatment option instead of exposing them to their fears in real life, they are made to imagine them. The situations they are afraid to be in or the consequences of engaging in the behavior they fear are the kinds of scenarios they are made to mentally visualize. This step is utilized when it is not possible to expose the client to their feared object or situation in real life as it can be impossible or morally unethical. (for example, if a person has a fear of running over pedestrians on the street), in such cases, they are made to imagine that scenario and its consequences. With time, and constant exposure to such thoughts, the distress and anguish generated by those thoughts are decreased and the person can think rationally. Most of the time the guilt and shame associated with thinking such distressing thoughts mentally hurt the person. They are so burdened by these thoughts that they tend to avoid facing or confronting them. Once the thoughts are confronted, their power is diminished and the person can make rational and calm choices of how to deal with the perceived situation. 

Ritual Prevention: 

In this method, the treatment plan deals with the behavior part of the disorder. The ritualistic or repetitive behaviors cause major strain in the life of the patient. It can be severely disabling and hampers their functionality. The clients are encouraged to avoid engaging in these behaviors. (For example, constantly washing hands, checking if the taps are closed, etc. through various behavioral techniques. 

CBT techniques of OCD (3-way guide)

First Technique

• Identifying the need

To identify the needs the SALT technique is quite useful. It helps the therapist and the person to identify, assess and understand the situation and their thoughts. 

Have a mental talk with yourself and confront your OCD. 

S-Stop and focus on what is happening.

To have a clear understanding of the situation by staying alert. 

A-Ask the OCD what it is trying to do for you right now.

Confront the disorder and try to analyze the cause. 

L-Listen to what it’s trying to do for you 

Understand in what ways it is affecting you. Does engaging in those obsessions and compulsions make you feel safe or in control?

T-Try to come up with other ways you would feel the same sense of security without the added burden of OCD. 

Second Technique 

• Distinguishing between reality and imagination. 

OCD is a thought disorder that provokes people into committing irrational behaviors. The imaginations make it hard for people to tell reality apart from fantastical scenarios. Therefore it is necessary to keep them grounded and in touch with the real world. 

So this technique helps them regain their sense of reality by a few simple exercises. One of the exercises is to make the clients close their eyes and focus on the sounds around them. They would be instructed to tell how many times they heard a clap. 

Now the therapist aims to judge whether the client can tell accurately the number of times the therapist clapped. The reason why this technique might be a little overwhelming for people with OCD is that they have an active imagination and often have a weak sense of reality. So there are chances that they might hear sounds of fake claps even when the therapist hasn’t clapped. If the client manages to tell the exact number of real claps by filtering out the fake claps that they heard in their minds then it helps them regain trust in their senses. 

Though this might seem like a very complicated technique it is an effective way of helping the client in believing in their senses more than their thoughts. They would be able to realize that it is better to trust their senses than the illusory thoughts or voices in their minds. 

Third Technique 

• Externalization 

In this technique the therapist makes the client understand that their disorder does not define them. That their actions or behaviors aren’t caused voluntarily but due to the disorder which is separate from them. This eases their sense of guilt, shame, or frustration that is generated due to obsessive thoughts and compulsions.  

Questions such as the following can be asked to themselves to gain a clear understanding:

What are the reasons it gives you behave in this manner? 

What are the persuasion methods it utilizes to make you unable to resist those compulsions?

What do you think you will gain in return?

Thus, such techniques help the clients in managing the OCD and assist them in leading a normal and functional life. 

Conclusion.

In this article, we learned how OCD is treated with the help of CBT and how it helps in the management of the disorder. 

Frequently asked Questions

Does CBT help with OCD?

Yes, Cognitive Behavioral Therapy has been proven to be very effective in treating OCD. It has helped thousands of people learn to control their  Obsessive-Compulsive Disorder. In fact, CBT is one of the only research-proven methods for effectively treating OCD. Thus, more and more therapists are opting for CBT to treat OCD

How quickly does CBT work for OCD?

OCD and the Need for Certainty

The duration or number of sessions in therapy depends upon the severity of the disorder and also the client. Though generally, it takes about six months to one year with six to twelve weekly meetings during that period. The number of sessions decreases as the treatment progresses and there is development and improvement in the client’s behavior. 

How do I relax my OCD thoughts?

Following are a few tips to combat OCD thoughts:

Adapting to change and learning to let go

Control and handle unnecessary stress as it is known to negatively affect OCD.

Use relaxation techniques to cut down on stress and anxiety. Many effective relaxation techniques have proved to be effective. 

Mindfulness and meditation are very helpful in attaining tranquility and peace of mind. 

Is OCD psychological or neurological?

It has been found by researchers that Obsessive-compulsive disorder is a brain-based disorder. They are conducting more research to understand the brain mechanisms that might affect the symptoms of OCD and also the causes behind the compulsive behaviors in OCD. But more research is to be conducted to clearly understand whether OCD is a psychological or neurological disorder.

What vitamin deficiency causes OCD?

Vitamin B12 deficiency can cause psychiatric and even some neurological illnesses. But it is often overlooked. The neuropsychiatric illnesses associated with B12 deficiency are dementia, neuropathies, depression, and irritability. 

References

Mayo Foundation for Medical Education and Research. (2020, March 11). Obsessive-compulsive disorder (OCD). Mayo Clinic. Retrieved November 28, 2021, from https://www.mayoclinic.org/diseases-conditions/obsessive-compulsive-disorder/symptoms-causes/syc-20354432. 

Penn Psychiatry. Understanding CBT for OCD | Center for the Treatment and Study of Anxiety | Perelman School of Medicine at the University of Pennsylvania. (n.d.). Retrieved November 28, 2021, from https://www.med.upenn.edu/ctsa/forms_ocd_cbt.html.