Obsessive-compulsive disorder (OCD)
What is OCD?
Obsessive-compulsive disorder (OCD) typically involves both obsessions and compulsions. Obsessions are intrusive thoughts that cause distress, fear, and/or anxiety. They may include intense worries about harming a loved one or causing someone else’s misfortune. Fear of germs and contamination is another common theme in OCD. Obsessions with religious content are also common, even among those who are not religious. For example, a person may believe that certain thoughts are forbidden, creating anxiety about being punished in some way.
Compulsions, also known as rituals, serve the function of neutralising obsessive thoughts or the anxiety they create. These rituals can be mental or behavioural. The nature of compulsions varies from person to person, even though they serve a similar purpose for those performing them. Most people with OCD suffer from both obsessions and compulsions, which can become highly debilitating. Those struggling with OCD are often aware that their rituals are irrational but feel powerless to stop them. Many also experience deep shame about their condition, which may prevent them from seeking help.
OCD is not about rational thinking
It is important to note that OCD is not based on logic. People with OCD already know that their fears are irrational. They do not need more information or better arguments to convince them that their compulsions are unnecessary. The issue is that their emotional responses are automatic and cannot be controlled simply through insight or logic.
ERP works by changing the emotional response through direct experience. Using self-monitoring, exposure exercises, and structured tasks, the therapist and client determine the best approach to overcoming compulsions. Every treatment plan is tailored to the individual, incorporating:
Guided exposure exercises with the therapist
Homework assignments between sessions
Progress tracking and follow-up discussions
Talking to your therapist about OCD
Discussing OCD with a therapist is a crucial step toward recovery. It requires openness about one's thoughts and behaviours, even though many people with OCD feel ashamed of their symptoms.
Some individuals fear that talking about their obsessions may make them worse or that others will not understand what they are experiencing. If they have struggled with OCD for a long time, they may believe that no one can truly relate to their condition.
However, experienced therapists are well-versed in OCD patterns and can recognise the condition quickly, even though it manifests in many different ways. Knowing this can be reassuring for those who feel alone in their struggles.
Treatment for OCD
CBT therapy for OCD
Cognitive behavioural therapy (CBT) for OCD can take various forms depending on the type of OCD symptoms, the presence of other mental health conditions, and individual circumstances.
Exposure and Response Prevention (ERP) has proven to be highly effective in treating OCD. This method involves gradually exposing the individual to the triggers of their OCD while preventing them from performing their compulsive behaviours. The aim is to tolerate the discomfort and allow the anxiety to subside naturally rather than relying on compulsions for relief.
For example, a person who compulsively washes their hands excessively will be encouraged to wash their hands for a shorter period than usual and resist the urge to wash again. Over time, as they observe that their distress decreases without performing the compulsion, their OCD symptoms gradually diminish. Frequent exposure exercises between therapy sessions are essential for success.
Exposure to "forbidden" obsessive thoughts
For individuals with "forbidden" obsessive thoughts, exposure exercises can be helpful. By repeatedly allowing these thoughts to surface without performing compulsions, the individual gradually learns that nothing catastrophic happens, making these thoughts feel less distressing.
Other individuals may need to practice interrupting their compulsive thinking patterns and realising that nothing terrible occurs as a result.
Exposure therapy involves taking small, gradual steps toward facing OCD-related fears. If someone avoids germs due to contamination fears, they will be encouraged to gradually expose themselves to dirt or unclean surfaces. This may sound distressing, but it is done at a pace that feels manageable for the individual.
Similarly, someone who fears disturbing intrusive thoughts will be encouraged to intentionally think these thoughts and realise that they do not cause harm.
Before starting exposure exercises, it is essential that both the patient and therapist agree on the process. The therapist ensures that nothing unexpected happens and that the individual understands the rationale behind the treatment.
Response prevention is another key element of therapy. This means resisting the urge to engage in compulsive behaviours after exposure exercises. If a person finds it too difficult to resist their rituals, they may need to take smaller steps in treatment. Additionally, outside of therapy, individuals should gradually reduce their compulsions by shortening washing times, reducing checking behaviours, or asking fewer reassurance-seeking questions.
Psychological treatment for OCD
A key goal of therapy is to help individuals live better with their OCD. It is not always necessary to eliminate all OCD symptoms for treatment to be successful. Striving for complete eradication can become a trap in itself, as it may cause frustration and fear of relapse.
Instead, the focus should be on learning to manage OCD in a way that allows for a better quality of life.
Our therapists specialise in CBT for OCD and provide treatment in London, as well as online therapy for remote support.