Cognitive Behavioural Therapy for OCD

The term ‘OCD’, or obsessive compulsive disorder, has fallen into common parlance in recent years as a shorthand for describing people who are particular about cleanliness, or who perhaps like to check their house is properly locked before they go to bed. However, OCD itself can be extremely disruptive to the lives of affected people and their families, and now there is convincing evidence that it can be successfully tackled with CBT Cognitive Behavioural Therapy.

OCD is a form of anxiety in which a person experiences frequent intrusive and unwanted thoughts (obsessions), which are often followed by irresistible OCD affects around 750,00 people in the UKand sometimes repetitive behaviours (compulsions) which are an attempt to alleviate the obsessional anxiety.

It ranges in severity and content, but generally speaking is quite common — it is thought to affect approximately 750,000 people in the UK alone. Almost half of these cases are classed as ‘severe’ as they are disruptive to ability for the affected person to live their life as they want to, and can cause them great distress. The World Health Organisation has actually classed OCD as one of the top ten most disabling illnesses of any kind as measured by lost earnings and its effect on quality of life.

Though the common perception by the public is of OCD as repetitive hand washing or the flicking on and off of light switches, it is quite a varied phenomenon which presents itself in many different forms. Traditionally it has been viewed as falling into five categories:

  • Fear of catastrophe, related to checking behaviours
  • Fear of contamination, related to washing and cleaning behaviours
  • Fear of disorder, related to ordering and organizing behaviours
  • Fear of loss or discarding, related to hoarding behaviours
  • Fear of horrific thoughts, related to distraction thought techniques

So, a treatment that is going to successfully tackle OCD has to be able to get at the factors common to a wide variety of anxieties and associated behaviours. One such successful and popular treatment is CBT, which is effective in assisting recovery from OCD in roughly three quarters of all those who undergo it.

The rationale underlying this treatment is that intrusive thoughts are common to everybody; to a degree they are unavoidable. It is not the thoughts themselves that are intrinsically problematic, it’s what the person makes of them and the behaviours they undergo because of them: what people with OCD are therefore encouraged and supported to do is identify and modify those thoughts that cause anxiety, compulsions and upset.

As the name would suggest, Cognitive Behavioural Therapy consists of techniques to help us to develop more adaptive and healthy cognitions and behaviours with a recognition that what we think and what we do are deeply connected. An important component of CBT for OCD is ‘cognitive conceptualisation’, which focuses on tackling the feelings of shame and guilt that are common to those struggling with this problem and which can lead to delays of years and even decades before they seek help in the first place.

CBT therapists encourage a recognition that what we think and what we genuinely believe can be very different: intrusive thoughts of a sexual or violent nature do not make us ‘bad’ people, especially when, as with OCD, these thoughts cause us great distress. Research has repeatedly shown that ‘undesirable’ thoughts are common to approximately 80% of the population. These thoughts are not necessarily a reflection on our character and are not a Freudian manifestation of the deep-seated desires of our ‘unconscious mind’(!), rather they are a merely a reflection of the firing of neurons in our brain.

Another important component of CBT for OCD is ‘cognitive management’, which uses concepts from behavioural theory to empower the person to respond effectively to obsessive thoughts as soon as they notice them. Three commonly used cognitive management techniques are:

  • Extinctionthe phenomenon that taking away the elements that reward us for performing behaviours will cause those behaviours to stop. Though it might seem odd considering the disruption they can cause to peoples’ lives, many compulsions are actually a rewarding influence because they temporarily alleviate the anxiety associated with obsessions, even though they can actually strengthen these worries and fears. Encouraging the person to resist engaging in these behaviours via exposure (see below) can break the cycle.
  • ExposureFor OCD treatment this can involve encouraging a person with washing obsessions to touch something they deem ‘contaminated’ and not wash afterwards, or for peoples with order obsessions to leave household objects slightly ‘imperfect’ (books not in alphabetical order, or objects slightly off centre) without correcting them afterwards.
  • Habituationthe phenomenon that repeated exposure to a stimulus causes it to lose its power. For OCD treatment this can involve encouraging the person to meditate on a particular obsessive thought when it occurs, increasing exposure to it and leading to a reduction in its power to lead to upset and compulsive behaviours.

The House Partnership, 24th July 2011