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Cognitive Behavior Therapy

Cognitive Behavior Therapy makes use of two evidence-based behavior-altering techniques—Exposure and Response Prevention therapy (ERP) and Cognitive Therapy.

In Exposure and Response Prevention therapy, a mental health professional who is trained to treat individuals with OCD conducts a series of controlled ERP sessions.  This special therapy puts the OCD sufferer in situations in which he or she is exposed to the obsessions that they have, and they are gradually prevented from performing the compulsions they use to temporarily ease the accompanying anxiety.

For example, if you have an obsessive fear of germs, a therapist conducting ERP therapy may work with you to encourage you to touch a doorknob that you believe is contaminated, then wait longer and longer to wash your hands.  This gradual exposure and delayed response would help you learn to control the response.  Over time, you would learn to respond differently to the fear or thoughts about germs, which would actually lead to a decrease in the frequency and intensity of the obsession.

When therapeutic exposures are repeated over time, the associated anxiety shrinks until it is barely noticeable or even fades entirely.  The therapist guides the person to then take on more challenging exposures until those, too, become manageable.  Effective ERP leads to “habituation”, the process of losing the automatic fear response to obsessions, which leads to the very important realization that nothing bad happens when they stop performing compulsive rituals.

The therapist is then able to help you gain confidence and special skills to control the compulsion through the second form of therapy, Cognitive Therapy.

Cognitive Therapy, as applied to treating OCD, helps patients understand that the brain is sending “error” messages.  The therapist would help you learn to recognize these errors and respond to them in new ways to control the obsessions and their resulting compulsive actions. Cognitive Therapy is an effective treatment for many problems, and focuses on the meaning we attach to often-ambiguous experiences (e.g., “Mary doesn’t like me anymore because she walked by without saying hello.”). Cognitive therapy helps people stand back from often-automatic thoughts, look at the evidence closely, and tell themselves something more accurate (e.g., “Something is on Mary’s mind, but I don’t know what it is.”).

Cognitive Therapy for OCD focuses on the experience of negative thoughts (e.g., a new mother has the thought, “I might drop my baby on the floor.”). While most people easily dismiss such thoughts (e.g., “that’s a silly thing to think”), certain beliefs (e.g., thoughts seen as always important) cause some to react differently (e.g., “I am a bad mother for having such a thought!”). Research shows that understanding negative thoughts as important and attempting not to have “bad” thoughts produces the opposite effect!

Cognitive therapy for OCD sometimes focuses on metacognition (what we think about thinking processes). The therapist helps the person challenge specific metacognitive beliefs (e.g., “Having this thought means I might drop my baby”). For example, if you think, “I am as rich as Warren Buffett,” do you need to go and check your bank account?

This treatment may seem unusual.  You may even think it wouldn’t work, or that your child already tried to resist compulsions, without much success. But with the right therapist, and given time and support, Cognitive Behavior Therapy has helped thousands of people control their OCD.

Most ERP treatment is conducted on an outpatient basis once a week with exercises to practice at home between sessions.  In severe cases, some people may require more frequent sessions or inpatient treatment.  Not all mental health professionals are trained in ERP therapy, so it’s important to find one who is.  OCD Chicago can help you find a treatment provider.

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