Cognitive Behavioral Therapy Helps People with OCD Cope with Their Illness
While it was initially developed in the 1950s as an alternative to Psychoanalysis, therapists started using Cognitive Behavioral Therapy – CBT for short – to treat Obsessive Compulsive Disorder (OCD) during the 1990s. As more research is done demonstrating the positive effects of the treatment, more mental health practitioners are relying on it. Non-invasive and focusing on the “here and now,” there is some evidence to suggest that CBT can actually alter brain chemistry without resorting to medication. For sufferers of OCD whose condition is incurable but treatable, this is welcome relief.
What is OCD?
Technically defined as a complex neuropsychiatric disorder, Obsessive Compulsive Disorder is characterized by two distinct components: unwanted, uncontrollable thoughts and repetitive behaviors that are ritualistic in nature. People who suffer from this disorder generally recognize the irrationality of their thoughts and behaviors but are nonetheless unable to quell or change them.
It takes most people, on average, around 15 years of living with the disorder to finally seek help. When they do, it’s usually because their obsessions have become more steadily pronounced and irrational and their compulsions more all encompassing. Personal, family and occupational relationships may have taken a hit, while one’s quality of life has generally degraded.
Obsessive thoughts differ from compulsive behaviors. Thoughts vary, but they are characterized by excessiveness. For example, fear of germ contamination, an undue focus on religious and/or moral ideas, persistently violent or sexual mental images and a manic attention to order and symmetry are all common obsessions. Compulsions, on the other hand, are behaviors that must be performed in order to make the sufferer feel at ease. These include excessive hand washing; praying or rearranging; double and triple checking of locks, switches, etc.; and hoarding junk or waste. Some people must constantly tap their fingers, count and recount objects, or repeat words or phrases over and over again just to feel okay.
CBT and How It Can Help
Cognitive Behavioral Therapy differs from psychoanalytic-based treatments primarily in that its focus is the “here and now” rather than the past. Pure awareness of one’s problems and knowing from where they stemmed doesn’t, in itself, address how to change them. Change for the better, by contrast, is what CBT aims to achieve. For the treatment of OCD, the patient is taught to recognize their obsessive thoughts and compulsive behaviors as such. From there, the goal is to control, reduce and eventually eliminate the characteristics of the disorder.
In essence, Cognitive Behavioral Therapy is about unlearning old habits and relearning new ones. This involves, among other things, learning to recognize an obsession or compulsion for what it is, talking oneself through the feeling and moving past it by focusing on something else. One’s thoughts can be hard to expunge, but people can learn to ignore them.
Cognitive Therapy and ERP: Two Sides of the Coin
The treatment generally involves two primary components: cognitive and behavior therapies (distinct but closely related) and ERP or Exposure and Response Prevention. Cognitive therapy helps a patient see how their own thoughts are causing them anxiety. Behavior therapy looks at how one behaves and reacts to exterior stimuli that cause anxiety. This stage of the treatment is about recognition and revelation, about a patient seeing how their thoughts and actions have skewed their interpretation of reality. Irrational beliefs commonly held by OCD sufferers include:
• Need to control situations
• Overemphasis on importance of thoughts
• Striving for perfection
• Fear of perceived threats or dangers
With these beliefs out in the open, it is far easier to develop a plan to counteract them.
The next step, Exposure and Response Prevention, is a technique designed to force the patient to confront his fears, whether in the imagination or in real life. A person is gradually exposed to situations that have been purposely avoided out of fear. Another aspect of ERP – the Response Prevention part – is learning to prevent automatically falling back onto the compulsion as a means of assuaging the fear. As one learns to control or eliminate their fearful or otherwise obsessive thoughts, situations become less worrisome and anxiety is reduced.
To give an example of an ERP program, a therapist may ask a patient who fears contamination from germs to limit hand washings or to touch a public surface. People who compulsively check door locks may be encouraged to leave the door unlocked for a number of hours. There are countless other possibilities, each customized for the patient in question.
Homework and Treatment Duration
A key part of successful CBT is homework. Patients cannot simply practice while in session; they must take the skills they have learned home with them and begin to incorporate them into everyday life. In addition, relaxation techniques such as meditation or quiet reflection are helpful in taking the patient’s mind off of his worries. Healthy sleep habits, a good diet, and surrounding oneself with family and friends are also instrumental in overcoming this disorder. In more ways than one, OCD is about stress, so reducing stress in a healthy, positive manner is paramount to recovery.
Since its focus is on the here and now and not on the lengthy uncovering of layers of the subconscious, cognitive behavioral therapy often shows dramatic results in a relatively short time. Of course, this depends on the severity of the disorder, but many people see progress in a dozen sessions or less. In addition to one-on-one treatment, group therapy may also be a part of the healing process, for it helps to give a sufferer perspective as well as necessary support from peers.
It should be noted that children, too, can show signs of OCD. If this is the case, a full psychological exam should be undertaken, as many of the symptoms could point to other disorders including autism and ADHD. Cognitive behavioral therapy is effective with children as well, although games and rewards may be used to motivate them.
Although OCD manifests certain similar characteristics in all people who suffer from it, it is still an individual disorder that requires a personalized approach. CBT is so effective precisely because it is adaptable to everyone’s situation. In some extreme cases, medication may be necessary to augment the therapy, but for many, many more, the therapy itself is the best treatment.
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