OCD Treatment: Cognitive-Behavioral Therapy

One of the most effective CBT developments for the treatment of Obsessive-Compulsive Disorder (OCD) and related conditions is Mindfulness-Based Cognitive-Behavioral Therapy. The primary goal of Mindfulness-Based CBT is to learn to non-judgmentally accept uncomfortable psychological experiences. From a mindfulness perspective, much of our psychological distress is the result of trying to control and eliminate the discomfort of unwanted thoughts, feelings, sensations, and urges. In other words, our discomfort is not the problem – our attempt to control and eliminate our discomfort is the problem. For an individual with OCD or a related anxiety-based condition, the ultimate goal of mindfulness is to develop the ability to more willingly experience their uncomfortable thoughts, feelings, sensations, and urges, without responding with compulsions, avoidance behaviors, reassurance seeking, and/or mental rituals.  To learn more about Mindfulness Based CBT, click here.

Following a structured CBT protocol, the client gradually challenges all of his or her symptoms, and learns new, more productive methods of coping with anxiety. Over time, the individual becomes de-sensitized to previously anxiety-provoking situations and thoughts, and the obsessions and compulsions are eliminated, or significantly reduced in frequency and magnitude. Using this treatment approach, most clients make dramatic improvement by meeting with their therapist on a weekly basis over a period of just 4-6 months, followed by two or three “booster sessions”. Some clients may also benefit by having a small number of family or couples therapy sessions to address the impact OCD is having on their relationships. And a minority of clients may require a more intensive approach that includes 2-3 sessions per week or even home visits.

CBT Combined with Medication for the Treatment of OCD and Anxiety Conditions

Some individuals with OCD, OC Spectrum Disorders, or related anxiety disorders, may also benefit from combining CBT treatment with one or more medications that are sometimes prescribed for these conditions. The goal of medication, or “pharmacotherapy,” is to reduce obsessional anxiety, thereby increasing the individual’s ability to utilize and benefit from CBT treatment. This is particularly helpful with clients for whom the prospect of exposure therapy is so anxiety-provoking that they are initially unwilling to try CBT. For these individuals, after the medication has begun to reduce their obsessions, it is recommended that they complete a regimen of CBT while continuing the pharmacotherapy. Medication may also be beneficial for individuals experiencing depression, which is sometimes present in those with OCD and related disorders, or with other psychiatric conditions.

But it is important to stress that CBT is the primary treatment for OCD. Numerous research studies completed over the past twenty years have concluded that CBT is the most effective treatment for OCD. In fact, in 1997, the Journal of Clinical Psychiatry surveyed over sixty OCD researchers and treatment specialists from across the world in order to determine the best treatment for OCD. The resulting publication, entitled Expert Consensus Treatment Guidelines for Obsessive-Compulsive Disorder, described CBT as “the psychotherapeutic treatment of choice for children, adolescents and adults with OCD” and noted that it is “the key element of treatment”.

Despite this endorsement, many clients are tempted to rely on medication alone. But four facts provide a compelling case against the “medication-only” route. First, analyses of numerous studies comparing CBT and pharmacotherapy have concluded that CBT treatment for OCD is more effective in both the short and long-term. Second, the potential short-term side-effects of these medications are well-documented and include anxiety, insomnia, nausea, diarrhea, difficulty concentrating, and sexual dysfunction. Conversely, CBT has no side-effects. Third, many of these medications have not been fully studied over an extended period of time, and many researchers and clinicians are concerned about the possibility of long-term side-effects, particularly for children, and for pregnant or breast-feeding women. And finally, studies have shown that when individuals treating OCD exclusively with pharmacotherapy discontinue the medication, as many as 90% may experience a complete return of their OCD symptoms. Conversely, those who complete a course of CBT treatment for OCD usually have a far lower rate of relapse. With CBT, the techniques you learn are always with you and provide a set of tools that can immediately be utilized if and when symptoms return.