OCD Recovery: How to Treat OCD Using Cognitive Behavioral Therapy (CBT)?
For many people, Obsessive-Compulsive Disorder (OCD) seems like a behavioral quirk.
OCD has even become somewhat of a common term thrown around lightly to tease anyone who feels the need to be orderly.
The truth is, OCD is much more than that.
It is a severe and crippling illness, characterized as much by the mental torment of recurring intrusive thoughts as repetitive physical actions such as repeated hand-washing.
On average, people who suffer from OCD can waste up to six hours a day on their obsessions and four hours on their compulsions.
Today, you’re going to learn more about OCD and how to manage it using CBT techniques.
Ready? Let’s get started!
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Obsessive-Compulsive Disorder (OCD)
Obsessive-Compulsive Disorder (OCD) is a chronic mental illness that affects over 2.2 million people in the USA alone.
OCD is the fourth most common mental disorder after depression, substance abuse and anxiety.
People with OCD suffer from intrusive and unsettling thoughts, or urges that often compel them to engage in repetitive, ritualistic behaviors.
Understandably, this mental illness can cause a great deal of distress over feeling stuck in obsessions and compulsions.
In severe cases, it can be hard for the person to think about anything other than their obsessions.
OCD is a form of anxiety, that wrongly make people believe that the only way to alleviate their anxiety is by giving into their compulsions. Which it does, but it also creates a much more complex problem, as it takes away the person’s sense of control over their lives.
1. Types of Obsessive Thoughts and Compulsions
Depending on the particular obsessions or compulsions of the individual, OCD can have different symptoms.
Some of the most common obsessive thoughts include:
Orderliness and symmetry – an excessive worrying about the neatness and tidiness of everything.
Contamination – an excessive fear of being contaminated with germs and bacteria.
Rumination – In the context of OCD rumination is actually a train of prolonged thinking about a question or theme that is undirected and unproductive. Many ruminations dwell on mistakes that one has done or might do, and so on.
Checking – this kind obsessive thought leaves the person wondering if they’ve already turned off the lights, turned off the stove, locked the windows and doors, etc.
Dark Thoughts – this induces a fear of even thinking about “sinful” or bad things.
Violence – a person with these thoughts often fears causing harm to others, even though they do not want or intend to.
Some of the most common compulsive behaviors include:
- Hoarding/accumulating “junk”
- Repeated hand washing or cleaning
- Repeating certain words
- Performing certain tasks repeatedly
- Constant counting
Although there are different types of obsessions and compulsions, what is effective in treating one type of OCD is also effective for the rest as well.
2. Self-Assessment: Do I Have OCD?
The following are some of the symptoms people commonly experience as part of OCD:
1. Unpleasant thoughts come into your mind against your will and you cannot get rid of them.
2. You ask people to repeat things to you several times, even though you understood them the first time.
3. You constantly have to review mentally past conversations and actions to make sure that you didn’t do something wrong.
4. You check things more often than necessarily.
5. You collect things you don’t need or avoid throwing anything away because you are afraid you might need it later.
6. You get upset if objects aren’t arranged properly and feel obliged to arrange them.
7. You are excessively concerned about cleanliness.
8. You avoid using public toilets because you are afraid of disease or contamination.
9. You feel obliged to follow a particular order in dressing, undressing or washing yourself.
10. You feel compelled to count while you are doing things.
11. Even after doing something carefully, you still feel you haven’t finished it or made a mistake.
Cognitive Behavioral Therapy (CBT) For OCD
Cognitive behavioral therapy – or CBT is short-term, goal-oriented psychotherapy treatment that takes a practical approach to problem-solving.
The guiding principle behind CBT is that our thoughts determine our feelings and behaviors. By correcting or changing your distorted thoughts, you’ll be able to change your feelings and behaviors.
CBT is used to help treat a wide range of issues in a person’s life, from sleeping difficulties or relationship problems to anxiety and depression and even OCD.
Cognitive-Behavioral Therapy CBT is one of the most effective kinds of therapy that can treat OCD patients and alleviate their anxiety.
#1. Exposure and Ritual/Response Prevention (EX/RP)
EX/RP is a CBT technique that helps in managing obsessions and decrease compulsions of OCD patients.
This technique involves gradually exposing the individual suffering from OCD to situations that trigger their obsessive thoughts and compulsive behaviors.
This will help the individual learn how to respond more effectively to the situation, as they are prevented from carrying out their ritualistic behavior and forced to find new and better way of responding to the stimulus.
Over time, their frequency of their compulsions and the intensity of their obsessions will decrease.
Here’s how you can do it:
* Make a detailed list of your obsessions and compulsions and arrange them from the least problematic to the most based on how recurrent or how distressing they are.
* Start working on the least problematic as it’ll be easier to treat.
* Identify when the symptoms occur and what is likely to trigger it.
* Expose yourself to this particular stimulus and refrain from responding to it with a compulsion for a certain period of time.
Fr example, if you might have obsessive thoughts about orderliness and symmetry triggered by the sight of unclean or disorganized things.
You can ask a friend to help you expose yourself to certain situations where there may be unclean or disorganized things, like at your friend’s house.
Because you know that you shouldn’t go around touching other people’s things without their permission, you have no choice but to resist the uncontrollable urge to tidy up after them.
Try to stop yourself from acting on your obsessive thought for around five minutes. Ask your friend to distract you or talk you through it.
When you start feeling comfortable, stop yourself for ten minutes, then fifteen minutes and so on, until it eventually your obsessive thoughts become so mild that you can easily ignore them.
Using a distraction can be helpful when resisting obsessive thoughts, such as talking to a friend, meditating, cooking, making lists, ect.
#2. Cognitive Therapy
Cognitive Therapy is another CBT technique that focuses on reframing your way of thinking. It helps you identify thought patterns that are causing you anxiety or stress and change them into more functional ways of thinking.
Cognitive Therapy uses strategies like self-talk, thought stopping, and relaxation training.
For example, if you have an obsession with violence, you might find yourself wondering, “What if I set one of my children on fire?” for no apparent reason. The thought makes you immensely guilty because you worry that having that thought alone is already evil.
You might not be aware of this, but you’re constantly practicing self-talk. It’s the monologues in your mind that goes on from the moment you wake up to the moment to go to bed.
In Cognitive Therapy, self-talk is practiced deliberately by choosing positive and encouraging affirmation that you repeat to yourself as you process your personal experiences.
In the example stated above, you can remind yourself that you’re not your disorder. That you’re not a bad person, and that it’s your OCD that’s making you think these terrible things. Simply observe your thoughts and remind yourself that they don’t control you.
Repeat positive affirmations like, “I am kind, caring, and compassionate,” or, “I am in control of my thoughts.”
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#3. Habit Reversal Training (HRT)
Habit Reversal Training (HRT) is a CBT technique that aims to reverse the habit that is typically performed in certain situations.
This technique is especially helpful in minimizing or possibly stopping unwanted behaviors or habits, like nail-biting, hair pulling, and other repetitive behaviors.
Habit reversal training has five different parts:
1. Awareness Training
Before minimizing or stopping a certain behavior, it’s important to become aware of the particular behavior. By paying attention to your behavior, you can identify when you typically perform it and what are its triggers and signs.
2. Identifying and Strategizing
In this step, you identify the problem your behavior presents and strategize a new behavior to replace the old one, or a way to fight your urge. Start deliberately practicing the new behavior.
For example, if your typical behavior in response to a stressful situation is pulling your hair, the new behavior could be to play with an elastic band or putting your hands in your pockets.
3. Finding Your Own Motivation and Sticking With Your Plan
Finding a source of motivation will help you keep doing your new behavior. Write down a list of all the reasons why you want to go through HRT and keep it where you see it.
4. Reducing and Relaxing
Unwanted behavior occurs especially during stressful times. So it’s important to learn how to reduce your stress levels and manage it. Give yourself enough rest and relax your body.
Relaxation techniques, such as mindfulness meditation, yoga, progression muscle relaxation, and deep breathing can help you relax your body and lower your stress levels.
5. Testing and Training
This is when you start practicing your new behavior and fight any urges to go back to your old behavior.
#4. Imaginal Exposure (IE)
Because OCD is a complex and wide mental illness, some treatments might not work for certain OCD obsessions.
For example, Exposure and Response Therapy encourage individuals to, gradually, expose themselves to situations that trigger their obsessive thoughts.
This can work for someone who suffers from obsessive thoughts about getting germs from touching a doorknob, by allowing themselves to touch doorknobs without washing their hands. But it is not applicable for someone who suffers from obsessive thoughts about losing loved ones.
In this case, they can undergo Imaginal Exposure. IE, help individuals visualize different scenarios that train then on how to react to these situations.
* Identify a particular situation that triggers your OCD (for example, losing your loved ones)
* Imagine yourself in the situation (or look at it for distance). Picture that specific scenario over and over again until you feel less triggered by it.
* Remind yourself that it’s not reality and that it won’t happen.
By comforting your worst fears, your level of anxiety and the intensity of your emotions will slowly diminish.
Another alternative to Imaginal Exposure is writing imaginative stories. Through writing your fears, you can expose yourself to OCD triggers and face your negative thoughts.
Looking for more techniques to help you deal with anxious thoughts? Check out this article: 10 Powerful Techniques To Control Your Negative Thoughts
Wondering what to read next?
- How to Treat Your Anxiety Using Cognitive Behavioral Therapy (CBT)?
- How to Treat Depression Using Cognitive Behavioral Therapy (CBT)?
- Self-Loathing: How to Stop Self-Hatred and Start Loving Yourself?
- Overcome Social Anxiety: How to Defeat Social Anxiety and Create Confidence?
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- Portions of this article were adapted from the book Cognitive Behavioral Therapy: The 21 Day CBT Workbook for Overcoming Fear, Anxiety And Depression, © 2019 by Jacob Greene. All rights reserved.
- Portions of this article were adapted from the book The Man Who Couldn’t Stop, © 2014 by David Adam. All rights reserved.
- Portions of this article were adapted from the book Break Free from OCD, © 2011 by Fiona Challacombe, Paul Salkovskis, and Victoria Bream Oldfield. All rights reserved.