How is OCD Treated in Therapy?


Obsessive-Compulsive Disorder (OCD) is a mental health condition that affects 1-2% of the population. The World Health Organization estimates that it is one of the top 10 causes of illness related disability worldwide.

You might wonder if OCD can be cured? The issue with this question is that mental health is not black and white. Instead it can be better understood as a pattern of thoughts, feelings, and behaviours. OCD has a very specific pattern of thoughts, feelings, and behaviours.

Psychotherapy (in particular Exposure and Response Prevention) can help free you from the OCD cycle, and gain more autonomy in your life.

The OCD Cycle

To understand how OCD is treated in psychotherapy, it is first important to understand the OCD cycle.

If you are caught up in this cycle you’ll find it consists of four parts:

  1. Obsessions – First an intrusive and distressing thought or image (called an obsession) will show up in your mind. This thought can feel very alarming, and will often centre on something you care about. You might have a thought that you will harm someone you love, or maybe you will bring in a germ that will get someone you care about sick.
  2. Feelings of Distress – This thought or image will trigger significant distress. You may feel anxiety, fear, guilt, shame, or a feeling like you are losing control.
  3. Compulsions – Because so much distress shows up, you do something (either an action or a mental act inside your head) to get rid of it. If the obsession is about harming someone maybe you start avoiding being alone with people you care about, or maybe you say a prayer in your head to try to protect them.
  4. Relief – This compulsion provides you with some relief from the distress. This relief however does not last, and the cycle starts again when another obsession shows up.

Everything we do, we do for a reason – we just may not know the reason at first! With OCD, the final part of the cycle is what keeps it going. The compulsion provides you with relief from the distress.

In some sense doing the compulsion works for you. However you may notice that there is no end to the cycle, and even though you feel some relief it is not long before another obsessive thought shows up again.

How is OCD Treated in Therapy?

Research has shown that Exposure and Response Prevention (ERP), a form of Cognitive-Behavioural Therapy (CBT), is effective for treating OCD. In ERP the aim is to interrupt the OCD cycle.

In therapy you are gradually exposed to situations where obsessions will show up, and then you practice interacting with the obsessions in a new way where you watch thoughts come and stay and go instead of getting caught up in them. These skills can help take the power out of your thoughts so they no longer bully you or push you around.

An important part of breaking the OCD cycle is the response prevention part – as we allow the obsessive thoughts to come and stay and go we reduce and eventually stop the compulsions. This work can be challenging as your distress levels might increase. What you will find though is that this distress does not last forever, it will often peak and then subside.

Thought-Action Fusion – Don’t Believe Everything You Think

One experience that is very common in OCD is something called thought-action fusion. This is just a fancy way of saying that you see thoughts as the same as actions. For example, you might be sitting in a crowded theatre and have the thought enter your head “wow, I could stand up and swear in front of this entire crowd!” Everyone has thoughts like these, but if you have OCD it might feel as if you actually stood up and swore at everyone.

Your mind might start saying “why am I having that thought, that must mean I am going to do it, I should get out of here as fast as possible”. This is why part of therapy involves practicing treating our thoughts as thoughts instead of actions.

Through practice it is possible to relate to your obsessions in a new way, one where they no longer push you around, or control you. This will allow you to move through the world the way YOU want to, not the way OCD wants you to!

Interested in Therapy with Stephanie?