Navigating OCD therapy types: Achieving relief from thoughts and compulsions

Obsessive-compulsive disorder (OCD) is a mental illness characterized by intrusive, unwanted, and obsessive thoughts that can cause a person to perform repetitive, compulsive behaviors. OCD can disrupt a person’s daily life and cause significant distress, but there are a variety of treatment options available that may help. When weighing these options, it can be valuable to understand the goals of each and the studies on their effectiveness in reducing symptom severity. 

What is obsessive-compulsive disorder (OCD)? 

OCD is a mental illness impacting about 2.3% of adults in the U.S. throughout their lives. The condition involves "obsessive" thought patterns, often consisting of highly distressing material, beliefs, or messages. Although not everyone with OCD experiences compulsive behaviors or rituals, compulsions can also be a part of the condition. 

Themes associated with thoughts and compulsions can vary for each person with the condition. For example, one might experience OCD related to fear of harming oneself or others. Another person might experience "order and symmetry OCD," where they feel they must keep specific situations in order through rituals like checking, cleaning, or organizing. These behaviors are often repetitive and cause difficulty functioning in several areas of life. For example, someone might compulsively start cleaning in a public space, ignore a conversation to perform a ritual, or become anxious when a friend doesn't wash their hands a certain way. 

What are intrusive thoughts?

It can be essential to understand the difference between intrusive thoughts and impulsive thoughts. In the media, some people say their "intrusive thoughts are taking over" to refer to a silly or impulsive action like throwing a piece of food by accident or saying something they didn't mean. However, intrusive thoughts are not fun, humorous, or easy to cope with. 

Intrusive thoughts are typically disturbing thoughts that can be graphic in nature, scary, and repetitive. They might include images of violent scenes, a thought that one has accidentally gone against their morals without knowing it, or a thought that one "wants" to complete an illegal or unhealthy action. For example, someone with harm-related OCD might see images in their mind of themselves harming their partner. 

Due to the often graphic nature of intrusive thoughts, the individual experiencing them typically does not want to go through with them and is often heavily distressed by them. If someone loves their partner profoundly and has violent thoughts about them prompted by OCD, they might complete a ritual to ignore the thoughts or lessen their anxiety.

How to reduce stigmatizing terminology

Note that using the wrong terminology to make jokes, such as "obsessive Christmas decorator," "obsessive cleaning disease," or "my intrusive thoughts won," can be stigmatizing to those with OCD and may even have a negative impact on their quality of life. Using OCD to create a play on words or joke about your desire for cleanliness can make it seem that OCD is not real or challenging for those who live with it. It also emphasizes cleaning as a symptom of OCD when cleaning-oriented compulsions are only present in some individuals with the condition. Instead of these terms, consider using the following: 

• Organized
• Impulsive thoughts
• Clean
• Neat 
• Tidy 
• Perfectionistic
• Detail-oriented.

Can OCD be effectively treated?

OCD is usually a chronic, long-lasting condition, but it can be treated or managed with medication or psychotherapy, like cognitive therapy. Many forms of OCD treatment, like exposure and response prevention therapy, have been studied and associated with significant symptom remission.

The most effective treatments for symptom relief

Below are a few common therapeutic options for OCD symptom relief. However, it can be beneficial to talk to your doctor if you'd like to learn more about resources in your area.

Cognitive behavioral therapy(CBT) 

Cognitive behavioral therapy has been called by some experts the "current gold standard of psychotherapy." It uses cognitive restructuring exercises, roleplay, worksheets, mood tracking, and other techniques to help clients replace unwanted thoughts with more productive ones. The premise of CBT is that thoughts can influence feelings and behavior. When thoughts are changed, behavior and feelings may follow. 

By working through intrusive or repetitive thoughts, people with OCD may find relief. As these thoughts are often the root of compulsive behavior, reducing the thoughts can help rid a person of the behavior, as they might not feel the urge to complete it anymore. Talking about the causes behind the development of OCD may also benefit those who might have developed fears due to an adverse event in early life. 

Other forms of talk therapy, like CBT, might include psychodynamic therapy, and commitment therapy (ACT), or cognitive processing therapy (CPT). Talking to your therapist may help you determine which method is most effective for you. 

Exposure and response prevention therapy (ERP)

Exposure and response prevention therapy (ERP) is a form of behavior therapy that involves exposing an individual to situations that typically prompt obsessions or compulsions but then refraining from the compulsive behavior. 

ERP therapy is considered one of the most effective forms of treatment for OCD. An ERP therapist may start by taking a history of your symptoms and asking you to rate your fears on a scale of one to 100. Afterward, they can have you rate the fear you might feel if you were to ignore a compulsion urge in response to those fears. You can start with your lowest fear and expose yourself to it in small increments. 

For example, if you fear taking baths due to contamination OCD, you might start by sitting in the bathtub for ten seconds without water. Your therapist might then have you progress to sitting in the bathtub with water, then sitting in the bathtub without cleaning it or getting out. The final step might be sitting in a tub of water for ten minutes. These exercises can be done at home and recorded on a mood-tracking sheet to show to your therapist at your next session. 

If you can complete exposure therapy, you may reduce your fear response to stimuli once you've found you can cope without performing a compulsion. In addition, since exposure often takes fear to a higher level than you might come across in regular life, you may start to associate your baseline fears with more comfort, as you've already experienced "worse." 

Exposure can also be done in a therapy session. For example, if you have a fear of telling others your intrusive thoughts, your therapist might have you practice exposure by writing them down while in session with them. You might then progress to stating the specific themes of the thoughts before telling your therapist what the thoughts are. In this case, speaking about the thoughts takes away their "power," showing you that your therapist is not there to judge you and that you can co-exist with these thoughts without them being true. 

Radically open dialectical behavior therapy (RO-DBT) 

Dialectical behavior therapy (DBT) is a well-known therapeutic modality developed to treat adverse symptoms of personality disorders like borderline personality disorder (BPD). Inspired by this therapeutic modality, Dr. Thomas R. Lynch developed radically open-DBT (RO-DBT) for those living with obsessive and compulsive behaviors, including those with OCD or obsessive-compulsive personality disorder (OCPD). 

RO-DBT is often performed in a group format but can also be practiced with an individual therapist. Like traditional DBT, it usually involves a workbook; the difference is that it tends to focus more on compulsive behaviors, over-control, and difficulty with emotional expression. It teaches communication skills, letting go of convictions, and identifying and becoming comfortable with life's "unknown" areas. 

Many people with OCD may experience limiting beliefs about themselves, others, or the world. They might hold ideas that they believe to be facts, such as the belief that certain activities are dangerous or that no one "should" go hiking due to wild animals. These beliefs might have some basis in reality, but RO-DBT takes the stance that knowing and controlling every life situation can be impossible. 

Although it is a relatively new treatment for OCD, a few studies have looked at the effectiveness of RO-DBT for OCD. This research has found that the approach can be innovative and helpful in targeting chronic and treatment-resistant mental illness or behavioral patterns. However, this type of therapy might be the best fit for those living with over-control of their thoughts, surroundings, relationships, careers, or beliefs.

Medication 

In some cases, medication may sometimes be beneficial in managing symptoms of OCD. Medications that are commonly used to help treat OCD include serotonin reuptake inhibitors (SRIs), selective SRIs (SSRIs), and tricyclic antidepressants. It is vital that you consult your primary care physician or psychiatrist before starting, changing, or stopping a medication.  

Inpatient treatment 

Some people may find that their OCD symptoms are so severe they impact every area of life and make it difficult to care for themselves. In these cases, inpatient options to treat OCD could be valuable. Inpatient programs for OCD often offer the following: 

• 24/7 supervision 
• An onsite doctor for medical concerns
• Availability of frequent therapy appointments and ERP
• Support groups to talk to others with OCD
• A focused environment to work on your healing
• Follow-up support after you leave
• Case management and resource support
• Nurses, doctors, and mental health professionals 

If you believe you might benefit from inpatient treatment, contact a clinic in your area or ask your primary care physician if a referral might be required. 

Where to find counseling for OCD 

If you're looking for treatment for OCD, you can start by searching online for therapists in your area. Many therapists take a specialized approach to a therapeutic modality or condition that they have experience treating. If you're looking for ERP, you might search for an "exposure therapist near me." 

If your OCD symptoms make it difficult to set new appointments or leave the house, you can also try online counseling through a platform like BetterHelp. Online therapy platforms allow you to match with and meet with a licensed therapist from wherever you have the internet, so you don’t need to leave the house. When you sign up, you can indicate the symptoms you're experiencing and what type of therapist you'd like to be matched with. In addition, you can choose between phone, video, or chat sessions depending on your preferences. 

Researchers have also backed up the efficacy of online therapy. One research study examined the effectiveness of online video teletherapy for OCD using exposure and response prevention. This study found the online program to be an effective treatment option, concluding that “video teletherapy treatment demonstrated effectiveness in reducing obsessive-compulsive and comorbid symptoms and improved quality of life.”