Obsessive-compulsive disorder (OCD) can be life-altering, affecting an individual at school or work, in social settings, and at home. Daily chores and errands can feel complicated and stressful for those with this condition.
However, improvement may be possible through various treatments, including types of therapy that use operant conditioning. Operant conditioning may help you make progress and maintain it. It can often be found in therapeutic modalities like exposure and response prevention therapy (ERP) and cognitive-behavioral therapy (CBT), which effectively treat OCD. Learning about these types of therapy could help you make an informed decision about the type of treatment that might benefit you.
What Is OCD?
Obsessive-compulsive disorder is a psychological condition that can cause obsessive thoughts and compulsive rituals. Rituals can vary and might include repetitive behaviors that are difficult to control. Some common rituals include counting steps, hand washing, or repeatedly checking locked doors. There are multiple types of OCD and fears associated with these behaviors or thoughts, and not everyone with the condition fears the same stimuli. For example, one person with OCD might have relationship-oriented fears, whereas another may feel fine about their relationships but struggle with fear of contamination or poison.
If you or someone you love experiences OCD, you're not alone. The urge to complete rituals or avoid distressing thoughts can be strong and overpowering, and you might perceive that you've lost control over your body and mind. However, there are ways to treat this condition and its distressing symptoms.
The treatment of OCD goes back to the 1940s. Famous behaviorist B.F. Skinner researched a few ways to support symptoms like the ones associated with OCD. His theories of operant conditioning are still used today in many popular therapeutic modalities that have been proven to reduce the symptom severity of this condition.
What Is Operant Conditioning?
In 1948, B.F. Skinner made a few discoveries using a "Skinner box." The box allowed him to observe the behavior of animals and the way that they responded to their environment. He discovered that all stimuli could be divided into three categories: neutrals, reinforcers, and punishers. Skinner found that if a particular behavior resulted in a positive response, that behavior was reinforced. However, if it resulted in a negative response, that same behavior might not be repeated.
There are a few examples of this theory in daily life. For instance, if a child throws their toys around the house when they don't get the treat they want from their parent, they might receive a negative response by still not getting the treat. If they do not receive the treat, they might stop this behavior over time. On the positive end, if the child partakes in positive behaviors and receives a treat, they might notice that positive actions are more effective than throwing items.
This principle may also explain the symptoms of OCD. By engaging in ritual behavior, a person with OCD may experience temporary relief from anxiety symptoms. This positive result can reinforce ritual behavior. For example, someone who fears being robbed might check that their doors are locked multiple times daily. When they check the doors, they might temporarily feel relief. When the relief wears off, and the worrying thoughts return, the person might start to partake in the behavior again, eventually causing a ritual to form.
How Does Operant Conditioning Work?
Premised on reinforcements and rewards, operant conditioning provides incentives for healthy behaviors and consequences for unwanted behaviors.
In psychology, psychiatrists, psychologists, and therapists sometimes use operant conditioning to help people overcome obsessive-compulsive behaviors. The therapy is based on observing the environmental stimuli that reward unwanted behavior and then creating a plan to control OCD behaviors with positive and negative stimuli.
For this to happen, however, the individual may be asked to ignore their compulsion to avoid the anxiety incited by the situation. If they engage in compulsive behavior, they aren't repeating operant conditioning enough to experience habituation, which can cause anxiety to continue.
Operant conditioning can create positive reinforcement for compulsion. For instance, instead of washing their hands, an individual could meditate or engage in another positive activity. Instead of returning home to check the locks, they could call a friend to chat. These actions can produce positive responses from the environment while ignoring the compulsions of OCD.
Examples Of Operant Conditioning In Therapy
A few types of therapies use theories based on operant conditioning to control OCD symptoms and show how positive and negative rewards can be used. The following types of therapies may be utilized for OCD.
Exposure And Response Prevention Therapy (ERP)
To become habituated to an inciting anxiety event, an individual may learn to sit with their fear and face it head-on until the anxiety passes. Exposure therapy is one type of therapy that is often used for OCD, and it has been highly associated with symptom remission.
For OCD, exposure treatment might first involve outlining a list of one's compulsions, intrusive thoughts, and fears. They may then assign a number on a scale of one through 100 to signify how afraid they are of those fears or not performing their compulsions. For example, a person with a fear of sickness might have a list that looks like the following:
- Going in public (fear: 10)
- Talking to a sick person (fear: 30)
- Not washing their hands (fear: 40)
- Touching a public toilet (fear: 80)
- Ignoring thoughts about germs (fear: 85)
- Going to the doctor's office and not washing their hands after (fear: 100)
Each individual's fears and the number they associate with them can vary. After outlining these fears, the therapist may help the client practice exposure to the lesser fears first. In the above example, the individual might start by going into a public place and not washing their hands or leaving when they feel anxious. They can then track their anxiety and report it to their therapist.
After practicing exposure effectively with a few fears, they might lead up to more intense worries. After completing exposure therapy, the person may notice that they are less afraid of certain situations and thoughts and may feel better able to avoid a compulsion, as they've been positively conditioned to see that fear itself may not have the consequences they feared.
Behavioral therapy focuses on changing behaviors and may use operant conditioning. In a behavioral session, a therapist may ask you to replace your compulsive behavior with a different, healthy behavior. Positive behavior can serve as a positive reinforcement that teaches you that there are other methods for coping with anxiety and stress.
Cognitive-Behavioral Therapy (CBT)
CBT is an approach to treating OCD in which the therapist seeks to help clients explore what is causing their compulsive behaviors. For example, while in CBT, an individual with OCD may uncover that their compulsion is a response to not perceiving that they have control. The therapist and client can then work to help the individual curb this behavior and feel safer and in control of their life. CBT is often used alongside ERP for OCD.
If you are seeking support in overcoming your OCD symptoms, don't hesitate to contact a trained counselor. If your symptoms make it difficult to leave home or go to a new location, you can also try online therapy. Platforms like BetterHelp may allow you to be matched with a counselor experienced in exposure therapy, behavioral therapy, or CBT for OCD symptoms.
In addition, online therapy has been shown to be an effective treatment option for a range of conditions, including OCD. For instance, a recent review article conducted an overview of the effectiveness of internet-based cognitive behavioral therapy (ICBT) in treating various psychiatric disorders, and it concluded that ICBT is effective in the treatment and management of disorders such as OCD, as well as depression, generalized anxiety disorder, social anxiety, and more
You can contact your therapist via phone call, video chat, or in-app messaging through an online therapy platform. Your therapist may also send you worksheets and resources over the app or website to support your therapeutic journey.
Is OCD linked to operant conditioning?
OCD is linked to operant conditioning as a method of therapy used to treat the disorder.
How is operant conditioning used in CBT?
When used as a supplemental tool in cognitive behavior therapy (CBT), operant conditioning for OCD assigns reward or punishment to a patient's voluntary behaviors. This type of treatment should be guided by a licensed, professional clinical psychologist or counselor with experience treating obsessive-compulsive disorders.
Can operant conditioning cause anxiety?
When a neutral stimulus is associated with a distressing unconditioned stimulus (a process referred to as classical conditioning), that association will typically create a conditioned stimulus for fear and aversion. This is the primary function of operant conditioning; however, repeated exposure to an avoidance response may create distress for those in treatment.
How can operant conditioning be used to treat anxiety disorders?
While it can be counterproductive in some cases, operant conditioning can be used to treat anxiety disorders in others. Unhealthy behaviors associated with the conditioned stimuli that reinforce OCD may be discontinued through the reward/punishment system of operant conditioning.
What is a real-life example of operant conditioning?
Some of the most common examples of operant conditioning include:
- Giving a child a sticker for completing their homework encourages them to continue doing it.
- Taking pain medication (removing the pain) reinforces the behavior of taking medication regularly.
- Giving a time-out to a misbehaving child to discourage future misbehavior.
- Taking away a teenager's car keys for breaking curfew to reduce future instances of tardiness.
What are the four types of operant conditioning?
The four primary forms or components of operant conditioning include:
- Positive Reinforcement— Adding a desirable stimulus or reward to increase the likelihood of a behavior being repeated.
- Negative Reinforcement—The removal or avoidance of an aversive stimulus to increase the likelihood of a behavior being repeated.
- Positive Punishment— Adding an undesirable stimulus or consequence to decrease the likelihood of a behavior occurring again.
- Negative Punishment— Taking away a desirable stimulus or privilege to decrease the likelihood of a behavior happening again.
Are you born with OCD, or is it a learned behavior?
While the origins of OCD are still unclear, experts posit that genetics, heritability, neurological abnormalities, and environmental factors all play a role.
How do you stop OCD spirals?
Spirals, or "thought loops," are a symptom of OCD characterized by intrusive thoughts about the disorder's focus. Despite its persistence, there are some things you can do to lessen or discontinue an OCD spiral:
- When you realize what's happening, call it by name. Once compulsive thoughts enter your mind, they can "nest" there if they're not exposed for what they are— obsessive thoughts about a conditioned fear.
- Practice acceptance and non-engagement. Part of labeling the thought is accepting it as it is. Try to take a moment to acknowledge the possibility that the thought probably isn't the truth, and you don't have to act on it.
- Take a moment for sensory awareness and mindfulness. This is a significant step in the ritual prevention process because it helps take you out of your mind and away from the obsession spiral. Stop what you're doing and notice your breath. Scan your body for tension and notice what it feels like in its space. (Are you standing? Sitting? Lying down?)
This step can be especially powerful if you engage your senses. What is the temperature of the room? How do your clothes feel on your skin? Is there a smell that catches your attention? Splash cool water on your face or run your hands under cold water. All these things can help ground you in your body and keep your thoughts from spiraling.
Is OCD triggered or brain-based?
OCD is commonly recognized as a biological, brain-based disorder. Current research reveals that areas of the brain associated with identifying situations that may need intervention are overactive in people with OCD. In contrast, areas of the brain that signal when it's time to cease the intervention (stopping the OCD reaction) are underactive.
Several factors, including head trauma, neurological disease, or genetics, can cause this organic contributor. But OCD can also be triggered by a traumatic experience or stressful life event.
What in the brain triggers OCD?
Current studies on the neurological cause of obsessions show an imbalance in the neurotransmitters glutamate and GABA (gamma-aminobutyric acid) in the anterior cingulate cortex of OCD patients.
Glutamate acts to boost communication between neurons in the brain, and GABA inhibits them. When glutamate levels are too high, and GABA are too low, it reinforces OCD behaviors by causing an "overreaction" to the thoughts that trigger OCD and hindering the brain's ability to recognize when actions are no longer necessary to obey those thoughts.
A better understanding of the causes of OCD in the brain can help researchers develop better long-term treatments for people with obsessive-compulsive disorder.
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