What therapy is best for OCD?

Obsessive-Compulsive Disorder (OCD) is characterized by the presence of thoughts and fears (obsessions) that prompt behaviors to reduce those fears (compulsions).   It’s a debilitating disorder that can take possession over many hours of a person’s day and rob them of joy, connection, and ability to function in multiple settings.  OCD is heavily fear-based, meaning the driving emotion is always anxiety. 

Though people with OCD are generally very rigid and structured in their patterns to reduce the experience of anxiety, change is very possible.  The brain is malleable no matter the age; old connections can be unpaired and new connections can be forged.  To accomplish this, therapists typically use a combination of Cognitive-Behavioral Therapy (CBT) and exposure techniques.  In CBT, the focus is on the relationship between thoughts, emotions, and behavior, specifically in how they interact with (and influence) each other.  For example, someone may identify feeling fear that their hands are dirty, think about washing their hands, and complete the compulsion by performing the behavior.  Learning about these cycles and patterns is the first step to change.

Once both the therapist and client have a good understanding of the way OCD operates in their life, a technique called Exposure and Response Prevention (ERP) can be implemented.  Exposure is necessary to breaking the cycle and changing the brain, as talk therapy does not allow the brain to experience, and sit through, the ups and downs of an anxiety response.  This is typically built as an exposure hierarchy, where the person is slowly exposed to anxiety-provoking situations (exposure) without performing compulsions (response prevention).  If we revisit the example of handwashing, the person may touch something dirty, use grounding techniques to sit through the resulting anxiety, and avoid responding until the stress cycle has completed itself and the anxiety resolves on its own.  The more that exposure is practiced, the more the brain unpairs obsessions and compulsions, therefore increasing the person’s ability to tolerate distress.

It is important to have many solid coping mechanisms before engaging in this type of therapy, as sitting in the anxiety can be very challenging.  Research shows that this method of therapy is incredibly effective in changing the brain’s relationship to anxiety and reducing symptoms for people with OCD.  There’s so much hope and power in this method of treatment that it’s definitely worth the discomfort it takes to change!