CBT for Obsessive-Compulsive Disorder (OCD)
- How Common Is OCD?
- What Is Obsessive-Compulsive Disorder (OCD)?
- Types of OCD
- What Causes Obsessive-Compulsive Disorder?
- What Are the Signs of Obsessive-Compulsive Disorder?
- How Is OCD Diagnosed?
- What Treatments Are Available for OCD?
- Types of Psychotherapy and Counselling for OCD
- Can Medication Help Those With OCD?
- Self-Help Tips for OCD
- How Can You Help a Loved One With OCD?
It is estimated that around 1.2 per cent of the UK population suffers from OCD, with around 740,000 people experiencing it at any given time. According to research, around half of those with OCD have severe symptoms, whilst just a quarter report experiencing mild symptoms.
Cognitive-Behavioural Therapy for OCD
Research indicates that cognitive-behavioural therapy (CBT) is highly effective in treating approximately 75% of people who suffer from OCD. It appears to be a faster acting, longer lasting, and more cost effective treatment over time, than medication, and does not involve the risk of side effects. Research also suggests lower rates of relapse following completion of a course of CBT, compared to that of medication, where relapse is more common.
There are two main components to CBT for OCD:
- Cognitive therapy: This component is concerned with the problematic thinking patterns sufferers commonly experience. It involves helping people understand how their thinking operates and to discover more effective ways of responding to obsessive thinking. This therapy element contributes positively to symptom relief and can lead to more personal confidence and inner calm than the obsessions could ever achieve.
- Behavioural therapy: This component provides the experimental and experiential element of the therapy and helps the sufferer learn to tackle impulsive behaviours. For example it might make use of a technique known as exposure and response prevention, which involves exposing yourself repeatedly to the source of your obsession and then asking you to refrain from engaging in the compulsive behaviour you usually employ to deal with it. For instance, if your obsession is with contamination, you might be told to touch a door handle in a public restroom and then not wash your hands afterward.
This Cogntive Behaviour Therapy combination enables sufferers to develop more self supportive thinking, complemented by effective strategies for managing life and anxiety provoking situations. Through this process, over time, there is less tendency or need to perform the old problematic ritual in order to alleviate uncomfortable feelings. Instead, people can experience an increased sense of control over their thoughts and behaviours and what they can achieve in their life.
How does CBT Therapy Work?
Your therapist will work with you, to help you:
- Make sense of overwhelming problems by breaking them down
into small parts
- Establish achievable goals that you want from your therapy
- Develop new thinking and behaviour patterns
- Develop skills and strategies for problem solving
- End your CBT therapy sessions when you feel you’ve achieved your goals
Obsessive-compulsive disorder (OCD) is a type of anxiety disorder that is characterised by out-of-control thoughts and repetitive rituals that you feel a compulsion to perform.
Those with OCD often realise that these thoughts and behaviours are not rational, but still can’t shake the urge to give in to them. Some people might go as far as washing their hands until the skin is raw or checking that the iron is off dozens of times.
Obsessive and compulsive habits initially appear to make the individual feel a bit better or provide a little relief and this is why they become habitual. However, eventually, OCD will begin to negatively affect the person’s overall well being, relationships and career.
OCD has two main components: obsessions and compulsions.
Obsessions are unwanted thoughts that occur repeatedly in your mind. They are often distracting or disturbing, and you cannot seem to stop them from occurring.
Compulsions are rituals or behaviours that you feel compelled to perform repeatedly, often with the aim of trying to make the obsessions go away. An example of this would be washing and sanitising your hands multiple times out of fear of contamination. Although you might temporarily feel relief, these actions do not actually solve the problem, and can even end up making it worse because over time, the rituals tend to become more time-consuming.
Although the condition can manifest itself in different ways, most OCD sufferers tend to experience one or more of the following categories of symptoms:
Checking: This involves checking things repeatedly to ward off danger or harm. For example, repeatedly checking that the door is locked or the cooker is turned off are forms of checking.
Counting and Arranging: This involves an obsession with symmetry and order. It is often accompanied with superstitions about particular colours or numbers.
Washing: This involves hand-washing or cleaning compulsions which are accompanied by fears of contamination.
Hoarding: This involves a hesitancy to throw things away out of a fear that something bad will happen if you do and is accompanied by tendencies to hoard things that are not needed or used.
Doubting and Sinning: This is where people hold the belief that if things are not done perfectly, they will be punished or something bad will happen to them.
Individuals who only occasionally hold some of the above thoughts or perform some of the listed behaviours, do not necessarily have OCD. It is when the behaviours and thoughts take up a lot of time and affect your relationships and daily life, that a diagnosis of is obsessive compulsive disorder tends to be considered.
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Contextual Causes of OCD
From a contextual perspective, certain environmental stressors appear to trigger OCD in some people or worsen their symptoms. A few of these stressors include:
- The death of a loved one
- Trauma / Abuse
- Changes to one’s living situation
- Relationship problems
- Issues at work or school
Psychological Causes of OCD
From a psychological perspective, the circumstances in which we spend our early childhood can have a significant affect on the development of OCD symptoms, both when we are young and as we grow older. When children grow up in conditions where there is stress or trauma, a habit, which can be focused on to the exclusion of all else, can provide a soothing distraction from a distressing environment over which the child has no control.
For example, a child might find it soothing to become preoccupied with counting the number of times they brush their hair, as a way of blocking out regular instances of inter-parental arguments. Whilst the habit may seem strange, it provides the child with a small feeling of control over a simple task and thus, a tiny relief from the helpless inability to stop their parents from fighting.
Because this behaviour is not an effective strategy for soothing distress, but the only thing a small child may have to hand, over time, the habit becomes obsessive as the individual feels compelled to engage in it more frequently, in an attempt to gain some relief. Such an obsession can then re-emerge or intenstify in adulthood, in situations where the individual is concerned about conflict with their partner or work colleagues.
A psychotherapy approach to OCD is designed to help sufferers understand the unique circumstances in which their habits are rooted and in relation to the example situation described above, show the individual how to develop more effective strategies for self soothing and dealing with conflict in their present life. When more effective self-soothing strategies are learned, old obsessions become less compulsive and can disappear altogether.
Whilst some people might only experience obsessions or compulsions, most people with OCD will experience both of these problems.
Here is a look at the signs of both:
- A fear of harming yourself or others.
- A fear of losing something that is important to you.
- A belief that everything must line up perfectly.
- A fear of germs or contamination.
- A fear of not having things you will need.
- Superstitions or strong beliefs that certain things are lucky or unlucky.
- Intrusive and violent or sexually explicit images and thoughts.
- A fear of contaminating others.
- Excessive thoughts about moral or religious ideas.
- A strong urge to arrange things in a certain way or order.
- Repeating certain words, tapping, or counting.
- Double checking things like switches, locks, and appliances to an excessive degree.
- Cleaning or washing things for a long period of time.
- Carrying out rituals or prayers in an excessive manner out of religious fear.
- Checking on loved ones repeatedly to ensure they are safe.
- Hoarding things that aren’t useful or needed.
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OCD is classified into three levels of severity:
- Mild OCD: When obsessive compulsive thinking and behaviour occupies less than one hour of your day
- Moderate OCD: When obsessive compulsive thinking and behaviour occupies two to three hours of your day
- Severe OCD: When obsessive compulsive thinking and behaviour occupies more than three hours of your day
- Performing acts that are not logically related to whatever problem they are being used to fix.
The following criteria is typically used to arrive at a diagnosis of OCD:
- The presence of obsessions, compulsions, or both issues.
- Obsessions and compulsions that consume a lot of time and interfere with your daily life, job, or social life.
- Persistent and recurrent impulses, thoughts, or images that are distressing.
- The inability to ignore these thoughts.
- The drive to suppress unwanted thoughts with compulsive behaviours.
- A strong urge to perform repetitive behaviours, such as counting or washing hands.
- Performing acts that are not logically related to whatever problem they are being used to fix.
If you are concerned you may have OCD and would like a formal diagnosis, your GP or a mental health professional can provide this. They will ask a series of questions based on the criteria above, to determine whether you are suffering from OCD and if so, to what level of severity.
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In addition to CBT are a few types of psychotherapy and counselling that can help people deal with obsessions and compulsions, as well as address the underlying causes of this condition.
Psychotherapy for OCD
Research has indicated that a purely insight orient psychotherapy approach such as psychodynamic or psychoanalytic psychotherapy shows little success in the treatment of OCD. However, an integrative psychotherapy approach to OCD, which includes elements of CBT, can be very effective in helping sufferers feel better and develop the ability to regain real control over their lives.
CBT does not explore how historic experiences can lead to the development of obsessive habit but instead focuses more on how to deal with the here and now stimuli. Whilst this is useful it can sometimes be limited in that it doesn’t always help people understand the whole picture of what they are dealing with. An integrative psychotherapy approach to OCD can fill this therapeutic gap. By providing insight into the root cause of obsessions, that are always unique to the individual sufferer, behaviour and thinking strategies for tackling the current obsession triggers can be finely tailored to produce more personally meaningful results. This can create the environment for new strategies to be embraced and applied more easily, since they are tailored to the individuals learning style, rather than the dictates of a specific therapy approach.
Counselling for OCD
These days, counselling for OCD is often a generic term used to refer to psychotherapy for OCD or CBT Therapy for obsessive compulsive disorder. Any counselling undertaken will be most effective if it includes elements of CBT Therapy. Like psychotherapy and CBT Therapy an effective course of OCD counselling typically entails a programme that helps you control your obsessions and curb the rituals that help feed the disorder. You and your counsellor will start to separate reality from anxiety and find ways to break the unhealthy cycle between unwanted thoughts and intrusive compulsions. It can also help you explore the underlying causes of your OCD to be sure everything is addressed, thus minimising the risk of future occurrences.
Group Therapy for OCD
Some individuals find that group therapy is a helpful way to combat the social isolation that OCD sufferers sometimes feel. It can also be a supportive place to open up to people who understand what you are going through and to share coping tactics.
Family Therapy for OCD
OCD can cause problems in a person’s family life and social interactions, which is why family therapy can sometimes help. This type of therapy can shed light on the condition so family members can be more understanding and help keep conflicts at bay. It can also show people ways to help their loved one.
Medication can be extremely useful during the early stages of psychotherapy and CBT treatment for OCD. When symptoms are very intrusive, medication can help reduce the intensity, thus enabling the individual to more easily engage in the therapeutic interventions and strategies than will enable them to regain control and feel better.
For those who do not find therapy effective, medication may help alleviate symptoms.
The most common medication prescribed for OCD is SSRIs (selective serotonin reuptake inhibitors). Some well know types of SRRI include:
- Citalopram (Cipramil)
- Escitalopram (Cipralex)
- Fluvoxamine (Luvox)
- Fluoxetine (Prozac)
- Paroxetine (Paxil)
- Sertraline (Zoloft)
Occasionally a non-selective serotonin reuptake inhibitor like clomipramine (Anafranil) might be used when SSRIs do not appear to help. However, it is not the first treatment of choice because it comes with more side effects.
Generally, it takes three to four weeks before you will notice any benefit from medication. Typically, it can take 12 to 16 weeks before the maximum effects can be adequately observed. On occasion, it is necessary to try a few different medications before finding one that works well for your symptoms. Sometimes a combination of medications can be the best solution.
UK mental health guidelines (NICE) recommend that if you find medication helpful you should keep taking it for 12 months to ensure symptoms continue to improve.
Whilst you can stop taking medication whenever you wish, it is always best, even if you are feeling better, to work together with your doctor to come off medication in a safe manner. Sudden, unsupervised changes in medication can lead to a re-experiencing of OCD symptoms and uncomfortable withdrawal-type symptoms.
Possible Medication Side Effects
Even though most doctors aim to find medication that will keep your symptoms under control, side effects are still possible. These might include:
- Sleep disturbances
- Stomach upset
- Decreased libido
- Suicidal thoughts
- Interactions with other medications or vitamins
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If you have OCD, there are several ways that you can help yourself in addition to seeking therapy.
OCD Self Help Tip 1:
Challenge Obsessive Thoughts and Compulsive Behaviours
When you feel yourself thinking obsessive thoughts and having compulsions, try to shift your focus to a different activity or thought. For example, try going for a walk, calling a friend, or picking up a good book. After a period of time has passed – say 15 minutes to a half an hour – reassess your urge. You will likely find that it has diminished.
Jot it Down
When you start to obsess, make a note of all your compulsions and thoughts. You can use a pen and paper diary or keep track of this on your computer or smartphone. Find the recording mode you like best. Try to record exactly what you are thinking. Keep going, even if it seems repetitive; in fact, it probably will be! The point is to see just how repetitive your obsessive thoughts actually are. Writing down these thoughts requires more work than thinking them, so it can help them disappear more quickly. In addition, writing the same thing over and over can help take away some of its power.
Stave Off Urges
If you know that your compulsive behaviour involves checking that your oven is turned off, try to do it with extra attention the first time, telling yourself out loud, “The oven is most definitely turned off.” If you obsess over checking that you locked the door, take a picture of your locked door with your smartphone as you head out to prove to yourself that you did it. When you get the urge to check these things again later, tell yourself you are simply having another obsessive thought and do not give in to it!
Set Aside Worry Time
Many people with OCD spend an extraordinary amount of time thinking about their worries. Some people find it very helpful to consolidate worry periods, so they can carry out their daily functions uninterrupted. Set a convenient time and place that will be devoted to worries and obsessive thoughts each day. For example, you might decide to have your worry time from 9:30-9:40 a.m. each morning in the dining room. When the time rolls around, head to the set place and let yourself think all of the negative thoughts that you want. When time is up, take a few deep breaths, let go of your thoughts, and go back to normal life. When these thoughts do start to enter your mind throughout the day, push them out of your head and tell yourself you will save it for the next worry period. If pushing them from your mind doesn’t work note down a quick bullet point heading for the work and save, knowing you can go over it the next time you are in your worry period. This can help prevent your brain from worrying that a worrying thought will not be dealt with.
Record Your Thoughts
Another technique is to record yourself discussing the obsessive story or phrase and then playing it back to yourself repeatedly for about 45 minutes each day until you no longer feel distressed by it. This continuous confrontation can help minimise the anxiety that the obsession induces.
Self Help for OCD Tip 2:
Adopt a Caring Approach Towards Yourself
Embracing a healthy lifestyle can help you to keep OCD-related fears and behaviours at bay.
Relax: Stressful events can trigger obsessive and compulsive behaviour, so try to practice some form of relaxation for at least half an hour per day. For some people meditation can be particularly helpful. Mindfulness meditation is a type of meditation that is increasingly popular and helpful with anxiety and depression symptoms. Other good choices could include having a long bath, doing some deep breathing or a short yoga practice.
Eat healthier: Be sure to eat breakfast every day. Try to eat small meals throughout the day to avoid the anxiety that can come from low blood sugar. Consume fruits, vegetables, and whole grains; these complex carbohydrates can keep blood sugar stable and boost your levels of soothing serotonin.
Get moving: You can refocus your mind when obsessions and compulsions crop up by exercising. At least half an hour of aerobic activity per day is ideal. This can help boost your energy, release feel-good endorphins, and relieve stress and tension.
Give up bad habits: Alcohol and nicotine might seem to temporarily make you feel better, but they can actually make you feel worse in the long run. Despite the initial feeling of reduced anxiety when you consume alcohol, when it wears off, it causes among other side effects, a big blood sugar drop which can make you feel even more anxious than before you started drinking. When you smoke it might initially feel calming but that fact is that nicotine is a strong stimulant that actually increases anxiety and OCD symptoms.
Sleep well: Not getting enough sleep can only amplify feelings of anxiety. It is much easier to keep your mood even when you’ve had enough sleep, so aim for at least eight hours per night.
OCD Self Help Tip 3:
Reach Out to Others for Support
Build a support system from friends and Family: OCD can be very isolating, which is why it is important to connect with other people. Talking about your fears can help them seem less upsetting, so have a network of friends and/or family who you can turn to for support.
Connect with a Support Group: Not everyone has friends or family who are available or able to support them with OCD. An OCD support group can provide you wish a space where you can share3 and get support from others who really know what it’s like and are also keen to feel better. Find out more about OCD support groups in the UK. http://www.ocdaction.org.uk/support-groups#zoom=6&lat=53.47602&lon=-2.31441&layers=BT
If you’re reading this guide because you want to help a loved one who is struggling with OCD, here are a few ways in which you can be supportive:
Don’t pressure him or her to stop performing rituals. People with OCD can’t simply stop their behaviour and the pressure will only make them feel worse.
Don’t play along with the rituals. While you can’t force a person to stop performing OCD rituals, you shouldn’t go along with them, either. This will only reinforce the behaviour. Support your loved one without supporting his or her rituals.
Be patient and positive. OCD can be difficult to overcome, so be patient while your loved one works through it. Don’t be hard on them when they give into rituals and be sure to praise them when they do manage to resist their urges. Avoid personal criticisms and focus on the positive.
Try to keep family life normal. Do your best not to let your loved one’s OCD affect the entire family, and try to create a stress-free place that won’t exacerbate OCD symptoms.
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