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Treatment of Obsessive Compulsive Disorder (OCD) with Cognitive Behavioral Therapy (CBT)

By: Thom Lucas, LCSW Ray of Hope Counseling Services. A review of an article by Allen Weg

When clients come to a cognitive behavioral therapist with an anxiety disorder, such as obsessive-compulsive disorder, the focus of the therapy is an intervention called “exposure and response prevention,” or ERP. It means just what it sounds like — a person repeatedly approaches or is “exposed to” the very thing that makes him or her anxious or uncomfortable, and then attempts to stop themselves from engaging in behaviors that are designed to lower that anxiety.

Cognitive behavioral therapy (CBT), in contrast to traditional “talk” therapy, is shorter in duration and focuses not so much on early life experiences or unconscious processes, but rather on “here and now” problems, and on the education and coaching of clients as they learn new ways to think and behave in order to solve those problems.

In OCD, obsessions, or anxiety-producing intrusive thoughts or images, are usually followed by compulsions, or behaviors that the person does on purpose to lower that anxiety. For instance, if an obsession takes the form of “that thing is dirty/contaminated” the compulsion would be to avoid touching that thing, or to wash excessively if you did touch it. ERP would then involve the person touching “contaminated” things on purpose, followed by specific efforts on the part of the person to NOT wash.

In ERP, with repeated and lengthy “exposure trials,” the person “learns” to let go of these fears through a process called “desensitization.” Essentially, after exposing themselves repeatedly to a feared thought, thing or situation over and over again, they get used to it, and it bothers them less and less over time.

OCD: Easy to Describe, Difficult to Understand
Storytelling and metaphor use is often the best way to present subtle and confusing ideas in a succinct and concrete way. It is a wonderful way to go beyond merely describing something or even explaining it. Narratives serve to illustrate not just an idea, but the very foundation of an idea. By hearing a story, the listener shares an experience with the narrator which enables him to understand what is being discussed in a way that mere description cannot accomplish. It is a way to get inside the mind of the narrator.

And so something beyond telling is required. Explanations don’t seem sufficient when you are being instructed to think and behave in a way that seems contradictory to your goals. It is often hard to “think outside the box,” to think nonlinearly.

In the arts, whether we are referring to dance, music, sculpture, painting, writing, poetry, theater, or film making, there are countless examples of an emotion, a struggle, or an experience of some kind, which is communicated indirectly and expressed through the artistic medium. This artistic representation, when done effectively, allows the audience to better understand what is being communicated than if the idea being presented was done so by mere instruction. And so it is with describing the diagnosis and the treatment of OCD.

Finding the Right Therapist Key to Successful Treatment of OCD
The good news is that help is available, and that we in the mental health field have gotten pretty good at helping most people with OCD to a significant degree. We don’t have what one would call a cure (yet), but rather we teach clients how to manage their OCD.

OCD and related anxiety are treatable and respond quickly to CBT which is a teaching type of therapy. You learn the skills in therapy and through homework assignments practice these skills in your everyday life.

If you suffer from anxiety or OCD contact a qualified CBT therapist, which are available at Ray of Hope Counseling Services.

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