Obsessive-Compulsive Disorder Therapies: Overview of Treatments and Approaches

Spend any amount of time on the internet and you’re likely to encounter the term “OCD” in reference to a wide variety of things. It’s understandable why some might be confused about what exactly obsessive-compulsive disorder is, why it is so frustrating for those who have it and what treatment options are available for it.

In some circles, OCD has become shorthand for wanting things neat and tidy or a tendency to like order in life. However, the clinical presentation of obsessive-compulsive disorder is much more pervasive and disruptive to the lives of those who live with it.

What Is Obsessive-Compulsive Disorder?

Obsessive-compulsive disorder consists of intrusive and unwanted thoughts, images, ideas or impulses that the person often knows are irrational yet cause anxiety anyway (obsessions), and the subsequent urge to perform some kind of response, such as a behavior or counter-thought to make them feel better (compulsions). These obsessions and compulsions take up a significant part of a person’s day and interfere with their ability to go about their lives.

Common Presentations of OCD

There are several common themes in the ways OCD may appear. Some may be concerned about the prospect of becoming sick and avoid touching things or surfaces, or go through extensive and unnecessary cleaning rituals to “feel clean” and safe.

Others might be frequently consumed with the idea that they have or have not done something that could cause a catastrophe, like leaving a gas stove on or leaving their front door unlocked. They then must check an unreasonable and excessive number of times to convince themselves they’ve avoided danger.

There are other types as well, including similar problems with a need for order or completeness or symmetry, and unacceptable thoughts about immoral, violent, and/or sexual acts.

Avoidance and Family Accommodation

Those with OCD also may spend a lot of their time avoiding situations that might trigger their obsessive thoughts. This would include avoiding surfaces that they believe are contaminated, avoiding driving for fear that they might have caused an accident without knowing it, staying at home to avoid having to go through extensive checking rituals.

Family members, often in an attempt to help, may assist those with OCD in their rituals or help them avoid triggers for their obsessions.

Awareness and Frustration

Many people who show symptoms of OCD recognize that this pattern of thoughts and behaviors are excessive and often irrational, which makes their struggle even more frustrating. However, there are treatment options for OCD that have been shown to be effective for many.

Obsessive-Compulsive Disorder Therapies

Cognitive-Behavioral Therapy (CBT) for OCD

Cognitive-behavior therapy or CBT offers us a way of understanding how those with OCD struggle to break their patterns. We start with the assumption that intrusive thoughts are normal and common.

While common, the vast majority of people don’t give much attention or assign meaning to them. There are many of us who may have intrusive thoughts about yelling at someone who cut us off in traffic, or that something bad might happen on some flight we’re about to go on, or reach for our hair when we hear of a lice outbreak. It happens to all of us!

Why Intrusive Thoughts Are Not the Problem

The intrusive thoughts themselves are not the problem, it’s what they mean to us and how we respond to them that make the difference. A person who believes they might have left the stove on, but then mentally retraces their steps and feels reasonably certain that they’ve turned it off, likely feels comfortable about going on with their day.

The person who must be certain they have turned off the stove and can only do so after excessive checking and re-checking, likely feels unbearably anxious.

Exposure and Response Prevention (ExRP)

A Helpful Analogy: Fear of Dogs

When describing exposure-based treatments to patients in my practice, I often use the analogy of a child who is afraid of dogs. How would you help a child get over their fear of dogs?

You might show them pictures of dogs and talk about how they would approach one. You could watch dogs at a dog park from a distance at first, gradually getting closer and closer over time. You could start with approaching a small dog and work your way up to larger dogs. This is an example of how exposure therapy generally works. The treatment for OCD shares many of the same philosophical approaches as this example.

The Cycle of Fear and Compulsion

When a person with OCD experiences a frightening and intrusive thought (“Hundreds of people touched that door handle, there’s germs all over it”), they believe that this thought:

1. a) is true,
2. b) represents a catastrophic threat to their safety, and
3. c) means that they must take action to prevent danger.

Engaging in a compulsion (e.g., excessive hand washing) prevents the person from recognizing that their feared outcome is unlikely (no sickness occurs) or uncomfortable but tolerable (they develop a mild cold a week later).

How ExRP Works in Practice

Exposure and response prevention (ExRP) uses CBT principles. Like with the fear of dogs example, the goal of treatment is exposure to the situations that trigger a person’s anxiety while preventing them from engaging in their compulsions.

This acts as a test of the assumption that catastrophic outcomes will happen if they do not take action.

In the above example, a person with OCD who fears contamination from surfaces might be asked to touch various surfaces during their therapy session and then refrain from handwashing. They would also be asked to monitor how their actual outcomes vary from their feared ones (e.g. no sickness developed despite the lack of handwashing vs. their fear that they will become incredibly ill if they don’t wash their hands).

The Process of Habituation

Over time, as patients are exposed to their feared situations and prevented from doing their compulsions, their fear tends to reduce—a process mental health professionals call habituation.

Those who have been through exposure therapy report that they may still experience intrusive thoughts, though the urge to engage in compulsions is lessened to the point where they can go about their day.

Imaginal Exposure (IE) Therapy

For some, the prospect of engaging in feared activities (e.g., touching ‘contaminated’ surfaces, or leaving the home after checking the front door once) is very distressing.  Imaginal exposure is an intervention that can be done to help patients reduce their fear before they tackle the “in-vivo” or live exposures.  A therapist may ask a patient to imagine themselves touching a pen that many others have used and then being unable to wash their hands.  The patients are asked to describe, in minute detail, what this experience may be like, including what thoughts they might experience, physiological changes that could occur, and feared outcomes that could develop. Over time, as the patient becomes more comfortable with these scenarios, they can progress to “in vivo” or live exposures.

This is an important OCD therapy technique used when real-life exposure isn’t possible or is too distressing. Including even a short section on this would deepen the understanding of ERP variations.

Obsessive-Compulsive Disorder: Holistic and Supportive Approaches

Since a portion of ExRP focuses on accepting intrusive thoughts and reducing the meaning assigned to them, some patients find other supportive approaches helpful in adapting this new mindset.  A common feature of mindfulness-based approaches is an acceptance of thoughts without judgment, which can be a useful skill to learn when receiving treatment for OCD.  Support groups can also be helpful in reducing the stigma associated with OCD and providing a sense of community and reducing isolation and shame some experience.

Holistic Therapy

The providers at Rittenhouse Psychiatric Associates treat OCD and other conditions with a holistic approach to therapy. While providers may have a focus on one or two types of therapy (such as Cognitive Behavioral Therapy for OCD) they will incorporate other therapeutic modalities into their treatment of obsessive compulsive disorder, and they will also include discussions about diet, exercise, meditation, relationships, work, school and other factors that may be affecting the person’s OCD symptoms, and their overall mental well-being. Our OCD specialists will also collaborate with a patient’s prescribing physician or nurse practitioner as well, if the person is also engaged in medication management.

Motivational Interviewing

While a number of patients who enter into treatment with a mental health professional are ready to take action to address their OCD symptoms, many others enter into treatment with reservations.  They may be concerned about what they will be asked to do, question whether therapy might work for them, or be worried about giving up their safety behaviors.  Mental Health professionals can use a conversational style called Motivational Interviewing to help patients resolve their ambivalence about their condition and help patients arrive at conclusions that align with the patients’ best interests.

Client-Centered Therapy

While ExRP and other CBT-based treatments do include the use of specific interventions and follow similar progressions, these evidence-based treatments can and should be modified to the person receiving them.  There is evidence suggesting that one of the most potent factors in predicting therapy success is the strength of a patient’s relationship with their provider.  Making sure patients feel understood and a measure of trust is developed with your provider is critically important for your success.  In this way, ExRP and other CBT interventions are not as much of a “paint-by-numbers” approach to treatment, but more client-centered in that fostering a strong working relationship is vitally important for effective interventions.

Additional OCD Resources and Support

Suicide & Crisis Lifeline

For those who are struggling not only with OCD but also with thoughts of self-harm or suicide, receiving immediate help and support is critical.  If you are having these thoughts, please dial 988 to access the National Lifeline.  Your call is free and confidential.  You can also go to your nearest emergency department if you are afraid you may harm yourself and want help.

OCD FAQs

1. What is the most effective therapy for treating OCD?

A: The most effective, evidence-based therapy for OCD is Exposure and Response Prevention (ERP), a form of cognitive-behavioral therapy (CBT). ERP involves gradually exposing individuals to feared thoughts, images, or situations that trigger obsessions, while helping them resist the urge to perform compulsions. Over time, this reduces the anxiety associated with the obsessions and weakens the compulsive behaviors. ERP is considered the gold standard in OCD treatment and is supported by extensive clinical research.

2. Can OCD be cured completely with therapy?

A: While OCD is typically considered a chronic condition, many people experience significant symptom relief and improved functioning with proper therapy, especially ERP. Though a complete “cure” is rare, therapy often leads to long-term management of symptoms. Some individuals may continue to have occasional intrusive thoughts, but they can learn to respond to them in healthier ways and prevent compulsions from dominating their lives.

3. What are some alternative or complementary therapies for OCD besides CBT?

A: In addition to CBT and ERP, other therapeutic approaches may be helpful depending on the individual’s needs. These include:

• Dialectical Behavior Therapy (DBT): Helps with emotional regulation and distress tolerance, useful for individuals with co-occurring emotional difficulties.
• Mindfulness-Based Therapy: Aims to increase awareness and acceptance of intrusive thoughts without reacting to them compulsively.
• Motivational Interviewing (MI): Helps individuals build motivation for change and commit to treatment.
• Medication: Often used in combination with therapy, SSRIs like fluoxetine and sertraline can reduce OCD symptoms.

4. How long does OCD therapy typically take to show results?

A: Therapy results can vary by individual, but many people begin to see noticeable improvement within 12-20 sessions of ERP, especially when therapy is consistent and includes between-session assignments. For more severe or complex cases, or when using intensive outpatient programs (IOPs), longer-term treatment may be required. Commitment, practice, and support all play crucial roles in how quickly someone progresses in OCD therapy.

Conclusion: Finding the Right Obsessive-Compulsive Disorder Therapies

Navigating obsessive-compulsive disorder therapies can feel overwhelming, but understanding the range of available treatment options is a crucial first step. From evidence-based approaches like Cognitive Behavioral Therapy and Exposure and Response Prevention, to emerging and holistic methods, there are effective tools to help individuals manage OCD symptoms and regain control of their lives. With the right support, education, and professional guidance, people living with OCD can find relief, resilience, and renewed hope on their path to recovery.

Let Rittenhouse Psychiatric Associates Listen and Help You

When we at Rittenhouse Psychiatric Associates identify as an academically minded practice, it’s because many of our providers are or have been faculty at local academic institutions who themselves have contributed to the body of literature we use to help our patients. It’s through this lens that I and others in our practice view the work that we do, which helps our patients feel better and improve their ability to function.

Schedule an appointment with Rittenhouse Psychiatric Associates today to begin your journey to better mental health.

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