Although Cognitive Behavioral Therapy (CBT) is a widely known and used effective treatment for mental health conditions such as depression and anxiety, when it comes to Obsessive Compulsive Disorder (OCD) traditional CBT might not be the best or most sufficient form of treatment.
OCD is a complex and often debilitating condition driven by a cycle of obsessions and compulsions that can be incredibly persistent and distressing. Obsessions which can also show up as intrusive thoughts usually cause incredible discomfort and feelings such as fear, disgust, shame, embarrassment, guilt, anxiety or “things just not feeling right, or right enough” resulting in repetitive behaviors or mental acts (compulsions) as means to decrease the discomfort caused by obsessions; thus, the cycle will go on and on.
Traditional CBT focuses on changing thoughts and thought patterns, but when it comes to rumination and mental OCD this is where we can get into trouble. In OCD these thoughts are often so deeply entrenched and emotionally charged that merely disrupting them isn’t enough. Furthermore, at times individuals have gotten really good/skilled at negating their obsessive thoughts by finding evidences against it (which is one of the skills taught in CBT); but this within itself can at times contribute to the mental rumination as it provides one with mental reassurance as a compulsive response (note that behaviors such as avoidance and reassurance seeking, including mentally can be a form of compulsion).
Traditional CBT’s heavy reliance on cognitive restructuring might work well for general anxiety and depression, but OCD thoughts are often not easily dismissed by logic alone. People with OCD may intellectually recognize their fears as irrational, but the emotional impact of these fears remains powerful, which makes things that much more overwhelming, resulting in feelings such as shame and embarrassment.
Traditional CBT may focus too much on altering thoughts and not enough on addressing compulsions directly, which are a significant part of OCD that required treatment. Thus, one of the most effective components of therapy for OCD is ERP.
Exposure Response Prevention (ERP) involves finding the source of ones anxiety provoking obsessions and preventing one from engaging in the usual compulsive response (which traditional CBT often does not include). This is done in a collaborative, curious, yet supportive and planned way with your psychotherapist, where consistency is a key factor.
Intolerance for uncertainty and the unknown: where the need to know can lead to compulsions such as researching, asking too many questions (resulting in coming across as being interrogative at times) are some other common symptoms of OCD. Traditional OCD may not adequately address the need to build tolerance for uncertainty (which can result in a lot of doubt for one). ERP, on the other hand, directly confronts uncertainty by encouraging individuals to face their fears without resorting to compulsive behavior or mental action.
Conclusion: while traditional CBT is a powerful tool for many other mental health conditions, its limitations in treating OCD highlights the need for specialized approaches such as ERP and ACT (Acceptance and Commitment Therapy). As these modalities help one directly target the compulsions and teaches them to tolerate the discomfort and uncertainty. You do not have to do it alone, the “togetherness” offered via the support of our empathic and experienced psychotherapists at Unitive Wellness Clinic, as well as the guidance provided in facing OCD can be an empowering and effective tool in overcoming OCD!
