The Effectiveness of Cognitive-Behavioral Therapy in Treating OCD

Exposure and response prevention is considered the first-line CBT therapy for those with OCD.

Editor’s note: This is the second of a two-part feature dealing with obsessive-compulsive disorder. The first part gave an extensive background on the disorder. 

Cognitive-behavioral therapies (CBT) use systematic strategies to implement change following the development of idiographic case formulations, and are based on cognitive and behavioral models of psychopathology.1

Although structured assessments are used to diagnose conditions, assess severity of illness, and guide treatment planning, CBT therapists largely rely on conducting analyses of specific episodes of distress or problematic thoughts and behaviors to help establish how symptoms and problem thoughts and behaviors are linked, to understand the function they serve for the individual, and to determine which symptoms, thoughts, and behaviors should become the primary targets of treatment.

Case conceptualizations are based on these functional chain analyses, and treatment strategies are systematically implemented to address targeted specific episodes of distress or problematic thoughts and behaviors as they and when they occur in the patient’s daily life. Global improvement in symptoms and functioning is seen as resulting from a process of generalization of multiple efforts at making such moment-to-moment changes. 

Cognitive Models and Treatment

Cognitive models propose that emotional disorders, including obsessive-compulsive disorder (OCD), are characterized by maladaptive cognitive styles.2 The most comprehensive cognitive model of OCD to date suggests that obsessional thoughts are normal, but that individuals with OCD experience secondary automatic thoughts that arouse anxiety and result in the performance of both passive and active (compulsive rituals) avoidance behaviors in order to alleviate anxiety.3,4

These automatic thoughts are hypothesized to represent dysfunctional assumptions and beliefs such as a sense of inflated responsibility for negative outcomes, an exaggerated sense of being vulnerable to harm, and an underestimation of their ability to cope with negative outcomes.

Individuals with OCD are consumed with doubt and uncertainty and find it difficult to endure their doubt and uncertainty. They tend to have magical thoughts, often fusing thoughts and actions, are extremely perfectionist and rigid in their thinking, place a high degree of overimportance on their thoughts, and attempt to have absolute control over their thoughts.5,1