Cognitive behavioral therapy (CBT) and exposure and response prevention (ERP) are common therapies for obsessive compulsive disorder (OCD). They may help a person identify and challenge obsessive thoughts.
While ERP and CBT may help reduce OCD symptoms, these are not the only types of psychotherapy a person with the condition may find useful.
For example, if a person’s OCD began due to a traumatic event, trauma therapies such as eye movement desensitization and reprocessing (EMDR) may also be beneficial.
Keep reading to learn more about different types of psychotherapy for OCD and how to choose one.
CBT is an approach to therapy that addresses a person’s way of thinking and behaviors. Specifically, it looks at how thoughts affect emotions, which influence behavior.
In the context of OCD, CBT can help a person understand how obsessive thoughts can lead to compulsive actions. Through talking with a therapist and practicing CBT techniques at home, a person may learn to identify these thoughts and manage them in other ways, reducing checking behaviors.
Over time, a person may also learn to challenge these thoughts and the beliefs underlying them. For example, if a person often worries they have not locked their door, this may come from a belief they are unreliable or that they will be a target of crime. A therapist may help a person question if these beliefs are accurate or helpful.
Unlike some other forms of psychotherapy, CBT tends to focus on the present rather than the past.
ERP is a type of CBT that works by gradually exposing a person to something they are afraid of in manageable steps. This can undermine the fear and prove it is not a threat or that the person can handle it without carrying out compulsions.
This therapy does not force a person to face their fears before they feel ready. The person sets their own pace, starting with small steps and only moving onto the next stage when they feel confident.
If a person has too much anxiety to test real-world situations, a therapist might suggest imaginal exposure instead. This involves using visualization or pretend scenarios before moving on to real ones.
ERP is the psychotherapy of choice for OCD. Over time, an individual learns that nothing bad will happen if they do not perform their compulsive behaviors. This may lead to fewer and less intense compulsions.
Trauma therapy is an umbrella term for several types of therapy that specifically address the impact of traumatic events on mental health. It is potentially useful for people with OCD, as there is a significant relationship between this condition and traumatic experiences.
OCD is much more prevalent among those with post-traumatic stress disorder (PTSD) than the general population. PTSD is a condition that can develop as a result of any type of severe distress, leading to persistent anxiety and hypervigilance.
A person with PTSD may feel they are always on alert for danger. This can lead to symptoms such as:
- intrusive thoughts
- difficulty sleeping
- feeling “on edge” or easily startled
- flashbacks of the event
- difficulty remembering the event in detail
- avoiding any reminders of the event
- anger or irritability
- feelings of guilt or shame
Trauma therapies such as EDMR address traumatic memories, helping a person understand and process them. If a person’s OCD began as a way of coping with these memories, trauma therapies might help with both.
Learning coping mechanisms for trauma can also be important for undergoing ERP. Without having learned these skills, a person may find ERP too intense, as it may trigger traumatic memories.
Unlike some other types of therapy, EDMR does not involve focusing on traumatic memories for a long time, describing them in detail, or doing any additional therapy work at home.
Other types of psychotherapy for OCD include:
- Acceptance and commitment therapy (ACT): This form of CBT focuses on the way people respond to events. A 2021 review of 16 previous studies found that ACT in combination with medication may help with OCD.
- Dialectical behavior therapy: This a form of CBT that seeks to balance a person’s acceptance of themselves at the moment with intense efforts to decrease unhelpful behaviors. A 2016 study involving 30 participants with OCD indicated it may be an effective treatment.
- Psychodynamic therapy: This involves exploring an individual’s early life experiences and relationships to determine how they may be affecting present-day emotions and behavior.
Research from 2017exploring the effect of short-term psychodynamic therapy on OCD suggests it may offer benefits.
In looking for the most effective treatment, it helps to look at research findings and mental health organizations for direction.
However, while ERP has strong research behind it, research also supports the efficacy of other therapies. Although scientists have investigated some types of psychotherapy more than others, this does not necessarily mean other forms will not help.
Psychotherapy is individual, and it is important that people pursue what works best for them. This is true for both the type of therapy they use and the therapist they choose to work with.
It can be challenging to choose a type of therapy for OCD, as several have evidence for their effectiveness. It may help to consider:
- Aims: For example, if a person wants to focus on reducing compulsive behaviors that disrupt their life, they may wish to choose a type of CBT. If they want to address a traumatic event or series of events that may have caused their symptoms, trauma therapy or psychodynamic therapy may be more suitable.
- Location: Psychotherapy is available through in-person sessions and online. If a person wants to have in-person sessions, they may have more limited options based on the therapists in their area.
- Cost: Some therapists may charge more than others or recommend a longer course of treatment, which involves higher expenses.
- Availability: Some therapists may have appointment times that fit a person’s schedule, while others may not.
It may help to make a shortlist of options or ask for recommendations from a doctor. A person can then contact therapists. Some may offer free initial consultations, which can help with making a decision.
It is important to always make sure therapists have the correct licenses and accreditation to practice psychotherapy.
Psychotherapy for OCD can include exposure and response prevention or cognitive behavioral therapy (CBT). These therapies address the thoughts and behaviors involved in OCD, reducing obsessive thoughts and the urge to carry out compulsions.
Other types of therapy that may be helpful include trauma therapies, such as eye movement desensitization and reprocessing, or other types of CBT, such as acceptance and commitment therapy or dialectical behavior therapy. Another treatment option is psychodynamic therapy, a form of talk therapy that does not fall under the umbrella of CBT.
There are many options when it comes to psychotherapy. If a person does not find one type helpful, this does not mean therapy does not work for them. It may take a few attempts to find a type of therapy that fits with a person’s aims and needs.