Treat Obsessive Compulsive Disorder With Cognitive Behavioral Therapy

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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.

Because this is initially a very scary process, clients with OCD do these exposures as slowly or as fast as they feel they can handle, thereby allowing them to feel in control of the therapy. In addition, ERP is usually done one small step at a time, so that clients can "build up their strength" much like one would do by lifting weights, starting with lighter weights first and then "graduating" to heavier and heavier weights as they build their strength.

This metaphor of weight lifting is just one of the many stories that I use when conducting therapy. To help clients and their families understand ERP, which at first can sound very scary and quite strange, I use different stories to help them understand how this process works.

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.

OCD is relatively simple and easy to describe, but it is extremely difficult to fully understand. Once presented with information about this psychiatric disorder, we are left with the questions, "OK, I get what happens, but how can that be? How does that make sense? Why are people thinking and doing those crazy things?"

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