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OCD Treatment (ERP & CBT): Exposure & Cognitive Restructuring

OCD Treatment Building Blocks

The most effective treatment for OCD, exposure and response prevention (ERP), is built on a combination of cognitive and behavioral strategies.

Question: To what extent would a change of mindset (e.g., changing my expectations for myself) be helpful in recovering from OCD? What is likely to happen if I delay formal treatment with a psychologist and work instead on changing my own mindset?

OCD Treatment Components: Cognitive Restructuring + Exposures

Regardless of whether or not it occurs in the context of formal psychotherapy, changing your mindset will be a critical component of your recovery. If you do any reading on cognitive behavioral therapy (CBT), you’ll see this referred to as “cognitive restructuring.” Devoting time to challenging and modifying your underlying belief system is essential for fighting OCD, but research on OCD indicates that this process alone will probably be insufficient if it’s not integrated with appropriate exposure-based behavioral strategies (e.g., exposure and response prevention [ERP]).

OCD Treatment Delays

In general, I do not advocate treatment delays. As you get older, OCD tends to become more intractable and intertwined with who you are, making it more difficult to separate yourself from your OCD. Moreover, most people find that their rituals morph and expand over time, if left untreated. Nevertheless, everyone is different with their own unique biology and experience. There is certainly no guarantee that in your particular case, your OCD will get worse over time. However, the prevailing view is that earlier treatment is more effective and staves off later problems. This is why I recommend early treatment for kids, teens, and adolescents with cases of early onset (pediatric) OCD.

OCD Professional Treatment vs. Self-Help Strategies

The best thing you can do for yourself is to combine cognitive techniques (e.g., cognitive restructuring) with the behavioral components of exposure and response prevention (ERP). The basic principles of treatment will be the same whether you are tackling symptoms related to checking, potential danger/disaster, harm, repeating, washing/contamination, or another type of compulsive behavior. There are some good self-help books available to provide general guidance, but these resources typically are not a good substitute for individual therapy conducted by a trained psychologist. You will be most likely to progress quickly if you have an OCD specialist physically present to educate and guide you through early exposures.

For tips on completing ERP exposures, please refer to my earlier post on identifying and resisting subtle rituals, which will help you maximize your treatment gains.

Questions? Comments? Tips for challenging OCD-related cognitions? Share below.

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  1. Progress may be quicker with psychologist, but gains can be made even on your own. Certainly not easy, and it’s better to have someone supervising and reassuring you on the way, but like me, when you got job and there is no ocd specialist in 100 kilometers radius you gotta do what you gotta do 🙂

    • You’re right, Sebastian. Some people can do very well with self-help based strategies. And you’re not alone in your isolation–the distance issue is a huge obstacle for many individuals. Fortunately, remote therapy options like Skype or phone-based therapy can sometimes be helpful for meeting the needs of individuals who don’t have direct access to local therapists with specialty training.

  2. Hello Dr. Seay,

    My OCD is 24/7 without significant spikes in symptoms. I’ve used almost every modality without much success since I was diagnosed decades ago. I I have led two lives- one few people know about -OCD suffering and the other as an apparent success in my chosen fields of employment.

    My most troublesome symptom (I have every possible OCD symptom in varying degrees) is non-substance contamination. This involves waves of anxiety if I fail to perform any normal living behavior without the right accompanying thought, bodily function, clothing, environmental order and sequence, etc. being correct. All of my life activities are contingent on each other being near perfect in the above mentioned areas. If the objective conditions are not met, I must repeat them until it is “right” or I stop due to exhaustion. have never read in any OCD literature about my particular manifestation of OCD.

    My second most pernicious symptom is overwhelming guilt that some aspect of a normal business or personal financial transaction was erroneous. The anxiety escalates until I overpay the merchant, vendor, friend or acquaintance. I am a naturally generous person, but the sums of money I have expended to obtain some measure of relief is considerable. I have kept pages if “debts.” Many fade after time, but many remain for decades and new ones are created regularly as I live my life. For example, posting this would normally necessitate me asking repeatedly if there were any fee or charge for me to pay.

    This is no way to live. This is just my narrative and the first time I have ever posted it. Thank you for the opportunity.

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