Cognitive Behavior Therapy
Cognitive Behavior Therapy or CBT is a form of psychological treatment based on learning principles. This means it is a therapy based on experience. Most cognitive behavioral therapists would agree that homework or activities outside the session are essential for the progress in this form of therapy. This form of therapy has been shown to be effective with a wide variety of psychiatric problems.
CBT for OCD is based primarily on two principles: exposure & response prevention and cognitive therapy. These are based on both laboratory research and fairly extensive trials with adults and children that have demonstrated the efficacy of this form of therapy in changing behavior. Interestingly, it has also been demonstrated that the therapy has an effect on glucose metabolism in the brains of patients with OCD that is similar to the effects seen with serotonergic medications.
Exposure is an essential practice in CBT for OCD that most simply may be described as having the patient face their fear. This is an anxiety provoking activity for patients. Some clinicians find that intentionally increasing anxiety for a patient to be an unfamiliar activity, which may contribute to the scarcity of therapists who are able to conduct CBT. At the UFOCD Program our experienced psychology staff is trained in this form of therapy. In the clinical setting it has been demonstrated that exposure results in a habituation of anxiety, that is, through repeated trials of exposure to the feared stimuli, the patient with OCD has a decreased experience of anxiety. This is similar to "getting back on the horse after you've fallen off".
Response prevention, also called ritual prevention, follows exposure and involves the patient with OCD refraining from engaging in repetitive compulsive activities that consume time and interferes with their functioning. Often these repetitive rituals or compulsive activities function to ease anxiety. Again numerous studies have shown through response prevention or initially through partial response prevention, that patients may decrease and eventually eliminate these time consuming and interfering compulsive rituals that they engage in so often. Finally, cognitive exercises such as restructuring teach the patient to challenge anxiety provoking thought processes (related to obsessions) and the necessity of performing compulsive behaviors are included.
CBT for OCD is best conducted at the site of the patient's worse symptoms. Often this is described as in vivo. This is essential to exposure or facing the fear. It is important that, following treatment, patients with OCD be able to interact in the places in their daily lives that have previously been the sources of trouble or more often, which they had come to avoid. CBT for OCD often involves imaginal exposure as well, or facing fear situations through the imaginal exercises. However, most clinicians will agree that it is important that patients do face their worst symptoms at the site where they occur. This is helped by family awareness or participation in treatment. The support of a spouse of an adult patient, or with a parent for a child, or in some situations by an adult child for an older adult, is often considered essential. However, in other situations where family members are resistant and lacking insight regarding CBT, their participation may not be helpful and can sometimes be destructive.
Studies with CBT for OCD show a success rate of 60 to 85% in patients with behavioral rituals. For example a study in 2005 reported that after behavior therapy, 86% of adult OCD patients were significantly improved. In children, the results are quite similar. In fact, a 2007 study completed by our program found that about 85% of children were rated as significantly improved after CBT. The findings in these studies of CBT, as well as other outcome studies, suggest that observed results are maintained at follow up.