Non-Pharmacological Treatments (Cognitive-Behavioural Therapy)

Approaches to nonpharmacological treatments of patients with OCD include behavioral therapy that involves exposure to feared situations and the prevention of compulsive behavior and cognitive therapy in which maladaptive thoughts such as an exaggerated sense of risk, an enhanced sense of personal responsibility for events or excessive doubt are challenged. This last often is accompanied with family intervention. Cognitive-behavioral therapy (CBT) is considered the most effective. Several studies have  demonstrated the efficacy of CBT in OCD patients. The combination of CBT and pharmacotherapy is effective in reducing the symptoms of OCD, and may be superior to pharmacological or nonpharmacological therapy alone, especially in refractory cases where the patient is showing resistance of individual treatments.

CBT: Cognitive–behavioral therapy for obsessive–compulsive disorder

 Cognitive behavioral therapy has resulted in an OCD treatment protocol that is beneficial for individuals with this condition. Compared to traditional psychotherapy in which sessions are spent discussing the client’s problems, CBT treatment for OCD is shown to be more efficient. Both the client and the therapist take active roles in assessing the problem and in devising active steps towards alleviating the symptoms. In the UK, the National Institute for Health and Clinical Excellence’s guidelines on obsessive–compulsive disorder recommend cognitive–behavioral therapy, including exposure and response prevention, as an effective treatment for the disorder. A cognitive–behavioral model of OCD begins with the observation that intrusive thoughts, doubts or images are almost universal in the general population and their content is indistinguishable from that of clinical obsessions. An example is the urge to push someone onto a railway track. The difference between a normal intrusive thought and an obsessional thought lies both in the meaning that individuals with OCD attach to the occurrence or content of the intrusions and in their response to the thought or image. In CBT, a functional analysis is conducted and a hierarchy of the patient’s feared situations and thoughts is generated. Graded exposure follows, beginning with the stimuli that are the least anxiety-provoking, repeated self-exposure to feared stimuli will lead to extinction. Response prevention involves instructing the patient to resist the urge to carry out a particular compulsion and wait for the ensuing anxiety to subside.  Compulsions may be reduced gradually or patients instructed to delay their compulsive response for as long as possible. A patient unable to resist a compulsion to wash their hands would be asked to re-expose themselves to the feared stimuli – for example recontaminating themselves by touching a toilet seat and thus negating the effect of the compulsion.