OCD Therapy & How it Works

OCD Therapy 

OCD is fairly common, but often poorly understood. Did you know that in the course of 1 year,  1.2% of the U.S. population experiences clinical OCD? That’s the size of the population of Los  Angeles! And, there is a lifetime prevalence of 2.5%- that’s the size of the population of New York  City! But what exactly are we talking about here? 

What is OCD? 

OCD may have a reputation for causing someone to be overly clean or tidy, and people  commonly make jokes about it, saying things like, “Oh, she’s so OCD” in describing a person who is  fastidious. But OCD is NOT an adjective, it’s a serious disorder that causes a lot of suffering for those  

who have it. OCD stands for obsessive-compulsive disorder, and those who have it suffer from both  obsessions and compulsions. Let’s explain more what those terms mean: 

Obsessions are generally thoughts that just won’t go away, and are paired with disturbing  emotions, usually anxiety but sometimes emotions such as disgust. In fact, at one point OCD was  classed as an anxiety disorder. Some examples of what an obsession looks like internally: • “What if my thoughts will cause my loved ones to die?” 

• “What if germs make me sick or make me contagious to others?” 

• “What if that bump I just felt was a dog, and I ran it over?” 

• “What if I left the stove on and the house burns down?” 

• “What if I hurt a loved one because I had a thought about it?” 

These thoughts are very “sticky” and cause a great deal of distress. They lead to the second half of the  equation, known as compulsions.

Compulsions are repetitive behaviors or rituals that are aimed at making the obsessions and the  feelings that come with them go away. Compulsions aren’t always visible. Some happen internally, like mentally reviewing, repeating phrases, or trying to “solve” the thought. Some examples include: 

• Repeating “lucky” numbers or even prayers repeatedly inside your head to prevent a  loved one from dying 

• Washing hands repeatedly to “make sure” the germs are gone 

• Circling back around in your car to see if there are any injured animals, or replaying it  over and over in your head 

• Driving back to your house after you’ve already left for work to check the stove • Asking for constant reassurance from others that you are not capable of hurting someone you love 

The problem, is that while the compulsions may provide temporary relief, they actually reinforce the  obsession and cause them to come back stronger and more frequently, leading the sufferer to get stuck  in a loop, which causes great distress and takes time away from what they would actually like to be  doing. 

How do we treat OCD? 

Currently, the gold standard treatment for OCD and the one that has the strongest evidence-base is called Exposure and Response Prevention Therapy, otherwise known as ERP. ERP entails working  together with your therapist to make lists of obsessions and compulsions, and deliberately choosing an  item on the list (often starting with less scary obsessions) to practice exposure to. For example, if a  person has an unrealistic fear of germs, they may be asked to touch a doorknob and then not wash their  hands for 30 minutes. This can be done both in-session and at home for practice. They can then build to rubbing their hands on their face after touching the doorknob, and then not washing. It can be scary to  do this, but with the support of your therapist practice can lead inhibitory learning, where your brain 

learns that you are safe touching everyday objects. It is not enough to know intellectually that an  activity is safe; most people with OCD are aware that their fears are irrational. This is why behavioral  therapies involving exposure are important for helping your brain learn at a deeper level. 

ERP isn’t the only game in town, however. There are other therapeutic modalities that can be  used to enhance ERP, or to be used as second-line treatments. Most commonly, these include  mindfulness-based therapies such as Acceptance and Comittment Therapy (ACT) and Dialectical  Behvavioral Therapy (DBT). Mindfulness-based therapies can help you change the way you relate to  your thoughts and feelings in more helpful directions. They make it easier to cope with difficult  feelings. 

Finally, there is a newer modality called Inference-Based Cognitive Behavioral Therapy. It  involves learning a lot of new ways of thinking and sometimes works for people who have not done  well with other treatments. Because it is so new, you will have to look around to find somebody who is  trained in it. Clicking the link shown here will give you more information. 

Also, remember that therapy is one approach to treatment. Some people may also benefit from  medication. For OCD, selective serotonin reuptake inhibitors are helpful for many people. This class  includes medicines like Prozac, Zoloft, and Lexapro. You can ask your doctor more to discuss the risks  and benefits of medication. 

Kids Can Have OCD Too 

OCD often has it start in childhood and adolescence, but may go undiagnosed for many years.  In fact, about 8 out of 10 people who develop OCD will have done so by their 18th birthday. Sometimes it can be difficult to tell the difference between excessive worry/anxiety and OCD in children. They  may try to keep compulsions hidden out of embarassment. Addtionally, sometimes compulsions can  occur as excessive reassurance seeking which on the surface might just be seen as worrying. While it 

can be difficult to figure out if OCD is occuring, the sooner it is diagnosed and treated, the more likely  the treatment will be helpful. Note that some autistic behaviors such as stimming can be difficult to  discern from a behavior that functions as a compulsion. A mental health professional who is trained and education in OCD treatment and is neurodiversity-informed may be able shed some light on ambiguous behaviors. 

Authored by- Amanda Worley

References 

Craske, M.G., Treanor, M., Conway, C.C., Zbozinek, T., and Vervliet, B. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy, 58, 10-23. https://doi.org/10.1016/j.brat.2014.04.006 

Hale, L., Strauss, C., & Taylor, B.L. (2013). The effectiveness and acceptability of mindfulness based therapy for obsessive-compulsive disorder: A review of the literature. Mindfulness, 4, 375-382. DOI 10.1007/s12671-012-0137-y 

Inference-Based Cognitive Behavioral Therapy: A New Treatment Approach to OCD. (2026). Inference-Based Cognitive Behavioral Therapy. https://icbt.online 

International OCD Foundation. (2026). International OCD Foundation. https://iocdf.org/ 

Nazeer, A., Latif, F., Mondal, A., Azeem, M.W., & Greydanus, D.E. (2020). Obsessive-compulsive disorder in children and adolescents: epidemiology, diagnosis and management. Translational Pediatrics, Suppl 1, S76-S93. https://doi.org/10.21037/tp.2019.10.02

Tsao, S., DiChiara, C., & Murphy, S. Exposure and response prevention therapy for OCD [live online training]. Cognitive Behavioral Institute. https://www.cbicenterforeducation.com/