"Obsessions are unwelcome and distressing ideas, thoughts, images or impulses that repeatedly enter your mind. Compulsions, are behaviours or acts that you feel driven to perform although you may recognise them as senseless or excessive” (Goodman et al, 1989).
In OCD, compulsive behaviours will reduce the anxiety associated with experiencing obsessional thoughts. Anxiety is managed by avoiding situations related to the obsessional thoughts and seeking reassurance from other people that the feared outcome will not occur.
Obsessive and intrusive thoughts, mental images, or urges can occur repeatedly and can trigger symptoms related to anxiety. Some obsessive thoughts include:
Fear of contamination or germs.
Repetitive thoughts about religion, or sex.
Aggressive thoughts towards self or other people.
Fear that will be responsible for something terrible happening.
Compulsions are repetitive behaviours that act on obsessive thoughts. Some compulsions include:
Excessive hand washing or cleaning.
Arranging items in a precise order.
Repetitive checking behaviours (e.g. repeatedly checking door is locked).
Not all habits or rituals are compulsions. However, people experiencing OCD may generally spend more than an hour every day on intrusive thoughts and behaviours. Cognitive Behavioural Therapy (CBT) with exposure and response prevention (ERP) is the recommended treatment plan for OCD. It involves the following:
Working with a therapist to assess thoughts, feelings, and behaviours.
Developing a formulation to explain ongoing difficulties with cognitive and behavioural components including maladaptive appraisals of intrusive thoughts, dysfunctional beliefs about rituals, avoidance and reassurance seeking.
Creating an intervention plan based on cognitive behavioural framework using the principles of exposure and response prevention (ERP).
In session, the therapist will help the client normalise thoughts and feelings. This can help to reduce anxiety and improve the clients ability to cope with intrusive thoughts. To assist with this improvement, the therapist might use interventions such as, cognitive techniques to challenge distorted beliefs.
Behavioural techniques might be used by the therapist during sessions to reduce the validity of intrusive cognitive beliefs. To assist with this, an exposure hierarchy might be developed to identify feared situations. Verbal techniques can also be used to challenge beliefs that an intrusive thought will lead to a feared outcome.
The therapist might ask for the client to complete work at home, such as thought records, which will then be reviewed in session. This work will help to make connections between thoughts, feelings and behaviours.
For more information about attending therapy sessions for OCD, please contact Belfast Psychology Services at firstname.lastname@example.org.