Cognitive Therapy and Obsessive Compulsive Disorder

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Cognitive Therapy as Treatment for Obsessive Compulsive Disorder

Using cognitive therapy for obsessive compulsive disorder (OCD) is perhaps the most effective treatment available. When dealing with OCD, or any type of anxiety disorder, cognitive therapy teaches the patient healthy and effective ways of dealing with certain stimuli that invoke anxiety. For the individual with OCD, this means responding to obsessive thoughts without resorting to compulsive behavior; in essence, the brain is retrained.

Exposure and Response Prevention

Part of cognitive therapy is exposing the patient to situations that cause them to react compulsively. This is called exposure and response prevention (ERP). Jeffrey Schwartz, a psychiatrist and author of Brains on Purpose, states that exposure helps “people with OCD learn—under the continuing guidance of a professional therapist—to expose themselves to stimuli that intensify their obsessive thoughts and compulsive urges and then learn how to resist responding to those thoughts and urges in a compulsive manner.”

An example of ERP would be having a patient who is a compulsive hand washer to touch something dirty without washing their hands afterward. At first, the patient will experience anxiety over not carrying out their ritual; in time though, they will be reconditioned and not feel the need to engage in such compulsive behavior. This technique can be very difficult to process at first, but it is key to overcoming the obsessive behaviors.

Schwartz' Four Steps

Schwartz lays down four steps in using cognitive therapy for obsessive compulsive disorder. These are:

  • Relabel: Recognize that the intrusive obsessive thoughts and urges are the result of OCD.
  • Reattribute: Realize that the intensity and intrusiveness of the thought or urge is caused by OCD; it is probably related to a biochemical imbalance in the brain.
  • Refocus: Work around the OCD thoughts by focusing your attention on something else, at least for a few minutes. Do another behavior.
  • Revalue: Do not take the OCD thought at face value. It is not significant in itself.

Cognitive Therapy and Obsessive Compulsive Disorder: The Role of the Patient

Numerous studies have shown cognitive therapy to be extremely beneficial. However, in order for a successful outcome, “it is essential that the client accept the responsibility to participate willingly in his or her own therapy” (Phillipson, 2010). Part of this process is teaching the patient to recognize that their obsessive thoughts are irrational and that no harm will come from not indulging in the compulsion to act on those thoughts.

Schwartz, whom also has OCD, says that “by understanding this process by which we empower ourselves to fight OCD and by clearly appreciating the control one gains by training the mind to overcome compulsive or automatic responses to intrusive thoughts or feelings, we gain a deepening insight into how to take back our lives. Changing our brain chemistry is a happy consequence of this life-affirming action. True freedom lies along this path of a clarified perception of genuine self-interest.”


Phillipson, S. (2010). A prelude to cognitive-behavioral techniques for the treatment of OCD. Retrieved November 24, 2010, from

Schwartz, J. (2010). Dr. Jeffrey Schwartz’ four steps. Retrieved November 24, from