Trying to find a therapist for OCD feels a bit like strolling down the supplements aisle. Probably all of them are good for you, but which is the right one to target your exact problem? Likewise, how can you choose the right kind of therapy for OCD? In this brief article, we’ll check out the main treatment options available for obsessive-compulsive disorder.
The Worst Kind of Therapy for OCD
Here’s a funny story. Before I was diagnosed with OCD, I worked with a counselor to deal with some of the negative thoughts that were fueling my depression. She prescribed cognitive behavioral therapy (CBT), and proceeded to laud its far-reaching benefits and its near-universal application.
“I prescribe this kind of therapy for everyone,” she gushed. “Literally everyone – except people with OCD, because it can backfire on them.”
Famous last words.
CBT is a broad umbrella term for many cognitive and behavioral tools–but what she meant (and what we proceeded to do together) leaned heavily on talk therapy, cognitive restructuring, thought challenging, and examining the evidence for or against my specific fears.
If you have OCD, you can already imagine why that backfired!
I was obsessively faithful about doing my therapy homework, but after a few months I realized I had gone from having moderate depression to having severe depression. My mind, reeling for an answer (us OCD people are always looking for answers) remembered my counselor’s statement.
I’m glad she said it. It was the only reason I ever looked up OCD to find out more. This CBT stuff is backfiring, I thought. She said this method only backfires on people with OCD. Could I have that?
Like most of the general population, I had a very ignorant understanding of what OCD is – I thought it was just for those people who wash their hands a lot and like to sort their socks by color.
I’ve learned a lot since my diagnosis and subsequent treatment. If you’re looking to begin therapy for your OCD, I applaud your decision. Just make sure you start the right kind of therapy! Below I’ve created a chart that will hopefully give you some tips for choosing a method that will be most helpful to your situation — I’ve also included some unusual and extreme treatment options that you might find outlandish, but it’s a broad guide to let you know what’s available!
6 Treatment Options for OCD
| Therapy Type | Synopsis | Good For: |
| Traditional Talk-Based CBT or Cognitive Restructuring | A broad umbrella term for various cognitive and behavioral tools. Often involves inward reflection on emotional states and intentionally searching for what thought pattern or “misbelief” lies at the core of negative emotions, then actively challenging it. | Highly effective for depression; can be somewhat helpful for OCD but be extremely cautious, as it can backfire and cause excessive rumination. |
| Inference-Based Cognitive Behavioral Therapy (I-CBT) | A newer, evidence-based CBT approach developed specifically for use with OCD. It helps people recognize and correct the faulty reasoning that turns imagined possibilities into obsessional doubt, allowing them to trust present reality rather than perform compulsions. | Everyone with OCD. |
| ACT (Acceptance-Commitment Therapy) | Involves identifying triggers that cause you anxiety, accepting that you cannot always resolve these disturbing thoughts, and –together with your therapist — committing yourself to acting on present realities and your deepest values rather than feared potentialities. Most often viewed as a companion to I-CBT and/or ERP. | Everyone with OCD, but especially those on the obsessive end of the spectrum, such as HOCD, ROCD, Scrupulosity, and Pure-O. |
| Exposure and Response Prevention Therapy (ERP) | Involves intentionally exposing self to the anxiety source (at once or in incremental stages, in real life or in imagination) to desensitize the mind to the feared stimulus. As exposure occurs, the individual is encouraged to resist escaping it and to resist attempting to “solve” or negate the problem with compulsive behavior. | First-line response for all types of OCD. Considered the “gold standard” approach. |
| Medication | Typically, SSRI’s are prescribed for individuals with obsessive-compulsive disorder. | Varies. Some individuals improve with medication while others do not. Often involves trialing different medications and dosages to find one that works well. |
| Psychosurgery | Several forms of last-resort intervention involving brain surgery. May involve drilling into the brain and burning away specific tissue with a heated probe, or sending concentrated gamma waves through the skull to destroy a certain area of brain tissue. Such surgeries are said to give relief to 50-60% of patients. | Possibly helpful for OCD patients with very severe symptoms who are unresponsive to either medication or any of the various kinds of psychotherapy. |
| Deep Brain Stimulation (DBS) | Involves opening the skull, but does not destroy any brain tissue. Instead, electrodes are inserted (similar to a pacemaker) that send electrical impulses to the brain. It appears to work in part by making previously impossible ERP more achievable. | Possibly helpful for OCD patients with very severe symptoms who are unresponsive to either medication or any of the various kinds of psychotherapy. |
| Transcranial Magnetic Stimulation (TMS) | A noninvasive treatment that uses repeated magnetic pulses to stimulate brain circuits involved in OCD. It iss typically used alongside therapy or medication when standard treatments have not provided enough relief. | Possibly helpful for OCD patients with very severe symptoms who are unresponsive to either medication or any of the various kinds of psychotherapy. |
| Residential Treatment | Intensive outpatient or residential programs are also available for more targeted care. | Those with moderate to severe OCD that is not responding to weekly therapy sessions. |
How to Choose the Right Kind of Therapy for OCD: Thoughts on Thought-Stopping
You may have noticed that I did not include “thought stopping” in my list. Why not?
Again, I digress for a story.
I tried out a counselor once at the beginning of my treatment and informed her right away that I had been diagnosed with OCD and did not wish to follow traditional talk therapy. She smiled, nodded, and wrote down a few notes on her pad. When I began describing my symptoms, she stuck her pen behind her ear and said, “what we’re going to learn together is how to do thought-stopping.”
I was like, wait — what? SERIOUSLY?
How did all these therapists get degrees and still give bad advice to people with OCD?
Thought-stopping was a popular treatment for OCD several decades ago. Supposedly you would even get a rubber band around your wrist and you were supposed to snap yourself whenever you started having intrusive thoughts or rumination. But the thought-stopping crusade was an epic fail in the OCD world, as it usually made patients worse, not better. As Dr. Fred Penzel says,
“Although you can resist performing a compulsion, you cannot refuse to think an obsessive thought.”
Dr. Fred Penzel
How terrible to be told to do something that isn’t possible, then feel like your failure is your own fault!
If your therapist attempts to take you down the “thought-stopping” trail, stop right there. You probably don’t have a therapist who is as up-to-date in psychology as he or she should be.
Conclusion
This is my quick pit-stop compilation of the main interventions used to treat OCD. So how can you choose the right kind of therapy for OCD?
Start by looking for a clinician who understands OCD specifically, not merely someone who treats anxiety in general. Ask what methods they use and listen for approaches such as ERP, I-CBT, and ACT. A knowledgeable therapist should understand the difference between helping you challenge an unhealthy pattern and accidentally joining you in an endless investigation of whether your obsession might be true.
The right treatment will not teach you to suppress intrusive thoughts, achieve perfect certainty, or reason your way out of every fear. Instead, it will help you recognize OCD’s patterns, step out of compulsive responses, tolerate what cannot be resolved, and return your attention to the life and values that matter to you.
Medication or more intensive treatment may also be appropriate, depending on the severity of your symptoms. But wherever you begin, remember: therapy should not make you increasingly dependent on reassurance or more entangled in your thoughts. Good OCD treatment helps you become freer to let the thoughts exist without allowing them to run your life.
Best wishes on the journey,
Medically reviewed by Samantha Bray, LCSW. Find her at www.ocdinsights.com.
Hello Jamie,
Thank you for the wonderful insight you have provided on this topic. I am curious to know more about what God’s word says about modern science /medicine. Could you provide those biblical references you mentioned? Thank you!
Thank you so much for posting this! Therapy can be overwhelming and so it’s so helpful to have someone who has lived with this condition for a long time and knows what can be unhelpful. I’m glad you pointed out that CBT can cause excessive rumination in people who are very obsessive. I definitely lean more on the obsessive side of Scrupulosity. And I would often try to get to the bottom of a thought or feeling and sometimes it would help but other times it would cause me to go on a spiral for hours as I make epic mind maps trying to figure it out. I’m definitely going to look into the ones you suggested. Again thank you so much. You are like a spiritual brain surgeon! Partnering with God to truly save lives. If you ever doubt your purpose or calling just remember that. But also like no pressure! 😅 God works together all things for the good of those who love Him and are called according to His purpose. So no matter what happens He can turn it around for good.
“Spiritual brain surgeon,” lol I like that! When I was a kid I read the book by Ben Carson about how he went from being a poor inner city kid to being a world famous brain surgeon, and he inspired me to want to be a brain surgeon and save people’s lives. For a long time if you asked me what I wanted to be when I grew up, I would have told you that. But, I never ended up being very good at math and science, so I didn’t pursue medicine. I totally love the metaphor you’ve used; it’s very meaningful to me! Thank you, you made my day! :)
Jaimie