What Therapy Works Best for OCD?

Struggling with OCD is difficult; you constantly feel like your worst nightmare is on the verge of coming true if you don't carry out your compulsions. You want relief, but maybe you're not sure what kind of therapy would be best. So, what therapy works best for OCD?

The good news is that OCD is well-researched mental health condition that has a few clear, "Gold Standard" treatments, meaning treatments that have been found to be highly effective above and beyond other types of treatment. Two of these treatments, or types of therapy, are Inference-Based Cognitive Behavioral Therapy (I-CBT) and Exposure and Response Prevention (ERP). Let's explore each of these types of therapy a little bit further.

I-CBT works by targeting a thinking pattern called Inferential Confusion. Essentially, Inferential Confusion leads us to over-rely on our imagination and all of the worst case scenarios we can create in our mind, rather than using context clues and real world information to assess a situation. For example, a person with OCD who is stuck in the Inferential Confusion thinking process might wrap up a play session with their pet cat and begin to worry that their cat ingested a piece of the toy and might end up with a blockage that could lead to complications or death, even with no evidence that this actually occurred. They may feel that they need to repeatedly check their cat's breathing or look in the litter box for evidence of the ingested piece of toy, even though the toy is totally intact and their cat is not acting out of the ordinary in any way. For a person without OCD or who is not stuck in Inferential Confusion, seeing the toy intact and their cat behaving normally would be enough real world data to make them not even register this fear as a possibility. For the person with OCD who is stuck in Inferential Confusion, anything that can be imagined is a risk that needs action, even without any real world data to support it as a possibility. Inferential Confusion, then, is what creates the defining feature of OCD: obsessional doubts.

I-CBT helps the person to recognize when they are falling into the trap of Inferential Confusion, and then focuses on changing this thinking pattern. Over the course of I-CBT therapy, the person learns to put greater emphasis on real-world data and address doubts or fears they may be holding onto about themself that contribute to their OCD. Because I-CBT addresses Inferential Confusion as the root of OCD, it sends the whole OCD cycle to a grinding halt. Research indicates that I-CBT is a great approach for older teens and adults alike.

ERP is also a highly effective therapy for OCD, but it works by a different pathway than I-CBT. ERP is focused on addressing the fears and compulsions present in OCD, and it accomplishes this through exposures. In ERP therapy, the person with OCD collaborates with their therapist to create an exposure ladder, or hierarchy. The lower rungs of the ladder elicit more mild fears, and the higher rungs create intense fear and anxiety. Exposures begin at the lower rungs, and the person and their therapist build up to the higher rungs. For example, if the person has fears of germ contamination, exposures could start as small as imagining touching a doorknob and waiting before washing their hands, and move toward actually touching doorknobs and other triggers while delaying or avoiding the compulsion of handwashing or sanitizing. The therapist helps the person going through ERP by guiding them through increasing their distress tolerance and finding non-compulsive ways to manage fear and anxiety. ERP therapy has been tested and found effective for kids, teens, and adults and is a good fit for many, especially those with clear compulsions.

My name is Gabby Collins, LCSW, and I am a licensed therapist in California specializing in OCD, anxiety, and eating disorders. I am trained in both I-CBT and ERP, I work with tweens, teens, and adults, and I see folks either in-person in Los Angeles or virtually throughout California. If you'd like to schedule a free consultation to learn more about working with me for the treatment of OCD, click the button below.

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