Treatments for OCD and Anxiety

David W. Anderson, MS, LCPC, RPT-5, Wichita OCD Center’s founder, provides a number of treatments that have shown to be effective for OCD, anxiety and Tourette Syndrome. Appointments are available both in-person and via telehealth.

What is CBT?

Cognitive Behavioral Therapy (CBT) is a type of psychological treatment that helps people learn how to first identify and then change thought patterns that are having a negative impact on their emotions and behavior. This process is called cognitive reconstructing. CBT is a short-term, problem-focused treatment option.

Benefits of CBT include developing an awareness of negative, unrealistic thoughts that impact mood and feelings, and then using healthier thought patterns. CBT is an effective option for both in person and teletherapy treatment and it’s a relatively affordable type of therapy.

Research suggests that CBT can be as effective as psychiatric medications or other forms of psychological therapy, if not more so.

When CBT Is Used

Cognitive Behavioral Therapy has shown to be an effective treatment for a range of mental health conditions and life stresses, including:

• OCD

• Anxiety disorders

• Depression

• Phobias

• Panic attacks

• PTSD

• Anger issues

• Bipolar disorder

• Disordered eating

• Personality disorders

• Alcohol and drug addiction

• Stress management

• Grief and loss

• Divorce and relationship issues

• Insomnia

• Chronic pain or illness

• Low self-esteem

What to Expect

Treatment involves exercises to be completed in the session and at home to change behavior and thought patterns. An individual treatment plan is developed based on a person’s specific triggers, themes and core fears. CBT techniques and strategies may include:

• Relaxation

• Journaling

• Mindfulness

• Meditation

• Role-playing exercises

• Exercises to challenge beliefs

How CBT Works

The basic premise of CBT is that a person’s thoughts or feelings about situations influence how they behave. Treatment is based on the idea that negative thoughts, behaviors and emotions are based in part on learned behavior patterns and thought errors that can be changed through:

• Identifying and challenging negative thoughts

• Learning how to face fears

• Developing self-confidence

• Recognizing distorted thinking

• Replacing negative thoughts with objective, realistic ones

• Understanding the reasons behind other people’s behavior

• Developing skills to cope with difficult situations

Ultimately, the goal is to develop a more healthy and realistic relationship with our thoughts and feelings. This allows a person to learn to control the way they interpret and respond to events rather than reacting.

What is ACT?

Acceptance and Commitment Therapy is related to CBT in that it’s an action-oriented form of psychotherapy. ACT helps individuals learn to accept their thoughts and feelings about difficult situations and then commit to making behavior changes in spite of these thoughts or emotions.

When ACT is Used

ACT is often used effectively as a treatment for obsessive-compulsive disorder, depression, social anxiety disorder and psychosis. It’s also a helpful therapeutic method for individuals dealing with social anxiety, test anxiety and workplace stress. Those with medical conditions such as diabetes, chronic pain and substance abuse can also benefit from ACT.

What to Expect

ACT treatment involves listening to the things you say to yourself, particularly about negative experiences or issues such as troubled relationships, traumatic experiences or physical ailments. Then, your therapist will guide you through the process of increasing cognitive flexibility. Dr. Steven Hayes, one of the founding contributors to ACT, calls this “putting your mind on a leash”.

How ACT Works

The guiding principle behind ACT is that suppressing negative feelings, emotions or experiences will actually create further discomfort. Instead, ACT presents strategies such as mindfulness, commitment to action and paying attention to personal values. Through these techniques, individuals can learn to change their emotional state by changing their relationship with their mind, changing their behavior and accepting their experiences.

What is CBIT?

Comprehensive Behavioral Intervention for Tics is a non-pharmacological treatment for Tourette Syndrome (TS) developed in the early 2000s. It’s a behavioral therapy that helps both children and adults make behavior changes and learn to tic less.

When CBIT is Used

The American Academy of Neurology recommends CBIT as the first line of treatment for TS.

What to Expect

Treatment includes working with a therapist and at home. CBIT sessions involve observing situations in which tics are better or worse, learning how to recognize the steps of an urge or tic, discussing steps for resisting the urge to tic, and practicing a competing response to the tic. While it won’t cure TS, CBIT has been shown to improve tic management and quality of life.

How CBIT Works

CBIT consists of three strategies for managing tics:

1. Developing an awareness of tics and recognizing the urge to tic.

2. Learning competing behaviors that can be done when there’s an urge to tic.

3. Changing situations and daily activities in order to help reduce tics.

What is ERP?

Exposure and Response Prevention (ERP) is the most established and proven tool that we have for treating OCD. Treatment involves being exposed to things that cause feelings of anxiety or obsession (exposure) and then choosing not to perform a compulsive behavior after being “triggered” (response prevention).

When ERP is Used

In multiple clinical trials, ERP has proven to be as effective as psychiatric treatment with medication and without any side-effects, establishing ERP as the first-line treatment for OCD and OC-related disorders.

What to Expect

Rather than confronting on your own the objects, images, situations and thoughts that make you feel anxious, you and your therapist will collaborate to create gradual exposures and response prevention for your OCD triggers. Your therapist will help you learn and practice ERP during sessions so that you can then take ERP home. Treatment ends when either OCD symptoms are gone or you have learned to do ERP so well that you will be able to develop and design your own exposures and response preventions with possible intermittent booster sessions with your therapist.

How ERP Works

ERP’s effectiveness comes from the commitment to avoid giving into the compulsive behavior when confronting one’s obsessions or anxiety. Over time, a person learns that the obsessional fears are not as severe or as likely as predicted and that safety can be achieved without compulsive rituals. This method of being exposed and then preventing a compulsive response can naturally cause a decline in anxiety through a process called “habituation”.

Inhibitory Learning Model

What is Inhibitory Learning?

The inhibitory learning model takes ERP a step further to help people learn safety in relation to their obsessional fears, to the point that the safety learning begins to hold its own in the face of fear learning that may continue to persist. We know that fear learning and safety learning occur in different parts of the brain so safety learning doesn’t and can’t replace fear learning. The goal is to repeat the safety learning over and over again until it becomes the dominant response to the trigger.

When Inhibitory Learning Is Used

ERP doesn’t necessarily erase or help people unlearn their obsessional fears; while better responses than compulsive rituals may be learned, the fear is still there. Inhibitory learning is used to help people learn new safety information about their feared stimulus and eventually overcome the obsessional fear permanently.

What to Expect

Inhibitory learning treatment is similar to ERP but with more challenging exposure exercises. The response practices are geared toward improving OCD symptoms over the long term, and eventual fear extinction. The goal is to help the safety information make a deeper impression than the fear information of a stimulus.

How Inhibitory Learning Works

There are several different inhibitory learning strategies:

Focusing on anxiety tolerance – Inhibitory learning is based on developing the knowledge that the feared stimuli are actually safe. This strategy helps people learn that the feelings and emotions triggered by the stimuli are also safe. Fear, anxiety, disgust and guilt are all hallmarks of OCD, and although they may be upsetting and intense, this approach teaches people that the thoughts and emotions themselves are not harmful and can be tolerated.

Disconfirming expectations – It’s common for people with OCD to predict negative outcomes. This could be anything from causing harm to being unable to tolerate uncertainty and anxiety. In these cases, the inhibitory learning model is used to design an ERP exercises that disproves the prediction. Every exposure practice is focused on whether or not the predicted negative outcome occurred. The ERP session ends when the expectations are disconfirmed rather than when anxiety is lessened.

Surprise – Research has shown that when a person is surprised by the outcome of an exposure session, it makes a strong impression. ERP exercises can be designed in such a way that the person is happily surprised that the feared outcome didn’t happen. This usually involves exposure to feared situations that are more intense, longer or more frequent that the person deems safe or manageable. However, the learned safety from this approach is strong and can inhibit obsessional fear.

Variety – For the best fear extinction results, safety learning should happen in a variety of situations because what’s learned in one context may not be remembered in another. Therefore, exposure practices are designed with varied locations, stimuli, contexts and emotional states.

Combining fear cues – Using multiple fear cues in one exposure session is another effective way to create learned safety. When a feared outcome doesn’t happen even though several fear cues are present, it creates a strong response that helps inhibit obsessional fear.