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4 therapy techniques for clients with OCD

These techniques are commonly used to help treat symptoms of obsessive-compulsive disorder.

Only about 2 percent of U.S. adults have experienced obsessive-compulsive disorder (OCD) in their lifetimes, meaning most therapists encounter this condition far less frequently than they do issues like generalized anxiety and depression. With some practice and education, though, therapists can learn to care for clients living with OCD. Here’s where to begin.

What is obsessive-compulsive disorder?

According to the DSM-5, a patient meets diagnostic criteria for OCD if they experience obsessions, compulsions, or both. Most people with OCD experience both. 

Obsessions include recurrent and persistent thoughts, urges, or mental images that are difficult to suppress and usually cause anxiety or distress. Common examples include fears of contamination or accidentally harming others, such as by forgetting to turn off the stove and causing a fire. 


People with OCD typically use compulsive behaviors to manage obsessions and reduce anxiety associated with them — even when there’s no logical link between the behavior and the thought. Counting, ordering, hand-washing, and checking (such as to make sure the door is locked or the stove is off) are common compulsions. People with OCD can spend large amounts of time completing their compulsive actions, to the detriment of their work, relationships, and personal lives.

To treat OCD effectively, a therapist must address both thoughts and actions. Typically, a therapist aims to help their client confront triggers that spark obsessive thoughts and cope with those thoughts without resorting to compulsive behaviors.

Therapy techniques for OCD

Every client is unique, and treatment is never one-size-fits-all. But the following techniques are commonly used to treat symptoms of OCD.

Cognitive behavioral therapy (CBT)

Most therapists are familiar with cognitive behavioral therapy (CBT), which hinges on helping clients recognize and correct maladaptive thought patterns. In the context of OCD, CBT is typically used to help clients notice when they are experiencing an intrusive or obsessive thought and break the cycle of reacting with compulsive behavior. Instead of turning the car around to go home and make sure the door is locked, for example, the client might learn to remind themselves that they locked the door when they left.

Exposure and response prevention (ERP)

Exposure and response prevention (ERP), a subtype of CBT, is considered a gold-standard treatment for OCD. It involves gradually exposing a client to situations that trigger their obsessions, without immediately falling back on compulsions to manage the resulting anxiety. As clients get used to facing their fears, they learn to cope with their stressors in healthier ways, ideally until distress associated with those triggers fades away.

Typically, the therapist starts with relatively minor stressors before working up to bigger ones. If a client is afraid of germs, perhaps their therapist would start by asking them to touch a public door knob without immediately washing their hands afterward. Over time, they could work up to more taxing situations, like holding a pole on the subway.

Imaginal exposure

Imaginal exposure is essentially ERP that happens within a client’s own mind. Instead of helping a client face their fears in the real world, their therapist would help them imagine how brushes with an anxiety trigger would look. The goal is the same: helping the client practice facing their stressors so they lose power. 

Imaginal exposure can be a more comfortable first step for clients who are nervous to try full-on ERP, or an effective alternative for people whose triggers cannot be easily encountered or simulated in real life. This technique can also work well for clients who experience only obsessions, without accompanying compulsions.

Acceptance and commitment therapy (ACT)

ACT’s central goal is to help clients make peace with their obsessions and anxieties, viewing them as natural parts of life rather than inherently bad things that must be suppressed. As a client achieves greater acceptance, they ideally feel less of an urge to control thoughts or anxieties with compulsions.

Compared to ERP, ACT has not been researched as extensively as an OCD treatment — but it shows promise as an alternative method.


Example uses of therapy techniques for OCD

Every patient requires and deserves personalized care. But the example below may help you understand how to integrate OCD treatment techniques into your own practice.

Anna is a 30-year-old woman who practices compulsive hand-washing because she is afraid of getting sick. She washes her hands dozens of times per day, taking time away from her life and damaging her skin, and is afraid to enter environments where she may be exposed to germs without the ability to immediately wash her hands.

Her therapist may start with CBT techniques such as cognitive restructuring. If Anna experiences recurrent thoughts like, “I will definitely get sick if I don’t wash my hands,” her therapist might help her replace those thoughts with more measured ones like, “My immune system will keep me safe if I can’t wash my hands right away.” 

Anna’s therapist may then guide her through imaginal exposure, visualizing what it would be like to go to the park or ride a bus without washing her hands afterward. When Anna is ready, her therapist might progress to full ERP. To start, perhaps the therapist would guide Anna as she shakes hands with a stranger without immediately washing her hands afterward. Over time, they could work up to more stressful situations, like riding public transit.

Headway makes it easy to offer great care.

It can be tricky to know where to start when working with a new patient, whether they’re struggling with OCD, anxiety, depression, or other mental health concerns. But with free resources for creating treatment plans, templates for documentation and tracking patient progress, and a supportive community of fellow providers to lean on, Headway has all the tools you need to work with any client.

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