A Cognitive Behavioural model of Obsessive Compulsive Disorder

I have recently added a new PDF of a CBT model of OCD to the self help resources at Thrive Wellness. In this post I would like to provide some detail on this model.

CBT model of OCD

The cycle of OCD all begins with intrusive thoughts: distressing thoughts that seem to pop out of nowhere and are inconsistent with personal values. Pretty much everyone experiences intrusive thoughts from time to time. In OCD, however, these intrusive thoughts become so repetitve and distressing that they are referred to by a different name: obsessions.

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Compulsions: fast-acting anxiety relief! (With a price…)

As I have previously written, there are two key facets of Obsessive Compulsive Disorder: obsessions and compulsions. In this post I want to explain what compulsions are, and why they occur.

Essentially, compulsions are actions or thoughts that are repetitively performed in an attempt to reduce or eliminate anxiety or distress triggered by obsessions. A compulsion may be an attempt to prevent obsessions from coming to mind (perhaps by repeatedly praying for such thoughts to be prevented, or repeating a phrase intended to block such thoughts), or it may be an attempt to prevent some feared outcome associated with the obsession (such as calling a friend to warn them to be careful after having an image come to mind of that friend being in an accident).

In the beginning stages of the development of Obsessive Compulsive Disorder compulsions provide fast relief from the anxiety or distress created by intrusive thoughts – uninvited, upsetting thoughts that can pop into our minds unexpectedly.
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Intrusive thoughts: the uninvited visitors

There are two key facets of Obsessive Compulsive Disorder: obsessions and compulsions. Obsessions are thoughts, images or urges that repeatedly and uncontrollably intrude, unwelcome, into a person’s mind. They are a source of distress, often because the content is unpleasant, theatening or believed to be socially unacceptable. A passion for cars, or cooking, would not be classed as an obsession – even if you talk about it so much it annoys your friends: Obsessions are the last thing you would want to be thinking about; interests are the first things you want to think about.
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It gets worse before it gets better

There is a common paradox for psychological therapy: many times the strategies we have found to provide us relief from our problems are at the same time perpetuating our problems. For example, a man suffering depression may find that staying in bed all day is the only way to get some slight relief from his persistent sadness and guilt. Yet, at the same time, staying in bed is keeping him isolated from social supports that could play an important part in his recovery. It is also feeding back into his guilt when, at the end of the day, he reflects on all the things he “should” have done instead of being in bed.

A woman with a phobia of mice may find running and hiding in another room if she sees a mouse gives her relief from her feelings of terror – yet in doing so she has unintentionally reinforces her automatic fear response to seeing mice.

Therapy generally involves, at some point, changing unhelpful patterns in one way or another. Initially this means stopping use of strategies that have had at least short-term benefits. Consequently, therapy can at times be very uncomfortable: you make a choice to confront difficult feelings and experiences that you have developed a range of strategies for avoiding. Because of this I often caution clients that “it gets worse before it gets better.” It is often necenssary to sit through discomfort, sometimes considerable discomfort, to experience the reward of mastering a problem.
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“Are you sure?”

cracksObsessive Compulsive Disorder – OCD – what do you think of when you hear those words?

Do you imagine someone repetitively washing their hands? Do you imagine a person carefully dodging cracks and seams in pavement? Perhaps you picture someone in their home with everything perfectly symmetrically arranged and perfectly tidy.

While all of the above are examples of what a person with Obsessive Compulsive Disorder might experience, there are vastly more, and often subtle, ways the condition can present.
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