Obsessive-compulsive disorder (OCD)

What is obsessive-compulsive disorder (OCD)?

OCD usually includes both obsessions and compulsions. Obsessions are intrusive thoughts that cause discomfort, fear and/or anxiety. They can include, for example, strong concerns about hurting someone close to you, or causing another person's unhappiness. Worries about germs and/or infection are another common obsessive theme. Obsessions with religious content are common even in those who are not religious. For example, they may think that certain thoughts are forbidden, which causes them to worry that they will be punished in some way.

Compulsions are also called rituals, and their function is to neutralize the obsessive thoughts or the anxiety they cause. They can be mental rituals or specific behaviors. The rituals may look different, although they have a similar function for the person performing them. The vast majority of people with OCD suffer from both obsessive thoughts and compulsive behaviors, which in the long run become very disabling. In addition, OCD sufferers often know that the rituals are completely meaningless. It is common for OCD sufferers to feel ashamed of their problem and reluctant to seek help.

Therapy or CBT treatment for OCD

CBT treatment for Obsessive Compulsive Disorder (OCD) can take many different forms. The form it takes depends on the type of OCD problem you have, whether you also have other mental health problems, and other circumstances.

Response prevention exposure has been shown to be effective for people with OCD. This involves exposing the person to what triggers the compulsion but not doing the action as they usually do to reduce the discomfort. It's about putting up with the discomfort and seeing it fade away anyway.

For example, a person who washes their hands many times a day for many minutes at a time may learn to wash their hands for less time than usual and put up with the discomfort. When the person sees that the discomfort is reduced without the compulsive act, they also start to reduce their OCD. It requires a lot of exposure between sessions for it to work.

Exposed to forbidden obsessions

For the person who has "forbidden" obsessive thoughts, exposure to these thoughts can be used. When the person sees that they can think these thoughts without anything dangerous happening, these thoughts can feel less charged. For other people, it may be a matter of daring to interrupt their obsessive thoughts and see that nothing dangerous is happening.

Exposure means challenging your compulsions in small steps, practicing approaching the things that provoke the compulsions. If you react to dirt and therefore avoid everything you perceive as dirty, you should practice getting dirty. It may sound very unpleasant and perhaps horrible, but it should be done at the pace you can manage. Similarly, if you are afraid of certain nasty intrusive thoughts, you should train yourself to think them and discover that they cannot provoke the disasters you usually feel might occur.

It is important to agree on what will happen before this training. The patient should understand why you are doing this treatment - understand the idea behind it. The practitioner should reassure the patient that nothing unexpected or surprising will be done. Ritual prevention means practicing to resist the impulse to do rituals. During the exposure exercises you should not do any ritual afterwards. If you cannot do that, you have taken too big a step. You should also consciously reduce the rituals even when you are not practicing exposure. This means shortening the time you wash, checking fewer times, limiting your questions to the parents in case of a disaster, and so on.

It is not about reason, not about understanding that you are not at the risk you perceive. The victim usually does not need more or better arguments that the coercion is excessive. He or she already knows that. The reactions to the situations are automatic and cannot be controlled by information or insight. Exposure and ritual prevention influence emotions through direct experience. Through conversations, rating scales, homework in the form of self-observation, exercises together with the therapist, you will find out what is important/possible to work on. Each form of treatment is based on an agreement that sets out the therapist's view of the problem and a clear description of the treatment principles. Treatment programs often include exercises with the therapist, homework between sessions and follow-up of how the homework has worked.

Tell the therapist about obsessive thoughts and OCD

Telling your therapist about your problems is obviously important. It means having the courage to tell them what it's like. If you suffer from OCD, you are often ashamed of how you think and feel, and perhaps especially of all the strange things you do. You may also have the feeling that it could get worse if someone finds out what I think or do. It can feel like it's dangerous to tell. If you've had the problem for a long time, you may think that no one can understand how you feel. However, an experienced therapist will usually recognize the pattern, even though there are many variations of what coercion can look like. Being able to demonstrate this can be very reassuring for the patient.

Psychological treatment of obsessive thoughts

An important outcome of psychological treatment is learning to live better with your compulsions. It is not necessarily a failure of treatment if some OCD problems remain at the end of treatment. The demand to be completely free of OCD problems can in itself be a trap, you become afraid of signs of relapse, irritated at not being able to cope with everything that a person without OCD can and does. c. If the focus is instead on living better with your OCD, you can find a better quality of life. Psychological treatment can work towards this goal.

We offer CBT and therapy in Stockholm, Gothenburg and Malmö, as well as digitally.