Behavioral therapy for obsessive-compulsive disorder

Therapeutic relationship: A sustainable relationship between patient and therapist is an important factor in the effectiveness of treatment and is a prerequisite for therapeutic interventions.

Psychoeducation: Comprehensive communication of information relevant to the illness.

Exposure with response management (ERM) for compulsive behaviors: The patient is confronted with an anxiety-inducing stimulus (real or imagined) (exposure) and is not allowed to perform his/her compulsive rituals. E.G.: A patient who suffers from a pronounced compulsion to wash is asked to touch the street floor with his/her hand and is not allowed to wash afterwards. The patient should learn to endure the associated negative emotions, cognitions and increased physiological arousal. The exercise must not be stopped before the patient experiences an anxiety attack. He/she should experience that the feared consequences do not occur.

Exposure with reaction management (ERM) for obsessive thoughts: The worst obsessive thought (e.g. "I will kill my child") is described as precisely as possible: The dreaded event should be formulated in the present tense, in clear words, in the first person and in great detail - like in a script. The patient writes a first draft at home, which is completed during the therapy session with the therapist. The patient is asked to read the anxiety-ridden story aloud in the presence of the therapist. Repeated reading or listening to the story, even at home, causes it to lose its threatening quality. Exposure can also take place through repeated, detailed presentation of the feared event - under therapeutic guidance.

In the case of tormenting - for the patient morally reprehensible or threatening - obsessive thoughts, it can also be helpful to record them (cell phone, MP3 player, dictation machine) and listen to them again and again (loop tapes).

All thoughts or behaviors that would reduce the anxiety (triggered by the obsessive thought) in the short term must be avoided during the exposure.

Prolonged exposure (in the case of compulsive actions and/or obsessive thoughts): Obsessive-compulsive content does not arise by chance, but can be traced back to stressful life events. The patient is often unaware of these connections. During the exposure, the negative emotional states that arise are questioned in more detail by the therapist, e.g: "How do you know these feelings?", "Have you experienced similar emotions before?", in order to make these life-historical events accessible to the patient's memory (affect bridge). Insight into this biographical development enables emotional relief for the patient.

Labeling of obsessive thoughts: The description of compulsion as a neurobiological disease phenomenon contributes to the emotional distancing of compulsion.

Functionality: The question of the functionality of the coercion is central to successful treatment. In other words, it is important to clarify what the patient's coercion is "useful" for. Examples of possible functions: Dissociation, autonomy, the compulsion to cope with feelings of guilt, aggression, social anxiety, a lack of self-worth or depression; the compulsion as protection from responsibility, to obtain affection or attention, etc. The aim is to get rid of the compulsive behavior and develop alternative, healthy coping strategies.

Indirect symptom therapy for OCD: The following interventions can (indirectly) contribute to improving symptoms: reducing perfectionism, reducing fear of losing control, dealing with social deficits and self-esteem problems, improving perception of emotions, developing positive coping strategies, improving problem-solving skills, developing positive behavior, dealing with trauma

Mindfulness: The aim of mindfulness training is to distance oneself from obsessive thoughts and unpleasant feelings.

Other methods: Depending on the individual problem (e.g. personality problems, depressive symptoms, alcohol abuse), other psychotherapeutic methods may be used in specific cases.