Behavioral therapy for obsessive-compulsive disorders

Therapeutic relationship: A solid therapeutic relationship between patient and therapist represents an important active factor for treatment and is a prerequisite for therapeutic interventions.

Psychoeducation: Comprehensive provision of illness-relevant information.

Exposure and Response Prevention (ERP) for compulsive acts: The patient is confronted with an anxiety-provoking stimulus (real or imagined) (exposure) and must not perform his/her compulsive rituals. For example: a patient with a pronounced washing compulsion is asked to touch the street ground with his/her hand and may not wash afterwards. The patient should learn to tolerate the associated negative emotions, cognitions and increased physiological arousal. The exercise must not be stopped before the patient experiences a decrease in anxiety. He/She should learn that the feared consequences do not occur.

Exposure and Response Prevention (ERP) for obsessive thoughts: The worst obsessive thought (e.g., 'I kill my child') is described as precisely as possible: the feared event should be formulated in the present tense, in clear words, in the first person and very detailed — like a script. The patient drafts a first version at home, which is completed with the therapist during the therapy session. The patient is asked to read the anxiety-laden story aloud in the presence of the therapist. By repeatedly reading or listening to it at home, the story loses its threatening quality. Exposure can also take place through repeated, detailed imagination of the feared event — under therapeutic guidance.

For tormenting — morally reprehensible or threatening to the patient — obsessive thoughts, it can also be helpful to record them (mobile phone, MP3 player, dictation device) and listen to them repeatedly (loop tapes).

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

Prolonged exposure (for compulsive acts and/or obsessive thoughts): Obsessive contents do not arise randomly but can be traced back to stressful life events. These connections are often not conscious to the patient. During exposure, the occurring negative emotional states are examined more closely by the therapist, e.g.: "Where do you know these feelings from?", "Have you experienced similar emotions before?", thereby making 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: Describing the compulsion as a neurobiological disease phenomenon contributes to the emotional distancing from the compulsion.

Functionality: For successful treatment, the question of the functionality of the compulsion is central. That means it must be clarified what purpose the compulsion serves for the patient. Examples of possible functions: boundary setting, autonomy, the compulsion to cope with guilt feelings, aggression, social anxieties, low self-esteem or depression; the compulsion as protection from responsibility, to obtain care or attention, etc. The goal is to give up the compulsive behavior and build alternative, healthy coping strategies.

Indirect symptom therapy for obsessive-compulsive disorder: The following interventions can (indirectly) contribute to improvement of the symptoms: reduction of perfectionism, reduction of fear of loss of control, addressing social deficits and self-esteem problems, improving emotion awareness, building positive coping strategies, improving problem-solving skills, developing positive behaviors, processing of traumas

Mindfulness: Mindfulness training aims to achieve a distancing from obsessive thoughts and unpleasant feelings.

Other methods: Depending on the individual problem (e.g. personality issues, depressive symptoms, alcohol abuse), additional psychotherapeutic methods may be applied in the specific case.