OCD Disorder and 4-step CBT

It is widely accepted that the most successful, long term treatment for OCD disorder is cognitive behavioral therapy (CBT). In the '90s, Dr. Jeffrey Schwartz came up with four steps that can effectively change brain circuit activity in patients with OCD disorder.

Still in accepted use today, this four-step CBT technique teaches the patient to perform exposure-response therapy on his/her own.

OCD Disorder CBT Step 1 – Re-labeling

1. Recognize OCD disorder thoughts and urges. This involves mindful rather than superficial awareness.
2. Focus your efforts and make mental notes. If you can't focus, write it down.
3. Keep a diary as an "impartial spectator." Writing in the third person helps.
4. Recognize what's real, what's only a symptom, and label it as such in your diary. Label obsessions and compulsions.
5. Delay or resist the urges until they fade.

Example: I don't really think my desk is messy. I'm just having the obsession that it is. I don't feel I have to fix it all over again. I just have the compulsion to do it again.

What it does: Recent studies show that this actually changes the biochemistry of OCD disorder. But changing an underlying biological issue usually takes several weeks or months and it needs you to be persistent.

OCD Disorder CBT Step 2 – Re-attributing

1. Remind yourself that OCD disorder is a medical condition. It isn't your fault.
2. Remind yourself that your OCD thoughts and impulses are meaningless, false messages coming from your brain.
3. Reattribute thought and impulse intensity to the true cause: a biochemical imbalance in your brain. (Numerous studies show that OCD sufferers have a malfunctioning caudate nucleus, a sort of filtering station in the front part of their brain, which processes complex messages.)

What it does: Recognizing OCD as a medical condition means it is treatable and can be overcome with some effort.

OCD Disorder CBT Step 3 – Refocusing

1. You should consciously do yourself what your caudate nucleus would normally and automatically do if you didn't have OCD: alert you to change behaviors.
2. For a few minutes, shift your focus or attention to something else.
3. When the impulse hits, rather than performing the usual compulsive ritual, do something else. Choose something pleasant or constructive (e.g., work on a hobby like knitting, go for a walk, work out, shoot hoops, etc.).
4. Vary up your response routine (e.g., basketball one day, drop some money in a jar the next).
5. Also try to delay your response time. Yes, even for constructive responses.

What it does: Gives you back your decision making power. When you refocus, your brain's biochemical conditions no longer run the show!

OCD Disorder CBT Step 4 – Revaluing This final step is the natural result of all the first three. After going through the previous steps, you will start to revalue your OCD disorder thoughts and impulses.

Whereas before, you immediately acted on an impulse, giving it much value as essential to averting something from happening to you or those around you, after going through CBT, you now put a very low value on these OCD disorder impulses.