OCD Therapy

Cognitive behavioral therapy of OCD involves addressing and dealing with two elements: perceived threat, involving overestimates of both the probability of danger and the consequences of not engaging in a ritual, and perceived personal responsibility, involving overestimates of the degree of responsibility and the consequences of having been responsible.

Perceived threat. Several cognitive behavioral therapy techniques can be used to examine and correct the overestimations of danger in OCD patients, van Oppen and Arntz (1994) recommend having the patient calculate the probability of the catastrophe's occurrence. This technique involves the joint probability of a sequence of low probability events. The probability of each event in the chain is calculated and the joint probability is compared with the patient's initial probability estimate.

The patient then realizes that the probability of the catastrophic event is miniscule at best. The patient's estimate of the probability of events in the sequence can also be tested by deliberately initiating certain events in the chain and observing whether the next predicted event follows.

Consider the case of a mother who fears that her child will severely hurt or kill himself with a knife that is not locked up when she leaves him alone in the house for a few minutes. A number of events must take place for this to happen. For example, she must have forgotten to lock the knife up or put it outside of the boy's reach. Next, the boy must have found the knife, wanted to handle it, handled it in a dangerous way, and cut himself in such a way as to inflict a major wound.

Next, there must be no one else in the house to watch over the boy or help him if he did indeed cut himself, etc. The likelihood of all these conditions coming together in the feared way is very small. This technique could be combined with exposure and response prevention. Notice that a careful listing of the events in the hypothesized sequence yields a script very similar to one a patient would actually write while making up a loop tape for imaginal exposure sessions.

Imaginal exposure in which the mother listened over and over to a loop tape describing the worst possible outcomes of leaving without checking the cupboard could be used, along with behavioral experiments in which certain hypothesized events in the sequence could be deliberately enacted to test the likelihood that others would follow.