A CBT Approach to Obsessive Compulsive Disorder (OCD)

Obsessive Compulsive Disorder or OCD is an anxiety disorder. A person who is experiencing OCD will have intrusive thoughts or images. They will experience intrusive and obsessive thoughts which may lead to a compulsion to act in a particular way to control their anxiety. For example, a person may have recurrent obsessive thoughts about germs, which compels them to wash their hands over and over again. The person will often believe that if they do not carry out the ritual something negative will happen, rationally they often know that this idea sounds absurd but they have to carry on in order to control their anxiety levels. Common compulsive behaviours include counting rituals, constantly checking that things are locked even when they’ve been checked loads of times before and excessive hand washing.

When a client comes into counselling suffering from OCD, I will often use CBT and Jeffery Schwartz four-step method as detailed in his book ‘Brain Lock.’ Schwartz breaks down his treatment plan in to four steps, which he calls the ‘Four R’s’. It is important for clients to practice the following steps daily.

If you are suffering from OCD you will find the following method empowering. You do not have to continue to endure the OCD; you can take the treatment of your OCD in to your own hands.

The Four R’s


Step 1:  Relabel

First, you need to learn how to recognise the obsessive thoughts and compulsive behaviours. This means that when you notice the thoughts and urges you acknowledge that although they are there, they are not genuine, it is the OCD that is behind them. It may help at this point  to say out loud ‘ The thought that I am having is an obsessive thought and  the behaviour that I am carrying out is a compulsive urge’.  Get clear on what is REALLY happening.

The aim of this first step is to relabel intrusive and unwanted thoughts and urges, be as clear and as direct as you can. For example, learn to say, “My hands are not dirty. I am just having obsessive thoughts that my hands are dirty.” You must learn to recognise the intrusive, unwanted, obsessive thoughts and urges and label them as symptoms of the OCD. This will allow you to see the thoughts and behaviours for what they  really are and when you start to see that clearly, you will be a step closer to eradicating the OCD from your life.

Step 2: Reattribute

The second step of the method is to reattribute the thoughts and behaviours to their root cause, i.e. the OCD. When you start feeling increased levels of anxiety and the intrusive thoughts and subsequent behaviours take over, shout out loud “It’s not me, it’s my OCD.” (if you’re in public, scream it in your mind) This acts to remind you an reinforce that the thoughts and behaviours have no purpose and are false messages sent from the brain. The aim of this step is to reattribute the power of the thought or urge to its real cause.  You need to remind yourself that you have a medical condition called Obsessive Compulsive Disorder and it is this that is driving your behaviour.  Acknowledging and accepting this fact, is the first step towards developing a deeper understanding that these symptoms are not as they appear and is a trick of the mind. You start to learn that it is ok to question the thoughts and although you may not be able to eradicate or control the thoughts immediately, you do begin to learn that you do not have to act on them.

The Relabel and Reattribute steps are usually carried out together in order to bring about a deeper understanding of what is  ‘really’ happening when an OCD thought or urge enters your mind.

Step 3: Refocus

The Refocus step is the action phase.  It is where you start actively doing something about the OCD. It is also very often the most challenging step of the method. It’s going to be tough but here, you need to begin to shift your focus and attention onto something else. You take the first steps, you acknowledge the thoughts, you create an understanding that it is the OCD and that you are being fed false messages by your brain and then you focus on doing something completely different. In the initial phase, it may only be possible to refocus for a few minutes but with practice you will learn to focus for longer periods of time. It is often useful to prepare yourself for this stage in the process.  Find something that you will be doing that is useful and positive. So for example, instead of washing your hands you may choose to take a walk around the block, listen to some music on your MP3 player or write in your journal. The thing is to choose a different behaviour to the one you normally do and stick to it. Say to yourself, “I’m experiencing a symptom of OCD. I will go for a walk for ten minutes or listen to some nice music.”

The aim of this step is to stop reacting to the OCD. You may feel anxious or feel a level of discomfort for a while as you get used to a new way of being but with practice it will get easier. You will soon learn and accept that even though the OCD thoughts are present, you don’t have to respond to them, you have choice.

Step 4: Revalue

Step 4 is really the outcome of the first 3 steps. With repetition you soon become aware that your obsessive thoughts and your compulsive behaviours are not real and they can be ignored and you now have a choice in how to react and act. With this new perspective you will be able to revalue and devalue the urges that are being fed by your OCD and challenge them until they fade. You need to revalue the thoughts as ‘messages with no significance at all.’

These four steps will empower you to take control of your life and your OCD instead of letting the OCD control the quality of your life.



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