CBT is directive, collaborative, and skills-based. It is a short-term treatment (12-20 sessions), though duration can vary based on presenting problem, symptom severity, and preference. A central component of CBT is identifying cognitive distortions (faulty thinking patterns). For example, one cognitive distortion is “all-or-nothing thinking” where you see things as black or white, clean or dirty, safe or dangerous with no in between. Once you are able to recognize distortions, you can challenge or “restructure” your thoughts with more objective and flexible ways of thinking. This is sometimes done with a thought record, which involves writing down stressful situations, identifying your automatic thoughts, and developing alternative, more helpful ways of thinking.
EXPOSURE AND RESPONSE PREVENTION (ERP) is the gold standard treatment for OCD and anxiety disorders. ERP consists of exposure, which includes gradually approaching things that you are afraid of (e.g., driving, using a public restroom, giving your child a bath, etc.) while removing behaviors (response prevention) that take away the anxiety in the short-term, but maintain the anxiety in the long-term. For example, someone who is afraid of dogs might start by looking at photographs of dogs and work up to walking by dogs and then petting dogs. With practicing ERP, two things often occur. One, you will notice your anxiety decreases during and in-between exposures. This is a process called “habituation” whereby anxiety decreases over time when you stop avoiding and do nothing to take your anxiety away. Think of it like this- when you enter a cool swimming pool, at first the temperature of the water feels uncomfortable and you may want to get out, but if you stay in the water, over time, your body adjusts. The pool doesn’t feel as cold even though the temperature hasn’t changed. In other words, you “habituate” to the temperature of the pool. Second, in ERP, you learn something new. For example, you may learn that the situation is not as dangerous as you thought or that you are capable of tolerating anxiety without engaging in compulsions or avoiding the situation. This is a process called inhibitory learning whereby new learning that occurs in exposure therapy “inhibits” the feared learning.
ACCEPTANCE AND COMMITMENT THERAPY (ACT) is also a type of CBT that aims to increase psychological flexibility, which means learning to make space for distressing thoughts and emotions (acceptance) and living in accordance to what is most important to you (values). ACT focuses less on the reduction of internal experiences (e.g., obsessions, anxiety) and more on the way they are experienced. ACT-Based Exposure Therapy focuses on exposures that the client finds meaningful and worth doing based on their values. The goal of exposure is to learn how to let obsessions and anxiety come and go without them interfering with your life.
