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OCD – Cognitive-Behavioral Model

OCD involves “intrusive and distressing thoughts, impulses, or images about possible harm coming to oneself or others”, which must then be neutralized through counter thoughts or behaviors to prevent harm or negative consequences from occurring.

Individuals with OCD assume that the intrusive thoughts are a sign that something terrible will happen, so they engage in all types of neutralizing, undoing, and compensatory behaviors (checking, washing, ordering, meaningless rituals, self-statements) in order to prevent negative outcomes.

The idea is that the OCD is maintained by the irrational belief that each time that an obsession occurs a compulsion needs to be performed. Alternatively, if one gets to the point where in the presence of an obsession one manages to block the compulsion, the OCD fades.

Exposure and response prevention (ERP) – is one of the most effective treatments in OCD and is based on a behavioral principle called classical extinction.  Basically,  one makes any effort not to engage in their compulsions. The espectation is that something terrible will happen but in fact nothing does. As a result, the fear and the obsessions diminish.


Exposure and response prevention (ERP)


  1. Develop a hierarchy of obsessions and compulsions, listed in order from least to most distressing
  2. Start with the least distressing item and do the Exposure that can be done by imagining the situation or by actually exposing oneself in real life to the situation (for example touching a doorknob)
  3. The exposure will elicit a desire to perform the compulsion.
  4. The patient’s compulsive response must be prevented.
  5. Repeated exposure in the absence of the compulsions leads to the reduction (extinction) of the anxiety (distress).
  6. Move on to the next item on the hierarchy and so on.
  7. Booster sessions may be required if obsessions begin to provoke anxiety again.


Developing the hierarchy of obsessions and compulsions

  • Try to think of all the obsessions present at the current time and the compulsions are needed to be performed to reduce the distress.
  • Now, try to think of the distress associated with not being able to complete each listed ritual. Rate it 1 to 10 where 10 is the biggest distress ever and 1 the lowest.
  • Re-organize your list starting with the lowest scores

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