The MHS Journals

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Dialectical Behavior Therapy for OCD, Does it Work?

May 5, 2020

Dialectical Behavior Therapy (DBT) is one type of treatment that your clinician may recommend to help with Obsessive-Compulsive Disorder (OCD). You may be wondering how DBT can help and how it’s different from other courses of treatment. DBT is a type of cognitive-behavioral therapy (CBT) in that it focuses on how the things you feel and the emotions you experience influence your behavior.

True to its CBT roots, DBT focuses on mindfulness, acceptance, validation, and the building of trust. Originally, DBT was developed by Marsha Linehan in the 1970s at the University of Washington to help clients with Borderline Personality Disorder and Posttraumatic Stress Disorder (PTSD). However, it’s now used to treat a variety of mental health conditions. The primary way DBT differs from other forms of treatment is the concept of acceptance of all thoughts, both good and bad.

DBT uses four primary skill sets, heavily influenced by Buddhist teachings, to enable clients to manage their daily lives.

DBT sessions are usually facilitated in groups, in addition to an individual therapy component. Between sessions, clients record how they are using skills, and if this skill use was effective at reducing distress.  When at a session, they will discuss their skill use and problem solve any barriers that might get in the way of future skill use.

What is OCD?

Obsessive-Compulsive Disorder (OCD) is a type of anxiety disorder. People diagnosed with OCD experience severe anxiety stemming from obsessive thoughts and feelings. To relieve stress, the person may take on certain obsessive behaviors. Obsessions may take the form of unwanted thoughts or images that never go away and cause abnormal levels of worry. Compulsions are behaviors that must repeat to relieve anxiety. Compulsions often accompany obsessions. For example, a person may be obsessed with avoiding germs and compulsively wash his or her hands over and over again.

Are You Born With OCD?

OCD affects about 2.5% of people throughout a lifetime. Men and women seem to be affected equally, and all races and cultures experience OCD. The disorder usually manifests in the late teen years or early adulthood, although younger children and teens may be affected too. Symptoms may be harder to spot in young children because they may appear to be typical childhood behaviors.

The causes of OCD are not entirely understood. One subtype can begin with or be complicated by a case of strep throat. These circumstances may account for up to 25% of childhood cases of OCD. It is unclear whether people are born with a predisposition toward OCD, and no single gene has been identified as linked to the disorder. However, OCD may be related to gene groupings, and people with a family history of OCD do seem to be more at risk.

What is the Difference Between Cognitive Behavioral Therapy and Dialectical Behavioral Therapy?

Different types of therapies use CBT as the underpinning for the practice. For example, exposure-response prevention therapy (ERP) has long been the gold standard for OCD. However, some clients feel that CBT is too aggressive and pushes too hard for change, leaving them feeling judged, confronted, and invalidated. When a form of therapy like ERP doesn’t work, you still have options, and DBT is one of them. In both the short and long term, CBT demonstrates success in helping clients with OCD.

With CBT, the focus is on measurable changes in behavior, while DBT monitors acceptance and nonjudgment. While ERP directly confronts obsessions and compulsions, DBT does not. Instead, DBT focuses on dealing with the anxiety that comes with fear, obsession, and compulsive behaviors. It’s important to note that most people need medication along with therapy of some form to manage their OCD.

How Does DBT Help OCD?

DBT helps with OCD by focusing on acceptance and non-judgment of feelings. Studies have found that DBT skills help clients deal with the stressors of everyday life, improving the quality of life, the skills to self-control, and reducing feelings of hopelessness in clients with OCD. Acceptance, nonjudgment, and mindfulness all demonstrate effectiveness at helping clients manage OCD. The relationship between client and therapist is critical to success; the client must learn to be honest about behaviors and feelings. The therapist must create an environment free of shame and feelings of failure so that clients are willing to take risks and open up to make lasting changes.

With DBT, clients are validated when they attend sessions and honestly discuss their progress in applying the principles of the therapy. Here are some examples of how these skills are used:

  • Distress tolerance helps clients distract themselves from upsetting thoughts and feelings.
  • Emotional regulation skills help to manage obsession and fear-related anxiety. Over time, clients come to understand that anxiety lessens with time, and they don’t have to give in to the compulsion.
  • Interpersonal effectiveness skills help clients enhance relationship functioning so they are less likely to seek reassurance from others.
  • Mindfulness means being present in the moment rather than clinging to upsetting thoughts. The concept also includes the practice of being nonjudgmental toward feelings and thoughts and understanding that they are neither good or bad. It also involves redirecting thoughts back to the moment when repetitive motions try to intrude.

How Can I Get Help?

MHS is certified by the Minnesota Department of Human Services (DHS) as an accredited Adherent Dialectical Behavior Therapy provider. MHS offers services for adults and adolescents, including individuals with developmental disabilities, co-occurring mental health, and substance abuse disorders, chronic pain issues, cancer, and thought disorders. Contact us today to schedule your intake assessment.

Image Credit: Getty/ KatarzynaBialasiewicz