Cognitive Therapy Basics

OCD is a common problem that can be overcome with CBT, either by using a CBT based self-help book or via more intensive therapist support, depending on its severity.

OCD is characterised by obsessions and compulsions. An obsession is a persistent thought, image or urge that comes into your mind and sets off feelings of anxiety and distress. These obsessions occur frequently, are intrusive and not easy to get rid of. For example, common obsessions in OCD include, thoughts or images of violence, blasphemous thoughts, fear of contamination, sexual thoughts or images and excessive concern with health. In OCD a compulsion is an act or ritual that is repeated and repeated in reaction to an obsessive thought. A compulsion may be an behavioural act such as repeatedly checking the door is locked or a mental act such as saying something or picturing something to make the distressing feeling, associated with the obsessive thought feel better.

Usually when I treat people for OCD at my CBT therapy practice in Edinburgh, I find that the method that the person with OCD uses to cope with or solve their OCD, is the very factor keeping their OCD going. This is because people with OCD commonly give a special meaning or powerfulness to their obsessive thoughts, usually that having the thought will lead to something bad happening to themselves or others. As a consequence, the person will usually mistakenly believe that the way to solve the obsessive thought is to try to block it or carry out a compulsion to “undo” the thought. What we know is that our brains work in such a way that trying to block a thought will only make it more frequent and whilst carrying out a compulsion will make the person feel better initially, it will actually feed the OCD so that the problem keeps going.

This can be likened to having “just one puff” to get rid of a craving for nicotine when trying to give up smoking. Whilst for a short period the craving is dealt with (distressing feeling in OCD), it actually leads to stronger and increased cravings.

When working with clients at my CBT therapy practice, Edinburgh who have OCD a lot of time is spent identifying the persons OCD maintaining factors. Typical factors that keep OCD going include: giving thoughts more meaning then they deserve, misunderstanding about why you have the particular obsessions you have, avoidance and safety seeking behaviour (avoiding anxiety triggered by the thought by blocking or undoing the thought with a compulsion, avoiding situations that you associate with the obsessive thought, asking others for reassurance), giving too much time and attention to your obsessions, trying to control your thoughts and thinking biases.

CBT therapy, Edinburgh, works by helping the person unravel the factors that maintain their OCD in order to build a different solution to overcome it. Treatment will then involve exposure and without responding, with the support of your therapist. This basically involves accepting your obsessive thoughts in such a way that you learn to tolerate the anxiety which accompanies them without carrying out any compulsions. Eventually the anxiety naturally fades so that you will be able to experience the thought without finding it distressing. This is called habituation.



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Obsessive Compulsive Disorder (OCD) is a common psychological condition that I see frequently in my work as a therapist in Edinburgh. A diagnosis of OCD is made when a person shows the two key features of obsessions and compulsions. An obsession is a persistent thought, image, or urge that seems to enter the mind from nowhere and causes significant distress. Compulsions are things done again and again in response to an obsession or obsessions, in an attempt to reduce the stress. Compulsions are usually physical acts (such as washing the hands excessively or repeatedly checking door locks), but they can also be mental acts.

As a therapist in Edinburgh I see a lot of clients suffering from OCD, and I am frequently asked what causes it. Unfortunately the causes of OCD are not known for sure, but there are some likely culprits and I give a brief summary of these in this article.

Genetic factors seem likely to play some role in a person developing OCD. If you have a “first-order” relative with OCD (that is, a parent or sibling has OCD), then your chance of developing OCD yourself is in the region of 5%. However, it should be noted that OCD affects about 1% of the general adult population in the West, so an increased risk is present but it certainly isn’t enormous.

Subtle abnormalities in the brain have also been put forward as causes of OCD, but this has not been well supported by the research to date. Brain scans do not show any structural abnormality, and the more recent “functional” scan results (e.g. showing high frontal lobe activity) probably reveal the brain’s response to OCD, rather than being the cause of OCD.

It has been hypothesised that a key element underlying OCD is a relative lack of the neurochemical serotonin in certain parts of the brain. The only evidence for this has been the fact that OCD seems to respond (at least sometimes) to the SSRI class of antidepressants (SSRI meaning Selective Serotonin Reuptake Inhibitor – these drugs increase the amount of serotonin in the brain). Obviously the fact that some condition improves when a medicine is taken does not mean that the medication is acting on the cause of the condition. If you break your leg and are in severe pain, morphine will reduce the pain but it will have no affect on the cause of that pain!

One of the more interesting theories about the causes of OCD has been related to sufferer’s memories. This theory postulated that OCD sufferer’s may have poor memories and that is why they repeat their compulsions so frequently! In reality, OCD sufferer’s memories are fine but they don’t seem to trust them as well as other people do.

A final focus of research in OCD has been the apparent “triggering” of the condition. OCD commonly starts in the late teens and early twenties, and often seems to follow on from some form of emotional, psychological or physical stress. Common stresses include pregnancy and childbirth, physical violence, bullying, bereavement, or even the change of job or role at home. Whilst such “triggers” are common, they are not ubiquitous and a significant minority of people I see as a therapist in Edinburgh develop OCD without any identifiable stress.

So, in summary, the cause or causes of OCD remain obscure and more research needs to be done. However, even without definite causes being known, there are well-researched and effective treatments for OCD. As mentioned above, SSRI drugs are commonly used to help OCD sufferers, but the most effective treatment is Cognitive Behavioural Therapy, or CBT. This is the treatment of choice recommended by NICE (the Institute of Clinical Excellence – a Government body that advises clinicians about the safety and efficacy of different treatments for illness). Please see my other articles for more information about CBT in Edinburgh.

Dr Steve Last is a Psychiatrist and therapist in Edinburgh who uses CBT techniques to treat common psychological problems such as depression, anxiety and OCD. Please visit http://www.drstevelast.co.uk for more information about psychological problems and CBT.



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