Overcoming OCD
Information for College Students

Cognitive Behavior Therapy and the College Student

CBT is considered the “gold standard” treatment for OCD.

Cognitive Behavior Therapy is the gold standard treatment for OCD.  It makes use of two evidence-based behavior-altering techniques—Exposure and Response Prevention therapy (ERP) and Cognitive Therapy.

Your college or university student health center or counseling center should be able to help you find a cognitive behavior therapist who treats individuals with OCD.  If there is no one on staff with cognitive behavior therapy credentials, ask to be referred to a therapist in a nearby city or town.  Other kinds of traditional therapy, such as “talk therapy” or any number of other “therapies” like hypnosis, relaxation or stress management, acupuncture or nutrition counseling won’t treat OCD.

OCD won’t go away by itself.

How Does CBT Work?

First, the cognitive behavior therapist would probably ask you to complete a questionnaire about your obsessions and compulsions.  Most use the Yale-Brown Obsessive Compulsive Scale (Y-BOCS).  This test can determine if you actually have OCD and, if so, how severe it is.

In ERP therapy, the therapist conducts a series of controlled sessions exposing you to your fears and obsessions—and gradually preventing you from performing the compulsions you usually use to ease the accompanying anxiety.

For example, if you have an obsessive fear of germs, a therapist conducting ERP therapy may work with you to encourage you to touch an object that you believe is contaminated, then wait longer and longer to wash your hands.  This gradual exposure and delayed response helps you learn to control the response.  Over time, you learn to respond differently to the fears or thoughts about germs, which would actually lead to a decrease in the frequency and intensity of the obsession. 

When therapeutic exposures are repeated over time, the associated anxiety shrinks until it is barely noticeable or fades entirely.  The therapist guides you to then take on more challenging exposures until those, too, become manageable. Effective ERP leads to “habituation,” the process of losing the automatic fear response to obsessions, which leads to the very important realization that nothing bad happens when you stop performing compulsive rituals.

Using ERP, the therapist is then able to help you gain confidence and special skills to control the compulsion through the second form of therapy, Cognitive Therapy.

Cognitive Therapy helps patients understand that the brain is sending “error” messages.  The therapist would help you learn to recognize these errors and respond to them in new ways that help control the obsessions and their resulting compulsive actions. Cognitive Therapy is an effective treatment for many problems, and focuses on the meaning we attach to often-ambiguous experiences (e.g., “Mary doesn’t like me anymore because she walked by without saying hello.”). Cognitive therapy helps people stand back from often-automatic thoughts, look at the evidence closely, and tell themselves something more accurate (e.g., “Something is on Mary’s mind, but I don’t know what it is.”).

Cognitive Therapy for OCD focuses on the experience of negative thoughts (e.g., a new mother has the thought, “I might drop my baby on the floor.”). While most people easily dismiss such thoughts (e.g., “that’s a silly thing to think”), certain beliefs (e.g., thoughts seen as always important) cause some to react differently (e.g., “I am a bad mother for having such a thought!”). Research shows that understanding negative thoughts as important and attempting not to have “bad” thoughts produces the opposite effect!

Cognitive therapy for OCD sometimes focuses on metacognition (what we think about thinking processes). The therapist helps the person challenge specific metacognitive beliefs (e.g., “Having this thought means I might drop my baby”). For example, if you think, “I am as rich as Warren Buffett,” do you need to go and check your bank account?

This treatment may seem unusual.  You may even think it wouldn’t work, or that you’ve already tried to resist compulsions, without much success. But with the right therapist, and given time and support, Cognitive Behavior Therapy has helped thousands of people control their OCD.

Surprisingly, the effects of CBT can even be seen on brain scans—your brain will transmit signals differently after CBT than before therapy started.

Most ERP treatment is conducted on an outpatient basis once a week with exercises to practice between sessions.  In severe cases, some people may require more frequent sessions or inpatient treatment. 

That Seems Easy Enough—Why Can’t I Try This ERP Therapy On My Own?

It’s not that simple.  To be effective, exposure and response prevention sessions must be planned and conducted by a trained cognitive behavior therapist.  This type of professional would know the proper way to design a program for your particular set of symptoms that will bring you relief in the shortest amount of time.  The sessions may be conducted outside of the therapist’s office if the obsessions and compulsions are at their worst outdoors, or in a public place.  Some CBT therapists will conduct sessions by phone if needed.  They also will design homework exercises for you to do between sessions.  Unfortunately, you can’t do it alone.

How Do I Know CBT Really Works?

You can read what others have found out about CBT and living with OCD in the Personal Stories section of this web site.  CBT and ERP require real effort and commitment on your part but the good news is they really DO work. 

How Do I Find A Therapist?

Not all mental health professionals are trained in CBT and ERP therapy, so it’s important to find one who is.  If your student health center or counseling service is unable to help you find a cognitive behavior therapist, OCD Chicago can help you find a treatment provider in the Chicagoland area, or check the International OCD Foundation web site to find a cognitive behavior therapist close to where you are.

What About Medication—Do I Need That Too?

Sometimes medication is prescribed in combination with CBT.  If your cognitive behavior therapist thinks you would benefit from medication, he or she will refer you to a psychiatrist who will prescribe it.

Sometimes a doctor on campus at the student health center or in private practice will prescribe a medication that reduces general anxiety without suggesting CBT.  If you really have OCD, medication alone is generally not as effective as medication AND CBT.  In fact, with medication, you don’t learn how to think differently or how to control the obsessions and compulsions.  Medications intended to decrease anxiety may make it easier for you to be successful in CBT, but they do not take the place of CBT.  And, sadly, when people who have only used medication stop taking the meds, they generally find that the symptoms come right back.

Learn more about OCD medications

Read personal stories of CBT success

Help finding a cognitive behavior therapist

Back to Overcoming OCD