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Definition
By Mayo Clinic Staff

Cognitive behavioral therapy is a common type of mental health counseling (psychotherapy). With cognitive behavioral therapy, you work with a mental health counselor (psychotherapist or therapist) in a structured way, attending a limited number of sessions. Cognitive behavioral therapy helps you become aware of inaccurate or negative thinking, so you can view challenging situations more clearly and respond to them in a more effective way.

Cognitive behavioral therapy can be a very helpful tool in treating mental disorders or illnesses, such as anxiety or depression. But not everyone who benefits from cognitive behavioral therapy has a mental health condition. It can be an effective tool to help anyone learn how to better manage stressful life situations.

RISKS
In general, there’s little risk in getting cognitive behavioral therapy. Because it can explore painful feelings, emotions and experiences, you may feel emotionally uncomfortable at times. You may cry, get upset or feel angry during a challenging session, or you may also feel physically drained.

Some forms of cognitive behavioral therapy, such as exposure therapy, may require you to confront situations you’d rather avoid — such as airplanes if you have a fear of flying. This can lead to temporary stress or anxiety.

However, working with a skilled therapist will minimize any risks. The coping skills you learn can help you manage and conquer negative feelings and fears.

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Treatments and drugs
By Mayo Clinic Staff

Appointments & care

At Mayo Clinic, we take the time to listen, to find answers and to provide you the best care.
Learn more. Request an appointment.
Obsessive-compulsive disorder treatment may not result in a cure, but it can help you bring symptoms under control so they don’t rule your daily life. Some people need treatment for the rest of their lives.

The two main treatments for OCD are psychotherapy and medications. Often, treatment is most effective with a combination of these.

Psychotherapy

A type of therapy called exposure and response prevention (ERP) is the most effective treatment. This therapy involves gradually exposing you to a feared object or obsession, such as dirt, and having you learn healthy ways to cope with your anxiety. Exposure therapy takes effort and practice, but you may enjoy a better quality of life once you learn to manage your obsessions and compulsions.

Therapy may take place in individual, family or group sessions.

Medications

Certain psychiatric medications can help control the obsessions and compulsions of OCD. Most commonly, antidepressants are tried first.

Antidepressants that have been approved by the Food and Drug Administration (FDA) to treat OCD include:
•Clomipramine (Anafranil)
•Fluvoxamine (Luvox CR)
•Fluoxetine (Prozac)
•Paroxetine (Paxil, Pexeva)
•Sertraline (Zoloft)

However, other antidepressants and psychiatric medications used for other conditions may be prescribed off label to treat OCD.

Choosing a medication

With OCD, it’s not unusual to have to try several medications before finding one that works well to control your symptoms. It can take weeks to months after starting a medication to notice an improvement in your symptoms. Your doctor also might recommend combining medications, such as antidepressants and antipsychotic medications, to make them more effective in controlling your symptoms.

Don’t stop taking your medication without talking to your doctor, even if you’re feeling better — you may have a relapse of OCD symptoms. Antidepressants aren’t considered addictive, but sometimes physical dependence, which is different from addiction, can occur. So stopping treatment abruptly or missing several doses can cause withdrawal-like symptoms, sometimes called discontinuation syndrome. Work with your doctor to gradually and safely decrease your dose.

Medication side effects and risks

In general, the goal of OCD treatment with medications is to effectively control signs and symptoms at the lowest possible dosage. Here are some things to consider:
•Side effects. All psychiatric medications have potential side effects, which may include stomach upset, sleep disturbance, sweating and reduced interest in sexual activity. Talk to your doctor about possible side effects and about any health monitoring needed while taking psychiatric medications. And let your doctor know if you experience troubling side effects.
•Suicide risk. Most antidepressants are generally safe, but the FDA requires that all carry the strictest warnings for prescriptions. In some cases, children, teenagers and young adults under 25 may have an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed. If suicidal thoughts occur when taking an antidepressant, immediately contact your doctor or get emergency help. Keep in mind that antidepressants are more likely to reduce suicide risk in the long run by improving mood.
•Interactions with other substances. Some medications can have dangerous interactions with other medications, foods, alcohol or other substances. Tell your doctors about all medications and over-the-counter substances you take, including vitamins, minerals and herbal supplements.

Other treatment

Sometimes, medications and psychotherapy aren’t effective enough to control OCD symptoms. Research continues on the potential effectiveness of deep brain stimulation (DBS) for treating OCD that doesn’t respond to traditional treatment approaches.

Because DBS hasn’t been thoroughly tested for use in treating OCD, make sure you understand all the pros and cons and possible health risks.

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Tests and diagnosis
By Mayo Clinic Staff

Appointments & care

At Mayo Clinic, we take the time to listen, to find answers and to provide you the best care.
Learn more. Request an appointment.
To help diagnose OCD, your doctor or mental health provider may do exams and tests, including:
•Physical exam. This may be done to help rule out other problems that could be causing your symptoms and to check for any related complications.
•Lab tests. These may include, for example, a complete blood count (CBC), screening for alcohol and drugs, and a check of your thyroid function.
•Psychological evaluation. A doctor or mental health provider asks about your thoughts, feelings, symptoms and behavior patterns. Your doctor may also want to talk to your family or friends, with your permission.

Diagnostic criteria for OCD

To be diagnosed with OCD, you must meet the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association. This manual is used by mental health professionals to diagnose mental illnesses and by insurance companies to reimburse for treatment.

General criteria required for a diagnosis of OCD include:
•You must have either obsessions or compulsions or both.
•You may or may not realize that your obsessions and compulsions are excessive or unreasonable.
•Obsessions and compulsions are significantly time-consuming and interfere with your daily routine and social or work functioning.

Your obsessions must meet these criteria:
•Recurrent, persistent and unwelcome thoughts, impulses or images are intrusive and cause distress.
•You try to ignore these thoughts, images or impulses or to suppress them with compulsive behaviors.

Compulsions must meet these criteria:
•Repetitive behavior that you feel driven to perform, such as hand-washing, or repetitive mental acts, such as counting silently.
•You try to neutralize obsessions with another thought or action.
•These behaviors or mental acts are meant to prevent or reduce distress, but they are excessive or not realistically related to the problem they’re intended to fix.

Diagnostic challenges

It’s sometimes difficult to diagnose OCD because symptoms can be similar to those of obsessive-compulsive personality disorder, anxiety disorders, depression, schizophrenia or other mental illnesses. Someone with true obsessions and compulsions has OCD, although it’s possible to have both OCD and obsessive-compulsive personality disorder. Be sure to stick with the diagnostic process so you can get appropriate diagnosis and treatment.

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Preparing for your appointment
By Mayo Clinic Staff

You may start by seeing your primary doctor. Because obsessive-compulsive disorder often requires specialized care, you may be referred to a mental health provider, such as a psychiatrist or psychologist, for evaluation and treatment.

What you can do

To prepare for your appointment, think about your needs and goals for treatment.
•Make a list of any symptoms you’ve noticed, including any that may seem unrelated to the reason for the appointment.
•Make a note of key personal information, including any major stresses or recent life changes.
•Take a list of all medications, vitamins, herbal remedies or other supplements, as well as the dosages.
•Make a list of questions you’d like to ask to make the most of your appointment time.

For OCD, basic questions to ask may include:
•Do you think I have OCD?
•How do you treat OCD?
•How can treatment help me?
•Are there medications that might help?
•Will talk therapy (psychotherapy) help?
•How long will treatment take?
•What can I do to help myself?
•Are there any brochures or other printed material that I can have? Can you recommend websites?

Don’t hesitate to ask questions anytime you don’t understand something.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
•Do certain thoughts go through your mind over and over despite your attempts to ignore them?
•Do you have to have things arranged in a certain way?
•Do you have to wash your hands, count things or check things over and over?
•When did your symptoms start?
•Have symptoms been continuous or occasional?
•What, if anything, seems to improve the symptoms?
•What, if anything, appears to worsen the symptoms?
•How do the symptoms affect your daily life?
•In a typical day, how much time do you spend on obsessive thoughts and compulsive behavior?
•Have any of your relatives had a mental illness?
•Have you experienced any trauma or major stress?

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Risk factors
By Mayo Clinic Staff

Factors that may increase the risk of developing or triggering obsessive-compulsive disorder include:
•Family history. Having parents or other family members with the disorder can increase your risk of developing OCD.
•Stressful life events. If you’ve experienced traumatic or stressful events or you tend to react strongly to stress, your risk may increase. This reaction may, for some reason, trigger the intrusive thoughts, rituals and emotional distress characteristic of OCD.

Complications
By Mayo Clinic Staff

Individuals with obsessive-compulsive disorder may have additional problems. Some of the problems below may be associated with OCD — others may exist in addition to OCD but not be caused by it.
•Inability to attend work, school or social activities
•Troubled relationships
•Overall poor quality of life
•Anxiety disorders
•Depression
•Eating disorders
•Suicidal thoughts and behavior
•Alcohol or other substance abuse
•Contact dermatitis from frequent hand-washing