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How Long Does CBT for OCD Take?

Most people want to know how long their therapy will last.

Obsessive-compulsive disorder (OCD) is a surprisingly common psychological problem. Thirty years ago, it was believed to be a relatively rare condition, but it is now known that OCD affects many millions of people at any given time. In the United States, its lifetime prevalence is 2.3 percent, meaning that 23 in a 1,000 people will be afflicted with OCD at some point in their lives.

If left untreated, in most cases, OCD can straightjacket a person's life with immobilizing anxiety and time-wasting, self-defeating, and socially destructive rituals. What's worse, many people with OCD will develop depression that not only intensifies their suffering but often complicates and lengthens treatment, too.

Nevertheless, as debilitating as it can be, when treated with skillfully done, cognitive-behavior therapy (CBT) that emphasizes a crucial method called exposure and response or ritual prevention (ERP), OCD's anxiety and depression producing grip can be broken.

Interestingly, since the onslaught of the current, COVID-19 pandemic many people who in the past were incapable of understanding the apparent “bizarreness” of OCD can now keenly empathize with the plight of some OCD sufferers. Remember during the very early stages of this horrible pandemic when we knew very little about the viruses’ prevalence, contagiousness, and lethality? In March and April 2020, many of my non-OCD patients told me they felt that leaving their houses was akin to walking into the Chernobyl exclusion zone! They didn’t know what was safe and what wasn’t, what they could touch and what was potentially deadly, or how much to wash and clean and sanitize.

Do you remember the sense of threat, risk, and danger you felt during the early stages of the pandemic? The dread that the virus was getting on you, coming into your house, or you were possibly spreading it to other people? And remember how many precautionary measures you took to restore your sense of safety and security? Well, that is what some OCD sufferers experience constantly—all day every day—for years and years on end. Hence its high comorbidity with major depression. Because a fear-driven life spent constantly doing worse than meaningless rituals can be very depressing.

The vast majority of patients seeking treatment for OCD will inquire how long therapy usually lasts. A totally fair and intelligent question. Here is my answer to it.

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The number of sessions or duration of treatment depends on several factors:

Insight. The patient knows the anxiety is irrational rather than believes it is reality-based. Insight is known to be associated with briefer treatment and better outcomes.

Motivation. How committed to active, directive, and stressful therapy is the person? Grit and a willingness to tolerate beneficial distress is a good predictor of success.

Severity. OCD can be mildly to moderately disruptive, or at times totally incapacitating. Naturally, the severity of the condition is highly correlated with treatment duration. That is, the more disruptive and severe the symptoms, the longer treatment usually takes.

Duration of symptoms. How long have signs and symptoms been significant? For a few months or for many years? Since OCD rituals are essentially deeply ingrained and biologically driven habits, it makes sense that the longer the habit has been present the more difficult it can be to break or change it.

Complications. This refers to coexisting difficulties such as clinical depression, other psychosocial difficulties and certain medical conditions. Of course, these complications can often render treatment more difficult and time-consuming.

Use of medication. The decision whether or not to refer for, or initiate, medical therapy is always significant in the comprehensive assessment and treatment of OCD. But this doesn’t mean that OCD suffers always need medication to beat their anxiety. Nevertheless, appropriate psychotropic medication can often jump-start or catalyze non-medical therapy and thus often leads to faster success.

Family involvement. In many cases, the role and involvement of family members are very important. Are family members inadvertently enabling OCD behavior or actually helping the sufferer get better? Clearly, if well-intended but misguided family members are enabling OCD behavior, treatment will need to be much more multifaceted and likely longer.

Therapists’ expertise, skill, and experience. When OCD therapists under-challenge their patients during ERP by failing to evoke adequate anxiety during treatment it will lead to weak results and poor outcomes. This happens either because of mere inexperience but also, ironically, because of therapists’ own anxiety preventing them from engaging their patients in more robust and effective exposures.

In my experience, these are the important considerations in the calculus of predicting treatment duration and outcome. Best case, all of the factors are leaning in the positive direction, in which case the length of therapy could be as short as 6 to 12 sessions. (Specifically, this means a person with good insight, high motivation, no more than moderate symptoms, who has no comorbid complications, who is amenable to the use of medication, and whose family or significant others are willing to participate in a co-therapist manner with a highly experienced and skilled clinician.)

The typical course of therapy, however, usually requires six months to one year—half a dozen to a dozen consecutive weekly meetings, then about three months of meeting every two weeks, then monthly meetings thereafter. This is all provided a person is suitable for outpatient (currently virtual) treatment. Some people require residential treatment and will need supportive and maintenance therapy for years after that. But they, of course, are most often the ones on the extreme end of the severity continuum and have significant complications.

To learn how to beat OCD with CBT, see this post.

Remember: Think well, Act well, Feel well, Be well!

Copyright 2021 Clifford N. Lazarus, Ph.D. This post is for informational purposes only. It is not intended to be a substitute for professional assistance or personal mental health treatment by a qualified clinician.

Dear Reader: The advertisements contained in this post do not necessarily reflect my opinions nor are they endorsed by me. —Clifford

To find a therapist, please visit the Psychology Today Therapy Directory.

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