A question that is frequently asked by many who want to understand how recovery in Harm OCD works is – what is better for recovery; CBT or ERP? Or, sometimes these concepts are used interchangeably. Even by doctors. Many professionals recommend ERP for the treatment of OCD, sufferers go to CBT specialists and come back disappointed and with a firm belief that CBT does not work. Hence, a word of clarification is required. ERP is one of the several types of CBT and is considered to be the gold standard in treatment of all types of OCD (including Harm OCD; McKay et al., 2015).
CBT is an umbrella term, and ERP is a specific branch under this umbrella. As an analogy, CBT is like science and ERP is like biology. Just as all biology is science but all science is not biology, all ERP is CBT, but all CBT is not ERP. In this chapter we shall understand what CBT is.
CBT: CBT has two components to it – Cognitive and Behavioral. Cognitive comes from cognition which refers to thinking. In the cognitive part of CBT, the attempt is to change the thinking pattern of the person. The objectives are to understand the way the person thinks and identify cognitive distortions (that is thinking errors) to correct faulty thinking (Kuru et al., 2017). For example, if you think that you should not have any thoughts of harming anyone even mildly, otherwise you are a terrible person, you are a victim of a cognitive distortion referred to as ‘All or Nothing’ or ‘Black or White’ thinking. According to the ‘All or Nothing’ cognitive distortion, your mind tells you that unless you are perfect with absolutely zero margin of error, you are a horrible, vicious or evil person.
Similarly, your mind may tell you that feeling a bump when driving your car means that you have run someone over. This is a cognitive distortion referred to as ‘Jumping to Conclusions’. Once you understand the irrationality of your thinking, you can then work towards not falling prey to the cognitive distortions. Through the cognitive part of CBT, you are made to understand the irrationality of the thought. The cognitive part of CBT thus works to realign incorrect thinking.
The behavioral part of CBT works towards getting you to change your behavior through a process called cognitive restructuring. For cognitive restructuring, you would need to observe your intrusive and other negative thoughts and map them to the cognitive distortions you identify in each case. Once that is done, you would need to provide an alternate response that is healthier and more adaptive. The next step is to put the restructured cognition into action through implementation.
For example, for the ‘All or Nothing’ thinking example above, if you restructure your cognition by understanding that it is fine for you to have occasional harm thoughts like everyone else, the behavioral change you bring about is accepting them without trying to make them go away or fight with them. Or in the ‘Jumping to Conclusions’ example above, if you restructure your cognition by realizing that your jumping to conclusions is erroneous, you may be able to stop yourself behaviorally from going back to check if you have indeed run someone over.
If CBT is not administered and the understanding of the irrationality of the thought is not provided, modifying behavior is possible but the effort may seem unreasonable and hence difficult.
The entire next chapter focuses on these cognitive distortions. Read through them many times and absorb the information well. Try to map your obsessions and other thoughts to the cognitive distortions to understand their irrationality. The more aware you are, the better you will get at handling your irrational thoughts.