As a treatment center specializing in Cognitive-Behavioral Therapy (CBT) for OCD and related anxiety conditions, we regularly do exposure therapy with our clients.  When we first broach the subject, it is not unusual for a client to be taken aback by our suggestion that they directly face their fear.  Some variation of “why on earth would I want to do that” is not an uncommon reply.

When beginning therapy with these clients, we explain that the basic principle of exposure therapy is that one will become less afraid of just about anything if they are exposed to it frequently and regularly.  So if a young boy is afraid of dogs, the exposure would be to purposely, repeatedly spend time with dogs until such time that the fear is reduced to a minimal level.

The question then often arises how this works.  So here is a simple, non-clinical way to understand how exposure helps to diminish anxiety.

First, by doing exposures, one discovers that the feared event often (or never) occurs.  The client who touches doorknobs without washing afterward discovers over time that they don’t get sick and die.  The client with Social Anxiety learns that people at the mall don’t respond as if he is an idiot or a freak.  The woman with BDD discovers that nobody points at her in horror.  And the boy afraid of dogs learns that he doesn’t get bitten.

The second benefit of exposure is that the client learns that, if they don’t do their customary compulsive or avoidant behavior, the anxiety almost always go down all by itself.  If the person who is afraid of germs touches some doorknobs and then doesn’t wash, they will at first experience some anxiety.  But that anxiety eventually goes away – and often more quickly than if they had washed their hands.  Likewise, if a person with BDD goes out without their usual camouflage of a big hat, their initial anxiety will diminish over time – again, often more quickly than if they had worn the hat.

The third way in which exposure works is by helping clients see that even if a feared thing does come to pass, it is not necessarily catastrophic.  People do get sick or experience panic attacks, others do sometimes evaluate us negatively, and dogs do occasionally bite.  But if by chance these events do occur, the client has an opportunity to learn that it isn’t so bad after all.  I personally have been sick more times than I can count, have had panic attacks, have been evaluated negatively on numerous occasions, and have been bitten by a dog.  I have never liked these experiences, but they were not catastrophic.

The fourth, and perhaps most important benefit of doing exposures, is that the client learns an incredibly valuable lesson – that they are capable of tolerating the anxiety that they have avoided for so long.  Clients often spend years doing compulsions and avoidant behaviors in an effort to avoid the feeling state of anxiety.  In fact, the fear of the feeling of anxiety is the single thing that relates all anxiety-based conditions.  And when one does repeated exposures, they learn that, lo and behold, they are far more able to tolerate this feeling than they realized.  What they thought would be unbearable turns out to quite bearable after all.  Less than ideal perhaps, but hardly unbearable.

People who don’t have anxiety disorders cannot fathom just how terrifying the prospect of exposures can be to someone who has spent years avoiding the very thing we are asking them to face.  But to those with anxiety disorders, this fear can control and drastically diminish their life.  In facing their fears head on, they learn these four valuable lessons which help them change their life from one of anxiety, avoidance, and dread, to one in which they can choose to live as they have always dreamed.

•Tom Corboy, MFT, is the director of the OCD Center of Los Angeles, a private, outpatient clinic specializing in Cognitive-Behavioral Therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD) and related conditions.  He can be contacted director@ocdla.com.

This article is right on target.

As a center specializing in the Cognitive-Behavioral Therapy for the treatment of OCD and related anxiety disorders, our therapists see this problem on a regular basis. There is extensive research showing that the most effective treatment for OCD is a very specific set of CBT techniques.  And when I say extensive research, I mean numerous controlled research studies going back 20 years.  Our treatment program focuses entirely on CBT not because of some arbitrary preference but because it is what scientific research has shown to be the most effective means of alleviating our clients’ difficulties.

Despite this fact, I receive calls on a regular basis from new clients who have had years of ineffective treatment that seems to have been based on their therapists beliefs rather than on scientific research.  I have had clients tell me about years of experience with Freudian analysis, Gestalt therapy, EMDR, NLP, hypnosis, herbs, supplements and good old fashioned “talk therapy”.  The problem is that none of this works for OCD or related anxiety disorders!  What works for OCD has been established, yet it seems that most therapists simply don’t care – they learned how to do therapy a certain way, they believe it is the right way, and they subject their clients to that method, with no apparent interest in learning what would actually work.

In fairness to other therapists, it is worth noting that the problem originates with graduate schools.  Most simply do not teach the specific techniques needed to effectively treat OCD and other anxiety disorders.  When I was in graduate school in the early 1990s, I was amazed by how little time was spent discussing OCD – about five minutes! I am not making this up.  The simple truth is that the great majority of therapists don’t appropriately treat people with OCD and related anxiety disorders because they are not trained properly.

One thing the Newsweek article got wrong was its report that this problem is “less true of psychiatrists, since M.D.s receive extensive scientific training”.  My experience has been that many psychiatrists have no interest in learning about therapy at all, and solely want to use medication to treat OCD and other anxiety disorders.  In fact, until just a few years ago, psychiatric training programs were not even required to offer coursework in counseling.  Psychiatrists could graduate and become psychiatrists with no formal training in providing counseling of any sort.  Countless times I have heard from new clients that their psychiatrists have told them that there is nothing that can be done for OCD except to take medication.  In one case, I had a client whose psychiatrist told him that CBT was a waste of time and simply didn’t work for OCD.  I wasn’t surprised when that psychiatrist then referred the client to his wife, a Freudian analyst (again, I am not making this up).

Begley’s article quotes a recent editorial by Walter Mischel of Columbia University, who noted that “the disconnect between what clinicians do and what science has discovered is an unconscionable embarrassment”, and added that he was concerned that the field of psychology will “discredit and marginalize itself” if it doesn’t pay more attention to evidence-based treatments.  I couldn’t agree more.  It is imperative that psychotherapists treat their clients with treatments that are supported by evidence rather subjective beliefs.  To do anything less is unethical.

•Tom Corboy, MFT, is the director of the OCD Center of Los Angeles, a private, outpatient clinic specializing in Cognitive-Behavioral Therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD) and related conditions.  He can be contacted director@ocdla.com.