11/24/2025
Therapies that can make OCD worse include general talk therapy, traditional cognitive behavioral therapy (CBT) that focuses on challenging thoughts, reassurance-based therapy, and inadequate or improperly applied exposure and response prevention (ERP). These methods can be ineffective because they may unintentionally give attention to obsessive thoughts or provide reassurance, which are counterproductive for treating OCD. Therapies that do not emphasize resisting compulsions or living with uncertainty can also worsen symptoms.
Types of therapy that can worsen OCD:
General talk therapy: This can make symptoms worse by encouraging you to analyze your thoughts, which gives them more importance. It can also lead to reassurance-seeking, where the therapist tries to logic away the fears.
Traditional CBT that doesn't include ERP: This form of CBT focuses on evaluating and challenging thoughts. Since OCD is driven by fear of uncertainty and not logic, challenging the thoughts is ineffective and can be counterproductive.
Reassurance-based therapy: Providing reassurance, such as "you didn't hit anyone," can temporarily relieve anxiety, but it ultimately reinforces the "what if" cycle of OCD and leaves you feeling less certain in the long run.
Improperly applied ERP: ERP is the gold standard for OCD treatment, but it can be harmful if done incorrectly. This can happen if the therapy is not implemented with a strong emphasis on response prevention (resisting compulsions).
"Imaginal exposure" without "in vivo exposure": Imagining scary scenarios without the real-life component can make OCD worse because the fear is not confronted directly in a real-world context.
Aversion therapy: A therapy that uses punishment to decrease a behavior has been shown to be ineffective and can be harmful when used for OCD.
What makes these therapies harmful?
Giving attention to thoughts: Obsessive thoughts are not logical and do not need to be analyzed or "fixed." Paying too much attention to them only makes them "stickier" and more distressing.
Encouraging thought suppression: Trying to stop or suppress an obsessive thought can have a "rebound effect," making the thought more accessible and intense in the future.
Providing reassurance: A therapist's reassurance can backfire by creating a need for more reassurance later, leading to a loop of dependence and uncertainty.
Failing to resist compulsions: If a person is asked to do exposures but is also allowed to perform compulsions (e.g., checking after touching something "dirty"), no new learning occurs and the cycle of OCD is not broken.
