Can DBT Ease OCD Symptoms?

So, you have obsessive-compulsive disorder (OCD) and for a while, a standard OCD therapy, specifically, exposure-response and prevention (ERP) therapy, was doing the trick. In other words, it was working for you – until it stopped. Your doctor switched you to another OCD therapy, cognitive-behavioral therapy (CBT), but that did not yield satisfactory results.

Lastly, your doctor decided that acceptance and commitment therapy (ACT) could be beneficial for your particular OCD symptoms, but that was also unsuccessful. Because the standard OCD therapies were no longer effective, your doctor decided that it would be best for you to continue with ERP therapy, CBT, and ACT, while also taking a selective-serotonin reuptake inhibitor (SSRI), like Luvox, Paxil, Zoloft, Lexapro, or Prozac.

SSRIs are antidepressants, designed to boost your serotonin levels and prevent serotonin from being reabsorbed by your body. Researchers suggest that people with OCD and/or other mental health conditions, such as anxiety or depression, are at risk of a serotonin deficiency or a low serotonin level. Serotonin, a neurotransmitter or chemical messenger in the brain, improves your mood, controls your behavior, promotes sound sleep and healthy digestion, and triggers feelings of happiness. Understand, however, that too much serotonin can lead to serotonin syndrome.

Unfortunately, combining standard OCD therapies with SSRIs failed to garner the desired outcome. So, your doctor switched your SSRI antidepressant to an SNRI, then to a tricyclic antidepressant, but nothing worked. Because all the other treatment avenues (SSRIs, SNRIs, and tricyclic antidepressants) failed to work, you were put on an antipsychotic, but even this failed to yield appropriate results.

So, now what? Are there any other therapies that could help with your OCD symptoms? Absolutely. Dialectical behavioral therapy (DBT) is one such therapy that has shown some success in reducing or eliminating pesky treatment-resistant OCD symptoms. If you are wondering what DBT is, what it entails, and how it can help you get your OCD symptoms under control, look no more! This article will help you better understand why DBT is and why it is used for OCD, so you can determine if it should be added to your handy OCD recovery toolbox.

OCD? What is That?

Obsessive-compulsive disorder (OCD) is an anxiety condition that involves involuntary, non-stop, distressing, and/or repetitive thoughts and/or behaviors. Common types of OCD fears (obsessions) may include reading OCD, harm OCD, contamination OCD, existential OCD, meta-OCD, relationship OCD (ROCD), suicidal OCD, danger OCD, etc.

Common types of OCD behaviors (compulsions) may include deliberately avoiding people or things that cause you to experience stress and angst (OCD triggers), constantly seeking reassurance from others that you are “okay” and “not a bad person,” excessively cleaning or sanitizing your home, car, and body, checking and rechecking the oven, stove, doors, windows, etc., to ensure everything is turned-off and secure, reading and re-reading the same text if unable to read it in a certain timeframe or if you accidentally read the word or sentence incorrectly, and/or becoming “fixated” on a partner, especially his or her flaws – to the point that you start to question (doubt) if he or she is the “right” person for you and vice versa.

Some people grapple with just obsessions (intrusive thoughts, urges, doubts, fears, mental images, etc.), while others struggle with just compulsions (repetitive routines or rituals). Most OCD sufferers experience both obsessions and compulsions. But regardless of whether you have one or both types of OCD, this mental health condition can be extremely debilitating – if left untreated.

Standard OCD treatment typically involves a multidisciplinary approach involving CBT, ACT, and ERP therapy – with or without OCD medications like SSRIs, SNRIs, antipsychotics, etc. Natural remedies and self-help tools also appear to be beneficial for OCD.

These natural remedies and self-help tools may include mindfulness meditation, CBD, yoga, hypnotherapy/hypnosis, adopting a healthy diet filled with vitamins and minerals, OCD books and workbooks, OCD podcasts, forums, helplines, and support groups, developing healthy coping skills and strategies, online OCD treatment programs, like the successful and effective Impulse Therapy.

When these “standard” OCD therapies have little-to-no effectiveness, other treatment approaches, like dialectical behavior therapy (DBT), may be explored. The good news is that with the right OCD treatment approach, you can get back on your feet and put OCD behind you!

Now That You Have Caught My Attention – What is DBT?

Similar to ERP therapy, dialectical behavior therapy (DBT) is a type of CBT. DBT is designed to help people, like OCD sufferers, how to apply mindfulness meditation, distress tolerance, emotional regulation, interpersonal effectiveness, acceptance, validation, and trust-building to their everyday lives. This psychotherapy was originally created to treat personality disorders, like borderline personality disorder and post-traumatic stress disorder (PTSD), however, this scope was widened to include other mental health conditions, like OCD.

The main difference between DBT and other psychotherapies is the ideal of “acceptance,” regardless of your thoughts, fears, doubts, emotions, urges, etc. “Acceptance” in this situation means looking at your obsessions without prejudice – your thoughts, urges, doubts, fears, etc., are neither good nor bad, nor right or wrong.

CBT focuses on “measurable” behavioral changes, while DBT teaches people how to accept their thoughts, feelings, doubts, urges, mental images, emotions, and fears – without judgment. Unlike DBT, ERP therapy focuses on confronting your obsessions and compulsions head-on. DBT, on the other hand, involves learning how to cope with anxiety-induced fears, obsessions, and compulsive behaviors.

Note: Some OCD sufferers feel that CBT is too aggressive and “pushy” when seeking change. This causes the individuals to feel judged, guilty and shamed, confronted, and invalidated, causing them to prefer an “easier,” non-aggressive” OCD treatment like DBT.

What is the Connection Between OCD & DBT?

Researchers suggest that DBT can be extremely beneficial for OCD, especially emotional regulation. DBT focuses on helping OCD sufferers accept their thoughts, fears, urges, doubts, mental images, and/or behaviors – without judgment, shame, or guilt. Learning DBT skills can help OCD sufferers cope with daily stressors and feelings of being out of control while easing feelings of hopelessness and helplessness, and improving their quality of life.

An effective way to properly manage OCD is through acceptance, non-judgment, and mindfulness meditation. One key factor in OCD treatment success involves developing a trusting relationship with the OCD therapist. One of the most important elements of DBT is the therapeutic relationship, primarily because it is this client/therapist relationship that promotes OCD sufferers to “open up” and share their true feelings without feeling criticized, dismissed, shunned, and/or inadequate.

Many OCD sufferers need that “validation” from their OCD sufferers to feel like there are making “strides” in OCD recovery. Once trust has been established, it is easier for OCD sufferers to take risks during their therapy process. Thus, you must be open and honest with your OCD therapist about your thoughts, urges, doubts, fears, feelings, mental images, and behaviors.

Your therapist, on the other hand, must create a “safe space” (an atmosphere that is free of shame and guilt and feelings of failure), so you feel “safe enough” and “comfortable enough” to share your genuine thoughts, feelings, and behaviors.

To make long-term changes in your thought processes and behaviors, you must feel “safe” and “secure” during the therapy process. If these elements, along with trust, are missing, you will be unable to fully open up, leading to a poor therapy outcome (an inability or unwillingness to do what it takes to make lasting changes).

Remember, DBT focuses on how your emotions dictate or influence how you behave. The goal of DBT skills is to help you handle non-stop, unwanted intrusive thoughts, urges, fears, doubts, emotional distress, mental images, and/or repetitive behaviors.

Note: Researchers suggest that DBT may be an effective OCD treatment option for some OCD sufferers, especially those, who have found ERP therapy (the go-to treatment for OCD), ineffective.

What Does DBT Entail?

Listed below are the different facets of DBT for OCD:

• Weekly individual (in-person) therapy sessions
• Weekly skills-training group sessions
• Off-session client/therapist consultations (as needed)

What DBT Skills Can Be Applied to My OCD Symptoms?

Listed below are valuable ways you can apply your DBT skills to your OCD symptoms, so you can live a happy, productive, and stress-free life:

• Distress Tolerance – Distress tolerance skills can be used to distract yourself or calm yourself when intrusive or upsetting thoughts, urges, mental images, fears, doubts or emotions arise.

• Emotional Regulation – Emotional regulation skills can help you better manage your anxiety-related obsessions and emotions. Emotional regulation skills can help you begin to understand that anxiety can and will diminish over time without urges to perform rituals and routines or seek assurance from others (compulsions).

• Interpersonal Effectiveness – Interpersonal effectiveness skills can help you manage the emotions linked to certain social interactions, which can include avoidance and reassurance-seeking behaviors.

• Mindfulness Meditation – Mindfulness meditation skills can help you be more “present” and “mindful” of what is happening around you (in the moment). Being mindful includes letting go of upsetting thoughts, fears, urges, doubts, and emotions.

In other words, mindfulness meditation involves being non-judgmental (realizing that your thoughts, urges, fears, emotions, etc., are neither “good” nor “bad” or “right” or “wrong”), and focusing your thoughts, urges, fears, emotions, etc., on the “present moment,” when intrusive, distressing, unwanted and repetitive thoughts, urges, doubts, emotions, fears, and/or behaviors arise.

How Long Do the Benefits of DBT for OCD Last?

Researchers suggest that DBT can last at least a year. Keep in mind, however, that this does not mean that you will no longer experience mild symptoms during this time. It also does not mean that the symptoms will not return in full force once that year ends. Thus, it is important to have periodic follow-ups with your OCD therapist.

What is It Like to Use DBT for OCD?

In my professional opinion, the best way to get a clear view of how effective or non-effective DBT is for OCD is to hear from OCD sufferers, who are currently using DBT for OCD, or who have used it in the past for OCD.

Listed below are personal reviews of DBT for OCD:

Darryl

“If you find that tolerating painful emotions or emotion regulation is difficult for you, DBT may be helpful. I personally do not know how OCD is conceptualized under a DBT lens, but I guess compulsions could be viewed as a ‘self-harm’ behavior used to regulate oneself. I am speculating here, but I do know that DBT is very good at teaching people with OCD how to tolerate negative emotions in healthier ways. The truth is emotional dysregulation is a huge problem in the OCD world – a problem that is not fully addressed by CBT and ERP therapy. Therefore, I would personally recommend ACT over DBT.”

Amy

“My therapist suggested I try DBT, so I did that for 2 years (in a group therapy setting). I really liked it and it helped me feel better. So, I would suggest that OCD sufferers at least try it, depending on what they are seeking from therapy.”

Mindy

“Hi, I am trying to find an ERP therapist in my state for individual therapy, but I am also considering joining a DBT group program near me. I feel like DBT could teach me how to better tolerate the distress and strong emotions that come with my obsessions, but I am unsure. If any of you have an experience with DBT, I would really appreciate your input and thoughts! Thanks!”

Jason

“I struggle with severe OCD. I participate in an outpatient OCD treatment program, but last night I went to a crisis center because I was having obsessive thoughts, relating to ethics and existentialism, triggered by my recent ‘break up.’ I had a feeling that I would have to go to the hospital because my thinking patterns had become so erratic.

More specifically, my thoughts were not making any sense. This had been happening for over two weeks, so I knew something was terribly wrong. Because of my experiences and OCD, I have a strong disregard for consequences. I also strongly believe that I am throwing my life away because people are always trying to preach to me about how bad the world is bad and what a bad person I am, so my way of dealing with the negativity surrounding me is to look for reassurance from others – reassurance that none of those things are right or true. I also have harmful and scary daily compulsions.

My new psychiatrist is the first person, who could get me to talk about what is really happening to me. She is also the first person that realized (and helped me see it for myself) that my obsessions and compulsions were worrisome signs of destructive behavior. As a result, she recommended that I try DBT to develop healthy coping skills and strategies. Has anyone ever used DBT to learn coping mechanisms? Did it work? I do not really love the idea of paying for someone to tell me to breathe in and breath-out, because I will probably not remember to do that once I get ‘all riled up.'”

Can Natural Remedies & Alternative Treatments Be Added to DBT?

Yes, they can be added to DBT for OCD.

Listed below are holistic tips that can be added to a DBT for OCD treatment plan:

• Stress-management techniques like mindfulness (FYI: OCD is characterized by high levels of stress and anxiety)
• Movement and regular exercise
• Proper sleep
• Nicotine and alcohol avoidance
• Leaning on friends and family for support, advice, and acceptance 
• Yoga
• Art therapy
• Music therapy
• Online OCD treatment programs like Impulse Therapy

References

• Cleveland Clinic. (n.d.). Serotonin syndrome. Retrieved from https://my.clevelandclinic.org/health/diseases/17687-serotonin-syndrome
• Baumgarten, H. G., & Grozdanovic, Z. (1998). Role of serotonin in obsessive-compulsive disorder. The British Journal of Psychiatry, 35, 13–20. Retrieved from https://pubmed.ncbi.nlm.nih.gov/9829022/
• Ahovan, M., Balali, S., Abedi, N., & Doostian, Y. (2016). Efficacy of dialectical behavior therapy on clinical signs and emotion regulation in patients with obsessive-compulsive disorder. Mediterranean Journal of Social Sciences, 7. Retrieved from https://www.researchgate.net/publication/-Compulsive_Disorder
• Kennedy, D. F. (2018). What if I…? Therapy Today, 29(10), 24–28. Retrieved from https://www.bacp.co.uk/search?UserLocation=36.03452512177637%2C-86.67126576733028&q=Kennedy&SortOrder=0
• de Zoysa, P. (2013). The use of mindfulness practice in the treatment of a case of obsessive-compulsive disorder in Sri Lanka. Journal of Religion and Health, 52(1), 299–306. Retrieved from https://doi.org/10.1007/s10943-011-9461-0
• Stiglmayr, C., Stecher-Mohr, J., Wagner, T., Meiβner, J., Spretz, D., Steffens, C., Roepke, S., Fydrich, T., Salbach-Andrae, H., Schulze, J., & Renneberg, B. (2014). Effectiveness of dialectic behavioral therapy in routine outpatient care: The Berlin Borderline Study. Borderline Personality Disorder and Emotion Dysregulation, 1, 20. Retrieved from https://doi.org/10.1186/2051-6673-1-20
• Chapman A. L. (2006). Dialectical behavior therapy: Current indications and unique elements. Psychiatry, 3(9), 62–68. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2963469