OCD Therapy in NYC
What Is OCD?
OCD can be distressing, time-consuming, and disruptive, but effective treatment is available. At Manhattan CBT, we use evidence-based treatments such as Exposure and Response Prevention (ERP) to help people reduce obsessions and compulsions and reclaim their lives.
People casually use terms like “OCD” and “obsession” to describe endearing quirks or harmless habits. In reality, OCD can be a serious condition and is thought to affect 1% to 3% of people worldwide. People with OCD suffer from repetitive thoughts or repetitive behaviors that they have trouble stopping. The condition’s impact can range all the way from mildly annoying to completely disabling.
Common OCD Symptoms
OCD involves either obsessions, compulsions, or both.
Obsessions
Obsessions are thoughts that feel intrusive and are accompanied by significant anxiety. These thoughts are typically experienced as unpleasant, and a lot of energy is spent trying to rid of them. Some of the more common obsessions involve one of three topics: blasphemy, violence, or sexual taboos. Obsessions are often experienced as “what if” thoughts — e.g., “what if I jumped out the window?” or “what if I lose control and attack my spouse?” or “what if I actually cheated on my spouse and don’t remember it?”
Compulsions
Compulsions are behaviors that are often driven by anxiety and that we have difficulty stopping, despite our efforts to do so. Common compulsions include hand washing, cleaning, checking and counting. Compulsions can also be mental. One example of this kind of compulsions is the repeated mental retracing of a conversation to make sure you didn’t say anything rude.
Perhaps the most common compulsion is excessive hand washing. Hand washing is part of good hygiene, but too much hand washing can be compulsive. For other OCD sufferers, there is no fear of a specific illness, it just feels like something they have to do, and they feel better after they do it.
Types of OCD We Treat
OCD can take many forms. Although the underlying treatment principles are often similar, the specific obsessions and compulsions vary widely from person to person. We regularly work with clients experiencing the following types of OCD:
- Moral OCD / Scrupulosity
- Relationship OCD (ROCD)
- “Just Right” OCD
- Contamination OCD
- Tourettic OCD
- Sexual Orientation OCD (HOCD or SO-OCD)
- Checking OCD
- Hit and Run OCD
- Pedophilic OCD (POCD)
- Existential OCD
- Pure O OCD
- Confessing OCD
- Harm OCD
You can learn more about each of these different forms of OCD on our Types of OCD page.
How OCD Therapy Works (ERP and CBT)
When obsessions or compulsions are bad enough that they interfere with our ability to function, it is a good idea to seek a consultation with a professional. Fortunately, there are several effective treatments for OCD. The two most commonly used include a form of cognitive-behavioral therapy called Exposure and Response Prevention (ERP, or ExRP), and also medication.
Once your therapist has determined that ERP therapy makes sense for you, they’ll spend some time talking with you about your symptoms and how they impact each other and impact you. They will then explain how and why exposure exercises might be helpful for you, making sure that you’re feeling comfortable with the plan.
Exposures
Once you’re ready to begin exposure exercises, your therapist will create a list of situations, places or ideas that trigger obsessive anxiety for you. You will work together to figure out which such situations are the easiest and hardest for you to tolerate. Based on that, you’ll begin practicing tolerating challenging OCD feelings that come with the easier situations first.
Over time you’ll find that these situations feel less and less difficult for you, and your therapist will encourage you to move on to more challenging situations, with their help. Eventually if you make good progress, you’ll find that things that used to be very uncomfortable for you start to feel easy.
The cycle of OCD
Compulsions provide temporary relief from anxiety, but they also strengthen the notion that the obsession was important and dangerous. ERP helps you break OCD’s cycle by learning that anxiety can rise and fall naturally without performing compulsions. Over time, the obsession loses much of its power.
Medication Options
Prescribers primarily use two classes of medication to treat OCD. Selective serotonin reuptake inhibitors (SSRIs) are medications that increase the amount of a naturally occurring chemical in the brain called serotonin. SSRIs include medications such as Luvox, Lexapro, Prozac and Zoloft. SSRIs are the first type of medications prescribed for OCD, and they are prescribed at high doses. Unfortunately around half of people treated for OCD with SSRIs do not respond well enough to meet their goals.
If SSRIs aren’t effective, prescribers will sometimes use other medications sometimes used to manage OCD. These include Anafranil (a tricyclic antidepressant) and medications called novel antipsychotics such as Abilify.
So Which Treatment Works Best?
Which is more effective, ERP or medication treatment? This question needs more research, but studies have suggested that ERP without medication is slightly more effective than medication without ERP (e.g., this study and this study). Many people have a greater comfort level with one of these two options over the other; if you strongly prefer one, seek it out! Treatment can change lives — life after OCD can be a whole new ballgame.
How Effective Is OCD Treatment?
Many people seeking treatment wonder whether OCD can truly get better. The answer is yes.
Exposure and Response Prevention (ERP) is considered the gold-standard psychotherapy for OCD and has been studied extensively. Research consistently shows that two thirds of people who complete ERP experience significant reductions in their symptoms.
Successful treatment does not mean never having another obsessional thought. In fact, such thoughts are a normal part of human experience. OCD treatment helps people change their relationship with those thoughts so they no longer trigger the same anxiety, compulsions, and disruption to daily life.
Many clients find that they spend less time obsessing, less time performing compulsions, and are able to return their attention to the things that matter most to them. Some experience substantial symptom reduction; others improve to the point that OCD no longer interferes meaningfully with their lives.
Even if you’ve struggled with OCD for many years, improvement is possible.
Why Choose Manhattan CBT?
Our therapists specialize in cognitive-behavioral therapy (CBT) for anxiety-related disorder like OCD. We treat OCD more often than any other disorder. Our treatment is evidence-based and tailored to the specific situations that trigger your OCD symptoms — whether those involve cleaning or checking compulsions or mental rumination about obsessional topics.
Clients choose our practice because:
- Our therapists are primarily doctoral-level psychologists, and all of us have specialized training in CBT
- We have specialized training and years of experience treating OCD
- CBT is our specialty – it’s all we do
- Treatment is goal-oriented and typically short-term
- We have extensive experience working with professionals and college students in NYC
- We offer both in-person sessions in Midtown Manhattan and teletherapy throughout New York and New Jersey
Our goal is not just to help you manage OCD, but to help you achieve as much symptom reduction as possible. Often that leads to clients having markedly reduced symptoms or no symptoms at all by the end of treatment.
How to Find an OCD Therapist Trained in ERP
Many people with OCD understandably seek therapy when their symptoms become a problem. However, this is not a guarantee they find effective treatment. Most therapists have not been trained or experienced in ERP. Despite that, many will treat OCD anyway. Finding a therapist with the right training can be hard. Here are some helpful questions to answer before starting psychotherapy for OCD:
- What training does the therapist have in doing ERP? (the answer should not be “none.”)
- Does the therapist give homework exercises to do between sessions? (The answer should be “yes”)
- How will the therapist measure your progress? (The answer should not be, “we’ll talk about it as we go and decide together.” The ERP therapist typically uses questionnaires to measure progress, but may use other indicators such as average number of times washing hands per day, or number of hours spent in obsessive rumination.)
Frequently Asked Questions
Exposure and response prevention (ERP) therapy, also known as exposure and ritual prevention (ExRP) therapy, is a cognitive-behavioral treatment specifically used for obsessive-compulsive disorder. It is centered around exposure exercises that help people with OCD become gradually more able to tolerate the feelings that lead to compulsions. This helps them reduce their OCD symptoms over time.
OCD therapy using exposure and response prevention typically takes anywhere from 12 to 25 sessions. Sessions are usually once a week, but not always. The length of treatment can be longer or shorter depending on the severity and complexity of your symptoms, how well you’re able to complete the exercises your therapist recommends, and other factors.
Many times, OCD responds well to ERP therapy even without medication — especially in mild to moderate cases. However, for many people, medication is helpful and sometimes necessary to help them reach their goals.
Yes — “pure O” OCD is our specialty. We treat many people with primarily obsessive OCD using a combination of exposure and response prevention (ERP), mindfulness, and other elements of cognitive-behavioral therapy.
Yes — research shows that whether the therapist is delivered in-person or over video, the expertise of the therapist and the type of therapy are more important in determining outcome than whether the therapy is in-person or not.
The providers at the Manhattan Center for Cognitive-Behavioral Therapy are out-of-network for insurance. If your plan is a POS or PPO plan, however, then your plan has out-of-network coverage that can be used to cover some of your costs.
Please contact us
OCD can be frustrating, exhausting, and time-consuming, but effective treatment is available. If you’re ready to explore whether CBT and ERP could help, we’d be happy to talk with you about your options.
We can help you in your efforts to find therapy for OCD here in New York. Our CBT therapists are doctoral-level psychologists. We also have student therapists who offer reduced-fee services. Our offices are in midtown Manhattan, but we offer teletherapy services to people elsewhere in New York State, New Jersey, Massachusetts, North Carolina, Virginia, and Florida. If you’re looking for therapy for OCD in another part of the country or world, please contact us — we are happy to help!
