In aversion therapy, the idea is that activity that is habitually paired with unpleasant activity becomes extinguished. An example of this would include electrical shocks for paraphilias and disulfiram for alcoholism, which produces nausea when consumed with alcohol. Those with OCD were sometimes given a rubber band on their wrist to snap every time they had an effective thought. This was not very effective.
Eventually, a researcher introduced a form of behavioral therapy in which individuals were exposed to distressing situations and objects for long periods of time. This was combined with strict prevention of rituals. Thus, it became known as exposure and ritual therapy. This treatment was found to be highly successive in several patients. Exposure in vivo, or exposure in real life, involves forcing the patient to confront triggers for obsessive thoughts. These include words, images, objects and so on.
For example, touching water faucets in a public restroom might trigger germ obsessions. Cues were presented in a hierarchical manner, beginning with the moderately distress-provoking ones and progressing to more distressing cues. During what is known as the imaginal component of the exposure therapy, the patient is asked to confront situations and scenarios which they think will occur if they do not perform the associated compulsion. During ritual prevention, the individual is instructed to abstain from ritualistic behavior which they believe will obviate the feared consequence.
For example, they will be asked to not wash their hands after they touch the floor, in order to extinguish the obsessive fear of becoming contaminated by not washing one’s hands. Finally, the patient is asked to process their experience during and/or after exposure and response prevention. The patient is asked to note whether or not their fears have been either confirmed or repudiated following refusal to engage in the compulsion associated with decrease in obsessive anxiety. Does the patient still have the anxiety? Are they as intense as anticipated? Is the obsessive anxiety as intense as it was near the beginning of the therapy.
Exposure and ritual prevention has repeatedly found to be successful in treating OCD. The same is true of cognitive behavioral therapy. This involves identifying unrealistic thoughts and attempting to change interpretations of the meanings of these thoughts. This results in lowered anxiety and fewer compulsions. Patients are instructed to articulate an awareness of their worries as pathological obsessions and their activities and rituals as pathological compulsions. He is to keep a diary of these obsessions, in which he writes down obsessions and gives their interpretations.
This may contain the content of the obsession, its beginning, the meaning attributed to it, and the patient’s response to the obsession. The therapist will review the diary and query the patient about whether or not the beliefs seem realistic. This helps the patient to cognitively identify their exaggerated or irrational thoughts and understand them as such. For example, if an individual believes that he must wash his hands five times a day in order to prevent his family from being harmed, he will be asked to do it only three times a day to see if this harms the family. This will help defuse the irrational nature of the obsession and its relation to the compulsion. Both cognitive behavioral therapy and exposure and ritual prevention therapy have been find to be highly effective in the treatment of OCD.