CBT for OCD: Challenging Irrational Obsessions to Break Harmful Compulsions

Intrusive thoughts feel urgent and threatening even when you know they’re irrational. You might spend an hour checking that you locked the door or washing your hands until they’re raw, all while recognizing the behavior doesn’t make logical sense.

This disconnect between knowing something is unreasonable and feeling compelled to do it anyway defines the frustrating reality of obsessive-compulsive disorder (OCD). The compulsions provide temporary relief that reinforces the entire cycle, making it stronger over time rather than solving the underlying problem.

At Mind Space Wellness, LLC, Caroline Bjorkman, DO, uses cognitive behavioral therapy (CBT) to help patients aged 12 and older break free from OCD’s grip. Rather than telling you to ignore obsessive thoughts, CBT teaches you to face them differently while gradually reducing the compulsive behaviors that keep the disorder alive.

OCD creates a cycle that feeds on itself

OCD traps you in a loop between obsessive thoughts and compulsive behaviors. An intrusive thought about contamination or harm creates intense anxiety. You perform a compulsion like hand-washing or checking to reduce that anxiety temporarily.

The relief reinforces the idea that the obsessive thought was dangerous and the compulsion was necessary. Your brain learns that compulsions solve the problem, making it more likely you’ll repeat the behavior next time the thought appears.

This cycle gradually expands. You might start by washing your hands after using public 

CBT breaks the cycle by changing your response to obsessions

CBT, a type of psychotherapy, for OCD teaches you to change your relationship with the thoughts themselves. The approach has two main components. 

First, you learn to recognize obsessive thoughts as symptoms of OCD rather than legitimate warnings. Second, you practice exposure and response prevention (ERP), which involves facing feared situations without engaging in compulsions.

Dr. Bjorkman guides you through this process gradually. If you have contamination fears, you might start by touching a doorknob and then waiting before washing your hands. The goal is to show your nervous system that you can tolerate the anxiety without performing compulsions.

Exposure exercises start small and build systematically

CBT for OCD doesn’t throw you into your worst fears immediately. Dr. Bjorkman creates a hierarchy of situations that trigger your obsessions, starting with scenarios that cause mild anxiety and progressing to more challenging exposures.

You still experience anxiety — that’s expected and necessary for the treatment to work — but  Dr. Bjorkman teaches you skills to manage this anxiety while resisting the urge to perform compulsions. Over time, your anxiety response to these situations naturally decreases.

Treating OCD with CBT takes time

CBT for OCD usually requires about a year's worth of sessions to see lasting improvement. The timeline depends on how severe your symptoms are, how long you’ve had OCD, and how consistently you practice the techniques between sessions.

Dr. Bjorkman assigns homework exercises that help you apply CBT skills in real-world situations. These might include gradually reducing checking behaviors, touching objects without immediately washing hands, or tolerating uncertainty without seeking reassurance.

CBT works best when you’re willing to experience discomfort

CBT requires facing anxiety rather than avoiding it. This approach works well for people who recognize their compulsions aren’t helping in the long term and are willing to tolerate temporary discomfort for lasting relief.

Dr. Bjorkman sometimes combines CBT with medication, particularly serotonin reuptake inhibitors, which can reduce the intensity of obsessive thoughts and make exposure work more manageable.

If OCD symptoms are interfering with your work, relationships, or daily activities, CBT can help you reclaim control from obsessive thoughts and compulsive behaviors. Contact our offices in Fort Lee, New Jersey, or the Upper West Side of Manhattan to schedule an appointment with Dr. Bjorkman and our team.