Using Motivational Interviewing Techniques for OCD

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The effectiveness of psychological treatments for obsessive-compulsive disorder (OCD), such as exposure and response prevention therapy, is well-established. But given that exposure-based therapies require the patient to directly confront those things they fear most, many people refuse treatment, drop out shortly after it's started, or don't keep up with homework assignments. Because of this, it's estimated that only 50% of people with OCD are able to benefit from exposure-based treatments despite their effectiveness.

But research has been ongoing to find ways to make exposure-based therapies more attractive for more people, and motivational interviewing techniques show considerable promise in this respect. 

History and Purpose of Motivational Interviewing Techniques

Originally, motivational interviewing techniques were developed to help increase people's motivation to change and reduce negative feelings towards treatment in individuals struggling with substance use disorders. Recently, motivational interviewing has been explored as a way of addressing these same issues in anxiety disorders, such as OCD. 

Motivational interviewing assumes that you want positive changes to take place in your life, but at the same time recognizes that fear can sometimes get in the way of such change.

The objective of motivational interviewing is to increase your motivation to change so that you can realize your goals, such as finding a romantic partner or steady employment.

Exploring What Drives You

One of the biggest components of motivational interviewing is thoroughly exploring what keeps you in the same OCD patterns and thoughts, despite the harm and suffering you may be experiencing. Why do you keep doing what you're doing? For example, although someone with OCD may currently be spending over two hours a day washing their hands, the desire to avoid the anxiety that comes with feeling contaminated may outweigh the distress and disruption to their life caused by this behavior. In another instance, someone experiencing extremely distressing intrusive and violent sexual obsessions about molesting children may be willing to suffer through them to avoid having to disclose these potentially embarrassing and shameful thoughts to a therapist, family member or spouse. 

Identifying Your Barriers

Motivational interviewing techniques can be used to help you become ready for more targeted exposure-based treatment. Barriers that could get in the way of your starting or completing therapy are identified and discussed in depth. Your therapist will usually use open-ended questions that are designed to help you arrive at your own conclusions. Remember, it is not uncommon to be unaware of or even to want to avoid thinking about the reasons you do not want to change. This is normal, particularly if your reasons for avoiding change are potentially distressing.

Once the barriers to change are identified, your therapist will work with you to identify both the advantages and disadvantages associated with participating in an exposure-based therapy. Following this, you and your therapist may have extensive discussions about your goals and whether the disadvantages of participating in therapy outweigh the goals you want to achieve or not.

Do Motivational Interviewing Techniques Improve Outcomes?

Overall, clinical research suggests that motivational interviewing techniques help more people benefit from exposure-based treatments for OCD. As well, there is some evidence that motivational interviewing may help patients gain more insight into the severity of their symptoms and how much OCD truly disrupts their lives.

If you are interested in behavioral therapy but also have strong reservations about such treatment, it may be helpful to try to find a therapist who specializes in motivational interviewing to help you along this treatment path.

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  • Maltby, N., & Tolin, D. "A brief motivational intervention for treatment-refusing OCD patients" Cognitive Behaviour Therapy 2005 34: 176-184
  • Simpson, H., Zuckoff, A., Page, J.R., Franklin, M.E., Foa, E.B. "Adding motivational interviewing to exposure and ritual prevention for obsessive-compulsive disorder: an open pilot trial" Cognitive Behaviour Therapy 2008 37: 38-49