One of the challenges associated with OCD is that the drive to engage in compulsions can come from distorted beliefs and distorted patterns of thinking.
The idea that there could be some truth to an obsession is not, in and of itself, a problem. But believing that if you have a thought about something, this must make it true – that is a problem. Cognitive therapy focuses on how we think about our thoughts, feelings, and sensations and aims to challenge the mistaken beliefs and assumptions that lead to compulsions.
Though we cannot control what thoughts we have, we are able to recognize when we are thinking about a situation in a way that is leading to false conclusions. These patterns of thinking are called cognitive distortions. A few examples include all-or-nothing thinking, catastrophizing, emotional reasoning, and disqualifying the positive. By identifying cognitive distortions, we can challenge them with more reasonable, objective ways of looking at the same situation. This is sometimes done with the use of a thought record, which involves writing down triggering situations, what your OCD is saying about them, and then what an alternative and more skillful way of looking at the situation might be.
Cognitive therapy for OCD is somewhat different from cognitive therapy for other disorders, such as depression. Challenging distorted thinking in OCD focuses less on disputing the unwanted thought and more on disputing the rationale for engaging in compulsions. In this way, it can function as a powerful compliment to Exposure with Response Prevention (ERP).