Occupational Therapy for OCD: Assessment, Goals and Activities
Can occupational therapy help OCD? Yes. How OCD affects daily life, OT assessment, goals and objectives, exposure ladders and activity-based care.
Can occupational therapy help OCD?
Yes. Occupational therapy has an important role in the treatment of obsessive-compulsive disorder (OCD). The occupational therapist involves the person in purposeful activity, so they can experience satisfaction while the anxiety caused by obsessive thoughts becomes less. The OT focuses on activities of daily living (such as self-care) and occupational tasks (such as job performance).
The areas of occupation affected by OCD can include activities of daily living, education, play, work, leisure and social participation.
What is OCD?
In OCD, obsessions are usually linked with compulsions. OCD affects roughly 1 to 2 in every 100 people at some point in their lives, often starting in childhood, adolescence or early adulthood.
| Obsession | Compulsion |
|---|---|
| An idea, image or urge that intrudes into awareness again and again | A behaviour or mental act that usually follows an obsession |
| Recognised as coming from one's own mind, but unwanted and distressing | Done to reduce anxiety or prevent a feared event, but not realistically connected to it, or clearly excessive |
| Often recognised as irrational or excessive | Most people realise the compulsion is excessive, though insight varies |
| The person tries to resist it but can't; failing to resist leads to marked distress | Brings short-term relief, which keeps the cycle going |
Insight varies: DSM-5 describes good or fair, poor, and absent insight.
Obsession
"Did I lock the door?"
Anxiety
Distress and doubt rise
Compulsion
Go back and check, again
Relief
Short-lived; doubt returns
Relief teaches the brain that the compulsion 'worked', so the cycle gets stronger. Treatment breaks it by facing the obsession without the compulsion.
Common types of OCD
| Theme | Obsession | Compulsion |
|---|---|---|
| Contamination | Fear of germs, dirt or illness | Excessive handwashing, cleaning, avoiding touching things |
| Checking | Fear of harm from a mistake, e.g. fire or burglary | Checking locks, switches, appliances repeatedly |
| Symmetry and order | Things must feel 'just right' | Arranging, ordering, repeating actions until they feel right |
| Intrusive thoughts | Unwanted violent, sexual or religious thoughts | Mental rituals, praying, seeking reassurance, avoiding triggers |
OCD mainly affects a person’s process skills (such as organising, sequencing, pacing and completing tasks), while motor and communication skills usually remain intact. Obsessions and compulsions also have negative effects on other areas of daily functioning.
For example: a person with OCD who feels compelled to check the lock of their house again and again before leaving for the office may often be late for work, which will likely harm their job performance.
Occupational therapy assessment for OCD
Occupational therapists assess and treat people with OCD in daily living and occupational areas. Obsessive and compulsive behaviour affects routine tasks, and the person may not be able to focus on daily activities because of the continuous obsessive thoughts and the compulsions that follow.
The OT assesses many areas of functioning, including habits, interests, thoughts, personal care, environment and work behaviour. The OT may use the Model of Human Occupation (MOHO) for assessment and treatment planning.
Interview, observation and different scales can be used. Common tools include:
- Interest Checklist
- Role Checklist
- Occupational performance screening, e.g. the Canadian Occupational Performance Measure (COPM)
- Assessment of Motor and Process Skills (AMPS)
- A time-use diary showing how many minutes rituals take each day
- Yale-Brown Obsessive Compulsive Scale (Y-BOCS), often completed by the team, to rate severity
Occupational therapy goals and objectives
Planning goals and objectives is the first step in treatment planning. The therapist observes and investigates the person’s main problem areas and plans accordingly. Here are examples of goals and objectives an occupational therapist might set for a client with OCD:
Problem 1Poor time management
GoalTo improve time management.
- Patient will complete the activity within the allotted time.
- Patient will follow the given schedule.
Problem 2Limited interaction skills
GoalTo increase interaction skills.
- Patient will actively participate in group activities.
- Patient will interact positively with peers.
Problem 3Morning routine takes over 2 hours
GoalTo reduce morning routine time so the patient reaches work on time.
- Patient will complete showering in 15 minutes using a timer.
- Patient will leave the house within 10 minutes of the planned time on 5 of 7 days.
Occupational therapy treatment for OCD
An occupational therapist can help a person with OCD through different therapeutic approaches that reduce the anxiety, stress and difficulty working that can arise from obsessions and compulsions.
Rapport building
This is the first and most important step of OT treatment. A positive early bond between the therapist and the person helps the therapist bring about positive change. Many people feel embarrassed about their rituals, so a non-judgemental, accepting attitude is essential.
Relaxation techniques and lifestyle
The OT can teach relaxation techniques and lifestyle changes that help reduce anxiety. Yoga, Jacobson’s progressive muscle relaxation, breathing exercises and meditation are commonly used. The OT can also help the person identify the environmental triggers that set off obsessions and compulsions, and plan how to handle them.
Graded exposure: the desensitisation ladder
The occupational therapist can support desensitisation to obsessive thoughts. Because the obsession is followed by a compulsion, a person who tries to break the chain may feel anxiety and restlessness. In this technique, the person makes a hierarchy of situations that trigger the obsession and grades them. They start with the lowest and progress slowly, resisting the compulsion at each step.
Hardest ↑
-
Lock the door once and leave for the whole workday90
-
Lock once, leave and go to the shop for an hour75
-
Lock once and walk to the end of the street without returning60
-
Lock the door once, say 'locked' aloud, and walk to the gate45
-
Check only twice instead of the usual ten times30
Easiest
Numbers are the person's own distress ratings (0–100). Each step is repeated until distress falls before moving up.
Occupational therapy activities for OCD
Purposeful activity to get unstuck: absorbing, purposeful activity can help a person shift attention and re-engage with their day after an episode. When stuck, people may become very distressed or irritable; getting them involved in something they really enjoy can help. (During planned exposure practice, though, the OT and person agree not to use distraction as an escape.)
Graded activity: the occupational therapist breaks a task into parts and asks the person to do one part at a time. When they complete it with satisfaction and without major anxiety, the therapist moves on to the next part.
Example: the person is asked to write about themselves. The therapist splits this into two parts, a positive side and a negative side. First, the person writes about the positive things about themselves. If this goes well and they aren’t distressed, the therapist moves to the next step: writing about the negative things, while observing the person’s anxiety level and thought process.
Familiar, meaningful activity: the person can be asked to do a favourite, familiar and meaningful activity. Because it’s familiar, they can do it easily and enjoy it. It can be similar to their work or daily living tasks. In daily life, though, there is more work pressure and less time, so the therapist also teaches time management skills.
-
Track
Use a time-use diary to see how long tasks and rituals take.
-
Plan
Build a written daily schedule with realistic time for each task.
-
Limit
Use timers and set end points for tasks like showering or cleaning.
-
Prioritise
Do the most important task first, before rituals can take over.
-
Review
Look at what worked each week and adjust.
Involving family
Families often get drawn into rituals, for example by giving reassurance or checking for the person. With the person’s consent, the OT can help family members understand OCD and gradually step back from accommodating rituals, in line with the treatment plan.
Summary
An occupational therapist provides activity-based therapy to people with OCD. The ultimate goal of occupational therapy is for the person to perform their daily routine activities without being controlled by anxiety, stress or obsessions, by rebuilding routines, time management, roles and confidence alongside ERP and medical treatment. Read more:
- Occupational therapy in mental health
- Occupational therapy for anxiety disorders
- Occupational therapy for depression
References
- Bavaro SM. Occupational therapy and obsessive-compulsive disorder. American Journal of Occupational Therapy. 1991;45(5):456–458.
- Rapoport JL. Obsessive-compulsive disorder. In: International Handbook of Phobic and Anxiety Disorders in Children and Adolescents. 1994:207.
- Marcil WM. Occupational Therapy: What It Is and How It Works. Thomson Delmar Learning.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed., text revision (DSM-5-TR). 2022.
Frequently asked questions
Can occupational therapy help OCD?
What is the best treatment for OCD?
How does OCD affect daily life?
What assessments do occupational therapists use for OCD?
What are examples of OT goals for OCD?
Written by
Payal Mehta, OT
Payal Mehta is a practising occupational therapist and co-founder of Occupational Therapy OT. She writes on pediatrics, sensory integration, and mental-health practice.
All articles by Payal →This article is for general education and is not a substitute for individualized assessment or treatment by a licensed occupational therapist. Always seek the guidance of a qualified professional for specific concerns.
