Can DBT Make Your OCD Worse?
Mindfulness, meditation, sitting with your thoughts—aren’t these the go-to solutions for everything lately? In the age of emotional wellness and self-regulation, these practices are often seen as universally beneficial. But for individuals with Obsessive-Compulsive Disorder (OCD), the story can be more complicated.
When mindfulness is misunderstood or misapplied, it can unintentionally reinforce compulsive patterns. “Sitting with your thoughts” might turn into mental checking. “Checking in with your body” could become a new form of reassurance-seeking. Even meditation can morph into a ritualized attempt to feel “just right.” And when these practices are drawn from Dialectical Behavior Therapy (DBT), it raises an important question: Can DBT actually make OCD worse?
In some cases, maybe —especially when DBT skills are used without a clear understanding of how OCD operates. But when integrated thoughtfully with Exposure and Response Prevention (ERP), DBT can offer powerful tools for emotional regulation, distress tolerance, and behavioral flexibility.
How DBT Skills Can Support ERP for OCD
1. Radical Acceptance and OCD: Making Space for Uncertainty
Radical acceptance is a DBT skill that encourages individuals to fully acknowledge reality as it is—without judgment, resistance, or attempts to change it. For people with OCD, this can be transformative.
In ERP, radical acceptance helps clients:
Accept the presence of intrusive thoughts without trying to suppress or neutralize them.
Acknowledge the discomfort of uncertainty and choose to live with it.
Let go of the need for absolute control or certainty.
This aligns with ERP’s goal of habituation—allowing anxiety to rise and fall naturally without engaging in compulsions.
2. Willingness vs. Willfulness: Choosing to Engage in ERP
Willingness, another DBT concept, is about approaching challenges with openness and flexibility. It’s the opposite of willfulness, which resists discomfort and clings to control.
In ERP, willingness supports:
Voluntary participation in exposures, even when anxiety is high.
Tolerating uncertainty instead of seeking reassurance.
Embracing the process of change, even when it feels uncomfortable or slow.
This mindset shift—from “I have to do this” to “I choose to do this”—can increase motivation and reduce resistance.
3. Opposite Action: Breaking the Cycle of Compulsions
Opposite action is a DBT skill that encourages individuals to act opposite to their emotional urges when those urges lead to unhelpful behaviors. In OCD, compulsions are often driven by fear, guilt, or anxiety.
In ERP, opposite action looks like:
Feeling the urge to wash hands but choosing not to.
Wanting to seek reassurance but staying silent.
Experiencing doubt but resisting the urge to check.
By practicing opposite action, clients weaken the link between anxiety and compulsion, helping to rewire behavioral patterns.
When DBT Skills Might Backfire in OCD Treatment
While some DBT skills can be a powerful complement to ERP, it’s important to recognize when its tools might be misused:
Mindfulness can become a form of mental checking or rumination.
Meditation may be ritualized to reduce anxiety or “feel right.”
Validation or emotional checking might reinforce compulsive self-monitoring.
This is why clinical guidance is essential when integrating DBT into OCD treatment. The goal is not to replace ERP, but to enhance it with skills that support emotional regulation and behavioral flexibility.
So, Can DBT Make OCD Worse?
If DBT skills are misunderstood or misapplied, they can unintentionally reinforce OCD symptoms. But when used strategically and in alignment with ERP, DBT can be a powerful ally in treatment.
For individuals with OCD—especially those who also struggle with emotion dysregulation, trauma, or interpersonal difficulties— learning DBT skills that align with ERP principles may provide additional benefits on their path to recovery.