The obsessive thought next generates feelings of anxiety and discomfort, which are relieved by performance of a compulsive ritual, such as hand washing. Successful behavior therapy first breaks the connection between the obsessive thought and the anxiety it produces and then breaks the connection between the performance of a ritual and the reduction in anxiety that follows. The former is accomplished by exposure and the latter by response prevention . Thus, the behavioral treatment of OCD based on this model is called exposure and response prevention. In response prevention, compulsive rituals that function to decrease the distress brought on by obsessive thoughts are delayed or prevented entirely.
Habituation is the process by which exposure therapy is thought to work.
Obsessive thoughts or images produce feelings of anxiety or distress that continue to increase to very uncomfortable levels. In the absence of a neutralizing ritual, this distress will eventually decrease to levels that are tolerable or vanish almost entirely. At this point the rituals will disappear because there is nothing left to escape from and they are no longer reinforced by reductions in anxiety. As with any psychiatric disorder, OCD can cause a range of impairment. In rare cases, psychiatric inpatient hospitalization is necessary for individuals with severe OCD symptoms.