CBT for POCD: techniques and benefits

If you are at the stage of looking for treatment for your POCD, I shall explain today one of the most widely used models of therapy, cognitive behavioural therapy (CBT) and how it helps with POCD. As a psychologist, I appreciate how difficult it is to come forward for treatment as you will experience deep shame and fear about the possibility of what has been going on for you, but these thoughts are ego-dystonic, meaning that they are at loggerheads with how you are as a person. Keep it in the front of your mind that you are suffering from OCD, and the content of your thoughts is not your fault.

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This page will focus on CBT, but for an overview of therapy options for POCD, please see this article.

Pedophilia OCD (POCD) is a subset of Obsessive-Compulsive Disorder (OCD) characterized by unwanted intrusive thoughts about inappropriate sexual behaviour involving children, which result in untold distress Cognitive Behavioural Therapy (CBT), particularly Exposure and Response Prevention (ERP), is highly effective in managing and treating POCD and in this article we shall focus on how CBT helps. I won’t go into detail explaining POCD as it has already been explained in depth here. but I shall point out that it is completely different from paedophilia, where there is an actual desire or intent.

How CBT Helps with POCD

CBT focuses on identifying and changing the thought patterns and behaviours that keep POCD going. For example, it might never have occurred to you that the thoughts and images that disgust you so much have a treatment to tackle them, and furthermore, the things that you have changed in your behaviour also need tackling. It makes sense; if your behaviour was back to normal and the thoughts changed, you would not have the distress of POCD, as it is kept alive by the amount of attention to pay to the thoughts and consequence behaviours.

A core component of CBT for POCD is ERP, which helps reduce compulsive behaviours and anxiety by exposing individuals to their fears in a controlled manner and preventing them from engaging in their usual compulsive responses. Studies have shown that CBT can significantly reduce the severity of OCD symptoms. For instance, a meta-analysis of 16 randomized controlled trials found that approximately 60-70% of patients with OCD experience substantial symptom reduction through CBT.

image of therapist with words CBT for POCD and Moodsmith logo

Steps of CBT for POCD

I have been working as a psychologist helping people with OCD for 20 years and will outline the steps that would happen in session with me. This will largely be the same for any clinician working within CBT as it is a highly structured model of therapy.

Session 1: Assessment and Psychoeducation

The initial assessment phase involves a thorough evaluation of the severity and nature of the POCD symptoms. This phase is crucial for understanding how to condition is affecting you. I ( or another psychologist) gather information about your history, when the symptoms first started and how they impact you on a daily basis. Psychoeducation is large part of the initial sessions, explaining in detail OCD and POCD, this helps to normalize your experience as up until now you may not know that other people experience this and can occur as part of OCD. This in itself can bring such relief.

Session 2: Identifying Obsessions and Compulsions

This can be quite difficult, but having your experience normalised in the first session helps tremendously. This is the start of CBT proper where you will be shown how to identify your obsessions and compulsions, even the act of labelling them as such, creates distance from them and helps you to see it more as something that needs treatment as opposed to saying something bad about you as a person. . You will be shown how to recognize the intrusive thoughts and the behaviours you engage in for example, common POCD obsessions include fears of harming a child, while compulsions might involve seeking reassurance or avoiding children. Recognizing these patterns is the first step towards addressing them. You will be keeping track of these thoughts and behaviours as part of your homework for the week.

Session 3: Creating a Hierarchical Exposure Plan

A graded hierarchy of feared situations is developed, starting from the least to the most anxiety-provoking scenarios. For example, it might begin with thinking about being near children and progress to more direct exposures, like being in a park where children are present. From experience, this is less frightening than it might seem when reading about it, as it is carefully managed by your therapist.

Session 4: In Vivo Exposure

In vivo exposure involves confronting real-life situations that trigger obsessions, such as visiting places where children are present. The therapist guides the patient through these exposures, helping them stay in the situation long enough for their anxiety to decrease naturally. This session focuses on the initial, lower-level exposures from the hierarchical plan. The patient practices these exposures between sessions, gradually building confidence.

Session 5: Imaginal Exposure

Imaginal exposure is used for scenarios that cannot be physically confronted. Patients visualize feared situations to reduce their anxiety gradually. The therapist helps the patient create detailed scripts that describe their feared situations in vivid detail. The patient listens to or reads these scripts repeatedly until their anxiety decreases. This method helps reduce the power of the intrusive thoughts by demonstrating that they do not lead to actual harm.

Session 6: Response Prevention

Response prevention involves refraining from performing compulsive behaviours. Practical strategies include delaying the behavior, using mindfulness techniques, and employing coping strategies to resist the urge to perform compulsions. The therapist works with the patient to develop a plan for resisting compulsions, providing support and reinforcement as the patient practices these strategies.

Session 7: Cognitive Restructuring

Techniques for challenging and changing maladaptive thoughts associated with POCD are employed. Cognitive restructuring exercises help patients reframe their intrusive thoughts more rationally, reducing their distress and anxiety. The therapist teaches the patient how to identify cognitive distortions and replace them with more balanced and realistic thoughts. This session often involves written exercises and practice in identifying and challenging distorted thinking.

Sessions 8-12: Continued ERP and Cognitive Restructuring

The following sessions focus on continued ERP and cognitive restructuring. The therapist helps the patient tackle more challenging exposures on the hierarchical list and reinforces cognitive restructuring techniques. Patients are encouraged to practice these skills daily and bring any difficulties to the sessions for troubleshooting and support. Progress is reviewed, and adjustments are made to the treatment plan as needed.

Finding a qualified CBT therapist is crucial for effective treatment. Online directories and professional organizations can help locate specialists. I always tell people to check in with their family doctor as they usually have a list of therapists in the area. Additional resources include self-help books, online forums, and support groups for individuals with POCD, providing ongoing support and community.


  1. Foa, E. B., Yadin, E., & Lichner, T. K. (2012). Exposure and Response (Ritual) Prevention for Obsessive-Compulsive Disorder. Oxford University Press.
  2. Abramowitz, J. S., McKay, D., & Storch, E. A. (2017). The Wiley Handbook of Obsessive Compulsive Disorders. Wiley-Blackwell.
  3. Journal of Anxiety Disorders. (2019). “Effectiveness of Cognitive Behavioral Therapy for POCD: A Case Study”. Volume 63, Pages 45-50.
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