OCD is often characterized by distress from uncertainty.

“Pure O” OCD is a phrase to describe someone who only experiences mental compulsions rather than behavioral compulsions.

I primarily work with OCD that presents with mental compulsions rather than the behavioral compulsions (ex: ordering behaviors, cleaning rituals) commonly portrayed in media. Some examples of mental compulsions include:

• Mental reviewing: Replaying memories to check if someone is upset with you or if you did something “wrong”

• Rumination or problem-solving: considering every possible outcome or option to make sure you are making the “correct” decision

• Reassurance-seeking: asking yourself or another person to reassure that you are a “good” person or that you are making the “right” decision

• Thought suppression or replacement: immediately suppressing or replacing a “bad” thought with something neutral or less distressing. For example, if you have the thought “what if my Mom dies tomorrow” you may try to soothe distress from this thought with images of your Mom living a long and healthy life.

Many of my clients experienced mental compulsions for years before realizing what was happening. Mental compulsions can be difficult to catch as they often are only experienced internally. Together we will learn to identify your mental compulsions and interrupt the OCD cycle.

Great, most of the clients I work with don’t! The stereotype that people with OCD always have a clean and organized home is outdated and only captures a small fraction of how OCD symptoms can present. Most of the people I work with who have OCD primarily experience mental compulsions. Please review the mental compulsions tab above for more information.

Many times the following phrases are used by my clients when they are in a OCD cycle. If these words resonate with you we will discuss it further in session and determine if Obsessive-Compulsive tendencies may be a part of your mental health.

• Researching or reviewing for hours until you feel like “I have all of the relevant information” or “my research is complete”

• Trying to find solutions to a problem for hours that you know cognitively you cannot solve alone (Ex: trying to figure out how to prevent yourself from getting cancer)

• Reviewing and revising the email to your boss until the email is “just right” or “perfect”

You may notice that many of these phrases include absolute language such as “perfect” or “complete.” OCD yearns for certainty so often times people with OCD will use absolute language.

The OCD Cycle describes the why OCD persists in the brain. The OCD Cycle is self-reinforcing and has four components: 1) The obsession 2) Distress 3) The compulsion 4) Temporary relief. OCD is differentiated from generalized anxiety by the compulsion and temporary relief components. Most people have intrusive thoughts that may be uncomfortable to experience. However, people with OCD engage in mental or behavioral tasks to reduce their anxiety about the uncomfortable intrusive thoughts. Let’s walk through an example of how the OCD cycle can work.

1. Obsession: You experience the uncomfortable intrusive thought “You will never be in a long-term relationship”

2. Distress: Because you care deeply about romantic partnership, your brain responds with a distress signal and you feel anxiety. This anxiety can build and become quite uncomfortable.

3. Compulsion: The brain tries to reduce the distress you are experiencing by engaging in behaviors to make you feel better about the uncomfortable intrusive thought. In this case, your brain may remind you of all of your previous romantic relationships to reassure you that you are capable of being in long-term relationship.

4. Temporary relief: Your anxiety is calmed with the reassurance that challenges the original intrusive thought. This temporary relief reinforces the OCD Cycle in your brain, further solidifying that you must “think things through” to experience relief from uncomfortable intrusive thoughts. However, it doesn’t last. Your brain questions the evidence you presented and the cycle starts over. In this example your brain could have another intrusive thought such as “Okay maybe you can be in a long-term relationship, but how would you know that your partner isn’t just settling for you?” With this new uncomfortable intrusive thought your brain is off to the races again, trying to soothe your distress.

The cycle repeats

Obsessive Compulsive Disorder (OCD) has been a hot topic recently. You may have heard an advertisement from NOCD and wondered if OCD could apply to you. You may notice that you seek reassurance from loved ones, mentally replay conversations in your head, or take hours to evaluate every possible outcome before making a decision. Does this mean you have OCD? Complex Trauma, OCD, and ADHD can all present with distracting thoughts that are hard to get space from. Together we will tease apart your symptoms and help you figure out which labels are most relevant to your symptoms. If OCD ends up being a part of your story, I treat OCD holistically utilizing ERP, ACT, and Parts Work.

ERP stands for Exposure and Response Prevention. Once we have established a safe therapeutic relationship we will begin identifying what activates your OCD. We will then intentionally bring your OCD online by exposing you to this activating stimulus and prevent your brain from engaging in compulsions. Overtime ERP creates a new neural pathway in the brain that shows you that you can survive the activating stimulus without engaging in compulsions.

Let’s walk through an example: You notice that reading an email from your boss (activating stimuli) prompts your brain to begin replaying every recent conversation you had with your boss to ensure your boss likes you. In ERP, we would intentionally have you read the email from your boss in session and work with your brain to prevent you from engaging in the mental compulsions (such as mental reviewing recent conversations with your boss). We start ERP with exposures that last several seconds so you can learn the interventions for stopping the OCD Cycle and build up confidence. We gradually increase the exposure time.

The concept of ERP is quite simple, but in practice ERP can be challenging for people with OCD. I am intentional with pacing and want you to leave each session feeling regulated, understood, and supported. Any type of exposure based work requires a significant amount of trust in your therapist and I take protecting you and our therapeutic relationship seriously. We will always go at the pace that feels aligned with you.

Acceptance and Commitment Therapy (ACT) is a new wave of Cognitive Behavioral Therapy (CBT) focused on the concept of Cognitive Diffusion. Cognitive Diffusion is critical in OCD treatment as Cognitive Diffusion teaches your brain how to view thoughts as thoughts rather than global truths that impact your self worth or image.

For example, you may have the thought “I’m a bad friend.” Utilizing traditional CBT would look like providing evidence that you are a good friend. However, this cycle of searching for proof that you are a good friend can become compulsive and suddenly you have spent several hours trying to prove your worth as a friend with little relief.

From an ACT lens, we will learn to attribute thoughts as simply thoughts that come and go. Instead of struggling to debate with your thoughts you can let them pass without internalizing any beliefs from them. These thoughts do not dictate your worth. This concept is foundational in helping you disengage with the OCD Cycle.

Some types of OCD, such as Taboo OCD or Harm OCD, come with extremely distressing or even violent intrusive thoughts. People spend their whole life holding in these scary intrusive thoughts, convinced they are secretly a terrible person.

One important distinction is that intrusive thoughts from OCD are Ego Dystonic. This means that these thoughts directly contradict your morals, values, and self-image. In order for the OCD cycle to work, the initial intrusive thought must cause distress. If you truly believed or desired your intrusive thoughts the OCD cycle would not work. The OCD cycle is reinforced because the intrusive thoughts are against your moral code. Your intrusive thoughts do not make you a “bad person.”

Many of the interventions we are trained on as therapists can unintentionally feed into the OCD Cycle. Validation, providing reassurance, reflecting on the evidence of a thought, and even mindfulness techniques can all become compulsions to reduce your anxiety about intrusive thoughts. Many of my clients with mental compulsions found their anxiety got worse in traditional talk therapy and never understood why. I am here to help you break the OCD Cycle rather than getting stuck in the loop with you.