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OCD Topics

Carol Edward's OCD Topics for therapists, coaches, mentors and anyone interested in learning more about obsessive compulsive disorder and related problems.

Struggling with Intrusive Guilt? Read This...

Struggling with Intrusive Guilt? Read This…

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First, guilt is an emotion that most people experience. For example, if someone lies, they may feel guilt. If someone steals, it’s likely they’ll feel guilt. If someone has deliberate unkind thoughts about someone, guilt might follow. The list goes on… you get the general idea.

Levels of normal guilt

Normally, unkind thoughts and misdoings tend to…

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Posted 1 week ago

What to do when a Phobia Becomes Obsessive

What to do when a Phobia Becomes Obsessive

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First, a phobia usually involves having a fear of spiders, dogs, fire, open or closed spaces, heights, animals, blood, or something else. People are affected usually only when faced with their specific phobia; yet, can generally switch off when their fear is out of sight.

Specific Phobia

A specific phobia, which is persistent and intense and where a…

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Posted 1 week ago

Struggling with Intrusive Guilt? Read This...

Struggling with Intrusive Guilt? Read This…

Photo by Rene Asmussen on Pexels.com

First, guilt is an emotion that most people experience. For example, if someone lies, they may feel guilt. If someone steals, it’s likely they’ll feel guilt. If someone has deliberate unkind thoughts about someone, guilt might follow. The list goes on… you get the general idea.

Levels of normal guilt

Normally, unkind thoughts and misdoings tend to…

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Posted 1 week ago

OCD - Why Include Mindfulness into Therapy?

OCD – Why Include Mindfulness into Therapy?

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Research is always looking at improving patient engagement and to decrease drop-out rates. A pilot study to integrate Mindfulness into ERP (Strauss et al, 2015) showed the drop-out rate was twenty-five percent. It could be said that the reason for this is that people on the OCD spectrum who show poor distress tolerance need the combined approach to…

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Posted 2 weeks ago

How to Stop OCD Messing with your Studies!

How to Stop OCD Messing with your Studies!

Photo by Public Domain Pictures on Pexels.com Do you forget information and worry there’s a fault with your memory? Do you worry that you didn’t read or write everything down correctly? Do you doubt yourself and believe your academic future is in trouble?
When OCD starts messing with your studies, it's time to take action. 
Below are 7 tips to help you get back on track!
imageTip 1 

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Posted 2 weeks ago

Tips to Help a Depressed Teen

Tips to Help a Depressed Teen

Photo by Zun Zun on Pexels.com Signs to look out for

In spotting the signs of depression, you may notice your teen complaining of physical changes, such as sleep disturbances, appetite changes (eating more or less than usual), gaining or losing weight, complaining of headaches, stomach aches, joint and muscle aches. During a physical state, a teenager’s thinking can often get confused,…

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Posted 2 weeks ago

Want the Confidence to Live with OCD Doubts?

Want the Confidence to Live with OCD Doubts?

building metal house architecture

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Complex thinking

AS HUMAN BEINGS, we are complex in our thinking and can be affected by certain influences depending on the situation we’re in. We want to be sure that we’re okay, that our families are safe, even when that comes with some uncertainty. For most us this is fine because naturally we know certainty cannot be guaranteed. Basically then, we live our…

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Posted 2 weeks ago


I created ocdkidsweb for parents and kids together! Why not take a look at the lessons, question sections and much more! See you there! Go to Caring Carol at: ocdkidsweb

Posted 19 weeks ago

When OCD Intrudes on Your Relationship...


I have thoughts that make me think I’m attracted to other people or that my partner will leave me for someone else. Now I’m obsessing whether I still love my partner or if they love me. Why is this happening?

Anyone can get doubts about whether the partner they are with is right for them. These are justifiable doubts. Rational thought and concrete decisions to resolve these are helpful. However, when obsessions are involved the doubts are contradictory given that OCD is a paradoxical disorder. Thus a resolve is harder to define because the outcome points towards inconsistent conclusions.

I obsess on “what-ifs?” Why do I do this? 

People who have ROCD or any OCD theme generally have difficulty coping with ambiguous situations. Even in non-OCD situations they have a tendency to doubt their competence in decision-making. Being sure about something means going through the “what-ifs” to prove or disprove whether there is anything legitimate to worry about, and then still being doubtful. Living with uncertainty can help you with the never-ending doubts and “what-ifs.”

How can I learn to live with uncertainty?

When high anxiety levels and compensatory rituals such as checking, reassurance and mental reviewing take over it’s crucial that you delay and resist giving into these rituals. Whilst compulsions serve to offset the negative effects of the obsession, this unfortunately is short-lived and therefore continues to feed the obsession. By systematically resisting the compulsions you learn to tolerate the feeling of uncertainty whist bearing with the anxiety until it reduces naturally, which is usually within the hour.

My partner’s habits play on my mind, so it must mean we’re incompatible, is that right?

Well this comes back to having doubts. In relationship OCD some of the thinking errors focus on values. As an example, if your partner has strong political ideals and you don’t then intrusive thoughts might be that since you don’t share those same ideals you’re not meant to be together. The same would apply if you were to have the strong political ideals because the problem is compatibility and having doubts and that. 

Yes, I obsess a lot about our different qualities

No matter how much you obsess about or compare your qualities with your partner you will never be satisfied with the outcome. Also, however much you seek reassurances or check for prove that having differences in beliefs or interests can never provide you with consistent answers. This is because, and as mentioned already, compulsions that correspond with your obsession serve only to keep the problem going in a circle.

I’m starting to understand a bit better, but I still don’t get why I have a fear of my partner leaving me for someone else too?

Remember the paradox noted earlier. Notice how OCD continues to sneak in with whatever matters most to you and confuses the already distressing symptoms you’re experiencing. From this perspective it’s not unusual to find yourself questioning your partner’s commitment to the relationship too. As you’ve seen, the fears associated with obsessions and compulsions put that extra strain on the relationship; and so it’s easy to think and reason emotionally how you might mistakenly “see proof” when it’s clearly not there. Realistically, insecurities about relationships are addressed through active listening, if this is the case; while OCD fears are addressed with cognitive behavioural therapy (CBT) and exposure response prevention (ERP).

In what way do you mean?

Basically CBT/ERP targets irrational doubts and encourages you to resist compulsions to starve the obsession; and active listening works on the basis that you talk about worrying aspects, perhaps memories in your past, or maybe a recent upsetting time in your life that may have triggered the obsessions. Anything that is discussed can help reveal why you may have deeper level relationship insecurities.

Should my partner be involved in therapy too?

Invite your partner to be involved if possible as this will help both of you to follow through with strategies that your therapist sets out for you at home. Most therapists are trained in core counselling skills that would incorporate the active listening part in therapy to address relationship problems with both partners. 

Photo Credit: pixaby

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By Carol Edwards © 2018 Updated 2019

Posted 22 weeks ago

Tips for Depersonalisation with Obsessive Compulsive Disorder


Question: “I’ve been diagnosed with OCD coupled with depersonalisation and derealisation and I ruminate on doubts and what-ifs about the fear of losing my mind or getting the early onset of dementia. It feels like I’m watching myself in a movie where the quality of life seems to have become lost in the slow rhythm of that movie. Why does this happen, and what if my doctor is wrong?”

This a sensation that would fit with derealisation brought on through stress or extreme anxiety, including distress associated with obsessive compulsive disorder. Since this is a stress-related sensation it explains why your doctor has ruled out any other type of psychiatric condition or dementia.

What can I do?

Well first, let me explain how imagined possibilities in OCD focus on faulty reasoning linked to thought–action fusion (TAF). What happens with TAF is that a person thinks as though their obsessive-related fear will be more likely to occur despite knowing this is irrational. Now add to the experience derealisation and you’ll see how TAF is very similar. That is, your perceived belief is that the likelihood of developing the early onset of dementia during an intense derealised or depersonalised episode outweighs the higher possibility that you won’t.

But it feels so real; sometimes I cannot recall information from my memory which is why I think it’s dementia.

This is because the sensation is so overwhelming that all reason is lost to the fear associated with the feeling that one’s surroundings are not real (derealisation) coupled with the imagined possibilities seen in OCD – e.g., “what if my lack of concentration means I’m losing my memory?” Basically, this is a dissociative condition which is a mental shift in the perception or experience of the external world so that it seems unreal. This shift or alteration in perception does not affect your basic character, it is a symptom of stress remember. When OCD is involved you can see how this can exacerbate the problem.

What are the solutions?

Emotion management and attention training can help you manage these dissociative states. What you would do is learn to use techniques that are very similar to facing your fears as you would if you were doing exposure response prevention for OCD.

Can you clarify?

Yes, in graded steps you would face your fears (exposure) while resisting doing your usual “safety” behaviours (response prevention). So if one of your fears is going out of the house to get some shopping and your usual response is to avoid/escape then you would learn to cope differently. That is, you would for example go out shopping and put into practice emotion-management techniques during your exposure. So when you experience symptoms that make you feel as though your environment is lacking in emotional colour and naturalness and you cannot grasp hold of that crisp and clear awareness in your present surroundings, you would encourage yourself to ride with it, because everything is natural, you’re just not experiencing it.

But what if I get a panic attack? I can’t do anything once I’m in a state of panic.

One tip is to identify situations that trigger your panic attacks? For example, you could write a list of situations that are stressful for you. Doing this can help you get prepared. By being prepared you can use coping methods like awareness/breathing techniques for managing lower triggering situations first, and then building on intermediate and higher triggering situations with Mindfulness techniques. These can include sucking on a boiled sweet and thinking about the fruity or minty taste as you work your way down the shopping aisle; focusing on the smells when you pass by the freshly baked bread; deliberately tuning into the music playing in the background; taking notice of the specific style and size of the text on products and guessing the font (e.g. Arial, Freestyle Script etc.); and taking note of various textures when choosing your items. Tuning into all of your five senses is helpful and keeps you more in control.

When I get this sensation I also feel separated from myself or that I might have changed appearance, and other times I forget certain things, like what I did earlier in the day. Why is this?

Well, dissociation is a state in which one’s thoughts and feelings seem unreal or that they don’t belong to you. There are different types of stress-induced dissociative states. These include the ones previously discussed (derealisation and depersonalisation). Others include identity confusion and dissociative amnesia which are discussed in further detail here. While these states are unpleasant, you can learn to live with them.

As well as Mindfulness techniques, how else can I learn to live with them?

By following the self-affirmations in Depersonalisation on and off the Autism Spectrum you can train yourself to become less threatened by your symptoms whilst building the skills you need to re-adjust and manage these sensations.

To summarise, embracing dissociative experiences whilst shopping (or doing something else) is achievable and reduces the chance of fear and panic.

Photo Credit: flickr.com

Disclaimer: this article is written not only through studies for my diploma in CBT but also my experience with dissociative states and the accounts of others experiencing similar sensations. However, as a complementary health therapist, I advise anyone experiencing these symptoms to consult with their medical practitioner in the first instance, and to rule out other possible causes. 

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By Carol Edwards © 2018

Posted 22 weeks ago

Address OCD and Pathological Doubt


One of the biggest problems that people with OCD face is being plagued with never-ending doubts and “what-ifs?” Because of these doubts they usually give into compulsions with the goal of “preventing” perceived obsessional threats or not feeling right, and to relieve anxiety. Unfortunately, compulsions do not work because they negatively reinforce the problem.

So if compulsions don’t eliminate doubts, what does?

This blog offers a solution, which has you questioning whether living with uncertainty is the better option; or worrying forever about something that might never happen.


First, doubt or certainty can never be removed from one or the other as an absolute. In other words you can be swayed towards certain beliefs, but you can never have perfect certainty about those beliefs. For example, one dictionary definition describes the word “perfect” as making something as good as or as safe as possible. Another one describes the same word as without faults, errors or flaws. 

So which one is right?

This is like a “for me to know and you to find out” scenario. But actually no one knows. 

In trying to grab hold of certainty as to whether your fears haven’t already occurred, or to “prevent” them from occurring in the future is usually when corresponding compulsions take over. These include seeking reassurance, checking, washing, ruminating, praying, avoidance or escape; and also counting, undoing, aligning, swapping a bad image for a good one, or using a string of words to counter an intrusive threat, and so on.

What’s the answer?

Well, if “perfect” suggests something can only be as good/safe as possible or on the other hand without faults, errors or flaws (where neither can be proved one way or the other) then this indicates that it would be better to live with uncertainty. As noted before, doubt or certainty can never be removed from one or the other as an absolute. Basically an ambiguous response therefore would work better than one that is not ambiguous because nothing is definite. For example:

“The search for certainty will always be fruitless. Compulsions are unsuccessful attempts for satisfying doubts and relieving anxiety for a short while thus proving that these are a useless pursuit, because no one can say what has, is or will happen. It makes sense therefore that compulsions feed fears and doubts and strengthens pathological doubt, the obsession.”

Does living with uncertainty begin to weaken the obsession?

Yes, because once you decide to live with uncertainty, you put yourself in a position to determine what you do next. This means that when you’re faced with an obsession and doubt creeps in and you are desperate to be sure about whether your fear has or will materialise, or that you’ve made the right choice about something, or that you’ve decided to tolerate asymmetry etc., you can choose to step on the opposite path – that is, the path that has you resisting compulsions. Not yielding to the compulsions teaches you that you are capable of building distress tolerance.

But what if the obsession is true, what then?

Well, since OCD is a paradoxical disorder, it clarifies that obsessions contradict that which is true about you; such as that rationally you are capable of tolerating asymmetry when OCD convinces you that you can’t possible manage anything unaligned or that you cannot possible touch one leg and not the other; and that rationally it’s ludicrous to believe you could be a paedophile/dangerous/gay (etc) when OCD tries to convince you that you could be - you get the gist. In a nutshell, intrusive thoughts produce and misfire the wrong statements about you and that which you fear. It’s fair to say that OCD is really just an exaggerated way of bringing to your attention that which you want to protect or to feel easy about, and there’s the paradox.

You might ask, but what if you’re wrong about everything you’ve just said?

In this case, I would reply by saying, I could be wrong… yet, I could also be right. By learning to accept that you will have doubts, you can then choose whether to live confidently with uncertainty and reach recovery; or live an underlying “threat” - the threat that has you forever on red alert about something that might never happen or be true about you.

Photo credit: Wiki

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Posted 22 weeks ago

Solipsism - Am I the only Mind that Exists?


How does the obsessive fear of solipsism manifest?

A fear that the self is all that can be known to exist becomes apparent when a person is emotionally terrified on a daily basis, and to the extent they question endlessly whether their own existence is real and/or that their loved ones around them could be just figments of their imagination.

Why can’t solipsism be refuted?

Solipsism is a theory.  This shows that while philosophical findings come across as “truths” the search continues, meaning this leads to one doubt after the other, one truth after the other, and so it goes on. 

Announcing the “belief” that the only thing somebody can be sure of is that he or she exists and that the true knowledge of anything else is impossible will never be set in stone, is that right?

In philosophical terms this is how it appears. The theoretical perspective is that there will never be any reliable evidence to humanely prove or disprove this concept. Basically any dispute for the philosopher will continue to be questioned with doubt or possible validity. This is why solipsism can never be convincingly refuted.

If solipsism cannot be refuted, how can I be sure that I am real and not the only one to exist?

This question suggests there will never be a satisfactory answer because an obsession cannot be analysed. It’s already been noted that solipsism is a theory that negates a possibility. So the best way forward is to treat the obsession with cognitive behavioural therapy for addressing thinking errors; exposure response prevention for resisting compulsions that otherwise feed the obsession; and to discuss SSRI medication with your doctor for passively reducing obsessional symptoms. Mindfulness is often also helpful.

Is there a similarity between solipsism and existential OCD?

According to intrusivethoughts.org: “Existential OCD is a subset of OCD in which sufferers are preoccupied with the philosophical aspects of life. You might obsess over questions like What’s the meaning of life? Why are we even here? If there’s no God, why should I care about anything? Your brain creates these abstract questions and creates an illusion where you need to solve them.”

Treatment for this subtype is the same as it is with solipsism OCD.

Do you have an example of an effective exposure technique for solipsism/Existential OCD?

Yes, one effective strategy for this type of obsession is to use a short exposure script.

How does this work?

Each time you use this method you expose yourself to your fear; so do be prepared for an initial increase in anxiety. The process for this strategy is to read the script onto a loop tape and play it back repeatedly for 20 minutes three or four times a day for one week. You are encouraged to repeat this weekly, and until habituation takes place.

Below is a low-key exposure script for this obsession. You will notice that there are absolutely no reassurance statements in the script. This is because your goal is to become bored with your fear instead of feeling anxious and threatened by it. Basically, because anxiety and boredom exist separately, you learn to live more comfortably with uncertainty once boredom overrides anxiety.

EXPOSURE SCRIPT: “In life, the truth is that I can never have 100% certainty about anything. No matter how many times I question, analyse, ruminate or how thoroughly I check or seek reassurance about the true knowledge of my consciousness and whether I am the only mind which exists, I can never be 100% sure; nor can I ever be 100% sure that others are not figments of my imagination. Further, I can never have an 100% accurate explanation about the meaning of life nor about what happens after death.  Moreover, the more I listen to OCD and let it ascertain the limiting factors of my behaviours and actions, the more my symptoms will intensify. The sooner I recognise that my compulsions serve emotional functions only, the sooner my recovery will start; or improve.”

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Image: flickr.com

By Carol Edwards © 2018

Posted 22 weeks ago

Afraid of Acting on Your Intrusive Harming Thoughts? Read This...



I’m afraid I will act on my intrusive harming thoughts? Is it true that this does not happen? And are compulsions the opposite of impulses in terms of people acting or not acting on their thoughts?

First, my thoughts on whether compulsions are the opposite of impulses are that in OCD a compulsion is to “prevent” harm; yet, an impulse outside of OCD can potentially cause harm. For example, when an OCD thought occurs and a person feels they are urged to act on that intrusive thought (e.g., harming oneself or someone else) it can seem a bit like Russian roulette. However, when a person who has an impulse control disorder is faced with an urge to harm oneself or someone else, this is like Russian roulette.

How do you mean?

Well, Russian roulette is a game of high risk. Each player, in turn, and using a revolver containing one bullet, spins the cylinder of the revolver, points the muzzle at the head, and pulls the trigger. The question is which player will get the bullet?

In likening the risk with OCD, let’s say OCD “says” to Mr Johnson (who has suicide intrusive thoughts with magical thinking, and is trying to work), “Take the gun from your drawer and shoot yourself (intrusive thought), or your family will die (magical thinking).” This leaves Mr Johnson in a “fight or flight” situation. Will he be the “player” who gets the bullet – that is, by fleeing the scene (avoidance ritual) to “prevent” harm and thus bringing his anxiety down momentarily? Or will OCD be the “player” who gets the bullet?

Where is this leading, and how would OCD get the bullet?

What would happen is that should Mr Johnson acknowledge, accept and allow the thoughts to come and go instead of escaping the obsessional scene then OCD would get the bullet. But because OCD is an anxiety disorder, Mr Johnson becomes so panicked that the urge to flee the “dangerous” situation overpowers him. By following through with the escape plan, he gains anxiety relief; however, this momentary gain means OCD “wins the game”.

In other words, the avoidance/escape ritual is a negative response, a reinforcing one, and it’s this that strengthens Mr Johnson’s fear-related obsession, and so OCD continues to master control.  Other compulsive behaviours that Mr Johnson does are checking, praying and seeking reassurance that no harm has or will occur. These compulsions serve only to exacerbate the problem; by giving into them Mr Johnson never gets the chance to prove that his fear isn’t evidence that something bad will happen.

Now despite the fact that OCD thoughts are paradoxical to Mr Johnson’s true wishes and desires (it’s his obsession that tells him he should kill himself to protect his family, not him) this unfortunately is of little use to him. Much of this is due to doubts and “what-ifs?” plus erroneous beliefs seen in OCD. Subsequently, he continues to yield to compulsions “just in case”. What he doesn’t trust yet is that obsessions do not convert to action, hence there being no need for compulsions to prevent a catastrophe.

But is there any further proof that he won’t act on his thoughts?

Yes and no, and by this I mean that certainty can never be guaranteed. Still, this doesn’t mean that biologically generated intrusive thoughts make Mr Johnson feel a legitimate pressure to respond, this pressure is fear, not a true call to action - this is the nature of the disorder. 

But if OCD is a disorder based on intrusive thoughts that are baseless, surely there is some proof of this, yes?

Well one theory of proof that intrusive thoughts do not convert to action is to consider how the perception of body movements (kinaesthesia) work. This involves being able to detect changes in body position and movements without relying on information from the five senses. Even though this confirms that any obsessional urge will automatically be restricted it’s more important to note that obsessions, as noted, are invalid pieces of information and thus do not follow through with action.

But if the urges are so strong, how do these differ from impulsive urges outside of OCD?

As far as impulses go, and when these are OCD-related, the urge can feel very strong. This is why people with OCD yield to the corresponding compulsive responses to “prevent” perceived harm, just like Mr Johnson does. Still, when referring back to kinaesthesia coupled with not only contradictory but also unverified information coming into the mind proves again that compulsive responses are not required.

How do obsessional urges seen in OCD and those seen in impulse control disorder (ICD) differ?

As the term shows, ICDs are a class of psychiatric disorders characterised by impulsivity, not obsessions. For example, one person with an ICD had an ongoing impulse to run across roads and reach the pavement before oncoming cars reached her. In contrast another person had an obsession to do a similar thing yet avoided going near roads. This clarifies the difference between harmful impulses seen in an ICD and avoidance of harm obsessions seen in OCD. The same goes for someone suffering from kleptomania, the impulse to steal differs for a person who has an obsessional urge to steal.

It’s clear to see then that an impulse seen in an ICD is challenging and dangerous in that the impulsive action could in all likelihood occur, a legitimate threat. Yet, an impulsive urge seen in OCD is an obsessional fear where the likelihood goes the other way, a false sense of threat.  In other words a person feels threatened that their OCD urges will come true and because of that the repeated compulsions to ward off perceived danger continue.

So ultimately, what can Mr Johnson do to make sure OCD gets the bullet instead of him?

By resisting compulsions in graduated steps Mr Johnson will begin starving the obsession and OCD will eventually get the final bullet. 


It can be determined that impulsive urges within the obsessive-compulsive category are not acted upon; yet compulsions to ward off perceived danger and to relieve anxiety are acted upon, but are not required. In addition, there appears to be no problems in the process that describes kinaesthesia in the way there could be in those who have an ICD. While no theory need be explained why obsessions cannot possibly come about (particularly in terms of reassurance) it does provide an avenue of thought for those interested in the bio-behavioural aspects of OCD. In sum, an obsession is just that which means intrusive thoughts have never been known to come true. Impulses in the ICD group on the other hand can occur - see further reading below.

Special note: Since writing this blog in early 2018 I came across a link for a blog by Jon Hershfield (late Dec 2018) and was surprised to find that he’d also covered kinasethesia and used the “Russian roulette” description to explain his viewpoint. Our thoughts on this are completely co-incidental (no plagiarism). I found Jon’s article an insightful read and would like to share this with my readers to gain his perspective on an often misunderstood conception regarding pure-obsessional manifestations: https://www.anxiety.org/ocd-fear-of-acting-out 

© Carol Edwards 2018. 

Impulse Control Disorders: Updated Review of Clinical Characteristics and Pharmacological Management

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Posted 22 weeks ago

OCD - A Biological Perspective


Part 1: OCD - A Biological Perspective

According to scientific research, coupled with clinical interventions, obsessive compulsive disorder (OCD) is considered to share both biological and psychological factors. The first part of this article explains briefly the biology of OCD. This includes a review on certain areas of the brain which show how particular structures in the basal ganglia seemingly play a role in this disorder. The second part explains how psychology plays a part and how thinking errors attached to intrusive thoughts link to faulty beliefs which exacerbate and strengthen the symptoms. It further demonstrates how cognitive behavioural therapy with exposure response prevention - a scientifically established based therapy - is able to correct the disorder at a bio-behavioural level.

The Basal Ganglia

Let’s first look at the brain parts that seem likely to play a role in OCD:

  • The orbito cortex
  • The cingulate gyrus
  • The amygdala (this is included as one of the basal ganglia due to its anatomical proximity, although properly it is part of the limbic system, important for emotions, instincts and desires)
  • The thalamus
  • The striatum which has two parts and therefore collectively known as the neostriatum.

Orbito cortex, cingulate gyrus and the amygdala

The orbito cortex and the cingulate gyrus are interactively involved whereby the first stores the value of things as good or bad and the latter signals that something doesn’t feel right (Prof. F. Toates). Further, the amygdala puts us in that “fight-or-flight” situation when, for example, fear or danger faces us.

The Thalamus

The thalamus acts as a kind of “relay station” whereby motor and sensory information (except smell) are received by it and projected to the cerebral cortex (Arthur S. Reber.) The cerebral cortex is responsible for the so-called “higher-mental processes” of language, thinking and problem solving (Reber).  Given the nature of its role, it makes sense how the thalamus loops the same information to and from the cerebral cortex in those who have obsessive compulsive disorder (OCD).

The Striatum

The striatum transmits information involved in thinking, automatic filtering and movement (Reber). This part of the brain exists as two identical cell types which are known as the:

  • Caudate nucleus for controlling automatic thinking and filtering and the
  • Putamen for controlling automatic movement

How do these brain parts cause obsessions?

Example: When “Lucy” brushes past someone, she experiences a sudden and fearful intrusive thought that she’s been infected with a sexually transmitted disease (STD).

Let’s look at what happens here.

Lucy’s orbito cortex interacts with the cingulate gyrus to signal that something is wrong. An additional interactional signal involving the amgydala puts Lucy in a “fearful” situation. Her response is to repeatedly de-contaminate without delay. This response shows that Lucy has developed a contamination obsession. Her corresponding compulsion (de-contaminating) acts as an irrational attempt to remove the “disease” or “dirty” sensation and to relieve anxiety momentarily.

What is the outcome?

In this example (and in all subtypes of OCD), the transmission that involves automatic thinking, filtering and movement (neostriatum) has become affected. As such, the network of interacting brain regions become locked (J.M. Schwartz). So after de-contaminating Lucy is less able to move to another thought/behaviour automatically because her thoughts loop the same information, hence further attempts to decontaminate.. [1]

Is it true that everyone get intrusive thoughts?

Studies show that mostly everyone gets intrusive thoughts from time to time. [2] However, obsessions are much stronger since these are rooted in the brain and repeatedly appear in the person’s consciousness without their will, causing intense fears. Put simply, obsessions are classed as intrusions that are activated and driven on a biological level, and therefore termed a psychiatric disorder.

The question still arises, if everyone gets intrusive thoughts, does this mean that all people to some degree have OCD?

On the contrary, it would seem that people who aren’t vulnerable to OCD may become fleetingly aware of intrusive thoughts but these are automatically filtered out via the caudate nucleus, and so alarm bells probably don’t even get the chance to ring. In this respect, the person doesn’t suffer from obsessions and for that reason isn’t affected by the fear and anxiety associated with those who have OCD; as a result, and following an intrusive thought, they move directly to another thought/behaviour with little or no concern (see neostriatum).

Is OCD inherited?

As we know, nature and nurture means genes and environment. In terms of OCD and this being genetically linked, it doesn’t necessarily mean a child will inherit the disorder, although there is a chance that the child could. Neither does an environmental/psycho-social trigger (e.g., illness, moving home, school, loss) mean a child will be exposed to it, but on the other hand it could be the reason. This suggests scientifically that there is only a leaning towards the theory that OCD is inherited between generations; and in terms of environmental triggers, it would seem that this can, but not always, bring on its appearance. All said, the two tied together – that is, an inherited tendency combined with a precipitating event appears to be the most common reason for the onset of OCD. It would seem therefore that certain events likely trigger the biological components brought on by a predisposed anxiety factor.


The interacting parts of the brain that cause OCD become locked. Subsequently, sensible reasoning gets confused. What follows are attempts to correct the obsessional problem with a corresponding compulsive behaviour (emotional response). Keep reading for Part Two: “OCD - A Psychological Perspective”.

Part 2: OCD - A Psychological Perspective


Is it true that paying attention to intrusive thoughts maintains OCD?

It’s more likely that a person’s attention is drawn to the types of beliefs seen in OCD. These beliefs serve only to exacerbate the disorder. [2] For example, when a non-OCD person gets a fleeting thought about harming someone and then questions that thought, such as: “I wonder what made me think that?” and then lets it drop, this brief error in thinking will filter out automatically along with the initial intrusive thought.  As a psychiatric disorder however, thinking errors that link to certain types of beliefs are much more intense. A moral tone, for example, is often added to the cognitive error – in this instance, labelling.

John says: “I am fearful that I could have harmed a person today (thinking error); deep down I must be a dangerous person (labelling).”

Why does this happen?

The person mistakenly believes that their thoughts are in some way linked to actions (thought-action fusion (TAF); Rachman, 1993). This has been divided into moral TAF and likelihood TAF. In moral TAF a person may believe that having an intrusive thought about harming someone actually makes them as guilty as if they’d literally committed the act. In likelihood TAF people believe they are more likely to do the offending act. [3] Still, while thinking errors may exacerbate the disorder, it is the self-reinforcing behaviours known as compulsions that feed and maintain OCD. Just to note, for those who have emotional contamination fears a further TAF known as object-TAF involves fearing that magical powers (e.g., harm, disease, evil etc.) can be transmitted from an object to oneself or others; and also into other objects. In this case the compulsions to ward off perceived danger are similar to those seen in the likelihood TAF and Moral-TAF, e.g., avoidance/escape, praying, ruminating etc.

So if compulsions reinforce and support OCD, what can change this?

The gold standard treatment for OCD is cognitive behavioural therapy (CBT) with exposure response prevention (ERP). This is a scientific-researched therapy. Medication (a selective serotonin reuptake inhibitor) is usually combined with therapy. The first actively alters brain chemistry; and the second improves serotonin levels and is known to reduce symptoms by up to 60%.

How does ERP work with cognitive behavioural therapy?

First, cognitive therapy helps to alter the types of beliefs seen in OCD, noted earlier; and the behavioural part (ERP) helps to prevent the self-reinforcing behaviours that are a direct consequence of the obsession [3]. Put another way, cognitive therapy teaches rational awareness and acts as the foundation for facing obsessions (exposure) and to resist yielding to corresponding compulsions (response prevention) while at the same time riding out raised anxiety. The end result is that the person is able to shift more freely to the next thought/behaviour (see neostriatum - part 1).

But why tolerate increased anxiety to recover?

The simple answer is to build distress tolerance. As a result, the person becomes habituated to whatever it is that causes them fear. Thinking/filtering plus movement thus reverts back to automatic, or at least becomes less sticky. [1]

Anxiety Tip: Being aware that anxiety reaches a peak during ERP and knowing that it reduces all by itself is key to losing a certain amount of fear when the gut feeling strikes. In other words, anxiety cannot go any higher after it’s reached its peak and therefore begins to subside without intervention, usually within 15-30 minutes and no longer than an hour. The more a person faces their obsessions in graded steps and resists giving into compulsions, the sooner their anxiety reduces overall.

Does Mindfulness work with traditional therapy?

This is looking more and more promising. You can read more about Mindfulness in my blog.


The interacting parts of the brain that cause OCD become locked (see part 1). As a consequence sensible reasoning becomes confused and attempts to correct the obsessional problem with compulsive behaviours (emotional responses) serve only to reinforce the problem. CBT with ERP is the treatment of choice, which leads ultimately to recovery, or at least much reduced symptoms. In moderate-severe cases medication is often also prescribed. Behavioural experiments are also effective; as is Mindfulness.


[1] Brainlock by Jeffrey M. Schwartz, M.D. with Beverley Beyette covers a cognitive bio-behavioural approach that can help you free yourself from obsessive-compulsive disorder.

[2] Radomsky and his colleagues found that the thoughts, images and impulses symptomatic of obsessive compulsive disorder (OCD) are widespread. “Almost everyone has these kinds of thoughts. They’re normal, and they’re a part of being human,” Radomsky said. For people who suffer from OCD, this knowledge “can be incredibly helpful to change the meaning that they ascribe to the intrusive thoughts.“  http://www.bps.org.uk/news/many-people-have-obsessive-thoughts

[3] Cognitive Therapy – Obsessive Compulsive Disorder – A Guide for Professionals by Sabine Wilhelm, PH.D. and Gail S. Steketee, PH.D

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By Carol Edwards © 2016. Updated 2018

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Posted 22 weeks ago

Obsessive Compulsive Disorder - If Only it Wasn’t for the Fear...


This article includes a free homework check with an open invitation to discuss the questions with Carol Edwards. 


A ritual seen in obsessive compulsive disorder is goal-directed but has no rational justification. For example, daily activities such as washing oneself once has an appropriate end-point – that is, to feel clean. However, going to excessive lengths in washing oneself to feel cleansed will never be satisfied, meaning the end-point can never be reached. Similarly, checking once that the doors and windows are closed before going to bed has a purpose, which is that the house has been made secure. Yet, checking repeatedly to “prevent” harm only serves to relieve anxiety in the short term, hence the repetition; thus, the end-point will never be arrived at.


Fear induces chemicals such as adrenaline and the stress hormone cortisol to be released into the blood stream. When this occurs, it triggers a fight-or-flight response that causes us to react to the situation appropriately. However, when this happens within the concept of OCD, the reaction is inappropriate. This is because people who have OCD haven’t learned yet that the “threat” element is as invalid as the intrusive thought itself, meaning an unwanted thought coming into one’s consciousness doesn’t mean corrective action is required. In other words, there is no danger because biological misfires (intrusive thoughts) do not materialise.

All obsessions are fear related; or they cause a floating sense of angst. It’s this fear that drives corresponding rituals to “correct” the problem. Obsessions might relate to harm, sexual, symmetry,  cleanliness, somatic and moral manifestations; and the time-consuming behaviours that are done in vain include reassurance seeking, double checking, bargaining, confessing, cleansing and praying.


The uncertainty of what has, is or will occur creates a resistance to rational persuasion, hence re-occurring doubts and the repeated responses to remedy the problem, albeit unsuccessfully. Basically, no amount of checking, reassurance or other repeated behaviour ever takes away that grain of doubt. A ritual won’t bring certainty, and it never will. This is why living with uncertainty is encouraged because the likelihood of an obsessional fear coming true is so close to zero it’s not worth the effort that’s put into worrying about it.


The way to break the circle of OCD is with cognitive behavioural therapy (CBT) with exposure response prevention (ERP). Cognitive behavioural therapy helps to correct errors in thinking. When these thinking errors change so do feelings; as a consequence, behaviours are healthier and outcomes are generally more favourable. Likewise when an unhelpful behaviour changes, healthier thoughts and feelings follow.  You can see here how thoughts, feelings and behaviours interact.

Thinking errors are when you assume your feelings are evidence of a fact – e.g., “I feel anxious, therefore the situation must be dangerous”; or “I feel guilty, so I must have done something wrong”; or “I felt a groinal response, therefore I must be gay, a paedophile (or other)” etc. These thinking errors are linked to faulty beliefs such as catastrophising and overimportance of thoughts. 

Bear in mind that feelings and responses are intrusive and misplaced; for example, one’s guilt is false because the obsession is false; assuming danger and feeling anxious is misplaced because the obsession is a horrible imagining; and a groinal response is an automatic misplaced reaction that syncs with the obsession. All obsessions are contradictions caused by faulty wiring in the brain and thus fire paradoxical information about you, your loved ones, your animals and your environment.    

By encouraging the resistance of pursuing purposeless goals exposure response prevention is able to help you build distress tolerance and eventual habituation. This is why ERP is the gold standard treatment intervention known to actively correct the brain parts to reverse the symptoms of OCD and reduce its negative effects.


Whilst medication is not an active replacement for working on rational goal-directed behaviours it is often required in moderate-severe cases to allow for cognitive improvement, and in which a person is then more able to become actively involved in ERP. Selective Serotonin Reuptake Inhibitors (SSRIs) such as Sertraline (Zoloft) are the usual prescribed medications for OCD and are known to passively alter brain chemistry to reduce obsessions, usually by up to 60%. Just to note: an old class of tricyclic antidepressants (commonly Clomipramine (Anafranil)* which works well for OCD) might be prescribed if a person cannot take to a SSRI. *Another medication in its place maybe prescribed since during 2018 it’s been reported that Clomipramine is not as available as it once was, but maybe temporary.


Now test your knowledge!

  1. What drives a person to pursue goal-directed behaviours that have no rational justification?
  2. In response to fear, how does one usually react?
  3. Within the concept of OCD, explain why a fear-related reaction is inappropriate?
  4. What makes a person resistant to rational persuasion?
  5. Which type of error assumes feelings are evidence of fact?
  6. If no amount of engaging in rituals ever takes away doubt, what is encouraged instead, and why?
  7. What are thinking errors linked to?
  8. Briefly describe your understanding of how thoughts, feelings and behaviours interact?
  9. Explain why emotions such as guilt are misplaced.
  10. What do people who have OCD need to learn about “threat”?
  11. How does ERP reduce OCD symptoms?
  12. Which treatment intervention is able to passively alter brain chemistry to reduce obsessions by up to 60%?
  13. What else does medication improve, and what is the active benefit thereafter?
  14. Write a brief summary to discuss your understanding of the main learning objectives described in the article. 

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By Carol Edwards © 2018

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Posted 22 weeks ago

MY OCD Brain Was Like a Computer Generated Control System!

I once considered OCD as “a brain disorder shaped to project into the consciousness a realistic imitation of the controls and operation of a complex system used for ‘fight-or-flight’ purposes.”

Hmm, that’s a mouthful and sounds complicated, but that’s how it felt for me for over 20 years living with obsessive compulsive disorder.

To explain, imagine you’re in an aircraft simulator in which the sudden loss of controls and operation of the machine meant the aircraft was about to crash. Now imagine whether you would jump to action with a ‘fight-or-flight’ response. It would make sense if you did, because the simulated experience has you naturally feeling that a sense of real danger is looming.


When my OCD was severe, the usual ways of trying to reduce anxiety and squeeze negative emotions, caused by this obsessive-compulsive fight-or-flight system, was to seek reassurance, escape/avoid, check, pray, align objects, re-read, re-think or ruminate; among other compulsions.

In a rational moment I sat and thought about the feeling of anxiety that often overwhelmed me with fear as I struggled with obsessions, and then I asked myself, Is this feeling simulated?

The point here is that being faced with a realistic imitation of an event (obsession) that regularly assigned fear into my mind, and then standing back and observing subsequent anxiety as anxiety and not real danger made it easier for me to see that the fear-related content was counterfeit.

“And so I asked myself, Is this feeling simulated?”

Yes, at the time, I felt the physiological symptoms of anxiety but the danger element wasn’t real; it was a mistaken interpretation that I applied to the obsession (or intrusive thought, image or impulse) and in which case the parts of the brain responsible for emotions/anxiety was misguided, hence my term “simulated anxiety”.

For example, just because I had the thought that deadly harm would come to my child if I didn’t align two objects perfectly did not make the thought more tangible or more likely to occur. In other words, when putting in some rational perspective it was clear that my intrusive thoughts were not authentic or sincere in spite of their appearance into my consciousness; just like the air-craft simulator, the experience appears real but it isn’t real.

However, the “danger” element does not rest that easily.

As a further example, the underlying sense of danger had me going back and forth to make straight the two objects again and again to “prevent” a fatal accident involving my child. My compulsive behaviour did help remove a perceived sense of threat momentarily and this remained a temporary solution. At first my compulsions for reducing anxiety and eradicating “threat” was accidental, not intentional. On reflection, I can see that I trusted my feelings and alas got taken along with the realistic imitation of events.

My rational perspective was lost to this conflicting disorder.

One of the problems I encountered time and again was finding myself in the grip of an obsession and being confused with what was and wasn’t a true fight-or-flight anxiety situation. During the confusion, OCD got “louder” and projected to me that danger was imminent; that I was at risk of loss, harm, death, destruction unless I gave into the symmetry ritual.  Basically, my aversion to asymmetry had locked itself into magical thinking and so I obeyed again and again my brain’s misled command, “Go back and straighten those objects, or else”. My rational perspective was lost to a conflicting disorder which left me faced with a false wall – a mental obstruction that when pushed away would reveal factually that no action (compulsion) was ever required.

But wait…

Even when my rational thoughts pushed past that obstruction to advise me no action was needed, I was still left with doubts. As a consequence, I felt pressed to question the significance of my thoughts, and then the significance of the next set of thoughts; and also analysing the importance of my feelings, such as, “Am I, in reality, kidding myself, and if so what kind of mother does it make me if I don’t align the objects?”  So I decided it was safer to meet the terms of my disorder to “save” my child, and so it went on.

“On reflection, I can see that I trusted my feelings and alas got taken along with the realistic imitation of events.”

This persistent spiral of examining my thoughts and evaluating my feelings left me feeling exhausted. Even then, I tried to resist going into my child’s room to openly check that he was still breathing; or phoning the school reception to check he was okay; and I attempted to walk away from aligning objects to prove this was all in my head. Yet, there I was going over the “what-ifs”, thinking about thinking for hours on end. I wanted answers about an answer relating to my responsibility OCD; I had a “need to know” beyond knowing; I had to be assured about reassurance; I felt urged to straighten something beyond straight. Quite frankly, I was in a meta-cognitive spiral of conflict that meant I was losing the capacity to agree or disagree with my brain’s faulty control system, and so I repeatedly surrendered “just in case the bad thing happened”.

My meta-cognitive cycle looked liked this:

  1. Obsession (the thought that harm will come to my child feels real, so how can I be made sure it isn’t real?)
  2. Anxiety (my feelings tell me this is real, so it must be real - thinking error)
  3. Compulsion (open rituals such as double-checking to reduce anxiety; or mental rituals where my cognitive attention was on needing to “know beyond knowing” (questioning doubts), and to analyse feelings such as guilt etc, albeit unsuccessfully)
  4. Short-term anxiety relief after giving into open and hidden compulsions… then straight back to the obsession.

“I was losing the capacity to agree or disagree with my brain’s faulty control system, and so I repeatedly surrendered ‘just in case the bad thing happened'”.

What helped me recover can help you too.

Cognitive behavioural therapy (CBT) and exposure response prevention (ERP) together with Mindfulness techniques helped me find remission. These are the tried and tested methods for treating OCD, as are selective serotonin reuptake inhibitors (SSRI medications). 

Applying a rational statement in favour of an irrational one can be helpful when doing ERP. This might be, “I will discover that my anxiety is only temporary” instead of “I cannot cope with my anxiety when I do exposures.”

Integrated Mindfulness has you sit with your thoughts without judgement or appraisal and where you agree to allow the thoughts to come and go without yielding to any compulsions; therefore, a rational statement could be, “I will discover that my anxiety is part of the process of Mindfulness when sitting with my thoughts, and with ERP this will help me reach habituation” instead of, “It’s too hard to sit with my thoughts, it doesn’t work.”

In a nutshell, hard work and perseverance throughout therapy is worth it for longer term benefits.

"Just because I had the thought that deadly harm would come to my child if I didn’t align two objects perfectly did not make the thought more tangible or more likely to occur.”

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By Carol Edwards © 2018

Posted 22 weeks ago

O.C.D. An Effective Strategy for Exposure Response Prevention

O.C.D. is the acronym for Opt-out, Consider, Decide. This is my self-applied technique for helping you face your obsessions and to further assist you in resisting giving into compulsions during your exposures; or in any situation where you might find yourself being triggered.


How does O.C.D. work?

Well first, when you’re faced with an obsession OPT-OUT provides you with an opportunity to step back and CONSIDER two options. These two options are to help you DECIDE clearly whether to (1) step back in to the irrational moment whereby you give into the compulsion or (2) whether to stay out and resist doing this negative reinforcing behaviour.

What type of compulsions does O.C.D. help with?

All compulsions whether open, such as handwashing; or hidden ones which might be praying or mental reviewing; plus, it can help with avoidance and escape behaviours.

Why is it important to resist giving into compulsions?

It’s important because OCD sends us incorrect messages that something is “wrong” or “doesn’t feel right”. This overwhelms us with exaggerated gut feelings of fear and dread. When we give into compulsions we find relief from this type of distress. Yet, this is temporary relief, hence the term negative reinforcing behaviours.


So what is the best way to resist compulsions?

Well, when you OPT-OUT you get the chance to stand back and observe your unwanted intrusive thoughts objectively. You are then provided with a vital moment of awareness in which to use your critical thinking skills. During this crucial moment your choice is to CONSIDER whether going back in will be worthwhile. You will have a brief moment to gauge whether what you are experiencing is based on fears and beliefs lacking in reason or logic, or a legitimate and true concern. If your instinct is with the first one, then you can DECIDE to stay out and ask no "what-if” questions thereafter - these type of questions aren’t helpful because they feed doubts, and certainty can never be guaranteed. Do bear in mind that when you make the decision to stay out you will also be agreeing to ride out associated anxiety until it begins to subside naturally, and it will, usually within 30 to 60 minutes.

But how can I tell the difference; I mean what if it’s a legitimate concern?

Most likely you’ll automatically figure out that you’re dealing with a legitimate issue because you won’t feel threatened, yet more concerned about problem-solving rationally. For example, if you had real thoughts about a bad thing happening because you forgot to lock the door before you went to bed, you would simply get up, lock the door, then go back to bed. Problem solved. For someone with OCD however, the underlying “threat” urges them on an emotional level to check the door repeatedly to “prevent” harm.

So if the problem is obsessional this means the  O.C.D. strategy offers the chance to act quickly, and before anxiety wins the moment, is that right?

Yes, you get the chance to stay out and follow through with your EXPOSURE where RESPONSE PREVENTION is the aim. With practice response prevention helps you build distress tolerance, leading ultimately to habituation. Thus, the overall outcome during graduated exposures with ritual prevention can, and does, lead to recovery?

How else can doubts and “what-ifs?” be dealt with?

When facing your obsessions and you endure the dreaded “what-ifs” one helpful thing to do is change your self-dialogue. Doing this helps you live with uncertainty. Altering your dialogue contributes to starving your obsessions. For example, your new response might be: “Maybe (name fear) will happen; maybe it won’t”… “Maybe I did cheat on my partner; maybe I didn’t”… “I might have caused an accident; I might not have either” … “Perhaps I left the stove on; on the other hand perhaps not”, and so on. With practice this does get better.

But my magical thinking makes me feel like something bad could happen?

Remind yourself that magical thinking gives you a sensation that makes you believe something could/has/will happen, but that a sensation isn’t factual.

What if I want my intrusive thoughts, it can feel like that sometimes? 

Basically, thoughts come into our minds all day involuntarily.  What happens is that when a disturbing thought comes in the difference is how an OCD-person and a non-OCD person thinks about the thoughts; that is, the non-OCD person will let the thought go without attaching meaning; yet, the person with OCD grabs hold of that thought and starts to ruminate about it, analyse it, fear it, avoid it, escape it, check it, compare it, seek reassurance, pray about it, question if they want it or like it, and might go as far as “forcing” themselves to “act” on it to prove or disprove they will or won’t stop themselves. 

But in reality thoughts cannot make things happen. They do not convert to action no matter how far you or anyone else pushes the boundaries. The point here, and this is the most important thing to identify, is that it’s not your fault when intrusive thoughts pop into your head. The OCD brain’s way of saying, “Hey, you love your family so much that you wouldn’t harm a hair on their heads” comes through as a paradox, but the disorder is a paradoxical one - this is why you get incorrect messages sandwiched between normal ones.

The disorder can be corrected by resisting the compulsions that correspond with the obsession. One thing worthwhile thinking about when you’re facing the O.C.D. challenge (and despite the intensity of your fear) is that if you step back in and do the compulsion, nothing bad will happen; and if you stay out and don’t do the compulsion, nothing bad will happen either.

But what if you’re wrong?

In this instance, I’d say your experiences are no doubt showing you otherwise. For example, in all the time you’ve had intrusive thoughts, how many times have they come true? I’m guessing your answer is “not once”.

So what if I step back in and give in to the compulsion, what then?

It’s simple. Try again next time. There are no failures when you face your obsessions, just doing that alone is an achievement, so do keep practising exposures with response prevention and you will get there eventually.

Check out “Caring Carol’s 3-Step Doubting Challenge” for kids!

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By Carol Edwards © 2018

Posted 22 weeks ago