Category: OCD

Do you ever have a thought pop into your head and you just can’t stop thinking about it? OCD consists of persistent and distressing intrusive thoughts, images, or urges referred to as obsessions. These obsessions trigger intense anxiety or discomfort, which lead people to engage in repetitive behaviors or mental rituals called compulsions in an attempt to cope with or alleviate the distress.

In this video, we’re going to look at four main types of OCD and the best ways to treat them, focusing on obsessions.

Contamination-based OCD is characterized by obsessions about germs or contaminants leading to illness and compulsions like obsessive handwashing, sanitizing surfaces, and avoiding touching objects out of fear of getting sick or making someone else sick.

Responsibility for harm-based OCD is characterized by obsessions about being responsible for accidentally causing harm, such as leaving the stove on and burning down the house or accidentally hitting a pedestrian while driving. Compulsions involve constant checking and rechecking to try to prevent harm or ensure that no harm was done.

Symmetry, ordering, and arranging OCD is characterized by feelings of discomfort or dissatisfaction associated with the perception that things aren’t ordered or arranged symmetrically or that they just don’t feel right. Compulsive behaviors may involve meticulously arranging items until they achieve a sense of symmetry or perceived perfection or feel just right. Unlike other types of OCD, there often isn’t fear or anxiety about negative consequences of things not being arranged just right, just a strong uncomfortable feeling of incompleteness that needs to be resolved.

Taboo or forbidden or unacceptable thoughts OCD is characterized by obsessions regarding thoughts related to harm and aggression, sexuality, morality, or religion, such as “What if I push someone into traffic?” not accidentally like with a responsibility for harm-based obsession, but “What if I push them intentionally?” or “Am I a sinner?” The compulsion often involves avoiding situations that could trigger these thoughts, or compulsions may be mental rituals such as neutralizing thoughts by replacing bad thoughts with good ones, repeating prayers or affirmations, or excessively analyzing thoughts and behaviors looking for reassurance.

OCD in which compulsions don’t entail overt actions and behaviors but consist of covert mental acts and rituals is commonly known as pure O OCD for purely obsessional. While this technically still involves obsessions and compulsions, the compulsions are primarily internal cognitive processes, though there are almost always these at least subtle overt compulsive behaviors as well.

Treatment for OCD involves cognitive therapy to help reduce obsessions, which is what we’re going to focus on in this video, and a type of behavioral therapy known as ERP (exposure and response or ritual prevention) that helps reduce compulsions and compulsive behavior. I’ll talk about this in another video that I’ll link to in the description once it’s out.

Everyone experiences intrusive, unwanted thoughts throughout the course of our everyday lives. There’s nothing special about these thoughts, and just having them doesn’t automatically lead to OCD. People without OCD have the same types of intrusive thoughts as people with OCD. What matters is how we interpret these thoughts, and there are six types of beliefs that are associated with OCD. So, we’re going to look at these beliefs and some strategies to counter them, which can reduce obsessive thinking and will help with exposure and response prevention for compulsive behaviors that we’ll be learning in the next video.

One of these beliefs involves assigning excessive importance to our thoughts. We believe that merely having a certain thought implies that it’s meaningful and potentially dangerous. “I wouldn’t be thinking about this if it weren’t important. There must be some truth to it, or I wouldn’t be thinking it. Or if I’m having this thought, that must mean I want it to happen.” But just having a thought doesn’t imply significance or importance.

We have thousands of thoughts every day, and most of these thoughts come and go without us really noticing them. They’re just like background sounds in our minds while we’re focused on other things. But with obsessive thinking, sometimes what might be just a fleeting thought to someone else captures our attention because we find it personally significant and believe it reflects our true character, intentions, or future actions. For example, we have a thought of harming a loved one and then worry excessively that we’re a potential danger to that person, so we start to obsess over it. Or a thought might have an emotional pull; it triggers anxiety, and our anxiety leads us to perceive the thought as important and a sign of threat or danger. This is an example of emotional reasoning, but our emotional reaction to a thought is subjective; it’s not evidence of any objective threat. My anxiety is not evidence that I probably did.

One way we can give undue importance to our thoughts is what’s known as thought-action fusion (TAF) likelihood bias. We perceive that just thinking about something makes it more likely to happen. But having the thought “What if I accidentally harm my child?” doesn’t increase the likelihood that I will harm my child, and we can test this out. See how often your phone battery dies this week and then, every day next week, think about forgetting to charge your phone so it dies and see if your phone battery is more likely to die this week than it did in the previous week when you weren’t thinking about it.

With TAF moral bias, we believe that thinking about something bad is morally equivalent to actually doing something bad. So, let’s explore the strength of our TAF moral bias. Imagine a person who has intentionally driven their car onto a sidewalk trying to harm pedestrians. On a scale from 1 to 10, rate how morally reprehensible you find this. Now, imagine another person who has entertained the thought of driving their car onto a sidewalk but has never actually acted on this thought and rate this person on the same moral scale. If we find these two scenarios morally equivalent or close to equivalent, that reflects TAF moral bias. So, if we do find them morally equivalent, we can seek the opinion of friends and family about these scenarios, which will likely reveal that most people don’t regard bad thoughts as remotely equivalent to bad actions. And this can help loosen our TAF moral bias.

If we wonder why would we even have these bad thoughts if we weren’t bad people and didn’t want to do this at least on some level, well, everyone has thoughts pop into our heads about things we find immoral but would never actually act on. And that doesn’t make us bad people; that’s just how our minds work. And over-importance of thoughts is correlated with the belief that we need to control our thoughts and prevent ourselves from having these personally significant thoughts that we regard as dangerous. And this belief is particularly strong in taboo forbidden or unacceptable thoughts OCD. But no matter how hard we try, we just can’t control our thoughts in a way that allows us to prevent ourselves from ever having certain kinds of thoughts.

But learning to be mindful of our thoughts can help reduce obsessive thinking. Mindfulness involves being aware of the thoughts that enter our minds and simply observing them without judgment, allowing them to be there until they naturally pass away, similar to how we might respond to a sound we hear in the background. We just notice the sound and then let it fade away, and this is naturally what happens with intrusive thoughts if we don’t get caught up in them and start obsessing over them. They just come and go, much like background sounds. We can also use cognitive diffusion, which is a mindfulness technique that helps us get some distance from our intrusive thoughts so that we can let them go. I have videos that describe these strategies in detail that I’ll link to in the description.

OCD is also associated with a sense of inflated responsibility, the belief that we have the power to bring about or prevent negative outcomes, accompanied by feeling a strong responsibility to protect ourselves and others from harm. If there’s any chance we could prevent something bad from happening, we must do so at any cost. This can lead to compulsive checking. For example, someone with contamination-related OCD might fear that touching a doorknob or shaking hands will spread germs and cause people to get sick, leading to compulsive handwashing rituals.

One way to counter such beliefs is with what’s called a “responsibility pie,” which involves breaking down the feared scenario and systematically dissecting all of the possible contributing factors. It’s possible someone will get sick, and if so, sure, we might not have perfectly decontaminated our hands before shaking their hands. But the person could have been exposed to germs elsewhere in the office, or perhaps their kids caught a bug at school that they passed on. And even if they did contract something from shaking our hands, if they had practiced good hygiene and washed their hands afterwards, the risk of illness would have been diminished. Then, by assigning a percentage of possible responsibility to each factor and representing it on a pie chart, we gain a more accurate perspective and see that we’re not close to being fully responsible for preventing others from getting sick, which can reduce our need to engage in compulsive behaviors.

People with OCD also tend to overestimate threats, seeing situations as more dangerous than they actually are and exaggerating the likelihood and severity of harm, especially in situations that aren’t inherently dangerous. This belief is characteristic of contamination-based OCD as well as accidental harm-based OCD, where we overestimate the likelihood that we did leave the door unlocked and the severity of the consequences if that were actually true.

We can challenge these beliefs through cognitive restructuring, which involves changing or modifying a negatively biased thought with a thought that’s more accurate and better reflects reality. Here are some questions we can ask ourselves that can help us come up with a more balanced perspective that reduces the amount of anxiety we feel:

• What am I worrying or predicting will happen?
• How likely is it that what I’m worrying about will happen?
• What evidence do I have that it will happen?
• What evidence do I have that it may not happen?
• What are some other possible scenarios, other outcomes, other ways things might turn out?
• Looking at all of this information, what’s the most likely thing to happen?

I have a number of videos that go into cognitive restructuring in more detail.

OCD is also associated with an intolerance of uncertainty and the need to do everything possible to try to remove any and all doubt. Perfectionistic beliefs are also common with OCD, the tendency to think that there’s a perfect solution for every problem and that doing things perfectly without any mistake is not just achievable but also necessary. Even small mistakes are believed to have serious consequences.

So, how can we become more accepting of uncertainty and reduce our need for perfection? First, it’s important to recognize that in most aspects of life, absolute certainty and perfection are unattainable goals. We need to work on shifting our focus from aiming for certainty or perfection to tolerating a state of “good enough” and balancing our desire for certainty or perfection with the practical reality that absolute certainty or perfection is never entirely achievable.

In general, if we look at the benefits versus costs of seeking absolute certainty or perfection, we’ll often find that there are some short-term benefits, but these come at the expense of significant long-term costs. For example, we may get some temporary relief from anxiety and discomfort, and the illusion of control and attention to detail can lead to higher quality results. However, in the long term, we also experience increased anxiety and stress, and it’s very time-consuming and can damage relationships, lead to procrastination, and result in missed opportunities.

We can use cognitive restructuring to challenge our beliefs about the need for certainty or perfection, which we talked about in reference to assessing threats and danger more accurately. I describe strategies to do this in a number of other videos. Mindfulness can help us accept uncertainty and imperfections as we simply become aware of our thoughts, urges, or feelings regarding certainty or perfection and just acknowledge them, allowing them to be here without acting on them. We can try labeling these thoughts and urges and then gently letting them go. If they stick around, we allow them to be here but in the background of our awareness as we shift the focus of our attention to whatever we’re doing in the present or just something neutral like our breath. These mindfulness skills take some practice, but they’re things anyone can learn to develop.

Learning to reduce obsessive thinking is an important first step in managing OCD. In the next video, we’ll build upon this and look at exposure and response prevention, which targets compulsive behaviors and is regarded as the most effective treatment for OCD. You’ll find that video along with all the videos I mentioned here together on my website, so please check that out. Please hit the like button and subscribe to my channel. If you’d like to support my channel and help me make more videos like this, I really appreciate it. Please check out the donation links in the description.

Clark, D. A. (2020). Cognitive-Behavioral Therapy for OCD and Its Subtypes (2nd ed.). The Guilford Press.

Cognitive assessment of obsessive-compulsive disorder. Obsessive Compulsive Cognitions Working Group. (1997). Behaviour research and therapy, 35(7), 667–681. https://doi.org/10.1016/s0005-7967(97)00017-x

This transcription was auto-generated by YouTube. I’ve only added minimal editing, so I apologize for any errors, run-on sentences, etc.

We have tens of thousands of thoughts a day but most of them barely register. And the ones that we do notice often aren’t even related to anything we’re doing at the time. Usually the best way to deal with automatic negative thoughts is to not give them your attention in the first place.

They’re like a clickbait headline that looks like it’s gonna be really interesting, but once you click there’s really nothing worth seeing and the best course of action is to just not click on them in the first place. But sometimes we can’t resist and we click anyway. And then we find ourselves going down that rabbit hole and keep clicking on another and another and another, at which point it can take quite a bit of effort to pull ourselves back out.

And the same is true once we start following our automatic negative thoughts. A big part of mindfulness is about learning to let go of these types of thoughts and refocus our attention in the present moment. But that’s often easier said than done for a couple of reasons.

First we tend to believe that if we have a thought it’s somehow interesting or important and something we should pay attention to, so we don’t want to just let it go. But of our tens of thousands of thoughts every day, most of them are just noise in our head, mindless distractions that don’t need our attention at all. And once we come to terms with this it’s a lot easier to just allow these thoughts to pass from our mind without even thinking about them.

But secondly, the thoughts that we tend to notice are the ones that provoke an emotional reaction. And these are not as easy to simply let pass from our minds, because as we’ve seen once our thoughts and emotions start interacting together, they feed into and reinforce each other. And as a result thoughts that carry some emotional weight are much more difficult to just let go, as the emotion acts as a kind of magnet, and keeps pulling these thoughts back into our head.

One way to let go of thoughts is to treat them as if they were just sounds going on in the background. We generally don’t pay attention to these sounds or think about them very much, and we just allow them to pass in one ear and right out the other. And we can do the same sort of thing with our thoughts, not give them any undue attention and think about them or try to figure out what they mean, and just treat them like mental noise in the background allow them to pass into our mind and then right out again.

Another metaphor for this way of relating to our thoughts is to simply treat our thoughts as if they were clouds passing through the sky, noticing as a cloud or a thought passes into our field of awareness, sticks around for a while, and then continues to float through the sky or through our mind until it passes away.

Or sitting back and observing our thoughts as if we were at the movies and watching our thoughts being projected on the screen in front of us, not actively participating or getting caught up in the action on the screen that is our thoughts, and just sitting back and watching them as they unfold.

But often it’s not that easy to just sit back and watch our thoughts, and in the next video we’ll learn some additional strategies and techniques we can use to help us step back from our thoughts and let them go called cognitive defusion.

This transcription was auto-generated by YouTube and formatted by ChatGPT.

People sometimes toss around the phrase “I’m so OCD” to describe personality traits like a need for order, organization, and routines. But obsessive-compulsive disorder (OCD) goes well beyond that. OCD is characterized by persistent unwanted thoughts or obsessions that lead to repetitive behaviors or mental acts called compulsions. These obsessions can trigger intense anxiety or feelings of discomfort, and the compulsions are performed in order to alleviate this anxiety or discomfort or to prevent a feared event or situation from happening.

The most effective way to treat OCD is with exposure and response prevention (ERP). ERP involves facing fears or obsessions (the exposure part) without engaging in the compulsive behaviors or rituals that typically follow (the response prevention part). ERP helps us confront our fears in a controlled way, breaking the cycle of obsessions and compulsions. It’s like teaching our brains that the feared outcomes are unlikely and the anxiety and discomfort are tolerable and manageable without needing to engage in compulsive behavior.

We’re going to look at some general descriptions of how ERP can help manage four main subtypes of OCD, and then we’ll learn how to practice ERP in more detail. This was an example of ERP for contamination-based OCD. With responsibility for harm-based OCD and checking compulsions, we might find ourselves constantly worried that we left the stove on and that it could potentially cause harm like burning down the house. With ERP, we would deliberately resist the urge to check the stove repeatedly after turning it off and learn to tolerate the anxiety that arises without going back to check. By doing so, we teach ourselves that our fears are exaggerated and that we can tolerate the anxiety and uncertainty without resorting to compulsive checking.

With symmetry, order, and arranging OCD, we have a compelling need for things to be just right, and we feel discomfort or unease when items aren’t arranged precisely as we think they should be. In ERP, we disrupt this need for perfection. We intentionally place objects in a slightly disordered fashion and then resist the urge to rearrange them to achieve symmetry. Through this process, we learn to manage the discomfort that arises from things not being ordered perfectly and to tolerate these feelings without the need to compulsively rearrange things.

In taboo or forbidden thoughts OCD, we might experience distressing and intrusive thoughts that go against our values, like thinking about harming a loved one, creating significant anxiety. Compulsions often involve mental rituals like trying to stop ourselves from having these thoughts or trying to neutralize them with good thoughts. With ERP, we invite these thoughts in and then resist the urge to engage in mental rituals or seek reassurance. By facing these thoughts, we learn that they’re just thoughts, they’re not dangerous, and they don’t define our character or intentions.

In theory, ERP sounds quite simple – we just prevent ourselves from engaging in our compulsive behaviors. But that’s much easier said than done, or we’d already be doing it. Reducing the strength of our obsessions can help make ERP more manageable, and I talk about how to do this in another video. I also have a video that describes the theory and practice of exposure therapy in general in detail, which can help with ERP.

So the first step in ERP is to come up with a list of about 8 to 10 exposure situations that trigger our obsessions and provoke compulsive behaviors. The items on the list should be as specific as possible and include things that cause a range of anxiety or distress, from situations that seem somewhat manageable to situations that might feel almost impossible. Everyone’s lists will be different, but here are some sample situations for an exposure list for contamination-based OCD. You’ll find a full sample list on my website that I link to in the description, along with sample lists for other subtypes of OCD.

The traditional way of doing exposure therapy is to start with the situation that causes us the least amount of distress and then work our way up through the list to the one that causes us the most distress. But more recent research suggests it might be more effective to go through the list in a quasi-random fashion, making sure to include some of the most anxiety-provoking situations towards the start.

Now, there are four things we want to learn from our exposure exercises. We want to violate our expectations about what we think will happen and learn that our feared outcomes are less probable or severe than we predict. We also want to learn that anxiety is a natural human emotion that is both safe and tolerable, as are things such as discomfort arising from uncertainty, lack of perfection, and so on. And we want to learn that we don’t need to rely on compulsive behaviors to tolerate anxiety or discomfort or provide us with safety, and that we’re able to function in our daily lives despite feeling anxiety or discomfort.

For this example, we’re going to use a high distress exposure. So, the situation is to spend a day at work without avoiding touching things I fear could be contaminated or avoiding shaking hands, and so on. Refrain from washing my hands or using sanitizer throughout the day and then come home and prepare and eat dinner with my family without first washing my hands.

So, before starting the exposure, we ask ourselves: What do I expect or predict will happen by not avoiding contaminated objects at work? I will bring it home and infect myself or my family.

What am I most worried about or fear the most? I worry that my family members might get sick because of my actions.

Is there anything I’m worried I won’t be able to tolerate? I’ll feel guilt, anxiety, and intense worry about my family’s health, and I won’t be able to stand feeling this way, and I’ll end up giving in and washing my hands. How likely do I think it is that what I’m worried about will happen on a scale from 0 to 100?

Then we do the exposure exercise and afterwards ask ourselves: What happened during the exposure? Did my fears come true? Throughout the day, I forced myself to refrain from compulsive behaviors. I touched doorknobs, shared office equipment, shook people’s hands, and even went to the restroom without washing or sanitizing my hands afterwards. After work, I prepared and ate dinner without washing my hands first, and nobody felt sick after dinner, and the next morning everyone was still healthy.

Was I able to tolerate the distress, and if so, how? It wasn’t quite as bad as I expected. While some anxiety and discomfort arose, especially at the start of the exposure every time I came into contact with something that might have been contaminated, and just before we ate dinner, I noticed these feelings gradually diminished without me having to do anything about them. I practiced some mindfulness techniques and acknowledged the anxiety but resisted the urge to give into compulsions.

How was this outcome different from what I expected? I thought that not avoiding contaminated objects and especially not washing my hands afterwards would lead to someone in my family falling seriously ill. But everyone was fine and there were no signs of illness.

What did I learn from this? I learned my fears were exaggerated. I realized that my anxiety, while intense at times, was tolerable and I could manage it without resorting to compulsions. I learned my OCD tends to blow things out of proportion, and my anxiety doesn’t always match the actual level of risk. The experience reinforced the idea that my OCD fears aren’t based in reality. It showed me my family wasn’t in imminent danger due to my actions, which allows me to challenge future OCD-driven thoughts more effectively.

These exposure and response prevention situations can be more effective when combined with the exercises in my video about obsessive thoughts and challenging beliefs that contribute to OCD. And these exercises can also help give us the courage to engage in ERP if we’re finding it difficult to get started. But what if I do ERP and someone in my family does get sick? Well, first, we can’t be sure they caught it from us. If there’s an illness going around, they could have caught it from a lot of different sources.

And even if they did catch it from us, people spread germs all the time and catch illnesses from other people all the time. There’s no way to prevent ourselves from ever transmitting germs, and if we have OCD, our compulsive attempts to do so have a very negative impact on the quality of our lives. ERP isn’t about putting ourselves or others in irresponsibly risky or dangerous situations. It’s about learning to live our lives in ways comparable to most people without the burden of debilitating compulsions.

Now, let’s talk about Purely Obsessional OCD, often known as Pure O. This form of OCD involves taboo, forbidden, or unacceptable intrusive thoughts about violence, causing harm, sex, religion, or fear of making mistakes. Unlike traditional OCD, Pure O doesn’t manifest in overt compulsive behaviors but instead involves mental acts and rituals.

Compulsions in Pure O include mental rituals like neutralizing bad thoughts, mentally praying, checking, and incessant mental replaying. The goal is to control and prevent these intrusive thoughts from arising. However, despite the name Pure O, it also involves compulsions, although they’re harder to distinguish from obsessions as both occur in our minds.

An exposure exercise for Pure O might involve deliberately thinking about harming a loved one, allowing the thought without suppression, and resisting mental compulsions. Practicing mindfulness, acknowledging the thoughts without fighting them, and allowing them to pass can be part of the exposure.

If we find ourselves repeating neutralizing thoughts or prayers, changing the words can disrupt the usual ritual. Writing a detailed script of feared scenarios, reading it out loud, or recording and listening to it can also be helpful exposures. By preventing mental compulsions, we learn that the feared consequences linked to these thoughts seldom occur.

In Pure O, there are also overt behavioral compulsions like seeking reassurance or avoiding triggering situations. An exposure could involve confronting these situations directly, such as going to the kitchen with knives present, resisting compulsions, and learning that thoughts alone aren’t dangerous.

For more strategies on managing Pure O and obsessive thinking, check my video on OCD and obsessive thoughts available on my website.

Contamination-Based OCD Exposure Exercises

• Use a pen that other people have used without cleaning or wiping it first. Resist the urge to wash or sanitize hands immediately afterwards.
• Go shopping and hold the cart handle without gloves. Don’t sanitize or wash hands until I’m home, and don’t avoid touching my face or other objects out of fear of contaminating them.
• Use a public restroom and put my bag on the floor rather than looking for a place to hang it, and avoid cleaning it afterwards.
• Shake hands with someone without sanitizing afterward. Touch my face with unwashed hands.
• Touch items in a dumpster with bare hands. Resist urge to wash hands until before my next meal.
• Walk barefoot inside a public restroom, and touch the floor with my hands. Don’t wash hands until next time I eat. Don’t clean feet until the next time I shower.
• Use a public restroom without washing my hands afterwards. Don’t avoid touching doors or anything else in the restroom. Eat some snacks with my hands before washing or sanitizing them.
• Spend a day at work without avoiding touching things I fear could be contaminated or avoiding shaking hands, etc. Refrain from washing or sanitizing hands during the day. Go home and prepare and eat dinner with my family without first washing my hands.

Checking Compulsion Exposure Exercises

• Leave a kitchen appliance plugged in (e.g., toaster) without checking it multiple times to make sure it’s off. Leave it plugged in and walk away without going back to check.
• Make a low-stakes decision without second-guessing it multiple times, and resist the urge to keep revisiting the decision excessively. If doubt creeps in, notice any discomfort but stick with what I already decided instead of changing my mind back and forth.
• Have a conversation with a friend without analyzing it afterward for mistakes. Don’t replay it back in my head to see if I may have said something wrong or embarrassing.
• Close and lock the front door as I leave the house. Once I’ve locked it, resist the compulsion to check again. Go shopping for an hour and any time I start to worry I might have forgotten to lock the door, resist any urges to turn the car around and check, or leave the store early.
• Turn off the stove after cooking breakfast and resist the compulsion to check repeatedly. Go to work without checking to see if it’s off before leaving. Don’t ask anyone else to check while I’m at work.
• Lock the car once and resist the urge to check multiple times, and then go in to work without checking on the car for the rest of the day. Trust my initial action and tolerate any anxiety without giving in to the compulsion to go back to the car to check that I did lock it.
• Leave the house without going back to check that all lights and appliances are turned off. Resist the urge to return and check. Notice the discomfort but trust my initial actions and manage any anxious thoughts or feelings with mindfulness.
• Send a work email without rereading it obsessively. Check it over once and then resist the compulsion to keep checking it over and over. Send the email and then resist the urge to reread it to make sure I didn’t make any mistakes.
• Drive to a destination and resist the urge to go back and check if I’ve harmed anyone on the way. I will trust my driving skills and decision-making without returning to the scene. I will resist mentally reviewing my entire driving route after reaching my destination. I will refrain from replaying the journey in my mind to search for potential mistakes or incidents.

Symmetry, Order, and Arranging OCD Exposure Exercises

• Mix various types of utensils (forks, spoons, knives) in a kitchen drawer. Resist the compulsion to sort them into separate compartment.
• Wear intentionally mismatched socks. Resist the urge to change into matching pairs.
• Place items on my desk in a random pattern without any specific order. Resist the need to arrange them symmetrically.
• Place books or items on a shelf in an intentionally uneven or disorderly manner without categorizing them by size or genre. Resist the urge to create ordered sections or keep rearranging them until they feel “just right.”
• After doing laundry, quickly fold clothes once and place them in drawers in the order they were folded. Resist the urge to refold anything that isn’t perfectly neatly folded, or to rearrange them in a more organized manner.
• Cook a meal using ingredients placed haphazardly on the kitchen counter. Resist the compulsion to organize them systematically before starting to cook. Set the table using mismatched plates, glasses, and utensils and resist the urge to match them symmetrically before eating.

Taboo, Forbidden, or Unacceptable Thoughts OCD Exposure Exercises

• Spend 10 minutes deliberately visualizing taboo thoughts without analyzing or trying to suppress them. Allow the thoughts to come and go without judgment. Avoid trying to neutralize the thoughts with “good” thoughts.
• Write down an obsessive thought in detail. Describe the thoughts, emotions, and fears associated with them. Read back what I’ve written without seeking reassurance or resorting to any neutralizing mental rituals.
• Record the obsessive thought in detail. Listen to the recording multiple times without seeking reassurance or resorting to any neutralizing mental rituals.
• Engage in a conversation with a friend about a taboo or uncomfortable topic. Discuss it openly without changing the subject. Resist engaging in any mental rituals to neutralize the effect of what we’re talking about or any taboo thoughts I’m having related to the topic.
• Watch a movie or read a book that includes themes related to my taboo thoughts. Allow myself to experience the discomfort without turning away or seeking distractions.
• Put myself in situations that could trigger my taboo thoughts (e.g., driving, visiting crowded places, attending social events, being in the kitchen with my partner, putting my baby down to sleep). Resist the urge to avoid these situations and tolerate the anxiety.
• Bring to mind a taboo thought and then go shopping to show myself I can carry out daily tasks even when I’m anxious about something I’m thinking about. Resist the urge to perform any mental rituals to ease my anxiety or discomfort.

Abramowitz, J. S., Deacon, B. J., & Whiteside, S. P. H. (2019). Exposure Therapy for Anxiety: Principles and Practice (2nd ed.). The Guilford Press.