Imaginal Exposure for OCD and Anxiety

Imaginal exposure is a powerful treatment technique
for OCD and related anxiety disorders.

What is Imaginal Exposure

For many people struggling with OCD and related anxiety disorders, one of the most beneficial treatment tools is imaginal exposure. In order to best understand this technique, it is first necessary to understand the basic idea of Exposure and Response Prevention (ERP).

ERP is a specific type of Cognitive Behavioral Therapy (CBT) that has consistently and repeatedly been found by researchers to be the most effective treatment for OCD. Simply put, ERP is the “B” part of CBT. Using this technique, a client learns to become less afraid of fearful situations by challenging the behavioral compulsions that they employ in an effort to reduce their fear. The basic principle behind ERP is that, by repeatedly confronting their fear (exposure) without doing any compulsive anxiety-reducing actions (response prevention), the client will become less afraid when faced with anxiety-provoking situations. This process is known as habituation, which is really just a fancy way of saying that we become less afraid of things as a result of repeatedly being exposed to them. Read More »

    

ROCD (Relationship OCD)

ROCD (Relationship OCD) is often misunderstood by
mental health professionals and the public.

Relationship OCD (ROCD) is a form of Obsessive Compulsive Disorder (OCD) in which the sufferer experiences intrusive, unwanted and distressing thoughts about the strength, quality, and “true nature” of their love for their partner. Obsessions in ROCD include a preoccupation with a partner’s appropriateness as a mate, overall level of attractiveness, sexual desirability, or long-term compatibility, and often arise in otherwise entirely healthy relationships.

When most lay people think of OCD, they envision hours of hand washing or compulsive lock checking. However, there are numerous equally exhausting sub-types of OCD in which the compulsive symptoms are less overt, and which together are colloquially described as Pure Obsessional OCD, or “Pure O”. But this term is a misnomer, as people suffering with Pure O exhibit numerous, albeit less obvious, compulsions. And while these compulsions are less noticeable by others, they still take a huge toll on sufferers. ROCD is one such sub-type.

Read More »

    

This is the second installment of a multi-part series on Scrupulosity, a specific variation of Obsessive-Compulsive Disorder (OCD) that focuses on religious and moral perfectionism.  This article focuses on how one can learn to identify and challenge common cognitive distortions seen in Scrupulosity.  Please note that this article will focus exclusively on religiously-focused Scrupulosity, and that future installments will address Moral Scrupulosity.

Scrupulosity in OCD

Cognitive Restructuring can be a valuable component of treatment for Religious Scrupulosity in OCD

Scrupulosity is a type of Obsessive Compulsive Disorder (OCD) rooted in irrational, distorted thoughts (obsessions) related to one’s religious beliefs, morals, or personal ethics.  An individual with Scrupulosity experiences these unwanted thoughts as being at odds with their faith, their relationship with God, or their moral and ethical values.

As with all types of OCD, the individual with Scrupulosity responds to their obsessions with compulsive behaviors that they employ in an effort to reduce, eliminate, or reverse their unwanted thoughts and the anxiety they cause.  Scrupulosity becomes a clinical issue when an individual’s behaviors are motivated by a desire to control anxiety rather than the pursuit of a genuine connection to their faith, morals, or ethics.

Read More »

    

A discussion of Harm OCD and its treatment using Exposure and Response Prevention (ERP).  Part four of a series.

Harm OCD treatment

Exposure and Response Prevention (ERP) is the key component to effective treatment for Harm OCD.

In our three previous articles in this series, we discussed the primary symptoms of Harm OCD, along with how one can use mindfulness and cognitive therapy to address unwanted harming thoughts.  In this installment, we focus on directly challenging the behaviors associated with Harm OCD by using Exposure and Response Prevention (ERP).

What is Exposure and Response Prevention

The primary behavioral therapy tool used when dealing with Harm OCD is called Exposure and Response Prevention (ERP).   While cognitive therapy challenges the content of our intrusive thoughts, and mindfulness addresses our perspective towards those thoughts, ERP directly confronts the behaviors done in response to those thoughts While mindfulness and cognitive therapy set the table, ERP is the main course.  This is where the real work gets done.

Read More »

    

The impact of OCD and related anxiety based disorders on the family is often overlooked.  In this multi-part series, we present first-hand accounts of the ongoing impact of OCD, BDD, and Bipolar Disorder on one man and his family, as told to Elizabeth Kassel, MSW, of the OCD Center of Los Angeles.

Life with OCD

Those suffering with OCD need
understanding and treatment

My name is Robert and I have Obsessive-Compulsive Disorder (OCD).  I am a thirty-four year old, single man and work as a personal fitness trainer. My story is not typical, but it is the only one I have . . .

I was four years old when I looked at a picture Bible and saw an image of Satan. My thought was, “Satan is cool!” He wore a red cape and was “ripped!”  My obsession was that, since I thought he was cool, I was evil and I would go to hell. I knew that evil people hurt others, and I was terrified of hurting someone. It never occurred to me to tell my parents. I figured all kids thought this way too, but the other kids just seemed to be “managing” it better than I was. They didn’t appear bothered by the eternal consequences of their actions like I was. They were talking back, swearing, being disrespectful and acting cocky, but weren’t worried about going to hell. I figured that thinking Satan was cool and that I was evil was “normal”, and that I just had to be more laid back and figure out how to worry less.

One day when I was fourteen, I had an intrusive thought that I wasn’t funny. I couldn’t shake it and kept a journal of funny quips so I could be “funny” in social situations. I tried to keep up the compulsion of memorizing stuff from the “funny book” so I wouldn’t be “slow”. I wanted to be quick witted, playful and charming.  The irony is people said I was funny – I just didn’t “feel” like I was.  I fought to I remember “my lines” to get rid of the anxiety. At about the same age, I had the obsession that my penis wasn’t the right size. I was pre-pubescent and a “late bloomer.” When in the locker room at school, I compared the boys’ penises to my dad’s penis and thought, ”Wow! They’re tiny!” I even asked my mom one day, “Does size matter?”

Read More »

    

Many people mistakenly think of Obsessive Compulsive Disorder (OCD) solely as a condition in which people wash their hands excessively or check door locks repeatedly.  There are actually many sub-types of OCD.  In this ongoing series, Kevin Foss, MFT of the OCD Center of Los Angeles discusses Scrupulosity, in which an individual’s OCD focuses on issues of religion, morals, and ethics. Part one of a four-part series.

Scrupulosity OCD

Those with Scrupulosity experience profound feelings of anxiety and guilt related to religion, morals, and ethics.

One of the first documented references to Obsessive Compulsive Disorder (OCD) was in a 1691 sermon by Bishop John Moore of Norwich in which he discussed men and women who were overwhelmed with unwanted thoughts, and tormented by feelings of guilt and shame over what he described as “religious melancholy.” Priests had started to notice that some churchgoers were attending confession several times a day, and repeatedly confessing to the same sins and shortcomings that they feared would result in divine judgment and eternal damnation. Their penance and absolution would provide only a fleeting glimpse of peace, and then their fears would come roaring back.

In retrospect, we now know that this obsessive religious fervor is a manifestation of OCD known as Scrupulosity. People of various religions across the world are haunted by feelings of doubt, guilt, and anxiety that torment them by attacking that which they find most dear – their faith. Scrupulosity is a form of OCD in which the sufferer’s primary anxiety is the fear of being guilty of religious, moral, or ethical failure. Those afflicted with Scrupulosity fear that their effort to live according to their spiritual values not only isn’t good enough, but is in direct violation of God.

Read More »


Choosing a Different Route on the Anxiety Highway

Mindfulness for OCD and Anxiety

Mindfulness can greatly enhance Cognitive Behavioral
Therapy (CBT) for the treatment of OCD and Anxiety.

“Mindfulness” seems to be everywhere these days. In the culture at large, mindfulness is becoming a common practice for many as a means to finding basic peace of mind. And in the field of mental health, mindfulness is quickly coming to be seen as a technique that can help relieve symptoms of OCD, anxiety, and other psychological conditions.

After reading the above paragraph, you may be thinking, “Sign me up!” After all, we live in an era of instant gratification, and most of us usually want a quick fix to our problems. But mindfulness is not something one masters overnight. It is a journey that requires effort, commitment, and dedication. While mindfulness may provide relatively rapid relief to one’s distress in certain situations, it is perhaps better conceptualized as a long-term shift in perspective that allows us to better manage the complexity of human psychological experience. Like learning a new language, mindfulness takes time and patience to master, and ongoing effort to remain fluent.

Read More »

Thought-Action Fusion in OCD

Thought-Action-Fusion is a common
problem for many struggling with OCD.

Virtually everybody experiences unwanted thoughts from time to time, for we human beings are not always in charge of what we think.  But for sufferers of Obsessive Compulsive Disorder (especially Pure Obsessional OCD), the problem is not just the presence of unwanted thoughts, but also the attention and meaning one gives to them.

OCD and Thought-Action Fusion

Obsessive Compulsive Disorder (OCD) not only produces constant mental noise and endless worry, but also often includes a cognitive process known as thought-action-fusion.  The distorted thought at the heart of thought-action-fusion is the irrational assumption that just because a “bad” thought presents itself to your mind, then it is undeniably followed or accompanied by a specific “bad” action.    For some, this fusion is so strong that they believe that their thoughts actually cause actions to occur. Clients who suffer from thought-action fusion often report intense fear because of their belief that their thoughts will come true.  Thought-action fusion is particularly common in the Pure O variant that is colloquially known as Harm OCD. For example, a teenage girl may worry that if she has a thought of a home invasion happening to her family, then the break-in will undoubtedly occur.  Or a college student might fear that he will wander out of his dorm room and harm someone without knowing it.  If this student is struggling with Harm OCD complicated by thought-action fusion, he might be overcome with a debilitating belief that, because he thinks this thought, then he is almost certainly a sociopath and is likely to act on it. Read More »


The OCD Center of Los Angeles discusses resistance and certainty-seeking in OCD and related anxiety based conditions. Part one of a two-part series.

Resistance and acceptance in OCD and anxiety

Resisting our unwanted thoughts, feelings, and
sensations is a futile task that is doomed to failure.

When treating clients with Obsessive-Compulsive Disorder (OCD) and other anxiety based conditions, two of the most important topics we discuss are “resistance” and “certainty-seeking”.  People suffering with these conditions often have unpleasant and unwanted thoughts, feelings, and bodily sensations, and resistance to these experiences is a normal, natural reaction.  Simply put, when faced with something uncomfortable or painful, we humans instinctively resist it, and quickly look for ways to reduce our discomfort through avoidance.  But unfortunately, while resistance may internally feel like the correct response to our uncomfortable thoughts, feelings and sensations, it actually serves to inflame them.

For most people, it seems counterintuitive to reduce resistance and allow uncertainty to remain in the face of these uncomfortable internal experiences.  Many are likely to think something along the lines of “I must find a way to keep this thought, feeling, or bodily sensation from happening again”.  But this philosophy of resistance in regards to our unwanted internal experiences will actually cause them to become more powerful.  As illogical as it may seem, oftentimes the best solution is to lower our resistance, surrender, and accept what is being offered.

Read More »


A discussion of the treatment of Harm OCD using Cognitive Restructuring.   Part three of a series.

Harm OCD treatment

For those with Harm OCD,
Cognitive Restructuring is a key part of treatment.

In our previous installment of this series, we looked at Mindfulness for the treatment of Harm OCD, and how a change in perspective towards unwanted thoughts and feelings can lead to a change in compulsive behaviors.  But as many sufferers well know, one’s response to intrusive harm thoughts is frequently automatic.  Those with Harm OCD have conditioned themselves to respond to their harm thoughts in a certain way, and very little thinking may go into it.

Mindfulness encourages us not to waste time and energy attending to thoughts and feelings with urgency when those thoughts and feelings could be simply observed and allowed without response.  This is not only difficult to do, but requires practice, training, and education that may not always be immediately practical early in treatment.  If we must attend to the content of our thoughts directly, we should attempt to do so with as little mental ritual as possible.  So we ask the question, “What is it that I am thinking about my thoughts that appears automatic, yet may be voluntary and may be pointing me in the wrong direction?

Cognitive Distortions Commonly Experienced in Harm OCD

The reason why a harm sufferer feels compelled to compulsively analyze, avoid, or otherwise over-respond to harm thoughts is because they are filtering these meaningless little ones and zeroes through distorted lenses that spit them out as unacceptable indictments.  These lenses are called cognitive distortions.  Here are some examples of common cognitive distortions experienced in Harm OCD: Read More »

  • OCD is Fake News

    OCD is just fake news that your brain makes up. From the OCD Center of Los Angeles. Helping clients in California and around the world since 1999.

  • HOCD: 30 Things You Need To Know

    HOCD is a type of OCD in which the individual obsesses about their sexual orientation. Here are 30 things you should know about HOCD. From the OCD Center of Los Angeles.

  • Doubt, Denial and OCD

    A discussion of “The Denial Obsession” in OCD, in which sufferers obsess that they don’t really have OCD, but are merely “in denial”. By Lauren McMeikan, MA, and Tom Corboy, MFT, of the OCD Center of Los Angeles.

  • Dermatillomania: A Skin Picker’s Guide to the Dermatologist

    How one woman with Dermatillomania finally opened up to her dermatologist about her longtime struggle with skin picking.

  • Imaginal Exposure for OCD and Anxiety

    Imaginal exposure for the treatment of OCD and anxiety is discussed by Tom Corboy, MFT, of the OCD Center of Los Angeles.

  • ROCD: Relationship OCD and The Myth of “The One”

    ROCD (Relationship OCD) is an often misunderstood variant of OCD. By Sheva Rajaee, MMFT and Tom Corboy, MFT of the OCD Center of Los Angeles.

  • Moral Scrupulosity in OCD: Cognitive Distortions

    Cognitive distortions are common in the Moral Scrupulosity subtype of OCD. Part three of a multi-part series.

  • OCD in the Family

    One mom’s story of her son’s battle with OCD and its profound impact on their family, as told to Elizabeth Kassel, MSW, of the OCD Center of Los Angeles.

  • Scrupulosity in OCD: Cognitive Distortions

    A discussion of cognitive distortions in the religious Scrupulosity subtype of OCD. Part two of a multi-part series.

  • OCD and Eating Disorders

    Diagnostic similarities and differences between OCD and eating disorders are discussed by Kimberley Quinlan, MFT, Clinical Director of the OCD Center of Los Angeles.

  • Harm OCD Treatment With ERP

    Harm OCD treatment using Exposure and Response Prevention (ERP) is discussed by Tom Corboy, MFT, Executive Director of the OCD Center of Los Angeles .

  • My Life with OCD

    The impact of OCD and related anxiety based disorders on the family is often overlooked. In this multi-part series, we present first-hand accounts of the ongoing impact of OCD, BDD, and Bipolar Disorder on one man and his family, as told to Elizabeth Kassel, MSW, of the OCD Center of Los Angeles.

  • Scrupulosity: Where OCD Meets Religion, Faith, and Belief

    The Scrupulosity sub-type of OCD is discussed by Kevin Foss, MFT, of the OCD Center of Los Angeles. Part one of a four part series.

  • Mindfulness for OCD and Anxiety

    Using mindfulness to enhance traditional CBT for OCD and anxiety is discussed by Kimberley Quinlan, MFT, Clinical Director of the OCD Center of Los Angeles.

  • Hoarding, Cluttering, and Compulsive Shopping: My Childhood Story

    One woman’s story of her life as the child of multiple generations of hoarders.

  • OCD and Thought-Action Fusion

    Thought-Action Fusion is a frequent problem for those with OCD. This issue is discussed by Laura Yocum, MFT, of the OCD Center of Los Angeles.

  • OCD, Anxiety, and Resistance

    Resistance and acceptance in OCD and related disorders is discussed by the OCD Center of Los Angeles.

  • Harm OCD Treatment: Cognitive Restructuring

    Harm OCD is often misunderstood, but it can be effectively treated using an integrated treatment plan that includes Cognitive Restructuring. Part three of our ongoing series that explores “Harm OCD” and its treatment .

  • OCD & Anxiety: Five Common Roadblocks to Treatment

    Learn the five common mistakes that interfere with successful treatment of OCD and anxiety. By Kimberley Quinlan, MFT, Clinical Director of the OCD Center of Los Angeles.

  • Harm OCD Treatment: Mindfulness Based CBT

    Harm OCD is an often misunderstood condition that can be effectively treated using Mindfulness integrated with CBT. Part two of a multi-part series from the OCD Center of Los Angeles.

 

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