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How to Confront the Intrusive Thoughts of OCD

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November 21, 2018
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The Emotional Distress of OCD

The intrusive and overwhelming thoughts that come with Obsessive-Compulsive Disorder, or OCD, can feel like a “tsunami of emotional distress.” That’s how Wajahat Ali describes OCD in his New York Times article, “OCD: My Exhausting Best Friend.”

OCD is an anxiety disorder in which a person has uncontrollable, recurring thoughts or obsessions and behaviors that he or she feels the urge to repeat over and over. While some of these thoughts are common and useful, like checking to make sure the stove is turned off, a person is usually diagnosed with OCD when these thoughts and behaviors are intense and may interfere with daily functioning.

Treatments for OCD: CBT and ERP

Without OCD, the person dismisses the intrusive brain’s offerings, usually in three seconds, says Steven Phillipson, a psychologist who specializes in the Cognitive Behavioral Therapy, or CBT, and Exposure and Response Prevention, or ERP.

CBT teaches people how to respond rationally to irrational thoughts, so they can interrupt the automatic responses that may be disruptive to functioning. For example, a person who is overly worried about germs and washes their hands multiple times can learn, with CBT, to wash their hands once by purposely choosing a new thought, that one washing is prevention enough. However, some people with OCD often realize their thoughts may be irrational, but can’t stop them. Phillipson has found that Exposure and Response Prevention can be quite successful in treating OCD.

ERP involves repeated exposure to the fearful thoughts without giving into the short-term relief delivered by compulsions. The idea behind this therapy is that you can’t outthink or outrun the disorder. You have to make the voluntary choice to confront it. For example, if you’re obsessed with germs and contamination, then you have to give your compulsions an intermission and instead use public toilets and avoid repeatedly washing your hands. You choose to deal with the threat. Eventually, your brain habituates to the threat and is even bored by it, realizing there is nothing to fear.

Phillipson compares OCD to a best friend who desperately wants to protect us, but warns us about threats that are not legitimate.

The Lifelong Challenge with OCD

Wajahat Ali, in his New York Times article, says, “I obviously need a new best friend.”

The intrusive presence of OCD is not always obvious to others, says Wajahat.

“Most people wouldn’t guess that I’m constantly tortured by disturbing thoughts. I’ve hosted live TV shows and given speeches in front of large audiences,” says Wajahat.

“During the LSAT, a few friends from college sat next to me because they said I had a calming energy. They had no idea of the internal storm always raging in my mind.”
“As far as acting on my thoughts and fears, I don’t. I’m possibly the most boring man on earth,” says Wajahat. “I’m married with kids, don’t drink or get into bar fights.

Confronting OCD with ERP Therapy

Despite his success with work and the ability to lead a balanced life with family and friends, Wajahat says he decided it’s time to confront OCD head-on.

“OCD has exhausted me. I’m tired of suffering,” says Wajahat. “I’m now doing Exposure and Response Prevention, voluntarily exposing myself to my fears. It’s terrifying and often excruciating, like walking through a gauntlet of horrors without a shield or sword, armed only with belief and resolute conviction.”

He expects the effort of ERP to pay off in the long-term.

“All the while, I’m working to abandon shame and guilt about my mental health disorder and to embrace the ‘best friend’ I didn’t ask for,” says Wajahat. By embracing OCD, his goal is to take the power out of it, and to help make intrusive thoughts the kind that pass by in a short time.

Intrusive Thoughts are Common and Don't Usually Result in OCD

For those who suffer with OCD, it may be comforting to know that about two million Americans over the age of 18 have been diagnosed with the disorder, according to the National Institutes of Health.

And for those who do not suffer with the intensity that leads to an OCD diagnosis, they have much company among people who have milder challenges from these obsessive compulsive thoughts and behaviors.

A new study by psychologist Adam Radomsky at Concordia University in Montreal found 94 percent of people have intrusive thoughts, like “What if I left the door unlocked?” The important point is that for most people, the obsessive thoughts don’t linger, people don’t ruminate on them. The research by Radomsky is focusing on one possible cause of OCD being related to the idea of “losing control over thoughts or behavior.” So in addressing that underlying issue of control, the research is moving into new territory that can lead to additional strategies to lessen the negative impact of OCD.


Ali, Wajahat, “OCD: My Exhausting Best Friend,” New York Times, Oct. 13, 2018

National Institute of Mental Health, “Obsessive Compulsive Disorder,” November 2017

Gagne, Jean-Phillipe and Radomsky, Adam, “Manipulating Beliefs about Losing Control Causes Checking Behaviour,” Journal of Obsessive Compulsive and Related Disorders,” October 2017

Bushak, Lecia, “OCD Symptoms Are More Widespread Than You Think: 94 Percent of People Have Intrusive Thoughts,” Medical Daily, April 8, 2014

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