I am a NOCD Therapist with substantial experience in treating OCD - Ask Me Anything

Hello, that's a good question. We would use the same method for every member called ERP or Exposure and Response Prevention. It can certainly feel impossible to practice exposures since you have been struggling with this for this long. However, with a good ERP therapist, you can work your way through addressing the habits that have developed because of OCD. It may feel scary to sit with the thought of addressing OCD now, but I've seen many people regardless of age, successful complete ERP therapy.

Hello, obsessions can manifest in many unique ways. In this case it sounds like the "curiosity" thoughts are a way to make you question your morality. The underlying obsession I hear is: What kind of person are you if you are allowing yourself to engage with these thoughts? Morality obsessions are fairly common despite the round about way that the obsession is coming up. Also, intrusive thoughts may be long or short. Many times the intrusive thoughts feel longer because a person is engaging in compulsions which continue the intrusive thoughts.

Guilt and shame are common emotions when struggling with harm or morality OCD. Many times it puts people in a double bind to resist the compulsion and feel intense distress or engage in the compulsion and feel guilty afterwards. In this case, it sounds like you are forced to choose between the type of discomfort you have to experience. A possible exercise that might help would be writing down some reasons that you choose to practice resisting compulsions, which might help to feel motivated when you sit with the distress that OCD causes.

Hello, ERP is recognized as the gold-standard treatment for OCD, supported by decades of research and clinical success. It consistently demonstrates higher efficacy rates than other treatments. While ERP can feel challenging at first, it teaches your brain that feared thoughts and situations aren’t actually dangerous, helping to reduce anxiety and compulsions over time. ICBT, on the other hand, avoids exposure, which may limit its ability to build real-world tolerance to uncertainty—a key component of OCD recovery. At NOCD, we specialize in evidence-based ERP therapy because it is longitudinally researched, highly effective, and the most widely recommended approach for treating OCD. If you'd like to learn more, you can book a free 15-minute call with NOCD to see how ERP could work for you. Hope this helps!

@Anonymous To add to that from the patient/client perspective, I’ve tried 15 therapists and many kinds of therapy (including CBT) over the years for anxiety, depression, PTSD, and OCD. I could go on for ages about what I know about the different types of therapies by now, but here’s the short version: The other conditions won’t really get better unless the OCD is being addressed. ERP is the only treatment for OCD that addresses the root of the condition; the other treatments are either copycats or don’t fully work. My experience was that CBT and similar therapies helped my anxiety and depression feel better in the moment while my OCD got worse over time, which led to continuing depression and anxiety. With ERP, it’s a challenge to tolerate the anxiety and depression in the short term, but the benefit I am getting from tolerating those is the decrease in OCD (and anxiety and depression) over time. When the ERP is running into issues from my other conditions, we just modify it to accommodate. (i.e. Modify a treatment that works for OCD to accommodate the anxiety, rather than the other way around.)

Good question, if you are currently working with an ERP specialist discuss the exposure during your next session. I would like to give more information, but that would require me to know more about the type of exposure you tried, and I want to maintain your privacy. Sometimes, exposure can take a long time to achieve habituation depending on the intensity of the obsession. Additionally, I am wondering if you are retriggering yourself throughout the day. Meaning that you are completing the same exposure multiple times in one day rather than starting the exposure and it lasting all day. I hope that this is helpful despite not being able to discuss the specifics.

@NOCD Therapist - Tim F. - Thanks so much for your insight. Maybe it was not so much being triggered for the rest of the day but an intense feeling of guilt and then rumination and catastrophizing... I did get retriggered and have an anxiety spike when watching a tv show but that was later in the evening. I will speak more with my ERP therapist tomorrow.

Hello, there may be a couple of reasons this is occurring. First, notice if you are engaging in mental compulsions when you attempt to complete the exposure. Mental compulsions can be tricky because they occur so naturally that we are unaware of them. Additionally, the type of exposure you are practicing might contribute to the lack of intensity. For example, imaginal exposures, where you imagine something you fear, tend to be less distressing than an In Vivo exposure where you directly interact with the thing that you are fearing.

@Tim Flaharty Thanks a lot for your answer! Yes, I try to do imaginal exposures and when I do that it feels somewhat artificial. But maybe it still helps to know: I don’t have to run away from the thought, I can run towards it.

Hello, intrusive thoughts are a common occurrence that many people struggle with. How to deal with them varies depending on what these thoughts might entail. A first step for dealing with these thoughts might be to write them down and sit with the discomfort that they bring without attempting to make them go away. For example when practicing exposures in a therapy session we focus on sitting with the thoughts that scare us and limit avoidance of these thoughts. Many times when we try to avoid thinking about the thought we actually renieforce it and prompt it to come back later.

Hello, It is common for obsessions to expand or change. Obsessions do not tend to be purposeful or controllable. However, with ERP we can change how to respond to the obsession. During ERP therapy we would identify different compulsions that feed into the obsessions and work to eliminate them. For some this may lead to a decrease in obsessive thoughts or at least a decrease in how distressing they feel.

Hello, I hear your frustration, and you're not alone in feeling this way. I should note that Exposure and Response Prevention (ERP) is widely regarded as the gold standard for OCD treatment. That said, not everyone benefits equally. ERP remains the most evidence-based treatment we have for OCD. Studies consistently show that ERP outperforms other therapies in reducing compulsions and distress over time. It works by targeting the underlying mechanisms of fear and avoidance that drive OCD symptoms, retraining the brain’s response to anxiety. However, ERP is not a one-size-fits-all approach. Fortunately, research is evolving. Efforts are underway to enhance ERP with approaches like inhibitory learning models, cognitive flexibility training, and acceptance-based strategies. I note your concern about the lack of research into OCD’s physiological roots. Advocacy for diverse treatment options is essential, and patient voices like yours are a critical part of that push. It sounds like ERP hasn't worked for you. I'd love to hear more about what approaches you’ve tried and what aspects of ERP have been most challenging for you. Sometimes, small adjustments can make a big difference in treatment outcomes.

Hello, many times obsessions may alert us to what we care for most. In this case, it sounds like your children and potential grandchildren are very important to you. OCD tends to attack what a person values most to get that person to engage in compulsions.

@Tim Flaharty Yes, and I have the fear of my wife and separating one day, been together since we were 16! I never knew getting older was so scary lol!

Hello, that's a good question. In short, yes OCD obsessions tend to change depending on the stressors that a person is currently dealing with. Anything can become an obsession including sexual performance.

Good morning, I noticed that you had a couple questions and I'll do my best to answer them all in this post. It sounds like you're concerned about having said or done things in the past that might have upset or hurt others. Yes, OCD can make people question their reality and if they have said bad things in the past. Additionally, people can experience obsessions as another voice responding to your thoughts or repeating the things that you are afraid have happened.

@LiaExe28 Do you have any advice for any of this. Partially was a rant cuz I feel kinda lonely

Hello, I can see how those thoughts feel distressing. It sounds like OCD is making it difficult to enjoy your anniversary. An early step we teach in ERP is to sit with uncertainty of the thought. Rather than trying to prove that you love or do not love your bf. Try to sit with the uncertainty that your feelings might change.

Hello, this is a tough question. OCD is considered treatable but not curable. Meaning obsessions may last for the rest of your life. Relationship OCD can be particularly difficult because relationships are always changing and it's impossible to achieve certainty. One thing that might be helpful is to catch if you are frequently trying to gather information to validate your fears or reassure yourself that everything is okay. More than likely these types of behaviors are compulsive and will reinforce your fears about the relationship.

Hello, POCD can be particularly distressing for people. One thing that might help to think about is that OCD will target what you value or are afraid of most. In this case your thoughts are not accurately revealing who you are rather they are trying to scare you into completing compulsions.

Good question, at this point you might want to try a response prevent phrase. These are phrases that one might use to block the desire to do a compulsion. When you practice these you should feel distress or discomfort if using them correctly. An example that might work, in this case, would be "Replaying this conversation may not improve my relationship with this person." Hope this helps!

Hello, ERP is considered the gold standard for OCD treatment and may be used despite the type of obsession or compulsion. The idea behind ERP is fairly straightforward. Obsessions are continued or worsened by compulsions, therefore the address the obsession one must first stop compulsions and sit with the discomfort that they provide. I hope this helps!

Hello, it is common for obsessions to morph over time. Meeting with a trained ERP therapist might help in a couple of ways. One, your son may know what the trigger is and feel uncomfortable discussing it because of the nature of the obsession. In this case, a person that your son views as neutral, like an ERP therapist, might help him feel ready to talk about it. Secondly, if your son is struggling to identify triggers for OCD an ERP therapist would be able to practice building a timeline with your son on when the anxiety or distress is occurring and from there identify the obsessions/triggers.

Hello, worrying about the death of your parents or other loved ones can certainly be distressing. When using ERP we would look at stopping any kind of compulsions that are being used to feel better or more certain about your parents health. By resisting the urge to engage in compulsions it may help you feel more present and enjoy the time that you do have with them.

Hello, one option is to have her sleep alone. Another that might work is having her write out what she is afraid of happening when she is sleeping alone. Then she may read this "Script" to practice sitting with the feared outcome.

Yes, these types of obsessions tend to develop during adolescence.

Hello, yes compulsions can develop from any repeated behavior or thought pattern. One thing to notice is if you are doing or thinking something to feel more certain about an obsession.

Hello, showing indifference may be a helpful tool when struggling with an obsession. From what you are describing you may actually be practicing ERP because you are resisting the urge to give into a compulsion.

@Tim Flaharty Also Does anything that eases you up count as compulsion?