Living WITH OCD
Written By Dr. Melissa Jermann
“The more we practice acceptance of symptoms and focus our energy on our values, the quieter our OCD becomes.”
OCD 101
Obsessive-Compulsive Disorder (OCD) is characterized by intrusive thoughts, images, or bodily sensations that trigger distressing emotions (e.g., anxiety, doubt, guilt, shame), often leading individuals to engage in compulsive behaviors (mental or behavioral) that they feel driven to perform to reduce distress, neutralize the obsession’s perceived meaning, and/or prevent a feared outcome. OCD is widely considered a neurobiological disorder, involving differences in brain circuits responsible for error detection, threat evaluation, habit formation, and emotional regulation. Research consistently points to the involvement of regions such as the orbitofrontal cortex (OFC), anterior cingulate cortex (ACC), thalamus, and basal ganglia; areas that help evaluate significance, detect when something feels “wrong,” regulate attention, and initiate behaviors (Pauls et al., 2014; Stein et al., 2019).
At the same time, neuroimaging findings are generally modest and not perfectly consistent across studies. One ongoing challenge in neuroscience is a “chicken-and-egg” question: do these brain differences cause OCD, or do they develop and strengthen over time through repeated obsessions and compulsions? Most likely, the answer is both. OCD appears to reflect an underlying biological vulnerability in these neural circuits that is then reinforced and shaped by learning and behavior over time (Gillan & Robbins, 2014). What we do know is that these networks generate exaggerated “something is wrong” signals, which may help explain why intrusive thoughts can feel urgent, meaningful, and personally significant even when they conflict with one’s values or intentions.
Although OCD was historically categorized as an anxiety disorder, it is no longer classified that way in the DSM-5. OCD now falls under a separate category titled “Obsessive-Compulsive and Related Disorders.” This shift reflects our growing understanding that OCD is not simply about anxiety; it is about obsessions, compulsions, and the urgent need to resolve doubt and uncertainty. Anxiety is often present, but it is not the only emotional driver of the disorder. Many individuals experience guilt (“What if I did something wrong?”), shame (“What if this thought means I’m a bad person?”), disgust (“What if this doorknob is contaminated?”), sadness (“What if this means my relationship isn’t real?”), or even anger (“Why am I having these thoughts?”). OCD attaches itself to these emotions and convinces you that the only way to feel better is to gain certainty and ot resolve the doubt.
OCD symptoms often emerge when a biological vulnerability in the brain’s threat-monitoring and error-detection systems interacts with normal intrusive thoughts. While everyone has random intrusive thoughts (e.g., “What if I forgot to turn the stove off” or “What if I want to take this knife and stab my partner?”), individuals without OCD will typically acknowledge these thoughts as odd and move on with their day. However, for someone with OCD, the intrusive thought becomes paired with an exaggerated emotional response driven by the brain’s heightened “something is wrong” signal. This results in high levels of emotional arousal, leading to the thought “feeling real.” One may start to doubt they saw the stove was turned off or begin to believe they might lose control and kill their partner, leading to increasingly more emotional arousal.
However, this alone does not fully explain why OCD feels so convincing. OCD involves both brain-based vulnerability and reasoning processes that strengthen doubt. Another important process called inferential confusion helps strengthen the association between an intrusive thought and the meaning attached to it (O’Connor & Aardema, 2012; Aardema et al., 2020). Inferential confusion occurs when the mind shifts away from present-moment evidence and begins reasoning from imagined possibilities rather than concrete reality. In other words, the individual begins to treat what could happen as if it is happening or is highly probable in the present moment.
For example, you may be calmly cutting vegetables in your kitchen. In reality, nothing dangerous is happening. Then all of a sudden you get an intrusive thought: “What if I lose control and hurt my partner?” Instead of recognizing this as a random intrusion, the OCD mind begins constructing a story around it. “Well, I guess I could lose control and do it. I hear stories all the time of people snapping. If it feels real, maybe it means something.” At that moment, the intrusive thought becomes fused with meaning. The association between the thought and danger strengthens, not because of evidence, but because of the “what-if” reasoning process attached to it. The doubt deepens, and the thought feels increasingly real. This shift from reality-based reasoning to possibility-based reasoning has been identified as a central cognitive process in OCD (Aardema & O’Connor, 2012; Aardema et al., 2020).
OCD themes often feel especially disturbing because they are ego-dystonic, meaning they conflict with a person’s core values, desires, and sense of self. Intrusions in OCD frequently target the exact opposite of what someone truly cares about. For example, if you deeply value being a kind and empathetic person, OCD may generate intrusive thoughts about harming someone or secretly being evil. If you value your relationship, OCD may create doubts about whether you truly love your partner. If you value morality, OCD may question whether you are secretly dishonest or unethical. OCD does not randomly select themes; it latches onto what matters most to you. This is why the thoughts feel so alarming. They seem to threaten your values and identity. The more meaningful the value, the more convincing the doubt can feel. Ironically, the presence of distress often reflects how strongly the value exists, not its absence. OCD attacks what you care about precisely because it is important to you.
As humans, we want to do everything possible to stay in emotional homeostasis (i.e., feeling content/grounded); therefore, individuals with OCD will start to engage in compulsions to try to alleviate their emotional arousal and solve the doubt. In many cases, compulsions are not only attempts to reduce discomfort, but attempts to determine whether the obsession is meaningful or true. The individual is not just trying to feel better; they are trying to figure something out. In the Harm OCD example above, some compulsions may be mental (e.g., self-reassurance, ruminating to figure out if the thought is “real,” analyzing one’s feelings to determine intent) or behavioral (e.g., hiding knives, avoiding their partner). This is when operant conditioning kicks in - once we feel emotion reduction from a compulsion, we want to do it again! The cycle of obsessions and compulsions involves negative reinforcement, meaning if I do a compulsion, I get rid of discomfort, so I will likely do it again.
However, another layer is at work here. When someone ruminates or checks internally to determine whether a thought reflects their values or character, they are attempting to resolve uncertainty. They are seeking certainty about identity, values, intentions, safety, morality, or memory (to name a few). Even if the compulsion provides temporary relief, it also reinforces the idea that the doubt was relevant and needed to be solved. The brain learns, “If I analyze this enough, I might find the answer.” The thing about compulsions is that the relief only lasts a short time, or they may even lead to more triggers. Over time, the mind becomes increasingly stuck in doubt, and the obsession feels more significant because it is repeatedly treated as something that must be figured out. Compulsions temporarily reduce discomfort, but they block corrective learning. The brain never gets the opportunity to learn that the feared outcome was unlikely or tolerable without ritualizing.
Willingness: The Key to OCD Treatment
When I start with a new client, they are typically experiencing high levels of distress due to their symptoms. Given what we learned about the brain sending false alarms, this makes sense! When the brain’s error-detection system is firing excessively, it creates a powerful sense that something is “wrong” or unresolved. That signal feels urgent and meaningful. A new client will typically be very anxious and overwhelmed, and some may also feel intense guilt and shame about their intrusions. If it is their first episode of OCD, they may also feel confused and frustrated. However, one of the telltale signs that it is someone’s first encounter with OCD treatment is the strong urge to get “rid” of all of their symptoms.
It is important to note that we cannot get “rid” of intrusions, but we can change our response to them and break the cycle of OCD. There are three highly effective evidence-based treatments, and I will be discussing two in this article, including Acceptance and Commitment Therapy (ACT) and Exposure and Response Prevention (ERP), and will share another article on Inference-based Cognitive Behavioral Therapy (I-CBT) shortly. The very fact that I have built my career as an OCD specialist and am writing this article attests to its success! However, it is crucial for you to understand that we do not engage in treatment to get “rid” of uncomfortable emotions, thoughts, images, or body sensations. We also do not engage in treatment to finally solve the doubt or “prove” the obsession wrong. We engage in treatment to show our brains that we are WILLING to tolerate these uncomfortable internal experiences and choose to give them irrelevance. We are teaching the brain that doubt does not require resolution and that the error signal can fire without action. If there is any phrase you remember from this article, let it be this:
The more we resist OCD, the more it will persist!
I understand you may be thinking, “Melissa, why would I start treatment if we aren’t going to get rid of my OCD?!” I also acknowledge that this may seem very counterintuitive. Still, to show our brain that these internal experiences are not a threat, we must be willing to experience them. The term “willingness” is a significant aspect of Acceptance and Commitment Therapy (ACT) and means “making room” for all uncomfortable feelings, thoughts, physical sensations, memories, etc. Willingness means allowing the brain’s exaggerated “something is wrong” signal to be present without trying to shut it off.
Willingness is about living with the AND instead of the BUT. (e.g., “I want to go out with my friends, AND I’m anxious about it” instead of “I want to go out with my friends BUT I’m anxious.”). Willingness leads us to pivot toward our discomfort rather than avoiding or trying to reduce it. In doing so, we create new inhibitory learning. The brain begins to update its prediction: “I felt doubt, and nothing catastrophic happened.” This shows the brain that your uncomfortable internal experiences (e.g., anxiety, intrusive thoughts) are no longer a threat, reducing the severity of your symptoms over time.
When we begin to pivot toward willingness, we also build distress tolerance (i.e., our ability to handle discomfort or challenges). A helpful metaphor is imagining OCD as a giant hairy monster (i.e., Sulley from Monsters Inc.); the more we run away from Sulley, the more our fear and anxiety will continue to be reinforced. However, if we welcome Sulley, we might initially feel scared but will eventually adjust to his presence and feel less uncomfortable. Now we can sit across from Sulley and realize he is not as scary as anticipated! More importantly, we learn that Sulley’s presence does not dictate our behavior. Now we are pivoting our energy from trying to keep Sulley out to focus on what matters to us - our values. Remember, willingness isn’t about getting rid of your symptoms but about fully experiencing them. The goal is to welcome uncomfortable internal experiences AND still pursue your value-based life.
Mindfulness Matters
Meditation and mindfulness have gained significant attention in today's therapy and self-help world. However, it is essential to note that there are several misconceptions surrounding these practices. I like to think of mindfulness as an umbrella term, and meditation is one way we build and practice this skill. Mindfulness is being aware of our current thoughts, emotions, bodily experiences, and environment in the present moment. It is about observing these experiences through a non-judgmental, non-reactive lens. This is one of the most valuable skills in OCD treatment because it helps us observe intrusive thoughts/images and anxiety from this lens. Mindfulness directly counteracts OCD’s urge to pull us into imagined possibilities and “what-if” stories, and anchors us in present-moment awareness. It shifts us from possibility-based reasoning back to reality-based awareness.
When I start working with clients, they say, "These thoughts are awful!” or “My anxiety is so bad and terrible!” When we constantly judge our inner experiences as BAD or AWFUL, this signals to the brain that they are threatening and need to be avoided or eliminated (aka bring on the compulsions!). In many ways, suffering is not caused solely by the presence of pain, but by our judgment that the pain is unacceptable and must be removed. Pain is an inevitable part of being human. Suffering increases when we resist that pain, fight it, or interpret it as dangerous. One of the first things I do in treatment is point out an individual's judgmental language when describing these inner experiences. We can effectively disengage from obsessions by using neutral language and focusing on describing rather than reacting.
Mindfulness does not eliminate pain. It changes our relationship to it. Instead of “This anxiety is unbearable,” we practice noticing, “Anxiety is present.” The pain may still exist, but without the added layer of resistance and catastrophic meaning-making, it becomes more tolerable. When we stop arguing with our internal experiences, we reduce the secondary suffering that comes from judging and resisting them.
Reactive: “These thoughts are so annoying and terrible. Anxiety is so awful.”
Mindful Noticing: “I’m noticing many intrusive thoughts and anxiety right now. It is uncomfortable, and I don’t like the thoughts, but I can non-judgmentally observe and let them be here with me.”
This may seem silly, but changing our language around thoughts and emotions is crucial to the treatment process. It allows us to create a different relationship with our internal experiences. When we describe rather than judge, we weaken the automatic link between the intrusive thought and meaning. It can be uncomfortable to experience a wave of thoughts and anxiety or guilt, but responding to them with negativity and judgment only intensifies your discomfort. Now you are uncomfortable about the discomfort itself, which leads to more emotional dysregulation and more compulsions. Instead, if we can be willing to ride the emotion wave, notice the discomfort, and recognize that these are thoughts and emotions, the wave will come and go much more quickly. We are allowing the error signal to rise and fall without engaging it. This is much easier said than done and takes practice through meditation and ACT-based exercises in therapy sessions.
When I first talk about meditation with my clients, most will say they have tried it but don’t see how it’s helpful, or get frustrated because they can’t “clear their head.” This is one of the biggest misconceptions that I hear. Meditation does NOT mean sitting down and thinking about nothing. We cannot control our thoughts during meditation, but we can control how we respond to them! A guided meditation will typically pick something as an anchor to focus on, such as your breathing. The goal is to focus on your breath and non-judgmentally acknowledge whenever a thought or emotion pulls you away and then shift your attention back to your breath. This lets us notice and observe that thoughts or feelings are present while choosing not to react. Each time you redirect your attention without analyzing the thought, you are practicing response prevention on a micro level. Even if you have to shift back to your breath every few seconds, that is OK - it’s how you build your mindfulness muscle!
Naming Your OCD
Throughout this post thus far, you may have noticed that I talk about OCD as a different entity separate from you (i.e., OCD is never satisfied vs. YOU are never satisfied). Throughout my training with OCD specialist Dr. Steven Phillipson and learning from ACT, I have seen the transformative power of creating a separation between oneself and OCD. Many individuals with OCD feel confused and frustrated when their intrusive thoughts do not align with their beliefs and values (i.e., ego-dystonic). We are taught that our cognitions make up who we are or reflect our character.
From the Harm OCD example above, if an individual has intrusive thoughts about harming their partner, this may lead to them thinking - “I am a horrible partner,” “What if this means I don’t love my partner,” or “Am I secretly a murderer?!” This then results in anxiety, confusion, guilt, or shame because this individual is using their intrusive thoughts to reflect their character. This is inferential confusion in action: the mind treats a possibility as evidence of identity. Two important things to remember in OCD treatment are:
We CANNOT control intrusions
We are NOT our intrusions
This may sound like a strange concept to you, but if you think about how many thoughts you have throughout the day, not all of them reflect your values and character. We all have intrusive thoughts that are creative and interesting. Suppose I am driving and have intrusive thoughts or images about swerving off the side of the road or running someone over. Does this make me suicidal or a murderer? No, it makes me a human with intrusive thoughts, which I can actively choose to separate myself from.
However, what often makes intrusive thoughts feel convincing is not just the thought itself, but the emotion that follows it. When anxiety, guilt, or shame arise, the mind quickly builds a story around that emotion. The story might sound like, “If I feel this anxious, something must be wrong,” or “If I feel guilty, maybe I did something bad,” or “If this feels real, it must mean something.” The emotion becomes evidence, and the narrative built around it strengthens the doubt - this is called cognitive fusion.
Part of treatment is learning to defuse not only from the intrusion but also from the emotion associated with the intrusion. Instead of trying to solve it, analyze it, or disprove it, we practice noticing, “I’m having the thought that this means something,” and “I’m noticing the feeling of anxiety right now.” The emotion may still be present, but we are no longer allowing it to dictate the storyline of the intrusions. When we step back from the narrative rather than trying to control the emotion itself, the thought begins to lose its urgency.
To help my clients work towards this separation, I teach ACT defusion skills and have each client select a name for their OCD. Some clients like to keep it simple and call it their “OCD.” In comparison, others prefer names other than their own, such as Hillary, Jose, Craig, etc. When we name our OCD, it allows us to “defuse” or separate from the intrusive thoughts and the emotions that go along with those intrusions. By labeling intrusions as OCD, we interrupt the automatic fusion between the intrusion and its assumed meaning. Intrusive thoughts only have power if we give them power. Otherwise, intrusive thoughts are just bits and pieces of language and sounds without meaning.
Separating from OCD is hard work! However, through a combination of mindfulness and defusion skills, it is possible to develop autonomy from OCD. Remember, there is an inner YOU observing your intrusive thoughts and emotions, and this is the YOU that decides which thoughts to give attention to vs. label as irrelevant. The famous question that will come next is, “How do I know me vs. OCD?" The answer is - you get to choose what is! I imagine that answer may be anxiety-provoking. Using this technique in itself is an exposure because we are taking the risk of labeling something as OCD and choosing self-trust in the presence of doubt. When you label something as OCD, your brain will say, “But what if it isn’t?!” Our response is, “Okay, OCD, maybe it isn’t, but I am taking the risk and deciding to label it as OCD and continue with my day.” Instead of resolving the doubt, we are choosing to move forward rather than seek certainty. This phrase alone puts you in charge of your life, rather than having OCD dictate it! Building upon mindfulness and defusion skills also helps you to engage in the most effective treatment for OCD - Exposure and Response Prevention (ERP).
Embracing Doubt & Exposure and Response Prevention (ERP)
The nature of OCD often leads people to question everything, including their own OCD diagnosis. Even after being diagnosed, the initial relief may only be temporary as the dysfunctional alarm system of OCD reactivates. In other words, the brain’s exaggerated error-detection system begins firing again, creating that familiar “something is wrong” feeling. If this resonates with you, I imagine you understand that all the answer-seeking, Googling, arguing with the thoughts, or receiving reassurance is never enough to get complete relief. OCD is what I like to call the “answer gremlin.” It will want more and more answers to try to prove or disprove your intrusive thoughts/images and resolve the doubt. However, the answer gremlin is never fully satisfied. Even if I were to give you an OCD diagnosis right now and tell you all your intrusive thoughts are irrational, it wouldn’t matter!
This makes OCD frustrating, given that many intelligent, logical, and rational individuals understand that OCD is illogical. However, no matter how hard you try, you cannot out-logic OCD. So you might think, “Uh, okay, so what do I do then?” Well, we stop giving the answer gremlin what it wants - answers! When you boil it down, OCD is not simply about uncertainty; it is about doubt that feels urgent and meaningful. The mind generates a question, “What if this means something?” and then demands resolution. To try to quiet that doubt, we seek answers, analyze, check, or problem-solve (i.e., compulsions). The temporary relief that follows reinforces the belief that the doubt was important and needed to be solved. However, the more we try to resolve the doubt, the stronger it becomes. To learn to live with OCD, we must stop treating doubt as a problem that requires an answer and instead learn to let it exist without engaging with it, while rebuilding our self-trust.
We accomplish this by using non-engagement phrases (e.g., “Maybe,” “I’m not sure,” “I guess we’ll see”) when OCD asks us questions. So when one has the intrusive thought, “What if I want to stab my partner with this knife?” the skillful response would be, “Maybe.. and I am going to continue to cut up this onion and go about making dinner.” Notice that this response does not try to solve the doubt. It allows the possibility to exist without engaging in the story attached to it. This is also called "response prevention" in Exposure and Response Prevention (ERP) therapy. If you have never been in OCD treatment, this response may seem unconventional or scary. However, when we use non-engagement phrases and embrace uncertainty, we show OCD that these thoughts are not a threat. We are demonstrating to the answer gremlin that these thoughts are insignificant and do not require an answer. The more we practice sitting with the discomfort of uncertainty, the more we allow new learning to occur.
One of the most important ways to demonstrate willingness to your OCD brain is through Exposure & Response Prevention (ERP). If you have been researching treatments for OCD, you may be familiar with this term. Let’s break it down:
Exposure: Planned assignments (e.g., behavioral, imaginal) that target core OCD fears
Response Prevention: Resisting compulsions through disengagement skills
ERP helps retrain the brain’s error-detection system by allowing intrusive thoughts and doubt to be present without performing compulsions, which ultimately shows your brain that intrusions are not a threat. During ERP, we intentionally and systematically approach situations, thoughts, images, or sensations that trigger obsessions, whether through in-vivo (real-life) exposures, imaginal scripts, or interoceptive exercises and we practice response prevention by resisting rituals such as reassurance-seeking, mental reviewing, checking, or avoidance. Rather than trying to calm yourself down or make the anxiety disappear, you allow the discomfort, doubt, guilt, or uncertainty to rise and fall on its own. Over time, this creates new learning in the brain: “I can experience this, and nothing catastrophic happens,” and “I can tolerate uncomfortable feelings without solving them.” To do this, we must first be willing to engage in ERP. It is typical to experience resistance to engaging in ERP, given that you are told to face your fears. This is why a fear hierarchy is developed, ranking potential exposures from least to most distressing.
An important thing to know is that your anticipatory anxiety about exposures is typically higher than when actually engaging in them. Clients often report that their distress levels are lower than expected and wonder if exposures are “working.” When exposure therapy was first created, the thought was that if you “recreate” the emotion, you would habituate to it, resulting in symptom reduction. However, it is challenging to create the same level of anxiety in planned exposures compared to when you are naturally triggered in your environment. The analogy of being tickled rings true for ERP - it is much harder to tickle yourself than when someone else does because we know it is coming. This is similar to a planned exposure; since we know it is coming, we may not feel as anxious, which is ok!
Modern research suggests that ERP works not because anxiety disappears, but because the brain builds new associations. Instead of “intrusive thought = danger,” the brain begins learning “intrusive thought = tolerable.” The underpinning effectiveness of exposures is the willingness to experience whatever comes up during them. We are saying - look, OCD brain, I am so willing to have these thoughts, emotions, bodily sensations, etc. I am going to deliberately expose myself to them. Over time, our willingness to bring on this discomfort signals to the brain that these internal experiences are no longer a threat.
If you are thinking about or just starting ERP with an OCD specialist, you want to remember a few essential tips. First and foremost, we are not engaging in ERP to get “rid” of OCD symptoms. Many clients engage in ERP, desperately trying to relieve their symptoms, and if this is your mindset going into ERP, it will NOT be effective. If we are genuinely willing to experience these symptoms, then exposures are targeted to demonstrate willingness and acceptance instead of relief-seeking. We are not trying to resolve doubt; we are learning to coexist with it. Again, I understand this seems counterintuitive, but as stated previously, the more we seek relief within treatment, the less we will get it.
Second, ERP is hard work; you will only see change if you do the work outside of your therapy sessions. Your therapy session is typically only forty-five minutes, 1x per week, unless you are engaged in more intensive treatment. Forty-five minutes is not enough time to work on ERP, so most of the work you will engage in will be on your own. This is where discipline comes into play. Discipline is defined as consistent work towards a goal in the absence of motivation. I often hear things like, “I didn’t feel motivated to do exposures this week” or “I didn’t find the time.” Motivation is an ever-changing feeling; its presence can be incredibly energizing. However, it is not a constant state and may fluctuate over time. Some weeks, we will be tired, overworked, or overwhelmed with life responsibilities. This is when we practice discipline and make time in our busy schedules for ERP, because it aligns with our values of self-care and mental health. The moral of this paragraph is to do your ERP homework!
Lastly, effective ERP treatment involves continuously practicing response prevention outside of exposures. I tell all my clients that they can do all the exposures in their hierarchy, but if they are still engaging in compulsions when triggered organically, they will not see results. Typically, I have my clients engage in response prevention and practice disengagement strategies before starting exposures. This allows clients to practice tolerating the distress of resisting compulsions before jumping into exposures. Remember, you still reinforce your symptoms if your behavior is inconsistent. Each time you resist a compulsion, you allow your brain to update its prediction about danger. Each time you engage in a compulsion, you reinforce the doubt. This in no way means we have to be perfectly skillful. Treatment progress is not linear and does not equal perfection. Given this treatment's difficulty, being kind to yourself along the way is essential! Overall, the secrets to skillfully engaging ERP are consistency, discipline, and, most of all, self-compassion.
The biggest takeaway from ERP treatment is that, over time, it does something even deeper than reducing symptoms: it builds self-trust. OCD convinces you that you cannot trust your memory, your intentions, your feelings, or your judgment. It tells you that unless you analyze, check, or seek reassurance, you can’t trust yourself. Each time you resist a compulsion and move forward anyway, you send your brain a different message: “I can handle this.” Self-trust is not built by achieving certainty; it is built by taking action in the presence of doubt. When you repeatedly allow uncertainty and doubt to exist and continue living according to your values, you begin to trust your ability to tolerate discomfort without needing answers. That is where real confidence develops, not from proving the obsession wrong, but from learning that you can live with the doubt.
Reclaiming Your Life Through Values
When you suffer from symptoms of OCD, you often lose touch with what is important to you, your values. One of the core fundamental principles of ACT is connecting to our values despite challenging emotions or thoughts. Values are belief systems that shape our goals, guide our behavior, and connect us to a meaningful life. Values are a compass that guides our behavior. There is a popular metaphor in ACT called “Passengers on the Bus,” which allows you to visualize yourself driving a bus, and the passengers on this bus are all your unwanted thoughts and emotions telling you when to turn and stop. You begin to realize that you are no longer in control of where you are driving the bus and that these internal experiences are in control. If you’re reading this right now, I want you to ask yourself, are you driving the bus of your life, or is OCD? If you are constantly preoccupied with symptoms, seeking relief, and making behavioral decisions based on your fears, there is a good chance OCD is in the driver's seat of your life.
So, you might wonder, how do I regain control of the bus? My first assignment with all my clients is a values clarification exercise to help them take a good look at what is important to them in life. Clarifying what is meaningful helps us guide our energy to what matters. If OCD drives the bus, your energy is probably dedicated to seeking answers/relief, engaging in compulsions, and avoiding. This leaves very little energy to connect to your values and leaves you feeling dissatisfied or even depressed. It is also important to note that OCD tends to attack parts of our values system (e.g., family, partner, health), making it seem more challenging to connect. Remember, OCD does not randomly select themes; it targets what you care about most. The stronger the value, the louder the doubt can feel.
This is when the power of AND comes into play again, and implanting this word into our daily language is crucial for getting our life back. You can have symptoms of OCD AND make decisions based on your values. Here are some examples below:
“I want to feel connected and close to my partner, but I have intrusive thoughts about harming them.” VS. “I experience intrusive thoughts about harming my partner AND have a fulfilled and loving relationship.”
The shift from BUT to AND is not just linguistic; it is neurological and behavioral. Each time you act according to your values while doubt is present, you build new learning in the brain. You are teaching yourself, “I can move forward without solving this.” That is how self-trust is rebuilt. Understanding that we can connect to our values AND experience symptoms of OCD allows us to regain control. This article is titled “Living WITH OCD” because that is precisely the goal of treatment. We learn that we do not have to fight with or avoid our OCD, but instead learn to walk alongside it through acceptance.
Acceptance: The Path to Recovery
Acceptance is one of the most powerful stances we can take in OCD treatment and within life in general. However, we don’t just wake up one day and say, “Okay, I accept all the pain in my life. I am healed!” I like to think of acceptance as something we consistently strive toward and a daily choice. I believe many people confuse acceptance with liking something. We do NOT have to like specific thoughts, emotions, etc., to accept them. Acceptance does not mean approval. It means dropping the struggle.
A helpful metaphor is to imagine a bee buzzing around your head. You might start trying to push the bee away or run from it, but it keeps following you, maybe with even more vengeance. Then you realize that if you just let the bee buzz around, it eventually leaves. You don’t have to like a bee buzzing around your head, but you can accept its presence. This is precisely how we must look at intrusive thoughts, emotions, or bodily sensations. You don’t have to like the content of your intrusive thoughts or uncomfortable feelings, but you can accept that they are there. When we resist pain, we amplify it. When we judge our internal experiences as dangerous or unacceptable, we add a second layer of suffering. Acceptance removes that second layer. The doubt and anxiety may still be present, but we are no longer treating those experiences as problems that must be solved.
You might be thinking (sarcastically), “Oh yeah, I’ll just accept these terrifying thoughts and anxiety, no big deal, Melissa!” I very much understand that this is easier said than done. Accepting rentless intrusions or any pain is hard work and takes consistent practice. We demonstrate acceptance by engaging in ERP and through our behavior. We show our OCD that we can have these symptoms AND live the life we want, which is what the path to recovery looks like. Acceptance is not passive. It is an active stance of willingness. It is choosing to move forward even when the brain’s error signal is firing, and doubt is present.
The more we practice acceptance of symptoms and focus our energy on our values, the quieter our OCD becomes. Acceptance looks like taking a stance and saying, “Okay, OCD, you can give me any intrusion you want, I'm willing to experience it, and I will still make value-based decisions - Bring it on!” Over time, this is what builds resilience and self-trust; not certainty, but repeated committed action in the presence of doubt. This is why I teach my clients a different way to relate to their symptoms, leading to symptom reduction and the regaining of their lives. I teach them how to live with OCD, not by eliminating every intrusion but by refusing to let doubt and uncertainty dictate their direction. Freedom from OCD is not the absence of discomfort. It is the decision to move forward anyway.
© 2026 Dr. Melissa Jermann Psychology Services LLC - All Rights Reserved - Disclaimer: This site should not be construed as therapeutic recommendations or personalized advice. Interaction with this blog does not constitute a therapeutic relationship. This blog aims to provide general information for educational purposes only. It is not intended or implied to supplement or replace the advice of your mental health professional. This information should not be used to self-diagnose mental health conditions. Consult with your mental health provider before implementing anything read here.
