What is Obsessive Compulsive Disorder (OCD)?

Obsessive-Compulsive Disorder (OCD) is a neurobiological condition characterized by intrusive thoughts, images, urges, or bodily sensations that trigger distressing emotions such as anxiety, guilt, shame, disgust, or doubt. While everyone experiences intrusive thoughts from time to time, individuals with OCD are more likely to interpret these experiences as meaningful, important, or threatening, leading them to feel an urgent need to resolve the uncertainty or prevent a feared outcome.

Research suggests that OCD involves differences in brain networks responsible for threat detection, error monitoring, habit formation, and emotional regulation. These brain circuits can generate an exaggerated "something is wrong" signal, making intrusive thoughts feel especially real and personally significant, even when they conflict with a person's values and intentions. OCD is not simply an anxiety disorder. Rather, it is a disorder of obsessions, compulsions, and difficulty tolerating uncertainty and doubt.

To reduce distress or determine whether an obsession is true, individuals often engage in compulsions. Compulsions can be behavioral (such as checking, washing, or seeking reassurance) or mental (such as rumination, reviewing memories, mentally analyzing, or trying to gain certainty). Although compulsions may provide temporary relief, they reinforce the OCD cycle by teaching the brain that the doubt was important and needed to be solved. Over time, this strengthens the obsessions and keeps the cycle going.

OCD can present in many different themes, including contamination, harm, relationships, morality, health, sexuality, religion, and many others. Although the content varies from person to person, the underlying process is the same. OCD creates doubt around what matters most to you and convinces you that certainty is necessary before you can move forward. In reality, recovery involves learning to respond differently to intrusions and discomfort rather than trying to eliminate it.

How Do We Treat OCD?

Individualized Treatment Plans

Everyone is impacted by OCD differently, therefore it is important to develop a treatment plan that works for your unique symptoms. We will work collaboratively with you to develop an individualized plan tailored to your goals, values, and needs. You determine how fast or slow we go in treatment. We will meet you where you are at!

Psychoeducation

There are many misconceptions and stereotypes about OCD. It is our job to make sure you fully understand your symptoms and how compulsions are reinforcing them. We will help you understand the underpinnings of OCD, your triggers/symptoms, and what treatment will look like.

Modern Evidence-Based Treatments

We are trained in three of the most effective treatments for OCD that are backed by research!

• Exposure & Response Prevention (ERP)

  This is considered the “gold standard” treatment for OCD. ERP will involve building a hierarchy of feared stimuli and gradually engaging in exposures at increasing difficulty. ERP also involves tools and techniques to disengage from compulsions (i.e., response prevention). Exposures may consist of imaginal exposures and/or in vivo exposures (i.e., real life situations).

• Acceptance & Commitment Therapy (ACT)

  At Mindful Psychological Services, we combine ERP and ACT, leading to better treatment outcomes. ACT teaches us what is called “psychological flexibility” through mindfulness, willingness, defusion, and acceptance. Through ACT we learn how to look at thoughts and emotions from a distance and accept their presence instead of trying to change or avoid them while connecting to what is most important to us - our values.

• Inference-Based Cognitive Behavioral Therapy (I-CBT)

  I-CBT is an evidence-based treatment for OCD that focuses on the reasoning process that leads to intrusive doubts and obsessions. Instead of starting with exposures, I-CBT works by identifying and challenging the faulty inferences that fuel obsessive thinking, such as mistaking possibility for probability or confusing imagination with reality. Clients learn to recognize when their minds are engaging in “obsessional doubt” and to shift back to present-moment, common-sense reasoning. This approach can be particularly helpful for those who struggle with more taboo OCD themes. This can be helpful for clients who haven’t responded well to exposures or have concerns with engaging in ERP.

• Dialectical Behavior Therapy (DBT) Skills (Adjunctive Treatment)

  While DBT is not a primary treatment for OCD, it can be a valuable adjunct to ERP, ACT, and I-CBT. DBT helps individuals build skills to regulate emotions, tolerate distress, practice mindfulness, and respond more effectively to difficult thoughts and feelings without relying on compulsions. These skills can strengthen treatment by increasing one's ability to engage in exposures and navigate uncertainty.

For more information on treatment recommendations, check out the International OCD Foundation’s treatment guide.