Obsessive-Compulsive Disorder (OCD)
You’ve always thought you just had “really bad anxiety.” Sometimes you ruminate on things you did 12 years ago. The phrase, “What if?” plagues you.
Uncertainty rules your life - if you could just be certain you didn’t do that thing, or that this action would make things better, you’d be okay.
Maybe you wash your hands until it feels just right. Maybe you mentally review every interaction for hours, even though you desperately do not want to.
You know that logically it doesn’t make sense. That no matter how many times you tell yourself “that’s ridiculous” or check the locks, it’s never going to be good enough.
That’s because OCD doesn’t listen to logic. It relies on possibility, not facts - and possibilities are limitless and unprovable. OCD doesn’t play by your rules, you play by OCD’s rules.
The good news is that once you know the tricks that OCD uses to convince your brain to listen to it - it loses its power.
Once we reveal the magician’s tricks, you’re able to disengage and walk away.
Once you learn and understand that you can tolerate the uncertainty and distress that comes with disengaging from what OCD tells you that you must do - you are free to turn towards things in your life that give purpose and meaning.
Once you realize that your thoughts are just thoughts, not facts, you gain the power of choice - something that OCD has told you for a long time that you do not have.
Maybe you already know you have OCD, but have yet to take the leap into treatment. Or maybe you are reading this because you’ve been in anxiety treatment for years with no movement. If reading this feels like someone is understanding you for the first time, it’s possible that you have OCD.
There are evidence-based,
effective treatments for OCD.
You do not have to live
in the “what if” anymore.
ERP is often referred to as the “Gold Standard” for treating OCD, Panic Disorder, Phobias, and anxiety. In ERP, a trained therapist helps you gradually face the thoughts, images, situations, or sensations that trigger your obsessions while you intentionally refrain from performing the compulsive behaviors or rituals that typically follow. Over time, this process weakens the fear response, teaches your brain that anxiety will decrease without compulsions, and significantly reduces OCD symptoms.
Exposure + Response Prevention (ERP)
I-CBT is a specialized evidence-based form of cognitive therapy developed specifically for OCD that focuses on how obsessional doubts and intrusive thoughts are created in the first place. Instead of emphasizing exposures or rituals, I-CBT helps you recognize and correct a reasoning pattern called inferential confusion, which is a tendency to give imagined “what if” scenarios more weight than direct sensory evidence. In this process, you learn to trust your senses and reduce OCD doubts. Research shows I-CBT can meaningfully reduce OCD symptoms and may be especially helpful for people who find exposure-based approaches very distressing.
Inferential Cognitive Behavioral Therapy (I-CBT)
Principles of ACT are often infused into OCD treatment. This involves using ACT’s focus on acceptance of unwanted thoughts, mindfulness, and commitment to valued actions alongside traditional OCD work. Rather than trying to eliminate obsessive thoughts, ACT helps you change your relationship to them, so you notice them as thoughts and not facts, and act in ways that align with what matters most to you - even when anxiety is present. This approach increases psychological flexibility and can reduce compulsive responses. ACT is often used as an adjunct to first-line treatments like ERP and has growing empirical support for reducing OCD symptom severity or improving engagement in meaningful life activities. ACT’s role in OCD is supported by systematic reviews and clinical research showing meaningful symptom improvement when it’s applied thoughtfully in treatment.
Acceptance + Commitment Therapy (ACT)
| Feature | ERP (Exposure & Response Prevention) | I-CBT (Inference-Based CBT) | ACT (Acceptance & Commitment Therapy) |
|---|---|---|---|
| Core Philosophy | Face the Fear. You learn new safety associations by facing triggers without performing rituals. | Trust Reality. You are confusing a "possibility" with reality; you need to return to sensory evidence. | Change the Relationship. Thoughts are just words; don't let them dictate your actions. |
| Primary Goal | Inhibitory Learning. Learning that you can tolerate uncertainty and anxiety without relying on compulsions. | Resolving Doubt. Correcting the "inferential confusion" so you trust the here-and-now rather than the "what if." | Psychological Flexibility. Pursuing what matters to you (Values) even in the presence of unwanted thoughts. |
| View of the Obsession | It is a False Alarm. We focus on the function (triggering fear) rather than analyzing the content. | It is a Reasoning Error. A "false inference" where imagination overrides direct sensory data. | It is a Private Event. Just a "passenger on the bus"—it can make noise, but it doesn't drive. |
| Role of Exposures | Central Tool. Used systematically to build tolerance to uncertainty and break the fear cycle. | Reality Testing. You interact with triggers to prove your senses are reliable, not primarily to feel anxiety. | Values-Based Action. You face triggers because they are standing in the way of the life you want to live. |
| Best For... | Clients seeking the gold-standard behavioral approach to break the cycle of compulsions. | Clients who want to understand why the doubt feels so real and prefer a logic-based approach. | Clients who get stuck "arguing" with thoughts or need deep motivation (values) to engage in treatment. |