Q&A

OCD can take many forms and themes often change over time. I work with a wide range of OCD presentations, including: Contamination OCD Relationship OCD (ROCD) Harm OCD Health anxiety and somatic obsessions Existential OCD Religious or moral scrupulosity Sexual orientation OCD Perfectionism and “just right” OCD Checking compulsions Mental compulsions and rumination Regardless of the theme, treatment focuses on changing the relationship to uncertainty, fear, and compulsive responses rather than debating the content of the thoughts themselves.

Not all compulsions are visible. Many people with OCD experience internal compulsions such as overanalyzing, mentally reviewing conversations, seeking certainty, self-reassurance, researching online, replaying memories, or trying to “figure out” intrusive thoughts. These mental rituals can keep OCD cycles going just as strongly as observable compulsions.

ERP is an active, evidence-based treatment approach designed specifically for OCD and anxiety disorders. While insight and emotional exploration can be valuable, OCD often becomes stronger through excessive analysis, reassurance, and attempts to achieve certainty. ERP focuses on helping individuals gradually face fears while reducing compulsive responses and avoidance patterns. The goal is not to “think your way out” of anxiety, but to change how you respond to it.

ERP should feel challenging, but it should not feel cruel, abrupt, or retraumatizing. Treatment is collaborative and individualized. Exposures are approached gradually and strategically, with attention to building confidence and flexibility over time rather than forcing someone into overwhelming situations before they are ready.

Yes. ERP can be highly effective through teletherapy and, in some cases, virtual treatment is actually advantageous because exposures can happen directly in your real-life environment rather than only in an office setting. Virtual ERP may include exposures related to intrusive thoughts, uncertainty, contamination fears, avoidance, checking behaviors, reassurance seeking, health anxiety, panic symptoms, social anxiety, and more.

Yes. Many individuals struggle with intrusive thoughts, rumination, reassurance seeking, perfectionism, or chronic anxiety without fully understanding what is driving their symptoms. Part of the assessment process involves identifying patterns that may be maintaining distress and determining the most appropriate treatment approach.

Intrusive thoughts often target the things people value most, which is part of why they feel so distressing. One of the paradoxes of OCD and anxiety is that the more urgently someone tries to gain certainty, eliminate doubt, or prove a thought is untrue, the more stuck they often become. Treatment helps individuals respond differently to uncertainty and fear rather than becoming trapped in cycles of analysis and reassurance.

Yes. Reassurance seeking is one of the most common compulsions in OCD and anxiety disorders. This may include asking others for certainty, repeatedly researching symptoms online, checking feelings, mentally reviewing situations, or needing confirmation that everything is “okay.” Although reassurance may provide short-term relief, it often strengthens anxiety in the long term.

Some people experience what is commonly referred to as “Pure O,” where compulsions happen primarily internally rather than outwardly. However, even when compulsions are less visible, they are still very real. These compulsions may include rumination, analyzing, mentally checking, or neutralizing thoughts.

Insight alone is often not enough to break anxiety or OCD cycles. Many people intellectually understand that their fears may be irrational, yet still feel trapped emotionally and behaviorally. Lasting change typically comes from learning to respond differently to fear, uncertainty, discomfort, and avoidance patterns over time.