For the past 15 years, I have had the privilege of working with clients with obsessive-compulsive disorder (OCD) through my work as a clinical psychologist. I absolutely love working with folks with OCD as they tend to be incredibly creative, kind, ethical, reflective, and intelligent; not to mention that they often have a wicked sense of humor! Over the years, I have gathered a large collection of tips and tricks for treating OCD from a cognitive-behavioral and acceptance and commitment therapy lens. I would love to share a few of these creative analogies and strategies with you here.
Cognitive Flexibility: “What would you bet on?”
OCD likes to have 100% certainty before making a decision, acting on a behavior, or resisting a compulsion. Unfortunately, we almost never have 100% certainty about anything! This leaves folks with OCD feeling stuck, wracked with indecision and fear, and continuing to perform compulsions. However, when we make a bet, we typically just look at the odds and bet on the most favored outcome. So, we can ask clients: “If you had to bet on an outcome, what would you bet on? Where would you put your hard earned $100?” This can be helpful because when we are looking at the odds, even if the odds are 70/30 for example, we know to bet on the 70% option. We don’t need 100% certainty before making that bet.
Mindfulness: Changing the Channel
Rumination is often a huge part of OCD – such as, ruminating about perceived mistakes, mentally reviewing our memories to ensure we did not harm someone, or trying to figure out the answer to an unsolvable question. Clients have found the following Netflix analogy to be very relatable.
Netflix is designed to try its hardest to make us binge watch all the episodes of an entire show. After an episode has played and is over, if we sit back passively and do nothing, after 10 seconds Netflix will automatically start playing the next episode….and the next….and the next. Once the episode starts, we get hooked by the show, and it’s hard to stop watching. BUT, if we act quickly in those 10 seconds, we can get up, grab the remote and switch to a different show that we actually want to watch. We get to choose the show!
This is similar to rumination in OCD. If we sit back passively, our minds will run with whatever we are thinking about, that is, whatever sticky thought has hooked us. We may snowball with these thoughts and keep thinking about this painful topic for hours. However, we can take control, by picking up the “remote” and changing the channel to a stream of thoughts that we actually value and want to engage with in meaningful ways. This is mindfulness – that is, gently directing the focus of our attention. We are not at the mercy of having to ruminate on whatever thoughts happen to enter our minds; we can change the channel. And yes, those other thoughts may still enter our minds, and keep trying to hook us, but we can pick up that remote over and over again.
Defusion: OCD as just a Story
Picture this: You are watching a movie in an IMAX theater, it’s 4D with surround sound, you are wearing 3D glasses, and you are fully immersed in the story. It’s a dangerous thriller. You are sweating, your heart is racing, you are feeling tense, and you are perched on the edge of your seat. You are experiencing real physical symptoms. The story feels so real……and then you have to pee. So, you take off your glasses and begrudgingly walk out of the theater. You squint while your eyes adjust to the brightness of the lobby. You see people chatting and laughing, and you are bombarded with the smell of popcorn from the concession stand. And you realize that the movie was just a story that felt very real. You experienced real physical symptoms and you had the real emotion of fear…..but, it was all just a story.
Similarly, OCD will tell elaborate and convincing stories! These stories will feel so believable. They will cause real physical symptoms, and they will lead to real emotions of fear, disgust, guilt, and so forth. AND, ultimately, OCD is just a story. 
I hope you enjoyed these tips and tricks for treating OCD! If you are a clinician, please feel free to use these analogies and strategies in your clinical practice. If you are a client struggling with OCD, I hope you find these analogies to be helpful.
If you are seeking specialty services for the assessment or treatment of OCD, please do not hesitate to reach out to our intake team at Cambridge Psychology Group. We provide OCD treatment through individual therapy, group therapy, and our 2-week Intensive CBT Program for Anxiety and OCD. We know how critical it can be to access immediate care, and as such, we try our best not to keep a wait list so that clients can be immediately matched with our OCD clinicians.
Written by Beth Shikatani, PhD, a clinical psychologist at Cambridge Psychology Group who specializes in treating OCD, anxiety, and perfectionism. She is the director of the Intensive CBT Program for Anxiety and OCD, a 2-week accelerated program that provides one-on-one exposure therapy to adults and adolescents with difficulties with OCD, social anxiety, panic disorder, agoraphobia, health anxiety, and specific phobias. She also leads 2 virtual OCD Skills & Support Groups for clients to learn CBT and ACT skills and connect with others who have shared, lived experiences with OCD. Dr. Shikatani is the Director of Clinical Training; she is available to give workshops to mental health professionals and the community, as well as provide consultation services on a short- or longer-term basis.