Intrusive Thoughts: Learning to Step Back From the Screen
Everyone experiences intrusive thoughts. A strange, disturbing, or unwanted thought can pop into anyone’s mind. Someone without OCD might notice the thought and think, “Wow, that was weird,” before moving on with their day.
For someone with OCD, however, the experience can be very different. Instead of simply noticing the thought and letting it pass, they may begin to question what it means: “Why did I have that thought? What does this say about me? Does this mean I secretly want this? What does this say about my intentions or who I am as a person?”
This is where OCD can become extremely consuming.
I like to compare the intensity of intrusive thoughts to sitting in the front row of a movie theater. Have you ever sat in the front row during an action movie? When you are that close to the screen, the action can feel incredibly intense. You are completely captivated by what is happening in front of you. It can be difficult to see anything else in the room because the screen takes up almost your entire field of vision.
That is what intrusive thoughts can feel like for someone with OCD.
The thoughts can feel scary, vivid, and incredibly real. When you are sitting in the “front row” of OCD, the thought can become the only thing you can see. The evidence around you, your past experiences, your values, and what other people may be telling you can feel distant or irrelevant. Even when the people in your life can clearly see that OCD is telling you a story that doesn’t fit with reality, it can be incredibly difficult for you to see that yourself.
The fear can feel overwhelming, almost like a tidal wave that is about to consume you. And when that fear becomes intense enough, you may begin to believe the story OCD is telling you about the thought.
OCD is very good at convincing you that an intrusive thought is important simply because it showed up in your mind.
But here’s the interesting thing about the movie theater: imagine slowly moving from the front row toward the back.
As you move farther away from the screen, you begin to gain some distance. The movie is still playing. The images are still there. The story hasn’t changed. But suddenly, you can see more than just the screen.
You can see the rest of the theater.
You can notice the people sitting around you. You can see the walls. You can look at the exits. You can recognize that you are sitting in a movie theater watching a movie.
The screen is still there but it is no longer your entire reality.
This is the kind of distance I hope to help my clients develop in therapy. The goal isn't necessarily to make intrusive thoughts disappear. Instead, we work on recognizing how close you are to the screen and developing the skills to step back far enough to see the full picture.
Will the intrusive thought still be there?
Yes.
But now you have some distance from it.
You can notice the thought without immediately treating it as a fact. You can notice the fear without assuming the fear means something is wrong. You can recognize the story OCD is telling you without automatically believing it.
The goal is not to convince yourself that the screen isn't scary. The goal is to remember that the screen is only one part of the room.
OCD can pull us into our imagination, asking us to analyze, predict, question, and search for certainty. Mindfulness and present-moment awareness can help us step back into reality and to notice what is actually happening right now rather than becoming completely absorbed in the story OCD is telling us.
The movie is still playing.
But you don't have to sit in the front row.
Mental Compulsions: Understanding the Hidden Battle of OCD
According to the International OCD Foundation, more than 3 million individuals are living with OCD today, and it takes an average of 14 years for someone to receive an official diagnosis. Many barriers can delay diagnosis, including fear of disclosing unwanted intrusive thoughts, symptom overlap with other anxiety disorders, and the presence of hidden mental compulsions that can make OCD difficult for therapists to identify.
Checking and cleaning rituals have long been viewed as the hallmark compulsions of OCD. Media portrayals often reinforce this narrow understanding by focusing primarily on visible compulsions such as excessive cleaning or checking behaviors. However, there is an entire category of compulsions that often goes unnoticed during both diagnosis and treatment: mental compulsions.
Because they occur internally, mental compulsions can be more difficult for therapists to recognize and easier for individuals to become trapped in. Like physical compulsions, mental compulsions serve as an attempt to reduce the anxiety triggered by unwanted intrusive thoughts. Unfortunately, the more an individual relies on these compulsions for relief, the stronger the OCD cycle becomes.
Mental compulsions can include:
Mental reviewing
Mental checking
Reassurance seeking
Rumination
Repeating phrases or prayers mentally
Making mental lists
Although these compulsions are invisible to others, they reinforce the same cycle of doubt and anxiety. Individuals attempt to reduce their distress by engaging in mental rituals designed to create certainty or relief.
Examples of mental compulsions may sound like:
The anxiety will go away if I keep repeating this phrase in my mind.
The anxiety will go away if I keep analyzing this intrusive thought.
The anxiety will go away if I keep reassuring myself that everything will be fine.
The anxiety will go away if I make a mental list.
The anxiety will go away if I keep reviewing that conversation.
These strategies may provide temporary relief, but when intrusive thoughts return—as they inevitably do—the cycle begins again. Individuals struggling with mental compulsions can spend hours trapped in their own minds, attempting to think their way out of anxiety. Instead, the ongoing rumination strengthens the OCD cycle and reinforces the need for certainty.
Understanding mental compulsions changes the way clinicians approach OCD treatment. Therapists become more aware of how traditional talk therapy can unintentionally reinforce mental rituals and strengthen the OCD doubt cycle. It also changes how therapists engage with clients, encouraging them to avoid providing reassurance solely to reduce anxiety in the moment.
As clinicians, it is essential to recognize how mental compulsions maintain OCD. Traditional talk therapy can sometimes become a breeding ground for these compulsions when sessions focus on helping clients find certainty about their intrusive thoughts. Effective OCD treatment requires helping clients develop a different relationship with uncertainty rather than seeking reassurance or answers that temporarily relieve distress.
By increasing awareness of mental compulsions, we can help individuals receive more accurate diagnoses, access appropriate treatment sooner, and better understand the hidden battle that so many people with OCD face every day.
Resources
For more information on OCD and mental compulsions, consider the following resources:
Overcoming Unwanted Intrusive Thoughts by Sally M. Winston and Martin N. Seif
Needing to Know for Sure by Martin N. Seif and Sally M. Winston
According to the International OCD Foundation, more than 3 million individuals are living with OCD today, and it takes an average of 14 years for someone to receive an official diagnosis. Many barriers can delay diagnosis, including fear of disclosing unwanted intrusive thoughts, symptom overlap with other anxiety disorders, and the presence of hidden mental compulsions that can make OCD difficult for therapists to identify.
Checking and cleaning rituals have long been viewed as the hallmark compulsions of OCD. Media portrayals often reinforce this narrow understanding by focusing primarily on visible compulsions such as excessive cleaning or checking behaviors. However, there is an entire category of compulsions that often goes unnoticed during both diagnosis and treatment: mental compulsions.
Because they occur internally, mental compulsions can be more difficult for therapists to recognize and easier for individuals to become trapped in. Like physical compulsions, mental compulsions serve as an attempt to reduce the anxiety triggered by unwanted intrusive thoughts. Unfortunately, the more an individual relies on these compulsions for relief, the stronger the OCD cycle becomes.
Mental compulsions can include:
Mental reviewing
Mental checking
Reassurance seeking
Rumination
Repeating phrases or prayers mentally
Making mental lists
Although these compulsions are invisible to others, they reinforce the same cycle of doubt and anxiety. Individuals attempt to reduce their distress by engaging in mental rituals designed to create certainty or relief.
Examples of mental compulsions may sound like:
The anxiety will go away if I keep repeating this phrase in my mind.
The anxiety will go away if I keep analyzing this intrusive thought.
The anxiety will go away if I keep reassuring myself that everything will be fine.
The anxiety will go away if I make a mental list.
The anxiety will go away if I keep reviewing that conversation.
These strategies may provide temporary relief, but when intrusive thoughts return—as they inevitably do—the cycle begins again. Individuals struggling with mental compulsions can spend hours trapped in their own minds, attempting to think their way out of anxiety. Instead, the ongoing rumination strengthens the OCD cycle and reinforces the need for certainty.
Understanding mental compulsions changes the way clinicians approach OCD treatment. Therapists become more aware of how traditional talk therapy can unintentionally reinforce mental rituals and strengthen the OCD doubt cycle. It also changes how therapists engage with clients, encouraging them to avoid providing reassurance solely to reduce anxiety in the moment.
As clinicians, it is essential to recognize how mental compulsions maintain OCD. Traditional talk therapy can sometimes become a breeding ground for these compulsions when sessions focus on helping clients find certainty about their intrusive thoughts. Effective OCD treatment requires helping clients develop a different relationship with uncertainty rather than seeking reassurance or answers that temporarily relieve distress.
By increasing awareness of mental compulsions, we can help individuals receive more accurate diagnoses, access appropriate treatment sooner, and better understand the hidden battle that so many people with OCD face every day.
Resources
For more information on OCD and mental compulsions, consider the following resources:
Overcoming Unwanted Intrusive Thoughts by Sally M. Winston and Martin N. Seif
Needing to Know for Sure by Martin N. Seif and Sally M. Winston