The Insight That Changes Everything
Here's something that sounds strange but is demonstrably true: every single thought you have is an intrusive thought.
Try this right now. Predict your next thought before you have it.
You can't. No one can. Thoughts just arrive. Every thought is uninvited. Every thought intrudes.
If all thoughts are intrusive, then intrusive thoughts cannot be the problem. The problem is that a subset of your intrusive thoughts have become emotionalised in a way you interpret as threatening.
Your brain produces random thoughts constantly—including bizarre ones. When you randomly think of a pink elephant playing a harp, you don't panic. You don't analyse what it means. You don't try to make it go away. You just let it pass.
But when your brain produces a thought about harm or contamination or relationship doubt, suddenly you treat it completely differently. Even though it's the same brain producing thoughts in the same way.
The goal isn't to stop intrusive thoughts—that's impossible. The goal is to treat the scary ones the same way you treat the pink elephant.
Understanding the Mechanism
When you have an OCD episode, there are actually four distinct components—not one overwhelming experience:
The Thought
The initial intrusive thought. "Did I lock the door?" "What if I hurt someone?" This is just your brain generating content—it happens to everyone.
The Initial Feeling
A small spike of anxiety or discomfort. This is functional—like a smoke detector that beeps when you burn toast. It's doing its job. This is normal, manageable discomfort.
The Meaning You Add
Where trouble begins. "I'm a monster for thinking that." "This anxiety means something is really wrong." "I need to figure this out." This is where you interpret the thought as dangerous.
The Secondary Suffering
The emotional response to that interpretation—shame, panic, despair, disgust. This is what actually hurts. This is where most of the suffering lives.
Most people experience these as one undifferentiated "OCD attack." But they're four separate things. And steps 3 and 4—the meaning you add and the suffering that follows—are where most of the pain actually lives.
The target: We're not trying to eliminate the initial thought (impossible) or suppress the first feeling (counterproductive). We're targeting the interpretation layer—how you respond to the thought and the secondary suffering that creates.
If we can change your perception of that initial arousal—make it less aversive—then the need to escape it dissipates. The rituals lose their urgency when the threat isn't threatening. And it slowly unwinds.
Why You Can't Think Your Way Out
OCD thoughts are specifically designed to be impossible to disprove. They're structured as "non-falsifiable propositions." No amount of evidence can conclusively disprove them.
When traditional treatment asks you to "gather evidence" and "dispute the thought," you're being asked to prove there's no teapot orbiting Pluto. And no matter how many times you scan Pluto, your OCD will say, "But did you check the dark side?"
Why Cognitive Challenging Often Fails for OCD
People challenge their thoughts. They challenge it for half an hour and get somewhere. The next day, they have to re-litigate the whole thing again. It's a very inefficient way to go about this.
You're trying to solve something you philosophically cannot solve. That's why we need a different approach.
OCD Themes We Treat
OCD can attach to anything. The content doesn't matter—it's the same mechanism with different inputs. But it helps to know you're not alone with your specific theme:
Contamination
Fear of germs, chemicals, bodily fluids, or "emotional contamination." Washing, cleaning, avoiding rituals.
Harm OCD
Fear of "snapping" and hurting someone. Intrusive images of violence. Checking that you haven't caused harm.
Checking & Doubt
Repeatedly checking locks, stoves, emails, memories. Never feeling "sure enough."
"Pure O" (Mental OCD)
Rituals happen in your head: ruminating, reviewing, neutralising, "figuring it out," mental checking.
Relationship OCD
Endless doubt about whether you love your partner, if they're "the one," constant checking of feelings.
Unwanted Sexual Thoughts
Intrusive thoughts about orientation, taboo content, or children. Often accompanied by intense shame.
Scrupulosity
Moral or religious OCD. Fear of having sinned, being "bad," or not being good enough.
Symmetry / "Just Right"
Need for things to be even, balanced, or feel "right." Ordering, arranging, repeating until it feels complete.
If you're carrying a theme you're ashamed of—one you've never told anyone—that's common in OCD, and it's treatable. The shame is often the worst part.
What We Actually Do in Sessions
This is not open-ended talking about your feelings. It's structured treatment targeting the mechanism that keeps OCD alive.
Map Your Pattern
Understand exactly how OCD works in your case. Identify your specific triggers, the meaning you add to them, and your compulsions—including the mental ones you might not recognise as compulsions.
Stop Feeding the Thoughts
Learn to respond with "Sure. Whatever. Maybe. I don't know. But now what?"—not with engagement, analysis, or desperate attempts to prove them wrong.
Change Your Relationship with Emotion
The goal isn't to eliminate anxiety. It's to change your perception of it so it's no longer experienced as threatening. Same sensation, different meaning.
Lower Your Baseline Arousal
High stress makes intrusive thoughts feel more credible. We work on nervous system regulation to create "mismatch"—low arousal plus scary thought doesn't compute.
Find-a-Five Exposure
ERP done properly. We keep anxiety at 5/10 or below during exposure, using the smallest possible behavioural units. No flooding. No forcing. Gradual, sustainable learning.
Drop the Compulsions
Including the hidden ones: mental reviewing, reassurance-seeking, "figuring it out," checking your feelings. These feel helpful but keep OCD alive.
The goal isn't to feel calm during exposure. The goal is to learn that you can handle uncertainty and anxiety without rituals—and the alarm system quiets as a byproduct.
What Recovery Actually Looks Like
Recovery is NOT:
- Never having intrusive thoughts again (impossible)
- Feeling calm all the time (unrealistic)
- Proving your fears wrong (can't be done)
- Getting certainty (doesn't exist)
Recovery IS:
- Treating intrusive thoughts like a pink elephant with a harp—noticed, maybe, but not engaged with
- Having anxiety arise and not needing to escape it
- Losing interest in thought content because it's no longer threatening
- Living your life regardless of what thoughts show up
- Less time lost to rituals and mental loops
- More capacity for the things that matter to you
This Takes Work
OCD treatment requires practice, not just understanding. You can read every book about tennis ever written, but you don't learn tennis from a book—you learn it by hitting balls.
The people who do well are the ones who practice between sessions. They do the exposures. They resist the compulsions. They sit with the discomfort. It's not comfortable, but it works.
Common Questions
No. In OCD, intrusive thoughts are typically the opposite of your values—which is exactly why they're so distressing. The horror you feel is evidence that these thoughts are ego-dystonic (against your values), not ego-syntonic (aligned with your desires). If you were actually dangerous, you wouldn't be horrified by the thought.
No. We use a "Find-a-Five" approach—keeping anxiety at 5/10 or below during exposure. We use the smallest possible behavioural units and build gradually. If anxiety spikes above 5, we step back. This isn't about suffering through fear; it's about learning at a sustainable pace.
Possibly. Many people have "Pure O" where the compulsions are entirely mental: ruminating, reviewing, analysing, "figuring it out," checking your feelings, mental neutralising. These invisible rituals are still compulsions, and they keep OCD alive just like physical ones do.
Traditional talk therapy often makes OCD worse because discussing the content of obsessions can function as a compulsion—you're "figuring it out" with the therapist's help, getting temporary relief, and reinforcing the cycle. OCD needs a specific approach that targets the mechanism, not the content.
It varies with severity and how much you can practice between sessions. Many people see meaningful improvement within 12-16 focused sessions. Some need longer. The key is consistent practice—treatment doesn't work by osmosis.
OCD is typically a chronic condition, but it can absolutely be managed to the point where it no longer controls your life. Many people reach a state where intrusive thoughts still occur but don't trigger the cascade of distress and compulsion. The goal is functional recovery, not the elimination of all intrusive thoughts (which isn't possible for anyone).
Cammeray, on Sydney's Lower North Shore. Easy access from the North Shore, Northern Beaches, and CBD.
Quick Self-Assessment
For each statement, select how much that experience has distressed or bothered you during the past month. This takes about 3-5 minutes.
Subscale Breakdown
Important: This self-assessment is for informational purposes only and is not a clinical diagnosis. Only a qualified mental health professional can diagnose OCD. If you're concerned about your results, please consult with a psychologist or your GP.
Ready to Change Your Relationship with OCD?
If you're tired of the endless loops and ready for a different approach, let's talk about what treatment could look like for you.
Book a SessionIn crisis? If you're in immediate danger or at risk of harming yourself, please call 000. For urgent support, contact Lifeline on 13 11 14. This page is for information only and is not a substitute for emergency care.