Understanding Pure O: You Are Not Having Intrusive Thoughts All Day, You Are Ruminating

Most people with intrusive thoughts (often referred to as Pure O) and most people who treat intrusive thoughts, think that these thoughts are involuntary and uncontrollable.   The truth is that the vast majority of what people call intrusive thoughts — almost all of them — are actually being thought or imagined on purpose, in an effort to […]

Defining Rumination

Different therapists and researchers (and farmers, actually) use the word rumination in different ways, and that makes it important to define exactly what I mean when I use that word. When I talk about rumination, I’m talking about any type of mental engagement with the problem; put another way, I’m talking about shifting into problem-solving […]

Why Rumination is a Continuous Loop

If you’re a compulsive ruminator, you know that ruminating feels like frantically going in circles without getting anywhere.  The goal of this article is to explain why that is. Before reading this article, it’s important to have a solid grasp of how OCD works and what the ‘core fear’ is, so if you haven’t already […]

Rumination is a Compulsion, Not an Obsession, and That Means You Have to Stop

The fact that rumination is a compulsion is foundational to effective OCD treatment.  In order to explain why, let’s start by defining our terms: An ‘obsession’ is a distressing thought that occurs to a person.  The thought is distressing because it’s associated with the possibility of making an irreversible mistake that has permanent consequences (for […]

How to Stop Ruminating

I’m in the process of writing a more thorough manual about how to stop ruminating, but I wanted to make a barebones version available in the meantime: Here is the basic exercise I use to teach people how to stop ruminating: Identify a problem that you usually ruminate about. Your job is to not try to […]

I Know How to Stop Ruminating but I Can’t Seem to Stop All the Time

(How to Stop Ruminating addressed the problems people most frequently encounter when learning how to turn off rumination.  If you don’t know how to turn off rumination at all, start with that article.  This article addresses the problems that people most frequently encounter when they know How to Stop Ruminating, but can’t seem to stop all the […]

How are You Justifying Rumination?

This article is for you if you already know that You Are Not Having Intrusive Thoughts All Day, You Are Ruminating; know that Rumination is a Compulsion, Not an Obsession, and That Means You Have to Stop; and know How to Stop Ruminating. Whenever you find it difficult to stop ruminating, the first question to ask yourself is […]

Exposure is Never a Replacement for Response Prevention

Perhaps the most common question I hear OCD therapists ask is what Exposure to do for a certain compulsion.   Unfortunately, such a question reflects a misunderstanding of how ERP works, because Exposure doesn’t eliminate compulsion.  The only thing that eliminates a compulsion is the decision to stop doing it.  This is the Response Prevention part […]

Exposure Is About Learning, Not Habituation

When I was first trained in exposure therapy, I was taught that exposure works because the patient habituates (gets used) to the stimulus that causes them anxiety, or habituates to the feeling of anxiety itself.  On paper, this makes a lot of sense. Here’s how I used to explain it to patients: “If a person […]

What If Exposure Shouldn’t Make You Anxious?

The following is a thought piece.  In contrast to my other articles, it’s not meant to educate as much as to start a conversation.  When I started on my journey away from the importance of desensitization, I initially just let go of the idea that feeling anxious during an exposure was an important mechanism in ERP.  […]