Common Mental Compulsions
Contributed by staff member Cayley Gersh, M.A.
Compulsions (repetitive attempts to alleviate the distress or anxiety that often comes with uncertainty) can take many different forms. Some of the most easily recognizable forms are physical behaviors, such as cleaning, hand washing, rearranging, or checking appliances. However, other times compulsions are sneakier mental actions that an observer wouldn't be able to see. While mental compulsions can be particularly difficult to notice, identifying them is an integral first step; once identified, they can be resisted or spoiled. It is critical not to give into compulsions as they perpetuate the cycle of OCD. Only by resisting compulsions can you give your brain the opportunity to learn an alternative response pattern to the obsession or intrusive experience and thereby gain sustained relief from your OCD symptoms.
Below, we have identified frequent mental compulsions that folks engage in during exposures or in response to intrusive thoughts. Becoming familiar with these sneaky compulsions is essential in many cases to make treatment gains!
Problem solving
Planning for outcomes that haven't happened yet to assure yourself that you can handle it.
Obsession: What if I have a panic attack during the wedding?
Compulsion: Mentally planning every possible way to escape, calm down, or leave if it happens.
Suppressing
Trying to think of other thoughts or divert attention elsewhere in an attempt to suppress or avoid intrusive thoughts or the distress associated with them. Note: this is different from response prevention/mindfulness in an important way: suppression is the perspective that we want to focus on something so hard we don’t experience intrusive thoughts- response prevention is allowing our mind to say whatever it wants to, while at the same time placing attention on the present moment.
Obsession: What if you shout something offensive out loud?
Compulsion: Quick! Think about your to-do list to avoid this thought.
Searching/checking for evidence
Searching for a way to answer the unanswerable question: the "what if" that your OCD and anxiety have presented to you. There are various avenues this can take; one can check…
In the past, checking past behavior as evidence of the certainty of future behavior
Obsession: What if I cheat on my partner?
Compulsion: I have never cheated before.
Through logic: if this is true, then that is true
Obsession: What if I am a bad person?
Compulsion: Bad people don't worry about being bad, therefore I must not be a bad person.
Through feelings or sensations: if I feel this, it means that
Obsession: What if I hurt my mom?
Compulsion: If I feel upset by that thought, it means I won't.
Through mental review: let's replay past events in an attempt to determine what happened, what something meant, or whether certainty can be achieved
Obsession: What if I said something offensive?
Compulsion: Replaying the conversation repeatedly to determine exactly what was said.
Reassurance
Trying to push out intrusive thoughts by reassuring yourself that it will be ok, they won't happen, or they aren't true. Similar to how we may seek reassurance from those around us, we may internally reassure ourselves.
Obsession: What if I accidentally hit someone with my car and didn't notice?
Compulsion: No, you would definitely know if you hit someone.
Obsession: What if I don't really love my partner?
Compulsion: Of course you love them. You've been happy together for years.
Depressive compulsion
Accepting the worst-case scenario as true instead of acknowledging the uncertainty. Choosing the worst outcome brings about sadness, but it also provides a false sense of certainty, which is sometimes preferred over the anxiety and distress associated with uncertainty.
Obsession: What if ERP doesn't work for me?
Compulsion: It won't, you will be struggling with this forever.
Obsession: What if I made the wrong decision?
Compulsion: I definitely did, and I've probably ruined everything.
Mental compulsions are not dangerous or wrong; they are understandable attempts to reduce anxiety and gain certainty. However, when they become repetitive, they can keep OCD and anxiety going. The goal of ERP is not to stop intrusive thoughts from occurring, but rather to practice noticing mental compulsions and choosing not to engage with them. Over time, this helps individuals build tolerance for uncertainty and learn that anxiety can decrease on its own far more effectively without compulsions. By resisting the urge to compulse, we end up experiencing significantly less anxiety and can live happier, healthier lives.