OCD, Intrusive Thoughts, and How Acceptance and Commitment Therapy (ACT) Supports ERP

Obsessive-Compulsive Disorder (OCD) is often misunderstood as simply “being neat” or “liking things organized.” In reality, OCD is a complex mental health condition marked by distressing obsessions (intrusive thoughts, images, or urges) and compulsions (repetitive behaviors done to reduce anxiety). One of the most painful symptoms people with OCD experience is being disturbed by intrusive thoughts. This means thoughts that feel unwanted, alarming, or even morally wrong.

These intrusive thoughts are not reflective of who you are, but they can feel overwhelming and lead to shame, anxiety, and fear. If you’ve ever asked yourself, “Why am I having these thoughts if I don’t want them?” you’re not alone. Millions of people experience intrusive thoughts as part of OCD.

Intrusive Thoughts in OCD

Intrusive thoughts can take many forms: violent images, fears of harming others, unwanted sexual thoughts, or doubts about morality and faith. The important thing to know is that everyone experiences intrusive thoughts, but people with OCD attach deep meaning to them, making them harder to dismiss.

When someone with OCD becomes disturbed by an intrusive thought, they often feel compelled to “neutralize” it through compulsions like checking, reassurance-seeking, prayer, or mental reviewing. This cycle makes the thoughts stronger over time.

The neutralizing efforts send “DANGER, DANGER!” signals to the brain.

Subtypes of OCD: How Intrusive Thoughts Show Up

OCD can look very different depending on the person. Here are a few common subtypes:

• Scrupulosity (Religious OCD): Involves fears of offending God, committing blasphemy, or not being “pure enough.” This can lead to repetitive prayer, confession, or avoiding religious spaces altogether.

• Harm OCD: Includes fears of accidentally or intentionally harming oneself or others. People often avoid knives, driving, or being alone with loved ones due to these intrusive thoughts.

• Contamination OCD: Characterized by extreme fears of germs, disease, or spiritual “uncleanness.” Compulsions may include excessive cleaning, washing, or avoiding public spaces.

• Relationship OCD (ROCD): Marked by doubts about one’s partner or relationship, often leading to endless checking of feelings or reassurance-seeking.

These subtypes all share the same cycle: intrusive thoughts trigger fear, which leads to compulsions that keep the OCD loop alive.

How ERP Helps with Intrusive Thoughts OCD

Exposure and Response Prevention (ERP) is the gold-standard treatment for OCD. ERP involves gradually facing intrusive thoughts or feared situations while resisting the urge to perform compulsions. Over time, the brain learns that the feared thought does not need to be controlled, neutralized, or avoided.

However, ERP can feel intimidating… especially if your intrusive thoughts challenge your values, beliefs, or identity. This is where Acceptance and Commitment Therapy (ACT) can make ERP more effective.

ACT and ERP: Working Together

Acceptance and Commitment Therapy (ACT) focuses on accepting the presence of difficult thoughts and feelings without judgment, while committing to actions aligned with your values. Instead of trying to eliminate intrusive thoughts, ACT teaches you to relate to them differently.

Here’s how ACT supports ERP for OCD:

• Acceptance instead of resistance: Intrusive thoughts lose power when you stop fighting them. ACT provides mindfulness-based tools to notice thoughts without getting hooked.

• Values-based living: ACT helps you focus on what matters most to you, rather than letting OCD dictate your decisions.

• Defusion skills: You learn to see thoughts as “just thoughts,” not dangerous truths. This mindset reduces the anxiety that drives compulsions.

Research shows that combining ERP and ACT therapy for OCD can increase treatment effectiveness and reduce dropout rates, since ACT helps clients tolerate the discomfort of exposures (Twohig et al., 2015).

Working with a Therapist

OCD can feel isolating, but recovery is possible with the right support. Online OCD therapy can provide effective ERP and ACT-based interventions from the comfort of your home, which is especially important if you live in rural Kansas or prefer telehealth counseling.

At Deconstruction Counseling, I specialize in helping people heal from intrusive thoughts. If intrusive thoughts are overwhelming your life, you don’t have to go through it alone.

👉 Book an appointment with Deconstruction Counseling today and start your recovery journey.

References

Abramowitz, J. S., McKay, D., & Storch, E. A. (2017). The Wiley handbook of obsessive compulsive disorders. Wiley-Blackwell.

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.; DSM-5-TR). American Psychiatric Publishing.

Twohig, M. P., Abramowitz, J. S., Smith, B. M., Fabricant, L. E., Jacoby, R. J., Morrison, K. L., ... & Lederman, T. (2015). Adding acceptance and commitment therapy to exposure and response prevention for obsessive-compulsive disorder: A randomized controlled trial. Behaviour Research and Therapy, 73, 31–41. https://doi.org/10.1016/j.brat.2015.07.009

Leckman, J. F., & Bloch, M. H. (2016). Clinical features of obsessive-compulsive disorder. In Handbook of Clinical Neurology (Vol. 138, pp. 181–193). Elsevier.

Kahl, K. G., Winter, L., & Schweiger, U. (2012). The third wave of cognitive behavioural therapies: What is new and what is effective? Current Opinion in Psychiatry, 25(6), 522–528. https://doi.org/10.1097/YCO.0b013e328358e531

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