Verified by 
When I was in my 20s, I became consumed with the thought that I’d given myself HIV/AIDS.
I was not yet diagnosed with OCD, but knew I had some sort of a monster in my head, one that was terrorizing me around the clock, as illustrated in this excerpt from Is Fred in the Refrigerator? Taming OCD and Reclaiming My Life (with my monster’s voice in italics):
If Dr. Cowles could have looked into my brain, she would have seen that thoughts about AIDS and HIV had become the new soundtrack of my life. I was still functioning at work, using my best Disney-taught onstage skills to project an aura of happiness and confidence. But wherever I was, I wasn’t really there. Because I was really back on that old stage in the theater of my mind, where we once again engaged in our never-ending, exhausting pas de deux.
You’ve given yourself AIDS, you stupid girl!
No, that’s not how you get AIDS! I’m fine!
That’s what you think. And you can’t even get tested because it takes six months for the virus to incubate.
It doesn’t matter. I know that’s not how HIV and AIDS are transmitted.
What you know is meaningless! You know nothing. I know everything, and you are going to die!
I could hear it constantly, endlessly berating me. I had no reprieve. Reasoning with my mind was useless and, in fact, seemed to make things worse. And nothing—not even my workaholic ways—would make the thoughts stop. From the first moment I woke up until the time I went to bed, drained and demoralized, I heard my monster’s voice. Heard it taunt me about a disease that had terrified me ever since I was twelve years old and I heard Tom Brokaw talk about HIV and chimpanzees on NBC Nightly News as I ate my peas and carrots in the kitchen with my parents.
While it’s unsurprising that after months of listening to this never-ending harangue I became depressed, what is surprising to me is my realization years later of why I was depressed: I had come to believe what my mind was telling me—that I had HIV and would develop AIDS.
After coming to this conclusion, I pushed the mute button on my life. I couldn’t fully enjoy anything I did, because I knew that I had ruined everything. I couldn’t be excited about the future, because I wouldn’t be here to enjoy it. I couldn’t relax around my friends and family, because when I saw them, I envisioned the disappointment I’d eventually see on their faces when they learned what I’d done.
Believing that I had HIV was buoyed and reinforced by the subtle compulsion of letting myself become depressed and then changing how I engaged in life as a result of that depression.
Deconstructing an OCD episode
It may be a foreign concept to think of an emotion as a compulsion. Because doesn’t OCD cause emotions, not the other way around?
Let’s break down what happens in an OCD episode to see how feelings other than anxiety can strengthen the compulsive cycle.
1. You have an intrusive thought. And these aren't "OCD thoughts," by the way. They are intrusive thoughts, which everyone has. The OCD shows up in the next step of the cycle.
2. Your OCD reacts to that thought. It says things like, “Why did we have that thought? That’s a terrible thought! We wouldn’t think it if it weren’t true. And what if thinking about it makes it happen?!”
3. You feel anxious.
4. You do a compulsion. This may be as simple as what I did with my OCD above, what I called my "pas de deux": I argued with it in my mind. In other words, I acted like what OCD said had merit and needed to be addressed.
5. The compulsion tells your brain that this is a dangerous thought that you need to keep doing something about. Otherwise, you wouldn’t be addressing it.
6. Steps 1 through 5 start repeating in a loop (which is what was happening to me in the excerpt above). You aren’t winning the argument with OCD. You become consumed by the content of the obsessions, you’re anxious all the time, you think this is never going to end, and worst of all, you start believing what OCD is telling you.
7. When you start believing OCD’s scary stories, the acceptance of those thoughts as true causes you to experience the emotions you would feel if those stories were indeed true. Most often, these are depression, guilt, regret, shame, and/or grief.
8. In classic cognitive-behavioral fashion, our emotions then dictate how we act: depressed, guilty, regretful, ashamed, and/or grief-stricken. We change our behavior to match our mood, and unfortunately, how we are acting reinforces our mood and our thoughts.
I was recently discussing reasons why people with OCD get stuck in long-lasting episodes with Jon Hershfield, OCD expert and co-author with me of Everyday Mindfulness for OCD: Tips, Tricks & Skills for Living Joyfully. Jon said that when people with OCD have good insight, the compulsions they do are to obtain certainty that OCD is wrong, because they know at their core that what OCD is saying is most likely nonsense.
But he said that when people with OCD lose insight, they start to do compulsions to get certainty on the other end of the spectrum—meaning that since they cannot get certainty that OCD is wrong, they surprisingly start to participate in compulsions to attempt to prove that the OCD is right. After all, the OCD just wants certainty. It doesn’t care what type of certainty it gets.
After hearing Jon’s brilliant perspective on insight, my theory is that the longer you have an OCD episode around one particular obsession, the more likely your perspective becomes skewed about this topic, and you start to lose insight.
As your insight diminishes, how you participate in compulsions changes in that you start to try to prove the OCD right, not wrong. And the more you act like OCD is right, the more you unintentionally create negative emotions to support that belief. Then you change your behavior so that it lines up with what you are thinking and feeling, creating a vicious cycle of OCD.
The challenging part of breaking out of this cycle is that because your insight into what the OCD is doing is lower, these OCD-induced emotions of depression, guilt, regret, etc., not only feel normal, but you also believe you deserve to have them because you’re such a rotten person, further strengthening the OCD cycle.
How to break out of the cycle
Exposure and response prevention therapy (ERP) is the evidence-based therapy for OCD, and at its core, it means to do things that you want to do while in the presence of intrusive thoughts without doing mental or physical compulsions.
I’ve written several posts about some techniques for doing ERP, including "Shoulders Back! The Man in the Park" and "Interrupt OCD's Mental Rituals with 'May or May Not,'" and you can also see Everyday Mindfulness for OCD for a more detailed discussion of OCD and ERP and various ERP games you can play (as it’s more fun, and in my experience more effective, if you do what OCD and anxiety expert Reid Wilson, Ph.D. recommends and treat beating your OCD as a mental game).
However, people who are experiencing depression/guilt/regret/etc. as a ritual mistakenly try to do ERP by participating in an activity they value while focusing on how depressed/guilty/regretful/etc. they feel. These emotions and the focus on them are compulsions because they are based on believing the OCD’s scary stories. If people with OCD do exposure without response prevention, (i.e., while doing compulsions), they are sabotaging their attempts to get better.
For instance, say your OCD told you that someday you’re going to snap and kill your children. You used to fight with the OCD in your head about this and avoid doing things on your own with your kids, but you’ve done the ERP of taking your kids to the park, playing games, and watching movies with them, etc., and you can do all that now without much anxiety. But when you’re with them, you still feel like it’s a given that eventually you’re going to kill them, even though you’ve done lots of ERP, and thinking you’re a potential killer makes you depressed.
You go ahead and do the activities with your kids, and you act like you’re having fun, but the whole time you’re in your head noticing how depressed you are. This makes you feel like even more of a bad person, as well as a failure for not being able to beat OCD. So your attempts at ERP stall out, and you stay stuck thinking and feeling like you’re a murderer-in-waiting.
Show it ‘til you grow it!
The way to stop participating in the "emotions as a ritual" compulsion for the example above is to do activities with your kids while finding some small bit of joy and focusing with your whole being on that joy while you’re in the activity. For instance, notice the way your older child’s smile is now looking so much like that of your spouse. Or how much you like the sound of their squeals of glee as they chase each other around the park. Or how it feels when your younger child hugs the stuffing out of you to thank you for spending time with her.
Focus on whatever happiness you can find in the situation. When the OCD inevitably says, “You can’t enjoy this, you’re going to murder them!” you go right back to focusing on whatever joy you’ve found and then do something to act joyful to support your focus: smile intensely, chase your kids and laugh like you used to when you were 10 years old, hug the stuffing out of your child in return when she comes to say “thank you” for the great outing.
Allowing yourself to feel and experience joy is the real exposure here because you are now doing the opposite of what the OCD thinks you should do. In OCD’s twisted world, it reasons:
“Responsible potential murderers [or insert whatever OCD is threatening you with here] wouldn’t let themselves be happy. Responsible people deserve to feel miserable because of what they might do or what might happen. In fact, being miserable is protective, because if you suffer enough, maybe somehow you’ll keep this bad thing from happening. The universe will feel bad for you and not heap more suffering upon you if you’re already in misery. But if you act happy, you are tempting fate. You’re acting like you don’t care that you’re having these thoughts, and you’re not preparing for them or working in your mind to prevent them from coming true and that means you're a horrible person!”
In other words, OCD wants you to have the "right" emotion, the one that matches its scary stories. The exposure exercise is to purposely call forth the "wrong" emotion, the one that's the opposite of how OCD wants you to feel.
Please note I am not suggesting that you fake it until you make it. Faking it means that you feel miserable and go anyway, focusing on how miserable you are while faking that you’re having fun. That will likely only get you marginal, if any, improvement.
I am instead recommending what Heather Hansen describes in The Elegant Warrior: show it ‘til you grow it. Find a little tiny bit of joy, focus on it, and grow it. Let yourself be happy, even if it’s only 5 percent of the happiness you would feel if you weren’t having this obsession, and use that as a springboard to act as if what your OCD is saying is garbage.
Continuing with my example of the parent above, act with your heart, your mind, your body, and your very soul like you are enjoying a day with your kids. Let down your guard. “Tempt fate.” Enjoy your life. And know this isn’t a one-time exercise… these types of episodes take a while to build up, and they can also take a while to resolve as you work to keep focusing on finding and growing joy, bit by bit, day by day.
Acting like what your OCD says is irrelevant is the essence of good exposure therapy. So regardless of what the OCD is saying to you, allow yourself to experience joy and to take actions based on that joy.
Don’t make the same mistake I did 20 years ago by believing the OCD and letting it rob you of more time and happiness. Instead, let yourself enjoy the gift that life is. Show it ‘til you grow it!
For notifications of new blog posts as well as OCD-taming tips & resources, sign up for my Shoulders Back! newsletter.
These blog posts are not a replacement for therapy, and I encourage all readers who have OCD to find a trained ERP therapist. See the IOCDF treatment provider database for a provider near you.
