People with OCD often describe a powerful sense of doubt: “What if I’ve missed something?” or “What if I’m not really sure?” That feeling of uncertainty can drive checking, reassurance-seeking and repeated mental reviewing. Recent research has highlighted an interesting pattern in OCD, where people may have lower overall confidence even when they are still able to respond appropriately to the evidence in front of them. In other words, the feeling of uncertainty does not necessarily mean that something is actually wrong or that more checking is needed.

This is where approaches such as Exposure and Response Prevention (ERP) and Metacognitive Therapy (MCT) can be helpful. ERP involves learning to tolerate uncertainty without carrying out the usual compulsive response, while MCT focuses on the beliefs and thinking processes that keep doubt and threat-monitoring going.

In my work, the aim is not to help people achieve perfect certainty, but to help them become less governed by the need for it.