This week, the BABCP is holding a workshop at Bangor University called “Mad, bad and dangerous”: The cognitive-behavioural approach to OCD. The title reflects a very real fear for many people with OCD: the worry that having a disturbing intrusive thought might mean something terrible about who they are, what they want, or what they might do. Intrusive thoughts can feel so frightening precisely because they are unwanted and completely at odds with a person’s values.

In my work at Symmetry CBT, I help people understand the difference between having a thought and acting on it, and how attempts to gain certainty can keep OCD going. This can include repeated checking, seeking reassurance, mentally reviewing what happened, avoiding triggers or trying to suppress the thought altogether. From both a CBT and Metacognitive Therapy perspective, the aim is not to prove that a thought could never return, but to reduce the importance given to it and change the responses that keep it powerful.

Exposure and Response Prevention (ERP) can also play an important role by helping people approach feared thoughts, situations or uncertainty without carrying out the usual compulsive response. Over time, this can help someone discover that they do not need to neutralise every intrusive thought or obtain complete certainty before moving on. The goal is to help the thought become less significant and less able to dictate attention, behaviour and daily life.