Proven Ways to Cope with Mental Compulsions in OCD

If you have obsessive-compulsive disorder (OCD), you may experience compulsions. These are repetitive thoughts or mental acts that you feel driven to perform in response to an obsession. These behaviors, known as covert rituals, or mental compulsions can be as distressing and time-consuming as physical actions like hand washing or checking. They are often not observable to others, making them a hidden but challenging aspect of living with OCD.

At Therapy for Women, our licensed therapists specialize in OCD therapy using exposure and response prevention (ERP) therapy. This is considered the gold-standard approach. We understand how debilitating mental compulsions can be.

What Are Mental Compulsions?

Mental compulsions are compulsive behaviors that take place in the mind rather than physically. Just like with physical compulsions, the goal of performing a mental compulsion is to try to ease the anxiety and distress caused by an obsessive thought. However, engaging in them actually reinforces the obsession and worsens OCD symptoms in the long run.

Some common examples of OCD mental compulsions include:

• Mentally reviewing or replaying events or conversations to check for feared mistakes or reassurance
• Mentally repeating special words, phrases, prayers, or numbers
• Counting in certain patterns or numbers
• Purposely thinking “good” thoughts to neutralize “bad” thoughts
• Compulsively making lists in your head
• Hyper-analyzing your thoughts or bodily sensations for feared hidden meanings
• Mentally undoing or canceling out unwanted thoughts or actions
• Mentally reassuring yourself that feared consequences won’t happen

Mental compulsions can be very tricky to recognize because they are not outwardly visible. The line between obsessions and mental compulsions can also blur. If you find yourself stuck in repetitive thought loops or feeling compelled to perform mental rituals for hours each day, it may be a sign that you need more help.

Physical vs. Mental Compulsions: What’s the Difference?

All OCD compulsions serve the same purpose: relieving the anxiety an obsession creates. The difference is simply where they happen. Physical compulsions are visible behaviors, while mental compulsions run silently in your mind. Most people with OCD experience some mix of both.

The most common physical compulsions include:

• Checking: repeatedly confirming doors are locked, appliances are off, or nothing harmful has happened
• Washing and cleaning: excessive hand washing or sanitizing to prevent contamination
• Counting: repeating actions a specific number of times until something feels “just right”
• Arranging: ordering items symmetrically or in a particular way to ease discomfort
• Reassurance seeking: repeatedly asking others to confirm everything is okay

Whether a compulsion happens in your hands or your head, the relief it brings is temporary, and each repetition strengthens the obsession behind it. The good news: ERP treats both kinds the same way, and it works on both.

How to Stop Mental Compulsions with ERP Therapy

The most effective way to tackle mental compulsions is through ERP therapy for OCD. In ERP therapy, you work with a trained therapist to gradually expose yourself to feared thoughts and situations that trigger your compulsions. At the same time, you resist the urge to perform the compulsive behavior. For mental compulsions, this involves allowing yourself to experience the distressing obsessive thoughts without engaging in any rituals.

ERP Exercises

Exercises for mental compulsions may include:

• Writing down your obsessive thoughts without neutralizing them with mental compulsions
• Recording yourself speaking your feared thoughts aloud and listening to the recording
• Doing everyday activities while letting obsessive thoughts pop up without analyzing them
• Agreeing with and even exaggerating your feared thoughts instead of mentally arguing with them

ERP therapy can be challenging and anxiety-provoking, but it is the most effective treatment for all types of OCD. A study published in the Journal of Clinical Psychiatry found that ERP therapy significantly reduced OCD symptoms in 80% of patients. The gains were maintained at follow-up an average of two years later.

With help, it is possible to retrain your brain. ERP therapy helps you develop the skills to tolerate distress, resist compulsions, and challenge the beliefs underlying your OCD.

Our Approach

If you’re struggling with OCD, you are not alone. Our experienced therapists can equip you with the tools to overcome mental compulsions. We can help you take back your life from obsessive-compulsive disorder.

Starting therapy can feel overwhelming, especially when you’re battling OCD. We strive to create a warm, non-judgmental environment where you can feel supported and understood. Our compassionate therapists will work with you to develop a personalized treatment plan that addresses your unique needs and goals. Click here to get started.