Metacognition is what we think about our thinking. We can experience thoughts as automatically valid and needing attention, or we can experience thoughts as transient, not necessarily significant. Those with OCD over index to their thoughts and apply too much significance to every thought that comes into their consciousness.

Sometimes a therapist cannot set up in vivo exposures either in the therapy room or as homework. Sometimes an in vivo exposure would be too dangerous, too extreme, or simply not viable. In these cases, an imaginal exposure is the next best option.

For those who cannot simply allow those intrusive thoughts to float by, the next best tool is Cognitive Behavioral Therapy (CBT). Studies have shown that for OCD individuals, the pain of intrusive thoughts stems from two major distortions in thinking: 1) Overestimation of Threat 2) Overblown Sense of Responsibility.

In Cognitive Behavioral Therapy for Obsessive-Compulsive Disorder, I encourage my clients to choose a “name” for their OCD. A name helps a client understand that their OCD is a bully inside their brain and does not represent their authentic thoughts.