OCD is often linked to ritualism and addiction. It is usually to do with anxiety or insecurity (see anxiety section). The behaviour is often very ritualistic and if it is not carried out or the obsessive thought is fought against then it can cause feelings of anxiousness or uncomfortableness. Normally people with OCD have one or more of their basic needs not being met. When these get met it will help the OCD lift.

The most common compulsions in adults are:

• Thoughts of contamination (which can lead to obsessive washing or cleaning)
• Doubt (E.g. Whether you have locked doors or turned off switches)
• Thoughts of having physical symptoms
• Symmetry (straightening pictures, lining pens up on a desk
• Aggressive thoughts

Compulsions are usually carried out to prevent or reduce anxiety or distress. Often it is believed the compulsive behaviour will prevent something unwanted occurring. OCD affects not just the person carrying out the behaviour but also those around them. When a compulsion is carried out the person enters a trance as the compulsion takes control. This trance can be triggered by specific situations, thoughts, feelings or times of the day or by a heightened level of tiredness.

To help remove the compulsion, clients can imagine watching a screen with someone calmly NOT carrying out the compulsive behaviour. Notice what they look like, how relaxed they appear, how they know that person is relaxed. Notice how well everything goes before during and after they hadn’t carried out the compulsive behaviour. Notice what else is better for them as they continue to behave differently. Then take a few moments to relax deeply and gently into that person in the screen. Seeing through their eyes, hearing what they would hear. ‘Try on’ their behaviour and beliefs. ‘Pretend’ what it is like to be them. Enjoy the feelings. Notice how much calmer they feel. Notice the benefits of being this way. Go to some old familiar situations where they had carried out the compulsive behaviour and notice the difference in how they respond to those situations as this person. Notice how calm they feel, how unbullied they feel to be going through the situation being the one in control, calm and relaxed. Then imagine being this person in some future situations when they would expect to have carried out that old compulsive behaviour. Notice how pleasurable it is to respond in this more desirable way. Tell the client to practice this regularly. If occasionally they still get the old compulsive feeling which can happen for a short while as they adjust to not doing that old behaviour suggest they could do this experiment – each time they feel the need to carry out the compulsion treble it. E.g., if they have to check everything is locked 3 times before they leave the house then check it 9 times. Tell them to stick to this whenever they feel the need to carry out the compulsive behaviour. This won’t be appropriate for all cases but if you can set a task that will make the compulsion a chore or change it in some way it is more likely to lead to the compulsion stopping.