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Treatment of Unwanted Thoughts & Sensations in OCD

OCD and Thought Control

If you insist on being symptom-free, “normal” body- and thought-noise become potential threats. This is because they are perceived as unwanted and dangerous.

In my post about the treatment of sensorimotor OCD, a reader asked about the ultimate goal of treatment. Should the goal of treatment be to never notice an unwanted thought or symptom?

Suppressing Unwanted Thoughts & Sensations in Pure-O & Sensorimotor OCD

Let’s explore this idea in detail. Suppose I adopt the goal of being 100% symptom free. After all, this is the endpoint of treatment that most people are seeking.

What are the implications of this goal?

You will likely slow down your progress.

Why? Because every day you will encounter something that violates your expectations.

Unwanted thoughts are a normal part of the human experience. Everyone has thoughts that are unwanted, aggressive, selfish, perverse, or deviant at times. For people without OCD, these thoughts tend to be fleeting because the thoughts themselves aren’t treated as significant. They are accepted as normal brain noise. These thoughts may register, but they quickly get buried beneath other more pressing or interesting thoughts.

For people with Pure-O OCD, unwanted thoughts may occur over and over again. Often these thoughts are considered dangerous or preventable, or they may be regarded as problems in need of solutions. Many people with Pure-O OCD become emotionally invested in filling their heads with the “right” kinds of thoughts.

It is largely the importance we attribute to our unwanted thoughts that determines whether or not they get stuck. As soon as we shift into problem-solving mode via a behavioral ritual or a mental compulsion, we increase the salience and power of the perceived threat.

Rituals reinforce and sustain what-if’s, which is why rituals are so good at maintaining OCD symptoms over many days, months, and years.

If you read my last post about thought control in OCD, you recognize that never having an unwanted thought is an impossible goal. Our brains just don’t work that way. If you insist on being symptom-free, “normal” body-noise and thought-noise becomes a potential threat. This is because it leads you to characterize something normal as unwanted and dangerous.

If you think about it, you’ll realize that it is often not the actual occurrence of symptoms themselves that creates anxiety, but rather the personal ramifications of those symptoms. For people with Pure-O OCD, fear is often based on the possibility that having an unwanted thought means something about you (e.g., maybe you secretly want to harm a family member or maybe you’re really gay). For people with sensorimotor OCD, fear is often based on the idea that you’ll notice unwanted sensations for the rest of your life and that these symptoms will prevent you from living the type of life you want.

Because of these fears, many people with Pure-O OCD (including sensorimotor OCD) adopt thought control as a means for managing, preventing, or reducing the impact of obsessions. Unfortunately, attempts at thought control and fear about a future dominated by symptoms often create a self-perpetuating cycle of fear and avoidance.

Unwanted Thoughts: OCD Feedback Loop

Because thought control is incompatible with the way our brains actually work, it is destined to fail. As soon as it fails and your unwanted thoughts return, your desperation and fear is likely to increase exponentially. This causes many people with Pure-O to re-double their efforts at thought control because they don’t see any other way out. Again, these efforts fail. After repeating this cycle multiple times, individuals often conclude that they are “doomed.”

Moreover, because individuals don’t want their current experience to be “tainted” by their symptoms, they frequently begin avoiding and isolating. They disengage from work responsibilities, stop dating, no longer go to the movies, quit playing golf, etc. Avoidance comes to pervade much of daily life. When avoidance is extreme, symptoms can become a person’s only companion.

Because our brains are constantly abuzz with noisy thoughts, we are guaranteed to notice something unwanted if we look hard enough. If we insist on being 100% symptom-free, it’s easy to become hypervigilant and more sensitized to potential threats. We then are primed to notice smaller and smaller deviations from what we consider “normal”.

As you are engaging in treatment and are getting better, how you handle breakthrough symptoms will largely determine your outcome. If you say, “Aha! It’s still here! I’m never going to escape this!” you turn up the volume on your symptoms. If instead you say, “I can do complex things, even if some of my attention is focused on my symptoms,” the volume is dialed down.

Recovery from OCD involves breaking this cycle by re-engaging in life. It involves treating breakthrough symptoms as normal and unavoidable.

In some ways, this is a very Acceptance & Commitment Therapy (ACT) based way of thinking about your symptoms.

OCD Treatment Goals

Back to the original question…what should be one’s ultimate treatment goal? It should not be to control your thinking. We all have unwanted or “unacceptable” thoughts at times. It is how we respond to these thoughts that either perpetuates them or allows them to drift elsewhere.

Instead, we should work on living according to our values and building the types of lives we want for ourselves despite our symptoms. In a way, embracing coexistence with the unwanted actually creates more space in ourselves for those things we truly want.

Questions? Comments? What have you adopted as your treatment goals? Share below.

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  1. Thanks for the post, some much needed inspiration and direction on this type of OCD I suffer with. Though you hint at it in this post (by including them together) do you think pure-o unwanted thoughts and sensorimotor OCD are very similar?

    • Yes, I think there are many similarities between sensorimotor OCD and Pure-O, most notably the predominance of mental rituals in the two conditions. I think this is particularly true with regard to rituals involving thought control and thought suppression.

      Although Pure-O and sensorimotor OCD are characterized by different obsessive content, both respond to similar treatment approaches (i.e., ERP targeting mental rituals). FYI, I see many patients who experience symptoms of both conditions simultaneously.

  2. Hello Dr.:
    Simple, important, person to person (and to psychology expert) question. Please answer! Is it possible to hit someone with a car and not know it under any normal circumstances? (not intoxicated, not speaking on the phone or doing something else, not speeding – just driving carefully during the daylight time as any OCD person would)? So, is it possible not to know or is it always some kind of delusion of OCDs that you could not know it despite all those, described here circumstances? Or would you say that it is actually not possible under any normal conditions and in case of OCD it is always a delusion?

    I trust this will receive your consideration, and I look forward to hearing from you soon.


    • Hi Rys,

      OCD is often referred to as “the doubting disease,” and overcoming OCD involves learning to be okay with doubt and uncertainty. You might want to read my post on hit-and-run OCD here:

      Trying to know if you would know if you hit someone is an example of a reassurance seeking ritual. Even if someone gives you a direct answer to that question, you will only achieve temporary reassurance. Inevitably, you will ask the question again because reassurance does not last.

      Treatment can help break the doubt-> reassurance-> doubt cycle.

      Good luck!

  3. Thank you for these articles you post, they helped me out a lot. I read all of your articles and it completely goes over all the symptoms I have with my HOCD. I know most people refer to OCD at the “doubting disease” but I just don’t get how one unwanted thought could have made me this way. I mean I do have obsessive thoughts, and currently have (for the most part) conquered other OCD problems I had before this. I currently see a therapist that specializes in OCD and he told me to learn to live with it and practice dismissing the thoughts till they mean nothing and it’s routine. I just don’t get why I keep having these intrusive thoughts,images,and urges that I don’t want. I just figured after a year of going through this so far and being in many relationships with girls my mind would drop it and I could get on with my life. Can you offer any advice to help me get through this? I’m tired of feeling anxious and uneasy everytime a intrusive thought pops in.

    • Although HOCD can feel different than other types of OCD, it’s just as treatable as other forms. It’s hard to know what guidance to give, but here’s something I tell my patients:

      Even if you’re having intrusive thoughts nearly constantly, it’s still important to schedule and complete proactive exposures.

      In my opinion, you cannot beat this by just dealing with the unwanted thoughts that pop up spontaneously. If you’re only dealing with the spontaneous thoughts and not actively seeking out exposure, you’re likely to reach a plateau in your recovery.

      Best of luck!

    • I absolutely now how you feel. I too have other forms of OCD but they come and go depending on the day, fear, etc. This is the conclusion I have come to: None of those OCD thoughts has anything to do with my core values – who I am as a human being. They neither take away or add value. They say nothing about my identity other than “I have OCD”. On the other hand, saying “I am gay?” or “Do I want to have sex with (insert anything here)?” goes directly to our sense of identity or shame about who we may be. I can shrug off the uncomfortable notion that I cant stop thinking about “Show me the blueprints” (check it out on youtube) but to shrug off the lurking feeling inside me that some other person I never knew I was is taking over, occupies a completely different cognitive space.

  4. thanks alot sir,for giving me such detailed information,now I am living my life freely just becoz of u,once again from the bottom of heart thank u

  5. Hi there Dr seay
    Iv been reading through your articles with lots of intrest and would really appreciate your insight into whats going on with me at the moment.
    Ive suffered with panic attacks on and off for the last 13yrs(mainly off)with the exception of 10 yrs ago when i was pregnant with my 1st child,i had a really bad cold and couldnt breath at all through my nose which wouldnt of normally bothered me i would of taken some nightnurse at night and slept through it but because meds are to be avoided i obviously didnt take anything which resulted in a night whereby i didnt sleep at all and became very anxious. this anxiety completely absorbed me the following day and i was dreading going to bed that evening incase i didnt sleep again.This resulted in me not sleeping for 4 nights and becoming very anxious with severe panic attacks where my body would jolt as adrenaline coursed through my body,i didnt have a clue what was happening to me and was terrified of the consequences for me and my unborn child.The end result was i was put on 25mg of dothiepin at bedtime from 28weeks pregnant which i came off at 34 weeks pregnant because i felt so much better but that episode in my life has always been there in the backgroud like a bad dream.
    since then ive had the odd panic attack thats led to a bit of anxiety in the day but then its quickly dissaprered but i do have an anxiety related related response to not being able to breath through my nose or not being able to sleep.
    My current situation is im currently 28 weeks pregnant with my third child and started to feel anxious again about a month ago(i have pregnancy related rhinnitus)which only really bothered me innitially at night i took an antihistamine which made me feel better but i night i became very focused on my breathing so i could fall asleep.This then led me to question whether i could cope with rhinnitus if it didnt clear up after i had the baby that thought made me panic and i became very intrested in my breathing in the day,I soon realised that it felt like i was controloing every breath i took ,which really worried me beacuse id been breathing subconsciously for the last 37 yrs without ever thinking about it & now i was hyper aware which made me feel abnormal ,anxious and scared that i was loosing my mind. I focused on my breathing for about 2 weeks i then read your article on pure o ocd somatic obsessions,swallwed once consciously and that was it ive forgotton about my breathing and ive been stuck on my swallowing for the last two weeks,because im pregnant sleep has become somewhat allusive so ive been taking 25 mg of promethazine at night which has helped but in still waking every couple of hours and if i ,im start thinking about my swallowing(which i always do) i start feeling anxious that im not going to get back to sleep,im really struggling to ralax in the day,altthough i can have moments whereby i be distracted,its still always there in the backgroud.
    I was diagnosed just over a week ago with GAD and im waiting for CBT ive also started a programme of accupuncture,just felt like i needed to do something pro-active rather than just sit waiting for CBT Ive only had two treatments but have definately felt some benefits.
    Also feel i need to point out ive been under alot of stress this last 12 months,ive had a miscarrige thgen 3 weeks later my dr suspected i may have ms,my brain scan came back all clear then 4 weeks after that i became pregnant again and ive had a lot of emotional and financial stresses during this pregnancy.
    my question is to you do you taking everything into account do you think i could be suffering from a pure o somatic obsessions?Just really need to know when i finally get some CBT that its the right type.

  6. i was just wandering i have OCD thoughts and they invovle me stabbing family members or i ocassionally think that if i am getting annoyed i will, think”err i could just kill him”, however i would not and these thoughts really scare me. Could somebody please offer me advice how to rid of these thoughts and will i really become a murderer?

    Yours Faithfully Thomas.

  7. Hi Dr Seay,
    I am writing to inform you of horrid, intrusive thoughts i have been experiencing. They began late september and ever since have really worried me, actually killing someone is my greatest fear and i hope i will never engage in such an act. My mother is aware of this, and i frequently ask her to visit a therapist, my mum is a great mum, however at the moment i am unable to see a therapist. Knowing my mothher she probably will advise me to visit a therapist . All i would like to understand is, do i really have Harm OCD or am i actually a budding serial killer. My birthday is just around the corner and, i would love to be with my family, however the ‘thoughts’ of me killing my family haunt me once again, making me depressed.

    What i want to know, will i be serial killer and kill my family? Also do i really have Ocd.

    Thank you for your time!

    • Have you read my post about the fear of killing others? That article talks about aggressive obsessions and the fear of being a serial killer. While you’re there, also see my reply to Alexandre in the comments, which talks about reassurance-seeking questions.

      Wishing you the best!

  8. Hi Steven,

    So essentially I have been experiencing sensorimotor OCD for almost 3 months now. I tried going to some therapists but none of them had any experience with this type of problem. I have been out on Prozac but only 20 mg which I have heard is the amount for anti depression not OCD. It has been the worst with breathing for me but I have also experienced it with blinking and swallowing. I at first only wanted it to just go away but now I am focusing on the fact that I can still live my life and do complex things despite it. However, I’d still like for it to eventually go away. I think I’d like to do ERP. Do you have any advice for how to find therapists that can do ERP, or maybe any things I can perform myself. For me the fear is that it won’t go away. Also would you advise raising my dose to like 60 mg while I also seek ERP treatment? Any other advice would be great. In the long run I’d like to only think about it a couple times a day if possible, is that a realistic long term goal?

    Thanks a ton,

    • Hi Nick,

      Outcomes are individualized, so there’s really no way to predict your specific therapeutic endpoint in advance. As you read in the article, aspiring to a symptom-free existence is most likely to slow down your progress. Work on coping with your symptoms and handling them with grace, rather than trying to eliminate them entirely. The concept of acceptance will be a very critical component of your recovery.

      Techniques that are also likely to be helpful in this regard include imaginal exposure, including exposure to the idea that it may never go away.

      I would suggest finding a therapist via Approaches that tend to be well-suited for SMOCD include ERP, as well as Acceptance and Commitment Therapy (ACT). RE: medication, as you mentioned, OCD tends to respond to higher SSRI doses than depression requires. As such, you might want to consult with your doctor or psychiatrist about the possibility of upping your dose.

      • You are right, in retrospect making your ultimate goal to get rid of the symptoms only makes you fail every time they come up. Trying to avoid the symptoms or distract yourself only reinforces the fear and anxiety. Right now I have changed my approach to recovery. I don’t have the money right now to see a therapist so let me know if I’m on the right track. Now I have started doing ERP therapy to myself. I am going to set an hour a day to just focus on the symptoms and try to do imaginative ERP as well. Then throughout the day I do my tasks thinking about my breathing and blinking. Therefore if I am able to perform the task it is a success. What do you think about this approach? I wish I could just go see a therapist but I don’t think I financially can. Also my final goal now is to learn to coexist with the symptoms and not let them cause anxiety in me.

  9. This has honestly brought so much peace into my mind and has really made me understand that I’m not “doomed” and I’m also not alone. I’ve suffered from these intrusive thoughts for as long as I remember and always just assumed there was something unbelievably wrong with me. Reading this, I realize that almost every single symptom and the descriptions of the OCD cycle fit so perfectly to my own brain mechanisms that it’s scary. I’ve already been diagnosed with OCD as well as Generalized Anxiety Disorder, but even while knowing that these are the reasons behind my unwanted obsessions, I still find myself locking on to them and doubting whether or not it’s really a disease or I’m just some sick crazy person. This article has made me realize that I don’t have to live a life like that and I can overcome my submission to these thoughts. This site has really made me motivated to try hard to accept and be at peace with myself and my doubts, and has also made me realize that I’m not crazy! Thank you so much!

  10. I think I have HOCD as I all of a sudden started to fear I was actually a lesbian. The timing coincided with being lonely at Uni and wanting to switch degrees. Now, I can’t get the thought out of my head. I don’t sleep, I feel nauseous, I’m taking an anti-depressant. I was never boy crazy but now what I used to feel about boys, love scenes is gone and replaced by thoughts about whether I’m attracted to girls. So then I have to check and if I feel a little something I get anxious and the cycle continues. I can’t do anything. At work I’m checking and thinking, at school it’s all I do. I can’t even read of watch a movie without feeling hyper aware and overwhelmed.

  11. hello dr.
    I am suffering from doc put me on fluoxetine.will it stop my unwanted thoughts?plz.reply sir….

  12. Hello,
    I also suffer from sensation OCD and other kinds of OCD.
    Its maybe also BDD but i am not really sure now.
    i been to psychologist before and i started going now again for trying to understand if i want to marry my current girlfriend or not (not realizing it might be ROCD) then i talked to him about my sensation or BDD symptoms and since then i feel it more.
    i get a feeling sometimes that my right nasal becomes bigger or swolen, i keep touching it to shrink it back to normal again, i used to ask people before if they see something and they all say they did not. now i know that people dont see it and i am almost sure that its only a feeling and not really getting bigger (although it feels like it is).
    another problem for me that also got to do with appearance is my relationship with my current girlfriend. we have a very good relationship and she is a very understanding person, i shared with her all of my OCD problems and stress and she allways understand and accept me the way i am, she is smart and good looking in general. problem is that sometimes i think she is not pretty and i feel like i am ashamed of her (although i am not perfect myself and she is not ugly for sure)
    now, i worry to go back to the psychologist as i feel that its just make the sensation OCD worse although i understand that it might be a good thing. (the nose thing was an issue few years ago and became small issue and now its an issue again after talking about it with the psychologist)
    sorry for my bade English, its late here and its not my mother tongue
    will be happy to hear your opinions about my story.
    Thank you in advanced.

  13. Helllo, thank you for your post. I have been diagnosed with OCD, I saw a picture of child pornography, and I have been very sick thinking about this pictures, I have also had sensations between my legs when I see children.

    What type of OCD do I have? Sensorimotor OCD or pure OCD? I would really appreciate any feedback on my condition as these sensations are unwanted and it’s a mystery to me why they happen in the first place.

  14. Hello Doctor.
    Why is it that some people suffer from,say, the fear of having sexual thoughts about parents/images when they are not actually attracted to their parents while others do not? Does this somehow indicate that unconsciously the suffering individual might actually be attracted to their parents? I would be really thankful if you replied.

  15. Hei steven.thanks for information.Im diagnosed in Norway with ocd (often i doubt about it).can you explain what impulse and urges mens. I have thoughts about killing my doughter -and often its wanted,not unwanted. My terapist says i have impulse control..

    • The topic of unwanted urges can certainly be confusing. I discussed this concept in a bit of detail in the comments of one of the posts on OCD & pets. Maybe it would be helpful to take a look at that conversation, especially the last part that talks about “urges” vs. “intentions.”

  16. Doctor I’ve been having unwanted thoughts and I have to say I really feel hopeless.. I’ve been diagnosed with hocd and I have read an article about people saying OCD doesn’t exist.. But I know it does exist.. And I read an article about people with hocd coming out and accepting it…that is when I started panicking
    And I had this cold feeling,I honestly couldn’t sleep..Ever since I was a little girl I wanted a boyfriend and get married.. I just want to know why does some people act out?

  17. I think I developed this ocd when I was 14 years old.Before developing these unwanted thoughts I was an student who scored above average marks and was a topper in various competitions.This ocd makes me think anything unnecessarily or create images of any kind in my mind whenever I read which I can’t prevent.But reading your above article says that I should learn to love with these thoughts Learn to think and read at the same time but this decreases my efficiency to a very low level with I can’t clear top competitive exams which I hope to do in the future and this is not the kind of live that interests me.All I want is to read without these recurring images which are unfounded and can be of anything.Isnt there any way I could get rid of these thoughts while raiding?Learning to live with them doesn’t make anything better for me quite contrary to as you say.Please help

  18. Sir your articles are really insightful. I am able to relate most of what you have written for obsessions in OCD. Makes me feel a lot better. God bless you 🙂

  19. Dear Steve, I hope you are good! I am in a very dark place, consumed with unwanted horrible sexual thoughts that have been plaguing my life on and of since i was a child (im 50 now!) I have t check the thought to see how i feel and i never seem to get a valid conclusion. (the thoughts are distressing oral sex thoughts with men, children, anyone!) Sometimes when checking it seems that the thoughts are ok, just a sensation and my mind says, see youlike the thought. But i hate having the thought, it causes me so much distress and severe depression. I also have to analyse the thought and i try to work out where the thought originated from which is very hard to remember. I constantly ruminate about the past to see when i had the thoughts and if i liked the thoughts or not. Is checking your thoughts valid, does it give you a good idea of how you feel? If i like the thoughts that makes me a perverted monster! I have never felt aroused or anything sexual when having the thought. mainly anxiety, fear and dread and then analysis afterwards. Most of the time the thoughts feel just like anxiety and fear and a sensation in my lips, which is weird. Very surreal. Very rarely is it a full blown image of the horrible sexual act. Its as if the fear precludes the sensation. I have periods of my life, usually when stress free or busy that the toughts fade itnto the background, but i also have triggers which scare the life out of me. Im like if i have these thoughts most f the time they must mean something. I find it very difficult to accept the thoughts and not ruminate. Also my mind ruminates about the thoughts i have had and makes me feel so guilty and not wanting to carry on. It is a living hell. Often my mind says , but maybe you liked the thought you had. Trying to rememeber how i felt in the past is draining and im sure mentally damaging. I have done several PhD in my mind! Also i feel so much regret as there are lots of things that i have always dreamed of doing and havent done, mainly to indecision, or low esteem or fear. I want to get my life back as i still have time to get better and return to studying and loving my family and being happy again. These stupid thoughts have taken so mch of my life away. I have been dignsed with ocd but i iften doubt whether this is true and recently it seems that the thoughts are intentional , like some kind of self punishing impulse which gives me an anxiety rush. I am sure i am placing far too much significance on these bloody thought! Some advice would be very kind of you. Have a lovely weekend Julian

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