When Love Triggers Anxiety: How ERP Helps ROCD
In my last two posts, I discussed Exposure and Response Prevention (ERP) for ROCD (relationship OCD). I summarized how exposures work in ERP and began to discuss how response prevention works to address compulsions. Response prevention is arguably the most difficult and most important part of ERP, which is why I want to spend more time talking about response prevention skills when doing ERP therapy for OCD and ROCD.
What Response Prevention Means in ERP Therapy
As described in my last post, response prevention is about not doing a physical compulsion-an action you take in response to the distress you're experiencing (for example, repeatedly checking something, washing something, researching something, etc.)-and riding the wave of anxiety. I describe in detail what riding the wave of anxiety means in my last post, which you can read here: ERP for ROCD: What Treatment Looks Like When Doubt Feels Constant (part two)
Mental Compulsions: The Harder-to-Spot OCD Behaviors
I want to talk about those sneakier compulsions that can often be harder to manage and harder to catch. These are mental compulsions. Mental compulsions are the quiet things you do in your mind to try to make your distress go away, and just like with physical compulsions, this is how you get stuck in the OCD cycle.
Common mental compulsions include:
mental reviewing (like rumination)
memory checking
neutralization (for example, trying to replace a negative thought with a positive thought)
fortune-telling (repeatedly trying to predict the future in imagined scenarios)
mental reassurance seeking (repeatedly trying to say calming things to yourself).
There are many more.
Addressing Mental Compulsions Early in ERP
Just like with all compulsions, mental compulsions are repeated because OCD wants certainty, and we can never provide that for ourselves. We will always find a loophole, another "what if," another perspective to consider. So even if you are not doing compulsions that others can see, you could be performing compulsions silently in your mind. At times, you might not even notice that you are engaging in mental compulsions because it has become so automatic.
So what do we do about mental compulsions when doing ERP for OCD? I like to address these early on in treatment. Other therapists might do things differently, but I have found it helpful to teach clients how to manage mental compulsions-especially rumination-before getting into other exposure work. I am going to give a few examples of how I do this, and I will use ROCD as the theme in my example.
A Hypothetical Example of ROCD and Mental Rumination
I am going to use a hypothetical client situation to illustrate. Let's say Jill is struggling with ROCD and trying to figure out if she is in the RIGHT relationship. She used to do a lot of research about relationships, constantly asked friends for reassurance, and confessed all her thoughts to her partner. These things started to bother her friends and her partner, so she stopped doing these compulsions. But she still finds herself experiencing anxiety regularly and feeling obsessed with trying to figure out if she is in the right, most healthy, most aligned relationship.
She spends lots of time ruminating over things her partner says that bother her, constantly analyzing her partner's style and lifestyle and trying to predict how she will feel about these things in the future. She is often scanning herself for attraction toward her partner and others as she desperately tries to determine, with certainty, whether she is attracted to her partner.
On the outside, she might not seem like she is stuck in an OCD cycle. In fact, Jill is high-functioning and is able to go to work and hang out with friends. But she is not totally present and engaged with her life because internally, she is in another world in her mind. Sound familiar? If you're suffering from OCD or related challenges, this probably sounds all too painfully familiar.
Practicing Response Prevention for Mental Compulsions
Here's the thing, though: what Jill is doing in her mind is a habit. And we can change habits. So what I would do during the first stage of OCD therapy with Jill is ask her to write down a distressing thought. Not the most distressing thought about her relationship, but an intrusive thought that gives her a medium level of anxiety. I would then have her write this down on an actual sticky note or in a note on her computer or phone, anywhere she will see it multiple times a day. I often have people set reminders on their phone with the intrusive thought. This way, Jill will see the distressing thought throughout the day and practice not engaging with it. This means reading the statement and then purposely carrying on with her day.
If her mind starts to ruminate, analyze, or answer "what ifs" about the thought, she practices noticing that and then shifting her attention away from the thought, even when she feels anxious and like she HAS to figure it out. With time, this thought will either not bother her as much because she has learned that it is not dangerous by intentionally confronting it, and/or she learns that she can tolerate anxiety and move on with her life without performing mental compulsions.
Please note that this is not therapeutic advice. Developing a treatment plan can be quite nuanced and individualized, but my hope as an OCD therapist is that this gives you an idea of how ERP therapy for OCD works while also giving you a taste of what it's like to manage mental compulsions.
In my next blog, I will discuss more response prevention skills I teach my clients in ERP for ROCD. Stay tuned.
Learning to Step Out of the OCD Cycle
If you've been following along with this series, you may be starting to notice how OCD operates-how it pulls you into doubt, urges you to find certainty, and keeps the cycle going through compulsions. ERP therapy focuses on gently interrupting that cycle so you can relate to fear, doubt, and uncertainty in a different way.
Jen Lescher, LCSW, offers Exposure and Response Prevention (ERP) therapy for OCD and ROCD. In therapy, the work focuses on understanding how OCD shows up in your life, identifying compulsions (including the mental ones), and learning practical ways to respond differently when intrusive thoughts appear.
Virtual ERP Therapy Throughout Massachusetts and California
I offer ERP therapy in Boston, MA, and also work virtually with clients throughout Massachusetts and California, making specialized OCD treatment accessible even if you're not located near my office.
If You're Ready for the Next Step
If you've been reading these blogs and noticing your own patterns-rumination, reassurance-seeking, mental reviewing, or the feeling that you need certainty before you can move forward-it might be time to explore additional support.
ERP therapy at Jen Lescher, LCSW, can help you learn how to step out of the OCD cycle and develop a different relationship with anxiety.
If you're considering therapy, you might start by:
Learning more about ERP therapy and OCD treatment
Exploring additional blogs on OCD, ROCD, and anxiety
Reaching out to schedule a consultation to see if working together feels like the right fit
Additional Support for Relationship OCD
Along with one-on-one OCD therapy, I also offer supportive resources that address challenges many clients face outside of sessions. On the Common OCD Themes page, you can explore detailed insights into recurring thoughts and behaviors. The OCD and Social Life page offers guidance for managing friendships, dating, and relationships while living with OCD and anxiety.
About the Author: Jen Lescher
I'm a therapist, a devoted coffee lover (truly - it's one of my favorite daily comforts), and someone who values small moments of presence. That might look like slowing down with mindfulness, getting behind my camera, or taking a quiet walk just to notice what's around me. Photography especially keeps me grounded and curious - two qualities I bring into my work with clients.
I've been drawn to healing and spirituality since my teenage years and have explored many paths along the way, from meditation to energy-based practices. At the same time, I'm just as likely to be blasting music in the car or listening to a true crime podcast. To me, healing isn't only about stillness or insight - it can also include movement, humor, and moments of joy. Therapy should make room for all of that.
I've worked in a variety of mental health settings since 2007, and that experience shaped one of my core beliefs: healing is never one-size-fits-all. It's personal. It evolves. It can feel messy. And it's always possible.
Training & Background
Inference-Based CBT (ICBT) for OCD - The OCD Training School & The Cognitive Behavioral Institute
Certified in Exposure and Response Prevention (ERP) - The Cognitive Behavioral Institute
Gottman Method Couples Therapy - Level 1
Master's in Social Work - Portland State University, 2012
