Free From OCD. A Workbook For Teens With Obsessive-Compulsive Disorder (PDFDrive)

Publisher’s
Note
This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold with
the understanding that the publisher is not engaged in rendering psychological, financial, legal, or other professional services. If
expert assistance or counseling is needed, the services of a competent professional should be sought.
Distributed in Canada by Raincoast Books Copyright © 2010 by Timothy A. Sisemore Instant Help Books
A Division of
New Harbinger Publications, Inc.
5674 Shattuck Avenue Oakland, CA 94609
www.newharbinger.com
Cover design by Amy Shoup All Rights Reserved
Epub ISBN: 9781608820979
The Library of Congress has Cataloged the Print Edtion as: Sisemore, Timothy A.
Free from OCD : a workbook for teens with obsessive-compulsive disorder / Timothy A. Sisemore.
p. cm.
ISBN 978-1-57224-848-9
1. Obsessive-compulsive disorder in adolescence--Treatment. 2.
Obsessive-compulsive disorder in adolescence--Popular works. I. Title.
RJ506.O25S57 2010
618.92'85227--dc22
2010019138
contents
A Letter to Teens
A Letter to Parents or Caregivers
ACTIVITY 1. RECOGNIZING YOUR STUCK THOUGHTS AND
RITUALS
ACTIVITY 2. HOW DO STUCK THOUGHTS AND RITUALS AFFECT
YOUR LIFE?
ACTIVITY 3. IMAGINING YOURSELF FREE FROM OCD
ACTIVITY 4. TRACKING YOUR OCD
ACTIVITY 5. RECOGNIZING YOUR TRIGGERS
ACTIVITY 6. RANKING YOUR SYMPTOMS ON THE STAIRS OF
CARES
ACTIVITY 7. NAMING YOUR STUCK THOUGHTS AND RITUALS
ACTIVITY 8. IDENTIFYING YOUR IRRATIONAL THOUGHTS
ACTIVITY 9. EXAGGERATION OR DISTORTION? HOW TO TELL
ACTIVITY 10. BEING REALISTIC ABOUT DISTORTED AND
EXAGGERATED THINKING
ACTIVITY 11. CONTROLLING THE NEED FOR CONTROL
ACTIVITY 12. LOOKING LOGICALLY AT YOUR STUCK THOUGHTS
ACTIVITY 13. GETTING PSYCHED TO FIGHT
ACTIVITY 14. STOP THAT THOUGHT!
ACTIVITY 15. ARGUING WITH YOUR STUCK THOUGHTS
ACTIVITY 16. REPLACE THAT THOUGHT!
ACTIVITY 17. THINKING IT TILL YOU’RE TIRED OF IT
ACTIVITY 18. DON’T BE FOOLED BY FEELINGS
ACTIVITY 19. CONQUERING YOUR NERVOUS FEELINGS
ACTIVITY 20. RECOGNIZING YOUR THOUGHT LOOPS
ACTIVITY 21. HOW RITUALS MAKE STUCK THOUGHTS WORSE
ACTIVITY 22. STANDING YOUR GROUND AGAINST RITUALS
ACTIVITY 23. HANGING IN THERE WITH NERVOUS FEELINGS
ACTIVITY 24. EASING YOUR ANXIETY WITH DEEP BREATHS
ACTIVITY 25. SHOULD OTHERS HELP YOU FIGHT YOUR
RITUALS?
ACTIVITY 26. DISRUPTING YOUR RITUALS
ACTIVITY 27. MAKING YOUR RITUALS IMPOSSIBLE
ACTIVITY 28. PLANNING TO PREVENT YOUR RITUALS
ACTIVITY 29. DON’T DO IT!
ACTIVITY 30. BEATING YOUR STUCK THOUGHTS WITH
EXPOSURE
ACTIVITY 31. WHAT ARE YOU AVOIDING?
ACTIVITY 32. FACING YOUR FEARS IN YOUR IMAGINATION
ACTIVITY 33. RANKING SITUATIONS THAT MAKE YOU NERVOUS
ACTIVITY 34. MAKING A PLAN FOR EXPOSURE
ACTIVITY 35. EXPOSING YOURSELF
ACTIVITY 36. DOING WHAT YOU FEAR ON PURPOSE
ACTIVITY 37. HANDLING THINGS THAT AREN’T “JUST RIGHT”
ACTIVITY 38. PUTTING IT ALL TOGETHER
ACTIVITY 39. BACK IN THE GAME
ACTIVITY 40. THE STORY OF YOUR SUCCESS
A Letter to Teens
Dear Friend,
From the fact that you picked up this workbook, I’d guess that you have faced
some stubborn, troubling thoughts or some irritating, strong urges to repeat
certain behaviors. You’re certainly not alone. Many young people wrestle with
similar problems, varying from some that are pretty mild to those that are so
severe that they change almost every aspect of life. Most teenagers who have
obsessions and compulsions keep them to themselves as best they can. They
might confide in a parent, friend, or teacher, but for the most part they find the
symptoms either embarrassing or fear getting teased about them. That’s
understandable—being young is hard enough without having to deal with
obsessions and compulsions.
I believe that you can beat these problems, or at least make them a lot easier to
deal with, if you faithfully work through this book. I know that the idea of a
workbook may put you off, but it’s the “work” that will make you better—not
just reading. In fact, I think that the time you spend doing these activities will
easily be made up by your spending less time dealing with stubborn thoughts
and rituals.
These thoughts and rituals are part of a full-blown problem called obsessive-
compulsive disorder (OCD). The primary symptoms are obsessions, or thoughts
that occur over and over, which are usually worries about something bad
happening. We’ll be calling them “stuck thoughts” to stress that they don’t have
to be symptoms, just irritating problems. Compulsions are the almost irresistible
impulses to do certain things over and over. They are often used to ease
obsessions. We’ll be calling these “rituals” in the pages ahead. But I don’t want
you to focus on whether or not you “officially” have OCD. Rather, if you have
stuck thoughts and/or rituals, these activities should help. You may do them
completely on your own or have a parent or friend help keep you going when the
activities challenge you a bit. Either way, your efforts will help you regain
control of your life, for stuck thoughts and rituals want control of your life, and
they shouldn’t have it.
So congratulations on taking the first step to beating these thoughts and rituals—
admitting that these things are bothering you—and on picking up a book to help
you do something about it.
I wish you the best as you break free from OCD.
Tim Sisemore
A Letter to Parents or Caregivers
Dear Caring Adult,
Teens with obsessions and compulsions are usually not “bad” kids and so their
anxiety and frustration are often overlooked. By being concerned enough about a
teen in your life to look into this workbook, you’ve taken a step to help the
young person you care about.
Teens vary in how open they are about obsessive-compulsive disorder (OCD),
for it’s a pain to feel controlled by these symptoms at a time of life when teens
are trying to develop more freedom. But beating the symptoms of OCD can be
very freeing (thus the title of the book) and can help teens move on into
adulthood. Moreover, beating something as challenging as obsessions and
compulsions can boost teens' self-confidence as they face challenges in the
future.
Teens also vary in how much they’ll want adults to be involved in their
completion of this workbook. I suggest giving your teen that choice. You can
serve as encourager and accountability partner, but only if the teen is receptive to
that. You also can help if your teen gets stuck in obsessions or compulsions
without being aware of it—again, only if he or she is open to that. If not, you
may be seen as nagging or interfering. The bulk of the work in beating these
symptoms is for your teen, not you. You might just ask what role your young
person wants you to take, and stick to it.
The techniques in the book are built on scientifically supported strategies for
counseling. I’ve turned them into activities so that many teens will be able to
make progress without counseling. However, OCD can be stubborn and
counseling often is necessary. These activities can also be part of such
counseling. While medication can be helpful as well, I suggest at least giving the
workbook and counseling chances first unless your teen is suffering so much that
it is compromising a normal life.
I know your teen will appreciate your support, your respect, and your patience as
he or she moves toward victory over obsessions and compulsions, and I wish
you both success. Thank you for caring.
Tim Sisemore
1 recognizing your stuck thoughts and rituals
for you to know
There are many kinds of obsessions (stuck thoughts) and

compulsions (rituals) that can trouble you, and they may
change over time. Learning to recognize them can help you
overcome them.
In the classroom, Marci seemed to act like everyone else. But in private, she
really struggled. Her mind was almost always on trying not to get sick. She
worried about being around anyone who had the slightest sniffle, and she waited
till she got home to go to the bathroom so she didn’t have to use a public one—
and so others wouldn’t see how long she spent washing her hands after she went.
She also feared that something bad might happen to her mom if she didn’t tap
her foot ten times every time this worry crossed her mind, which was often.
Marci held it together fairly well around her friends, but these stuck thoughts and
rituals broke loose when she got home.
Marci had only a couple of the common problems that make up obsessive-
compulsive disorder. We’ll call obsessions “stuck thoughts” as they are worries
that are hard to shake (like Marci’s worries about getting sick or something
happening to her mom). We’ll call compulsions “rituals” as they are things you
do over and over (like Marci’s washing her hands and tapping her foot), usually
to try to control stuck thoughts.
Since you’re reading this, it’s likely you’ve had some stuck thoughts or rituals.
The first step to beating them is to recognize them.
for you to do
Think through the past couple of days. How many of these stuck thoughts have
you had? Using your journal, list the thoughts you come up with.
#___ ___________________________.
#___ ___________________________.
#___ ___________________________.
#___ ___________________________.
#___ ___________________________.
Go back through your list and rank them from the most bothersome to the least
bothersome, putting a 1 by the most annoying, and so forth.
What are some of the rituals that you experience? Once again, think through the
past couple of days and list all the rituals you remember doing.
a. ___________________________
b. ___________________________
c. ___________________________
d. ___________________________
e. ___________________________
Good job!
wrapping it up
Often certain rituals go with certain stuck thoughts. It doesn’t have to be just
one. Write the letters (a, b, c, and so on) of the rituals that tend to go with each of
your stuck thoughts: Stuck thought #1 leads to ritual(s):____, ____, ____, ____.
Stuck thought #2 leads to ritual(s):____, ____, ____, ____.
Some stuck thoughts aren’t really connected to any rituals. They’re just kind of
there. List any of your stuck thoughts that don’t seem to lead to rituals.
_________________________________
_________________________________
_________________________________
Some rituals just reduce nervousness and aren’t related to stuck thoughts. Was
this true of any of yours? List any rituals that aren’t related to stuck thoughts.
_________________________________
_________________________________
_________________________________
Are your symptoms worse than you thought, not so bad, or about what you
figured?
_________________________________
_________________________________
_________________________________
2 how do stuck thoughts and rituals affect your
life?
for you to know
As if it isn’t bad enough to wrestle with stuck thoughts and

rituals, for many teens these symptoms can have a big
impact on many areas of their lives—particularly in
friendships and self-confidence. In some ways these “side
effects” can be worse than the stuck thoughts and rituals
themselves.
Jamaal doesn’t really appreciate his new nickname, Mr. Perfect. Though he has
really tried not to, he still has to keep every paper straight in his organizer and
catches himself straightening up his friends’ papers. He used to feel good about
himself and thought he was pretty popular and cool. But now that his stuck
thoughts and rituals have gotten worse, he doesn’t go out with friends much
because he just doesn’t want to hear the teasing. He has to go to school but
wouldn’t if he didn’t have to. Though his friends say they’re just teasing, Jamaal
doesn’t find it very funny. Having OCD is a pain.
for you to do
Have others—family, friends, or teachers—noticed your rituals? What kinds of
things have they said about them?
Have others pointed out that you’ve changed in some way since OCD became a
bigger problem for you? Can you remember what they said?
_________________________________
_________________________________
_________________________________
How do you think your stuck thoughts and rituals have impacted your
relationship with your parents? Have your parents been helpful or do they make
you feel worse?
_________________________________
_________________________________
_________________________________
How have your stuck thoughts and rituals impacted your relationships with your
friends? Have your friends been helpful or do they make you feel worse?
_________________________________
_________________________________
_________________________________
Are there places or activities that make you uncomfortable or that you try to
avoid because of these symptoms?
_________________________________
_________________________________
_________________________________
Since stuck thoughts and some rituals are often “invisible,” only you know about
them. How have these changed the way you feel about yourself?
_________________________________
_________________________________
_________________________________
How do your symptoms affect the sense of control you have over your life?
_________________________________
_________________________________
_________________________________
What is the single biggest change in your life that is due to OCD?
_________________________________
_________________________________
_________________________________
Keep these changes in your life in mind as you work through this book, because
knowing how much OCD affects your life can give you motivation to fight it.
wrapping it up
As you went through the exercise, did you discover some ways OCD has
affected your life that you hadn’t noticed before? If so, what were they?
_________________________________
_________________________________
_________________________________
Can you think of any other ways that OCD has affected your social life or your
self-esteem?
_________________________________
_________________________________
_________________________________
How does what you’ve learned in this exercise affect your thinking and feeling
about OCD?
_________________________________
_________________________________
_________________________________
3 imagining yourself free from OCD
for you to know
Often it’s helpful to imagine your destination as you begin a

journey. As you begin working on your OCD, imagining life
without it can motivate you to keep going.
It wasn’t until Carlota talked to her school counselor that she realized how much
time her stuck thoughts and rituals were costing her. Now she knew why she felt
so stressed and frustrated—her free time was filled with worries and rituals.
Tired of all this, Carlota was ready to free up more time to hang out with friends
and play video games. She missed those things and planned to work hard on her
OCD so she could win back her free time.
Wonder how much time your stuck thoughts and rituals are costing you?
for you to do
Think first about your rituals, like doing things a certain number of times or
checking the doors on your house before leaving for school. About how much
time do you think you spend doing these things on a typical day? Run through a
whole day in your mind to come up with your guesstimate.
I spend about _____ (hours) and _____ (minutes) a day on my rituals.
What problems do they cause you (for example, having to get up early, take
more time doing things, go out of your way to avoid situations, etc.)?
_________________________________
_________________________________
_________________________________
Now think about your stuck thoughts, like worrying that someone you love will
get hurt if you don’t avoid all the cracks in the pavement on the way to school.
Try to estimate how much time you spend with these thoughts on your mind in a
given day.
I spend about _____ (hours) and _____ (minutes) a day on my stuck thoughts.
What problems do they cause you (for example, getting distracted at school,
changing your routines, causing you to avoid being with friends, etc.)?
_________________________________
_________________________________
_________________________________
Daily time OCD takes from me (ritual time + stuck thought time) =
_____ hours, _____ minutes
Think about this: Each hour per day you spend on OCD means 365 hours a year.
That’s about the same number of hours that you’d spend if you had to go to
school for your entire summer break!
wrapping it up
How do you feel now that you’ve figured out how much time your symptoms
take from you?
_________________________________
_________________________________
_________________________________
List some things you’ll do with the time you have once you overcome OCD—
for example, having an extra hour a day for friends or learning to play the guitar
or doing homework (well, maybe not).
_________________________________
_________________________________
_________________________________
List three words to describe your thoughts and feelings about getting that much
time back.
______________ ______________ ______________
Take a moment to close your eyes and imagine your new life. How does it feel?
How is your social life better? How much freer do you feel without the burden
of your stuck thoughts and rituals? How does it feel to imagine waking up in the
morning without stuck thoughts and rituals? Don’t write anything here … just
enjoy imagining.
Overcoming OCD will make you feel more control over and confidence in your
life as you will have beaten a powerful adversary!
4 tracking your OCD
for you to know
OCD symptoms vary from minor bothers to major hassles.

You can begin to get better by learning to track how bad the
symptoms are and what makes them better or worse.
For years Katie worried about doing something wrong, and more recently she
had been almost paralyzed by the urge to pray for forgiveness many times a day.
This urge made it hard for her to concentrate in class and even to pay attention
when she was watching movies. Katie became so frustrated that she decided to
try to figure out when her symptoms got worse. She noticed that she worried the
most intensely the day after she stayed up late doing her homework. Realizing
this, she was able to predict when her symptoms might be at their worst and to
get some control over them. Knowing how to rate how severe her stuck thoughts
were helped Katie recognize them better, plan a strategy to fight them, and track
the improvement as they became less severe.
for you to do
Choose one of your stuck thoughts or rituals that bothers you most and think
about how much it bothers you based on the following scale: OCD Rater
1 = The thought (or impulse to do a ritual) crossed my mind, but I went on doing
what I was doing.
2 = I thought about it for a minute, but shook it off and carried on.
3 = It made me nervous, and I felt I needed to do something (like a ritual) to ease
my nervousness.
4 = It really bothered me. I couldn’t keep my mind on what I was doing and felt
very strong urges to do a ritual.
5 = It overwhelmed me. I was lost in worry and/or felt I couldn’t help doing the
ritual.
Choose a time when you’re not incredibly busy and take the time to notice and
record each time you catch yourself in the act of a stuck thought or ritual. Fill
out the form below in your journal until you have caught yourself ten times.
wrapping it up
During what activities or times of day did your OCD seem more severe?
_________________________________
_________________________________
_________________________________
During what activities or times of day did your OCD seem not so bad?
_________________________________
_________________________________
_________________________________
What might explain why your stuck thoughts or rituals are worse at those times?
More stress? More free time to think about them? Being around (or away from)
certain people or situations?
_________________________________
_________________________________
_________________________________
Did you notice anything about how you reacted differently (had stronger urge for
a ritual, felt shaky or nervous, etc.) when the stuck thoughts were stronger
compared to when they weren’t?
_________________________________
_________________________________
_________________________________
Keep tracking your OCD, even if only in your head, as this will be a useful skill.
5 recognizing your triggers
for you to know
Stuck thoughts and rituals aren’t always as random as they

may seem. If you look closer, often there are places, times,
or activities that stir them up. These are called triggers.
Enrique felt like his stuck thoughts owned him. They seemed to pop up all of the
time, and he thought there was no escaping them. He struggled to control his
rituals in public, but doing so wore him out and made him feel worse once he got
home. One day, though, his best friend, Michael, asked, “How come you always
start worrying about your mom when you’re driving? Seems like every time
we’re in your car you bring it up or want to make sure she’s okay.”
Michael helped Enrique to see a trigger for OCD: a place, time, or activity that
increases the likelihood of worries and rituals. Michael helped his friend feel less
trapped by his stuck thoughts. Knowing your triggers can help you feel freer and
start to fight feisty thoughts and actions. This activity invites you to learn some
of your own triggers.
for you to do
Think of your top two stuck thoughts and rituals. For twenty-four hours, keep a
record of where you are and what’s going on when you notice these worries or
rituals popping up.
Stuck thought #1:
Stuck thought #2:
Ritual #1:
Ritual #2:
Now take a couple of minutes to think of any other triggers you might have that
you didn’t experience today but have noticed in the past. Write below any you
came up with.
_________________________________
_________________________________
wrapping it up
Based on this activity, list the most common trigger for each of your top stuck
thoughts and rituals. You might come up with more than one.
Stuck thought #1 ______________ Trigger ______________
Stuck thought #2 ______________ Trigger ______________
Ritual #1 ______________ Trigger ______________
Ritual #2 ______________ Trigger ______________
Think about your triggers for a minute. Can you find any things they have in
common (time, people you’re with, being tired, etc.)?
_________________________________
_________________________________
Are there any of these triggers you might be able to avoid or prevent?
_________________________________
_________________________________
Are there some of these you simply can’t avoid (like homework, bedtime, or
watching TV)?
_________________________________
_________________________________
Finally, are there any you could avoid but really shouldn’t (like being at the mall
with friends) because the activity is too important to avoid?
_________________________________
_________________________________
6 ranking your symptoms on the stairs of cares
for you to know
Battling stuck thoughts and rituals can be challenging

because you have to face the symptoms head-on. It is
generally a good idea to begin with less troubling things to
build confidence to take on the tougher ones.
Kumiko is a great student and typically manages to solve any problem she faces.
But her OCD is a different story. Her approach has been to just tough it out and
stop her rituals. Will power hasn’t done the trick, and she is disheartened as she
repeatedly turns the lights on and off and feels almost helpless to stop.
Kumiko’s strategy is pretty common, but it often doesn’t work. OCD is stubborn,
and you can easily want to give in. The trick may be to start small and work your
way up, working on the easier things before tackling the harder ones.
This activity will help you sort out which things are the hardest and which are
not as challenging.
for you to do
OCD has lots of ways to get on your nerves: worrisome thoughts, repeated
actions, making you avoid certain places or activities, and so forth. Think about
these three categories (stuck thoughts, rituals, things you avoid). List ten of these
that bother you and don’t worry about putting them in any order just yet.
1. _________________________________
2. _________________________________
3. _________________________________
4. _________________________________
5. _________________________________
6. _________________________________
7. _________________________________
8. _________________________________
9. _________________________________
10. _________________________________
Now think about which might be the easiest to battle and which would be the
most difficult. Then rank them from the easiest to hardest, writing one down on
each step of the “Stairs of Cares.” This will help you choose which problems to
work on first. As you “walk” up the stairs, you’ll be growing in skills and
confidence to be free from OCD.
wrapping it up
Have you had any experiences like Kumiko’s, where you felt you just couldn’t
change your behavior no matter how hard you tried? Briefly describe them.
_________________________________
_________________________________
_________________________________
_________________________________
How does ranking your cares change the way you think or feel about them?
_________________________________
_________________________________
_________________________________
_________________________________
Look at the bottom step and think about working to overcome it. Write a brief
pep talk to get yourself psyched.
_________________________________
_________________________________
_________________________________
_________________________________
7 naming your stuck thoughts and rituals
for you to know
Often it’s helpful to imagine your destination as you begin a

journey. As you begin working on your OCD, imagining life
without it can motivate you to keep going.
In his quiet moments, Jerry knows that he won’t get sick if he uses the school
restroom. Nobody else gets sick. Yet when he gets near it, he feels nervous and
scared. The idea that germs are waiting for him overcomes him, and he turns
away. He immediately feels relief—and frustration that he gave in once again.
When his counselor suggested naming his stuck thought “Germ-man,” Jerry
found power to fight as he challenged the ideas “Germ-man” was putting in his
head.
Some stuck thoughts and rituals have a grain of truth (there are germs in the
bathroom, for sure); others are pretty unreasonable (turning the light off six
times will not keep you from failing a test). To beat them, you have to see them
for what they are: your enemies who are trying to deceive you. Giving them a
name helps you separate these from the rest of your mind and prepares you to
argue with them.
for you to do
We’ll work with your top four troublesome stuck thoughts and/or rituals,
encouraging you to think through the reason you do each, giving it a name, and
drawing a comic face to represent it. You might look back at the Stairs of Cares
in Activity 6 for ideas.
Using your journal, describe the reason that you do stuck thought, ritual, or
pattern #1. For example, “I close the door six times because I think it will keep
me from having an accident” could be named “Doora the Explora”; or “I count
to twelve in my head to keep me from doing bad things that pop into my head”
might be named “the dirty dozen.”) Describe
it: _________________________________
_________________________________
Name it: _________________________________
Give it a face:
Describe the reason that you do stuck thought, ritual, or pattern #2.
_________________________________
_________________________________
Name it: _________________________________
Give it a face:
_________________________________
_________________________________
Name it: _________________________________
Give it a face:
_________________________________
_________________________________
Name it: _________________________________
Give it a face:
wrapping it up
On a scale of 1 to 10, with 1 being “No problem” and 10 being “I really believe
it deep down,” how convincing are each of the stuck thoughts or rituals you
named?
Name:_________________________________ Score:_____________
Name:_________________________________ Score:_____________
Name:_________________________________ Score:_____________
Name:_________________________________ Score:_____________
Have you ever thought of these stuck thoughts or rituals as outside yourself and
not belonging to you?
_________________________________
How does naming them help you separate yourself from them?
_________________________________
_________________________________
How does it feel to think that they are not really part of you but invaders?
_________________________________
_________________________________
How might this view of them change your approach to overcoming them?
_________________________________
_________________________________
8 identifying your irrational thoughts
for you to know
Stuck thoughts are either irrational worries or real worries

that are exaggerated. Though they may seem real, you must
recognize that they’re not logical before you can fight them
well.
Justin angrily turned after he was bumped while getting a book from his locker.
He was just about to say something rude to the boy who bumped him when
Rene, who had seen the incident, stopped him. “Justin, ease up. That guy tripped
coming down the hall and bumped you accidentally. He didn’t mean it.”
This story shows that emotion comes from your opinion or thoughts about
events, not from the truth of the events themselves. The truth here was that the
bump was an accident. Justin, though, assumed someone meant to push him. His
anger was the result of misinterpreting what happened. Rene’s explanation
changed Justin’s thinking and thus his feeling. Learning that feelings can come
from mistaken beliefs is key to understanding stuck thoughts.
for you to do
Feelings largely depend on your thinking. The pattern looks like this: What
Happens → What You Believe About It → Your Emotional Response
Let’s apply this to Justin’s situation:
He is bumped→ “Somebody is challenging me!” → Anger But after Rene
explains what happened:
He is bumped→ “It was an accident.” → Calm See the difference? What you
believe affects how you feel. The stuck thoughts of OCD follow the same
pattern. For example: There are some germs on the doorknob → “I know if I
touch the doorknob I’ll get germs and get really sick.” → Anxiety and avoiding
the doorknob The middle part is a big piece of OCD. Most people know there
are germs but don’t think they’ll get sick. Changing that thinking is important to
gaining control over OCD.
Think of three of your stuck thoughts and chart them below:
Stuck thought: _________________________________
What Happens → What You Believe About It → Your Emotional Response
_____________________→_____________________→_____________________
Stuck thought: _________________________________
_____________________→_____________________→_____________________
Stuck thought: _________________________________
_____________________→_____________________→_____________________
wrapping it up
For each of the three stuck thoughts you just described, briefly explain why it is
not logical, or why it is probably inaccurate in reality.
Stuck thought #1
_________________________________
_________________________________
Stuck thought #2
_________________________________
_________________________________
Stuck thought #3
_________________________________
_________________________________
Was this part easy or hard for you? Why do you think so? If it was hard, the next
exercise will help.
_________________________________
_________________________________
9 exaggeration or distortion? how to tell
for you to know
OCD lives on irrational thoughts that may trick you into

believing them. Knowing how to sort the true worries from
the distorted ones will help you gain control over your OCD.
Rosalia was proud that she now had a driver’s license and could drive herself to
school every day, but she had started worrying a lot about having a wreck. She
felt better when she closed the car door four times before starting the engine,
believing this would keep her from having a wreck. Still, she wouldn’t tell her
friends why she was doing this because she knew deep down that it didn’t make
sense.
for you to do
People with OCD have two main ways of distorting the way things really are.
First, there is worrying about things that pretty much could never happen. For
example, you might fear that someone will die if you don’t tap the table six
times. The feelings in OCD can make this seem like a real danger, but if you get
some distance from the feelings, you realize there’s no way this is true: it is a
distortion.
The second type is trickier, for here you worry about a real danger that is pretty
unlikely, but blow it up to be much bigger than it really is. This was where
Rosalia started. Sure she might have a wreck, but there is really only a small
chance of that. This possibility is probably not worth the amount of worry she’s
putting into it: it is an exaggeration. Then she combines it with a distortion when
she thinks that closing the car door four times keeps her from having a wreck.
List some of your stuck thoughts and note whether they are exaggerations or
distortions: Stuck thought: _________________________________□
Exaggeration □ Distortion Stuck thought:
_________________________________□ Exaggeration □ Distortion Stuck
thought: _________________________________□ Exaggeration □ Distortion
Stuck thought: _________________________________□ Exaggeration □
Distortion Do you have any rituals that are exaggerations or distortions?
Washing your hands to get rid of germs would be an exaggeration.
Ritual: _________________________________□ Exaggeration □ Distortion
wrapping it up
Since stuck thoughts and rituals often go together, they can form combos, or
combinations, of irrational thoughts. Do you have some combos with a little of
both (like Rosalia’s exaggeration about the wreck combined with a ritual that is a
distortion)? If so, list them below: Combos
Stuck Thought: _________________________________(□ Exaggeration □
Distortion) goes with Ritual: _________________________________(□
Exaggeration □ Distortion).
Stuck Thought: _________________________________(□ Exaggeration □
Distortion) goes with Ritual: _________________________________(□
Exaggeration □ Distortion).
It is important to identify both parts and see how they work together. Usually the
ritual helps ease the anxiety of the stuck thought, but you need to see the
problem with both to fight and overcome them.
10 being realistic about distorted and
exaggerated thinking
for you to know
Since feelings can make distorted and exaggerated thinking

seem rational, learning how to be more realistic is a step
toward mastering your stuck thoughts and rituals.
Will was tough on erasers. He went through one a week. He finally confided in
Mary that he secretly believed that his teachers would give him an F on papers
unless they were perfectly neat and showed no signs of erasures.
“Will, you don’t really believe you’ll get an F if your paper isn’t neat, do you?”
she asked.
“I know it’s silly, Mary, but I get really tense worrying about it, and erasing is
the only thing that helps,” Will replied.
“Think about it, Will. Who do you know that ever got an F just because their
paper was not perfectly neat? Come on, you’ve seen my handwriting. No
penmanship awards for me, but my grades are as good as yours.”
Mary’s words got Will to thinking about what the odds really were that his stuck
thought would ever come true.
for you to do
Most people understand distortions aren’t really true (Will knew deep down that
he wouldn’t get an F for a stray pencil mark here and there). Teens with
distortions usually realize they’re not logical, but they just seem to be real when
you’re focused on them.
For your distortions, finish the statement below: “Even though I feel nervous
when I think (write out your distortion)
_________________________________
I know in my heart that the truth really is that it will never happen.”
Try it on one more.
“Even though I feel nervous when I think (write out your distortion)
_________________________________
I know in my heart that the truth really is that it will never happen.”
Exaggerations are a little more challenging. How likely is it that you will get
sick if you touch the doorknob on a public restroom? Sure there are germs, and
there is the outside chance you might get sick from them. Think of how many
doorknobs you touch in a day; what are the odds of this making you sick—
maybe 1 in 1000, or lower? But if you have OCD, you feel like the odds are at
least 500 out of 1000. You can recognize distorted thinking by thinking through
what the odds really are and comparing them to what they feel like when you are
facing them.
Now pick one of your exaggerations to work on.
When you’re fighting this stuck thought or ritual, it feels like the odds of the bad
thing happening are _____ out of 100.
Think about this more. Consider why other people aren’t as troubled by it. Think
about past times you’ve done this and nothing bad happened. Analyze like a
computer to consider what the chances really are of this happening.
The real odds are something like _____ out of 100.
If you’re not sure, talk with a parent or friend to get their estimate.
Now make it into a statement:
“To me, the odds of __________________ happening feel _____ like out of 100,
but when I really think about it, they’re more likely _____ out of 100.”
Try this on another exaggeration.
“To me, the odds of happening __________________ feel like out of _____
100, but when I really think about it, they’re more likely _____ out of 100.”
wrapping it up
You are now taking the first step to arguing with stuck thoughts and rituals that
are, putting it plainly, lies that OCD tells you.
Memorize the statements you completed above. Then take one morning or
afternoon and practice saying them to yourself when you face your distortions
and exaggerations during that time.
Describe your experience. Was it hard to remember to do? Was it easy or hard to
do? Did it change the way you felt? Add any other thoughts you have about the
experience.
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
You’re off to a good start. Keep practicing.
11 controlling the need for control
for you to know
Most of the irrational thinking and behavior around OCD

involves trying to feel more control over what happens than
you really have. But you actually have more power when
you gain control over your need for control.
Tony felt better after he called Kyle to make sure he didn’t hurt his feelings at
school. The problem, though, is that Kyle and all of his friends are tiring of
Tony’s asking them if he hurt their feelings all the time. Tony’s stuck thought is a
worry that he’ll lose his friends if he says or does something that offends them.
His only relief is asking them to make sure, the ritual that eases his worry.
Notice what’s happening. Tony is trying to control his friendships by being nice
—too nice. He then tries to control his nervousness by asking for reassurance.
Do you see the real problem? Tony may lose friends by trying so hard to control
his relationships.
for you to do
What do each of your OCD symptoms try to give you control over?
#1 This stuck thought/ritual/pattern (fill in the
blank) _________________________________
gives me a sense that I can control _________________________________
#2 This stuck thought/ritual/pattern gives me a sense that I can control
_________________________________
#3 This stuck thought/ritual/pattern gives me a sense that I can control
_________________________________
Now for each, can you think of how they can backfire? How might each cause
you to lose control over something?
Stuck thought/ritual/pattern #1
_________________________________
_________________________________
_________________________________
wrapping it up
You’re now catching on to one of the secrets of defeating OCD: seeing how the
need to control things can control you in ways you don’t want.
For each of the symptoms you used, write a sentence explaining why it doesn’t
control what it wants you to think it does, and one that states a better way to
think about it. (For example, Tony might write, “I can’t control how people think
about me because I’m not their boss. I can be thoughtful, be kind, and listen to
them because these are things good friends do.”) Stuck thought/ritual/pattern #1
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
Now you’re getting control of OCD instead of it telling you what it wants you to
control!
12 looking logically at your stuck thoughts
for you to know
Stuck thoughts must be seen for the irrational things they

are, no matter how strong your feelings are. Seeing why they
aren’t logical will empower you to overcome them.
Every day, Robert wrestled with the thought that he might get into trouble at
school if he didn’t tap the door on his way into every class. Though he knew it
probably wasn’t true, his powerful anxious feelings convinced him to keep
tapping. Robert’s counselor understood but explained how anxious feelings are
like car alarms, which are designed to go off when someone is breaking into a
car, signaling danger. But most of us hear them going off accidentally so often
that we almost ignore them. They are still loud, but they don’t make us anxious.
Stuck thoughts can set off our “nervous alarms,” which are quite loud in making
us feel there’s danger. But, as is usually true when you hear a car alarm, there’s
no real danger. Stuck thoughts just make you feel like there is.
This explanation sort of clicked for Robert, but he still had a hard time seeing
how his stuck thoughts were false; he really felt not tapping would lead to
trouble.
for you to do
It’s tough to fight stuck thoughts since they lead to very strong feelings of
anxiety. They convince you that there is a serious danger ahead—but they are
liars. For a few minutes, try to set aside feelings and look at your stuck thoughts
logically. Choose one stuck thought to start with.
My stuck thought tells me that this bad thing will happen:
_________________________________
_________________________________
unless I do this:
_________________________________
_________________________________
_________________________________
Now be the defense attorney and present any evidence for the truth of the stuck
thought. (Robert might say, “I’ve always tapped the door before walking into a
classroom and have never gotten into trouble at school, so it must work.”)
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
Next, be the prosecutor who has to prove your stuck thought is a lie. Some
questions you might ask yourself: Has the dreaded thing happened to other
people? If it’s so bad, why doesn’t anybody else worry like I do? What is the
worst that could happen if the bad thing actually did happen? You might also
look back at the odds that you figured out in Activity 10. Finally, explain why
the defense argument is not logical.
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
Now repeat the activity with other stuck thoughts.
wrapping it up
Now you be the judge. The evidence should argue that the stuck thought is guilty
of lying to you. Do you agree? If so, which argument was most helpful in
convincing you?
_________________________________
_________________________________
You probably suspected all along that the stuck thought wasn’t true. Why do you
think it is so hard to act on logic instead of feeling?
_________________________________
_________________________________
What might help you to fight the strong feelings that stuck thoughts produce?
_________________________________
_________________________________
Two good ideas for this are to remind yourself of the argument that convinced
you and to have others remind you to use your logic.
13 getting psyched to fight
for you to know
Battling OCD takes more than just logic; you have to fight
feeling with feeling. The anxious feelings of OCD are best
overpowered by feelings of determination.
Sonja was encouraged when she convinced herself that her mother would not die
if Sonja didn’t say the alphabet before leaving the house. But when morning
came and she headed for the door, the fear was intense. She shook her head in
frustration as she started: A, B, C …
Feelings motivate us more that simple reason does. We’ve all called a friend to
chat when we should have been doing our homework. Talking brings pleasure
and tempts us, even though we know we ought to do the homework. If that’s true
of normal emotions, how much more will it be true of resisting the powerful
feelings of OCD?
for you to do
Let’s get you fired up to fight so that you do better than Sonja did. We’ll work on
three feelings to help you win.
Anger
How do you feel when someone lies to you? Why?
_________________________________
_________________________________
Think of your OCD as a person who is lying to you and causing all the problems
that go with your OCD. What would you say to that person?
_________________________________
_________________________________
Maybe even better, imagine yourself telling this person off for lying to you and
tricking you into believing the stuck thought.
Determination
When sports teams face a challenge, the coach pulls them together and gives
them a pep talk to build a focus and commitment to working hard to beat a tough
opponent. What might you say to yourself to motivate yourself to battle the lies
of stuck thoughts?
_________________________________
_________________________________
Hope
Imagining victory aids in winning. Describe the feeling you’ll have when you
beat your lying stuck thought.
_________________________________
_________________________________
wrapping it up
Let’s pull these approaches together to maximize motivation. If you are more of
a visual person, draw a picture in your journal that represents your determination
to defeat the thoughts and false alarms of OCD. If you are more of a word
person, write a brief pep talk to yourself. It will be a challenge, but you’re going
to win. Believe that, not your OCD.
14 stop that thought!
for you to know
One of the tricky things about stuck thoughts is that they are
so frequent that they feel automatic. A big step in beating
OCD is learning to catch and interrupt your obsessive
thinking.
Can you remember a scene like this from a movie? One of the characters is upset
or panicked and is yelling or fussing or just plain freaking out. A calmer
character approaches and slaps or shakes the panicked person, breaking up the
episode.
Stuck thoughts are much like that: They can come over you and control you—
sometimes without your being aware of them. They may keep rolling along
unless you startle yourself out of the pattern.
for you to do
Thought-stopping is a skill that is pretty simple: once you catch yourself
obsessing, you jolt yourself out of it. There are two parts to it.
First, as soon as you notice the stuck thought, yell “Stop!” Since that might look
a bit weird in public, you might just yell it in your head when you’re not alone.
Second, like the slap in the movie scenes, a mild pain can sometimes help. A
couple of suggestions are wearing a rubber band around your wrist and snapping
it as you say stop, or pinching yourself gently as you say it. You might think of
something else. Write your choice below:
_________________________________
Now practice. For the next twenty-four hours, really focus on catching yourself
obsessing and interrupt yourself with a firm “Stop!” and mild pain. As you get
better at this, you may drop the pain part. This won’t stop the stuck thoughts
(though it may help), but it breaks them up so you’re in a better position to fight
them.
wrapping it up
Briefly describe your thought-stopping experience after doing it for a day. Any
surprises? Frustrations? How consistently did you use it?
_________________________________
_________________________________
_________________________________
_________________________________
As you did this, what effect did it have on your obsessing? Did it help, hurt, or
change your patterns in any way?
_________________________________
_________________________________
_________________________________
_________________________________
If you had trouble being consistent, think of a way to improve and note it below.
_________________________________
_________________________________
Remember: this isn’t supposed to stop stuck thoughts, just disrupt them.
15 arguing with your stuck thoughts
for you to know
Once you catch yourself obsessing, you can argue with your
stuck thoughts. This will reduce the anxious feelings and
make it easier to avoid rituals.
Mi Sun stayed up very late every night studying because she feared she would be
a failure if she did not do her absolute best in school. She would close her books
and turn out the lights only when her mother threatened to ground her if she did
not go to bed.
Tired of getting into an argument with her mother every night, Mi Sun began
arguing with her stuck thought about perfection. “Nobody is perfect, and I’ll still
make good grades if I study a little less. Besides, staying up late leaves me
sleepy in school so it really hurts my performance. It is a lie that I have to be
perfect to be okay. In fact, I’m a better person when I have control over this
stuck thought than when I give in to it.”
Mi Sun did better when she stopped listening to her stuck thoughts and talked
back to them instead.
for you to do
Imagine yourself having your worst stuck thought right now. Write down what
you can say to it to tell it who’s boss and why. Call it by a name so you are clear
that it doesn’t speak for the real you. Try to list at least three reasons why it is
not logical.
_________________________________
_________________________________
_________________________________
_________________________________
Now do the same for your second most bothersome stuck thought.
_________________________________
_________________________________
_________________________________
_________________________________
Now try it with one more.
_________________________________
_________________________________
_________________________________
_________________________________
You’ve got the hang of it. Once you notice that you’re having the stuck thought,
argue with it. You might write all your arguing points on an index card and keep
it with you so you can refer to them if you need to.
wrapping it up
On a scale of 1 to 10, with 1 being “I couldn’t do it at all” and 10 being “I argued
down those stuck thoughts every time,” how would you rank your success?
Now think of how you could move your score up a notch or two (and you don’t
have to reach 10 to be doing well!).
How could you better remember to argue when you catch yourself obsessing?
_________________________________
_________________________________
Can you think of other arguments to use with your stuck thoughts?
_________________________________
_________________________________
How could you improve your motivation to fight these thoughts, given the
strong feelings they produce?
_________________________________
Keep practicing. This is a skill that requires a little work.
16 replace that thought!
for you to know
Now that you know how to disrupt obsessive thoughts and

to defeat them in debate, you can take the next step by
replacing them with pleasant ones.
Owen dreaded eating. He was mortally afraid that anything he ate could cause
him to get sick to his stomach and throw up. This fear was even worse at school
because he worried he might not make it to a bathroom in time. When he was
worrying about this he knew that it didn’t really make sense, but the thoughts
just kept coming.
He noticed one day that once he started talking to his friends while he ate his
lunch, the worries eased up. He realized that if he could get his mind on
something else, he didn’t obsess as badly.
for you to do
Try a little experiment. Count to twenty in your head but as you do, do not think
about purple elephants.
Tough, huh? It’s the same if you try not to think about your stuck thought. Seems
the more you try not to, the more you do it.
Once you stop your obsessive thought, the idea is to get your mind on something
else that is comforting, not anxiety inducing. This can be thinking about a
favorite person, a happy movie, or an upcoming event you are looking forward
to. Maybe the best one is to think of a favorite (preferably upbeat) song that you
can sing (if only in your head).
Think about the options and choose the specific thought you want to use when
you stop a stuck thought:
_________________________________
For the next twenty-four hours, when you notice you are having a stuck thought,
focus your thinking on your replacement thought instead. Good luck!
wrapping it up
On a scale of 1 to 10 with 1 being “no help at all” and 10 being “worked like a
charm,” rate how well replacing your thoughts worked in freeing your mind
from your stuck thoughts:
Most likely your score was somewhere in the middle. Think more closely about
your experience. Describe what happened when you tried to replace your stuck
thought.
_________________________________
_________________________________
_________________________________
_________________________________
Did you come up with any strategies that helped you do better as the day
progressed?
If so, describe the strategy.
_________________________________
_________________________________
For most people, it takes some practice and persistence, with the stuck thought
gradually fading into the background as they think the pleasant thought more
clearly. Keep working and you’ll get it!
17 thinking it till you’re tired of it
for you to know
Stuck thoughts seem to come when you least want them.

One way to get more control over them is to think them on
purpose—until you wear them out!
Katerina settled down to watch a few minutes of TV before going to bed, but
then there they were again: those unwelcome thoughts that she might get sick
and end up vomiting. As usual, she got so upset by these thoughts that she really
did start to feel sick to her stomach. Frustrated and tired of losing sleep so many
nights, she finally shared her misery with her mom.
“Katerina, those thoughts seem to own you. Why don’t you do something to
fight back? Have you tried thinking them on purpose till you’re sick of the
thoughts instead of sick to your stomach?”
So to her room Katerina went and tried to think of nothing but getting sick to her
stomach. Taking charge felt good, and after a while she felt relaxed enough to
drift off to sleep.
for you to do
Take a lesson from Katerina and try this on one of your stuck thoughts. There are
a couple of ways to do this, so choose the one that suits you best.
Make a list of some of the common thoughts that go with the stuck thought
you’re going to work on. (Katerina might have listed “What if I lose my lunch?”
and “Wonder if my dinner will make me sick?”) List of things I think when my
thought gets stuck:
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
If you have a cell phone with a voice recorder, or some other type of audio
recorder, try this: Think the thoughts on your list out loud for about ten minutes
straight, taping yourself as you do so. Then, when the stuck thought sneaks up
on you, take control and just play the tape of your worrying out loud. Play it
several times till you get tired of listening to yourself worry. You’re getting
control of your stuck thought!
The second way to do this is similar but without the tape. Keep your list of
common thoughts handy, and when the stuck thought comes, stop what you’re
doing, pull out the list, and think or talk through it over and over till you get tired
of it. Try not to let your mind wander off the stuck thought; you want to be in
control of it.
wrapping it up
After you’ve done this a few times, write how it felt to think these thoughts on
purpose rather than let them sneak up on you:
_________________________________
_________________________________
_________________________________
_________________________________
You may want to take this type of control one step further. Set up one or two
times a day when you schedule stuck-thought time. At those times, play your
tape or go through your list. When the stuck thoughts come at other times, talk
back to them by telling them to wait their turn at the next scheduled worry time.
18 don’t be fooled by feelings
for you to know
Even though you’re learning to fight stuck thoughts, you

may still find that the nervous feelings that go with them are
strong. Understanding why will make it easier to cope with
them.
Nancy felt her chest tightening as she neared the cafeteria. Her heart beat faster,
and she started to tremble. Would today be the day she'd say something stupid
while eating with her friends, destroying the popularity she’d worked hard to
gain? She marched down the hall with determination, only to slow and stop
outside the door. “I couldn’t eat anyway, and my friends will think something’s
wrong if they see how nervous I am,” she thought. Nancy turned away and
strolled down the hall to the vending machine, feeling better with each step.
Maybe she would have only a bag of chips, but it was worth it to avoid the fear
and, possibly, shame that awaited her. Yet as she ate her chips, she felt depressed
by another defeat. She knew she should have gone to lunch, but her feelings
scared her too much.
for you to do
Ever felt like Nancy? The physical sensations and feelings that come with stuck
thoughts can overwhelm you. Even though Nancy knew deep down her fear was
irrational, the feelings scared her enough to stop her.
List some of the physical sensations you experience when you have stuck
thoughts or rituals. (You might want to wait till you have a battle with them so
you can pay close attention to your physical sensations.)
_________________________________
_________________________________
_________________________________
What do you understand about why you might have these feelings?
_________________________________
_________________________________
_________________________________
Nancy’s feelings are all part of the fight-or-flight response designed to help us
either battle a fearsome enemy or get away from it. To fight or run, we need a
faster heart rate, heavier breathing, and such. The shaking that Nancy
experienced may come from her body being activated and ready to fight or flee.
All these reactions prepare us for a danger we face or warn us when we’re
approaching a place where we’ve been scared before.
Think about your symptoms. What “danger” are they preparing you for?
_________________________________
_________________________________
Knowing why you have these feelings can help you understand that you need not
be afraid of the feelings themselves.
wrapping it up
Let’s revisit Nancy for just a minute. Knowing about the fight-or-flight response,
which do you think Nancy did?
Why do you think she felt better as she walked away from the cafeteria?
_________________________________
_________________________________
_________________________________
Now to the feelings you have when your stuck thoughts strike: do you think the
danger you envision is real or exaggerated?
Note that the danger doesn’t have to be a real one to stir up these feelings.
(Think of how nervous you can feel in a scary movie when you know deep down
that you’re safe.) What do you do to try to ease the feelings?
_________________________________
_________________________________
_________________________________
How does that help or hurt your stuck thoughts?
_________________________________
_________________________________
_________________________________
19 conquering your nervous feelings
for you to know
Understanding the feelings of the fight-or-flight response

readies you to fight instead of flee. Using your thinking
skills, you can retrain your feelings so they don’t sound the
“false alarms” caused by stuck thoughts.
Nancy (whom we met in Activity 18) had had enough. She was ready to fight the
feelings that kept her from going to the cafeteria at school to eat with her friends.
She armed herself with her best argument against the stuck thought that she
would say something to embarrass herself and lose her friends: “We all act silly
together, and that’s part of the fun. Even if I do say or do something
embarrassing, they’re my friends and will laugh with me, not at me. These
nervous feelings are false alarms because the truth is there’s nothing to be scared
of.”
As Nancy expected, her heartbeat quickened as she neared the cafeteria. She
knew now what was going on: the fight-or-flight response. This time, she was
determined to fight. She took a deep breath and kept walking, reminding herself
that her feelings were a false alarm. She wouldn’t lose out on another fun lunch
with her friends.
Nancy got her tray, sat next to her friends, and again reminded herself that the
nervous feelings wanted her to flee a nonexistent danger. She started talking to
her friends and felt her tensions ease. She enjoyed the food and friendship at
lunch—but not as much as the thrill of fighting fear and winning!
for you to do
Look at Nancy’s story. See if you can come up with five strategies she used to
fight her feelings instead of fleeing because of them.
1. _________________________________
2. _________________________________
3. _________________________________
4. _________________________________
5. _________________________________
Good job. Now use these strategies to make your own plan for your nervous
feelings.
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
Next, try your plan. It may take some practice, but don’t let false-alarm feelings
stop you from doing what you want or need to do.
wrapping it up
Nancy likely will have to go through her plan a few more days before going to
lunch gets fairly easy. After you’ve tried your plan about five times, answer
these questions.
What’s been the hardest part of using your plan?
_________________________________
_________________________________
What adjustments could you make that might help you? (Look back at Nancy’s
story if you need some help.) _________________________________
_________________________________
Do your feelings seem to be worse, about the same, or better? Why do you think
that is?
_________________________________
_________________________________
Before Nancy conquered her nervous feelings, she found relief by walking away.
It is important to realize this action actually increases the chances of your having
the nervous feelings next time you’re in that situation. It’s like your body says,
“Oh, so there was a danger, and I’m glad we got away. We’ll stay away from that
from now on.”
Remember this when you’re tempted to flee rather than fight your feelings.
20 recognizing your thought loops
for you to know
Understanding how stuck thoughts and rituals make a loop

in your mind can equip you to take a stronger stand against
them.
Gavin sighed with relief as he finished tapping the table. Even if only for a few
minutes, the relief the magical taps brought him was immense.
Gavin lived in fear that he would suddenly shout out a curse word, something he
didn’t think was right. The thought came to his mind very often, but especially
when he was in public places, like school and the music store he worked in.
When the fear welled up in him, only tapping a surface ten times helped. But the
problem was that the thought would be back shortly. The relief was only
temporary, and he was having to do this more and more. His friends were
starting to ask why he tapped things so much. Gavin longed for something that
would make his stuck thought go away for good, not just for a minute.
for you to do
Gavin’s story shows how stuck thoughts and rituals often form a loop that might
look like this:
For Gavin, the loop would look like this:

Now it’s your turn. Choose one of your stuck thought/ritual patterns and put it in
the loop.
Try one more.
Sometimes the ritual will be more logically related to the stuck thought. For
example, washing your hands does indeed get rid of some germs for those who
have stuck thoughts about that. That still leads to the thought loop you’re
learning about.
wrapping it up
Here’s the mystery: if the ritual makes you feel better for a minute, why doesn’t
it last? Do you have a guess?
_________________________________
_________________________________
Try resisting the ritual a little more than usual for a few hours. What happens
when you do so?
_________________________________
_________________________________
Why do you think that happened?
_________________________________
_________________________________
Notice some of the weapons you’re gaining in your fight against OCD:
The “believe it’s true” step is attacked by skills in challenging thinking.
The “anxiety” step is attacked by skills in understanding feelings.
The “ritual” step is challenged by preventing the ritual and exposing

yourself to the things you fear, skills you’ll be learning soon.
21 how rituals make stuck thoughts worse
for you to know
Rituals trick you into believing they help when they really
don't. Knowing this will give you power to fight them.
Kayla’s stuck thought was worrying that she would forget things: her friends’
names, phone numbers, and things she was supposed to do. She coped with this
worry by constantly writing things down—even things she knew she really
didn’t have to remember, like the license numbers of her friends’ cars and such.
She knew it was out of hand, but she still couldn’t go anywhere without her
sacred scratch pad and pen.
Kayla talked this over with her boyfriend one day, and he questioned why she
wrote stuff down when she knew she didn’t need it. This got her to thinking, and
she realized it made her feel safe from her fear. But if her fear wasn’t real, what
was she doing? Kayla thought, “It’s like being afraid of a lion in the city. You
know there isn’t one, but you stay in the house to be safe anyway. That just
doesn’t make sense.”
Kayla discovered just one of the reasons why giving in to rituals worsens stuck
thoughts. They make you feel safe, but you were safe to start with. Let’s learn a
few more.
for you to do
The problem with stuck thoughts is they are never satisfied. Every time you give
in to one by performing a ritual, you actually make the stuck thought and the
ritual stronger! There are several reasons for this. Choose one of your patterns to
think about as we look at these.
First, as Kayla realized, the stuck thought gets worse because you think it’s real
and manage to avoid the danger—but the danger is only in your head. In doing
so, you “prove” to yourself the danger was real. After all, why would you do it if
you didn’t need to? Rituals convince you that false fears are true.
Write out how this would apply to your pattern:
_________________________________
_________________________________
_________________________________
Second, rituals also make stuck thoughts worse by giving you a false sense of
control over them. Since you can’t do anything to truly reduce the fear (since
there’s no danger anyway), your mind invents an activity that gives you the
illusion you’re doing something to help. Again, OCD proves to be tricky.
How does your ritual give you a sense of control over your stuck thought?
_________________________________
_________________________________
_________________________________
Finally, rituals make stuck thoughts worse because they treat the “symptom,” not
the “disease.” That is, they act as if the worry is real and temporarily fix it rather
than attacking the real problem: the irrational thought.
Describe how your ritual treats the worry as if it were true.
_________________________________
_________________________________
_________________________________
What is the irrational thought that really needs to be treated?
_________________________________
_________________________________
wrapping it up
One final thing to note is that using rituals to ease the nervousness of stuck
thoughts also leads to doing the rituals more.
Think of it this way. If you’re feeling thirsty, what do you want to
do? _________________________________.
And doing that makes you feel _________________________________.
Anything we do that makes us feel better is a reward. So what will you want to
do next time you’re thirsty? _________________________________.
Yep, the same thing.
So if writing things down makes Kayla feel better when she’s nervous, guess
what she’ll want to do next time? _________________________________
(That was too easy, huh?)
Share your reaction to learning how tricky the relationship between stuck
thoughts and rituals is.
_________________________________
_________________________________
22 standing your ground against rituals
for you to know
Rituals are a form of fleeing a false fear; to beat them you

must stand and fight for the truth!
Rhiannon knew she was way too scared of getting sick. She thought about it
almost constantly, but her nervousness really skyrocketed when she heard a
cough, sneeze, or sniffle. This reaction became so bad that she tried to leave the
room when she witnessed any of these. It was the only thing that eased her
anxiety. But she couldn’t leave the house when her sister coughed, nor could she
leave the classroom if a schoolmate had a sniffle. Rhiannon then developed the
ritual of rubbing her hands on her pant legs five times as if to clean away the
germs. She knew this didn’t really keep away germs, but it did ease her stress. It
was beginning to take up so much time that she wasn’t getting her work done in
class. Something had to give.
Rhiannon told herself that the rubbing was silly and tried not to do it, but she
would become more nervous and then give in to the ritual. She was feeling
desperate and wanted help.
for you to do
While Rhiannon was on the right track, she wasn’t having success. Let’s think
about why. First, the story tells us two things she did to reduce her stuck thought
about getting sick. They are: 1. _________________________________
2. _________________________________
These illustrate the two main ways to cope with stuck thoughts: avoiding the
feared thing or situation (or doing something to comfort your mind, like washing
your hands or checking to see if you turned off a light), and finding a “magical”
ritual to reduce the fear. Sometimes the rituals simply reduce a vague feeling of
stress without a stuck thought.
Choose one of your rituals to work on. What is it?
_________________________________
Describe the feeling or stuck thought that the ritual relieves.
_________________________________
_________________________________
Rituals hang around only because they make you feel better, not because they
actually solve a problem or prevent the worry. They’re actually a way our bodies
fool us. There are two solutions. First, you need to stand your ground and not
perform the ritual.
How could Rhiannon do this?
_________________________________
_________________________________
How could you do it for your ritual?
_________________________________
_________________________________
This solution is called response prevention: not doing the thing that magically
eases your anxiety.
The second is to deliberately face the thing you’re afraid of but know you
shouldn’t be. Rhiannon had to do that when she couldn’t leave the classroom,
and she needed to do it all the time.
What do you need to do to face the false fear that leads you to avoid some
things?
_________________________________
_________________________________
wrapping it up
Knowing what to do is easier than doing it. Why do you think it is so hard to
simply not do the ritual?
_________________________________
_________________________________
_________________________________
Why is it hard to face the false fear your stuck thought causes you?
_________________________________
_________________________________
_________________________________
23 hanging in there with nervous feelings
for you to know
Rituals shortcut the process of overcoming anxiety by

keeping you from sticking it out. If you hang in there when
dealing with false fear, it will go away after a while.
After the movie, Brad winced as he walked out of the dark theater into the
sunlight. It never occurred to him to duck back into the building because he
knew in a few seconds his eyes would adjust to the brightness. As he thought
about this, it hit him. If he hung tough with his anxieties instead of doing his
rituals, would his body adjust? It was worth a try.
Brad had stumbled onto a great idea. If he kept going back into the dark, his eyes
would never get to adjust. Doing rituals to ease the anxiety of OCD is the same
thing. You have to stay with the feelings for a while, and the anxiety will go
away.
for you to do
To begin, let’s learn to rank the nervousness you feel when tempted to do rituals.
Remember, sometimes it will be because of stuck thoughts, sometimes not. Let’s
use a 1 to 10 scale.
Use these guidelines:
1 = don’t even notice the feelings
2 = feel just a touch nervous
3 = feel uneasy, but can cope
4 = thinking about my ritual to get some relief 5 = pretty uncomfortable, wanting
to do my ritual 6 = nervous, wanting badly to do something to help 7 = so
nervous I feel my heart beating faster or my breath getting heavy 8 = so nervous
that I’m almost shaky
9 = can’t take it; have to do my ritual or something 10 = feel like I’m having a
panic attack
Next time you have your stuck thought or feel tempted to do your ritual, see how
far up the scale you can go before you give in. Don’t worry about what your
rating is at this point. Just practice monitoring your feelings and noting how
intense they are before you give in.
Do ten scores for the next ten times you feel like doing your ritual. List them
below:
1. ___________
2. ___________
3. ___________
4. ___________
5. ___________
6. ___________
7. ___________
8. ___________
9. ___________
10. ___________
What was the lowest score at which you did your ritual? ______
What was the highest score you got to before doing your ritual? ______
wrapping it up
You’ll be learning more skills to help you hang in there, but try a couple of times
to see if you can beat your highest score before doing your ritual.
What was it like staying with the feeling instead of doing the ritual?
_________________________________
_________________________________
Did you come up with any strategies on your own to help you stay with it?
_________________________________
_________________________________
Another way to practice this is to track how long you can go from the first
thought of the ritual until you do it. Use your watch and time yourself five times:
______ seconds ______ seconds ______ seconds ______ seconds
______ seconds Did it get easier or harder as you went along?
24 easing your anxiety with deep breaths
for you to know
Facing your feelings without giving in to your ritual

sometimes takes more that arguing with stuck thoughts. You
might have to remind your body to relax since the danger
isn’t real.
Hailey was feeling it. She wanted so badly to turn the car radio on and off, but
she knew that had nothing to do with her mom being safe. She was battling the
irrational stuck thought that something bad would happen to her mom.
“That’s silly. Mom can take care of herself, and there’s nothing miraculous about
me messing with the radio!” she reminded herself.
But the nervous feelings kept coming. She could feel her heart beat and she felt
warm. Hailey told herself there was nothing to fear, but her body was acting as
though she were in danger. Her mind knew it was a false alarm, but she needed
to settle down her body.
for you to do
When you have nervous and stuck thoughts, your body responds to them as
though the danger were real, preparing you to fight or flee. Your body may hang
on to nervous feelings, especially if it is trained to find relief through rituals.
One of the things you can do to take charge of your body is to take deep breaths
that tell your body everything is okay, helping it to relax. Here’s how. Read this
once to get the idea, then try it a couple of times.
Sit comfortably in a chair, without slouching. Rest your arms on the

armrests or on your legs. Put your feet flat on the floor. Pay attention
to the slight pressure you feel from the weight of your body on the
chair. Now, take in a deep breath and hold it for five seconds. Then, let
it out very slowly, taking as long as you can until you almost need to
cough out the last little bit of air. Repeat this, but now pay attention to
your body more than to the breath. As you release the breath, notice
the sensation of your body sinking into the chair and losing tension.
You are telling your body to relax because everything really is okay.
On the third breath, you might repeat a statement that denies the stuck
thought, like “Relax; my mom is fine, and I don’t need to do any
rituals.”
Practice this a few times right now. Then try it a few times when you are feeling
nervous and fighting off your rituals.
wrapping it up
Describe the feeling you had after practicing deep breaths a few times when you
weren’t nervous.
_________________________________
_________________________________
_________________________________
Describe the feeling you had when using deep breaths to battle your nervousness
around stuck thoughts and rituals.
_________________________________
_________________________________
_________________________________
On a scale of 1 to 10, when fighting your feelings, how strong were they before
the deep breaths?
What score would you give your feelings after the deep breaths?
Keep practicing your breathing along with the strategies for battling stuck
thoughts.
25 should others help you fight your rituals?
for you to know
Sometimes rituals are like bad habits: you do them without

thinking. Having a parent or friend remind you can help you
to use your skills.
Karim was always near some hand sanitizer. He reached for it every time he
thought he might have touched something that was germy. He knew this wasn’t
necessary and he wanted to try to resist. The problem was that his ritual was so
automatic that he didn’t even notice he was doing it many times. Karim knew he
couldn’t beat his ritual if he wasn’t more consistent in fighting it.
Karim’s mom had been pretty cool about his OCD. She wanted him to overcome
it, but she didn’t nag him about it all the time. He turned to her for help. “Mom, I
keep using the sanitizer without even knowing when I do it. It’s like I’m on
autopilot. Could you just say something simple when you see me reaching for it,
like ‘Karim, what’s your plan?’ That’ll remind me to try to resist it.”
She agreed, and it really helped … even though it sometimes aggravated him.
for you to do
Ever have a hard time catching your rituals like Karim did? You can use most of
the skills you’re learning on your own, but sometimes catching yourself when
you get stuck or are performing a ritual can be difficult. Still, you might feel like
going it alone.
List a few reasons you would rather do this on your own.
1. _________________________________
2. _________________________________
3. _________________________________
4. _________________________________
List a few reasons you could use someone reminding you when you are doing
rituals or getting stuck.
1. _________________________________
2. _________________________________
3. _________________________________
4. _________________________________
Think it through for a bit. What seems better for you: fighting OCD solo or using
a helper? Why do you think so?
_________________________________
wrapping it up
If you decided to go solo, write down a few ideas on how you can try to catch
yourself before you do your rituals.
_________________________________
_________________________________
_________________________________
_________________________________
If you decided you could use some help, list a few qualities of the kind of person
who might help.
_________________________________
_________________________________
_________________________________
_________________________________
Based on your list, who will you ask? It can be most anyone that you are around
often.
_________________________________
And one bonus if you use a helper: knowing someone else is keeping an eye on
you will strengthen you even more to win the battle against OCD.
26 disrupting your rituals
for you to know
Learning to control your rituals just a bit before you try to

knock them out altogether can help you feel power over
them.
Karim, our friend from Activity 25, was feeling a little better now that he was
catching himself when he reached for the hand sanitizer, but the thought of not
using it made him really nervous. He understood that it was a false fear and that
he wouldn’t really get sick, but he knew the tension would disappear if he just
gave in.
He wondered, “How can I at least make a little progress so I feel I have some
control over them? It feels so much like they rule me, and that’s not good.”
Suddenly, Karim remembered something his basketball coach had said: “If the
other team gets in a rhythm and is starting to win, call a time-out to disrupt their
flow.”
“That might work with my ritual!” he thought. Karim decided he would wait
thirty seconds before he used the sanitizer. Even if he did do it, at least it was
now a bit more on his terms.
for you to do
Karim was on to something, for it is often possible to shake up your rituals so
they are less automatic and more under your control. There are several ways to
do that. Before we look at them, think of one of your rituals to practice with.
Write it here: _________________________________
_________________________________
_________________________________
Be aware that some of these disruptions will work better for your ritual than
others, since rituals differ.
1. Delay the ritual. This is what Karim did. How could you do that for yours?
_________________________________
_________________________________
2. Make the ritual less convenient. In Karim’s case, he could put all the hand
sanitizer in the upstairs bathroom so he had to go upstairs to use it. How could
you make your ritual less convenient?
_________________________________
_________________________________
3. Change the ritual. Karim could get rid of the hand sanitizer and use only
soap that is in the bathroom. How could you change yours?
_________________________________
_________________________________
4. Slow the ritual. Even if Karim decided to rub his hands very slowly with the
hand sanitizer, it would change the rhythm of the ritual. How could you do
something to slow yours down (for example, count more slowly)?
_________________________________
_________________________________
5. Shorten the ritual. Karim could decide to use just a drop of sanitizer and rub
his hands back and forth only once. What would a shorter ritual look like for
you?
_________________________________
_________________________________
wrapping it up
Which of these five disruptions seems like something you could do?
_________________________________
Try it for a day, then describe your experience:
_________________________________
_________________________________
Did you feel you gained some control, or did you feel frustrated because it didn’t
work too well?
_________________________________
_________________________________
If it’s working, keep it up. If not, don’t lose heart. Try again with another
disruption.
If one of these worked, share what it feels like to have some power over your
ritual:
_________________________________
_________________________________
27 making your rituals impossible
for you to know
Since you can’t do two things at once, some rituals can be

overcome simply by planning to do something that makes
them impossible to do.
Aisha was getting embarrassed because now you could see thin places in her hair
from where she had pulled out hairs. She knew this was a harmful ritual, but it
seemed to reduce her feelings of stress. When Aisha kept track of her habit, she
found she did it mostly when she watched TV or when she was going to sleep at
night.
“If only I could keep my hands from being free to reach for my hair. It’s almost
automatic, and if they weren’t available, I’d be able to stop this before I have to
think about wearing a wig to the prom,” she thought.
Aisha first tried sitting on her hands when she watched television, and that
helped. But her hands still slipped out and found her hair. Her dad suggested that
she try to keep her hands busy. She bought some soft modeling clay and kept it
by her seat in the den. She made it a plan to work the clay in her hands when
watching television. This not only kept her from pulling out her hair but relieved
her stress as well.
Bedtimes were more of a challenge. Aisha couldn’t busy her hands and try to
sleep at the same time. But as her habit got better during the day with the clay,
she found she could do better at night by keeping her hands under her pillow.
She was pumped because she now felt she could go to the prom without being
embarrassed.
for you to do
Many rituals can be helped by planning to keep busy doing something that
makes them impossible. Aisha came up with some good plans. Backup plans for
bedtime could have included other things, like putting her hair in a shower cap at
night or wearing mittens on her hand so she couldn’t grab the hairs. It may take a
little creativity, but it can be done.
Let’s start by working on a ritual that is a behavior you struggle with. Write it
here: _________________________________
Do you need to find something to busy your whole body (for example, moving
to a different part of the house or taking a walk) or just a part (like your hands)?
_________________________________
If a part, which part? _________________________________
Think of three things you could do to keep your body/part occupied so you can’t
do the ritual (for example, if your ritual is touching doorknobs, you could keep
your hands in your pockets when you walk near doorknobs).
1. _________________________________
2. _________________________________
3. _________________________________
Some rituals are in your head, not actions you perform. These include things like
counting, praying, and repeating certain phrases. Here you may want to plan to
think a pleasant thought that will occupy your mind instead.
What is a mental ritual you’d like to
fight? _________________________________
List three things you could plan to think about when tempted by your ritual: 1.
_________________________________
2. _________________________________
3. _________________________________
Now you’ve got a plan. Pick one of your high-risk times for rituals. Start with
one contradictory behavior or thought and try it for a few days. If it doesn’t do
the trick, try another.
wrapping it up
Briefly describe your experience with making your ritual impossible.
_________________________________
_________________________________
_________________________________
Did you have to try more than one strategy? If so, why do you think the first one
didn’t work?
_________________________________
_________________________________
Did any of them work? Why or why not?
_________________________________
_________________________________
(If they didn’t, hang in there, and try some of the other skills that are still to
come.) Overall, how much did you improve over a week doing this? Did you
reduce your rituals by a third? Cut them in half? What fraction of improvement
do you estimate?
28 planning to prevent your rituals
for you to know
Standing up against your rituals is the key to getting rid of

them. Since this is a challenge, having a plan is a good idea.
April’s belief in God was a big part of her life. She had been raised in a religious
family and loved going to services. Since she developed OCD, however, she
doubted her faith. She worried often that she might not truly believe in God.
Learning that this was a common stuck thought didn’t help. All she could do to
ease her anxiety was to say a prayer for faith. She knew this was a ritual and not
really necessary, but it was hard to stop. Since she always closed her eyes when
she prayed, her parents and friends noticed her doing this. April was ready to
stop this repetitive prayer and get back to a healthier faith in God.
April met with the counselor at her school to ask for help. The counselor
explained to April that she needed to resist the temptation to pray when she
knew it was a ritual and not something she really needed to pray about. He
helped April make a plan on how to dispute the thoughts and deal with the
anxiety she felt. April was excited to have a plan for victory at last!
for you to do
Like on a dance or sports team, it is crucial to have your players in place before
you begin. Here are some things you’ll want to cover before you seriously try to
avoid your rituals. Let’s look at how April might answer them before you try it
yourself.
When do I tend to do it most? “When I’m tired or don’t have much to do.”
What is the stuck thought that leads to my ritual? “Being afraid that I don’t
really believe in God.”
How do I know the ritual really doesn’t work? “It makes me feel better, but it’s a
trick. Why would I pray for faith if I didn’t believe in God in the first place?”
How do I know the stuck thought isn’t true? “It’s silly, because God is very
important to me. It’s just my OCD trying to make me miserable.”
What will I say to myself when I start thinking my stuck thought? “Leave me
alone, Doubter. You’re a liar, and I know it!”
What will happen if I resist doing my ritual? “I’ll feel more nervous for a while
because it’s such a habit.”
What will I do when I feel the stress of resisting the ritual? “I’ll use my deep-
breathing skills to tell my body it’s a false alarm. I will try to get my mind on
something else and remind myself the feelings will pass if I’m patient.”
How will I celebrate when I succeed? “Every time I win over the ritual, I’ll let
myself stay on the computer five extra minutes that night.”
Now take one of your rituals and put your plan together.
When do I tend to do it most? _________________________________
What is the stuck thought (if any) that leads to my ritual?
_________________________________
How do I know the ritual really doesn’t work?
_________________________________
How do I know the stuck thought isn’t true?
_________________________________
What will I say to myself when I start thinking my stuck thought?
_________________________________
What will happen if I resist doing my ritual?
_________________________________
What will I do when I feel the stress of resisting the ritual?
_________________________________
How will I celebrate when I succeed?
_________________________________
wrapping it up
Take a minute to think if there are any other things you need to prepare for
before you resist your rituals. Write down any you come up with.
_________________________________
_________________________________
_________________________________
Draw a picture in your journal that represents your readiness to resist your
rituals.
29 don’t do it!
for you to know
The way to rid yourself of rituals is to “Just Say No!” A

good plan prepares you to do just that. The final step is to
turn the plan into action.
April (from Activity 28) had worked hard to give herself the best chance of
overcoming her ritual of praying for faith when she was nervous that she didn’t
believe in God. She set a day to start when she wasn’t too busy and figured she
wouldn’t be tired. She wanted to give this her best shot.
When the day came, April changed her prayer to say, “God, help me beat my
OCD.” It was tough going, and she didn’t win every round. By the end of the
day, she figured she’d resisted the ritual about half the time. When she found
herself getting discouraged, April remembered the words of her counselor:
“Progress, not perfection.” She had made progress and could choose to feel good
about that rather than getting down because she wasn’t yet perfect. She would
keep trying tomorrow.
for you to do
Let’s follow April’s lead. When do you think a good time would be for you to
begin your fight with your rituals? Be specific and consider things like being
rested and not distracted by busyness.
_________________________________
Fight your rituals for one day, then complete the report below. (You might want
to make copies of this so you can use it over and over.) Day and
date: _______________ Ritual I fought:__________________
I feel I did (circle one): great well average poorly badly My
guess would be that I resisted my rituals completely about _____ percent of the
time today.
I at least put up a fight about _____ percent of the time today.
Things I can do differently tomorrow to help me improve my ratings:
_________________________________
_________________________________
Keep working at it. Rituals don’t develop in a day, and beating them can take a
little while, too.
wrapping it up
Write a journal entry for your experience on the first day of resisting rituals,
sharing your thoughts, feelings, successes, failures, and attitude about continuing
to work at this.
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
If you’re having a hard time, consider these suggestions:
Have a friend or parent help you.
Begin work on an easier ritual.
Work on the ritual only part of the day.

Try simply disrupting the rituals (see Activity 26) for a few days, then try
resisting them again.
30 beating your stuck thoughts with exposure
for you to know
Stuck thoughts try to convince you that you need to fear

things that are not dangerous. Avoiding the feared things
makes the stuck thought worse. Learning to expose yourself
to what you fear empowers you to overcome that fear.
Did anyone ever try to get you to eat a food you thought you wouldn’t like? You
might have reluctantly tried a bite. But you expected it to be bad, so it probably
didn’t taste good the first time. If you kept at it, gradually—after trying a few
times—you might actually have started to like it. You had to overcome two
problems: you were negative about it to start with and then you had to get
familiar with the new taste.
This is a good comparison for what has to happen to overcome the fears
associated with stuck thoughts and rituals. Even though people tell you not to
fear these things, your OCD makes you think they’re really dangerous, and so
you’d rather avoid them than try to face them. But when you do face them a few
times, the fear goes away and you gain freedom from your false fears. This is
called exposure, and learning to do it is the last major tool in beating OCD.
for you to do
Let’s practice understanding exposure before you apply it to your situation.
Kevin’s stuck thought is that he hurts people’s feelings by his choice of words
when he texts them. So he avoids texting his friends.
Why is Kevin afraid to text?
_________________________________
What will Kevin have to do to expose himself to his feared object?
_________________________________
How will Kevin probably feel when he does this the first few times?
_________________________________
What advice would you give Kevin on how to handle his thoughts and feelings
when he tries to expose himself to texting?
_________________________________
How do you think Kevin will feel after he’s exposed himself to the feared
situation several times?
_________________________________
Veronica gets really nervous if her family members don’t sit at the same places
at the dinner table and if the silverware is not arranged in a specific pattern. She
knows there’s no danger here; it just makes her feel uncomfortable.
What will Veronica have to do to expose herself to the situation she fears?
_________________________________
How do you think Veronica will feel the first time she does that?
_________________________________
What advice would you give Veronica on how to handle her thoughts and
feelings when she exposes herself to this situation?
_________________________________
_________________________________
_________________________________
And, of course, you know she’ll feel much more at ease after she does it a few
times!
wrapping it up
What are your first thoughts and feelings about trying exposure on your fearful
thoughts and situations?
_________________________________
_________________________________
_________________________________
If you did the activities just before this one, you have already experienced
hanging in with fearful feelings without giving in to rituals.
Do you think exposing yourself to your fearful thoughts and situations will be:
easier harder about the same
What steps might you take to prepare for this important step in your victory over
OCD?
_________________________________
_________________________________
_________________________________
31 what are you avoiding?
for you to know
People with OCD can fear places, things, situations, certain

actions, or certain thoughts. You need to be aware of all the
things you’re avoiding so you can apply your exposure skills
to all of them.
As they waited for class to begin, Juanita peered over Angela’s shoulder and saw
her homework.
“Angela!” she said. “Your writing is neater than the print on my computer. How
do you make all your rows of words line up to be the exact same length? That
must take you forever!”
Angela smiled but started thinking. She had been perfectionistic about the
neatness of her homework for so long that she didn’t even notice it. She had
made great progress on some of her stuck thoughts and rituals but hadn’t even
thought about her discomfort with any of her writing being messy or out of
balance. Angela decided this would be the next project for her exposure skills.
for you to do
Sometimes nervous feelings lead you to avoid things so automatically that you
aren’t even aware you are doing it. Let’s make a list of everything your anxious
thoughts and feelings cause you to avoid. It might help to ask someone who
knows you well if there are any you missed.
Particular items I avoid (things I think are dirty, pictures that might make me
have violent thoughts, etc.) _________________________________
_________________________________
Places I avoid (public restrooms, places I associate with bad luck, etc.)
_________________________________
_________________________________
Situations I avoid (messy homework, books in a different order, etc.)
_________________________________
_________________________________
Actions I avoid (saying certain words, wearing certain colors, etc.)
_________________________________
_________________________________
Thoughts I avoid (thinking of death, counting to any number except the number
that goes with my ritual, etc.) _________________________________
_________________________________
wrapping it up
Which of your answers were hardest to think of: items, places, situations,
actions, or thoughts?
_________________________________
Which one of these do you think will be the hardest to expose yourself to?
_________________________________
Which do you think will be the easiest?
_________________________________
Can you think of any of these you have genuine reasons to avoid? (For example,
if you think bad language is wrong, you actually should avoid bad language.)
_________________________________
32 facing your fears in your imagination
for you to know
Often it’s easiest to start facing fearful situations in your

imagination. Many times you’ll that find the feared situation
is only in your head.
It isn’t unusual that at fourteen, Connor likes horror movies, yet every time a
scene from one of the movies pops into his head, his OCD makes him think that
he is a violent person and may do something bad. Connor knows the facts: just
because he has seen some scary films doesn’t mean he’s a serial killer. Still, any
thought about one of the movies really upsets him.
Connor had struggled with fearing germs before, and exposing himself to public
restrooms helped him overcome it. But how can he apply this technique to a fear
that is only in his head?
Connor figured it out. Instead of running from the thoughts, he thought about the
movies on purpose, took deep breaths when he felt anxious, and told himself,
“OCD will not beat me!” Sure enough, he soon felt better.
for you to do
Exposing yourself to uncomfortable things in your mind is useful when, like
Connor, you have a stuck thought about a fear that is only in your head. It can
also help you build confidence for real-life situations by coping with minor
discomfort caused by just thinking about them. Let’s try.
Do you have a stuck thought that makes you afraid of thinking about or
imagining a particular thing? If so, what is the thing you fear? (For Connor, it
would be becoming a violent person.) _________________________________
What is the thought that leads to the fear? (Connor feared thoughts about horror
movies he’s seen.)
_________________________________
Mental exposure means thinking the thought on purpose while fighting the fear.
How would you do that, based on skills you’ve already learned?
_________________________________
_________________________________
_________________________________
Now, think through a lower level of anxiety caused by imagining a situation that
you fear due to stuck thoughts. (For example, Connor might have imagined
walking into a school bathroom when he was battling the stuck thought that
going there would make him sick.) Learning to think it without getting as
nervous prepares you to face the situation in real life.
Choose one of your real-life fears caused by stuck thoughts:
_________________________________
List several ways you might imagine this situation that would cause different
levels of anxiety, from most difficult to least. (Connor might just think about the
school restroom and then get more nervous by imagining himself walking into
it.) 1. _________________________________
2. _________________________________
3. _________________________________
Using skills you’ve learned, write what you could think that would enable you to
face this situation with less fear.
_________________________________
_________________________________
_________________________________
_________________________________
Now, try exposing yourself to the fearful thing in your mind while fighting the
fear with the thought you just wrote.
wrapping it up
Describe your experience trying to expose yourself to a thought you fear.
_________________________________
_________________________________
_________________________________
If you’re using several levels of imagining, move on up to the next once you
make good progress on the easiest.
After you’ve tried exposure, what changes would you make in the strategy you
used? (Remember, learning from experience is important in beating OCD.)
_________________________________
_________________________________
_________________________________
How does completing this activity make you feel about facing real-life situations
that make you nervous?
_________________________________
_________________________________
_________________________________
33 ranking situations that make you nervous
for you to know To overcome OCD, you need to know not

only the situations that you fear, but also all the similar
situations—both real and in your thinking—that make you
nervous. You will be more successful if you know which
make you the most nervous and which aren’t so bad. In
exposure, you start with the less troublesome ones and work
your way up Shandara, whom we’ll be getting to know over
the next few activities, feared having to throw up. She had
decided the smell of food anywhere but home would make
her sick at her stomach. She then got really nervous about
throwing up. This was now so bad that she couldn’t even go
near the doors of the school cafeteria.
Shandara had learned that she needed to expose herself to her fearful situation,
but how could she when she couldn’t even get near the cafeteria? Not to be
defeated, she thought hard and then realized she didn’t have to start in the
cafeteria. She thought about all the places and situations where she felt nervous
or sick and decided that she’d start on something easy.
for you to do
First, know how to rate your symptoms of nervousness on a scale of 1 to 10
(Activity 23 can help you do this.) Choose one thing you avoid due to OCD, and
think through all the parts of it that stir up nervousness. Shandara, for example,
would think not just about the cafeteria but also about different places and
situations in it. Then she’d think of places near the cafeteria that bothered her.
Finally, she’d list other things that make her nervous, like talking to her friends
about the cafeteria or just thinking about it (yes, include thinking about it,
looking at pictures of it, and other ways it can bother you without your actually
being there or doing it).
Now, actually go to each situation briefly (or do the action briefly) to see how
nervous each makes you. For some you may just have to guess if it’s too
troubling to actually do them. Rank each on a scale of 1 to 10.
wrapping it up
Once you have a list of all the situations that you avoid because OCD makes you
uncomfortable, and how much each bothers you on a scale of 1 to 10, the next
step toward success is to rank order them like Shandara did.
Shandara’s scale might look like this:
34 making a plan for exposure
for you to know
When you face your nervous situation, you’ll need a plan to

help you hang in there when you have nervous thoughts and
feelings.
Shandara was determined to beat the OCD that kept her from having lunch with
friends at school. She got tired of giving them excuses and finally came clean,
explaining to them that she was afraid she’d throw up when she smelled and saw
the cafeteria food. They promised to encourage her as she worked through her
plan to gradually get closer to eating with them. But she knew it would take
more than her friends’ encouragement, so she made a plan for how she would
cope with her nervous feelings and thoughts when they came.
for you to do
Shandara had her bases covered, for you need to have three things to hang in
there when you expose yourself to your nervous thought or situation you’ve
chosen to work on.
First, many teens can use some accountability. Shandara chose one way: letting
friends (or parents) know what you’re doing so they can ask you how it’s going.
This approach is a little gentle pressure to get you through. The other way is to
make yourself accountable to start on a certain day.
Which do you prefer? (Circle one) friend or parent self When will you
start your plan? Be specific and commit yourself to this choice.
Day _____________ Time _____________
Second, you need to have a plan for coping with anxious thoughts. Review your
thinking skills from earlier in the book if you need to and write your plan here:
When I start my nervous thought that _________________________________
_________________________________
might happen, I will stop the thought, identify it as a lie, and argue back at it by
saying _________________________________
_________________________________
Third, there are those troubling feelings that come. What do you do with them?
Identify them as the liars they are, too, sounding an alarm when there’s no
danger.
Write what you will say to yourself about them:
_________________________________
_________________________________
Then, talk back by calming yourself through deep breaths and saying, “Settle
down, self. There’s no danger.”
wrapping it up
Can you think of any other things you might do or say to yourself to help you
cope with the nervous thoughts and feelings that may come when you expose
yourself to your difficult situation?
_________________________________
_________________________________
Do you have any songs, poems, or prayers that help you get psyched up that
might be useful here as well?
_________________________________
_________________________________
You might put this all on a reminder card to carry with you.
35 exposing yourself
for you to know
Overcoming situations you fear because of stuck thoughts

takes letting yourself be exposed to them until your
nervousness eases up. The key is beginning with less
stressful situations and working your way up.
Shandara had worked hard to prepare to face her fears of the school lunchroom.
She knew in her heart that the food there wasn’t what made her sick at her
stomach; it was the nervousness caused by her OCD. She had a plan: to take
deep breaths and remind herself of the fun she was missing talking with her
friends during lunch whenever the lie of OCD made her think there was danger
at lunch. She was ready.
Monday came, and she was working through her plan. She even opened the
cafeteria door. But then the combination of nervousness and nausea sent her
back down the hallway to safety. Too much too fast: Shandara needed a more
gradual plan.
If Shandara can learn to manage her anxious feelings one step at a time, she can
work her way to success at having lunch with her friends.
for you to do
Here’s a checklist to make sure you’re ready to expose yourself to a situation
that makes you nervous.
You know how to rank your nervous feelings as they occur from 1 (mild)
to 10 (severe).
You have listed situations that make you nervous, starting with mental
situations that cause mild distress and continuing up to the real situation
itself.
You have a plan for deep breathing and talking back to your anxious
feelings, including being convinced that the fear isn’t real.
And let’s add one more to help motivate you.
You have set up a little reward for yourself for each step you pass, and a
big one for when you reach the top:
My rewards: _________________________
Great. Now that you’re ready, here’s the idea. Start with the lowest fear. Imagine
it or put yourself in that situation. What is your rating of
discomfort? _________________________
If it’s 3 or less, move on up to the next one and so forth until you have at least a
4.
Now stay with the fear and use your skills until you can get it down to a 2. Take
as much practice as you need. When you succeed, move up to the next step in
your list. Use your skills until this drops down to a 2. Got the idea? Keep going
until you get all the way up your list. Take your time, but this is the key to
beating OCD.
wrapping it up
After you’ve worked on this plan for a few days, answer the following questions.
What changes did you make in your plan as you went along?
_________________________________
_________________________________
_________________________________
Which step was the hardest so far?
_________________________________
If you did get stuck on a step, what did you do?
_________________________________
_________________________________
(Suggestions include changing what you say to yourself, getting someone to
help, adding a little step between where you are and the one you’re stuck on, or
changing rewards.) If you are making progress, describe how it feels:
_________________________________
_________________________________
If parents or friends know you’re working on this, share your success with them.
36 doing what you fear on purpose
for you to know
One of the best ways to prove to yourself that you’ve

overcome stuck thoughts and rituals is to intentionally do
the thing they worried you about.
Camille probably checked to see if she unplugged her hairdryer ten times before
she could get out the door. She didn’t want to be responsible for burning down
the house or something. Her checking continued even though her parents
convinced her that many things are plugged in all day and don’t cause fires.
When trying to talk herself out of worrying about it failed, Camille was ready for
drastic action. She left her hairdryer plugged in on purpose. It was sort of funny
that she actually didn’t worry as much because she now knew it was plugged in.
She was nervous off and on during the day at school, but she wasn’t surprised to
pull into her driveway that afternoon to see her house still standing. She knew
her need to check her hairdryer would be less of a problem from now on.
for you to do
Lots of teens will find it a great idea to actually have permission to disobey—not
their parents, but their OCD. Like them, you don’t have to do what it says! Many
kinds of OCD problems can be “disobeyed,” like Camille did:
If you fear germs on a sink, you can make yourself touch the sink.
If you fear driving because you worry that you’ll do something wrong,
you can go for a drive—provided you have your license!
If you get nervous when your backpack is messy, you can wad up a
couple of papers and toss them in.
If you are anxious that you’ll say something that isn’t perfectly accurate,
you can say something you know isn’t precise.
What problem caused by OCD do you have that you could defy by doing it on
purpose?
_________________________________
What will you need to do to disobey it?
_________________________________
What skills that you’ve learned can help you defy the thing you’re avoiding?
_________________________________
_________________________________
_________________________________
Now give it a go.
wrapping it up
What were you thinking when it was about time to disobey your OCD?
_________________________________
_________________________________
Did defying your OCD make you more or less nervous than you thought it
would?
______ Why? _________________________________
_________________________________
Is there anything you’ll do differently next time you try this?
_________________________________
Succeeding in disobeying your OCD felt as good as
_________________________________
Sometimes new stuck thoughts and rituals try to work their way into your life.
This skill can help run them off before they get a hold on you.
37 handling things that aren’t “just right”
for you to know
OCD often makes kids feel like they have to do things “just
so” or have things “just right” to keep from feeling nervous.
The skills you’ve learned can help with this, too.
Nolan obsessed about looking just right at school. His sister hassled him because
he took so long in the bathroom in the mornings, making sure that his clothes
and hair were perfect. He couldn’t leave until he was confident that no one could
fault his appearance. Still, he knew he was overdoing it, and he knew no one
would stop being his friend if his hair wasn’t just right.
Getting detention for being late yet again made Nolan determined to stop this
behavior. He had come a long way in overcoming OCD, and this piece of it
would be next to go down in defeat. The following morning, Nolan didn’t even
comb his hair after his shower and skipped a belt loop on purpose so that his
outfit wasn’t perfect. Sure a couple of his friends teased him—but not before
Nolan joked about it himself. What a great feeling to be released from trying to
look just right!
for you to do
First, let’s identify the things like this that bother you. These can include stuff
like having to completely erase any mistakes on your paper, feeling you have to
make 100 on every assignment and test, having to balance your desk so that
there are a certain number of things on each side, and so on.
_________________________________
_________________________________
_________________________________
Now think about why you feel you have to have things “just so.” Write it here:
_________________________________
_________________________________
Usually this behavior is to avoid an uncomfortable feeling similar to
nervousness. Use your reasoning skills: is this a genuine fear or a false one?
What can you say to yourself when you think or feel this way?
_________________________________
_________________________________
How might you use your skills at facing your fears and exposing yourself to
them to fight acting this way, based on what you have learned so far?
_________________________________
_________________________________
_________________________________
wrapping it up
Some people whose OCD makes them sensitive to things being “just so” get
frustrated or irritated with others who don’t do things the way they want them to.
From what you know about OCD, why do think this might be?
_________________________________
_________________________________
What advice would you give to a person who struggles with this problem?
_________________________________
_________________________________
Do you think this might apply to you? Why or why not?
_________________________________
_________________________________
How might the skills you practiced in this activity help when others don’t do
things just the way you want them to?
_________________________________
_________________________________
38 putting it all together
for you to know
To keep strong against stuck thoughts and rituals, it is

helpful to review what you’ve learned.
Lindsay was feeling pretty good about the progress she’d made on her OCD. She
had texted her cousin Danielle about her fight with stuck thoughts and rituals,
but when they got to see each other at the family reunion, Danielle wanted to
hear the whole story.
Lindsay was more than happy to oblige her cousin. As she talked, Lindsay
realized how far she had come—even more than she had realized before. She
also noticed that a couple of the skills she had learned had slipped her mind. She
was glad to realize this, because she knew her OCD could strike back if she gave
it a chance.
for you to do
Since you may not have a cousin asking you to tell the story, imagine a
newspaper editor hears of your progress and wants you to write a brief story. The
editor asks you to cover a little about what OCD is, what you did to get better,
and what advice you might give to other teens who have it. You might look back
over the activities you’ve done before you write this, and try to be detailed.
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
wrapping it up
In doing this activity, did you notice any important skills that had slipped your
mind? If so, which ones?
_________________________________
_________________________________
_________________________________
What do you think is the biggest difference in your life now that your OCD is
more under control?
_________________________________
_________________________________
_________________________________
What do you think you need to do to keep fighting your OCD to finish it off and
to keep it out of your way?
_________________________________
_________________________________
39 back in the game
for you to know
OCD is a bit naughty and will often try to sneak up and take
over your life again. Realizing how far you have come can
help you stay strong and resist new stuck thoughts and
rituals.
As Jamaal, whom we met back in Activity 2, sat in class waiting for the teacher
to begin, he remembered last semester when he was about ready to drop out of
school because his ritual of straightening everything got him teased by his
friends so much. Now he enjoyed being in class and could even look at a messy
stack of papers without feeling an urge to straighten them. He realized he had
probably been depressed before. But now, with his thoughts being his own and
not the nagging of OCD, he was happier than he’d been in a while. School was
still hard, but he was happy to be there.
for you to do
Think back to when you began this program (review Activities 2 and 3 if you did
them). For each area, tell how your OCD affected your life then. What has
changed in these areas, if anything, now that OCD is less in control of your life?
wrapping it up
Which area of change surprises you most?
Why? _________________________________
_________________________________
How has your improvement affected your school work and performance?
_________________________________
_________________________________
What are you doing with your freedom that you couldn’t do before?
_________________________________
_________________________________
40 the story of your success
for you to know
Knowing how far you’ve come, and planning for the future,
will help keep you free from OCD.
Reese had been pretty much free from stuck thoughts and rituals for months
now, but suddenly she found herself afraid she’d say something bad about
someone accidentally and saying a ritual prayer to ease her anxiety.
“Not going there!” she said to herself. She thought back on how miserable she’d
been when she let her OCD talk to her instead of her talking to her OCD. She
pulled out her review sheet where she’d written down her keys to success, and
she resolved to fight back from the start. As she expected, her OCD backed off
and left her alone once again. What a great feeling to know she had tamed an
animal like OCD!
for you to do
Reese was wise to have a brief summary of what she’d learned ready in case her
thoughts came back.
Make a summary sheet of the keys to your success so you have it ready for
future reference. It is a good idea to review these keys from time to time, even
before OCD tries to get back in.
REMINDER OF MY KEYS TO SUCCESS

When I notice myself thinking a stuck thought, I know I have to fight it and treat
it as the lie that it is. The best ways to do that are:
1. _________________________________
2. _________________________________
3. _________________________________
When I feel nervous if I don’t do a ritual, I must resist the ritual. The best ways
for me to do that are:
1. _________________________________
2. _________________________________
3. _________________________________
When I feel nervous, I can replace my rituals by:
1. _________________________________
2. _________________________________
3. _________________________________
wrapping it up
From what you’ve learned working on your OCD, what might be a few
situations where you think your OCD might sneak up on you again?
1. _________________________________
2. _________________________________
3. _________________________________
What is your plan for staying alert in those situations?

_________________________________
_________________________________
_________________________________
Who could you ask to tell you if he or she notices any signs of stuck thoughts
and rituals in your behavior?
Set a few dates to review the sheet you just made to help prevent OCD from
coming back.
One month from today: _________________________________
Three months from today: _________________________________
Six months from today: _________________________________
Commit yourself to these reviews. Put them on a calendar or in reminders on
your cell phone. These are “booster shots” to maintain your gains.

Here’s wishing you a wonderful life free from OCD!

Timothy A. Sisemore, Ph.D., is professor of counseling and psychology at
Richmont Graduate University in Chattanooga, TN, and maintains a private
practice in clinical psychology. He specializes in treating anxiety disorders in
children and adolescents. Sisemore is author of several books, including I Bet I
Won’t Fret.

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What is the purpose of this workbook?

What is the purpose of this workbook?

What activities are included in the workbook?

What activities are included in the workbook?

Publisher’s

for you to know

There are many kinds of obsessions (stuck thoughts) and

for you to know

As if it isn’t bad enough to wrestle with stuck thoughts and

for you to know

Often it’s helpful to imagine your destination as you begin a

for you to know

OCD symptoms vary from minor bothers to major hassles.

for you to know

Stuck thoughts and rituals aren’t always as random as they

for you to know

Battling stuck thoughts and rituals can be challenging

for you to know

Often it’s helpful to imagine your destination as you begin a

for you to know

Stuck thoughts are either irrational worries or real worries

for you to know

OCD lives on irrational thoughts that may trick you into

for you to know

Since feelings can make distorted and exaggerated thinking

for you to know

Most of the irrational thinking and behavior around OCD

for you to know

Stuck thoughts must be seen for the irrational things they

for you to know

for you to know

for you to know

for you to know

Now that you know how to disrupt obsessive thoughts and

for you to know

Stuck thoughts seem to come when you least want them.

for you to know

Even though you’re learning to fight stuck thoughts, you

for you to know

Understanding the feelings of the fight-or-flight response

for you to know

Understanding how stuck thoughts and rituals make a loop

For Gavin, the loop would look like this:

Try one more.

The “believe it’s true” step is attacked by skills in challenging thinking.

The “anxiety” step is attacked by skills in understanding feelings.

The “ritual” step is challenged by preventing the ritual and exposing

for you to know

for you to know

Rituals are a form of fleeing a false fear; to beat them you

for you to know

Rituals shortcut the process of overcoming anxiety by

for you to know

Facing your feelings without giving in to your ritual

Sit comfortably in a chair, without slouching. Rest your arms on the

for you to know

Sometimes rituals are like bad habits: you do them without

for you to know

Learning to control your rituals just a bit before you try to