The Nature of Obsessive Compulsive Disorder: The Basic Phenomena

This is the first part of a series of blog posts that I will be writing regarding the nature of OCD. This first blog post aims to introduce the basics for those who are interested in learning some of the theory behind the phenomena. Please stay tuned for further updates regarding cognitive theories,  prevalence, what keeps OCD cycling, cognitive distortions and thinking errors, treatment options and relapse prevention.

A good understanding of the basic phenomena, to what obsessions are and the nature of how compulsions relate to obsessions is crucial for working effectively with service users with OCD. In my experience of offering training courses on OCD and working with this client group, there seems to be confusion over the basics, which is not exclusive to the general population, but also health care professionals. The following blog post aims to introduce the basics of OCD, the theories and provide examples of how it all fits together.


Obsessions are involuntary and often described as unwanted, intrusive thoughts, images, impulses or urges that are regarded as repugnant, senseless, unacceptable and very difficult to dismiss. Obsessions are accompanied by intense feelings of anxiety and discomfort, and an urge to ‘neutralise’ the thoughts (Salkovskis, 1999).

Intrusive thoughts have been researched extensively and regarded as universal, are experienced by those without a diagnosis of OCD or complaint of anxiety and are not thought to be problematic (Freeston et al., 1991; Rachman & de Silva, 1978; Salkovskis & Harrison, 1984). However, for those with OCD marked distress is common.

Rachman (2003) outlines the core, classical obsessions as aggressive/harm, sexual or blasphemous in nature and is common to experience more than one theme and explains how obsessions are regarded as ‘ego-dystonic’. This means that the obsessions are contrary to the person’s beliefs about themselves, their morals and what they find socially acceptable. It is understandable, knowing that obsessions are as far removed from the person’s own sense of being, that one might experience intense anxiety, and attempt to neutralise the intrusive thought or attempt to prevent the thought from entering one’s mind again.


Compulsions are voluntary, and often regarded as ‘neutralising’ behaviours that are carried out to offer temporary relief from the discomfort and anxiety caused by the obsession (Rachman, 2003). Although compulsions are seen as entirely voluntary behaviours, to the person experiencing obsessions the need to ‘neutralise’ is not seen as voluntary but vital to avoid catastrophic events or harm coming to self or others, or to minimise the impact of any obsessions they fear they might have carried out.

Compulsions can take the form of both overt (visible) and covert (unseen) behaviours, such as hand washing (overt) or mentally praying repetitively (covert) (Rachman, 2003). As overt rituals are easily seen, it is easier to recognise the possible symptoms, but for those who experience purely covert rituals it can be a little more difficult to detect.

There are two further forms of neutralising behaviours that are theorized. The concepts of Verification and Restitution has been widely discussed and researched. For people seeking verification, they may neutralise in order to prevent anything “bad” from happening, e.g. cleaning rituals to prevent cross contamination or spread of germs, or checking doors to ensure they are secure. Secondly, Restitution neutralising may be performed when one becomes convinced that something “bad” has already occurred or they fear they might have caused harm, and the neutralising behaviours take form to minimise its impact and put things right (Cougle et al, 2007).


Obsession: “I might not have turned the gas off properly, the house might blow up and I will lose all of my belongings, because of my carelessness”.

“If I don’t check the gas, it might be left on and I will be responsible for the house blowing up, and if people are in next door, they could be killed by my careless behaviour and I will go to prison”.

Compulsion: Repeatedly checking the gas hob or switch is off and checking the oven for the smell of gas (overt compulsions/rituals and verification).

Obsession: “What if I am potentially a psychopath and I might want to harm my own children”

Repetitive intrusive images of harming one’s own children.

Compulsion: Avoiding spending time with children or avoiding motherly/fatherly roles or hiding or eliminating objects that are potentially weapons from ones home e.g. sharp knives (this is a non exhaustive list of examples).

Obsession: “How do I know I haven’t put poison into my mum’s cup of tea?”

Compulsion: Pour the cup of tea down the sink and make a new cup (overt, restitution), or avoid making drinks altogether (covert).

The case of ‘false memories’

It is not uncommon for those who live with OCD to experience ‘false memories’. A false memory is an event that one might believe has took place, but is nothing but imaginational. False memories can seem very real and understandably can heighten anxiety. Needless to say, false memories cause anxiety because intrusive thoughts, images, impulse or urges are never pleasant in nature, and when one becomes frightened that they may have played out something heinous and terrible, it starts the process of restitution and reassurance seeking behaviours.


*Note to healthcare professionals – obsessions are ego-dystonic and not a true reflection of the person who experiences them and there has never been a single case of anyone undertaking any single obsession or intrusive thought. Obsessions are as far removed from the person’s morals and values that the mere thought of these creates intense anxiety and fear. People who experience intrusive thoughts/obsessions are not at any risk to harming themselves or others.


Cougle, J., R., Lee, H. and Salkovskis, P., M. (2007) “Are responsibility beliefs inflated in non-checking OCD patients?” Journal of Anxiety Disorders. 21 (1) pp. 153-159.

Freeston, M. H., Ladouceur, R., Thibodeau, N., & Gagnon, F. (1991). “Cognitive intrusions in a non-clinical population: I. Associations with depressive, anxious, and compulsive symptoms”. Behaviour Research and Therapy, 29, 585–597.

Rachman, S., & de Silva, P. (1978). “Abnormal and normal obsessions”. Behaviour Research and Therapy, 16, 233–248.

Rachman. S. (2003) The Treatment of Obsessions. Oxford: Oxford University Press

Salkovskis, P. M., & Harrison, J. (1984). “Abnormal and normal obsessions: A replication”. Behaviour Research and Therapy, 22, 549–552.

Salkovskis, P. m. (1999). “Understanding and Treating Obsessive Compulsive Disorder”. Behaviour and Research Therapy. 37, Supp. 1 S29-52

The Wellness Toolbox

This toolbox was developed specifically for service users that attend the Obsessive Compulsive Disorder (OCD) support group that I run, and is tailored very much to OCD but can be very easily used with a variety of other mental health problems.

What is a Wellness Toolbox?


A wellness toolbox is a folder full of information on what kinds of things will help to keep you well. These things are information about your mental health problem, coping strategies, activities that you enjoy, goals for the future and information on what may trigger anxiety and what to do in times of crisis.

A wellness toolbox is very individual as different people enjoy different things, and people are inherently individual. But what a toolbox like this can offer you is a snap shot of things to draw upon for the times when we feel we may be unwell or becoming unwell, and having a resources file to draw upon can help us to focus more.

Knowledge is Power

As part of your wellness toolbox, it is useful if you can gather information all about what you are experiencing, about your mental health problem and anxiety.

You may even wish to write about your positive experiences, your achievements and goals for the future (hierarchy of fear, life goals etc…). When goal planning, it is always useful to imagine a long term goal, but to break that down into small and achievable steps in order to meet it in the future.

Knowledge is the key to understanding OCD and by doing this, it can help you realise that it is not only you who is experiencing these thoughts, images, impulses, urges or doubts, especially in the times when you are alone.

Coping Strategies

It is always useful to have a few resources at hand for times when you feel anxiety creeping upon you, or when you need to wind down.


  • Going to the gym
  • Walking the dog
  • Reading a book
  • Spending time with family
  • Writing a journal/creative writing
  • Getting rest and relaxation/stress reduction exercises
  • Listen to music
  • Speak to my doctor/therapist
  • A list of social networks for support


It is crucial to understand the things that can trigger OCD and anxiety, and being aware of these triggers can prepare you for them or equip you with the knowledge on how to avoid a crisis.


  • Alcohol and drugs
  • Stressful activities
  • Arguments
  • Not enough sleep
  • Certain dates and anniversaries
  • Low mood
  • Stress
  • Increased responsibilities
  • Poor memory


Trigger Action Plan

What would help you if one of your triggers came up? What has worked in the past for you, and what has worked well for others?


  • Speaking to a friend/peer counselling
  • Doing some breathing exercises
  • Taking time out


Crisis Planning

A crisis plan is something that is very individual. It details:

  • How you are and feel when you are well
  • Signs for you or others to watch for if becoming unwell
  • Support networks to access
  • Advice for yourself and others on how to help in these times of crisis (or advice on what others can avoid doing that may make your situation worse).

Creative Writing as a Therapeutic Intervention: A Reflection on a Training Course

I attended a training course at the University of Huddersfield yesterday, actually called “Yoga for Creativity”. As much as the course was demonstrating how yoga techniques can enhance well-being, the facilitator asked us to explore how to use creative and meditative writing as a means of therapeutic intervention. The basis of this reflection is how creative and meditative writing can be applied in  mental health settings as a therapeutic intervention, and a further reflection will be written exploring Yoga as a therapeutic intervention.

The first exercise which the facilitator asked the group to engage in really excited me as I started to think that this is an intervention that could be utilised within my practice. The activity was taken from Goldberg (1986) where writing is used as a ‘timed exercise’. The facilitator asked us to:

  1. Write continuously for 10 minutes 
  2. To keep our hands moving with no pauses in writing
  3. No crossing out
  4. Forget the rules of spelling, punctuation and grammar
  5. Lose control, don’t think and forget logic
  6. Go for the jugular (don’t be afraid to dive right into writing that exposes our feelings or makes us feel naked)

After the allocated 10 minutes we could read what we had written and discuss with our neighbours the content (if we so wished). Surprisingly, the activity didn’t end there and the facilitator asked us to highlight up to 8 sentences in our creative writings. These sentences had to ‘jump out’ at us or offer meaning. After choosing our 8 sentences, we were asked to then make a poem out of the sentences in any order. This was brilliant. I began to think about how I could potentially use this as a therapeutic intervention related to mental health, and namely within my OCD Support and Recovery group.

As I was carrying out the exercise, I felt a sense of exposure, but this wasn’t anxiety provoking. It led to more of a curiosity as to what would come out from my 10 minutes writing without pausing. I guess it’s a lot like Freud’s  ‘free association’ but with a little bit of a twist. I like that idea a lot!

I think that if this intervention was used within my group, it has the potential to get a lot of ‘thoughts’ out on paper. For some this could be more anxiety provoking than others, dependent on the nature of OCD and the content of intrusive thoughts and obsessions. This is something that will have to be further explored through talking this activity through with members of the group to hear their perspectives and possible anxieties.

Possible Intervention

Follow the guidelines for intervention above but:

  1. Ask group members to write for 10 minutes continuously on the theme of OCD
  2. Highlight up to 15 positive words or sentences
  3. Adapt those 15 words into a creative poem related to their OCD.

Action Plan

  • I intend to research the evidence base for creative writing as a therapeutic intervention further. I have bought a book titled “Writing Well: Creative Writing and Mental Health” by Deborah Philips, Liz Linington and Debra Penman and also have a couple of chapters photocopied from “Ordinary Magic: Everyday Life as Spiritual Path” by John Wellwood from the training course attended. This will be read and studied further.
  • Speak to group members about their perspectives on using creative writing as a therapeutic activity to inform part  of their Recovery Action Plan.
  • Conduct the adapted activity on myself and see if it works.
  • Reflect further once I have used this activity on myself, and within a therapeutic environment.


Goldberg, N. (1986) Writing Down the Bones. Boston: Shambhala

Philips, D. Linington, L. and Penman, D. (1999) Writing Well: Creative Writing and Mental Health. London: Jessica Kingsley Publishers

Wellwood, J. (1992) Ordinary Magic: Everyday Life as Spiritual Path. London: Shambhala

Occupational Therapy Symposia: Identity and Transitions

After a very interesting conference I made my way over to the University of Salford to attend the occupational therapy symposia focussing on identity and transitions.

There were 4 presentations discussed but during the symposia I began to consider how OCD can shape ones identity, and what can happen to ones identity after the onset of OCD and anxiety. I began to reflect on my own experience and how my life and whole attitude to life and myself as a person has changed due to the experience of OCD.

Anyway I thought that this would be something that would be worth exploring!


Questions to think about for reflective blog post on identity:

  • How did my occupational identity change after the onset of OCD, depression and anxiety?
  • What role loss did I experience?
  • What occupations were lost?
  • Does OCD give you an identity or does mental illness change your identity?
  • What is identity?


Reflection on Completing the ‘Preparing to Teach in the Lifelong Learning Sector’ from 2011/2012

The Preparing to Teach in the Lifelong Learning Sector (PTLLS) module has introduced me to the teaching profession and how education and learning works in the lifelong learning sector, but it has also introduced new theories and how they inform teacher practice. The aim of this reflective evaluation is to consolidate my learning throughout the (PTLLS) module to demonstrate professional growth and to show how theory has been applied and impacted upon my practice as a student teacher.

The PTLLS module has enabled me to gain new knowledge and skills in three main sub areas: teaching practice, theory and practical experience. However, Initially I began by researching what makes a good teacher. I reflected on previous teachers of mine, reflected on how they taught, how they engaged their learners and their teaching methods. I realised that a good teacher can diversify, make learning accessible, interesting and also captivate their audience.

The PTLLS module provided an introduction to the wider roles and responsibilities of the teacher and the role of the Institute for Learning (IfL) in providing an ethical and professional structure to guide practice (Duckworth et al, 2010; Gravells, 2011). IfL, 2008).  Following the IfL Code of Professional Practice is the responsibility of all teachers’ as doing so ensures each learner is provided with a seamless service underpinned by respect, professionalism and quality (Gravells, 2011). All teachers should reflect on their practice (Gravells, 2011; IfL, 2008) to learn, grow and now that I am aware of the roles and responsibilities, I am able to act as a reflective professional who empowers each learner to achieve their educational goals.

The teacher is required to break barriers to learning (IfL, 2008) e.g. learning needs, and to identify these barriers through the use of initial and diagnostic assessments (Gravells, 2011) e.g. through application forms or interviews. Through learning how to identify needs, I believe I am able to empower learners by providing learning that is suitable to their needs. This has been achieved through following support plans for dyslexic learners and providing handouts on specific coloured paper based upon their needs.

Theoretically, I have learned numerous theories of learning, such as ‘Blooms Taxonomy’ and how the cognitive, affective and psycho-motor domains inform teacher practice. Bloom suggested that learner’s experience 5 stages ‘attention, perception, understanding, short-/long-term memory and change in behaviour’ (Gravells, 2011, p. 58). My understanding and learning of ‘Bloom’s Taxonomy’ now assists me with a deeper understanding of the learning process and how to plan lessons aimed to reach each domain.

Furthermore, I have developed knowledge and skills in learning styles analysis, such as Honey and Mumford (1992), and Fleming (2005) who indicated that there were four styles of learning, however the PTTLS module focussed on three: Visual, Aural and Kinaesthetic (Gravells, 2011). Through developing knowledge in how to identify learning styles, I am now able to analyse how each learner learns and processes information best, and so adapt how I provide learning to meet individual learner needs, thus ensuring inclusivity (Gravells, 2011; Silver et al, 1997).

Importantly, the PTLLS module prepared me for putting theory into practice. The micro and mini teach enabled consolidation all of learning, such as how to develop a successful lesson plan mapped to learning outcomes using specific, achievable, realistic and timely aims and objectives, how to embed functional skills necessary to meet legislation requirements set by the Education and Skills Act (2008) ( and ensuring good time management within the lesson. A knowledge of, and experience of successful lesson planning is crucial to enable effective teaching and assessment (Gravells, 2011). This experience built confidence in my abilities as a teacher but importantly, it highlighted personal learning needs that I am required to develop and action in order to become a better teacher in the future, such as projecting my voice to make sure I am heard by all learners.

As a student teacher I understand the importance of learning and to continuously improve upon practice. Due to the nature of the profession, teachers’ must have a sound knowledge base, keep up to date with developments within their area of expertise in order to maintain professional standards and to ensure one is fit for purpose and fit for practice (Gravells, 2011; IfL, 2008).  Student teachers’ should employ strategies for further learning, and skills acquisition, and in evaluating practical teaching and mapping it to classroom learning in Teacher Education.

A method of learning that teachers’ and all student teachers’ must participate in is reflective practice (Gravells, 2011). The importance of reflection should not be underestimated, as learning can take place anywhere and at any time. Teacher’s must evaluate their practice to continuously improve and become better teachers’ (Gravells, 2011) and become better equipped to deal with challenging situations. An example from my experience of reflecting on performance is through considering how to become better at classroom management.

As a teacher one must never stop learning. Continuing professional development (CPD) is a requirement of the IfL to prove teachers’ are providing a service that is current, quality assured and ensures that the teachers’ knowledge and skills are constantly replenished (Gravells, 2011; IfL, 2008; IfL, 2009. By maintaining CPD this ensures professionalism flourishes, demonstrates a commitment to IfL standards and most importantly, a commitment to your learners (Gravells, 2011; IfL, 2008; IfL, 2009).


I will now discuss three ways in which my practice has been developed since undertaking the PTLLS module.

Firstly, I believe that I have learned about the importance of planning. Planning lessons is crucial for success (Gravells, 2011). I have learned how to integrate functional skills into my lesson planning and to map them to learning outcomes, a crucial aspect of lesson planning (Gravells, 2011) and meeting the requirements set by the Education and Skills Act (2008) (

I have learned about the importance of using differentiation as an approach to teaching to respect the individuality of learners (Timmons, 2010).  Utilising theory, such as learning styles analysis is crucial to ensure you are teaching effectively for each learner, and promoting inclusivity in your practice (Gravells, 2011). Theory informs teacher practice (Gravells, 2011) and the PTLLS module has given me a valuable insight to its importance.


Finally, and most importantly, the PTLLS module introduced the IfL Code of Professional Conduct (2008). This is possibly the most important aspect of learning in the PTLLS module because it has ensured that quality is measurable. I believe that following these standards of conduct and professionalism will act as a guide for providing a quality service to learners.


Duckworth, V., Wood, J., Dickinson, J. and Bostock, J. (2010) Successful Teaching Practice in the Lifelong Learning Sector. Exeter: Learning Matters

Gravells, A. (2011) Preparing to Teach in the Lifelong Learning Sector. 4th Ed. Exeter: Learning Matters

Institute for Learning (2008) Code of Professional Practice. London: Institute for Learning

Institute for Learning (2009) Guidelines for your CPD. London: Institute for Learning

Silver, H. Strong, R. and Perini, M. (1997) “Integrating Learning Styles and Multiple Intelligences”. Educational Leadership. (9), pp.22-27.

Timmons, J. (2010) Becoming a Professional Tutor in the Lifelong Learning Sector. 2nd Ed. Exeter: Learning Matters.

Other References (Date Accessed – 18/12/11)

Meditation and Breathing Exercises: A Quick Reflection

I have been attending a Mindfulness Meditation group for the last 8 weeks and during my time as an attendee I have experienced a variety of mediations, breathing exercises, learned some Mudra’s and listened to some interesting excepts from books such as ‘The Power of Now’ by Eckhart Tolle.

Prior to attending this group I had little experience of meditation and breathing exercises. I had used ‘Progressive Relaxation’ with clients who experienced anxiety disorders, but this was the length and breadth of my knowledge of breathing exercises and anxiety management. Today though, I was introduced to a very interesting breathing exercise by a very experienced Yoga and breathing exercises teacher. The exercise encourages you to exercise your entire lungs, and in rather an interesting way by directing your thumbs in different directions (I will write a further blog with pictures to illustrate this with instructions on how to use it). After completing this exercise I was left with a sense of contentment, energised and totally relaxed.

I feel that this particular exercise is easy to do, learn and easy to apply to practice. It has broadened my range of skills in anxiety management, and leaves me with a stronger sense of confidence in applying breathing exercises for my OCD Support and Recovery group.

I believe that this breathing exercise benefits the client by promoting a sense of wellbeing, but it also exercises the entire lungs and aids in increasing lung capacity. This not only would be a useful intervention to utilise in mental health but also possibly in pulmonary rehabilitation with clients with respiratory disorders such as COPD or asthma. Infact, one group member commented how 60 years ago, as a child she had asthma and recalled a similar intervention in hospital to help manage her asthma before inhalers became the norm.

Action Plan

  • I am going to do a write up about this interesting breathing exercise, and will include pictures to show how to position your thumbs.
  • Use this breathing exercise with my clients who may experience anxiety to work on increasing their wellbeing and providing them with an interesting tool to manage their own anxieties to enable optimal occupational participation.
  • Investigate further breathing techniques to broaden my range of skills for anxiety management and document these on my blog.
  • Make enquiries about local Yoga classes to attend to learn techniques to promote my own personal wellbeing and to integrate into my own practice with clients too.