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collect informa]on that can help you to decide what steps to take next.Circle the answer that most represents how you feel. If you answer “True” to at least two of thestatements within a group of ques]ons, you are most likely experiencing symptoms thatcharacterize OCD.Obsessions1. The same thought appears in my mind repeatedly. True False2. I have obsessed over the same thought for at least a two-week period.True False3. I have thoughts and see images that are disturbing to me. True False4. I find myself trying unsuccessfully to stop or control the distressing thoughts and imagesI experience. True FalseHow many of these statements did you circle as true?Compulsions1. I feel compelled to engage in repe]]ve behaviors in response to my obsessive thoughts.True False2. My repe]]ve behaviors are all aimed at reducing the anxiety or mental distress derivedfrom my obsessions. True False3. I recognize that the compulsive acts I engage in are most likely not helpful to me, but Ifeel compelled to do them anyhow. True FalseHow many of these statements did you circle as true?ContaminaAon OCDA fear of becoming contaminated or contamina]ng someone else with germs afer coming incontact with real or imaginary unclean objects, places, or people.1. I avoid touching certain things because of possible contamina]on. True False2. I clean my living space excessively. True False3. I wash my hands excessively. True False4. I ofen take extremely long showers or baths. True False5. I am overly concerned with germs and diseases. True False6. I am afraid of going into hospitals. True Falsek2

7. I am afraid of coming in contact with people who seem to be dirty.True False8. I am afraid of certain colors that I associate with germs or dirt. True FalseHow many of these statements did you circle as true?Symmetry and Ordering OCDThe fear that nega]ve consequences will follow or that harm will come to you or those you careabout because objects are arranged or posi]oned in the wrong order and do not follow acertain pajern.1. I must have certain things around me set in a specific order. True False2. I spend a lot of ]me making sure that things are in the right place. True False3. I no]ce immediately when my things are out of place. True False4. It is important that my bedding be straightened out impeccably. True False5. I need to arrange certain things in special pajerns. True False6. When other people rearrange my things, I get extremely upset. True FalseHow many of these statements did you circle as true?Harm OCDA fear of harming yourself, a loved one, or a stranger through deliberate or thoughtless acts.1. I fear that I will blurt out inappropriate words at an inappropriate moment.True False2. I worry that I will harm someone by making careless mistakes. True False3. I worry about the fate of complete strangers. True False4. I believe I have the power to keep people from harm. True FalseHow many of these statements did you circle as true?Checking and RepeaAng OCDA fear that manifests itself in the constant feeling that something bad will happen if you don’trepeatedly check to make certain that everything is all right.1. I frequently have to check things over and over again. True False2. I have difficulty finishing tasks because I repeat ac]ons. True Falsek3

3. I ofen repeat tasks in order to prevent something bad from happening.True False4. I worry excessively about making mistakes. True FalseHow many of these statements did you circle as true?PerfecAon OCDHaving an unrealis]c and unhealthy obsession about performing tasks to a standard that isexcessively high and impossible to reach.1. I have an excessive preoccupa]on with past mistakes. True False2. I fear making new mistakes. True False3. I have constant doubts about whether I am doing something correctly.True False4. I have very high expecta]ons for myself and for others. True FalseHow many of these statements did you circle as true?Magical Thinking or Thought-AcAon Fusion OCDBelieving that simply thinking about an ac]on is equivalent to actually carrying out that ac]on.1. I believe that my thoughts can cause something to happen. True False2. I believe that thinking about an unwanted event makes it more likely the event willhappen. True False3. I believe that my thoughts are dangerous. True False4. I believe that certain numbers, colors, phrases, or ac]ons are unlucky and can causeharm. True False5. I believe that certain numbers, colors, phrases, or ac]ons are lucky and are responsiblefor good things happening. True FalseHow many of these statements did you circle as true?If you circled more statements as true than false in one or more sec]ons, you should considerthe idea that OCD symptoms play a large and impacrul role in your life.k4

ReflecAonDo you like the way your life has been going?Do you feel confused and overwhelmed by the thoughts and feelings you’ve been having?Do you want to address these thoughts but not know how to describe what you areexperiencing?Do you feel like you want and need to make a change in your life but don’t know where tobegin?FeedbackRate this exercise on a scale of 1 to 4, with 1 being the lowest and 4 being the highest.This exercise was helpful overall.1 2 3 4It helped me learn something new.1 2 3 4It helped me reach my goals.1 2 3 4k5

Understand What Drives Your OCD CycleObjecAve: To bejer recognize, understand, and manage your symptoms by becomingeducated about the OCD cycle.You Should Know The OCD cycle is made up of several components. Learning what thesecomponents are and how they work together is crucial to understanding why you feelcompelled to repeat the same unhelpful behaviors over and over again.TriggersA trigger can be anything that evokes a nega]ve or distressing reac]on within you. It can be arelentlessly intrusive thought, or a disturbing image flashing in your mind like a neon sign,warning of harm to yourself or the people you care about. It can be an object like a door handleor a fork, a place as scary as a cemetery or as innocuous as a classroom. It may not meananything to anyone but you.What makes the triggering event unique is the meaning you give to it. For example, a doorhandle might just be a door handle to someone else, but your OCD will tell you repeatedly thatthe door handle is infected with contagious germs. An empty classroom on its own may meannothing, but you might become triggered because your OCD tells you that the seats are not inthe proper order, or that there aren’t the right number of seats, or even that someone hascolored in red marker on the desk and that color means danger or blood.ObsessionsThe meaning your OCD gives to these varied triggers gives them a sense of importance andpower that turns them into obsessions, which are defined as the persistent, disturbingpreoccupa]on with an ofen-unreasonable idea or feeling that you believe must be acted on.CompulsionsThe desire to control or stop the disturbing thoughts and images you see ofen becomes sooverwhelming that you might find yourself feeling compelled to engage in ac]ons that yourOCD tells you are necessary to end the obsessions. You might find yourself washing your handsover and over, coun]ng or rearranging items, or avoiding places or people in a fu]le effort toease your anxiety.EmoAons and Physical SensaAonsThe emo]ons and physical sensa]ons that accompany your obsessions and compulsions canhelp increase the intensity of your OCD cycle, keeping it in perpetual mo]on. Exploring andunderstanding your emo]ons and physical experiences and how they impact and influence yourOCD cycle is crucial to your recovery.k6

EmoIons: Your obsessions can be further strengthened and propelled by an assault ofemo]ons—for example, fear, anger, frustra]on, or disgust—that lead to an overwhelming senseof shame, embarrassment, and hopelessness. As your obsessions generate more intensity, youstart to feel a growing, some]mes overwhelming, sense of anxiety.Physical SensaIons: The false sense that you are in danger or that those you love are in dangeris fueled by anxiety-driven bodily sensa]ons that fool you into thinking that the fear orimpending sense of doom you feel is real and imminent, and that you must do something aboutit right away.ReliefThe sense of accomplishment and sa]sfac]on you feel at repea]ng a behavior aimed at endingyour OCD as well as the overall sense of peace and relief can be intoxica]ng, deluding you intofeeling that engaging in compulsions is the answer.RepeatHowever, even if you fight to control your fears or escape from them, the roots of your fearsdon’t go away. You will recognize that this relief is only temporary, as your doubts and fears startto grow again, con]nuing the vicious cycle.Does This Sound Like You?LaShawn ofen wondered why he felt the overwhelming need to engage in compulsive acts thatdidn’t really make any sense to him. He also wondered why afer comple]ng the acts heimmediately felt such a sense of freedom, which seemed to dissipate just as quickly as it hadcome.What to DoIn this ac]vity, you’ll track your OCD cycle for a week in order to get a full picture of your uniquecycle. You’ll iden]fy the triggers, obsessions, and compulsions that make up your cycle so thatyou can clearly see the rela]onship that exists between them. Understanding the OCD cycle—what it is, how it works, and how it impacts your life—can help you bejer manage your OCDsymptoms and increase your sense of personal autonomy.Monitor Your OCD CycleMake a list of your triggers. These can be events, places, objects, numbers, colors, people or anyother triggers that are unique to your experience.k7

Make a list of your obsessions: the images or thoughts that intrusively appear in your mind.List any behavior you feel compelled to engage in order to relieve the anxiety you feel from yourobsessive thoughts.Using the checklists that follow, iden]fy the emo]ons and physical sensa]ons that exist withinyou as you are experiencing your cycle. These feelings provide the fuel that powers your OCDsymptoms, ofen serving to give those symptoms more weight than they deserve.EmoAonsPlace a check next to any of these emo]ons that overwhelm you during your obsessions or thatseem to trigger your anxiety. Use the blank lines to add others you Isola]onFearJealousyBijernessDisgustAnnoyancek8

Physical SensaAonsPlace a check next to the physical sensa]ons you experience. Use the blank lines to add others.Racing heartSwea]ngChest pain, ]ghtness, heavinessFeeling hyper and filled with energyDifficulty seeingUpset stomachFeeling dizzy and/or light-headedWeakness in major muscles,especially the legsNumbness and ]ngling in the handsand feetDry mouthLabored breathing, feeling short ofbreath, hyperven]la]onHot and cold flashesNow, track your OCD cycle for a week.OCD Tracking FormDay and sdayThursdayFridayk9PhysicalsensaAonsEmoAons

Day and moAonsSaturdaySundayReflecAonHow did exploring the rela]onships between all the various elements increase yourunderstanding of your OCD cycle?What do you think impacted your urge to engage in your compulsions the most: your emo]ons,your physical sensa]ons, or your thoughts? How will that informa]on assist you in managingyour OCD?What do you think it would look like if you could find a way to break your cycle?How do you think breaking your cycle could impact your need to engage in compulsions?What did you learn about yourself by exploring your OCD cycle?k10

FeedbackRate this exercise on a scale of 1 to 4, with 1 being the lowest and 4 being the highest.This exercise was helpful overall.1 2 3 4It helped me learn something new.1 2 3 4It helped me reach my goals.1 2 3 4k11

Name Your OCDObjecAve: To visualize your problem as a separate external en]ty rather than internalizing itas a problem that defines you.You Should KnowNarra]ve therapy is commijed to externalizing your problems instead of internalizing them byhelping you recognize that you are not your problem. This type of therapy allows you torecognize, appreciate, and focus on your resilience and sense of self-worth—assets that haveallowed you to survive and thrive as best you can under condi]ons that are difficult to navigate.It inspires you to come from a place of strength that is within you, drawing upon your hopes,dreams, skills, and values to guide you through a difficult ]me.Naming the problem is a technique developed within narra]ve therapy. The emphasis placed onhow you speak about your rela]onship to a problem is key to your ability to feel posi]ve andhopeful. For example, when you say to yourself, “I am depressed” or “I am an angry person,”you recognize the emo]onal punch that is detrimental to you instead of being life affirming.This recogni]on allows you to fully separate yourself from a problem, rather than definingyourself as the problem, thus preven]ng the problem from strengthening the troublesomenarra]ve you use to describe your life.Does This Sound Like You?Maria ofen described herself as a flawed person who was obsessed, compulsive, and unable tocope with the world around her. She wanted something bejer for herself but believed stronglythat her problems were so incapacita]ng that there was not much hope in making any las]ngchanges in her life.What to DoNaming your OCD will allow you to see yourself as a whole person with many facets, instead ofviewing yourself through the nega]ve lens of your OCD. Crea]ng this separate iden]ty willallow you to accept and own the role the problem takes in your life; voice your problem using language in a way that transforms it into a singular thing that ismanageable and not overwhelming; objec]vely examine your rela]onship to your problem so that you decide for yourselfwhat role you would like it to play in your life; be angry at or cri]cal of the problem instead of yourself as an individual;k12

transform the problem into an en]ty that can be visualized and understood.Follow these steps to create a name for your problem:1. Think of how you visually see the problem unfolding.2. Think of the emo]ons the problem evokes.3. Think of how you would physically describe the problem.4. Write a sentence or two describing how you experience the problem.Choose from these examples or make up your own unique name.AngerVolcano: I am angry like a volcano building slowly and erup]ng, hur]ng and burning everyone inits path.Cobra: My anger is like a cobra. I feel it quickly, and it strikes without warning.Lightning rod: My anger rises quickly and is bright like a lightning strike, and then just as quicklyit is over and I regret it.DepressionBlanket: It feels comfortable and safe at first, like a familiar blanket, but eventually it feelssmothering and heavy, holding me down, holding me back.OCDJailer or warden: It keeps me cap]ve and forces me to do its bidding.Prison: I am trapped in a place I can’t get out of.Monster or bully: My OCD is like an evil being in a nightmare that chases me and always catchesme.ObsessionFly: My obsessions are like flies constantly bothering me.Bee: My obsessions are like bees constantly buzzing in my ear.CompulsionHamster: My compulsions are nonstop, like a hamster on a treadmill.Boulder: Some]mes I am unable to stop myself from engaging in my compulsions. When theystart, the pressure becomes too great to resist, like a boulder rolling down a hill.k13

Using the space that follows, create a name for your problem and describe how it affects you.You can think of one name for your OCD or separate names for your obsessions and yourcompulsions if you prefer. Feel free to color your crea]on or decorate it in any way you wouldlike.ReflecAonHow did it feel to visualize your problem on paper instead of allowing it to dominate yourthoughts?How did it feel to separate your problem from yourself instead of internalizing it?k14

Was it easy or difficult to think of a name for your problem? What emo]ons did the processevoke for you?FeedbackRate this exercise on a scale of 1 to 4, with 1 being the lowest and 4 being the highest.This exercise was helpful overall.1 2 3 4It helped me learn something new.1 2 3 4It helped me reach my goals.1 2 3 4k15

Write Your OCD StoryObjecAve: To explore your thoughts and feelings about the role OCD has played in your life bycrea]ng an OCD narra]ve.You Should KnowPeople with OCD ofen spend years struggling to understand and define an illness that is hard topin down, hard to diagnose, and even more difficult to address because their dominantnarra]ve is one of problems, limits, and hopelessness.Narra]ve therapy uses the power of storytelling to transform the ofen nega]ve and narrowstories your OCD encourages you to tell about yourself into an alternate story that reflects amore posi]ve framework which takes into account a wide array of experiences and emo]ons.Telling your story is a great way to begin the momentous task of libera]ng yourself from yourOCD. It takes bravery and perseverance to examine both the posi]ve and nega]ve aspects ofwhat makes you a whole person with honesty and integrity. Afer years of doing everythingpossible to avoid facing what you fear the most, it may seem almost impossible, but thebenefits of slowly taking stock of your life instead of mindlessly rushing from one thing toanother, of taking the ]me to organize your thoughts and feelings, can help you grow personallyand emo]onally so that you can more clearly see your future.Does This Sound Like You?Patrick found himself inundated with his obsessive thoughts, which had been part of his life forso long that couldn’t really remember a ]me when he had ever been free of them. Even whenhe was with family and friends, Patrick ofen found himself feeling alone with only his disturbingthoughts for company.What to DoCrea]ng your own OCD story can help you recognize and understand the role OCD has played inyour life, enabling you to establish or reestablish your iden]ty and shape your purpose in theworld. Remember that, especially when you are describing your rela]onship with OCD, thestories that you tell about yourself are not stagnant but are, in fact, just the opposite. They areevolving, with mul]ple endings and possibili]es.Use the following story map ques]ons to create your story. Whether you use the name youcreated for OCD in the preceding ac]vity or simply call it “OCD,” refer to it as if it were aseparate en]ty from you. Write your story in the first person; for example:

A Therapy Assignment Workbook Between Sessions Resources Norwalk, CT, USA. . Her eclec]c style of therapy includes mindfulness, cogni]ve, narra]ve and solu]on-focused therapy designed to emphasize the healing nature of posi]vity and one's own personal strengths and values. Her methodology has been shaped by her extensive work facilita]ng