OCD and the two theories
Imagine a new parent who, while bathing their baby, has a sudden image of letting go. They are horrified. They start checking the bath temperature three times, asking their partner to do bath time, and replaying the moment to make sure it didn’t mean anything. Within weeks, a single unwanted image has taken over a large part of their day.
The psychologist Paul Salkovskis, whose work at Oxford and later Bath shaped how OCD is treated across the NHS, made a reassuring discovery about thoughts like this. Intrusive thoughts occur in at least 90% of the general population, with the same content as clinical obsessions. The difference in OCD is not the thought. It is what the thought is taken to mean, usually that you are responsible for preventing harm.
Salkovskis argued that checking, seeking reassurance and pushing thoughts away bring short-term relief but confirm the thought was dangerous, which he compared to trying to escape a hole by digging faster. His solution was to put two theories side by side. Theory A says you are dangerous and must keep doing the rituals. Theory B says you are someone who is very worried about being dangerous, and the rituals are what keep the worry going. You don’t have to believe Theory B on day one. The work is to test both, through careful experiments, and see which one the evidence supports.
This is why a good OCD therapist won’t simply reassure you. Reassurance is another ritual. Salkovskis put the alternative in one line to his patients: “Don’t trust me, test it out for yourself.”
If intrusive thoughts are taking up hours of your day, OCD responds well to this kind of specialist CBT. Read more about OCD therapy, or get in touch.