Telling Thoughts Apart in OCD and Depression

You’ve gone to a therapist, and you want help. You have been diagnosed with OCD and depression; what now?

You are down and cannot stop these looping thoughts in your head that make you feel sad, afraid, and panicky. You spend hours a day on these thoughts, and they are making you unable to engage with family, work, and your free time. You are stuck in your head. 

Thankfully you have been told that there are tools to help with these looping thoughts. Here is where it can get tricky because different tools help with different kinds of looping thoughts. 


If you have thoughts about the past that make you feel down, low energy, guilty, and make your body feel heavy, you will likely have ruminative thoughts. 

Ruminating thoughts lead to depression, and it is best to behave your way out of them, distract yourself or challenge these thoughts. 

Dealing with Ruminative Thoughts

  • Engage in an activity that makes you feel happy or effective even if you do not feel like it. 
  • Do something meaningful instead of allowing these thought loops to bring you down.
  • If someone insulted you like these ruminative thoughts, you would probably defend yourself or avoid that person. Please do the same with these nasty thoughts; avoid them or argue against them.

Obsessive Thoughts

Suppose you are having intense spikes of fear from a single thought that usually starts with the words “what if,” you may be having an obsessive thought intrusion. Obsessive thought intrusions are unwanted thoughts regarding things like getting sick, violent thoughts, someone hurting you, or losing control in some way. You will likely have a strong urge or compulsion to get rid of these thoughts, either with physical or mental actions. For example, you might want to wash your hands or think for hours about the things you touched or did not touch in a day. 

Coping with Obsessive Thoughts

Dealing with thought intrusions can be challenging because the treatment involves leaning into the distress. The most effective treatment (exposure with response prevention) can make you feel more anxious in the short term. The key with thought intrusion is to face the fear without engaging in any actions that reduce that fear. What prevents people suffering from OCD from learning that their thoughts are not dangerous is engaging in activities or rituals that take away their fear immediately. 

Mental actions or rituals could include:

  • Thinking about future possibilities with “what if” scenarios
  • Searching your memories
  • Thinking about the likelihood of a feared event
  • Using words or images to block a thought
  • Making mental lists
  • Any mental action that “undoes” thought intrusion, such as praying

Physical actions or rituals could include:

  • Hand washing
  • Knocking on wood
  • Asking others for reassurance
  • Anything physical action that “undoes” the intrusion 

Thinking about a fear that most of us have unlearned will help explain why you have to face OCD intrusions. People are often nervous when they are first learning to drive. With enough practice, they learn that they can drive while nervous and that they do not have to be so afraid of driving. If you never got in the car, you would lose the opportunity to face the fear and learn to drive with fear. 

Facing thought intrusions without rituals allows you to learn that you can continue with everyday things despite thought intrusions and may enable you to learn that your thoughts are not dangerous. Facing OCD symptoms is not that different from learning to drive!

Engaging with reassuring or distracting thoughts/actions during a thought intrusion may feel good at the moment. Still, they will make the rituals/thought intrusions have more significant space in your head and may make them more intense over time! 

Putting these Both Together

You may notice that you have to engage in opposite ways of dealing with ruminative thought and obsessive thought intrusions! If you lean into ruminative thinking, it will make your depression worse. At the same time, if you avoid an obsessive intrusive thought, then you miss an opportunity to learn to deal with it! With practice and maybe some help from your therapist, you will become an expert at noticing the difference between these two and doing the thing that will help you out the most! 


by Christopher Grandits PhD

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