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Specialized Treatment

The OCD Cycle

The OCD cycle starts with an intrusive thought (obsession) that sparks anxiety or distress. To relieve the discomfort, a person engages in a compulsion—a repetitive action or mental ritual. This provides temporary relief, but it reinforces the idea that the obsession was a real threat, making future anxiety even stronger. Over time, the cycle repeats, keeping OCD in control. Breaking this cycle with Exposure and Response Prevention (ERP) helps weaken OCD’s grip by teaching the brain that anxiety passes without needing compulsions.

Obsessive Compulsive Disorder

Obsessive-Compulsive Disorder (OCD) is a mental health condition characterized by intrusive, distressing thoughts (obsessions) and repetitive behaviors or mental rituals (compulsions) performed to reduce anxiety. These compulsions can provide temporary relief but often reinforce the cycle of OCD.

Common obsessions include fears of contamination, harm, or losing control, while compulsions may involve excessive cleaning, checking, counting, or seeking reassurance. OCD is not about being “neat” or “particular”—it’s a condition that can significantly impact daily life.

Effective treatment often includes Cognitive Behavioral Therapy (CBT), particularly Exposure and Response Prevention (ERP), which helps individuals confront fears and resist compulsions in a controlled way.

If OCD is interfering with your life, support is available. Therapy can help break the cycle and provide tools for managing symptoms.

Exposure and Response Prevention (ERP) is a proven, evidence-based therapy specifically designed to treat Obsessive-Compulsive Disorder (OCD).

ERP involves gradually exposing individuals to their feared situations or intrusive thoughts while helping them resist the urge to engage in compulsions or avoidance behaviors.

By breaking the cycle of OCD, ERP reduces anxiety over time and teaches the brain that these triggers aren’t as dangerous as they seem, empowering individuals to reclaim control of their lives.

ERP teaches us habituation; that anxiety is temporary and will decrease over time, along with the intensity of your urge to engage in compulsions, disconfirmation; that the catastrophic predictions of OCD are either extremely unlikely or simply don’t happen, and mastery; to build the confidence to tolerate doubt, uncertainty, and unwanted thoughts without trying to change or suppress them, allowing you to regain control from OCD. 

The Cycle of Pulling/Picking

Body-Focused Repetitive Behaviors (BFRBs): Excoriation, Trichotillomania and more

You’re not “just picking” or “just pulling.” Body-Focused Repetitive Behaviors (BFRBs)—like skin picking (excoriation), hair pulling (trichotillomania), and nail biting—are real, distressing conditions that often come with feelings of shame, secrecy, and the exhausting effort to stop… and then start again.

You’ve probably tried willpower, distraction, covering things up, even punishing yourself for the behavior. But BFRBs aren’t about weakness or lack of discipline—they’re about a cycle your nervous system has gotten stuck in, often in response to stress, boredom, or anxiety.

At Thought Shift Therapy, we treat BFRBs using Habit Reversal Training (HRT)—a research-backed, compassionate approach that helps you gain awareness of your patterns and build new ones that work with your brain, not against it. We’ll work together to:

  • Identify triggers: both emotional and environmental

  • Build “competing responses” (behaviors that replace the urge)

  • Rewire the urge-reward loop

  • Address the deeper emotions that might be fueling the cycle

Whether you’ve been dealing with this for months or most of your life, you deserve support that goes beyond surface-level advice. Let’s get to the root—and help you regain a sense of control, confidence, and calm in your body again.

Body-focused repetitive behaviors (BFRBs) are self- grooming behaviors in which individuals pull, pick, scrape, or bite their own hair, skin, or nails, resulting in damage to the body.

For these behaviors to be considered a disorder, they typically occur often enough to:

  • Cause noticeable emotional distress or interfere with daily life—such as work, school, or relationships

  • Result in physical harm or injury to the body

  • Contribute to feelings of confusion, isolation, and low mood or depression

We use Habit Reversal Training (HRT)—a behavioral therapy that helps increase awareness of the urge and teaches new, more helpful responses. It’s part of a larger framework called CBT for BFRBs, which may also include mindfulness, emotional regulation strategies, and identifying what’s underneath the behavior.

Because it focuses on changing patterns, not fighting urges. HRT works by helping you catch the behavior in the moment and gives your body and brain a new, healthier way to respond. It’s practical, empowering, and rooted in research—and over time, it helps break the cycle.

HRT teaches us that change doesn’t come from willpower alone—it comes from awareness, practice, and compassion. Through this therapy, you learn to notice the moments leading up to the behavior, understand what your body and mind are trying to communicate, and choose a new way to respond.

It’s not about forcing yourself to stop—it’s about building a toolkit that helps you feel more in control, less reactive, and more connected to your needs. Over time, HRT helps you rewrite the script, so your urges don’t have the final say.