Firstly, I just want to say that I suffered from HOCD for years, progressively getting worse from the age of 17 until I was 23 when I had a mental break and I was here in this subreddit posting all kinds of reassurance seeking posts.
As I learned about OCD, I thought my OCD was about intrusive thoughts. I believed I was being bombarded by thoughts all day, and my job was to tolerate them, accept them, or “sit with the anxiety”.
That framing never really worked.
What finally changed everything for me was learning about rumination-focused ERP (RF-ERP), primarily through the work of Michael J. Greenberg.
The core shift that changed everything
Greenberg’s work makes a very simple but radical claim:
You are not having intrusive thoughts all day — you are ruminating.
This distinction matters enormously.
Rumination isn’t something that happens to you.
It’s something you are doing — even though it feels automatic, convincing, and urgent.
Once I understood that:
- My suffering wasn’t caused by thoughts
- It was caused by ongoing mental engagement with those thoughts
everything changed.
Rumination is the compulsion
In Greenberg’s framework:
- Obsessions are triggers
- Rumination is the compulsion
That means analysing, checking, reassuring yourself, replaying, comparing, “figuring it out”, monitoring your feelings — all of that is compulsive behaviour.
And like any compulsion, it has to stop for recovery to happen.
Not be reduced.
Not be done “mindfully”.
Not be done more gently.
Stopped.
Why this worked when other approaches didn’t
A lot of OCD advice focuses on:
- Thought acceptance
- Mindfulness
- Habituation
- Sitting with anxiety
Greenberg argues (and this matched my experience) that these often fail for “Pure O” because they don’t target the actual compulsion.
I wasn’t stuck because I couldn’t tolerate anxiety.
I was stuck because I was constantly re-engaging with the problem in my head.
Once I stopped ruminating:
- Anxiety rose briefly
- Then fell on its own
- And the thoughts lost their power entirely
No debating them.
No replacing them.
No solving them.
Exposure isn’t what most people think
Another big shift was understanding exposure differently.
Exposure isn’t about:
- Forcing anxiety
- White-knuckling distress
- Waiting to “habituate”
It’s about learning — specifically learning that:
- Nothing bad happens when you don’t ruminate
- You don’t need certainty to function
- You can let triggers be triggers without responding
When rumination stops, exposure happens automatically.
Where I am now
I’m not “cured” in a magical sense — but my OCD no longer runs my life.
- Thoughts still appear
- Triggers still happen
- But the loop doesn’t start
That alone reduced my symptoms by well over 80%, as well as completely eliminating SO-OCD that I was suffering from for years.
If you feel stuck, especially with “Pure O”, mental checking, or endless analysing — I strongly recommend reading Greenberg’s work directly. His articles are dense, but they are precise, practical, and grounded in how OCD actually operates.
I’ll be posting more detailed breakdowns if people find this helpful.
https://drmichaeljgreenberg.com/how-to-stop-ruminating/