A middle-aged man needed my help in managing distressing thoughts over which he felt he had no control. His response to these thoughts was to compulsively ruminate. He believed if he could “figure them out,” relief would follow. Unfortunately, this approach directed more attention to the thoughts and was therefore counterproductive.

Through exposure and response prevention (ERP), he learned to manage these thoughts without spiraling into a state of intense distress. They still enter his awareness sporadically, but he now has confidence in his ability to manage them with his new coping skills. His life is fuller, and he no longer avoids social situations that once triggered his obsessive thinking.