One type of OCD involves repetitive thoughts that are intrusive, unwanted, and distressing. A person may have thoughts they regard as disturbing or immoral and may experience guilt and shame. They may have recurrent fears that they may suddenly act in a way that goes against their own wishes and causes harm to themselves or others. They may have doubts about whether they have already caused harm or be plagued by questions that cannot be answered with certainty.
Psychologists Martin Seif, PhD, and Sally Winston, PsyD, have produced some of the best work on this type of OCD. Below are links to brief article and a webinar, and a reference to their book on the subject.
Article: Winston, S. M., & Seif, M. N. (2019). Unwanted Intrusive: Thoughts How to overcome sticky, frightening, obsessive, or disturbing thoughts. Psychology Today.
Webinar (on You Tube): Overcoming Intrusive Thoughts
Book: Winston, S. M., & Seif, M. N. (2017). Overcoming Unwanted Intrusive Thoughts: A CBT-Based Guide to Getting Over Frightening, Obsessive, or Disturbing Thoughts. New Harbinger. [Amazon]
An outline of Chapter 7: How to handle thoughts when they happen, from: Winston, S. M., & Seif, M. N. (2017). Overcoming Unwanted Intrusive Thoughts: A CBT-Based Guide to Getting Over Frightening, Obsessive, or Disturbing Thoughts. New Harbinger.
In the book listed above, Winston and Seif recommend a six step process for handling intrusive thoughts. They use the acronym "RJAFTP" to refer to the steps: (1) R: Recognize; (2) J: Just thoughts; (3) A: Accept and allow; (4) F: Float and feel; (5) T: Let time pass; (6) P: Proceed. Here is a description of these steps:
(1) R: Recognize the thought as an automatic intrusive thought. Pause and label it as such. Observe the feelings you have about the thought with curiosity, detachment, and compassion.
(2) J: Just thoughts. Recall that these thoughts are “just thoughts.” They are not wishes, intentions, commands, or urges to act. They are typical of the types of random and unimportant thoughts everyone has from time to time. They are the mental noise that is a byproduct of the way our minds work. The thoughts are not dangerous and do not need to be feared. They only seem dangerous because you have misinterpreted them and have repeatedly reacted with fear and attempts to control or avoid the thoughts.
(3) A: Accept and allow the thoughts to be present. Trying to control, neutralize, or avoid the thoughts implies that they are important and dangerous. It increases your fear of the thoughts and increases their frequency. Because of this, it is critical to “drop the struggle” with the thoughts and simply allow them to come and go on their own accord. Do not try to suppress them or distract yourself from them. Do not try to argue with them or reason them away. Refrain from any ritual that you have used to try to make yourself feel better. Because the thoughts are unimportant, they do not require special attention or response. In the past, you have been in a tug of war with your thoughts. Drop the rope.
(4) F: Float and feel. Float above the any temptation to be drawn into a struggle with the thoughts and above your feelings about the thought. Floating is an attitude of non-active, non-urgent, and non-effortful observation. It is patient, compassionate, and forgiving. If you feel yourself getting drawn into struggling with thoughts or feelings, pay attention to what you can see, hear, smell, and touch in the present moment. Focus on what actually is here and now, rather than being tempted to engage questions of what if (e.g., “what if the thought represents my true wishes,” “what if it the thought means I am a bad person”).
(5) T: Let time pass. There is no urgency. You are dealing with discomfort, and not danger. There is no need to check to see if this method is working, or to do anything else. Time will allow your natural calming reaction to take effect, on its own.
(6) P: Proceed. Even while you are having the thoughts, continue whatever you were doing prior to the intrusive thought.