Obsessive thoughts and repetitive compulsions

He spent close to three hours a day seeking reassurance: checking locks, turning off the stove again, resending messages. He knew it was not rational, but every time he stopped himself his anxiety multiplied.

We began by mapping the relationship between the thought and the compulsion: the obsessive thought arrives and the compulsion brings short relief. The goal was never to remove the thought.

Then came graded ERP: the compulsions were ranked and the easiest started first, with daily recording of anxiety levels so that progress was visible.

By month four, each cycle had shrunk from hours to minutes. By month eleven he said he no longer counted his days — and that, he said, was the biggest gain of all.