FearCast Podcast Episode #224 — Why Does OCD Feel So Real?

Host: Kevin Foss, MFT
Date: April 14, 2025
Theme: Exploring why OCD feels so convincing and real, particularly with Sexual Orientation OCD (SO-OCD), including the mind-body connection and strategies for responding.

Episode Overview

In this episode, Kevin Foss tackles a deeply relatable question from a listener, Callie, about why her OCD feels so real—especially Sexual Orientation OCD, which has been particularly sticky compared to her other OCD themes. Kevin unpacks the neurobiology of anxiety, explains the mind’s powerful ability to generate real sensations and urges from imagined situations, and provides thoughtful advice on responding to persistent intrusive thoughts. The tone is reassuring, humorous, and compassionate.

Key Discussion Points & Insights

The Rhythms of Anxiety and Anticipating Triggers

• Anxiety as a Normal, Even Useful, Part of Life
  Kevin reflects on the natural ups and downs of anxiety, noting how life events, seasons (e.g., holidays, finals), or anniversaries may amplify anxious feelings (07:40).

  "What we're talking about here isn't how do we eliminate all anxiety... Instead, it's how do we learn to live with the reality that sometimes we're going to get anxiety... and they're not very fun, but how do we learn to ride through them in an effective sort of way?"

• The "Yerkes-Dodson Line": Anxiety Can Improve Performance, to a Point Kevin describes how mild anxiety sharpens focus, while excessive anxiety impairs us (11:20).

  "There is this magical line where there is this pinnacle between anxiety and performance. And then as anxiety continues beyond that, your performance starts to decrease."
  "Anxiety often isn't bad. It's a helpful thing. It's just obnoxious, right?"

Listener Question: Why Does OCD Feel So Real?

[15:30] — Callie’s Question: Sexual Orientation OCD Feels Incredibly Real

• Background:
  Callie shares her experience with multiple OCD themes but finds SO-OCD especially persistent and convincing, wondering: "Why does it feel so real?"

  "Sexual orientation OCD convinced me that I was a lesbian... even though I didn't want to touch women in that way. This really put a damper on my heterosexual relationship..."

[17:10] — The Brain-Body Connection: Fight, Flight, or Freeze

• It's Real…But Not in the Way Anxiety Says Kevin begins with humor and honesty:

  "So it feels real because it is real. That's what I got for you, have a good day. Wouldn't that be terrible if that's how I ended the episode...? OCD feels real because it is real... in a way, but not all the ways that anxiety wants you to think. Let me explain." (17:25)

• How Imagined Fear Triggers Real Sensations

  • Amygdala doesn't distinguish between real and imagined threats; it triggers the same physiological anxiety response either way (19:40).

[21:40] — Guided Experiential Exercises: Lemon & Spider

• Lemon Exercise:
  Kevin guides listeners to imagine touching, smelling, and licking a lemon, resulting in real physical reactions like salivation—despite the lemon not existing (22:38).

  "Your body had a real reaction when you were imagining the lemon, but you didn't have a real lemon in front of you, right?"

• Spider Exercise:
  Listeners imagine a spider crawling up their foot—often feeling tingling or the urge to move, demonstrating how imagination provokes real bodily responses (24:00).

  "As we imagine something, our body will start to manifest sensations, awareness, or even urges..."

• Sexual Thoughts:

  "When we imagine sexual thoughts... our brain recognizes it as sexually relevant content...our body then has this awesome way of responding...with physical sensations...even though it’s an image of something you have or haven’t desired." (25:40)

[27:00] — Thought-Action Fusion: Why Thoughts, Sensations, and Urges Feel “Like Reality”

• Having a thought can bring emotional or bodily sensations as if the event has actually happened, driving guilt, shame, or worry.
• This is how horror movies and love stories work—we feel real stress/love during a film, even if we’re not experiencing those things directly.

  "Do you know what we call movies...that you don't get that response to? We call them bad movies..."
  "We have this reaction..."

[31:30] — Amplifiers: Why These Feelings Linger & Become Convincing

• Brain Habits:
  The more you think about something, the more your brain gives you opportunities to think about it (the Tetris effect) (32:30).

  "Your brain doesn't know you have OCD. Your brain just knows you think about this thing a lot. So it goes, Gosh, Callie loves to think about her sexual orientation a lot. So...let's give her more of that."

• Mental Distortions & Risk Overestimation:
  Cognitive distortions, such as overestimating the chance a fear might come true, make feared thoughts seem more credible (34:00).

• Cultural, Family, and Personal History:
  Family or societal narratives, or past trauma, can add emotional weight, making certain obsessions extra “sticky” (35:00).

• Compulsions Reinforce the Cycle:
  Every time a compulsion is performed, it grants the thought credibility and keeps the cycle going (37:15).

  "The more you use [compulsions] to solve the anxiety, the more you've given a neutral thought...credence...and then getting that relief...will increase the urge to do that again."

[38:00] — Practical Takeaways: What to Do About “Real-Feeling” OCD

• Observe Body vs. Mind:
  Root yourself in what’s really happening around you and accept that the body is reacting to imagination.

  "Separate the story, the thought, from what your body is experiencing. That’s where we talk about diffusion from your thoughts—simply observing your body’s response while observing your surroundings."

• Eliminate or Minimize Compulsions:
  This starves OCD of the reinforcement that makes it feel so strong and important.

[41:10] — Why Does SO-OCD Linger More Than Other Themes?

• Consider: What is the specific feared outcome?

  • Family rejection?
  • Not knowing yourself?
  • Uprooting life as you know it?

• Questions for deeper reflection:

  "Why is it that this thought is so dangerous to you? Why is it of particular value to you, ‘needing to be straight or to know the fullness of your sexuality?’"

• Sometimes traumatic events contribute, but not always—a “sticky” obsession can just be happenstance, with extra reinforcement through compulsion (44:40).

• How to Respond to Returning Themes:

  • Treat recurring obsessions ("I've seen this movie before") as old news, not urgent emergencies.
  • Don’t treat it like “now it’s special or new—because it ain’t.” (48:20)

    "It's the same general story, right? So, you've seen this movie before, you've seen the show before, you know it. Why spend more time on it?"

• Host’s Own Example:
  Kevin shares his own recurring anxiety about public speaking, which always resurfaces before talks. He recognizes the pattern and treats it as a familiar background event, not a crisis.

  "Back to the top of the show...it's old news. I've seen this before...Do I want it to happen? No. Is it possible? Sure. But it's part of our rhythm..."

Notable Quotes & Memorable Moments

• On Validation & Humor:

  "So it feels real because it is real. That's what I got for you, have a good day." (17:25)

• On Thought-Action Fusion:

  "Sometimes the thought-action fusion can be... believing that the more we have that thought, the more likely it is to actually happen." (27:50)

• On Repetition and OCD:

  "Your brain doesn't know you have OCD. Your brain just knows that you think about this thing a lot." (33:00)

• On Recurring OCD Themes:

  "You've seen this movie before... Why spend more time on it?” (48:15)

• On Handling Anxious Patterns:

  "When it shows up, I go, ‘Oh, yeah, I know this story. All right, I'm going to go throw my career away. Here we go.’" (49:00)

Timestamps for Important Segments

| Time (MM:SS) | Segment | |------------------|-------------| | 07:40 | Discussion on rhythms of anxiety and anticipating triggers | | 15:30 | Callie’s listener question about SO-OCD’s realness | | 19:40 | Explanation of fight/flight/freeze and imagined threats | | 22:38 | Guided lemon imagination exercise | | 24:00 | Guided spider-on-foot imagination exercise | | 27:00 | How thought-action fusion makes OCD “feel” real | | 32:30 | How repetition amplifies OCD themes | | 34:00 | Cognitive distortions and risk overestimation | | 35:00 | Role of family/culture/trauma | | 37:15 | Role of compulsion in reinforcing OCD | | 38:00 | Techniques: Distinguishing mind vs. bodily sensations | | 41:10 | Why SO-OCD may linger more; finding the “feared story” | | 48:20 | Treating old obsessions as familiar, not emergencies | | 49:00 | Kevin’s personal example; “throwing my career away” fear |

Summary Takeaways

• OCD feels real because the brain and body systems are reacting to imagined scenarios—this is a normal biological response.
• The more you dwell or respond to OCD thoughts (with mental or physical compulsions), the more frequent and powerful these thoughts feel.
• Cultural, historical, and personal factors can heighten the stickiness of specific themes.
• The path to relief is awareness, disengagement from compulsions, and recognizing these thoughts as familiar (old movies), not urgent crises.
• Compassion and non-judgment toward yourself are crucial as you resist compulsive behavior.

Host’s Closing Wisdom:

"Take a risk, challenge yourself, and don't take your brain too seriously." (Show sign-off)