Get to Know OCD – Episode Summary

Episode: My OCD Was Happening Entirely in My Head

Host: Dr. Patrick McGrath (A)
Guest: Lauren Rosen (B), Licensed Psychotherapist & Author
Release Date: March 5, 2026

Overview

This candid and insightful episode centers on “mental compulsions”—the often-invisible experience of doing compulsions in one’s mind, rather than through overt physical actions. Lauren Rosen, a therapist specializing in OCD (and someone with lived experience of OCD herself), joins Dr. Patrick McGrath to discuss her own decade-spanning journey with OCD, how mental compulsions can fly under the radar, and how her new “Mental Compulsions Workbook for OCD” hopes to transform understanding and treatment for sufferers.

Major Themes:

• The challenges and nuances of identifying mental compulsions
• Personal and professional insight from both Dr. McGrath and Lauren Rosen
• The importance of mindfulness, acceptance, and values-based living for those with OCD
• Barriers to diagnosis and recovery, particularly when obsessions are primarily mental
• Intersections of OCD and substance use

Key Discussion Points & Insights

Lauren’s Journey with OCD

Her history, delayed diagnosis, and the role of mental compulsions:

• Lauren recounts beginning to struggle with intrusive thoughts at age 7, centering on death and existential fears ([02:49]).
  • “I started to experience intrusive thoughts at that point...terrifying. And in spite of my parents’ best efforts, I did not get a diagnosis then...It would be 17 years between then and when I was diagnosed and received proper treatment.” — Lauren ([03:10])
• She describes a hallmark OCD challenge: retrospectively recognizing patterns only after proper diagnosis.
• OCD’s intersection with substance use emerged in her life as she scrutinized her sobriety after eating tiramisu (due to its alcohol content). This led to years of mental rituals and reassurance-seeking ([04:43] to [05:40]).

Motivation for entering the OCD therapy field:

• Her own experiences inspired her to specialize in OCD, especially around mental compulsions, which she found grossly under-recognized ([07:12]).

The Challenge of Mental Compulsions

What are mental compulsions? How do you spot them? ([14:01]–[18:18])

• Mental compulsions are unseen but potent: reviewing, analyzing, neutralizing, praying, rehearsing, debating in your mind, etc.
  • “Are you thinking a lot?...Are you trying to figure out something with absolute certainty in your mind… to neutralize whatever bad thing you think might happen?” — Lauren ([14:45])
• They differ from physical compulsions in that they can be much harder for clinicians, family, and even sufferers to detect.
• OCD feeds on the misconception that only physical rituals matter—when in fact, mental rituals can be just as impairing.

Risks of missed or delayed diagnosis:

• “It’s sobering...the most recent white paper...staggering statistics in terms of, like, how many people struggle and don’t have proper diagnosis and treatment.” — Lauren ([08:33])
• Dr. McGrath and Lauren emphasize the average 14–17 year gap before appropriate diagnosis, which Lauren herself experienced ([09:40]).

Real-world parallels:

• Lauren compares these compulsions to everyone’s experience of “arguing in your head,” or obsessing about a sports outcome: “That’s thinking...that causes a lot of suffering too... I wish there was more discussion...maybe that would help people experiencing mental compulsions to see those behaviors as like hand washing or door checking.” ([17:08])

Mindfulness, Acceptance, and Recovery

The role of mindfulness: ([19:33]–[23:18])

• Lauren dispels myths: Mindfulness is not about clearing your mind, feeling Zen, or meditating perfectly.
  • “If someone’s figured out a way to clear their mind that does not involve drugs or alcohol, I would ask they contact me directly, because that sounds delightful, but it’s not reasonable.” — Lauren ([20:11])
• Mindfulness allows observing thoughts non-judgmentally, helping prevent the urge to resist or neutralize them.

Living with uncertainty:

• OCD’s “what if?” pattern is relentless: “I’ve said OCD is the yeah, but what if disorder. It doesn’t matter what answer I give you, you’re going to have a ‘yeah, but what?’” — Dr. McGrath ([28:27])
• Lauren reinforces: acceptance is about acknowledging the presence of a thought, not assenting to its content ([27:51]).

Values-based living:

• The conversation frequently returns to the concept of values as guiding stars for recovery:
  • “Getting people to live the values they want to live, and not the ‘values’ that OCD says you should be living—compulsions.” — Dr. McGrath ([26:04])

Practical Tips and Common Struggles

Recognizing and interrupting mental compulsions: ([34:48]–[39:34])

• Use values as anchors to shift focus away from compulsions.
• Align actions with personal values rather than OCD’s demand for certainty or guarantee.

Common pitfalls:

• Expecting perfection: “If you’re just like, ‘I need to make absolutely sure I never engage in a mental compulsion,’ how do I do that?...That becomes a compulsion: trying to never have a compulsion.” — Dr. McGrath ([39:36])
• Self-criticism after lapses: “And I see this so often, people beating up on themselves…I should know better by now. That’s not a mental compulsion necessarily, but it’s a really unhelpful mental behavior.” — Lauren ([39:34])
• Recovery involves awareness, not hypervigilance; noticing a mental compulsion is a step forward, not a failure.

Notable advice for clinicians:

• Flexibility trumps rigid perfectionism. “One of the greatest things you can do [as a therapist] is be flexible in your interactions...Solving a rigidity problem with rigidity is not going to work.” — Lauren ([42:10])

Notable Quotes & Memorable Moments

• On acceptance of taboo thoughts:
  “Accepting the presence of a thought is not the same as accepting the content of a thought... You’re not saying that it inherently means something about you.” — Lauren ([27:51])

• On the complications of mental rituals: “You can delay a mental compulsion, if you have the ability. If it automatically occurs, you can undo it with a doubt statement at the end of it.”
  — Dr. McGrath ([38:14])

• On living with feelings:
  “One of the benefits of having to go through OCD is that you learn you can feel anxious and do anything...And that, from my vantage point, is freedom.” — Lauren ([45:04])

• On being present:
  “If you’re not here and now, you’re missing life.” — Lauren ([24:13])

• Rilke’s advice on accepting experience:
  "Let everything happen to you. Beauty and terror. Just keep going. No feeling is final." ([45:57])

Timestamps for Key Segments

| Timestamp | Segment | |-----------|--------------------------------------------------------------------| | 02:49 | Lauren’s early experience with OCD and path to diagnosis | | 05:27 | The tiramisu anxiety episode and OCD’s impact on sobriety | | 09:29 | Discussion on delays in diagnosis and treatment | | 14:18 | How to spot mental compulsions; why they’re misunderstood | | 19:33 | Introduction to mindfulness and its misconceptions | | 24:13 | How OCD pulls you away from the present | | 26:04 | The importance of values for recovery | | 27:51 | Acceptance, especially around taboo obsessions | | 28:27 | “The yeah, but what if disorder” – the endless questioning | | 34:48 | Practical tips for response prevention with mental compulsions | | 39:36 | Perfectionism and self-criticism in OCD recovery | | 41:14 | Reflections: Advice to younger self and younger clinician | | 45:04 | Final advice: Allowing all feelings and embracing freedom |

Final Advice

• Lauren’s closing wisdom:
  “Be willing to feel all the feelings, and then you get your life back, and then you get to do life on your terms… Feel the feels.” ([46:37])

• Dr. McGrath's mantra:
  “Be better to yourself than your OCD ever will be.” ([47:32])

Tone & Atmosphere

• Conversational, supportive, open, and often humorous—even amid in-depth or potentially heavy topics.
• Both host and guest advocate for self-compassion and gentle, individualized approaches to recovery.
• The discussion is realistic about difficulty but anchored in practical hope.

Suggested Next Steps

• For those struggling with or suspecting mental compulsions, Lauren Rosen recommends greater self-awareness, values-based action, self-compassion, and seeking evidence-based treatment like ERP with mindfulness and ACT components.
• Her “Mental Compulsions Workbook for OCD” serves as an interactive guide for sufferers and clinicians alike.

For help with OCD or related conditions, visit NOCD.com.