Episode Overview

Title: The Automatic OCD Compulsions You Don’t Notice Yourself Doing
Host: Dr. Patrick McGrath, Chief Clinical Officer at NOCD
Air Date: November 23, 2025

In this episode, Dr. Patrick McGrath delves into the often-overlooked world of automatic, mental compulsions in Obsessive-Compulsive Disorder (OCD). The conversation focuses on how these mental rituals develop, why they can be so challenging to notice, and what treatment approaches can help, especially when these compulsions seem to unfold “automatically.” Dr. McGrath offers both clinical insights and practical strategies for listeners, emphasizing the importance of uncertainty tolerance and specialized therapy.

Key Discussion Points & Insights

1. The Nature of Automatic Mental Compulsions

[00:00 - 02:00]

• Dr. McGrath opens by describing a common experience among those with OCD: "Have you found yourself in the midst of mental compulsions and wondered how you'd got there... you finally realized you're on the 10th time reviewing something or... the third hour of going over that conversation you had..."
• Mental compulsions often begin automatically, without conscious awareness. Examples include reviewing scenarios or obsessing over what-ifs.
• These mental rituals are just as real and impactful as physical compulsions, even if they're less visible.

2. The Frustration of Automaticity & Initial Treatment Challenges

[02:00 - 04:00]

• Dr. McGrath acknowledges the difficulty of "catching" mental compulsions in action because they can start before you're aware of them.
• However, he stresses it's possible to "catch yourself in the midst" and make a change mid-compulsion.

Notable Quote

"We might not be able to catch something right away when it starts... we can learn to catch ourselves in the midst of something and then take a different course. What I like to call undoing it, right?" — Dr. McGrath [01:19]

3. The “Undo” Tool: Finishing with Doubt

[04:00 - 06:00]

• Dr. McGrath suggests a specific practical strategy: end a mental compulsion with doubt.
  • For example, after a mental review, add a statement like, "Well, maybe or maybe not, or that could or couldn't be, and I'll have to learn to live with that."
• This technique prevents OCD from achieving the "satisfaction" of certainty, thereby disrupting the compulsion cycle.

Notable Quote

"By adding this statement of doubt to the end of a mental compulsion, you're not allowing yourself to finish feeling satisfied... You're allowing yourself to finish in doubt and uncertainty." — Dr. McGrath [04:32]

4. Learning to Live with Uncertainty

[06:00 - 08:00]

• Dr. McGrath highlights a key therapeutic theme: learning to tolerate uncertainty is essential for managing OCD.
• He points out the paradox of OCD: it demands certainty in one tiny area of life while allowing doubt everywhere else.
• Emphasizes the “absurdity” of this selective demand for certainty.

Memorable Analogy

"OCD says it's okay to have doubt about 99.9999% of your life... but for this .0000001%, you must have certainty. Well, that is weird, isn't it?" — Dr. McGrath [06:50]

5. Recognizing and Treating Mental Compulsions

[08:00 - 10:00]

• Many people—and even some professionals—fail to recognize mental compulsions.

• Dr. McGrath jokes about how mental compulsions would make for boring TV:

  "Let me show you what a TV show would look like of somebody doing mental compulsions. Here we go."
  (Pause for silence.)
  "Not very exciting television, if that's the case..."

• It's vital to work with specialists trained to identify and treat both physical and mental compulsions with Exposure and Response Prevention (ERP) therapy.

• He encourages patients to ask their therapist direct questions about their understanding of OCD and ERP.

6. Importance of Specialist Care and the Role of NOCD

[10:00 - End]

• Dr. McGrath describes how at NOCD, therapists are specially trained to handle both types of compulsions.
• He advises listeners to seek an evaluation if they're struggling with persistent mental rituals, even if they’re unsure if it’s OCD, anxiety, or depression.

Notable Quote

"If you have a therapist that you're feeling is just not getting it, ask them the questions. Do they really understand OCD? Do they really understand ERP work?... Find yourself a specialist who does." — Dr. McGrath [09:20]

Notable Quotes & Moments

• On the invisibility of mental compulsions:

  "People who aren't well trained in OCD may only be looking for physical compulsions because, well, that's what you see in TV and movies... We don't show those, and therefore people don't know that those are part of obsessive compulsive disorder, but they absolutely are." — Dr. McGrath [08:25]

• Encouragement for seeking specialized help:

  "If you're looking for help for OCD and you find yourself stuck in your head a lot and wondering, might these be mental compulsions? It doesn't hurt to reach out and get a diagnostic evaluation..." — Dr. McGrath [11:00]

Episode Takeaways

• Automatic mental compulsions are a key part of OCD and are often overlooked—by sufferers and even some clinicians.
• Catching and 'undoing' compulsions by ending them with a statement of doubt is a useful technique.
• Living with doubt and uncertainty is not only possible; it's essential to effective OCD management.
• Working with OCD specialists trained in both mental and physical compulsions is crucial.
• Exposure and Response Prevention (ERP) therapy should target both forms of compulsions.

Useful Timestamps

• 00:00 — Introduction to automatic mental compulsions
• 01:19 — How to "undo" a mental compulsion
• 04:32 — The technique of ending a compulsion with doubt
• 06:50 — The paradox of OCD’s demand for certainty
• 08:25 — Why recognizing mental compulsions matters
• 09:20 — Advocating for yourself in treatment
• 11:00 — Invitation to reach out for specialized help

For listeners seeking more information or support, Dr. McGrath recommends visiting nocd.com.