The OCD Stories

Episode 522: Lauren Rosen - Mental Compulsions in OCD

Host: Stuart Ralph
Guest: Lauren Rosen, Therapist, Author of "The Mental Compulsions Workbook for OCD"
Release Date: January 25, 2026

Main Theme & Purpose

This episode delves deeply into the topic of mental compulsions in OCD, a frequently misunderstood and under-recognized aspect of the condition. Stuart Ralph welcomes back therapist Lauren Rosen, founder of the Center for the Obsessive Mind and author of The Mental Compulsions Workbook for OCD. Together, they unpack what mental compulsions are, why they’re so tricky, how mindfulness and cognitive techniques can help, and strategies for building a healthier relationship with one's thoughts.

Key Discussion Points & Insights

1. Lauren's Recent Work and Courses (02:24–05:20)

• Lauren is developing a practical mindfulness course for anxiety disorders, with colleagues Drew Linsalata and Joanna Hardas, to make acceptance-based skills more accessible outside formal therapy.
• The course uses principles from Acceptance and Commitment Therapy (ACT) and is not solely for OCD, but broadly for anxiety, focusing on “how do I accept?” and “how do I let go?”.
• Quote — Lauren:
  “Everyone engages in mental behaviors… before I found the realm of OCD, I had no sense that there was some activity going on in my mind that I had any sort of agency around, you know?” [05:20]

2. The Challenge of Mental Compulsions (05:20–09:00)

• Mental compulsions are universal human experiences, but in OCD they become entrenched and automatic.
• Before discovering OCD resources, neither Lauren nor many clients realized these internal processes could be changed.
• There’s an overlap in applications — guilt, anxiety, and other emotions.
• Quote — Stuart:
  “It feels like you can't… no agency, can't control it.” [06:04]

3. About the "Mental Compulsions Workbook" (09:00–16:28)

• Lauren's book grew out of clinical experience and a desire to bring clarity and self-help tools for those grappling primarily with internal compulsions.
• Writing the book was an exercise in deepening her understanding and making complex concepts actionable without the need for direct therapy.
• Journaling mental compulsions (with appropriate guidance) can help identify patterns and support mindful awareness.
• Quote — Lauren:
  “By writing it down, it slows you down in the process, and it does help to breed that sort of mindful awareness of what's going on...” [12:40]
• Quote — Stuart (on seeing thoughts in writing):
  “It might increase the chances of being like, oh, that’s ridiculous, for sure.” [13:30]

4. Defining and Recognizing Mental Compulsions (16:27–20:26)

• Mental behaviors include thinking, problem solving, analyzing, evaluating—most human minds do these, but in OCD, they become excessive and serve to reduce discomfort.
• Specifically, in OCD, these are mental compulsions—actions done in the mind to try to resolve doubt, alleviate anxiety or guilt, or gain certainty.
• Mental compulsions may look like worry, rumination, debate, review, or rehearsal.
• Quote — Lauren:
  “...mental compulsions… are intended to resolve doubt and uncertainty… but they come at a great cost, as all compulsions do.” [18:30]

5. The Hidden Nature and Impact of Mental Compulsions (20:26–23:25)

• Mental compulsions are harder to spot—therapists may miss them, and so might individuals with OCD.
• A large portion of what people call “obsessing” is actually compulsing.
• Mental compulsions cause significant life impairment; for many, they can appear functional externally but leave people internally absent.
• Quote — Stuart:
  “I was engaging in life and just about holding a job, but I wasn’t present. I wasn’t doing a good job.” [21:11]

6. Mental Compulsions and Co-Occurrence with Other Compulsions (23:25–24:13)

• Most people who perform physical compulsions also engage in mental compulsions, usually without realizing it.

7. Book Structure & Theoretical Framework (24:25–32:09)

• The book’s first section maps the “topography of the mind”—giving language for mental processes, distinguishing thoughts vs. thinking vs. compulsions.
• Explains how mental compulsions play out across different OCD subtypes.
• Explores why disengagement is difficult; compassionately addresses the fear and ambivalence that come with stopping mental behaviors.
• Offers cognitive strategies (values-based decision-making, not just restructuring for reduction in emotion).
• Mindfulness is framed as attentional training—a core component for response prevention in OCD.
• “Mindfulness practices really are uniquely suited to supporting someone in noticing when they’re thinking, and dropping it, and then coming back and re-engaging with life.” — Lauren [30:24]
• ERP is discussed, with mindfulness as a practical tool for “response prevention”.
• Quote — Lauren:
  “Having a really clear sense of, like, how do I practice response prevention with this? A lot of the book is dedicated to that as well.” [29:40]

8. Mindfulness & Attentional Training (32:09–41:45)

• Mindfulness meditation is the central skill Lauren recommends—it develops non-judgmental awareness and the capacity to notice & disengage from mental compulsions.
• The process is: anchor attention, notice when you wander (often quickly), practice non-judgment, and gently refocus—over and over.
• This builds a “congenial relationship” with your mind and can be applied across daily life.
• Quote — Lauren:
  “It gives a lot of opportunity for practicing non-judgment... which is crucial because it, that breeds acceptance.” [44:08]
• Quote — Stuart, on mindfulness helping therapists too:
  “There’ll be times I’m with clients and, of course, my mind will wander, and I have to notice that, accept it, bring myself back to the client in the moment.” [31:19]

9. Adapting Mindfulness for Those Triggered by Meditation (42:14–44:54)

• For some, meditation can be overwhelming. Lauren suggests alternative mindful activities (e.g., mindful dishwashing, listening to music attentively) for those unable or unwilling to start with formal seated practice.
• It's about adapting, not forcing: “Meeting people where they’re at is important.”

Notable Quotes & Memorable Moments

• On the universality and agency in mental behaviors:
  “Everyone engages in mental behaviors… before I found the realm of OCD, I had no sense that there was some activity going on in my mind that I had any sort of agency around, you know?”
  — Lauren Rosen [05:20]

• On writing and self-awareness:
  “By writing it down, it slows you down in the process, and it does help to breed that sort of mindful awareness of what's going on...”
  — Lauren Rosen [12:40]

• On noticing the process instead of content:
  “If you see the process that's going on… If you're seeing that, you're not really seeing the content… You can leave it alone easier.”
  — Stuart Ralph [46:41]

• On the costs of mental compulsions:
  “One of the greatest costs associated with mental compulsions is the amount of time that gets lost in your own mind.”
  — Lauren Rosen [31:01]

• Metaphor for rumination:
  “The more you stick your foot in the puddle, the cloudier it gets… You keep your foot in, trying to clear it, and it gets cloudier. It’s the same in our mind.”
  — Stuart Ralph, referencing Alan Watts [33:02]

• On being gentle with oneself:
  “Be gentle with yourself. Put one foot in front of the other. One step at a time, you can walk through it and you’ll deal with it as it comes.”
  — Lauren Rosen [51:22]

Timestamps for Important Segments

• 02:24 — Lauren discusses her new mindfulness course
• 05:20 — Agency and universality of mental behaviors
• 09:00 — Writing “The Mental Compulsions Workbook” and the unique challenges
• 13:46 — Using journaling as an act of diffusion
• 15:32 — Breaking down mental processes into a “flow”
• 16:28 — What are mental compulsions? Definitions & examples
• 18:43 — Compulsions as attempts to resolve doubt
• 21:11 — How mental compulsions can create functional but disengaged lives
• 24:25 — Structure and overall flow of the workbook
• 29:58 — Book strategies: cognitive, values, and mindfulness approaches
• 32:09 — Mindfulness as attentional and response prevention practice
• 41:06 — Stuart’s experience with mindfulness and daily life skills
• 42:35 — Adapting mindfulness for those unable to meditate
• 44:54 — Using music as a mindfulness anchor

Practical Tools & Skills Highlighted

• Mindfulness Meditation:
  Seen as the “most comprehensive intervention” for mental compulsions. Fosters non-judgmental awareness, acceptance, and repeated practice of noticing and disengaging from rumination or worry. [34:45–41:45]
• Adapted Mindful Activities:
  Mindful dishwashing, listening to music, or other sensory-focused tasks can serve as accessible alternatives. [43:39–44:54]
• Journaling (with clear purpose):
  As a structured way to externalize and examine mental patterns—not as compulsion, but as conscious awareness practice. [11:46–13:46]
• Values-driven Decisions:
  Choosing response (or non-response) to thoughts based on values and long-term goals rather than emotional discomfort. [27:58–29:58]

Closing Reflections

Lauren’s Key Message:
Even when the mind seems overwhelmingly messy, the underlying mechanics of OCD—and particularly mental compulsions—are simple and understandable with practice and the right tools. Approaching the inner world with non-judgment and curiosity can become freeing.

Stuart’s Take:
Skills like mindfulness and response prevention are not just for OCD, but are relevant life skills for everyone who wants a better, more present relationship with their own minds.

Further Resources

• Find more about Lauren Rosen and updates for her mindfulness course via her Instagram (as referenced by Stuart, [09:00]).
• The Mental Compulsions Workbook for OCD — available now.
• The OCD Stories Podcast