Podcast Summary: "Sensorimotor OCD"

Your Anxiety Toolkit – Episode 434 (May 19, 2025)
Host: Kimberley Quinlan, LMFT
Guest: Max Maisel, PhD, OCD Specialist

Episode Overview

This episode dives into a lesser-known but highly distressing form of Obsessive Compulsive Disorder (OCD): Sensorimotor OCD, also referred to as somatic or somatically-focused OCD. Host Kimberley Quinlan and OCD specialist Max Maisel unpack what sensorimotor OCD is, why it can be so debilitating, how it’s commonly misunderstood, and—most importantly—share deeply practical, science-based strategies for managing and overcoming it. The conversation centers on acceptance, exposure and response prevention (ERP), and how to truly “de-fuse” from the trap of hyper-awareness. Both professionals bring clinical and personal stories, offering tangible hope and nuanced advice for sufferers.

Key Discussion Points and Insights

What Is Sensorimotor OCD? (00:51)

• Definition: Sensorimotor OCD is characterized by persistent, unwanted awareness of automatic bodily processes (e.g., blinking, swallowing, breathing, heartbeats) or sensations (e.g., the position of the left hand), leading to anxiety and compulsive efforts to “get rid” of that awareness.
• Nature of Awareness: The awareness is intrusive, can seem both involuntary and become “voluntary” through compulsive checking/monitoring.
• Core Fear: The underlying fear is that this awareness will “ruin my life”—it will detract from life's enjoyment, social interactions, or the ability to focus, and that it will “last forever.”
• Range of Distress: This can range from mild annoyance to extreme, even paralyzing, impairment.

  “It gets to the point where people can't become unaware of these different things...it can be absolutely debilitating.” — Max (02:28)

Common Triggers and Presentations (04:19)

• Triggers Vary Widely: While classic triggers include swallowing, blinking, breathing, or heartbeat, virtually any sensation or body process could become the focus (e.g., holding a video game controller, visual “floaters”, bowel or bladder sensations).
• Values-Based Attack: OCD often targets what matters most to the person—for example, gaming for a gamer or creative pursuits for an artist.
• Stress as a Factor: Episodes may be more frequent or intense during periods of stress or anxiety, but hyper-awareness can come out of the blue.

  “OCD really targets what we care most about, which is why it’s so vicious.” — Max (05:01)

Mental and Behavioral Compulsions (07:43)

• Compulsions Are Often Mental: The main compulsion is resistance to the awareness. Sufferers attempt to rid themselves of awareness through distraction, reassurance, and especially monitoring/checking if the sensation is still present.

  “That monitoring is the tricky one...self-monitoring, that self-check, is almost automatic...” — Kimberley (08:46)

• Paradox: Attempts to “make it go away” only increase salience; the more you fight awareness, the more it sticks.

Evidence-Based Treatment: Exposure and Response Prevention (ERP) (10:06)

• Nuanced Application Needed: Standard ERP can be ineffective if done incorrectly with sensorimotor OCD. Inappropriate ERP might unintentionally reinforce the focus (e.g., deliberate hyper-focusing on blinking as exposure can become compulsive).
• Key Principles:
  • Response Prevention: The most critical step is not to engage in any compulsions (e.g., not to check, resist, or try to suppress awareness).
  • Radical Acceptance: Fully and openly accept that the awareness may stay, with an attitude of, “I’m willing for this to never go away.”

  “As soon as people can bring radical acceptance...your OCD won’t be able to help but become bored.” — Max (13:33)

• Practical Examples:
  • Use acceptance language. Instead of fighting the feeling/thought, try: “I hope I never get this blinking out of my awareness. I want to live my life always aware of my blinking.”
  • Practice shifting focus naturally rather than forcibly (see “the white noise machine” metaphor, 14:49).
  • Employ app reminders to prompt radical acceptance amidst valued activities (painting, playing games), e.g., “Remember, you’re blinking right now,” then practice acceptance instead of resistance.

  “I want you, with every brain cell in your head, to will for OCD to give you awareness of your eye blinking...and after five minutes, you forget!” — Max (15:16)

• For Those "Stuck" 24/7: Start with micro-shifts and celebrate any small ability to accept, even just noticing resistance without acting.

Roadblocks to Treatment (22:38)

• Compulsions About Compulsions: Sufferers can get entangled worrying about “Am I doing ERP right?” or “Is this mindful focus a compulsion?”

  “We can almost do compulsions about whether we’re doing compulsions.” — Kimberley (25:16)

• OCD Symptom Shifting: OCD may “flip-flop” from one sensation to another (blinking → swallowing → heartbeat), but the core work remains the same: accepting whatever is in awareness, not getting caught up in content.

  “It’s all the same thing...can we accept that our brain just gave us this thing?” — Max (27:06)

Stories, Metaphors, and Hope (29:16)

• Max’s Personal Story: Max recounts experiencing his own intense sensorimotor OCD “spike” noticing visual floaters. Using radical acceptance (“I hope I always see floaters”) led the experience to fade rapidly.

  “After about 20 minutes—gone, nothing. Because I lost the fear and my OCD, my brain got bored.” — Max (32:07)

• Tinnitus Analogy: Acceptance is key even where symptoms genuinely persist.
• Timeline for Relief: Progress can be slow and is rarely linear—expect small (1-3%) shifts. The goal is not to never notice the sensation again, but to let go of resistance and restore meaningful engagement with life.

  “Even just noticing that I’m resisting...without having to stop resisting, that awareness is such an awesome foundational place to start.” — Max (22:20)

Notable Quotes and Moments (with Timestamps)

• 01:06 – “At any given moment, there is a ton of different stuff happening within our bodies...But now we’re talking, and I’m like, ‘Oh my gosh, I’m blinking a lot, aren’t I?’” — Max
• 05:01 – “It targets what people care the most about...which is why OCD is as vicious as it is.” — Max
• 08:46 – “Even I...keep monitoring to see if I’m noticing it, which makes you notice...now I’m thinking about my blinking.” — Kimberley
• 13:33 – “Can it be okay living a life that is less optimal?...If we can bring this sense of acceptance...your OCD won’t be able to help but become bored.” — Max
• 17:58 – “Reminders...they’re purposely bringing up this unwanted thing in awareness...the goal will be to practice radical acceptance.” — Max
• 19:33 – “That reminder is sort of a metaphor: I radically accept you in my life.” — Kimberley
• 28:07 – “[If symptoms shift], it’s all the same thing...It’s about something being in our awareness and our rejection of that.” — Max
• 32:07 – Personal story about floaters — “After about 20 minutes—gone, nothing. Because I lost the fear and my OCD, my brain got bored.” — Max
• 35:19 – “If your only goal is that ‘I don’t have to notice this anymore,’ you will keep noticing it. The recovery is that you don't do those compulsions.” — Kimberley

Practical Tools & Takeaways

• Learn the Trap: The more you resist a sensation or awareness, the more it sticks. Paradoxically, radical acceptance (even of never finding relief) is liberating.
• ERP—Done Right: For sensorimotor OCD, ERP is best done through nonresistance and radical acceptance, not by hyperfocusing as a form of exposure.
• Behavioral Reminders: Use reminders to practice acceptance within valued activities, rather than avoid them until you feel “good enough.”
• Gentle Self-Compassion: Validate how torturous and overwhelming this subtype can feel, and take the process in small, manageable steps.
• Watch for OCD’s Tricks: Be alert to the tendency to obsess about “doing it right,” and allow uncertainty/messiness as exposure.
• Recovery Is Living Well With Symptoms, Not Necessarily Symptom Erasure: Focus on restoring valued activities rather than chasing perfect awareness.

Further Resources & Contacts

• Max Maisel:
  • Website: beachfrontanxiety.com
  • Instagram: @Dr.MaxOCD
• Kimberley Quinlan:
  • Podcast and resources at CBTSchool.com

A beautiful life is possible—even with sensory motor OCD.