You’ve done it again, spent 45 minutes mentally replaying a conversation from this morning, looking for something you might have said wrong. Or maybe you count to four silently before walking through a doorway, and if you lose count, you start over. You’ve never told anyone because you can’t quite explain it, and besides, it all happens inside your head. Nobody would understand.
If that resonates, you may be experiencing what clinicians call mental compulsions. They are a real, recognized, and very common feature of Obsessive-Compulsive Disorder (OCD), and because they are entirely internal, they are among the most frequently missed and misunderstood mental health experiences there is.
What Is OCD, and Where Do Mental Compulsions Fit?
OCD is characterized by two core features: obsessions (intrusive, unwanted, distressing thoughts, images, or urges) and compulsions (repetitive behaviours or mental acts performed to reduce the distress caused by obsessions). According to the National Institute of Health, OCD affects approximately 1 to 3 percent of the global population, making it one of the most prevalent psychiatric conditions worldwide.
Most people associate OCD with visible, physical compulsions: hand washing, checking, ordering, or tapping. These do exist and can be debilitating. But compulsions are not always physical. The DSM-5 the diagnostic standard used in North America specifically recognizes that compulsions can be mental acts, such as praying, counting, or repeating words silently. For a meaningful portion of people with OCD, these internal rituals are the primary or sole form of compulsion.
Early psychiatric research proposed the idea of “Pure O” OCD, a subtype involving obsessions with no corresponding compulsions. Current evidence has overturned this. A landmark study published in the Journal of Anxiety Disorders examined 1,086 individuals in intensive OCD treatment and found that both obsessions and compulsions were present in every single participant. For some, the compulsions were simply more covert, taking the form of mental rituals rather than observable behaviours.
What Do Mental Compulsions Actually Look Like?
Mental compulsions can be surprisingly varied. What they share is their function: they are attempts to neutralize, escape, or reduce the anxiety triggered by an obsessive thought. Here are some of the most common types:
Mental Reviewing
Replaying a past conversation, event, or action over and over in an attempt to confirm that nothing harmful occurred. This can feel like “just thinking things through,” but unlike ordinary reflection, it is driven by anxiety and never fully resolves it.
Reassurance-Seeking (internal)
Internally arguing against an intrusive thought, trying to convince yourself that your fear is unlikely or irrational. Though it temporarily reduces discomfort, it paradoxically reinforces the obsessive cycle.
Thought Neutralizing
Replacing a “bad” or frightening thought with a “good” or safe one. A 2024 study found this was the most common mental compulsion in their sample, reported by over half of participants, often paired with praying or silently repeating reassuring phrases.
Counting and Repeating
Counting internally, repeating phrases or numbers until something “feels right,” or mentally performing a prayer or sequence a specific number of times. Interruption of the sequence often triggers the need to restart entirely.
Emotional Checking
Monitoring your internal emotional state to verify you are feeling the “correct” emotions, particularly common in relationship OCD, where someone may repeatedly scan for feelings of love or attraction to manage fear of uncertainty.
Memory Hoarding
Attempting to preserve memories or experiences with perfect accuracy, driven by a sense that they will be critically important later. This often extends to information, conversations, or sensory details.
“People often don’t even realize they’re doing mental compulsions until we point out that they’re a thing. They can feel almost automatic.” OCD specialist clinicians at NOCD (treatmyocd.com, 2026)
Why Are They So Hard to Recognize?
Mental compulsions are invisible by definition. Unlike hand-washing or lock-checking, there is nothing for a loved one or even a therapist to observe unless they specifically ask about it. The rituals can also feel so fast and so habitual that the person experiencing them barely registers them as separate, deliberate acts.
There is also a cultural and clinical bias toward the more recognizable presentations of OCD. Research suggests the average person waits approximately 13 years between the onset of OCD symptoms and receiving a correct diagnosis. For those whose OCD manifests primarily through mental compulsions, that delay is often even longer, because their experience doesn’t match the popular image of the disorder.
This matters clinically. A 2024 study in Cureus noted that the prevalence of mental compulsions is likely underestimated in part because the most commonly used OCD assessment tool, the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), does not fully capture covert rituals. Without targeted inquiry, they can go undetected even in a treatment setting.
The OCD Cycle: Why Compulsions Make Things Worse
Understanding why mental compulsions are harmful requires understanding the OCD cycle. An intrusive thought or image triggers significant anxiety. The compulsion, whether physical or mental temporarily relieves that anxiety. Relief reinforces the behaviour, making the compulsion more automatic and the obsession more persistent. Over time, the obsessions become more frequent and the compulsions more elaborate, because the brain has learned that the ritual is the only way to find temporary relief.
This is why reassurance-seeking including internal reassurance, backfires so reliably. Each time you successfully argue yourself out of an intrusive thought, your brain logs the message: this thought is dangerous enough to require a response. The doubt returns, and the cycle continues.
Evidence-Based Treatment: What Actually Helps
Exposure and Response Prevention (ERP)
ERP is recognized as the gold-standard psychological treatment for OCD by the American Psychiatric Association, UK NICE Guidelines, and the broader international research community. It works by gradually exposing a person to the thoughts or situations that trigger their obsessions, while supporting them to refrain from performing the associated compulsion including mental ones.
For mental compulsions, response prevention means sitting with the anxiety generated by an intrusive thought without mentally reviewing, neutralizing, reassuring, or counting. Over time, the brain learns through direct experience that the feared outcome does not occur and that the anxiety will naturally subside on its own without any ritual. This process is called habituation.
The research outcomes are meaningful. Approximately two in three people with OCD experience clinically significant improvement through ERP. In one study of youth receiving ERP via teletherapy, participants showed a median reduction in OCD symptoms of over 38% within 13 to 17 sessions, with ongoing improvement across the following year. Studies of adults consistently show reductions not only in OCD symptoms, but in comorbid depression and anxiety as well.
Acceptance and Commitment Therapy (ACT)
ACT is increasingly recognized as a frontline psychological treatment for OCD, particularly well-suited to mental compulsions. Where traditional cognitive approaches ask a person to evaluate and challenge the content of their thoughts, ACT takes a different route: rather than arguing with an intrusive thought, clients learn to observe it with distance, to notice it without being controlled by it. This is especially important for mental compulsions, because the act of cognitively challenging an obsessive thought can itself become a ritual, inadvertently reinforcing the very cycle it aims to break. ACT’s core techniques, cognitive diffusion (unhooking from the literal meaning of thoughts), acceptance (allowing uncomfortable thoughts and feelings without fighting them), and values-based action (living meaningfully despite uncertainty), address the function of mental compulsions rather than their content. Research supports its effectiveness: a 2021 systematic review and meta-analysis published in the Journal of Obsessive-Compulsive and Related Disorders found ACT produced significant reductions in OCD symptom severity, with effect sizes comparable to ERP. For many clients, ACT and ERP are used in a complementary way, with ACT providing the psychological flexibility needed to fully engage with exposures.
Accelerated Resolution Therapy (ART)
At Reflective Soul, our entire counselling team is trained in Accelerated Resolution Therapy, an evidence-based trauma therapy that uses eye movement and image rescripting to help clients process and resolve distressing memories and intrusive experiences rapidly, often in fewer sessions than traditional approaches. For clients whose mental compulsions are tied to traumatic memories or deeply embedded anxiety patterns, ART can be a powerful complement to OCD-focused work.
Medication
Selective serotonin reuptake inhibitors (SSRIs) are a first-line pharmacological treatment for OCD and are often used in combination with ERP or CBT. Research consistently shows that the combination of medication and psychotherapy produces better outcomes than either alone. If medication is a consideration for you, our integrative team, including our Naturopathic Doctor, can help you explore options that align with your whole-person health picture.
When to Reach Out
You don’t need a formal OCD diagnosis to benefit from support. If you recognize yourself in any of the patterns described above, if you spend meaningful time on internal rituals that feel necessary but bring only temporary relief, if intrusive thoughts are disrupting your ability to be present, or if anxiety is shaping your days in ways that feel out of proportion, those experiences deserve attention.
Mental compulsions are not a character flaw, a sign of weakness, or evidence that your fears are real. They are a learned pattern, and learned patterns can change with the right support.
At Reflective Soul Therapy & Wellness, we offer trauma-informed, evidence-based care for OCD, anxiety, and related conditions including counselling, ART therapy, and integrative naturopathic support.
If you’d like to explore whether this resonates with your experience, we invite you to reach out for a free consultation. reflectivesoulwellness.com | Intake@ReflectiveSoulWellness.com | (778) 484-9388
References
Pal, V., Ramdurg, S., & Chaukimath, S. (2024). Assessment of the prevalence and types of mental compulsions in patients with obsessive-compulsive disorder in North Karnataka: A cross-sectional study. Cureus, 16(10), e71960. https://doi.org/10.7759/cureus.71960
Williams, M. T., Farris, S. G., Turkheimer, E., Pinto, A., Ozanick, K., Franklin, M. E., … Foa, E. B. (2011). Myth of the pure obsessional type in obsessive–compulsive disorder. Depression and Anxiety, 28(6), 495–500.
Brakoulias, V., Starcevic, V., Belloch, A., Brown, C., Ferrao, Y. A., Fontenelle, L. F., … Viswasam, K. (2017). Comorbidity, age of onset and symptom dimensions of obsessive-compulsive disorder (OCD). The co-occurrence of obsessions and compulsions in OCD. Journal of Anxiety Disorders.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). APA Publishing.
National Institute for Health and Care Excellence. (2005). Obsessive-compulsive disorder and body dysmorphic disorder: Treatment (Clinical Guideline CG31). NICE.
Mao, L., Hu, M., Luo, L., Wu, Y., Lu, Z., & Zou, J. (2022). The effectiveness of exposure and response prevention combined with pharmacotherapy for OCD: A systematic review and meta-analysis. Frontiers in Psychiatry, 13, 973838.
StatPearls. (2024, February 24). Obsessive-Compulsive Disorder. NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK553162/