Dr Ben Mead Clinical Psychologist

Intrusive Thoughts – Moralistic and Relationship OCD – CBT treatment

Did you know that a study in 1992 by the highly esteemed psychologists Christine Purdon and David Clark (Purdon and Clark, 1992) found that 22% of men, without a diagnosed mental health condition, have thoughts of fatally pushing a friend? Women were shown not to fair a little better (9%…). But, still, 1 in 11 women or 1 in 5 men, do not find themselves acting on these thoughts.

Intrusive thoughts can be profoundly unsettling, not because of their content but because of the meaning people attach to them. When a distressing idea appears suddenly and without invitation, it’s easy to assume it reveals something important—about your morality, your intentions, or your relationships. For people experiencing moralistic OCD or relationship OCD, this interpretation becomes the engine of anxiety. Cognitive Behavioural Therapy (CBT) offers a way of stepping back from these interpretations and understanding intrusive thoughts are just part of the mind’s natural activity rather than evidence of danger or personal failure.

CBT treatment often starts with psychoeducation. Many people feel isolated by their intrusive thoughts, convinced that no one else could possibly think the things they do. Learning that intrusive thoughts are normal and universal—and that their presence says nothing about character—can be quietly transformative for many of the clients I see. In moralistic OCD, thoughts often centre on fears of being harmful or immoral. In relationship OCD, they may revolve around doubts about compatibility, attraction, or commitment. CBT helps people recognise that these thoughts are not moral verdicts or relationship assessments; they are simply mental events. However, naturally it can be tricky to determine what are our actual beliefs and what are intrusive thoughts.

Given this, CBT encourages a shift in how thoughts are interpreted. Cognitive restructuring invites people to examine the assumptions that give intrusive thoughts their power. Someone might ask themselves: “What am I assuming this thought means?” or “What evidence supports the conclusion I’m drawing?” This process isn’t about arguing with the thought but about loosening the grip of rigid interpretations. Over time, individuals begin to see the thought as uncomfortable rather than meaningful.

Exposure and Response Prevention (ERP) builds on this foundation. ERP involves allowing the intrusive thought to be present without engaging in the usual mental rituals—checking, analysing, seeking reassurance, or trying to “solve” the discomfort. For moralistic OCD, this might mean asking a client to notice a distressing thought without launching into moral self‑examination. For relationship OCD, it might involve sitting with uncertainty about feelings without testing the relationship or mentally reviewing past interactions. ERP helps the mind learn that discomfort can rise and fall naturally, and that intrusive thoughts lose their intensity when they are not fed by compulsive responses.

CBT treatment often also involves behavioural experiments. Behavioural experiments offer another gentle but powerful intervention. These experiments test the predictions that intrusive thoughts often carry. For example, with someone with moralistic OCD I might ask them to see if they can allow a thought to pass without neutralising it and observe that nothing dangerous happens. Someone with relationship OCD might be asked to spend time with their partner while allowing uncertainty to exist, noticing that connection can still emerge even when doubt is present. These experiences help build a more flexible, compassionate understanding of the mind.

Finally, CBT encourages a return to values. Intrusive thoughts often pull people into avoidance, rumination, or self‑monitoring. Values‑based action redirects attention toward what matters—kindness, curiosity, connection, integrity. When behaviour is guided by values rather than fear, intrusive thoughts begin to feel less central and less authoritative.

CBT does not aim to eliminate intrusive thoughts; instead, it helps people relate to them differently. In doing so, it opens space for a life that feels more grounded, more intentional, and less governed by the noise of the mind.

As always, any questions about this, do feel free to contact me.

How to switch off after work and move into ‘Home mode’

Switching off after work is a struggle that many people experience, and I see this a lot in my online clinic and also in my clinic in Guildford. Constant emails, work chats and the temptation to “just check in” means the lines between work life and home life can become really blurry. We can only push ourselves so far and so it is not uncommon that a difficulty in switching off from work can be a precursor to chronic stress, burnout, poor sleep, home arguments and a high sense of lethargy. Online Therapy and Cognitive Behavioural Therapy (CBT) appointments can really help with this.

However, whilst therapy can explore deeper reasons for the higher levels of stress (i.e., what thoughts are maintaining us to push ourselves), there are a few simple tips that can have a real meaningful impact and help us switch off after work:

1. Create a hard stop time. Decide a time to finish work and do your best to stick to it. This help create a boundary for your brain to transition. Some jobs do not allow this, so in these situations, a ‘soft stop’ approach can be more appropriate. This just involves not starting anything new unless absolutely necessary.
2. Have a shutdown routine. The commute enables this to happen. However, it’s effectiveness often depends on what the commute is like. A busy train, standing like sardines is not a relaxing experience, and tends not to move us into home-mode! Neither is being stuck in a traffic jam. If your commute is uncomfortable or draining, then consider stopping for a bit – perhaps sitting down on a bench, or going for a walk before you walk through the front door. For those who work from home, consider pausing in your work room for 5-10mins before entering the home setting. Maybe play a game on your computer, anything to just highlight that the work day has finished.
3. Change your clothes. Whether you work from an office or at home, it can be really helpful to have different clothes for work-mode and home-mode. So, if you work from home, pause, leave your home office, and get changed into home clothes that you would typically not wear to work. Essentially, you’re trying to show your brain that you’re in a different mode now.
4. Engage in non-work passions. Consider going straight from work to a hobby. Drawing, reading, playing an instrument or sports can be a good way to unwind from work.
5. Try to establish a good sleep routine. ‘Sleep Hygiene’ (link to my other blog) is a term used to describe the best way to look after our sleep. A big part of sleep hygiene is routine. Establishing a good sleep routine is really useful to help us wind down, relax in the evening and get ourselves in a good headspace for sleep. This means, no working in bed, nor whilst relaxing in front of the TV. By showing the brain that the problem-solving / decision-making / planning and organising part of the day is passed then it will be more likely to get to sleep and be comfortable to stay asleep.

Switching off after work is something that requires intention and consistency. The more you do it, the more natural it’ll become and the more comfortable it’ll feel not to do that ‘one more email’. Research has shown that those who experience more detachment from work during their personal time are more content with life and experience less psychological strain, without being less engaged whilst at work (Sonnentag, 2012).

As always, if this is something you would like help with, do feel free to get in touch, and whether it’s myself or one of my associates we would be happy to help.

Am I depressed?

It is not uncommon for me to receive a query from an person asking whether they are depressed. Often this is supplemented by statements about how, on the outside, their life is really good. Lovely house, work is fine, no major money issues, loved ones healthy. But, something just doesn’t feel right to them.

The first thing to add is that depression can hit us all. Young, old, rich, poor, active, less active. Depression is typically seen as have symptoms such as:

• finding little interest or pleasure in activities
• being tired, lethargic
• having difficulty concentrating on everyday activities
• feeling hopeless
• being very critical to oneself or feeling like you are letting others down

Having these, or some of these symptoms can be an indication of depression. How this is treated though can vary widely between individuals. Whilst cognitive behavioural therapy (CBT) and Acceptance and Commitment Therapy (ACT) have been shown to be really helpful in helping individuals with these symptoms, the actual strategies adopted can vary widely between interventions. Essentially, two people can be given CBT for depression, but their treatment can look quite different. Tailoring therapy to the individual is therefore key for therapy to be beneficial. During the assessment stage of therapy, I will work with you to understand your symptoms, how they came about but most importantly, how they are being maintained. Indeed, one the most common maintaining factors to depression is in the first paragraph in this blog post – a person being critical towards themselves due to how they are feeling.

Imagine you were at a party at a friend’s house, people smiling, having a good time. Your friend says to you that they are feeling low. Now, if your friend had some things in their life to be thankful for, you may help direct their attention towards those. This could be helpful. However, ask yourself how you would direct them to these things? Would you say it compassionately, calmly with a soothing voice or would you say it aggressively, critically, perhaps calling them an idiot for feeling low? It’s amazing how, when we feel low, we can adopt the latter approach with ourselves – and that is about as helpful as it would be if we did it to our friend. As the saying goes, “it’s not what we say, it’s how we say it” – the same is true for our internal dialogue. Understanding and developing techniques to build a healthy relationship with our mind is one of the interventions in cognitive behavioural therapy for depression.

Do get in contact if you would like to find our more about therapy for depression, or even if you just wish to ask the question of this blog. As I say, depression can present itself in many ways, I’ve touched on a couple in this article, but your experience may be very different. My job is to help understand you, and help you move forward in life so that it is more meaningful and fulfilling for you.

What is a Therapy appointment like?

A question I am sometimes asked is ‘What happens in a therapy appointment?’. Unfortunately, this is in fact quite a tricky question to answer…. at least succinctly! This is because, much depends on the therapy model offered, and also the personal style of a therapist.

There are many different models of therapy. Cognitive behavioural therapy (CBT) is probably the most well-known, but there are also side streams of CBT (often termed ‘3rd-wave CBT approaches’) like Acceptance and Commitment Therapy (ACT) and Mindfulness based CBT (MBCBT). There’s also other completely different types of therapy such as Psychoanalytic therapy (think Freud…), family therapy, eye-movement desensitisation and reprocessing (EMDR), Hypnotherapy, person-centred counselling to name just a few. Each of these models of therapy have different approaches. For example, in person centred counselling, often the therapist adopts more a reflective stance, whereas in CBT a therapist may be more questioning about certain beliefs. In ACT, it is more about sitting with difficult thoughts, whereas in CBT it is about stepping back and challenging them. This is a very loose distinction though and one could argue too general a distinction.

Some things are constant across therapies though. A safe, non judgmental space is key to therapy. A place where a client feels they can express their views and be treated with curiosity. Where they can be open.

In both my online and in-person sessions in Guildford and Basingstoke, psychology appointments can vary depending on what type of therapy suits the client best. I am though a big believer in being genuine though. Therefore, I am always open to discussions about what would work best for the client and whether this is an approach I can adopt.

Any questions, as always, please do not hesitate to ask.