Describe the OCD cycle and explain how obsessions, anxiety/distress, compulsions, avoidance, and temporary relief can reinforce one another.

Identify common and less-recognized presentations of OCD, including harm-related intrusive thoughts, contamination fears, checking, “just right” experiences, scrupulosity, relationship concerns, reassurance seeking, rumination, and other mental compulsions.

Differentiate features commonly associated with ego-dystonic intrusive thoughts from indicators that warrant further assessment for suicidal or homicidal intent, psychosis, or other safety concerns.

Recognize ways that reassurance, avoidance, checking, rumination, and other attempts to gain certainty can unintentionally maintain the OCD cycle.

Explain the basic principles of Exposure and Response Prevention (ERP), including the role of approaching feared uncertainty while reducing compulsive responses.

Describe how values-based action and tolerance of uncertainty can help clients move toward meaningful activities even when intrusive thoughts or anxiety are present.