In today’s article I want to discuss one of the treatment options for Sexual Orientation OCD; we are going to look at Cognitive Behavioural Therapy (CBT). CBT is an evidence based model of treatment for OCD and many research studies have shown it to be effective. I shall explain what the therapy model is, but also offer some practical ways that you can try CBT yourself. You can learn more about CBT here in my guide.

What is HOCD?

HOCD is a form of OCD where you experience persistent, unwanted thoughts and anxieties about your sexual identity. Even though these obsessive thoughts about your sexual orientation feel very real It might surprise you to learn that HOCD has nothing to do with your sexual identity, rather all those thoughts are what we call obsessions that exist within obsessive compulsive disorder. My remit today is not to discuss HOCD in detail, rather I want to start to offer solutions in this article, but you can read more about HOCD in this article.

How CBT Can Help

CBT helps you look at how your thoughts, feelings, and the things that you do, are all related. In the context of HOCD, it helps you to look at your thoughts differently, the type of thoughts that are currently upsetting you, and you will learn to see them for what the are – just thoughts, not facts – and develop healthier ways of thinking about them. At the moment when you get one of those thoughts it probably makes you feel anxious or upset and you might seek some form of reassurance. CBT will help you manage your anxiety and show you how to stop doing all the behaviours that inadvertently keep this all going; namely the compulsions.

Why CBT Works for HOCD

I think the best way for me to explain this to you, is to give a case example of an old client who came for therap; heterosexual man who started having intrusive thoughts about being attracted to men. When in session with myself I could visibly see how upset he was by these thoughts, even admitting them to me, a psychologist, took a few attempts as he was ashamed and said he was scared I would judge him as being homophobic, which he was clearly not. When I asked him how he coped with these thoughts, he said he almost ‘policed’ all his interactions with his male friends, and had even stopped going to some football matches as he couldn’t cope with the thoughts.

This is a classic example of how the “core mechanisms” of HOCD maintain the disorder, where a thoughts, makes you feel something bad, you perform a compulsion and these keeps in all going, in the case of my client if he saw a guy on the street and had the thought am I attracted to him, this made him feel very anxious, and he mistook this sort of fear reaction as evidence that his thought must be true, which in turn made him avoid the man and tried to avoid a lot of his regular interactions with men, such as going to the football, which he loved. All of this actually maintain the HOCD, and CBT breaks this down and changing all of this throughout things like

• Cognitive Restructuring: This is a core component of CBT and loosely just means changing the way you think about something (you can learn more about cognitive components of HOCD here.)  Alex learns to challenge the thought (“Maybe I’m attracted to him”) by asking himself: “Is this thought based on facts or feelings? Have I ever been attracted to men before? What’s more likely – that I’m suddenly gay, or that this is just an intrusive thought?”
• Exposure and Response Prevention (ERP) : ERP is a behavioural intervention in cognitive behavioural therapy, Alex gradually confronts his fears. He starts by looking at pictures of attractive men, then watching films with same-sex romantic storylines. During these exposures, he resists the urge to analyze his reactions or seek reassurance. This helps him learn that he can tolerate the anxiety without resorting to compulsions. Read about ERP for HOCD in more detail here.

By consistently applying these CBT techniques, Alex can gradually reduce the power of his intrusive thoughts and break free from the cycle of anxiety and compulsions that maintain HOCD

Try CBT for yourself

Here are some practical CBT techniques you can start using today:

I want you to start looking at any thoughts that you are finding upsetting; the image below is a thought record and you can copy the format if you find it helpful. Every time you get a thought relating to HOCD write it down, but also write down how you felt, for example, anxious, disgusted, afraid, and then see what you did next, did you seek reassurance or jump on google. Why I am asking you to do that, is to start to notice the connections between your thoughts feelings and behaviours, is one has a knock on effect on the other as you can see in the diagram below. Rather than accepting your original thought as gospel, is there another way to look at it? For example,

• Intrusive thought: “I must be gay because I noticed that man’s shirt.”
• Emotions: Anxiety, fear, confusion.
• Behaviour: Avoided looking at the man, started questioning my past relationships.
• Challenge: “Just because I noticed someone’s clothing doesn’t mean I’m attracted to them. I’ve never been attracted to men before. This is just an intrusive thought.”

These are just some ways that you can apply the principles of CBT yourself, but if you are struggling I recommend you arrange to meet with a licensed mental health professional who can help you further.