When people come to me with HOCD, what they often want—understandably—is certainty. They want to know what their thoughts mean. They want clarity about who they are. And they want the fear to stop.
I always tell them the same thing: HOCD isn’t about your sexual identity; rather it is to do with what your brain does with uncertainty. If you haven’t already read it, I recommend to read my Guide to HOCD before attempting to do the work I shall be suggesting to do in this article.
In this short series, I’m going to show you how to start using Cognitive Behavioural Therapy to work with HOCD—not just to understand it, but to actually do something about it. This is the same process I’ve used with clients for years. You don’t need to solve the thoughts. You just need to learn how to change what they mean to you and how you respond to them.
What is HOCD?
HOCD stands for “Homosexual Obsessive Compulsive Disorder.” It’s not a diagnosis you’ll find in a manual, but it’s a well-recognised theme of OCD. It usually shows up as, unwanted thoughts about your sexual orientation, even if there’s been no prior history of questioning it. You might be straight and suddenly start having intrusive thoughts like:
- “What if I’m actually gay and I just don’t know it?”
- “Why did I look at that person?”
- “I felt something—does that mean I’ve been lying to myself?” Related reading
If you’ve ever panicked because you felt aroused during a thought or image, I’ve written a full post explaining why this happens — and why it doesn’t mean the thought is true.
HOCD and feel aroused – why does this happen?
And these thoughts don’t just pop up. They spiral. You might check your physical reactions, compare yourself to others, replay things in your head that you did in the past, or look for reassurance online.
f the thought feels overwhelming or emotionally intense, that doesn’t mean it’s meaningful. It just means your brain has flagged it as important. I’ve written more about why HOCD thoughts feel so real, and what that actually tells us:
HOCD thoughts feel real — does that mean they are true?
The more you try to fix it, the more stuck you feel.
What CBT Can (and Can’t) Do
CBT won’t give you certainty. And that’s the point.
What CBT can do is help you:
- Recognise the thought patterns that keep you trapped
- Reduce the compulsive behaviours that feed the anxiety
- Learn how to sit with doubt without needing to fix it
And yes—it works. But it’s something you do, not just something you learn about.
Step 1: Spotting the Thought That Sends You Spiralling
This is the first step: slowing everything down enough to spot when your brain gets triggered.
It sounds simple, but often people are already halfway through the panic before they realise what thought set it off.
You might notice a person walking by, and a second later you’re stuck in your head. Or you feel something in your body and your thoughts go out of control. The key here is noticing what just happened, without judging it.
You need to ask yourself the following;
- What was the situation or trigger?
- What did I think, or what popped into my mind?
- What did I do next?
Here’s an example: You’re watching a film and notice a male actor is attractive. A thought pops in—“What if I’m actually gay?” Your stomach drops. You pause the film. You start analysing—“Did I feel arousal?” You scan your body. You check how you’ve responded to female actors in the past. Within five minutes, you’re down the rabbit hole.
That all started with one thought.
Another example: You walk past someone in the street, notice their appearance, and instantly panic. “What does that mean?” you think. “Why did I look?” You then spend the next hour going over how you felt.
That’s what we want to look at further.
I often suggest keeping a small log (even just notes in your phone) of these spirals:
- Trigger
- Thought
- Emotion
- What you did next
You don’t have to analyse it and get stuck. Rather I am going to show in this series how to check if the thought is true or not.
This simple act of starting CBT by noting and working with your thoughts starts to slow the process down. It helps you separate what happened from what your brain did with it.
In the next step, I’ll show you what to do once you’ve spotted the thought. But for now, your only job is to start catching it as early as you can.