Patients build elaborate rebuttals to their obsessive fears, and the arguing sustains the OCD
STUDY: Kirkham EJ, Wellcome Open Research 2026
STUDY TYPE: Delphi consensus study
FUNDING: Wellcome Grant
Background
This consensus paper describes a compulsive thought process in OCD: excessive rationalization:
- Arguing with or trying to logically disprove an unwanted thought.
- It resembles a technique used in CBT therapy (cognitive reappraisal), except the reasoning brings no relief.
The authors gathered input from 20 adults with lived experience of OCD, average age 34, who lived 19 years on average with OCD.
Results
Top-ranked items included “I spend a lot of time coming up with reasons why my fears are unlikely to happen” and “I argue with my unwanted thoughts because I want them to go away.” Full items are below.
Patients described the process as effortful and largely futile, not the relief-bringing reappraisal it resembles: “Coming up with rational responses to my worries rarely provides me with the relief I am looking for.”
Practice Implications
- Treat excessive rationalization as a compulsion, and don’t mistake it for healthy reasoning.
- Ask your OCD patients whether they debate or try to disprove their fears in their heads, and if they do, redirect exposure and response prevention toward tolerating the uncertainty rather than winning the argument.
- Learn more about little-known symptoms of OCD through the Spectrum Project.
—Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
