I use the series of exercises in this article to help patients practice eliminating compulsive rumination. Per Targets and Rationales for RF-ERP Exposures, the goal of these exercises is not to make the patient anxious. Rather, the goal is for them to learn that they can control rumination, even when they encounter a trigger. Some […]| Dr. Michael J. Greenberg
Published March 2025 In Malan’s Model of OCD, we introduced the idea that OCD functions as a defense mechanism that negotiates an emotional conflict. In this article we’ll go into further detail regarding the origins of emotional conflicts and how OCD functions as a defense. We’ll then use that understanding to conceptualize a psychoanalytic approach […] The post OCD as a Defense Mechanism appeared first on Dr. Michael J. Greenberg.| Dr. Michael J. Greenberg
OCD isn’t random or illogical. It is a comprehensible, logical strategy (avoidance and compulsion) aimed at preventing the Core Fear. Recovering from OCD requires recognizing that you are employing a strategy that doesn’t work, and learning that you have the ability to make different choices that lead to feeling better. Put another way, recovering from OCD […] The post It Matters How We Talk About OCD: The Importance of Using Language of Agency appeared first on Dr. Michael J. Gree...| Dr. Michael J. Greenberg
Three Types of OCD Cases: Integrating Malan’s Model of OCD with the Core Fear Model As discussed here, an individual’s OCD symptoms are aimed at avoiding a specific form of emotional distress, or Core Fear. And as discussed here, OCD symptoms are aimed at preventing a loss of attachment. So is the Core Fear always […] The post Three Types of OCD Cases appeared first on Dr. Michael J. Greenberg.| Dr. Michael J. Greenberg
The below is the first article I wrote on this topic a few years ago. These ideas have evolved significantly since that time. Rumination-Focused ERP: Turning Exposure On Its Head and Targets and Rationales for RF-ERP Exposures offer the most current version of my approach to exposure. I believe that the issue of compulsive thinking, or […] The post Rethinking the Process and Treatment of Compulsive Rumination appeared first on Dr. Michael J. Greenberg.| Dr. Michael J. Greenberg
Please note that the below is an older article that requires significant revision in light of how my definition and conceptualization of compulsive rumination have evolved over the past few years. I do not think this article presents a complete, or completely accurate, description of compulsive rumination. Nonetheless, I have chosen to keep it posted […] The post Why Rumination is a Continuous Loop appeared first on Dr. Michael J. Greenberg.| Dr. Michael J. Greenberg
Please note that this is an older article. Thinking about exposure in terms of learning was a conceptual stepping stone between thinking in terms of habituation (the classical model) and thinking in terms of restoring agency (my current model). Rumination-Focused ERP: Turning Exposure On Its Head and Targets and Rationales for RF-ERP Exposures offer the most […] The post Exposure Is About Learning, Not Habituation appeared first on Dr. Michael J. Greenberg.| Dr. Michael J. Greenberg
Please note that this is an older article. Thinking about exposure in terms of learning was a conceptual stepping stone between thinking in terms of habituation (the classical model) and thinking in terms of restoring agency (my current model). Rumination-Focused ERP: Turning Exposure On Its Head and Targets and Rationales for RF-ERP Exposures offer the most current version of my […]| Dr. Michael J. Greenberg
DR. MICHAEL J. GREENBERG Specialized Cognitive-Behavioral and Psychoanalytic Treatment for OCD I’m a licensed clinical psychologist* specializing in the treatment of OCD, and the director of OCD Associates, a practice specializing in Rumination-Focused ERP. Much of my work has focused on the cognitive-behavioral treatment of compulsive rumination, which I believe to be the cornerstone of […]| Dr. Michael J. Greenberg
I’m sure this article will elicit some harsh responses from people who use ACT to treat ‘Pure O.’ I did not write this article to cause a stir. I wrote it because I feel compelled to speak out against an approach that I believe hurts patients. Please read with this in mind, and feel free […]| Dr. Michael J. Greenberg
* Published December 2022 Defining Compulsion In RF-ERP, the defining characteristic of an OCD symptom is the person’s subjective lack of agency, or their feeling that they don’t have a choice about whether they engage in that symptomatic behavior (1). According to this definition, no behavior is ever objectively OCD. Rather, it is a person’s […]| Dr. Michael J. Greenberg
* Published December 2022 Causal Justifications Introduction A central component of RF-ERP is challenging the ways in which a person justifies ruminating. In order to argue effectively against a justification, one must first fully understand it. This entails helping the patient to formulate exactly why they think it is important to ruminate. Patients are usually […]| Dr. Michael J. Greenberg
* Published December 2022 Anatomical Models of Rumination Rumination as defined in RF-ERP captures all sorts of different thought processes. Taking a closer look at these thought processes can be helpful in various ways. This article presents a few different anatomical models one might use to organize the content of someone’s rumination. Notably, these models […]| Dr. Michael J. Greenberg
* Published December 2022 Three Types of OCD Cases: Integrating Malan’s Model of OCD with the Core Fear Model As discussed here, an individual’s OCD symptoms are aimed at avoiding a specific form of emotional distress, or Core Fear. And as discussed here, OCD symptoms are aimed at preventing a loss of attachment. So is […]| Dr. Michael J. Greenberg
Please note that Rumination-Focused ERP is a new and evolving approach to ERP. Neither this exercise nor the rest of the treatment has been researched, and therefore neither is evidence-based. Please also note that this article is for your information only and does not constitute clinical advice or establish a patient-psychologist relationship. This article describes […]| Dr. Michael J. Greenberg
As discussed here, directing attention is a controllable mental process, and as discussed here, directing attention is part of our definition of rumination. Sometimes people feel like they can’t stop paying attention to something; this is especially a problem for people with sensorimotor OCD. The key to solving this problem is differentiating between something being […]| Dr. Michael J. Greenberg
An essential part of treating OCD is distinguishing between mental processes that can and cannot be controlled. This can be especially confusing when it comes to attention. Confusion about this leads, in turn, to confusion about distraction, as well as to difficulty eliminating rumination. The purposes of this article are: (1) to explain what aspects […]| Dr. Michael J. Greenberg
Understanding the Core Fear is foundational to effective treatment of OCD, and can unlock even the most baffling cases. Dr. Elna Yadin introduced the idea that each person with OCD has a ‘Core Fear,’ and that their avoidance and compulsions are aimed at preventing it. This idea is very powerful, because OCD symptoms can seem […]| Dr. Michael J. Greenberg
Different therapists and researchers (and farmers, actually) use the word rumination in different ways, and that makes it important to define exactly what I mean when I use that word. When I talk about rumination, I’m talking about any type of mental engagement with the problem; put another way, I’m talking about shifting into problem-solving […]| Dr. Michael J. Greenberg
Please note that Rumination-Focused ERP is a new and evolving approach to ERP. It has not yet been researched, and therefore to the extent that it differs from classical ERP, it is not evidence-based. How you conceptualize OCD and ERP affects not only how you do exposure but also what you do as exposure. By […]| Dr. Michael J. Greenberg
* Published December 2022 In his book Individual Psychotherapy and the Science of Psychodynamics, Dr. David Malan offered a simple model for conceptualizing the emotional and relational dynamics underlying OCD. This article presents my simplified version of Malan’s model, largely loyal to the original but filled in and slightly adjusted. I have found this model […]| Dr. Michael J. Greenberg
I recommend reading Awareness, Attention, Distraction, and Rumination before reading this article, since the concepts discussed there are foundational to the approach outlined below. Sensorimotor OCD (also known as Somatically Focused OCD) refers to cases in which people become hyper attentive to their bodily sensations, such as breathing, swallowing, or heartbeat. While this might not sound so […]| Dr. Michael J. Greenberg
Please note that Rumination-Focused ERP is a new and evolving approach to ERP. It has not yet been researched, and therefore to the extent that it differs from classical ERP, it is not evidence-based. In classical ERP, it is considered important that the patient feel anxious during exposure, because the goal of exposure is habituation. […]| Dr. Michael J. Greenberg