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Appointments

Houston OCD Counseling is an out of network provider which means you will initially be responsible for the full session fee at the end of each session. Our office will provide you with a detailed receipt, also known as a Super-Bill, after each session that you can then forward to your insurance carrier. We recommend you contact your insurance carrier to inquire about full or partial reimbursement directly to you, and if preauthorization for sessions is required.

Accepted Forms of Payment

  • Health Savings/Flexible Health Spending Account Cards
  • Therapist Rates
  • Individual Therapy session with Michael Soderstrom (30 minutes) $130
  • Individual Therapy session with Michael Soderstrom (60 minutes) $200
  • Initial Diagnostic Evaluation/Testing (60 minutes) $250
    Testing will be done at home and a psychological report will be emailed to you within a week after evaluation & testing is completed.
  • Case Management $150 per hour (pro-rated per 15 minutes)
    Indirect services, such as letter-writing, form-completion, and participation in consultations or meetings made at your request
  • Fee for No-show or Cancellation of Appointment in less than 24 hours $100

Thank you for your interest in pursuing counseling services at Houston OCD Counseling with Michael Soderstrom, MA, LPC-Supervisor. I am glad to make myself available to respond to your questions, concerns, and comments during scheduled appointments with me. Please take the time to complete the attached documents as thoroughly as possible. All information you provide will help me to know you better, which will help me in developing an appropriate treatment plan for you. I have attached The Notice of Privacy and Practices for your perusal. Due to HIPPA laws, there are specific items which must be covered which contribute to the amount of material you will receive from my office. The intent of HIPPA is to guarantee the security of your healthcare information in this office, as in any healthcare provider’s office. Once again, thank you for your patience and efforts in completing this information packet. I look forward to establishing a great relationship with you. I hope that I will be able to assist you in your journey.

PATIENT REGISTRATION FORM

PATIENT INFORMATION
Patient’s First Name:

Patient’s Last Name:
Patient’s Middle Name:
Nickname:
 Patient Date of Birth (MM/DD/YYYY):
Patient Gender:
Marital Status:
Other
Patient Address:
Home Phone Number:
Cell Phone Number:
Work Phone Number:
Email Address:
Emergency Contact Name:
Emergency Contact Number:
I like to send my patients appointment reminders in advance of their appointments. How would you prefer to receive your reminders?
Please create a Login Name and Password to receive extra secure HIPPA compliant emails, appointment reminders, and to schedule your appointments online. Please use alpha-numeric characters only, upper and lower case, no special characters, and no punctuation.

Login:
Password:
OK to keep charge card info in an encrypted secure file?
Credit Card:
Credit Card Number:
Expiration Date:
Security Code (from back of card):
Card Holder’s Name & Billing Address:
Patient Referred by:
When did symptoms appear:
Do you take medications?
Please name them:
Are you currently being seen by another psychotherapist?
Who?
Are you currently under the care of a psychiatrist?
Who?
 How would you rate your current health?
 How would you rate your sleeping habits?
How many times a week do you generally exercise?
How Long?
Types of Exercises?

If you would like me to speak or communicate with your psychiatrist, family doctor, another psychotherapist, or any other person(s) in the future, you will need to fill out the attached “Release of Confidential Information” sheet. Please provide the name, phone number, and email address of the person you would like me to contact.

Appointment Policies: You will be charged for cancelled appointments unless notice is received at least 24 hours prior to the appointment time so that the time may be scheduled for another client. Payment is expected at the time of each visit unless prior arrangements have been made. You will be responsible for the agreed upon late notice or no-show fee of $100 per session. I understand and accept the policies concerning both the cancellation of appointments and payment for services.


Signature 1

Client Signature
(Parent or Guardian if patient is under 18 years of age)


 Date:

General Information and Procedures

Length of Session: 30 – 60 minutes

Cancellations: Your session time is reserved for you and is taken seriously. Except for emergencies, cancellations must be made 24 hours in advance to avoid being charged. Please feel free to call and leave a message or send a text message to me at 281.780.8318 and I will cancel your appointment.

Additional Fees: Forensic, Court, and Civil and Criminal Legal Related Fees Policy

  • Fee for court subpoena is $200 per hour in court.
  • $200 per hour preparation time, report preparation, and court travel time.
  • Fees are payable in their entirety one week before the hearing or deposition date by the party issuing the subpoena, requesting participation in a deposition, or requesting a written report for a specific hearing or court order; with no exceptions.
  • Photocopies of your records will be charged at a rate of $1.00 per page. Advanced notice for copies is strongly urged so I will have time to access your records and make requested copies.
  • Accounts not paid in full may be turned over to Collections if payment arrangements are not made.

Fee Structure: The client is financially responsible for payment at the time of service. We do not accept insurance. Our office accepts credit cards for payment of session fees.

Confidentiality: Information shared in sessions is held in the strictest confidence according to federal law (Regulation 42 CFT Part 2). Exceptions include legal obligations (such as child abuse, elder abuse, testimony required by a judge, personal danger to self or an identifiable victim), information provided to parents if the client is a minor, and consultation with professional peers in regard to your case, without revealing your identity. Release of information to another professional may be done only with your written consent.

Client Privacy: Recent laws have been enacted for client privacy. It is important to know that email and mobile phone conversations are not always secure because they can be potentially intercepted. Therefore, by signing this document you understand that if we have correspondence by e-mail or mobile phone, there is a potential for confidentiality to be compromised.

Counseling Approach: To get the most out of counseling or therapy, it is important to assume responsibility for your experience. Therapists can only help you based on the information you provide. If you are like most people, you probably have some sensitive issues you are not comfortable discussing with others. Those are usually the things you most need to talk about with your therapist. Depending on your circumstances, you may be asked to include some family members’ participation in your treatment. Regular, consistent participation in treatment sessions, as well as any “homework” assignments will facilitate the process, but no therapist can ethically guarantee total achievement of all your goals. Please feel free to ask questions about the process and let me know if you are not satisfied with how your treatment is progressing. Because of the nature of the therapeutic process, you may experience periods of emotional discomfort on the way to your goals. No single therapist is the right fit for everyone. If you do not feel that I am the right fit for you, I will be happy to provide a referral list to you of other therapists. You are free to discontinue treatment at any time.

Role of Office Manager: I understand I may be contacted by the office manager at Houston OCD Counseling for administrative issues, testing inquiries, and appointments. This contact will be made through email (patientassistant@houstonocdcounseling.com) or through the office number (281.780.8318). By signing this form, I acknowledge and understand the role of the office manager in gaining information to move me through the treatment process. As the client/patient, I may use these same means of contact when necessary to make administrative and testing inquiries, and for appointments.

The signature below confirms that the information has been read and discussed with the therapist.
I, , accept the policies listed above. I hereby give fully informed consent to Michael Soderstrom, MA, LPC-Supervisor, to enter into a psychotherapeutic relationship.

Signature 2

Client Signature
(Parent or Guardian if patient is under 18 years of age)


 Date:

Thank you so much for taking the time to completely fill out this important information. Appointments are held via Zoom, Face Time, or in person.

Michael Soderstrom, MA, LPC-Supervisor
Licensed Professional Counselor-Supervisor
9432 Katy Freeway, Suite 400
Houston, Texas 77055
Phone: 281.780.8318
patientassistant@houstonocdcounseling.com
www.houstonocdcounseling.com
RELEASE OF CONFIDENTIAL INFORMATION
I, , consent to the release of information regarding my therapy, testing, medical history, and other relevant documents,
FROM:
Name:
e-Mail Address:
Phone:
TO:
Michael Soderstrom, MA, LPC-Supervisor
Licensed Professional Counselor-Supervisor
9432 Katy Freeway, Suite 400
Houston, Texas 77055
Phone: 281-780-8318
patientassistant@houstonocdcounseling.com
www.houstonocdcounseling.com
Client / Responsible Party Signature
I understand that I may withdraw my consent at any time.
Signature 3

Client Signature
(Parent or Guardian if patient is under 18 years of age)


 Date:
Therapist Signature


Date:
RELEASE OF CONFIDENTIAL INFORMATION
I, , consent to the release of information regarding my therapy, testing, medical history, and other relevant documents,
FROM:
Michael Soderstrom, MA, LPC-Supervisor
Licensed Professional Counselor-Supervisor
9432 Katy Freeway, Suite 400
Houston, Texas 77055
Phone: 281.780.8318
patientassistant@houstonocdcounseling.com
www.houstonocdcounseling.com
TO:
Name:
e-Mail Address:
Phone:
Client / Responsible Party Signature
Signature 4
I understand that I may withdraw my consent at any time.

Client Signature
(Parent or Guardian if patient is under 18 years of age)


 Date:
Therapist Signature



Date:

NOTICE OF PRIVACY AND PRACTICES

Your rights are to:

  • receive a copy of this Notice of Privacy and Practices.
  • receive treatment in a confidential and safe environment.
  • receive privacy and confidentiality in all matters.
  • not have information released to others without your written release, except as required by law.
  • have access to your medical records in this office (a fee may be charged for copies).
  • receive care that is respectful, of high-quality, and considerate.
  • receive information that is understandable and complete, including treatment and care outcomes.
  • participate in decisions about treatment.
  • receive consideration with regard to personal beliefs and values.
  • receive prompt response to requests.

Every patient has the responsibility to:

  • give accurate and complete information about your health (complete the forms provided).
  • ask questions about anything that you do not understand.
  • participate in your treatment.
  • report changes to your health care provider.
  • accept financial obligations to your provider.
  • respect the privacy of others.
  • treat others with consideration and respect.

The information you provide will be used as follows:

  • to treat you, provide mental health care.
  • to collect fees for services provided.
  • research (without identifying you).
  • to comply with the law.
  • help with public health and safety issues.
  • address workers’ compensation, law enforcement, and other government requests.
  • respond to lawsuits and legal actions.

Confidentiality: Information shared in session is held in the strictest confidence according to federal law (Regulation 42 CFT Part 2). Exceptions include legal obligations (such as child abuse, elder abuse, testimony required by a judge, personal danger to self or an identifiable victim), information provided to parents if the client is a minor, and consultation with professional peers in regard to your case, without revealing your identity. Release of information to another professional may be done only with your written consent.

Client Privacy: Laws have been enacted for client privacy. It is important to know that email and mobile phone conversations are not always secure because they can be potentially intercepted. Therefore, by signing this document you understand that if we have correspondence by e-mail or mobile phone, there is a potential for confidentiality to be compromised.

By signing below, I acknowledge receiving a copy of this Notice of Privacy and Practices describing my right to privacy of my protected health information (PHI) under the Federal HIPAA Privacy Law, as follows:

  • How my PHI may be used and disclosed
  • My privacy rights regarding my PHI
  • The medical practice’s obligations concerning the use and disclosure of my PHI
  • My rights and responsibilities
Signature
Patient Name/Guardian (Please print)

Signature 5

Client Signature
(Parent or Guardian if patient is under 18 years of age)


 Date:
Michael Soderstrom, MA, LPC-Supervisor
Licensed Professional Counselor-Supervisor
9432 Katy Freeway, Suite 400
Houston, Texas 77055
Phone: 281.780.8318
patientassistant@houstonocdcounseling.com
www.houstonocdcounseling.com

Welcome to Houston OCD Counseling! Please take a minute to read these instructions for completing the following tests.

First, you will complete the Y-BOCS Symptom Checklist.

Second, you will complete the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) (10 Questions).

Third, you will complete the DASS (42 Questions).

Fourth, you will complete the Obsessive Beliefs Questionnaire - Extended (OBQ-EXT) (111 Questions).

Fifth, you will read and complete the List of Cognitive Errors and circle the rating for each that you find yourself making consistently with your obsessions and compulsions.

Finally, you will read the Bringing Clarity to Mental Rituals article and circle the mental rituals you find yourself doing consistently.

Thank you for taking the time to complete these tests. It is extremely important for your treatment outcome that you take the necessary time and effort to answer each question as honestly and truthfully as you can. If you give me accurate answers then I can give you the very best treatment plan based on what I learn about your OCD, anxiety, and depression through the tests. I look forward to scoring your tests and then returning to you our thorough informative Psychological Evaluation & Behavioral Report with my analysis of your condition and my treatment plan. Talk to you soon!
Michael Soderstrom, MA, LPC-Supervisor
Licensed Professional Counselor-Supervisor
www.houstonocdcounseling.com

Yale-Brown Obsessive Compulsive Scale Symptom Checklist

PATIENT FIRST NAME:
PATIENT LAST NAME:
Date:

Instructions: Generate a Target Symptoms List by asking the patient about specific obsessions and compulsions. Check all that apply. Distinguish between current and past symptoms. Mark principal symptoms with a "P". These will form the basis of the Target Symptoms List. Items marked " * " may or may not be an OCD phenomenon. 

Current Past Principal AGGRESSIVE OBSESSIONS
Fear might harm self
Fear might harm others
Violent or horrific images
Fear of blurting out obscenities or insults
Fear of doing something else embarrassing*
Fear will act on unwanted impulses (e.g., to stab a friend)
Fear will steal things
Fear will harm others because not careful enough (e.g., hit/run motor vehicle accident)
Fear will be responsible for something else terrible happening (e.g., fire, burglary)
Other
Current Past Principal CONTAMINATION OBSESSIONS
Concerns or disgust with bodily waste or secretions (e.g., urine, feces, saliva)
Concern with dirt or germs
Excessive concern with environmental contaminants (e.g., asbestos, radiation toxic waste)
Excessive concern with household items (e.g., cleansers, solvents)
Excessive concern with animals (e.g., insects)
Bothered by sticky substances or residues
Concerned will get ill because of contaminant
Concerned will get others ill by spreading contaminant (Aggressive)
No concern with consequences of contamination other than how it might feel
Other
Current Past Principal SEXUAL OBSESSIONS
Forbidden or perverse sexual thoughts, images or impulses
Content involves children or incest
Content involves homosexuality*
Sexual behavior towards others (Aggressive)*
Other
Current Past Principal HOARDING/SAVING OBSESSIONS
Distinguish between hobbies and concern with objects of sentimental value
Current Past Principal RELIGIOUS OBSESSIONS (Scrupulosity)
Concerned with sacrilege and blasphemy
Excess concern with right/wrong, morality
Other
Current Past Principal OBSESSION WITH NEED FOR SYMETRY OR EXACTNESS
Accompanied by magical thinking (e.g., concerned that another will have an accident unless things are in the right place)
Not accompanied by magical thinking
Current Past Principal MISCELLANEOUS OBSESSIONS
Need to know or remember
Fear of saying certain things
Fear of not saying just the right thing
Fear of losing things
Intrusive (nonviolent) images
Intrusive nonsense sounds, words, or music
Bothered by certain sounds/music*
Lucky/unlucky numbers
Colors with special significance
Superstitious fears
Other
Current Past Principal SOMATIC OBSESSIONS
Concern with illness or disease*
Excessive concern with body part or aspect of appearance (e.g., dysmorphobia)*
Other
Current Past Principal CLEANING/WASHING COMPULSIONS
Excessive or ritualized handwashing
Excessive or ritualized showering, bathing, tooth brushing, grooming, or toilet routine.
Involves cleaning of household items or other inanimate objects.
Other measures to prevent or remove contact with contaminants.
Other
Current Past Principal CHECKING COMPULSIONS
Checking locks, stove, appliances, etc.
Checking that did not/will not harm others
Checking that did not/will not harm self
Checking that nothing terrible did/will happen
Checking that did not make mistake
Checking tied to somatic obsessions
Other
Current Past Principal REPEATING RITUALS
Rereading or rewriting
Need to repeat routine activities (e.g., in/out door, up/down from chair)
Other
Current Past Principal COUNTING COMPULSIONS
Current Past Principal ORDERING/ARRANGING COMPULSIONS
Current Past Principal HOARDING/COLLECTING COMPULSIONS
Distinguish between hobbies and concern with objects of monetary or sentimental value (e.g. carefully reads junk mail, picks up old newspapers, sorts through garbage, collects useless objects)
Current Past Principal MISCELLANEOUS COMPULSIONS
Mental rituals (other than checking/counting)
Excessive list making
Need to tell, ask, confess
Need to touch, tap, or rub*
Rituals involving blinking or staring*
Measures (not checking) to prevent harm to self, harm to others, terrible consequences
Ritualized eating behaviors*
Superstitious behaviors
Trichotillomania*
Other self-damaging or self-mutilating behaviors*
Other
Next

YALE-BROWN OBSESSIVE COMPULSIVE SCALE (Y-BOCS)

PATIENT FIRST NAME:
PATIENT LAST NAME:
Date:
Questions 1 to 5 are about your obsessive thoughts

Obsessions are unwanted ideas, images, or impulses that intrude on thinking against your wishes and efforts to resist them. They usually involve themes of harm, risk, and danger. Common obsessions are excessive fears of contamination: recurring doubts about danger, extreme concern with order, symmetry, or exactness; fear of losing important things.

Please answer each question by circling the appropriate number.

1. TIME OCCUPIED BY OBSESSIVE THOUGHTS
How much of your time is occupied by obsessive thoughts?
2. INTERFERENCE DUE TO OBSESSIVE THOUGHTS
How much do your obsessive thoughts interfere with your work, school, social, or other important role functioning? Is there anything that you don’t do because of them?
3. DISTRESS ASSOCIATED WITH OBSESSIVE THOUGHTS
How much distress do your obsessive thoughts cause you?
4. RESISTANCE AGAINST OBSESSIONS
How much of an effort do you make to resist obsessive thoughts? How often do you try to disregard or turn your attention away from these thoughts as they enter your mind?
5. DEGREE OF CONTROL OVER OBSESSIVE THOUGHTS
How much control do you have over your obsessive thoughts? How successful are you in stopping or diverting your obsessive thinking? Can you dismiss them?
The next several questions are about your compulsive behaviors.

Compulsions are urges that people have to do something to lessen feelings of anxiety or discomfort. Often, they do repetitive, purposeful, intentional behaviors called rituals. The behavior itself may seem appropriate but it becomes a ritual when done to excess. Washing, checking, repeating, straightening, hoarding, and many other behaviors can be rituals. Some rituals are mental. For example, thinking or saying things over and over under your breath.

6. TIME SPENT PERFORMING COMPULSIVE BEHAVIORS
How much time do you spend performing compulsive behaviors? How much longer than most people does it take to complete routine activities because of your rituals? How frequently do you do rituals?
7. INTEREFERENCE DUE TO COMPULSIVE BEHAVIORS
How much do your compulsive behaviors interfere with your work, school, social or other important role functioning? Is there anything that you don’t do because of the compulsions?
8. DISTRESS ASSOCIATED WITH COMPULSIVE BEHAVIOR
How would you feel if prevented from performing your compulsion(s)? How anxious would you become?
9. RESISTANCE AGAINST COMPULSIONS
How much of an effort do you make to resist the compulsions?
10. DEGREE OF CONTROL OVER COMPULSIVE BEHAVIOR
How strong is the drive to perform the compulsive behavior? How much control do you have over the compulsions?

DASS

PATIENT FIRST NAME:
PATIENT LAST NAME:
Date:

Please read each statement and circle a number 0, 1, 2, or 3 that indicates how much the statement applied to you over the last week. There are no right or wrong answers. Do not spend too much time on any statement.

The rating scale is as follows:

  • 0 Did not apply to me at all
  • 1Applied to me to some degree, or some of the time
  • 2Applied to me to a considerable degree, or a good part of the time
  • 3Applied to me very much, or most of the time
1. I found myself getting upset by quite trivial things
 2. I was aware of dryness of my mouth
 3. I couldn’t seem to experience any positive feeling at all
 4. I experienced breathing difficulty (e.g., excessively rapid breathing, breathlessness in the absence of physical exertion)
 5. I just couldn’t seem to just get going
 6. I tended to over-react to situations
 7. I had a feeling of shakiness (e.g. legs going to give way)
8. I found it difficult to relax
 9. I found myself in situations that made me so anxious I was most relieved when they ended
 10. I felt that I had nothing to look forward to
 11. I found myself getting upset rather easily
 12. I felt that I was using a lot of nervous energy
 13. I felt sad and depressed
 14. I found myself getting impatient when I was delayed in any way (e.g., elevators, traffic lights, being kept waiting)
 15. I had a feeling of faintness
 16. I felt that I had lost interest in just about everything
 17. I felt I wasn’t worth much as a person
 18. I felt that I was rather touchy
 19. I perspired noticeably (e.g., hands sweaty) in the absence of high temperatures or physical exertion
 20. I felt scared without any good reason
 21. I felt that life wasn’t worthwhile
 22. I found it hard to wind down
 23. I had difficulty in swallowing
 24. I couldn’t seem to get any enjoyment out of the things I did
 25. I was aware of the action of my heart in the absence of physical exertion (e.g., sense of heart increase, heart missing a beat)
 26. I felt down-hearted and blue
 27. I found that I was very irritable
 28. I felt that I was close to panic
 29. I found it hard to calm down after something upset me
 30. I feared that I would be “thrown” by some trivial but unfamiliar task
 31. I was unable to become enthusiastic about anything
 32. I found it difficult to tolerate interruptions to what I was doing
 33. I was in a state of nervous tension
 34. I felt I was pretty worthless
 35. I was intolerant of anything that kept me from getting on with what I was doing
 36. I felt terrified
 37. I could see nothing in the future to be hopeful about
 38. I felt that life was meaningless
 39. I found myself getting agitated
 40. I was worried about situations in which I might panic and make a fool of myself
 41. I experienced trembling (e.g., in the hands)
 42. I found it difficult to work up the initiative to do things
Previous Next

OBSESSIVE BELIEFS QUESTIONNAIRE – EXTENDED (OBQ-EXT)

PATIENT FIRST NAME:
PATIENT LAST NAME:
Date:

This inventory lists different attitudes or beliefs that people sometimes hold. Read each statement carefully and decide how much you agree or disagree with it. For each of the statements, choose the number on the rating scale matching the answer that best describes how you think. Because people are different, there are no right or wrong answers. To decide whether a given statement is typical of your way of looking at things, simply keep in mind what you are like most of the time.

Use the following scale:

  • 1disagree very much
  • 2disagree moderately
  • 3disagree a little
  • 4neither agree or disagree
  • 5agree a little
  • 6agree moderately
  • 7agree very much

As you use the scale, try to avoid the middle point (4), but rather indicate whether you usually disagree or agree with the statements about your own beliefs and attitudes.

1. Having bad thoughts or urges means I’m likely to act on them.
 2. Having control over my thoughts is a sign of good character.
 3. If I am uncertain, there is something wrong with me.
 4. If I imagine something bad happening, then I am responsible for making sure that it doesn’t happen.
 5. If I don’t control my unwanted thoughts, something bad is bound to happen.
 6. I often think things around me are unsafe.
 7. When I hear about a tragedy, I can’t stop wondering if I am responsible in some way.
 8. Whenever I lose control of my thoughts, I must struggle to regain control.
 9. I am much more likely to be punished than are others.
 10. If I’m not absolutely sure of something, I am bound to make a mistake.
 11. There is only one right way to do things.
 12. I would be a better person if I gained more control over my thoughts.
 13. Things should be perfect according to my own standards.
 14. The more distressing my thoughts are, the greater the risk that they will come true.
 15. I can have no peace of mind as long as I have intrusive thoughts.
 16. Things that are minor annoyances for most people seem like disasters for me.
 17. I must know what is going on in my mind at all times so I can control my thoughts.
 18. The more I think of something horrible, the greater the risk it will come true.
 19. In order to be a worthwhile person, I must be perfect at everything I do.
 20. When I see any opportunity to do so, I must act to prevent bad things from happening.
 21. It is ultimately my responsibility to ensure that everything is in order.
 22. If I fail at something, I am a failure as a person.
 23. Even if harm is very unlikely, I should try to prevent it at any cost.
 24. For me, having bad urges is as bad as actually carrying them out.
 25. I must think through the consequences of even my smallest actions.
 26. If an unexpected change occurs in my daily life, something bad will happen.
 27. If I don’t react when I foresee danger, then I am to blame for any consequences.
 28. If I can’t do something perfectly, I shouldn’t do it at all.
 29. I must be ready to regain control of my thinking whenever an intrusive thought or image occurs.
 30. Bad things are more likely to happen to me than to other people.
 31. I must work to my full potential at all times.
 32. It is essential for me to consider all possible outcomes of a situation.
 33. Even minor mistakes mean a job is not complete.
 34. If I have aggressive thoughts or impulses about my loved ones, this means I may want to secretly hurt them.
 35. I must be certain of my decisions.
 36. If someone does a task better than I do, that means I failed the whole task.
 37. If I have an intrusive thought while I’m doing something, what I am doing will be ruined.
 38. In all kinds of daily situations, failing to prevent harm is just as bad as deliberately causing harm.
 39. Avoiding serious problems (for example, illness or accidents) requires constant effort on my part.
 40. Small problems seem to always turn into big ones in my life.
 41. For me, not preventing harm is as bad as causing harm.
 42. I should be upset if I make a mistake.
 43. I should make sure others are protected from any negative consequences of my decisions or actions.
 44. If I exercise enough willpower, I should be able to gain complete control over my mind.
 45. For me, things are not right if they are not perfect.
 46. Having nasty thoughts means I am a terrible person.
 47. I often believe I am responsible for things that other people don’t think are my fault.
 48. If an intrusive thought pops into my mind, it must be important.
 49. Thinking about a good thing happening can prevent it from happening.
 50. If I do not take extra precautions, I am more likely than others to have or cause a serious disaster.
 51. If I don’t do as well as other people, that means I am an inferior person.
 52. I believe that the world is a dangerous place.
 53. In order to feel safe, I have to be as prepared as possible for anything that could go wrong.
 54. To avoid disasters, I need to control all the thoughts or images that pop into my mind.
 55. I should not have bizarre or disgusting thoughts.
 56. For me, making a mistake is as bad as failing completely.
 57. It is essential for everything to be clear-cut, even in minor matters.
 58. Having a blasphemous thought is as sinful as committing sacrilegious act.
 59. I should be able to rid my mind of unwanted thoughts.
 60. I should be 100 percent certain that everything around me is safe.
 61. I am more likely than other people to accidentally cause harm to myself or others.
 62. For me, even slight carelessness is inexcusable when it might affect other people.
 63. If something unexpected happens, I will not be able to cope with it.
 64. Having bad thoughts means I am weird or abnormal.
 65. I must be the best at things that are important to me.
 66. Having an unwanted sexual thought or image means I really want to do it.
 67. If my actions could have even a small affect on a potential misfortune, I am responsible for the outcome.
 68. Even when I am careful, I often think that bad things will happen.
 69. Having intrusive thoughts means I am out of control.
 70. It is terrible to be surprised.
 71. Even if I think harm is very unlikely, I should still try to prevent it.
 72. Harmful events will happen unless I am very careful.
 73. I should go to great lengths to get all the relevant information before I make a decision.
 74. I must keep working at something until it’s done exactly right.
 75. Being unable to control unwanted thoughts will make me physically ill.
 76. Having violent thoughts means I will lose control and become violent.
 77. To me, failing to prevent a disaster is as bad as causing it.
 78. If I don’t do a job perfectly, people will not respect me.
 79. Even ordinary experiences in my life are full of risk.
 80. When things go well for me, something bad will follow.
 81. If I take sufficient care, I can prevent any harmful accident from occurring.
 82. When anything goes wrong in my life, it is likely to have terrible effects.
 83. Having a bad thought is morally no different than doing a bad deed.
 84. No matter what I do, it won’t be good enough.
 85. I often think that I will be overwhelmed by unforeseen events.
 86. If I don’t control my thoughts, I will be punished.
 87. I need the people around me to behave in a predictable way.

OBQ ADDENDUM

Fear of Positive Experiences

1. For me, good things are always followed by bad ones.
 2. If I start to feel good, something will ruin it.
 3. I don’t deserve to feel good.
 4. I should avoid pleasure because it might trigger bad thoughts.
 5. If I start to make progress, I won’t be able to maintain my gains.
 6. Good feelings are always replaced by bad ones.
 7. I’ll be punished for having a good time.
 8. If I become too confident, I will fail.
 9. If someone trusts me, eventually I’ll let them down.
 10. When someone has confidence in me, eventually they’ll be disappointed.
 11. If I am too successful, surely, I’ll fail.
 12. If I do well in treatment, eventually I’ll relapse.
 13. If I get better, I won’t be able to handle all the expectations placed on me.
 14. I’d rather keep things the way they are than try something new.

Consequences of Anxiety

15. It’s important to me to control anxiety.
 16. I’m often afraid that I’ll be overwhelmed by anxiety.
 17. If I get highly anxious, I could lose control of myself.
 18. If the worse happens, I won’t be able to cope with it.
 19. I can’t tolerate feeling nervous or tense.
 20. Anxiety will never go away.
 21. Too much tension could lead me to explode.
 22. Whenever I feel anxious, it must mean that danger is lurking about.
 23. If I get anxious, I won’t be able to manage it.
 24. When I cannot keep my mind on a task, I worry that I might be going crazy.
 25. I like to be in control of my emotions.
 26. When I feel nervous, I’m afraid I might be mentally ill.
 27. High anxiety is harmful.
 28. I am not confident that I can control my anxiety.
 29. Once I get nervous, I think my anxiety might get out of hand.
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LIST OF COGNITIVE ERRORS

PATIENT FIRST NAME:
PATIENT LAST NAME:
Date:

RATING SCALE:

  • 0Not at all
  • 1Seldom
  • 2Occasionally
  • 3Sometimes
  • 4Often
  • 5Always
1. Polarized, or all-or-nothing thinking (also called black and white or dichotomous thinking): You see things in only two categories and there is no middle ground (e.g., matters are either good or bad, safe or toxic, clean or contaminated).
 2. Labeling: Labeling is a version of all-or-nothing thinking. Instead of saying, “This didn’t go well. I misunderstood.”, you attach a global negative label to yourself: “I’m a failure.”
 3. Overgeneralization: You interpret one isolated current situation as a sequence of bad events by using words like “always” or “never” when you describe it or think about it.
 4. Mental filter (also called filtering or selective abstraction): You focus on an isolated negative detail and selectively attend to it so that ultimately your interpretation of everything that’s happening becomes distorted.
 5. Discounting the positive: You disqualify positive events and assume that they don’t matter. If you accomplish something you could be proud of, you tell yourself that it wasn’t that important, or that anyone could have done it.
 6. Mind reading: You automatically assume that others are reacting negatively to you without having evidence of it.
 7. Fortune-telling (also called catastrophizing): You automatically assume that things will turn out terribly before they even start and without having any evidence for this prediction.
 8. Magnification: You blow out of proportion your shortcomings and problems (usually this goes along with minimizing or discounting all your positive qualities).
 9. Emotional reasoning: You assume that your feelings reflect the way things really are, “I feel guilty, so I must have done something wrong.” “I feel anxious, therefore the situation must be dangerous.”
 10. “Should” and “Must” statements (also called imperatives): You expect that things should be the way you want them to be. If they are not, you feel guilty. “I shouldn’t have made so many mistakes.”
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Bringing Clarity to Mental Rituals

PATIENT FIRST NAME:
PATIENT LAST NAME:
Date:

The basic rules of behavioral therapy teach us that we cannot control our thoughts and feelings, that we CAN control our behavior, and that our thoughts and feelings change when our behavior changes. For physical behavior, such as washing one’s hands it can easily be understood that an ocd sufferer is physically capable of resisting washing. The compulsion to wash comes from a desire to avoid extreme mental and emotional discomfort that the ocd sufferer associates with not washing. However, not all “behavior” is physical behavior. While we are not capable of controlling what thoughts exist, we ARE influential in determining HOW we choose to respond to those thoughts mentally. These responses or behaviors may take several different forms, but in the case of ocd, they are no less compulsive than furiously scrubbing at the sink.

Here is a brief glossary of mental compulsions (a.k.a. mental rituals) common to Obsessive Compulsive Disorder. Note that each of them apply not only to thoughts, but to feelings, physical sensations, urges, impulses, and any other internal data that one may experience.

  • 0Not at all
  • 1Seldom
  • 2Occasionally
  • 3Sometimes
  • 4Often
  • 5Always
MENTAL REVIEW (a.k.a. retracing, replaying, rewinding, ruminating)
Mental review is occurring when a person is examining a past experience repeatedly for the purpose of letting it go. This is sometimes referred to as “rewinding the tape” because it is the mental equivalent of studying a scene over and over. Since the sufferer believes that reviewing the event (interaction, conversation, statement, etc.) will result in resolving it and subsequently reducing uncomfortable thoughts and feelings, it is a compulsion. It also comes in the following forms: 		MENTAL CHECKING

One form of mental checking is occurring when the sufferer is digging up a thought for the purpose of engaging in mental review, also known as ruminating. This also occurs when a sufferer becomes aware of an obsession being absent. They then mentally “check” to see if the thought still bothers them and compulsively test it to see if it is truly resolved. This is essentially bringing on an obsession to prove it has gone away. Mental checking can also be applied to feelings and bodily sensations, such as in checking one’s groinal response to a sexual obsession. This includes mentally investigating the potential source of a thought or feeling to determine why it occurred. 		SCENARIO TWISTING (hypothesizing, theorizing)
This mental ritual combines review and checking by first replaying an event that did take place, and then adding a hypothetical element of the event that could have but did not take place. Someone engaging in this compulsion would then proceed to analyze how they would have behaved if the feared scenario did take place. The ritual is aimed at determining how appropriately one would respond in a feared hypothetical scenario in the hope that they will have certainty of their moral constitution. 		REVERSE RUMINATING
While mental review often involves replaying the past, “reverse ruminating” involves playing back invented ideas of the future in an attempt to check for likelihood of catastrophe. Unlike scenario twisting, which starts with a real event, reverse ruminating takes place entirely in the future, at an upcoming performance, encounter, interview or some other future event that could go terribly wrong. It is often confused with simply preparing, but it is better described as compulsively going over and over something that has yet to happen in an attempt to relieve discomfort about what could happen. 		THOUGHT NEUTRALIZATION
This is a mental behavior centered around silently saying words or attending to thoughts that are the opposite of the unwanted ocd thoughts. The belief is that a “good” thought will neutralize a “bad” one and pre-empt unwanted consequences. 		SELF-REASSURANCE
Many ocd sufferers ask people close to them to help them attain a sense of certainty about an obsession. They may also do this through compulsive research on the internet or elsewhere. Self-reassurance comes in the form of mentally repeating reassuring statements to gain a sense of certainty that the unwanted consequences of a thought will not occur. Often times this is a ritualized version of positive affirmations. 		COMPULSIVE FLOODING
As a behavioral technique, flooding can be an effective form of short-term exposure with response prevention for an unwanted thought. It would typically take the shape of agreeing with and exaggerating the thought until critical thinking skills and mindfulness can return. Sometimes sufferers who engage in a lot of obsessional thinking will use this technique as a form of testing their reactions to situations and force themselves to flood unwanted thoughts in specific circumstances. Because it is painful, it demonstrates that the thoughts are ego dystonic and this functions as a form of self-reassurance (this is very prevalent in sexual and harm obsessions). 		SELF PUNISHMENT
For ocd sufferers who experience a lot of guilt feelings, mental self-abuse and self-punishment is often utilized. This is also very common in depression. The sufferer believes they have done something wrong or committed some sort of unforgivable error. To accept that sometimes they do the wrong thing and to move on would mean tolerating the discomfort of feeling like they were getting away with a crime. To account for this, they may intentionally force feelings of guilt and negative self-thoughts as a form of sentencing for their crime. Once they have been adequately punished, they are more likely to feel able to move on. While this is obviously uncomfortable, it is nonetheless compulsive because it functions by avoiding the discomfort of feeling like they have escaped justice. 		MEMORY HOARDING
As in physical hoarding, the ocd sufferer engaging in this compulsion is going out of their way to save small bits of information for potential recall. This often occurs at the sacrifice of staying in the moment or enjoying anything for fear of missing out on carefully storing an event in memory. Examples of this may involve compulsively memorizing interactions with people or actively attending to memorization of the details of a room or a book. 		COMPULSIVE PRAYER
For scrupulosity sufferers, prayer is often used to counteract the intrusion of anti-religious or otherwise unacceptable thoughts. Prayer becomes ritual when it is used repeatedly to neutralize thoughts or evade them, rather than as an attempt to more genuinely connect with one’s religious faith. 		COUNTING
The mental behavior of counting in a mathematical pattern or of counting steps, objects, lines, etc., can come in two forms. It can be its own compulsion, in which the ocd sufferer feels the need to count to keep something bad from happening, or it can be used as a form of compulsive avoidance by counting instead of allowing other unwanted thoughts to stay present.

It was long believed that people who were not doing noticeable physical compulsions were “purely obsessive” (sometimes called “Pure O”), but is now understood that mental compulsions play a key role in all forms of Obsessive Compulsive Disorder. Treatment for reducing mental compulsions involves the same approach widely understood to be effective for OCD in general, which is cognitive behavioral therapy (CBT). In addition to traditional CBT however, a heavy emphasis on Mindfulness may be a useful tool for combatting mental compulsions.

Developing Mindfulness skills can aid in the ability to observe urges to do mental rituals before they start, to identify them without judgement when they are happening, and to develop a capacity to process what was going on after they may occur. From this standpoint, a sufferer can work on removing themselves from the compulsion and bring themselves back to the present to focus on accepting and tolerating the ocd-fueled discomfort.

The list above is by no means an exhaustive one and our understanding of mental rituals continues to evolve. But with the help of an ocd specialist in mindfulness-based cognitive behavioral therapy, no ocd sufferer should have to consider themselves untreatable or alone for doing compulsions inside instead of out.

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