I work every day with OCD sufferers from around the world. For the most part, these people are on the severe end of the OCD severity index. Unfortunately, too many of them have been there for far too long.

OCD sufferers can get stuck. They go round and round as if on a merry-go-round of obsessions and compulsions. But it isn’t just going around, it’s going around in a slow, downward spiral.

These people are desperate for help. They want to know what they need to do to fix the problem. They ask about medications. They ask about this therapy and that therapy. They ask about supplements. They ask, How did you?, and How do I?

I have found that when OCD sufferers are caught in the downward spiral, they are limited in their ability to grasp the basic concepts of OCD recovery. It’s a sad state to be in. But what if things could be simplified so that it is easier to understand, to comprehend, to wrap one’s head around?

How does one recover? Whole books have been written on the subject. There are hundreds if not thousands of therapists out there who are specifically trained how to teach sufferers how to recover. There’s oodles on websites (including this one) dedicated to OCD recovery. There’s a lot of information out there on recovery and it must seem overwhelming to many sufferers who are spiraling down. Is there a core to recovery? Is there a simple concept to hold onto that can be built upon during recovery?

Yes. OCD recovery requires the sufferer to change. Change. That’s it, in a nutshell. Every single OCD sufferer feels stuck and seems stuck to those on the outside looking in. They’re stuck going round and round, moving from obsession to compulsion and back again. But many sufferers simply can’t see that the going round and round is what is causing them to be stuck.

Change. To recover, OCD sufferers need to change. What do they need to change? Two things: Sufferers must change they way they think about the obsessions and they must change their response to the obsessions (compulsions). All the cognitive work that comprises the big ‘C’ in CBT, all the crucially important slowing down and stopping of compulsions, and all the exposures and response preventions that make up ERP (the core of the big ‘B’ of CBT), are all about changing the way an OCD sufferer thinks and behaves.

This is where it starts. It is not enough for a sufferer to say they are sick and tired of the OCD merry-go-round. The start to recovery must include a commitment, a willingness, to change. From that, recovery can begin.

Change is the key to recovery. Without change, recovery is not possible.

All OCD sufferers are subjected to obsessions (commonly called intrusive thoughts). The thoughts come with an alarm, a sense or urgency, that something bad has happened, is happening, or will happen. Invariably, sufferers choose to believe the thoughts, erring on the side of caution. That is the first mistake. The second mistake is trying to fix the perceived problem by doing one or more compulsions.

OCD is a thinking and behaving disorder. It’s not about the intrusive thoughts. It’s about what is done about the intrusive thoughts that is important. Reacting to the thoughts, primarily by taking them seriously and then doing compulsions, is what gets sufferers stuck. To get unstuck, a commitment to change thinking and behavior, and the drive to actually do that (repeatedly, until it’s done right and then more) is required to move down the road of recovery.