One of the most important aspects of treating anxiety and avoidance behaviors—especially in OCD—is identifying the core fear that drives them.

We can’t effectively treat anxiety unless we target the feared stimulus itself. This comes up repeatedly in OCD treatment, where the disorder is often fueled by the imagination. It’s not just the feared event itself that maintains OCD, but the imagined consequences of not engaging in compulsions or safety behaviors.

Identifying the Core Fear

A crucial part of treatment is helping clients uncover what they’re really afraid of. This often involves asking questions like:

• If your fear were to come true, what would happen next?

• If you didn’t engage in the compulsion, what’s the worst thing that could happen?

• What is it that feels so unbearable about the possibilities you’re imagining?

When I start unpacking clients’ fears with them, we often uncover imagined worst-case scenarios that can often be quite remote from the initial feared behavior or situation.

• “If I get sick from germs, my family will have to cancel their vacation plans, and they’ll all be mad at me.”

• “If I have a bad thought about someone, something bad might happen to them, and it will be all my fault.”

• “If I make a wrong decision, I’ll regret it forever, and I won’t be able to ever move on.”

For many clients, their fear is also not just about an external consequences—it’s about a lack of trust in their ability to cope with the emotions or thoughts that could come up for them. Some fear being trapped in endless guilt, sadness, or uncertainty. Others fear regret, making the “wrong” choice, or facing a reality they don’t want to accept.

The Role of Grief in Healing

In truth, in my experience, most disorders, including anxiety and OCD, are often connected to a difficulty with grieving. Clients often don’t believe they can survive loss, uncertainty, or imperfection. They don’t trust that they can cope with painful emotions if things go wrong. So, they try to avoid risks at all costs—believing that a single regret, mistake, or disappointment could ruin everything.

But the price of trying to control the uncontrollable is steep. Life becomes about avoiding discomfort rather than living fully. Instead of learning they can survive pain, clients create a world where feared outcomes grow bigger and more impossible to face. The avoidance itself reinforces the belief they must keep controlling, analyzing, or preventing potential distress.

Healing isn’t just about stepping outside one’s comfort zone or facing fears—it’s also about learning how to experience emotions without feeling completely alone in them.

Grieving as Acceptance, Not Resistance

One of the hardest parts of this process is realizing that grieving is not about giving up or losing. Many people, especially those with OCD, experience grief as an internal fight against reality. It can feel like a temper tantrum, an angry protest against something they can’t control, a feeling of being forced to submit to an outcome they don’t want.

But real grief isn’t about resignation or helplessness—it’s about acceptance. It’s the quiet, powerful process of making space for what is instead of exhausting ourselves fighting for what isn’t.

Grieving means saying, “I don’t like this, but I can allow it to exist. I can feel my sadness, my disappointment, my regret—without needing to erase it or control it.” It’s about softening rather than hardening, about turning toward our emotions instead of treating them like enemies to be annihilated.

When we stop resisting reality, we find that pain becomes something we can move through—not something that traps us forever. And when we allow ourselves to grieve in the presence of someone who holds space for us, it no longer feels like something we have to cope with alone.

Safety in Relationship: A Missing Piece in OCD and Anxiety Treatment

Many clients don’t even know what it means to use another person for comfort, understanding, or co-regulation. They don’t know what it’s like to take in someone else’s care in a way that makes grief and fear feel more manageable—because it is shared, because it is held.

Instead, they remain stuck on the level of,

• “What should I do about this?”

• “What should I think about this?”

They look for certainty and solutions instead of connection and emotional support. But learning to process emotions in relationship—by elaborating, feeling, and explaining one’s inner experience to another—is a fundamental part of healing.

When I work with clients, I focus on:

• Identifying feared outcomes and challenging their avoidant patterns.

• Developing coping thoughts that help them tolerate uncertainty.

• Building relational security so that fear and grief don’t feel like burdens they must face alone.

I ask clients:

• What do you need to feel safe enough to lean into this fear?

• What do you need from me to feel more secure?

• How can we move from analyzing your thoughts to experiencing your feelings?

Anxiety, OCD, and avoidance behaviors thrive in isolation and control—but healing happens when we allow ourselves to feel, to grieve, and to be supported through the discomfort of uncertainty.

What Do You Need When Anxiety or OCD Take Hold?

If this resonates with you, ask yourself:

• Do I believe I can survive discomfort, uncertainty, or grief?

• Do I avoid my feelings by analyzing and intellectualizing?

• Am I open to receiving comfort from others, or do I try to solve everything on my own?

The goal isn’t just to “face fears” in a vacuum—it’s to build a sense of safety in the experience of being together with a caring other. Therapy helps create that space, allowing you to move beyond control and into real, meaningful connection.

If you’re struggling with OCD, anxiety, or avoidance, I’d love to help you navigate this process. Healing isn’t just about thinking differently—it’s about feeling differently in the presence of someone who truly understands.