Center for the Treatment and Study of Anxiety

04/03/2026

Myth: “Pure O” OCD means there are no compulsions—only obsessions.

Reality: Clients with “Pure O” OCD do engage in compulsions. These compulsions are often internal, mental, or subtle, which makes them easier to miss in assessment and harder for clients to identify as compulsive behavior.

When we conceptualize “Pure O” as obsession-only, we risk:

- Under-identifying compulsions
- Mislabeling rumination as insight or processing
- Missing key ERP targets
- Reinforcing reassurance-seeking within therapy

Common Mental Compulsions in “Pure O” OCD
These behaviors are performed to neutralize distress, reduce uncertainty, or regain a sense of certainty or safety:
1. Mental Rumination (Replaying intrusive thoughts or scenarios, Analyzing “what it means” about the self, Trying to solve or disprove the obsession, Asking internally: “Why did I think that?” “What if this means…”)

2. Mental Checking (Monitoring thoughts, feelings, or bodily sensations,
Checking for certainty “Do I feel anxious enough?” “Do I feel aroused?”, Scanning memory for evidence that disproves feared conclusions)

3. Reassurance-Seeking (Silently reassuring oneself, Repeatedly asking clinicians, loved ones, or the internet for validation, Interpreting therapist reactions as confirmation or disconfirmation)

4. Thought Neutralization (Mentally replacing a “bad” thought with a “good” one,
Praying, counting, or repeating phrases to cancel out thoughts, Using mantras to create certainty rather than tolerance)

5. Mental Review (Reviewing past events to ensure no harm, wrongdoing, or moral failure occurred, Replay conversations or interactions to confirm intent or accuracy)

Clinical Takeaway
Mental compulsions function no differently than observable rituals:
they maintain the obsession–compulsion cycle by teaching the client that relief comes from control, certainty, or neutralization.

Effective treatment requires:

- Explicit identification of mental rituals
- Clear distinction between rumination vs. treatment-relevant processing
- ERP that targets internal responses—not thought content
- Modeling uncertainty tolerance rather than reassurance

“Pure O” is not thought-only OCD—it’s OCD where the compulsions are easier to hide.

03/31/2026

Remembering Dr. Foa through her obituary in the Philadelphia Inquirer—an extraordinary individual whose contributions left an indelible mark on so many lives. Our thoughts continue to be with her family, friends, and all who were influenced by her work.

“Her work truly changed the field,” colleagues said. She “spent her career doing what she believed mattered most: studying what actually helps people get better."

03/30/2026

Fear is powerful—but it’s also treatable.

Specific phobias can quietly limit clients’ lives, reinforcing avoidance and distress.

Exposure therapy changes that—and it’s the gold standard for lasting improvement.

Learn more in our workshop: https://linktr.ee/ctsaatpenn

Join us for Overcoming Fear: Exposure Therapy for Specific Phobias, a beginner‑friendly, full‑day workshop designed to help clinicians confidently apply exposure‑based techniques in practice.

✅ Learn core principles of exposure therapy
✅ Build effective, step‑by‑step exposure hierarchies
✅ Troubleshoot common barriers to treatment success
✅ Earn 6 CE credits

📅 Monday, April 20, 2026
⏰ 9:30 AM–5:00 PM EST
💻 Live on Zoom

🎓 Presented by Dr. Sandy Capaldi, licensed clinical psychologist and nationally recognized expert in exposure‑based treatments.

👉 Register now and start helping clients face fear with confidence.

03/27/2026

In Tribute to Edna B. Foa, PhD

The Center for the Treatment and Study of Anxiety (CTSA) mourns the passing of our founder, mentor, and guiding force, Edna B. Foa, Ph.D.

Edna was far more than an internationally renowned scientist and clinician: she was the heart of CTSA. Through her brilliance, determination, and unwavering belief in the power of evidence-based care, she transformed the understanding and treatment of anxiety-related disorders and changed the lives of countless individuals and families around the world.

As a pioneer of exposure-based therapies, Edna was fearless in challenging convention, tireless in her pursuit of scientific rigor, and deeply compassionate toward those who suffered. She held us to the highest standards while inspiring curiosity, humility, and courage. For many of us, she was not only a teacher and supervisor, but a lifelong mentor whose influence shaped our careers, our clinical practice, and our values.

Edna built CTSA as a place where science and humanity coexist: where patients are treated with dignity, clinicians are trained with care, and research is conducted with integrity and purpose. That mission endures because of her.

We will honor Edna’s legacy by continuing the work she devoted her life to: advancing science, training future generations, and helping people reclaim their lives from fear.

She will be deeply missed and forever remembered.

03/23/2026

Most clinicians think they’re doing exposure therapy for specific phobias…
but research shows that the biggest predictor of sub‑optimal outcomes is therapist under‑exposure — meaning exposures aren’t long enough, intense enough, or frequent enough to produce real inhibitory learning.

Here’s the surprising part 👇
Clients aren’t the ones avoiding the hard exposures… we are.

Not intentionally, of course — but because:
• we worry about “pushing too hard,”
• we fear triggering too much distress,
• or we're unsure how to structure exposures that actually stick.

Yet decades of evidence tell us:

The most powerful exposures look uncomfortable — because they’re meant to.
When they’re done correctly, they’re also incredibly safe and life‑changing.

Effective exposure for specific phobias is built on:
🔹 expectancy violation, not habituation
🔹 dismantling safety behaviors, not working around them
🔹 strategic, creative stimuli selection, not generic hierarchies
🔹 longer exposures than you’d think—often 30–45 min
🔹 emotional learning over symptom reduction

What most therapists miss?
👉 The difference between exposure and “helpful‑seeming avoidance.”

It’s subtle. And it’s everything.

🎯 If you’ve ever wondered…
• How do I design exposures that actually create inhibitory learning?
• What do I do when a client freezes or refuses?
• How do I adapt exposures for telehealth?
• How do I track progress beyond SUDS?
• How do I stop accidentally reinforcing avoidance?
…then this workshop was built for you.

🏆 JOIN US FOR A PRACTICAL, SKILL‑HEAVY WORKSHOP

Overcoming Fear: Exposure Therapy for Specific Phobias

You’ll learn:
✨ step‑by‑step exposure design
✨ how to run sessions that reduce phobic responding fast
✨ common therapist mistakes — and exactly how to fix them
✨ live demonstrations + real exposure planning templates

Your future clients will thank you.

Your clinical confidence will, too.

To register 👉 https://linktr.ee/ctsaatpenn

03/20/2026

Many people with OCD experience involuntary arousal sensations in response to intrusive thoughts or even simple, unrelated actions. These sensations can feel especially frightening when they show up alongside taboo or unwanted intrusive thoughts. OCD often turns these automatic body reactions into a spiral of fear and self‑doubt, even though they’re usually driven by anxiety, adrenaline, hypervigilance, or a completely normal physiological response — not attraction.

Arousal‑like sensations can happen for many non‑sexual reasons:
• anxiety or panic creating random body sensations
• heightened focus on the body, making normal sensations feel amplified
• fear‑based physiological reactions
• automatic muscle or nerve activity in the pelvic area

These are normal bodily responses that OCD mislabels as evidence of something they’re not.

Sexual‑theme OCD often creates questions like:
“Does this mean I wanted it?”
“What does this say about me?”

But an arousal sensation does NOT equal desire, intent, or attraction. It’s often just a fear‑response sensation that OCD misinterprets.

Recovery comes from changing how you interpret the sensation — not trying to make it disappear. Helpful tools include ERP therapy, reducing reassurance‑seeking, allowing sensations to come and go without analyzing them, and understanding that arousal sensations are automatic, meaningless physical reactions.

Clinicians, are you looking for the tools to help your clients with OCD arousal sensations? Join one of our ERP trainings: https://linktr.ee/ctsaatpenn.

03/18/2026

💡Relationship OCD (ROCD)

Most people assume Relationship OCD is just “being unsure” about your partner… but here’s the truth:

ROCD isn’t about the relationship — it’s about the intrusive fear of uncertainty itself.

Even in healthy relationships, people with ROCD experience distressing, unwanted thoughts like:

* “What if they’re not *the one*?”
* “What if I don’t love them enough?”
* “What if I’m making a mistake?”

And instead of those thoughts drifting away, ROCD turns them into obsessions — leading to compulsions like constant reassurance‑seeking, checking your feelings, or mentally replaying moments to “prove” the relationship is right.

💬 What You Need to Know

ROCD isn’t a reflection of your partner’s worth or the quality of the relationship.
It’s a pattern of intrusive doubt + compulsive checking — the same OCD cycle, just in a different area of life.

The truth?
Healthy relationships still have questions.
ROCD makes those questions feel like emergencies.

🌱 The Good News

With ERP and support, people learn to:
✨ tolerate uncertainty
✨ stop checking and reassurance loops
✨ trust themselves and their relationships again

Register for CTSA's ROCD workshop to learn more: https://linktr.ee/ctsaatpenn

03/16/2026

Supporting a child with OCD can feel confusing—what helps in the moment doesn’t always help in the long run. ❤️

Today we’re breaking down the common pitfalls caregivers fall into and how small shifts can make a big difference.

Healing happens when families learn to support brave steps forward, not OCD’s demands. 💪✨

can learn more at our training workshops: https://linktr.ee/ctsaatpenn

03/13/2026

CTSA Clinician Fact of the Day: A Little‑Known Insight About Specific Phobias

Did you know?

Although many people assume specific phobias fade over time, they often persist for years—and even decades—in a substantial subset of patients, particularly when untreated. Research shows that phobias can last for decades in 10–30% of individuals, and are linked with elevated risk for other anxiety, mood, and substance‑use disorders.

And here’s another surprising detail:
Many individuals experience multiple phobias simultaneously—an estimated 75% of people with a specific phobia fear more than one object or situation.

Clinician takeaway:
Even when a phobia seems “narrow,” remember that comorbidity and chronicity are the rule, not the exception—early, targeted, evidence‑based intervention (especially exposure therapy) is key to preventing long‑term impairment.

Learn more at our April 20, 2026 - Overcoming Fear: Exposure Therapy for Specific Phobias Workshop: https://www.med.upenn.edu/ctsa/Specific_Phobias.html

03/11/2026

3 Mistakes Clinicians Make When Delivering Exposure Therapy
…and how to avoid them to strengthen outcomes.

Mistake #1: Staying in the Comfort Zone
Clinicians sometimes choose exposures that are too mild, hoping to ease clients in gently.

But exposures that don’t activate anxiety don’t create corrective learning.

What to do instead:
Choose tasks that reliably trigger discomfort (but are still safe). The learning happens in the stretch zone, not the comfort zone.

Mistake #2: Providing Reassurance
It’s easy to unintentionally comfort the client during exposures—validating, explaining, micro‑coaching, or “softening” the uncertainty.

But reassurance = safety behavior, and safety behaviors block the brain from learning “I can handle this.”

What to do instead:
Hold back reassurance. Allow the client to sit with uncertainty and discover their own capability.

Mistake #3: Ending Exposure Too Soon
Many clinicians end exposures the moment anxiety decreases—but that can actually reinforce avoidance.

What to do instead:
Continue the exposure long enough for the client to learn that anxiety naturally rises and falls without escape or avoidance.

You’re building tolerance, confidence, and flexibility.

Want more tips like this? Follow for evidence‑based therapy guidance.
—or—
Enroll in one of our Exposure Therapy Training Workshops: https://bit.ly/CTSAtrainings

03/09/2026

📘 Understanding the Role of Avoidance in Anxiety

Learn more in our training workshops: https://linktr.ee/ctsaatpenn

Avoidance feels helpful in the moment—but for clients with anxiety disorders, it’s one of the strongest forces keeping symptoms alive.

When clients avoid feared situations, sensations, or thoughts, their anxiety gets short‑term relief but long‑term reinforcement. The brain never has the chance to learn: “I can handle this.”

Instead, it learns: “That was dangerous—good thing I escaped.”

This creates a powerful cycle:
➡️ Anxiety → ➡️ Avoidance → ➡️ Temporary Relief → ➡️ More Anxiety

For therapists, helping clients understand this cycle is key to motivating meaningful behavior change.

Avoidance maintains anxiety by:
• Reinforcing perceived danger
• Blocking corrective learning
• Increasing anticipatory fear
• Shrinking life activities and flexibility

Therapeutic takeaway:
Exposure, behavioral activation, values-based action, and gradual approach all interrupt the cycle—allowing clients to build confidence, expand their world, and experience true long‑term relief.