At the Cognitive Behavior Therapy Center of Silicon Valley, we offer cognitive behavior therapy (CBT) for people with “Just Right” OCD involving obsessions with symmetry and perfection and compulsions to arrange or fix things. Our approach to treating Just Right OCD is practical, goal-oriented, compassionate, and scientifically-based while focusing on your individual needs.

What is Just Right OCD?

“Just right” obsessions are thoughts and/or feelings that something is not quite right or that something is incomplete. You may feel very uncomfortable when confronted with situations where objects are misaligned or in disarray or when something does not appear perfect.

“Just right” OCD symptoms involve more of a sense of “incompleteness” rather than the need to “avoid harm” seen in more typical OCD symptoms. “Just right” symptoms are more likely to be experienced as discomfort or tension rather than anxiety. Both “just right” and other kinds of OCD involve an overwhelming sense of doubt that leads to compulsions. People with either “just right” or other kinds of OCD both know that their thoughts are unwarranted, but can not shake the nagging feeling that ‘perhaps they are wrong.’ In both “just right” and other kinds of OCD, doing the compulsion reduces anxiety, making the person more likely to seek relief through their compulsion the next time the feeling happens.

Individuals with obsessions about symmetry and exactness may have magical thinking associated with their concerns. For example, they may worry that their mother will have accident unless things are in the right place. In other cases, the need for symmetry may just “feel right” and not be accompanied by magical thinking (e.g. just makes the person uncomfortable).

Examples of Just Right OCD include:

• Feeling that your hands are not quite clean when washing them and washing your hands until the sense of “incompleteness” goes away.
• Feeling that your comb is not in ‘quite the right place’ on the dresser, and proceeding to pick it up and put it back down – repeating until the feeling of incompleteness is gone.
• Practicing piano and feeling that a certain note is ‘off’, and needing to play it over and over until it sounds right – even though tuning of the note has not changed in any real way.
• After touching a table, feeling a sudden need to touch it again (and again) until a feeling of tension/distress goes away.
• Needing to express yourself ‘precisely’ in written or spoken words (even in your own head) – ‘working through’ wording until it meets your standards of being ‘just right’.

Symptoms of Just Right OCD

Over 50% of those with OCD experience “just right” obsessions or compulsions. Those with “just right” OCD symptoms are likely to have:

• Perfectionism (e.g., concern over mistakes)
• Obsessional slowness (i.e., loss of time due to obsessional ‘loops’)
• Need for control/predictability
• Ordering/arranging/symmetry behaviors/evening-up
• A sense that the mind does not rest (i.e. a mental ‘broken record’)
• Reassurance-seeking (i.e., comparing notes with others, to determine whether their sense of something being ‘off’ is valid)
• Counting rituals, repetitive behaviors and checking behaviors
• Procrastination (i.e. “putting off” tasks), greater difficulty making decisions, trouble delegating tasks and general inflexibility

Cognitive Behavioral Model of Just Right OCD

According to the CBT model, it is normal to experience intrusive thoughts, urges and discomfort from time to time. If you have Just Right OCD, however, you view physical discomfort, tension and anxiety as intolerable. Or you may believe if you don’t fix or adjust something to make it just right that something bad will happen. This may cause you significant distress or anxiety. You may then attempt to soothe yourself with an ordering, fixing, repeating or arranging ritual that temporarily reduces your anxiety. Because anxiety is relieved in the short-term, the anxiety cycle continues with the next urge or thought.

Cognitive Behavior Treatment of Just Right OCD

The goal of CBT for Just Right OCD is to teach you that you can manage the anxiety associated with obsessive thoughts about symmetry or perfection without performing compulsions or rituals to fix or arrange objects. You will learn a type of CBT called Exposure and Response Prevention (ERP). Treatment will include education about Just Right CD and how it is maintained, cognitive strategies that will help you respond differently to anxiety and intrusive thoughts, and behavioral strategies to help you delay and/or eliminate compulsive behaviors. ERP/CBT will help you face your anxiety and discomfort about things not being “just right” and practice new ways of responding to anxiety. With practice and experience facing your discomfort, you will find yourself less disturbed by the feelings of incomplete and more able to cope with anxiety and urges.

However, “just right” symptoms can make treatment more difficult. It is often more difficult to address obsessions of “incompleteness” because they are less concrete than those of “harm avoidance.” Complete response prevention may be difficult for those with severe/very generalized “just right” symptoms. More typical OCD symptoms are triggered by specific things, while “just right” symptoms can be affected by virtually every part of the day.

How to Get Help for Just Right OCD

The Cognitive Behavior Therapy Center of Silicon Valley is located at 16579 Los Gatos Almaden Road on the border of San Jose. With our convenient location between highways 85 and 17, we serve the Silicon Valley communities of San Jose, Los Gatos, Mountain View, Santa Clara, Sunnyvale, Saratoga, Los Altos, Palo Alto, Cupertino and Campbell, CA. Contact us for more information on how we can help you overcome Just Right OCD.