Intrusive Thoughts, Appraisals and Compulsions

This CBT worksheet helps young people understand how intrusive thoughts, images and doubts can lead to compulsive behaviours in OCD. Drawing on the cognitive-behavioural model of OCD, it explores how threatening interpretations (appraisals) of intrusive experiences can increase anxiety and create urges to engage in compulsions.

With completed examples and a blank worksheet, the resource supports collaborative formulation, helping young people identify their own intrusive thoughts, the meanings attached to them and the compulsive responses that maintain the OCD cycle. It can be used to support psychoeducation and introduce the rationale for exposure and response prevention (ERP).

References and Further Reading

  • Caron, A., & Robin, J. (2010). Engagement of adolescents in cognitive–behavioral therapy for obsessive–compulsive disorder. PsycNET.
  • Derisley, J., Heyman, I., Robinson, S., & Turner, C. (2008). Breaking free from OCD: A CBT guide for young people and their families. Jessica Kingsley Publishers.
  • Franklin, M. E., Freeman, J. B., & March, J. S. (2018). Treating OCD in children and adolescents: A cognitive-behavioral approach. Guilford Press.
  • Kaiser, B., & Bouvard, M. (2009). Obsessive-compulsive disorder in children and adolescents: Efficacy of combined treatment. Clinical Neuropsychiatry.
  • Kircanski, K., Peris, T. S., & Piacentini, J. C. (2011). Cognitive-behavioral therapy for obsessive-compulsive disorder in children and adolescents. Journal of Child and Adolescent Psychiatric Clinics of North America, 20(2), 239–254.
  • Krebs, G., Volz, C., & Turner, C. (2018). OCD: Tools to help you fight back!. Jessica Kingsley Publishers.
  • Riggin, B. M., & Lack, C. W. (2016). Cognitive-behavioral therapy for youth with obsessive-compulsive and related disorders. Current Psychiatry Reviews.
  • Van Noppen, B., Sassano-Higgins, S., Appasani, R., et al. (2021). Cognitive-behavioral therapy for obsessive-compulsive disorder: 2021 update. Focus, 19(4).
  • Wagner, A. P. (2003). Cognitive-behavioral therapy for children and adolescents with obsessive-compulsive disorder. Brief Treatment and Crisis Intervention.