if you have a number of symptoms in the cluster and a number of the additional relevant factors, then you have something called a disorder, or a mental health condition. a treatment is considered effective when it results in a reduction of the symptoms and other factors that make up the disorder. more specifically: all of the above are desired outcomes of cbt and erp and for a significant number of ocd sufferers, these outcomes are truly accessible and really result in a reduction of the symptoms and other factors that define having ocd. believing that you are a “loudthinker” (what i called myself in online support groups during my treatment), and that embracing all of the above leads to mastery of this ocd experience, is what actually makes the treatment stick. i no longer meet the dsm’s clinical criteria for ocd, so the book can tell me i don’t have ocd, and i am not distressed by that second thought at all.