The OCD Cycle goes around in a circle. At the top of the circle is Obsession. This is the trigger and the obsession inoculation stage. Obsession leads to Compulsion, which is the reinforcer and behavior therapy stage. Compulsion continues and splits into Doubt and Temporary Anxiety Reduction. Doubt is the negative reinforcement and cognitive therapy stage. Temporary Anxiety Reduction is the stage where OC is strengthened and leads to the Stimulus stage, which can be internal or external.
Both lines merge back into the Anxiety stage, which is considered the fuel stage. This is the stage where Relaxation Response Training comes into play. Additional factors that play into the Anxiety stage include the following: stressors, psychodynamics, immune dysfunction, hormonal change, weather, diet, and family of origin issues. This stage completes the cycle by returning to the Obsession stage.