When country music superstar Luke Combs recently revealed his struggle with Purely
Obsessional OCD (Pure O), many fans were shocked to learn about this lesser-known but deeply distressing form of Obsessive-Compulsive Disorder (OCD). Unlike the common perception of OCD symptoms, which often involve visible compulsions like hand-washing or checking behaviors, Pure O involves hidden mental rituals such as rumination, mental reviewing, and silent reassurance.
Luke Combs’ Battle with Pure O OCD
Combs first experienced intrusive thoughts when he was just 12 years old. In a recent interview, he described how these obsessions “just come into your mind and then they cause you stress.” He emphasized the frustrating nature of the disorder, where the harder one tries to suppress these thoughts, the stronger they become. Combs called Pure O “particularly wicked” because of how intrusive and distressing these thoughts can be, making daily life exhausting and overwhelming.
His openness about this struggle shines a light on an often misunderstood anxiety-related disorder, helping others recognize that they are not alone.
What Makes Pure O Different from Traditional OCD?
Despite its name, Pure O is a misnomer—the idea that it lacks compulsions is false. While
individuals with Pure O may not engage in obvious physical rituals, they perform mental compulsions to alleviate distress. These can include:
Rumination – Analyzing a distressing thought over and over, trying to “solve” it.
Mental Reassurance – Silently telling oneself that everything is okay or seeking certainty.
Thought Neutralization – Replacing a “bad” thought with a “good” thought to feel better.
Avoidance Behaviors – Steering clear of triggers that might provoke unwanted thoughts.
Like all anxiety disorders, Pure O operates in a cycle—obsessive thoughts trigger anxiety,
leading to compulsions (mental rituals) aimed at reducing stress. Unfortunately, these repetitive behaviors only reinforce the cycle, making the thoughts seem even more threatening over time.
How Pure O is Treated: Exposure and Response Prevention (ERP)
The gold standard for OCD treatment is Exposure and Response Prevention (ERP), a specialized form of Cognitive Behavioral Therapy (CBT). ERP helps individuals manage their fears without engaging in compulsions—whether physical or mental. Instead of trying to push intrusive thoughts away or neutralize them, ERP encourages acceptance and tolerance of uncertainty.
Key ERP strategies for Pure O include:
Exposure Scripts – Writing out the worst-case scenario and sitting with the anxiety instead of avoiding it.
Mindfulness & Acceptance – Allowing intrusive thoughts to exist without trying to “fix” them.
Response Prevention – Resisting the urge to mentally review, reassure, or suppress thoughts.
Luke Combs touched on this idea, emphasizing that the less one tries to “figure out” the thoughts, the less power they have: “You start realizing… the less you worry about why you’re thinking about something, the more it just kind of goes away.” His experience mirrors what research has shown—accepting uncertainty and resisting compulsions leads to long-term relief.
The Importance of Acceptance and Exposure Work
Since Pure O thrives on fear of one’s own thoughts, individual therapy focuses on learning that thoughts are just thoughts—not reflections of one’s character or reality. Acceptance-based approaches help individuals stop fighting against their minds, while exposure work reduces the anxiety associated with intrusive thoughts over time.
For those struggling with Pure O or other related disorders, Luke Combs’ story offers hope.
OCD sufferers should know that mental health professionals with specialized training in evidence-based therapies like ERP and CBT can help them regain control over their lives.
Highly trained licensed clinical psychologists and therapists work with patients to break free from the cycle of obsessions and compulsions, using strategies that allow them to lead a fulfilling life.
If you or someone you know is dealing with Pure O OCD, seeking support from an expert team offering anxiety services can be life-changing. With the right treatment, support, and commitment, overcoming OCD symptoms is possible.
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