I tried out the two suggestions and they were helpful.
My patient volunteered some criteria that he himself thought would help him differentiate between normal and obsessive doubt: he said the intensity of the accompanying emotion could be used as an indication: ,, if I feel atomic pressure it must be obsessive; if I only feel somewhat tense it probably is normal doubt. The second criterion- he said- was length of time: ,,the longer the doubt lingers, the more the chance/risk it is obsession. He recognized the thought : ' I must be absolutely sure that my decision is perfect' and ' I must know exactly what the outcome will be' as contributing to his intense anxiety. Basing myself on the excellent book of Schwarz: Brainlock, I explained to him that the thought itself was a false message of the nucleus caudatus that- according to Schwarz' research- triggers the obsessive thoughts in the first place. At the end of the session I asked my patient to write down on an index card that he will always have with him, an alternative thought, one he can believe in and identify with, to neutralize the toxic effect of the obsessive thought.
I hope and think we advanced- thanks to the good ideas I got from the two of you.
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