Those Darned Unwanted Thoughts!

[David Baxter PhD]

Those Darned Unwanted Thoughts!
by Robert L. Leahy, Psychology Today
June 1, 2009

Have you ever felt plagued by thoughts and images that you just couldn't stand? Perhaps it's the nagging thought, "I made a mistake" or "I think I have cancer" or "I'm going to lose control." These thoughts seem to intrude on your mind and you try to block them out. You think about your thought and you say (to yourself) something like the following:

• I'm having that thought again.
• What's wrong with me that I'm thinking that?
• It must mean something about me.
• I have to do something---make sure it doesn't become a reality
• I have to stop having that thought.

You have begun noticing that thought and you are interpreting it over and over as something really significant??something about you. Maybe it "means" you are going crazy, you're evil, you're going to have a panic attack, you're going to attack someone. You are running around thinking your mind is your enemy. You feel out of control and wonder, "Why am I having these crazy thoughts?"

You are battling your mind. You think, "Normal people don't have these thoughts". You are afraid of the thought, embarrassed, and you think that the thought predicts something about the future. Maybe the thought means you are dangerous or that you will be punished by God.

Welcome to the world of "intrusive thoughts". Cognitive therapy can help you. Your problem is not that you are having intrusive thoughts. Your problem is how you are evaluating them, how you are trying to suppress them, and how you avoid situations that evoke them. The problem is not the thought??it's what you try to do about the thought.

Thinking about your thoughts
Three rules are important.

1. Everyone has crazy and disgusting thoughts
2. Thoughts are not the same thing as reality
3. Thought-suppression doesn't work.

Research on people without anxiety disorders shows that almost 90% of them have "bizarre" thoughts??thoughts about contamination, harm, religious impropriety, losing control, sexual "perversion"??you name it, we all have thought about it before. So, your "weird" thoughts might mean nothing about you. Join the crowd. We are all a little weird. I like to think of this as "we all have an imagination".

Thoughts and reality are not the same. If they were, you'd be rich. Try to think about a pot of gold. Think about it all day. Wish for it. Pray for it. At the end of the day, all you will have are a lot of thoughts. You can't take your thoughts to the bank.

Your idea that thoughts=reality is what Jack Rachman of the University of British Columbia called "thought-action fusion". People with obsessive compulsive disorder think, "If I think I will lose control, I will" or "If I think that Satan might possess me, he will". Sorry, it's just a thought.

Also, thought suppression doesn't work. Perhaps someone told you, "Snap a rubber band on your wrist every time you have that (BAD) thought". It doesn't work. The thought keeps coming back. Leon Tolstoy described a game he played when he was a kid in Russia. They would stand in a corner and try not to think about a white bear. Years later, Harvard psychologist Dan Wegner showed that people instructed not to think about a white bear were more likely to think about white bears. Thought suppression leads to thought rebound.

Cognitive therapists have been interested in how we evaluate our intrusive thoughts. For example, Canadian psychologists Christine Purdon and David Clark have reviewed the research on intrusive thoughts. They find that evaluations and thought-control strategies for intrusive thoughts and images are a core feature of all of the anxiety disorders. People with OCD try to suppress and neutralize thoughts and images??often with compulsive rituals. People with social anxiety disorder treat their intrusive thoughts about "appearing anxious" as the equivalent of being humiliated. And people with PTSD treat their intrusive images and sensations as evidence that the trauma is happening now. It's like we are running away from our minds.

It's like trying to run away from your hips. No matter how fast you run, they're always there.

Robert L. Leahy, Ph.D., is the author of Anxiety Free, The Worry Cure, and Beat the Blues. He is Clinical Professor of Psychology at Weill-Cornell Medical School and Director of the American Institute for Cognitive Therapy.

 

[Daniel E.]

Your problem is not that you are having intrusive thoughts. Your problem is how you are evaluating them, how you are trying to suppress them, and how you avoid situations that evoke them. The problem is not the thought––it's what you try to do about the thought.

In the following case history, Leahy advocates a similar approach to dealing with the urges for compulsive behavior:

Changing the relation to the urge.
Her view was that the urge controlled her and overwhelmed her. I asked her to give me a visual image of what the urge would look like if it were a real phenomenon outside of her. She pictured the urge as a large black cloud enveloping her and pushing her down. I asked her to imagine the urge as a small, cartoon-like character, dressed in a circus outfit, sitting in a chair, with his legs dangling over the side. I asked her to imagine the urge as having a high-pitched squeaky voice. Her mood lifted as she laughed at this image.

I asked her to talk to the urge. She began scolding the urge, telling it she would squash it and eliminate it completely. This was another example of her lack of acceptance and overengagement with the urge. I suggested that this would only add to the sense that the urge had power over her. Rather than eliminate the urge, I recommended we find a “space and place”—here at the party, here in her life. The urge would be there, but she could simply be polite to it, much as she might be to an unwelcome guest at a party. The goal would no longer be to control or eliminate the urge, but simply notice it, acknowledge its presence, give it the right to be “alive” and walk out the door without checking. She asked, “What if I still have the urge later?” I suggested that she say, “Hello—how is your day going?” and then get on with her activities. (Similar ideas are conveyed in Acceptance and Commitment Therapy; see Hayes et al., 1999).

I provided her with a vignette that described an urge that shows up at a therapist's office without an appointment (Leahy, 2007). The dialogue in the story is between a therapist and an urge that feels ignored. The therapist is empathetic and curious about the urge, who appears more and more concerned about losing his place in the world. The therapist takes the urge on a sight-seeing tour of New York City. The patient greatly enjoyed the story and recognized that the urge (or intrusion) could be viewed as a prankster who was no longer getting any response. She indicated that this personalization and externalization of the urge was quite helpful in feeling less controlled by the urge and less angry at herself and her intrusions.

This new way of relating to the urge was immensely helpful to her: she could abandon her perfectionism and her dysfunctional thought/urge control strategies. Indeed, the more she could treat the urge as background noise (rather than her central focus), the less controlling the urge felt. This allowed her more ability to engage in ERP.

Emotional Schemas and Self-Help: Homework Compliance and Obsessive-Compulsive Disorder

 

[adaptive1]

I am having one of those days where it is challanging to accept the thoughts and refocus. I know we all have these days, but it feels overwhelming sometimes, generally I am happy about how far I have come but I certainly don't have all the answers. Sometimes a wave of depression washes over me awhen I feel unable to get unwanted thoughts out of my head. I know I have to let them just be but sometimes I feel like it says in the article. I feel like the thoughts are a seperate entity or person as if there is someone else that is inside my head that I am constantly fighting. Of course, that other person inside is me. Anyway, its all good, things will return to "normal", I know what I need to do, just feeling a little tired of it today.

 

[Cat Dancer]

I'm sorry, adaptive. I know how hard it is. Hang in there. Thinking of you.

 

[Daniel E.]

I was reading this again today, and I thought it was somewhat humorous:

I have a few people in my life who struggle with obsessions in the same way I do. Whenever I can’t stand the noise in my head anymore, I call up one of them and say, “They’re baaaaaack…….” And we laugh.

http://forum.psychlinks.ca/obsessive-compulsive-disorder-ocd/15136-9-ways-to-stop-obsessing.html ​

​

 

[Daniel E.]

Obsessions Obsessions Are Not The Real Problem
by Frank Morelli, M.A.

...Obsessions Are False Messages

I always show my clients pictures of PET scan imagery that reveal the inner workings of the brain, pointing to the neurological causes of their obsessions. Borrowing from Dr. Jeffrey Schwartz, and his book Brain Lock, clients learn to RELABEL their obsessions as false messages caused by a “short circuit” in the brain. The relief of knowing this truth often eliminates for many clients long held, unrealistic appraisals of the self, such as, “I must be a bad (or weak) person for having those thoughts.”

A helpful metaphor I use to describe intrusive obsessions is to liken them to pop-up ads we often encounter while surfing the Web. Just like pop-up ads, obsessions are not under our control; they are always unwanted, and always annoying. Just as importantly, though, is for clients to realize that getting better emotionally does not depend on eliminating obsessions, which, in fact, is unnecessary, even perhaps, unattainable...

What can we do? I teach my clients to recognize the following: obsessions alone are not enough to disturb the sufferer emotionally; there must be a consequent negative appraisal of the obsession, which actually produces the anxiety and depression felt by the person. This also provokes compulsive behavior. It looks like this:

1. A father graphically imagines stabbing his son to death obsessively.
2. He consequently tells himself (negative appraisal), “This must be what child murderers think. I’m an evil and corrupt man!”
3. He consequently feels horrifying anxiety and depression, prays compulsively for God’s forgiveness, and avoids his son.

Once my clients are convinced that their OCD is a brain glitch, it becomes easier to attack the negative self-talk with corrective self-talk. Mind you, this is not easy to do. It often takes great practice, which includes managing pathological doubt (e.g. “Well, there’s always a chance I could murder my son, even if by accident.”). One cannot be passive with OCD: it takes consistent, deliberate, conscious effort to attack the problem. What is the problem? Negative appraisal. This is what produces emotional disturbance.

When the father in our example realizes his imagined thoughts arise via faulty neuro-circuitry, he is ready to take the next step, which is challenging the accuracy of his assumptions. This is where CBT is most helpful. A skillful therapist will guide the client to ask several reality driven questions, such as, “Where is the evidence that you are an evil and corrupt man?” Because this father finds his obsession to be morally repugnant, he will be asked to consider if it is likely that a serial killer feels any moral outrage for wanting to stab a child to death. The answer is obviously, “No.” Serial killers enjoy obsessing about their victims. In contrast, all OCD sufferers regard their obsessions as ego-alien, i.e. against their value system.

Additionally, this man can be challenged to consider and test the hypothesis that all human beings are capable of having disturbing thoughts, even murderous thoughts, which hardly makes one a murderer at all. This dad can ask trusted friends and relatives to verify the truthfulness of this premise. He will discover that we all have bad thoughts on occasion. The significant difference being that OCD sufferers obsess about their negative thoughts, the rest of us really do not. Once again, this is related back to the OCD brain glitch.

Borrowing from our example above, the corrected appraisal can take this form:

1. A father graphically imagines stabbing his son to death obsessively.
2. He consequently tells himself (corrected appraisal), “This is an OCD thought due to a glitch in my brain circuitry. It’s also an involuntary thought. I didn’t produce it and this thought is not me. Like anyone else, I can have a bad thought. Just because I think it doesn’t make me evil. I’ve spent enough time considering the issue.”
3. He consequently feels healthy concern and relief.

Behaviorally, the father in our example would be encouraged to act on something right now that adds value to his life. Since all OCD obsessions are “junk mail of the brain”, they do not deserve copious amounts of our energy. This dad can deliberately spend time playing with his son, for example, not only as an ERP exercise, but also to neutralize the compulsive praying. It is likely that in less than fifteen minutes, his anxiety will reset to zero. Nothing terrible happens and this father learns to appreciate the value of loving a joyful son.

Finally, the fuel for OCD is anxiety. Cut off the fuel source and obsessions are likely to decrease dramatically. When clients change the meaning they give to their obsessions through reappraisal or thought correction, anxiety is lessened. When they commit to neutralizing their compulsions consistently, clients engage the “brain trick” head on, further robbing OCD of the anxiety it needs to fuel future obsessions. The bottom line is obsessions are not the real problem at all; it is the meaning we give to them that makes all the difference with coping emotionally.