Managing Pure O: Using cognitive defusion for intrusive thoughts

Obsessive-compulsive disorder (OCD) is a mental health condition characterised by persistent, unwanted thoughts (obsessions) and repetitive behaviours (compulsions) aimed at reducing the distress caused by these thoughts.

While the stereotypical image of OCD often involves visible compulsions, such as hand-washing or checking locks, there is a less well-known but equally distressing form known as "Pure O." In Pure O, the compulsions are primarily mental, involving internal rituals or avoidance strategies rather than overt behaviours.

This article will explore pure O, focusing on how cognitive defusion can be used to manage intrusive thoughts and reduce engagement with these thoughts.

What is pure O?

Pure O, or purely obsessional OCD, is a form of OCD where individuals experience intense, intrusive thoughts without accompanying external compulsive behaviours. However, the term "Pure O" is somewhat misleading, as those with this subtype do engage in compulsive behaviours, though these compulsions are mental rather than physical.

Common examples of Pure O intrusive thoughts include fears about harming others, fears of committing immoral or illegal acts, intrusive sexual thoughts, and fears about blasphemy or offending religious principles. These thoughts can be terrifying and deeply distressing, causing significant anxiety. The mental compulsions might include rumination, mental checking, seeking reassurance, or trying to neutralise or suppress the thoughts.

The nature of intrusive thoughts in Pure O

Intrusive thoughts are a hallmark of OCD and are especially prominent in Pure O. These thoughts are unwanted, distressing, and often contradictory to the individual’s values or desires. The nature of these thoughts can lead to intense emotional responses, including fear, guilt, and shame.

For example, a person with Pure O might have a sudden, intrusive thought about harming someone they love. This thought is not a reflection of their true desires, but rather a random and involuntary mental event. However, the person might misinterpret this thought as evidence that they are capable of such harm, leading to significant anxiety and distress.

The distress is compounded by the fact that these thoughts are recurrent and difficult to dismiss. The more the individual tries to suppress or neutralise the thought, the more it persists, creating a vicious cycle. This leads to the use of mental compulsions, such as ruminating about why they had the thought, mentally checking to see if they really want to harm someone, or seeking reassurance from others that they are not a bad person.

Cognitive defusion: A tool for managing intrusive thoughts

One of the most effective psychological strategies for managing intrusive thoughts, particularly in Pure O, is cognitive defusion. Cognitive defusion is a concept derived from acceptance and commitment therapy (ACT), a form of cognitive-behavioural therapy. The primary goal of cognitive defusion is to change the way an individual relates to their thoughts, rather than trying to change the thoughts themselves.

In traditional cognitive-behavioural therapy (CBT), the focus is often on challenging and reframing irrational thoughts. While this can be helpful, it can also inadvertently reinforce the belief that the thoughts are important and need to be controlled or changed. In contrast, cognitive defusion encourages individuals to observe their thoughts without getting entangled in them.

What is cognitive defusion?

Cognitive defusion involves creating space between oneself and one's thoughts. Instead of seeing thoughts as accurate representations of reality or as commands that must be obeyed, cognitive defusion helps individuals to see thoughts as mere mental events —passing ideas that do not necessarily have any bearing on reality.

The key idea is that thoughts are not facts. For someone with Pure O, this can be a liberating realisation. For instance, having a thought about harming someone does not mean that the individual will actually harm someone or even want to. It’s just a thought, and like all thoughts, it will pass if it’s not given undue attention.

Techniques for cognitive defusion

Labelling thoughts: One of the simplest cognitive defusion techniques involves labelling thoughts as just thoughts. Instead of saying, “I am going to harm someone,” the person can say, “I am having the thought that I might harm someone.” This subtle shift helps to create distance between the self and the thought.

Mindfulness: Mindfulness practices are central to cognitive defusion. By cultivating a mindful awareness of the present moment, individuals learn to observe their thoughts without judgment. Mindfulness teaches that thoughts are transient and not inherently significant unless we choose to engage with them.

Visualising thoughts as objects: Another technique involves visualizing thoughts as objects passing by. For example, one might imagine their intrusive thoughts as leaves floating down a stream or clouds passing through the sky. This visualisation reinforces the idea that thoughts come and go and do not need to be acted upon.

Silly voices: Some therapists encourage individuals to repeat their intrusive thoughts in a silly or exaggerated voice. This technique helps to undermine the seriousness of the thoughts and reduce the fear response associated with them.

Thought parade: Another technique involves imagining intrusive thoughts as part of a parade passing by. The individual simply watches the thoughts go by without trying to engage with them, recognising that they will eventually move on.

The "Thank you, mind" technique: When an intrusive thought arises, one can say, “Thank you, mind,” acknowledging the thought without becoming involved with it. This response conveys an acceptance of the mind’s activity without giving the thought any special significance.

Benefits of practising cognitive defusion

The practice of cognitive defusion offers numerous benefits for individuals dealing with Pure O, primarily by reducing the distress associated with intrusive thoughts and breaking the cycle of mental compulsions.

1. Reducing anxiety

By practising cognitive defusion, individuals learn that thoughts do not need to dictate their emotions or behaviours. This reduces the anxiety associated with intrusive thoughts because the thoughts lose their power to provoke a strong emotional response. Over time, this leads to a reduction in the frequency and intensity of the thoughts, as the individual stops feeding them with attention.

2. Enhancing emotional regulation

Cognitive defusion fosters emotional regulation by encouraging a non-reactive stance toward thoughts. Instead of getting swept up in a wave of anxiety, guilt, or shame every time an intrusive thought arises, the individual can observe the thought with curiosity or indifference. This allows for greater emotional stability and reduces the likelihood of spiralling into distress.

3. Improving self-compassion

Many individuals with Pure O struggle with feelings of guilt, shame, and self-loathing due to the nature of their intrusive thoughts. Cognitive defusion helps to break this cycle by reinforcing the idea that thoughts are not reflective of one’s character or desires. This can lead to increased self-compassion, as the individual begins to recognize that having unwanted thoughts is a common human experience, not a personal failing.

4. Reducing avoidance behaviours

Cognitive defusion can also reduce avoidance behaviours, which are common in Pure O. When individuals learn to accept their thoughts without reacting to them, they become less likely to avoid situations or activities that might trigger intrusive thoughts. This leads to a more fulfilling life, as the individual can engage in a wider range of experiences without being held back by fear of their own mind.

5. Breaking the cycle of compulsions

As individuals practice cognitive defusion, they begin to see that they do not need to engage in mental rituals to neutralise or manage their thoughts. This realisation helps to break the cycle of compulsions, as the individual learns that the thoughts will pass on their own if left alone.

6. Reducing rumination

Rumination is a common mental compulsion in Pure O, where individuals endlessly analyse or question their thoughts in an attempt to find certainty. Cognitive defusion helps to reduce rumination by encouraging the individual to accept the uncertainty of their thoughts rather than trying to resolve it. This acceptance of uncertainty is a key component of recovery from OCD.

Pure O can be a deeply distressing condition, but it is possible to manage and reduce the impact of intrusive thoughts through the practice of cognitive defusion. By changing the way one relates to their thoughts, rather than trying to change the thoughts themselves, individuals with Pure O can reduce their anxiety, improve emotional regulation, and break the cycle of mental compulsions.

Cognitive defusion offers a path to greater emotional freedom, self-compassion, and empowerment, allowing individuals to live more fully despite the presence of intrusive thoughts. With time and practice, cognitive defusion can become a powerful tool in the journey toward recovery from Pure O.