OCD intrusive thoughts
When people think about OCD and hear someone mention they have OCD, it is most likely that they see OCD in terms of OCD contamination - the fear of washing as the obsession and the compulsion that accompanies it, that of repeatedly feeling the need to wash.
What are obsessions and compulsions?
Obsessions are intrusive, unwelcome, distressing thoughts and mental images, whilst compulsions are the behaviours that those with OCD perform in an attempt to exorcise the fears and anxieties that are being caused by the obsessions.
What many people don't realise is that OCD is varied in its topics. It is not limited to obsessions about dirt and contamination but can consist of many other areas that manifest as intrusive thoughts such as:
- violent thoughts
- religious or scrupulosity
- relationship OCD
- inappropriate sexual thoughts
- sexual orientation thoughts
- obsessions about hoarding or saving
- need for order and symmetry
- repetitive rituals
- nonsensical doubts
- superstitious fears
- cleaning and washing
- hoarding or collecting compulsions
- bodily functions (such as blinking)
This list is not exhaustive and there are many others, all of which compromise intrusive thoughts, compulsions and obsessions.
These thoughts are unwanted, distressing, and upsetting. The person who experiences them also experiences panic and anxiety as they question their reality, character and morality. They cannot fathom why they would be having these vile thoughts. These can also follow them into dreams.
It is important to note that although many fear these impulses, nobody with OCD has acted upon their most immoral or disturbing and dark thoughts. Sufferers live in misery with these thoughts and find them repugnant when the thoughts go against their values and morals. OCD attacks the very things that the sufferer values, hence what is most important to them and what the mind can think of being the worst possible thing, such as newborn mothers who have intrusive thoughts of harming their babies. These thoughts are just that - thoughts, meaningless ones.
The reality is that intrusive/unwanted thoughts are normal and common, we all experience them. The difference is how people respond to them. Usually, people that don't suffer from intrusive thoughts are able to dismiss them, forget them and attach no meaning to them. In comparison, those who suffer from intrusive thoughts, attach meaning, feel discomfort and unease and start to question themselves for having them. They start fearing that they may become a danger and act on these and they become scared, hence the obsession results in thoughts becoming stuck.
Attaching meaning, therefore, gives the thoughts power and makes them stronger, resulting in repeated attacks. In the book, Brain Lock (2016) by Jeffery M. Schwartz, a psychiatrist calls this stuck point exactly that; brain lock. He explains that the brain has become stuck in an inappropriate groove.
These thoughts then become torturous. When the unwanted thoughts become stuck then the content is given false importance. The thoughts get stuck precisely due to the fact that the person doesn't want them or agrees with them. OCD is a manipulating bully that will go after the things people hold most important and so represent the opposite of what a person may desire. They do not make the person having them a bad person. They are a misfiring in the brain, not a reflection of the sufferer’s character. These thoughts are also upsetting as they will try to disrupt the most beautiful moments in your life.
The key is that these thoughts lose their power when the individual no longer tries to repress, avoid or control them and doesn't react with fear or give them importance as ascribing meaning to them fuels them. The more we push them back the more they bounce back. This was seen in an experiment where candidates were told not to think about a white bear; the more they tried to push the thought away the more it came alive.
Intrusive thoughts are like those malignant pop-up ads on our computer - they unexpectedly pop up when we least expect them and when we don’t invite them in.
There was a time when it was believed that avoidance of triggers and distractions would help and that those that suffered from this disorder would need long-term psychotherapy. This is now acknowledged as not the case and that suppression and avoidance aren't effective.
Mindfulness is used as an approach to accepting the thoughts are there, this doesn’t mean agreeing with them or liking them, it means acknowledging that they are there and allowing them to sit so that they eventually get bored of not receiving attention and slowly start to be starved of their power and gradually fade or better control over them is achieved.
Due to the fact that new research and more effective ways are being found and old approaches have been discovered not to be helpful, it’s pivotal that as counsellors we need to keep updated with what approaches are deemed no longer effective and to be open to new ways of helping clients.
The CBT approach has over the years now been proven to be effective in dealing with forms of OCD and intrusive thoughts.
The four-step method for OCD
A very useful self-help method for managing and controlling thoughts, using this approach, and of which is pioneered by many organisations who work in this area, is Professor Jeffrey Schwartz’s four-step method. The four steps are: relabel, reattribute, refocus and revalue.
Let’s look briefly at each step:
This is acknowledging that the thought is a false message and relabelling it for what it is - “this is my OCD talking”, “these are obsessions and compulsions, this is not reality and what I feel I need to do is not a need”, “this is my mind playing tricks and trying to fool, bully and manipulate me, “this is a disorder just like any other disorder”.
With reattribute you learn to put the blame straight on the brain. It helps to answer why thoughts persist - “it’s my brain, this isn’t me”. Just like a person that suffers from epilepsy cannot stop the attacks the same with obsessions and compulsions, however with this disorder, the more we train our brains the more we can divert the signals. We can tell ourselves “these are not real thoughts and this is a false alarm”.
This helps with compulsions and to change behavioural responses by focusing the attention on something useful and constructive. It’s acknowledging the thought but not responding and reacting to it but telling it that you are going to focus on other things rather than listen to the lies. The idea of this is that when you change your behaviour, you are changing your brain.
This is not giving meaning and value to symptoms. It is being able to see them as meaningless thoughts (obsessions) and compulsions. It is being able to see the obsessions and need for compulsions as lies and defining the reality and truth. If we see obsessions as just that and having no meaning then they lose power, we can be able to feel less uncomfortable and anxious knowing it doesn’t define or character and do not belong to the core values we present, that they are the complete opposite. A powerful mind can change the brain by altering responses to the messages the brain sends.
As counsellors, we must be aware of the variety of different obsessions and compulsions a client may present with and it is imperative that we do not see this disorder as a true reflection of our client’s thoughts and character but rather for the medical condition that it is which is related to a biochemical imbalance in the brain.
Clients must remember it is not how they feel but what they do that matters and that OCD attacks the very things that are important to them. They are not bad people, they are having bad thoughts and that thoughts do not define us, we all get crazy thoughts now and then, this is normal and doesn’t mean we are dangerous or evil and will act on them. If an individual questions if they have OCD, most likely it is OCD.
The very fact they question their thoughts or find certain thoughts repugnant and seek help indicates they are not bad. In fact, most people with intrusive thoughts have high morals, hence why it leads them to question these thoughts and attach meaning to them rather than be able to ignore them and pass them off for what they are meaningless and false messages.