CBT for OCD Intrusive Thoughts

For those of us with Obsessive Compulsive Disorder (OCD), much of our dysregulation comes from how we interact with our thoughts.  When an intrusive thought pops into our heads, s.a. “That ambulance must be going to my house, my kids must be hurt,” we tend to give it too much weight.  We do so by ruminating (overthinking a possibility), checking to make sure our loved ones are ok, or even performing a seemingly unrelated ritual like counting syllables.  In allowing ourselves to do a physical or mental compulsion in response to an intrusive thought, we are intrinsically giving it more power.  

So how, then, do we take power away from intrusive thoughts?

Some clients are successful at an approach of imagining intrusive thoughts as floats on a parade.  You don’t try to join the parade, you don’t try to stop the parade, you simply watch the parade move past you.  Those who are able to passively observe their intrusive thoughts and not interact with them have the most success in ultimately defeating this negative thinking.  

However, for those who cannot simply allow those intrusive thoughts to float by, the next best tool is Cognitive Behavioral Therapy (CBT).  Studies have shown that for OCD individuals, the pain of intrusive thoughts stems from two major distortions in thinking: 1) Overestimation of Threat 2) Overblown Sense of Responsibility.

First let’s tackle Overestimation of Threat.  Our brains were designed with negative biases because evolutionarily, this kept us safe from threat.  It was better and easier if our primitive brains saw all shadows in the darkness as potential predators, rather than risk missing the danger.  However, in our modern lives, this overestimation of threat leads us to routinely believe that bad things are much more likely to happen than in reality.  Furthermore, we also overestimate how bad the outcomes will be of these unlikely bad things.  The ambulance is almost certainly not heading to our house, and if it were, ambulances go to houses all the time where there is no actual mortal danger.  Short rebuttal: Our kids are totally fine.  

Our intrusive thoughts also get the best of us because OCD causes us to have an overblown sense of responsibility. By this, I mean we tend to assume fault under most circumstances.  We also believe ourselves to have more power over a situation than we truly have – especially when it comes to protecting our loved ones from danger.  Sometimes inflated responsibility presents as a superstition, when we blame our failure to perform a ritual (such as leaving someone out of our nightly prayer), as the reason behind a misfortune.  Fortunately, an overblown sense of responsibility can also be rebutted with some simple CBT.  One easy technique is to flip your analysis onto someone else – would you hold your loved one responsible for all the misfortunes in their midst? 

Those of us with OCD tend to feel over-responsible because it feels safer than feeling powerless.  However, for OCD treatment we must lean into this powerlessness, because at the end of the day, we must accept that we cannot control this world and no amount of anxiety will pave the road for a perfectly safe life.