When negative self-talk becomes obsessive

CBT (Cognitive Behavioral Therapy) teaches us to identify the negative distortions that plague our self-talk.  Most people with anxiety judge themselves far more harshly than they would judge others.  Negative self-talk can sabotage our opportunities for growth and make us feel less than, even during life’s most victorious moments.

During CBT therapy treatment, many clients learn to identify negative self-talk, dispute it in the moment, and move on with their days.  For many, part of CBT treatment also includes an exploration of the origin of the core self-beliefs, such as “I am not worthy” and “I am not lovable,” that are fueling current negative distortions.  Once these insights are unlocked and CBT skills are practiced enough times, moments of negative self-talk naturally occur less and less.  Some clients come into session with a realization that they spent a week without self-criticizing!

Unfortunately, for others, negative self-talk is treatment resistant.  Therapy sessions can feel like a game of whack-a-mole, where no negative bias can be defeated fast enough before another pops up.  Some brains produce hundreds, sometimes thousands of negative self-talk statements every day.  Negative self-talk can almost feel like an ever-present hum in the back of our minds; it never actually goes away. 

In these cases, the client and I have to consider the possibility that negative thinking about themselves is actually a presentation of obsessive rumination.  Negative self-talk that seemingly has no off button can be a less obvious symptom of Obsessive Compulsive Disorder (OCD).  What can happen is a client has a fear that they are a bad person, unworthy of their job, an inadequate parent, etc., and intrusive thoughts about their failings can spin out of control. 

CBT can still be an effective treatment for obsessive rumination, but most of the time, we also need to add other approaches, including exposures to our fears.  For example, if our obsessive negative rumination revolves around being unworthy of our jobs, we might do a visualization exercise where we imagine that fear being fully actualized.  In our therapeutic conversation, we take the “What if it were true” scenario to an extreme and sit with the distress.  After some time, the distress dissipates and the power of the fear is lessoned, at least somewhat. 

Confronting a fear can be deeply healing, and sometimes a far more effective treatment than trying to convince ourselves many times a day that our fear is distorted.  Furthermore, CBT skills such as examining the evidence, naming the distortion, and disputing the thought, can actually become mental rituals which provide short term relief but are reinforcing of the obsession in the long-term.