How Do We Stop Intrusive Thoughts?

[taurean]

Well for many of us that is the $6 million question. 

And the answer? 

We stop giving belief to them, and engaging in carrying out compulsions as a result of them. 

Because when we do that consistently they lose power and frequency. 

It's the getting to that stage that makes the journey difficult. 

It doesn't happen quickly - no quick fix. 

We must first accept that our intrusions are based upon an OCD core belief that is false, exaggerated or revulsive. 

That we cannot have certainty of this, we must accept probability. 

And we need to team up not believing, not connecting with the intrusions with structured exposure and response prevention sessions. 

So many of us slip back into the clutches of the OCD when we listen to it, not our advisers. 

But many of us can get better if we follow this CBT trail. 

The path lies ahead, with a fork. Take the fork that leads to CBT, with the commitment to stick to it, and we can get better. 

Take the fork that leads to carrying on the way we are, listening to and believing the OCD, and things won't improve and will likely get worse. 

[taurean]

So what about any intrusions after we have gone through the therapy process, and they weaken in terms of frequency and power? 

It becomes possible to gently but firmly ease them away, without focusing on them. 

Everyone gets intrusive thoughts, and that is what they do with them. They are assessed as worthless nonsense, and eased away. 

[worriedjohn]

27 minutes ago, taurean said:

 

That we cannot have certainty of this,

we must accept probability. 

And we need to team up not believing, not connecting with the intrusions with structured exposure and response prevention sessions. 

So many of us slip back into the clutches of the OCD when we listen to it, not our advisers. 

But many of us can get better if we follow this CBT trail. 

The path lies ahead, with a fork. Take the fork that leads to CBT, with the commitment to stick to it, and we can get better. 

Take the fork that leads to carrying on the way we are, listening to and believing the OCD, and things won't improve and will likely get worse. 

Don't you think we should believe the thoughts to face them? Thinking thought to be ocd and not believing them is an escape from them?

[taurean]

No I personally do not belong to that school of thought. 

I go with Jeffrey Schwartz's concept of labelling and attributing them to OCD. 

And I was taught in CBT that with certain types of theme, such as paedophile, harm, sexual preference and orientation, relationship the OCD is attacking one or more of our true core values, and alleging the opposite to be true. 

 

[malina]

1 hour ago, worriedjohn said:

Don't you think we should believe the thoughts to face them? Thinking thought to be ocd and not believing them is an escape from them?

I think that the goal is to see the situation logically. The aim should be to see the thoughts as being illogical and to stop responding to them. If you believe them, how are you then seeing them as not being realistic?

I personally find it okay to accept them in the sense that they are not catastrophic, but I don’t like the idea of believing them. I suppose my intrusive thoughts are about self harm, it’s hard to believe that to be true.

[paradoxer]

How do we stop intrusive thoughts? By not trying to stop them. Every time we try to prevent them it sends a message to the brain that they are somehow relevant. Let them be - you can't stop them anyway, but don't focus on them ... engage with them, or fall into the (all too easy) desperate escape mode of rumination. 

[taurean]

paradoxer.

If everyone determined to practice this, the rates of recovery would significantly increase. 

[paradoxer]

1 hour ago, taurean said:

paradoxer.

If everyone determined to practice this, the rates of recovery would significantly increase. 

Cheers taurean. 

[worriedjohn]

22 hours ago, taurean said:

No I personally do not belong to that school of thought. 

I go with Jeffrey Schwartz's concept of labelling and attributing them to OCD. 

And I was taught in CBT that with certain types of theme, such as paedophile, harm, sexual preference and orientation, relationship the OCD is attacking one or more of our true core values, and alleging the opposite to be true. 

 

Then you believe that for certain types of themes, I have to attribute them as OCD and just refocus instead of believing them?

Edited February 25, 2019 by worriedjohn
punctuation mistake

[Ashley]

On 24/02/2019 at 13:52, taurean said:

I go with Jeffrey Schwartz's concept of labelling and attributing them to OCD. 

 

2 hours ago, worriedjohn said:

Then you believe that for certain types of themes, I have to attribute them as OCD and just refocus instead of believing them?

 

I actually don't believe this. Well, not eventually. Initially (whilst the person is new to OCD and not getting any help or support) this approach can be helpful to demonstrate to the person suffering that the thoughts are not them, it's not a precursor to intent and help them identify these are OCD thoughts.

But this should only ever be a short term approach and never play a part in treatment and overcoming OCD because it doesn't allow for a person to get used to uncertainty and doubts the intrusive thoughts trigger. If we're not careful labelling becomes a safety seeking compulsion, a way of avoiding the doubts and uncertainty I guess.

Just my thoughts on the subject.

 

[taurean]

Agreeing with the thoughts is one approach some eminent therapists use, but found no favour with me personally for the below reasons. 

What I was taught in CBT was very clear to me - with such themes as harm, paedophilia, sexual preference, relationship what the OCD does is attack our true core character values, alleging we have would or could act contrary to those values. 

This of course causes extreme distress and the worry that the OCD could be true. 

Agreeing with that is to my mind not going to help any, and I wasn't taught to. 

But I was taught that by cognitively understanding that with those themes our true core values remain in place, and it's all OCD lies, we can both work successful ERP and use labelling and refocusing to shift our mind into better territory and away from connecting and the urge to carry out compulsions. 

Since OCD lies exaggerates or causes revulsion within its core beliefs I think its best care is taken to work in cognitive knowledge towards accepting that our behavioural response is caused by the fear that what OCD is saying might be true. 

This is powerful CBT at work, evidenced in the careful strategic use of behavioural experiments by clinical psychologists which can be very helpful to open the eyes of a sufferer to what is actually going on in their mind, show what is actually OCD at work. 

To help with the OCD demanding certainty, therapists use the concept of probability. OCD will take an inch and make a mile out of an issue, claim that 2+2=5. By showing that what it says isn't true in that mathematical example, or most probably isn't true in others, and learning to accept that, we can overcome that demand for certainty. 

 

[leif]

Yes maybe depends on themes and personality what approach might work best?

I find for me with contamination and checking, it works best not to dismiss the idea altogether as impossible, but rather to go with what is more probable and more logical when trying to do an exposure exercise with it.

So to deal with fear of contamination by blood, for instance, it is good for me to acknowledge that there are things transmitted by blood, but that the place where ocd takes it is too far.

or when I leave the house and my intrusive thought is maybe I left the stove on (since I only checked once and not 3 times as my ocd wants to), my best  response to the thought seems to be--yes, maybe I did but I probably didn't.

 

[Ashley]

1 hour ago, leif said:

Yes maybe depends on themes and personality what approach might work best?

I don't think the type of OCD matters in this respect to be honest,  regular relabelling something as an OCD thought is unlikely to help a person move on from on OCD long term.

[taurean]

51 minutes ago, Ashley said:

I don't think the type of OCD matters in this respect to be honest,  regular relabelling something as an OCD thought is unlikely to help a person move on from on OCD long term.

Agreed. It is a tool to use short term, then using CBT to learn about how the disorder works, then going through exposure and response prevention to face up to intrusions and disarm them. 

When we go through the CBT programme the intrusive thoughts should ease in power and frequency, as paradoxer said. 

[paradoxer]

There's a tricky balance between cognitive insight and falling into the trap of reassurance. (Regardless of differences in opinion here - I think we are all aware of the paradoxical nature of/ and dealing with the disorder ). So yes, I know it's OCD, but if I leap directly and 'consciously' to that insight as an escape route, it risks dancing to the disorder's tune. So, that precarious tightrope runs along a tricky combination of insight, disregard, refocus, and perhaps even conceding the chance that the obsessions are valid, but refusing to engage in that debate. 

Anyone suggest that tackling this disorder's easy? 

[taurean]

There are some good pointers here in what we have said, but with appropriate cautions. 

If we can initially find aid to stop us obsessing and carrying out compulsions by the not connecting not believing and refocus method then that's great. 

But as Ashley says, that won't get us better. We have to go on to CBT to work our homework and disarm the disorder. 

The paradox is that by not doing what the disorder makes us do, we can start to get better. But woefully far too many of us aren't able to keep this up, and are drawn back into the maelstrom of OCD. 

I was hoping, by posting this topic, to show that this is what happens if we don't keep up the task of not connecting with or giving belief to the intrusions. 

But when we do - and go on to working through CBT - recovery can be made. 

3 hours ago, paradoxer said:

Anyone suggest that tackling this disorder's easy? 

It isn't. But by taking the apparent complexity out of what with CBT is actually a relatively simple concept, it becomes easier

 

Edited February 26, 2019 by taurean

[dksea]

On 24/02/2019 at 22:45, worriedjohn said:

Don't you think we should believe the thoughts to face them? Thinking thought to be ocd and not believing them is an escape from them?

I'm with Taurean on this one.
For example if I'm having the intrusive thought "maybe I'm having a heart attack", the prudent thing to do if I'm supposed to "believe" the thought would be to call an ambulance right?
Instead I find that recognizing the thought is probably OCD, that I don't need to give it time, and that I'm probably NOT having a heart attack and should just get on with my day is the more beneficial approach.  The key, is to recognize the "probably" part.  Recognizing that OCD is causing me to seek certainty, that certainty is an impossible goal, and I need to accept doubt.

[worriedjohn]

17 hours ago, Ashley said:

I don't think the type of OCD matters in this respect to be honest,  regular relabelling something as an OCD thought is unlikely to help a person move on from on OCD long term.

I think relabeling doesn't give you chance to desensitize of your fear. When you are relabeling, you are not feeling the anxiety that is caused by OCD. But ultimately OCD fear (obsessions) are caused by OCD and they are not genuine danger. In CBT, the patient work with the therapist to discover how their fear is entirely blown out of proportion or false and it is caused by OCD. But while doing ERP the person may be guided to imagine their disastrous scenario to be true to make himself anxious. But it is for the period he is doing ERP only. This is how far I know about CBT. When the person is not doing the ERP excercise, is it not necessary to learn that the chance of his/her fear being true is very very low and it is only false alarm send by OCD?

Edited February 26, 2019 by worriedjohn

[taurean]

It's probably a matter of therapists' approach too. Plus what works for one may not work for another. 

But I found with my own CBT that going into the ERP it was necessary to understand the cognitive side first. Then when sitting with the intrusion I could relate to my knowledge that it was a result of - in my case - a false OCD core belief. 

Gradually during exposures my brain learned to accept this. 

So that is certainly my preferred method. 

We often say on here that ERP may not be working because the patient has not been through and accepted the cognitive part of the CBT first. 

How can you overcome something if you believe the threat to be true? 

[taurean]

It's quite normal in ERP to be guided by the therapist into imagining the feared situation. We don't have to be actually IN that situation. Just thinking of it will bring up the default fear/threat reaction, which can then be tackled with the cognitive knowledge already learned. 

There is no need to be told to believe it, but plenty of need to have been told why we shouldn't believe it. 

[Ashley]

54 minutes ago, worriedjohn said:

I think relabeling doesn't give you chance to desensitize of your fear. When you are relabeling, you are not feeling the anxiety that is caused by OCD.

Exactly right, that's how I understand it too.

 

39 minutes ago, taurean said:

It's probably a matter of therapists' approach too.

It perhaps is, but it shouldn't be!!!  If I ever have a therapist that told me to keep relabelling my thoughts as OCD, without encouraging me to face them I would immediately find a new therapist. 

 

 

[Emsie]

I’m finding this discussion very interesting. 

I can see how you can face your fear/thoughts for example if you fear stabbing someone with a knife. In this situation you’d use the knives for cooking let’s say and expose yourself to being around others. You’d sit with the anxiety and carry on. 

But how do you face your thoughts when your fear a certain symptom is cancer or MS etc or you fear a health issue with a loved one? It’s not something I can agree with. For example...’yes, that lymph node I can feel is cancer’. (A doctor said it was normal and nothing to worry about, but I had to see the doctor for reassurance). And I can list many situations like this where I have sought reassurance. 

When I was in CBT, my therapist advised me to notice the thoughts and not engage to break the cycle. Is that ok? 

[taurean]

12 minutes ago, Emsie said:

When I was in CBT, my therapist advised me to notice the thoughts and not engage to break the cycle. Is that ok? 

To break the cycle, Yes. 

But we need to understand how the OCD is working, and we need to expose ourselves to the fears - but for me in the knowledge of the cognitive side in order to recover. 

Part of the cognitive side for me - on such themes as yours Emsie - is the understanding of why others don't fear these issues. The general public all have the same inbuilt self-protection instincts so are not outwardly likely to put themselves into harms way. 

In CBT this is a powerful tool in the therapist's armoury. 

Do I fear semen or poo? No. Why not?Because life's experiences, and what I have learned about those substances, have shown me I have no need to fear them - simply apply normal standards of hygiene around them. 

[Emsie]

5 hours ago, taurean said:

To break the cycle, Yes. 

But we need to understand how the OCD is working, and we need to expose ourselves to the fears - but for me in the knowledge of the cognitive side in order to recover. 

Part of the cognitive side for me - on such themes as yours Emsie - is the understanding of why others don't fear these issues. The general public all have the same inbuilt self-protection instincts so are not outwardly likely to put themselves into harms way. 

In CBT this is a powerful tool in the therapist's armoury. 

Do I fear semen or poo? No. Why not?Because life's experiences, and what I have learned about those substances, have shown me I have no need to fear them - simply apply normal standards of hygiene around them. 

Thank you for your help here, Roy.

My therapist only went as far as just noticing the thoughts and not engaging with them to break the cycle. That was the main work, plus reducing and stopping compulsions. I think the premise was break the cycle enough times for each obsession and the thoughts in general will fade and loose their power. But I can have so many different obsessions. 

I never did any structured ERP. And that’s what I don’t understand....how do I do that with health fears? 

symptom/observation = serious illness/cancer; googling for reassurance and then making it x1000 worse with new ‘knowledge’; reassurance seeking from husband and then sometimes a trip to the GP - that’s a common pattern for me. 

Just to say Roy, I don’t fear those issues you’ve described, the theme I cannot crack is Health (mine and sometimes my daughters). 

Edited February 26, 2019 by Emsie

[taurean]

Maybe you need to look deeper down to understand if there was a "seeding event" that caused the health anxiety. 

In the case of a team secretary at my work some years ago, the seeding event was her husband suddenly dying, leaving her to bring up their son on her own. 

Her fear was that she would get a life-threatening illness that prevented her from doing this, and any health problem she had was awfulised into such, with reassurance-seeking visits to the doctor. 

We told her this seemed to be obsessional and what we saw as why the OCD had latched onto it. 

Understanding why she was reacting in this way - the cognitive side of CBT - coupled with facing up to the intrusions such as "what if its xyz? (a terminal illness)" by being mindful of what the OCD's game was - to plant the suggestion of a catastrophic diagnosis - helped her to tough the thoughts out and resist the urge to compulse. She appeared to recovered well from this. 

So maybe dig down to find out what the actual OCD core belief is in your case and whether it was trauma induced as hers was. 

If you can't identify exactly what the OCD core belief may be (which could then lead to discovering any underlying trauma if there is one ), try using the "downward arrow" technique. I will look for a previous explanation of this from the search field, and hopefully add it to the thread. 

Remember, at any time, in a safe place you can bring into your consciousness a trigger thought to tackle in a structured ERP session - we don't have to be actually in the situation to do this. 

Edited February 26, 2019 by taurean