Ocd related CBT full of contradictions and useless for most cases of extream OCD?, I hope I can be convinced otherwise.

[confusedcd]

I truly hate to be pesimistic, salty and all defeated but I'm finding it hard not to question the true effectiveness and accuracy of Cbt in relation to OCD.

Firstly I want to adress the many contradictions that seem to crop up within the general approach towards dealing with Ocd, firstly it is said the first part of the cycle is the Obsession element (such as the intrusive thought/intrusive rumination) cbt of which the generally accepted and preached approach ttpically starts using something like:

1. Minful recognition and labelling

This being using mindfullness to be aware of and recognise how a subconcious intrusive thought comes in (I.e with a negative feeling/conitation/ego-dystonic nature/content and the desire to perform a compulsion therafter).

To note there seems to be a pool of no no's, these are buzz word like terms an Ocd sufferer is told not to engage in e.g:
Rumination, Supression techniques, Avoidance behaviours (avoiding a normal activity), anticipation, neutralising, reasoning, analyzing, assigning/allowing a negatively based judgment/narritive towards a thought, i.e this is negative, scary etc

But as I will explain many of the steps seem to inpinge or risk instigating the many things that are said to feed and make Ocd worse.

For example the above first step 1 seems to breed and or atleast can instigate many of the Ocd compulsions such as:

- Hypervigilance: mindfulness seems in someway a watchful state of mind as it requires a level of thought checking/monitoring/analysing of what came up, all of which we are told not to do)
- this could then become very ritualistic and compulsive as it offers a way to neutralise a negative though understanding.

Next I want to adress the notion of "Labelling" intrusive thoughts:

This being using a short descriptive word i.e "ocd" or "instrusive thought" or "anxiety" to labell an intrusive thoughts.

Again I can find easy contradictions with this tool I can pick from the pool:

I.e labelling requires a level of analysing a thought to be able to understand the type of thought appropriatly enought to labell it, it in a sense also acts to neutralises the thought removing the fear behind and acts as  reasurance in many cases to which to an ocd sufferer can become addictived to.


Next we have the second step:

Step 2: Response:  Acceptence

This is often said to follow up after indentification it is said you need to conciously accept the thought, the uncertainty that comes with it and the fact we will get scary thoughts and feelings.

AGAIN things to be said about this:

It involves more concoius action and any such action towards our brain can be deemed as resistive as they saying goes -  What you resist, persists." - carl Jung


Finally the next typocal step is to:

Step 3:    Refocus attention

I.e Lastly so not to become entangled with a subconcious intrusive thought, but also so you can avoid going into a compulsive action] you need to conciously disregard (move on) the thought by avoiding any such engagement/compulsive reaction bla bla bla......

Now this is somewhat more achievable during the day as I can keep myself busy but at night after getting to sleep I wake up around 12 or 2 am now with a lessend sleep drive I then find myself with nothing but my own thoughts and as an ocd sufferer these are quick, intusive, and stimulating, I then try to put in place the Cbt learnt but automatic rumination seems to step in, I can switch it off temporarily but I quickly (approx 10 or so seconds later) find myself in the throws of it again.

I often feel as if I have more than Ocd going on and this is why it has been so unneffective but perhaps my approach and or understanding is off too, anyhow thanks for reading my vent any thoughts and insights are greatly appreciated.

Keep strong all.

[lookingforpeace2]

I get confused too - having been told in some cases I should challenge the thought eg theory a/theory b, come up with counter evidence why my thought is unlikely to be true, and then also not to engage or try to challenge the thought because then it will make you think you need to reassure yourself with evidence that the thoughts aren’t true 

I’m not a professional so I’m just speculating from my own experience, but I think for me, when I first started therapy I wouldn’t have been able to do the ‘accept the thought may be true and move on’ practice, because it would have been so so terrifying and so alien to me that I would have rejected it. Maybe to get me to a state where I was more aware and had more of an understanding of what was going on, I needed to go through the process of seeing how unevidenced my thoughts were, (they probably aren’t true) before moving up to the level of acceptance of  ‘they might be true)

noones ever said to me that that’s a deliberate strategy though, I’m sort of reverse engineering it from my experience so interested if anyone else has found the same 

[Relinsky]

My biggest fear is that my intrusive thought may be true, so "accepting that it may be true" seems like utter disaster to me.

[PolarBear]

Personally, I am against Theory A/B. Two reasons. You're asked to figure out which is more likely. OCD sufferers automatically default to the worst case scenario. Sufferers will often choose the most pessimistic view, even if the likelihood is remote.

Secondly, Theory A/B requires you to analyze the thought and figure out two opposing scenarios. This is engaging with obsessions, the one thing sufferers need to not do.

I find simpler is better. You are hit with an obsession. Think, I'm not going to deal with that right now. Turn your attention onto something else. If you can get into the habit of foing that, you will be further ahead.

A note about acceptance: When an obsession strikes, at first you do not need to accept it might be true. That's for later, when you are doing well with ERP. I reached a point where several times a day I looked in a mirror and said, "I am a pedophile. " I didn't start out doing that. It would have been damaging to my recovery.

 

[PolarBear]

3 minutes ago, Relinsky said:

My biggest fear is that my intrusive thought may be true, so "accepting that it may be true" seems like utter disaster to me.

Exactly. Read my response above about this very issue.

[comfortscorned]

5 hours ago, PolarBear said:

Secondly, Theory A/B requires you to analyze the thought and figure out two opposing scenarios. This is engaging with obsessions, the one thing sufferers need to not do.

I was thinking the exact same thing this morning while reading a CBT book. I am sure it is helpful to some people but weighing up arguments for and against things being dangerous sounds exactly like my ocd. Theory A is never going to win because there is always some potential danger in any situation.

I've had more success by recognising when my worries fit the pattern of ocd and then just not engaging with them. Trying to analyse the risk just makes it feel scarier.

Edited February 23 by comfortscorned

[snowbear]

A question on CBT -yay!   My favourite topic. Let's see if we can straighten out the kinks in your understanding of how CBT works.

 

Using mindfulness - mindfulness is about  observing without judgement.

It is never about hypervigilance   nor does it require you to analyse your thoughts. Quite the opposite!

There are two parts, i) observe. Treat unwanted thoughts like leaves flowing down a river - notice them, let them carry on 'passing through' and allow them to disappear into the distance without intervening in any way.

ii) without judgement. I can't stress the importance of this enough. Mindfulness is based on acceptance.

Judgement is the opposite of acceptance. 'This is good, that is bad, this makes me a monster, that needs neutralising...' etc.

With acceptance, nothing is ever good or bad - it simply is. Fact.

Not 'fact-that-I don't-like' or 'fact that I'm struggling to come to terms with'   just fact (neutral.)  Neither good nor bad, it just is, and when you accept it you allow it to be what it is without feeling you have to change it in any way.

If you're resisting then yeah, it'll stick around. Because resisting is a form of judgement. 'I can't allow this to just be. It's 'bad', therefore I am morally obliged to do something about it.'

With acceptance you permit yourself to let go of that judgement thinking. It's not bad, it just is. What 'just is' doesn't carry any kind of moral obligation to change or fix it. So you let it go, without the need for further action.

If letting it go is still a struggle, then you're hanging on to that hidden judgement thinking like a dog with a bone!

 

 

Labelling - the idea of labelling is to quickly identify the thought as intrusive/ unwanted. No more than that.

If you start to analyse the thought in any way (also referred to as 'engaging' with it) then you've moved into compulsion territory.

Labelling is all about giving yourself permission NOT to engage with the thought.

For example, say you have a scary thought; 'I'm a pedo.'   If you engage with that your next thoughts might be 'I'm going to go to prison, I'll lose everything I care about.' And you're off again, lost deep in the badlands of compulsions.

The idea of labelling it is to immediately recognise 'This is my OCD topic, my biggest worry (being a pedo) Here I go again'. Then - knowing it's just an intrusive thought and therefore doesn't merit any further analysis - you apply the mindfulness technique of letting it float past you without further ado.

 

 

Refocus attention -  When you first start to resist engaging with your OCD tghoughts it's common to last all of 10 seconds before the thought circles back round and demands attention again. Pretty universal to every sufferer I'd say! But by routinely adopting the 'Label it, let it go, and get busy thinking about something else' approach -and with consistent practise - those 10 seconds soon extend to 20, to 60, to ten minutes and so on. 

This is where mindfulness can help again.

Thought> let it float on by, think about something else > thought cycles back again > let it float on by without judgement and think of something else> thought recurs > let it float on by without judging the thought AND without passing judgement on yourself or getting upset that it keeps coming back again and again. Stay calm. Let it be. Accept its presence without judgement or engagement. Focus on something else... and on, and on.

I've lain awake at night in the past where a thought has kept cycling round for hours on end. These days I have a list of go-to topics I can use for refocusing. Within seconds of an unwanted thought entering my brain I just switch my thinking to one of my pre-chosen, no-judgement-attached topics and another 2 seconds later I've forgotten the intrusive thought was ever there. It just took a LOT of practise, and refocusing without allowing any self-judgement or frustration every 10 seconds at first, to get to where I'm at now.

 

Ditching their 'autopilot' judgement thinking is a hard step for a lot of people.  As children we're constantly trying to win the approval of our parents and do the right thing, so it becomes an ingrained habit to label everything as either good or bad, right or wrong. And I do mean everything! Every thought, every feeling, every action, every inaction... We learn to be our own judge and jury, a little voice in your head passing judgement on every second of your life.

As we get older we're more able to try out different kinds of thinking such as acceptance, open-mindedness, playfulness, logic...

and our emotional range increases - amusement, serenity, self-compassion, gratitude... and so on.

Applying a judgement of some kind to everything is just habit. And like any habit that has outgrown its usefulness can be replaced with something healthier through practise, practise, practise.

 

Consistency is key to faster change. If you apply the new thinking and approach every time you catch yourself passing judgement or getting caught up in ruminations and analysis about 'that's bad' then being non-judgemental soon becomes the 'new habit' and your new autopilot response.

Just keep trying. ALWAYS without passing judgement on yourself . No labelling it as 'that was a failure', 'I'm no good at this'  etc. Just,

'Ok, duly noted, I got a bit judgemental this time. I'll just try again next time.'

 

Hope that helps explain what you're trying to do with your CBT!

 

 

[Handy]

Intrusive thoughts are thoughts you don't put there yourself, so one sees them & ignores them 

 

CBT isn't for everyone & I don't know how to classify success of CBT. I think it should look at 1 year success rates.

[vivi_x]

This is something I’ve always found really difficult. I’ve had CBT 5 times and talking therapy twice, and each and every time it has made me worse.  
 

So disclaimer, I recently got diagnosed with Autism and ADHD and was told that because of that CBT is far less likely to work on me and I’d probably need a modified form of CBT because of how rigid the Autism makes my brain and how the ADHD makes my brain do what I can only describe as the zoomies  
 

That aside, I have always found that all CBT does is make me think about the intrusive thoughts when I’m trying to not think about them. Exercises like the A or B approach or the anxiety equation are exactly how my OCD manifests, in that any cause for anxiety is automatic reason for maximum anxiety. I do think that sometimes thinking my way out of the OCD logically can help me, but usually in terms of ‘this worst case scenario isn’t the end of the world’ but obviously that isn’t universal and doesn’t work for all thoughts or all people. Another method I have found useful is the bully idea, the bully is saying nasty things to you and engaging (even if you’re just saying ‘that’s not true leave me alone’) will only fuel their fire and let them know they’re getting to you. The best way to deal with a bully is to act like you don’t care what they’ve said or why. But that can be draining and hard so I get it’s not for everyone. 
 

I also think it could be linked to who is providing the CBT and their experience and knowledge of OCD. I think it’s obvious that CBT should be used differently depending on whether you’re treating GAD, depression, OCD etc. but a lot of providers have the same approach regardless of who and what they’re treating, and I think one of the main reasons for this is probably underfunded NHS counselling services who are instructed to work from worksheets and don’t always have the experience or opportunity to adapt how they are treating people. Not to say that is their fault at all, just that it’s my experience, and honestly you can’t blame them with the way they are overworked, understaffed and underpaid, they’re usually counselling students just doing their best, but that doesn’t mean it isn’t confusing and harmful for someone who doesn’t understand what they’re doing wrong. My most vivid memory of CBT is going in and filling out the OCD questionnaire that they use to track whether you’re improving, the counsellor saw it distressed me to have to label how often each thing bothered me (you know the one where they put ‘I have thoughts that I am unclean’ or ‘I wash my hands more than I should’ and you have to say sometimes, most of the time, or all the time). She would apologise but say that they had to do it for their statistics tracking which is understandable but I think shows how inflexible they are able to be. My score only ever got worse. 
 

The last time I was doing CBT it made me much much worse, and I had just started ERP when covid hit so they were suddenly unable to tell us to do any of the exposure, which to my mind just wholeheartedly confirmed all of my fears, which in combination with the bombardment of don’t touch things and wash your hands posters that were being put up everywhere, probably made that my worst CBT experience. 
 

I have found it helpful to read ‘CBT for OCD’ books, as I think they are more targeted and explain the theories in depth which helps for me at least, where as sometimes when you’re doing it with someone in counselling they expect you to just accept the method and go with it without explaining why it’s meant to work (but hey that’s probably the autism). 
 

Either way, I don’t entirely think it’s pessimistic to not understand why or how or even if it’s working, because sometimes things just don’t work for everyone, we’re human not machines. But maybe tweaking things like finding a counsellor that fits for you or explaining that a particular method doesn’t work for you, or seeing if you can approach something differently might work. 
 

i don’t think it’s cut and dry, again, we’re people not machines and we’re all different but we’re all just trying to get better. I think snowbear has some great points in how to get it to work for people like us. 

8 hours ago, snowbear said:

Let's see if we can straighten out the kinks in your understanding of how CBT works.

I guess my point is, don’t be too hard on yourself, it can take time to find what works for you, but it’s important to keep trying. I’m still trying to find what works for me and if I do I’ll make sure to share it with you all

[Mini]

19 hours ago, PolarBear said:

Personally, I am against Theory A/B. Two reasons. You're asked to figure out which is more likely. OCD sufferers automatically default to the worst case scenario. Sufferers will often choose the most pessimistic view, even if the likelihood is remote.

Secondly, Theory A/B requires you to analyze the thought and figure out two opposing scenarios. This is engaging with obsessions, the one thing sufferers need to not do.

I find simpler is better. You are hit with an obsession. Think, I'm not going to deal with that right now. Turn your attention onto something else. If you can get into the habit of foing that, you will be further ahead.

A note about acceptance: When an obsession strikes, at first you do not need to accept it might be true. That's for later, when you are doing well with ERP. I reached a point where several times a day I looked in a mirror and said, "I am a pedophile. " I didn't start out doing that. It would have been damaging to my recovery.

 

I agree that you can get stuck in this debate over whether A or B is the answer. I have got stuck in this myself with my worry that I've developed schizophrenia after having OCD for a long time. I can temporarily think it's all just OCD but then my thinking then very quickly reverts to the other theory.

[confusedcd]

On 23/02/2024 at 20:36, snowbear said:

A question on CBT -yay!   My favourite topic. Let's see if we can straighten out the kinks in your understanding of how CBT works.

 

Using mindfulness - mindfulness is about  observing without judgement.

It is never about hypervigilance   nor does it require you to analyse your thoughts. Quite the opposite!

There are two parts, i) observe. Treat unwanted thoughts like leaves flowing down a river - notice them, let them carry on 'passing through' and allow them to disappear into the distance without intervening in any way.

ii) without judgement. I can't stress the importance of this enough. Mindfulness is based on acceptance.

Judgement is the opposite of acceptance. 'This is good, that is bad, this makes me a monster, that needs neutralising...' etc.

With acceptance, nothing is ever good or bad - it simply is. Fact.

Not 'fact-that-I don't-like' or 'fact that I'm struggling to come to terms with'   just fact (neutral.)  Neither good nor bad, it just is, and when you accept it you allow it to be what it is without feeling you have to change it in any way.

If you're resisting then yeah, it'll stick around. Because resisting is a form of judgement. 'I can't allow this to just be. It's 'bad', therefore I am morally obliged to do something about it.'

With acceptance you permit yourself to let go of that judgement thinking. It's not bad, it just is. What 'just is' doesn't carry any kind of moral obligation to change or fix it. So you let it go, without the need for further action.

If letting it go is still a struggle, then you're hanging on to that hidden judgement thinking like a dog with a bone!

 

 

Labelling - the idea of labelling is to quickly identify the thought as intrusive/ unwanted. No more than that.

If you start to analyse the thought in any way (also referred to as 'engaging' with it) then you've moved into compulsion territory.

Labelling is all about giving yourself permission NOT to engage with the thought.

For example, say you have a scary thought; 'I'm a pedo.'   If you engage with that your next thoughts might be 'I'm going to go to prison, I'll lose everything I care about.' And you're off again, lost deep in the badlands of compulsions.

The idea of labelling it is to immediately recognise 'This is my OCD topic, my biggest worry (being a pedo) Here I go again'. Then - knowing it's just an intrusive thought and therefore doesn't merit any further analysis - you apply the mindfulness technique of letting it float past you without further ado.

 

 

Refocus attention -  When you first start to resist engaging with your OCD tghoughts it's common to last all of 10 seconds before the thought circles back round and demands attention again. Pretty universal to every sufferer I'd say! But by routinely adopting the 'Label it, let it go, and get busy thinking about something else' approach -and with consistent practise - those 10 seconds soon extend to 20, to 60, to ten minutes and so on. 

This is where mindfulness can help again.

Thought> let it float on by, think about something else > thought cycles back again > let it float on by without judgement and think of something else> thought recurs > let it float on by without judging the thought AND without passing judgement on yourself or getting upset that it keeps coming back again and again. Stay calm. Let it be. Accept its presence without judgement or engagement. Focus on something else... and on, and on.

I've lain awake at night in the past where a thought has kept cycling round for hours on end. These days I have a list of go-to topics I can use for refocusing. Within seconds of an unwanted thought entering my brain I just switch my thinking to one of my pre-chosen, no-judgement-attached topics and another 2 seconds later I've forgotten the intrusive thought was ever there. It just took a LOT of practise, and refocusing without allowing any self-judgement or frustration every 10 seconds at first, to get to where I'm at now.

 

Ditching their 'autopilot' judgement thinking is a hard step for a lot of people.  As children we're constantly trying to win the approval of our parents and do the right thing, so it becomes an ingrained habit to label everything as either good or bad, right or wrong. And I do mean everything! Every thought, every feeling, every action, every inaction... We learn to be our own judge and jury, a little voice in your head passing judgement on every second of your life.

As we get older we're more able to try out different kinds of thinking such as acceptance, open-mindedness, playfulness, logic...

and our emotional range increases - amusement, serenity, self-compassion, gratitude... and so on.

Applying a judgement of some kind to everything is just habit. And like any habit that has outgrown its usefulness can be replaced with something healthier through practise, practise, practise.

 

Consistency is key to faster change. If you apply the new thinking and approach every time you catch yourself passing judgement or getting caught up in ruminations and analysis about 'that's bad' then being non-judgemental soon becomes the 'new habit' and your new autopilot response.

Just keep trying. ALWAYS without passing judgement on yourself . No labelling it as 'that was a failure', 'I'm no good at this'  etc. Just,

'Ok, duly noted, I got a bit judgemental this time. I'll just try again next time.'

 

Hope that helps explain what you're trying to do with your CBT!

 

 

Hi pal, thanks alot for your time and detailed message, it is appreciated massively.

I have used the information you mentioned to help tighten up my understanding and process so fingers crossed it helps providing I adopt it properly and consistently.

So I have a follow up question so giving the cbt model suggests to notice an intrusive thought arising and not allow it to create a follow up compulsion, but then if an instance such as rumination does occur one should cut it off and redirect ones attention, my question is is that I often find that my intrusive thoughts can intercept a normal train of thought part way through and shape the train of thought thereafter, with this said if I genuinly need to think a train of thought of which is or could be intercepted at times it can therfor be inconvienient to have to forget an important train of thought that I may need to adress and follow the step of refocusing away, I dont seem to see this adressed often and so I want to ask if this is something you have experienced yourself and do you know what then know what the best approach would be to combat this?

Many thanks

Edited February 26 by confusedcd
Spelling

[snowbear]

7 hours ago, confusedcd said:

my question is is that I often find that my intrusive thoughts can intercept a normal train of thought part way through and shape the train of thought thereafter, with this said if I genuinly need to think a train of thought of which is or could be intercepted at times it can therfor be inconvienient to have to forget an important train of thought that I may need to adress and follow the step of refocusing away, I dont seem to see this adressed often and so I want to ask if this is something you have experienced yourself and do you know what then know what the best approach would be to combat this?

Ok, I think I get what you mean. Just to be sure we're talking about the same thing I'll use an example. If I've misunderstood what you're asking then let me know with an example of your own.

So...

Let's say your train of thought is 'It's bin day tomorrow, I need to sort the recycling and put the bins out.'  (Wanted train of thought that requires action.)

Then you're hit by an intrusive thought, 'What if I [insert OCD thought] while putting the bins out! 'This' might happen   'that' might happen . What if I die, what if I get arrested and sent to prison, what if... and you're off on one, ruminating and catastrophising before you catch yourself on.

CBT tells you to notice these intrusive thoughts, halt the ruminations and refocus away.

So you'd refocus back to the train of thought you wanted to think. You might say to yourself,  'Forget all the what ifs. Right now, focus on getting the recycling sorted and stay focused until after I've put the bins out.'

You might also use the mindfulness idea of 'Stay in the moment' to keep the ruminations at bay while you work through the task at hand.

Is that what you meant?

In other words refocusing doesn't have to be 'Change the topic completely', only 'Keep to the core topic, or whatever needs sorting, and don't allow yourself to get distracted by the intrusive thoughts.'

[Handy]

They say we are not our thoughts. What this means is that we are a person having these thoughts, but they are not us. 

[Garfield]

On 24/02/2024 at 00:48, Handy said:

Intrusive thoughts are thoughts you don't put there yourself, so one sees & ignores them.

So who puts the thoughts there ?

[confusedcd]

On 26/02/2024 at 20:09, snowbear said:

Ok, I think I get what you mean. Just to be sure we're talking about the same thing I'll use an example. If I've misunderstood what you're asking then let me know with an example of your own.

So...

Let's say your train of thought is 'It's bin day tomorrow, I need to sort the recycling and put the bins out.'  (Wanted train of thought that requires action.)

Then you're hit by an intrusive thought, 'What if I [insert OCD thought] while putting the bins out! 'This' might happen   'that' might happen . What if I die, what if I get arrested and sent to prison, what if... and you're off on one, ruminating and catastrophising before you catch yourself on.

CBT tells you to notice these intrusive thoughts, halt the ruminations and refocus away.

So you'd refocus back to the train of thought you wanted to think. You might say to yourself,  'Forget all the what ifs. Right now, focus on getting the recycling sorted and stay focused until after I've put the bins out.'

You might also use the mindfulness idea of 'Stay in the moment' to keep the ruminations at bay while you work through the task at hand.

Is that what you meant?

In other words refocusing doesn't have to be 'Change the topic completely', only 'Keep to the core topic, or whatever needs sorting, and don't allow yourself to get distracted by the intrusive thoughts.'

Thanks for your response, and sorry mine took a while I've been struggling alot with my Pure O.

I understand what you mean regarding your post, but when an intrusive thoughts cuts in part way through a normal train of thought and shapes it into an innacurate narritive sometimes I feel only awarness of the innacuracy through understanding is what keep me safe.

Either way I still find myself further confused with the method to take, I understand cbt involves a process but the method of which ultimately seems to involve a person trying not to engage with a thought, couldn't this be misconstrude by the brain as the thought being something that therfore that ultimately needs avoiding, of which naturally a person will assign fear on the incoming thought as it arises due to the fact that we are ultimately trying to deminish it in time and so in a way we are still telling ourselves the notion that such a thought coming in is not good and is part of a problem and because of this it will be subconcously hard to accept as part of the acceptance part of the method.

Ultimatly the aim of the technique is almost risistive in nature, I know I am probably still missing something but the technique seems extreamly hard to adopt and really hard to apply to each individual.

Also when I have an intrusive thought that comes in for a second of two it feels like an absolute truth and therfore fear and anxiety proceed, I sometimes use quick rational to say it is stupid as I worry that the content if left unanswered or un-rationalised over a long amount of time maybe become a believed narritive.

sorry for the barrage of questions I am in a talk therapy but as you can see Cbt/Erp for me atleast throws up more questions than it does answers to my problem. 

 

[snowbear]

8 hours ago, confusedcd said:

sometimes I feel only awarness of the innacuracy through understanding is what keep me safe

If by that you mean engaging with it long enough to recognise it as an intrusive thought, OCD rubbish etc before dismissing it and getting on with what you were doing - great!

If by that you mean analysing the thought, working through it 'logically' and 'sorting it/trying to fix the problem' before dismissing it - that's compulsion.

The more you dismiss intrusive thoughts without checking you're safe, the sooner you'll start to feel safe without working through them. It's one of those cart-before-the-horse things where if you try to feel safe first you're trapping yourself into sticking with the status quo (OCD response.)

 

8 hours ago, confusedcd said:

the method of which ultimately seems to involve a person trying not to engage with a thought, couldn't this be misconstrude by the brain as the thought being something that therfore that ultimately needs avoiding, of which naturally a person will assign fear on the incoming thought as it arises due to the fact that we are ultimately trying to deminish it in time and so in a way we are still telling ourselves the notion that such a thought coming in is not good and is part of a problem and because of this it will be subconcously hard to accept as part of the acceptance part of the method.

Maybe a bit of overthinking going on here?

When you dismiss an intrusive thought without engaging, you send your brain the message 'Such thoughts are irrelevant, don't bother me with them' and you reinforce that message through your behaviour -  allowing the thought to be there without trying to push it away or reacting to it, while getting on with more important things.

That's not avoidance. Avoidance is where you push the thought away and react every time it resists being dismissed or crops up again. Reacting to the thought sends the message 'this is important' (whether that's important to avoid or important to fix.) Allowing the thought to be present without engaging with it  sends the message 'this is neither threatening, nor important.'

 

8 hours ago, confusedcd said:

the aim of the technique is almost risistive in nature, I know I am probably still missing something but the technique seems extreamly hard to adopt and really hard to apply

If you go straight to behavioural therapy (ERP) then the technique is all about resisting - and for some people that's very hard.

But the cognitive technique I'm teaching you here is the opposite of resisting - it's allowing (to be present) without reacting. 

If that is a struggle it's because some part of you is choosing to engage with the thought. You want to 'check it out' more than you want to ignore it.

 

8 hours ago, confusedcd said:

when I have an intrusive thought that comes in for a second of two it feels like an absolute truth and therfore fear and anxiety proceed, I sometimes use quick rational to say it is stupid as I worry that the content if left unanswered or un-rationalised over a long amount of time maybe become a believed narritive.

Of course it feels like an absolute truth - that's why we have OCD! We get caught out by that initial believability and set off on the path of compulsions because it feels so believable and real.

Using a quick 'that's stupid' and letting it go at that's absolutely fine. It's part of training yourself to recognise an intrusive thought when it happens.

But if you catch yourself feeling desperate and repeating 'it's just nonsense, stop panicking,' over and over   then it's become a reassurance compulsion.

Don't get too caught up in 'getting the technique perfect'. Just make a start, see how you get on and if problems or difficulties arise we can look at solutions as we go.

[Zelda]

On 23/02/2024 at 13:38, PolarBear said:

Personally, I am against Theory A/B. Two reasons. You're asked to figure out which is more likely. OCD sufferers automatically default to the worst case scenario. Sufferers will often choose the most pessimistic view, even if the likelihood is remote.

Secondly, Theory A/B requires you to analyze the thought and figure out two opposing scenarios. This is engaging with obsessions, the one thing sufferers need to not do.

I find simpler is better. You are hit with an obsession. Think, I'm not going to deal with that right now. Turn your attention onto something else. If you can get into the habit of foing that, you will be further ahead.

 

I agree that it may not be helpful for engaging with each intrusive thought, however when I had a low sense of acceptance that my thinking was OCD related this was a helpful exercise. In this sense, it was a way into exposure and other tools as it helped me to question the underlying premise of my behaviours at the time - that I was a dangerous person, that I would ruin everything if i didn’t respond to the thoughts. Theory b here being I am a careful person etc… much more evidence for this. Broadly speaking I come back to this message all the time when struggling.
 

 However, I agree it can be unhelpful for dealing with the thoughts themselves - for example when it comes to calculating the risk of a fire or spreading illness I am rubbish, and A/B only starts me ruminating more! 

[Zelda]

On 23/02/2024 at 13:38, PolarBear said:

Personally, I am against Theory A/B. Two reasons. You're asked to figure out which is more likely. OCD sufferers automatically default to the worst case scenario. Sufferers will often choose the most pessimistic view, even if the likelihood is remote.

Secondly, Theory A/B requires you to analyze the thought and figure out two opposing scenarios. This is engaging with obsessions, the one thing sufferers need to not do.

I find simpler is better. You are hit with an obsession. Think, I'm not going to deal with that right now. Turn your attention onto something else. If you can get into the habit of foing that, you will be further ahead.

 

I agree that it may not be helpful for engaging with each intrusive thought, however when I had a low sense of acceptance that my thinking was OCD related this was a helpful exercise. In this sense, it was a way into exposure and other tools as it helped me to question the underlying premise of my behaviours at the time - that I was a dangerous person, that I would ruin everything if i didn’t respond to the thoughts. Theory b here being I am a careful person etc… much more evidence for this. Broadly speaking I come back to this message all the time when struggling.
 

 However, I agree it can be unhelpful for dealing with the thoughts themselves - for example when it comes to calculating the risk of a fire or spreading illness I am rubbish, and A/B only starts me ruminating more!