Unwanted, strange thoughts are something that we will all experience at some point. Your brain might suddenly display an unusual or disturbing mental picture, or create an uncomfortable mental impulse. Most people experience these mental occurrences as typical brain activity that fades away naturally. These thoughts can evolve into persistent and disturbing patterns for some individuals.
Obsessive-Compulsive Disorder (OCD) is a condition that can cause intrusive thoughts and other distressing symptoms. While this condition can be challenging to fully understand, the good news is that it is treatable. Evidence-based therapeutic techniques can help you manage OCD symptoms and work toward improved well-being.
Our team of psychologists at Laburnum Psychology provides evidence-based care to patients with Obsessive-Compulsive Disorder (OCD). This article will define intrusive thoughts and explain OCD cycles while discussing evidence-based therapy methods.
What are Intrusive Thoughts and Obsessive-Compulsive Disorder (OCD)?
It can be helpful to understand that intrusive thoughts can appear naturally in everyone. Our minds can receive unwanted thoughts, images, and urges. These can appear unexpectedly and in many cases, may contradict our personal values and beliefs.
Intrusive thoughts can take various forms, including:
- Wishes to harm others
- Concerns about contamination
- Religious offenses
- Sexual taboos
The thoughts that people experience do not indicate their personal character or hidden desires. People with OCD react differently to others when they experience intrusive thoughts.
The main features of OCD include two key components:
Obsessions: Obsessions refer to the intrusive mental content which people experience repeatedly and persistently. The person with OCD will usually find it very difficult to dismiss their intrusive thoughts because they assign high importance and anxiety to them. This, in turn, produces severe distress.
Compulsions: People with OCD perform compulsions as mental or physical actions or rituals, such as:
- Handwashing
- Checking activities
- Silent word repetition
- Counting or prayer
People perform compulsions with a sense that it will prevent the feared situations from occurring and minimise obsession-related anxiety.
Some individuals who live with OCD can spend up to numerous hours per day experiencing obsessions and performing rituals. This can be very undermining of ordinary life functions and can be highly impairing. For others, symptoms may be relatively mild, and while it may not be greatly impairing of life function, it may nevertheless be distressing.
The Vicious Cycle of Obsessions and Compulsions
The core nature of OCD depends on a strong pattern which repeats itself. A key first step can involve psychoeducation – in other words, learning about the psychological mechanisms that establish and maintain the patterns.
- Obsessions: Intense anxiety, fear, or disgust arise when an intrusive thought appears. For example, touching a ‘dirty’ surface may lead to thoughts of contamination.
- Anxiety: A state of heightened distress is triggered by the intrusive thoughts, images, or urges that are experienced as threatening or unacceptable. This distress creates a strong sense of urgency to reduce the perceived risk or relieve the discomfort.
- Compulsions: The anxiety relief comes from performing a compulsion. The person may start washing their hands repeatedly over multiple minutes, for example. The nature of compulsions can be many and varied (washing, counting, touching, reciting words or phrases, eye movements, twitches and other bodily movements, etc). Compulsions can be overt behaviours, or internal processes such as counting.
- Temporary Relief: Compulsions create a momentary feeling of relief. This process can bring temporary relief, however it also serves to reinforce the pattern, thus strengthening the anxiety associated with the obsession and the perceived need to perform compulsions to reduce the sense of threat and anxiety.
The brain receives an incorrect signal after performing the compulsion, which states ‘the action brought safety’. Each repetition of this cycle makes the link between obsession and compulsion stronger, thus making intrusive thoughts more intense in their next occurrence. The cycle progresses deeper and develops stronger power as time passes.
Cognitive Behavioural Therapy (CBT) for OCD
Cognitive Behavioural Therapy (CBT) is an evidence-based method for treating Obsessive Compulsive Disorder. CBT addresses the cycle by focusing on two essential elements: thinking patterns (cognitive) and compulsive behaviours (behavioural).
Through the cognitive aspect of CBT, you will learn to assess and dispute the beliefs you develop about your intrusive thoughts. A therapist will help you learn that:
- Having a thought is not the same as acting on it
- Thoughts will always appear unexpectedly, but you can work to maintain control over how you choose to respond to them
- The intrusive thoughts you experience do not shape your identity or personal qualities
- By transforming the way you relate and respond to your thoughts, you can decrease the anxiety they cause
Exposure and Response Prevention (ERP) – An Evidence-Based Approach
The behavioural component of CBT for OCD includes a specific approach known as Exposure and Response Prevention (ERP), which is a well-researched treatment option. When performed under the guidance of an experienced therapist, can be beneficial.
Exposure: The first step consists of systematically facing the triggers which activate your obsessions and related anxiety. A person with contamination fears can begin their treatment by touching triggering surface, systematically moving up a scale of difficulty. The therapist collaborates with you throughout this process while respecting your chosen comfort level.
Response Prevention: Following exposure to the triggering stimuli you will actively resist the urge to perform your compulsion. It is important to allow yourself to experience the anxiety while resisting the urge to perform the compulsions / rituals.
When you resist performing compulsions during exposure situations, your brain will process key learnings, enabling your anxiety to decrease through habituation, while also recognising the the consequences never occur.
This approach can disrupt the OCD pattern, and with practice, many people can experience a meaningful reduction in obsessions and compulsions.
The International OCD Foundation recognises ERP as the gold standard psychological treatment for OCD, with extensive research supporting its effectiveness.
Mindfulness and Acceptance-Based Approaches
Other therapeutic methods alongside ERP are also supported by research evidence. Acceptance and Commitment Therapy (ACT) and other mindfulness-based approaches assist you to transform how you view intrusive thoughts through skill-building.
Mindfulness is a practice that teaches you to observe intrusive thoughts with natural curiosity instead of fighting them or attempting to dismiss them (which tends to make them more powerful). Through ACT, you can come to see that intrusive thoughts can exist as innocuous mental processes similar to passing sky clouds, instead of commands that require immediate action.
The approach can assist to disconnect from the battle, so you can focus on navigating life based on your core values rather than obsessions and compulsions – even when disturbing thoughts occur.
The Importance of a Supportive Therapeutic Relationship
A positive therapeutic relationship is a key factor in OCD treatment. A qualified therapist provides both technical expertise as well as an empathetic, supportive environment. Therapy needs to be a safe, non-judgemental space for full understanding and complete support.
Our team at Laburnum Psychology work to build strong collaborative partnerships with all of our clients. We have clinicians on our team who possess substantial experience delivering CBT and ERP therapy for OCD. Our team will work alongside you throughout the treatment process, supporting you as you work to manage challenges.
Intrusive thoughts and OCD can create feelings of isolation, but you are not alone. Evidence-based treatments are available to help you work toward significant relief from symptoms.
We provide OCD psychology services in Melbourne for clients who need assistance. Our team can help you through the process of treatment – call (03) 9877 9178 or use our online form to find out more.
