“I just don’t get why everything has to be a fight with you…”
Conquer Intrusive Thoughts & Obsessive Compulsive Disorder
Ever had your computer get into a loop? We’ve all had that frustrating experience, often accompanied by a frozen cursor or a spinning beachball of death, where your laptop locks up as it tries again and again to do something it never manages to complete.
Imagine, just for a moment, that the computer is actually your own mind doing the same behaviour. That’s the experience of Intrusive Thoughts & Obsessive Compulsive Disorder.
If it’s just your computer, you sit there in silent irritation for a few minutes, hoping you saved your work. Then you take drastic action – usually by force quitting the application or, worse yet, the entire computer.
If only it were possible to force quit and reboot your mind!
Conquer Intrusive Thoughts & Obsessive Compulsive Disorder
Modern psychology tends to treat intrusive and obsessive thoughts as unique and different subjects. On the surface, this seems relatively reasonable. After all, OCD is a diagnosable disorder, while some level of intrusive thoughts are common to most of humanity. But, just because we have hung a diagnostic code on one set of symptoms (and thus can bill treatment for such to an insurance company) does not, as so many have implied, render a collection of most of the same issues some harmless “human trick” we should just ignore.
The suffering people experience from intrusive thoughts may not be as intense as full-blown OCD, but it’s very real and can be extremely debilitating. Taking those thoughts seriously can often prevent what may eventually become a much more severe mental disorder.
So what is OCD? What does it stand for, and what are the symptoms?
Obsessive-Compulsive Disorder Symptoms: OCD is a diagnosable mental disorder where a person repeatedly experiences specific unwanted and distressing thoughts they feel unable to control and which feel like they do not fit with their sense of self. The DSM 5 Obsessive Compulsive Disorder criteria state that these thoughts often result in the repeated performance of compulsive behaviours. Usually, the person will readily admit that those behaviours make little to no sense, but they feel unable to stop for more than a short time.
How does that differ from Intrusive Thoughts?
Intrusive thoughts are involuntary and unwelcome ideas, images or unpleasant thoughts that create distress and feel difficult to control for more than short periods. The thoughts are often highly persistent, associated with memories or worries and create anxiety that can lead to a sense of paralysis in life or relationships. Research has shown that virtually every person on the planet has experienced them.
Really, the above Obsessive-Compulsive Disorder definition and the definition of Intrusive Thought differ in only two meaningful ways:
(1). People diagnosed with obsessive thoughts are less able to ignore them than those who have “only” been diagnosed with intrusive thoughts.
(2). People who have been formally diagnosed with OCD also exhibit obsessive-compulsive behaviours.
Yes, that’s it!
Intrusive Thoughts are nothing more than less severe Obsessive Thoughts and need to be seen as just as essential to address.
Understanding OCD Intrusive Thoughts:
There are many different types of OCD, and the list of obsessive behaviors is nearly endless. Still, the obsessive thoughts themselves generally fall into a much more limited set of categories:
- Pure Obsessional OCD – No visible compulsions.
- Contamination OCD – Fear of getting sick or of germs.
- Harm OCD – Becoming overwhelmed by thoughts of violence or damage.
- Pedophilia OCD – Not a desire for children, unwanted thoughts about such.
- Sexual Orientation OCD – Obsessions about being gay or lesbian.
- Just Right OCD – a vague sense that something isn’t right.
- Relationship OCD – Intolerance for typical intimate uncertainty.
- Religious or Scrupulous OCD – Fear of moral or religious failure.
What causes OCD in adults?
OCD symptoms in adult men and women, contrary to public opinion, rarely emerge out of nowhere. There is some evidence of genetic factors playing a role. Some research has found obsessional thinking can appear after recovery from infections or as a side effect of certain medications or street drugs. However, most research suggests that environmental factors such as child abuse, neglect or shame, trauma and other highly stressful events play a much more foundational role.
That’s a diplomatic way of saying that, while we may have been born with a predisposition for OCD, Intrusive or Obsessive thoughts are actually our brain seeking relief from shame, emotional pain and how trauma brands us with an identity based on what was done to us. The vast majority of those seeking treatment for OCD have a history of what are termed ACEs (Adverse Childhood Events), and most researchers regard them as at least a trigger. It could be said that intrusive or obsessive thoughts are a Smart-Person’s addiction where repetitive thoughts and compulsive behaviors are used to avoid more distressing memories.
Where does OCD come from?
One of the most common obsessive thoughts that plague people struggling with this disorder is the fear that they have caused harm to someone or something else. Many people will stay up at night worrying that that strange bump in the road they felt on their way home was caused by having run over a fawn, rabbit, or other woodland creature.
Conversely, many people enjoy hunting. They spend much of the year acquiring skill with firearms and eagerly await the dawn of hunting season, where they head off into the woods to hunt for fresh venison.
It almost goes without saying that these are NOT the same person!
Intrusive or obsessional thoughts always emerge from our value systems – specifically, our deepest and most core values. These thoughts are disturbing to us because they are attached to things that are deeply meaningful to us. We all have unwanted ideas continually flowing through our minds, but it is only the ones that go against the values we hold most dear that are experienced as intrusive and cause us to feel fear, shame or disgust. Because we naturally have an intense adverse reaction to thoughts and ideas that run contrary to who we are, we end up reinforcing the thinking pattern through the intensity of emotions we feel.
Fear, shame and disgust are our brain’s way of making us pay attention to something so that we do everything in our power to avoid it in the future. That works great if it helps us avoid a pile of rotting garbage on our favourite walking path, but not nearly as well when it comes to our inner worlds. When we suppress our emotions and run away from our thoughts, we are repeatedly teaching our brains that those thoughts and feelings are dangerous and to be feared. And, because our avoidance does generate a short term sense of relief, we also reinforce the patterns of mental or physical avoidance themselves.
However, because the intrusive or obsessive thoughts do not define reality, trying to change our external world to fix an internal problem never works in the long term. As soon as we pull back from one set of triggers, smaller and smaller things start to trigger us until our lives have become so tiny that all we are left with is our thoughts as triggers – and those can always keep growing. For obvious reasons, OCD and relationship problems are rather strongly correlated with each other due to how small they can cause our lives to become.
OCD is an anxiety disorder, not a form of prophecy. Healing involves dealing with the anxiety instead of avoiding the threats and disasters it causes us to perceive. We are up against our thoughts, how we experience them and the panic they produce, not a menacing reality.
Is there any effective treatment for OCD?
Yes, there is! Intrusive Thoughts and Obsessive Compulsive Disorder are addressed in three primary ways:
(1). Short term treatment with psychoactive medications such as antidepressants (generally SSRIs.)
(2). Cognitive Behavioural Therapy/Exposure Therapy with Response Prevention.
(3). Internal Family Systems Therapy and/or Emotion-Focused Therapy for trauma.
The various Calgary counselling services generally tend to focus on the last two. Alberta’s medical community seems to regard Selective Serotonin Reuptake Inhibitors as being a more effective cure. However, research consistently shows that the best OCD treatment for children and adults involves ALL of the above.
Build your treatment plan for Intrusive Thoughts and OCD:
Effective medications for Obsessive Compulsive Disorder:
One of the most common questions I get asked in this area is, “What is the most effective SSRI for OCD?” Because OCD is an anxiety disorder, nearly everything about addressing it also triggers anxiety and taking medication is usually at the top of the list. People are looking for security, afraid of having to try a whole bunch of drugs and fearful that they will be given something that doesn’t work or, worse yet, harms them. Unfortunately, that is a challenging question to answer.
We have a diversity of medications in this area for a simple reason: people are different. Medicine that works well in one gender can sometimes work poorly in the other. Some drugs work better for younger vs older people, and other drugs are specific to certain life situations. For example, one of the most commonly prescribed SSRIs is Zoloft – a powerful antidepressant. It’s quite widely dispensed because it has been proven to be safe for use during pregnancy, and, as a result, most women of childbearing age are prescribed it. Does that mean it’s necessarily the best drug for every woman? No, but it works well, and it definitely avoids certain risks and legal liabilities.
Picking the best SSRI for OCD is an incredibly complex mental juggling act. Even many highly skilled physicians feel so much discomfort with it that they will immediately refer their OCD patients to a psychiatrist rather than handle it themselves. But, even if I can’t make any suggestions, the question is still important. Being informed about what is going into your body does matter. Perhaps the best help I can offer is to provide you with an OCD medications list to research and discuss with your doctor.
The U.S. Food and Drug Administration (FDA) has approved several medications to treat OCD, which include:
- Anafranil (Clomipramine) for children & adults ten years and older
- Prozac (Fluoxetine) for children & adults seven years and older
- Paxil, also called Pexeva (Paroxetine) for adults only
- Zoloft (Sertraline) for children & adults six years and older
- Luvox (Fluvoxamine) for children & adults eight years and older
(Each of the above links to Wikipedia will open in a new page so you can research these drugs without losing your place in this article.)
Typically, doctors start at the lowest possible dosage and may use multiple medications to avoid higher dosages. It is not uncommon to have to try a number of different drugs before you experience the benefits you desire without intolerable side effects. With all medications, it’s essential to talk with your physician about side effects and interactions in addition to doing your research.
Exposure Response Therapy for OCD and Intrusive Thoughts:
Once a medication has made the obsessive thoughts seem less overwhelming, the next step is facing the anxiety (instead of running from it) and learning to stay calm. This type of therapy is called Exposure with Response Prevention, and it is highly effective at restoring control over at least the behavioural part of the problem.
In an ideal world, we would somehow find a way to face all of those anxiety-inducing experiences in real life or “in vivo.” However, in vivo exposure therapy is often difficult, costly and even impossible to accomplish. For example, how would anyone face their fear of flying in an aircraft in vivo enough times to reduce their anxiety without requiring bankruptcy protection from the courts? Would it really be a good idea to not wash your hands after touching a doorknob in an age of COVID-19 just to get over your obsessive thoughts about germs?
For this reason, most exposure therapy is done in other ways called Imaginal Exposure Therapy. One of the more effective Imaginal Exposure Therapies is a hybrid of Cognitive Behavioral Therapy and Mindfulness-Based Cognitive Therapy known as Acceptance and Commitment Therapy (ACT.) When we feel fear, shame or disgust, it’s only natural to try to avoid that which causes those feelings in the future. However, when we engage in ritual behaviours that reduce fear, shame and disgust, we strengthen both the response and the actions. It’s a process called negative reinforcement wherein the brain gets trapped in a loop where the rituals that reduce unpleasant feelings also become how the brain is trained to feel them. ACT reverses negative reinforcement.
ACT therapy for OCD is a form of treatment based on facing fears and your internal responses to them. For all forms of anxiety and fear reactions, you have to face your fears to reduce them. ACT is a means of accomplishing this mostly within your own mind. Essentially, ACT teaches you how to cure OCD yourself by giving you the tools to be mentally present to those unpleasant feelings while regaining control of your internal responses. Acceptance and Commitment Therapy doesn’t eliminate the mishandled emotions or stressors that create the problem, and it usually cannot completely eliminate the intrusive thinking. However, it can allow you to decrease the thoughts to the point that they no longer interfere with your life. In conjunction with medication, it can create a place of sufficient internal stability that you can go to work on fixing the deeper problems that play into this kind of thinking.
Therapy techniques for OCD and Intrusive Thoughts:
Reactive mood disorders nearly always result from mishandling and repressing our emotions. Our western world regards emotions as a problem to be medicated and sees the parts of us feeling such as needing to be hidden away from polite company. Just watch our commercials or listen to the things we say to each other: “Feeling down, take a pill.” Feeling anxious? You need to talk with your doctor about _______.” Experiencing even the slightest pain? You need an Advil or Tylenol.” “Need a pick me up? Eat this sugary treat.” “Need to get over someone? The best way to get over someone is to get under someone else.” The message is straightforward: “Do ANYTHING but listen to your body or emotions and attend to what they are telling you.”
In many ways, we counsellors and psychotherapists are often just as guilty of the above. Many of the Calgary counselling services addressing Obsessive Compulsive Disorder and Intrusive Thoughts seem to regard exposure therapy as a cure rather than just a means to an end. When a Calgary Christian Counsellor or Registered Psychologist puts up a website in this area that doesn’t very clearly say that OCD is rooted in how you treat your heart, they too are promising yet another pill that only makes the symptoms go away.
Our emotions and physical responses or sensations exist for a reason. Like the gauges, indicators, and so-called idiot-lights on our cars’ dashboards, our internal responses tell us what is going on under the hoods of our persons. We ignore them at our peril. Competent therapy for OCD in children and adults must be rooted in understanding how we repress emotions. It needs to teach us to listen to our feelings, and it needs to help us take steps that change our worlds as a result of what we learn from those emotions.
Because OCD and Intrusive Thoughts are so profoundly connected to trauma, one of the most effective means of accomplishing this third element is called Internal Family Systems Therapy (IFS.) In the late 1980s, Dr. Richard C. Schwartz developed this uniquely integrated approach to individual psychotherapy and trauma therapy that combines systems theory with the awareness that the human mind is made up of discrete subpersonalities. His research found that these different parts of the mind are much more separate and distinct than was previously realized and that, as a result of trauma, we tend to push away further or exile the parts of us that were hurt.
They found that those exiled parts were the most involved in the inexplicable and confusing patterns of cognitive behaviour, which are part of many disorders such as Post Traumatic Stress Disorder, Anxiety Disorders (Of which OCD is one) and various kinds of abuse. Since the mid-1990s, when his theories began to be empirically validated, IFS has exploded in popularity spreading to most countries and even becoming the foundation for Pixar’s hit animated movie, Inside Out. In 2015, IFS was fully validated as effective and listed with the National Registry for Evidence-based Programs and Practices.
Internal Family Systems Therapy is a non-time-limited form of client-led and permission-based therapy that teaches people how to be their own therapists and guides them as they learn to communicate with and repurpose the parts of themselves trapped in these destructive loops. Your psychologist is there as a guide, but you do the work of healing so that, in the future, you can continue your own journey of healing. IFS is unique in that our clients determine where each session goes and how fast or slowly it will progress. Especially in severe trauma cases, this brings a deep sense of safety, the reclamation of personal power and a powerful experience of agency and ownership of the process of therapy, which is an essential element of all lasting change.
Are you ready to conquer your Intrusive Thoughts or Obsessive Compulsive Disorder?
Healing them is neither quick, nor is it one dimensional. It requires approaching the problem from medical, behavioural, cognitive, mindful/meditative, emotional, addiction-informed and trauma-based methodologies, and it requires that you take personal ownership of working out your own healing.
The good news is that recovery is possible! Reach out today and begin your journey towards healing both your Obsessive Compulsive Disorder and the relationship problems it has created.