 The Role of Thought-Action Fusion in the Development and Maintenance of OCDWritten by Hillary Gorin, PhD, LCPEveryone has ‘intrusive’ thoughts that are odd and even disturbing, inappropriate, or taboo, at times (Grayson, 2014). Individuals without obsessive-compulsive disorder (OCD) recognize that intrusive thoughts, or thoughts we are not consciously producing that just pop into our heads, are not anything to be alarmed by and don’t need to be interpreted as potentially dangerous. They might think to themselves, “well that was a strange thought” and move on with their day. However, someone with OCD will be inclined to react to an intrusive thought with fear, panic, and shame and interpret the thoughts as potentially meaningful and dangerous. They might alternatively say “Oh my, that is awful, I need to get that out of my head, would I act on this thought? Why am I having this terrible thought? I must be a monster.” They then may assume that having this terrible thought MUST mean that they will act on the thought and that every thought will lead to action, and therefore they must do something to prevent the terrible thing from happening (i.e., compulsive behavior).
As referenced in a previous blog written by Johanna Younce, MA (see OCD and “Unacceptable” Intrusive Thoughts - You are Not Alone - OakHeart, Center for Counseling (oakheartcenter.com)), a study conducted on 777 students from 6 continents (13 different countries), found that 94 percent of people without OCD have the same of intrusive and unwanted thoughts, images and/or impulses that someone with OCD has (Moulding et al., 2014). So why is it that individuals with OCD have such a strong reaction to these intrusive thoughts when someone without OCD does not react really at all? Well, OCD is sometimes referred to as a thought phobia. In other words, individuals with OCD believe that their thoughts are very powerful and they fear having certain thoughts due to the belief that every thought is significant. Most of us tend to believe that thinking positively will result in positive outcomes and thinking negatively will result in negative outcomes. However, we do not think this in a literal sense. We believe that negative thinking isn’t great for our well-being. Conversely, someone with OCD might believe that negative, intrusive and disturbing thoughts (that are highly normative) will likely result in negative outcomes. In this sense, individuals with OCD tend to believe that whatever thought comes to mind will result in action or result in very real consequences. I think we all sometimes wish our thoughts were that powerful. Wishing for a billion dollars would then result in financial prosperity. Wishing for world peace would result in world peace. Unfortunately, individuals with OCD don’t just believe positive thoughts will result in positive outcomes. They also believe the alternative. I think we can all recognize that this belief would be challenging and quite distressing. If every intrusive thought that pops into someone’s head could lead to an actual outcome in the world, our world would be a scary place! For example, when we are running late and the car in front of us fails to see that the light turned green, many people likely experience anger followed by intrusive thoughts about the person in that car. Individuals with OCD tend to believe, because they had that bad thought, there is an increased likelihood that the person in the car ahead will actually experience harm. Thought-action fusion reflects the distorted thinking described above that is often characteristic of OCD: This distortion suggests, because I think it, it must be so (Grayson, 2014). Because we think many ridiculous thoughts throughout the day, this psychological phenomenon causes significant distress in individuals with OCD. For this reason, the most effective treatment for OCD is exposure and response prevention (ERP), which entails exposing someone to a scary thought (ones that they are already having) and then refraining from trying to undo the thought via a compulsion. Studies have been conducted to understand the neurobiology of thought-action fusion. Researchers have identified areas of the brain that are likely involved, including the inferior orbitofrontal gyrus, several prefrontal cortex regions, the insula, and the globus pallidus (Lee et al., 2021). Lee and colleagues (2021) found that the superior and middle frontal gyri (dlPFC), medial prefrontal cortex (PFC), and inferior parietal lobule were correlated with OCD symptoms. A recent meta-analysis showed that all of these regions were associated with OCD in functional imaging studies (Rasgon et al., 2017). For instance, individuals with OCD were found to have abnormalities in the insula (associated with disgust) and the unacceptable thought dimension of the dorsolateral and dorsomedial prefrontal cortex (PFC; associated with cognitive control; Rasgon et al., 2017; as cited in Lee et al., 2021). This neurobiology of thought-action fusion exhibits that OCD is a medical/ biological condition and therefore requires treatment that will assist with training the brain, which is the goal of exposure and response prevention treatment. ERP treatment aims to help you either reduce the frequency of intrusive thoughts or learn to recognize that most thoughts are just thoughts without much or any meaning. By intentionally provoking or “sitting with” your scary or distressing thoughts in exposure-based therapy, you can start to learn that intrusive thoughts do not lead to action and that thought-action fusion is simply a thinking error. This is a major goal of treatment. An additional goal in treatment is to realize that a thought is just a thought; it means nothing without intentional action. For instance, one exercise that I sometimes have my patients participate in is to have the thought “stand up” for one minute. I then tell them, “now actually stand up.” To actually stand up, requires intention. Intended action requires more than a thought. The goal of treatment is to see that you are more than your thoughts. We are here to help you too start to believe this. If you are interested in counseling, call OakHeart at 630-570-0050 or 779-201-6440 or email us at [email protected]. We have counselors, psychologists, and social workers available to help you at one of our locations in North Aurora, IL, Sycamore, IL, and/or via Telehealth Online Therapy Services serving Kane County, DeKalb County, Dupage County, and beyond. References Abramowitz, J. S., Deacon, B. J., & Whiteside, S. P. H. (2019). Exposure therapy for anxiety: Principles and practice (2nd Ed.). The Guilford Press. Foa, E. B., Steketee, G. S., & Rothbaum, B. O. (1989). Behavioral/cognitive conceptualizations of posttraumatic stress disorder. Behavior Therapy, 20, 155–176. https://doi.org/10.1016/S0005-7894(89)80067-X Grayson, J. G. (2014). Freedom from Obsessive-Compulsive Disorder: A personalized recovery program for living with uncertainty. Berkley Books. Krypotos, A-M., Effting, M., Kindt, M., & Beckers, T. (2015). Avoidance learning: A review of theoretical models and recent developments. Frontiers of Behavioral Neuroscience, 9(189), 1-16. https://doi.org/10.3389/fnbeh.2015.00189 Lee, S. W., Cha, H., Jang, T. Y., Kim, E., Song, H., Chang, Y., & Lee., S. J. (2021). The neural correlates of positive versus negative thought-action fusion in healthy young adults. Clinical Psychopharmacology and Neuroscience, 19(4): 628-639. https://doi.org/10.9758/cpn.2021.19.4.628 Moulding, R., Coles, M. E., Abramowitz, J. S., Alcolado. G. M., et al. (2014). Part 2. They scare because we care: The relationship between obsessive intrusive thoughts and appraisals and control strategies across 15 cities. Journal of Obsessive-Compulsive and Related Disorders, 3(3), 280-291. https://doi.org/10.1016/j.jocrd.2014.02.006 Rasgon, A., Lee, W.H., Leibu, E., Laird, A., Glahn, D., Goodman, W., et al. (2017). Neural correlates of affective and non-affective cognition in obsessive compulsive disorder: a meta-analysis of functional imaging studies. Eur Psychiatry, 46, 25–32. https://doi.org/10.1016/j.eurpsy.2017.08.001. Resick, P. A., Monson, C. M., & Chard, K. M. (2014). Cognitive processing therapy: Veteran/military version: Therapist’s manual. Department of Veterans Affairs. Comments are closed.
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