Thought-Action Fusion in OCD

Thought-Action Fusion in OCD

Written by Kat Harris PhD, LCP

Thought-Action Fusion (TAF) is one of the many kinds of cognitive distortions (errors in thinking or interpreting) that individuals with OCD are more likely to make than individuals without OCD. In fact, I believe it is one of the most central cognitive distortions in OCD and must be properly assessed and targeted in treatment. 

​Obsessive-Compulsive Disorder (OCD) is a disorder characterized by obsessions and compulsions. Obsessions are persistent unwanted thoughts, images, impulses, or doubts that are intrusive and distressing. People with OCD tend to interpret these thoughts, images, or impulses as being dangerous, intolerable, or shameful, and therefore do not want to have them. These obsessions tend to elicit feelings of anxiety, fear, disgust, uncertainty, and frustration. Obsessions are repetitive and intrusive and attempts to suppress the thoughts often only make things worse. 

Compulsions are strong urges to engage in a behavior and/or mental act to try to reduce the frequency of, or distress associated with, the obsessions and/or to try to keep the feared outcome(s) from happening. Although compulsions are technically purposeful behaviors or mental acts, many individuals with OCD feel that they do not have control over the compulsions and might not even realize that they are doing them. Attempts to stop or reduce compulsions often result in intense anxiety and distress.

Individuals with OCD misinterpret the meaning of their thoughts, images, and/or urges, engaging in an attribution of significance. Everyone experiences unwanted, bizarre, or senseless intrusive thoughts/images that don’t necessarily have anything to do with anything other than our brains are capable of creating all kinds of random things. People without OCD are able to carry on without assigning meaning to those thoughts. For example, an individual without OCD might have the thought of slapping a random stranger as they pass. This individual without OCD might think to themselves “well that was random” and move on with their day, promptly forgetting about the thought. They know they don’t want to slap anyone and trust their “knowing” that they don’t want to and trust that they won’t. In other words, they understand the thought to be random mental noise and nothing more. However, a person with OCD might have the same exact thought of slapping a stranger as they pass, and instead think to themselves “why did I just have that thought??” “does having that thought mean I might actually slap someone??” “what if having the thought means I am a danger to others??” “If I am having bad thoughts, maybe that means I might lose control and do something bad” so on and so forth. In other words, they attach meaning to the thought and interpret having the thought as being potentially threatening/dangerous. Of note, these examples both represent individuals who do not want to harm anyone. 

Thought-Action Fusion (TAF) is an example of a specific kind of attribution of significance related to the meaning we give our thoughts. Specifically, TAF reflects the belief that having a certain thought/image/urge either increases the likelihood of the feared outcome occurring (Likelihood TAF) or that having a certain thought/image/urge is morally equivalent to actually doing what the thought entails (Moral TAF).

In the example above, an individual with Likelihood TAF might believe that having the thought of slapping a stranger actually increases the chances that they will do so. So they might start engaging in compulsions such as having their hands in their pockets anytime they are around people, or seeking reassurance from trusted others that they are not going to lose control and slap someone, or completely avoiding situations that trigger the thought in the first place. 

An individual with Moral TAF might believe that having the thought of slapping a stranger is morally equivalent to actually slapping a stranger. This often results in the individual feeling significant amounts of shame and guilt. They may engage in significant compulsions related to “figuring out” whether they are bad or sinning. 

I often explain to my clients that I think of individuals with OCD as being kind of like thought hoarders. Think of our brains as having many many conveyor belts of hundreds of thousands of thoughts. Some of these thoughts are meaningful and need to be picked up off of the conveyor belt and placed into various piles such as “need to problem-solve” or “need to reflect” or “important.” But most of our thoughts are just mental noise and need to be left on the conveyor belt until it finally lands in the thought trash. People without OCD leave most of their thoughts on the conveyor belt because they understand and are comfortable with the idea that many thoughts are meaningless. However, people with OCD will see a meaningless thought that should be left on the conveyor belt and scoop it up “just in case” or because “what if” it means something or needs to be dealt with or maybe it’s important. 

In treatment, Exposure and Response Prevention will help identify cognitive distortions such as TAF, and work to alter these distortions via exposures. If you are interested in counseling for OCD, 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.