One of the questions that often comes up both in my clinical practice and in the online support groups I contribute to is, “How do I respond to my thoughts?” Or more specifically, “What is the right way to respond to my thoughts?” There is a hidden OCD trap here in the search for the exact right way to respond to thoughts. If we can be certain about the one true or “best” response to thoughts, it means that thoughts themselves have one true nature. If we can fail in our response to thoughts, the implication is that thoughts have an intrinsic power, a quality that must be carefully examined. Yet this idea actually flies in the face of the central thesis of OCD mastery, which is that thoughts are thoughts, not threats. The significance of their content is attributed to them, not hidden in them, and whether they are “worth” incorporating into some behavior or better left alone is not the sort of thing that fits into a concrete equation.
Ultimately, I don’t believe there is a best practice for responding to thoughts (OCD or otherwise). There are practices that I see working better for some people and for others not so much. There are practices that have a higher success rate (if we are associating the reduction of suffering with success) and practices that only work every once in a while in specific situations. Any practice done by rote, or done every single time, especially if done in a sense of urgency, can quickly turn compulsive. Here are some options for responding to thoughts along with their potential pros and cons for OCD mastery:
Doing Nothing About Your Obsessive Thoughts
One of my favorite things to do in general, or at least it would be if I ever did it for very long. Nothing. In terms of thoughts and the responses we give them, doing nothing means completely ignoring thoughts as meaningless chatter, no different than the ambient noise of traffic from a distance. How can we do nothing in response to thoughts? Well, first, we have to believe that nothing is happening. Easier said than done. Doing nothing in response to a thought means not even taking a moment to acknowledge that the thought (or feeling or sensation) has occurred and simply plowing through your chosen activity as if unaware of any competition for your attention. It’s the “Keep Calm and Carry On” of navigating OCD.
Pros of doing nothing:
- It treats the thought like the non-event that it is.
- It stays out of the content of the thought altogether.
- It wastes as little attention as possible.
- It may enable the completion of tasks otherwise disrupted by OCD.
Cons of doing nothing:
- It requires one to be in a state of mindful acceptance from the start, which is a major challenge for most people.
- It can easily become a form of compulsive avoidance, a refusal to acknowledge that the thought occurred in the first place and a refusal to experience feelings as they are.
- Active “ignoring” can trigger an additional sense of being in denial (and thus more anxiety).
- It can quickly devolve into a habit of “white-knuckling” through life, which is unsustainable.
In a basic mindfulness meditation practice, mental noting means labeling the internal activity that is occurring in the moment one becomes distracted from their anchor (usually the breath). So, for example, if I am meditating and I notice how bored I am, I might gently say to myself, “boredom,” and then return to watching my breath. If I notice that I’ve wandered off into a train of thought, I may say, “thinking” and gently hop off the train as best I can. Similarly, when just going about my business in life, I may become distracted by an obsessive thought. I might respond to this as well by saying “thinking.” Or I could be more specific and acknowledge when the thought applies to a particular OCD concern, as in “murder thought” or “disease thought.” Once acknowledged, I then return to whatever I was doing before I became distracted (as in, going back to a specific activity) or I incorporate feeling distracted into that activity (do what I was doing but with somewhat divided attention). The point is I release myself from acting on the thought in any way past noting its existence.
Some may find it useful to mentally note “OCD thought” but I generally do not recommend this. By drawing distinctions between OCD thoughts and other kinds of thoughts, we are already playing into the distorted belief that the content of the thoughts has intrinsic value. If we must disown thoughts by calling them “OCD”, then we are saying we would be bad for having them without OCD. But they are thoughts, not threats. So even the worst thoughts are better off being understood as ours. This doesn’t mean that we like them or that they represent us, but simply that we have minds and minds have thoughts.
Pros of mental noting:
- It’s honest about the experience of having the thought but without getting too deep into content and without acting directly on the thought.
- It often lightens the sense of doom by positioning the thinker as an observer of thoughts instead of a victim.
- It renders the debate over whether a thought is “good” or “bad” completely pointless.
Cons of mental noting:
- It does give the thought some attention and for some this could lead to too much attention.
- It opens up a window to covert mental rituals and can become a compulsion itself (e.g. having to accurately label the thought every time or checking to make sure you’ve noted everything).
Agreeing With the Uncertain Potential
Most obsessive thoughts come in the form of “what-if” questions like “What if I hurt someone?” or “What if I get a disease from having touched this?” Those that don’t present this way often still involve concerns like “what if I can’t tolerate this?” Given that certainty is a myth, it is reasonable to say that if we can think it, the likelihood of it also being a true about reality is something greater than 0%. It may not be much greater (as in, the ceiling above me may collapse at any moment but probably won’t), but it is nonetheless something other than an impossibility.
So if we were to respond to an unwanted thought with a statement like “That may or may not occur” or “I don’t know” or “Anything’s possible, but I have other things to attend to at the moment,” we are noting that the thought is present, owning that it is ours, and accepting that it has some amount of potential to be connected to reality. Other responses in this vein could include commenting directly to the OCD as in, “Duly noted” or “Mysterious” or “Well, that’s an interesting idea.” To be clear, this is not agreeing that the feared thought is true, that the feelings mean some specific thing, or that we can make predictions about the future. Indeed, it is the opposite of taking the bait. It is defeating the debater by refusing to go on the defensive.
Pros of agreeing with the uncertain potential:
- It provides a functional exposure (well, maybe that could occur, I don’t know) while interfering in ability to complete rituals (it leaves the verdict on thoughts intentionally incomplete).
- It is honest (any statement that starts with “maybe” is technically true however improbable, as in “maybe I will be abducted by aliens tonight” vs. “it is proven fact that I will not be abducted by aliens tonight”)
- It can develop into a healthy habit of openness to uncertainty and mindful awareness.
Cons of agreeing with the uncertain potential:
- It can increase anxiety because of the absence of reassurance and the assessment that fears can come true.
- It does get involved in the content of the thought, which can be a slippery slope to mental rituals
- It requires significant effort to resist following it up with compulsions and can be exhausting
You may find all sorts of books and blogs alike that recommend simply agreeing with the thought. Done effectively, this can be a way of basically pulling a thought through the mind that would otherwise be stuck. It says, “Alright, fine, it’s all true, let’s get on with it already.” Or you might agree more emphatically, thus allowing yourself to become so affected that you experience strong urges to do compulsions, which you can then practice resisting. Every ERP is a learning opportunity.
Note however that in this discussion I am primarily talking about how to respond to thoughts moment to moment. This is different from how to respond to thoughts in the course of a specific exposure exercise that you may be working on in your treatment. Some forms of imaginal exposure, for example, may promote the use of saying that an unwanted thought is “true” and really hanging on to this as a strategy for increasing anxiety to a level that can produce therapeutic benefits. But in the day-to-day, the habit of affirming the content of thoughts can also be problematic because, quite frankly, there’s more to life than ERP.
Pros of agreeing with thoughts:
- It provides an immediate exposure to the feelings associated with the content (as in, when I say the words “I will kill my baby”, I feel disgust and I can then do exposure to that feeling, which is the feeling I most often have trouble resisting compulsions around).
- It is a way to outdo the OCD and beat it at its own game, which can be confidence-building and even humorous.
- It eliminates the need for debate over the meaning of the thoughts by assigning it a blunt meaning without analysis.
Cons of agreeing with thoughts:
- It isn’t technically honest (you could kill your baby, but you can’t know that you will).
- It can become a form of compulsive checking (did I like it when I said it?) which can easily spin out of control.
- It can be used as a form of compulsive self-punishment.
- It gets involved in the thought content and it may cause panic or trauma responses in some susceptible people
Hey, over here! A word about distraction.
Many readers may have heard that distraction is a good thing because it takes your mind off of the OCD. Or you may have a heard that it’s a bad thing because it functions as compulsive avoidance of your obsessions, ultimately making them worse. Both of these things can be true or untrue depending on intention. Distraction is just anything that interferes in your ability to give full attention to anything else. To use distraction as an intervention with unwanted thoughts in OCD, the benefits and drawbacks are rooted in whatever message the brain is likely to receive from the shift in attention. Is the brain being informed that thoughts are unimportant such that attention can be lifted from them with ease and dropped on something else? Or is the brain going to get the message that thoughts are so terribly important, we can’t bear to be in their presence for even a moment without distraction?
In the course of exposure, you become very uncomfortable. To get away from the uncomfortable feeling, you might distract yourself with a video game you’ve played a thousand times that helps you shut off your thoughts. This is what I would call “bad distraction” because it sabotages the exposure therapy (by not allowing you to feel the discomfort and learn from it) and because the attention is being placed in a dead zone and not on something that promotes growth or represents a meaningful value. It is escape. Now let me be clear, escape is not the enemy all the time. We all have a right to check out from time to time. But in the midst of an exposure is not a helpful time for this.
Imagine you’ve just been triggered and the way you are accustomed to responding to triggers is to engage in an elaborate mental ritual that involves reviewing all of your memories associated with the trigger, imagining fictional scenarios where you respond a specific way to your trigger, chanting thoughts that neutralize your fears, or any or all of the above. In other words, the train of your mind is headed to Compulsion Station and you need to get off. Though it is widely agreed that “thought stopping” or trying not to have or not have certain thoughts, is ineffective, derailing a mental ritual is fair game. Ritual-stopping is not thought-stopping.
I sometimes refer to this as running interference. If you can’t think, you can’t complete a mental ritual, and if you abandon a mental ritual before it produces any satisfaction, you’re doing ERP. You’ll know it’s ERP because it will feel flippant or irresponsible to suddenly stop devoting your attention to the ritual and devote it to something else. To effectively drive a wedge between you and the ritual, you can push the mind to attend to something that requires focus and is incompatible with ritualizing. A good example is to try to remember the sound of a 56k modem connecting to the internet (a what? said the reader born in the 1990s). Or, feel free to recollect the lyrics to Peter Cetera’s The Glory of Love, which is infinitely worse than Rick-rolling yourself (look it up). The point is, you can’t focus on these things and complete your rituals at the same time, and, once disengaged from the ritual, you can work on resting your attention more mindfully on the present moment. I call this “better” distraction, rather than “best” because this kind of distraction has no real value of its own and is just a tool for disengaging from rituals. Used excessively, it opens a susceptible thinker up to potentially using this tool as a compulsion itself.
If we understand distraction as something that is interfering in focus, “good” distraction is probably not even a kind of distraction so much as a kind of self-direction. In other words, running to something of value instead of running from something scary. One of the greatest challenges obsessive thinkers have is coping with unstructured time. Without a specific present to return to, mindfully stepping back from obsessions doesn’t make much sense. A highly trained and skilled meditator may be able to rest his attention on the feeling of his feet on the ground, but most people find this uninspiring.
So good distraction is filling your life (not to the brim) with things that you value already or have the potential to add value. Good examples are hobbies that leave products behind, such as writing music, painting, or building something. Non-compulsive cleaning or exercising can be good, but they may lack the mental invitation to truly latch the attention securely. Watching movies and television can be a great distraction if the thing being watched is something that will feed your artistic heart, teach you something, or at least give you the opportunity to float a fan theory by your friends. Mindless reruns of shows that provide you nothing but noise and leave you feeling empty inside will not serve this function. So best distraction is when we are mindful of our OCD enough to know that it could use some competition and then to self-compassionately provide ourselves with something worth attending to.
Don’t be Perfect
Be beautifully imperfect. It’s harder but it pays better. There is no one right way to respond to thoughts. And if there were, to use it every time would quickly turn it into another “wrong” way, a compulsion. The endgame here is being able to see thoughts as thoughts, not threats. You can entertain them, but only if you wish to entertain. You can expose to them, but only if you want to do the work in that moment. You don’t always have to. You can allow and accept them exactly as they are, but only if you can do so without bullying yourself (“Accept! Accept!!”). If you carry with you a big toolbox for OCD, you can develop the self-confidence needed to reach in there with eyes closed, pull out whatever you connect with in that moment, and use it to navigate OCD in that moment alone. Mastery over OCD is not about being right all the time. It’s about versatility.
Led by Jon Hershfield, MFT, The Center for OCD and Anxiety is a private pay outpatient center devoted to the treatment of obsessive-compulsive disorder and anxiety disorders.