It may not be unusual to have random thoughts come to you. We have no control over the thoughts that enter our minds. However, it is up to us to decide what to do with them once they arrive. (OCD Treatment: Understanding “Intrusive” Thoughts, 2013). It might come to mind at random, such as a dog we saw on the street, a chat we had with friends, or a horror film we watched recently. Even while these kinds of thoughts may be common, some people might also have upsetting, unsettling, or absurd ones. These could be disturbing, sexually explicit or violent thoughts, thoughts of harming oneself or others, or of speaking something taboo. (Broughton, 2020)When such thoughts get stuck and occur repetitively, it causes great distress or anxiety in a person. These anxiety provoking recurrent thoughts are referred to as intrusive thoughts. (Ackerman, 2022).
Intrusive thoughts observed in Obsessive Compulsive Disorder (OCD) is different from having disturbing thoughts occasionally. An intrusive thought can develop into an obsession, which may lead people to avoid stress-inducing events. This can have a significant influence on people's day-to-day psychosocial functioning. For instance, a woman who has intrusive sexual thoughts about her brother-in-law would avoid him, which could affect her relationship with her spouse and other family members. Intrusive thoughts in OCD may occur with overt compulsive behaviors where compulsive acts are physically acted upon, or it may occur with covert compulsions as observed in Pure O. Pure O, also referred to as a Pure Obsessional OCD, is characterized by intrusive, unacceptable and upsetting thoughts that are not physically acted upon as compulsive behavior, but instead engage in mental compulsions to confirm their thought. These include covert rituals like silent praying, un-doing thymes or phrases, silent repeating of correct or opposite thoughts to balance the unpleasant thought and cognitive neutralization strategies like thought stopping, rationalization, distraction and self-punishment (Tripathi et al., 2018). Some of the various hypothesis that explain why such intrusive thoughts arise are the presence of a predisposing biology, an overly strict and protective education, the inhibition of impulses and desires, thought- action fusion and an inflated sense of responsibility ( You’ll read more about thought action fusion and inflated sense of responsibility in the next section)
It has been shown in research how intrusive thoughts occur universally, however the majority of them are viewed as being not problematic(Barrera et al., 2011) . According to the Cognitive Behavioural Model by Salkovskis, developed by Paul Salkovskis who is a pioneer in health psychology, OCD patients' elevated importance or appraisal of intrusive thoughts, which would lead to maladaptive responses, distinguishes them from typical intrusive thoughts. (Salkovskis, Forrester & Richards, 1998). Most individuals with OCD believe their ideas are unacceptable and worry that something negative will happen. They believe it is their responsibility to respond to, stop, and undo these thoughts when they occur and will retaliate by exerting enormous effort to do the same. But eventually, the compulsive behaviors that people engage in as a form of solution to gain relief, would only give them temporary relief due to which they will repeat the same behavior over and over. Hence, as Salkovskis claims, “the solution becomes the problem”. They might first simply occupy a few minutes each day engaging in compulsive acts until filling up several hours. (International OCD Foundation, 2017)
Among many theories that explain the Obsessive Compulsive disorder, Salkovskis’s Cognitive Model of OCD is one of the most known. He explains how having such obsession may trigger automatic thoughts about one’s own ability to control one’s thought. It is the intensity of hyper-responsibility or tendency to try too hard to get rid of an intrusive thought that determines the severity of OCD according to Salkovskis. A set of beliefs that an individual develops as a result of any early experience or critical incidence, causes them to misinterpret the significance of the intrusions in their lives. It may also cause them to doubt their sense of responsibility to stop generating such thoughts as they fear it may lead them to perform a distressful compulsive act. This is seen among OCD patients as the guilt or shame they experience as a result of such thoughts. The beliefs they develop is the idea that ‘not preventing a disorder is the same as making it happen’. It is this assessment of the thoughts that act as a primary factor for anxiety. The recurrent and persistent pattern of the thought depends on the automatic thought that is generated as a result of the importance it is given. These thoughts are responsible for what the obsessions can generate and also makes them feel anxious and uncomfortable. (403 Forbidden, 2018)
Figure 1 below shows the diagrammatic representation of Salkovskis’s Cognitive Model.
Case example: Sarah, a 20 year old, has a constant need to keep things in perfect symmetry without which she cannot carry on through the day. She has the tendency to rearrange the books on the book shelf, pens and papers on her table and other things in her room in a perfectly aligned symmetry. She started engaging in these acts during her early high-school days but has intensifies since then. On an average, she spends 5 to 6 hours a day rearranging things in her room. While at college, her teachers noticed her urge to write words and letters until there is no visible imperfections or asymmetries in her handwriting. She would strike off and erase until she is able to write in a desirable shape and alignment. During exams she was reported to request for too many additional papers due to her need for perfection in writing, which was very concerning for the exam faculties. As a child, her parents were very strict and overprotective and would not allow her to go out and play with other children living in her residential compound. She also had the terrible experience of being bullied in her school days.
With respect to the Cognitive Model proposed by Salkovskis, The early experience of an authoritative parenting style predisposed her to develop the symptoms of OCD. The critical event here is her experience of being bullied in school. This led her to develop a set of dysfunctional assumptions, which is the need to place all objects around her in a perfect symmetry to prevent a disaster. These assumptions became automatic recurrent thoughts and doubts, which eventually lead her to place great significance to that thought .However according to Salkovskis, the solution- which is the hyper-responsibility developed by Sarah to place things in a perfect symmetry, is seen to be the problem. This misinterpretation of significance of intrusive thoughts causes her to engage in neutralising actions which is the ritual of arranging things in order which may provide temporary relief. Attention and reasoning bias refers to tendency to look for trouble, in this case Sarah would look for any sign of asymmetry. Mood changes refer to the anxiety or distress that is caused due to the intrusive thoughts which is relieved temporarily after performing a neutralising action. Counterproductive Strategies refer to the thought suppression of the necessity for a symmetrical arrangement in order to avoid distress.
Link for the website: https://psychopathology.wixsite.com/ocd-guide
References
1. 4. OCD Treatment: Understanding “Intrusive” thoughts. (2013, October 14). [Video]. YouTube. https://www.youtube.com/watch?v=_Wss6W11bPM
2. Broughton, E. (2020, September 16). What you need to know about intrusive thoughts and OCD. Patient. https://patient.info/news-and-features/what-you-need-to-know-about-intrusive-thoughts-and-ocd
3. Ackerman, C. E., MA. (2022, June 20). What Are Intrusive Thoughts in OCD & How to Get Rid Of Them? PositivePsychology.Com. https://positivepsychology.com/intrusive-thoughts/
4. International OCD Foundation. (2017, October 10). How I Treat OCD Killer Thoughts: Treating Violent Obsessions. https://iocdf.org/expert-opinions/expert-opinion-violent-obsessions/
5. 403 Forbidden. (2018). Warbletoncouncil. https://warbletoncouncil.org/teoria-Salkovskisss-toc-5392#:%7E:text=Among%20the%20many%20theories%20that%20try%20to%20explain,thoughts%20Regarding%20one%27s%20own%20responsibility%20regarding%20thought%20control.
6. Kumar, A., Sharma, M. P., Narayanaswamy, J. C., Kandavel, T., & Reddy, Y. J. (2016). Efficacy of mindfulness-integrated cognitive behavior therapy in patients with predominant obsessions. Indian Journal of Psychiatry, 58(4), 366.
7. Barrera, T. L., & Norton, P. J. (2011). The appraisal of intrusive thoughts in relation to obsessional–compulsive symptoms. Cognitive Behaviour Therapy, 40(2), 98-110.