Over the last few weeks, I have had a secret. For most people, this secret would not have been seen as important, but to me it was. Every time I had these thoughts I became overwhelmed with anxiety, fear and an almost palpable sense of terror. As soon as the thought of this secret flashed through my mind, I would have visions that would take me to its worst-case outcome. As I played these thoughts out in my head, I physically experienced extreme anxiety, as if the discovery of my secret was actually happening.
Just a few days ago, I was on the treadmill and the thought flashed through my mind again. I was immediately plagued with heightened anxiety. Even the lady on the treadmill next to me noticed and commented that my face had a strange look on it. In response to the thought, I did what most people would do. I tried not to think about it.
At that point, I started a conversation with the lady next to me…and the thought popped up in my head. After the conversation was over, I read a trashy magazine… and the thought popped up in my head again. I then began running as fast as I could, dripping with sweat and breathing deeply, and the thought still managed to surface. Actually, not only did it surface, but it continued to inflate in my head, as if it was going to soon explode.
I got off the treadmill, and it was only then that I realized what I had been doing. I was trying to suppress an unwanted, intrusive, anxiety provoking thought. Even though I discuss this concept daily with my clients who suffer with Obsessive Compulsive Disorder (OCD) and anxiety, I had forgotten it for myself, and had spent over an hour trying to push away these scary thoughts instead of embracing them.
Thought Suppression Research
Thought suppression is a common feature seen in OCD, especially for those who suffer with what is sometimes called Pure Obsessional OCD, or “Pure O”. But nobody wants to have anxiety provoking thoughts. When we experience unwanted, distressing thoughts, we quite naturally respond by trying to control them, ignore them, or push them away. Unfortunately, many clinical studies have proven that trying to suppress unwanted thoughts usually results in the person experiencing the thoughts more often and in a more intense way. That was definitely the case for me.
The concept of “thought suppression” was first studied by Wegner, Schneider, Carter, and White in 1987. In this study, a group of people were asked to not think about (or to suppress thoughts of) white bears for 5 minutes. During this time, participants were asked to verbalize their thoughts and ring a bell each time they thought about a white bear. Following this initial 5-minute period, participants were then asked to purposely think about white bears for another 5-minute time period. The results showed that participants reported thinking about white bears almost twice as often in the 5-minute period during which they were asked to not think about white bears.
If you suffer with intrusive thoughts, you may ask “Why doesn’t this happen with all of my thoughts? Why is it that I always remember and I am always plagued by these intrusive thoughts, yet I can forget many of the items on my grocery list?” The answer is simple – the items on your grocery list are not anxiety provoking, and you are not trying to forget them. The problem with trying to suppress unwanted, anxiety provoking thoughts is that the more effort you put into forgetting these thoughts, the more likely you are to be unable to forget them.
Treating Intrusive OCD Thoughts
So, if you have ever experienced the angst of unwanted, intrusive thoughts…or if you are curious about my secret, you might be wondering “How can I get those horrible thoughts out of my head?” or “How did she get those thoughts to go away?”.
The most effective approach to take in managing intrusive, unwanted thoughts is Cognitive Behavioral Therapy (CBT). And the most basic tool in CBT is what is commonly known as Cognitive Restructuring, in which a person with an unwanted thought briefly and objectively reviews the thought. For example, when I stopped to look at my secret thought, I immediately realized that it was neither rational nor realistic. I identified it as such, and assigned it an alternative thought that I could use to challenge the thought when it next arose.
Unfortunately, for those with OCD, Cognitive Restructuring can quickly become a compulsion in itself. We have treated many people who are unable to get the benefits of Cognitive Restructuring because they quickly resort to compulsively analyzing their thoughts (and the alternative thoughts they come up with to challenge their unwanted thoughts) in an attempt to control them.
For this reason, a different approach is needed. When faced with intrusive, unwanted, anxiety provoking thoughts, the most effective long-term cognitive tool is what is commonly called “mindfulness”. From a mindfulness perspective, when one experiences intrusive, unwanted, anxiety provoking thoughts, the goal is not to attempt to reject them or or push them away, but rather to allow and accept their presence in your mind – to have a more open and peaceful relationship with them. This doesn’t mean that you need to enjoy the thoughts or accept the legitimacy of their content. It merely means that you accept reality as it is…and reality is that these thoughts are in your head. Think of it as being similar to accepting a rainy day when you had planned to go to the beach – you may not like the rain, but you will be a lot happier accepting it and getting on with your day than you will be if you get angry at the rain for existing.
The most important component in managing unwanted thoughts is changing one’s behavioral response to these thoughts. People with OCD often try to control and/or avoid their anxiety-provoking thoughts. Unfortunately, as noted above, this only results in having more of the same thoughts.
While it may seem counter-intuitive, the most effective behavioral response to unwanted thoughts is to allow them to exist while making no effort whatsoever to control or change them. In fact, if you really want to challenge these thoughts, the best approach is to purposely choose to have them. If you do this, you will soon discover that you have de-fanged these thoughts. You may still have these thoughts – after all, many people, including those without OCD, have similar thoughts – but you will care far less about them. They are, after all, just thoughts
So how did I deal with my “secret”? Using the above techniques, I accepted that the thought was not that important and that it did not require such a heightened and lengthy response. I accepted that this thought is no more important than most of the thoughts I have on any given day, such as “what color shirt shall I wear” or “what will I have for lunch” or “should I shower before or after dinner”. The most important thing to remember is that suppressing the thought will only make it stronger. Avoidance will almost certainly not make the thought go away.
I am assuming the fact that you have read this far means that either a) you have experienced the distress and aggravation of failed attempts to use thought suppression, or b) you are still waiting to learn what my secret was. If you are among the first group and are experiencing unwanted thoughts, please don’t hesitate to contact us so we can help you learn the tools to manage your intrusive thoughts. And if you are among the latter group and are still hanging on to hear the juiciness of my secret, read the last paragraph again – the secret and the thoughts were not important!
•Kimberley Quinlan, MFT, is a psychotherapist at the the OCD Center of Los Angeles, a private, outpatient clinic specializing in Cognitive-Behavioral Therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD) and related conditions. In addition to individual therapy, the center offers six weekly therapy groups, as well as online therapy, telephone therapy, and intensive outpatient treatment. To contact the OCD Center of Los Angeles, click here.