By now, virtually anyone with even a passing interest in politics and current events has heard the term “fake news”. If you haven’t heard this term, just turn on a cable news channel on any given day and you are bound to hear a news story (or ten) about how we are being inundated with fake news that is designed to alter our political beliefs (and our votes). Regardless of your political persuasion, a Google search of the term “fake news” will lead you to a multitude of articles that describe somebody (or some country) that is presenting reality in a distorted fashion in an attempt to persuade you to see things their way. So what does this have to with Obsessive Compulsive Disorder (OCD)? Allow us to explain…
The writers and producers of fake news stories manipulate reality, sometimes by taking facts out of context, and other times by entirely fabricating story details (i.e., lying). Fake news stories always build their narrative on what can most charitably be called “unsubstantiated claims”. But even a cursory examination of these claims would lead any objective observer to conclude that these stories are at best misleading, and at worst, utterly untrue. The stories aren’t backed up by facts, but they sound just real enough to seem feasible.
And this is exactly what OCD does – it offers up scary thoughts for which there is no factual support, yet which appear plausible enough to lead one to believe that they may actually be true. OCD takes unimportant thoughts that occur in one’s mind completely out of the context of the real world and who the individual actually is as a person, and fabricates nightmarish scenarios (i.e., obsessions) that are not even remotely based in reality. But because these obsessive thoughts initially manifest in the sufferer’s own mind, they seem realistic, even though there is no compelling evidence to support them. In other words, OCD is fake news written, produced and directed by your own wayward brain.
OCD is a condition in which an individual is barraged by repeated, unwanted, intrusive thoughts that cause the sufferer to experience extreme anxiety. These thoughts often focus on issues that the individual views as terrifying threats to either their well-being or their self-image. Some typical OCD obsessions include:
- “What if I have been exposed to a horrible virus like AIDS.”
- “What if I forgot to turn off the stove and the house burns down.”
- “What if my sexual orientation is not what I want it to be.”
- “What if I molested my child.”
- “What if I am a killer.”
- “What if I committed a terrible sin.”
- “What if I don’t really love my spouse.”
But here’s the thing about these thoughts – they are just ideas that the OCD sufferer’s brain makes up. Of course, there actually are killers and pedophiles in the world, and some people really do get AIDS, and sometimes people do accidentally burn down their house. But for those struggling with OCD, these unwanted thoughts are just baseless obsessions that pop into the sufferer’s head, and which they believe may be true, despite all evidence to the contrary. It’s as if they have been exposed to a fake news story about themselves, and they have bought it, lock, stock and barrel.
So how does this happen? How is it that people come to believe something for which there is absolutely no evidence whatsoever?
The Brain is a Machine For Jumping to Conclusions
In his book Thinking, Fast and Slow, Nobel-prize winning economist Daniel Kahneman describes the human brain as being “a machine for jumping to conclusions”. He writes how humans have two types of thinking. System 1 thinking is fast, automatic, intuitive…and frequently wrong! It is thinking on autopilot, in which we make quick decisions based on the limited information we have available at any given moment. System 1 thinking serves us well in that it provides a cognitive shortcut that helps us to quickly evaluate threats so that we can protect ourselves. For example, if a woman is walking alone down a dark street late at night and sees a group of young men up ahead, she probably won’t spend a lot of time rationally analyzing the situation – her System 1 thinking will just signal “potential threat!” and she’ll likely take action by crossing the street, or quickly getting into her car, or dodging into a local building.
Conversely, System 2 thinking is slow, deliberative, and rational…and usually more accurate. It’s how we would ideally approach any situation – by thinking it through and making a logical evaluation. But we naturally seek the quick fix provided by System 1 thinking. It’s just simpler and quicker, and can be really helpful in a pinch. Unfortunately, it’s oftentimes wrong. Most of the guys you see up ahead on a dark street are not a threat – they’re just trying to get home, like you.
Fake News, Instinct and The Pleasure Principle
Why do we engage in System 1 thinking if we rationally know that it is frequently inaccurate? In a word: instinct. It’s automatic! System 1’s quick judgments keep us safe from threats and lead us toward rewards. System 1 thinking operates in alignment with one of psychology’s foundational precepts, the “pleasure principle”, which postulates that we instinctually seek pleasure and avoid pain. We don’t generally put a lot of mental effort into figuring out why we don’t like pain – we just instinctually avoid it because it doesn’t feel good. That’s the pleasure principle in action.
And so, when a painful, unwanted thought appears in the consciousness of the OCD sufferer, they don’t react with well-reasoned System 2 logic. Instead, their System 1 thinking senses a threat and kicks into gear. Their brain quickly jumps to the conclusion that this unpleasant, uncomfortable thought must mean something terribly important. After all, the thought is present in their consciousness. Why would it be there unless it meant something important? And because the thought’s content is scary, the sufferer’s brain instinctually puts the pleasure principle into practice and tries to get rid of it.
But the truth is that everybody has all sorts of bizarre thoughts that don’t mean much of anything. We all daydream and fantasize about all sorts of weird things that we would never do in real life. And we all have unexpected thoughts that don’t reflect our actual intentions. Nevertheless, System 1 thinking often leads the OCD sufferer to believe that their strange thoughts are extremely important, and that they must be addressed and resolved as quickly as possible. And if there’s one thing that System 1 thinking is good at, it’s coming up with quick, albeit often bad, answers.
For example, if I am on the 405 freeway on a hot summer afternoon during rush hour, and someone cuts me off in order to gain an extra 20 feet of asphalt ahead of me, I may have a passing thought about killing the guy. That doesn’t mean I actually want to kill him – it means I am frustrated by the mercilessly slow LA traffic, and I am having a less than stellar emotional response to someone cutting me off.
While those without OCD will quickly write off this type of thought as being ridiculous, a person with Harm OCD may just as quickly jump to the conclusion that this thought must mean something important about their character and intent. We have treated people with these types of harming thoughts who have stopped driving entirely because they feared they would willfully kill someone on the road. Likewise, we have treated new moms with Postpartum OCD who won’t change their infant child’s diaper for fear that they will molest them. And we have treated many others with HOCD who won’t spend time with members of the same sex because they fear they will act on random thoughts they have had about being gay.
In all of these cases, the thoughts were ego-dystonic, meaning that they were inconsistent with the individual’s true character, values and desires. In fact, those with OCD are often most tormented precisely because their obsessive thoughts are diametrically opposed to how they see themselves and who they really are. The mere presence of these thoughts in their minds tortures them, despite the fact that their experience over time very clearly indicates that these thoughts are not in any way a reflection of who they actually are, or what they want. But once fake news is presented to the brain, the sufferer immediately jumps to the conclusion that these thoughts reflect who they really are, even though the only “evidence” they have to support this conclusion is a thought that made them extremely uncomfortable.
System 1 Thinking and The Obsessive Compulsive Cycle
OCD starts when System 1 thinking runs amok. As the pleasure principle dictates, we instinctually want to avoid discomfort, and compulsive behaviors are an overzealous attempt to do just that as quickly as possible. It is an unreliable, disproportionate response that makes OCD get worse, not better. The process goes something like this:
1) An uncomfortable thought (i.e., an obsession, aka fake news) presents itself to you.
2) System 1 thinking quickly (and incorrectly) leads you to believe that this thought is a significant threat, which in turn leads you to feel anxious,
3) The pleasure principle dictates that you take action against this supposed threat and the unpleasant emotional state of anxiety that comes with it.
4) In an effort to proactively address this threat, you choose to do a behavior (i.e., a compulsion) that you hope will eliminate or at least reduce the threat and the related anxiety.
5) This behavior works in the short-term – your distress is reduced.
6) Unfortunately, this success reinforces the idea that the thought was indeed a significant threat (even though it was just a thought), and that the best way to deal with the anxiety that this kind of thought produces is to take swift action to eliminate it.
7) The next time this, or a similar, anxiety-provoking thought arises in your consciousness, your System 1 thinking quickly remembers that the compulsive behavior worked before, and you once again do that behavior, or some other equally counterproductive behavior.
8) Again, the behavior works…in the short-term. The cycle continues, ad infinitum.
Basically, OCD is like a dog chasing its tail – lots of work going around in circles, never actually catching the object of its pursuit. This tail-chasing process is known as the Obsessive Compulsive Cycle, and can be conceptualized like this:
We would be far better off if we did not over-react to our thoughts, but instead chose to tolerate our discomfort in the short-term, thus giving us the opportunity to discover that it is, in fact, quite tolerable. Then we could use System 2 thinking to logically pursue a more viable response to it. If we were to instead use system 2 thinking, the process would go something like this:
1) An uncomfortable thought (i.e., an obsession, aka fake news) presents itself to you.
2) System 2 thinking leads you to rationally consider the thought’s importance.
3) You are likely to feel some anxiety, but it is less intense and more manageable.
4) Because of the pleasure principle, you might be tempted to run from even this reduced amount of anxiety. But because you are using System 2 thinking, you have the capacity to make a different choice.
5) Instead of doing compulsions, you choose to sit with your discomfort until it naturally dissipates or even disappears completely.
6) When you sit with the discomfort instead of over-responding to it, you eliminate the reinforcement that has been feeding your anxiety. As a result, your anxiety decreases even more.
7) You eventually are faced with another trigger. This is normal. Triggers happen. There is no way to get through life without being exposed to things that trigger you.
8) Your brain responds to the trigger by generating more uncomfortable thoughts (i.e., obsessions). This too is normal. Uncomfortable thoughts are a natural part of the human experience. But you are now getting better at quickly switching to System 2 thinking. As a result, you feel less anxious and you do fewer compulsions. You are learning a new, more effective way of responding to your unwanted thoughts.
When using System 2 thinking, your thought process looks something like this:
When we use System 2 thinking, and give ourselves the opportunity to tolerate discomfort related to unwanted thoughts, we learn four important lessons.
1) The feared event almost never occurs. For example, you are highly unlikely to purposely kill another driver on the road. Yes, some people do kill others in a fit of road rage, but the great majority of people don’t.
2) The anxiety almost always goes down all by itself. Just by sitting with the discomfort, it dissipates – often quite quickly.
3) If the feared situation or event actually does come to pass, it is not necessarily catastrophic. You may get a disease from a dirty doorknob, but it is more likely to be a common cold, not AIDS.
4) You are far more capable of tolerating the anxiety than you think.
This last point is the most important lesson. You are unlikely to ever like feeling anxiety, but if you let yourself feel it without over-reacting, you will become far better at tolerating it. And in so doing, you will break the Obsessive Compulsive cycle that directly feeds your OCD. Simply put, the goal is to become more comfortable with your discomfort so that your actions can serve you, your goals, and your values, instead of serving to compulsively quiet your anxiety.
Over-Reacting to Obsessions
Another way to conceptualize OCD is to see it as a three-step process of over-reacting to thoughts that are not particularly important or meaningful.
Step one in this process is to over-attend to one’s thoughts. People with OCD tend to pay way too much attention to their thoughts, going so far as to actively monitor their thinking in an effort to see if their unwanted thoughts are still present, and whether or not those thoughts continue to upset them. Conversely, people without OCD spend virtually no time at all analyzing their thoughts or their reactions to those thoughts.
Step two is to over-value one’s thoughts. This is where System 1 thinking rears its ugly head. Those struggling with OCD assign meaning and import to what are arguably meaningless, unimportant thoughts. Everybody thinks crazy stuff, but people without OCD laugh off the weird things that pass through their minds, while those with OCD often take their weird thoughts very seriously. Remember, OCD is fake news, and deserves to be valued as such.
Step three is to over-respond to one’s thoughts. This is the “compulsive” part of OCD, where the pleasure principle comes into play. The sufferer takes action to reduce or eliminate the discomfort that arises in response to their unwanted thoughts. This action commonly occurs in any of four ways:
- Overt Compulsions. A physical action done in an attempt to feel less anxious, such as hand washing, or checking locks or stove burners.
- Avoidance Compulsions, wherein the sufferer attempts to avoid situations in which they anticipate unwanted thoughts (and anxiety) might arise.
- Reassurance Seeking Compulsions. For example, asking others to confirm that you did not run over a pedestrian, or molest a child, or commit a terrible sin.
- Mental Compulsions. For example, repeatedly reviewing a past event in your mind, compulsively fretting about something you fear you may do in the future, purposely calling up a “bad” thought to check if it still causes you distress, or compulsively praying in an attempt to eliminate an unwanted thought.
If done in an effort to control one’s thinking, all of these compulsive behaviors will consistently backfire by reinforcing the importance of the thoughts, causing OCD to worsen rather than improve.
Mindful Acceptance and Cognitive Behavioral Therapy (CBT) for OCD
Just as fake news is unlikely to stop showing up in your Facebook feed, the intrusive, unwanted thoughts experienced by those with OCD are unlikely to spontaneously remit. The first step in better managing your anxiety-provoking thoughts is to accept their presence. Many people with OCD struggle with this concept, thinking that it means resigning themselves to a life of constant, unmitigated misery. But acceptance is not resignation – it is accepting reality as it is, instead of fighting what is out of your control. Resisting reality does absolutely nothing to change it, just as becoming upset by every fake news story doesn’t change the fact that fake news exists. A more useful reaction is to accept the existence of whatever life presents to you – whether it be fake news or the unwanted thoughts that pop into your mind – without reacting impulsively or compulsively.
It’s important to stress that this doesn’t mean accepting that your obsessive thoughts are meaningful or accurate. It only means accepting that they exist without fighting them so much. In other words, it means accepting the presence of fake news without accepting the content it offers. We liken it to accepting that it is raining on a day that you had planned to go to the beach. You can get upset about the presence of the rain, but that will do nothing to stop it. The most helpful reaction is to accept the presence of the rain, and to choose to spend the day doing something else despite it. Mindful acceptance of reality is a shift in consciousness away from fighting what is out of your control, and towards focusing on what is in your control. Rather than over-responding to your thoughts, choosing instead to accept their existence without a struggle, and getting busy living exactly as you would if you weren’t experiencing them.
At the same time, you can challenge the content of your thoughts. This is the “cognitive” part of Cognitive Behavioral Therapy (CBT). Gently reminding yourself that your OCD thoughts are nonsense with no real evidence whatsoever to support them can help you to reframe these thoughts as being unworthy of your attention. This is the essence of System 2 thinking – vetting the fake news that your brain is presenting to you, considering whether the information is realistic and accurate, and then formulating a more objective appraisal of, and response to, the situation. The goal is to move from a default stance of blindly accepting that your obsessions are meaningful, and towards a place where you are more likely to quickly reject these unwanted thoughts without getting drawn down the rabbit hole with them. The key is to be sure that you don’t use this cognitive step compulsively in an effort to reduce your anxiety. Compulsively challenging your thoughts is every bit as much of a problem as any other compulsion.
The most important tool in challenging the fake news generated by your mind is called Exposure and Response Prevention (ERP). This is the “behavioral” part of Cognitive Behavioral Therapy. The simplest way of describing ERP is that it focuses on purposely exposing yourself to the very situations that cause you to be anxious, without doing any compulsive or avoidant behaviors to ameliorate your discomfort. Many people with OCD are extremely resistant to this technique, believing that they will be overwhelmed by unbearable anxiety. But ERP done with a compassionate, well-trained therapist isn’t torture. It should be done gradually, in a structured manner, and at a pace that works for the sufferer. Any attempt to jumpstart your recovery by taking on more anxiety than you can reasonably handle is likely to lead to a spike in your anxiety, and a subsequent rejection of ERP. Done correctly, ERP will be the cornerstone of your recovery from OCD.
Just as you don’t believe everything in your newsfeed, you’d be wise not to believe everything that you think. While our thoughts sometimes directly and objectively reflect reality, they are often nonsense that makes us unnecessarily afraid and behaviorally overprotective. Using CBT, you can learn to implement System 2 thinking – to slow down and consider your thoughts instead of jumping to the conclusion that they are universally accurate and important. As you begin to practice this more measured response to your thoughts, your actions will no longer be dictated by the fake news generated by your brain, and you can begin to free yourself from enslavement to OCD.
•Tom Corboy, MFT, and Lauren McMeikan, MFT, are psychotherapists at the OCD Center of Los Angeles, a private, outpatient clinic specializing in Cognitive-Behavioral Therapy (CBT) for the treatment of OCD and related anxiety-based conditions. In addition to individual therapy, the center offers five weekly therapy groups, as well as online therapy, telephone therapy, home visits, and intensive outpatient treatment. To contact the OCD Center of Los Angeles, click here.