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Written by Paulina Syracuse, Advanced Doctoral Extern
Scene 1: You’re taking a walk with your loved one when, all of the sudden, you have a thought of your loved one getting into an accident and dying. Your anxiety and fear spikes at the thought and possibility of this terrible event occurring. To reduce this anxiety, you repeat the word “safe” in your mind 8 times to counteract the original thought. Although your fear reduces, you continue to feel uncertainty about your loved one’s safety and feel the need to repeat the word whenever you think of the person or see an accident occurring on TV or in the media to prevent harm from coming to them.
Scene 2: You’re getting ready for the day in the morning, and you begin worrying about something bad happening even though you can’t identify exactly what might happen. The thought of something bad happening makes you very anxious and you have the urge to complete the rest of your morning routine in a “perfect” way, like putting your clothes on in a certain order, to prevent a bad thing from happening. You feel better right after, but now every morning you must do your routine in this same “perfect” way or else you fear that a bad thing will happen.
Scene 3: You were just surprisingly broken up with by a person you really liked. He needs some time to think about his life, and will reach out if he changes his mind. You are sad and anxious, but decide to focus on putting positive energy out into the world in order to get him back. If you think of another person, or have a bad thought about the break up, you have intense anxiety because you fear that these negative thoughts are going to mean he won’t come back. You begin seeing posts on social media about breakups and relationships ending and begin worrying that they are a “sign” that you and your partner will never get back together.
While these scenes may seem different, they both describe a common phenomenon: magical thinking in obsessive-compulsive disorder or OCD.
Let’s start with the basics. OCD involves the presence of persistent, unwanted thoughts, sensations, images, urges, and/or doubts that are anxiety-provoking – which we call the obsession – with a physical or mental act that is done in an attempt to reduce this discomfort – which we call the compulsion. In magical thinking OCD, the person feels compelled to engage in a compulsion to prevent something from happening.
Examples of magical thinking include but are not limited to:
- Fear that a bad outcome or harm may come to themselves or someone else unless one says or thinks a certain word or phrase, does something in a certain way or at a certain time, and/or counts up to a certain number
- Fear that a bad outcome or harm may come to themselves or someone else unless they neutralize a bad thought by saying or thinking a good thought, word, or phrase
Magical thinking OCD may present in a number of different ways. Despite this variety of presentations, a specific cognitive error is present that dominates the person’s way of thinking called thought-action fusion. In thought-action fusion, the individual believes that thinking a thought will result in the feared outcome occurring. Although the individual may logically know these events are not connected, they feel compelled to engage in the compulsion anyway. Why? Because the individual fears the possibility of the event occurring and feels a heightened sense of responsibility to prevent it from happening, i.e. having to say “safe” a certain amount of times to “ensure” your loved one’s well-being. While those reading this know that repeating a mantra won’t actually change or protect from an outcome, but in magical thinking OCD, it FEELS like it does. The person feels that this uncertainty and anxiety is too great of a risk and must be avoided at all costs. This often leaves the person in a vicious cycle of obsessions and compulsions that feels impossible to break free from without risking imminent disaster.
Fortunately, researchers and clinicians have developed an evidence-based treatment for OCD called exposure and response prevention (ERP). In ERP, the person is exposed to a feared situation or thought without engaging in their compulsions. Using Scene 1 as an example, this person may be asked to read news articles about an accident, like a car or plane crash, without saying the word “safe.” In scene 2, for example, the individual would be asked to do their morning team in an “imperfect” way and switch up how they are prepping for the day.
If you’re reading this blog and some of these thoughts or compulsions sound like you, you may be thinking “I could never risk that! Isn’t it better the be safe than sorry?” Of course, we never want anything bad happening to ourselves or our loved ones. However, it is important to know that one’s thoughts, fears, and worries aren’t the problem, but rather how one responds to the anxiety and uncertainty. In ERP, a person collaboratively works with a trained professional to gradually approach your fears and test the predictions that you fear will happen if you don’t engage in a compulsion. Ultimately, the person learns to tolerate uncertainty and takes back control – it is definitely scary in the beginning, but in the long run, you regain the ability to live your life in an adaptive, less-anxiety-led way.
If you are reading this and some of these thoughts and compulsions sound like a loved one, there is hope. We’ll share a blog in the future about how to support someone who is struggling with OCD or in the Exposure Response Prevention process. It’s important to not rationalize or try and take a logical approach to the magical thinking thoughts and behaviors. OCD is not rational! Just as importantly, you may want to reassure your loved one in order to decrease their distress. Sadly, this actually makes the OCD worse over time – the temporary relief provided from you saying, “Of course they’re not hurt!” or “Of course he will come back!” can lead to the need for more and more reassurance, and actually increase the cycle the individual wants to break. Helping your loved one get evidence-based treatment is the best thing you can do; and then ask them or work together with the therapist to understand how you can be a part of the recovery process!
Evidence-based treatment for OCD is proven to be highly effective and change is 100% possible. We have worked with thousands of people and have seen the change first-hand. If you are struggling, send us a message. We can help.