What is the difference between an automatic intrusive thought and the act of thinking? Understanding the difference is a key part in understanding the treatment of OCD. What many people consider “obsessing” is actually a compulsion called rumination.
An automatic intrusive thought is something you don’t have control over. All humans have automatic thoughts. For example, if I’m walking down the street I may have the automatic thought “that little kid is cute”. Because this thought holds no meaning to me, I probably do not give that thought any attention and keep walking down the street. However, if I had POCD and I had that automatic thought, I would likely give that thought much more meaning.
When we give a thought meaning and power that can lead to mental compulsions, such as rumination. In this scenario, rumination may look like:
“Does it mean something that I think that kid is cute? Am I attracted to that child? What if I am? Oh my gosh, what does that mean about me? No, maybe I’m not. I don’t know. How do I know for sure…….” And that can continue for minutes or even hours.
Other mental compulsions can include:
- Self-reassurance: “I’m sure I’m not a pedofile”
- Replacing a negative word with a positive one: Don’t think the word “pedofile”, think the word “saint”
- Mentally reviewing a past incident to gain evidence for or against being a pedofile
- Mentally checking feelings and bodily sensations
It’s critical that mental compulsions are stopped when practicing ERP. If you have POCD and you do an exposure (such as looking at a picture of a toddler in a diaper) and you resist doing a physical compulsion, but you instead do a mental compulsion you are still “practicing OCD” and not doing ERP.
It can feel incredibly challenging to not only recognize mental compulsions in the moment, but also resist them. Many people report that mental compulsions feel automatic and not in their control. Good ERP treatment includes focus on recognizing rumination and practice resisting it. Scripts and response prevention messages can help focus the mind back to coping with uncertainty rather than doing mental compulsions. Stopping mental compulsions does not happen quickly. It takes practice. But through the practice of mindfulness and ERP, stopping mental compulsions can be done.
If you have OCD and are struggling resisting compulsions on your own, reach out to inquire about ERP treatment for OCD.
