Thinking Errors and Cognitive Distortions in OCD
By George Maxwell, CBT Therapist
Obsessive Compulsive Disorder (OCD) is a debilitating psychological condition which is characterised by the sufferer experiencing distress and difficulties in normal functioning caused by intrusive thoughts and compulsive behaviours. Typically we would treat OCD using Cognitive Behavioural Therapy (CBT) with a big emphasis on Exposure and Response Prevention (ERP). However, we also know that changes in the way we think about intrusions in OCD can play a big part in effective treatment.
In this article, I’m going to introduce some of the most common thinking errors and cognitive distortions in OCD and link them to how they maintain the condition.
What are Thinking Errors and Cognitive Distortions?
The “C” bit in Cognitive Behavioural Therapy relates to Cognition. Cognition refers to any mental event or process that occurs in a given problem – Thoughts, memories, worries, rumination, attention and planning are all examples are all Cognitive. In CBT, one of the basic assumptions is that changes in how we think about our experiences can maintain a given problem. OCD is no different.
Despite being highly complex, evolved processing machines, our brains are not without their glitches. Whilst we would all like to think that we can think in clear, rational thought, our brains and our thinking can all be subject to distortions, biases and misinterpretations which can lead to the experience and maintenance of unnecessary or unwanted emotional experiences. Such errors in our thinking can have their roots in our past experiences (e.g., what we have learned or been taught about the world) or can be caused by some of the glitches we acquired through evolution.
It’s important to state that it’s not our fault that we have thinking errors – this isn’t about an individual having “faulty thinking”. We all are prone to thinking errors and cognitive distortions. They are actually built into our systems.
What we can do however, just as we are going to do here, is make ourselves aware of the types of thinking errors and cognitive distortions that can present themselves. We can learn them, label them and detach from them to ease our emotional distress.
So without further ado, here are some of the most common thinking distortions in OCD.
The most common thinking errors in OCD
- Thought-action Fusion: This is when the OCD sufferer has the belief that just thinking a thought leads them to carrying out a particular action, or is the same as doing the action. So, just as the name suggests, “Thought” and “Action” are mentally fused together. So, if I have the intrusive thought, “push the man in front of the train” I believe that this thought alone increases the chance of me acting upon it.
Thought-event fusion: The belief that having a thought can cause an event or means that the event has happened. So, having the intrusive thought that I’ve driven over someone in my car is an example of this. This can lead to rumination and doubting rituals.
Thought-object fusion: The belief that an object carries thoughts, feelings or personal characteristics. For example, in Hoarding OCD, the sufferer may not want to part with a particular item because it embodies the feelings and thoughts of a loved one with whom it is loosely associated with.
Intolerance of uncertainty beliefs: This refers to the individual’s beliefs about needing certainty, and about their ability to cope with uncertainty in the world. Intolerance of uncertainty is an underlying element across many of the anxiety disorders and basically means that when an individual is exposed to just a small amount of uncertainty they have a big aversive response. In OCD because of this need, we will see people go to extreme lengths to minimise their exposure to uncertainty in the world, giving rise to the full spectrum of checking, cleaning, ordering and avoidance type behaviours. The problem with trying to achieve 100% uncertainty however, is that it’s an impossible task – no matter what we do, there is still always some uncertainty in the world. A much better approach is to increase our tolerance. For more information on intolerance of uncertainty, take a look at this section on Generalised anxiety disorder (GAD).
Overestimation of threat and underestimation of ability to cope: So here we have an exaggeration about how threatening both external and internal events can be for an individual. This is coupled with an underestimation of an ability to cope with threat. So for example, the individual with OCD may overestimate the threat associated with an intrusive thought, thinking that it is more of a danger to them than what it actually is. They will then also underestimate their ability to cope with such a thought, triggering off behaviours like avoidance, neutralising and thought suppression.
Exaggerated responsibility beliefs: This is when the OCD sufferer believes that, because they had an intrusive thought about something bad happening, that they would be responsible for it happening (if it ever does!) So if they have an intrusive thought about a family member being in a car crash for example, they would believe that they would be responsible for that event occurring. This exaggerated responsibility belief then leads them to take misplaced responsibility for the event and engage in behaviours to try to minimise the event occurring in real life.
Anxiety sensitivity: Anxiety sensitivity is where the individual with OCD (or other anxiety disorder) believes that the physical sensations of anxiety are overly distressing and unbearable for them to tolerate, even just a little bit. They may believe that things like changes in breathing, increased heartrate and physical tension, all of which are physical aspects of normal anxiety, are potentially harmful to them and as such must be avoided at all costs.
Controllability of thought beliefs: The belief that we should be able to control any and all thoughts that enter our minds. When there is a strong belief in this area, the fact that intrusive thoughts occur can lead to distress and the implementation of counter productive strategies to counteract them.
Perfectionism: As the name suggests, Perfectionism in OCD, refers to the belief that things (our living environment, our relationships, our thoughts) need to be perfect. Often in OCD, if things are not perfect then the individual will associate this with intolerable feelings of anxiety and intrusive thoughts about bad things happening. Linked to both exaggerated responsibility beliefs and intolerance of uncertainty, perfectionism can lead the individual to assume that if an intrusive thought becomes true then it is because they have not achieved perfection in their thoughts or actions. This style of thinking is particularly common in orderliness OCD, in which just the slightest thing being imperfect can trigger a great deal of distress for the individual.
- Emotional reasoning: This is a thinking style that is again common amongst anxiety based disorders. Emotional reasoning is a thinking error in which we believe that, just because we feel the physiological and emotional feelings of fear and anxiety, something bad will happen. So we notice that we feel anxious, on edge or otherwise “not right” and based upon this information alone, we determine that something bad is going to happen in the real world.
The more we know about how our problems work, the more equipped we are to do something about it and OCD is no different. By understanding and memorising the most common thinking errors in OCD we are equipping ourselves with the knowledge to intervene in our distress. So learn them, label them and detach from them. See what happens.