How To Stop Thinking

You Like OCD's Intrusive Thoughts

 Why you don't really like your intrusive thoughts in obsessive-compulsive disorder

First, the brain's basal ganglia are known to be responsible for the sticky thoughts in OCD. However, there is another part of the brain that is associated with the basal ganglia. It is the nucleus accumbens (NA). It carries aversion on one side and desire on the other. The septum that divides it is only a few millimetres thick. To imagine it, think of the septum that separates the nostrils. Because the NA's divide is so thin, you can visualise how closely someone can like and dislike something together. Picture it like smelling a pleasant aroma with one nostril and an unpleasant one with the other nostril and then remembering a mixture of those scents. In that case, it's hard to decipher one from the other.

In OCD, the NA is the part of the brain that is targeted for deep brain stimulation. It's not targeted because of the erroneous like or urge factor per se, but because it is linked to treatment-refractory OCD. That means the disorder is more stubborn to treat with exposure-response prevention (ERP). In some cases, it is a deep level of absorption that is missed. Such a state involves a person being so preoccupied with the obsession that they are unaware of other things around them.

The point is that when you think you want to act on the thoughts, the urge is false because the obsession has no real meaning. Instead, because it glides so close to aversion is why it appears to look like somebody experiences both like and disgust. It doesn't happen with everyone who has pure-intrusive thoughts. Still, for those that do feel an urge to want to do the things they don't want to do, the solution is to prevent absorption. To do this, you would stop yourself engaging with the obsession and instead pay attention to ritual prevention.

For ERP treatment to be successful, you cannot let your imagination sway you away from that. For example, when you get so absorbed in a harm obsession, you can quickly lose sight of response prevention. It can be when you're doing exposure. It can also happen when you're triggered. Ritual prevention squeezes the obsession. But suppose a person has a groinal response when exposed to a sexual obsession, they might wonder why. They might then check and become absorbed in the obsession. In other words, doing rituals to prove they don't want the groinal response can inadvertently lead to heightened arousal. And all the while their symptoms don't seem to be improving, and they're unaware of absorption, they might worry that their increasing excitement down there is something else, not the physiological symptoms of anxiety in OCD.

In another example of absorption, let's assume a person tests out why they're not feeling anxiety during ERP for a religious obsession about despising God. By testing, the person inadvertently allows a subtheme to morph into the original obsession. By checking (ritual) why they're not feeling anxiety (subtheme) in response to the primary obsession (despising God), their attention on ritual prevention for the primary obsession goes astray, and the problem gets worse.

The way out of this spiral, therefore, is to resist getting involved with the obsession and trying to figure out what the thoughts and feelings mean or why anxiety is lacking. As we've seen, it can lead to a subtheme and absorption. Instead, it's crucial to alter thinking errors in response to the obsession. More specifically, and as already noted, to work with the ERP hierarchy and concentrate on ritual prevention for the primary obsession. Incidentally, a thinking error usually involves moral thought-action fusion. For example, "Because I have feelings that make me think I want to act on the thoughts or because I think I enjoy them, it must mean deep down I'm a bad person." An altered statement might be "I'm having involuntary thoughts; I will let them come and go while paying attention to ritual prevention."

To learn more about my desire-aversion theory, you can read my interview with Sunil Punjabi, a mental wellness counsellor at unshackle.in. To find the interview, click the link below.

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