What do you do when the obsessions seem real? According to the metacognitive model (Myers & Wells, 2005), people suffering from mental disorders like OCD consider having the thoughts as being equal to acting on the thoughts, due to the metacognitive belief called ‘thought-action fusion’ (Myers et al., 2009). You may think you are a bad person because you get the thought of harming someone. But that is untrue. It is like saying that merely having the thought of winning a lottery makes me rich and I should splurge on expensive vacations. This does not make sense at all.
Cognitive Defusion (not diffusion) from Acceptance and Commitment Therapy is an important concept in the Harm OCD recovery process. Cognitive Defusion focuses on being more aware of your thoughts. Instead of trying to push our thoughts away, change them or fight with them, we may be able to learn to view them differently. Based on our apperception, that is, our sense making, the same stimuli may mean different things to different people.
For example, in the pre-Covid-19 era, the word positive had positive connotations. However, after the world experienced the horrors of Covid-19, the word positive in fact, developed negative connotations, where people were terrified at being diagnosed Covid-19 positive. That is, the word ‘positive’ was fused with being undesirable.
Thus, it is not the thought that is the problem, but how we relate to it. When we fuse with statements like ‘I am a loser’, we feel bad, sad for ourselves or angry at ourselves. We judge ourselves, on the basis of our thoughts, instead of letting them pass us by, without judgment. Cognitive Defusion is the process of separating the thoughts from the meaning we attach to them so that we may be able to focus on things that matter. Defusion is a skill that allows us to detach from our thoughts and reduce the impact our thoughts have on us.
In Harm OCD, a big problem is the appraisal of your intrusive thoughts as real. When you get an intrusive thought, say, you are an evil person, it seems real, because you are fused with the thought. If you learn to defuse, you may be able to deal with it better. But you may think ‘Since the thought is mine, isn’t it me?’
Well, you are thinking the thought but it is not you. Think of it like this. You are a body that is entirely grey in color – person 1 in figure 3.12. This is the complete you and only this is you. You have an intrusive thought, an automatic thought that pops into your head, which is black in color as shown on person 2. Notice that this thought is different from the real you, an addition to the real you. Notice also that it is possible to recognize that ‘you are not your thoughts’ and also possible to separate the thought from yourself as shown on person 3.
Figure 3.12: Cognitive defusion
An intrusive thought is automatic. You don’t ask for it, you don’t invite it. It just happens. You that you are not responsible for getting that thought. It is like someone throwing a water balloon at you. You have no control over when it will hit you and how. So, you may choose to:
- Assign meaning to and fear the thought – ‘I want to stab my manager. This means I am evil.’
- Try to convince yourself and your Harm OCD (or Jay) that it is not true – ‘I want to stab my manager. No. I am a good person. I do not want to stab anyone.’
- Try to mull the thought over in your mind to find a resolution to the doubts that come up- ‘Am I evil? But I have always been kind. Then why am I getting this thought? Have I turned evil finally?’
If you do any of these, that is engage with the thought and have an internal dialogue, it amounts to a compulsion and your Harm OCD will become stronger. So, when you get a thought that seems real, one of the ways to defuse the thought from yourself is to add two prefixes one after the other. Here is an illustration.
Your initial thought: I am evil.
This thought is the automatic intrusive thought that pops up as a result of your Harm OCD. You can defuse this thought by using the first prefix.
The first prefix: I AM GETTING THE THOUGHT THAT I am evil. Alternatively, you can say, JAY IS TELLING ME THAT I am evil.
With this, you create a distance from the thought. This informs you that the thought is not yours but being given to you externally, by Jay. Once you realize this, you can add another prefix.
The second prefix: I AM OKAY WITH getting the thought that I am evil. Or, I AM OKAY WITH Jay telling me that I am evil.
Remember you are not expected to be okay with being evil. You just have to be okay with the thought of being evil. If you have the insight, you know that your thought is untrue. This is how you practice cognitive defusion with your obsessive thoughts. This acceptance of the futility of your thoughts can help you to not do the compulsions. Personally, I find this method the best but there are other methods. There is an article that outlines a few other ways of practicing cognitive defusion provided by The University of Sydney, which you can download from https://t.ly/_91X. Do try all of them and see which ones work well for you. Also, practice defusion in Worksheet 3.12. An example has been provided for reference.