Ep. 180: What is the Difference Between an Intrusive Thought and a Mental Compulsion?

Welcome back to another episode of Your Anxiety Toolkit Podcast. We have a lot to tackle in this episode!  We are going to be talking about a really important topic which has a lot of confusion surrounding it.  Today we are going to explore the difference between an intrusive thought and a mental compulsion.
OCD starts with an obsession. This is an intrusive, repetitive, unwanted thought, feeling, sensation or urge that you cannot control this.  Once you’ve had that intrusive thought, feeling, sensation and urge, you usually feel anxious and uncomfortable because it is unwanted.  You then have this natural instinct to try and remove the discomfort and the uncertainty that you feel. This is what we call a compulsion. Usually we feel some form of relief from the compulsion, but this becomes a problem because it only reinforces to our brain that the thought was important. Your brain continues to send out the alarm that the thought must mean something. Now many of us are aware of the form that physical compulsions can take such as hand-washing, jumping over cracks, moving objects and so forth. Actually one of the most common compulsions is mental and that takes the form of rumination. The problem people run into is that rumination is sometimes hard to identify. That is why I am doing this episode because so many people have asked, how do I differentiate between the intrusive thought and a mental compulsion? And what do I do? We know we should not be blocking thoughts, so how do we stop mental compulsions. If I’m not supposed to suppress my thoughts, what am I supposed to do if I catch myself doing mental compulsions? Is stopping mental compulsions thought suppression?”
I would say, technically, no. But it depends. Let’s go straight to the solution. We want to acknowledge that we’re having an intrusive thought, feeling, sensation or urge or an image. our job is to do nothing about it. We need to do our best not to solve that uncertainty or remove ourselves from that discomfort. That’s our goal. And then our job is to reintegrate ourselves back into a behavior that we were doing, or we would be doing, had we not had this thought. So here is an example. Let’s say I’m typing. I have an intrusive thought about whether I’m going to harm my child. So I have this, I’m going to acknowledge that it’s there. I’m actually going to practice not trying to make that thought go away. But instead, bring that sensation or thought with me while I type on my computer. As I’m typing, I’m going to notice the sensations of my fingertips on the keyboard. I’m going to notice the smell of the office. I’m going to notice the temperature of the room I’m in. And I’m going to then catch if my mind directs away from this activity towards trying to solve. If I catch myself trying to solve it then I am going to bring my attention back to what I’m doing. I find that if I’m getting caught in some kind of mental rumination, I get down on the ground and I start playing with my son. The OCD may continue to try and get your attention, but you are going to continue with what you are doing and not engage with the thoughts. It is important to remember that compulsions feed you back into a cycle where you will have more obsessions, which will feed you back into having more compulsion’s. It’s a cycle. We call it the Obsessive Compulsive Cycle. So we really want to sort of be skilled in our ability to identify the difference.  This is really, really hard work. I think about when you’re originally first learning anything, everything is really confusing and everything looks kind of the same. When you first start doing it, these are going to look very similar and it’s going to be difficult to differentiate the difference, but once you get better at being around this and labeling it and catching it, you will be able to see the differences in these two things, even if it’s very, very nuanced or they look very, very similar.

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Transcript of Ep. 180

This is Your Anxiety Toolkit episode number 180.

Welcome to Your Anxiety Toolkit. I’m your host, Kimberley Quinlan. This podcast is fueled by three main goals. The first goal is to provide you with some extra tools to help you manage your anxiety. Second goal, to inspire you. Anxiety doesn’t get to decide how you live your life. And number three, and I leave the best for last, is to provide you with one big fat virtual hug, because experiencing anxiety ain’t easy. If that sounds good to you, let’s go.

Welcome back, everybody. Hello. Thank you for being here with me. We have a lot to tackle in this episode, so I am going to jump in as quick as I can. I know this is such a huge concept and topic, and there’s so much confusion around it. So let’s really today talk about the difference between an intrusive thought and a mental compulsion. We also want to figure out which ones we want to work with and which ones we want to allow. We want to talk about the difference between allowing a thought and engaging in a thought. There’s so much to cover here. So before we get started, a couple of really exciting things, I really want you to keep an eye out for. On March 15, 2021, we are relaunching the free OCD training. It’s called the 10 Things You Absolutely Need to Know About OCD.

It’s not called the 10 things you need to know. It’s called the 10 Things You Absolutely Need to Know About OCD. I have shared this free training multiple times, tens of thousands of people have taken this training. I’ve gotten nothing but amazing responses back. And the coolest thing is people even said, “I’ve watched it before. This is the second or third time I’ve watched it when you released it. And it really reminded me of these core concepts that we have to remember when we’re talking about OCD.” So even if you’ve watched it before, even if you’re pretty well versed in OCD, I still encourage you to listen and take the free training. It’s just jam packed with information and science and all the good stuff. And even if you’re a therapist, I encourage you to take it. So if you’re interested, go over to cbtschool.com/10things, or you can click the link in the show notes.

I am so excited to share that with you. Now, one more thing, keep an eye out, because as of March 19th, we are relaunching ERP School with some exciting bonuses, which I will announce in next week’s episode. So excited again to share this with you. And what an amazing community, what an amazing opportunity I’ve had to teach so many people about ERP. And now also teaching therapists. We have now got ERP School approved by The National Association of Social Workers. So if therapists out there, you can actually get CEUs for taking ERP School, which is very, very cool. All right, let’s get straight to the show. Let’s talk about the difference between an intrusive thought and a mental compulsion first. So the first important piece to remember here, as we pull apart what to do with what thoughts, because that’s really what this is about.

We must first understand the foundation of OCD. So OCD starts with an obsession. This is an intrusive, repetitive, unwanted thought, feeling, sensation or urge. It’s not just a thought. It could be a sensation. It could be a feeling like de-realization or guilt. It could be a sensation like a feeling in your left finger or feeling in your nose or whatever that may be, everybody’s different. But it does start with this intrusive thought. And the thing you must remember here is you cannot control this. This is the first experience of OCD, right? You have the intrusive thought, feeling, sensation or urge, and this is the thing you can’t control. So there’s a really big point right off the bat. The second piece here is once you’ve had that intrusive thought, feeling, sensation and urge, you usually feel anxious and uncomfortable and it’s unwanted. And so your natural instinct is to do something to remove it.

You’ll do it to remove the physical discomfort, the emotional discomfort, the uncertainty that you feel. And that is what we call a compulsion. Now, as many of you know, we know the kind of more mainstream compulsions that are known in our society. Hand-washing, jumping over cracks, moving objects and so forth. But one of the most common compulsions is mental. It’s thinking. It’s rumination. And that’s the thing that’s really hard to catch. And that’s why I’m doing this episode because so many people have asked, how do I differentiate between that intrusive thought and a mental compulsion? And what do I do? Like I said at the beginning, I’m not supposed to block thoughts, but I’m not supposed to do mental compulsions. And that’s thinking too, and what this does, right? So let’s go back to the cycle. You have a thought, feeling, sensation and urge.

It makes you uncomfortable. Then you do a compulsion to make it go away. And usually you do get some form of relief. But the problem with this is that then it reinforces that that thought was important. Therefore, your brain continues to send out the fire alarm, the safety alarm, the smoke detector, it sets off all of those alarms in your brain and then sends out more anxiety with more of that thought, feeling, sensation and urge. So let’s go back to the main concept. You’re not to try and suppress your thoughts because the more that you suppress your intrusive thoughts, the more you have them. I’ve done full episodes about this in the past. So if you want to go back and listen, suppressing your thoughts will only make them worse. But here is where it gets tricky. People will say again, “If I’m not supposed to suppress my thoughts, what am I supposed to do if I catch myself doing mental compulsions? Is stopping mental compulsion’s thought suppression?”

And this is where I would say, technically, no. But it depends. So what we want to do, let’s go straight to the solution. We want to acknowledge that we’re having an intrusive thought, feeling, sensation or urge or an image, right? It could be an image too. And then our job is to do nothing about it. To do our best not to solve that uncertainty or remove ourselves from that discomfort. That’s our goal. And then our job is to reintegrate ourselves back into a behavior that we were doing, or we would be doing, had we not had this thought. So let’s say I’m typing. I have an intrusive thought about whether I’m going to harm my child, or I have an intrusive thought about whether I cheated on my partner, or I had an intrusive thought on whether I’m gay or straight, or I had an intrusive thought about harming somebody, or a religious obsession, or a sensation, or a health anxiety sensation.

So I have this, I’m going to acknowledge that it’s there. I’m actually going to practice not trying to make that thought go away. But instead, bring that sensation or thought with me while I type on my computer. As I’m typing, I’m going to notice the sensations of my fingertips on the keyboard. I’m going to notice the smell of the office. I’m going to notice the temperature of the room I’m in. And I’m going to then catch if my mind directs away from this activity towards trying to solve. If I catch myself trying to solve, yes, I am going to practice not doing that thinking. I’m going to practice not trying to solve it. And then bring my attention back to what I’m doing. I find that if I’m getting caught in some kind of mental rumination, I get down on the ground and I start playing with my son.

He’s really into Lego right now. And so I fully, fully throw myself into this. I do my best to fully engage as best as I can. Now, I’m still going to have the presence of intrusive thoughts because I cannot control that. So it’s going to sound a little bit like this. OCD is going to say, “Hey, what about this? What if this happens?” And I’m going to say, “Hi, thought. I’m actually typing an email right now. And that’s what I’m going to do. You can be there. I’m going to allow this uncertainty to be here and I’m going to keep typing.” So then I start typing. And then OCD will be like, if I were to externalize it, would be to say, “No, no, no, no. This is really important. You really have to figure this out.”

And I’ll go, “No, thank you. I’m really cool that you’re here, but I’m going to type.” And then it’s going to say, “Hey, Kimberley, this is really important. And if you don’t give me your attention, I’m going to… Something really bad is going to happen.” And I’m going to go, “Thank you. But I’m writing an email right now.” And then you’re going to be like, wow, I’m doing pretty good. Look at me go. I’m fully practicing the skill of not engaging in my intrusive thought. And then it’s going to say, “Listen…” Let’s say I’m impersonating OCD. It’s going to say, “Listen, I am not going to stop bugging you until you give me your attention.” And I’m going to go, “That’s fine. I’m actually going to call your bluff on that. I’m writing this email. You do not get to tell me what to do.” And it’s not going to give up.

It’s going to keep going. “Kimberley, Kimberley, Kimberley, Kimberley, you must pay attention to my thoughts. You must pay attention. I’m trying to alert you to a very big danger.” And often this is where people get worn down. They’re like, “Oh my gosh, it’s not going away. Maybe it is right. Maybe I should do it. Maybe I can’t handle this anxiety. Maybe this is too much for me. Maybe it’s just easier to do the compulsion.” But I’m going to be here with you, urging you to keep allowing that intrusive thought to be there. It will basically roll over and start crying and fall asleep at some point, like a toddler, who’s too tired and is rejecting his nap. But all he needs is to nap. It eventually will die down, but you have to be willing to stick and be consistent with not engaging in the pleads of OCD, the urgency of the obsession, the catastrophization of the obsession.

Because it’s going to be making it into a… What do they say? A molehill into a mountain. It’s going to be making a small problem, a big problem. And what I mean by that is the present of a thought is not dangerous. It doesn’t mean it’s a fact. It doesn’t mean it requires your attention. Some people with OCD have a part of your brain that’s going to set this thought on repeat. And because we’ve tried to suppress it in the past, it is probably going to want to be very, very repetitive. And your job is to do nothing at all. If you do, and I’ll say this again, if you do catch yourself doing mental compulsion’s, it’s okay to stop doing that. That’s not thought suppression. As long as you’re… You don’t want to over-correct. So if you catch yourself doing mental compulsions, don’t over-correct by also trying to block the thought.

That’s where we get into trouble. Instead, you just do a small correction back to what am I doing? What am I engaging in right now? What do I value? Because we do not value compulsion’s. Compulsion’s feed you back into a cycle where you will have more obsessions, which will feed you back into having more compulsion’s. It’s a cycle. We call it the Obsessive Compulsive Cycle. So we really want to sort of be skilled in our ability to identify the difference. If you can’t identify the difference it’s going to be really hard to know which is which, and how to respond in those moments. And a lot of this is when we’re super anxious, it’s really hard to think logically. It’s really hard to think… Is this true or is it not? Or so forth. It’s not even helpful in that moment.

Whereas, it may be like three days later. You’re like, “Oh my goodness, what was I thinking? That was a bit strange. I wonder why I got so caught up in that.” And that’s because when we’re anxious, our brain has a difficult time coming up with problem solving that is effective. So the more you can be able to identify it, and I encourage my clients throughout the day is catch yourself doing mental compulsion. Don’t beat yourself up, but practice this idea of going, “This is me doing a mental compulsion. This is me having an intrusive thought. This is me having an intrusive thought and wanting to do mental compulsion.” And being able to label them so that in the moment when you really are at a nine or a 10 out of 10 of anxiety, or uncertainty, or discomfort, you’re able to be more skilled in your response.

Super, super, super important stuff here, guys. But we don’t want to shame here. Again, this is really, really hard work. I think about when you’re originally first learning anything, everything is really confusing and everything looks kind of the same. I always think of like The Devil Wears Prada, this is a crazy example, but the actress is laughing at these people because they’re looking at a belt that looks almost the same, but it’s very different in their eyes. And the one main character is like, “They’re the same belt.” And they look at her like she’s crazy. And this is the same, right? When you first start doing it, these are going to look very similar and it’s going to be difficult to differentiate the difference. But once you get better at being around this and labeling it and catching it, you will be able to see the differences in these two things, even if it’s very, very nuanced or they look very, very similar.

Okay, that’s all I’m going to say for now. The tools are the same. If you really want to go back and practice and learn these mindfulness skills you can practice, go back and listen to some of the previous podcast episodes. I actually encourage you to go back and listen to some of the earlier episodes, because in those episodes, I totally, I was laying out this awesome content on how to be mindful. Some of my best podcasts are the very first few ones, which is like back-to-back major skills, major tools. It was laying the foundation for how to be mindful with obsessive thoughts. So go back and listen to those or sign up for the free training coming up or, and you can also sign up for ERP School, which is coming back very, very soon.

We also have Mindfulness School for OCD, which is a course that really deep dives into practicing mindfulness related to obsessions and compulsions. So that’s there for you as well. Okay. A lot. Sorry, I’m talking so fast. It’s something I’m so passionate about and is something that I really wanted to make sure I covered and get very clear on. I’ve had a couple of you reach out and really be stressed about figuring out the difference. I’m hoping that’s super helpful.

One last thing before we go, please do leave a review. I know I keep begging you at the end of every episode, but it really would mean the world to me. If you get anything from the podcast and you want to give back in any way, I would love a review from you. Your honest review, you don’t have to fabricate anything. I really love them. I read every single one. And once we get to 1,000 reviews, we will give away a free pair of Beats headphones so that you can hear me crystal clear in your ears. And you of course can pick the color of your choice with those. So all my love to you.

Please do go and leave a review. I hope today’s episode [crosstalk 00:17:05] was helpful. And get excited [crosstalk 00:17:05]. All right, have a good one, guys. All my love to you. It is a beautiful day to do the most beautifully difficult hard things.

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