Mental Checking or Intrusive Thoughts?

[perry12]

Hi all

I am just stuck in a little rut. I have been suffering with Pure O/Harm OCD for 6 months and intrusive thoughts.

I have been through CBT and educated myself with books and I think I am on the right path to beating this thing as I know many others have done.

The issue I have is that my thoughts don't feel intrusive anymore, they are more like a reminder. So its like my mind is looking for the thoughts when I return to situations when I first had the intrusions if that makes sense. Whereas before i was getting intrusions left, right and centre, firing like a gun. Now I can be having a good couple of hours but when I return to a situation where the intrusions used to fire, its like I am looking for them and checking if they are still there if that makes sense, then they hand around again.

Are these still intrusions and do they still need exposure or is there a different approach to this, how would you describe it?

I would appreciate any help guys

[MyNameIsTerry]

Hi Perry,

It's good to hear you are finding what works for you.

Memory is part of how this all works, like anything really. Your subconscious stores "data" and it's not limited to thoughts, feelings, emotions, sensations, etc as it can also timestamp things and add in situational data like locations. For instance, it's common for a panic attack to occur in the place they have happened before and anyone who's ever had a situational anxiety trigger like a supermarket knows how it takes a load of repetition through exposure to get past it.

So, it's possible that by returning to the situation your subconscious finds that in memory and fires an intrusive thought or just anxiety sensations associated with that place. So it is possible to have intrusive thoughts which are triggered by the situation. However, if you don't feel that popping out of your subconscious and you feel that you are consciously trying to recall it, to check if something should come to you (like an intrusive thought) then this is more like a testing compulsion.

Testing compulsions are something we do to check we are still reacting the way we think we should be. A good example if someone with POCD purposely looking at a child that would have formed part of their original fears or it may mean using imagery like a catalogue or a TV programme with children in. It's all about proving to yourself that you react with the expected fear response.

A problem with this can be that over time your reactions change. Some people start to get more depressed than scared and they then worry this change represents a further shift towards the inner demon they think has been coming out of them, the other them they are afraid of. So, testing compulsions can be difficult for more than one reason.

Exposure can still be used, but it will be a matter of how you do it that matters. You know compulsions only reinforce the obsession so the aim needs to be not to perform the compulsion hence you can use exposure to enter the situation with the aim of reducing & eliminating the compulsion. You could aim to stop the compulsion in one go and keep doing that, which can be hard. You may try to phase it out the ERP way if you can come up with a plan to work through increasing harder steps.

[perry12]

Thanks for explaining that to me

It is definitely a checking compulsion by the sounds of it. I am walking to the situation and I am looking or waiting for it to come, or I will be having a good little spell and my mind is then thinking 'is the intrusions still there, what about that intrusion, what about this intrusion'

I do expose myself when going to situations where the intrusions come but at what point do you stop doing the exposure? because it becomes a habbit to keep doing the exposure when I am predicting the intrusion will come if that makes sense? or is it just a case of forgetting exposure every now and then and seeing if the intrusions are still there

What concerns me is can intrusions just then become memories that will always be with us? for example, when I wake up in the morning, I am thinking to get dressed, sort the dog, do my teeth etc etc we have a routine that is always there, can an intrusive thought just become part of that routine even if your feelings towards it change? or will the red flag be removed from the thought automatically because your brain may know you don't NEED the thought but I must always have the 'brush my teeth' thought so that keeps firing

:shrug:

[MyNameIsTerry]

Exposure is something you do to get beyond the fear and to experience anxiety reducing. Then through repetition and moving forward to ever more difficult exposures you make the previous one extinct so it no longer bothers you. With intrusive thoughts this can mean getting to the point where whilst a thought may come, it really no longer bothers you. Eventually the thought just stops coming as the trigger (the person or event) is no longer evoking the negative fear response your subconscious is looking for and now new (or old) positive/neutral neural pathways develop and come to the forefront to be used whilst the old fear based ones become mothballed.

So, if you are at the point where you no longer feel the fear from the exposure, or when exposing the intrusive thought causes no issue, you are making great progress. The remnants, the fact it still "fires" can sometimes just take as bit longer to go but it will. However, be wary of then acting on testing compulsions because you are trying to find the negative response when really it is no longer happening and you need to just accept that things are ok.

All memories remain, but that's not important because the subconscious can change what is linked to those memories. So, don't worry about it always being in your mind somewhere because the point is it will be so weakened, and the positive/neutrals attached to the memory will now be so strong, that unless you allow yourself to fall backwards into an anxiety disorder, it may never surface again. The same can be said for anxiety disorders in general though.

Yes, an intrusive thought can become part of a routine where it is allowed to form itself as part of one. But it doesn't matter because the same process that allowed it to learn to be there can learn for it not to be there too.

Yes, the habit of brushing your teeth is a required process in your day. You can unlearn this to and become unhealthy, just like how we struggle to keep such routines going when anxious or depressed and then they are a struggle to reinstitute. But brushing your teeth, getting dressed and sorting the dog are all positive/neutral ones, they don't evoke the fear response. And the more you do them, the more you keep them "current". Your intrusive thought will no longer serve a purpose, whether in that routine or not, hence will get mothballed.

[perry12]

Thanks Terry, that is one of the best explanations I have had. My therapist who I have been seeing privately and costing a lot of money has just kept going and going at exposure therapy even though I am having hardly any if any response to it, the anxiety is almost not there with the thoughts but then I do get the odd days where I do feel anxious with the thoughts but I think it is just when I am sick of having them and stuck in a circle of not knowing what direction to go in or anything.

Basically if my anxiety has died down and virtually going from the thoughts, I should take a mindfulness 'state' and just allow myself to think anything, not block thoughts but just let anything flow and in time my mind should mothball the thoughts I have no need for and return to a 'normal' state?

I had read success stories of people overcoming intrusive thoughts by exposing themselves to them whenever they popped up, they would think about them deeply and let themselves feel the anxiety and over time they just disappeared. But with this method I found myself waiting for me to return to situations where the thoughts first came up and then would constantly expose myself whenever I was there if that makes sense. I possibly wasn't even having intrusive thoughts I am exposing myself before they even had chance to pop up.

Would you say the accepting, mindfulness is the route I need to take now, keep myself busy and in as much as a normal routine and my mind will re wire over time?

thanks again

[MyNameIsTerry]

It's a bit worrying if you are not getting a better explanation of the professionals. But thanks, I really appreciate it. The memory side was explained to me by a member who has since left NMP who had recovered from panic, not OCD. He knew a ton more about it though.

Crikey, it sounds like your therapist doesn't understand exposure therapy. Once you get to a point where a step is no longer bothering you it's easily time to move onto a harder one and keep going. I found a useful paper aimed at therapists about how ERP can fail and what they should be doing. It might be a useful read:

http://www.nomorepanic.co.uk/showthread.php?t=159265

Yeah, we get those wobbles. Sometimes it can be due to mood or just being under more stress or a symptom that has been bothering us and we find it impacts on something we thought we had conquered. It's not a step back, it's just something to make an adjustment to. I have it myself with supermarkets sometimes but I challenge or it accept it and plough on and it seldom lasts. I dealt with my nausea symptoms long ago (thanks to a Mindfulness epiphany when ill once) but even now if I am not feeling well they can raise themselves when in the supermarket but I deal with it and it quickly fades.

If by blocking thoughts you mean trying to push them away, that doesn't work. Blocking with a negative emphasis is going to be signalling back that you don't like the thoughts and that's a tick in the box to the subconscious that it's "valid". If you mean challenging in the CBT way with positive/neutral methods then that's fine. But yes, accepting thoughts is another way to beat them. There are acceptance methods built around this and Mindfulness includes it from the "curious observer" point of view.

The more your intrusive thoughts are met with a positive/neutral response, the more they will fade. The area of the limbic system in the brain that looks for the response only looks for negative. So, if you starve it, the process ends up downgraded. I think this might be why sometimes we find the thoughts still come but without the fear they used to bring because we are steadily unpicking those associations between the thought and al the fear response stuff. Remember, it's all neurons attached by synapses. Those synapses can attach to other neurons, new associations get made, new clusters, etc. So, you can move things back to earlier healthier thinking or vice versa. That's really how these fears form and the process is the same whichever way you apply it, part of neuroplasticity - how we learn.

The success stories you mention are people who are not trying to push their thoughts away, they learn to accept them and all the unpleasant sensations they bring. This means not sending back that negative signal I mentioned earlier. They starve the process. It's an OCD process and it's a cycle, by breaking that part of the cycle, it can't tick that end box to say its a valid thought process.

I think with this it's more a matter of allowing it to come and then not running away from it or pushing it away. They just let it happen. What you were doing is more the therapist driven way of exposure exercise.

I think it's a matter of knowing where the line us. Knowing the difference between performing a testing compulsion and a healthy exposure exercise / Behavioural Experiment. With testing, you are using it negatively because you are trying to check you are still reacting with fear. With the exposure exercise you are bringing on the fear with the intention of allowing it to fade to prove it's not a threat. With the Behavioural Experiment you are trying to prove something isn't what your irrational thinking is telling you it is e.g. staring at a loved one wishing harm to come to them can't cause them harm.

I don't want to say not follow your therapists advice. To be honest, I think they need to listen to you because their exposures are not working for you. Usually it's because the person can't stop the panic so they need an easier exercise, a "stepping stone". You are the opposite, which is great because it shows you are getting through your anxiety. So, either your therapist needs to be upping the intensity or shifting to a new strategy.

I can't see why your therapist wouldn't agree with Mindfulness practice, it's well known to help anxiety and NICE approved for recurrent depression anyway so it has NHS backing. Really in an exposure exercise you are often too afraid or distracted but if you can practice acceptance within it, all the better as it will add more power to the exercise to get you recovered.

[perry12]

That ERP paper looks very interesting, I am going to print it off and have a thorough read of it.

Thanks for your responses as always, they do help :)