What Are My Coping Skills?

BE PRACTICAL
Do you have directions? Contact numbers? A plan or goal? Money? The right clothes? Phone charged? Snacks/water? Enough time to get some place? And, do you need to be overthinking things (what can you reasonably let go of)?

REACH OUT
Know who supports you and let them in – tell others what you are going through.
Foster rapport; reach out to strangers if necessary; connect with helpful others.

COMMUNICATE
Ask nicely. Experts will help you more if you say, “Would you be willing to . . .” I’m wondering if you could educate me about this . . . “ “I’d be so grateful if . . . “ “This isn’t my area of expertise – what is your recommendation?”

PRACTICE SELF CARE
Breathe! Sleep, hydrate, and be well-nourished.

PRACTICE SELF-COMPASSION
“Channel” a wise, compassionate adult, and comfort your anxious self.
Be soothing, calming and understanding towards yourself.
Be forgiving to yourself or others.

BE DIRECT
Articulate needs / use direct rather than indirect communication.
Advocate for yourself / ask for help.
Utilize resources.

PRACTICE IMPULSE CONTROL
Act less impulsively – try not to hurt others or yourself.
Think before acting, such as your tone of voice or the words you are saying.
Don’t agree right away. Say, “Let me think about it – I’ll get back to you.”
Don’t overshare with the wrong people.
Slow down; take a break.
Don’t trade short-term relief for long-term negative consequences (e.g., escape/avoidance).
Don’t try to cope with drugs or alcohol.

BE FLEXIBLE
See alternate perspectives; practice empathy by putting yourself in others’ shoes.
Consider options and be flexible; go with a different plan if necessary.

BE PREPARED
Put in hard work: study, prepare, and don’t procrastinate.
Find the right experts and once you trust them, really follow their recommendations.

BE “GOOD ENOUGH”
Notice avoidance, procrastination and perfectionism, and don’t let them sabotage you. Just move forward and be “good enough.”
(Perfectionism makes it hard to approach things, while being good enough paradoxically helps you to do your best).

ADJUST YOUR THINKING
Only let your mind focus on something tangible or concrete – like making reservations, writing a to-do list, budgeting money, or researching something you need an answer to.

LABEL THE THOUGHT/ COME BACK TO THE PRESENT
Intangible thoughts, like worry, won’t help you, so don’t let them take you for a ride.
Practice being an Observer:
Say, “Worry, there is worry.” Or, “That’s a ‘what if’ thought.”
Bring your attention back to what you are doing, or redirect to another activity.
Tune in to your senses in that moment (sights, sounds, smells, etc).
Say, “Back to now.”

TRUST YOURSELF
Remember that you only show up in the Now, not in some imagined future scenario.
In the present moment, the moment you will always be in, you will have access to information that makes it more possible to respond.
For these two reasons – that 1) You will be there; and 2) you have all the information you need – you can trust yourself.

STAY HOPEFUL
Don’t wait for confidence to come before taking risks.
Fake it till to you make it.
Or, fake it till you become it.
Other: ________________

© Heather Stone, Ph.D. 2016

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Write a Letter to Your Suffering Self

Clients tell me that they have absolutely no idea how to have self-compassion, and while they easily demonstrate compassion for others, they just don’t know how to be compassionate with themselves. First, let me take some of the pressure off of you by suggesting that you don’t have to be over-the-top, out of character, or even “gushy” when you treat yourself compassionately. Rather, try to acknowledge your suffering with some sincere appreciation or sympathy. Simply wish for your own wellbeing. And most importantly, do not ever judge yourself as bad, stupid, or weak.

As an exercise in self-compassion, I suggest that you try to mentally divide yourself into two different parts. Imagine, if you will, that you are two separate selves, one that is wise and compassionate, and the other that is deeply suffering. Because many people are invested in avoiding or rejecting their anxious selves, just noticing this part can sometimes feel uncomfortable. What helps is to envision looking at your Suffering Self as if it were seated in an empty chair, right in front of you.

Who, exactly, is this Suffering Self? This is the part that is hurt and scared, the part that is hoping for reassurance and assistance. It is the part of you that’s “younger.” When humans suffer – when we are sick, injured, or anxious – we tend to regress in the sense that we actually feel smaller. In those moments, it can feel like our regular adult self just completely disappeared, putting this younger side in charge of any given situation. But if you think about it, the younger part is the least equipped to deal with something difficult, because when we’re younger, we don’t have skills, confidence, or experience. We shouldn’t expect this injured or frightened self to take charge or to do battle for us. And yet, we continually do so, often pushing this self to the front lines, so to speak.

Even if you have had little exposure to some caring, competent adults, you can still picture how such persons would behave. Capable adults can be soothing and calming. They are also better at seeing alternate perspectives, acting less impulsively, articulating their needs, utilizing resources, considering options, and most importantly, making direct requests.

What helps is to envision looking with compassion and curiosity at your own Suffering Self, as if it were seated in front of you. Try to consider, how does this image look to you, at this moment? What is its age? What can you say about its posture, countenance, or mood? What might this Suffering Self be thinking? What does it want? Amazingly, you might begin to describe this vulnerable part in much detail. Try to consider whether there is hope or hopelessness, what type of assistance, protection or company it needs, and from whom.

After learning more about your Suffering Self, begin writing your letter, as best you can. Take whatever time is needed to make it as personal and meaningful as possible. In terms of content, here are a few guidelines:

The majority of the letter is simply about offering validation. This is because when we are suffering, we don’t want so much to be talked out of our pain, and we don’t always need to be given advice. Rather, we want to know that our suffering was real, that it mattered, and that we feel understood. So, write as if you can convey this type of sympathy and understanding. These are some general phrases that could be used:

Dear Suffering Self,

I understand that when you are in this difficult place, you feel __________.
When things are this hard, you want to ___________.
You start to think that ______________, and wonder whether _______________.
You can’t help wishing that __________________.
____________ is a thought that often comes into your mind.
If you could long for anything it would be that you could have __________, __________, _________.
If somebody could just care enough to notice, they would see _______________.
______________ is what you need the most, but you have sometimes wondered whether it would ever come.
Having ____________ would make all the difference in the world.

The last part is to provide a comforting presence while refraining from giving instructions or advice. Such statements might be,

Suffering Self, you are so right to feel this way! This makes perfect sense to me. Of course you would feel exactly as you do. You have been in this place for such a long time, and I realize how hard this has been for you. I can see that you are in so much pain.

I am here with you; you don’t have to feel alone.
I see your goodness and your value.
You may have been overlooked or misunderstood in the past, but you are not anymore.
I trust you, and want to earn your trust as well.
I see the truth and the situation you are in, exactly as you do.
I know I have fallen short sometimes, but now I want to be here, I want to do my best.
I will stay with you so that you can feel reassured.
I care deeply about your feelings and your struggle.
Everything about you and what you are feeling matters to me.
If I could protect you, if I could stand by your side – even in certain moments of your past – I would do so unhesitatingly.
I am by your side and will take care of you. You are not alone.
I hope you can feel my presence. I’m here for you.”

The importance of this letter has many aspects to it, but the most relevant piece is that it will create a reminder or bridge for you to find your inner strength during difficult times. Put this letter somewhere where you will find it, and if you’re ever in a scared, hopeless or desperate state of mind, just take this letter out and read it. And try to believe it. After all, it came from the wisest, most compassionate part of you.

©2016 Heather Stone, Ph.D.

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How to Practice Willingness

Many psychological approaches based in Cognitive-Behavioral Therapy, Acceptance and Commitment Therapy and other mindfulness-based therapies propose willingness as an effective technique for coping with a variety of symptoms. I agree that this paradoxical approach is the best way to address our suffering, and you may too, once you realize that resistance has never really provided the relief you were hoping for.

Before we continue, I want to emphasize that the strategies I am proposing should only be used in regards to inescapable suffering – anything that you feel subjectively, such as a feeling, thought, or physical sensation. We are not talking about a situation you might be in, like being abused by a boss or a romantic partner. This approach is not intended to be a tool for remaining in unhealthy situations, since there are truly dysfunctional environments we sometimes need to remove ourselves from. What we’re talking about here is the relationship you have to your migraine, nausea, tinnitus, depression, or panic – anything that arrived unannounced and that you experience internally.

Intuitive = No / Counter-Intuitive = Yes

Despite how frequently we resort to distraction, avoidance, and escape as our usual “go-to” responses, these intuitive strategies most certainly fail when it comes to reducing our suffering. Even though we are able to see this at times, we still end up utilizing these self-defeating strategies. After the symptom has passed, it’s easy to have insight about how futile these attempts were, since we can clearly see what did or didn’t help. But when we are deeply struggling – when we are at our lowest ebb – we tend to forget what to do. Thus our insight waxes and wanes: at best, it is intermittent; at worst, it goes straight out the window.

Even when we begin to remember that we can’t escape our pain, it can still be very hard to practice willingness as an alternative to resistance. As it turns out, willingness is not especially hard to sell as an idea, but it is very difficult to sell as a practice. And it gets even harder when I encourage my clients to go further and actually want their symptoms, which is something I often suggest that they do. You may be feeling horrified after reading the last sentence, and believe me, I get it. Everything about this approach feels wrong. But so are our intuitive strategies, and since these don’t work very well, it might be time to try something new.

FAQ

Before we go on, let me first respond to some frequently asked questions, such as “What about self-care?” and “Shouldn’t I fight an illness or search for a cure?” Yes, of course, but here is something you need to consider. If the mind is working on something tangible, like scheduling a doctor’s appointment or researching treatment, that’s absolutely fine, because you are engaged in a task that’s measurable – you’re doing something concrete. But if your mind is refusing to feel something in the present moment that actually exists, resistance isn’t going to work, and that’s when such control strategies fail. If your mind is working on an escape route such as, “How long am I going to feel this way?” and “How can I make this pain go away?” – it isn’t doing anything productive, and it isn’t the best use of your mind. Rather than trying to escape the inescapable, see if you can just show up for the present moment you are in, and if that moment happens to include some discomfort, try moving towards your pain rather than pushing it away. Don’t worry; there’s more to this process, and I’ll help you learn how to do this.

Feel the “No!”

It’s easiest to begin by first noticing the resistance or implied “refusal” you have in response to your distress. This is a perspective of, “This can’t be happening. . . This is unacceptable. . . I can’t let this go on.” And yet, deep down, we know we ultimately lose those types of ultimatums with our bodies or our minds, since most often our symptoms just steamroll right over us.

Rather than engage in this losing battle, see if you can begin to appreciate how the refusal goes hand in hand with continued suffering. Vow to hold onto this insight, understanding that it is your sense of refusal which actually sets up you to fail, because “what we resist persists.” Once you feel more aligned with this awareness, locate the feeling inside your body that feels like a protest. Feel the “NO!” response, and see if you can soften the rigid stance you are taking. Then, draw in your next breath, taking the position of being “all in” or “fine; here goes . . . . “

It’s Not Forever

You may be glad to know this isn’t something that you need to do all day long. Practicing willingness can and should be done in small bursts – whatever you feel you can manage. If it feels too daunting, set the timer. You even can start with just thirty seconds, but I think for it to work effectively you should do it for at least five to twenty minutes. You also need to practice in a quiet space with no interruptions, because it’s too hard to achieve the right results when there are other distractions that are competing for your attention. Because of your symptoms and everything else you are dealing with, you need to put yourself in a quiet space in order to focus.

Admitting the Truth

Once you are in a place where you cannot be interrupted, begin by just admitting that the discomfort is there. You don’t have to like it, and you don’t have to agree with it, but see if you can simply admit the truth, that the experience is present. Ok so far? From there, move closer and closer toward it. And once you get really close to it, try going even farther than you intended. As with any skill or technique, the best way to nail it is to “over-shoot.” You actually have to go beyond the admission, go beyond the acceptance, and move straight into willingness. And then go past it.

“Oh, my God!” you might intuitively groan. “What is beyond willingness?” What is beyond willingness . . . is . . . (bear with me) . . . . wanting the symptom. It is actually going after the feeling, seeking it out, wanting it, and then . . . wanting more. I know it sounds hard, but I promise, what you’ve been doing has been harder.

The Problem of Resisting

Let’s talk more about resisting, and why it tends to increase our suffering. Resisting is sort of an attempt to flee, but if you think about it, it’s impossible to flee from an internal experience. The “fight-or-flight” response that’s built into our hardwiring was designed to protect us from danger, but it only applies to danger that is external. This survival mechanism was only supposed to help us run from an avalanche or flinch from a snake. It was never meant to help us avoid something subjective—something that’s inside the skin.

When we practice resistance as a coping strategy, we are trying to flee, at least mentally, and when we attempt this, all we are aware of is the pain. Feeling “trapped” is a common experience that goes with symptoms like anxiety or pain, but this notion only exists because “fleeing” is somehow considered to be an option. But how can it be? We’re residing inside of ourselves, and there is no place to go. Likewise, avoiding or fleeing from a triggering situation isn’t a viable strategy either, because Reality doesn’t like to replace what already exists with our own preferred circumstances.

But willingness gets along with Reality, because willingness agrees with what already exists. This gives us more energy, because agreeing takes a lot less work. While resistance produces the unintended consequence of increasing our discomfort by imploring us to struggle, wanting our suffering makes it less so. The reason? It’s because wanting something provides the awareness that we are separate.

To Relate is to Separate

Let me provide a little bit more explanation. When suffering predominates, the “Observer” part – the part that usually helps us to feel more distance – doesn’t like what it sees, and tries to vacate the scene. But without such presence, the suffering takes center stage. The result is to feel “fused” with the suffering, unable to achieve any distance. When we “refuse to feel,” there is no longer a sense of truly relating to our suffering – only a sense of hiding or turning away. In the end, “refusing” leads us straight into jeopardy – causing us, paradoxically, to be “re-fused” with our pain. And if it’s distance we want, it can only happen where there is a dynamic – a dynamic of relatedness. The most powerful tool you have when it comes to easing your suffering is to discover the real “You” that has the ability to notice things, and to want what’s real.

As you regard your discomfort from a curious place, you will begin to notice that You and the symptom are in relationship to each other. Moving towards it, even wanting your suffering, establishes a relationship dynamic that didn’t exist before, and therein lies your freedom. Suddenly you will discover that You and the experience are not the same. This safe presence can also give you something reassuring to focus on. One of the nicest things about practicing willingness is that it helps you find a great comfort in your ability to feel your own presence.

 “You” Are Not Your Symptom

In the beginning, don’t be surprised if you feel your own presence to be very small. Up until now, you may have only experienced the temptation to disappear, and the attention on your suffering has made it the most important thing. But even if you can sense only 1% Observer and 99% discomfort, this is a significant foundation that you can build upon. The good news is that you have already proved that the discomfort does not consume all of you – you just noticed that it isn’t 100%. Better still, paying more attention to the Observer will help it to become larger, and pretty soon your suffering will feel smaller by comparison.

Contrary to what you might think, showing up willingly in the presence of pain or discomfort can be a deeply moving experience, especially if you have never fully witnessed the truth about your own bravery. Knowing yourself in this new context affords you another gift as well. You will begin to see the best, most sincere part of you, the part that is willing to attend to something difficult – the part that can show up in a genuine, heartfelt way. This can change your internal experience. You might not learn anything new about how difficult your symptom is, but you will learn something about your own character and your courage that you never saw before. Aside from the eventual reduction in your symptoms, this is a very connected feeling that will affect your self-worth and the quality of your life.

Moving Forward, Inch by Inch

You are already getting a glimpse of why this might be a good idea, so let’s approach willingness together in a more structured way. From a compassionate standpoint, start inching your way forward. Take time with each step, and consider each one deeply:

  • Find the refusal
  • Soften the “No!”
  • Admit that the feeling is here
  • Agree that the feeling is here
  • Agree with the feeling
  • Want the feeling
  • Want more of the feeling

Discover all the nuances as you progress through this exercise, and notice how we’re not taking any action here. You’re still here, and the experience is still here. Nothing has really changed . . . or has it? Notice whether this exercise made you feel worse, better, or the same. If you’re still feeling bad, you might be evaluating too soon. Ask yourself sincerely: Did you try to use this exercise as a control strategy to make the discomfort go away? Because if you did, it wouldn’t work.

Take a big breath right now. The only way it’s going to work is if you go into willingness for its own sake, pure and simple. Change your objective. The purpose is not to reject the feeling, but to explore willingness in an open-minded, completely genuine way. Once your intention has changed and you are completely satisfied with your integrity, go through the steps again, this time making willingness your only goal. You can evaluate your suffering perhaps later on today, as a footnote. But don’t hold it so fiercely in front of you at this point.

I’m Still Resisting ~ It’s Hard to Change

We recently learned how just doing this practice for the sole purpose of reducing your symptoms will eventually backfire, so it will become necessary to find deeper incentives for agreeing to have this experience. In order for you to want your suffering – really want it – you are going to need to find a higher purpose, or it might be too difficult to approach. This is going to be a very personal thing, and you must answer to yourself, from a heartfelt place, why on earth this would be a good idea. This is hard to do, so you will need to dig deep. If you have difficulty coming up with your own higher justifications, you may borrow from some of these below:

Why Do I Want to Feel This? (Finding Incentives Through Your Values)

  1. If you value self-improvement and personal growth, you might appreciate that: Moving towards my pain gives me practice to be with uncomfortable experiences. There will be many times in life where I need to demonstrate strength and flexibility in the face of adversity. This is an opportunity to develop myself. It’s like working a muscle, or training for something difficult, the inner equivalent of weight training or running a marathon.”
  1. If you value self-care and a holistic path to wellness, you may similarly appreciate that: Experiencing the pain helps me to not dissociate or use resistance, which can produce an unnecessary layer of suffering or discomfort. This is a natural, organic and straightforward way to ease my suffering.”
  1. If you value scientific thinking and the process of evidence-based discovery, consider that: Feeling all of my suffering gives me the chance to truly test my beliefs, such as the prediction that moving towards my symptom will only cause it to cascade out of control. Exposing this as a myth would be worth taking the risk. It’s a relief to have direct experience and a way to navigate through this. In this way, I can prove what works and what doesn’t.”
  1. If you value balance and having energy for other areas of your life, consider that: Agreeing with my suffering helps me to let go of the struggle, which was taking too much energy, removing me from what’s important in my life, and leaving me depleted and exhausted.”
  1. If you value the grace and serendipity that can emerge from random moments, this perspective can feel meaningful: Becoming intimate with my suffering tells me I am likely to learn something new that I may never have known otherwise. Because agreeing with my discomfort is so unfamiliar and difficult, everything that follows is sure to be a new understanding. Because this is a rare occurrence, it can be considered to be a gift. I’m not sure what the gift is yet, but I’m open to receiving it.”
  1. If you value being in the Now and practicing Mindfulness, this may feel important: Meeting my suffering forces me to be in the present moment. There is still a “connected” feeling about being in the Now, even if the Now is difficult.”
  1. If you value having a wider range of feelings and a fuller range of experience, this perspective affords that opportunity: Feeling more of the discomfort helps me to feel more expansive, rather than feeling trapped and limited inside my pain. I’m tired of making ultimatums with my symptoms that I eventually lose, of shrinking and hiding from discomfort. It hurts a whole lot, but when I agree to feel more, I notice more space inside of me, more room to breathe. It’s easier now to live inside my own skin.”
  1. If you value Truth, this higher justification may have unique significance: If I fully admit that I am in pain, I am closer to truth. Because I value truth, this experience feels meaningful. To me, there is no such thing as desirable or undesirable truth. Truth is always sublime.”
  1. If you value being closer to Reality, this perspective may also be inherently meaningful: Admitting the presence of my suffering helps me to come closer to what’s real, to meet Reality on its terms. When I insist that Reality conform to my wishes, it never happens, and I frequently get discouraged. Avoidance, distraction or escape are just “control tactics” – indirect and ineffectual means of trying to change my internal experience. I have better insight about this now. The willingness to be with what’s real is a privilege that feels simple, moving and meaningful. I choose Reality.”
  1. If you value developing self-worth and self-discovery, this incentive may feel important: To see this kind of bravery as I practice willingness, I have a window into my true nature, my character, my triumphant spirit. Moving closer to my suffering allows me to see who or what I am when I truly show up with presence.”
  1. If you care deeply about others, this higher justification may have importance: “Moving toward my suffering allows me to know more directly what others are experiencing. Finding the courage to face my suffering may allow me be of service to others, and to have more compassion.”

A personal note to my reader: Thank you for reaching for something so difficult. What more could a therapist ask for? Your willingness made me respect the hell out of you. I am deeply impressed by your bravery. You are so much more than your suffering. Be well.

2016 Heather Stone, Ph.D.

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Cognitive Defusion and Mindfulness Exercises

Cognitive defusion is the technique of becoming untangled from our thoughts. While cognitive fusion is the process of believing that our thoughts are literally “true,” cognitive defusion is the ability to regard thoughts simply as thoughts. The result of defusion is usually a decrease in the thought’s power over us as we loosen our attachment to the thought. The thought would not be something you had to believe or disbelieve, but would be only something you would notice. The goal of practicing defusion is to become a little bit more flexible around the thought, and to have a little more distance from it.

Defusion exercises work well when we have:
Depressing thoughts;
Thoughts about low self-worth;
Ruminative thoughts (mentally replaying something that happened in the past); or
Worry thoughts (imagining something scary happening in the future).

  1. Thank the mind” for the thought, but don’t resist the thought or try to suppress it. Don’t struggle with it, interpret it, elaborate on it, or try to process it. The thought is seductive – it will appear that if you just think about it a little longer, you’ll have some clarity and then be able to let it go, but that rarely happens. Trust me.

  2. Redirect your focus to some meaningful activity. Physically move into a different room, listen to music, go for a walk, read a book, etc. Redirecting your focus isn’t the same as “thought suppression” (which never works). Instead, becoming absorbed in something new is a form of mindfulness where you are paying attention to something real in the present moment, and in a non-judgmental way.

  3. Become an Observer by saying, “I’m having the thought that ______,” and finish saying the thought that you were just having. Or, “I’m having the feeling that ________.” Becoming a witness of your thoughts creates some distance between you and your mind.

  4. Just name things: Say, “worry, there is worry.” Or, “that’s catastrophizing,” etc. (if you are familiar with the names of cognitive distortions). Don’t put an evaluative label on the thought as being good or bad. The reason for this is that we will always try to use escape or avoidance if we think something is “bad,” but this strategy doesn’t work when it comes to our internal experiences. All we can do is notice our experiences until they lose their power.

  5. Notice when you are judging. Instead of perceiving a thought or feeling as “good or bad,” use more descriptive words, like, “helpful or unhelpful,” “adaptive or maladaptive,” “encouraging or discouraging.” Get more specific. Try to see your private experiences just as they are, as information (perhaps even misinformation) – but don’t judge them as having positive or negative qualities (for the reason explained above).

  6. Come back to the present by saying, “Back to now,” or “It’s not happening right now.” The truth is, past and future imaginings really aren’t happening right now! Don’t think of this strategy as simply trying to make yourself feel better. Think of it as being actually true. Then, redirect your focus to the present moment.

Cognitive Defusion for OCD Thoughts.

If you have scary, intrusive thoughts, and they tend to recur with a predictable “theme,” you may be experiencing obsessive thoughts. Research has shown that we intuitively try to help ourselves by suppressing the thought, which requires switching to different thoughts in order to cancel it out.

However, this strategy backfires and creates a “rebound effect,” making the intrusive thought even more persistent. To avoid this rebound effect, eventually settle on just one of these techniques, and use it each and every time your obsessive thought occurs:

  1. Come up with a “replacement” image – something arbitrary and neutral, like a red Volkswagen, a pink balloon, whatever – and always replace your thought with that same image each time the thought occurs. Don’t switch around to different images, make the image always the same.

  2. Visualize the thought appearing in your inbox on the computer. Notice the subject line, read the message once, but don’t delete it – just let it hang out in your inbox as a “read” message. Here you are deliberately agreeing not to suppress the thought. Don’t even think about replying to it. See if you can tolerate it just sitting there. Make a decision not to delete it.

  3. See the thought appearing as a new message on your cell phone. Picture listening to the message once but not deleting it, allowing it to remain forever in your imaginary voicemail. Accept the discomfort around it. Just say, “Yep, it’s still there.” Don’t check it and make a decision to not delete it.

  4. Picture your thought, feeling or image as an unwelcome guest, something you would rather turn away if it actually appeared at your door. Open the door and let it in. Let it be unpleasant, noisy, or scary. Imagine “making room” or “creating space” for it by letting it sit next to you or take up space in the room. It sounds hard but it’s an effective strategy. Pretty soon it will stop trying to get your attention.

  5. Imagine you have a “willingness dial,” where you allow yourself to be 100% willing to be with the thought or image. Turn the imaginary dial up all the way to 100 while you also turn your “resistance dial” close to zero. Say, “I want this feeling.” Or, “I want this thought.” You can also say, “Bring it on,” or “I’m willing to be uncomfortable.” I believe that this technique works better than all the others, because it goes after the anxiety and turns it on its head.

Remember the saying, “What we resist persists.” Do the opposite of what your intuition wants you to do.

Mindfulness

Mindfulness is a separate practice you will do on purpose, with or without symptoms or triggers, to train your mind and body to become more balanced and peaceful. It’s good if you set aside quiet time to do this every day, but some people work on being mindful throughout many of their waking moments (for example, tuning into your senses while you are bathing, doing dishes, stroking your pet, taking a walk, putting gas in your car, or cooking a meal).

Mindfulness encourages you to have ongoing, non-judgmental awareness with internal and environmental events as they occur on a moment-by-moment basis. Remember that the present is moving, so you will try to stay present with each new moment as it emerges. Think of it like exercise: you aren’t expected to do it continuously, but you can make an effort to do it intentionally at various designated times. There are different mindfulness practices, but the one that will translate best into your everyday life is the ability to become an Observer and just make contact with each experience as it shows up, noticing things in a neutral, compassionate, or curious way.

Set aside time for mindfulness, and just watch each thought, physical sensation, or feeling as it comes into and out of awareness. Lower your expectations: it’s probably not going to feel glamorous, euphoric, totally quiet, or even like an “Aha!” experience. But it will feel better to simply have more distance from your thoughts. Just practice noticing your thought instead of analyzing it, getting lost in it, or pushing it away. If you do this over time, the thought will just come in and out of consciousness – it will just move on. But the mind is sneaky and will eventually take over again, so as soon as you notice you are suddenly lost in a thought, thank yourself for noticing this and come back to the Observer position. Simply start over again and don’t be discouraged. Remember, this is why they call it a “practice.” If you get lost a hundred times, just come back a hundred times.

If this seems too unstructured or vague, you might enjoy using some of these techniques to help you feel that you are “doing” something with your thoughts. By using visualization, you can gently interact with your thought, thereby giving your practice a little more structure. Although I’m giving you some different visualizations to choose from, settle on just one of these for the duration of your meditation session.

Mindfulness Exercises:

  • Imagine each thought appear as a drop that emerges and then disappears into a calm lake. Wait for the next thought to appear, and then watch it drop and disappear in the same way. Just notice.
  • Picture yourself sitting above a stream, place your thought on a lily pad, and watch it float gently by. When the next thought appears, do the same thing until it flows away from you and out of sight.
  • Imagine spray-painting your thought on the side of a car, and watching the car drive down the street until it disappears. When the next thought appears, do it again.
  • Imagine yourself driving a car and seeing your thoughts appear above you on billboards. Each time a thought appears on a billboard, imagine driving under or past it, leaving it far behind.
  • Imagine sitting in a field watching your thoughts float away on clouds. See this happening each time a thought appears until it eventually drifts away.
  • Imagine seeing your thought written in the sand before a wave washes over it and smooths it away. When the next thought appears, watch how it is erased in the same way.
  • Make up your own mindfulness exercise! But don’t switch around during an exercise – just keep to the one you choose for that day and keep practicing until you feel some distance from your thoughts.
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Missing Pedophile OCD: Don’t Let This Happen to You

Don’t let what happen to me? Did I read this right? Now that my title has grabbed your attention, I hope you will allow me to explain: By “you” I am referring to you, the therapist; by “this” I am referring to a potential misdiagnosis; and by “Pedophile OCD” I am referring to a form of Obsessive-Compulsive Disorder that is one of the worst types there is. With POCD, the person is worried that they might be a pedophile. But they aren’t.

This is perhaps your potential new client – someone who was finally brave enough to make it through your door and share their most unspeakable fear – that they might be a sexual predator of children. In actuality, this is a harmless human being who was beseeched by a “what if” thought that entered their mind at the most inopportune moment. Perhaps they heard the word “pedophile” in the news or watched an evil predator on TV. They might have had a random image of a child flash through their mind right when they were in the middle of making love. Or, at another ill-timed moment, they saw a photo of a child next to someone’s bed, or heard the voice of a child playing outside – right at the moment of orgasm.

In that split second, these paired associations partnered together “Pavlovian style” and did a hostile takeover on somebody’s brain. And now that person fears they are somebody evil. From that day forward, “What if I’m a pedophile?” is a thought that never stops running through their mind. Combining the scariest form of “Harm OCD” with the worst of “Sexual Orientation OCD,” POCD is a shameful, isolating experience. As they come to you for help, you are likely to ask your own set of questions: “Is this about sexual attraction? Is it Pedophilic Disorder? Is the client a danger to others?”

These are questions that previous therapists also had. Many of them took the clients’ words prima facie, leaving them feeling more worried and shameful. According to my clients, psychodynamic therapy came at great financial cost and over many long years, but exploratory work did nothing to ease their pain. Aversion therapy encouraged techniques like snapping their wrists or making themselves sick, an ineffective and demoralizing process. Old school CBT therapists, not current with the research on “thought suppression,” unsuccessfully recommended “thought-stopping.” Psychoanalytically trained therapists urged them to talk about repressed sexual urges, creating an inference of plausibility. Trauma-based therapists conveyed the possibility of a past molestation, an event that never occurred. Some therapists produced needless fear by mentioning that this might be “reportable.” Specialists in paraphilic (sexual) disorders often took the lead, leaving clients feeling even more deviant and defective than before.

“Well,” you might be thinking, “what if this OCD specialist is also looking through her narrow lens, and overlooked the fact that this really is a pedophile?” To answer this very valid question, Pedophilic Disorder can and should be ruled out, and if there is no desire to view child pornography, that is a very strong clue. There is also almost always some history of OCD in the person’s past, even if it used to be counting or checking, and often there is a family member who also suffers from OCD. But the real litmus test is how the client feels about their intrusive thoughts. If they’re breaking down in your office, and saying their thoughts are disturbing, it’s ego-dystonic. It’s their worst nightmare, not someone else’s.

None of us ever wants to confuse a diagnosis or offer the wrong treatment, but missing this diagnosis, when it applies, has the potential to forever desecrate a client’s life. This is a diagnosis we have to try never to get wrong. Imagine, for a moment, just how many other lives would be impacted if someone with POCD (or their therapist) never knew just what it was. These are clients who make false confessions, or isolate themselves for the purpose of “protecting” children. Imagine . . .

  • A woman ends a relationship with her dearest friend who opens a daycare center.
  • A nurturing mother no longer touches her baby.
  • A wedding is called off after the couple decides to share all of their innermost thoughts.
  • A gifted fifth grade teacher abruptly ends his career.
  • A loving husband and would-be father reneges on his promise to start a family.

In my article, Searching for Bad News: The Circuitous Path of Obsessive Thinking, I describe how people with obsessive types of OCD use a form of internal hypervigilance; checking their minds to see if certain thoughts have gone away, checking their body to see if they feel aroused when thinking about a child, or checking their character to see if they feel like a bad person inside. None of that is possible, by the way. As we learned from Daniel Wegner’s “White Bears” experiment, we have to conjure up a thought in order to reject it, and once that happens things get sticky from there. Clients who focus on their genitals don’t truly get an answer about whether they feel anything. Many males report feeling a vague uneasiness in their groin area, and because they feel “something,” they worry it is evidence of sexual arousal. Checking their character involves trying on different scenarios to investigate what their reactions “might” be, but in this dissociated game of speculation, they can’t really be sure. (Was that a surge of repulsion or excitement? It’s hard to tell).

Whether they feel something or they feel nothing, checking rituals become self-reinforcing. Behavioral compulsions, if there are any, might include checking the news to see if they were identified as a criminal, or checking children’s faces to see if they look frightened or uneasy in their presence. But children may wince or turn away for a variety of reasons, including the discomfort of being stared at. Sadly, POCD clients are likely to dismiss such reasonable explanations, making up their own “evidence” to vilify themselves.

When clients ask the question, “What if I’m a pedophile?” I tell them they’re not asking the right question. The question they should be asking is, “Do I have OCD?” Rather than researching the characteristics of predators on-line and running a side-by-side comparison (an ill-advised “checking” compulsion), we look at the diagnostic criteria of OCD.

If the first goal of therapy is psychoeducation, another important aim is to convey the futility of checking. When I hear clients insist on “knowing” who or what they are, I do various experiential exercises to demonstrate that “some things are impossible to check.” These clients are not just pondering, “What if I’m a child molester?” they are really wondering, “What if I’m a child molester and I don’t know about it?”

This subtle distinction is actually a blatant diagnostic clue. It might be real even though I don’t know about it” is a nothingness, a void, an empty space that cannot be examined because nothing is there. Even though it is an amorphous idea that cannot be explored, OCD clients are determined to unravel this type of paradox. To them, a lack of verification seems like a guilty “yes” when it is really a sincere “no.” Different images, different thoughts, different situations, different states of arousal – all need to be investigated and exhausted until the “there is nothing” answer remains. As one client explained, “You want to be 100% certain that something isn’t true. So you search really, really hard to make certain. But in the process, you get so attached to the idea that you start to believe it.”

Exposure-based treatment in CBT isn’t about watching child pornography or encouraging inappropriate interactions with children. Rather, the work is to achieve habituation. Clients may be encouraged to write or say triggering words, look at their niece or nephew’s picture, listen to children’s voices, or show up at events where children are present. Moving up the “hierarchical scale,” we work with an imaginal exposure that the client writes, records, and listens to in their own voice. The script contains their worst scenario: being accused and convicted of child molestation, devastating their loved ones who ultimately disown them, losing their sense of who they once were, and watching their lives come crashing down. Having no more threats left in its arsenal, OCD relents. Treatment is surprisingly quick (weeks to months), and, when introduced in the right way, remarkably effective.

So, now that you recognize this disorder:

  • A friendship endures through a lifetime of seminal moments.
  • A child sleeps in her mother’s arms.
  • A couple’s wedding vows express wholehearted trust.
  • A teacher touches the lives of two generations of children.
  • A husband strokes his pregnant wife’s belly.

All because you didn’t miss Pedophile OCD.

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Treating Insomnia with Cognitive-Behavioral Therapy and Relaxation Techniques

Insomnia and other chronic sleep disorders affect more than 40 million people in this country, and studies have shown that anxiety and stress play a significant part in this problematic condition. Quality of life, general health, and performance at work or other areas of life are frequently impacted, and the effects of chronic sleep deprivation can be debilitating. Newer research indicates that there is a vicious cycle between anxiety and insomnia – while anxiety can certainly interfere with sleep, sleep deprivation can also lead to an anxiety disorder.

Anxiety and stress are often the principal causes of insomnia, due to the secretion and elevated levels of stress hormones. Cortisol and its precursor, adrenocorticotropic hormone (ACTH), are the typical culprits involved in sleep disturbance. While increases in cortisol can be adaptive in helping the individual to deal with short-term stress, the oversecretion of cortisol that accompanies chronic stress will keep the individual from achieving a restful sleep. What does all of this mean? It means that managing your stress levels during the day will help you to sleep much better at night.

The Anxiety Disorders Association of America (ADAA) along with numerous reputable organizations list cognitive-behavioral therapy as a first line of treatment for people with insomnia. What’s more, this treatment is safe and effective. Unlike hypnotics, benzodiazepines, and other sleep medications, cognitive-behavioral therapy is completely natural and helps you overcome the underlying causes of insomnia. By addressing the thoughts and behaviors that can interfere with sleep and by helping you to develop better sleep habits, the benefits of CBT can be long lasting – and there are no side effects. To find a CBT therapist in your area, you can go to the Anxiety Disorders Association of America (ADAA) website, and use their provider locator feature. www.adaa.org

Helpful Tips.

1) Get some cardio exercise daily, and really wear yourself out (in a good way). Refrain from exercising 2-3 hours before bed. Don’t drink alcohol or eat sugar at night, because your blood sugar will spike and then drop during the night and wake you up. If you have to indulge, try to eat some protein at night to keep your blood sugar from dropping too much. Don’t drink too much liquid in the evening to avoid using the bathroom. Turn everything off, especially electronic screens and LED lights – they can interfere with melatonin levels and circadian rhythms.

2) Practice “sleep hygiene.” Only use your bed for sleeping, sex or relaxation so that your mind knows what your bed is for and doesn’t make any negative associations with going to bed. If you are lying in bed unable to sleep, get out of bed and don’t go back until you reclaim your bed for relaxation only. Don’t study in bed. Keep waking hours the same even if you’re tired, so that your sleep cycle doesn’t get off-track.

3) Keep a pad of paper next to your bed. If you have a particular worry, or if something simply pops into your head that you don’t want to forget, write it down before you go tosleep. Include the time tomorrow that you intend to either succumb to the worry or takecare of something concrete. While suppressing a thought never works (trying to silence your thoughts can backfire and make them even stronger), delaying a thought until later actually does work. Worrying on purpose during the day for a discrete period of time can also be an effective strategy, sometimes creating the paradoxical effect of making it difficult to worry. To clarify, planning to worry at a brief, designated time is totally different than “worrying all the time,” or letting your worry sneak up on you! But, you must actually make good on your promise, and attend to the worry or the task the very next day at the time you “promised” to do it.

4) Get yourself medically checked out for sleep apnea or other breathing obstructions. You might be waking yourself up to breathe, so it’s worth ruling this out, just to make sure. Don’t sleep on your back in case your own snoring wakes you up. If your partner is the one who snores, elicit their help in treating their snoring issue or sleeping arrangements.

5) This one’s important: be willing to be awake or asleep. If you refuse to be awake, you will be! Never give yourself imperatives or ultimatums – we always lose those types of power struggles with ourselves. With that said, it is okay to self-soothe, practice healthy behaviors, learn some new tools, comfort yourself, and improve your parasympathetic nervous system – but try to approach these things in a gentle, more flexible way.

6) Relaxation techniques are especially important in lowering stress levels throughout the day and improving your sleep at night.

First, slow and deep, diaphragmatic breathing (breathing through your nose, making your stomach, versus your chest, rise and fall), will produce a state of physical well being that tells your mind it is ok to relax.

Second, mindfulness can be practiced at any time, and any place, by simply directing your non-judgmental awareness to whatever is happening in the present moment. Or, you can become intently absorbed in following (or counting) your breath. Mindfulness meditation practices improve the relaxation response (parasympathetic nervous system) that lowers stress hormones and results in less reactivity to stress and pain. The best part is that the benefits carry over to your waking life, allowing you to witness your mind from a distance rather than becoming tangled up in your own thoughts.

Because the ADAA specifically lists meditation and music as two important relaxation techniques for reducing anxiety and stress, I have created some beautiful, relaxation music especially for you! I have also provided a very restful and calming spoken word“relaxation recording” that you can listen to at any time for relaxation and/or sleep. These free gifts can be downloaded and played at your convenience from my website in the section entitled, “Relaxation Room.” I recommend listening to music at night with the proper headphones on, so purchase headphones such as these that will feel as comfortable and smooth as your own pillow: www.sleepphones.com

Sleep well,

Heather Stone, Ph.D.

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OCD Distortions (And Who Says They’re Wrong)

Authorship Confusion.
Daniel M. Wegner uses the phrase “authorship confusion” to describe how people mistakenly assume responsibility for causing an event, simply because the thought preceded the occurrence.

Believed-In Imaginings.
Theodore Sarbin offers the phrase “believed-in imaginings” to suggest that people affirm the existence of improbable things. A hypothetical perspective, such as a “what if” thought, morphs into an “it is” thought – creating the feeling that an imagined scenario actually exists. The person considers something as if it were true, and pretty soon it appears to be true. When this happens, the belief and the phenomenon cannot easily be differentiated.

Causal Mistakes and Reasoning Errors.
Jean Piaget states that from a very young age, people develop mistaken beliefs about causal relationships between the mind and the physical world. Examples might include certain rituals such as counting, checking or repeating – compulsions that are intended to bring about something good or prevent something bad. The mind errs by taking unrelated events and connecting them, creating the feeling that there is a meaningful relationship between the two. Suddenly, meaningless things take on unique significance.

Cognitive Fusion.
Steven C. Hayes explains that we believe our thoughts to be literally true when perhaps they are not, and this happens because ideas arise convincingly inside our heads in the form of language. In this way, thoughts become convincing and we become “fused” with our thinking. The assertion, “I’m right and I can give you the reasons” is a strong indicator of cognitive fusion. Matthew McKay and Patrick Fanning agree: “There is no one so sure as someone totally deluded.”

Cognitive Motivation to Reduce Uncertainty.
Leonard Zusne and Warren Jones describe that we all have a cognitive motivation to secure explanations, however faulty. This drive to remove uncertainty is so powerful that the mind will prefer to fill the gap with incorrect information (even with catastrophic explanations) rather than tolerating the unknown. Jeffrey S. Victor explains that even disturbing beliefs receive credibility: “A mistaken explanation for emotional pain can be preferable for a confused person to the ambiguity of uncertainty.”

Congruence is Preferred Over Truth.
Zusne and Jones also describe how people want to believe something simply because it matches up with how they feel. Illness, fatigue, chronic pain, menapause, and PMS are good examples of this, where events or interactions become exaggerated or misinterpreted. The best example of this is a panic attack, where people explain the “spike” in their nervous system as evidence that they are dying, going crazy, or losing control. However, just because the thought feels congruent with our physical or emotional state, it doesn’t make it true.

Magical Thinking.
Sigmund Freud, Margaret Mahler, and Ernest Becker have discussed magical thinking as a “primitive” (early) defense mechanism that was originally designed to protect us from feeling helpless. Magical thinking is a universal condition that continues throughout everyone’s lifetime, often emerging in the face of “existential anxieties” surrounding separation, death or uncertainty. But in other moments where we feel a loss of control (like when chance, hope, luck, fear, or danger are present), magical thinking will show up as well. Magical thinking is the belief that thoughts and reality are connected and that thinking can influence the actual world. Omnipotence (the belief that we caused something by thinking about it) is one form of magical thinking, and so are superstitions. In fact, most of the distortions in this handout are, to some extent, a form of magical thinking. From a behavioral perspective, magical thinking exists largely to control the uncontrollable.

Negativity Bias.
Human beings have evolved to become very anxious, but this trait helped our ancestors more than it helps us. Aaron T. Beck explains that in earlier times when our physical survival was at stake, we could not afford to miss any danger signals. “It is better to have ‘false positives’ (false alarms) than ‘false negatives’ (which miss the danger) in an ambiguous situation. One false negative – and you are eliminated from the gene pool.” This is why it is said that “evolution favors anxious genes”: Our hypervigilant ancestors passed their genes on to us, and now we suffer from “negativity bias” – a propensity to focus on negative events or even perceived threats to the exclusion of neutral or positive things.

Overvalued Ideation.
This phrase means that the person “importantizes” or “overvalues” certain ideas, making random, fleeting thoughts more meaningful or threatening than they actually are. For example, having a disease or illness can seem plausible simply because it was on tv, mentioned in a conversation, or encountered in some other innocuous context. The International Obsessive-Compulsive Foundation describes this phenomenon as “when the person with OCD has great difficulty understanding that his/her worry is senseless.” Jonathan Grayson similarly says it is “the belief that the concerns underlying the symptoms are entirely realistic.”

Thought-Action Fusion.
Stanley Rachman describes a tendency to confuse thinking about an action with the action itself. For example, we all have senseless, random thoughts, such as, “What if I just drove into oncoming traffic right now?” or “What if I stood up and shouted an obscenity in the middle of church?” As often seen with OCD, these transient thoughts make some people concerned that they might actually do those things. However, actions require execution and volition; thinking the thought isn’t the same as actually doing it.

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Searching for Bad News: The Circuitous Path of Obsessive Thinking

I Believe Something Terrible.

Many people are invested in “proving” the existence of something they are terribly worried about. Even though this would be the worst news imaginable – that something terrible is happening or has already happened – they are committed to believing the very thing they do not want to be true. For such people, searching for bad news is a self-defeating strategy, an attempt to deny ambiguity and cling to an illusion of safety, by simultaneously proving and disproving something dreadful.

The purpose of this article is to explore what it is like for the person who is searching for bad news and why they do it; to give practical advice to support persons about how not to respond; and to provide an alternate way of thinking for the suffering person, one that encourages trust and the ability to tolerate uncertainty. While some of their perspectives may sound quite extreme, these maladaptive thinking styles reflect certain cognitive distortions that, to some degree or another, may be common to all of us. Thus, it is through an existential lens – a universally shared difficulty in tolerating the unknown – that I wish to explore this particular phenomenon.

I Did Something Terrible.

In instances where the person thinks or feels something extremely disconcerting that does not feel consistent with who they really are, their psychological suffering can be overwhelming. “Ego-dystonic” is the phrase that is used to describe an internal experience that is felt to be foreign, threatening, or alien to the person’s sense of self. This is what it is like for the person who feels certain that they have committed a terrible offense, even when that crime never really took place.

The person might believe they have cheated on a test, cheated on their partner, run over someone with their car, or committed a serious crime – like a murder or sexual assault. But they haven’t. Any conclusion they arrive at isn’t the right one: either they aren’t guilty but their perceptions were wrong (ok, that doesn’t make any sense), or their perceptions were right and they did something terrible (ok, that does make sense, but the notion is unthinkable). The confusion around it is extremely distressing, completely exhausting, and utterly disorienting – not only to the person who is suffering, but to significant others who are sure to be drawn in to this problematic quandary.

You may recognize these as typical symptoms of people suffering from Obsessive-Compulsive Disorder. The Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association (“DSM-5”) describes obsessions in part as: “recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.” Additionally, a person can have “either obsessions or compulsions” to qualify for the diagnosis; they do not need to have both. (p. 237).

Mental acts, as OCD sufferers will describe, can be considered to be compulsions, even though they are not readily visible to others. Many seekers of bad news check their minds to see if certain thoughts have gone away, or check their feelings to see if they still feel like a bad person inside. Behavioral compulsions manifest differently, as they are more visible to others and are directed outward toward the environment. These compulsions would include things like checking the news to see if they were identified as a criminal, checking their mail to see if they were accused of cheating, checking children’s expressions to see if they were perceived as a child molester, or checking the streets to see if they ran over someone with their car. With both behavioral and mental compulsions, the purpose is to reassure the anxious person, reduce their distress, or prevent some dreaded event, but none of these attempts ever fully allays the person’s fears. As such, these acts often need to be repeated.

Most OCD sufferers demonstrate the insight that the obsessions or compulsions are excessive and unreasonable. The presence of insight seems to go with ego-dystonic (incongruent) experiences, while a lack of insight seems to go with ego-syntonic (congruent) experiences. In other words, insight goes with the awareness that one’s thinking is messed up. Is the presence of insight a good thing? Yes and no, because when it exists it can be felt as a double-edged sword. Having the awareness that a thought is unfounded, while at the same time feeling utterly powerless to make it go away, can be deeply disturbing.  On the other hand, a lack of insight binds the person to their own nightmare, convincing them that their most catastrophic fears are verifiably real.

Needless to say, seekers of bad news often float all around this spectrum, depending on how entrenched their belief is and whether it fits closely with their personality. To obsessive people, the worry is unrelenting, and the experience is almost real. They feel it to be true but don’t want it to be true, so they keep checking for evidence, just to make sure. Sadly, there is never any closure regarding their doubts. Their OCD brain is misfiring, telling them that they need to figure it out, and it works in overdrive trying to solve this maddening puzzle.

You Did Something Terrible.

Some obsessive thinkers lack the awareness that a belief is unreasonable, while at the same time insisting that it can be proven, validated or controlled. In this case, insight is missing, but the person thinks everything matches up just fine. With this kind of obsession, the person holds the conviction that the other person has done something very bad. The obsessive person may be convinced that their partner is cheating on them, even though it never happened. This is a different brand of torment, perhaps more difficult for the innocent person, who is wrongly and perpetually accused of something they didn’t do.

While these seekers of bad news don’t want their suspicions to be true, they still feel quite convincing. “Why,” they might ask, “would I be having this strong, intuitive feeling if it weren’t really happening?” To verify such a belief, the person looks for “evidence” of the cheating behavior: a phone call that took place while their spouse was in the next room. The presence of a random, attractive person in their partner’s life. A brief moment when their partner’s presence wasn’t accounted for. A new co-worker that was never mentioned until now. And so on.

Could this be OCD as well? Perhaps. But there is another diagnosis, “Obsessive-Compulsive Personality Disorder” (OCPD), which sounds the same, but is quite a bit different. Unlike a mood disorder, OCPD fits within a category of “personality disorders,” and it is thus classified differently in the DSM-5. Personality disorders are generally longstanding, entrenched, often inflexible patterns of thinking and behaving that lead to distress or impairment.

And with this particular disorder, OCPD, the person shows a propensity toward perfectionism, control, and a lack of insight. Thoughts feel correct, opinions feel justified, and conclusions feel congruent. The badness doesn’t exist in them, it exists in the other. They still get to feel good about themselves. This sense of rightness, of congruence, is ego-syntonic. It feels correct, but it is still far from the truth.

I Have Something Terrible.

Still another version of searching for harmful evidence is when the person thinks that something is physically wrong with them or someone they love, such as having a terminal illness. Once more, this feels like an inherent badness lurking inside of them, something that is totally unwanted, alien, and threatening to the individual. And yet, it is felt to be very real. The person searches the internet for confirmation about the disease, both wanting to be wrong and wanting to be right. Neither answer is felt to be satisfying.

If they are wrong, it wouldn’t explain why the symptoms emerged, or why the “evidence” appeared so real in the first place. So they keep searching until they find something. Even the process of searching itself becomes a trigger that creates more distress and further impetus for checking. Every new disease they read about sends off alarm messages of horror and fear. Not finding the evidence they were looking for is still really bad news: it means that the answer is still out there – they just haven’t found it yet. On the flip side, if they are “right” – if they do find some small piece of confirming evidence that matches up with their suspicions – they are devastated. Both corroboration and contradiction lead to worry. And both discoveries are reinforcing; the person is compelled to search some more.

And who else gets involved? Lots of people, because they start looking for countless reassurances from loved ones, experts, and professionals. Interactions with medical professionals that would normally be reassuring only raise further doubts and fears. “Why did the doctor pause at that moment, or look at me funny?” “What would a different doctor say who had more knowledge or expertise?” “What if the tests were inaccurate?” “Why did he originally mention _____, if he thinks I don’t have it?”

One former client with this type of medical anxiety insisted to me that all the doctors she ever went to were “no good.” When I asked her what evidence she had for believing that, she explained that nobody was good enough to figure out what was really wrong with her. This “evidence” she could maintain – that bad doctors explained her missing diagnosis, and her missing diagnosis explained bad doctors – was a circular line of reasoning that perpetuated her beliefs. This is also a fitting example of “self-confirmatory bias,” where the person produces faulty evidence to maintain a highly flawed belief system. In this way, it could be argued that a person with features of OCPD would rather be right than be happy.

Common Elements of These Obsessions.

All three of these scenarios (I did something, you did something, or I have something) all share some very common features. A negative result following a test or a search (negative in this case means that nothing was found) is hardly perceived as a welcome finding. Rather, it perpetuates more ambiguity and fear – the feeling that something really is wrong but hasn’t been discovered yet. To be wrong feels disconcerting and invalidating. To be right is validating but catastrophic. This is the paradox that torments obsessive people, but only certain types of people: 1) people who are very, very afraid, and 2) people who believe that the only remedy for their fears is to live in a world where they have 100% certainty. These are people with a need for control.

This is not to say that these folks do not suffer horribly over this problem, because the dilemma resides deep within their very existence (this is why I say that this problem is existential). While demonstrating a propensity for a need to control, these individuals are human after all, and are certainly no match for Life itself. They cannot outsmart death. They need people, but they don’t want to need them, and they cannot deny that eventually they must depend on others for their survival, safety, or intimate needs. This awareness doesn’t sit well with them. Thus, these individuals often hate to fly because they don’t trust pilots, they don’t like going to doctors because they are all “quacks,” and they wouldn’t trust other women to be in the same room with their husbands.

As one wise client said to her jealous partner, “You’re right. You don’t have to trust anybody. But you should.” That was one of the most poignant statements I have ever heard. We live in a world where others have more knowledge, skill, and expertise than we do. They are flying our planes, and performing our surgeries. They are also trying to love us. We cannot help but to turn our trust over to others at times, and indeed, we should. As Ernest Hemingway eloquently said, “The best way to find out if you can trust somebody is to trust them.”

Unraveling the Distortion.

Why are these folks so invested in being right, when the outcome would be so catastrophic? Why do they defend their belief so fiercely? What is driving this type of committed behavior, to uncover an outcome that is so completely awful? And what is the link between their thinking style and refusing to live with ambiguity?

Bad News Feels More Certain than Good News.

I believe that there is a certain kind of addiction to certainty that some people have. And between good news and bad news, bad news is more certain (e.g. death and taxes). While good luck, fortune and health can feel fleeting and provoke experiences of impending loss, certain types of bad luck can seem permanent. So if you crave certainty, bad luck will fit more neatly into your paradigm. And seekers like this, who believe that absolute certainty is possible, will try to fit at least one-half of reality (the bad half) into this thought system, and that is one way in which their style of thinking can be maintained.

The Cost Feels Too Great to Let it Go.

Many people tell me this, that the cost is too great to overlook it and let it go. Which is very strange, because it doesn’t really prove the validity of what they are saying, although they think it does. A wife is convinced that her husband is cheating, and must regard the “what if” thought as real or she will have completely lost face “if it turns out to be true.”

This is important, listen to this carefully: the word “if” comes up in each and every case, and the “if” gets inserted so quickly and discretely that one may have hardly noticed it was there. “If it turns out my husband were cheating,” she continues, “I would have been completely foolish to trust, knowing that that trust was never deserved, and that he betrayed me.” Again, this is similar to someone with health anxiety: “I can’t afford to be wrong in this case. If something is wrong with me, I should  treat this with seriousness, with urgency. Time is of the essence. There are certain windows of opportunity where early detection and intervention are necessary. I’d be foolish to dismiss it if my diagnosis turned out to be true. It’s too important.”

Things Deeply Valued Receive Importance.

Notice another common element here: these urgencies are existential, and all of these things, even being cheated on by one’s spouse, relate back to the matter of existence or the existence of others. As such, they become huge, life-and-death issues. How to prepare for danger, whom to trust, when to act, the need to repent or confess – these are serious things, things that seem to define us, precious things, things that are central to our existence. For that reason, the person cannot think lightly about them. Impending death, limits of time, trust and betrayal, saving one’s life or one’s relationship – justifies maintaining the fear. The perceived consequence of letting down one’s guard feels, well . . . irresponsible. The person feels as if they or others are actually contributing to catastrophe by ignoring it. And so they can’t let it go.

Some Things Are Impossible to “Check.”

The questions that worriers return to – What if I’m a cheater? A murderer? A child molester  – and I don’t know about it? – are amorphous thoughts that are impossible to “check.” I see lots of OCD clients that got triggered by watching a documentary on sociopaths, for example. They try to test their minds to see if they might be a murderer, and while they don’t think they murdered anybody lately(!), they aren’t sure.

In truth, however, the assertion, “It might be real even though I don’t know about itis a nothingness, a void, an empty space, a lack of presence that cannot be examined because nothing is there. But for the person who craves 100% certainty, this is the worst news ever – that they can’t check what’s missing. It’s a paradox that tortures them. For the OCD sufferer, the lack of verification of something bad seems like a guilty “yes” but it’s really a sincere “no.”

Remember that the person who never gets a confirmed medical diagnosis really doesn’t have a disease. And the partner who didn’t cheat really didn’t cheat. The lack of confirmatory evidence is a “no.” The insanity occurs when the suspicious person insists that yes, something is there, they feel it (emotional reasoning), but it just hasn’t been identified yet. Every test must be exhausted until the “there is nothing” answer remains. But tests are endless, and doctors are endless, and hypothetical diseases are endless. There isn’t a disease and there isn’t going to be – certainly not in the way they anticipate it. So is the endless array of attractive human beings that move in proximity to one’s partner. We can’t obliterate them. We can’t exhaust all the possible “no” answers until one certain “yes” answer stands alone. Especially if there is no “yes” answer. It can’t be done.

The Path of Incorrect Reasoning (Why Dreadful Thoughts Are so Convincing).

At least FOUR predictable things always go wrong here. First, due their acute distress, the person has decided on some level that the only remedy for their profound suffering is to achieve total relief, and that usually means the absolute certainty of guaranteed safety. Nothing short of this feels like it could possibly take their pain away. Rather than struggling to live with relative certainty (information that is “good enough,” “accurate enough” or “complete enough”), a person with OCD desires total reassurance. And because they are demanding something that Reality cannot offer to them, they paradoxically remain in a perpetual state of insecurity and fear.

The second cause of this downward spiral has to do with the act of bringing the dreaded thought into awareness, and this is a type of mental compulsion. Once an idea has frightened them, obsessive worriers frequently bring the dreaded scenario into consciousness for the purpose of letting it go. In essence, they are trying hard to see it in order to be able to reject it. So . . . what happens once the image is brought into the person’s mind?

This is a significant question, because it leads to the third mental operation that maintains this vicious cycle. “As if” thoughts (thoughts that start out as scary images or hypothetical musings) quickly morph into “reality.” The person considers something as if it were true, and pretty soon, it becomes true. When this happens, the belief and the phenomenon cannot easily be differentiated. Another way to describe this is that sometimes we become “fused” with our ideas – believing our thoughts to be literally true when in fact they are not. This, by the way, is likely a universal condition of overconfidence to which we are all susceptible.

There is also a fourth mental culprit that drives this obsessive machine. Once the thought appears, the OCD mind simply cannot let it go. This has to do with “overvaluing” the thought or sensation and focusing on it in an intensified way. While most people regard transient thoughts or sensations to be random, fleeting or harmless, someone with an OCD brain can’t seem to move on. This process of “overvaluing” or “importantizing” – assigning meaning and credibility to insignificant experiences – is a common mistake generated by OCD brains. These minds are over-processing while focusing on too much detail. In the end, they will defend from a place of total conviction that the harmless things they worry about are quite real, simply because their brain incorrectly overestimated their value.

 

Where Others Fit In: “Damned if it’s True/Damned if it Isn’t.”

And “damned if you agree/damned if you don’t.” Persons with this level of worry draw others into endless conversations that never go anywhere. Half the time they want others to agree that they are right and that the dreaded event is actually happening, while at other times they want reassurances that they are wrong and that everything is ok. As such, the response they receive from others is equally problematic, and the person feels alternatively invalidated or only temporarily reassured. There is no response they can get from others that feels ultimately satisfying due to their own ambivalence, but they continue to pull others into the conversation nevertheless.

An Endless Cycle: Circular Conversations that Lead to Nowhere.

Therapists, spouses, doctors, or family members who are lured into these discussions become dismayed over the person’s attachment to their fear. Ironically, the person would rather be right and have everyone agree that their worst fear is actually happening – than to discover that they are wrong but that all is well. Conversations become circuitous and never-ending because the fearful person mistakes the “what if” or “as if” thoughts to be literally true, while the listener considers these “if” thoughts to be either hypothetical or false.

The circular discussion is perpetuated while the person argues, “But if something were wrong with me, there would be catastrophic consequences if I ignored it! Right?” And “if I cheated, I couldn’t live with myself, I’d be living as if I were a fraud, I’d have to make it right, and I’d have a responsibility to confess. Don’t you agree?” But be careful here, this is somewhat of a trap. I say this is a trap because the person has their own trap of ambivalence: wanting to be right and wanting to be wrong, both at the same timeand is trying to prove them both. Simultaneously.

The listener might be tempted to answer, “Yes, if it were true, you would be right to be concerned and justified to act quickly.” But the anxious person hears this not as a hypothetical statement, but as verification that the feared scenario exists. They are already suffering from overvalued ideation, and have assigned credibility to meaningless, illogical beliefs. In addition, they have already fused the “if” with reality. In this way, they achieved moving the sympathetic listener into an illogical argument. And they will want to end the conversation there: “See?  I’m right. This is why I am so justified in my thinking!”

But something went wrong here, in this type of conversation. The logic only hangs together if it were true. But “if it were true is not the same as “it is true,” and that is the confusion that the person suffers from. In other words, the obsessive person is confusing the “what if” thought with some perceived reality, a reality that doesn’t really exist. This began as a hypothetical statement that could be discussed in the abstract. It was not intended to prove anything. The error is that if he actually had an incurable disease, time would be of the essence. But he doesn’t. The “what ifis a thought, not a reality. It is my experience that unless and until that difference in perception is acknowledged, the conversation will never end.

Resist the Urge to Engage.

“Ok,” someone might ask, “then what would the listener do or say instead?” The short answer is: “Very Little.” First, I would completely stay out of the content, or both people will become lost and exhausted by the conversation. To give importance or attention to the worry – to discuss the validity of whether or not something really happened or really exists – will undoubtedly lead to endless circuitous conversations. Also, reassurances don’t last, as any OCD sufferer will surprisingly tell you in a heartbeat. In regards to accusations of cheating, this may fall into the realm of emotional abuse, and might be an opportunity for the listener to set boundaries (the obsessive person should not be checking their partner’s phone records, etc.). Defending one’s innocence when wrongly accused is demoralizing and inappropriate.

Appropriate Responses.

Process comments, on the other hand, work much better. I would suggest briefly sympathizing with the person in a compassionate but calm voice, and without being led by the momentum of the person’s anxieties. “I can see that you’re really suffering right now. I’m sorry that you have to deal with this so often. I feel badly, that this is so hard for you.” Most importantly, I would also suggest asking, “How can you reassure yourself right now?” “What are some tools or techniques you have learned that help you through these difficult moments?” “What can you do to take care of yourself right now?” In other words, I recommend helping the person look to the self for comfort, and to walk their own path.

Here are some other helpful phrases that can be used:  “This sounds like a familiar conversation, one that we have often returned to, and we both end up very exhausted and distressed over this. I’m not sure that this one would turn out much differently, even if we were both tempted to go over it again. I want to reassure you, but I think you would agree that reassurances are only temporary, and don’t really help you overall. We both need to stop talking about this. This isn’t productive.”

My Advice to Seekers of Bad News.

For those of you who think you did something terrible: You didn’t. Don’t hurt yourself anymore. I’m only saying this to you once. Next time you are afraid, reassure yourself as best you can, with kindness and compassion in your heart.

For those of you who think the other did or will do something to hurt you: Look within, not at the other, because the destructive person might really be you. You may be eroding the foundation of a very important relationship, as well as the quality of life of a very important, innocent person — for no good reason.

For those of you who think you have something terrible: The information you have so far is relatively accurate. You are susceptible to the same perils that all human beings face, but for now you are probably ok. If you truly believe that your life is so fleeting and important – Live it. Immerse yourself in it. That’s completely different than worrying about it, and it would be the best thing for you to do.

Let It Go.

I think at some level you long to give this up. This path has been too hard for you. You wish for 100% certainty, but none of us get to have that in this life, not even you. Living with ambiguity is hard, but what you have been doing is much harder. It certainly hasn’t gotten you any closer to the safety and certainty you crave. So long as you insist that the world be safe and secure, while the nature of reality proves otherwise, you will be destined to a lifetime of perpetual unhappiness. You cannot make the world other than what it is. Additionally, holding yourself in fear . . . all the hyper-vigilance . . . bracing yourself for anticipated pain . . . it’s not going to help you cope if the pain were to come. Like a body that is tense when it falls, it only hurts more.

You might say, “Of course I’ve tried! I just can’t seem to let it go!” But we are talking about two different strategies here. You would like to let it go after the thought quiets down and doesn’t bother you anymore, so that you can finally release it; whereas I’m suggesting you let it go while it feels persistent and unfinished. I’m not saying let it go when you have some resolution, or when you feel more comfortable. I’m saying make a healthy decision to stop proving or disproving the bad news, now, while your intuition is going in the other direction. You can do it.

Don’t Trust Your Mind in This Case.

There are two things you must remember: 1) the mind is very faulty, and 2) it loves congruence. It would rather be wrong and have everything match up, than to have a feeling of not knowing. Disturbing events beg for credibility, so the mind starts offering assumptions to “help” make sense out of ambiguous situations. Because we think that the interpretation should fit the circumstance, and because the feeling is catastrophic and extreme, we think we ought to have a really extreme explanation to go along with it and back it up.

Consider the person who thinks they are dying, going crazy, or losing control when they are actually suffering from a panic attack. The interpretation was wrong, but at least it was congruent, which is why the mind produced it. Only such extreme, catastrophic explanations correspond to the unexplained “spike” of physiological arousal in the person’s autonomic nervous system during a panic attack. But those explanations turn out to be incorrect. Your faulty interpretations arise in much the same way: only catastrophic explanations seem to fit the intensity of your fears. But they aren’t the right ones.

The important message I’m suggesting here is that the mind would actually prefer to give you the really bad news that you are dying or your partner is cheating or you ran over someone rather give you the unclear message: “This is weird. My brain is misfiring.” But that is exactly what you need to be saying. I like this quote from Jeffrey S. Victor: “A mistaken explanation for emotional pain can be preferable for a confused person to the ambiguity of uncertainty.” This is huge. Please think about this, because it will help you give less credibility to the false messages your mind is offering.

Nothing is Written in Stone.

Have you ever seen those decorative stones that have inspirational phrases carved in them, such as “hope,” “serenity,” or “peace?” Well someone clever came up with one that really intrigued me. Etched in the stone, the message said, “Nothing is written in stone.” This is a bid of a mind-teaser. The message says that “nothing” is written in stone, but to convey this message, the word “nothing” had to be written! As soon as it appears, “nothing” becomes “something.” This is the very same problem that you are creating. You want something unknown to appear, so that you can reject it. But as soon as you see it, it seems to exist. The truth is, however, it is you who put it there. As one client aptly stated, “You want to be 100% certain that something isn’t true. So you search really hard to make certain. But in the process, you get so attached to the idea that you start to believe it, as if it really took place.”

Develop Self-Compassion.

It will be necessary to give yourself lots of compassion for your suffering. The feeling is real, even though the thought is not. Thus, when you address yourself, say from a heartfelt place: “Feeling something doesn’t make it real. Still, I feel bad for my suffering. It feels real, but it isn’t real.” If you say this with compassion, with conviction, and as many times as is necessary – if you separate your symptoms from reality, if you give yourself a different kind of validation for your suffering – your symptoms will finally leave you alone.

Test Your Belief in a Different Way.

The next time you feel attached to a belief, here is a better way to find out if it is true. Stop checking. Do an internal search, but not with your thoughts this time. Keep the judgments and the evaluative labels completely out of it. Turn into your body and tune into your feelings. What is your stance in regards to the position you are taking? If you feel tempted to defend it, if you feel driven to explain it, if you have an urgency to prove or disprove it, if you feel pressured, if you feel adamant, or if you feel tight and contracted when you talk about it – it might not be true.

The fierceness and rigidity we have around something we are defending often indicates that the belief is delusional. Otherwise, we feel much more flexible (i.e., “it could be true/it could not be true”). For example, what if I told you that your car was no longer parked outside? You might look at me quizzically, and say, “What?! Are you sure? I’m pretty sure it’s still there.” You wouldn’t start defending adamantly from the depths of your soul that you were right and I was wrong. I’ve learned over many years that none of my clients really tend to argue with me, except when they are asserting some sort of delusional belief. When that happens, I often think about the following quote: There is no one so sure as someone totally deluded.” (Matthew McKay and Patrick Fanning).

Live With the Unknown.

Your task is to refrain from checking your mind to see if you, your health, or others are “bad,” or to check the news, internet, laws, or other people’s opinions. Live with ambiguity. Relax into knowing that, without hyper-vigilance, you have relatively complete and accurate information. The ambiguity that is in and around you is an unclear, imperfect, benign presence that can be trusted and accepted.

The Unknown that you fight so vehemently – that you fear, blame, rail against, and pray would become Real so that it could finally leave you alone – is often better than every known thing you have ever wanted to control. Let me put it another way: every good thing in your life that surprised you was previously unknown to you. You didn’t anticipate or create the people who showed up and loved you. You didn’t manage or direct the gifts that you were given, either literally or metaphorically. Live with the Unknown, because the stuff that will make you happy in life will be the stuff that you can’t control.

Still Unsure?

The following list cites credible sources that explain how and why we tend to produce (and even defend) a faulty belief system. Look closely to see if you can identify any famous persons mentioned here, and consider whether you too might share the same vulnerability to human error.

 

Who Says I’m Wrong?

Authorship Confusion.

Daniel Wegner creates the phrase “authorship confusion” to describe how people mistakenly assume responsibility for causing an event, simply because the thought preceded the occurrence.1

‘As If’ and ‘What If’ Thoughts Lead to Believed-In Imaginings.

Theodore Sarbin offers the phrase “believed-in imaginings” to describe the storied constructions people use to verify the existence of improbable events. A strong level of commitment to one’s story leads to a sense of realistic perception, causing the believer to move from an “as if” perspective to a conviction of actual reality. The person considers something as if it were true, and pretty soon, it becomes true. When this happens, the belief and the phenomenon cannot easily be differentiated.2

Causal Mistakes and Reasoning Errors.

Jean Piaget states that from a very young age, people develop mistaken beliefs about causal relationships between the mind and the physical world. Examples include thinking that actions, gestures or mental operations such as counting can bring about a desired event or stave off something bad, or that there is a meaningful relationship between random occurrences.3 Numerous other authors agree that the mind makes certain mistakes by allowing individuals to connect unrelated events while giving them unique significance.4

Cognitive Fusion.

Steven C. Hayes explains that we believe our thoughts to be literally true when perhaps they are not. Most of us have a propensity to look “from” our thoughts instead of “at” our thoughts, since ideas arise convincingly inside our heads in the form of language. Additionally, certain notions are defended and maintained because they exist in networks – or “relational frames” – with other thoughts. In this way, ideas become entrenched and we become “fused” with our thinking. “I’m right and I can give you the reasons” is a strong indicator of cognitive fusion.5

Cognitive Motivation to Reduce Uncertainty.

Leonard Zusne and Warren Jones illustrate that, “A ‘why’ question requires a ‘because’ answer. If the information is not available, incorrect information will be used.”6 The authors describe that we all have a cognitive motivation to secure explanations, however faulty. Other researchers agree that when individuals are faced with conditions of incomplete knowledge, they are compelled to construct beliefs in order to fill the gap of ambiguity and the unknown. This cognitive motivation to remove uncertainty is so powerful that the mind will prefer to fill the gap with incorrect information rather than to maintain a condition of uncertainty.7

Congruence is Preferred Over Truth.

Zusne and Jones also describe how we want to believe something simply because it matches up with how we feel. Our conclusions are geared toward seeking an internal state of congruence and consistency, and in this way we can replace the disturbing psychological condition of uncertainty or imbalance.8

Difficulty Tolerating Uncertainty.

Jeffrey S. Victor explains why even disturbing beliefs receive credibility, writing, “A mistaken explanation for emotional pain can be preferable for a confused person to the ambiguity of uncertainty.”9 Donald Spence agrees that because people do not easily tolerate uncertainty, they create irrational accounts when plausible explanations are unavailable.10 In an attempt to make life meaningful and for it to make sense, people assemble beliefs from a number of sources in order to stitch together personal unknowns. Steven Jay Lynn, et. al. concur that for this reason, individuals are vulnerable to a condition of overconfidence that is susceptible to the mind’s many flaws and imperfections.11

Evolution Favors Anxious Genes.

Aaron T. Beck explains that “our tendency to exaggerate the importance of certain situations – believing them to be a matter of life and death – overmobilizes our apparatus for dealing with threats and thus overrides normal functioning. It has been said that ‘evolution favors anxious genes.’ It is better to have ‘false positives’ (false alarms) than ‘false negatives’ (which miss the danger) in an ambiguous situation. One false negative – and you are eliminated from the gene pool. Thus, the cost of survival of the lineage may be a lifetime of discomfort.”12

Magical Thinking.

Numerous famous writers including Sigmund Freud, Margaret Mahler, and Ernest Becker have discussed magical thinking as a primitive defense that is often used to relieve certain anxieties tied to the existential pain of separation, self-esteem, limitation, longing, loss, chance, death, and uncertainty. Magical thinking is described as the belief that thoughts and reality are connected and that thinking can influence the actual world. This is a universal condition that begins in infancy and continues to a large extent throughout everyone’s lifetime. Omnipotence (the belief that we caused something by thinking about it) is one form of magical thinking. Superstitious thinking is also similar to magical thinking.13

Heather Stone explains that magical thinking often emerges as an attempt to bypass ambiguity and the necessary psychological work of authentic suffering and existential awareness.14 Other authors clarify that under such conditions of uncertainty, lack of information, or an inability to explain phenomena, magical thinking will predominate. Magical thinking especially emerges when elements of chance, accident, hope, fear, and danger are conspicuous.15 Other forms of suffering that provoke magical thinking are seen at such times when profound longings emerge that accompany a perceived lack of control.16 From a behavioral perspective, magical thinking exists largely to control the uncontrollable.17

Overvalued Ideation.

The International Obsessive-Compulsive Foundation describes this phenomenon as “when the person with OCD has great difficulty understanding that his/her worry is senseless.”18 Jonathan Grayson similarly says it is “the belief that the concerns underlying the symptoms are entirely realistic.”19 Steven Phillipson states that from this perspective, “the patient is not fully aware in a logical way that the threat is of an irrational nature. 20

Reinforcement.

Famous behaviorists such as Ivan Pavlov, Edward Thorndike, and B.F. Skinner all produced well-known studies on superstitious behavior, demonstrating that when reinforcement and behavior are accidentally or intermittently paired, people learn that certain meaning exists, and that meaning has lasting power over them, even if it’s wrong.21

Susceptibility to Coincidence.

Stuart Vyse writes that our personal beliefs end up being formed by observing coincidences, and that this human sensitivity to coincidence is an “overlooked psychological truth and a monumental understatement.” 22 Raeann Dumont concurs, “Our personal belief system has been constructed by observing coincidences. . . .  All of us, in every stage of life, have a limited reality.”23

Thought-Action Fusion.

Stanley Rachman describes “thought-action fusion” as a tendency to confuse thinking about an action with the action itself.24

Notes

1 Daniel M. Wegner and Thalia Wheatley, “Apparent Mental Causation: Sources of the Experience of Will,” American Psychologist 54, no. 7 (July 1999): 480-492.

2 Theodore R, Sarbin, “Believed-In Imaginings:  A Narrative Approach,” in Believed-In Imaginings:  The Narrative Construction of Reality, ed. Joseph de Rivera and Theodore R. Sarbin (Washington, D.C.: American Psychological Association, 1998), 19.

3 Jean Piaget, The Child’s Conception of the World (London: Routledge & Kegan Paul, 1929), 139-147.

4 Donald P. Spence, “The Mythic Properties of Popular Explanations,” in Believed-In Imaginings, 217-228; Jeffrey S. Victor, “Social Construction of Satanic Ritual Abuse and the Creation of False Memories,” in Believed-In Imaginings, 209; Leonard Zusne and Warren H. Jones, Anomalistic Psychology, A Study of Magical Thinking (Hillsdale: Lawrence Erlbaum Associates, 1989), 13 and 14.

5 Steven C. Hayes, Get Out of Your Mind and Into Your Life (Oakland: New Harbinger Publications, Inc., 2005), 57;  “Real Tools for Real Change,” in Quick Tips for Therapists, www.newharbinger.com; Jason B Luoma, Steven C Hayes, “Cognitive Defusion,” in Empirically Supported Techniques of Cognitive Behavior Therapy: a Step by Step Guide for Clinicians, ed. W. T. O’Donohue, J.E. Fisher, and Steven C. Hayes (New York: Wiley, in press), 5.

6 Zusne and Jones, Anomalistic Psychology, 13, 14.

7 Piaget, The Essential Piaget, 146; Zusne and Jones, Anomalistic Psychology, 13 and 14; Steven Jay Lynn, et al., “Rendering the Implausible Plausible: Narrative Construction, Suggestion, and Memory,” in Believed-In Imaginings, 133.

8 Zusne and Jones, Anomalistic Psychology, 229-243.

9 Victor, “Creation of False Memories,” 209.

10 Spence, “The Mythic Properties of Popular Explanations,” 217-228.

11 Lynn, et al., “Rendering the Implausible Plausible,” 133.

12 Aaron T. Beck and Gary Emery, Anxiety Disorders and Phobias: A Cognitive Perspective (New York: Basic Books, 1985), 4.

13 Ernest Becker, The Denial of Death (New York: The Free Press, 1973), 155, 180 and 181; Mel. D. Faber, New Age Thinking, A Psychoanalytic Critique (Canada: University of Ottawa Press, 1996), 27; Robert W. Firestone, The Fantasy Bond (Los Angeles: The Glendon Association, 1985), 182 and 183; Sigmund Freud, An Autobiographical Study, in The Standard Edition of the Complete Psychological Works of Sigmund Freud, vol. 1, ed. and trans. James Strachey (London: Hogarth Press, 1959), 66; Giora Keinan, “Effects of Stress and Tolerance of Ambiguity on Magical Thinking,” Journal of Personality and Social Psychology 67, no. 1 (July 1994): 48-55; Margaret Mahler, et al., The Psychological Birth of the Human Infant (New York: Basic Books, 1975), 44; Jean Piaget, The Child’s Conception of the World, 139-147; Géza Róheim, Magic and Schizophrenia (New York: International Universities Press, 1955), 10, 11, 45 and 46; Stuart A. Vyse, Believing in Magic: The Psychology of Superstition (New York: Oxford University Press, 1977), 196-211; Zusne and Jones, Anomalistic Psychology, 13-32, 229-259.

14 Heather Stone, The Therapeutic Value of Magical Thinking: Exploring the Gap Between Longing and Fulfillment, Doctoral Dissertation (Petaluma: Meridian University, 2005), 8, 10, 13, 20, 21, 113, 142, 179-181, 192.

15 Vyse, Believing in Magic, 11.

16 Mahler, et al., The Psychological Birth, 44; D.W. Winnicott, “Transitional Objects and Transitional Phenomena:  A Study of The First Not Me Possession,” The International Journal of Psycho-Analysis XXXIV (1953): 94; Jacqueline D. Wolley, “Thinking about Fantasy:  Are Children Fundamentally Different Thinkers and Believers from Adults?” Child Development 68, no. 6 (December 1997): 998; Vyse, Believing in Magic, 11.

17 Vyse, Believing in Magic, 81.

18 International OCD Foundation, www.ocfoundation.org, Glossary of Terms.

19 Jonathan Grayson, Freedom from Obsessive-Compulsive Disorder: A Personalized Recovery Program for Living With Uncertainty (New York: The Berkeley Publishing Group, 2003), 236.

20 Steven Phillipson, “God Forbid,” www.ocdonline.com.

21 Edward L. Thorndike, A  History of Psychology in Autobiography 3, ed. Carl Murchison (Worcester, MA: Clark University, 1936), 263-270; Ivan P. Pavlov, Conditioned Reflexes:  An Investigation of the Physiological Activity of the Cerebral Cortex, trans. G.V. Anrep (Oxford, England: Dover Publications, 1960), 291; Pavlov, “Lecture I,” in Shipley Thorne, ed. Classics in Psychology (New York: Philosophical Library, 1961), 789; Burrhus Frederic Skinner, “‘Superstition’ in the Pigeon,” Journal of Experimental Psychology 38 (1948): 168-172.

22 Vyse, Believing in Magic, 60.

23 Raeann Dumont, The Sky is Falling (New York: W.W. Norton & Company, 1996), 43.

24 Stanley Rachman, “Obsessions, Responsibility, and Guilt,” Behaviour Research and Therapy 31, no. 2 (February 1993): 149-54; Rachman, “A Cognitive Theory of Obsessions,” Behaviour Research and Therapy 35, no. 9 (September 1997): 793-802.

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Automatic Thoughts

What just happened? (Just quickly relay the facts).

Was I already in a difficult space before this even happened? How come? (What was the context?)

What went through my mind immediately after I got triggered? If I was looking at a cartoon of myself in this particular scenario, what would be written in the “bubble” over my head? (This will be the foundation of the automatic thought).


Now, try to elaborate a little further to expand the automatic thought:

  • What does this say about me if it is true?
  • What does this mean in a larger sense – about me, my life, or my future?
  • What am I afraid might happen?
  • What is the worst thing about this, if it were true?
  • What does this mean about how others might perceive me?
  • What does this mean about my relationship to others in general?
  • What images or memories do I have in connection to his situation?

So, your automatic thought will be a few phrases pieced together, such as:

I / others / and / so / I’ll always / it will never / it means / therefore / etc.

(See if you can put together a long sentence to expand on your automatic thought, using your own words).

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Who Says I’m Wrong?

Cognitive-behavioral therapists typically present a list of “cognitive distortions” that describe the common errors we make at the level of our thoughts. (You are likely to find a list of those distortions in virtually every CBT workbook, and even in the Articles section of my website). However, there is another process of faulty reasoning that has to do with forming incorrect beliefs, and at this deeper level, our judgment can get even further off track. Why does the mind generate such causal mistakes, or fill in missing data with false information? The following list cites some credible sources that explain how and why we tend to produce (and even defend) a faulty belief system. Look closely to see if you can identify any famous persons mentioned here, and consider whether you too might share the same vulnerability to human error.

Authorship Confusion.

Daniel Wegner creates the phrase “authorship confusion” to describe how people mistakenly assume responsibility for causing an event, simply because the thought preceded the occurrence.1

‘As If’ and ‘What If’ Thoughts Lead to Believed-In Imaginings.

Theodore Sarbin offers the phrase “believed-in imaginings” to describe the storied constructions people use to verify the existence of improbable events. A strong level of commitment to one’s story leads to a sense of realistic perception, causing the believer to move from an “as if” perspective to a conviction of actual reality. The person considers something as if it were true, and pretty soon, it becomes true. When this happens, the belief and the phenomenon cannot easily be differentiated.2

Causal Mistakes and Reasoning Errors.

Jean Piaget states that from a very young age, people develop mistaken beliefs about causal relationships between the mind and the physical world. Examples include thinking that actions, gestures or mental operations such as counting can bring about a desired event or stave off something bad, or that there is a meaningful relationship between random occurrences.3 Numerous other authors agree that the mind makes certain mistakes by allowing individuals to connect unrelated events while giving them unique significance.4

Cognitive Fusion.

Steven C. Hayes explains that we believe our thoughts to be literally true when perhaps they are not. Most of us have a propensity to look “from” our thoughts instead of “at” our thoughts, since ideas arise convincingly inside our heads in the form of language. Additionally, certain notions are defended and maintained because they exist in networks – or “relational frames” – with other thoughts. In this way, ideas become entrenched and we become “fused” with our thinking. “I’m right and I can give you the reasons” is a strong indicator of cognitive fusion.5

Cognitive Motivation to Reduce Uncertainty.

Leonard Zusne and Warren Jones illustrate that, “A ‘why’ question requires a ‘because’ answer. If the information is not available, incorrect information will be used.”6 The authors describe that we all have a cognitive motivation to secure explanations, however faulty. Other researchers agree that when individuals are faced with conditions of incomplete knowledge, they are compelled to construct beliefs in order to fill the gap of ambiguity and the unknown. This cognitive motivation to remove uncertainty is so powerful that the mind will prefer to fill the gap with incorrect information rather than to maintain a condition of uncertainty.7

Congruence is Preferred Over Truth.

Zusne and Jones also describe how we want to believe something simply because it matches up with how we feel. Our conclusions are geared toward seeking an internal state of congruence and consistency, and in this way we can replace the disturbing psychological condition of uncertainty or imbalance.8

Difficulty Tolerating Uncertainty.

Jeffrey S. Victor explains why even disturbing beliefs receive credibility, writing, “A mistaken explanation for emotional pain can be preferable for a confused person to the ambiguity of uncertainty.”9 Donald Spence agrees that because people do not easily tolerate uncertainty, they create irrational accounts when plausible explanations are unavailable.10 In an attempt to make life meaningful and for it to make sense, people assemble beliefs from a number of sources in order to stitch together personal unknowns. Steven Jay Lynn, et. al. concur that for this reason, individuals are vulnerable to a condition of overconfidence that is susceptible to the mind’s many flaws and imperfections.11

Evolution Favors Anxious Genes.

Aaron T. Beck explains that “our tendency to exaggerate the importance of certain situations – believing them to be a matter of life and death – overmobilizes our apparatus for dealing with threats and thus overrides normal functioning. It has been said that ‘evolution favors anxious genes.’ It is better to have ‘false positives’ (false alarms) than ‘false negatives’ (which miss the danger) in an ambiguous situation. One false negative – and you are eliminated from the gene pool. Thus, the cost of survival of the lineage may be a lifetime of discomfort.”12

Magical Thinking.

Numerous famous writers including Sigmund Freud, Margaret Mahler, and Ernest Becker have discussed magical thinking as a primitive defense that is often used to relieve certain anxieties tied to the existential pain of separation, self-esteem, limitation, longing, loss, chance, death, and uncertainty. Magical thinking is described as the belief that thoughts and reality are connected and that thinking can influence the actual world. This is a universal condition that begins in infancy and continues to a large extent throughout everyone’s lifetime. Omnipotence (the belief that we caused something by thinking about it) is one form of magical thinking. Superstitious thinking is also similar to magical thinking.13

Heather Stone explains that magical thinking often emerges as an attempt to bypass ambiguity and the necessary psychological work of authentic suffering and existential awareness.14 Other authors clarify that under such conditions of uncertainty, lack of information, or an inability to explain phenomena, magical thinking will predominate. Magical thinking especially emerges when elements of chance, accident, hope, fear, and danger are conspicuous.15 Other forms of suffering that provoke magical thinking are seen at such times when profound longings emerge that accompany a perceived lack of control.16 From a behavioral perspective, magical thinking exists largely to control the uncontrollable.17

Overvalued Ideation.

The International Obsessive-Compulsive Foundation describes this phenomenon as “when the person with OCD has great difficulty understanding that his/her worry is senseless.”18 Jonathan Grayson similarly says it is “the belief that the concerns underlying the symptoms are entirely realistic.”19 Steven Phillipson states that from this perspective, “the patient is not fully aware in a logical way that the threat is of an irrational nature. 20

Reinforcement.

Famous behaviorists such as Ivan Pavlov, Edward Thorndike, and B.F. Skinner all produced well-known studies on superstitious behavior, demonstrating that when reinforcement and behavior are accidentally or intermittently paired, people learn that certain meaning exists, and that meaning has lasting power over them, even if it’s wrong.21

Susceptibility to Coincidence.

Stuart Vyse writes that our personal beliefs end up being formed by observing coincidences, and that this human sensitivity to coincidence is an “overlooked psychological truth and a monumental understatement.” 22 Raeann Dumont concurs, “Our personal belief system has been constructed by observing coincidences. . . . All of us, in every stage of life, have a limited reality.”23

Thought-Action Fusion.

Stanley Rachman describes “thought-action fusion” as a tendency to confuse thinking about an action with the action itself.24

Notes

1 Daniel M. Wegner and Thalia Wheatley, “Apparent Mental Causation: Sources of the Experience of Will,” American Psychologist 54, no. 7 (July 1999): 480-492.

2 Theodore R, Sarbin, “Believed-In Imaginings: A Narrative Approach,” in Believed-In Imaginings: The Narrative Construction of Reality, ed. Joseph de Rivera and Theodore R. Sarbin (Washington, D.C.: American Psychological Association, 1998), 19.

3 Jean Piaget, The Child’s Conception of the World (London: Routledge & Kegan Paul, 1929), 139-147.

4 Donald P. Spence, “The Mythic Properties of Popular Explanations,” in Believed-In Imaginings, 217-228; Jeffrey S. Victor, “Social Construction of Satanic Ritual Abuse and the Creation of False Memories,” in Believed-In Imaginings, 209; Leonard Zusne and Warren H. Jones, Anomalistic Psychology, A Study of Magical Thinking (Hillsdale: Lawrence Erlbaum Associates, 1989), 13 and 14.

5 Steven C. Hayes, Get Out of Your Mind and Into Your Life (Oakland: New Harbinger Publications, Inc., 2005), 57; “Real Tools for Real Change,” in Quick Tips for Therapists, www.newharbinger.com; Jason B Luoma, Steven C Hayes, “Cognitive Defusion,” in Empirically Supported Techniques of Cognitive Behavior Therapy: a Step by Step Guide for Clinicians, ed. W. T. O’Donohue, J.E. Fisher, and Steven C. Hayes (New York: Wiley, in press), 5.

6 Zusne and Jones, Anomalistic Psychology, 13, 14.

7 Piaget, The Essential Piaget, 146; Zusne and Jones, Anomalistic Psychology, 13 and 14; Steven Jay Lynn, et al., “Rendering the Implausible Plausible: Narrative Construction, Suggestion, and Memory,” in Believed-In Imaginings, 133.

8 Zusne and Jones, Anomalistic Psychology, 229-243.

9 Victor, “Creation of False Memories,” 209.

10 Spence, “The Mythic Properties of Popular Explanations,” 217-228.

11 Lynn, et al., “Rendering the Implausible Plausible,” 133.

12 Aaron T. Beck and Gary Emery, Anxiety Disorders and Phobias: A Cognitive Perspective (New York: Basic Books, 1985), 4.

13 Ernest Becker, The Denial of Death (New York: The Free Press, 1973), 155, 180 and 181; Mel. D. Faber, New Age Thinking, A Psychoanalytic Critique (Canada: University of Ottawa Press, 1996), 27; Robert W. Firestone, The Fantasy Bond (Los Angeles: The Glendon Association, 1985), 182 and 183; Sigmund Freud, An Autobiographical Study, in The Standard Edition of the Complete Psychological Works of Sigmund Freud, vol. 1, ed. and trans. James Strachey (London: Hogarth Press, 1959), 66; Giora Keinan, “Effects of Stress and Tolerance of Ambiguity on Magical Thinking,” Journal of Personality and Social Psychology 67, no. 1 (July 1994): 48-55; Margaret Mahler, et al., The Psychological Birth of the Human Infant (New York: Basic Books, 1975), 44; Jean Piaget, The Child’s Conception of the World, 139-147; Géza Róheim, Magic and Schizophrenia (New York: International Universities Press, 1955), 10, 11, 45 and 46; Stuart A. Vyse, Believing in Magic: The Psychology of Superstition (New York: Oxford University Press, 1977), 196-211; Zusne and Jones, Anomalistic Psychology, 13-32, 229-259.

14 Heather Stone, The Therapeutic Value of Magical Thinking: Exploring the Gap Between Longing and Fulfillment, Doctoral Dissertation (Petaluma: Meridian University, 2005), 8, 10, 13, 20, 21, 113, 142, 179-181, 192.

15 Vyse, Believing in Magic, 11.

16 Mahler, et al., The Psychological Birth, 44; D.W. Winnicott, “Transitional Objects and Transitional Phenomena: A Study of The First Not Me Possession,” The International Journal of Psycho-Analysis XXXIV (1953): 94; Jacqueline D. Wolley, “Thinking about Fantasy: Are Children Fundamentally Different Thinkers and Believers from Adults?” Child Development 68, no. 6 (December 1997): 998; Vyse, Believing in Magic, 11.

17 Vyse, Believing in Magic, 81.

18 International OCD Foundation, www.ocfoundation.org, Glossary of Terms.

19 Jonathan Grayson, Freedom from Obsessive-Compulsive Disorder: A Personalized Recovery Program for Living With Uncertainty (New York: The Berkeley Publishing Group, 2003), 236.

20 Steven Phillipson, “God Forbid,” www.ocdonline.com.

21 Edward L. Thorndike, A History of Psychology in Autobiography 3, ed. Carl Murchison (Worcester, MA: Clark University, 1936), 263-270; Ivan P. Pavlov, Conditioned Reflexes: An Investigation of the Physiological Activity of the Cerebral Cortex, trans. G.V. Anrep (Oxford, England: Dover Publications, 1960), 291; Pavlov, “Lecture I,” in Shipley Thorne, ed. Classics in Psychology (New York: Philosophical Library, 1961), 789; Burrhus Frederic Skinner, “‘Superstition’ in the Pigeon,” Journal of Experimental Psychology 38 (1948): 168-172.

22 Vyse, Believing in Magic, 60.

23 Raeann Dumont, The Sky is Falling (New York: W.W. Norton & Company, 1996), 43.

24 Stanley Rachman, “Obsessions, Responsibility, and Guilt,” Behaviour Research and Therapy 31, no. 2 (February 1993): 149-54; Rachman, “A Cognitive Theory of Obsessions,” Behaviour Research and Therapy 35, no. 9 (September 1997): 793-802.



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