This is a guest post by Alegra Kastens, a licensed Marriage and Family Therapist who founded the Center for OCD, Anxiety, and Eating Disorders.
Compulsions related to obsessive-compulsive disorder (OCD), whether mental or physical, are something you choose to carry out in response to obsessions. Compulsions are active and can be stopped. However, when carried out repetitively for extended periods of time, the compulsions might become so habitual they might not feel like a choice. Instead, they might feel automatic or involuntary. But, is this really true?
This is a fantastic question and one that can be controversial, in my opinion, because of semantics. Before I dive into the answer, let’s look at Oxford Languages’ definitions of automatic and involuntary.
Automatic (adjective): Done or occurring spontaneously, without conscious thought or intention
Similar: involuntary, unconscious, knee-jerk, reflexive, spontaneous, unintentional
Involuntary (adjective): Done without will or conscious control
Similar: unconscious, reflexive, unintentional, uncontrollable
These definitions may ring true for people with OCD, specifically related to conscious awareness. If you have been performing mental compulsions for a while, you might jump into them without conscious awareness of doing so. This can happen when you habitually respond to a stimulus (ex. intrusive thought) with a behavior (mental or physical), and condition your brain to associate the stimulus with that behavior. In other words, the mental compulsion can become a conditioned response to an obsession that you jump into without consciously meaning to. For example, if you have repeatedly checked on your groinal area after having unwanted sexual intrusive thoughts, over time you might find yourself checking without making a conscious decision to.
There’s a very important caveat to this, though: engaging in compulsions with little to no conscious awareness does not mean that we have no control over mental compulsions, or that they cannot be stopped. What it does mean is that we might need to utilize mindfulness skills to create awareness of mental compulsions when we are carrying them out without conscious awareness. This can look like noticing the mental compulsion, naming it to create awareness of it, and stopping the active mental engagement. Mental compulsions can be stopped just as physical compulsions, like sanitization, can be stopped.
While intrusive thoughts pop in passively, without our control, mental compulsions are active responses that we can control. We can stop how we are choosing to mentally respond to intrusive thoughts and images, sensations, and feelings. We can stop mental compulsions.
If you are a person who engages in habitual mental compulsions without conscious awareness, you might be asking, HOW?
If a person has been ruminating for so long that they habitually engage in it without realizing it, that person can utilize mindfulness skills to create awareness of mental compulsions. The first step is to notice that you are performing a compulsion. At some point, even 30 minutes into ruminating (or mental checking, hypothesizing, mental review, etc.), it is likely that you notice the mental gymnastics. This is when you can label it for yourself: I notice that I am ruminating right now. Labeling in this way tells the brain that you are aware of the thought process. Then, you stop ruminating. You stop actively thinking about an obsession and turn your attention to something that is more meaningful and helpful in the present moment.
Over time, through awareness, the goal is to create more space between the obsession and mental compulsion so that you are aware of the choice you have to resist.
Stopping a compulsion is not easy. There is often a strong urge to continue carrying out the behavior, like an itch that you are not scratching, that you must tolerate without giving in to the compulsion. It’s not as simple as “just stop,” but stopping is possible. It’s a muscle to strengthen over time.
In order to create awareness of mental compulsions, it is imperative to have an understanding of what constitutes a mental compulsion. Psychoeducation about mental compulsions can help you better understand your own symptoms as you work on response prevention.
When obsessions and compulsions are both occurring in the mind, response prevention can be trickier to navigate—but it is very possible with the right tools.
Get your life back from OCD
If you’re struggling with compulsions like these, NOCD can help. Our licensed therapists deeply understand OCD and are specialty-trained in treating OCD with ERP. They’ll work with you to create a treatment plan personalized to your unique needs and help you regain your life from OCD. You can book a free 15-minute call with our team to learn more about getting started with OCD treatment.