If you live with OCD, you’ve likely heard the following: Thought-stopping and thought suppression do not work; such attempts backfire and lead to even more of the very thoughts you’re not wanting to experience. In the same breath, you’ve likely also heard that one goal of OCD treatment is to stop carrying out mental rituals like rumination and mental review of the past. So which is it, you might be asking yourself, am I supposed to stop thoughts or not?
While seemingly contradictory, both of the above sentiments are true.
Thought-stopping is a cognitive-behavioral technique that involves attempting to stop the occurrence of unwanted thoughts. Through exercises like shouting the word STOP, visualizing a red stop sign, and snapping a rubber band when an unwanted thought or image arises, thought-stopping aims to interrupt, get rid of, and prevent the recurrence of unwanted thoughts. Sometimes the person is asked to think a more “positive” thought instead or re-direct their attention to something “more helpful.”
Thought-stopping attempts to stop both automatic, involuntary intrusions that cause distress and cyclical, unhelpful patterns of thinking like rumination. This is where the nuance lies: We cannot stop our brains from producing involuntary thoughts—and attempts to do so usually only make the thoughts feel stronger—but we can choose to stop actively engaging with those involuntary thoughts.
People with OCD spend a lot of time and energy trying not to experience unwanted intrusions. It makes sense, in theory, because intrusive thoughts and images are ego-dystonic: opposite to a person’s values, desires, beliefs, and self-concept. Someone with pedophilia OCD (POCD) does not want to experience unwanted sexual thoughts, just like someone with harm OCD does not want to experience intrusive violent images. In practice, though, this attempted suppression and stopping of thoughts increases the likelihood that they will experience the very thoughts they’re trying to get rid of.
Trying to stop automatic, involuntary intrusions often backfires for people with OCD. In one study by psychologist Dr. Daniel Wegner, suppressing thoughts (telling your brain not to produce certain thoughts) actually created more of the very thoughts the participants were asked not to think. Thought suppression contributed to a rebound of the unwanted thoughts. This paradox, that trying not to think something contributes to thinking it more, is known as the Ironic Process Theory.
The truth is that we cannot stop automatic, involuntary thoughts. We do not have control over what our brain produces much of the time, but we do have control over how we engage with what our brain produces. In other words, we cannot stop automatic intrusions from popping into our mind but we can stop how we are actively engaging with them mentally. We can stop mental rituals.
Thought-stopping of automatic, involuntary thoughts by replacing unwanted intrusions with more “positive” thoughts is actually a mental ritual that people with OCD commonly carry out to neutralize unwanted thoughts. For example, someone with blasphemous intrusions like “I hate God” might feel the urge to replace that thought, every time it arises, with “I love God” to prevent any perceived consequences of experiencing the unwanted thought (e.g., going to hell) or wipe the slate clean (i.e., the “bad” thought doesn’t exist because of the “good” one). The neutralization doesn’t stop the unwanted thoughts from occurring. Like any other compulsion, it reinforces the obsession. It tells the brain that the unwanted thought is meaningful, dangerous, and important to pay attention to, which is the opposite of what the person is trying to achieve. It keeps a person stuck in the grips of the recurring OCD cycle.
A primary goal of effective OCD treatment is to stop engaging with obsessions compulsively. This includes mental rituals like thought neutralization, rumination about obsessions, and self-reassurance.
Just like people with OCD carry out physical compulsions such as sanitizing excessively or turning the car back around to check that they haven’t hit someone, people with OCD also carry out mental rituals in response to obsessions. These mental rituals are an attempt to “resolve” obsessions, alleviate anxiety, or prevent some dreaded outcome from occurring—but compulsions create confusion and not clarity.
Common mental compulsions include (but are not limited to):
- Rumination: actively analyzing an obsession, fixating on an obsession, attempting to solve an obsession through thought
- Mental review: mentally recalling and going over the past (an event, memory, conversation, incident, one’s behavior, etc.) in an attempt to alleviate distress about it, seek clarity about it, gather evidence to prove or disprove one’s obsessions, etc.
- Mental checking: internally checking one’s feelings and bodily sensations
- Hypothesizing: imagining a scenario (related to an obsession) to test one’s reaction to it
- Self-reassurance: continuously reassuring oneself about the content of an obsession
- Thought neutralization: replacing a “bad” thought with a “good” thought
Though these compulsions are mental, this does not mean that they’re involuntary and cannot be stopped. It might be helpful to think about mental compulsions as mental behavior. Just like people with OCD can prevent themselves from washing their hands a second time or driving the car around the block again, people with OCD can prevent themselves from choosing to mentally engage with an obsession. Mentally reviewing your past for evidence of deviancy is a choice. Ruminating about the likelihood of you suddenly acting on an intrusive thought and hurting someone is a choice. Replacing an unwanted intrusion with one that feels more desirable is a choice.
But my mental compulsions are involuntary, you might be thinking. A better word for this is habitual. Sometimes people are so used to engaging in compulsive rituals, mental or physical, that they start to carry them out without much conscious awareness. While mental compulsions can become somewhat of a habit, they are still an active choice. If you are engaging in habitual mental compulsions, utilizing mindfulness skills to create awareness of mental compulsions and interrupt them can be helpful. This can look like noticing the mental compulsion, naming it to create awareness of it, and stopping the active mental engagement.
The nuance, in summary:
- If by thought-stopping, a person is referring to stopping and getting rid of an automatic intrusive thought, this is often unhelpful.
- If by thought-stopping, a person is referring to interrupting an unhelpful thought pattern like rumination and turning their attention to what is more helpful in the present moment, this is response prevention—a key tool for disrupting the OCD cycle and managing symptoms.
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.
