Obsessive Thinking, Worry, and Cognitive Behavior Therapy

Why Worry? Worry is an anxious preoccupation with an anticipated negative event.  Over the course of evolution, worry helped us adapt by directing awareness to true problems that once identified can be effectively addressed. In this way worry is effective in managing challenges of your everyday life.

Unhealthy Worry For some people, this process breaks down. Their minds become trapped in a endless process of “figuring it out.” They are plagued by thoughts and images of disastrous outcomes that in reality may never come to be. Worriers are particularly challenged by problems that have no clear solution. Instead of accepting and managing these difficult realities, they are viewed as evidence of the futility of even trying to work things out.

Obsessive Thinking Unhealthy worry is part of a broader problem called obsessive thinking. Obsessive thinking is an inability to gain control over recurrent, distressing thoughts, images. These thoughts and images are embedded in a complex network of feelings, sensations, and at times, behavioral rituals and routines. Brain imaging studies indicate that obsessive thinking is associated with a neurological dysfunction of unknown cause that forces thoughts into repetitive loops. Obsessive thinking is like a hamster wheel in your brain, with a parade of different animals entering and exiting over time.

Rumination Obsessive worry is focused on future outcomes. Ruminationanother form of obsessive thinking, is the uncontrollable preoccupation with the past. Rumination is experienced as guilt, regret and anger, over perceived mistakes, losses, slights, actions taken or not taken, opportunities forever lost, with irreversible, catastrophic results. Rumination is accompanied by condemning, all-or-none criticism, and the overwhelming belief that if things had been different then existing and future misery could be avoided.

The Damage Done Obsessive thinking intensifies and prolongs distressing emotions. For example, worry reinforces anxious feelings – you literally scare yourself – which, in turn, only leads to more worry. The process can extend into anxious periods lasting hours, days or weeks, at times “spiraling” into panic attacks and emotional “spikes” of anger, guilt and shame. Obsessive thinking limits effective problem solving, and promotes procrastination, avoidance and withdrawal, only resulting in further problems. Obsessive thinking plays a prominent role mood disorders, including dysthymia, major depression, bipolar disorder, and is the defining symptom of Generalized Anxiety Disorder (GAD), Obsessive-Compulsive Disorder (OCD), Panic Disorder, and many other psychological conditions.

Attempts to Control Obsessive Thinking “Stopping” the Thoughts Obsessive thinking is difficult if not impossible to control. If you are prone to obsessive brain patterns, you’ve likely tried forcing the unwanted thoughts out of your mind. Despite its intuitive appeal, evidence shows that this strategy rarely works. In fact, research shows that attempts to “force away” obsessive thoughts may only intensify obsessive thinking.

Rituals Temporarily “Soothing”, “neutralizing” cognitive-behavioral routines often develop as natural attempt to control onslaught obsessive thinking. Research shows that such routines, or “rituals”, only serve to reinforce obsessive thinking.

Cognitive Behavior Therapy Understanding the Problem Cognitive-behavior therapy begins with the scientific understanding of obsessive thinking. The goal is to dispel misconceptions that may fuel the problem, and to equip you with the knowledge, to begin your recovery. Rather than frustrating you with the unrealistic goal of stopping the thoughts, cognitive-behavior therapy helps by weakening the connection between obsessive thinking and the rest of your waking life. In other words, faced with the reality that there is no on/off switch, CBT turns down the volume. The strategies are designed to minimize engagement in the obsessive process, reducing attention to its useless content, cutting off its fuel supply, and reducing the intensity and urgency of its call, while working to developing new, more effective sources of emotional reward. Cognitive Restructuring To step back from emotional thinking, engage a wise mind, that is at once informed by your feelings, and grounded by a healthy appreciation of objective observation and reason.

Acceptance-Mindfulness: An emotionally grounding starting point, is the emotionally sober determination of which elements of the problem can be effectively changed, and which are fixed and enduring enough to repel the best attempts at change. To change, requires courage, and emotional fortitude, to persist in practicing new ways of thinking and behaving, and to accept, that is, to adjust to immovable challenges, requires the same courage, fortitude, and persistent practice.  Mindfulness is the experiential practice of acceptance – exercising the mental muscles needed to engage effective cognitive-affective-behavioral routines persistently over time.

Attention Shifting: This strategy simultaneously encourages the application of a balanced, reasonable alternative thought, and the practice of “letting go” of obsessive content. Rather than attempting to “stop” the obsessive process, it works by shifting your attention to a predetermined thought and/or action. For example, the statement “these are just thoughts, they are not helping but are only hurting me”, or “I don’t know what will happen in my future, but the probability of _________ [fill in the blank] occurring is slim”, followed by three deep breaths and return to the task at hand.

Relaxation: Practice exercises to let go, both physically, in your body, and emotionally, in your mind.

Repeated Exposure: Exposure for panic attacks, phobias and OCD is the most reliable treatment in the behavioral health field. It is used to “desensitize” (habituate) the person to feared, distressing situations, thoughts, feelings and sensations. Exposure is a “paradoxical” approach, where you go against instinct by “facing” (opening up to, accepting, surrendering to) the object or irrational distress.

Behavioral Activation: The ultimate goal of treating obsessive thoughts is to “get out of your head” and into your life. Behavioral activation is focused on just that – setting specific goals to engage in meaningful, healthy behaviors, as opportunities to practice attention shifting and application of other cognitive behavioral techniques.