Some people just think... and think... and think things over (and over) again. That’s what we would call an “intrusive thought,” an unwanted thought that comes out of nowhere that creates anxiety or guilt. If that thought continuously sticks around over time, without any reassurances (whether internal or external) or any compulsions, we’d call that “Pure O.”
Pure O is a type of OCD, and it’s one that most people don’t potentially see because it doesn’t have the behavioral compulsion component tied to it.
With Pure O, a person won’t stop thinking the thought until they’re literally exhausted from all the worrying. They’ll either fall asleep, or they’ll distract themselves by doing other activities. But often times, if they have some idle time, the ruminations return.
The intrusive thoughts could be about anything --- germs or diseases -- And they can change or morph over time. For example, common childhood/adolescent intrusive thoughts might be about separation or thoughts about death and infinity. As you age, the thoughts could morph into ruminations about STDs and other specific diseases.
"Toes in the Water" Treatment
From a Cognitive Behavioral Therapy point of view, one approach that’s been shown to help people learn how to cope with those thoughts, and reduce the intensity of the anxiety that arises from them is called Exposure & Response Prevention (ERP) Therapy.
ERP is designed to help us come up with a hierarchy of fear. We start with the smallest ones, or the one that causes us the least amount of distress, and we embrace the feeling that’s coming up when we’re exposed to a particular stimulant/trigger.
An example would be going to the bathroom and washing your hands once, and coming out and being able to embrace the uncertainty of, “OK, maybe there are germs in my hand.”
There’s a simple principle behind this. When you go to the beach in the summer and you put your toes in the water and you think “Oh wow, the water is really cold,” and you jump out and say, “Oh no. I’m not going in today.”
But you also notice that plenty of people in the water are enjoying themselves.
After just a few minutes, the water doesn’t feel as cold. The water temperature hasn’t changed, but our perception of the water has. That is the principle of ERP.
“Fear of fear”
Another common intrusive thought is the idea of “fear of fear,” which causes people to avoid. If I’m scared of dogs, I would typically avoid dog parks or places where I might encounter dogs.
With ERP, I’d want to stand 30 ft from a dog park and learn how to embrace the physiological sensations arising within me.
Then over time, I’d gradually push myself closer and closer to the dog park. I wouldn’t suggest that someone attempt ERP exposure on their own. Typically it works best in the company of a therapist who’s aware exactly what’s going on in the moment.
When we’re able to tolerate the thoughts and emotional distress --- they are less likely to be apparent in our consciousness and control us.
OCD is like a juice maker. It’s the context of which something works, the content is the fruit. You can make a juice out of anything. OCD can affect any thought that a person can have. It’s a process rather than content.
The most common way people think about OCD is probably something like, “His desk is so neat and clean. He must be OCD.”
That is completely inaccurate. When a person’s desk is organized, it doesn't necessarily mean they have OCD. More often, people who struggle with actual OCD are not necessarily organized or neat. From a clinical point of view, there’s a distinction between a personality style an OCD disorder.
The most important takeaway is to understand it in this way:
“My thoughts are not me. This is an issue that I have --- and not a character flaw.”
Konstantin Lukin, Ph.D., is a licensed clinical psychologist in Ridgewood and Hoboken, NJ. He has extensive clinical and research experience spanning individuals of all ages, in both inpatient and outpatient settings. He specializes in men’s issues, couple’s counseling, and relationship problems. His therapeutic approach focuses on providing support and practical feedback to help patients effectively address personal challenges. He integrates complementary modalities and techniques to offer a personalized approach tailored to each patient. He has been trained in cognitive-behavioral, dialectical behavior, schema-focused, and emotionally focused therapy, and has also been involved with research projects throughout his career, including two National Institute of Mental Health-funded studies. He is a member of the Association for Behavioral and Cognitive Therapies, New Jersey Psychological Association, Northeast Counties Association of Psychologists, New York State Psychological Association, The International Centre for Excellence in Emotionally Focused Therapy, The New York Center for Emotionally Focused Therapy, the International OCD Foundation, the Association for Contextual Behavioral Science (ACSB) and a regular contributor to Psychology Today.