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6 Thinking Patterns that Make OCD and Anxiety Worse

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In this video we’ll look at six types of thinking that feed OCD. They make it worse. And the reason we look at these is because when you can notice these thoughts and clarify that they aren’t helpful and then replace believing them with something else, you can actively decrease OCD symptoms.

OCD is caused by a combination of factors: genetic and biological — so that’s what’s going on with our bodies, including inflammation, nutrition, and stress, etc. — environmental — which is our experiences — and the psychological — so how we think. And the way you think and act determines whether you feed or starve your OCD. 

6 Thinking Patterns That Make OCD Worse

So let’s explore six thinking patterns that make OCD worse, and then we’ll talk about what to do about it. 

1. Inflated Responsibility

The first one is inflated responsibility. So this is where you believe that you are responsible for preventing bad things from happening to everyone. It’s epitomized by the nursery rhyme “Don’t step on a crack or you’ll break your mother’s back.” 

People with OCD may obsess over every little thing they do, as they feel personally responsible for preventing others from getting cancer, getting in an accident, losing their job, or even they feel responsible to prevent natural disasters from happening. 

The magical thinking leads to compulsions like “I have to pace 100 steps to prevent an earthquake from happening” or “I have to drive around the block 20 times to make sure that the speed bump wasn’t actually a person.” 

Now, while a person with OCD may logically know that doing the compulsions doesn’t actually prevent something, they still may fear that if they don’t do their ritual and then something bad does happen it would be their fault. So they do the compulsion anyway. 

It’s like an attempt to gain control over something that we can’t control. It’s the uncertainty of not knowing if something bad will happen. So for someone with OCD, that uncertainty is extra uncomfortable, and compulsions are an attempt to make that discomfort go away. 

2. Thought Fusion

Number two is believing that thinking it and doing it are the same thing. So this is where you believe that if you think something, it’s just as bad as doing it. If you have a sexual thought, it’s as though you acted on it. Or if you wish someone disappeared, it’s as though you murdered them. 

Someone with OCD may feel actual guilt for a crime they didn’t commit; they just thought about it. And not only did they not do the thought, but in general they would be horrified if they did do that. They didn’t want to stab someone while they were cutting up veggies. They have no desire to harm a child. 

These things sound horrible, and they believe that thinking this thought is as bad as actually acting on it. So they may engage in compulsions to make those thoughts go away. 

So this might look like keeping busy counting or hand washing, etc. And they might do these so that their mind doesn’t have time to think about the obsession. Or they might engage in compulsive prayer to repent from a sin that they haven’t committed. 

3. Excessive Concern With Controlling Thoughts

Number three is excessive concern with controlling one’s thoughts. So it’s thinking things like, “I shouldn’t ever think this.” 

And you’ll see this a lot with like religious OCD, or scrupulosity, um where people think, “I should never think a sexual thought. I should never feel angry.” And this can be fed by religious teachings. 

So in my church we were taught that your mind is a stage and there can only ever be one thing on it at a time, and if something bad comes onto it you need to take it off the stage and put something else good onto it, like singing a hymn. 

Now, this might work for 90% of people, but for people with OCD, they worry obsessively about controlling their thoughts, to the point that it actually makes those thoughts more likely. And that worry or the compulsions they’re doing to avoid those thoughts may interfere with their life. So they avoid or they distract or they use compulsions or anything to prevent a thought from popping into their mind. 

Now, I’ve learned that there are two types of thoughts: the type that pops up randomly — and we really can’t control these, and it backfires to try — and then the type of thinking that we do as an action, as a behavior — and we can definitely influence this type of thinking. But struggling against the random pop-in thoughts or the intrusive thoughts definitely makes them worse. 

4. Overestimation of Threat

Number four is an overestimation of threat. This is believing that the most likely outcome of a situation is the worst possible outcome. It’s thinking, “This will end up in tragedy for sure.” 

Now, with OCD and anxiety disorders, things that seem threatening are extra loud. The anxiety makes them seem more likely. Someone with OCD may believe, “If I don’t buckle my seatbelt we’ll get in a crash and all of my family members will die” or “If I don’t check the stove 15 times the house will burn down.” 

5. Intolerance of Uncertainty

Number five is intolerance of uncertainty. It’s thinking, “I need to be 100% certain.” 

Now, while almost everyone dislikes that feeling of uncertainty, people with OCD struggle a lot more than the average person to tolerate any uncertainty. 

They may check for reassurance over and over. They might ask, “Did I hurt your feelings? Are you sure I didn’t hurt your feelings?” Or they may ask, “Do you actually love me?” over and over and over. Or they might ask, “Am I sure I locked the door?” and then they would check dozens of times. 

These attempts to avoid uncertainty can make things worse. 

6. Perfectionism

The sixth type of thinking that can make OCD worse is perfectionism. It’s believing “I can’t make a mistake. It would be horrible if I made a mistake.” 

So this is like a form of catastrophizing. “It would be awful if I messed up. It would be terrible if I did something wrong. I have to make sure that I never make a mistake on my assignment, so I’ll check it, and I’ll check it so many times that I don’t turn it in because I’m not 100% sure that every single thing is accurate.”

6 Things You Can Do

So these are the six thinking patterns that make OCD or anxiety worse. But it’s important to know that you can change how you think. Or, more specifically, you can change how you relate to your thoughts. You can change what you pay attention to. 

1. Notice and Acknowledge

So the first step is to notice these thoughts and just acknowledge that they’re thoughts, that they aren’t necessarily true or helpful; they’re just thoughts.

2. Replace Unhelpful Thoughts

Now, for some people it is helpful to replace these unhelpful thoughts with a more rational or helpful thought. So saying something like, “I’m not responsible for preventing natural disasters. I need to let it go” or saying, “Thoughts are just thoughts. They don’t mean anything about me. I’ll just shift my attention back to what I want to be doing instead.” 

Or with perfectionism you say something like, “I can’t be perfect. I’ll just focus on progress instead.” Or a phrase like, “Done is better than perfect,” etc. And this is kind of a more traditional CBT, and it works for some people. 

3. Work With a Therapist Trained in ERP

But for other people this type of CBT can lead to this constant internal struggle against thoughts. And the more you struggle with something the more attention you give it, and the more attention and energy you give it uh the more your brain dedicates to those thoughts. Basically, it makes those thoughts stronger for some people. 

So when possible, it’s best to work with a therapist who is trained in ERP, which is exposure response prevention, where you essentially learn to allow the thought to be there without acting on it, without buying it, without doing the compulsion. When you don’t engage in the compulsion, it retrains your brain to be less anxious and to not buy into those obsessions.

4. Recognize Your Thoughts and Shift Your Attention

Now, there’s another type of OCD where you don’t engage in external compulsions, and this is called pure O, where the worry, the rumination, is the compulsion. So people with pure O use mental compulsions to manage anxiety and obsessions. 

So for example, I once had a client who was an actor in school, and she worried about what position she’d get in the play. And she knew all the other actors in her troop really well, so she would compulsively assign all the different roles to different actors, and she would try out each situation in an attempt to gain some control and decrease uncertainty about auditions. 

Now, this became a disorder because she would sometimes spend hours each day compulsively rearranging these roles in her head, and this interfered with her ability to do her homework. 

Now, in this situation a therapist would help her stop compulsive worrying by recognizing these thinking patterns and shifting her attention back to what she needed to do, which is her homework. So I would recommend that you do ERP with a therapist.

5. Practice Cognitive Defusion

There are also two skills from acceptance and commitment therapy that can be really helpful. The first is called cognitive defusion, where you learn to notice thoughts without buying them, without believing them, without acting on them, without struggling against them.

6. Learn to Tolerate Uncomfortable Emotions

And ACT also helps people practice accepting uncertainty. And this is a skill you can learn, to tolerate uncomfortable emotions without needing to act on them or trying to force them to go away. This skill is called willingness, and I’ve got a bunch of videos teaching both of these skills on my channel. So if you Google therapy in a nutshell and cognitive distortions or willingness, you can learn more about them. 

Long story short: you really can learn to change your relationship with your thoughts so that they don’t feed your OCD anymore. 

I hope you found this video helpful. Thank you for watching, and take care.

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