Do you live in dread of distressing, unwanted and unrelenting thoughts which you believe say something shameful or terrible about you, and which you fear may lead you to perform what you consider a very inappropriate act? If so, you are not alone and may be suffering from a common form of Obsessive Compulsive Disorder (OCD)…taboo intrusive thoughts.
Obsessive Compulsive Disorder (OCD) is a common mental health issue which is characterised by repetitive, unwanted, and intrusive thoughts (obsessions) and subsequent attempts to ignore, suppress, or neutralise the thoughts (compulsions). Intrusive thoughts which manifest with OCD can occur in different ways. The most well-known are obsessions around contamination (and the accompanying compulsion of persistent handwashing) and obsessions around symmetry and order. However, another form of OCD which is not as well known, but quite prevalent, are taboo intrusive thoughts.
Taboo intrusive thoughts are usually aggressive/violent, religious, or sexual in nature. They are unwanted and strongly conflict with one’s values and self-concept. For example. one may have a persistent fear that they are going to perform an illegal sexual act. They arouse high levels of anxiety, fear, distress, and self-doubt. Taboo intrusive thoughts are not usually accompanied by any obvious compulsions…the associated compulsions are usually hidden and performed mentally. For example, someone with sexual intrusive thoughts may compulsively check their body for signs of sexual arousal as a from a reassurance. There is often an attempt to avoid any place or situation where the thoughts are more likely to occur. While such strategies may reduce anxiety temporarily, they are ultimately counterproductive in reducing the intensity and frequency of the thoughts.
There is often a long delay between the onset of the thoughts and seeking help. Because of their highly stigmatized content, one can feel the need to conceal their experiences of the thoughts. Individuals with taboo intrusive thoughts, and also the general public and mental health professionals, are often not aware that these thoughts are classified as OCD. Recognition of this is important so that individuals with taboo intrusive thoughts can receive appropriate therapeutic interventions.
The following interventions have shown to be effective with OCD:
· Psychoeducation: knowing accurate information about unwanted intrusive thoughts can help make them feel less threatening. Taboo intrusive thoughts are common in the general population, and most people have experienced them at some time or another. The difference is in the level of distress they cause.
· Cognitive Therapy: focusses on how one appraises their intrusive thoughts, on the unhelpful beliefs which lead to maladaptive interpretations of the thoughts and their meaning. For example, the belief that the mere presence of a thought means that it is important, and that one should be able to always control their thoughts. Those with taboo intrusive thoughts tend to greatly overestimate the level threat. Perfectionism and an excessive need for certainty are also often present.
· Exposure and Response Prevention Therapy: aims to prevent maladaptive responses to the thoughts. The individual is gradually exposed to situations which provoke their intrusive thoughts and tries as best they can not to engage in maladaptive coping strategies and behaviours, such as reassurance seeking and avoidance. The aim is to gradually reduce the fear and distress associated with the thoughts. Overtime the individual recognises that the thoughts are not as threatening as they had perceived, and can develop more empowering responses to them.
· Mindfulness: involves focussing one’s awareness on the present moment. This attentional focus can enable one to avoid become completely immersed in their thoughts and increases capacity to interrupt the ruminative cycles associated with intrusive thoughts. The goal is to develop an attitude of acceptance, non-judgement and non-reactivity towards thoughts, feelings, and bodily sensations.
· Breathing practices: Being mindful of one’s breathing is an effective of mindfulness practice. In addition, specific breathing strategies can enable one to regulate the overwhelming fear and distress that accompany taboo intrusive thoughts. For example, exhale focussed breathing, where one increases the duration of their exhale, can help regulate the anxiety and distress associated with intrusive thoughts and help develop the capacity to accept and react less to them.