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Obsessive Compulsive Disorder: Seven Effective Behavioral Strategies
Obsessive Compulsive Disorder: Seven Effective Behavioral Strategies

Section 3
Track #3 - Violent & Sexual Mental Images - CBT Tools for
'Cutting Down Thoughts'

CEU Question 3 | CEU Answer Booklet | Table of Contents | OCD
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On the last track, we discussed four steps in effective behavioral strategy number two:  Creating a Ritual Journal.  The journal included the following four steps:  defining compulsions and obsessions; a compulsions chart; an obsessive thought chart; and an exposure story.

On this track, we will discuss three types of obsessive thoughts and effective cognitive behavioral therapy strategy number three: Cutting Down Thoughts.  These three types of obsessive thoughts include:  mental disaster image; violent mental image; and solution thought. 

3 Types of Obsessive Thoughts

Share on Facebook #1 Mental Disaster Image
The first obsessive thought we will discuss is the mental disaster image. 

Karl, age 43, had problems with obsessive thoughts regarding disaster images. He had taken his family to Disneyland for a relaxing summer vacation, but once he arrive, Karl began to envision terrible disasters befalling the park. 

Karl stated, “Ever since 9/11, I can’t get the idea of terrorist attacks out of my mind.  When we went to Disneyland, all I could think about was how easy of a target we all were.  I saw a man put a paper bag into a trash can, and all I could see was the park being blown apart by a bomb from that trash can.  I saw it so vividly, all the dead bodies and the paramedics.  I even saw my family dead on the sidewalk.  So I made them stay at least a hundred feet away from me while I checked all the trash cans.  Once I decided they were ok, I’d let my family move on.  I ruined our whole vacation doing that, but the image of my dead family would not leave my mind until I had checked the trash cans.” 

Karl’s obsession stemmed from a fear generated by the September 11th attacks and as such his mind obsessed over the possibility of a terrorist attack. 

Think of your Karl.  Is his obsession with protecting his loved ones a result of an unwanted mental image?

I explained to Karl the concept of a mental disaster image.  I stated to Karl, “Disaster imaging is an image that depicts a great catastrophe befalling yourself or your family.  Sometimes, your  rituals will be triggered not by a situation, but by this ever present thought that tells you that you are responsible for what happens to others around you.  If you should fail in protecting your loved ones, you could never forgive yourself.  It is this guilt that haunts you.  Oxford psychologist Paul Salkovskis hypothesizes that many people with OCD develop their obsessive thoughts out of an ingrained sense of accountability for any disasters.  Therefore, I feel that to ultimately help you cope with these thoughts, it is important to attack the thoughts themselves.” 

How would you explain this concept to a client.  Do you think this would slightly alleviate their fears?

Share on Facebook #2 Violent or Sexual Mental Images
The second type of obsessive thought is the violent or sexual mental image.  Unlike the disaster image, a violent mental image consists of the client picturing him or herself committing acts of violence or sex. Most of the time, these images are extremely gratuitous or sadistic, thus the strong desire in the client to destroy them. 

Stephen, a 23 year old... client of mine, worried about the homosexually explicit images that would all of a sudden pop into his head. 

Stephen stated, “I have this voice in my mind that always asks stuff like, ‘Are you gay?’ or ‘Are you a pervert?’  Sometimes, I get these images of me having sex with another guy and I freak out.  I don’t find guys attractive at all, and I also don’t have any problems with gay guys.  But still I get these terrible thoughts.  One time, I had the thought that I wanted to have sex with my best friend.  I can’t look him in the eye anymore, because all I can see is that mental image.  I grab onto a phrase and repeat it to myself.  I’ll say something like, ‘No, I’m not, no, I’m not, no, I’m not!’ over and over again.” 

Often, clients who suffer from these types of mental images feel a distinct pang of shame and embarrassment, much more so than those who suffer from disaster images. 

Think of your Stephen.  Is he or she suffering from violent or sexual mental images?  How is this affecting his or her self-esteem?

Share on Facebook #3 Solution Thought
In addition to disaster and violent mental images, the third type of thought is the solution thought.  This is the unexplainable thought client which tells the client that by performing a certain ritual, he or she can avoid the disaster or get rid of the intruding mental image.  With Karl, it was checking all the trash cans in Disneyland. 

Another client of mine, Cynthia age 35, would imagine her mother dying from a heart attack. Cynthia stated, “I’d see her so clearly, just sitting there at the breakfast table or in her favorite arm chair reading a book and then all of a sudden she’d convulse and not move anymore.  Since I was young, some form of this image kept coming up.  When I was really young, they really scared me.  But as soon as I saw the image, another thought would come into my head, saying, ‘Tap your fingers on the table eight times.’  So I did.” 

I asked her, “Did the tapping help?”  She answered, “Well, the terrible thing never happened, and at first it did help to get rid of the bad thoughts.  But I’d have to do it more often every time.  I’d think, ‘I didn’t tap eight’ or ‘I didn’t tap hard enough’ and I’d just keep tapping until it went away.  Now I do it without even noticing, like a tick or something.” 

This occurrence is common among OCD clients who fear harm.  The ritual becomes so intense that it soon takes over the client’s life, but does nothing to dissuade them of their fear. 

Share on Facebook Cognitive Behavior Therapy Technique:  Cutting Down Thoughts
CBT Strategy number three is “Cutting Down Thoughts.”  In order to help Karl, Stephen, and Cynthia, I asked them to try “Cutting Down Thoughts.”  In this exercise, I asked each of them to negatively personify their thoughts as a bully, creep, or petulant child that needs to be reprimanded.  I asked them to write in their ritual journals sayings that they could use when the thoughts would spontaneously appear in their minds. 

The idea of this exercise is to cause the client to become more aware of the thoughts.  As in the case of Cynthia, some clients commit the rituals without knowing why or when they are doing it.  By acknowledging the thought and then cutting it down, the client can better monitor their own behavior. 

Stephen, who distinctly heard a taunting voice in his head, stated, “I like to use sarcasm, so in my journal I wrote phrases that me and my friends use when we’re trying to mock the other person.  The next time I heard the voice ask me, ‘Are you gay?’ I taunted back, ‘Your mom is gay.’  I said this out loud and I actually stopped and laughed at myself.  I still get the thoughts, and the images, but I’m also getting better at viewing them as something that’s annoying and not life threatening.” 

Think of your clients... who suffer from intruding mental images.  Could cutting these thoughts down be beneficial?

On this track, we discussed three types of obsessive thoughts and effective cognitive behavioral therapy strategy number three: Cutting Down Thoughts.  These three types of obsessive thoughts included:  mental disaster image; violent mental image; and solution thought. 

On the next track, we will discuss the Tridimensional personality theory developed by Dr. Cloninger which includes three different dimensions and effective behavioral strategy number four:  "Assertive Dialogue".  The three dimensions of the tridimensional personality included:  harm avoidance; novelty seeking; and reward dependence.

 Online Continuing Education QUESTION 3
What are three types of obsessive thoughts? To select and enter your answer go to CEU Answer Booklet.

 
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Obsessive Compulsive Disorder: Seven Effective Behavioral Strategies

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