Intrusive thoughts are unpleasant. They often strike at the most inconvenient time, taking you out of the present moment, and away from valuable, meaningful experiences. One of many techniques to help cope with intrusive thoughts involves the practice of cognitive defusion. This is a skill based on Acceptance and Commitment Therapy (ACT), in which you practice distancing yourself from your intrusive thoughts (and feelings), and therefore allow a greater sense of choice in how to respond. It is seeing your thoughts as a separate entity that you can observe, and choose whether to buy into the messages you see. The opposite, cognitive fusion, is when you fuse with your thoughts, as if your thoughts are commands, truths, and warnings that need to be followed. While there are many ways to practice cognitive defusion, below is one example of how to do so. *All names and other identifying information below are fictitious.
Katy, a 31 year old female, has Obsessive-Compulsive Disorder, centered around the fear of harming others. Katy worries about losing control and stabbing a family member, poisoning her husband's food, and running a pedestrian over with her car. This leads to numerous checking compulsions, including replaying events of her day, frequent requests for reassurance from family members, in addition to other time-consuming rituals that leave Katy feeling frustrated, angry, and exhausted.
Here is how Katy practices cognitive defusion when she notices herself becoming anxious while preparing dinner:
Katy: Hello Anxious Mind. Nice of you to show up.
The Mind: Did you not see that bottle of Clorox on the counter?!!! Why is it there?!
Katy: Oh, I hadn't noticed it. Thank you for pointing it out. I'm not sure why it's there, but I want to get back to preparing dinner. Come watch me.
The Mind: But what if you poured it in the soup without knowing? You're going to kill your husband! Go smell the soup. Does it smell funny? You know what, just throw it out and start over - just to be sure.
Katy: There, there. Look at you telling me a horror story. Very creative! I need to go grab some peppers from the fridge. I've been meaning to try this new recipe for months. It looks good!
The Mind: Peppers? You're going to chop peppers? With a knife? And risk stabbing your husband?
Katy: Listen, I'm in the middle of preparing a nice meal. You're welcome to keep telling me your story, but I apologize if I miss all the gory details. Preparing this meal is more important than listening to your frightening tale right now.
The Mind: Don't grab that knife. That's the sharpest one. Remember - you have a fear of knives! Your discomfort is going to be unbearable!
Katy: I hear you, and I notice my discomfort. I can tolerate it. This is a good opportunity to work on conquering my fear, and I can't wait for my husband to try my new soup!
The Mind: No! Go send your husband into another room. Are you crazy? What if you lose control and go after him? He's sitting right there on the couch - wayyy too close for comfort.
Katy: I want to talk with my husband while I prepare dinner - hear about his day, talk about our plans for the weekend. Excuse me for a second... "Hey Joe, how was that business lunch with Mark today?"
The Mind: What are you doing???? You have a knife in your hand!
Katy: "Hey, Joe, want to help me set the table. I left plates out on the counter...over here."
The Mind: YOU'VE GONE TOO FAR! He's going to stand next to you? While you're holding the sharpest knife in the kitchen?
Katy: Yes, yes he is. I'm glad you noticed. You're quite observant.
The Mind: You need to listen to me! You are going to be responsible for his murder! Think about the headlines tomorrow morning: Katy, 31, of New Jersey, stabs husband in chest at dinner. You don't want that do you?
Katy: Well, of course that would be an unpleasant news story, but for the time being, all I know is that I'm standing here, chopping a salad. The soup is smelling good, my husband is helping me set the table, and here you are trying to write the next greatest thriller, which is pretty good by the way.
The Mind: You're willing to take this risk? Don't you love your husband?
Katy: I do love him, very very much. That's why I'm choosing to make dinner and spend the night together. Maybe I am taking a risk. Look, I can see you're pretty persistent and want to stick around. Want to join us for soup and salad? I'll pour you a bowl.
The Mind: NO! I want to protect you! Do you really want to spend the rest of your life in jail?
Katy: Here, why don't you come sit next to us. I'll be talking with my husband, but feel free to keep chattering away in the background. Bon appetite!
As you can see, Katy was able to distance herself from her intrusive, uncomfortable thoughts, which allowed her to respond in ways that were helpful, and promoted a values-based evening (spending time with her husband and cooking a new meal). She did not argue or reason with her thoughts. Instead, Katy acknowledged them, even invited them in. She did not try to push them away. Fighting with her thoughts and fusing with them, probably would have resulted in a missed opportunity to converse with her husband, and perhaps another night of take-out instead of cooking a meal she has been wanting to try. What's important to keep in mind, is that Katy was not 100% comfortable that evening. While she might have enjoyed herself only 25% of the time, she reminded herself that enjoying a nice evening part of the time, is better than choosing to miss out on the experience completely.
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