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OCD, Magical Thinking, and Thought / Action Fusion

OCD, Magical Thinking, and Thought / Action Fusion

Dr Burns,

Have you ever come across a form of anxiety where people think they have done something just because they had the thought of doing it? For example, I had a friend working in an analytical laboratory, and he was testing tablets which had to be tested in a certain order. He was worried about mixing up two of them and therefore believed he had done this. As a result, he had to get new tablets from the batch and repeat the test causing a great deal of anxiety.

What is the distortion here?



Thank you Shane,

The name of the distortion is Emotional Reasoning, as in “I am so incredibly anxious right now that the danger must be real!” In other words, you reason from your emotions, thinking they reflect reality. Anxious individuals nearly always assume that their anxiety means that the danger is real.

Depressed individuals also do this. They think, “I feel hopeless, so I must BE hopeless.” Or, “I feel like a loser, so I must really be worthless.”

Emotional Reasoning is misleading because our emotions result from our thoughts—and not from what is actually happening. And if your thoughts are distorted, your feelings will not reflect reality any better than the curved mirrors in amusement parks that make your image look weird.

Other distortions in this case include Fortune Telling—telling yourself something awful is about to happen when there is no evidence. All anxiety results from this distortion. For example, if you have a fear of flying, you are probably telling yourself that if you get on a plane, there’s a good chance it will run into turbulence and crash.

The problem you described in your friend is common in individuals struggling with Obsessive Compulsive disorder (OCD)—the obsession is the thought that something awful is about to happen, and the compulsion is the ritual or habit you engage in to try to undo the danger. A common example is people who drop a letter in the mail box, and then they check over and over to make sure the letter has actually dropped into the mail box.

This belief something awful might happen just because you are thinking about it is also called Thought / Action Fusion by some experts. In other words, you believe that just because you are thinking something, it will happen. This explains the resistance that many anxious individuals have to using Exposure, which is crucial to effect treatment. They think if they allow themselves to think of something awful, and become anxious, something awful will happen. This is, of course, superstitious nonsense, but humans, for some reason, have a strong urge to be superstitious and to believe in things that cannot possibly be true!

You can also think of this Magical Thinking—you believe that if you are thinking about some awful outcome, and feeling extremely worried, then the thing you fear might really happen. Magical Thinking is very common in all forms of anxiety. For example, you may tell yourself that if you worry enough about an upcoming test, you’ll work hard and get a good grade. You may also tell yourself that if you were cured of your performance anxiety, then your performance in school would deteriorate. That is another one of the biggest reasons that anxious individuals so often resist treatment. On the one hand, they are suffering, but at the same time, they are convinced that the anxiety is protecting them from something awful.

Hope this helps!



Anxiety and Magical Thinking

Hi web visitors,

The following is a note about anxiety that I just sent to my Tuesday training group at Stanford this week, and it occurred to me that you might find it of interest. You may need the definition of Outcome Resistance and Process Resistance to grasp the note. Outcome Resistance means that although the patient is suffering, he or she will resist effective treatment for a wide variety of reasons. In anxiety, the Outcome Resistance nearly always results from Magical Thinking. In other words, the patient has the superstitious belief that the anxiety, although uncomfortable, protects him or her from some terrible catastrophe.

Process Resistance means that the patient may (or may not) want a positive treatment outcome, but does not want to engage in the therapeutic process required to cause a successful outcome. For anxious patients, the focus of the Process Resistance almost always has to do with Exposure Techniques. Nearly all anxious patients will fairly forcefully resist using Exposure because it is so frightening to them. They simply do not want to have to face their fears. If the therapist gives in, and agrees not to use Exposure, the likelihood of full recovery is poor.

And about 75% of mental health professional do give in to the patient’s resistance, because the therapist also fears Exposure therapy, thinking it is, indeed, dangerous for this or that (erroneous) reason. I call this “Reverse Hypnosis.” In other words, the patient has hypnotized the therapist into believing that Exposure is dangerous as well!

If you’d like to read about my new insight on this topic of the effect of Magical Thinking on Outcome Resistance and Process Resistance for anxiety disorders, CLICK HERE.