Thought-Action Fusion and OCD

OCD is a complex illness with many causes, including biological, psychological and social factors. A psychological process that may help cause and maintain OCD symptoms is thought-action fusion. Let’s explore the relationship between thought-action fusion and OCD symptoms.

What Is Thought-Action Fusion?

Thought-action fusion is when you believe that simply thinking about an action is equivalent to actually carrying out that action. For example, if a thought randomly pops into your mind about something unacceptable—such as murdering your partner—you would believe this to just as bad as actually harming them.

Thought-action fusion can also lead people to believe that thinking about an unwanted event makes it more likely that the event will happen. For instance, you might think that by imagining a loved one dying in a car crash, it somehow increases the chances that this will actually happen.

Symptoms

The degree to which someone with OCD is prone to thought-action fusion predicts how severe their OCD symptoms will be. This has led many to suggest that thought-action fusion could be a cause of OCD symptoms. Interestingly, thought-action fusion and OCD symptoms and could be linked by another psychological process called thought suppression.

Although just about everyone experiences strange, bizarre or shocking thoughts throughout the day, if you have OCD, you may overreact to these “dangerous” thoughts by trying to suppress them, which only causes them to come back worse than before. Of course, this can lead to a vicious circle of more thought suppression followed by more distressing thoughts.

Thought-action fusion may promote thought suppression by making you feel that your thoughts are "dangerous." Indeed, if you believe that the thought of harming your partner popping into your head is equivalent to actually having harmed them, then understandably, this is a dangerous or threatening thought.

Treatment

Addressing thought-action fusion is a key component of many cognitive-behaviorally oriented psychological treatments for OCD. Although the imagined link between thoughts and actions is almost always illogical, if you have OCD it can sometimes be difficult to have insight into the irrationality of these thoughts. Therapy focuses, in part, on challenging the imagined link between thoughts and actions/outcomes through experiments or observation.

For example, if you are afraid that thinking about a bomb going off in your workplace makes it more likely that this will happen, you could intentionally think about this and then see if this feared outcome comes true or not. Although initially distressing, these types of experiments can help challenge beliefs about the link between thoughts and actions as well as make thought suppression less likely; indeed, if your thoughts are not actually dangerous, why push them away?

Behaviorally-oriented therapies such as acceptance and commitment therapy (ACT) also work to build flexibility in thinking rather than trying to eliminate distressing thoughts like obsessions using a variety of mindfulness techniques, metaphors, and life enhancement exercises. ACT teaches clients to be less invested in their thoughts, which helps to avoid the tendency to label thoughts as dangerous.