Thought-action fusion is a concept that is closely related to OCD. It is the idea that having a bizarre thought is the same as carrying out the act itself. Individuals presenting with thought-action fusion may feel certain that their thoughts imply immoral character. With that, they may also believe that having that thought increases the likelihood of committing the action. Because doubt plays an integral role in OCD, the individual often does not trust that they can have a bizarre random thought without attaching excessive meaning to that thought. Let’s take a look at some examples.
An individual is standing in the subway station and has the thought “What if I jump in front of the subway car?” or “What if I push someone down there?” Without thought-action fusion, an individual will recognize the thought as a bizarre thought with minimal to no meaning about what that thought says about them. Within seconds, they are likely thinking about something else and going on with their day.
An individual suffering from thought-action fusion, sometimes called magical thinking, will obsess about the bizarre thought and attach excessive or rigid meaning to what that thought says about their character. The paradox is that this individual does not want to be thinking the thoughts they are now obsessing about. Yikes! This creates a moral dilemma that often results in anxiety, doubt, frustration, and confusion. As they continue to engage in obsessive thinking, the certainty that this thought means something about their character and the likelihood of an immoral action will ensue and this creates a vicious cycle. Thought-action fusion is often addressed first by educating the client and may involve the combination of cognitive restructuring and ritual prevention. Returning to the subway example, a fear of jumping in front of the subway car may lead to excessive googling, reassurance seeking surrounding topics of morality, avoidance behaviors (not taking the subway), or passive avoidance behaviors (standing at a 'safe' distance).
As you can see, having one single bizarre thought can become a slippery slope in the presence of thought-action fusion. Helping the individual normalize bizarre thoughts is an initial and often validating step. Most people have occasional bizarre thoughts but can let them go without attaching excessive meaning. Psychoeducation about the functions of the brain in the context of producing a thought, is most helpful when it is paired with strategic exposure to the unwanted stimuli. Oftentimes individuals will still obsess about bizarre thoughts even though they do not believe the thoughts mean anything about their character or that thinking about them will increase the likelihood of pursuing the obsession in some way. For this reason, exposure to the unwanted stimuli is recommended. Exposures should always be completed with the help of a trained professional. Exposure to unwanted stimuli without a clinician's help could exacerbate or even worsen symptoms.
If you or a loved one suffers from thought-action fusion and/or obsessive-compulsive disorder, click here to begin treatment with one of our trained professionals.
- Brittany Steiner, LPC
