Can you do me a favour?
I want you to think about your thoughts.
Not just any thoughts: The Thought Spiral.
We all have thought spirals. You know, where your thoughts feel like they’re on an automatic playback loop? If you suffer from OCD, your thought spirals likely plague your existence.
Those with OCD have very strong and triple-thick rubber resistance band kinds of thought spirals. In OCD, the part of their brain that “gear shifts” (called the caudate nucleus, if you’re curious), unhooking the rubber band to start to play something else–a kind of “thank you, brain for sharing”–isn’t working. The thought loop plays and plays, intrusively, sometimes horrifyingly.
Even if you don’t have OCD and you can gear shift, you still probably know the rubber band thought loop I’m describing. I think that OCD is likely a spectrum and we all fall somewhere on the spectrum of our brain’s ability to shut off the caudate nucleus and gear shift out of a thought spiral.
Mental states such as fatigue, low blood sugar, dehydration, depression, anxiety, brain inflammation, and so on, make it more difficult to gear shift, because the brain requires a lot of energy to shut off the caudate nucleus.
The difference in those who have OCD is that the gear shift gets stuck way more frequently and the gears get lodged more strongly than those on the far other end of the spectrum.
On the far end of the spectrum may be those who hardly think about anything and let everything go and are super chillax and take nothing personally and all that (possibly some very experienced mediators can get there too).
So, back to the original question. Can you locate your thought loop?
That rubber band that fixates on whether your friends hate you because they took longer than 15 minutes to answer in the group text?
That rubber band that convinces you that the strange mole on your left thigh looks two shades darker than yesterday and you read on Google that that could mean that it’s cancerous, and your doctor looked at it (and then the doctor whose second opinion you sought) and said it was fine but that doctor might be a quack, what medical school could they even have gone to anyways, and now you’re planning your funeral?
Can you identify your thought spirals when they occur?
Thought rubber bands have a flavour. They sometimes speak in their own voice, or a particular tone. Or the way the thoughts jump from concept to concept is different from your normal, balanced and sober thoughts.
The thought spirals might produce a certain feeling in your body that is familiar (and often unpleasant): perhaps a sinking feeling in your stomach, or a 60-lb labrador retriever sitting on your chest. There may be a couple rubber band flavours: a mean one, a frenzied one, one that sounds like your mother, and so on.
Can you locate yours?
Does it have a name?
Sometimes people call it “OCD”–this is probably why people with OCD (especially “Harm OCD”, or thought loops that involve harming others, more on those later), often feel such relief at receiving the label. The label might help us (and our loved ones) recognize that we have a rubber band in the first place. That just because we have thoughts doesn’t necessarily mean anything. And this begins the process of something called Externalization.
Sometimes “OCD” isn’t the best name.
Some people call their thought loop “Herbert”.
I once heard a hilarious story where an individual named hers “Yes, Ma’am!”
Externalization.
Externalization is the act of locating the phenoma we have identified with as something outside of ourselves.
Oh my, imagine if you actually were Herbet (or OCD, or “Yes, Ma’am”). What if you actually believed them? Imagine believing OCD when she tells you that your best friend Glenda from 5th grade saw that funny look on your face that you let slip for a second when she revealed to you that she’s getting a divorce and you now think she thinks that you’re judging her and now she thinks you’re a horrible person or her feelings are hurt and that’s not the type of person you are you should have looked more supportive or asked more questions.
Ugh, that would be horrible.
Now you can think of OCD (or whatever your thought loop is called) as a person, or an entity separate from yourself that occupies your head from time to time. You can see it as a separate thing that might be helpful sometimes. Maybe you have the same values as your OCD sometimes (like the values of being a good and supportive friend and not making weird involuntary faces at Glenda).
Maybe the OCD stepped in quickly once to remind you to check your watch and you did and you actually did need to leave because more time had passed than you thought.
But, you can also think of OCD as a person who you are not 100% overlapped with. Maybe you’re really not friends with OCD if she’s the kind of person who keeps talking about you harming your dog, even though you love your dog (this is reference to certain versions of OCD, called Unwanted Thought Syndrome, or Harm OCD, where people have disturbing, often violent thoughts that are completely unaligned with their true selves. People might think about harming their dog or engaging in violent acts even thought they love their dog more than anything and haven’t squashed so much as a mosquito in their lives).
If you externalize these rubber band thought spirals, you are able to start the process of disconnecting from them. Then, you can start work with them. You can start to realize that they don’t mean anything.
Externalization helps us realize that thoughts of harming your dog aren’t your thoughts. And, more importantly, they don’t actually mean anything about you, your friend Glenda, or reality.
And, if you’re reading this and identify with any of the examples, let me just be your gear shift here and remind you that you are not these thoughts!
I’ll say it a different way: the fact that you’re upset by certain thoughts and think you’re a bad person for thinking them is more proof that you are not these thoughts.
In fact, for a moment I want you to think of a way in which you can’t possibly be that thought. Let’s just stop here for a second. I want you to think of a time you did something really nice for your dog. Did you get her a treat? Ok, then you’re not the type of person who would harm her!
(In an interview, Dr. Steven Phillipson says that he wouldn’t hesitate to let one of his patients with intrusive thoughts about pedophilia babysit his kids. “I’d be far more worried about you than them,” he assures his patients, highlighting that intrusive and unwanted thoughts don’t mean the thinker will act on them–but cause immense distress for the person thinking them).
Externalization helps us share our thoughts. This is why I believe the “Stop the Stigma” campaign is so important. It’s super hard to gear shift on your own. It’s especially hard to do it when you’re under-slept, or undernourished, or having a bad day. We need other people to be the gear shift for us sometimes, while we’re learning to grease the gears ourselves.
I call this “Outsourcing the Prefrontal Cortex”, running something by a friend who knows you and can reassure you that whatever horrific thought or idea is looping in your brain isn’t true or important or indication that you’re a bad person or need to call the police and go back and check if you ran someone over or text the person again.
There are times when I can get caught in thought spiral and I remember yanking at the gear (so there was a part that was able to externalize and even determine that the gear needed to be shifted, which already takes lots of practice). Despite my efforts, though I just wasn’t able to nudge it.
So I talked to a friend. And sometimes even saying it out loud helped—saying it out loud was a way to confront the thoughts. And she and I laughed and she reassured me. And I felt silly but it was what I needed to hear. And the gear moved. And I relaxed. And my brain could move on.
Sometimes seeking reassurance can be a compulsion, however. The difference lies in whether you can tolerate the thoughts and externalize them as thoughts, and Outsource your Prefrontal Cortex in order to unstick your gear shift.
There are three brain areas involved in OCD: the Orbitofrontal Cortex, the Anterior Cingulate Cortex and the Caudate Nucleus.
We are smart social creatures and our brains are geared so that we can learn from our mistakes. The orbitofrontal cortex sounds off an alarm when it thinks we’ve done something wrong. It is our error detection system. It’s the shock you feel when you realize, “Hey did I run over a speed bump back there or…”
The anterior cingulate cortex keeps us feeling uneasy and unsettled until the mistake is corrected. And the caudate nucleus, our “gear shifter” responds to error correction and turns off once we’ve done something correctly so we can move on.
In OCD all three areas are hyperactive. The main neurotransmitter of this brain circuit is glutamate, our excitatory neurotransmitter. This is why NAC (n-acetyl cysteine) can be such a helpful supplement for OCD, tourettes, tics, skin picking and hair-pulling, binge eating, and thought spirals and compulsions, as it “mops” up glutamate in the brain and can calm down the entire circuit. It’s also thought that the orbitofrontal cortex might be low in serotonin, why many people with OCD are prescribed Zoloft or another SSRI medications and can see some benefit from them–5HTP can be a helpful supplement for supporting serotonin synthesis in the brain but shouldn’t be mixed with SSRIs.
The gold standard treatment for OCD is Exposure and Response Prevention Therapy, or ERP.
ERP works by first viewing the thought loops as sticky, addictive substances while addressing our fears surrounding them by exposing us to the thoughts. If you’re afraid of snakes, exposure therapy engages a step by step process of getting you in front of a snake until the fear centre of your brain, the amygdala no longer associates friendly, non-poisonous snakes with danger. ERP is similar–when we face the intrusive thoughts head-on they start to lose their power over us.
ERP involves sitting with the thought loops and refraining from engaging in any compulsions until the brain stops caring about them, and the alarm stops sounding. OCD doesn’t necessarily involve compulsions–often the compulsions can be mental, such as constantly telling a friend (over-outsourcing the prefrontal cortex, let’s say).
It involves heading into the intrusive thoughts, and thought spirals, perhaps listening to recordings of yourself saying them, and sitting with the feelings of discomfort until you are used to them. You know when someone’s car alarm goes off in a parking lot and no one even turns to look? That’s how ERP wants you to engage with your intrusive thoughts.
Mindfulness and externalization are helpful tools to aid the process of ERP.
Often it’s necessary to explore why certain subject matter of the thoughts is so “hot”–perhaps looking under the hood at traumas and implicit memories that you may have experienced that may have led to an over-active alarm system. However, it’s probably necessary to start by building the skills of exposure and response prevention so that you can stay stabilized throughout your trauma therapy, by dampening the alarm system that kicks off the thought spirals.
One thing not to do, if you have OCD, is to go to a therapist who does more psychodynamic therapy, or who examines the “deeper” meaning of the thoughts. Your brain is already trying to do that (“What kind of person has these kind of thoughts?”) and it’s not helpful. Addressing trauma maybe be incredibly helpful at some point in your treatment plan, but analyzing and picking apart the thoughts is probably more damaging than useful.
Seeing the thoughts as just thoughts that show up in the mind and don’t mean anything important is a better attitude to take towards them.
You might not have OCD (again, I believe that it’s a spectrum), but you definitely have thought loops. You do have rubber band thoughts. And you do have a gear shifter.
When I get stuck in thought loops I try to gear shift by saying, “I’m enough”.
It’s not much, but it sometimes settles things down. Whatever I’m worrying about and obsessing about doesn’t matter as much–because I’m enough, just as I am.
It’s simple, and it’s been working.
If you suffer from OCD or you are having a hard time managing your intrusive thoughts, finding a therapist who focuses in ERP, or working with an ND who can help you strengthen your “gear shift” can be incredibly helpful places to get started.
You are not your thoughts.
