Fran Miller, Ph.D. ©
In my clinical practice ten or fifteen years ago, I noticed that many of my clients were experiencing moderate underlying depression. Now it appears to be entirely different. Although mild or moderate depression may be a factor, almost all clients coming into therapy are experiencing anxiety. And a large percentage of those are also experiencing moderate or severe difficulty with obsessive thinking tendencies. Obsessive thinking is generally a problem when negative or fearful thoughts are repeatedly part of your thinking or when they are intruding on your thoughts while you are trying to attend to something else.
I think that the number of stresses and concerns that are prevalent today are obviously a contributing factor. Starting with the broader background concerns, we are living in a time of international strife and turmoil. And nationally the political atmosphere is more extreme and antagonistic creating more divisiveness and conflict. Although the economy is considered to be positive right now, it is still very difficult and challenging for young people, and also for many that are older, to obtain an education, find a professional niche, and be able to meet the economic challenges of today. What used to be considered “the American dream” isn’t possible for many, maybe a majority, in our society today. I believe these background concerns are causing an overload of stress that affects our thought patterns. Add in familial, relational, and personal concerns, and the result is anxiety.
There are many recommendations for obsessive thinking tendencies that come from the field of psychology. One interesting theory that comes out of psychoanalytic theory is that there are unresolved issues that are suppressed and out of awareness. This classic theory is that the most significant suppressed issue is the fear of mortality and impermanence. The obsessive thinking tendencies function to keep this suppressed material out of awareness. These and other possible fears and concerns can be explored in the psychotherapy process.
Rather than pursuing the suppressed material, frequently cognitive therapy techniques are recommended for obsessive thinking, and learning to refocus is a key element in these techniques. Let’s use meditation training as an example. The instruction for the concentration method of meditation is to focus on the count of one’s breath, a word, or an image while sitting silently and still in a meditation posture. Each of those factors is important. To sit still is to eliminate thoughts about movement and stress in the body. To sit in silence eliminates extraneous external input for a period of time and allows focus. When sitting in silence and stillness you can begin to learn to focus your attention on just your breath. Just one word. Or on just one image. This practice and learning is very helpful for obsessive thinking problems because it helps you to learn to limit your thinking, to concentrate, and even to experience peace.
Here is a general overview and summary of some of the main cognitive techniques. In therapy we go over these in more detail and apply them to your personal circumstances.
Cognitive Restructuring: Negative thinking is a significant destructive symptom. If you observe your thinking patterns, you may notice a predominance of negative sentences that you are saying to yourself. “You’re so stupid.” “That was a dumb thing to do.” “I blew that interview.” “I’ll never amount to anything.” This kind of exaggerated negative criticism wears down self esteem, confidence, and motivation and causes anxiety and depression. The psychological technique that is recommended for negative thinking is cognitive restructuring. Cognitive restructuring is a simple technique that has extensive and long term benefits. It’s very easy to practice, but it does take time and a very intentional effort. When you notice you are thinking a negative sentence, take a moment and write it down. Take a few minutes to do this throughout the day. Later, when you have time, take a few of the negative sentences, and write out accurate alternative sentences. For example: “I’m so stupid,” would be more accurate as, “I could have responded in a better way, but I know I am generally intelligent,” or “I’ll never amount to anything,” could be rephrased, “Sometimes I have a setback or make slow progress, but I know I’m making my way towards my goals slow but sure.” These accurate corrections of thinking patterns make a huge difference in self esteem, energy level, and motivation.
Thought Stopping: Mathew McKay, Ph.D., Martha Davis, Ph.D., and Patrick Fanning address thought stopping in the workbook, Thoughts and Feelings. They state that research has shown that thought stopping is 20% effective with compulsive ritual behaviors, but it is 70% effective with simple phobias. It can be used effectively when thoughts or images are repeatedly experienced or lead to unpleasant emotional states. To work with unwanted thoughts, McKey, Davis, and Fanning recommend listing the unwanted thoughts, listing pleasant thoughts, then while thinking of the unwanted thoughts, interrupt and switch to the pleasant thoughts, and then to repeat the process many times. They also recommend following unwanted thoughts with a specific breathing technique. I describe some breathing techniques below.
Changing Hot Thoughts: McKay, Davis, and Fanning also discuss working with hot thoughts. Hot thoughts are thoughts that have a particular emotional strength — a thought that impacts your mood either because of its power or frequency. They recommend listing a hot thought, along with your feelings and automatic thought responses. Then list the evidence that supports your hot thought. After reflection, list the evidence against the hot thought. After this process you can evaluate the situation based on the objective facts, and your feeling response will change accordingly.
Relabel, Reattribute, Refocus, and Revalue: In the book, Brain Lock, by Jeffrey Schwarz, M.D., he recommends four words that begin with “re” for combatting obsessive thinking: relabel, reattribute, refocus, and revalue. He encourages that you relabel unwanted thoughts, urges, and behaviors. He says to call them what they are: obsessions and compulsions. He recommends making a conscious effort to keep firmly grounded in reality, and striving to avoid being tricked into thinking that the feeling that you need to check, or count, or wash, for example, is a real need. He emphasizes that it is not a real need.
His second recommendation is to reattribute the causes of obsessive thinking. It has both organic and learned causes, and when you get stuck in one thought or fear, you may believe it is not possible to shift thoughts or behaviors. To reattribute is to be aware that you can, in fact, learn to change the thinking patterns by effort and practice.
To refocus, Schwarz recommends practicing doing a different behavior or refocusing your thinking in a particular way. He states that the more you practice refocusing, the easier it becomes. I will make some particular recommendations for refocusing below.
By revaluing, Schwarz says that when you come to understand that your obsessive thoughts are just distractions to be ignored, you will be able to devalue the pathological urges and fend them off until they begin to fade. He explains that as your thinking becomes clearer, it will become easier to see the obsessions for what they are. He states, “Your brain will function in a much more normal automatic way. As a result, the intensity of your symptoms will decrease.”
Cognitive Distortions: Other cognitive difficulties are cognitive distortions. In the workbook, Thoughts and Feelings, described above, McKay, Davis, and Fanning describe eight distortions:
Filtering – you are focusing on negative details
Polarized thinking -you are perceiving things are black or white, good or bad.
Overgeneralization – you reach a conclusion based on a limited amount of evidence.
Mind-reading – you think you know what people are thinking
Catastrophizing – you think of the most catastrophic possibility
Magnifying – you exaggerate the degree or intensity of a problem
Personalization – you assume others responses are reactions to you
Shoulds – you have a list of rules for you and others to follow.
The goal in working with cognitive distortions is to be aware of a distortion in your thinking, and, as with cognitive restructuring, to reformulate your thoughts into a more accurate and reasonable representation of the circumstances. With study, exercises, and practice you can come to recognize and reformulate cognitive distortions. By describing situations realistically you can more readily determine your alternatives and responses.
Recitation and memorization: Expanding on the recommendation to refocus, I like to recommend recitation or memorization of language, math, science, philosophy or literature. For example a math major in college can memorize and recite math theorems, in physics one can memorize the laws of nature. This is a way to refocus your mind in a constructive and productive way. Many of my clients like to memorize and recite a favorite literary or spiritual quotation. For example, you could memorize the quote of Zen teacher, Shunryu Suzuki, from the book, Crooked Cucumber: “A person of joyful mind is contented with his lot, and even in adversity he will see bright light.” I memorized the Ten Verse Kanon Sutra in Japanese while walking my dog in the Hoyt Arboretum:
Yo Butsu u in.
Yo Butsu u en.
Bu po so en
Jo raku ga jo
Cho nen Kanzeon!
Bo n’en Kanzeon!
Nen nen ju shin ki
Nen nen fu ri shin…….
I often use the Ten Verse Kanon Sutra if I am thinking negative or discouraging thoughts —not because of any magical qualities of the words, but because of the positive thoughts and associations to them. I have memorized numerous quotes from my Zen teacher, a renowned Zen master, Robert Aitken, Roshi. Reciting such a quotation can be helpful in refocusing my attention or for a centering and relaxing reflection.
Visualization: Another method that is very helpful in interrupting obsessive thinking patterns is visualization. You can implement a more formal visualization by taking time to lay down in a quiet place, get into a relaxed position, and slowing your breathing. With your eyes closed, you can visualize a favorite vacation spot – imagine driving or walking to that location. Then imagine taking a place sitting or lying down. Imagine the vista – a calm lake or waves across the ocean horizon and the trees or sandy cliffs that are nearby. Imagine you hear the sound of the wind in the trees or the waves crashing on the ocean shore. There might be birds chirping, singing, or flying nearby. Imagine the deep fragrance that fills the air. Relax in that place for some moments, focusing on your slow and deep breath.
Frequently you can do a mini version of a visualization by taking just a moment to remember a beautiful spot and become aware of your breath. Previously I had seen a client from New York who used to frequently escape to Central Park so it became a very familiar place to him. Once he moved to Oregon, and with the help of cognitive psychological techniques, he found that if he refocused on the details of Central Park—the path cutting through the park, the trees and flowers along the way, the lake and gazebo with geese and birds— that he could relax, feel calmer, and quiet his mind. Here in Oregon if you refocus on a hike along the Gorge, canoeing on the Deschutes, running at the coast, smelling the fragrance of pine or hearing the birds along a walk, you can experience the same benefits. My grandson is an experienced sailor. He can refocus his mind on the challenges of sailing on the Columbia, remembering the feel of the wind on his face, the sound of the waves, the speed of the boat, and free his mind of negative or intrusive thoughts.
Obviously you can’t go around imagining calming scenes all the time. But on occasion, when thoughts are becoming negative and repetitive, you can take time to sit still in a relaxed position, enjoy some moments of silence, and feel the calming effects of a visualization.
Concentration meditation: I find it interesting that the field of psychology and also the teachings of Buddhist philosophy both address cognition and the ability to refocus and concentrate the mind. In Buddhist training, the instruction for the method of concentration meditation is to focus on the counting of the breath or on just the breath. The formal instruction is to count one on the inhale, one on the exhale, then two on the inhale and two on the exhale, and so on to ten, then go back to one. If your mind begins to think of other things, then you return to one. You focus on just the count of one, just the count of two. Or you focus on your breath, just your inhale, just your exhale. Other forms of concentration are to focus on one word or on one image – to forget yourself, Robert Aitken teaches, in the act of uniting with something. In a book about the renowned Japanese Zen Master, Hakuin, Albert Low quotes Hakuin recommending to meditate “without clinging to nor rejecting the object of the senses.”
I find that with a strong intention and persistent effort, you can gain control of your thinking and learn to become positive, accurate, and encouraging rather than to be consistently critical and fearful or to get stuck in repetition. Thus you can develop your capacity to “train your brain,” and rather than think negative, critical, fearful or repetitive thoughts, rather than cognitive distortions, you will develop your skill and capacity to have a relaxed and focused mind.
With obsessive thinking tendencies, whether you look at it psychologically or spiritually, the solution has to do with learning to refocus – and sometimes – to focus your attention on a calm mountain lake, on the colors of the sky at sunset, or a bird greeting you on a forest walk. Robert Aitken writes in the Original Dwelling Place:
As I step outdoors, suddenly a thrush bursts into song in the little milo tree
by our front porch. House, garden, memories, and plans completely disappear,
and in the incredible silence, she evokes from my heart her lovely voice again
and again. This is the “entry into the inconceivable” of song within song,
of life within life.