I've noticed a phenomenon that is often present in those suffering from anxiety and OCD that I haven’t heard much about until I came across Inference-Based Cognitive Behavioral Therapy and inferential confusion (I hope to do a blog post on this in the future). To help demonstrate this phenomenon, let me start off by giving an example involving a client with harm and sexual-themed obsessive-compulsive symptoms.
Jerry fears randomly “snapping” and stabbing his mom with a kitchen knife. The reasons his mind gives him for why he might do this are: maybe I’m a psychopath-to-be; people have told me I act impulsively; after all, anything is possible; maybe I unconsciously hate my mom and want to cause her harm; I must be having these thoughts for a reason; I might lose control and do something without thinking first - like when I passed the basketball to the opposing team during last night's game." These violent thoughts about his mom produce a lot of anxiety. He also feels guilty for even having the thoughts in the first place. Any kind of sharp object or places where there are likely to be sharp objects are triggers for him. Fortunately, Jerry has been through appropriate OCD treatment and has good insight into his symptoms. He is able to recognize his anxiety and guilt as most likely being caused by OCD and is then able to prevent any compulsive responses such as: avoidance, confession, checking, etc. Instead, he is able to embrace uncertainty and uncomfortable feelings, and carry on with things that are important in his life.
Later on, Jerry’s mom does something that really upsets him - perhaps she forgot to pick him up after basketball practice (NOTE: It doesn’t necessarily matter what it was that upset Jerry). Jerry is now experiencing a "true" anger toward his mom and has reasonable justification for why he is angry toward her. Suddenly, all of Jerry’s fears come rushing in. He gets intrusive visuals of him physically torturing his mom. His mind tells him “Maybe I really do want to kill my mom - after all, look how upset I am with her. I feel like I want to scream at her. I'm so mad at what she did that I want to just punch her. Or better yet...STAB HER and KILL HER SLOWLY.” His mind may naturally start looking for past instances where his mom upset him, using these instances to fuel even more anger. Jerry is really struggling with these thoughts and emotions this time around and the guilt and anxiety are much more intense than usual. He instantly goes into his old patterns of safety behavior such as avoidance and reassurance-seeking.
Because Jerry was experiencing the emotion of anger that was brought about outside of his typical OCD context (ie by an event that isn’t typically triggering his OCD) his mind begins using the emotion of anger as justification for why he should attend to his anxious and guilt-inducing harm thoughts. It’s as if Jerry’s angry emotions and thoughts, triggered by something his mom did that upset him, became blended with the thoughts and feelings he experiences when his OCD is typically triggered.
Here is another example involving Jerry: Jerry fears being sexually attracted to children. He gets disturbing sexual thoughts and mental images anytime he sees anything that reminds him of a kid. Just the mere thought or image of a child will send Jerry into an anxious and guilt-ridden state. Fortunately, Jerry has received excellent OCD treatment and went through plenty of exposure to treat this manifestation of his OCD. He no longer avoids children, and when he does get sexual thoughts about kids, he finds them irrelevant and is able to move through the day unphased.
Fast forward to a random Friday night when Jerry gets home from a stressful week at work. He opens up his laptop and browses to a pornographic website and begins masturbating. (He does this a few times a month to relax). However, as he's masturbating he starts having thoughts of kids. He panics, closes his laptop, and starts avoiding kids altogether again.
What happened? Jerry's mind blended two different contexts. One of genuine arousal from pornography, and the other of thoughts of kids. This led Jerry to infer that he really might be attracted to kids because both genuine arousal and sexual thoughts of kids were existing simultaneously. Two different contexts becoming blended into one.
Jerry's incorrect reasoning may go something like this “I am truly aroused but I’m having these thoughts that bother me at the same time. Maybe these thoughts actually don’t bother me and I truly enjoy them since my body is displaying clear signs of arousal. Do I stop, or keep going? I’m not sure. I’m confused. If I stop I might be giving in to OCD, but if I keep going I might be agreeing with the uncomfortable thoughts.” This example is a bit more layered than the first in the fact that just a sexual thought itself, regardless of its object(s) of focus, can trigger a sexual arousal response. This is often referred to as a groinal response. The explanation is more complex than this and has to do with how our mind can create arbitrary relationships between pieces of information. (Maybe more on this in another blog post).
This post is really meant to be informational versus instructional. If someone has an experience like Jerry and isn’t aware of this phenomenon, she may have a more difficult time than she could be having. In other words, simply knowing this phenomenon exists may be helpful. Similar to how knowing OCD exists can be helpful. Or how knowing black-and-white thinking exists. We need to be knowledgable and aware of these experiences in order to call them out. One thing that can be incorporated into such bothersome experiences is mindfulness. Acknowledging what thoughts, feelings, and sensations we're having in an open, compassionate, non-judgemental way, can be useful.
Blending is:
A type of thinking error (cognitive distortion) where feelings and thoughts from one event or context get misattributed to another and allow the process of reasoning to “make sense (albeit in an unhelpful way) to the sufferer, often leading the suffer to perform compulsions or engage in avoidance.