Internalisation in OCD

We all have thousands of thoughts every day. Many never fully enter our awareness, flickering briefly before dying away again. Some thoughts do catch our attention, however, and we respond to them more or less constructively.

In this article, I describe what happens when we internalise a thought. First, however, I need to explain briefly what internalisation means. Internalisation is a process in which a thought suddenly receives a great deal of attention. You begin to ruminate on what the thought means and why it arose. You end up taking responsibility for the thought, and it begins to shape how you understand yourself. Using the story of Bjarne and the internalisation model, I will show some of the consequences internalisation can have.

Case: Bjarne

The internalisation model

I will now introduce the internalisation model, using Bjarne’s example to illustrate the process and the different ways internalisation can manifest. Internalisation is something we all do from time to time, but to varying degrees.

In the internalisation model, the process begins with a thought. The following sections explain how the thought can become linked to responsibility, control, focus and self-worth.

Thoughts

In everyday life, we have thousands of thoughts, most of which never really rise to the surface or capture our attention. We usually deal with the thoughts that do capture our attention without much difficulty. But when a thought contains something distressing, it can develop into a longer stream of thoughts and create discomfort. Such thoughts may involve harming others, memories of past experiences and much else. When a thought captures our attention, we may feel an urge to act in response to it. In Bjarne’s case, we see him beginning to withdraw from his child. This happens because of the thoughts and his fear that they might become reality.

Responsibility

As the example illustrates, a sense of responsibility can arise from having the thoughts, rather than simply seeing them for what they are: thoughts within a stream of thoughts. Bjarne internalises his thoughts, meaning that he sees them as part of himself. He takes responsibility for having had them because he interprets them as an expression of his wishes. A natural consequence of seeing thoughts as an expression of who you are is to begin monitoring your thoughts. Bjarne’s fear of harming the child could also lead him to scan rooms for objects that might be used to harm the child. Once this process has begun, the distress can start to spread into other parts of everyday life.

Control

A heightened sense of responsibility can also lead us to take precautions to avoid situations in which the thoughts arise, or to seek safety in response to the content of the thoughts. One example is Bjarne’s decision to stop cooking. Another response might be constantly monitoring your thoughts and neutralising a thought with a repeated phrase. Both responses are attempts to gain control over the thoughts. We either try to avoid what triggers the thoughts or neutralise the thought through an action. This avoidance can begin to feel rewarding because the distress or the thought itself disappears, thereby reinforcing the control behaviour. As control behaviour increases, so does the focus.

Focus

On the one hand, Bjarne becomes focused on getting rid of the thoughts, which can increase his focus on avoiding topics that may trigger them. At the same time, Bjarne’s growing frustration also contributes to making his general pattern of thinking more negative. As a result, he notices experiences that can confirm his frustration, including Elisabeth’s growing frustration.

The negative focus often makes it easier to notice the negative aspects of everyday life and harder to see the positive. You could say that Bjarne begins to see everyday life through a filter that highlights the negative and makes the positive harder to notice. He may now become aware of distressing thoughts in other situations. Because he has previously been rewarded for avoiding what feels distressing, he will automatically feel an urge to repeat similar behaviour to achieve the same reduction in distress.

Self-worth

When focus becomes negative, we begin to question ourselves and enter a negative spiral that can take many forms. For Bjarne, the focus may be on avoiding situations in which thoughts of harming his son arise, which can create a situation shaped by OCD. It may instead centre on his frustration and his sense of not meeting his own or others’ expectations, which can lead to more depressive thoughts. In both cases, self-worth declines, which in turn leads us to question ourselves and can generate further negative thoughts.

At the same time, control behaviour can restrict the possibilities available in everyday life, leaving only a narrow space in which to act. Activities that once brought joy can now feel distressing and therefore bring less enjoyment. This can make negative thoughts more frequent.

How the interaction creates internalisation

The frequency of negative thoughts increases as our sense of responsibility, need for control and focus increase and our self-worth declines. The problem begins with a thought, but the thought itself is not the problem. The problem lies in how we respond to it.

By interrupting the process of internalising thoughts – by seeing them as thoughts that arise on their own and outside our control – we can begin to let go of some of the focus and responsibility that come with them. We should not deny that thoughts arise, because doing so is still an attempt to control them. Instead, we can allow the thoughts to pass and learn to leave the distressing thoughts alone, because they are not an expression of who we are. The point is that the thought itself is not the problem. The problem lies in how we respond to it.