Understanding Thought-Action Fusion and OCD

You’ve probably heard the old saying that goes something like, “thinking about something isn’t the same as doing it.” And that’s true. However, for some people separating thought from action isn’t so easy. It’s a phenomenon known as Thought-Action Fusion (TAF) and it plays a significant role in disorders like anxiety, depression, eating disorders, and obsessive compulsive disorder (OCD). Understanding this pattern of thinking is key to learning to manage your OCD.

What Is Thought-Action Fusion?

OCD is more than just washing your hands too much or counting the sidewalk cracks. It’s a disorder that is characterized by persistent, unwanted, and intrusive thoughts known as obsessions. These thoughts are often indicative of cognitive distortions or irrational patterns of thinking that create distress. 

Thought-Action Fusion (TAF) is a way of thinking in which the person believes that just thinking about something will have an effect on the person, those around them, or their world. In other words, just having the thought makes it more likely to happen. There’s not a distinction between thinking and doing. It’s a common theme in people with certain types of OCD obsessions. 

While the exact process remains unclear, research suggests that TAF may serve as kind of a bridge between the obsessive thoughts and the performance of compulsive actions. The purpose of the compulsion is to alleviate the distress caused by the thought. So, whether the thought could actually cause something to happen or occur becomes irrelevant. Just the idea of it is enough to create distress and the compulsion’s goal is to quash that distress. 

Types of Thought-Action Fusion

There are two types of TAF, each with a specific focus:

Moral TAF is based on the idea that one’s intrusive thoughts are somehow immoral or “bad”, reflecting poorly on the person having them. For example, a person with harm OCD having thoughts about hurting someone may feel guilty or ashamed as if they’d done it despite the fact they have never and would never harm another person and have no desire to do so. 

Likelihood TAF is based on the idea that having the unwanted thoughts will cause that thought to actually occur. For example, a person with contamination OCD might think: “If I shake hands with someone, I’m going to get sick from the germs on their hands.” Likelihood TAF isn’t unlike the notion of magical thinking, a similar cognitive distortion. Magical thinking is the idea that two unrelated things or events are somehow connected and can influence each other. For example, a person may believe that wearing their “lucky shirt” will mean a win for their team. Magical thinking isn’t always negative and in early childhood can even be part of the developmental process. Santa and his naughty list is a good example. Kids believe that Santa is always watching and brings gifts to kids who have been good all year. Magical thinking? Perhaps. Detrimental? Hardly. 

TAF and OCD – It’s Complicated

Despite TAF being central to prominent theories about OCD, there is more to the story. Research has found that the presence of TAF alone is not sufficient to account for OCD symptoms, meaning that a person can suffer from TAF but doesn’t necessarily have to have OCD. For example, some studies have found that after controlling for depression (a commonly co-occurring disorder), TAF was no longer significantly correlated with OCD symptoms. That doesn’t mean TAF is not a part of OCD but it may play a role in another related thought process – thought suppression. 

Thought suppression is a cognitive avoidance strategy that is characterized by the conscious effort to try and stop certain thoughts. It is especially common with the intrusive thoughts associated with OCD. While it may sound like a good idea, often these attempts to suppress can backfire, intensifying the intrusive thoughts. It’s a paradoxical phenomenon sometimes referred to as “ironic rebound” or the “white bear problem” based on research by psychologist Daniel Wegner.  

When a TAF-related belief is triggered, one might attempt to suppress those unwanted thoughts. Studies have found that when TAF-related beliefs are evoked, thought suppression seems to act as a mediator between the TAF beliefs and obsessive compulsive actions. At least in the short term, thought suppression may ease the distress of unwanted thoughts. However, thought suppression has been correlated with more frequent intrusions, higher levels of anxiety, and negative appraisals. Not surprisingly, acceptance-based approaches may be helpful in addressing TAF. 

Another way to look at this is the fact that thoughts are simply that. They are not intentions and don’t automatically result in actions. Just because you think something doesn’t mean you will do it or even want to do it. If that were the case, we would never fail at anything - a diet, a new routine, writing that novel you’ve had in mind for years.  

TAF may lend the sense that something IS true and WILL happen. However, intention matters. Here’s an example:

You’re having thoughts of violently hurting someone close to you. You think, “I am a violent psychopath because I have intrusive thoughts of harming others.” 

Here’s the tell: If you were truly a violent psychopath, would you be distressed by those thoughts? Probably not. 

Our thought patterns and responses play a key role in managing OCD and the relationship is complex and not completely understood. The good news is, if you have TAF and OCD, there are approaches that can successfully address those issues. 

Recognizing TAF

TAF can result in increasingly disturbing and upsetting thoughts leaving you with a never-ending sense of impending disaster or danger. Some signs of TAF can include:

• Being unable to stop intrusive distressing thoughts
• Believing that you’re a bad or immoral person for having the unwanted thoughts
• Feeling hopeless and helpless for not being able to prevent bad things from happening
• Judging yourself harshly, even when you have not acted upon your thoughts
• Believing that your thoughts can cause real-life events to happen
• Performing compulsions to prevent the unwanted fears/thoughts from happening

Treatment for TAF

If you suspect that you may be experiencing TAF, there is help.

To assess and diagnose TAF, a mental health provider may use an assessment tool known as the Thought-Action Fusion (TAF) Scale. This 12-item scale assesses both  moral thought-action fusion and likelihood thought-action fusion. 

Therapy

If you have OCD and TAF, addressing the TAF is a key part of your OCD treatment. The connection between the thoughts and the actions is almost always illogical so you may have difficulty gaining insight into these irrational thought patterns. 

Treatment for TAF and OCD is a multimodal approach meaning you may have several types of therapy and interventions in your treatment plan. Each is intended to address specific aspects of your needs. 

To address the thought patterns associated with TAF, cognitive restructuring is a CBT technique that helps you to learn to recognize and challenge irrational or unhelpful thoughts. It’s kind of like standing up to a bully. You learn how to say NO to the irrational thought. For example: “I might accidentally hit someone with my car.” A more logical and rational thought, based on fact, might be, “I’ve had this thought many times. I’ve driven many times. I have never hit someone with my car.”  

Acceptance and Commitment Therapy (ACT) is a type of cognitive behavioral therapy that has been found to be effective in addressing TAF in OCD. The goal of ACT is to increase flexibility in thinking and learning to accept rather than eliminate or “fight” distressing thoughts, feelings, or sensations using values-based strategies. ACT strategies might include: cognitive diffusion (learning to separate your thoughts from the inner meaning you attach to them), self-compassion exercises, mindfulness practices, or experiential exercises and the use of metaphors. 

Exposure and Response Prevention (ERP), a specialized form of CBT, is the gold-standard of care for OCD. Part of ERP is learning how to manage your obsessive thoughts without turning to compulsions. ERP involves gradually exposing the person to their obsessive fears without allowing them to engage in compulsions. Over time, this helps reduce the anxiety associated with obsessions. 

Self-Help

In addition to professional help, there are thing you can do to help manage your thinking:

Manage your stress – Stress can exacerbate OCD and anxiety symptoms. Relaxation is good for our mental health, and it can take many forms. Find what is relaxing and nurturing for you. Here are a few things to try: 

• Engage in gentle physical activity like walking or other exercise you enjoy
• Spending time in nature
• Listen to music

Increase your awareness – Awareness is the first step in overcoming any challenge. Work on becoming more aware of your thought patterns and acknowledge that they are not always true or accurate. 

Keep a journal – Keeping a log or journal can give you a place to track and explore your thoughts. Over time, you will gain insight into patterns and notice when and how they occur. This knowledge can allow you to be ready for them and to remind yourself of what is true rather than what your mind is telling you. 

Practice Mindfulness - Mindfulness practices, such as meditation, can be highly beneficial for people with TAF and OCD. Mindfulness encourages you to observe your thoughts without judgment, cultivating a sense of curiosity and detachment. By practicing mindfulness, you can learn to view your thoughts objectively as transient and unrelated to actions or moral worth. 

TAF is a common and challenging aspect of OCD.  With the right strategies, you can learn ways to manage your thinking and build the peaceful life you desire. It’s a challenge you don’t have to face alone and reaching out for help is the first step.

References

1. Türkarslan, K. K. (2020, October 23). Thought-Action Fusion and Psychopathologies: A Review of Literature. https://doi.org/10.31234/osf.io/wy8hn

2.  https://dictionary.apa.org/thought-action-fusion

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4. https://dictionary.apa.org/magical-thinking

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7. Marcks, B. A., & Woods, D. W. (2007). Role of thought-related beliefs and coping strategies in the escalation of intrusive thoughts: an analog to obsessive-compulsive disorder. Behaviour research and therapy, 45(11), 2640–2651. https://pubmed.ncbi.nlm.nih.gov/17673167/

8. Meyer, J. F., & Brown, T. A. (2013). Psychometric evaluation of the thought-action fusion scale in a large clinical sample. Assessment, 20(6), 764–775. https://pmc.ncbi.nlm.nih.gov/articles/PMC4418236/

9. Akhouri, D., Hamza, Kumar, S., & Reyazuddin, M. (2023). Acceptance and commitment therapy as an add-on treatment for the management of patients with obsessive-compulsive disorder. Industrial psychiatry journal, 32(Suppl 1), S179–S185. https://pmc.ncbi.nlm.nih.gov/articles/PMC10871435/

10. https://dictionary.apa.org/cognitive-restructuring

11. Self-care for OCD. (2023, October). Mind.org.uk. https://www.mind.org.uk/information-support/types-of-mental-health-problems/obsessive-compulsive-disorder-ocd/self-care-for-ocd/

12. International OCD Foundation. (n.d.). Mindfulness and Cognitive Behavioral Therapy for OCD. iocdf.org. https://iocdf.org/expert-opinions/mindfulness-and-cognitive-behavioral-therapy-for-ocd/