Sarosh Motivala, PhD 10/31/19 Sarosh Motivala, PhD 10/31/19

Dark Thoughts

To understand dark thoughts we need to wipe away our existing notions of the words and approach things with a fresh set of eyes. Let’s examine things with an open, inquisitive mind.

Mental experiences

Obsessions exist in the realm of mental experiences. They are subjective. I can’t tell what’s going on in your head - but you can. Similarly, you can’t tell what is going on in my head. But we can agree that there are types of mental experiences. Here’s something I’d like for you to play with: the user interface of the mind is built to simulate social interaction between two people. For example, I can talk to myself. Talking to myself involves speaking, internally to myself. My self or mind can talk back to me. It can communicate with me verbally (eg “Remember to mail that letter”) .

In addition to verbal interactions, my mind can communicate to me in other ways - with emotions. So what exactly is an emotion? We can slide down a slippery slope easily on this one. I will take a stab at a generic description for now (for more on this, Paul Ekman and Richard Davidson have a thoughtful book called The Nature of Emotions). Let’s say emotions are subjective, perceptual “states” of being that feel pleasant or unpleasant, with varying intensity. They can be brief or longer lasting, they have a “motivational” quality - in that they propel us to certain actions. They also have a social, communicative quality in that I might feel the urge to share or “let out” something or often others can guess or relate to what I am feeling.

Emotions are like colors - there are some primary ones and then there are an incredible assortment of blends. In OCD, the dominant emotions are anxiety, fear, panic, shame and disgust. Back when I was in academia, I had a conversation with a friend of mine who was trying to do a research study on emotions and the kinds of thinking that arises with specific emotions. One day I ran into him in our office hallway and he looked really frustrated. I asked him what was going on. He told me he was having trouble with his study because it was extremely difficult to devise aa procedure that cleanly and consistently produced a single emotion. “There’s always other stuff going on!” He told me that people might be anxious but also irritated; or a little sad. My take home message from this is that emotional experience can be simple at times, but a considerable amount of times it is complex. Sorry to make things even more complicated, but in OCD, people can feel considerable anxiety, panic, or fear about experiencing anxiety, panic, or fear. These “meta” emotions are emotions about an emotion. “I’m angry that I feel scared” or “I’m ashamed that I feel so panicked”. or “I’m nervous that I might get scared”. So besides verbal interchanges, our mind can communicate with us with emotions, and with emotions about emotions.

Our mind also communicates with us via intuitions and urges. An intuition can be thought of as emotion-laden sense of “knowing”. Here are some examples of types of intuitions: “I just know that this is the right thing for me to do”; “I have a feeling that something bad is going to happen”. Closely aligned with intuitions is another type of mental experience: urges. When partnered with emotions, urges are strong propellers of action. “I need to get out of here”. An urge is almost like an unpleasant feeling about being inactive coupled with a “promise” that some goodness will arrive if I engage in a specific action. Let’s look at thirst. I once was hiking on a trial in the Grand Canyon and ran out of water. My mouth was parched and I felt this uneasy dry mouth feeling - I’d also get images of being at the Canyon lodge cafeteria drinking a tall tumbler of water filled with ice. I could visualize it and it looked so gorgeous and I could feel that cold rush that would happen as I tipped the glass and felt the water gloriously run through my body. Do you know that feeling? So urges have this dual action of uneasiness with the present combined with a sense of fulfillment when the desired action is taken.

So let’s summarize. We talk to ourselves. We talk to our mind and our mind talks back. Our mind is not a unitary virtual person, but instead a variety of characters. Our mind communicates with us conversationally with words, with images, with emotions, with urges, with intuitions. See where I’m going with this? So far so good. But we haven’t addressed obsessions, compulsions, and all that good stuff. But before I do, first let’s characterize a few more players.

The negative propaganda machine

I’d like to propose to you that our minds have certain pumps; these pumps pour specific kinds of thoughts into our consciousness. I had the good fortune to be listening to an interview with Bill Nighy, a British actor who has been in a number of movies that I really like. This was back when I used to listen to radio. Remember the radio? Anyway, the conversation turned to depression and he described an inner voice he struggled with - he called it the negative propaganda machine. He described how it would fill his mind with dark, critical, horrible statements about himself; about his work, relationships and about his personhood. I could relate to this. What is this thing? This soulless machine pumping negative junk into my mind space.

Negative Automatic Thoughts

The negative propaganda machine was a central piece to the pioneers of cognitive-behavior therapy. In the formulation of what would eventually become cognitive therapy, Aaron Beck wrote that a depressed patient he worked with “consistently embraced a negative construction of himself and his life experiences”. These negative constructions included negative judgments of the world, the future and oneself. Today, psychologists

who specialize in CBT are interested in thoughts or thinking that have specific attributes. Early on in the development of CBT, researchers were interested in negative, automatic thoughts (NATs): automatic spontaneous thoughts about the self, self-efficacy and the future (“you are a loser”; “you will never succeed”, “you are going to become destitute and alone”). These thoughts “pop into” awareness, sometimes out of the blue, but often are triggered by situation you are in or what you are thinking about or doing. They seem to revolve around themes of loss, failure and danger. NATs are common, especially in depressive and anxiety disorders. NATs show up verbally; to the person experiencing NATs, the NATs seem believable and the person may even agree with them at times (“I really am hopeless”).

So far, we’ve speculated that my mind and I communicate with each other. My mind is complex and communicates in a variety of ways (via thoughts, images, urges, intuitions) and there are “pumps” that infuse my consciousness with specific kinds of ideas, images, urges or intuitions. One such pump is the negative propaganda machine that pumps NATs - negative thoughts about myself, my world and my future into my awareness. But in this story, there is another pump and it is even weirder and freakier than the negative propaganda machine.

The slime machine

Slime is popular these days. Kids like to make homemade versions of it. But I think it is gross. I don’t like it and if I get some on my hands, I will try to get it off as quickly as possible. Merriam-Webster offers up two curious definitions of slime- a viscous, glutinous or gelatinous substance and a morally repulsive or odious person. One definition is a physical phenomena and the other is a mental or social phenomena. And just like the Nickelodeon channel’s tendency to drop slime on people’s heads, we have a slime pump that drops slimy thoughts into our consciousness.

Disturbing, unwanted thoughts. Where do they come from? What do they want? What are they?

Thoughts like: “What if I left the door unlocked and an intruder is inside?” “What if I drove off the road right now?” “What if I had an impulse and caused a scene?”

73 - 60 - 45. These are the percentages of people who report that they have had the above disturbing thoughts frequently (if you have access to it, the research study was reported in a paper by Purdon and Clark in 1993 in Behavior Research & Therapy).

But wait there’s more. In their study they found that 21% of a random sample of young adults reported being disturbed by thoughts like “When I see a sharp knife, I have the thought of slitting my wrist or throat”. 48% reported having unwanted thoughts about running over pedestrians or animals while driving; 19% had frequent unwanted thoughts about exposing themselves in public and 55% reported unwanted sexual thoughts about a boss, teacher or other authority figure. Whoa! What’s going on here?

A more recent series of papers reported findings from an international multi-site study on bad slimy thoughts. Psychologists and psychiatrists call these types of thoughts intrusions. It looks like the slime machine pumps in intrusions in almost everyone. 96% of people in Turkey, 97% of people in Hong Kong and 100% of people in Iran who participated reported having these kinds of intrusive, disturbing thoughts in the past three months. Sadly, North Americans, South Americans and Europeans too had percentages ranging from 84% to 100%. Remember these participants were drawn from the general population, not a mentally unwell subgroup. Radomsky and a large group of coauthors summarized their findings in the Journal of Obsessive-Compulsive and Related Disorders in 2014.

Just like the propaganda machine that pumped in scary, depressing, hopelessness generating thoughts about ourselves, our world and our future, it seems like the slime machine pumps in weird, disturbing and shocking thoughts. Although nearly everyone seems to have these thoughts there are occasional. Thankfully the slime machine doesn’t repeatedly dump their minds with sludgy, slimy thoughts.

But what if it did?

Obsessions

Some people get deluged with disturbing thoughts that they struggle mightily to get rid of. We can imagine that their slime machine is big and nasty. Let’s call these kinds of thoughts obsessions.

In contrast to intrusions, that are experienced by virtually everyone, obsessions are different. Obsessions are more frequent, associated with stronger negative emotions, are considered more meaningful, and come with a much stronger urge to resist.

An unresolved puzzle is whether obsessions are intrusions that morphed into obsessions, or whether they are two separate things that have some similarities. We can explore that down the road, but for now, suffice it to say that our minds communicate with us via thoughts, images and impulses. Also, our mind has a few mental machines that squirt thoughts into our awareness. Some are like NATs, some are intrusions, and for some people, there is an obsession machine.

David A. Clark (in Cognitive Behavior Therapy for OCD, 2004) writes that obsessions have five attributes. They are: 1) intrusive; that is to say, the thought, image or impulse enters awareness “against one’s will”; 2) unacceptable - they are distressing in varying intensity to the person having the obsession; 3) accompanied by an urge to resist, the person feels a strong urge to resist, suppress, dismiss the obsession from conscious awareness; 4) uncontrollable , a person senses that their ability to control or suppress the obsession is i too brief or ineffective; 5) ego-dystonic meaning the obsession can (but not always) involve ideas that might be threatening to one’s sense of self or violate one’s sense of values or morality.

There is one last quality to obsessions that make them stand out: the person experiencing them can have trouble distinguishing the obsessional mental experience from tangible reality. A thought feels like reality. If I have a thought that I might be a child molester, I may actually feel like I am a child molester. If I see an image of a spider, I actually feel like I am seeing an actual spider. This blurring of the lines between external reality and subjective experience is extremely disturbing to the experiencer. Some people have described to me that at times, when anxious, they feel like they have a split brain - one part that “sees” that what is going on and realizes it is irrational, and another part that “feels” the obsession is real. The path to getting through and managing OCD can be difficult. But starting with a willingness to learn and understand what obsessions are and how our minds tend to work can help in making the route clearer.

Sarosh Motivala, PhD 10/24/19 Sarosh Motivala, PhD 10/24/19

The Focusing Response

You’ve heard of fight or flight of course. The two most thought about responses to a stressor or threat. Lesser known is the freezing response. You can see this one in animals. Freezing is a fairly automated response to an immanent predatory threat. Fighting, flighting, freezing all have their uses, but none of them are well suited to chronic stress. All of them are good for short bursts. The talent and skill needed for sprinting are different than those needed for a marathon. And make no mistake people, we are all in a marathon.

So is there another way to handle stress? Especially chronic stress? Yes. the focusing response.

Now there is a surface meaning for the word focus and it sort of gets at what I am talking about, but then there is a deeper, more mysterious meaning for the word that lies at the center of what I am talking about.

A quick search in the Merriam-Webster Dictionary and we find that focus as a noun has a few different meanings, including - 1) the center of attention; 2) directed attention; 3) “a state or condition permitting clear perception or understanding”. This is focus as a thing; but now, I’m thinking of focus as a response - an action, so let’s examine it’s definition as a verb. To focus means 1) to concentrate attention or effort; 2) to bring cause to be concentrated. On the surface, pretty straight forward. But now I’m going to make things weird. Before we leave Merriam-Webster, our stately dictionary adds a scientific definition - the point where geometric lines either converge or diverge and intersect, giving rise to an image (in a mirror or lens). Does this seem confusing? Let’s say it’s an apt way of describing the action of “bringing the lines of thought together” and also the location of “where things come together”. I like that. The Oxford Dictionary spells it out a little differently: “to adapt…so that things can be seen clearly”.

So far, some pretty good ways of defining focus. But here is where it gets even more interesting. The Oxford Dictionary goes on to say that the beginnings of the word focus are in the 17th century when it was used in mathematics and science, but its origin predates this, back to the Roman Empire, when the Latin word “focus” meant domestic hearth. Now, this is to me the deeper mysterious meaning of the word focus - domestic (or home) hearth, meaning the center of the home that provides warmth, light and sustenance. As Jim Morrison swaggered and sang, “Let me sleep all night in your soul kitchen, warm my mind near your gentle stove”, to me, focusing has a centering, rejuvenating feel to it. Jim was singing about going to the hearth after what was probably a long and crazy night out. To focus is to go to the hearth; to go to the center. But where is that exactly? Is it even a “place”? I think it is.

Centering is a nice way to think about focusing. In Peru, the ancient capital of the Incan empire was Cuzco. What a mysterious name! What could it mean? Turns out it means navel of the world. In old Incan culture, the navel was the center of a person’s being, the place where a person is connected with the universe through a spiritual umbilical cord. So the center of the soul of the Incan empire simply had to be named Cuzco. Their capital was the center of the world (to them) and was where they connected with the universe. Getting focused means “going to your Cuzco”. In humans, wanna know where our center of gravity is? Can you guess? Yup - the navel. Your center of gravity is where your hearth is; it’s your soul kitchen as Jim Morrison would say. And lastly, Hindu traditions conceptualize our bodies have energy centers called chakras. My grandfather used to tell me that the third chakra was the one that had fire and the warm burn of a home hearth as its symbol. Can you guess where that chakra is located in the body? It is located just above the....drum roll please...navel! So the statement “get centered” literally means “go to the navel”. Is it any coincidence then that belly breathing, so vitally important in yoga and meditation, is a way to get centered and to get focused?

Now let’s operationalize these varied definitions into something practical. I’m thinking that the focusing response first involves centering, or going to the navel, or going to the hearth. Whatever phrase you like better.

You go there not with your feet, but with your attention. So you take your attention to your belly. Four to five breaths should do it, but if you want to warm your mind by the gentle stove for while longer like Jim did, have at it.

Ok, after centering, the next step of focusing is observing/noticing. There are two basic things to observe. The outside or the inside. It’s hard to notice both at the same time. The outside could be visuals like people, birds, trees, or scents, odors, or sounds, or touches - the sun on your skin, the feel of air rushing into your nose, the feel of an ice cube on your finger tips. Then there’s the insides. Maybe it’s a radiating warm feeling in your belly, a tightness in your shoulders. Insides also include your mindspace. Maybe you notice a certain rush of thoughts, with a certain kind of intensity or flow to them.

Lastly, you practice welcoming/accepting. This is a verbal statement you make. I’ve heard people advocate for a welcoming statement like “I welcome this feeling of tightness” or “I welcome this feeling of fear”. This is not really my speed. I don’t have anything against this style, I just don’t talk to myself that way. I like a different welcoming form of self-talk - something like “this is good - this is ok. It’s fine to feel fear or tight. let’s go - you got this”. That last bit of “you got this” is like adding a little bit of seasoning to the acceptance pot - the specific seasoning being something called self-efficacy, a statement that you can handle this.

So to review, start with centering and going to the navel via your breath, then you do a bit of observing of your body state and your surroundings and then you close it out with a welcoming statement. That’s my way of focusing and developing that fourth fear response.