Cognitive Patterns in HOCD

If you are interested in how CBT can help with HOCD, this article explains how your cognitions; your thought processes influence and maintain your HOCD. It shall also explain how to help yourself using simple CBT techniques.

You can read more on HOCD here.

Key terms

  • Cognitions are all the processes involved in thinking, perception and reasoning.
  • HOCD is homosexual ocd and occurs when your obsessions focus on your sexuality.
  • CBT is cognitive behavioural therapy, as talking therapy that is used to treat all forms of OCD.

How do HOCD cognitions develop?

HOCD, or Homosexual Obsessive Compulsive Disorder, is a type of OCD that involves intrusive and distressing thoughts about your sexual orientation. These thoughts can be persuasive, and we tend to take our thought processes as the truth and never question their validity. So if you start to think that you have been getting your sexual identity all wrong, you immediately begin to worry instead of checking out the thought itself. This is where CBT comes into play, as it teaches you to examine your cognitions and their impact on your feelings.

Cognitive Distortions: Cognitive distortion is a term used in CBT, and it simply means mistakes in your thinking or a bias or mental filter. 

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You can read more on cbt here. and cognitive distortions in OCD here.

If you have HOCD, you will have many cognitive distortions about your sexual identity and being human; you will tend to magnify the significance of your thoughts, which adds to your already increasing anxiety.

An example of a cognitive distortion is ‘all or nothing thinking, or black and white thinking.’ There is no grey area or wiggle room with this style of thinking. For example, suppose you are a heterosexual male and think a man is attractive. In that case, your thinking is distorted if you believe I had a thought that one man was handsome. Therefore I must be gay.

This very concrete thinking style can lead to compulsions, such as ‘checking’ if you are attracted to men. Once you start having obsessive thoughts and compulsions, you move more into obsessive-compulsive disorder territory. In contrast, if you could stop it at the thought process part, you would never need to carry out a compulsion, in this case, the checking behaviour. 

How to correct the thought.

Ask yourself what evidence you have for the thought. In the example above, what evidence do you have that finding one man attractive means that you are now a gay man?

If you do not have convincing evidence, then you must come up with a more rational thought. For example, stating that one man is attractive does not change my sexual identity.

Thought-action fusion is another cognitive distortion where individuals with HOCD believe that having the thought must mean it is true.

You can read more on thought-action fusion here.

Thought Suppression:  Many people with HOCD, and you might be one of them, try to suppress their thoughts in the hope that they will feel better. However, this paradoxically leads to an increase in the frequency and intensity of these thoughts. The more you try to suppress the thoughts, the more they persist.

Compulsive Behaviours in HOCD: Compulsive behaviours are an integral part of HOCD and are often performed in response to intrusive thoughts. These behaviours serve as attempts to seek reassurance or alleviate anxiety temporarily. 

Reassurance seeking is a common compulsive behaviour where individuals constantly seek reassurance from themselves, others, or online sources regarding their sexual orientation. However, the relief obtained through reassurance-seeking is short-lived, reinforcing the cycle of doubt and compulsions.

Mental rituals are another form of compulsive behaviour in HOCD. This includes constantly checking and reviewing one’s thoughts, feelings, and physical reactions to determine their sexual orientation. Individuals may engage in mental exposure exercises or imagine scenarios to test their reactions, attempting to reduce uncertainty and alleviate anxiety. However, these mental rituals perpetuate the cycle of intrusive thoughts and anxiety.

How to manage and deal with HOCD thoughts

Step 1: Understand the role of cognitive distortions in HOCD

Cognitive distortions are patterns of thought that can distort how we perceive ourselves and the world around us. In the case of HOCD, distorted thinking can lead to compulsive behaviour and heightened anxiety. Common distortions in HOCD include:

  • Black-and-white thinking.
  • Disqualifying the positive.
  • Equating the presence of any gay thoughts or feelings with being less oneself.

It’s important to challenge these distortions through therapy but not to rely solely on logic to combat them. Exposure exercises, where one purposefully exposes themselves to anxiety-inducing situations, can help weaken the obsession. Cognitive restructuring, a way of identifying mistaken assumptions and responding to intrusive thoughts without doing compulsions, can also be used. Recognizing and challenging cognitive distortions is critical to treating HOCD and improving mental health.

Step 2: Challenge and replace HOCD thoughts with more rational ones

Step 2 in managing HOCD involves challenging and replacing irrational thoughts with more rational ones. To do this, it’s essential first to identify the irrational thoughts. Common HOCD thoughts include “I must be gay because I had a passing thought about a same-sex attraction” or “If I don’t feel attracted to someone of the opposite sex right now, then I must be gay.” Once you’ve identified these thoughts, challenge them by asking yourself if they’re based in reality or just a product of your anxiety. Replace them with more rational thoughts, such as “It’s normal to have passing thoughts about different attractions, and it doesn’t necessarily mean I’m gay” or “My attraction to others can fluctuate and change over time, and that’s okay.” Remember to be patient and persistent in challenging and replacing these thoughts, as it may take time and practice to retrain your thought patterns.

Step 3: Engage in exposure and response prevention therapy (ERP)

Step 3 in managing and dealing with HOCD thoughts involves exposure and response prevention therapy (ERP). ERP is a type of cognitive behaviour therapy consisting of confronting the thoughts and situations that trigger anxiety and obsessions while resisting the urge to engage in compulsive behaviours. This process helps to break the cycle of compulsive behaviour and stress by preventing the individual from experiencing temporary relief associated with the compulsion. ERP involves in vivo exposure, imaginal exposure, and ritual or response prevention. For instance, exposure to gay-themed pictures and videos of gradually increasing intensity while resisting the urge to convince oneself that they are straight. ERP is an effective way to overcome fears by gradually confronting things that cause the fear state while resisting the compulsive response. It is crucial to work with an OCD specialist and be patient with the ERP process.

Step 4: Implement cognitive restructuring strategies

Cognitive restructuring is a powerful technique to help individuals with HOCD manage and challenge distorted thoughts. This involves identifying cognitive distortions such as all-or-nothing thinking, emotional reasoning, and perfectionism and replacing them with more realistic and objective thoughts. To implement this strategy, individuals can keep a record of their triggering thoughts and examine the logic behind them. Practical techniques like thought records and cognitive reframing can be used to challenge and restructure these thoughts. For example, reframing the belief that finding someone of the same gender attractive means one is gay to the more realistic thought that it is normal to find people attractive regardless of gender. 

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