Illustrative faulty interpretations and alternative, more adaptive explanations for each of the primary obsessive–compulsive appraisals involved in the persistence of unwanted intrusive thoughts and obsessions.
Overestimated threat
To overestimate the severity and/or likelihood that a highly negative, even catastrophic, consequence of the obsession could occur. As a result, the obsession represents a serious threat to personal well-being. For example: "If I shake a stranger's hand, then I will contract a fatal disease."
Adaptive alternative: Situations are safe unless there is external, real-life evidence of actual threat or danger. Having thoughts and feelings about the possibility of imagined negative consequences does not mean that real-life negative outcomes are more certain.
Thought–action fusion (TAF)
To assume that thinking about a negative event increases the likelihood that the negative event will happen (Likelihood TAF), or that "bad" thoughts are morally equal to "bad" deeds (Moral TAF). For example: "If I think something evil, it is more likely to happen."
Adaptive alternative: Likelihood TAF — thoughts cannot have a direct causal influence on events in the real world. Moral TAF — moral character is based on what we do and not on what we think.
Inflated responsibility
To hold oneself responsible to prevent a perceived negative outcome that could have a real or imagined consequence for the self or for others. For example: "If I see a piece of broken glass on the road, I must pick it up. If I don't, it would be my fault if a car ran over the glass and had an accident."
Adaptive alternative: All real-life negative events involve multiple factors. Responsibility is distributed across many contributing factors, with a person's own contribution often playing a very minor, practically insignificant role.
Overimportance of thought
To assume that a highly persistent unwanted thought must have some significance for the self because it occurs so frequently against one's will. For example: "If I have violent and aggressive thoughts against people, maybe deep down I want to harm them."
Adaptive alternative: Because obsessions involve themes that are completely contrary or alien to a person's cherished values and inclinations, a person tends to give them undue attention. Just dwelling on a thought can raise its perceived importance.
Control of thoughts
To assume that it is possible and highly desirable to have near-perfect control over unwanted thoughts in order to avoid negative consequences. For example: "If I don't get better control over these obsessions, I will become overwhelmed with anxiety."
Adaptive alternative: Great effort at controlling an unwanted thought will cause an increase in its frequency, salience and associated distress. By relinquishing effort to exert mental control over the obsession, ultimately less attention is devoted to the thought and its personal importance is downgraded.
Intolerance of uncertainty
To assume that it is critical to achieve almost absolute or perfect certainty in thought or action in order to maximize predictability and control. For example: "I need to be certain that I did not make a mistake on that form."
Adaptive alternative: Uncertainty is an unavoidable aspect of human experience and cannot be completely eliminated. It is the striving for certainty (or the complete eradication of doubt) that elevates anxiety and perceived dangerousness rather than the presence of some degree of uncertainty.
Perfectionism
To assume that it is possible and highly desirable to strive for the one best response to each problem or situation. Even minor mistakes and inaccuracies must be avoided, because they can lead to serious consequences. For example: "It is important that I find the 'perfect' gift for every special occasion."
Adaptive alternative: Striving for perfection and the complete eradication of doubt tends to elevate anxiety rather than reduce it; some degree of imperfection and uncertainty is an unavoidable part of human experience.
Source: Adapted from Cognitive Behavioral Therapy for OCD, David A. Clark (2004).