Thought suppression worsens mood and obsessions but improves them subsequently: First evidence of a contrast avoidance effect for the maintenance of thought suppression

Abstract

Objective

The cognitive behavioral model for obsessive-compulsive disorder (OCD) suggests that suppression of unwanted thoughts (TS) is negatively reinforced by temporarily preventing obsessions and reducing distress. It further suggests that ceasing TS subsequently creates a rebound effect leading to increased obsessions/distress. However, the contrast avoidance model (CAM) suggests that TS concurrently increases and then sustains obsessions/negative affect, thus increasing the likelihood of negative and positive reinforcement (positive contrast) and avoiding a negative contrast later. We tested these theories using intensive ecological momentary assessment.

Method

Forty-nine individuals diagnosed with OCD received seven prompts/day for seven days examining current obsessions, TS, negative and positive mood.

Results

In line with CAM, higher TS was associated with higher concurrent negative mood and obsessions. Also, higher TS was associated with decreased obsessions and negative mood and increased positive mood 2 h later. Lower TS was associated with lower negative mood and obsessions concurrently and increased negative mood 2 h later. Thus, TS may have been negatively and positively reinforced—through subsequent (as opposed to concurrent) reduced negative mood and increased positive mood—and not engaging in prior TS was punished, such that it was associated with a subsequent uptick in negative mood.

Conclusion

Taken together, the present study showed the first evidence for a contrast avoidance effect (i.e., avoidance of sharp increases in negative emotion and decreases in positive emotion) for the maintenance of TS in OCD. Results suggest that targeting contrast avoidance may help reduce maladaptive cognitive strategies such as TS in OCD.