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When the cognitive load is increased, thought suppression typically becomes less effective. For example, in the white bear experiment, many general distractions in the environment (for instance a lamp, a light bulb, a desk etc.) might later serve as reminders of the object being suppressed (these are also referred to as "free distraction").
[1] [9] [10] OCD can also manifest exclusively through mental compulsions, such as mental avoidance and excessive rumination. This manifestation is sometimes referred to as primarily obsessional obsessive–compulsive disorder. [11] [12] Compulsions occur often and typically take up at least one hour per day, impairing one's quality of life.
An example of this difference could be that someone with traditional OCD is overly concerned or worried about security or cleanliness, whereas someone with Pure-O may be terrified that they have undergone a radical change in their sexuality (e.g., might be or might have changed into a pedophile), that they might be a murderer, or that they ...
Avoidance reinforces the notion that discomfort, distress and anxiety are bad, or dangerous. Sustaining avoidance often requires effort and energy. Avoidance limits one's focus at the expense of fully experiencing what is going on in the present. Avoidance may get in the way of other important, valued aspects of life.
Two examples of assessments developed to measure safety behaviors performed by people with social anxiety are the Social Behavior Questionnaire and the Subtle Avoidance Frequency Examination. [ 2 ] [ 27 ] An assessment developed to measure safety behaviors performed by people with panic disorder is the Texas Safety Maneuver Scale.
As of 2019, ERP is considered a first-line psychotherapy for OCD. [21] [26] A 2024 systematic review found that ERP is highly effective in treating pediatric OCD using both in-person and telehealth-based modailites. [27] Effectiveness is heterogeneous. Higher efficacy correlates with lower avoidance behaviours, and greater adherence to homework.
In addition to the fears themselves, the term agoraphobia is often used to refer to avoidance behaviors that individuals often develop. [27] For example, following a panic attack while driving, someone with agoraphobia may develop anxiety over driving and will therefore avoid driving.
When intrusive thoughts occur with obsessive-compulsive disorder (OCD), patients are less able to ignore the unpleasant thoughts and may pay undue attention to them, causing the thoughts to become more frequent and distressing. [7] Attempting to suppress intrusive thoughts often cause these same thoughts to become more intense and persistent. [11]