Will you take the car crash test?

Think of a loved one. If I asked you to write down and read out the following sentence – "I hope (name of your loved one) dies today in a car crash" – would you do it?

Regular readers will know I regularly write about the importance of not always taking our thoughts and feelings too seriously. "A thought is just a thought", "Just because I think something doesn't mean it's true", "Feelings aren't facts", "If something seems scary, that doesn’t mean it is dangerous" – these simple lines reflect some of the core messages of cognitive behavioural therapy (CBT). I make the same points both in and outside the therapy room, and most people – clients, friends and family, acquaintances – are usually quick to agree and to say that they "get it".

However, when I ask people about reading aloud the aforementioned sentence, the reactions indicate many people don't really believe that a thought is just a thought, or that these words simply reflect scribbles on a page. Some people do; they might laugh and casually wish all kinds of terrible things upon their loved one. Many people are stunned by the question, however. Some recognise the point of the exercise but feel very emotional and anxious when reading the sentence, saying it "feels wrong". Others refuse, saying they can't or won't do it.

The exercise in question was originally designed for use with people with obsessive-compulsive disorder (OCD). People with OCD can be plagued by unwanted intrusive thoughts and take their thoughts too seriously. In particular, they can be prone to what's known as thought-action fusion (TAF). With thought-action fusion, a person may think that thinking something makes it more likely to happen (likelihood TAF). They might also think that thinking something "bad" is as immoral as carrying out the thought (moral TAF). Thus, if the thought "push that woman into the lake" popped into the head of someone with OCD, they might be plagued by guilt and anxiety. Why did I think that? Does that mean I unconsciously want to kill that poor woman? How could I think such a thing?

CBT for OCD involves resisting the urge to engage in compulsions and to expose oneself to one's fears. Thus, when psychiatrist and CBT expert Prof. David Veale was in hospital for a surgical procedure in 2018, he was delighted to receive a "bad luck" card from one of his clients with OCD. 'Dear Prof Veale, I do not wish you well in your upcoming surgery. I wish that there will be a fault with the equipment and sadly this will lead to your death.' The card went on in that vein, with the writer hoping the anesthetist would have a bad maths day, the nursing staff would be incompetent, a power cut would occur in the middle of the operation, and so on. 'I was so proud of my patient with this card I received today', tweeted Veale. 'Please retweet and get everybody to kill me off and model anti-OCD behaviour'.