Why OCD Can Reinforce a Strategy That Feels Worse
The OCD study at the center of this chapter asks a different question from a laboratory rebound test: what happens when thought suppression appears repeatedly in daily life around naturally occurring obsessions? Its value lies in following the same people across many moments, so that immediate distress and later relief can be seen as parts of one pattern. The result does not prove that suppression causes either change, but it offers a concrete explanation for how a strategy can feel harmful and still become difficult to stop.
What repeated moments reveal
Swisher and Newman studied 49 adults who met diagnostic criteria for obsessive-compulsive disorder. Participants received seven smartphone prompts a day for seven days, producing 49 planned observations per person. Across the study, 2,401 prompts were delivered and 1,860 valid responses remained after five responses failed attention checks, a 77.3% compliance rate. Obsessions were present at least occasionally in 78.2% of completed prompts.
The design measured several experiences at each prompt. Participants reported how hard they had tried to suppress unwanted thoughts since the previous prompt. They also rated the severity of current obsessions, negative mood, and positive mood. Thought suppression was measured with three items, while momentary obsession severity was based on time occupied and interference with work, school, social life, or another important role. The questions were repeated often enough to separate two kinds of variation: differences between people and changes within the same person from one moment to the next.
That distinction matters. A person who generally suppresses more may also have more severe OCD, which would create a between-person association. The more specific question is whether the same person tends to report different obsessions or moods at moments when they have suppressed more or less than their own usual level. The researchers used multilevel models to examine concurrent associations at the same prompt and lagged associations across the next prompt.
The concurrent pattern was clear. Greater momentary thought suppression was associated with greater obsession severity at that same time and with more negative mood. It was not significantly associated with positive mood at that moment. In plain language, the people in the study were not reporting a calm present while they tried harder to push thoughts away. The moments of greater suppression were also moments in which obsessions and negative emotion were more prominent.
The lagged pattern pointed in the other direction. Higher suppression at one prompt predicted a decrease in obsessions and negative mood by the next prompt, roughly two hours later, as well as an increase in positive mood. Lower suppression predicted a later increase in obsessions and negative mood. The study therefore described a temporal sequence with two distinct states:
- At the time of greater suppression: more obsessions and worse negative mood.
- At the next assessment: fewer obsessions, less negative mood, and more positive mood than the preceding pattern would otherwise suggest.
The list is short because the relationship is easy to lose if all outcomes are folded into one score. Suppression was not associated with immediate comfort in this study.