What Is… Thought-Action Fusion

In this series, I dig a little deeper into the meaning of psychology-related terms. This week’s term is thought-action fusion.

Thought-action fusion (TAF) happens when people believe there is an equivalence between thoughts and actions. It was first described by researchers in relation to OCD, although it’s not exclusive to OCD.

There are a couple of different kinds of TAF. Likelihood TAF involves the belief that thinking about something makes it more likely to happen, and moral TAF involves the belief that thinking about an action is the moral equivalent to that action being performed or that event occurring.

A related concept is magical thinking, which involves the belief that thoughts, actions, or symbols can influence external events when there’s no logical reason to expect there to be a causative relationship. Thinking that knocking on wood actually has an effect on outcomes would be an example of this.

Thought-action fusion can increase the perceived importance and threat of intrusive thoughts. Inflating the significance of thoughts can lead people to try to suppress those thoughts, which in turn can intensify the thoughts. Appraising intrusive thoughts as more significant can also feed into a sense of moral responsibility for one’s thoughts.

The Thought-Action Fusion Scale

The Thought-Action Fusion Scale is a psychometric test developed by Shafran and colleagues to measure TAF in OCD. It contains three subscales—one for moral equivalence, one for increased likelihood of outcomes for others, and one for increased likelihood of outcomes for the self. Examples of items from each subscale are:

• “Having violent thoughts is almost as unacceptable to me as violent acts.”
• “If I think of a relative/friend being in a car accident, this increases the risk that he/she will have a car accident.”
• “If I think of myself being injured in a fall, this increases the risk that I will have a fall and be injured.”

The average person tends to have higher levels of thought-action fusion with regards to an increased likelihood of thoughts affecting outcomes for the self compared to an increased likelihood of their thoughts affecting outcomes for others, as they recognize that their thoughts are more likely to affect their own behaviours. People with OCD, on the other hand, don’t tend to make that distinction, and they’re more likely to see their thoughts as influencing others’ behaviours.

Association with mental disorders

While thought-action fusion is common in OCD, not all people with OCD have TAF, nor can TAF on its own fully explain the symptoms of OCD. Some research has linked TAF with greater severity OCD, but findings have been inconsistent, and some studies have suggested that the TAF seen in some people with OCD actually has more to do with depression than the OCD itself.

TAF can skew an individual’s sense of personal responsibility, and they may feel that they need to take some sort of action to neutralize the perceived threat, which may fuel compulsive behaviours in OCD. One way of trying to do this is mental neutralizing, which involves trying to change one’s thoughts in order to reduce the likelihood of bad things happening. This sounds consistent with what’s sometimes referred to as pure-O OCD, where compulsions are mental rather than behavioural.

Likelihood TAF can be an issue for people with other anxiety-related disorders, but they tend to use avoidance rather than neutralization strategies. In particular, likelihood TAF has been linked to generalized anxiety disorder. This may relate to the belief that worry, a major element of GAD, can influence the likelihood of feared outcomes occurring.

Moral TAF has been associated with depression, and this may relate to the self-blame, personalization, and guilt that can go along with the illness.

A related concept, thought-shape fusion, has been described in relation to eating disorders and thoughts about food. This includes beliefs about the badness of thinking about forbidden foods and beliefs that thinking about food will affect body size and shape.

The role of religion

Culture and religion may influence baseline levels of thought-action fusion. A small study by Berman and colleagues compared the way that highly religious Protestant Christians and agnostics/atheists reacted to being instructed to think about particular harmful scenarios. The researchers found that the religious participants had more TAF, believing that it was morally wrong to think or write about negative effects and doing so increased the likelihood of those events happening. Other research has also linked Catholicism and Judaism with moral TAF.

I first stumbled across the term thought-action fusion quite recently when reading the book Everything You Need to Know About OCD. While moral TAF can be an issue for people with depression, I don’t think that’s the case for me. Does TAF sound like a pattern of thinking that you tend to have?

References

• Berle, D., & Starcevic, V. (2005). Thought–action fusion: Review of the literature and future directions. Clinical Psychology Review, 25(3), 263-284.
• Berman, N. C., Abramowitz, J. S., Pardue, C. M., & Wheaton, M. G. (2010). The relationship between religion and thought–action fusion: Use of an in vivo paradigm. Behaviour Research and Therapy, 48(7), 670-674.
• Shafran, R., Thordarson, D. S., & Rachman, S. (1996). Thought-action fusion in obsessive compulsive disorder. Journal of Anxiety Disorders, 10(5), 379-391.
• Thompson-Hollands, J., Farchione, T. J., & Barlow, D. H. (2013). Thought-action fusion across anxiety disorder diagnoses: Specificity and treatment effects. The Journal of Nervous and Mental Disease, 201(5), 407.