The first concept to understand regarding taking responsibility is to differentiate between inflated responsibility and real responsibility. No one has responsibility for the thoughts, feelings, and sensations that occur in private experience. Other uncertainties that you don’t have control over include:

● Other people’s thoughts and feelings.

● The thoughts, feelings, and sensations that occur naturally in your experience.

● The life circumstances you were born into.

● Most of what happens to you.

All of these are categories of inflated responsibility. We can think about real responsibility by thinking about the word itself. Do you have the ability to respond to whatever it is that you have anxiety about? In the case of real responsibility, you have the capacity to respond. You might not have control over what happens to show up in your experience, but you do have the capacity to respond to it. Similarly, you don’t have certainty over what other people think and feel, but you do have control over how you respond to what other people convey to you.

It’s helpful to discuss real responsibility with people who experience intolerance of uncertainty because you often feel too much responsibility over that which you cannot control, but are paralyzed with anxiety about taking responsibility for what you can control.

The serenity challenge can help you understand the ideal way of relating to uncertainty:

May I have the serenity to accept what I cannot control,

The courage to change what I can change,

And the wisdom to know the difference.

An excessive or inflated sense of responsibility occurs when you interpret your thoughts in terms of whether they can cause distress or harm to yourself or others. That is, having the thought in and of itself gives you a sense of guilt or responsibility.

Examples include:

● I have the thought that I could have cancer or an STI. Does that mean I do?!? And, I feel anxious and uncertain. What does that mean?!?

● I had the thought that I don’t love my partner. Does that mean I don’t?!? And, I feel anxious and uncertain. What does that mean?!?

● I had the thought that I might have hurt, murdered, assaulted, offended someone in the past. Does that mean I did?!? And, I feel anxious and uncertain. What does that mean?!?

● I had the thought that I could have done more to help someone. Does that mean I should have?!? Am I bad because I didn’t act on that thought?!? And, I feel anxious and uncertain. What does that mean?!?

● I had the thought that I could work harder at something that I value. Does that mean I must?!? And, I feel anxious and uncertain. What does that mean?!?

● I had the thought that my anxiety might kill me, make me go crazy, or embarrass me. Does that mean it will?!? And, I feel anxious and uncertain. What does that mean?!?

● I had the thought that someone judged me. Does that mean they did?!? How do I know they didn’t?!? And, I feel anxious and uncertain. What does that mean?!?

● I had the thought that I’m not good enough. I also feel worthless and hopeless. It must be true.

Notice that the content of each of these examples are different, but the process is the same.

Here’s a recap of the anxiety/OCD process:

● You are already sensitized.

● An unwanted intrusive thought (that is, an obsession) or worry arrives in your mind with a whoosh of anxiety.

● It seems important so you search for what it means.

● The search gives you more anxiety and you search for what that means.

● The thought becomes more prominent in your mind, which appears to give it more meaning.

Content areas that are maintained by inflated responsibility typically seem meaningful. Part of overcoming inflated responsibility is challenging or letting go of the meaningfulness of the content as it operates in the anxious process. The trick is to hold to seemingly contradictory ideas in your head at the same time: the content of my thought might be or is meaningful, but the process I’m using to discover and work with the meaning is problematic, unhelpful to me, and/or driven by anxiety and OCD.

Examples include:

● It’s important to me that don’t harm children, but avoiding children in response to the thought that I could hurt them is OCD.

● It’s important to me that I uphold confidentiality and security standards at work, but triple checking or avoiding work related to security is OCD.

● It’s important to me that I act conscientiously, but replaying every social interaction makes me less likely to spend time with the people I love.

The content in all of these examples is meaningful. We can identify it as OCD because of its process – how it feels and acts. If the content is important to you, you should be able to choose to think about it. You shouldn’t have to think about it, because it happened to arrive in your mind.

When you are experiencing an inflated responsibility in the present moment consider if it is thought-action fusion and what your conscientious model would do.

Is this thought-action fusion? Individuals with anxiety sensitivity get sticky, catastrophic thoughts when they are sensitized. Thoughts feel like they are true, regardless of if they are rational or irrational and regardless of their truth. Thought-action fusion is when having a thought feels like its the same thing as behavior. Thoughts and behavior are not the same thing. Our minds can have thoughts that we don't act on and those thoughts don't mean anything about our character. One example is having the thought that I'm going to stab my puppy. If I have this thought while sensitized, it could feel like a possibility and a threat. I love my puppy, so if this thought happened a lot and I don't know what's happening, I'd probably feel afraid of my mind and wonder why I have these thoughts. I might get reassurance from myself or others or stop touching knives. The avoidance would make the thought more likely and then I'd really start to suffer. You can step out of the vicious cycle of intrusions, avoidance, intrusions, avoidance at any point. One opportunity to prevent an obsession-compulsion spiral or step out of one that is already occurring is to notice that your body is sensitized. Your self-talk is What feelings am I feeling and what sensations are occurring in my body? My body is sensitized, so the stickiness of this thought might be due to thought-action fusion, not a problem.

What would my conscientious model do? Pick a person you respect in the domain of life that your intrusive content occurs. If you have intrusions about accidentally hitting people or animals with your car while driving, pick someone you know who is good at driving. If you have intrusions about making mistakes at work, pick someone you respect at work. When you have an intrusion and then the urge to act to make the thought stop, slow down. Feeling urgency doesn't require an urgent response. Your self-talk is I'm noticing that I have the feeling of urgency but that doesn't mean I have to do something immediately. What would my conscientious model do right not? Would he go back and check that intersection? Would she write an apology email? If you actually can't tell, take a guess and use it as an opportunity to learn. Refrain from the urge to try to figure out whether or not that was the right answer and instead stay in the present moment and let yourself learn from the decision you just made.

The two common types of inflated responsibility thoughts that people have about the past are how do I know with certainty that I didn’t do something that I’m afraid I did? And I actually did something that was against my values in the past. I cannot have compassion and forgive myself for that behavior.

How do I know with certainty that I didn’t do something that I’m afraid I did? If you have this fear, it’s likely that you replay the situation in your mind, searching for details about the situation either in your own memory, through asking other people, or through compulsive internet research. Thoughts feel like they are true, regardless of if they are rational or irrational and regardless of their actual truth. Thought-action fusion is when having a thought feels like it’s the same thing as behavior. Thoughts and behavior are not the same thing. Our minds can have thoughts that we don’t act on and those thoughts don’t mean anything about our character. If you have a thought you don’t like and you avoid in response to it, you start a vicious cycle of intrusions, avoidance, intrusions, avoidance. One opportunity to prevent an obsession-compulsive spiral or step out of one that is already occurring is to notice that your body is sensitized. Notice the feeling of urgency. Slow down. Ask yourself: What feelings am I feel and what sensations are occurring in my body? My body is sensitized, so the stickiness of this thought might be due to thought-action fusion, not a problem.

I actually did something that was against my values in the past. I cannot have compassion and forgive myself for that behavior. If you have this fear, I have so many questions for you. In what way is self-criticism helpful to you? Will you become lazy, complacent, and a bad person if you show yourself compassion? Are you punishing yourself? What is the function of that self-punishment? In what way have you grown since that time? What contextual factors occurred that contributed to your behavior and what contextual factors are similar or different in your life now?

Common example of this are:

I’ve actually made a mistake at work that had devastating consequences, so now I have to check.

I’ve lost friends, family, or romantic relationships that I cared about, so now I need to check to make sure that I don’t lose relationships that are important to me.

My child and I have actually been very sick, so I need to make sure I/we don’t get contaminated.

I was in a car accident, so now I need to be very careful.

I did drugs or sexual activities that I don’t do anymore and now I have memories that I don’t like and/or I need to make sure that I’m not in similar situations now.

These are common examples, but there are so many other versions of this. In psychotherapy, you have the opportunity to discuss what happened, what’s different now, and whether or not forgiveness might be an option for you. Like avoidance, compassion and forgiveness are moment to moment decisions. You don’t forgive yourself once and then live with compassion forever. You can always try forgiving yourself for a few moments and then go back to beating yourself up if you don’t like it. Or, you can try forgiving yourself about one thing in one context and then expand on it, if you like it.

There are two scenarios where inflated responsibility may not follow the other examples.

Depression – The voice of depression is hopeless, helpless, guilty, and worthless. If you are experiencing depression, your hopeless, helpless, guilty, or worthless thought might not arrive with a spike of anxiety. Rather, you might already have those feelings and then the content of your thinking arrives in your mind with a ruminative texture that reinforces the depressive mood. This is also inflated responsibility. The nature of depression is that helpless, hopeless, guilty, and worthless thoughts and feelings arrive in your body and then you behave as though those thoughts and feelings are true, giving them more meaning than they deserve.

Recovery from depression involves understanding the depressive pattern and attempting to bring flexibility to depression reinforcing behaviors. As an example, if you are feeling worthless and helpless, your behavioral urge will be to give up. Any problem-solving behavior (to which you do not add self-criticism) has the opportunity to shift your feelings of worthlessness and helplessness.

Positive outlook towards responsibility of thoughts – The belief that what shows up in your mind has special meaning and is important for its own sake creates experiences that may not involve a spike of anxiety, but maintain inflated responsibility nonetheless. The following specific beliefs will keep you stuck in your thoughts, regardless of content:

● If I worry about something, that means I care. Or if I don’t worry that means I don’t care enough.

● Worry protects me from surprises, from having expectations that are too high, or from bad things happening to me.

● I would feel too uncertain or anxious if I didn’t worry. Or, if I’m feeling anxious or uncertain, I should worry to figure it out.

To overcome your positive outlook about responsibility of thoughts focus on choice and values.

● Am I choosing to think about this? If given the choice to think or act on this idea, is what I’m doing the best strategy to get a real answer?

● Do I value the time I spend on this?

● Would I choose to think about this and stay with this regardless of how I feel?