Magical Thinking: A Double-edged Sword

Most of us occasionally rely on magical thinking as a way to calm our nerves during stressful times, but what you may not know is that the inability to ignore intrusive thoughts be quite psychologically dangerous.


If you have missed part 1, be sure to check it out. As a short recap, MT is a psychological thought process that blurs the line between reality and imagination, urging one to use irrational and peculiar beliefs under the intention of preventing misfortune, e.g. ‘Using your lucky pen during exams will stop you from failing.’ Usually developing in children around the ages of three to four, MT becomes absent as children understand the natural laws by the time they are eight [1]. However, MT can persist in adults who experience anxiety as a coping mechanism and performance enhancer [1].


Aside from the occasional knuckle injury you might get from knocking on wood too many times, magical thinking can have detrimental consequences to an individual's psychological well being. When most of us experience intrusive thoughts we are able to ignore them, but the dysfunctional interpretation of these thoughts may be related to psychological disorders such as OCD and schizophrenia. [2].



Schizophrenia

According to the Diagnostic and Statistical Manual of Mental Disorders- IV-TR, MT is one of the defining characteristics of schizotypal personality disorder (SPD). SPD and schizophrenia share similarities, brief psychotic episodes with delusion and hallucinations, although in SPD the episodes are not as frequent and prolonged as in schizophrenia. In addition to being a predictor of developing schizophrenia, MT has also been linked to the occurrence of auditory hallucinations. These imaginary voices can validate the intrusive thoughts and further compound the damage caused by them [3].


MT has been found to be prominent in adults with schizophrenia compared to the normal population and non-schizophrenic psychiatric patients. In a study by García-Montes et al, participants completed the magical ideation scale, a 30-item true/false measure examining individual perceptions of cause-effect relationships, e.g. ‘ I have sometimes been fearful of stepping on sidewalk cracks.’ The study concluded that magical thinking distinguishes schizophrenic patients with auditory hallucinations from patients with psychosis and non-patients [4].


A complimentary study by Dubal & Viaud-Delmon demonstrated that individuals who experienced high levels of magical thinking were more vulnerable to auditory sensitivity (hyperacusis) as shown by figure 1. Hyperactivity of auditory areas triggers auditory sensitivity in hyperacusis, similarly auditory hallucinations occur due to spontaneous activation of the auditory cortex. Therefore, MT may be a factor predisposing auditory hallucinations [5].


Therefore, MT may manifest in schizophrenia through auditory hallucinations and contribute to the worsening of intrusive thoughts.


Figure 1: Individual hyperacusis score depending upon control, Physical Anhedonia scale (measures an individual’s inability to experience pleasure) and the magical ideation score (measure beliefs about forms of causation). Figure from Debal & Viaud-Delmon [5].



Obsessive-Compulsive Disorder (OCD)

MT in OCD manifests a bit differently - through beliefs that particular thoughts or actions will have a casual influence over outcomes [6]. When an individual completes actions such as, knocking and checking, MT then has the ability to subdue intrusive thoughts and provide the individual with a false sense of control, e.g. ‘If I don’t knock on the table 50 times then I’m going to fail my test.’


MT is the primary cognitive feature of the symptoms associated with OCD [6]. MT manifests in OCD through compulsions and urges individuals into believing their compulsions are protecting them and those around them from harm [6], e.g. ‘ If I don’t check outside the window repeatedly then they might not make it home.’Helgadottir et al., recruited participants to complete five questionnaires assessing different levels of MT, stress and anxiety in individuals experiencing OC symptoms. Furthermore, OC symptoms were higher in populations with high MT measures. Even when variables such as anxiety and stress were held constant, MT continued to remain significantly associated with OC symptoms, suggesting a notable relationship between the two [7].


Therefore, MT can disrupt an individual’s psychological health by worsening their OC symptoms.



Treatment of magical thinking

Treatment for pathological magical thinking requires addressing intrusive thoughts and understanding that the misinterpretation of these thoughts are related to psychological disorders.


A common treatment method for magical thinking is cognitive behavioural therapy (CBT) [9]. It is a goal-orientated psychotherapy treatment involving hands-on tactics to help individuals recognise their thought patterns and understand that misinterpreting these intrusive thoughts only worsen them [10]. Mindfulness-based therapy integrates CBT methods with mindfulness meditation practises to promote awareness to the present moment, enabling the individual to choose where their attention will be directed [10]. This process promotes the ability to observe and experience thoughts as they come and go without trying to suppress them. As shown in Figure 2, the participant reported a significant decrease in Thought-Action fusion (a form of magical thinking, in which the individual believes thinking of an action is equivalent to performing the action), suppression behaviour and distress when practising mindfulness. Another study by Wilkinson-Tough and team reported a mean reduction of 10.5% in the Yale-Brown Obsessive-Compulsive Scale score after 3 patients with OCD participated in just six 1-hour sessions of mindfulness therapy over 3 weeks [10]. Several case reports of patients with severe OCD found that mindfulness-based therapy had experienced notable reductions in intrusive thoughts. Mindfulness-based treatment was effective in reducing intrusive thoughts in patients, presenting increased awareness and the resistance to suppress thoughts to be valuable techniques [11].


In a review article examining the effectiveness of mindfulness-based therapy on patients with mild-severe OCD, there were significant reductions in OCD symptoms such as intrusive thoughts [12]. In addition, three out of the four studies reported patients experiencing an improvement in their quality of life, they were able to return to full-time employment and felt less distress [12]. Therefore, mindfulness- based therapy provides a promising outcome for individuals with intrusive thoughts.


Figure 2: A participant’s daily ratings of Thought-action fusion, suppression and distress in response to mindfulness. Figure from Wilkinson-Tough et al. [10]


MT is able to manifest in different psychological disorders and worsen intrusive thoughts. Although there are many effective measures that can be taken to understand the occurrence of intrusive thoughts and disregard them, it remains important to have a strong grasp of reality and not get too wild with your imagination.


Instead of being superstitious, perhaps try being just a little stitious.


References

1. Phelps K, Woolley J. The form and function of young children's magical beliefs. Developmental Psychology.1994;30(3):385-394. DOI: 10.1037/0012-1649.30.3.385


2. Fite R, Adut S, Magee J. Do you believe in magical thinking? Examining magical thinking as a mediator between obsessive-compulsive belief domains and symptoms. Behavioural and Cognitive Psychotherapy[Internet]. 2020. 48(4):454-462.

3. Rosell DR, Futterman SE, McMaster A, Siever LJ. Schizotypal personality disorder: a current review. Curr Psychiatry Rep. [Internet]. 2014.16(7):452. doi:10.1007/s11920-014-0452-1


4. García-Montes J, Pérez-Álvarez M, Odriozola-González P, Vallina-Fernández O, Perona-Garcelán S. The role of magical thinking in hallucinations. Comparisons of clinical and non-clinical groups. Nordic Journal of Psychiatry [Internet]. 2014 [cited 13 July 2020];68(8):605-610. DOI:10.3109/08039488.2014.902500


5. Dubal S, VauddelmonI I. Magical ideation and hyperacusis. Cortex [Internet]. 2008 [cited 3 July 2020];44(10):1379-1386. DOI: 10.1016/j.cortex.2007.06.008


6. Evans, D. W., Milanak, M. E., Medeiros, B., & Ross, J. L. Magical beliefs and rituals in young children. Child psychiatry and human development [Internet]. 2002 [cited 19 December 2020];33(1), 43–58. DOI: 10.1023/a:1016516205827


7. Helgadóttir F, Menzies R, Einstein D. Magical thinking and obsessive–compulsive symptoms in Australia and Iceland: A cross-cultural comparison. Journal of Obsessive-Compulsive and Related Disorders [Internet]. 2012. 1(3):216-219. DOI:10.1016/j.jocrd.2012.04.004


8. Foa EB. Cognitive behavioral therapy of obsessive-compulsive disorder. Dialogues Clin Neurosci. 2010.12(2):199-207.


9. Ben Martin P. In-Depth: Cognitive Behavioral Therapy [Internet]. Psych Central. 2020.


10. Wilkinson-Tough M, Bocci L, Thorne K, Herlihy J. Is mindfulness-based therapy an effective intervention for obsessive-intrusive thoughts: a case series. Clinical Psychology & Psychotherapy [Internet]. 2009. DOI: 10.1002/cpp.665


11. Hollander E, Allen A, Steiner M, Wheadon D, Oakes R, Burnham D. Acute and Long-Term Treatment and Prevention of Relapse of Obsessive-Compulsive Disorder With Paroxetine. The Journal of Clinical Psychiatry [Internet]. 2003. 64(9):1113-1121. DOI: 10.4088/jcp.v64n0919


12. Hale, L., Strauss, C. and Taylor, B., 2012. The Effectiveness and Acceptability of Mindfulness-Based Therapy for Obsessive Compulsive Disorder: A Review of the Literature. Mindfulness, [online] 4(4), pp.375-382.

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