Need to know
Jasmine came to see me in therapy because she was worried that she was going to kill her newborn daughter. She explained that, only a day or two after arriving home from the hospital after giving birth, a disturbing thought had popped into her mind one evening while she was changing her daughter’s diaper: If I just put my hands around her throat and squeeze, she’d be dead almost instantly… Jasmine was distraught at the idea that she was going to do something terrible to her new daughter. ‘I don’t want to hurt her,’ she explained, ‘but I’m scared this means I secretly want to… I haven’t let myself be alone with her for the past 48 hours because I don’t want to take the chance.’
My client went on to describe how more and more thoughts like the one of her strangling her daughter had been popping into her head recently. And she was all but certain that she was either losing her mind or secretly some kind of violent psychopath.
Thankfully, after a handful more questions, I was able to tell Jasmine confidently that I didn’t think she was either losing her mind or a psychopath. I also told her that I didn’t think there was any risk she would actually harm her daughter. And in fact, I thought it would be fine if she went home right now and held her daughter all by herself. I explained that what she was experiencing were unwanted intrusive thoughts, and that they were a symptom of anxiety, not delusions or psychopathy.
Over the course of several months, I worked with Jasmine to change the way that she thought about and reacted to her unwanted intrusive thoughts. By learning to respond to them as disturbing but not dangerous, both the frequency and intensity of Jasmine’s intrusive thoughts diminished significantly. And most importantly, she was able to be with her daughter and enjoy their early days together without the constant dread that she might do something awful.
We all have many thoughts throughout the day – ideas, beliefs, stories, plans or images that run through our minds. Often our thoughts are under conscious control, meaning that we initiate them and direct them to some extent: if you notice that you’re hungry, you might think about the closest place to find food. But not all thoughts are under our direct control.
Some thoughts simply show up in consciousness. If you have ever suddenly remembered a meeting or appointment you’d forgotten about, you know that thoughts can come about without your conscious intention or control. These are intrusive thoughts – thoughts that happen without our consent or effort. And while they are often beneficial or mundane, they can sometimes seem scary or even disturbing, in which case psychologists refer to them as unwanted intrusive thoughts.
Unwanted intrusive thoughts are quite common. Studies suggest that more than 90 per cent of people experience them at some point, and common themes include aggression, contamination and sexually inappropriate behaviour.
Some traditional psychological theories have suggested that intrusive thoughts represent unconscious desires or wishes, however no evidence supports this claim. Consequently, most modern psychotherapeutic approaches, such as cognitive behavioural therapy (CBT) – to which I personally subscribe – consider that the initial cause of intrusive thoughts is often simply random or unknown. All kinds of thoughts pop into our minds throughout the day, so the fact that occasionally there are frightening or disturbing ones isn’t surprising statistically.
Although intrusive thoughts don’t typically have a specific cause or origin, they can result specifically from trauma. In post-traumatic stress disorder, for example, it’s quite common to experience intrusive thoughts about the traumatic event for months or even years after the event itself.
When unwanted intrusive thoughts become frequent and distressing, as in Jasmine’s case, the reason has to do with how a person views and responds to these thoughts, not the thoughts themselves. For decades, we’ve known that thought suppression – deliberately trying to get rid of or avoid a thought – actually makes it more likely for that thought to show up in our consciousness.
In the now famous ‘white bear’ study in 1987, the psychologist Daniel Wegner and colleagues showed that explicitly instructing participants to not think of a white bear during a study task resulted in an ironic ‘rebound’ effect where thoughts of a white bear became even more frequent. Wegner later developed his ‘ironic process’ theory of thought suppression, which held that, although suppressing a thought can reduce its frequency in the short term, the mind then ‘checks in’ on that thought again in the future, resulting in more intrusions. It’s as if the extra attention that you give a thought by trying to suppress it tells your brain: ‘This thought is extra important, so remind me about it later.’
This ‘ironic process’ is the key driver of frequent unwanted intrusive thoughts in conditions such as obsessive-compulsive disorder (OCD): just as with the irrepressible white bears, the more you try deliberately not to have a scary thought, the more your brain will ‘check in’ on that thought later. This is how the occasional unwanted intrusive thought becomes a vicious cycle of intrusive thoughts, avoidance and anxiety. The key to escaping this cycle is to change your relationship with your thoughts.
In my own work as a CBT therapist, I start with the assumption that, however disturbing they might be, unwanted intrusive thoughts have neither a fixed meaning nor do they predict with any accuracy how a person will behave. Whereas some other psychotherapeutic schools might hold that unwanted intrusive thoughts represent a hidden unconscious urge or desire, my approach recognises that they don’t necessarily have to mean anything. That people with unwanted intrusive thoughts are terrified by them and deliberately try not to act them out strongly suggests that they in fact desire the opposite. Indeed, research suggests that the presence of unwanted intrusive thoughts doesn’t increase the risk of acting out the content of the thoughts.
