Intrusive thoughts are a common and disturbing symptom of anxiety. Cognitive behavioural techniques can help
by Nick Wignall + BIO
Detail from A Young Ladies Adventure (1922) by Paul Klee. Courtesy the Tate Gallery, London/ Getty
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.
If you or someone you love struggles with unwanted intrusive thoughts, the key insight to understand is that trying to get rid of the intrusive thoughts actually makes them worse, whereas being willing to experience and accept them makes them less intense.
Here are some practical steps you can take to change your relationship with unwanted intrusive thoughts and, in the process, teach your mind that, although they might seem disturbing or uncomfortable, your thoughts are not dangerous.
Acknowledge and label your intrusive thoughts. Avoid using terms such as ‘bad thoughts’ or ‘negative thoughts’. These labels reinforce the idea that the thoughts are dangerous and to be avoided. Instead, try to label them as something more neutral and realistic, for example ‘unwanted thoughts’ or ‘intrusive thoughts’. Briefly remind yourself that, although they might seem scary, unwanted intrusive thoughts are neither dangerous nor do they predict with any accuracy what you will actually do.
Write down your intrusive thoughts. It might help to ‘transcribe’ your unwanted intrusive thoughts on paper. When you notice an intrusive thought, jot down the specific thought or image you just experienced. This has two benefits: first, it forces you to slow down your thinking and tendency to worry because you can’t write nearly as fast as you can think. Second, taking the thoughts ‘out of your head’ and putting them on paper will help you get distance from them and give you a different perspective, making the thoughts feel less mysterious.
Validate your intrusive thoughts. To validate something means to recognise that it’s there, it’s real and it’s understandable, even if unpleasant. Remind yourself that it makes sense that your brain would remind you of these thoughts because you responded to them initially as if they were a threat. Although they’re unpleasant, intrusive thoughts are not a sign that your brain is broken or defective; it’s actually doing what it’s designed to do – make you aware of potentially dangerous things. In the same way that a fire alarm can get set off by a burnt batch of cookies, your brain is just a little confused about what’s dangerous and what isn’t.
Validate your own emotional response. Once you’ve validated the intrusive thoughts themselves, validate your own emotional response to them. Even if you know intellectually that intrusive thoughts aren’t dangerous, it’s understandable and completely normal that you might sometimes feel frightened and/or disturbed when they arise.
Redirect your attention. Once you’ve acknowledged and validated the intrusive thoughts and your own reactions to them, the final step is to gently but firmly redirect your attention elsewhere. Ultimately, continuing to ruminate, worry and brood about your intrusive thoughts maintains the false belief that they’re dangerous or a problem to be solved – which only increases the likelihood that your mind will continue surfacing the thoughts.
If you’re driving in the car, press play and start listening to that podcast you were looking forward to. If you’re in bed late at night, pull out your Kindle and read a little bit to allow your mind to relax and then eventually fall asleep.
Finally, be aware that redirecting your attention will be an ongoing process. Your attention will likely return to the intrusive thoughts from time to time. This is normal. Each time you notice your attention drifting to the intrusive thoughts, gently acknowledge that it’s not helpful and redirect back to the task at hand.
People often ask me: ‘Isn’t redirecting my attention the same as distracting myself from my thoughts or suppressing them?’ The difference is that with redirection you first acknowledge and validate the intrusive thoughts and only then shift your attention. The first step is crucial because it shows that you’re not afraid of the thoughts, while also not willing to stay fixed on them.
Mindfulness. Many people find that cultivating a mindfulness meditation practice can help them manage unwanted intrusive thoughts. In most forms of mindfulness, you practise holding your focus on something concrete, such as your breath or a mantra, and resist the urge to become distracted by other thoughts or sensations. This builds attentional control which can be helpful when it comes to disengaging from or redirecting your attention away from intrusive thoughts.
Postpone the thought. It’s often helpful to postpone thinking about an unwanted intrusive thought. To do this, create a dedicated time each day or once a week, when you deliberately recall, think about or write down your unwanted intrusive thoughts. Then, throughout the course of your day, if an intrusive thought comes up, postpone it by reminding yourself that you’ll think about it later, and then redirect your attention elsewhere.
Strategies to avoid or minimise. In addition to the above steps, it’s important to be aware of a few seemingly intuitive but ultimately unhelpful strategies that many people try when confronted with intrusive thoughts. Avoid these if you can:
To sum up, the most important question to ask yourself any time unwanted intrusive thoughts show up is this: What will my reaction to these thoughts teach my mind?
In other words, do your reactions to your intrusive thoughts communicate fear or confidence? If you find yourself wanting to do anything that looks like running away from or fighting with your thoughts, chances are you’re communicating fear, which will perpetuate the thoughts and your anxiety. On the other hand, if you can calmly approach those unwanted thoughts, observe them neutrally, then carry on with your day with the willingness to let them be a part of your experience, then you’re communicating confidence, which is the key to decreasing their frequency and intensity.
Perhaps the most powerful way to manage unwanted intrusive thoughts is to face them deliberately. Each time you calmly and deliberately approach your intrusive thoughts – and you experience that nothing terrible ensues as a result – you train your mind to see them as safe and, eventually, unimportant. This is known as ‘expectancy violation’ – when your negative expectations do not in fact come to be – and in this context, when repeated over time, it teaches your mind that, though they might seem scary, intrusive thoughts are not dangerous. As a result, your intrusive thoughts should decrease in both frequency and intensity in the long run.
Here’s a simple exercise that anyone can try to make serious headway against their intrusive thoughts.
The basic idea behind scheduled intrusion is to create a consistent time and place where you call to mind your unwanted thoughts on purpose, which has the effect of desensitising you to the fear attached to those thoughts.
Here’s how to get started:
This exercise, and the tips in the previous section, are often quite uncomfortable and difficult to complete. It’s important to always remind yourself that just because something feels bad doesn’t mean it really is bad or dangerous.
If something feels too difficult to implement, try breaking it down into smaller steps. For example, if doing scheduled intrusions for five minutes seems too daunting, it’s perfectly fine to do it for one minute. You might even try writing down a single thought at a time.
It’s also important to remember that what we’re dealing with here are mental habits, which means there are no immediate fixes. When you’re practising acknowledging and validating an intrusive thought and then redirecting, for example, it is normal for your mind to ‘pull’ you back to the thought. You very likely will have to make several attempts.
Finally, if you feel you can’t manage your unwanted intrusive thoughts on your own or if they’re causing you so much distress that they’re seriously impacting on your life – straining relationships, interfering with work, causing health issues – you should see a medical or mental health professional.
You can ask your primary care physician for a referral. Specifically, persistent unwanted intrusive thoughts are often a symptom of OCD, which is effectively treated by CBT and in some cases with medication as an adjunct.
The following suggestions are useful for learning more about unwanted intrusive thoughts and how best to cope with them: