Get Out Of My Head! - a note on intrusive thoughts

Intrusive thoughts are typically defined as some version of thoughts that come through in an unwanted, distressing manner when you are not thinking of anything related to them. I will start by giving a few examples of some of the most common intrusive thoughts that I have heard in my work or in my study:

1. You are driving over a bridge. You think "What if I drive off this bridge right now?" without any intent to do so and being frightened by the thought. You then might worry "what if my arms immediately pull to the side without me wanting this?" -- you may even picture this happening before your eyes, causing a great deal of distress. This is also typical of highway driving/going into oncoming traffic++

2. New parents (or aunts, uncles, grandparents, friends) are holding their baby and think of themselves dropping the baby. They might even "see" it happen before their own eyes, again with a great deal of distress.

3. Thoughts of stealing items in a store without any intent to do so.

4. Thoughts of cheating on partners, exams, etc

5. Thoughts of bringing harm to others++

6. Thoughts of harm coming to those you love (seeing images of them in car accidents, plane crashes, etc before your eyes)

7. Unwanted sexual thoughts/feelings

++Please note that this is different from suicidal or homicidal thoughts. The main difference here is that the thought itself causes an immense deal of stress when it comes about, and it is not called on in any fashion, but rather "thrown before your eyes" in a way that is out of your control. If you are wanting (not worrying about) to act on these thoughts, they are likely a somewhat different concern than what this post is about and you should seek support from a therapist in processing them in a slightly different manner.

Another thing I would like to clarify is that when I am referring to "seeing images" I am not referring to hallucinations. I am speaking to a flash in one's consciousness, much like a movie playing in your head or a daydream/nightmare, as opposed to something happening outside of your body.

Intrusive thoughts are extremely common. Even if I haven't shared an example that resonates with you, know that almost every single person has intrusive thoughts of some kind. However, for many people, they may have this "flash" or short experience and then let it go without much stress - "Of course I am not going to drop the baby" and letting that thought go without significant emotion behind it. For individuals with Generalized Anxiety Disorder, Panic Disorder, Post-Traumatic Stress Disorder, and [particularly] Obsessive-Compulsive Disorder, these thoughts can be debilitating. For these individuals, they have assigned meaning to these thoughts -- "WHY am I thinking this thing? Does this mean I am a monster or that I actually WANT this to happen?" -- what I have shared with clients who struggle with these questions is this -- the exact reason that you are distressed about it is letting you know that you are not going to act on these thoughts.

Assigning a greater meaning to thoughts in general is something that I discuss a lot with folks who are dealing with all sorts of mental health concerns. The concept of thoughts, feelings, and behaviors being connected comes out of Cognitive-Behavioral Therapy (CBT), but it also lays the groundwork for a lot of other therapeutic work. In a later blog post, I will go into more detail about Eye Movement Desensitization Reprocessing (EMDR) therapy, but thoughts and beliefs about oneself in relation to these thoughts are a huge component of EMDR therapy. So you can see why negative thought patterns - in particular ones that you cannot even control, such as intrusive thoughts - can cause a ripple effect and problems related to self-esteem, self-doubt, etc can all be affected.

So what do you do with these unwanted thoughts? The first instinct that most people have is to get rid of them immediately. For individuals with OCD (some, but not all, despite how OCD is depicted in most media), this often leads to a compulsion - "Now I have to count to seven in order to prove that I don't actually want this to happen." For others, it could be "checking" behaviors - "Am I doing this right?" or "do I seem okay to you?" or calling loved ones multiple times to make sure that they are okay. For others, it might mean that you avoid - passing the baby to someone else, having other people drive, sitting in a corner during an exam - so that you don't have to deal with the intrusive thought from the beginning. But for the majority of people, this means trying to push it down or out of their heads in a cognitive way (rather than behaviorally, like a compulsion or checking action). A metaphor I like to use is one of trying to push a beach ball underneath the water in a pool -- what happens? You will notice that it takes a lot of energy and then when you let go (as you must, eventually), it will come popping back and you'll have even less control as when it was just floating along on the surface. People might try to not think about certain things or say things like "that is ridiculous" and try to distract themselves, without paying attention to what is happening in their bodies.

So what should you do when you have an intrusive thought?

In the moment...

1. Name what is happening "that was an intrusive thought"

2. Try to notice how you feel without judgment "I am feeling anxious" not "What is wrong with me for thinking that?"

3. Try to think of a metaphor such as a train coming into a station, stopping, and then continuing. We don't want to get on the intrusive thought train - we are just noticing that it has come, acknowledging it, and letting it go.

4. Remember that you have about 60,000 thoughts a day. That was just one of them.

After the thought has passed, but you might be thinking about it later:

1. Again, notice any blaming language - are you blaming yourself for your thoughts? If so, do you blame yourself for weird dreams that you have? Similar concept.

2. Try to thank the intrusive thought for one piece of what it has done. "Thank you for reminding me how precious my baby is to me and how I want to be mindful when holding her."

3. Try to remember that your thoughts do not define you - it is about what you do/don't do about those thoughts that counts. If you have had a thought that it might be cool to be a zebra, does that make you any closer to actually being a zebra? No. When we get to a place where we can know that our thoughts are just thoughts, it can be very freeing.

4. Notice any themes that may arise from what the intrusive thought is about and bring them to your therapist. For example, monitoring your behavior, trusting your body/mind, worries about failure -- there is usually some unprocessed emotional material in there that could be trying to get your attention. An important distinction to make here is that you don't want to jump to "well the theme is that I am a monster" -- perhaps the theme is that you are worried that you are/will become a monster, but we want to avoid the cause and effect concept "I think, therefore I am"

5. Talking about them takes away some of their power. I have had so many people share with me that once they have named their intrusive thoughts in therapy, they have seemed less distressing.

6. Offer a replacement thought

7. Be patient and kind with yourself. Know that you are in control of your behavior, despite what your intrusive thoughts want you think.

Lastly, one strategy that can be helpful is related back to what the last post was about - monitoring how much distress you are in. I am not suggesting you get rid of the distress - definitely not. I am just asking that you are mindful of how much you are letting the distress of a thought alter your state of being. For example, it is possible that you could drop the baby - of course - but how likely is that to happen? And how much time are you worrying about it? If you will drop the baby 0.01% of the time, are you worrying about it that percentage of the time that you are thinking about it? Probably not.

I myself have dealt with intrusive thoughts, and I have found these strategies to be immensely helpful on a personal level as well as a professional one. Even though you are the only one in your specific brain, you are not alone in the experience of intrusive thoughts.