Back to Basics. This newsletter is an updated review. Sometimes people forget what they first learn, and so I’m presenting an overview here.
If you have experienced anxiety, then you know about intrusive thoughts. Intrusive thoughts are frightening thoughts about what might happen to you or someone you care about, or what you might do to yourself or another person. They seem to come from outside of your control, and their content feels alien and threatening.
For some people, intrusive thoughts are part and parcel of panic or some other intense anxiety. In these types of intrusive thoughts, it feels like the thoughts come about as a result of the anxiety, and they function to add more fear to the anxiety one is already experiencing. The intrusive thoughts keep the anxiety going, and maintain the fear-producing spiral. So, for example, you might think, “what if I have a heart attack?” in the midst of an anxiety attack. You are already in the altered state of consciousness that I call anxious thinking, and your thoughts feel likely to happen.
However, there is another class of intrusive thoughts that are called unwanted intrusive thoughts. These thoughts seem to come from out of nowhere, arrive with a distressing whoosh, and cause a great deal of anxiety. The content of unwanted intrusive thoughts often focus on sexual or violent or socially unacceptable images. Here are typical examples: “Killing someone. Torturing a pet animal. Stabbing a child. Throwing someone (or yourself) out of a window. Jumping onto a train track as the train comes into the station. Molesting a child. Raping someone. Taking off your clothes in public. Doing something disgusting or crazy” This is not a complete list, but it gives you a good feeling of the content of these thoughts.
People who experience unwanted intrusive thoughts are afraid that they might commit the acts they picture in their mind. They might imagine hurting someone or committing an act of sexual violation. Intrusive obsessive thoughts can be very explicit, and most people are embarrassed and frightened of them.
There are many myths about unwanted intrusive thoughts. One of the most distressing myths is that having thoughts of a sexual or violent or socially inappropriate nature mean that you want to do the things that come into your mind. This is simply not true. People do not want to do the things that enter their mind when they have unwanted intrusive thoughts. In fact, the opposite is true. It is the effort people use to fight the thought that makes it stick and fuels its return. People fight thoughts because the content seems alien, unacceptable, and at odds with who they are. So, people with violent unwanted intrusive thoughts are gentle people. People who have unwanted intrusive thoughts about suicide love life. And those who have thoughts of yelling blasphemies in church value their religious life.
The problem for people who have these thoughts–and one estimate is that more than 6 million people in the United States are troubled by them– is that unwanted intrusive thoughts feel so darn threatening. That is because anxious thinking takes over, and the thought—as abhorrent as it might be—seems to have a high probability of occurring. And, even if the probability is fairly low, the consequences of killing someone, or throwing a child out the window, and the like, are so enormous and horrendous, that the thought feels threatening and dangerous.
The Big Answer to Overcoming Unwanted Intrusive Thoughts:
People who are bothered by intrusive thoughts need to learn a new relationship to their thoughts. They have to learn that sometimes the content of thoughts are irrelevant . That everyone has occasional weird, bizarre, socially improper and violent thoughts. Our brains sometimes create junk thoughts, and these thoughts are just part of the flotsam and jetsam of our stream of consciousness. Junk thoughts are meaningless.
If you don’t pay attention or get involved with them, they dissipate and get washed away in the flow of consciousness.
In reality, unwanted intrusive thoughts have no effect on what people do. A thought—even a very scary thought—is not an impulse. People do not act on unwanted intrusive thoughts. The problem is not one of impulse control- it is over control and part of an anxiety disorder. They are at opposite ends of the continuum.
However, sufferers get bluffed by their anxiety, and they become desperate for reassurance. They want a guarantee that they won’t act on their thoughts. But guarantees are for products one buys, not for real life situations. Guarantees in real life don’t exist. If I told a patient that no one has ever acted on intrusive obsessive thoughts, they might say, “Well, there is always a first time.” We all know that there are certain things in life that have a very small probability of occurring, and it makes sense to live our life as if they won’t occur. For example, there is a tiny probability that a meteorite will fall out of the sky and hit you as you are reading this. I can’t give you a guarantee that it won’t happen, but the odds as so infinitesimally small that it makes sense to ignore the possibility. The same reasoning applies to intrusive obsessive thoughts.
But there is even more of a problem with reassurance: people become addicted to it and become reassurance junkies. They want reassurances because they are sensitized to the intrusive thought. That creates anxious thinking—the altered state of reality that makes thoughts feel like they will really happen. The only way to effectively deal with intrusive obsessive thoughts is by reducing one’s sensitivity to them. Not by being reassured that it won’t happen.
I like to remind patients that the content of their thought is irrelevant and they do best when they apply the paradoxical approach to cope with them: this means that if you try to engage your thoughts in any way—such as reasoning with them, pushing them away, altering your behavior to stay away from threatening situations—all these approaches will only serve to make the thoughts stronger and more intrusive. Here, as with other forms of anxiety, the operative rule is less is more. Leave the thoughts alone, treat them as if they are not even interesting, and they will eventually fade into the background.
Here are Steps for coping with Unwanted Intrusive Thoughts That I suggest to my patients:
- Label these thoughts as “intrusive thoughts.”
- Remind yourself that these thoughts are automatic.
- Accept and allow the thoughts into your mind. Do not try to push them away.
- Float, and practice allowing time to pass.
- Remember that less is more. Pause. Give yourself time. There is no urgency.
- Expect the thoughts to come back again
- Continue whatever you were doing prior to the intrusive thought.
- (I sometimes call this part LAD: Label, Accept, Don’t bother.)
- Label the thought
- Accept the feeling it gives you.
- Don’t bother to engage in avoidance and safety seeking behaviors. They work backwards.
Try Not To:
- Engage the thoughts in any way.
- Push the thoughts out of your mind.
- Try to figure out what your thoughts “mean.”
- Convince yourself that you would never do what the thoughts are saying.
- Change your behavior so that you avoid the possibility of acting on your thoughts.
- Label these as intrusive thoughts.
- Number your anxiety level and watch it go up and down.
- Allow the thoughts to remain without hindrance. (They will go away on their own).
- Focus on managing your anxiety in the present. (That means staying with What is as oppose to What if?)
This approach can be difficult to apply. But for anyone who keeps applying it for just a few weeks, there is an excellent chance that they will see a decrease in the frequency and intensity of the unwanted intrusive thoughts.
Martin N. Seif, Ph.D., ABPP