Overcoming Unwanted Intrusive Thoughts: A CBT-Based Guide to Getting Over Frightening, Obsessive, or Disturbing Thoughts

by Sally M. Winston PsyD

Or are you plagued by a thought that you might have already done something bad and somehow it slipped past you? Or that the fact that this thought has crossed your mind must mean something important?

These upsetting, distressing, frightening thoughts that enter your mind unbidden are called unwanted intrusive thoughts. Sane and good people have them.

Trying to keep thoughts out of your mind doesn’t work for you. It doesn’t work for anybody.

We would like you to start with the realization that there is nothing wrong with you, but there is something quite wrong with your method. And here is where this book can be helpful. We believe that giving your thoughts a name, helping you understand that you are not alone, and addressing the thoughts without shame and fear will go a long way toward reducing your misery.

Will recovery be easy? Probably not, because you will have to unlearn many unhelpful thinking habits, as well as your automatic emotional reactions to these thoughts and the ways you try to avoid them.

Just about everyone has intrusive thoughts. They are uninvited thoughts that jump into the mind and do not seem to be part of the ongoing flow of intentional thinking. Intrusive

Helpful Fact: Almost everyone has passing intrusive thoughts.

unwanted intrusive thought starts as just an ordinary intrusive thought, weird, funny, or repugnant as it may be. But not wanting the thought, worrying about it, or fighting with it stops it from passing quickly. Chances are, you don’t want it because you are upset or turned off by the content. But that is just the beginning. Because you worry about it, reject it, and try to push it out of your mind, it pushes back and becomes a recurring thought

unwanted intrusive thought sometimes feels like an impulse to perform an unwanted action. Other times, it feels impossibly stuck in your head. Your efforts to deal with it become all-encompassing and take up so much time, mental energy, and focus that your quality of life is degraded.

In the case of unwanted intrusive thoughts, there are three voices that are particularly relevant.

So we introduce you to the voices that we call “Worried Voice,” “False Comfort,” and “Wise Mind.”

Let’s start with Worried Voice, the voice of frightening imaginings. Worried Voice is the voice of “What if?” Worried Voice articulates the fears and doubts and misguided conclusions that predict tragedies and awful outcomes. This

Next is False Comfort. False Comfort invariably follows the “What if?” of Worried Voice. False Comfort is disturbed by these questions and tries to remove the discomfort. We call this voice False Comfort because it never achieves its goal. It often gives brief relief and the illusion of rationality. But it does not ultimately silence Worried Voice. In fact, it does the opposite.

Worried Voice and False Comfort invariably launch into a back-and-forth argument. This is the commentary that is part and parcel of every unwanted intrusive thought.

Helpful Fact: Your commentary, in the form of the back-and-forth arguments between Worried Voice and False Comfort, can be the most distressing aspect of your unwanted intrusive thought.

Finally, we welcome Wise Mind, who watches the constant arguments between Worried Voice and False Comfort from...

Wise Mind demonstrates mindful compassionate awareness.

A mindful attitude is made possible because there is a part of you that can stand back and look at your experiences—in real time—with perspective.

Helpful Fact: Observing and letting go of your commentary will go a long way toward gaining some relief from your intrusive thoughts.

“The Imp of the Perverse.” The phenomenon is that when you try not to think of something, you end up thinking about it even more. It’s

But let’s look at what you have done. You have created a “stuck” thought! The content of the thought is carrots, which is about as uncontroversial and non-upsetting as can be, but that thought has become stuck in your mind.

The simple truth is that what you resist tends to persist. This is the basic paradox—the ironic process—at work in making unwanted intrusive thoughts so persistent. Thoughts stick because of the energy you expend to fight them.

Helpful Fact: Thoughts stick because of the energy you expend to fight them.

People who have felt assaulted by thoughts of hurting others are loving people. That is why these thoughts are fought—and then become stuck.

So the content of unwanted intrusive thoughts is the opposite of what you want to be thinking about. It is the opposite of your values, the opposite of your wishes, and the opposite of your character. It is the opposite of you.

Suffering about unwanted intrusive thoughts is a disorder of overcontrol, not undercontrol. (Undercontrol disorders are sometimes known as impulsivity.) Disorders of overcontrol are usually accompanied by a problem with doubt or uncertainty. Put the two together—trying to control those things that you cannot control (in this case, your thoughts) and wanting to be absolutely, 100 percent sure that nothing bad will happen—and you have the formula for unwanted intrusive thoughts.

People who are impulsive act first and think later. People with unwanted intrusive thoughts are over-thinkers.

Helpful Fact: Despite how they might feel, impulses and intrusive thoughts couldn’t be more different.

You might have already discovered some of the factors. People are much more prone to unwanted intrusive thoughts when they are fatigued, have slept poorly, or are in a bad mood (anxious, crabby, irritable, feeling down or blue).

The day after consuming alcohol is usually a sticky day for most people.

and when you are lying down to sleep.

You know that some days our mind is stickier than other days, and it is easy to get worried about having sticky thoughts on those days. But avoiding makes the mind even stickier. It suggests that you are fragile or impaired on “sticky mind” days. You feel resentful, and you miss out on things. And you give yourself a message that somehow sticky thoughts are more dangerous on those days. Go on out. Shopping thoughts are just thoughts even in sticky times.

Any situation that is uncertain and has “high stakes” is a perfect place for stickiness of the mind to increase. As soon as it seems important to know something 100 percent for sure, that is where the unwanted intrusive thoughts will find their opening.

Look, you guys, nothing in life is risk-free—really, nothing. You can live with it or drive yourselves nuts around it. It’s up to you.

If you are already disturbed by your thoughts and working hard to keep them out of your mind, reading about a mother who murders her children or a gunman who shoots innocent children can very well trigger an intense spike of anxiety. This is because you are sensitized to that thought, not because you are going to do that.

Remember that your fearful reaction to reading about an incident initiates the process of trying to fight the thought, and the ironic process of the mind can take over and increase your disturbing thoughts dramatically.

And of, course, we are most afraid of things that would be terrible if they did happen, regardless of how unlikely or even virtually impossible they may be. This is another time when anxious people confuse the difference between stakes and odds. So if the stakes are high (like death, humiliation, or jail), then it really doesn’t seem to matter how unlikely it might be. And, of course, the media tend to focus on those events that are awful, dramatic, and traumatic.

Helpful Fact: Contrary to common sense, reducing your effort to avoid intrusive thoughts will often lead to less distress.

You may find that reading it might trigger increased anxiety and distress because you have put so much effort and energy into trying not to think these thoughts. But we know that whatever temporary upset you might feel, finding your own particular variety of unwanted intrusive thoughts will be extremely helpful.

Morally Repugnant Thoughts The first types of unwanted intrusive thoughts are about things that are morally repugnant. They include harming and self-harming, sexual, impure religious, and disgust-causing thoughts.

Harming and Self-Harming Thoughts The most common morally repugnant thoughts are of harming, either yourself or someone else.

Forbidden Sexual Thoughts Forbidden sexual thoughts are also common and can include thinking about sexual relations with relatives and children as well as unsavory or extramarital relations.

Impure or Blasphemous Religious Thoughts

pray harder to get my mind off the topics, but then I hear blasphemous things in my mind. I think I am being punished for a past transgression, but I do not know what it was, and I cannot pray for proper forgiveness. So I am praying more and more.

Disgust-Causing Intrusions These are thoughts that bother and disgust you, and take away from pleasure in life or the anticipation of pleasure. They usually occur when you engage in something pleasurable. These can include the belief that you

“Big Issue” Thoughts The next type of intrusive thought falls in the category of big issues and involves continual episodes of trying to answer questions about these issues that are essentially unanswerable. The most common ones involve the questions of uncertainty and lack of guarantees in life, the nature of reality, the purpose of life, and how can you know if you really, really believe or feel something. These questions seem really important and almost always involve questions with many dimensions and no definite answers.

Uncertainty and Unknowability Thoughts Being unwilling to accept that we cannot know or guarantee the future leads to this kind of preoccupation.

Questioning Reality It is one thing to have a truly philosophical curiosity about the nature of reality and quite another to be extremely upset and constantly preoccupied by such questions that do not have clear answers.

Purpose-of-Life Thoughts Some people have intense and persistent trouble knowing we will die and the implications of that. As a result, they feel compelled to repeatedly address this question every time a thought about it pops up. What is the purpose of life? Is there an afterlife; what if there isn’t?

Questioning Beliefs Our minds are filled with inconsistencies, ambivalences, and constant change.