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

by Sally M. Winston PsyD

Some people find this very disturbing and continually search for certainty. What do I really believe or feel about this?

Nonsensical Thoughts The third type of intrusive thoughts are ones that seem nonsensical, require rigorous mental checks when there doesn’t seem to any reason to do so, or involve incessant doubting.

Losing-Your-Mind Thoughts Some intrusive thoughts just seem utterly ridiculous as they whoosh into the mind for no apparent reason. They often feel like products of a mind on the edge of sanity. They are not.

Mental Checking This occurs alongside the feeling that something just doesn’t seem right and that you need to check that out.

Doubts About Relationships You fear that your intrusive doubting thought is an indication of something being or going wrong, despite little evidence to the contrary.

Scrupulous Thoughts These involve judgments about yourself or others in action, intention, or character. This category includes both religious and nonreligious preoccupation with your thoughts about right and wrong and judging your or someone else’s attempts to be totally pure, good, kind, fair, and giving.

Sexual-Orientation and Sexual-Identity Thoughts These types of intrusive thoughts center around the fear that you might possibly be living a life that is different from your true sexual identity or orientation. Your thoughts are not like those of people who are truly trying to explore their sexuality. They are filled with terror, not curiosity, alongside an urgent need to know and to know for sure.

Intrusive Visual Images We can think in two different ways. One type of thinking is in the form of words, sort of talking to yourself inside your head. Another way is to have images or pictures in your mind. Although many intrusive thoughts are experienced as disturbing “self-talk,” there are a number that are almost exclusively visual images (Brewin et al. 2010). You may have noticed this yourself. Here are some of the most common kinds of intrusive visual images. Intrusive images can be static pictures or short “videos.” They may incorporate actual memories or be completely made up. Crazy or Humiliating Actions Many people think they are hallucinating when they have a visual image of themselves doing something crazy or humiliating in a social setting, but they are not. These visual images often happen during socially anxious situations, and they are simply imaginative products of stuck thoughts translated into images instead of words. I keep having an image of myself vomiting all over myself and other people—you know, like President Bush—whenever I am at a formal event. Whenever I am being interviewed and whenever I’m at a party, I imagine myself freezing or yelling out something that makes no sense,

Illness, Dying, and Death Scenes These disturbing pictures can intrude any time—when you are relaxed, having fun, driving, or anxious about something else.

Traumatic Memories Traumatic images and memory intrusions often happen when someone has PTSD, but they can also happen to someone with a sticky mind who is upset by a thought, a memory, or even an imagined image. These may be a sudden reexperiencing, as if the traumatic events are happening again in the present (usually called flashbacks), accompanied by fear or whatever emotion happened at the time. Or they may simply be vivid, fixed visual memories of real things that happened or were imagined at the time of the traumatic experience.

While flashbacks and traumatic memories are indeed just thoughts and images and are therefore not dangerous in and of themselves, they may be stored in the brain in a different way because of the high impact of the original experience. If there is actually PTSD and not just a sticky mind, there are additional treatment methods not in this book that may be helpful. It may be worth consulting a trauma specialist for help with the other PTSD symptoms that often go along with flashbacks and difficult memories.

really two types of worry—productive worry and toxic worry (Leahy 2005).

Productive worry is a form of planning: it starts with a problem and comes up with an answer to that problem and an action plan to follow. Plus—and this is important—the solution and action plan then stop the worrying.

Toxic worry, on the other hand, involves trying to solve an issue where the outcome is uncertain or unknowable and there is no good answer to form an action plan. So you start to “solve” the problem once and can’t seem to come up with any good answer. So the worry returns, and then the entire process continues to repeat. It becomes stuck. Toxic worry starts with a what-if and continues in an endless loop of unsatisfactory “solutions.” Attempts to solve the problem in order to reassure yourself fail.

What defines toxic worry is not what the worrying is about, but how the worries behave—they get stuck, repeat, escalate, and preoccupy. They don’t subside and take a back seat when no solution can be found. So you are trying to engage in mental problem solving, but all you come up with are other possible negative outcomes (Borkovec et al. 1983).

There are three types of toxic worry: single-topic, multi-topic, and meta-worry (worry about worry). Helpful Fact: Toxic worry is not defined by the worry topic, but how the worry thoughts behave.

Single-Topic Worrying Sometimes you can worry about just one thing, going over all the different possibilities and possible outcomes related to that single topic.

Multi-Topic Worrying Worry can also be expansive and often spreads creatively from one topic to another.

Meta-Worry (Worry About Worry) Here, you worry that your worrying will damage your health, indicate that you are an undesirable person, or point to some other negative aspect of yourself. I read in a magazine that worrying is stress on the immune system and stress can contribute to diabetes and heart disease. I do everything I can to control my worrying because I know it can make me sick. My friends tell me that I am shortening my life with all my worrying. I already do Pilates, and I even drink green tea and pomegranate juice, but they aren’t helping. Maybe I should quit my job? It’s so stressful!

Not Entirely Unwanted Intrusive Thoughts Sometimes we find ourselves with uninvited thoughts or imagined scenes that are embarrassing or upsetting, but they seem to help our mind deal with something bothersome or painful, about which there is really nothing to do. They may serve as a diversion in a trapped situation or as a fantasy that makes us feel less helpless.

Revenge Here is an example of invited thoughts that turn uninvited and intrusive when they are judged dangerous or wrong.

Bereavement It is not the images and thoughts of someone who died that are necessarily uninvited. But if you are trying to get over it and move on or if you are worried that you are grieving in an unhealthy way, a struggle ensues.

Love Sickness Falling in love can be totally obsessive at any age. Feeling unable to keep the thoughts in check can be difficult especially if people around you notice. You can feel like you are losing perspective and becoming out of control.

Resentment Sometimes we entertain thoughts we wish we did not, and we enjoy them and try to push them away at the same time. My friend inherited a lot of money, and she is naturally thin and can eat whatever she wants. The other day she got reprimanded at work, and I have to admit I had the thought, Finally something is not so easy for her! I am ashamed of myself for thinking this. Not entirely unwanted intrusive thoughts are only a problem if you start struggling with them, if you worry about them and what they mean, or if you judge them as sick or bad. They pass when the emotion that is driving them (anger, grief, early romance, resentment) subsides over time. They are not indications of character or impulses to be resisted: they are your rich imagination at work. No one is free of not entirely unwanted intrusive thoughts. It is only the struggle against them that is problematic

Personal Loss, Failure, or Mistake There are a number of unwanted intrusive thoughts that center around the theme of past or future mistakes.

When I was working as an attorney, I worked on a case that got a lot of press and we won the case. But now I keep thinking that I never shared a minor detail with the other side, and even though it was almost twenty years ago, I keep having the thought that if someone found out about this, my reputation could be ruined. I have asked my partner how important this is, and she says it is trivial and to stop worrying about it, but it comes to me at all hours of the day and night.

As soon as I submit a paper for publication, I have the thought that my statistical analysis was wrong or I left out a vital piece of data. Or there is something unethical in the research, and I worry about this ruining my career. It keeps me awake at night.

Helpful Fact: Most of your distress is caused not by what you think or feel, but how you feel about and react to what you think or feel.

There are nine myths about thoughts in general that contribute to intrusive thoughts becoming stuck.

Helpful Fact: Busting myths with facts about thoughts will make intrusive thoughts less sticky.

Myth 1: Our Thoughts Are Under Our Control Many people falsely believe that our thoughts are under our conscious control, and so we should be able to control our thoughts.

Fact: The fact is that many of our thoughts—and some researchers believe that most of our thoughts—are not under conscious control.

Ask anyone who practices meditation. We aren’t in control of it, and we aren’t responsible for it.

How often do you tell yourself to think confident thoughts, only to be aware of self-criticism and worries creeping in?

Wise Mind: Everyone’s mind goes everywhere. It could be interesting to watch. I have no need to stop any of it. Nor do you. Thoughts are just thoughts, and they just happen.

Myth 2: Our Thoughts Indicate Our Character Another thought myth is that thoughts speak to our character or underlying intentions and that some people have an underlying dark side that is revealed only in their thoughts.

Fact: We know that thoughts have nothing to do with character. Character is a reflection of how you lead your life. It relates to what you actually choose to do or choose not to do.

Character is about the choices you make in life, not what pops into your mind.

These fantasies fuel the false idea that one’s underlying thoughts reveal actual intentions or nature even if disavowed, as if there can be an inner demon that can leap out against your will.

Interestingly, often people apply this myth only to themselves and their own thoughts. If a friend relates a wild, repugnant, or nonsensical thought, you are quick to reassure him that minds are capricious, that these thoughts are not meaningful, and that you have not lost respect for him. It’s easy to joke about someone else’s intrusive thoughts.

Helpful Fact: Thoughts have nothing to do with character. Only chosen actions do.

Myth 3: Our Thoughts Indicate the Inner Self This is the belief that thoughts are paths to our inner self, sort of like eyes being windows to the soul.

Fact: The fact is that everyone has passing weird, aggressive, or crazy thoughts. If every thought spoke to underlying character, then 90 percent of people would be weird, aggressive, or crazy. That is because about 90 percent of people acknowledge having intrusive thoughts that they characterize as weird, aggressive, frightening, or crazy.

Myth 4: The Unconscious Mind Can Affect Actions This is the belief that our unconscious mind is a powerful force that directs our thoughts and behaviors, sometimes operating in the dark and against our conscious minds and will.

Fact: Analyzing the meaning of Freudian slips and automatic associations—including the content of dreams—are popular ways of trying to understand the complex workings of the unconscious mind. But the momentary thought of dropping your baby certainly does not reveal any unconscious wish to do harm. And the sudden thought that you could jump off the balcony because the railing is low does not reveal hidden unconscious suicidal wishes.

Unfortunately, they both believe this myth, that such thoughts are meaningful bits of the unconscious mind and require a response. Another example of this myth is believing that thoughts of doubt are messages, signals, or warnings from the wiser more perceptive unconscious.

But it is simply not true that feared thoughts are fueled by underlying wishes or are warnings that should be heeded. There is an old assumption, sometimes stated in the form “The wish is father to the fear,” suggesting that your fear of doing something terrible is caused by your desire to do it. This is a myth with nothing to support it. It does only one thing: it contributes to the fears of people with unwanted intrusive thoughts.

Myth 5: Thinking Something Makes It Likely to Happen Believing that thinking something somehow makes that thing more likely to happen or makes it more true is the basis of this myth.

Fact: This is a complete misunderstanding of what is known about thoughts. Psychologists call this myth thought-action fusion (Rachman 1993, Salkovskis 1985) or magical thinking. The fact is that a thought is not a message about what is going to happen. Similarly, a thought is not a prediction or a warning of an awful action or occurrence in the future. Thoughts

all the many other doubts and feelings that passed without coming true. Even more importantly, your thoughts cannot make unwanted actions or events happen. Thoughts do not change probabilities in the real world. Thoughts do not move objects, nor can they hurt people. Additionally, thoughts are not aspects of your unconscious that might become uncaged and leap up and take control if you don’t remain vigilant. Thinking that someone might die will not make him more likely to die; a wandering thought about what it would be like to be unfaithful to a partner does not make you seek an affair; a sudden fearful thought does not make real danger or disaster any more likely. Please don’t confuse thoughts with facts. A fact can be true, or it can be false. A thought is just a thought. Thoughts are often our guesses about the world around us and the way it seems to operate. Thoughts themselves have no effect on the world. Helpful Fact: Thoughts do not change probabilities