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

by Sally M. Winston PsyD

Do you get upset or worried that your thoughts might actually lead you to do something awful? 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? Or is there a thought that drives you crazy because you just can’t manage to get it out of your mind? Do you live in dread that having bizarre, repetitive, repugnant, or unrelenting thoughts means something shameful or terrible about you? Do you hope and pray that these thoughts won’t come around again? But they do, and they continue to haunt you. They have become stuck.

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

Good people have awful thoughts. Violent thoughts come from gentle people. Crazy thoughts occur for people who are not the least bit crazy. You are not the only one who experiences repeating thoughts that just won’t leave your mind.

Helpful Fact: There is nothing wrong with you, just the way you are dealing with your thoughts.

Remember that knowledge is power, and the more you know about unwanted intrusive thoughts, the better you will be able to free yourself from the misery they bring.

The answer is learning an entirely new relationship to thoughts, which is being neither scared nor ashamed of them. Gradually, you will learn to tame those bullies in your head and live a life that is free from their torment.

Here is an intrusive thought that I had while writing this paragraph: I hope we lose power in this storm so I don’t have to keep working. The thought went winging by, and I made nothing of it. But here is the thing: if I were worried about my mind or my motives or my thoughts, I might be embarrassed to write this. I might worry about what the thought could mean about me. Shouldn’t I be enjoying my work? Does this mean I should retire? Am I getting burned-out? Could I be depressed if I want an excuse not to write this book? Why am I not concentrating? Do I really want to lose power? What is wrong with me that I thought that? Or, I might wonder that perhaps I have received a special message, and my thought means that I really am going to lose power, in which case, I should probably go get candles right now. Instead, I do nothing at all. The moment passes. It was just a thought not worth even considering what it means. I go back to writing.

An 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.

Because you worry about it, reject it, and try to push it out of your mind, it pushes back and becomes a recurring thought or image. After a while, it starts to redirect your attention: It starts arriving with a “whoosh,” and feels awful, disgusting, or dreaded. It contains an urgent feeling of needing to get rid of it. The content of many unwanted intrusive thoughts is aggressive, sexual, taboo, anxiety-provoking, or self-derogatory. An 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. Unwanted intrusive thoughts tend to recur repeatedly and seem to increase in intensity over time. Eventually, along with an increase in the frequency and intensity of the thoughts themselves, you might start to doubt and fear your own safety, intentions, morality, self-control, and sanity.

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 voice can seem irrational, ridiculous, even perverse, or downright crazy. Sometimes Worried Voice issues strange or urgent warnings. It interrupts, annoys, scares, and talks back. Worried Voice raises anxiety. Worried Voice is often the first voice to react to an intrusive thought or new sensation.

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. False Comfort almost always triggers yet another what-if or doubt from Worried Voice. False Comfort is actually so disturbed and frightened by Worried Voice that it continuously tries to argue, control, avoid, suppress, reassure, reason with, neutralize, or work around whatever Worried Voice comes up with. False Comfort tries hard but ultimately fails to lower anxiety. It often gets angry at or ashamed of Worried Voice and wishes it would just go away. It is afraid that some of the thoughts that pop up in Worried Voice indicate craziness, danger, annoyance, perversion, being out of control, or being disgusting.

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.

Wise Mind is calm, unimpressed, and unaffected. It knows Worried Voice can’t help itself and that False Comfort truly thinks it is helping. However, Wise Mind knows that False Comfort is actually spurring Worried Voice on, keeping the process going without realizing it. In contrast, Wise Mind is disentangled, free of effort, and accepting of uncertainty.

Wise Mind demonstrates mindful compassionate awareness. Mindfulness is a state of open and active attention to the present, moment by moment. It involves the experience of observing your thoughts, feelings, and sensations without judgment or evaluation. 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.

Here is an example of how the three voices react to a thought: Worried Voice: That kitten is so cute and vulnerable. What if I strangled it? It would be so easy. False Comfort: You would never do that! Worried Voice: Look—my fingers just fit around its neck. False Comfort: Don’t be ridiculous. You are kind and loving! Worried Voice: How do you know that? I had that surge of road rage yesterday. What if I can’t help myself? False Comfort: You just felt angry; you didn’t do anything. Just stop thinking that. It won’t happen. Worried Voice: There is always a first time, and I wonder if there is something sick inside of me. Why else would I have such a thought? False Comfort: Just think about something else. Let’s get away from the kitten. This is crazy! You are thinking crazy thoughts. Worried Voice: So you think I have crazy thoughts? Wise Mind: Let me step in here, please. These are just thoughts. I watch the two of you fight. I’m observing your commentary. I notice the more you argue, the more upset you get. And the more it seems like a real issue that needs attention. It is actually a wild intrusion of a thought that can happen to anyone and essentially means nothing. What would happen if you just let them be? Let them remain as thoughts.

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.

The thoughts you most do not want to have are the ones that get stuck. Of course! That makes so much sense. So we find that people who are struggling with violent thoughts are people who value gentleness, find violence abhorrent, and live nonviolent caring lives. People who have felt assaulted by thoughts of hurting others are loving people. That is why these thoughts are fought—and then become stuck. Similarly, people who believe that all vulnerable people and living things should be protected are people who fight common intrusive thoughts that sometimes involve actions like abusing children, throwing cats out windows, and dropping babies. These are the thoughts you fight—and because you fight them, they stick. If you are someone with strong religious beliefs, you sometimes come up with blasphemous thoughts and worry thoughts about not being faithful. These are the thoughts you fight…and they stick.

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.

Unwanted intrusive thoughts get stuck because you inadvertently fuel them by trying to push them away.

Because unwanted intrusive thoughts tend to get stuck and repeat when you struggle with them, they increase in intensity. Every time you fight them, they fight back, so there is a very intense feeling that goes with them—a whoosh of fear—and sometimes shame, disgust, or anger. This can make them feel like impulses—as if somehow you were being pushed, impelled, or provoked to do something out of control, ridiculous, or dangerous. This feeling can be very disturbing, but you need not worry: it is an illusion, a paper tiger, a false alarm. Your brain is issuing warnings where none are needed.

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 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). If you are a woman who is menstruating, hormonal changes during your cycle can increase the frequency and intensity of your unwanted intrusive thoughts. Certain drugs, such as caffeine, over-the-counter drugs, and physician-prescribed medications, such as steroids and asthma medications, can as well.

It is commonplace for people to have outbreaks of intrusive thoughts after the media report a human-caused disaster. Whenever there is a report of an event that is awful, we all gain an increased sense that horrible events really do occur, and it is not uncommon to wonder if perhaps we could do something similar. These wonderings may even include imagining it happening. 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.

Sensitization can be compared to an allergy. An allergic person has a strong reaction to substances that cause little response in others. In the same way, you react with great intensity to certain thoughts that others don’t.

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.

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.

the fact that people with intrusive thoughts like yours have recovered and live normal lives proves that your situation is not as serious, crazy, or hopeless as it may currently feel.

Belief in the myth that you are in control of your thoughts leads to the common but unhelpful suggestion that you can replace negative thoughts with positive ones and that this will help you control what you think. The facts indicate that you can deliberately think positive thoughts and distract your attention temporarily from unwanted thoughts to chosen ones. But the thoughts you are trying to replace tend to persist and usually return even more forcefully to your attention.

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. Thoughts are what pass through your mind. When thoughts just happen, it is not your choice. There is no place for issues of character when there is no chance for choice. A thought is not a fact or a statement about yourself. Character is about the choices you make in life, not what pops into your mind.

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. This includes the belief that whatever is in our mind is a reflection of our true thoughts and feelings, no matter how we might protest it is not so. So intrusive thoughts must speak some special, perhaps hidden, truth about us. 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.

Myth 4: The Unconscious Mind Can Affect Actions

Myth 5: Thinking Something Makes It Likely to Happen

Myth 6: Thinking Something Makes It Unlikely to Happen

Myth 7: Only Sick People Have Intrusive Thoughts

The big difference is that just about everyone has passing intrusive thoughts. Your intrusive thoughts feel very different because they are repeated and sometimes become stuck. This makes them feel particularly disturbing, like they are the product of a disturbed mind. But the stickiness of these thoughts has nothing at all to do with your character or your value as a human being. And it certainly has nothing to do with being a disturbed person. The stickiness has a lot to do with how you think and feel about these thoughts and the methods and intensity you are using to try to rid yourself of them.

Myth 8: Every Thought Is Worth Thinking Myth 8 is that every thought is worth thinking about, so it makes sense to and it is worthwhile to explore the content of any thought that crosses your mind or comes to your attention. Fact: The fact is that you, like cable TV, have many different channels of thought going through your mind at the same time. It is impossible to think about them all, and some of your channels are just full of junk (like maybe the infomercial channel or the local high school announcements). Not all are worthwhile to think about. Imagine that you are listening to your radio and something went wrong, so instead of listening to one station at a time, you were listening to two, three, five, or ten at once. One channel might be great music that you want to hear; another might be an absorbing discussion. Others might be a boring repeat newscast, a song that you hate, and a story that you have heard a hundred times before. Without giving it much thought, you would work to focus on the things that seemed interesting and let the other channels pass you by.

Mostly you pick and choose what to focus on without putting in very much effort. Some thoughts just seem more interesting to pursue than others. But when an intrusive thought pops up—no matter what the content—if you believe that all thoughts are worth thinking about (i.e., if you believe that there are no junk channels of the mind), you might choose to focus on that one thought and grant it meaning and attention it does not deserve.

Myth 9: Thoughts That Repeat Are Important You may believe that thoughts that repeat must be important. After all, it would seem, if a thought were not important, it would just fly out of our mind and be forgotten. The fact that the thought keeps recurring must mean that it is significant. Fact: The fact is that the importance of a thought has very little to do with how much it repeats. Actually, thoughts tend to repeat if they are resisted or pushed away. So if you have a repeating thought that you are resisting, that same thought will start to fade away when you stop trying to resist it. Any thought that you attempt to squish is more likely to keep repeating, like Don’t think about that itchy spot,

Thoughts that repeat are stuck, not important.

Remember that sticky thoughts are the opposite of wishes. They become sticky and intrusive precisely because you reject them and fight with them. They are not pleasurable fantasies. They are not unconscious desires. They do not indicate truths about you that need to be explored.

your anxiety is maintained and reinforced by avoidance.

Even though unwanted intrusive thoughts are signs of overcontrol and not impulsivity, you may actually feel that you have to put a lot of effort to keep yourself from acting on the thoughts. This is an illusion. They feel like impulses even though they are not.

Psychologists know that about nine out of ten people experience intrusive thoughts at least occasionally. So you are one of the nine out of ten. What has gone wrong in your situation is that you have taken your thoughts too seriously and believed that the content of your thoughts meant something important about the person you are or the sort of behaviors that you might commit.

Learning about why you have intrusive thoughts will not help you stop them nor reduce your distress. However, learning how you inadvertently keep intrusive thoughts going and what you can do to change this will be significant steps toward recovery. In other words, we need to keep our focus on the hows and the whats, and less on the whys.

Just as we associate two things together, like “up and down” and “left and right,” a well-worn pathway in the brain associates two things that follow each other, and they become connected (what psychologists call “conditioned”). If a thought is followed by an anxious experience, the pathway from thought to fear gets established. When this happens repeatedly, your brain becomes conditioned to react anxiously and automatically to that thought. This sets up the conditions for unwanted intrusive thoughts to take hold.

People with unwanted intrusive thoughts have an amygdala that has learned to become afraid (i.e., clang the danger-warning bell) of certain thoughts.

And, in our complicated world, there are a host of situations that aren’t objectively dangerous, but can seem or feel dangerous. If your amygdala sets off the alarm in response to a harmless thought, you get a false alarm of danger: the bell clangs, you get an instant whoosh of fear, and it is very easy to think that there is real danger. The result is that thoughts feel dangerous, you try to fight them, and—of course!—they become stuck.

Wise Mind remembers that first fear is automatic and second fear is something you can change. Wise Mind knows that feeling anxious is not the same as being in danger. When this happens, calming occurs on its own, naturally, and the intrusive thought passes into the stream of thoughts.

Ordinarily, the differences between thoughts and actions are clear. Anxious thinking creates an altered state of consciousness where scary thoughts can feel as frightening as scary behaviors. It is as if thoughts and actions feel fused together. Even though thoughts are triggering fears, people feel as if they are living through—not just thinking about—a dangerous experience. Thought-action fusion makes it seem that there is little difference between thinking about something and it actually happening. Thoughts no longer feel like a safe way to rehearse actions without consequences. What-ifs are not experienced as guesses or imaginings, they feel like visions of the actual future. Thoughts actually feel predictive. In addition, thought-action fusion makes it seem that thinking something is somehow morally equivalent to doing it—and therefore means something important about the thinker, so bad thoughts reveal a bad person.

Effort used to not think of a thought actually makes it more intrusive.