Have you ever been on a tall building and had a strange feeling you might lose control of your body and jump off the side? (This is actually a common experience, called “high place phenomenon,” that 50% of people reported having in a recent study). What about waking up in the middle of the night with a racing mind, or being unable to fall asleep because your mind is consumed with insecurities about the day before or worries about the future? Have you ever had a mental flash of a disturbing violent or sexual image that seems to come out of nowhere?
These are all examples of intrusive thoughts, distressing thoughts that pop into your mind out of nowhere. They are often called “unwanted intrusive thoughts,” because they are often undesired and can create fear and distress in the person having them.
What are intrusive thoughts?
Intrusive thoughts can take many different forms. Some contain disturbing or distressing content, like violence, sexual imagery, or harm to self or others. On a less disturbing but just as painful level, intrusive thoughts can include negative self-talk, critical thoughts about yourself or others, or worries that won’t leave your mind. Most of us have dealt with self-critical thoughts at some point, such as, “I’m worthless,” “I can’t do anything right,” or “I’m not good enough.” Or maybe we’ve felt fear for our loved ones and had intrusive images of their death or harm.
Every person faces intrusive thoughts to some degree or another. Moments like the ones mentioned at the beginning of this article are universal.
When do intrusive thoughts occur?
There are a few clinical situations in which intrusive thoughts like these are more common. In obsessive-compulsive disorder (OCD), intrusive thoughts and fears invade the mind and motivate compulsive behaviors like repeated hand-washing, counting, turning lights off and on, and other behaviors. Intrusive thoughts are more common in what is referred to as “pure O” OCD, in which obsessions and compulsions both take place in the mind and don’t impact outward behaviors.
Intrusive thoughts also manifest in depression and anxiety. Depressed individuals are often plagued with self-critical or negative thoughts about the self, the world, or others that interfere with daily living. Anxiety is characterized by worries about the future, and can cause insomnia due to being unable to shut off the mind at night or waking up with anxious thoughts.
Addicts often find that intrusive thoughts about their drug of choice motivate their urges to act out or use again. Euphoric recall, or a memory related to past use of substances or addictive behaviors, can be a powerful trigger that pulls someone back into their addiction. In sex and love addiction, fantasy about past or imagined sexual encounters and imagery from pornography or other material can intrude into the addict’s brain unannounced and affect desires to use.
Women in the postpartum period after giving birth can also face unwanted intrusive thoughts. In fact, almost all women surveyed in a recent study reported unwanted intrusive thoughts of harming their infant, although there was no increase in actual violence toward their children.
Emotional Response to Intrusive Thoughts
Often intrusive thoughts can be incredibly frightening. Let’s say you have a disturbing, violent image pop into your mind. If you identify with the thought as part of who you are, or as an actual desire or impulse to act in that way, you will likely feel fear. You might believe there is something wrong with you and that you are the only one who has these thoughts happen to them. Particularly if the thoughts repeat themselves, you might find yourself avoiding situations related to the thoughts, keeping the thoughts secret, attempting to make them go away through self- punishment, or other means of controlling the thoughts.
Often attempts to control thoughts, however, are fruitless. Fighting them only makes them worse or more intense. When your attempts to stop your thoughts don’t yield results, you might worry or fear that you are mentally unwell or that you may act on the impulses in your mind.
“The Secret History of Thoughts”
In 2015, the NPR podcast Invisibilia kicked off its first episode, “The Secret History of Thoughts,” with a fascinating story about a man plagued by intrusive, dark thoughts. In his case, he faced thoughts of harming his family that left him a shell of himself, frightened of carrying out the images that played throughout his mind. He tried many of the ways mentioned above of controlling the thoughts to no avail.
Eventually, this man sought out a counselor for help. His counselor took a radical approach, incorporating mindful acceptance with exposure therapy methods. You can learn more by listening to the podcast about why he took this approach and how psychology’s approach to thinking about thinking has changed over the years.
For this individual but also for many who struggle with intrusive thoughts, the problem isn’t the dark, intrusive thoughts themselves. Instead, the problem was how he reacted to the thoughts. His attempts to control them or make them go away only fed his fears and made them worse.
How to Respond to Intrusive Thoughts
Label them for what they are.
Simply having a name for what you’re going through can make it less scary. Naming intrusive thoughts as such helps you categorize them as normal parts of the human experience. You can know they are a common type of thought that many people have. You are not alone in them, and they can be managed.
By definition, intrusive thoughts cannot be controlled, and they don’t have the same importance or power as voluntary thoughts. They are also different from behaviors: thoughts are not intentions or impulses, but simply the firing of a synapse in your brain.
Understand the right relationship between the thoughts and the self.
The approach of assigning meaning or significance to all thoughts can do more harm than good. Overidentifying with your thoughts and making them part of your identity can cause you to imagine that you are a violent, predatory monster if you have a distressing intrusive thought.
Instead, know that your thoughts are not who you are. There’s no need to focus on them and give them inordinate power and meaning. Know that you do not have to listen to your thoughts or yield to the impulses they are urging you toward.
Accept your thoughts and let them pass by.
In the acceptance and commitment therapy model, which is a mindfulness-oriented approach to thoughts and behaviors, intrusive thoughts are seen as separate from the self. Rather than being afraid of intrusive thoughts, this model encourages defusion, or reminding yourself that thoughts are just thoughts and they do not have power unless you assign it to them.
To deal with intrusive thoughts, an ACT practitioner may suggest that you continue whatever activity you had been doing before the thoughts and/or focus on a value-oriented activity that you can do in contrast to those thoughts. For example, rather than obsessing over thoughts of self-harm, practice self-care. If you have a flash of a sexual or violent image, shift your focus to the present moment through mindfulness breathing. The more you treat these thoughts as insignificant, unimportant, and uninteresting, the less they will carry an impact.
Assess and reframe your thoughts for accuracy and helpfulness.
The cognitive-behavioral therapy model takes a more active approach, addressing your thoughts by questioning their validity or helpfulness in your life. You may intentionally shift your thinking patterns by reflecting on what you might say to a friend who was worried about intrusive thoughts. How might you encourage or support them?
Remind yourself of what is true about yourself in response to a thought. For example, if you have a violent image pop into your mind, remind yourself of why you don’t want to carry out that impulse and what your lack of desire to do so says about you as a person. Coping statements like, “these thoughts are not reality,” or “I don’t want to do these things, they are just intrusive thoughts” might be helpful replacements for disturbing or distressing thoughts.
Know when to get help.
If you notice intrusive thoughts impacting your daily functioning, leading to compulsive behavior patterns common to obsessive-compulsive disorder, or worsening over time, please seek help. Reach out to your doctor or a counselor if these thoughts turn into obsessions or if they are accompanied by behaviors like preparing to carry out violence or harm on yourself or others. If the thoughts came on rapidly, as with a new medication or recent life change, get in touch with your doctor. In some extreme cases, you may need to go to the emergency room for care, which your doctor will be able to help you discern.