Intrusive thoughts — what are they and how can you manage them?

Intrusive thoughts are painful and confusing — yet they’re also common. MTA Clinical Psychologist, Dr Lucy Mersh, shares some key strategies for managing them…

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I consider myself to be a caring person — so why would I periodically get thoughts of kicking out crutches or walking sticks from under people? It wasn’t until a friend shared that he had images of putting his hand in a shutting door, that I realised I wasn’t the only one who experienced uninvited and unwanted thoughts. In fact, it was a revelation for me to realise that everyone has thoughts that pop into their head that make them squirm and feel distressed.

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In Cognitive Behavioural Therapy (CBT), ‘intrusive thoughts’ are unwanted thoughts or images that occur spontaneously or can be triggered by external stimuli. These thoughts and images tend to be distressing and recurring, yet we may not even be aware of the stimuli that trigger them.

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One of the central tenets of CBT is that the event or experience does not cause distress — rather it is our interpretation or belief about that event that determines our reaction. For example, imagine I lived in a house with my four naughty nocturnal cats. I hear a crash in the night. The likelihood is that I believe the noise is made by a cat. As a result I might feel annoyed or amused, I might roll over and go back to sleep, or I might get up to let the cat out.

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Now imagine I live alone in a neighbourhood where there has been a spate of break-ins. Again I hear a crash at night. It is likely my emotional, cognitive and behavioural reaction would be very different to the first scenario. My belief is more likely to be that I am being burgled and in danger. I would be feeling frightened or angry, and rather than roll over and go back to sleep I would be calling the police, trying to keep myself safe. 

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The same principle goes for intrusive thoughts. It is not the content of the thought per se, but a person’s cognitive, emotional, physiological and behavioural reaction to the thought which may or may not cause distress. Going back to my original example, in my earlier days I was horrified when thoughts of toppling people over popped into my head. What could this mean about me? Was I an uncaring, nasty person? I remember the anxiety and desperately trying to push the thought away. 

In actual fact, many anxiety disorders actually contain an element of intrusive thoughts.  Common themes include causing harm to others or yourself, sexual behaviors, religion, making mistakes, or being a ‘bad’ person. As well as causing anxiety, they may also trigger feelings of shame and low mood, which is not surprising if a person is judging their intrusive thoughts as immoral, dangerous or bad. Sometimes people develop repetitive behaviours or compulsions in an attempt to ‘neutralise’ intrusive thoughts that may evolve into Obsessive Compulsive Disorder (OCD). Intrusive thoughts are also common in Post-Traumatic Stress Disorder, depression and bipolar disorder. In women, an increase in intrusive thoughts may occur after a hormone shift such as having a baby. It is not uncommon for loving parents to periodically experience intrusive thoughts about harming their child.

What can you do about intrusive thoughts?

Above all, it is important to remember that these kinds of thoughts are not an indication that you secretly desire to do the things that have popped into your mind. Everyone has intrusive thoughts; they are a natural part of being human. 

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The most obvious thing to do might be to try to push these thoughts away or try to stop them arriving at all. In fact, this is likely to increase their intensity and frequency. For instance, imagine you have an inflatable beach ball in a swimming pool. The beachball is your intrusive thoughts. To hide the beachball you try to push it under the water so no one can see it. The harder you push the ball under, the more forcefully it pings out of the water again. The same is true for intrusive thoughts. The harder you try to rid yourself of them, the greater the momentum they have.

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Rather than trying to push thoughts away, it is important to label them for what they are — thoughts, not facts. They are not a reflection of who you are as a person, nor do they make it more likely something ‘bad’ will happen. There is a huge difference between thinking and doing. 

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There are different approaches to reducing the distress from intrusive thoughts, but all agree that ‘thoughts are not fact’. Cognitive Behavioural Therapy (CBT), encourages thoughts to be identified, examined and worked through. Conversely, mindfulness techniques do not examine the content of the thoughts but rather encourage observation of them without judgement. For this reason, mindfulness based therapies might also be helpful. 

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In addition to working one-to-one with a therapist, there are things we can all be doing to manage our intrusive thoughts. There are numerous excellent mindfulness apps that can help introduce a few minutes of mindfulness into our day. Mindfulness doesn’t have to be about sitting down meditation, it can also be a mindful walk, run or even completing daily chores more mindfully. Then if (or rather when) an intrusive thought comes, do not engage with it, rather accept it and do not try to push it away.

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Using a more cognitive approach, you can label intrusive thoughts as such when they pop into your head, for example, ‘here’s another intrusive thought’. Try to remind yourself that these thoughts are automatic and not invited. Finally, do not let your feelings (such as anxiety or shame) about the thought change the way you behave — just carry on with what you were doing prior to the intrusive thought.

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Remember — intrusive thoughts can be scary and confusing, but they are also normal. They do not make you a ‘bad person’ in any way. And with time, care and patience you can find ways to manage any unwanted images or thoughts that pop into your head, helping to loosen their hold over you. 

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Looking for support with intrusive or obsessional thoughts, OCD or anxiety? Book a session with Dr Lucy Mersh, Clinical Psychologist.