Anxious intrusive thoughts and how to manage them

When you read this sentence, try as hard as you can not to think of a white polar bear.

You just thought about a white bear, didn’t you? Congratulations!! This small thought experiment, devised by cognitive scientists in the 1980’s, confirms that you have a normal mind!

We often overestimate how much control we can have over the thoughts and ideas that pop into our minds. This can make anxious intrusive thoughts truly challenging to manage.

This blog has been written in support of International Obsessive-Compulsive Disorder (OCD) Awareness Week. We discuss what anxious intrusive thoughts are, why we have them, how intrusive thoughts become ‘stuck’ in OCD, and strategies that can help us manage intrusive thoughts.

What are intrusive thoughts?

Perhaps you are a very cautious driver, but recall once having a disturbing intrusive thought about hitting a pedestrian with your car? Or an unwanted thought that you have left the house unlocked when you are away on holiday? An unwanted image of dropping your newborn baby, or of your parents becoming sick and dying? Or an unrealistic and unwanted violent or sexual mental image that goes against your actual desires and moral values?

These are common examples of intrusive thoughts – ideas, mental images, urges, or sensations – that pop into our minds spontaneously when we least want them to. They do not seem to fit with the situation we are in at the time, how we are feeling, or how we see ourselves and others.

While unwanted intrusive thoughts are very normal, they can sometimes cause feelings of anxiety, panic, disgust, or even shame. Those living with OCD, for example, may be extremely distressed by the intensity or frequency of their intrusive thoughts and go to great lengths to try to avoid, stop, or cancel out their intrusive thoughts. In this case, the intrusive thoughts have become ‘obsessions’, and the attempts to stop the thoughts are called ‘compulsions’.

This video provides a useful explanation of the role that obsessions play in OCD.

Why do we have intrusive thoughts?

Intrusive thoughts are a normal part of being human. Cognitive scientists think that humans have thousands and thousands of thoughts a day. In fact, more that 80% of people reported having an intrusive thought in the past 3 months.

The mind is a thought generating machine and there is no in-built quality control mechanism. It is capable of imagining an almost endless range of possibilities. On any given day, we are likely to have a whole range of thoughts – including happy, sad, scary and disgusting thoughts, realistic and unrealistic ones, and thoughts that are just plain weird!

We also know from past research that unwanted intrusive thoughts are more common when we are feeling stressed, anxious, or overwhelmed.

The white bear suppression (ironic rebound) effect:

Remember our white polar bear at the beginning of this article? Repeated scientific studies since the 1980’s have shown that the harder people try NOT to think a particular thought, the more they tend to think about it.

This finding has been named the ‘White Bear Suppression Effect’ after experiments in which participants were asked not to think of a white polar bear, and then monitored how often a thought about a bear intruded into their consciousness. Long story short, trying to suppress thoughts about white bears reliably increased the number of times the unwanted thought occurred.

This ‘ironic thought rebound’ effect is usually even greater for unwanted thoughts that are about something we find truly uncomfortable or upsetting, such as a situation we fear.

We may try to suppress intrusive thoughts in a range of different ways. We may be tempted to use distraction, replace or neutralise the thought with a positive one, argue/reason with the thought, confess the thought to others to get reassurance, pray the thought away, do a physical compulsion such as excessive checking or cleaning in response to the thought, or even completely avoid situations that trigger the thought.

These strategies often reduce the anxiety caused by unwanted intrusive thoughts in the short-term but cause the thoughts to pop up more in future.

In short, the harder we try to suppress intrusive thoughts, the more attention we actually give them. We train our brain that  unwanted thoughts are important or significant in some way, and therefore usually end up with more of them.

How do unwanted intrusive thoughts get stuck, and become obsessions? 

Several research studies have shown that holding certain beliefs about our thinking (called metacognitive beliefs) may lead us to worry about our thoughts in an obsessive spiral.

These include believing that our thoughts are important to monitor and control (‘thought control beliefs’), that thinking about ‘bad’ things can cause them to happen (‘thought likelihood fusion beliefs’), or that having intrusive thoughts about doing something ‘bad’ is the same as acting immorally (‘thought moral fusion beliefs’).

When we hold these beliefs, we are more likely to interpret our anxious intrusive thoughts as being dangerous and important to pay attention to, and to try to stop or suppress them in a way that actually has the opposite effect.

We tend to be the most bothered by, and try to get rid of, the intrusive thoughts that are against our values and who we are as a person. This means that our attempts to avoid the very thoughts that make us anxious can set up a vicious cycle that keeps distress going over time.

For example, imagine a very gentle person who has an unwanted and senseless intrusive thought about stabbing their partner, who they love dearly. This thought is likely to be disturbing and uncomfortable to have. The person may find the intrusive thought truly terrifying and difficult to let go of, especially if they believe that “I’m a bad person for thinking this” or “thinking this thought means I may lose control and actually stab my partner”.

Hiding all the knives in the house, leaving the kitchen when their partner is there, and trying instead to focus on positive thoughts about their wedding day may provide short-term relief from the anxiety the intrusive thoughts cause. However, these physical and mental coping strategies are compulsive attempts at thought suppression, and typically will increase the thoughts and the anxiety linked with them over time.

This vicious cycle of intrusive thoughts (obsessions) and distress, leading to physical or mental compulsions and relief, then more obsessions and compulsions in the future, explains how normal intrusive thoughts may turn into OCD.

Strategies for coping with intrusive thoughts or obsessions 

 aWhile it is not possible to stop intrusive thoughts from popping into our mind, a variety of science-backed strategies can help us learn to let go of intrusive thoughts. These include:

• Practicing accepting the intrusive thoughts and the difficult feelings they come up without judging them.
• Reminding yourself that thoughts are not facts – they are mental events and mental do not have the power to hurt you or anyone else
• Sitting with the thoughts, without analysing them or doing anything special in response to them, until the thought and the anxiety it brings up naturally passes (called ‘imaginal exposure’).
• Practicing mindfully observing the thoughts come and go, in the same way that one might watch passing cars or clouds in the sky (see the blog by Dr Gemma Healey for more info on detached mindfulness).
• Gently redirecting the focus of your attention back to what you are doing in a mindful way, rather than dwelling on your intrusive thoughts.
• If you find yourself worrying about what your intrusive thoughts mean, try postponing this until a designated daily ‘worry time’ (Dr Jemma Todd’s blog on managing worries explains this strategy in more detail).

Help for intrusive thoughts, obsessions and OCD 

If your intrusive thoughts are causing you emotional distress and getting in the way of life, seeking treatment with a professional can help.

Treatment for OCD typically involves Cognitive Behavioural Therapy, including Exposure and Response Prevention, which aims to reduce the distress and unhelpful behaviours linked with intrusive thoughts.

Written by Dr Melissa Mulcahy with input from Anin Karajagi, Clinical Psychologistists