What are intrusive thoughts?
Intrusive thoughts are unwelcome ideas or images that come into our minds. The key is we don’t want them, and we aren’t intentionally trying to think of them. They’re often upsetting and are about things we don’t desire to happen. Take this example: While driving, a person notices a pedestrian on the side of the road and suddenly thinks, “I could easily swerve and hit them,” but they don’t act on it.
Everyone has intrusive thoughts from time to time, and most of us don’t pay too much attention to them. We say to ourselves, “Oh, that was weird,” —like the thought of hitting the pedestrian —and move on. By that I mean, we redirect our attention back to whatever we were doing, whether that’s driving a car, reading a book, or having a conversation.
Intrusive thoughts are no more important than thoughts about what socks I should wear or whether to have cereal or a bagel for breakfast. They’re just thoughts.
Can intrusive thoughts seem real, and can they cause us to feel anxious?
Yes, they can seem real. Just as we might watch a horror movie and feel anxiety, distress, dread, and fear for the character facing danger—even though it’s not us in the movie—intrusive thoughts can evoke similar emotions. It’s normal to have an emotional reaction to a disturbing thought. That doesn’t mean that someone should be concerned they have a diagnosable mental health challenge.
People with OCD or other anxiety disorders often give more meaning to intrusive thoughts and their presence. They may struggle with questions like, “Does having the thought mean that I want to act on it?” They fear that recurring thoughts might reveal a hidden, dangerous desire —something they must remain vigilant about to prevent from happening.
This is especially true for distressing thoughts about harming others or engaging in other appalling acts. People with these thoughts often feel a lot of guilt and a sense of responsibility simply for having them. They conclude that only someone at risk of acting on such behaviors would have these thoughts.
Since they don’t hear their friends or family members discussing similar intrusive thoughts, they assume they should probably be concerned and stay hyper-aware to make sure they don’t act on them.
Why do intrusive thoughts reoccur?
They may seem unprompted. Sometimes they are, and sometimes it’s due to triggers in the environment.
Our brains are good at tending to threat over mundane information, which has probably helped us survive as a species. They also know how to target what matters most to us and bring those thoughts to the forefront.
If a person assigns importance to a thought, our brains take it as a cue to remember and revisit it. Anything a person does in response to a thought gives it importance, like dwelling or ruminating on it, or doing something to lower the chances of acting on it. In the example of the pedestrian, if a driver jerks the wheel suddenly for fear of acting on the thought, their brain takes in the information and says, “You reacted to this thought, which must mean it has some importance.” The brain stores that so the next time when faced with a similar situation or thought, it reminds the person of what they did, especially if the person experiences a sense of relief after doing something to decrease the distress caused by the thought or fear of acting on it. It becomes harder and harder to get past the thought because it’s been reinforced.
How can I manage intrusive thoughts?
While there isn’t a perfect plan to manage intrusive thoughts, I have three recommendations:
- Dismiss the thought without giving it any attention. While we can’t fully control our thoughts or emotional reactions to the thoughts, we can direct our behaviors in response to them.
- Continue with whatever you were planning to do before the thought appeared. Whether it’s getting lunch, watching TV, talking to a friend, or playing a game—go ahead and do those things. Don’t let the thought derail your life.
- Remember that successfully managing intrusive thoughts doesn’t mean they’ll completely go away or never return. It just means your brain is working through the information that it’s getting, and that’s normal.
For example, after a breakup, it’s natural to have thoughts about your ex. Not having any memories of them would be unusual, and those thoughts are likely to resurface at unexpected or inconvenient times. That doesn’t mean you’re not processing the loss or moving forward. It was an important relationship, and over time, you’ll hopefully reach a point where thoughts of them come up less often. How frequently they arise depends on what you do, how you respond to the thoughts, and the importance you assign to them.
Successfully managing intrusive thoughts means being able to experience them while still engaging in your life.
When should a person be concerned about intrusive thoughts?
Not every thought is impactful for every person. Mental health professionals look for:
- Thought and behavior patterns that occur frequently for weeks or months.
- Content of the thoughts, or what we would refer to as themes. Are they about religion, harming an infant, or contamination? Is there something specific that makes it difficult for a person to move past them? Usually, it’s because they’re incompatible with a person’s beliefs or values.
- Is there a ritualized or repeated way of responding to the thoughts?
- Are the thoughts and behaviors taking up a lot of a person’s time and interfering with the ability to live life?
- Are the thoughts and behaviors causing a significant amount of distress?
How can mental health treatment help?
People often avoid talking about intrusive thoughts for fear of being judged or misunderstood, worried that others might assume they are capable of acting on them.
Mental health professionals offer understanding and support, providing psychoeducation and strategies to help people manage their responses to intrusive thoughts while normalizing their presence. Unlike friends or family at times, they provide objective feedback, which can be incredibly valuable.
By Stephan Siwiec, PhD, psychologist, clinical supervisor, OCD and Anxiety Adult Residential Care at Rogers Behavioral Health in Oconomowoc
Rogers provides mental health support
Whether it’s intrusive thoughts or another mental health or substance use struggle, our team of compassionate experts will walk alongside you to help find your path to recovery. We treat children, adults, and teens in multiple levels of treatment in Wisconsin and a growing number of communities nationwide. When you’re ready, you can call 833-308-5887 for a free, confidential screening.
