Episode #118

Intrusive Thoughts & CBT

Intrusive thoughts are unwanted, unpleasant thoughts, often associated with OCD.

Why do intrusive thoughts happen?

How can you cope with intrusive thoughts?

What can you do to improve things?

Join me, Dr Julie Osborn, as I discuss the many types of intrusive thoughts and how you can help yourself. Click to listen now!

Reference Guides:

Full Episode Transcript

Hi, it's Dr. Julie. Welcome to My CBT Podcast! I'm a Doctor of Psychology and a licensed clinical social worker specializing in Cognitive Behavioral Therapy. I'm here to help bring the power of CBT into your life.

Thanks for being with me. And as always, I'm going to start off with an email I received from a listener. I got her permission, and I'm always grateful that you guys are reaching out to me. I also wanted to share that as of yesterday, from this taping, my podcast hit half a million downloads! I was so excited, quite a milestone. And not just excited, but humble and grateful because I only made it there with you guys listening and sharing with others that are finding this helpful as well. So that was really exciting. I posted on a lot of my social media. If you follow me, you can see it there. But that was really cool. So I wanted to thank you guys again.

So my email today is from Mary. It says,

“Hello, Dr. Julie. My friend recommended your podcast last week, and I've been listening to it every day. I started at the beginning in 2020 and do about two podcasts a day. I love it. I have a notebook. I'm ordering the workbook. It is so helpful. I just listened to an episode on forgiveness, and it really was the best explanation and understanding of how important it is to forgive myself. I'm going to start writing self-forgiveness letters following along with you is a truly new path in my healing journey. Thank you. Keep the messages coming.

Sincerely, Mary, from Madison, Wisconsin.”

So thanks again, Mary. Thanks for letting me share. I'm so excited that you're just finding so much help and you're getting the workbook. And you've fallen through. I'm excited to hear about your journey and your healing and all the steps that you're going to take to get there and your progress. So again, thank you. And as always, I encourage you guys to reach out and share questions, feedback, suggestions, looking for suggestions with podcasts. I really want to meet your needs and be able to tape things and share for topics that are really going to be meaningful for you guys. So today, I'm talking about something that's really common, isn't talked about a lot, a lot of shame, embarrassment with clients that suffer from this.

So I thought I'm just going to put it out there. So maybe you guys can start talking about it more with each other, and we don't have to feel so shameful about having intrusive thoughts. That's what I'm talking about today, is intrusive thoughts. So I did do a podcast on OCD called It's Not Me, It's My OCD, if you want to go listen to that. And I talk about intrusive thoughts there, but I'm going to get a little more specific today. So that's why I thought this would be helpful as well. So intrusive thoughts are unwanted, they're distressing, and they're really disturbing thoughts and images that are repeated over and over into your mind, and they can be about a wide range of topics, from violence or harm to loved ones to taboos to inappropriate sexual images. So these thoughts can be obviously really distressing, but it's important to remember that they're a common experience for many people. And intrusive thoughts are just like what they sound like. They're intrusive. You're not thinking about them. You don't want to think them. They just come into your mind. And a lot of times, this is connected with OCD.

And most often I would say OCD is portrayed as more of germ phobia, checking the door, make sure it's locked, checking the stove, the stuff they show in movies. But lots of people have not heard of intrusive thoughts, and lots of people have intrusive thoughts. They think they're horrible people. They think they must be going crazy. They think that there's something wrong with them because why would they even think this and it's not talked about and they don't understand what's going on. So once you understand what's going on and understand that it's part of OCD, then we can really use our CBT tools and really have good treatment. And lots of my clients have just eliminated their intrusive thoughts, or they get them to a place where when they do come up, they use their tools, they move on, and it's not as distressing to them. But let me tell you, when it first starts, it can be really distressing. So I'm going to actually go over 10 types of intrusive thoughts, some different examples. You can have just one, you might have more than one. But I just want to let you know, what does this even look like?

So the first one is violence or aggression. So these thoughts are about harming your sofa others, even if you have no intention on acting on them. And people with these thoughts, they don't act on them. Let me say that first and foremost. People do not act on their intrusive thoughts. The intrusive thoughts are super disturbing that I would even think this because it's something I never do or want to do. That's why they're so disturbing. An example of the violence or aggressive, intrusive thoughts might be imagining someone pushing someone in front of a train or stabbing someone. I've definitely had clients share both of these or driving into the center divider when they're driving, a lot of people share that thought with me as well, and hurting other family members. So obviously, it's very upsetting. Another one is sexual content. So this is inappropriate or explicit sexual thoughts and images that may involve people you would never consider in such a way or even involve maybe a taboo in your mind. So it's just like, What is going on? Why am I thinking this? This isn't something that I want to be thinking, and they can be over and over and over.

And the more stressed you are about them, they tend to only get worse until you learn how to deal with them and eliminate them. A third one is contamination or germ obsession. So a lot of us have heard about, but this is fear about getting sick and contaminated by touching certain objects or coming in contact with specific substances. Another one is a taboo or morally disturbing thoughts. So these are thoughts that go against your moral or religious beliefs. Such thoughts could be about blasphemy or engaging in illegal activities. Another one is fear of accidents or mishaps. So this is like excessive worry about accidentally causing harm like hitting a pedestrian while driving or dropping a baby. The next one is health-related anxieties. So this is constant, excessive worry about having a serious illness or disease, even when there's no evidence to support it. So a lot of people I see have health anxiety, and it's really hard. It's a challenging one to treat. I've done a podcast on this because there are real health issues in the world, but this is just excessive, and any little thing, they tend to go to the worst-case scenario.

They'll have a headache and they think they have a brain tumor, that thing. Another intrusive thought can be doubts and uncertainties. So this is when you repeatedly question decisions or fearing that you made a mistake, even when you logically know you haven't. You can imagine how exhausting this would be. You make a decision, you know what's right, and now you just question and question and question and go over and go over and go over. Having that uncertainty is the mother of anxiety. Another intrusive thought is fear of losing control. This is excessive worry about suddenly losing control and doing something harmful or inappropriate. That could be like shouting out in a quiet room or worrying that you're going to impulsively jump from a high place. Another really tough, intrusive thought are the images that people get. These are vivid, distressing, mental images of violent or disturbing scenarios that play in your mind without your consent. Again, that can be violent and sexual, the most common ones that my clients have dealt with. But whatever intrusive images, they could be anything that are really upsetting. And then the last one is fear of inappropriate social behavior.

So again, this is excessive worrying also about blurting out something embarrassing or offensive in a social situation. So they're all irrational, and we can hear that when we say it out loud, but I'm telling you, if you're struggling with this, I understand that if you're thinking over and over and these thoughts come up, or you're in the middle of a conversation about what your week is looking like, and all of a sudden, this thought comes into your mind and just like, Oh, my God, what is going on? You're going to tend to obviously be very anxious, but a lot of people really withdraw. They start to isolate. They don't want to put themselves in any situations that they think are going to trigger the intrusive thoughts. Your world can become very small. It's really, really hard. So it's just important to know and maybe give this a name if this is something you've been struggling with or someone you know and care about. You're like, Oh. I share a story back in the OCD podcast I originally did, I'll never forget, I worked with a woman who had come in, and for 10 years, she had these horrible, violent, intrusive thoughts.

She thought she was going crazy. She went, I'm not joking, to so many people. She went to her priests, she went different counselors, she went to her medical doctor. Nobody knew what it was. They all thought it was horrible. She had these thoughts. The church didn't give her good feedback, to say the least. And luckily, I did know about intrusive thoughts. I learned years ago, and she came to me in five minutes. I'm like, Well, you have OCD. And she's like, What? I'm like, Yeah, there's nothing wrong with you. You're not immoral. You don't have bad values. This is not about your character. This is a mental health issue, and we need to treat it. And this is a symptom of OCD. So again, OCD has many different symptoms, many different traits. So not everybody with OCD has intrusive thoughts. Not everybody with, and some people do, but like I said, OCD can be just about the germs maybe somebody has. Ocd might be just about the health anxiety. So this is just one main symptom, and I'm just wanting to clarify for you guys to understand what it is. And if there's something you've been struggling with and you don't know what it is and you think you're a horrible person because you think this way, or you have these thoughts, I should reframe that, sorry, that you have these thoughts that we really have to separate that from who you are because it's not about you.

This is your brain overactive and sending you faulty messages. So how can Cognitive Behavioral Therapy help you with having intrusive thoughts? Many different ways. And CBT is widely used and is really effective for managing intrusive thoughts. We know that it's based on the idea that our thoughts, our feelings, our behaviors are all interconnected. And when we can change our thought patterns, we can influence how we feel and behave. So it's a little different than the thought record, right? I wouldn't tell you to do a thought record because I don't want you to challenge these thoughts because they're intrusive, but we have to start separating them from who you are. I'm going to just go over a bunch of techniques that you can start using. If you are suffering from intrusive thoughts, I'd really recommend that you go find a therapist, especially a CBT therapist who works with OCD because it can really be life-changing and can really help you out. So that would be my first thing to say. It can be so overwhelming that I just think being with a professional, getting more educated, getting specific tools is going to get you well as fast as possible.

So some of the techniques are just awareness and mindfulness, recognizing and acknowledging that these and truthful thoughts without judging them. Don't get attached to these thoughts because they have nothing to do with you. Because you want to understand that having these thoughts doesn't define you or your character or what your values are. That's why they're intrusive, right? If they did define who you are, they wouldn't be upsetting. So just that mindfulness. I have this mantra I learned from a book called Brain Lock, which focuses on this. And the mantra was, It's not me, it's my OCD. It starts separating, right? It's not me, it's my OCD. Meaning this is a symptom. It doesn't define you, your character, anything about you. That's a super important place to get started and understand. So you can challenge these that when you have intrusive thoughts to be able... The challenge is saying that it's not me, it's my OCD. You know that there's no evidence. You've never acted on this. It's nothing that you want to do, and that knowing that these are all irrational fears that I'm having. You want to reframe and restructure how your thoughts are as well, all of these negative, intrusive, and irrational thoughts.

We want to have more balanced thoughts and be realistic, meaning just saying that if you have a thought that you're not a terrible person for thinking this, reframing it is that these are just thoughts. They don't define me. So this is where the CBT that... Again, we're not challenging the actual intrusive thoughts, but we're challenging the thoughts that I'm a terrible person for thinking this. That's different, that I'm not a good person. I shouldn't be around other people. My character isn't good. Those are the thoughts that are coming up from the intrusive thoughts that we need to put in a good place for you so that you can start really addressing the intrusive thoughts without getting caught up in thinking you're a bad person. Grounding techniques are always helpful. This is where you can engage your senses to bring yourself back to the present moment when you're getting overwhelmed with the intrusive thought. So you want to focus on what you can see, hear, touch, taste, and smell. This can help shift your attention away from the intrusive thought. So this is within the book I mentioned earlier, Brain Lock, that's by Dr. Andrew Schwartz, a really good book.

Again, it's just focused on CBT for OCD and the intrusive thoughts. And so the mantra is it's not me, it's my OCD. Second step is to tell yourself, My brain is sending me faulty messages. Third step is to go find something that brings you some pleasure. So that could be these grounding techniques to help shift your attention from the intrusive thoughts. So grounding yourself and going in doing something that brings you pleasure, not a chore or something you don't want to do, but something you enjoy. Joy as part of a distraction to start moving yourself away from being so wrapped up in the thoughts. Exposure therapy. This is something I would really just do with a therapist. Sometimes can be helpful where you can gradually expose yourself to situations or triggers associated with the intrusive thoughts, and this can desensitize you over time. But you really want to be with a professional to walk you through that so you don't get yourself over stimulated and overwhelmed and then feel like you just can't bring it back in. Another thing you can do is some people do the scheduled worry time. So worrying about, if I have this OCD worry, if I have these intrusive thoughts, is that you just set a specific time each day to follow you, yourself...

Or allow yourself, sorry, to worry or think about the intrusive thoughts. So this can help you contain them and prevent them from intruding throughout the day is that this is my time. I'm going to worry about them, I'm going to think about them, I'm going to go over my tools, and how am I going to handle them when they come up? There's also another therapy called Acceptance and Commitment Therapy, and they call it ACT, A-C-T. So this is a variation of CBT, and it focuses on accepting difficult thoughts and feelings, rather trying to control or eliminate them. So the fourth step from brainlock is really accepting like, Okay, this is what I'm dealing with right now. I know it's going to come up again. I know what it is, like labeling it, and then when it comes up, I have my tools and I will deal with them. So that can take away instead of worrying and worrying like, Oh, my gosh. When is this going to happen? When am I going to have intrusive thoughts? Is it going to be when I'm in the middle of a meeting? The more we think about it, the more stressed we are, our intrusive thoughts can come in.

So a lot of times, if my clients have come back and said, My intrusive thoughts are bothering me again, my first question I ask them is, What stressors are going on in your life? Because I really have noticed that when there's stressors going on in someone's life that these symptoms tend to come up. So that's something instead of just like, Oh, God, I have to make it stop. I have to make it stop. Ask yourself, what is going on in your life that you're stressing with? Maybe you're not addressing that you have to focus on. So using the acceptance and commitment therapy tools, again, it's about accepting that this is where I am right now. I can't necessarily control it, but I can take care of myself in other ways to keep my stress down and hopefully eliminate the intrusive thoughts. Another very important one regarding anything you're going through in your life is self-compassion. So you really need to treat yourself with kindness and understanding and grace. This is nothing that you have brought on yourself. You want to remember that having intrusive thoughts is a common human experience, and it doesn't make you a bad person.

So when I was talking earlier about some clients have said, Oh, yeah, I'm driving down the street, and I think about driving into the center divider. That might happen once or twice for them. That's an intrusive thought. Where did that come from? I don't want to kill myself, right? Then you have the extreme with the OCD where it's over and over and over again, and it's really hard to control. There's a spectrum here regarding what an intrusive thought is for each individual. If you have ones that come up hardly ever and you're like, Okay, that was weird, and you can move on, then you can deal with it on your own. When I was saying to get professional help that if these intrusive thoughts are really causing distress and problems in your life is when you really want to reach out for help. Another tool is just relaxation techniques, right? So that's good for all of us. Under any situation, we want to practice our deep breathing, doing progressive muscle relaxation, or meditation to help calm your mind, which will reduce your anxiety. And then I'm just going to reiterate again, just seeking professional help.

So if these intrusive thoughts are causing significant distress or interfering with your daily life, considering getting support from a CBT therapist, we can really provide specialized guidance and support to your specific situation, and that's what's really important. Also, I want to share with you something to remember is that progress in managing intrusive thoughts and hopefully eliminating them can take time, and you really need some patience. It's really important to be consistent with your CBT techniques, and again, and seeking help if you're really struggling. I wish it went away in a day, but it doesn't. But I do know people that have had intrusive thoughts, and they've either gone away or they're just so minimal. And if they do come back, they're like, It's not me, it's my OCD. And they can disengage from that and be able to move on from having the tools and the support that they had in the therapy they went to when it first started. So aside from the CBT tools I just shared, there's definitely lots of other techniques as well that can be really helpful in managing your intrusive thoughts. I wanted to share those with you as well.

I did mention the meditation. I want to talk about that a little more. Mindfulness meditation, you want to practice regularly, it can really help you observe your thoughts without judgment and create a distance from them. And this can be particularly helpful when dealing with intrusive thoughts that, Okay, those are my intrusive thoughts. I'm not going to get attached. They have nothing to do with me. My brain is sending me faulty messages, and be able to be there and be calm and let them just float away. So journaling can be helpful. Writing down, not the intrusive thoughts, but writing down the thoughts about that I'm a bad person, or this is something about my character, who I am, my values, writing down and getting a perspective can help you definitely develop more rational responses when you're starting to feel bad about yourself, so any journaling in that way could be helpful to you. Physical exercise is always great. Exercise and Wrigley can help reduce the anxiety and stress, which can also contribute to the intensity and frequency of intrusive thoughts. And adding to physical exercise, I want to say, which I share with all my clients over and over and over again, is how important sleep is.

When you're really struggling with intrusive thoughts, it'll keep you up at night. It makes it hard to sleep. A lot of times when we go to bed, our anxiety increases because all of our defenses for the day are gone and our brain just gets washed over with all our anxiety, and this can happen with the intrusive thoughts also. So finding ways to get good sleep, whatever that might be, if you need some help, go to your doctor, doing the journaling, doing the mindful meditation, listening to a meditation where someone else is talking to you, whatever is helpful, getting a good eight to 10 hours can really help you heal, can help you feel like you have the energy to even deal with the intrusive thoughts when they come. So I really encourage you, if you're not having a good sleep cycle, to really work on that. I do have a podcast on sleep that talks about good hygiene, if you want to listen to that. You also want to have some creative outlets, engaging in creative activities like art, music, writing, whatever you enjoy, where your creativity comes out, this can really provide a healthy way to express and process your emotions that you're feeling.

So whatever works for you, I say go for it. Again, the deep breathing techniques, having that really deep, diaphragmatic breathing can really calm your nervous system and reduce anxiety. And then this can help you have more control and address the intrusive thoughts when they do come up for you. So practicing all of these tools, I have a few more I'm going to go over, but I just want to say here, when you practice the breathing, the meditation, the physical exercise, being creative, like taking care of yourself every day is important because when you do have the challenges arise, like the intrusive thoughts, you're going to be more equipped to deal with them instead of being just anxious all the time and feeling fragile. And then the intrusive thoughts come and then you're like, Oh, my God. I just can't even deal with it. That's really important. Guided imagery and visualization is under the umbrella with meditation, but using guided imagery or visualization techniques helps you redirect your mind towards positive, calming, and enjoyable scenarios. So if I do like visualization for me, I think I really love the beach. And there are certain beaches I've visited that I really love the most, and I can close my eyes, and I start doing some breathing, and I start imagining myself at the beach, hearing the sounds of the water, the waves, smelling the air, and feeling the sand under my fingers and toes.

And when you do this, your brain can really take you back to that place, and it can really calm you down. So there's lots of different great visualization techniques, and a lot of therapists can help you with this also. So that's something that can be really helpful. Distracting yourself is a tool. It's not for 24-7, but it is a tool. Some people think it's a way of avoiding, but it's not. Sometimes we just need to distract ourselves from our own minds. Engaging in any activities that require your full attention, like puzzles, games, any hobbies, this can help divert your focus away from intrusive thoughts. There's a lot of different hobbies that, especially physical ones, that if you don't pay attention, you're going to fall down and get hurt. If you're playing a video game, you're going to die in the game. You have to focus. So finding things that really take your full attention can be really great ways to distract yourself. And again, when I was saying the third step from the brainlock book or second step, I'm sorry, is to... Now, I'm messing up here. It is the third step, is to find something that brings you pleasure so you can go distract yourself.

I will go over the four steps again at the end so I don't confuse you guys. Another really good tool is just self-compassion and affirmations. You really want to treat yourself with kindness and remind yourself that having your intrusive thoughts is not to find your worth or your character, and that you're a human being going through a very difficult time. Your brain is sending you faulty messages. You're going to get help, you're going to get better. And it's going to just take some time. And having really good support at this time in your life is another tool as well that is so important. Do not go through this alone. You're going to just feel like you're just trying to convince yourself over and over again. You need loved ones to say, You're okay, right? You don't have to focus on these thoughts. Let's go do something together. Let me go to the doctor's appointment with you. Let me make a phone call for you. I am here to support you. I know who you are as a person. This is not who you are, these thoughts. So it's really important to find people you can trust and share.

I know a lot of people feel really ashamed that they even think this until they really get a handle on it not being about them. So they tend not to share. But it's really important to find, at least I would say, a couple of people that you can share that they can be there for you and walk through this journey with you and give you the support to make you feel like you're going to be okay. You can trust how they see you because they know your character. If they say you're okay, then you know what? I'm going to just trust what they're saying right now. So that's super important. Another good tool is establishing a routine. So having some structured daily routine can provide you a sense of stability and predictability, and also reduces sometimes the opportunity for intrusive thoughts. If you're doing things, like I was saying about being focused and you got a routine and you're doing things every day, that can help you keep your mind on other activities? Having a routine is really healthy for our mental health anyways. And the tool I came up with with one of my clients we call it was listing your wins every day.

It's very easy when you're going through this to be like, Oh, my God, this happened. I didn't do very good. I had these thoughts again today, right? That being able to just say, That was a win. This was a win. I got up on time. I had a good night's sleep. I exercised. I was able to use my tools and eliminate my thoughts for an hour, that's a win. You're going to have a much longer win list than not. So that's really important to think about, What am I accomplishing? What have I done? What worked today for me? What did I do today that maybe I didn't do yesterday? Did I get out of the house when I've been just staying in because I didn't want any thing, any stimuli to create my thoughts, my intrusive thoughts to come in? What have I done? Any little thing. Any little thing. You walked around the block. I want you to see that as a win. Super important. Another thing that I haven't read anywhere is just something I came up with. There's no research behind this one, but a lot of my clients have found that helpful is at some point I say, Just get pissed off at your thoughts.

Instead of like, Oh, my God. Oh, my God. Why am I thinking this? What's wrong? Just get pissed off. What the hell? This is not who I am. I don't need to give this any energy. I'm not going there. I also had a client one time. I'll never forget. I really saw him maybe two or three times we talked. I'm like, You have intrusive thoughts? I explain. He's like, Oh, okay, well, if they're intrusive thoughts, then I don't have to worry because I'm having these thoughts about hurting my family members. But that's really not what I want to do. He was able to just let it go. I was like, Good for you. Everybody's different. We're not here comparing. I'm just giving you different scenarios, and you need to find what tools work for you. I always tell everybody, There's lots of tools. Not everyone's going to work for you, but I want you to try them so you can hone in and say, That's really helpful. This is really helpful. I'm going to use this. And one last thing with dealing with intrusive thoughts. Again, I'm not a psychiatrist. I refer to psychiatrists. This is a diagnosis that I do refer clients to for medication when the intrusive thoughts are just pretty much taken over their lives, and it's just too hard to cope.

And medication can really help. It doesn't mean you're on it forever. I do know people that have gone on it when their intrusive thoughts were really, really overwhelming. And then they came in, they did the therapy, they got better. And at some point, they decided to go off the medication, and they're still doing fine. Some people have stayed on. Whatever you're going to do, whatever is best for you is all that matters. But I'm just saying there's nothing that's in stone. A lot of people get freaked out with medicine. They're like, Oh, my God, if I start, I'm going to have to stay on forever. Not true. You work with your doctor, you figure out what's going to work best for you. But any good psychiatrist is going to tell you, You got to go to therapy, you got to get tools on how to deal with this. The medication is never a cure. And the more tools you have and the more you can cope with this and manage this, more likely, maybe you can get off your medicine one day if you want to. But again, a lot of people, medicine is fine, they live with it, it works for them, and the benefits are so great for them that the medication as well as the tools are really a good fit.

So I hope I shared enough for you to see that there's a lot of tools out there. There's a lot of things I can do. I don't have to suffer with intrusive thoughts and just hope they're going to go away or think I have to be a certain way and then they're going to go away because if I'm a good person, they're going to go away. It's got nothing to do with you, right? That's the big message here, is having intrusive thoughts is not a reflection on your values, your character, who you are as a person. You're the person you've always been. You've been loving, kind, compassionate, giving, being there for others, wanting to do the right thing. All of that is still there. Your brain is sending you the faulty messages. So let's go over the four steps before we finish up. Again, if you want to get Dr. Schwartz's book called Brain Lock, it has some pretty intense scenarios, vignettes in there, so be mindful. If that's going to bother you, don't have to read it. You can listen to my podcast. I'm here giving you the steps. The first step is the mantra.

If it's not me, it's my OCD. Step two is my brain sending me faulty messages. Step three is finding something that brings you some pleasure, some activity to distract yourself. And step four is accepting that these thoughts are probably going to come back again right now until I get better, and that I can accept that. And when they do appear, I know what to do. So I'm taking control over this. I don't have to feel like I'm out of control. And I know what I'm going to do when the intrusive thoughts appear and what I'm going to do to get better. And to find that support network, I really don't want you doing this on your own. So I hope this was helpful. Please share with anyone that might find it helpful as well, or you want to keep getting this out. I hope we hit a million soon, download. Just tells me more people are listening and finding help. And I hear that from you guys all the time with your emails.

So again, I'm so grateful. Thank you again for being listeners. Thank you for all your support.

And always remember to make decisions based on what's best for you, not how you feel.