Your support changes lives. Thank you!
Learn More
Discover a structured framework for assessing patients’ AI chatbot use, including its frequency,…
Authored by: Stephan Siwiec, PhD
What are Intrusive Thoughts?
Intrusive thoughts are unwelcome and upsetting ideas or images that come into our minds, without any intention from us. For example: While driving, you notice a pedestrian on the side of the road and think, “I could easily swerve and hit them,” but you don’t act on it.
Everyone has intrusive thoughts from time to time. When they occur, most of us say to ourselves, “Oh, that was weird,”—such as the thought of hitting the pedestrian—and then we move on. We redirect our attention back to whatever we were doing, whether that’s driving a car, reading a book, or having a conversation.
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, and dread, intrusive thoughts can evoke similar emotions. It’s normal to have an emotional reaction to a disturbing thought, but the emotion doesn’t actually inform us how ‘real’ the thought is.
People with OCD or other anxiety disorders tend to give more meaning to intrusive thoughts and 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 responsibility for simply having the thoughts. Since we don’t typically talk about our intrusive thoughts with others, they’re not normalized, so people conclude that only someone at risk of acting on such behaviors would have these thoughts.
Why do intrusive thoughts reoccur?
Our brains are good at focusing on threat cues over other mundane information. Prioritizing threats over other information likely helped our ancestors survive. The issue is our brains aren’t always good at sorting out what is a real threat and what is not, such as the horror movie example.
Our brains learn to prioritize information by importance. If a person assigns importance to any thought, our brains take it as a cue to remember and revisit it. Anything a person does in direct response to a thought can give it importance, like dwelling on it, or doing something to lower the chances of the feared outcome occurring.
In the example of the pedestrian, if a driver turns the wheel away, 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, it reminds the person of what they did to reduce the chances of causing harm and reinforces this with a sense of relief. It becomes harder to move on from the thought because it’s been reinforced, when in reality, that pedestrian was never really in any danger from you.
How can I manage intrusive thoughts?
While there isn’t a perfect plan to manage intrusive thoughts, I have three recommendations:
- Notice the thought, then leave it alone without further attention. While we can’t fully control our thoughts or emotional reactions to 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 just 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. This thought hit a nerve, and it’s normal for your brain to come back to it. With consistently giving it little importance, it should occur less and less frequently.
When should a person be concerned about intrusive thoughts?
Not every thought is impactful for every person. Mental health professionals look for:
- 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’re capable of acting on them.
Mental health professionals offer understanding, support and treatment as needed, providing psychoeducation and strategies to help people manage their responses to intrusive thoughts while normalizing their presence.
- Thought record: Many therapists encourage their patients to keep a thought record early on in treatment which helps organize the most impactful thoughts into themes, such as catastrophizing, probability overestimation, magical thinking, or all or nothing. From there, a mutually agreed-upon response plan can be developed.
- Thought challenging: For some patients, engaging in a strategy called thought challenging can be helpful to lessen the impact of these thoughts. An example is a person who has intrusive thoughts about a loved one getting in a car accident, and their compulsion or ritual is warning the loved one to drive safely. The thought challenge would be to consciously think that having this thought doesn’t increase the chances of it happening. The next step is sitting with uncertainty and not reaching out to the loved one.
- Let intrusive thoughts be: For others, letting the intrusive thoughts just be there, without a response, is the most effective path forward. In this instance, a person notices the thought and the feelings it brings up. They would allow the thought to exist without a response and turn their attention back to the task they were engaged in. Repeat as needed.
- Exposures: If these approaches don’t work after a few days or weeks and the thoughts create high distress and interfere with daily life, exposures can be assigned by the mental health professional to target these thoughts.
Whichever option is chosen, the priority is to give these intrusive thoughts the importance they deserve, which is almost no importance at all! It’s easier said than done, and important to remember that successfully managing intrusive thoughts means being able to experience them while still engaging in your life.
ADAA Resources:
- Find Your Therapist
- What is OCD?
- Mental Health Therapy Types: Find the Right Treatment for You
- Sign up for ADAA's Free Monthly Newsletter - Triumph
This blog was written in collaboration with Rogers Behavioral Health, an ADAA partner.
ADAA Blog Content and Blog Comments Policy
ADAA provides this Website blogs for the benefit of its members and the public. The content, view and opinions published in Blogs written by our personnel or contributors – or from links or posts on the Website from other sources - belong solely to their respective authors and do not necessarily reflect the views of ADAA, its members, management or employees. Any comments or opinions expressed are those of their respective contributors only. Please remember that the open and real-time nature of the comments posted to these venues makes it is impossible for ADAA to confirm the validity of any content posted, and though we reserve the right to review and edit or delete any such comment, we do not guarantee that we will monitor or review it. As such, we are not responsible for any messages posted or the consequences of following any advice offered within such posts. If you find any posts in these posts/comments to be offensive, inaccurate or objectionable, please contact us via email at [email protected] and reference the relevant content. If we determine that removal of a post or posts is necessary, we will make reasonable efforts to do so in a timely manner.
ADAA expressly disclaims responsibility for and liabilities resulting from, any information or communications from and between users of ADAA’s blog post commenting features. Users acknowledge and agree that they may be individually liable for anything they communicate using ADAA’s blogs, including but not limited to defamatory, discriminatory, false or unauthorized information. Users are cautioned that they are responsible for complying with the requirements of applicable copyright and trademark laws and regulations. By submitting a response, comment or content, you agree that such submission is non-confidential for all purposes. Any submission to this Website will be deemed and remain the property of ADAA.
The ADAA blogs are forums for individuals to share their opinions, experiences and thoughts related to mental illness. ADAA wants to ensure the integrity of this service and therefore, use of this service is limited to participants who agree to adhere to the following guidelines:
1. Refrain from transmitting any message, information, data, or text that is unlawful, threatening, abusive, harassing, defamatory, vulgar, obscene, that may be invasive of another 's privacy, hateful, or bashing communications - especially those aimed at gender, race, color, sexual orientation, national origin, religious views or disability.
Please note that there is a review process whereby all comments posted to blog posts and webinars are reviewed by ADAA staff to determine appropriateness before comments are posted. ADAA reserves the right to remove or edit a post containing offensive material as defined by ADAA.
ADAA reserves the right to remove or edit posts that contain explicit, obscene, offensive, or vulgar language. Similarly, posts that contain any graphic files will be removed immediately upon notice.
2. Refrain from posting or transmitting any unsolicited, promotional materials, "junk mail," "spam," "chain mail," "pyramid schemes" or any other form of solicitation. ADAA reserves the right to delete these posts immediately upon notice.
3. ADAA invites and encourages a healthy exchange of opinions. If you disagree with a participant 's post or opinion and wish to challenge it, do so with respect. The real objective of the ADAA blog post commenting function is to promote discussion and understanding, not to convince others that your opinion is "right." Name calling, insults, and personal attacks are not appropriate and will not be tolerated. ADAA will remove these posts immediately upon notice.
4. ADAA promotes privacy and encourages participants to keep personal information such as address and telephone number from being posted. Similarly, do not ask for personal information from other participants. Any comments that ask for telephone, address, e-mail, surveys and research studies will not be approved for posting.
5. Participants should be aware that the opinions, beliefs and statements on blog posts do not necessarily represent the opinions and beliefs of ADAA. Participants also agree that ADAA is not to be held liable for any loss or injury caused, in whole or in part, by sponsorship of blog post commenting. Participants also agree that ADAA reserves the right to report any suspicions of harm to self or others as evidenced by participant posts.