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Let's Talk about Intrusive Thoughts

By Colleen Stinchcombe

You’re sitting there minding your own business (or trying to fall asleep) when—boom—out of nowhere, you imagine a car crash killing your loved one on their drive home. It’s a terrible thing to think about, and you might be wondering WTF it means and where that even came from. These are called intrusive thoughts, and the good news is they happen to everybody. Here’s what you need to know about them—plus what to do if they’re really bothering you.

“An intrusive thought is an unwanted thought or image that comes into your head,” says Elizabeth McIngvale, PhD, LCSW, director of the McLean OCD Institute at Houston. “We all have bizarre, weird, and intrusive thoughts.” It can be almost anything—maybe you suddenly visualize your city on fire or punching your (perfectly nice) boss. Intrusive? Sure. Normal? Yep.

So hopefully it’s somewhat comforting to know that most people imagine truly gruesome scenarios from time to time. If they’re not bothering you (other than to make you think, Um, WTF?) then there’s no reason to worry about them. But persistent intrusive thoughts can play a role in several mental health conditions, particularly anxiety conditions like obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and generalized anxiety disorder (GAD).

“Even though everyone has intrusive thoughts, for some people, they get really stuck,” says clinical psychologist Maria Fraire, PhD, program director of the OCD Institute for Children and Adolescents at McLean Hospital. One way to determine whether intrusive thoughts are a problem for you is to figure out, “how much distress are they starting to cause? How much time are they taking up in somebody's day?” Dr. Fraire says.

So, how do you cope with intrusive thoughts if they’re really effing with your life? First, get in the habit of noticing when you’re having an intrusive thought, says Dr. Fraire. Call it out for what it is: an intrusive thought, rather than a reality. Next, work on letting these thoughts go rather than giving them tons of attention. “A good technique to have with intrusive thoughts is to allow them to come and go as they would normally,” says Jessica Frick, LPC, NCC, counselor at Metamorphosis Counseling in Erie, PA.

When you have a distressing thought, try not to probe at it too much. Instead of thinking, What does this mean? What if it really happens? Am I a horrible person for thinking this? try to treat it as a normal thought like any other. Chances are they’ll drift by more quickly that way.

Try it:

Save your bedtime thoughts for the a.m. You get in bed, ready for slumber to hit you like a tidal wave, only to be pelted by thought after thought (after thought?). This sudden brain activity is actually pretty understandable since we’re often afraid that we’ll forget some super important ideas or to-do list items, says clinical psychologist Ryan Howes, PhD. But writing it all down, or even just saving it somewhere safe on your phone, can help you fall asleep faster. “The notepad acts as [your] memory, so [you] don’t have to keep replaying it over and over,” explains Dr. Howes. “That replaying is anxious rumination and keeps the brain charged up instead of relaxing.” Basically, this trick is a way to say, “Hey, brain, I hear you, but let’s get to this tomorrow!”

The next time you’re ruminating over a thought (or LOTS of thoughts), write it down. When you wake up, “make sure ‘morning you’ returns the favor by actually reading what you wrote down,” says Dr. Howes. That way you really trust that you can get your slumber on the next time you try this hack.

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