Intrusive thoughts – a game of whack-a-mole

It is estimated that we have 70,000 thoughts a day. However what we notice, pay attention to or remember is much less than this. 

Intrusive thoughts are a concept in psychology that we use to describe thoughts which are unwanted and pop into our mind in an intrusive way and for some people these can be extremely distressing in nature. 

So what types of thoughts are we talking about? 

Common intrusive thoughts I see in clinic are thoughts that a harm is going to come to a parent or sibling, thoughts that something terrible will happen to them (for example they will be abducted, harmed by a monster, someone will break into the family home) or that they will do something shameful and embarrassing in front of friends. Since Covid I’ve also seen a huge increase in intrusive thoughts relating to contamination, being dirty or getting sick. 

Common intrusive thoughts I see in adults are about people harming themselves (different from suicidal ideations) for example thinking they might jump when a train pulls into the platform. Also thoughts relating to harm coming to their family, thoughts about causing harm to their children (this can be particularly common in the post natal period) or thoughts related to doing shameful sexual acts. I also see lots of thoughts relating to leaving doors open, cookers on or windows unlocked. 

So let’s start by saying that thinking something is not the same as wanting to do it. Our thoughts are not fact! 

It’s our interpretation about our thoughts and what they might mean or say about us that becomes the problem.  

Studies have shown us that intrusive thoughts are much common than you may think. But because of the disturbing nature of these thoughts and fear of what people might think, that these thoughts are kept secret and thus my clients never realise others have had exactly the same thought and there isn’t anything wrong with their thinking. In some studies 70%- 90% of people disclosed intrusive thoughts. 

So here’s the thing, thoughts come and go continuously (how else do 70,000 thoughts a day happen otherwise), and generally speaking if we don’t engage too much with a particular thought, don’t give it too much meaning or significance then it will disappear and then maybe resurface again sometime later. This is where I always think of the image of a mole popping up and disappearing and resurfacing in a different hole. 

However it is when a particular intrusive thought is given attention and meaning, it can become more distressing. People might assume that because they’ve had that thought, this means that it’s a warning sign that something is about to happen and they therefore have a responsibility to act upon. 

This can then trigger anxiety which can result in a person engaging in a behaviour, compulsion, ritual or routine to get rid of that anxiety (and the thought). Unfortunately the more we try to suppress thoughts or do something to push them away, the more attention we are giving them and the more our anxiety increases, thus resulting in more intrusive thoughts. Imagine the game of whack-a-mole, trying to bash that mole out of sight, only for it to pop back up again. 

Let’s illustrate this with some examples:

Example 1- I have an intrusive thought about jumping in front of the train, I notice that thought and start to feel anxious about why I’ve had that thought. I question what it means, does the fact I’ve had this thought mean I want to jump? (this is an example of engaging with the thought and giving it meaning). 

I take a step back from the platform, then another step. I’m feel safer, I haven’t jumped and I get on the train. The next day the same thought happens again and I do the same but this time I’m even further back just to make extra sure I won’t jump. Eventually I stop getting the train and opt for the bus instead. 

Example 2- I have a thought that I’ve not locked my front door. This makes me anxious and I return to check. The next day I have the same thought and I return to check again, but this time I’m feeling tired as I walk away, I have the thought again and I tell myself I cannot be sure I did check it and I return to check again. 

The behaviour (checking) is making me less anxious in the short term, but the more I do this, the more this reinforces this behaviour and I’m now checking the door multiple times every day and not only that the more I’m checking the more I doubt myself and the more anxious I am. Then, you guessed it, the increased anxiety then increases the amount of intrusive thoughts and I need to check more and more items around the house for safety. 

These 2 examples show us how intrusive thoughts can become the start of Obsessive Compulsive Disorder (OCD) and if not identified and supported quickly the obsessions and the compulsions can increase in frequency and then start spreading to increasing number of rituals. 

OCD can be effectively treated but research shows us the biggest barrier is people delaying getting support. On average his can be 12 years! So, if you recognise this in yourself or your child, get support sooner rather than later. 

Treatment for OCD and intrusive thoughts often feels like a game of whack-a-mole. My clients want techniques to whack the thoughts way, whereas we have actually got to think about a different way of responding to those pesky moles and that way is letting them be there but refocusing our attention onto other things. 

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