Overcoming Unwated Intrusive Thoughts

by Sally M Winston

  This metaphor illustrates that sometimes doing nothing, floating past an intrusion, just letting it remain, is the most effective way to be. This is a way of understanding the principles embodied in steps 3, 4, and 5—accept and allow, float and feel, and let time pass.

  Noisy Neighbors

  You are on your back porch reading, and you hear neighbors arguing with each other in angry voices. They do this all the time. You neither try to figure out what they are arguing about, nor do you go over and get involved. You just wait it out patiently and go back to your reading. They eventually stop.

  Headache

  You have a headache. You still go to work, and at some point during the day, you notice that the headache has gone away. You did not do anything to make it go away. Sometimes just continuing on with your everyday activity is an effective way to not struggle with an issue while you simply let time pass.

  These stories are ways of showing that everyday life is filled with examples of the suggestions outlined in the six steps to reduce stress over a thought. Continuing what you do while allowing time to pass is a way to let your mind and body relax by itself, naturally.

  You now have an attitude and strategy for better dealing with unwanted intrusive thoughts that ambush you out of the blue. This strategy and attitude encourage a new perspective and eventually will significantly reduce your distress. It will take practice to avoid the anxiety traps and hijackings, and to learn these new ways. But please don’t lose hope: this approach has been helpful for hundreds of people like you, who initially felt overwhelmed and at wit’s end. You have already learned so much and made such significant changes. The next chapter introduces a plan of deliberate actions that can develop new brain circuitry so unwanted thoughts lose their power and stop bothering you at all.

  Chapter 8

  Getting Over Unwanted Thoughts for Good

  Our goal is to change the way your brain works. This will result in changing how unwanted thoughts feel so eventually they will stop bothering you. What you have learned by now is that your usual and customary way of coping with unwanted intrusive thoughts fails to do that. In fact, it does the opposite and keeps your brain, your body, and your thoughts locked into their present cycle. We have explained how the attitude of acceptance is what opens the door for changes to occur, and in this chapter we lay out a program of deliberate actions to enable this to happen.

  There is widespread agreement that the most effective way to change your brain and get over your unwanted intrusive thoughts is—believe it or not—to allow yourself to think your frightening thoughts on purpose. In other words, to expose yourself to the thoughts intentionally, while practicing new and better ways to manage your reactions. When you take charge of the experience instead of being bombarded by it, you rewire your brain and create lasting changes. This is called exposure work.

  The attitude of acceptance is essential to gaining the most benefit from exposure work. In fact, exposure work without acceptance is just a recipe for misery and is ineffective. Being willing to be uncomfortable is important, but if you also understand how exposure works, it may give you additional motivation and courage. This will set the foundation for optimizing practice.

  Helpful Fact: Exposure is the active therapeutic ingredient for overcoming anxiety.

  Get Uncomfortable on Purpose

  Why should you make yourself more uncomfortable on purpose? Aren’t you reading this book in the hopes of becoming less uncomfortable?

  The answer is that we want you to do better than just feel more comfortable. Our ultimate goal is to help you end your suffering. That means taking a larger perspective and agreeing to put up with more discomfort in the present so you can suffer less in the future. The way to the other side of troubled water is through it since there is no effective way to run around it. And we know that to rewire the brain, we have to activate fears to change them. The good news is that practicing isn’t as frightening as you might imagine.

  Remember that your amygdala is just an alarm system. Think of it like an infant—it has no subtlety or words—so you can’t teach it new information by using words. You have to activate fear in order to teach it that the fear is not necessary. When you actively and willingly trigger the fear pathway, you allow your brain to be rewired. That allows fear to decrease and for the adoption of the attitude of acceptance.

  By now you have learned a great deal about how your brain and your body—in conjunction with your three inner voices, Worried Voice, False Comfort, and Wise Mind—create and continue to power your unwanted intrusive thoughts. Exposure is the opportunity to change the ways those characters interact. Exposure gives you the opportunity to put in effect the information you have already learned. Exposure is the way to turn your learning from “knowing in your head” to “knowing in your heart, brain, and body.” Exposure is the way to find and trust your own Wise Mind. Exposure is the opportunity to train your brain to change.

  You can never become fluent in a foreign language by only reading books on vocabulary and grammar. You need to tolerate awkwardness and discomfort, and practice speaking the new language. In exactly the same way, you will learn best how to overcome unwanted intrusive thoughts by intentionally provoking them and coping with them while your brain and body are reacting.

  Worried Voice:Oh, no! I can’t imagine that I’ll be able to intentionally think my awful thoughts. What if it makes me sick? Or makes me worse? Or what if I can’t handle it and lose control?

  False Comfort:Come on; I’ll help you. We’ll make sure you are okay and don’t do anything that sends you over the edge.

  Worried Voice:Over the edge! Oh no! Do you think I might lose my mind doing this exposure stuff? How will you make sure I don’t go over the edge?

  False Comfort:No, I think you will be fine. But all your worrying is starting to get to me. Why don’t you just think about something else?

  Worried Voice:How can I think about something else when I’m supposed to think the thought? Do you think I might actually do what goes through my mind? That would be terrible!

  Wise Mind:Both of you would do better by getting closer to the present. Do yourself a favor and listen to yourselves. Do either of you think you are helpful? We are being offered a path that has been helpful to others and seems like it might be helpful to us. I am willing to try something new as the old ways surely do not work. I would like to try it, and I hope you two can figure out a way to go along as well. You are just going to need a little faith.

  If the content of each intrusive thought is meaningless, you might be wondering why we ask you to think those particular thoughts. It is because your attitude and sensitivity toward these thoughts are what you are aiming to change. There is no better way to do that than to face precisely the worst thoughts you can come up with. If you avoid the thoughts that trigger you the most, you give them even more power. If you compromise and invoke anything less than the real thing, you are forgetting that thoughts—any thoughts—are just thoughts.

  Changing Your Brain: How Extinction Works

  There are two ways to explain how your brain learns to become less fearful as a result of exposure. One is called emotional processing, and the other is called inhibitory learning. Both theories are supported by brain research, so we are going to give you a short explanation of both.

  Emotional Processing Explained

  Emotional-processing theory (Foa and Kozak 1986) states that your brain develops false fearful memory structures that keep your fears alive. When you consistently avoid or run away from thoughts that trigger these memory structures, you never learn that they are incorrect and that your thought isn’t really dangerous. As a result of keeping away from the triggers, they remain part of your brain for very long periods of time. You don’t have the chance to habituate—or get used to—the thought because your false brain structures tell you they are dangerous and you should keep away.

  This theory explains why actively inviting the thoughts along with the anxiet
y creates corrective emotional processing so fearful memory structures in your brain become accurate. Real experience allows false fear memories to be emotionally processed, and your fear will then be erased. But there are two important requirements.

  The first is that corrective emotional processing only occurs in the presence of fear since the fear is what allows the memory structures in the brain to change. The technical term is “exposure plus activation.” Any exposure that activates anxiety brings the false fear structures into play, and they change as a result of seeing that nothing dangerous (as opposed to frightening) really happens.

  The second requirement is that you keep in contact with your triggering thoughts until your anxiety goes away or at least calms down considerably. This allows your brain to get used to the thought and habituate to it. You get maximum therapeutic benefits from exposures that are long enough for this to happen.

  Emotional processing theory makes it very clear why avoiding the thought won’t work. Avoidance keeps you experiencing the thought as dangerous or intolerable, and that sets the stage to retrigger your amygdala. Worried Voice plays the part of the false (but powerful) fear structures in your brain. But the voice of False Comfort is the voice that represents avoidance and distraction, and both of those interfere with emotional processing.

  Inhibitory Learning Explained

  Another more recent model explains the therapeutic benefits of exposure in a slightly different way. The inhibitory-learning model (Craske et al. 2008) of exposure says that people don’t really unlearn old, fearful responses. Instead, what happens is that new pathways are created in the brain that compete with the old, fearful response. The more new pathways that are created, the greater the chance that a nonfearful path will be chosen. If you practice it enough, you create many nonfearful responses that inhibit the scary one. A nonfearful response then becomes the default response, and you are no longer afraid.

  Imagine that your fearful response is the main road going through your town. And imagine that a planned highway is the new reaction. If a highway is built right next to the road, the highway will become used more and more until the road is barely used. The road still exists, but it handles less and less traffic as people get used to the convenience of the highway. Exposure work creates the new highway.

  Inhibitory learning is new learning. Even if you don’t entirely habituate to (become completely okay with) whatever you are trying to get used to, your new pathways are being formed. You do best when you practice frequently, in many different situations, under a variety of conditions. If we go back to the model of the highway, frequent and varied practice helps to create more on and off-ramps for the highway. It will be easier to get on and off, and you will use it more frequently.

  This way of looking at exposure also explains a distressing phenomenon that you have surely experienced. Sometimes, for no apparent reason, something that has stopped upsetting you some time ago can occasionally trigger a bolt of anxiety. Now we know that the fearful path is still there, but is hardly ever used. So you have to be prepared for anxiety to occasionally show up. It is actually more likely to happen when your mind is stickier, such as when you are fatigued or stressed by something else. What it means is that you are temporarily stickier, not that the learning you have already done is lost.

  What is most important about exposure is that you stay in contact with what frightens you until the feelings seem more manageable. They don’t have to go away, but you should stay long enough so they seem a little more tolerable. You might say that your description of the fearful feelings goes from “They are so uncomfortable that I find them intolerable” to “They are uncomfortable but tolerable.” The goal is to feel that you can tolerate the anxiety better, as opposed to eliminating it completely. There is a lot of evidence to suggest that being able and willing to tolerate anxiety, as opposed to eliminating anxiety, actually results in more durable and long-term recovery.

  In other words, it is your inability to tolerate your unwanted intrusive thoughts that keeps them going. That inability keeps your brain using the old, fear-provoking pathways and prevents new ones from being created.

  If unwanted intrusive thoughts just don’t matter because you have less fear of them and you are able to tolerate them much better, they then fade out on their own. New, nonfearful pathways in your brain are utilized and strengthened.

  Both theories have one very important aspect in common: the ingredient for getting over your fears is—paradoxical as it might seem—allowing yourself to experience them.

  Planned Practice vs. Incidental Practice

  In chapter 7 (“How to Handle Thoughts When They Happen”), we presented detailed steps to make the most of each unwanted intrusive thought as it occurred. That is incidental practice: making the most of an intrusion that seems to come out of the blue. It is practice you get to do when thoughts happen. But you can speed your recovery by deliberately increasing the opportunities to create new brain pathways.

  Planned practice occurs when you intentionally expose yourself to your triggers, or intentionally have the unwanted intrusive thoughts that set off your fear alarm system. You goal is to focus on what is happening inside you so you can practice reacting to the false alarms in new and more helpful ways, so you can teach your brain.

  For the time that you are actually engaged in planned practice, you want to be anxious! Experiencing anxiety helps you practice engaging the paradoxical attitude of acceptance while your brain and body are yelling, “Danger! Get away from here! Avoid!” This is a hard task, and it requires willingness to be uncomfortable. You are willingly allowing yourself to stay where you want to avoid, allowing uncertainty to remain when your inner voices are begging for certainty and intentionally allowing the feeling that seems so dangerous. We are asking you to react without urgency as your Worried Voice is screaming at you to “do something!” We are asking you to out-bluff anxiety, to refuse to be hijacked, and to stand up to the bullies in your mind.

  Once again, consider the alternative: to continue the enormous avoidance efforts you have already expended—and continue to expend—that don’t actually provide help and just maintain your suffering.

  Five A’s for Optimal Practice

  You will get the most out of planned practice if you can keep certain principles in mind as you grapple with unwanted intrusive thoughts. Remember that anxiety will be working hard to trick you into believing that your thoughts really do represent all the upsetting myths that were debunked in chapter 3 (“What Thoughts Mean: Myths and Facts”). In fact, this might be an excellent time to review that chapter, since your Worried Voice might very well be repeating every one of those myths.

  Here are the five A’s, which we will explain in more detail.

  Attitude of acceptance

  Assign accurate assessment

  Active allowance of awareness and affect

  Avoid avoidances (always attempt approach)

  Action: advance activities anyway

  Attitude of Acceptance

  In chapter 7, we explained how to apply the attitude of acceptance to each unwanted intrusive thought as it pops up. Now we are asking you to expand that attitude toward your planned exposure practice. Remember that acceptance is the opposite of fighting with the feeling or fleeing from the thought, and it is part of the paradoxical nature of anxiety that accepting the feelings and the thoughts is the most efficient way to get rid of them.

  Assign Accurate Assessment

  Remember that you are practicing with unwanted intrusive thoughts. They are thoughts, just thoughts, and only thoughts. They might feel different from many of your other thoughts, but that doesn’t change the fact that they are only thoughts. Despite the commentary that anxiety is feeding you, intrusive thoughts are not impulses, indications of your character, nor messages from you “inner self” that something awful happened or is about to happen.

  Helpful Fact: Anxiety tries to convince you that intrusive thoughts have a special meaning. Par
t of beating anxious thinking is refusing to be taken in by this misleading message.

  Your job is to stay with the label—that this is an unwanted intrusive thought and not an issue—and trust your assessment, despite the doubts and what-ifs that are sure to surface. Remember that your amygdala has sounded its false alarm, and so the thoughts “feel” different—they feel dangerous. Remember that feelings aren’t facts and that anxiety’s role is to trick you into running away from the thoughts and pushing away the feelings. You know this is an intrusive thought by the way it feels and the way it acts. It feels awful and contains an urgent sense to get rid of it. And it acts like a bad penny. It shows up again and again.

  Active Allowance of Awareness and Affect

  While you are practicing exposure to unwanted intrusive thoughts, your goal is to allow all thoughts and feelings into awareness. (The word “affect” is the term that psychologists use to describe emotions.) This is the ultimate goal that you are aiming for, but it’s not something that you should expect to obtain right away, so don’t get upset at yourself when—not if—you fall short.

  Keep in mind that the more of your emotions and thoughts you can keep in awareness, the more effective your exposure will be in producing habituation and inhibitory learning. Actively allowing awareness makes your planned practice work better and will help you avoid some of the pitfalls that anxiety brings.