Overcoming Unwated Intrusive Thoughts

by Sally M Winston

  Worried Voice:I’ll never be able to allow awareness. All the bad things that can happen fill up my mind. I’m a failure.

  False Comfort:I know you can try harder! Just a little more discipline and less mollycoddling will do it.

  Worried Voice:But I try as hard as I can. I can’t do it any better! I can’t stand it.

  Wise Mind:We can be both disciplined and gentle with ourselves. Our job is to allow awareness of all we can, and also to gently, tenderly, and kindly bring ourselves back to that task when we become distracted. Our mind naturally wanders off. That is okay. Discipline and gentleness: that’s the most productive approach.

  Avoid Avoidances (Always-Attempt Approach)

  Optimal practice embraces the principle that anxiety is maintained by avoidance, and overcoming anxiety means moving to areas of greater discomfort. Avoiding avoidances is the principle that describes this approach.

  Remember that the purpose of planned practice is to generate anxiety by doing what is required to trigger your amygdala. The amygdala only learns not to be afraid when the fear pathways are activated. Repeated clanging of the alarm response sets the stage for emotional processing, inhibitory learning, and for your brain to “rewire” itself so the thought no longer sounds the alarm. Avoidance blocks learning.

  Always attempting to approach the trigger will give you an overall direction to head when you are in the midst of practicing. If you are in the midst of a planned practice and you aren’t sure whether you should stay with the thought or distract yourself in some way, the always-attempt approach will guide you toward staying with the thought and discourage you from looking for a distraction. If, during a planned practice, you have the thought that this will interfere with your work later and so you should cut it short, this principle will encourage you to stay with the task and not avoid it because of some future concern.

  Avoidances can be both behavioral as well as mental. If you cancel a lunch with a woman who often triggers unwanted intrusive thoughts that you might be gay or you miss church services because of the fearful thought that you might yell out blasphemy, those are behavioral avoidances. And avoidance can be much subtler than that. You might go to church and insist on sitting in the last row so you can quickly and easily leave the church “just in case” the thoughts start up. Or you might go to lunch with the woman but talk incessantly and barely look at her. That is a form of avoidance as well.

  Additionally, avoidances can be purely mental. Avoidances occur when False Comfort tries to quiet Worried Voice. In these cases, you are trying to avoid the anxious feeling with internal dialogue. But, as you know, False Comfort is always followed by another round of Worried Voice.

  In general, all avoidances reinforce and empower your unwanted intrusive thoughts. It is the exact opposite of what we want. We want your intrusions to become less powerful and you to be less and less susceptible to their messages.

  Action: Advance Activities Anyway

  This principle reminds you to return to your task at hand after your planned practice session as well as after each intrusive thought that seems to come from out of the blue. Remember that your goal is to achieve a new way to relate to your thoughts that is unentangled and free of struggle. When you deliberately invite these thoughts, you do not give them the power to waylay your life.

  One way to achieve this is to continue doing the things you were doing prior to the thoughts. As we have mentioned in the previous chapter, unwanted intrusive thoughts can be compared to internal bullies. The most effective anti-bully activity is to refuse to let them change your daily activities. If you don’t, then you are giving power to the bully’s message. You can expect to feel afraid (there’s your amygdala again), but your most therapeutic reaction is to continue with your life and ignore the apparent message.

  The Nitty Gritty of Planned Practice

  Now we are going to explain some of the specific ways that you can practice on your own that will encourage the most therapeutic benefits of exposure. This might be a good time to review the six steps explained in the previous chapter.

  Go at Your Own Pace

  The overarching rule is that self-directed exposure work must feel manageable. You will make the most progress if you allow yourself permission to go at your own pace. Manageable does not mean comfortable since little anxiety reduction is learned by a comfortable brain. There is no set “speed limit” for how fast and how intensely you should work. There is no magic level of anxiety that is optimal. What feels manageable one day might feel much too difficult—or perhaps too easy—the next. The general principle is that you should strive to work at a level that feels manageable but is still a stretch or a challenge. This may vary from day to day, as your level of sensitization, or the “stickiness” of your mind, goes up and down. In general, the faster the pace, the more rapid the learning. But if you go so fast that you can’t apply the five A’s, then you might be just sounding the alarm and not learning anything helpful.

  Think the Thought—the Worst Thought—but with a Twist

  Since the thought frightens or disgusts you, one of the best ways to practice is to invite the thought to enter your awareness in a slightly altered way. Stay connected to the thought while accepting and allowing the feeling to remain. Here are some ways that you can practice having your most uncomfortable thoughts with a bit of change. And remember, humor is your best ally during practice.

  Sing the thought to the tune of “Happy Birthday” or “Twinkle, Twinkle, Little Star.”

  Write the thought over and over.

  Make a poem of the thought.

  Songify the thought (the app is free).

  Draw or paint the thought.

  Record the thought and play it back.

  Elaborate the thought into a full script with a terrible ending. Read it over and over.

  Write the thought on sticky notes and paste them all over the house (the mirror, the fridge, your purse).

  Translate the thought to another language.

  Say the words backward.

  Carry the written thought around in your pocket or tucked inside your clothing.

  Stand in front of a mirror and speak the thought out loud, over and over.

  Try to make the thought even worse—to the point of absurdity.

  Add the phrase I am having the thought that…to the thought, or I am seeing the image of…to the image, and repeat it on each step as you go up and down the stairs in your home or any time you encounter stairs.

  Helpful Fact: Humor goes a long way to making practice more manageable.

  Let us listen in on a dialogue.

  Worried Voice:Are you serious? Deliberately make myself anxious when I am not? I suffer enough!

  False Comfort:Wise Mind says this is the best way to feel better. It is like having to hurt a bit to get an injection, but the medication is worth it. We will likely be more anxious at first, and that is how change happens. Our brain needs to be activated to learn a new way. It should be okay.

  Worried Voice:But what if it isn’t? What if I just make myself worse?

  False Comfort:We can always fall back on the old ways, like gritting our teeth and holding our breath and avoiding stuff, even though it doesn’t really work.

  Wise Mind:This kind of work demands a leap of faith. Many others have taken this leap. Actually, being willing to take the risk is exactly the attitude that makes this whole thing effective. It is the willingness that is the key. The unwanted intrusive thought that is wanted and deliberately sought becomes a passing thought of no consequence.

  Avoid Getting Caught Up in Content

  There are some phrases that you can say to yourself as a way of helping you disentangle from the content of your intrusive thought. Here is a list that others have found helpful. You might think of some others as well.

  That’s a thought.

  Yes, damned if I can’t know that.

  Any thought can be tolerated, even that one.

  Nothing is certai
n, so I will get used to it.

  I can think of something worse.

  Change what-if to what-is: move from thinking to sensing. For example, instead of responding to a what-if question, pivot your attention gently over to your senses: what can you hear, see, smell right now here in the moment? What does your body feel like? Notice without judgment or struggle.

  Examples of Planned Practice

  It is sometimes hard to get the flavor of planned practicing by describing each element separately. For that reason, we present three separate scenarios involving planned practice in real life.

  “My son was in a car accident.”

  A young mother was plagued by unwanted intrusive thoughts and images that her son had been in a car accident. She was texting him many times a day to reassure herself that her thoughts were not omens or predictions, or that somehow they were the product of a mother’s “intuition.”

  After education about intrusive thoughts—what they mean and don’t mean—and an understanding that her efforts to avoid the thoughts were what was keeping them going, she agreed to begin planned practice. She was instructed to sing a new song “Johnny Is Dead by the Side of the Road” to the tune of “Twinkle, Twinkle, Little Star”—over and over, and to imagine a picture of him crumpled outside a crushed car at the same time. She was to do this not just when she had the urge to text him, but when she was showering, cooking, making the beds, vacuuming, shopping, eating, and every time she picked up a phone, computer, or other electronic device.

  At first this was very difficult for her, but surprisingly quickly, it was boring, and shortly thereafter, it felt absurd to be upset by the song. She had defeated the thoughts by deliberately inviting them to bother her.

  “What If I Kill Myself? I Don’t Want to Die!”

  A middle-aged man who lived alone kept having the profoundly disturbing and, to him, absurd thought that he might hang himself against his own wishes. This began after a celebrity had in fact done so, stunning and upsetting everyone. After sufficient psychoeducation, he was encouraged to carry around a rope so he would not forget to practice having the thought I could hang myself in a moment of impulse many times a day. He also placed a rope in his car and in his bathroom hanging from the shower rod. When he noticed his own False Comfort voice trying to reassure him with “But you are a happy man! You would never do that!” he was instructed to add “Nothing is impossible” and then to be willing to have the disturbing thought again on purpose. After a while, the ropes no longer made him upset.

  “I might oversleep.”

  A woman kept herself awake for hours every night, trying to respond to the unwanted intrusive thought I have to make sure my alarm clock is set properly. She would alternate between actually checking the clock and dealing with the returning thought that she had not set it properly. Usually she could refrain from more clock checking but not from more memory checking. She would carefully think back over her memory, checking it to make sure she clearly remembered doing it. She lay for hours trying to check her memories, reassuring herself and berating herself for the absurdity of the situation.

  She was instructed to tell herself I invite the thought that I may not have set the alarm properly. She began to sing the thought (including the elaborated story that she might be late to work) to “Lullaby and Goodnight.” She was not to attempt to fall asleep, but just lie in bed resting and allowing the unwanted thought. She got bored. She fell asleep after twenty minutes of planned practice. The struggle was over. It came back as a kind of jolt as she lay in bed, particularly when she was stressed by a work or family issue, but she knew not to fight the thought or try to make it go away. And it became a familiar passing thought on her way to sleep.

  Eventually you will discover that the thoughts you invite in—with acceptance, deliberateness, and willingness—change how they feel and how they act. They lose their power to frighten you, disgust you, upset you, or even deter you from doing whatever you wish. They lose their illusion of being meaningful and important. You feel more free.

  When you do these planned exposures, you are disentangling from them and disempowering them with your attitude of acceptance. The more you practice, the faster this happens. You take back control by refusing to control, and you regain composure and self-respect by allowing the natural course of your mind to proceed. You deprive the thoughts of the fuel of paradoxical effort, and they dwindle in importance and, eventually, in strength. Recovery occurs when it no longer matters whether the thoughts happen or not.

  In this chapter, we have discussed the most potent way to get over unwanted intrusive thoughts so they no longer cause you distress. In the next chapter, we address the best way to think about recovery, what it is, and how to maintain it.

  Chapter 9

  What Does Recovery Mean?

  In this chapter, we address recovery—what recovery is and how it is maintained. You may notice we are not using the word “cure,” which implies you had symptoms of an illness and now the illness is gone. We do this for a specific reason: unlike with an illness, the absence of symptoms is not a sufficient definition of recovery.

  Relief from the struggle with unwanted intrusive thoughts is certainly part of our achievable goals for you, but we are actually suggesting something even more ambitious. We want you to do more than simply have the thoughts stop bothering you. We are aiming for an inoculation for the future as well—so when intrusive thoughts occur once again (and you will remember, we all have them, and everyone can expect to experience them from time to time), you will be able to handle them so they do not cause a problem, do not get sticky and repetitive, and do not start that familiar internal dialogue that makes them frightening, disgusting, or shameful.

  You have certainly come a long way in your recovery, and we congratulate you! You have learned a lot about what thoughts mean and what they don’t mean, and you have done a lot of practice to change your automatic reactions to your unwanted intrusive thoughts. Let’s review what you will carry forward from here.

  There are three aspects of this inoculation that we have been addressing throughout this book. The first is a knowledge of how thoughts affect feelings and the understanding that your thoughts—and, in fact, any thoughts—have the capacity to automatically trigger your alarm system. The second is enhancing your ability to slow down so you are able to better observe the flow of thoughts. And the third is gaining a gentler, nonjudgmental, and more accepting relationship with your mind. The result is that you are able to accept and allow all your thoughts, along with the automatic feelings that come with them.

  When you started this book, if you had heard that our goal was to change your relationship to your thoughts, you might have had an objection that went something like this:

  Worried Voice:I don’t just want to change my relationship with those awful thoughts. I want them to go away and never come back!

  False Comfort:These people must know what they are doing. They seem to be saying that we have to accept, that we will be tortured, and that we will learn how to deal with it.

  Worried Voice:That is a raw deal.

  False Comfort:Maybe hypnosis would work.

  But you are at a point now where you can also access your Wise Mind. This is the part of you that has learned that accepting and allowing these thoughts is the path toward training your brain to stop fighting them. You have practiced a change of attitude when unwanted thoughts showed up, and you have deliberately invoked these thoughts in order to practice this Wise Mind response.

  Wise Mind:No, hang in there, guys. Here is the actual deal. If the thoughts really don’t matter to us, they actually stop coming! Because we have stopped fueling them with our disgust, fear, anger, and shame. The path to the other side of the storm where all is calm is through it. We can’t outrun it or circle around it. But if we walk forward through it, it does not take long to pass. We have the same goal: to not be bombarded by intrusive thoughts we don’t want.

  We say that Wise Mind is
right, and here is why: You were sensitized to the thoughts, and so you dreaded them, braced for them, and worried about their recurrence. You avoided situations that might trigger them.

  We call this anticipatory anxiety. You can think of it as the what-if about the what-if. Anticipatory anxiety causes you to project into the future in an attempt to prepare yourself for the next unwanted intrusive thought. You hope they do not come, and you are upset when they do. You are involved in a struggle with your mind.

  The result is that you keep oriented toward the future, pay very little attention to the present, and keep your body and mind sensitized. You remain vigilant, with your body poised to react. It keeps Worried Voice and False Comfort in constant conversation. It promotes stickiness in your mind. But most importantly, it keeps the unwanted intrusive thoughts coming! Defending against thoughts brings them to the foreground: your brain automatically re-creates them and continues the cycle.

  Starting the Cycle of Recovery

  You are now starting to experience intrusive thoughts in a new way. Your beliefs about them are totally different. You think that they are silly, unavoidable blips of your mind, holding no meaning, warning, or power. Pretty soon it becomes boring and unnecessary to be on alert for them. It would be like waiting with bated breath for something ordinary and expected to happen. Like waiting for paint to dry or for a clock to tick the next tick. You would naturally turn your attention to more interesting things, like whatever else you are thinking about or doing. Ordinary things like work, fun, or lunch. You could pay attention to other, more interesting thoughts and feelings. You would be free to experience the world around you.