Overcoming Unwated Intrusive Thoughts

by Sally M Winston

  This lowers overall sensitization, tension, and arousal. This happens quite naturally, without effort or intention. It is not a technique. It just feels normal as this happens: your mind simply becomes less sticky. Intrusive thoughts stop having a whoosh attached to them. They may still have the same content, but they feel different. And then they become passing thoughts. They come and go easily. Your worry about them reduces. Your sensitization goes down. The cycle continues. And then they just peter out, on their own, without any help from you. This is the fear-reducing cycle we presented in chapter 5. It ends disturbing, stuck, unwanted intrusive thoughts. They are only passing thoughts.

  Worried Voice:I have tried and tried to accept, and then when I check to see if it is working, the thoughts just keep coming back and bothering me. Acceptance just doesn’t work for me.

  Wise Mind:It is tricky. Acceptance is an attitude for allowing the thoughts and not a technique for stopping them. If you are checking to see if it is working, then you don’t actually have the attitude. It is like you have the words but not the music. Acceptance is when you actually don’t care whether the thoughts are there or not because they are not important or worthy of attention and because they do not matter. This attitude is what starts the cycle of recovery: reducing anticipatory anxiety, reducing the need for any kind of avoidance, and cultivating a basic okayness with your own mind. This down-regulating results in less stickiness and starts happening on its own once paradoxical effort and entanglement have stopped.

  Worried Voice:But how do I make it happen?

  Wise Mind:It is not something you do actively; it is passive, like falling asleep or allowing an ant to crawl down your arm without doing anything at all. It involves trusting the process—trusting that there is no hurry, trusting that there is no need for action, trusting when there is uncertainty, and trusting me, the wise part of you.

  Stickiness takes some time to go away because it is biologically based and bodies and brains need some adapting time. Sometimes the cycle of recovery takes longer than you wish, but it will happen as you continue to have the attitude that the thoughts do not really matter and there is no need to be on the alert for them. So patiently letting time pass while the body and brain heal themselves is part of the cycle of recovery.

  Setback

  We like to use the term “setback” instead of “relapse” for the return of unwanted intrusive thoughts. That is because unwanted intrusive thoughts pretty much always return at some point, and we want you to expect them and greet them as a chance to practice accepting them with the right therapeutic attitude.

  When you know that intrusive thoughts are likely to return, you are less likely to fall back on old ways of reacting. This can include shock, annoyance, and anger, which then escalate the problem. Part of your job is to remember that thoughts can return at any time, from weeks to years or even decades after they have petered out. But unless you lead an utterly charmed life with no stress, conflict, nights of poor sleep, and no excitement, change, or boredom, there will be a time when the brain just becomes temporarily sticky and old pathways in the brain circuitry are accidentally reactivated.

  Setback can happen with meaningless stress like too much caffeine, a cold virus, or bad news from the dentist. Or it can happen when you are dealing with something in your life that is an ongoing issue, like a conflict at work. It may even happen at good times, like if you finally get to have a vacation, you are sitting on the beach perfectly relaxed, and an intrusive thought surprises you. You get mad at it (Not now!), while Worried Voice and False Comfort start up their dialogue again after months of absence.

  If you do not expect this, then the natural responses to the unwelcome return of thoughts are (1) demoralization (Oh no, not this again), (2) anger (I was sold a bill of goods, or Why me?), (3) fear (I must be really a sick or bad person), or (4) hopelessness (That method works for some people but not for me; it is hopeless for me).

  If you understand that this temporary return of thoughts tends to happen to everyone in recovery, then it is far easier to greet it as an opportunity to practice the attitudes and anti-avoidance skills that may have become rusty over time. In fact, it is actually helpful for it to happen sooner rather than later, so when you have a return of some unwanted intrusions, you don’t have to read the whole book again and can just thumb through some reminders. Sometimes the thoughts that return are exactly the same old thoughts. Sometimes they are a slightly altered version of the same thoughts. Sometimes they have morphed into something completely different in content…but the telltale sign will be there. Remember, it is not the content but how the thoughts and images act and feel (and your instant desire to push them away or get entangled with them) that marks them as unwanted intrusive thoughts.

  Worried Voice:I used to worry that I could be a pedophile, and I got over it. I was fine for months. But now suddenly I am plagued with the thought that I could have Lou Gehrig’s disease. What a horrible way to go. I hate this.

  False Comfort:I know a good neurologist. I will make an appointment.

  Worried Voice:I already went to one. She said I have no signs.

  False Comfort:Maybe a second opinion would put your mind at ease?

  Worried Voice:She said I am almost certainly just anxious, but she could give me an MRI. I have been on WebMD, the Mayo Clinic website, and an ALS chat group to see if I should get one.

  Wise Mind:Let me step in here before you embark on a huge medical work-up. Do you recognize what is happening here? Is this thought acting and feeling like the pedophilia ones? Does it keep coming back? Are you getting entangled? Do you need to take a step back, slow down, and get this labeled?

  Worried Voice:OH NO! IT’S BACK!

  Wise Mind:Do you remember that we were hoping for a chance to practice what we have learned about how to handle unwanted intrusive thoughts? This is the chance.

  False Comfort:I think we should read the book again.

  Wise Mind:Not a bad idea. Everyone forgets the details.

  So a healthy way to regard setbacks, no matter when they happen, is that they are to be expected and that they are opportunities to practice what you have already learned about approaching the attitude of acceptance. Intrusive thoughts do not have to usher in another period of suffering and struggle. Often, it takes a bit of self-observation and some words from your Wise Mind to realize that your thoughts are just other examples of unwanted intrusive thoughts not worth exploring or getting entangled with. Here is a question to ask yourself if you notice you are worrying or preoccupied with something unwelcome that keeps intruding, bothering you, and repeating: What would wise mind say?

  As you know by now, recovery is actually an attitude—a willingness to have whatever thoughts happen to cross your mind, for however long they happen to stay, and whatever they are about. It is a set of beliefs about thoughts: that thoughts are just thoughts and they are not warnings, messages, moral acts, or facts. It is a set of beliefs about your own thoughts: that they are outcroppings of a sticky mind, the opposite of your values and wishes, and not worthy of attention. And it is a way of relating to unwanted intrusive thoughts that is un-entangled, nonjudgmental, and effortless. These attitudes and beliefs leave you inoculated for the future. And when it no longer matters whether the thoughts happen, they then have no fuel, and they fade away.

  Congratulations

  Congratulations for reading this whole book and for beginning your journey to full recovery. When the intrusion of an unwanted thought no longer activates an internal dialogue; no longer requires effort, action, or avoidance; and just simply does not matter; and when you no longer dread them or even care about them; you are free.

  If You Want More

  Finally, if you found this book applies to you and it was helpful, you may be interested in following up this work with additional professional help. Below are some websites with directories of local therapists who are trained to treat unwanted intrusive thoughts and for whom the ideas and sug
gestions of this book are familiar. Unfortunately, not just any therapist or person who claims to treat “anxiety” or unwanted thoughts may be as specialized as you are seeking.

  Anxiety and Depression Association of America: http://www.adaa.org

  International OCD Foundation: http://www.iocdf.org

  Association for Behavioral and Cognitive Therapies: http://www.abct.org

  Chapter 10

  When to Seek Professional Help

  So far, we have been talking about intrusive thoughts that are frightening but not at all dangerous. They might be frustrating, humiliating, or even shameful, but they are all events that exist only in your mind. Despite your enormous concerns, you are not likely to do the things you think about. As we mentioned, they are the product of over-control, not lack of control. They actually speak to the opposite of who you are because you fight the thoughts that feel most unlike your nature. They may feel like strange urges, but they are not what you wish or want, even “unconsciously.”

  However, there are different kinds of thoughts and preoccupations that keep returning, but have a distinctly different feel to them. If you find yourself continually returning to the types of thoughts presented in the next few paragraphs, it is best that you speak about them with a mental health professional. There are just a few types of these thoughts, but you should know about them.

  Invited Thoughts

  Certain fantasies, thoughts, or images of self-destructive behavior can be actual urges to handle feelings or situations that seem intolerable. People sometimes call upon them in times of distress, and they seem soothing or comforting—like escape plans if things get too hard to bear. It is also the case that invited thoughts of revenge or outrage lead to actual plans to do harm to others. Here are some examples:

  I want to cut myself because it makes me feel better after I do. At least it is visible, and I am in control of my pain. After I cut, I feel calmer or numb, and the mental pain goes away.

  I can always get drunk if I can’t manage. So what; who cares?

  If she leaves me, I can always just jump off a building or shoot myself if I can’t stand it. Then she will regret it.

  I deserve to be treated better, so I will let the air out of his tires. Let him wonder who did it and why. It will be my little secret.

  If she says that one more time, I will hurt her.

  If thoughts or images become actual plans or actions that are destructive to others or self-harming, they do not qualify as unwanted intrusions, and treatment is recommended.

  Real Suicidal Preoccupations

  For people who are depressed and struggling, the feelings evoked by the thoughts are not This is not me; I love my life, why would I even be thinking that? but rather the feeling is a sincere wish to die. In harmless unwanted intrusive thoughts, it feels like this: What if in a moment of craziness, I kill myself when I don’t really want to?

  In contrast, in serious depression, it looks something like this:

  I really deserve to die, or I actually want to die.

  This is hopeless; dying is my only option.

  My family will be better off without me. They will forgive me or will manage after a while.

  I can’t stand living any more. I have to do something drastic.

  Although the thought repeats, the feeling of deserving to be dead is totally different from the fear that you might—despite your conscious intentions—do something harmful to yourself. These thoughts appear in the context of other symptoms of depression or bipolar illness, such as loss of appetite, trouble sleeping, a loss of the ability to feel pleasure, irritability, and feelings of worthlessness and hopelessness. The idea of being dead feels comforting or appropriate instead of frightening.

  Real Pedophilia

  People who are sexually attracted to and aroused by children are few and far between. Many have their own justifications that support what they are doing. Some resist their fantasies and activities seeking sex with children either because they know these activities are illegal and do not want to get caught or because they sincerely believe it to be wrong. However, they find themselves pulled toward risky illegal activities on the Internet—with child pornography or with real children, strangers, or family. The important distinction is to understand that pedophiles are looking for stimulation and arousal. They are seeking a sexual release.

  On the other hand, people with unwanted intrusive thoughts involving the topic of pedophilia are shamefully and anxiously checking to see if they are perverted against their will, and—at the very same time—fervently hoping to prove that they are not. They are not looking for sexual stimulation; they are looking for reassurance that they are not the sort of person who is attracted to children.

  If Perspective Is Entirely Lost

  You might read this book and have no idea what we are saying or have no understanding of the points we are making. Or perhaps you think it is all nonsense. You might not be able to concentrate enough to think clearly. And this is not just a temporary feeling that lasts for a few minutes, a few hours, or a day or two, but something that seems pretty constant. In that case, reading this book is not going to provide answers.

  Hopelessness

  Sometimes a feeling of hopelessness is perceived as an actual fact. Hopeless feelings can happen even if the objective facts are that nothing at all is hopeless. In fact, hopeless feelings can happen in conditions that are easily treatable and situations that are easily fixed. The feeling of hopelessness can be sometimes made to seem more real by the struggle against it, as we have discussed in earlier chapters. However, hopeless feelings can lead to the false sense that there are no more options in your life, and so your life is over. This thought can repeat over and over. Here are some examples:

  I have lost everything. My boyfriend hates me, and I can never get him back. I am doing so badly in school that I will fail out. Even my friends see me as a loser and don’t want to spend time with me. My life is over.

  There is no point is any of this. I am just a loser.

  If you are truly unable to see beyond a feeling of hopelessness, it is time to seek professional help.

  Agitation

  Finally, there are times when racing thoughts can seem like intrusive thoughts. But racing thoughts are actually a symptom of agitation, which is associated with depression, bipolar disorder, or certain medical conditions. Racing thoughts tend to switch from topic to topic—they feel like you can’t finish one before the next is there.

  This agitation almost always goes along with other symptoms, including the inability to feel any pleasure in life (anhedonia) and early morning awakening (waking up with a “start” in the middle of the night, and then not being able to get back to sleep). People experience a significant change of appetites for food, sex, and ordinary daily activities. You might feel irritable, have a great difficulty with concentration, and feel utterly unable to relax. Your sense of humor might change. Because these feelings are so dramatic, agitation is often mistakenly called extreme anxiety, but in fact, it is a sign of depression or related conditions. It needs a different approach, very often medical in nature. It is highly treatable.

  You may read this chapter and say, “Yes, that is me.” And, if you do, the best help is from a professional, and not just a self-help book.

  But you may wonder, debate, and worry about whether you fit in any of these categories, and that is normal for anyone suffering from unwanted intrusive thoughts. After all, doubt is the engine that fuels anxiety. In fact, it is likely that you do not fit into any of these categories, but you will still get great benefits from this book.

  Acknowledgments

  First, I would like to express my thanks to Marty Seif, who has been the driving force behind this book and the only person who has ever convinced me to write any book. Our process of nudging, affirming, cajoling, and arguing on Google Docs, on the phone, and in person has been a pleasure. His astute mind fuels my creativity and, at the same time, keeps me from being sloppy. My main
teachers have been my patients, who have somehow found the courage to share their thoughts and feelings—even when they are disturbing, frightening, or embarrassing—and who have been willing to embark on many uncomfortable journeys of the mind with me. I am indebted as always to Steve Shearer, my codirector at the Anxiety and Stress Disorders Institute of Maryland, who has calmly and patiently managed so much more than his share of responsibilities while I have been writing and giving workshops. To my colleagues from whom I never stop learning—Reid Wilson, Carl Robbins, David Carbonell, Jonathan Grayson, David Barlow, and so many others I have met through the Anxiety and Depression Association of America—I am always grateful. Thank you to Molly Winston, who created our graphics and who quietly tolerated confusing and conflicting revisions along the way. And I tip my hat to three amazing women no longer with us who had such a profound influence on my life and career: Jerilyn Ross, Alies Muskin, and Zelda Milstein.

  —Sally Winston

  Three years ago I wrote a single page on my website with the title “Intrusive Thoughts.” It was listed under the “self-help” section and not at all easy to find. To my astonishment, that single page has been visited by almost half a million people over the past two years. People have written by the hundreds about their own situation, sometimes thanking me for the information I provide and sometimes asking how to find additional help. I became educated about the need for more help. And so this book was born.