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Key points
- They are disturbing, stressful and distressing.
- Everyone experiences intrusive thoughts from time to time.
- What you can do to reduce them and when to get help.
Do you ever find yourself daydreaming or distracted and your thoughts turn negative? You try to push away the upsetting thoughts, but it’s difficult, or even impossible. Those are intrusive thoughts. They are unwanted and involuntary thoughts or images that pop into our minds and become disturbing, stressful, or distressing. They come in a wide variety of unpleasant topics, commonly self-doubt, or some catastrophic outcome, health or financial.
Intrusive thoughts can happen to anyone and everyone from time to time. It can be a random thought of losing your job or swerving your car off a cliff, with no intention to act. It’s almost like a combination of imagination and an inability to stop one’s thinking. More severe intrusive thoughts are experienced by people with obsessive-compulsive disorder, Tourette's syndrome, depression, body dysmorphic disorder, post-traumatic stress disorder, anxiety disorders, eating disorders, and psychosis.
A person with severe intrusive thoughts will have challenges with relationships and work that affect daily life. The thoughts carry a heavy emotional toll, and the resulting anxiety can be hard to manage. However, having an occasional intrusive thought does not necessarily mean you have any of the above conditions.
Recognizing intrusive thoughts
People daydream all the time, but when the thoughts turn negative, they can feel alarmingly real. The result of these intrusive imaginations can leave you feeling scared, anxious, worried, or even afraid of yourself and worried about your future behavior. In extreme cases of despair or fear, people need to seek out help from a doctor or other trusted person to help relieve their burden of anxiety.
As a psychiatrist, I have been privileged to hear about people's inner dialogue all the time. Over the years I’ve noticed patterns from people with intrusive thoughts and identified solutions that can be helpful. For example, one pattern I see often in people who are either anxious, depressed, or have attention deficit, is the inclination to go down negative thought spirals. These can be based on reality, feel real, and incite fear. In my practice, we call these “daymares,” or the waking version of nightmares.
Some nervous or anxious thoughts are useful, and others are not. The quickest solution that has helped so many of my patients is asking one fundamental question: "What is the utility of this thought?"
Sometimes patients share that their nervous thoughts are useful. For example, the thought that you might be late on a work deadline or unprepared for an exam can compel you to do something about it. In these cases, the anxious thoughts have a function. They remind us to prepare or to get something done. These thoughts are more easily managed because they are rooted in reality and have tangible steps for actions that will help to relieve the anxiety.
Other times patients share what we call, “stabbing thoughts.” These are automatic and negative or catastrophic thoughts that occur over and over again. When asked, "What is the utility of this thought," the patients can’t answer leaving them feeling powerless with no agency over their thoughts. These thoughts are like eating junk food, or rubbernecking at a car accident – you know the outcome will not be good, but you cannot stop. It’s almost like an addiction to feeling unpleasant, and finding ways to achieve that – doom scrolling included.
Some people live in a constant state of stress where self-oppression becomes the norm. I’ve had patients over the years who tell me they wake up in the morning and scan the news to find something to worry about. I’ve called this “bingeing on negativity.”
What to do about intrusive thoughts?
How do you stop or minimize intrusive thoughts? First, understand the common causes and triggers. In my practice, we see patients with stress, lack of sleep, anxiety, and other major life changes experiencing intrusive thoughts. Being sad, hungry, or tired can make it harder to resist the temptation to go down these dark thought spirals. Ironically, we know that trying to directly suppress these thoughts can make them occur more often.
Learning coping mechanisms can be a big key to stopping or minimizing intrusive thoughts. Common techniques that can be helpful include mindfulness, acceptance of the thought, and de-stigmatization. The more you let these thoughts disturb you, the more they return. Conversely, if you accept them, and know that they are just trying to get your attention – you are better equipped to move past them. Talking to someone or writing down intrusive thoughts can also help minimize their power.
In addition to self-care, there are medical treatment options for more severe cases. Treatment options can include cognitive behavioral therapy or medications that may be prescribed. Keep in mind that in severely distressing cases, it is important to seek professional help.
References
Effects of rumination on unwanted intrusive thoughts: A replication and extension. Journal of Experimental Psychopathology. 2020.
M. Kollárik, et al.
