Read more: OCD intrusive thoughts: what is it and how is it treated? An OCD sufferer speaks out
Obsessional intrusive thoughts are unwanted disturbing thoughts that flash into the mind, repeating over and over again throughout the day – every day. Similar to a song that gets stuck in your head, they infiltrate the brain and latch on.
Intrusive thoughts are symptomatic of anxiety and obsessive compulsive disorder. It is estimated that 50 per cent of people diagnosed with OCD experience sexual or religious intrusive thoughts. Mothers also can be impacted with post-natal OCD, and may become preoccupied with harm to their new-born.
Many people experience disturbing thoughts but can pass them off and let them go. With intrusive thoughts, the individual feels shocked and horrified by their content and mistakenly believes them to be true. It is this response that intensifies their effect, maintaining a cycle which becomes habitual. Your brain and system then automatically reacts to such thoughts or images as threats, triggering an automatic stress or anxiety response. These tormentous thoughts attach to what is important to the person, such as core values or people.
Thoughts like these can become mental secrets, making them even more sinister to their host. It is often a lonely and hidden experience as it is a mental-health issue not often talked about, impeding disclosure because the person feels embarrassed or ashamed. Like most conditions, onset is multifaceted, with biological, social and psychological factors interplaying.
So how does this mental plague feature?
For some, their intrusive thoughts manifest in relation to sexual orientation. Others may involve thoughts of a sexual nature that are repugnant to the person and linked to inappropriate people. Avoidance, rituals, attempts to neutralise and seeking reassurance are part of this cycle.
Intense fear
Another type of obsessional intrusive thought revolves around harm to oneself or others. There is an intense fear of hurting someone, even though there is no past evidence of this and no grounding in reality. Liz (not her real name) was referred to me following the birth of her baby. She felt out of sorts and had initially passed it off as exhaustion. Her mood was low, anxiety high and she was diagnosed with post-natal depression by her GP. Liz had been too afraid to disclose the harming intrusive thoughts and these persisted. She feared social services being involved or losing her mind. Being alone with her baby triggered panic attacks and many tasks were passed on to others. In therapy, she found the courage to open up and learned they were just symptoms and experienced by others too. Her reaction to them eased and she acquired skills to lower their volume.
Treatment for obsessional intrusive thoughts needs to commence with a thorough assessment of the individual. If the person’s daily functioning is severely impaired, medication may be necessary. With evidence-based therapy such as CBT (cognitive behavioural therapy) and acceptance and commitment therapy, the thoughts can diminish and lose their terrifying grip. As with all psychological disturbances, empathy, non-judgment and positive support helps.
Psychoeducation teaches the person to understand that these thoughts are symptoms with no meaning and that their content is opposite to who the person is. For example, violent thoughts may intrude on a very gentle-natured individual. Focusing on the evidence and lessening the belief in the thoughts weaken their power. Instead of analysing their content, it is necessary to see them as meaningless.
Distraction techniques
Developing healthy distraction techniques to get out of the head can clear out this excess mental clutter. Retraining the brain takes regular rigorous practice, but reaps its rewards. Mindfulness moulds the capacity to engage with all thoughts in a healthier way and creates a gap between the thinker and thoughts. Knowing that just because you think the thoughts are true does not mean they are. Shifting the response from being shocked by these thoughts to just noticing them is part of recovery. Accepting that thoughts are not facts, and perceiving accurately what is and what is not reality based, can be freeing.
You cannot suppress your thoughts, as researchers at Harvard University found. Participants were asked to think about anything other than a white bear. People kept checking to see if they were not thinking of the white bear, and the white bear continued to pop up in their heads. However, it is possible to shift thoughts, move them around and focus on what is real. When the individual reaches a phase of wellness, the work needs to continue to prevent such thoughts attacking again. A healthy lifestyle, a regular exercise programme, pleasant interactions and ways to keep the mind clear are all part of relapse prevention.
Obsessional intrusive thoughts are exacerbated by increased anxiety and stress levels, so monitoring and managing these is essential. Self-help resources include the Headspace app and books such as Overcoming Obsessive Thoughts by David A Clark, Overcoming Unwanted Intrusive Thoughts by Winston and Seif and Brain Lock by Dr Jeffrey Schwartz.
If you or someone you know is struggling with such thoughts, remember:
1. Label them as intrusive thoughts. Name them, reveal them and get help.
2. Understand that they are only symptoms.
3. Know that they have no meaning.
4. Drop avoidant and ritualistic behaviours, at a pace.
5. Engage in healthy distractions.
6. Be reassured that they are treatable.
You are more than your thoughts. Let us move the mental-health conversation forward and support those whose minds are in turmoil.
Niamh Delmar is a counselling psychologist and mental health educator
