Updated: Jan 7, 2021
The terms intrusive thoughts are ubiquitous within the OCD community. Intrusive thoughts tend to be characterized as being unwelcomed, unwanted, involuntary, disturbing, and often persistent. They can present themselves in the forms of mental images, words, and ideas. There are also intrusive sensations (which we will think of as interchangeable with intrusive thoughts). Let's step outside the OCD realm for a minute and focus solely on the word intrusive. Because the word intrusive is an adjective, when we look up the definition in a dictionary (I used Merriam-Webster) we are essentially routed to the definition of the verb intrude. Merriam-Webster defines intrude as "to thrust oneself in without invitation, permission, or welcome." If we use this definition to distinguish between a thought and a thought that is intrusive, we would say what makes a thought intrusive are the characteristics written about earlier and contained in the definition (without invitation, permission, or welcome). If our intrusive thoughts no longer carried these characteristics would they still be intrusive? If we invited our intrusive thoughts, gave them permission to be, and even welcomed them, they may be less intrusive, and therefore perhaps less bothersome.
What stands in our way of welcoming our unwanted thoughts? Generally, it is some form of resistance, and as Steven Hayes puts it "What we resist, persists." What tends to be behind the resistance are several possibilities: What does this mean? Does it say something about me as a person? Am I bad, evil, gay, straight, a pedophile et cetera? A common example of the futile nature of trying not to think something is "Don't think of a pink elephant." There are several theories as to why trying to not think about something has a paradoxical effect. One is founded in relational frame theory, which suggests mental networks are formed and relationships created between inherently meaningless factors, such as the vocal word (sound) "kill" representing the mental image of stabbing someone. Both the word kill and the thought of killing is still not actually killing - they are symbols that represent the act of killing. So when we think "I like killing" or "I don't like killing" there may be no difference in how our mind and body handle it because, in order to make sense of what we said or thought, we have to use the mental image that represents killing (I.e. stabbing someone). There is also the pop-psychology term reverse psychology which attempts to make use of the concept "we want what we don't have." The reverse is also true, we think about what we don't want to think about. In addition, we also mentally check to see if we're thinking about the thing we don't want to think about which only makes us think about that thing. Further, we carry a negativity bias which gives more weight or credence to something deemed negative. And thank goodness we evolved to have a negativity-bias. Our ancestors didn't stay alive by appreciating the sunset, they stayed alive by being vigilant to that which was threatening, such as the rustling of bushes representing a tiger seeking prey. Herein lies an issue with saying "I had some intrusive thoughts." The term intrusive carries a negative connotation, and to some extent a judgment. So when we label a thought as intrusive, there is an underlying message or belief that an intrusive thought is bad. So now intrusive thoughts are different from other thoughts (thoughts that are not considered intrusive). This is a version of the issue from a prior blog post about labeling thoughts as OCD, and now we are in the business of making judgment calls of our thoughts - good, bad, or neutral. Thoughts are inherently none of these, they just are. It is the judgment or resistance toward them that make them either good, bad, neutral, and hence intrusive. A great way of detaching from identifying thoughts as intrusive is through exposure-response prevention and mindfulness (which can be considered a form of ERP). Russ Harris has a great animation about mindfulness; you can find it here.
When an intrusive thought comes up, consider the following:
Ask yourself, am I resisting or judging this thought?
Welcome the thought. Give it permission to be. Remember, accepting a thought DOES NOT mean we are agreeing with the thought. It simply means we are accepting its presence.
Intentionally bring the thought into your mind utilizing various triggers, such as: looking at something in your environment that reminds you of the scary thought; listening to a recorded version of the thought; saying the thought; reading the thought.
Diffuse from the thought. Acceptance and commitment therapy uses diffusion to keep the content of thoughts the same but change their context, and in doing so, help us develop a healthier relationship with our thought life. To learn more about this, I'd recommend the book The Happiness Trap by Russ Harris.
Do something that is important to you. Not for the sake of distraction, but to begin to learn how to function while having such thoughts and to practice being present.
Agree with the thought.
Exaggerate the thought.
Avoid talking to others about your thoughts when it is a form of reassurance.
The list above is by no means exhaustive, and some methods may work well for some and not so well for others. Take what works for you and leave the rest. The two things I've found most helpful, personally, are breath-focused silent meditation and doing activities that are important to me. Breath meditation helps in the way building strength at the gym helps. We are not only strong or getting stronger while we are at the gym, we keep that strength with us outside of the gym so long as we keep going to the gym. Doing activities that are important to me regardless of what my mind is telling me helps because my mind begins to learn that generally what I'm thinking is irrelevant and doesn't have to have a great deal of influence over my actions.
A quick note - I understand why we use the term intrusive thoughts to describe certain thoughts; it fits the bill perfectly. However, I think there is a benefit in reframing how we think about them. Moving forward, imagine that you no longer have "intrusive thoughts" but rather just "thoughts."
I'll end with a short story to summarize the concept. Two friends were in a car together traveling down the highway. Another vehicle suddenly moved in front of their car. The friend who was driving angrily changed lanes and pulled up to the car that moved in front of them and yelled, "You ##$%%$$#**!!! You cut me off!!!!" The following day the other friend was driving and the same thing happened, another car suddenly moved in front of theirs. The driver was calm and the friend in the passenger seat was furious and asked his friend "Aren't you pissed that car cut you off?" The driver calmly replied, "They can't cut you off when you let them in."