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Thinking the Unthinkable – Dealing with Intrusive Thoughts

What Is an Intrusive Thought?

An intrusive thought is an unwelcome and involuntary thought, image or unpleasant idea that isn’t aligned with your belief or value system and therefore causes distress. Attempts to block or stop the thoughts can lead to people obsessing about them. They may be compelled to minimise associated risks they incorrectly feel the thoughts could cause.

Intrusive thoughts fall under the umbrella of Obsessive Compulsive Disorder or OCD. Intrusive thoughts often feel uncontrollable, distressing, and difficult to manage because they can be so upsetting. People often hide the problem which can increase anxiety and lead to depression and feelings of isolation.

Are Intrusive Thoughts a Common Mental Health Issue?

When I first moved into private practice, I was surprised by the number of people who came to me with intrusive thoughts – far more than I’d ever seen within the NHS.

In reality, struggling with intrusive thoughts is extremely common. Studies have shown 98% of the population will experience the issue at some point. But why is it more prevalent in private practice? 

This is only my clinical experience, but I think it’s partly because CBT is considered a leading therapy in helping people alter their thinking and manage unhelpful thoughts.

In addition, the only way to be seen in the NHS is through GP referral. People can find it incredibly difficult to go to their general practitioners about unpleasant, distressing thoughts. They’re often extremely ashamed about what they’re experiencing. Many GPs aren’t familiar with intrusive thoughts, they may not specialise in mental health issues, and they therefore fail to respond in the most helpful way.

Why Do Intrusive Thoughts Cause So Much Distress?

Experiencing an intrusive thought is distressing because they run counter to our belief or value system.  

The most common intrusive thoughts are:

I could hurt that baby or I want to hurt my baby

I want to have sex with or I am attracted to a family member

I want to hurt myself

I want to hurt my pet

I want to stab my partner 

I hate god

If you don’t believe in god, having an intrusive thought that you hate god won’t bother you. If you’re devoutly religious, it could cause significant distress because it’s not aligned with your values.

Similarly, the only person who wouldn’t be distressed about violent thoughts is a violent person. A very gentle or caring person would be upset and worried.

What Happens When Intrusive Thoughts Arise?

The important thing to remember is it’s not the thought that’s the problem, it’s the meaning you give the thought.

Imagine you’re standing on a train platform and you have the thought ‘I could jump on the tracks’. I use this example on purpose because who hasn’t had that thought at the train station?  

The thought has two possible meanings:  

Theory A – Could this mean I’m suicidal and I want to harm myself?

Theory B – It’s just a thought.

When you consider theory A and theory B, the different meanings will ignite different feelings in you and then different behaviours.

If the thought and the meaning you assign it make you feel anxious, you’re more likely to find it distressing. If you believed you wanted to harm yourself, you might do lots of things to keep yourself safe and this would re-enforce the sense of risk, thus maintaining the problem.

But thoughts are not facts. Thoughts are triggered by many things in our day-to-day lives, as well as memories, worries or risks from our past. If they upset us, it’s because we’ve given them an unhelpful meaning.

When we don’t want to experience a thought, our subconscious mind red flags it as a problem and will alert you to any sign of it. This increases your awareness of the thought and makes it more likely. For example, if I say, ‘don’t think about pink elephants’ what’s the first thing you think about?

To have fully creative minds, we need to take in everything, be free flowing, and experimental. With this comes the inevitability that our thoughts won’t always be what we want. The more we try to restrict or control our minds, the more problems we’ll get ourselves into. The more we try to gain control, the less control we actually have.

Can CBT Help?

Accredited Cognitive Behavioural Therapists work with people experiencing intrusive thoughts all the time and the treatment protocols are very effective. In fact, just coming to therapy begins the process of treating the thought as an anxiety issue. Instead of keeping it a secret, you start to understand it as a psychological issue.

Many people feel a lot better after just the first session because they’ve had the opportunity to discuss the issue with someone who completely understands. I’ve also worked with clients who initially prefer not to tell me what the distressing thought is. This is fine too and the treatment protocols work the same.

If private therapy isn’t an option and you think you might be experiencing intrusive thoughts, you can ask your GP to refer you for a CBT assessment with the local primary care mental health team.

Useful Links

OCD Action

Signs and Symptoms of OCD

Does Pure O Exist?

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Sarah Rees

Sarah is a fully accredited Cognitive Behavioural Therapist and mental health writer delivering Modern Mental Health for you and with you in Mind. Sarah is the author of ‘The CBT Journal’ which helps you write for your wellbeing incorporating CBT techniques. For more information and to keep in touch have a look at