“This important book is essential and mandatory reading for anyone affected by unwanted and intrusive thoughts, and their health providers. The authors crystallize decades of experience into a perfectly clear and readable guide. The solution to this misunderstood problem is in this book.”
—Joseph A. Adams, MD, medical director at Baltimore Health Systems and Step By Step of Maryland, LLC, and past president at Smoke Free Maryland
“I wish I would have had access to this book twenty years ago! Sally Winston and Martin Seif have put all the pieces of the puzzle together to help people understand and overcome unwanted intrusive thoughts. This is a must-read book, packed with information to help people suffering with anxiety-provoking intrusive thoughts, as well as clinicians who are trying to help them.”
—Kimberly J. Morrow, LCSW, maintains a private practice in Erie, PA; specializes in the treatment of anxiety and obsessive-compulsive disorder (OCD); provides training and case consultation for clinicians through www.anxietytraining.com; and is author of Face It and Feel It
“It turns out that commonsense approaches to stopping our worries, such as pushing thoughts away, arguing with them, or seeking reassurance, actually feed these worries and help them grow. Sally Winston and Martin Seif—two of the brightest minds in our field—deliver a simple yet powerful two-step process for change.”
—Reid Wilson, PhD, author of Stopping the Noise in Your Head
“Finally, here is an effective, neurologically based clinical approach to dealing with unwanted thoughts (without having to use a rubber band). The authors’ clear and distinctive voice should be widely heard by cognitive behavioral therapy (CBT) clinicians, and by those engaged in an ongoing and unrelenting struggle with undesirable ruminations.”
—Ronald M. Doctor, PhD, professor emeritus of psychology at California State University, Northridge; author; active researcher; and practicing behavior therapist
“In their book Overcoming Unwanted Intrusive Thoughts, Winston and Seif tackle one of the great mysteries of human distress and suffering: the seeming inability to rid our minds of unbidden, unwanted, and disturbing thoughts, images, and memories. Readers are given a rare glimpse into the nature of unwanted intrusive thoughts, as well as their origin and impact on emotional distress. Written in a warm, engaging, yet knowledgeable manner, this book provides new insights for consumers and professionals alike on why common sense fails to soothe the troubled mind. Readers will find practical, research-based guidance on how to subdue unwanted intrusions and overcome their emotional disruption. This book offers much-needed help for those who struggle with the torment of persistent disturbing thoughts.”
—David A. Clark, PhD, professor emeritus in the department of psychology at the University of New Brunswick, and coauthor of The Anxiety and Worry Workbook and Cognitive Therapy of Anxiety Disorders with Aaron T. Beck
“Tens of millions of people have bothersome intrusive thoughts, and most often these thoughts are so unacceptable or embarrassing that many people have trouble telling anyone about them—even their closest family members or friends. At worst, these intrusive thoughts are part of severe problems such as OCD, but we know that almost anybody under stress can occasionally experience intrusive thoughts. Now, at last, a state-of-the-art psychological program written by two of the leading clinicians in the country with years of experience treating this problem is available. The program in this remarkable little book may be sufficient to help you overcome your intrusive thoughts, if therapeutic assistance may be needed, to guide you to the best available resources. I recommend this program very highly as a first step for anybody dealing with this issue.”
—David H. Barlow, PhD, ABPP, emeritus professor of psychology and psychiatry, founder, and director emeritus at the Center for Anxiety and Related Disorders at Boston University
“Winston and Seif have done a wonderful job in providing sufferers of obsessive intrusive thoughts with up-to-date and scientifically accurate information about this often crippling problem. This clearly written guide will serve both as a self-help resource, as well as a workbook to be used as an adjunct to psychotherapy.”
—Lee Baer, PhD, professor of psychology in the department of psychiatry at Harvard Medical School, and author of Getting Control and The Imp of the Mind
“An interesting and original account of a little-understood phenomenon—intrusive thoughts.”
—Fredric Neuman, MD, director of The Anxiety and Phobia Treatment Center, and author of Caring, Fighting Fear, and Worried Sick?
“What a great book for people who struggle with intrusive thoughts! Two highly skilled and respected experts in the treatment of chronic anxiety explain how intrusive thoughts work, what they mean and don’t mean, why they defy your best efforts at getting rid of them, and most importantly, how to change your relationship with these thoughts so they don’t remain a persistent, negative focus. They help the reader understand that intrusive thoughts don’t persist despite your best efforts; they persist because of your best efforts at arguing with, struggling against, and seeking to avoid these unwanted thoughts. Their book offers plainspoken instructions with lots of good examples that will help you let go of the guilt, fear, and confusion that so often accompanies intrusive thoughts. This is a must-read for anyone experiencing such thoughts, as well as the professionals who seek to help them.”
—David Carbonell, PhD, is a Chicago-based psychologist specializing in treating chronic anxiety for over thirty years, author of Panic Attacks Workbook and The Worry Trick, and “coach” at www.anxietycoach.com
“Winston and Seif have written an important and much-needed book. It speaks to those who suffer intensely from unwanted intrusive thoughts and, as a result, descend into a world of anxious isolation. The authors lift the sufferer from a frightening darkness into a world of understanding and onto a path to freedom. This is necessary reading for anyone suffering from the tyranny of unwanted thoughts, and it should be required reading for helping professionals.”
—Bruce Shapiro, MD, clinical professor of psychiatry at Columbia University College of Physicians and Surgeons
“If you live in fear of thoughts that pop into your head, this is the book for you! Two expert psychologists explain unwanted intrusive thoughts, and show you how to break free from the cycles that strengthen their grip on you. You don’t have to suffer because of your thoughts, and Winston and Seif show you the way out of your suffering. The information, strategies, and abundant examples within these pages make this a must-read for anyone trying to make sense of frightening intrusive thoughts, and wanting relief from the distress they cause.”
—Joan Davidson, PhD, codirector of the San Francisco Bay Area Center for Cognitive Therapy, and assistant clinical professor in the clinical science program at the University of California, Berkeley
“As humans, we often pride ourselves on our ability to think ourselves out of the distress and difficulties that we encounter. But these authors help us recognize that we aren’t in complete control of our thoughts, and help us to approach our thought processes from a more realistic and healthy perspective. They assist us in identifying common myths about our thoughts, and teach us that fighting thoughts is not the answer—it is part of the problem! With the strategies in this book, we learn how to reduce the stress and distress thoughts can trigger, and this takes away the power of those thoughts. The authors present clear explanations of the brain processes underlying intrusive thoughts, but even more importantly, explain why our typical efforts to overcome these thoughts fail. Finally, they provide a detailed guide of what we can do to reduce distress about unwanted thoughts, and to deve
lop a more accepting relationship with the mind.”
—Catherine M. Pittman, PhD, HSPP, licensed clinical psychologist, associate professor of psychology at Saint Mary’s College Notre Dame, and coauthor of Rewire Your Anxious Brain
Publisher’s Note
This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold with the understanding that the publisher is not engaged in rendering psychological, financial, legal, or other professional services. If expert assistance or counseling is needed, the services of a competent professional should be sought.
Distributed in Canada by Raincoast Books
Copyright © 2017 by Sally Winston and Martin N. Seif
New Harbinger Publications, Inc.
5674 Shattuck Avenue
Oakland, CA 94609
www.newharbinger.com
Cover design by Amy Shoup
Acquired by Jess O’Brien
Edited by Gretel Hakanson
All Rights Reserved
Library of Congress Cataloging-in-Publication Data
To Mort, Carla, Maggie, and Molly
—S. W.
To Samantha, Laura, Sam, Clare, Ruta, and Adam
—M. S.
Contents
Introduction
How to Get the Most out of This Book
Chapter 1: Recovering from Unwanted Intrusive Thoughts
Natural Voices of the Mind
Why Thoughts Get Stuck
Thoughts That Get Stuck
Intrusive Thoughts Versus Impulses
When Intrusive Thoughts Are Likely to Happen
Trigger: Personal Experiences
Trigger: The Media and Current Events
Chapter 2: Varieties of Intrusive Thoughts
Morally Repugnant Thoughts
Harming and Self-Harming Thoughts
Forbidden Sexual Thoughts
Impure or Blasphemous Religious Thoughts
Disgust-Causing Intrusions
“Big Issue” Thoughts
Uncertainty and Unknowability Thoughts
Questioning Reality
Purpose-of-Life Thoughts
Questioning Beliefs
Nonsensical Thoughts
Losing-Your-Mind Thoughts
Mental Checking
Doubts About Relationships
Scrupulous Thoughts
Sexual-Orientation and Sexual-Identity Thoughts
What If I’m Really Gay?
What If I’m Really Straight?
What If I’m Transgender?
Intrusive Visual Images
Crazy or Humiliating Actions
Illness, Dying, and Death Scenes
Traumatic Memories
Worry
Single-Topic Worrying
Multi-Topic Worrying
Meta-Worry (Worry About Worry)
Not Entirely Unwanted Intrusive Thoughts
Revenge
Bereavement
Love Sickness
Resentment
Personal Loss, Failure, or Mistake
Somatosensory Intrusions
Chapter 3: What Thoughts Mean: Myths and Facts
Myth 1: Our Thoughts Are Under Our Control
Myth 2: Our Thoughts Indicate Our Character
Myth 3: Our Thoughts Indicate the Inner Self
Myth 4: The Unconscious Mind Can Affect Actions
Myth 5: Thinking Something Makes It Likely to Happen
Myth 6: Thinking Something Makes It Unlikely to Happen
Myth 7: Only Sick People Have Intrusive Thoughts
Myth 8: Every Thought Is Worth Thinking
Myth 9: Thoughts That Repeat Are Important
Chapter 4: Unwanted Intrusive Thoughts Q and A
Chapter 5: How the Brain Creates Unwanted Intrusive Thoughts
The Neurology of Anxious Arousal
The Alarm Response
The Amygdala Learns to be Fearful
First Fear: The Amygdala’s Automatic Alarm
Two Paths to the Amygdala
The Amygdala and Unwanted Intrusive Thoughts
How Inner Voices Create Unwanted Intrusive Thoughts
Fear-Increasing Cycle
Fear-Diminishing Cycle
Anxious Thinking
Thought-Action Fusion
All Risks Seem Unreasonable
Thoughts Feel Sticky
Intolerance of Uncertainty
Chapter 6: Why Nothing Has Worked
Three Factors That Get in the Way
Sticky Mind
Paradoxical Effort
Entanglement
Ineffective Strategies
Self-Reassurance
Reassurance from Others
Prayer
Healthy Living
Other Counter-Productive Techniques
Popular Advice
Chapter 7: How to Handle Thoughts When They Happen
Six Steps to Reduce Distress Over a Thought
Step 1: Recognize
Step 2: Just Thoughts
Step 3: Accept and Allow
Step 4: Float and Feel
Step 5: Let Time Pass
Step 6: Proceed
Enemies of Acceptance
Guilt
Doubt
Urgency
Some Helpful Metaphors
The Intruder at the Party
Whack-a-Mole
Don’t Dignify the Question
The Waterfall
Mud on the Windshield
Noisy Neighbors
Headache
Chapter 8: Getting Over Unwanted Thoughts for Good
Get Uncomfortable on Purpose
Changing Your Brain: How Extinction Works
Emotional Processing Explained
Inhibitory Learning Explained
Planned Practice vs. Incidental Practice
Five A’s for Optimal Practice
Attitude of Acceptance
Assign Accurate Assessment
Active Allowance of Awareness and Affect
Avoid Avoidances (Always-Attempt Approach)
Action: Advance Activities Anyway
The Nitty Gritty of Planned Practice
Go at Your Own Pace
Think the Thought—the Worst Thought—but with a Twist
Avoid Getting Caught Up in Content
Examples of Planned Practice
“My son was in a car accident.”
“What If I Kill Myself? I Don’t Want to Die!”
“I might oversleep.”
Chapter 9: What Does Recovery Mean?
Starting the Cycle of Recovery
Setback
Congratulations
If You Want More
Chapter 10: When to Seek Professional Help
Invited Thoughts
Real Suicidal Preoccupations
Real Pedophilia
If Perspective Is Entirely Lost
Hopelessness
Agitation
Acknowledgments
Appendix:: A Recipe for Unwanted Intrusive Thoughts (What Not to Do)
A Recipe for Creating an Unwanted Intrusive Thought
Ingredients
Directions
Bibliography
Introduction
Have you ever stood on the edge of a train platform, minding your own business, and then suddenly, out of the blue, had the brief thought, I could jump off and die! Or have you been struck by the passing thought, Hey, I could push that guy onto the tracks!
When a room full of people is asked these questions, 90 percent of them will acknowledge they have.
But there is a second set of questions to ask that is much more important, and contains the key to the issues in this book. Do you get upset or worried that your thoughts might actually lead you to do something awful? Or are you plagued by a thought that you might have already done something bad and somehow it slipped past you? Or that the fact that this thought has crossed your mind must mean something i
mportant? Or is there a thought that drives you crazy because you just can’t manage to get it out of your mind? Do you live in dread that having bizarre, repetitive, repugnant, or unrelenting thoughts means something shameful or terrible about you? Do you hope and pray that these thoughts won’t come around again? But they do, and they continue to haunt you. They have become stuck.
These upsetting, distressing, frightening thoughts that enter your mind unbidden are called unwanted intrusive thoughts. Sane and good people have them. If you are plagued by thoughts you don’t want—thoughts that scare you—and thoughts you can’t tell anyone, this book may change your life.
Our first message is that you are not alone. There are millions of people who have thoughts just like yours. Good people have awful thoughts. Violent thoughts come from gentle people. Crazy thoughts occur for people who are not the least bit crazy. You are not the only one who experiences repeating thoughts that just won’t leave your mind.
Our best guesstimate is that there are upwards of 6 million people in the United States alone who, at some point in their lives, suffer from unwanted intrusive thoughts. The silence, fear, and shame surrounding the issue increase the suffering and isolation of many good people. You bear your burdens in isolation, not knowing that there are many others just like you.
Our second message is that you are very brave. You are brave to pick up this book and read this far. More than anything—because you think these thoughts might mean something important and could be dangerous—you work to keep these thoughts out of your mind. And we are sure that you have tried everything to do just that. So buying this book and reading about the subject is an act of courage.
Struggling the way you have, you have probably discovered a very frustrating and important truth. Trying to keep thoughts out of your mind doesn’t work for you. It doesn’t work for anybody.
And so we start with another basic truth: If you continue to do what you’ve always done, you are going to get what you’ve always got (Forsythe and Eifert 2007). In other words, if you want a different outcome, you will have to try a different method. We would like you to start with the realization that there is nothing wrong with you, but there is something quite wrong with your method. And here is where this book can be helpful. We believe that giving your thoughts a name, helping you understand that you are not alone, and addressing the thoughts without shame and fear will go a long way toward reducing your misery. But that is certainly not all. You are going to learn what we now know about unwanted intrusive thoughts, the various types of them, what keeps them going, and the very best approaches to living a life without the misery of these stuck thoughts.
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