Overcoming Unwated Intrusive Thoughts

by Sally M Winston

  I married my boyfriend, and he is my best friend, but last year I suddenly started having thoughts that I didn’t love him, which were all-consuming and anxiety-provoking. Then during an anxious time, the thought that maybe I’m a lesbian popped in my head, and that has been the most distressing. I was able to get rid of it for short periods of time, but now it’s stuck. It is not that I think being a lesbian is wrong or bad.

  What If I’m Really Straight?

  These thoughts are not part of a natural process of self-discovery. They feel different from regular thoughts.

  I am gay, I have been with the same boyfriend for thirteen years, and sometimes he just turns me off. People say this is normal, but then I wonder if maybe all these years I have just been fooling myself that I am gay because I am too much of a loser to try to date women. Then I start thinking, What if I am attracted to this woman, and how could I do that to Steve? I mean, I do like women. Then I am plagued by doubts, and I start testing myself. I even watched some straight porn to see if I got aroused and who I watched more, the man or the woman. What a waste of time, but I keep worrying about it. Why is this suddenly an issue after all these years?

  What If I’m Transgender?

  Transgender people have always sensed their gender identities and birth bodies do not match. But an intrusive thought about gender identity can happen to anyone.

  I have been reading all these articles about trans-people. Now I have had this repeating feeling that my breasts are bothering me because they are too big. Then I had this frightening thought that if I don’t want breasts, I could be a boy trapped in a girl’s body and that I was really meant to be a boy. I did some more Internet research, and I am worried this could be me. I can’t stop thinking about this no matter how hard I keep telling myself it is silly. But why would I be thinking this?

  Intrusive Visual Images

  We can think in two different ways. One type of thinking is in the form of words, sort of talking to yourself inside your head. Another way is to have images or pictures in your mind. Although many intrusive thoughts are experienced as disturbing “self-talk,” there are a number that are almost exclusively visual images (Brewin et al. 2010). You may have noticed this yourself.

  Here are some of the most common kinds of intrusive visual images. Intrusive images can be static pictures or short “videos.” They may incorporate actual memories or be completely made up.

  Crazy or Humiliating Actions

  Many people think they are hallucinating when they have a visual image of themselves doing something crazy or humiliating in a social setting, but they are not. These visual images often happen during socially anxious situations, and they are simply imaginative products of stuck thoughts translated into images instead of words.

  I keep having an image of myself vomiting all over myself and other people—you know, like President Bush—whenever I am at a formal event.

  Whenever I am being interviewed and whenever I’m at a party, I imagine myself freezing or yelling out something that makes no sense, and people will say, “What is wrong with that woman? She’s a crazy lady!”

  I don’t go to parties because I see myself blanking out and not being able to talk or control myself when people ask me questions.

  Sometimes when I meet someone new, I will actually see a little movie of myself poking my finger into that person’s eye or suddenly leaping across the room to strangle him or her. And this is even crazier—sometimes I see a dagger hanging in the air in front of me kind of tempting me to take it.

  Illness, Dying, and Death Scenes

  These disturbing pictures can intrude any time—when you are relaxed, having fun, driving, or anxious about something else.

  Sometimes I have a sudden picture of myself bleeding to death from Ebola, and the more I try to not look, the more gruesome the image. I get sick to my stomach.

  For no reason, I have a picture myself dead in a coffin except somehow I know I am not really dead, and I am trying to yell to the people at my funeral to get me out.

  Sometimes as I am driving over the bridge, I see myself careening over the side and falling toward the water; it is so vivid that I wonder if it is an omen.

  Traumatic Memories

  Traumatic images and memory intrusions often happen when someone has PTSD, but they can also happen to someone with a sticky mind who is upset by a thought, a memory, or even an imagined image. These may be a sudden reexperiencing, as if the traumatic events are happening again in the present (usually called flashbacks), accompanied by fear or whatever emotion happened at the time. Or they may simply be vivid, fixed visual memories of real things that happened or were imagined at the time of the traumatic experience.

  I keep seeing the car coming at me, over and over.

  The face of the man who raped me keeps coming into my mind, and I freeze.

  I can be anywhere, and suddenly I see myself dropping to the ground when the soldiers came to my door.

  I saw the news reports about the plane crash, and now I “see” a horrible scene in the plane as it is falling out of the sky. Everyone is screaming and crying. I know I wasn’t there, but I can’t stop seeing it.

  While flashbacks and traumatic memories are indeed just thoughts and images and are therefore not dangerous in and of themselves, they may be stored in the brain in a different way because of the high impact of the original experience. If there is actually PTSD and not just a sticky mind, there are additional treatment methods not in this book that may be helpful. It may be worth consulting a trauma specialist for help with the other PTSD symptoms that often go along with flashbacks and difficult memories.

  Worry

  Everyone knows about worry. There is no one who has never experienced the anxiety of an intense worry jag. So, even though worry is universal to human beings, we include worry as one type of unwanted intrusive thought because there are really two types of worry—productive worry and toxic worry (Leahy 2005).

  Productive worry is a form of planning: it starts with a problem and comes up with an answer to that problem and an action plan to follow. Plus—and this is important—the solution and action plan then stop the worrying. So, as a very simple example, let’s suppose you are driving in your car, look down, and realize that your gas tank is very low. You might worry about running out of gas. But then you come up with a solution in the form of I’m going to fill up at the gas station down the road. That action plan seems to solve your problem and stops your worrying.

  Toxic worry, on the other hand, involves trying to solve an issue where the outcome is uncertain or unknowable and there is no good answer to form an action plan. So you start to “solve” the problem once and can’t seem to come up with any good answer. So the worry returns, and then the entire process continues to repeat. It becomes stuck. Toxic worry starts with a what-if and continues in an endless loop of unsatisfactory “solutions.” Attempts to solve the problem in order to reassure yourself fail.

  Toxic worry can be about ordinary things like friendships, money, and scheduling—or it can be about highly unlikely things like rare illnesses and catastrophic events. What defines toxic worry is not what the worrying is about, but how the worries behave—they get stuck, repeat, escalate, and preoccupy. They don’t subside and take a back seat when no solution can be found. So you are trying to engage in mental problem solving, but all you come up with are other possible negative outcomes (Borkovec et al. 1983). In other words, no matter what False Comfort might say to Worried Voice, no matter how sensible or reassuring or distracting, Worried Voice has something else to come back with that keeps the what-if questions coming.

  There are three types of toxic worry: single-topic, multi-topic, and meta-worry (worry about worry).

  Helpful Fact: Toxic worry is not defined by the worry topic, but how the worry thoughts behave.

  Single-Topic Worrying

  Sometimes you can worry about just one thing, going over all the different possibilities and possible outcomes rel
ated to that single topic.

  I worry about my children every day. When I drop them off at the bus, I worry that they will get into an accident on the school bus. When I hear them cough, I worry that they might have asthma or pneumonia. I’m afraid they might get sick from their inoculations. I don’t let them play sports after school because I worry they might get injured. I worry that dental X-rays will hurt them.

  Multi-Topic Worrying

  Worry can also be expansive and often spreads creatively from one topic to another.

  Right now, I’m worried that a mole on my arm is melanoma, and I’m worried about the biopsy results. But then I’m ready to worry about my husband because his PSA (prostate-specific antigen) levels might be going up, and I don’t know how I can survive without him. And my daughter is 15½ and about to get her learner’s permit. I’m terrified of her being on the road by herself. I worry that all this stress is destroying my immune system. How will my children survive without me?

  The world has become such a dangerous place. I am afraid to go in a shopping mall now that terrorists have threatened us. I can get most things online, but I am still worried for my friends who don’t watch the news. More and more things worry me—like toxins. How far is this going to go?

  I could not sleep last night because I think I may have upset my friend with what I said, but she will never tell me, even if I ask, because she is too polite. Do you think she is angry at me? Now I am worrying about other people I might have offended. It is so easy to offend and not realize it; I haven’t heard from another friend for weeks, I wonder if I offended her too.

  I have to take a test next week, and I am worried that I won’t be able to concentrate, that I will fail the test, and that will make me do poorly in this course, which will affect my ability to get into law school. I have to get into law school. The more I think about it, the more I feel like my whole future is on the line if I don’t ace this test. And that makes me worry even more. Now I can’t concentrate, and my whole life can go down the tubes.

  If you get involved in multiple-thought toxic worry, your thoughts often involve a chain of catastrophic or negative possibilities that seem to force themselves into your awareness. Most people feel that they are uncontrollable.

  Meta-Worry (Worry About Worry)

  Here, you worry that your worrying will damage your health, indicate that you are an undesirable person, or point to some other negative aspect of yourself.

  I read in a magazine that worrying is stress on the immune system and stress can contribute to diabetes and heart disease. I do everything I can to control my worrying because I know it can make me sick. My friends tell me that I am shortening my life with all my worrying. I already do Pilates, and I even drink green tea and pomegranate juice, but they aren’t helping. Maybe I should quit my job? It’s so stressful!

  I’m sick of worrying all the time. I’m such a downer, and I know I’ve lost friends and boyfriends because of my worrying. People don’t want to be with someone like me, and I can’t blame them. I always see something that could go wrong, and I need to make sure everything is just right. I have no joy in my life, and I suck it from everyone around me.

  When I can’t control my thoughts, I feel like I am going crazy, and I worry about how long I can hold onto my sanity. My cousin has schizophrenia, and they say he started to act strange while he was in college, and it was downhill from there.

  When I lie down to sleep, I can’t stop the thoughts. I review everything I did that day and look for my mistakes. Or I am planning for tomorrow. Or I have to get up to urinate—or at least I think I do—and I watch the clock. Then I start thinking, Oh no. I only have three or four hours left to sleep, and I have to sleep. If I can’t sleep, I will not be able to work tomorrow, then more clock watching and worrying about sleeping tomorrow night.

  Not Entirely Unwanted Intrusive Thoughts

  Sometimes we find ourselves with uninvited thoughts or imagined scenes that are embarrassing or upsetting, but they seem to help our mind deal with something bothersome or painful, about which there is really nothing to do. They may serve as a diversion in a trapped situation or as a fantasy that makes us feel less helpless. They may be a preoccupation that keeps us from needed concentration, but the content was at least originally invited in.

  Revenge

  Here is an example of invited thoughts that turn uninvited and intrusive when they are judged dangerous or wrong.

  Every time my boss stands in my doorway, I start thinking I am going to blast him for what he said to me last week. I never would of course, but yesterday I started imagining letting the air out of his tires in the parking lot. And then I started asking myself if I would ever lose control and do it.

  Bereavement

  It is not the images and thoughts of someone who died that are necessarily uninvited. But if you are trying to get over it and move on or if you are worried that you are grieving in an unhealthy way, a struggle ensues.

  When I lie down at night, I see my mother’s face as I remember her before she was sick, and I can’t fall asleep. I am so sad. I look at photographs during the day. I hear her voice talking to me at the oddest times. I think about her constantly.

  Love Sickness

  Falling in love can be totally obsessive at any age. Feeling unable to keep the thoughts in check can be difficult especially if people around you notice. You can feel like you are losing perspective and becoming out of control.

  I am completely obsessed with him. I can’t concentrate. I want to know where he is and what he is doing every moment. Everything is dull and boring unless he is by my side. We text all day long. I can’t get anything done. This is over the top; I am going to lose my job if I don’t stop thinking about him.

  Resentment

  Sometimes we entertain thoughts we wish we did not, and we enjoy them and try to push them away at the same time.

  My friend inherited a lot of money, and she is naturally thin and can eat whatever she wants. The other day she got reprimanded at work, and I have to admit I had the thought, Finally something is not so easy for her! I am ashamed of myself for thinking this.

  Not entirely unwanted intrusive thoughts are only a problem if you start struggling with them, if you worry about them and what they mean, or if you judge them as sick or bad. They pass when the emotion that is driving them (anger, grief, early romance, resentment) subsides over time. They are not indications of character or impulses to be resisted: they are your rich imagination at work. No one is free of not entirely unwanted intrusive thoughts. It is only the struggle against them that is problematic

  Personal Loss, Failure, or Mistake

  There are a number of unwanted intrusive thoughts that center around the theme of past or future mistakes. Your thoughts may be experienced as “irrational” and overblown, but even so, there is the sense that you, in fact, have committed a terrible mistake that might never be undone. This makes you very anxious. You may have something specific in mind, or it may just be a sense that something important slipped your awareness or memory.

  When I was working as an attorney, I worked on a case that got a lot of press and we won the case. But now I keep thinking that I never shared a minor detail with the other side, and even though it was almost twenty years ago, I keep having the thought that if someone found out about this, my reputation could be ruined. I have asked my partner how important this is, and she says it is trivial and to stop worrying about it, but it comes to me at all hours of the day and night.

  I keep coming back to the thought that I should never have broken up with that boyfriend, even though he treated me terribly, the relationship seemed doomed, and I was miserable. At least I thought it seemed doomed. But I keep wondering if things could have somehow turned around. I keep trying to remember the moment when I messed it up.

  As soon as I submit a paper for publication, I have the thought that my statistical analysis was wrong or I left out a vital piece of data. Or there is something unethical
in the research, and I worry about this ruining my career. It keeps me awake at night.

  Is it right to make amends for something you aren’t sure about? I think I stole ten dollars from a friend in middle school; although to tell you the truth, I am not sure if I did or I made it up. It was thirty-four years ago, but maybe I should apologize or send her the money in case it is true. I try to tell myself it is not important, but the thought keeps coming back, so it must need resolution, right?

  If I hadn’t lost that money, I could take care of my family better. I am so worried that I won’t be able to afford retirement. I push the thoughts away, but it remains the monster in the room.

  I lost the girl of my dreams! I can’t believe that I let her go, and now I will never find love. I was so stupid, and now it’s too late to get her back. I can’t stop thinking about this. It makes me so sad.

  Somatosensory Intrusions

  Some people have intrusive sensations instead of thoughts, but they act the very same way as unwanted thoughts and images. Psychologists sometimes view these sensory intrusions as a form of hyper-awareness OCD. You feel a desire or a need to resist thoughts and observations about sensations. There are some self-help books on obsessive-compulsive disorder that address this issue as well (see, for example, Hershfield, Corboy, and Claiborn 2013).