How to deal with intrusive thoughts

0:00Just a heads up, this episode will discuss suicidal ideation. If you're having thoughts of self-harm, please seek help immediately through the Suicide and Crisis Lifeline at 988. You're listening to Life Kit from NPR. Hey, it's Marielle. Have you ever had a scary, maybe violent image pop into your head seemingly out of nowhere? Maybe it seemed so real that you wondered if it was actually going to happen. I get these sometimes when I'm driving over bridges. I picture my car careening into the water below. Or when I'm on the subway platform and I think, what if somebody pushed me onto the tracks right now?

0:43Then I shake my head, try to will the thought away. Psychologists call these intrusive thoughts. They are distressing, repetitive, and unwanted. And they can disrupt our lives. For NPR senior visuals producer L.A. Johnson, They started happening after she gave birth to her second child. Four days later, she was a wreck. She was in pain, sleep-deprived, and feeling anxious and sad. Her hormone levels were shifting dramatically. That happens after giving birth. Her mom suggested she take a bath to relax. I drew a bath and got in, lit a candle and closed my eyes, took a deep breath and sighed. I was just beginning to relax when, all of a sudden I had a disturbing thought pop into my head What if I just slipped under the water for a while put my head under and just stayed there What?

1:47I sat up fast and told that thought to stop just go away That wasn't what I wanted That's not me Where was that thought even coming from anyway? I was really, really scared. I had heard enough stories about postpartum depression that I knew I was probably experiencing some form of that. So I drained the tub and got out. I told my mom and husband what happened. And then I called my nurse midwife. I need help, I said. L.A. made an appointment with her therapist and psychiatrist for later that week. But, yeah, unfortunately this is a common experience. at least one in seven women experience depression during pregnancy or after childbirth.

2:32And intrusive thoughts can be a side effect of depression, though anyone can get them, whether or not they're depressed at any time. In fact, in an international study in the Journal of Obsessive-Compulsive and Related Disorders, researchers found that out of 700 participants who had not been diagnosed with a specific condition or been seeking medical treatment, 94 % had experienced distressing, unwanted, intrusive thoughts in the prior three months. On this episode of Life Kit, that's what we're going to learn about. LA reports on what intrusive thoughts are, where they come from, and what you can do to get rid of them.

3:14In my postpartum mental health journey, I tried many different therapies, psychiatrists, and medicines. I got to be pretty proficient in this world. But I also met some amazing therapists along the way. One of which is Unique Clark, who, full disclosure, facilitates a postpartum group therapy that I went to. But she's not treated me personally. I am licensed as a clinical social worker. And I work as a perinatal mental health therapist with MedStar Georgetown. And I work in the women's mental health program. So long story short, I'm a therapist. Unique says that intrusive thoughts are very common for postpartum parents.

3:52It could be thoughts that include, like, harm coming to our baby, fears about being a bad parent, about accidents happening. A common one is, like, what if I drop my baby as I'm walking down the stairs? Or, like, you visualize yourself and something happens. Those are the ones that are definitely jarring. Ugh, the dropping the baby fear. I definitely have that one. And I don't know one parent who hasn't thought about that at some point. But again, intrusive thoughts don't just happen in the postpartum period. They can happen anytime, anywhere. As clinical psychologist Brooke Smith in Reno, Nevada knows.

4:28The majority of people do have intrusive thoughts. Like the research has shown somewhere like 80-90 % of the population gets intrusive thoughts. And this is our first takeaway. You are not alone in having these thoughts. And while they're considered common, even normal, mental health disorders like PTSD, OCD, anxiety, or depression can play them up more, according to Eunique Clark. So if you have someone who is highly depressed, the automatic thoughts might shift to the negative. Same with anxiety, like there is a rumination that is happening about what's going on in our brain. And Brooke Smith says intrusive thoughts can happen all sorts of ways.

5:07In the context of OCD, it could be something like Like cleaning, like, you know, I touched this doorknob. That means that I'm going to get germs on my hands. Memories of past trauma. Thoughts about harming yourself. Suicidal thoughts. The possibilities are endless because it could be any thought. It's less the content and more like the form that the thought takes. It pops into your mind. It's distressing. You don't want it there. You try to make it go away, but it keeps coming back. That last part about it coming back is what can disrupt our lives and make us change our behavior. Maybe you avoid carrying your baby down the stairs.

5:47I avoided baths for months. As Brooke mentioned, people with obsessive compulsive disorder have intrusive thoughts followed by a compulsion, like handwashing. But again, anyone can have these thoughts at any time. They're just a weird part of being human. So why do we get intrusive thoughts? Psychologists like Brooke believe there might be a purpose. If we have intrusive thoughts about something, it's probably pretty likely that it's an area that we care a lot about. If we really care about something, like our children, right, or our own safety, or something like that, our mind will latch on to that.

6:25Because we place importance on this area, and so we'll get more thoughts in areas that we care about, that are important to us. And the disturbing ideas can come from anywhere. TV, a magazine, a book, or a movie. What if they stop breathing in their sleep? Slipping and falling. I'm getting closer to death and running out of time. What if I drop them and I'm on the stairs? Cars are going to crash into us. My life is passing me by. My baby would be better off with a different mom. Our brains are kind of like flypaper, right? So we pick things up throughout our lives, and our mind tends to regurgitate information back to us.

7:09Brooke says our thoughts are based on our perceptions and prior experience. So our brains are reminding us what we care about, potentially to make sure that those things that we care about are protected, safe from all the imaginable gory or gross terrors that we dream up. The brain says protect our children, our family, our safety at all costs. Through this lens, intrusive thoughts are actually trying to help us survive and thrive. That said, during the moments when the thoughts are happening, it can cause a lot of distress. And this is takeaway number two. Regulate your emotions. It's often hard to think straight when these intrusive thoughts come up.

7:52So have a few different grounding exercises at the ready. The five senses one is really good of like walking through your five senses by noticing like five things you can feel. feel for things that you can touch, everything you can smell, so on and so forth. The ideal, again, is to bring you back to what is happening right now. Unique says take a few deep breaths. Smell your perfume. Put on a cold compress on your forehead. Feel something soft. Listen to the birds chirp or taste a hot drink. Try different coping strategies to ground yourself. I found I like using the tip skills to ground myself.

8:36Let me break that acronym down for you. That's T for temperature change, like sticking your head in the freezer or drinking a hot liquid. I is for intense exercise, like doing 20 push-ups or jumping jacks, or going for a run. P is for paced breathing. I like to do box breathing, which is inhale for four, pause for four, exhale for four, pause for four, and so on. And the last P is for paired muscle relaxation, which is the trickiest of the steps, but it's basically when you squeeze your muscles and release them in a special order. There are lots of resources on YouTube that can teach you how to do this.

9:23Here's where like redirection is really helpful. It's like I had the thought I'm going to shift and go call a friend or go for a walk or eat my lunch. I'm going to find something else that occupies my mind and shift away.

9:41Because with these really vivid, disturbing images, they can feel real. But grounding ourselves will allow us to come back to a logical state where we remember that thoughts are not actions. They are not premonitions of what is to come. Like, just because I have the thought does not mean that this is actually going to happen. Labeling the thought helps reduce, actually, the confusion between the two and, like, reduce the fear. So, like, this is an intrusive thought. It's not a desire or plan. It is just a thought. I've walked down the stairs with my baby a thousand times and haven't fallen once.

10:16I've driven in a car daily and not gotten in an accident. Sure, these things could happen, but they haven't, and I'm doing all I can in my power to stay safe. The rest is out of my control. Every time I do one of these scary things and the bad thing doesn't follow, I have more proof against my intrusive thoughts, and I'm fact-checking my intrusive thoughts. This leads me to the harsh reality of one of the most effective ways to deal with intrusive thoughts, and it's a doozy. It's takeaway number three, and it is to accept your intrusive thoughts. Accept that you have them. Yeah, not so easy. But according to Brooke Smith, who practices acceptance and commitment therapy, or ACT, not avoiding your intrusive thoughts is the only way to move through them.

11:07It's like trying to problem solve and fix the weather, right? Like, we don't have control over that. and we can get mad about it and we can, you know, throw a fit about it and we can have it consume our minds and consume our day and it's not going to change the weather, but we will be miserable. Brooke says we have control over how much we suffer about our intrusive thoughts, but we don't have control over the thoughts themselves. So instead of being miserable by the fact that you have intrusive thoughts, like I was at first, learn to accept that they are a thing that happens. Because as Brooke says, it's important to remember that we can't make these thoughts simply go away.

11:49See, that's kind of the hitch, right? Is like, if you still want them to be gone, then you're not really accepting, right? And so that's actually the thing that's going to keep them in place. More Life Kit in a moment. When Brooke Smith was in school, her dissertation was on intrusive thoughts and what to do with them. Her study's findings are published in the Journal of Contextual Behavioral Science. We had three groups. We had a control group. We had a group that tried to control their intrusive thoughts. And then we had a group that accepted their intrusive thoughts and didn't try to control them.

12:31And we found that the group that accepted their intrusive thoughts actually had less physiological distress and stress than the other two groups. So it was kind of like a counterintuitive result. You know, the more that you allowed yourself to feel the distress and to have the thoughts, the less distressed you became. Let me repeat that. The more the group allowed themselves to feel the distress, the less distressed they became. This group accepted the thoughts. Yeah, so that was a big finding. Acceptance showed lower skin conductance levels than both of the other conditions, and skin conductance is like a proxy for anxiety and for stress.

13:13So it's like how much you're sweating, basically, when you're stressed. Okay, so how do we do this really difficult thing? Smith says, start by looking at your thoughts as just that. Thoughts. Not facts. Thoughts. Rather than seeing your thoughts as who you are and as real, we can actually kind of take a step back and start to look at our thoughts as opposed to from our thoughts. And this is a process in acceptance and commitment therapy that's called cognitive diffusion. And it's also referred to as like mindfulness of thoughts. So really seeing your thoughts as phenomena that come and go just like the weather comes and goes.

13:56So if your mind is the sky, sometimes it's sunny. Sometimes it's cloudy and a storm passes through. Or it rains. And then it clears up. And just like that, our thoughts can enter our mind and we can kind of observe the thoughts coming, staying for a while, and then passing away. And if we can step back and get that distance from our thoughts, that helps a lot to take the power out of them. Brooke says we don't choose these thoughts. These thoughts just come up. And since we don't control them coming in, that means they aren't a reflection of who we are. It's like it's an impersonal process, right?

14:37And so we can kind of start to watch that process. And that can, that's really the key treatment strategy that I emphasize with clients and in my research has shown that as well. If we're not feeding into the thoughts, and we're not trying to actively suppress them or avoid them, then we're not giving them power. And they do start to decrease in frequency and intensity over time. And Unique says it might feel counterintuitive, but talking about your intrusive thoughts gives them less power. That's takeaway number four. If people are isolated, that's when those thoughts happen too, because there's no one to bounce off.

15:16these ideas or to get the support or the validation that like this is normal. It stinks, but this is happening. Other people will help you fact check the thoughts. Talk to a friend or therapist about your thoughts. Just don't keep them to yourself. Share them and you'll notice they begin to lose their power. It's a truly common experience. So part of just even talking about it can help normalize the experience that like other people in my life, other people that I know, share this experience to. One woman in Unique's group therapy gave her intrusive thoughts a name. Gertrude the Intruder. She was bossy and always butted in to say something nasty.

15:55We began to call all of our intrusive thoughts Trudy, and it gave us a way to connect over it. It lightened the mood. Talking about it doesn't make it true. It doesn't increase the risk that, like, this is going to happen and I'm going to act on it. Unique also says to take notice of any patterns or triggers. Do intrusive thoughts happen when you're overtired, stressed out, isolated? Am I noticing that the thoughts get worse, like when I'm hungry, when I'm tired? Am I surfing through and watching too much TV and that has me, like, stressed out? Or am I on social media a lot and that comparison is starting to happen?

16:30For me, I notice them more when I'm sleep-deprived. Unique says you can ask yourself, am I prioritizing my rest? my nourishment, and most importantly, support. And support comes in all forms, a friend, family member, therapist, or group. And she recommends having a mantra ready and to tell your mantra to your friends so they can also remind you of it. This could be like the thought came and now I can watch it float away like leaves on a stream or a cloud in the sky or that this thought isn't me and I'm doing a good job as a mom. I like to switch up my mantras when they feel stale. Sometimes it's, I'm a good mom.

17:12Sometimes it's, I can do hard things. Sometimes it's, this too shall pass. Because anxiety, depression, grief, and anger are normal human emotions, almost everyone experiences these thoughts at some point in their life. It's part of the human experience. I still have them probably once every couple weeks. I'll just get some like really weird thought. Like, what can I do with this kitchen knife? I'm like, okay, that's a weird thought. I'm just going to keep going. For me personally, when the thoughts are scary, that's okay. Like that is the marker of what we're looking for. Like, is this disturbing for someone?

17:50Is it frightening for someone? It's when they're not so scary anymore is when we start to worry. Because if the scary thoughts start to feel believable, like a paranoia, Then we're teetering into psychosis. So the fact that you're having these thoughts and they scare you is really a good thing. So even when we experience intense levels of anxiety and depression and intrusive thoughts and other difficult internal experiences, we can still move in the direction of our values. Look, I've accepted that I have a vivid imagination that loves to spiral into all kinds of crazy scenarios. especially when I'm stressed or tired.

18:34I've accepted that it's part of who I am. And over time, Gertrude the Intruder gets a little more bearable. Nowadays, I look forward to bath time. It's one of my favorite activities to do with my baby. I can have scary thoughts, but still live my life. And that is what really matters. Splish splash.

19:10So, to recap, 1. Learn what intrusive thoughts are, because everybody has them from time to time. 2. When the thoughts are really intense, ground yourself using mindfulness. 3. Accept your intrusive thoughts. Acknowledge that they happen. 4. Talk about your intrusive thoughts. Fact check them and notice triggers.

19:38That was NPR senior visuals producer L.A. Johnson. If you or someone you know is thinking of suicide, please call or text the Suicide and Crisis Lifeline at 988. And that's our show. If you love Life Kit and you want more, follow us on Instagram at NPR Life Kit. There you'll find videos demonstrating some of our favorite tips, plus comics and cute little videos we make just for the gram about things like sleep myths and flirting and how to find things you've lost. Again, we're on Instagram at NPR Life Kit. This episode of Life Kit was produced by Sylvie Douglas. Our visuals editor is Beck Harlan and our digital editor is Malika Grebe.

20:21Megan Cain is our senior supervising editor, and Beth Donovan is our executive producer. Our production team also includes Andy Tegel, Claire Marie Schneider, and Margaret Serino. Engineering support comes from Robert Rodriguez and Stacey Abbott. Fact-checking by Tyler Jones. Special thanks to Ritu Chatterjee. I'm Mariel Cegarra. Thanks for listening.