Unwanted, Intrusive Thoughts & "Needing to Know for Sure"
Have you ever stood on the edge of a train platform, minding your own business, and then, suddenly, out of the blue, for no apparent reason, had the thought “I could jump in front of the train” or “I could push that guy off the platform?” Or have you been taking care of a baby and suddenly had a revolting intrusive thought like "What if I throw the baby down the stairs" or "What if I touch the baby's genitals?" Almost everyone has passing thoughts that are frightening, disgusting, bizarre or just plain ridiculous. There is nothing odd about this. But some people have passing thoughts like these that somehow get stuck and start repeating themselves, forming elaborate chains of internal dialogue in an attempt to counteract the thoughts or prevent what seem like potentially impulsive actions. These unwanted intrusive thoughts become obsessive, demand attention, provoke fear and shame, and often lead to doubts about sanity, control, motives, character and safety. They may prompt a sufferer to wonder if there is some dark and dangerous mystery within them: "Am I a psychopath? A child molester? A potential murderer? Am I unconsciously suicidal? Having these thoughts must mean something terrible about who I am!"
The presence of unwanted intrusive thoughts does not indicate anything about your character or sanity. In fact , the content of the thoughts are actually meaningless and irrelevant, no matter how compelling. These unwanted thoughts are not fantasies or impulses or urges. They are maintained and exacerbated precisely because you do not want them and by the effort you expend to try to stop them. What we know is that the ordinary passing thoughts that most upset someone, that violate their principles or values, that horrify or disgust them – those are the thoughts that are most likely to get stuck – precisely because of the efforts made to get rid of them, argue with them or neutralize them, either with internal dialogue, ways of attempting to reassure oneself or by developing avoidance behaviors. This we call paradoxical effort: In other words, the harder you try, the worse it gets. In the examples above, avoidance might start to occur by asking others to care for or change the baby’s diapers, take your car instead of the train, or start to avoid any books or TV that might mention sudden acts of violence or child abuse. Avoidance may seem like a way to cope at first, but it actually fans the flames of unwanted intrusive thoughts, undermines one’s sense of well being and mental health and tends to spread or generalize to other scary thoughts or other "safety behaviors."
There are other factors which influence whether thoughts get stuck. One is what we call entanglement. This is basically about your relationship with your own mind. Some people can take their thoughts with an attitude of detached observation. They don’t take the passing jumble of multiple channels of thoughts too seriously; they can laugh at absurd thoughts, or stand back and not get involved when socially or personally unacceptable thoughts pop into consciousness. They know and accept that a lot of what passes through everyone’s minds is essentially junk – sometimes noisy, sometimes distracting – but without value or meaning. Other people fall prey to a number of common myths – for example that every thought has a hidden meaning, or that thoughts can force people to act, or that our thoughts are actually under our control (when actually only our attention to them is under our control). The idea that every thought is worth thinking about is simply not true. But if you struggle with a thought, it will start repeating, and that makes it seem even more important.
Another factor is what we call stickiness of the mind. There are biological factors at work here, making some people genetically more predisposed to obsessive thinking. These people may also have other anxiety symptoms like excessive worry or panic attacks or signs of OCD – or they may not. Periods of stress in one's life or normal experiences like fatigue, illness or anticipated conflict can make any mind more sticky temporarily. Knowing what tends to make your mind more or less sticky can help alert you to times when you should strive to be unentangled and unfazed by your own thoughts.
Unwanted intrusive thoughts come in many forms. They can be morally repugnant, about harming oneself or others against one’s will, they can be impure or blasphemous thoughts. They can intrude in terms of doubt attacks about major questions of faith, the meaning of one’s life or the nature of reality. They can take the form of sudden shocking doubts such as “Do I really love my spouse?” or “Is my sexuality what I have always thought it was?” Bizarre worries can persist. Unwanted intrusive thoughts can even take the form of sensations (“Is there something wrong with my swallowing or breathing?”) or images (“I keep imagining myself throwing up in public”).
There are straightforward ways to overcome unwanted intrusive thoughts. They are the opposite of what most people try first. Desperate efforts to reassure oneself by mental checking or by asking others is common. However, the key lies in accepting and allowing the thoughts to occur rather than struggling with them. Changing your attitude and reaction when these thoughts occur can be extremely helpful but it can be hard to accomplish on your own. In addition, if avoidance patterns (including neutralizing compulsions and reassurance seeking) have developed, active exposure therapy to trigger the thoughts and practice being dis-entangled from them will be needed for an enduring recovery.
ASDI therapists commonly work with those struggling with unwanted, intrusive thoughts.
Books Co-Authored By Dr. Sally Winston
A detailed step-by-step program for dealing with unwanted intrusive thoughts can be found in Overcoming Unwanted Intrusive Thoughts (New Harbinger Press, 2017) by ASDI's own Dr. Sally Winston and co-author, Dr. Martin Seif.
It has also been translated into Spanish (see below), German (see below), Czech and Turkish
"This book has been selected as an Association for Behavioral and Cognitive Therapies Self-Help Book Recommendation—an honor bestowed on outstanding self-help books that are consistent with cognitive behavioral therapy (CBT) principles and that incorporate scientifically tested strategies for overcoming mental health difficulties. Used alone or in conjunction with therapy, our books offer powerful tools readers can use to jump-start changes in their lives."
Needing To Know For Sure Co-authored by ASDI's
Dr. Sally Winston.
(New Harbinger Press, 2019)
Powerful skills based in cognitive behavioral therapy (CBT) to help you break free from the fear of uncertainty and put a stop to compulsive checking and reassurance seeking.
“How do I know I made the right decision?” “What if I’m wrong?” “I need to know for sure.”
Psychotherapy Networker published an excerpt from Needing to Know for Sure.