What Is an Intrusive Thought? Understanding This Common but Distressing Symptom of OCD

If you’ve ever experienced an unwanted, distressing thought that came out of nowhere, you’re not alone. Far from it, actually. Research indicates over 90% of human beings experience what we call "intrusive thoughts." But for individuals with Obsessive-Compulsive Disorder (OCD), intrusive thoughts feel overwhelming and even horrifying, triggering intense anxiety.

At Hope Rekindled Counseling, Lauren Spencer, MS, LMFT specializes in providing OCD therapy in Washington State and Texas, helping clients understand and effectively respond to intrusive thoughts with evidence-based treatment.

What is an Intrusive Thought?

Intrusive thoughts are involuntary, unwanted thoughts, images, or impulses that suddenly pop into your mind. They are often shocking, disturbing, and completely out of character. Examples might include thoughts of harming a loved one, blurting out something inappropriate, or fears about acting on an impulse you do not actually want.

Everyone has intrusive thoughts from time to time, but for most people, they pass quickly and are dismissed. Often times people don't even know they've had one! For someone with OCD, though, these thoughts get “stuck” — meaning they stick around like a ping pong ball bouncing around your brain. OCD then tricks you into believing the thought must mean something important, leading to obsessive worry and then compulsions.

Intrusive Thoughts and OCD

In Obsessive-Compulsive Disorder, intrusive thoughts become obsessions. Obsessions are persistent, unwanted thoughts or images that cause significant anxiety. As an ICBT therapist, I also describe them as obsessive doubts. To cope, a person turns to compulsions to help decrease the terrible anxiety. Compulsions can be mental or physical actions and they're meant to neutralize the thought or prevent something bad from happening.

For example, someone with intrusive thoughts about contamination may wash their hands repeatedly. Someone experiencing intrusive thoughts about harming a loved one might avoid sharp objects altogether or mentally review their actions over and over for reassurance.

Why Do Intrusive Thoughts Feel So Distressing?

A common reason intrusive thoughts feel so disturbing is that they target what you value. They clash with your morals, identity, or what you love most — which is exactly why they cause so much fear and doubt. In reality, intrusive thoughts do not reflect your character or desires. They are simply blips in your brain that get stuck due to doubt over whether or not the thought is important.

When untreated, the cycle of obsessions and compulsions can take up hours of your day and severely impact your quality of life.

How Therapy for Intrusive Thoughts Can Help

Evidence-based OCD treatment, like Exposure and Response Prevention (ERP), Inference-based CBT (ICBT), and/or Acceptance Commitment Therapy (ACT), helps you relate to these thoughts differently and eventually without engaging in compulsions. Over time, this reduces the power intrusive thoughts hold over you and restores a sense of freedom.

How Different Treatment Options Conceptualize Intrusive Thoughts

While there are three evidence-based treatment options for OCD, they each conceptualize the problem with intrusive thoughts differently.

Exposure-Response Prevention holds the idea that intrusive thoughts are completely random and compulsions are a conditioned response. Basically, when you experience an intrusive thought like, "what if I offend God?", and this thought sparks anxiety, you've now conditioned your brain to turn on your threat response whenever you have a similar thought. And then, your brain learns compulsions are the only way to cope with this anxiety. This is why ERP treatment focuses on conditioning your brain to have new responses to anxiety and intrusive thoughts.

Acceptance-Commitment Therapy focuses more on the relationship we have to anxiety itself. The idea of intrusive thoughts being random distressing thoughts holds true for this approach, but the target of therapy is less on conditioning and more on improving our relationship to anxiety itself. The idea is if a thought pops in your brain, but you don't mind the anxiety it's causing, then you're less likely to engage in compulsions. And, bonus, your brain is learning that thoughts are just thoughts, and not something to be afraid of.

Inference-based Cognitive Behavioral Therapy takes a very different view on intrusive thoughts. Instead of embracing the idea that intrusive thoughts are random, ICBT suggests the problem is that people with OCD doubt whether or not the thought is true. In short, the problem isn't the thought, the problem is the doubt. It also suggests that intrusive thoughts are not random, but are triggered by either external or internal experiences (like seeing a knife or remembering a time you were struggling with OCD). This is a great approach for people wanting to learn the "why" behind their OCD symptoms.

Get Help for Intrusive Thoughts and OCD

If you’re struggling with intrusive thoughts and suspect you may have OCD, please know OCD is actually very treatable. You just need the right roadmap. At Hope Rekindled Counseling, I provide compassionate, specialized OCD therapy online for clients in Washington State and Texas.

Ready to take the next step? Reach out today to schedule a free consultation and learn how OCD therapy can help you regain your peace of mind.

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