Managing Intrusive Thoughts and Worries to Improve Mental Health

Have you ever experienced unwanted thoughts that appear out of nowhere and cause discomfort, anxiety, or unpleasantness? These are generally called "intrusive thoughts." While there's often no specific reason behind their appearance, they can become debilitating and negatively affect your life in various ways.

If you're experiencing this, you are not alone: intrusive thoughts can be prevalent. According to one study that included over 700 participants in 13 countries, more than 93% reported experiencing at least one intrusive thought during the previous three months. Based on other estimates from the Anxiety and Depression Association of America, around six million people experience intrusive thoughts in the United States.

Read on to learn more about intrusive thoughts, strategies, and resources for additional help. 

What are intrusive thoughts?

Intrusive thoughts may occur as mental images, urges, or phrases. They can be explained within medical psychology frameworks, and are typically benign. Everyone experiences intrusive thoughts to some extent, but for some people they may be a symptom of a mental health condition.

Unwanted intrusive thoughts can be distressing, intense and, in some cases, include suicidal thoughts. Those who are experiencing such thoughts should contact the 988 Suicide & Crisis Lifeline or seek emergency care.

Are intrusive thoughts normal? 

Because intrusive thoughts can feel strange and frightening, it’s hard to believe that they’re a normal part of human existence. Everyone has intrusive thoughts now and then. 

Why the brain produces unwanted thoughts

Scientists believe that unwanted thoughts are simply a part of the brain’s neural networking system, little misfires that come to the attention. However, some individuals may have stronger neural defense mechanisms that can protect the conscious mind from being hijacked by these uncomfortable thoughts. Recent research has found that hippocampal activation as well as dysregulation of the prefrontal cortex may weaken these defenses and put you at higher risk for hyperfocus on intrusive thoughts. 

Difference between thought and intent

The distress around intrusive thoughts is typically caused by the idea that the thought in your head is the same as committing the act of carrying out that thought. This is not true. You may have a fleeting image of stripping off your clothes and dancing in public. Unless there is something serious going on with your mental health, this is unlikely to happen. Randomly thinking a terrible thing isn’t the same as carrying out an action.

When intrusive thoughts become upsetting

Guilt over unwanted thoughts can impact one’s sense of self. When intrusive thoughts or memories become intense or frequent, they can begin impacting one’s daily life and ability to function. Such can be the case with mental health conditions like OCD, when these obsessive thoughts not only take up cognitive space and emotional energy, but can also lead to compulsive behaviors. 

Common types of intrusive thoughts

Intrusive thoughts are so common that psychologists have broken them down into common types and categories. The following are some common types of intrusive thoughts you might experience. 

Aggressive and violent intrusive thoughts

Some people may have aggressive thoughts or violent intrusive thoughts about hurting themselves or others. For example, you may think about cutting yourself, or new parents with postpartum depression may have intrusive thoughts about hurting their baby. People who have these thoughts likely do not want to act on them, but they may worry that deep down, a part of them wants to.

Sexual intrusive thoughts

It’s natural for humans to think about sex, and many of us do–often. However, when someone feels guilt about sex, they can become fixated on these intrusive sexual thoughts and worry over them. It can be especially distressing when these unwanted sexual thoughts are inappropriate, or don’t align with our identity. 

Religious or moral intrusive thoughts 

For individuals who are raised in strict faith traditions, it can be common to have intrusive religious thoughts that break faith or moral codes. For example, someone may obsess over the idea that they’ve committed the “unforgivable sin” or have sacrilegious thoughts during a service. 

Harm related and safety fears

Intrusive thoughts may also involve worrying over something bad happening to you or to others. For example, when standing on top of a tall building you may have an image of falling off that building. Or when driving you may picture yourself losing control of the car and getting into an accident. 

Intrusive thoughts and mental health conditions

Traumatic memories, hormonal changes, and other underlying problems can lead to frequent, intense intrusive thoughts and subsequent distress. When they interfere with daily life and relationships, they may be a feature of a mental health condition. The following are mental disorders in which intrusive thoughts are a common symptom. 

Obsessive-compulsive disorder

For individuals with obsessive-compulsive disorder (OCD), intrusive thoughts may feel more overwhelming and cause more severe disruptions. These intrusive thoughts or obsessions may cause repetitive behaviors (compulsions) because they hope these behaviors will help them end these thoughts or lead to a better outcome.

For example, individuals who experience obsessive-compulsive thoughts may constantly worry about whether doors are locked or stoves are turned off. These thoughts may cause them to repeatedly lock and unlock doors to ensure the locks are working. While obsessive compulsive symptoms may not be dangerous, they can affect one's quality of life.

Post-traumatic stress disorder

People living with post-traumatic stress disorder (PTSD) often experience intrusive thoughts that may be connected to a traumatic event or past news they've heard. These thoughts may trigger symptoms of PTSD, such as increased heart rate and sweating. Sometimes, the ideas can be so severe that they lead to flashbacks and intense psychological distress.

If you are experiencing trauma, support is available. Please see our Get Help Now page for more resources.

Eating disorders

People who have developed an eating disorder may experience intrusive thoughts that harm their mental health. These thoughts may result in frequent worry about food's impact on their physical body, which can cause additional stress about eating. Sometimes, these intrusive thoughts can lead to problematic behaviors, such as binging and purging. Those with eating disorders might also experience anxiety and depression alongside intrusive thoughts, which may further damage their mental health.

Anxiety disorders

Individuals with anxiety disorders often experience a persistent sense of worry or fear. Intrusive thoughts can arise as ongoing concerns about everyday situations, sometimes reaching debilitating levels and making daily tasks difficult. Individuals with anxiety disorders might obsessively ruminate over worst-case scenarios, even when there's little to no reason for concern.

Bipolar disorder

People with bipolar disorder may also experience intrusive thoughts. These intrusive thoughts can be particularly intense during manic or depressive episodes. During manic phases, intrusive thoughts might arise as grandiose beliefs or overconfidence, whereas during depressive episodes, they can be overwhelmingly negative and filled with despair. 

When intrusive thoughts become severe

In some severe cases, intrusive thoughts can cause risk or harm. If intrusive thoughts are delusional, or you become worried that you may follow through on violence against yourself or others, seek immediate help. You can reach the crisis lifeline 24/7, or call emergency services. 

Coping strategies you can use right now

Experiencing intrusive thoughts can be frustrating, especially if you aren't sure what's causing them and they're getting into your daily life. Luckily, there are ways you can learn to manage these thoughts.

Ways to manage intrusive thoughts

1. Identify your triggers: Often, individuals who experience intrusive thoughts feel so consumed with them that they don't realize what's triggering them. Issues like a major life change, a deadline at work, or even a loud or crowded environment can create stress. Identifying and addressing your stressors may help you tame intrusive thoughts.
2. Take action: Identifying triggers can be the first step in overcoming intrusive thoughts. When you've identified these triggers, it may be time to address them. You may need to remove yourself from a stressful situation or plan your time so you do not feel pressured to meet strict deadlines. Anything you can do to reduce stressors will help alleviate intrusive thoughts.
3. Practice gratitude through daily affirmations: One key component to overcoming intrusive thoughts can be developing an attitude of gratitude. This can be important because intrusive thoughts can have a way of encouraging individuals to develop a negative self-perception. If you highlight the positive aspects of your life every day, it can help you keep things in perspective.
4. Face your fears: This can be an essential step in conquering intrusive thoughts, and it will likely require the assistance of a therapist. Many people experience fear, but not all of us may fully understand why that fear is there or the trustworthy source of it. During your treatment, a therapist can help you to uncover and address these fears safely.
5. Talk about your feelings: Intrusive thoughts may cause individuals to feel shameful because they fear others won't understand. However, taking steps to talk about your feelings can be one way to take control of the situation. Again, this is where a therapist can help, as they will allow you to verbalize your thoughts and feelings in a safe, non-biased environment while providing valuable tools and insights to help you better understand and cope with these feelings.

Evidence-based treatments for managing intrusive thoughts

Learning to overcome intrusive thoughts is a process. Each day is a journey. While you may feel in control of your thoughts some days, there may be times when you need help processing and overcoming them. If intrusive thoughts have become a problem, talking to a counselor or a therapist and getting treatment may be helpful. You may want to contact someone in your area and schedule an appointment.

However, online counseling can be another great option if you're unsure about in-person counseling. BetterHelp offers a team of licensed, professional counselors dedicated to offering compassionate help to anyone in need. Their platform is completely discreet, and you may use it from the comfort of your home (or wherever you have an internet connection).

Talk therapy including cognitive behavioral therapy and exposure and response prevention therapy

Talk therapy is a first-line treatment for many of the conditions that feature intrusive thoughts. In particular, cognitive behavioral therapy is an effective approach to address and overcome intrusive and compulsive thoughts. Also, exposure and response therapy is a common and evidence-based treatment. Studies show that cognitive behavioral therapy (CBT) and exposure and response prevention (ERP) therapy are effective in helping many manage and reduce intrusive thoughts. 

Medication options in severe cases

In some severe cases, a provider will recommend medication in addition to talk therapy to help manage intrusive thoughts. This can apply to cases of BPD, OCD, depression, or anxiety disorders. Some common medications prescribed can include:

• Mood stabilizers lithium or valproic acid
• Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs)
• Antipsychotic medications (severe cases)

Alternative and complementary approaches

The foundation for controlling unwanted thoughts lies in understanding what they are and that you’re one of the more than six million people in the US who experience them. Recognize and acknowledge that they’re happening and accept that they’re not a reflection of reality or who you are as a person. 

Research shows that creating mental resilience can be an effective way to help manage stress and potentially reduce intrusive thoughts. While more research is needed to understand the connections, mindfulness and acceptance techniques have been shown to be helpful. Distraction, such as reaching out to a friend, or participating in a chosen hobby can also help to control intrusive thoughts. Research suggests that proactively engaging in activities that distract you from intrusive thoughts can effectively reduce them.

Mentally protective lifestyle habits can also stack the deck in your favor. Some of these include:

• Prioritizing quality sleep
• Getting regular exercise
• Building strong social connections
• Participating in hobbies and activities
• Avoiding or limiting alcohol and caffeine

Intrusive thoughts across the lifespan

According to research from Harvard Health Publishing, and the British Journal of Psychology, intrusive thoughts are more likely to occur during times of life transition or change. Researchers believe this is due to elevated levels of stress during these periods. 

Young adults and stress transitions

Young adults moving into the next chapters of life, including starting college, moving to a new city, or beginning a new career can be especially susceptible to experiencing intrusive or unwanted thoughts, especially if they are already experiencing other mental health conditions.  

Postpartum intrusive thoughts in parents

Having a new baby is another time when frequent intrusive thoughts can arise. Lack of sleep, high levels of stress, and in some cases, postpartum depression can contribute to this phenomenon.

CBT for intrusive thoughts, obsessive compulsive disorder, and mental health

Cognitive behavioral therapy is a great way to address and overcome intrusive and compulsive thoughts. Nearly 400 universities and researchers have studied Internet-based cognitive behavioral therapy (ICBT). A review of all of these studies found that ICBT is not only overall just as effective as in-person therapy for treating a variety of issues (including OCD), but it's more beneficial in terms of cost-effectiveness, greater client satisfaction, and cognitive improvement, and reduced negative stigma as clients can attend therapy sessions comfortably from their home. Internet-based therapy, the studies found, also results in a significantly lower dropout rate than in-person therapy and is less time-consuming.

How to stop intrusive thoughts and anxiety with online therapy

Nearly 400 universities and researchers have studied Internet-based cognitive behavioral therapy (ICBT). A review of all of these studies found that ICBT is not only overall just as effective as in-person therapy for treating a variety of issues (including OCD symptoms), but it's more beneficial in terms of cost-effectiveness, greater client satisfaction, and cognitive improvement, and reduced negative stigma as clients can attend therapy sessions comfortably from their home.

BetterHelp allows you to have sessions anytime, anywhere, though you may need an internet connection, depending on how you decide to meet with your therapist. Sessions may be customized to your needs and can be conducted via video chat, phone calls, instant messaging/texting, or live voice recordings.It's also beneficial to those living in areas where in-person therapy is not an option and those with busy or non-traditional schedules, as our therapists are worldwide and operate at all times. A quick quiz will help match you with a suitable therapist. From there, you can chat with them to determine if they are a good fit and then schedule sessions or choose another therapist if you don't think they're a good match.