Verified by 
Key points
- Unwanted intrusive thoughts aren't defined by their content.
- Unwanted “thoughts” include images, sensations, memories and stories.
- When trying to cope with unwanted intrusive thoughts, effort works backwards.
In response to our book, Overcoming Unwanted Intrusive Thoughts, we get hundreds of emails asking for clarifications and additional explanations. One of the largest group of messages concerns some variation of “Is this an intrusive thought?” or “Your book doesn’t mention this type of thought [an example is then provided], so how could this apply to me?”
These questions miss two major points about unwanted intrusive thoughts:
What You Resist Persists
First, these stuck, repeating thoughts usually begin with a doubting thought or sensation or image that was previously not a concern. It arrives with a whoosh of feeling that demands you take it seriously. You get absorbed in a story with a bad ending or a terrible implication.
So, you start resisting, arguing back, getting entangled, or trying to make it go away. And this makes it stickier and louder, and feel more “real” and more preoccupying.
You have been tricked into thinking that this struggle is required to protect yourself or others, or to be responsible, prevent mistakes, or prove you are okay. But this effortful resistance works backwards.
You might resist a thought for any number of reasons, but the central point is that it is the resistance that turns the initial jolt into terror, embarrassment, and mental anguish.
In contrast, if you are having passing thoughts--even odd ones--that don’t matter to you, or preoccupying ones you enjoy–like when you are falling in love–then these are not unwanted intrusive thoughts.
So, even if your particular stuck thought isn’t included in an apparently comprehensive list of unwanted intrusive thoughts, you are coping with unwanted intrusions if they stay stuck despite your (or, more accurately, because of your) struggles to distract yourself from them, argue them away, check on them, or make other efforts to get them to stop.
Unwanted “Thoughts” Include Images, Sensations, Memories, and Stories
The second major misunderstanding is that “thoughts” have to be understood in the broadest sense. These include disturbing memories (real or constructed) that you can’t seem to get out of your mind, visual images from your life or the news media that repeat, and musical sounds or rhythms that you hear in your mind over and over again, as well as disturbing or bothering sensations in various parts of your body.
Anything about which you create an imagined disturbing narrative can become a stuck unwanted repeating obsessional intrusive thought. Some common narratives include:
- “I won’t be able to stand it if this continues.”
- “If I could have done that, then what else am I capable of?”
- “This will drive me crazy.”
- “If that happened to someone, how can I trust it won’t happen to me?”
- “If I can imagine it, it must be possible.”
Here are some examples of unwanted intrusive thoughts not detailed in the book: People write of their inability to erase from their minds images of their spouses' sexual activity before they met, and experience intense jealousy from these imaginings. That this really happened is irrelevant; the stickiness of the images (which are made up by one’s imagination) is what qualifies them as unwanted intrusions.
Unwanted intrusive thoughts are defined by the way they act and feel, not what they are about.
Some get confused when it comes to memories that get stuck — for example, “I can’t stop thinking about the mistake I made on that email.” Memories are not the problem: You have imagined a story about what unforeseen consequences could possibly happen in the future, or what it might mean about you if you are not careful.
It is the story formed in your imagination about the memory that drives the resistance and creates the misery, not the memory itself.
Others write of vivid images making them believe that they might be suffering from some psychosis (“Are these hallucinations?” they often ask.) In this case, the intrusion is a visual intrusion, and the misunderstanding of the nature of intrusions then starts an additional cycle of “Maybe I’m losing my mind! What if I am schizophrenic?” which leads to additional unwanted thoughts.
Another common category of unwanted intrusive thoughts involves musical songs or rhythms circling around in your head. Again, we get queries from people who fear they are having auditory hallucinations, which initiates an additional “I will not be able to function/enjoy my life/pay attention to anything else if this does not stop” series of unwanted intrusions.
Additionally, intrusions can include sensations in parts of your body. People commonly become focused on their heartbeat or breathing, and this type of unwanted intrusion can lead to what some call health anxiety, or obsessive fears of illness or death.
Alternatively, the imagined narrative is not about being ill, but about living a ruined life unable to wrestle your attention away from the sensorimotor obsessional preoccupation. Trying to stop noticing is the resistance.
People can have real sensations of sexual arousal often called “groinal response,” followed by an anxious doubt (“what is going on here?”), and then an imagined story about what it could mean. Here is an example: A straight person has a previously not considered intrusive thought that they are gay (or vice-versa; a gay person has intrusions that they are straight).
A story or narrative forms in the imagination about consequences if this were true. They obsessively check to make sure those thoughts aren’t arousing them. And, as they become hypervigilant about that part of their body, they notice sensations that are misattributed as confirmation. This checking is resistance.
Perhaps most commonly, people experience “groinal” sensations when they have unwanted intrusive thoughts that they might be a child molester. This resisted thought becomes an obsessional doubt with a horrifying narrative. The loving grandfather with such an intrusion unconsciously searches his body to make sure there is no arousal—and, of course, misinterprets the anxious arousal as confirmation.
Sexual arousal is not desire. It can easily become an automatic conditioned response to anxious imaginings in the complete absence of desire or urge or intention.
Misunderstanding how a weird doubt, sensation, or image can suddenly turn the tables upside down—making you distrust what you thought you knew or distrust the body you used to trust—is what pushes you toward urgent resistance.
Identifying Characteristics
So here is how to identify an unwanted intrusive thought: (1) Is it stuck and repeating? (2) is it being resisted, regardless of its content? and (3) has it formed into an imaginary narrative of doubt and worry that seems to demand your attention?
Unwanted intrusive thoughts include images, memories, sensations, and stories. If your mind can create it, your mind can make it stick.
