Hi, I'm Dr. Tracey Marks, a psychiatrist,
and I make mental health education videos.
It's normal to have unwanted thoughts
that intrude into your awareness.
They're unwanted because
they're objectionable in some way.
They may be thoughts of harming someone or yourself,
doubts about decisions that you've made,
or fears about something bad happening
to you or someone else.
In the person without anxiety,
these thoughts can just come and go.
You may have an emotional response
of disgust or revulsion if it's bad enough,
but you're able to move on
to thinking about something else
and the objectionable thought
just has no lasting impact on you.
But in the person with anxiety,
these unwanted intrusive thoughts
can stick in your head
and cause you a lot of distress.
So if these thoughts are normal,
what makes some people get hung up on them
and others not?
Well, using the cognitive model
developed by the late psychiatrist Aaron Beck,
there's six ways
that we can turn these normal thoughts
into problematic intrusive thoughts.
The first way is having an inflated sense
of responsibility for the thoughts.
With this, you believe that
you have the power
to cause the negative outcome
or the duty
to prevent the negative outcome.
Let's say you grab a wine bottle
off the shelf
to pour yourself a glass of wine.
And as you look at the bottle,
you picture yourself hitting your partner
over the head with it.
With inflated responsibility,
you believe that even though
it's not like you to do such a thing
or you don't even have the desire to do that,
you have this other power
that can override your resistance
and make it happen.
You may even condemn yourself
for having such a thought.
A second way
that these fleeting thoughts
can morph into sticky, intrusive thoughts
is by attaching too much importance
to the thought.
With this, you believe that having the thought
makes it a fact,
or in the case of imagining a behavior,
seeing the image in your head
increases the possibility
that it's likely to happen.
For example, suppose you think
that you may have hit someone
while you were driving.
You don't remember seeing a person,
but you do remember hearing a bump sound
and then you start to doubt yourself.
Did you really commit a hit and run?
Seeing an image
in your mind of someone lying on the road
makes you think that
it must have happened.
Otherwise, how could you picture it so clearly?
Another version of this over importance bias
is called thought-action fusion.
Thought-action fusion
is where you believe
having the thought is just as bad
as committing the thought.
So if you had a thought
of touching your mom's crotch,
you might as well have just done it
because just having the thought
float through your mind generates
the same level of disgust and shame
as it would if you did it.
Number three is excessively thinking about
controlling your thoughts.
You believe that it is possible
to have complete control
over what you think
and that this level of control is essential.
Number four is overestimating the threat.
Sexual thoughts are a common theme
of unwanted thoughts.
Let's say you have a thought or image
that pops into your mind
of touching your child inappropriately
or being sexual with a relative.
The mere presence of that thought
in your head
sets you off into worrying
about how easy or hard it will be
to resist the urge
to act on those thoughts.
And you start to believe that
your children are relatives
are at risk of you being inappropriate with them.
After all, you wouldn't be thinking this way
if it weren't a high probability.
And since you don't feel strong enough
to control your thoughts,
how could you feel strong enough
to resist the urge?
Number five is having an intolerance of uncertainty.
This mindset is common with anxiety.
You believe that it's possible
to completely certain
that there won't be negative outcomes
and you become extremely anxious
when you can't get enough facts
to support your desired outcome.
Unanswered questions and loose ends
cause you a lot of distress.
The sixth way these fleeting thoughts can become sticky
is by having a perfectionistic mindset.
With this mindset,
you believe that it is possible for
everything to be perfect and just so,
and you don't tolerate mistakes.
What are the common types of intrusive thoughts?
I've already mentioned sexual
and here are four more.
Harm, injury and aggression;
contamination; doubt;
and religious thoughts.
Scrupulosity involves intrusive thoughts about
violating religious or moral codes.
And I'll talk more about that in a later video.
The natural reaction to intrusive thoughts
is to try to eliminate them all together
or reduce the anxiety they cause.
People with generalized anxiety
tend to use avoidance
and seeking reassurance
to reduce anxiety
and people with obsessive compulsive disorder
tend to use rituals to neutralize the anxiety.
But these strategies
only worsen the distress
and cause you to worry even more
about the thoughts.
So what can you do
to control these intrusive thoughts?
One approach is using
acceptance and commitment therapy techniques, or ACT.
ACT is a behavior therapy that teaches you
how to be more flexible with your thinking.
For example, you could start with mindfulness
by bringing your awareness to the present moment
and then reflect on how the thought is
one of many that you have
over the course of the day.
The thought is not fact.
It's just a thought.
You're the one who attaches meaning to it.
And you choose how much weight to assign to it.
You can assign less weight to the thought
and if you give it less weight,
you'll be less likely
to see the thought as dangerous
or draw conclusions about what
the thoughts say about you.
The next thing you can do
is recognize the triggers that set off the thoughts.
Write them down in a journal
so that you can look at them
from a bird's eye view.
Do you see a pattern?
Do you see a connection
between the trigger and your thoughts?
Maybe you get them while
you watch certain things on vision or online.
Maybe you get them
when you haven't had enough sleep
or when you've been eating too much processed food.
Yes, what you eat does affect your thinking.
Another behavioral approach
to lessen the impact of intrusive thoughts
is exposure therapy.
Exposure therapy teaches you
to confront the thoughts
instead of running away from them.
You confront them to purposely think about them
and maybe even saying them aloud.
Doing this doesn't feel good.
And it may cause you
to feel more anxious at first.
But over time,
you learn that the thoughts are safe
and you can tolerate them.
You can also learn to manage the anxiety
that the thoughts cause you,
you don't need to neutralize them.
Instead, you lean into them.
Leaning in shows you that you don't need
your safety behaviors to protect you
from the anxiety.
Ideally, a therapist is the best person
to help you craft the exposure exercises.
But if you don't have a therapist,
think of scenarios
that could result
in the outcome that you fear.
So for example, let's go back to the thought
of hitting your partner
over the head with a wine bottle.
Because of that thought,
you've stopped drinking wine at home
or you're afraid to handle
the bottle yourself.
And you always get someone
to pour the wine for you
while you look away.
These are some of your safety be behaviors.
In this example,
you could practice writing,
"I feel like I want to hit my partner
"over the head."
Write it out several times
like Bart Simpson does on the chalkboard
during the Simpsons opening.
Writing it out
takes the scary taboo thought
and makes it less threatening.
A next step up from that
could be holding the wine bottle
in your hand
and swinging it in the air.
Your arm will probably get tired from that.
Then you can hold the bottle in your hand
with your partner near you.
With this experience,
you can see that you do
have control over your arm.
It's not just going to
take a swing on its own.
Sit with the anxiety,
do some deep breathing to calm yourself
while holding the bottle.
This is what's called
situational exposure exercises.
You can also do imaginal exposure
where you picture scenes in your mind.
Imaginal exposure is good
when you have a situation
that you can't replicate in person.
Watch this video where I talk
about safety behaviors.
And when it comes available,
this one where I talk about scrupulosity.
Thanks for watching.
See you next time.