What happens when OCD attempt to Neutralise or suppress disturbing intrusive thoughts?

By Ashley Butterfield, Psy.D

Intrusive thoughts are unwanted thoughts, images, impulses, or urges that can occur spontaneously or that can be cued by external/internal stimuli. Typically, these thoughts are distressing (hence “intrusive”) and tend to reoccur. They are predominantly associated with Obsessive Compulsive Disorder, but they are often seen amongst the symptoms of other anxiety disorders. Common themes of intrusive thoughts include (but are not limited to): harm/violence, sexuality/sexual behaviors, religion, and making mistakes/causing accidents. Such themes generally provoke emotional distress, particularly when they are perceived as being out-of-character or against the person’s respective values. Intrusive thoughts often elicit feelings of guilt, shame, embarrassment, and/or fear. Consequently, many people are hesitant to reveal or disclose their intrusions to others. However, intrusive thoughts are far more common than typically believed. Intrusive thoughts are not unique to people who are struggling with a mental health concern(s). They are also experienced by individuals who do not routinely struggle with anxiety.  In fact, research has found that over 90% of the population experiences intrusive thoughts (Abramowitz, Deacon, & Whiteside, 2011). Some intrusive thoughts that have been identified by people who do not experience clinical anxiety include: thoughts of swerving their car into incoming traffic, images of hurting a loved one, thoughts of catching diseases, impulses to do something shameful, thoughts of leaving an appliance running and causing a flood or fire, thoughts that are blasphemous, etc. (2011).

The primary difference between intrusive thoughts that occur in the presence of clinical anxiety and those that do not is the way these thoughts are appraised. Individuals with clinical anxiety are more likely to judge their intrusive thoughts as bad, immoral, or dangerous. Such interpretations generally lead to emotional activation, which increases the perceived strength of the intrusive thoughts, which then increases the level of focus upon the thought. People with clinical anxiety are also more likely to spend more time thinking about the implications of these thoughts and take measures to attempt to prevent the feared potential consequences from occurring. Furthermore, they are more likely to overestimate the probability of experiencing these feared outcomes. People without clinical anxiety are more apt to dismiss such thoughts as out-of-character and go on about their day.

Others may suggest that people struggling with intrusive thoughts distract themselves, get their mind off of these thoughts, or just “simply” don’t worry about them. While this advice may be well-intentioned, adherence is generally not feasible in the presence of clinical anxiety. It is also not supported by research. Thought suppression (or attempts to otherwise banish a thought) tends to have a boomerang effect: no matter how hard you try to push them away, they continue to make their way back into your consciousness. I recently came across a good metaphor that helps envision the result of attempted thought suppression (https://www.anxietycanada.com/adults/how-write-worry-script). Imagine that you were at a pool and there was a large inflatable beach ball in the water. In this comparison, the beachball represents your intrusive thought(s). You decide to try to shove the beachball underneath the water line (i.e. you attempt to stuff down your intrusive thought). This requires a notable amount of both effort and strength. You most likely won’t be able to do it, or at least not for very long. And the moment you let up, even the slightest bit, the beach ball/intrusive thought will pop right back out of the water and back into your awareness.

The thing to remember about intrusive thoughts is that they are just thoughts (albeit distressing ones!). They are not predictions of the future and they are not reality. Experiencing intrusive thoughts does not make you a “bad” person and having these thoughts does not increase the likelihood that something bad will happen. There is a very BIG difference between thinking and doing. However, because such thoughts are distressing, many people reflexively try to suppress or get rid of them (to no avail). In the presence of anxiety and Obsessive-Compulsive Disorders, intrusive thoughts should especially not be suppressed, but rather, they should be examined, confronted, and worked through. This is the approach embedded within Cognitive-Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP). By learning how to systematically come into contact with intrusive thoughts, individuals can learn to effectively address these intrusions in ways that provide much more than the temporary relief offered by thought suppression, compulsive rituals, checking behaviors, and/or frequent confessing/apologizing.  In essence, these treatments will decrease both the frequency and the power of intrusive thoughts. Combined together, CBT and ERP can reverse the cycle between intrusive thoughts, misappraisals, emotional activation/distress, and compulsive behaviors.

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