Intrusive Thoughts

What to do when an intrusive thought shows up

Name it, let it stay, and go back to what you were doing. Harvard Health puts the idea this way: instead of fighting intrusive thoughts, learn to live with them, because the more you push a thought away, the more it persists ^[3].

1. Name it. Tell yourself this is an intrusive thought, not a plan and not a belief. For example: That's an intrusive thought. It's not what I want.
2. Let it stay. Don't argue with it, answer it, or judge yourself for having it. For example: It can sit there. I don't have to do anything about it.
3. Carry on. Return to the task in front of you, even if the thought comes along. For example: Back to the dishes. The thought can come with me.

The tool above does the first step in writing: after the words "I notice I'm having the thought," it puts your thought in quotation marks. You can say the same sentence silently on a train or at your desk.

If the thought also leaves your heart racing, the body needs its own minute. Try the steps in how to calm down, or see which vagus nerve exercises have anything behind them. Then go back to what you were doing.

Why "just stop thinking about it" backfires

A well-known experiment on this is Daniel Wegner's white bear study from 1987. Participants were asked not to think of a white bear, and they could not do it as instructed. Afterward, those who had tried to suppress the thought reported more thoughts about the bear than people who had been asked to think about it from the start. The authors suggested that attempted suppression may produce the very preoccupation it is aimed against ^[4]. A 2000 review reached a similar view: suppression is a popular form of mental control, but it can be counterproductive ^[5].

A meta-analysis of controlled studies found a small to moderate rebound effect, which varied with the kind of thought and how thought frequency was measured. Laboratory studies of the effect gave mixed results ^[6]. A later meta-analysis found no overall difference in how often thoughts came back between people with and without a psychological disorder, and the differences it did find were small and gave only mixed support to existing theories ^[7].

The original experiment used a neutral thought chosen by researchers and student volunteers, so it says little about frightening thoughts. The meta-analysis found only a small to moderate rebound. A thought you push away does not necessarily come back harder. Dropping the fight is a better bet than keeping it up.

Common intrusive thoughts: examples

You are standing on a subway platform with a toddler in your arms, and a picture flashes in of the child slipping toward the tracks. Your stomach drops. You step back from the edge. Nothing happens. The thought came anyway.

In the 13-country student survey, doubting thoughts were the most common type, and repugnant ones, such as sexual or blasphemous thoughts, were the least common ^[8]. For new parents, a prospective study of 100 mothers found that unwanted thoughts of accidental harm to the baby were universal and that close to half also reported unwanted thoughts of intentionally harming the baby. It found little evidence that these thoughts were linked to aggressive parenting. The authors call them a relatively normative experience in the early postpartum period ^[9]. The sample was small. "Little evidence" leaves room for exceptions. If such thoughts frighten you, tell your doctor.

Whether such a thought says something about you is covered in the section on acting.

Do normal people have intrusive thoughts?

Yes, and often. In a survey of 777 university students at 15 sites in 13 countries, 93.6% reported at least one intrusion in the previous 3 months ^[8]. A second survey of 1,473 people without a diagnosis in 7 countries asked about four kinds of unwanted mental intrusion, those linked to OCD, body dysmorphic disorder, hypochondriasis and eating disorders. It found that 64% had experienced all four, and concluded that they are a common phenomenon across cultures ^[10].

Both were self-report surveys. The first used students, so these numbers alone do not show that nearly everyone has them. The NICE guideline for OCD says that people distressed by obsessive thoughts should be told that such thoughts

"are occasionally experienced by almost everybody." ^[1]

Does having a thought mean you want to act on it?

"Does this mean I secretly want to?" No. Harvard Health says intrusive thoughts are not harmful and do not mean that you have a secret desire to do the things that popped into your mind ^[3]. Its suggested self-talk is that the thought is not how you think, not what you believe and not what you want to do ^[3].

What about the difference between intrusive and impulsive thoughts? No health-authority source we read defines it, so we offer no clinical rule. The NHS describes an obsession as an unwanted and unpleasant thought, image or urge that repeatedly enters your mind and causes anxiety, disgust or unease ^[11]. A thought you dread and have no wish to act on fits that description. That is our reading, not a definition.

Feeling pulled toward doing something, with part of you wanting it, is a different situation. Bring it to a doctor or therapist instead of working it out alone. If you fear you might act on a thought to harm yourself or someone else, use the contacts in the last section right away.

What helps, and what studies found

Three approaches have been compared in the lab. They do not do the same thing. Most of the work uses short experiments with people who do not have a diagnosis, so read the right-hand column as carefully as the middle one.

The tool on this page borrows from the defusion row. No trial has tested it, so treat it as practice in stepping back and not as a proven fix. If thoughts take a lot of your day, the last section says when to ask for help.

Mindfulness for intrusive thoughts uses the same move as the acceptance row: notice the thought, let it pass, and go back to what is in front of you. To practice that for a few minutes a day, try the short exercises on mindfulness for anxiety.

When intrusive thoughts may be OCD

An intrusive thought arrives suddenly and feels foreign. Replaying a real event from your past is different: that is rumination, and how to stop ruminating has a tool for it.

Whether intrusive thoughts are OCD is for a clinician to say. Having obsessive thoughts at some point is common, and the International OCD Foundation points out that it does not mean we all have "some OCD" ^[16]. The NHS describes a compulsion as a repetitive behavior or mental act you feel you need to do to temporarily relieve the feelings the obsessive thought brought on ^[11]. The NIMH defines OCD as uncontrollable, recurring thoughts, repetitive behaviors, or both, and says the symptoms are often time-consuming and can cause significant distress or interfere with daily life ^[17]. Some situations are worth bringing to a doctor:

• If a thought comes with an urge to check, wash, count or ask for reassurance, and you feel you must do it to get relief, tell a doctor. That pattern is how the NHS describes a compulsion ^[11].
• If the thoughts and the rituals take more than an hour a day, raise it. MedlinePlus lists at least 1 hour a day among the signs, together with being unable to control the thoughts or behaviors and having significant problems in daily life ^[18]. The International OCD Foundation uses "more than an hour every day" ^[16]. These are descriptions, not a self-test.
• If they get in the way of work, relationships or things you enjoy, the NHS advises speaking to a doctor when the thoughts keep coming and affect your daily life ^[11].
• If you are a new parent and the thoughts frighten you, tell your OB-GYN, midwife, your baby's pediatrician or your family doctor; the NHS gives the same advice ^[11]. In the U.S. you can also call or text the National Maternal Mental Health Hotline at 1-833-852-6262, free and open 24/7, in English and Spanish ^[19].

If worry in general, rather than single thoughts, is what wears you down, see how to stop overthinking, or take the GAD-7 self-check. Both are for orientation, not diagnosis. The last section on this page covers what to do next.

Frequently asked questions