How to Manage OCD Intrusive Thoughts

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Obsessive compulsive disorder (OCD) is a neurological condition where a person experiences obsessive thoughts and compulsive behaviours. The obsessive thoughts a person with OCD has can be intrusive.

Intrusive thoughts are distressing and unwanted. They repeatedly enter a person’s mind. The thoughts can range from a person thinking they have left their cooker on to violent or inappropriate ones. If the person has a persistent, unpleasant thought that dominates their thinking to the extent of it interrupting other thoughts, they may have an obsession.

Even if the thoughts could be repulsive or frightening, they are just thoughts and the person having them will not act on them. The thoughts will be classed as OCD if they cause the person distress or have an impact on the quality of their life.

What are OCD intrusive thoughts?

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Besides violent and inappropriate thoughts, OCD intrusive thoughts can also consist of the following:

• Germs, infections, or other kinds of contamination
• Doubts about doing tasks wrong or leaving tasks unfinished.
• Religion, blasphemy, or being an immoral person.
• Relationship intrusive thoughts, such as doubting whether a relationship is right or whether a partner’s feelings are strong enough. These thoughts might lead the person with OCD to end the relationship to get rid of the doubt and the anxiety.
• Fear of forgetting, losing, or misplacing something.

People with OCD can also experience these common compulsions of their intrusive thoughts:

• Compulsively repeating a ritual to reduce their anxiety.
• Checking themselves or others to ensure no harm has been done.
• Ruminating (continuously thinking about their intrusive thoughts.
• Seeking reassurance from others.
• The intense need to perform a task “just right.”
• Avoiding objects, places, or people that can trigger their intrusive thoughts.

What causes OCD intrusive thoughts?

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While the causes of OCD intrusive thoughts are uncertain, some psychologists have theories.

Psychologist Lynn Somerstein (2016) suggests that recurring intrusive thoughts are a sign that there is something difficult in a person’s life. For example, a person with OCD could be misunderstood by someone else and have intrusive thoughts about harming that person or themselves.

The person with OCD could also struggle with relationship issues, be stressed at work, or be frustrated with parenting. Instead of the problem remaining buried, it finds other ways to work itself up to the surface.

How to manage OCD intrusive thoughts

Build your support network

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Many people with OCD find it hard to discuss it. They might worry that others will not understand them. They might also have kept their OCD a secret for such a long time that it feels scary to put their experiences into words. Strengthening the relationships around them may help them feel less lonely and more able to cope.

• Talk to someone you trust about your OCD. Find a quiet space to talk that is free from interruptions. You could show them this information to help them understand. Some people find it helpful to write down their feelings and discuss them together.
• Spend time with friends and family. You might not feel ready to openly discuss your OCD yet, but spending more time with friends and family may help you feel more comfortable around them and, in time, more able to share your experiences.

Try reading self-help resources

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The following resources should be beneficial for OCD intrusive thoughts self-help (the printed books with their ISBNs are recommended by OCD UK):

• OCD Self-Help (PDF document)
• Break free from OCD by Challacombe, Bream-Oldfield, Salkovskis. (ISBN 0091939690)
• The Beating OCD Workbook by Fitzgerald. (ISBN 1473601347)
• Overcoming Obsessive-Compulsive Disorder by Veale & Willson. (ISBN 1849010722)
• Pulling the trigger – OCD, Anxiety, Panic Attacks and Related Depression by Shaw & Callaghan. (ISBN 1911246003)
• Brain Lock by Schwartz. (ISBN 006256143X)

Other beneficial resources for OCD intrusive thoughts include support groups, online discussion forums, and online OCD therapy courses. Please note that internet forums and self-help books may not always be helpful or accurate.

Go to cognitive behavioural therapy

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Cognitive behavioural therapy (CBT) remains the treatment of choice for those with OCD in the U.K. It is available through the NHS.

CBT is a talking therapy. Unlike counselling, it focuses more on the individual’s present rather than their past. This type of therapy also helps the individual explore and understand alternative ways of thinking and challenging their beliefs through behavioural exercises.

For those with intrusive thoughts, the aim of the CBT is not to stop the person from having them, but instead to help them identify and challenge the patterns of thoughts that cause their anxiety, distress, and compulsive behaviours.

Practise exposure and response prevention

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Exposure and response prevention (ERP) is a therapy that encourages people with OCD to face their fears and let obsessive thoughts occur without ‘putting them right’ or ‘neutralising’ them with compulsions.

An example of ERP for someone who has intrusive thoughts is to purposefully expose them to situations that stimulate the thoughts. The aim of the ERP is to show the person that what they are afraid might happen when they have an intrusive thought is unlikely to happen. For instance, the person may avoid or lock away knives because they are afraid of stabbing someone. In an ERP course of treatment, the individual would be exposed to knives and be asked to refrain from engaging in the compulsive acts that would usually follow their intrusive thoughts.

Try hypnosis

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Although hypnosis can be beneficial for some people with OCD, evidence is limited. The reason some people with OCD believe that hypnosis is helpful for them is because it can ease anxiety by calming the individual down and help them to relax. It can also teach the individual to be more aware of their intrusive thoughts so they can change them.

While it is unclear that hypnotherapy has any lasting healing effects on OCD, proponents of hypnotherapy say that during the relaxed state of hypnosis, a person could safely address some of their intrusive thoughts.

Separate your thoughts from your identity

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Even if a person with OCD does not experience thought-action fusion, they are more likely to deal with obsessive thoughts daily. They may feel so overwhelmed sometimes that they would give anything to break the cycle.

Although it is easier to believe, thoughts are just strings of words and are not inherently dangerous. The person with OCD is not obliged to take a thought seriously just because their brain generated it.

The intrusive thoughts a person with OCD experiences are not reflective of who the person is. Therefore, having a “bad” thought does not mean the person is also “bad.’

Intrusive thoughts do not always align with the person’s core values, beliefs, and morals. They tend to attack and focus on the things that offend the person. The same can be true for intrusive thoughts that cause fear, which tend to be what the person is most concerned about (for example, the health and safety of their family).

Be patient with yourself

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The person who has OCD intrusive thoughts should be kind and patient to themselves. They should remember that everyone experiences intrusive thoughts at times and the thoughts are not things the person is expected to be in control of. It is a good practice for the person to recognise the intrusive thought or feeling they are having, but this does not mean they have to identify with it.

If you are helping someone who has OCD, it is also advisable for you to be patient with them. Please remember that their fears are very real to them, even though they seem unrealistic, irrational, or extreme to you.

Practise mindfulness

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Mindfulness is a state of awareness that urges individuals to remain aware and present in the moment. Instead of dwelling on the past or fearing the future, mindfulness encourages awareness of an individual’s present surroundings.

There is strong evidence of the effectiveness of mindfulness in several mental health conditions, including OCD. This is because of how it changes a person’s relationship with their intrusive thoughts and emotions.

Examples of mindfulness that can be beneficial for OCD are as follows:

• Meditation
• Yoga
• Tai chi
• Qigong

The following tips can help a person effectively practise mindfulness:

• Paying attention to their senses (sight, smell, touch, taste, and sound).
• Taking notice of where their thoughts have drifted.
• Observe and accept their feelings with curiosity and without judgement.
• Choosing to return their thoughts to the present moment.
• Being kind to themselves.

Mindfulness can help a person with intrusive thoughts observe their thoughts without judgement and accept them. This allows them to not attach importance to them and break unhealthy habitual thought patterns.

To summarise, OCD intrusive thoughts are unwanted thoughts that enter a person’s mind and significantly impact their lives. These thoughts could be caused by a difficult moment in a person’s life. Ways to manage OCD thoughts include building a support network; self-help resources; CBT; ERP; hypnosis; separating thoughts from identity; patience; and mindfulness.

Useful Links

OCD Test
What not to say to someone with OCD