CBT for Intrusive Thoughts

cartoon image of therapy session with MoodSmith logo on clipboard
Dr Elaine Ryan
Written by Dr Elaine Ryan Psychologist and Founder of MoodSmith® Elaine obtained her Dr in Psychology from the University of Surrey and has worked in psychology for 20 years. Dr Ryan specialises in Intrusive Thoughts, OCD and anxiety-related conditions.

CBT for Intrusive Thoughts will help to change the structure of your brain

CBT stands for Cognitive Behavioural Therapy and is a recommended treatment for intrusive thoughts.  I will explain to you what CBT is and how it can help you with your intrusive thoughts.

What is CBT?

CBT stands for Cognitive Behavioural Therapy and is a therapy model used by psychologists (like myself) and therapists.

C stands for Cognitions (your thought processes)

B stands for Behaviours (the things you do and do not do)

T stands for Therapy


These are your thought processes.  Typical examples for intrusive thoughts are

  • Am I a bad person?
  • What if I act on my thoughts?
  • How do I know I won’t hurt anyone?
  • All those difficult sexualised thoughts
  • Blasphemous Thoughts
  • All those thoughts relating to harm

I should note this also cover images, as in addition to the thoughts, you may also have difficult images in your head that you do not want.


Think of behaviours as the things you do, or the things you avoid.

  • Staying away from children as much as possible, if your thoughts are relating to children
  • Putting knives (or other things that could harm) well away from you or in difficult to reach places
  • Avoiding people, places, or things that you think might ‘trigger’ your thoughts.
  • Changing your behaviour around kids, your partner


You will learn about the interactions between

  • your thoughts
  • the things that you do, and the things that you avoid
  • and how it can contribute to and keep your intrusive thoughts going

The Therapy is very directive.  This means that you will be given things to do, homework if you like, to help you change your thoughts and behaviours, and help you get your life back.

How will CBT help with Intrusive Thoughts?

It might be useful to read my main page on intrusive thoughts and then come back to this page.

The main point from the other page that you have just read is that your brain learns from repeated experiences.  This means the more times you have the thoughts, the more things you change or avoid; your brain pays attention to this and keeps giving the same things over and over again.  I am going to give an example to explain this a bit better.

If you are a mother or father and are having intrusive thoughts relating to children

If it is time to get your child ready for bed, and their night-time routine involves a bath, you might think, “but what if I look in the wrong place?”  This understandably might make you feel very anxious and lead to different thoughts such as;

“I’m a bad parent; something is wrong with me; I am disgusting.”  You could well avoid bathing your child and make excuses to get your partner to do this.  The same sort of scenario can be applied to changing nappies and dressing your child.

The more often you have these thoughts, and the more often you change your behaviours – this repeated experience is very similar to practice.  Your brain learns, and the next time you go to bathe your child, all the thoughts and feeling relating to bathing your child comes back to you.

How will CBT help?

The end product is to change the structure of your brain.  It sounds like a big claim, right?  But think of it this way.  This is not the best example, but hopefully, it makes sense.  Let’s say you have driven on the right-hand side of the road all your life and have never had to worry about changing gears, and then you decide to live in London for 5 years.

Even though you can drive, you need to unlearn driving on the right – think how much of this is automatic.  If you have never driven on the other side of the road, have you ever been on holidays where people drive on a different side of the road from you, and you want to cross from one side of the street to another?  It’s not easy; you automatically look the wrong way for the traffic when you step out onto the road!

If you want to drive in the UK, you have to change your brain’s structure relating to driving.  You do this through repeated learning experiences to use a gear stick, learning to drive on the left and how to negotiate corners.

Once you have accomplished this, you have changed the structure of your brain!

Back to CBT for Intrusive Thoughts.

CBT will help you not only to question the validity of your thoughts but to change them into more realistic, evidence-based thoughts.  It will also help you change the things that you are doing, such as avoiding bathing your child (or avoiding knives or … whatever the content of your intrusive thoughts are)

Over time, you are establishing new repeated experiences from which your brain can learn.  This is all done in conjunction with learning to manage your anxiety, as change sometimes makes us feel anxious.

What to take from this article

Just because you are having intrusive thoughts does not mean that you will act on them, nor does it mean that they are true or say something about you as a person.  There are effective treatments that can help you with intrusive thoughts, and CBT is one of them.

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