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CBT for Intrusive Thoughts

Written by Dr Elaine Ryan

Dr Elaine Ryan PsychD is a highly experienced Chartered Psychologist with 20+ years of experience in treating OCD and Anxiety Disorders. Member of the British Psychological Society (BPS), Division of Neuropsychology | EuroPsy Registered| Member of The UK Society For Behavioural Medicine 

CBT stands for Cognitive Behavioural Therapy and is a recommended treatment1 for the intrusive thoughts that you experience in Obsessive Compulsive Disorder (OCD), research2 consistently shows the efficacy of this well researched model of therapy.  I will explain CBT and how it can help you with 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

Cognitions

These are your thought processes.  Typical examples of 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 problematic sexualised thoughts
  • Blasphemous Thoughts
  • All those thoughts relating to harm

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

Stop Intrusive Thoughts

Online course to help manage intrusive thoughts

Behaviours

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 related to children
  • Putting knives (or other things that could harm you) well away from you or in difficult-to-reach places
  • Avoid people, places, or things you think might trigger your thoughts.
  • Changing your behaviour around kids, your partner

Therapy

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 helpful to read my main page on intrusive thoughts and then come back to this page. As noted by The American Psychological Association3, it is the ‘recurrent intrusive thoughts’ that are responsible for the rituals or compulsions, and it is here that CBT excels in helping you with your thoughts.

The main point from the other page you 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 avoid bathing your child and make excuses to get your partner to do this.  The same 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 bathe your child, all the thoughts and feelings 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 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 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 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 question the validity of your thoughts and 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 by learning to manage your anxiety, as change sometimes makes us anxious.

What to take from this article

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

  1. https://iocdf.org ↩︎
  2. https://pmc.ncbi.nlm.nih.gov/articles/PMC4516342/ ↩︎
  3. https://www.apa.org/topics/ocd ↩︎