CHAPTER 2

Automatic and Intrusive Thoughts

• What Are Automatic Thoughts?

Automatic thoughts are a central aspect of the CBT theory. Automatic thoughts are those that come into our minds quickly, without effort. They are short and related to the specific situation at hand. They occur during or right after the situation, as an “instinctive” response. They don’t include reflection or careful logic but usually seem quite reasonable. Some are perfectly logical; others are known as “dysfunctional automatic thoughts.”

If you feel that another thought better connects to the problem, you can focus on that instead. Or, if you feel that the issue underlying that particular automatic thought is not as important as other issues, you can set it aside and focus on other thoughts that had a stronger impact on your mood. When evaluating a series of automatic thoughts, assess how intense the feelings they stimulated were, and choose the thoughts that had the biggest impact.

Often, these types of dysfunctional thoughts result from cognitive distortions, or “thought traps,” which are essentially mistakes we make in the thinking process. Automatic thoughts tend to fall into a few categories of cognitive distortions. Identifying the general patterns can be helpful in changing the thoughts that are a part of that pattern. It may be helpful to write down some of your automatic thoughts and then look for patterns.

• What Are Intrusive Thoughts?

Intrusive thoughts are another type of common but upsetting thought. Our brains generate many thoughts and ideas over the course of a day. Some feel completely normal, productive, and helpful, and we view them as reflective of who we are. Some thoughts may strike us as odd or confusing but are easily dismissed and don’t cause much distress. We can also experience thoughts that seem bad, scary, or sickening—things that don’t fit with who we are or that make us feel terrible, yet are hard to get rid of. These are known as intrusive thoughts.

Intrusive thoughts are thoughts, ideas, or impulses that are unwanted and upsetting but continue to occur. They are difficult to stop or control, which often makes them more distressing. They may interrupt activities and thought processes and cause feelings of doubt, shame, guilt, confusion, fear, and anxiety. Intrusive thoughts are common symptoms of anxiety disorders, Obsessive-Compulsive Disorder (OCD), and Post-Traumatic Stress Disorder, but they can occur independently as well.

There are several types of intrusive thoughts, which may be treated in different ways. Obsessional intrusions usually relate to something that a person finds upsetting, disgusting, or repugnant, such as violence, taboo sexual acts, or his or her religious beliefs. These are often addressed within an OCD framework. Worry intrusions are anxious thoughts about future events or threats. Usually, dealing with anxiety through a range of CBT techniques will help reduce the frequency and severity of worry intrusions. Trauma-related intrusions are sudden recollections of past traumatic events. Addressing the feelings around these events with a therapist may help.

Examples of Intrusive Thoughts:

• Unwanted sexual thoughts involving a family member, child, or animal (obsessional intrusion)
• Unwanted sexual thoughts involving a coworker whom you are not attracted to (obsessional intrusion)
• Thoughts of committing a crime or violent act that you know you would never do, such as killing your spouse or harming your baby (obsessional intrusion)
• Fear that you won’t be able to stop yourself from saying something inappropriate in public (obsessional intrusion)
• Worries that you no longer believe in your religion, briefly thought something forbidden, or performed a ritual incorrectly (obsessional intrusion)
• Repeated, intensely felt doubts about your ability to perform on an upcoming exam you have studied for (worry intrusion)
• Recurrent, distressing thoughts about contracting a rare disease and dying (worry intrusion)
• Repeated thoughts about a humiliating event that happened in childhood (trauma-related intrusion)
• Unwanted, upsetting recollections of a violent event you experienced as an adult (trauma-related)

These are just some of the many forms that intrusive thoughts can take. Many people are surprised to realize that others have experienced similar types of intrusive thoughts. Knowing this can be reassuring and can help you reach a better understanding of intrusive thoughts as a common phenomenon, not a uniquely personal illness or failing.

Almost everyone has intrusive thoughts, but people respond to them in different ways. The key difference between people who do not struggle with their intrusive thoughts and those who do is not that the former do not have them, though they may experience them less frequently or intensely, but that they are able to dismiss upsetting, unwanted thoughts as meaningless. Those who struggle with obsessive thoughts tend to attach great significance to the thoughts and conclude that they really do believe or feel those things or really will commit those acts. They begin to build a narrative around the thoughts, with implications about their own character, behavior, and future actions.

The most important thing to understand about intrusive thoughts is that just having a certain thought or image does not mean it is true. Having an intrusive thought about an unacceptable violent or sexual action doesn’t mean you actually want to or will commit the act. If you are religious, having a distressing blasphemous thought doesn’t mean you truly believe it. Experiencing recurrent anxious thoughts about a future event does not mean that those fears are well-founded or that the bad outcome is likely to occur.

Steven Phillipson, Ph.D., is a true expert in the field. He reminds his patients that they are not “mentally ill.” Instead, they simply have an anxiety disorder. He also prefers to call intrusive thoughts “creative associations.” This attitude encourages patients to embrace their experience of these common, if sometimes disturbing, thoughts.