For some people, having intrusive thoughts is a recurring issue that may benefit from medical help.

What are intrusive thoughts?

Everyone has an inner monologue, a steady stream of thoughts, ideas, images, aspirations and recollections. But sometimes when you’re going about your business — thinking about what’s for dinner or where you put the TV remote — that flow of ideas is interrupted with an unsettling thought or image.

Intrusive thoughts are unwanted thoughts and images that can cause anxiety and distress. A global study found that 94% of people have intrusive thoughts, from the innocuous “Did I remember to turn off my curling iron?” to more disturbing thoughts of losing control and harming someone. Unlike regular thoughts, intrusive thoughts can feel strange and uncomfortable and are difficult to control.

Mayo Clinic psychologist Craig N. Sawchuk, Ph.D., L.P., says, “If you’ve ever been in a really high place and looked down, you may have thought ‘What if I lost control right now and pushed somebody over this ledge?’ ” That’s an intrusive thought.

The vast majority of people experience occasional intrusive thoughts that feel weird or a little uncomfortable but are easy to let go. But, for others, having intrusive thoughts is a recurring issue that may benefit from medical help.

Causes of intrusive thoughts

Intrusive thoughts can be prompted by many things — such as songs, news stories or a call from an old friend. Sometimes they just come out of the blue. Additionally, studies show that intrusive thoughts may happen more frequently when you’re experiencing stress, anxiety, lack of sleep or mental fatigue.

For some people, intrusive thoughts are more than just an odd occurrence here and there; they’re a part of daily life. These people may have a disorder, such as obsessive-compulsive disorder (OCD) or post-traumatic stress disorder (PTSD), that makes intrusive thoughts more prevalent and distressing.

Dr. Sawchuk says, “Intrusive thoughts can point to a disorder when they consume more and more of your time, effort and energy during the day. For OCD, the relative cutoff is spending more than an hour a day caught up in the intrusions and rituals. But there are other important factors to consider. The intrusions can cause you a great degree of distress and start to interfere with personal, social or work responsibilities. If your quality of life is suffering, it’s a good idea to seek help.”

Obsessive-compulsive disorder

Intrusive thoughts are a common symptom of obsessive-compulsive disorder (OCD). People with OCD experience:

• Obsessions. Repeated unwanted, intense thoughts or images, like an intense fear about germs or violent thoughts of harming someone.
• Compulsions. Behaviors that attempt to ease the distress caused by the obsessions or prevent something bad from happening. For example, repeatedly washing hands to get rid of germs.

In some cases, obsessions and compulsions can take up several hours of the day. Dr. Sawchuk explains that OCD “can be unbelievably consuming.” He says people with OCD have, “a high sense of responsibility and guilt, as in, ‘If I don’t take care of this, something bad will happen.’ “

For example, a person with OCD could be leaving for work and think, “Did I lock my door?” Dr. Sawchuk says, “The question isn’t coming from a place of idle curiosity. It’s coming from the idea that, ‘If I didn’t lock up, somebody could break into my house and it’ll be my fault.’ These thoughts tend to go to the worst-case scenario, and to someone with OCD, these scenarios feel likely to happen.”

Post-traumatic stress disorder

People with post-traumatic stress disorder (PTSD) also often have intrusive thoughts. PTSD is a mental health condition that’s triggered by experiencing or witnessing a traumatic event. Signs of PTSD include flashbacks, nightmares and severe anxiety, as well as uncontrollable thoughts about the event.

Anxiety disorders

People who have anxiety disorders, such as general anxiety disorder (GAD), have a persistent feeling of anxiety that lasts for months or years — often interfering with daily life. Many people with anxiety have recurring intrusive thoughts on a daily basis.

Examples of different types of intrusive thoughts

Intrusive thoughts are often odd, disturbing and startling. Many include violence or inappropriate behavior — that the person who is having the thought would never consider doing. Some of the most common intrusive thoughts revolve around:

• Sexual acts. Engaging in a violent or inappropriate sexual act.
• Violence against children. Dropping a baby out the window.
• Aggression. Killing a co-worker.
• Religion or aspects of religion. Yelling obscenities in church.
• Death. Jumping out of an airplane or off a mountain.
• Safety. Imagining a loved one getting hit by a car.
• Trauma. Recalling memories from a traumatic experience.

How to deal with intrusive thoughts

Finding a health care provider who is knowledgeable about intrusive thoughts, OCD or PTSD is the first step in treating these conditions. The International OCD Foundation or the National Center for PTSD can help you find therapists, clinics and support groups.

Dr. Sawchuk says, “Some health care providers are not familiar with OCD and may be alarmed by a description of these thoughts. But providers with experience in OCD and intrusive thoughts will recognize them for what they are, will not judge you, and will give you effective strategies to deal with these thoughts.”

Here are a few of the most common treatments you might experience with your health care provider.

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) is an evidence-based talk therapy (psychotherapy) addresses the thoughts and behaviors that contribute to anxiety. CBT is based on the idea that your thoughts, behaviors and feelings are all related to each other and have a significant influence on one another. It’s used successfully as a treatment for many psychological problems, and research has shown that CBT significantly helps 75% of people with OCD.

Most people with anxiety of any kind can benefit from CBT. People can experience long-lasting effects from a course of CBT that lasts about 4 to 12 sessions.

Exposure and response prevention

Exposure and response prevention (ERP) is one type of CBT. With ERP, therapists encourage people with intrusive thoughts or OCD to do the opposite of their compulsions.

According to Dr. Sawchuk, repetitive behaviors are like overlearned habits. “Exposure and response prevention is a treatment designed to break those habits,” he says. “This isn’t simple, but we try to make it a fair fight by starting with smaller challenges before working up to difficult ones. Then we practice these exposures many times to retrain the brain.”

ERP treatments can lead to some strange — but helpful — situations.

Dr. Sawchuk explains, “Someone with OCD may be taking showers for hours at a time, multiple times a day. Eventually, we try to get that person touching floors and then touching their face, then resisting the urge to wash and disinfect. This can be a powerful learning experience and a fair test of one’s fears. It demonstrates that what seems extreme (to the person with OCD) is often actually quite safe.”

When people struggle with intrusive thoughts, Dr. Sawchuk sometimes recommends that they write out scripts of their imagined worst-case scenarios and reread them several times in a given day. He says, “Initially, their anxiety might build, but with more readings those thoughts start to become boring and lose their significance. When that happens, the thoughts become less frequent.”

You can receive ERP at therapy appointments, intensive outpatient programs or residential programs. “One important thing about treatment with ERP is that you are learning how to be your own best therapist. That way you can maintain and build upon your progress outside of therapy appointments,” says Dr. Sawchuk.

Medication

Medication does not eliminate intrusive thoughts but can help control obsessions and compulsions. For example, when discussing intrusive thoughts related to OCD, Dr. Sawchuk says, “Generally, ERP is enough for mild OCD. For moderate to severe OCD, your care team will typically add medication — usually an antidepressant — to behavior therapy.”

Mindfulness

Research shows that mindfulness exercises can improve attention control, reduce anxiety and reduce intrusive thoughts. There are several variations of mindfulness or mindfulness meditation. People can learn to reduce the significance of their intrusive thoughts by observing them without judgment. The simplest form of mindfulness is focused on paying attention to the present moment — sometimes focusing on breathing or a specific object. Another option, called acceptance mindfulness, encourages you to look inward, noticing and acknowledging your thoughts and emotions, while choosing action based on important values.

Do intrusive thoughts mean anything?

Generally, no. For most people, intrusive thoughts are just byproducts of their busy brains going rogue. Neuroscientists suspect that more than 50% of thinking is “stimulus-independent thought,” such as daydreaming. Experts recommend accepting that intrusive thinking is a part of life. It’s not positive or negative, it’s just how brains work.

Why do I have intrusive thoughts?

If you’re having intrusive thoughts, it might be because you’re stressed, overtired or mentally spent. However, if you’re having intrusive thoughts several hours a day or obsessing over what your intrusive thoughts mean, you should be evaluated by a health care provider to see if you have OCD or a similar disorder.

Dr. Sawchuk says, “Without treatment, OCD doesn’t tend to go away on its own. But OCD is very treatable, even if you’ve had it for years or decades.”