How to Stop Intrusive Thoughts: What Works and What Backfires

About this tool

How to stop intrusive thoughts is the wrong question, and the better one is close by. Intrusive thoughts are unwanted thoughts, images or urges that arrive uninvited and feel out of character: harm coming to someone you love, a violent or sexual image, a blasphemous line in your head during a service, the idea that you did not lock the door, or left the stove on. In 1978 Rachman and de Silva compared the obsessions of people with obsessional disorders against the intrusions reported by people without them, and found the content was broadly indistinguishable. What differed was frequency, duration, distress and how hard the person worked to get rid of them.

That finding has held up across cultures. Radomsky and colleagues interviewed 777 university students in 13 countries across six continents and reported that about 94 percent had experienced at least one unwanted intrusion in the previous three months. Doubting intrusions were the most common; the repugnant ones, sexual or blasphemous, were the least. So an intrusive thought is not a symptom on its own, and it is not a window into hidden intent. The useful target is not the arrival of the thought, which nobody controls, but the meaning placed on it and the behavior that follows.

Rachman's cognitive theory of obsessions puts it simply: a normal intrusion becomes an obsession when it is appraised as personally significant and as a sign of danger or responsibility. The thought "I could push him onto the track" passes through most minds on a platform and is gone. Appraised as evidence of a hidden wish, it becomes something to monitor, test and argue with. The appraisal is where the distress lives. This is also the part that treatment changes, which is why therapists spend so little time on the content of the thought and so much on what the person concluded about it.

One specific appraisal does most of the damage. Shafran, Thordarson and Rachman described thought-action fusion, the belief that having a thought is morally equivalent to acting on it, or that thinking something makes it more likely to happen. Both halves show up constantly in intrusive thinking: feeling guilty for an image you did not choose, or feeling obliged to cancel out a thought in case it comes true. Noticing the fusion is often the single biggest relief available, because it separates two things that were never the same. A thought is an event in a brain. An act requires intent, a decision and a body.

The second mechanism is the one that makes fighting them counterproductive. In 1987 Wegner and colleagues asked people not to think about a white bear and found that people who had suppressed the thought went on to report it more once the instruction was lifted. Later reviews found that rebound real but modest, and the effect during suppression itself largely absent. Monitoring for a thought in order to block it requires keeping the thought partly in mind, which is why the attempt carries its own failure inside it. This is the mechanism behind every exhausted "I just want it to stop".

The skill that replaces suppression is cognitive defusion, developed within acceptance and commitment therapy by Hayes and colleagues. Instead of arguing with a thought or chasing it away, you change your relationship to it: label it as mental content ("there is the thought that I might hurt someone"), let it sit without responding, and go on with what you were doing. It is not a positive thought, a reassurance or a clever rebuttal, and it is not a trick for making the thought leave. The practice at Cognitive Defusion (ACT) gives several concrete versions. Done consistently, defusion drains the thought of significance, and the frequency usually falls as a side effect rather than as the aim.

Intrusive thoughts become obsessions in the clinical sense when they recur, cause marked distress and eat time, with or without compulsions: anything done to reduce the doubt or the dread the thought produced. Those are often invisible from outside. Mental reviewing of a memory to check what happened, praying in a set form, repeating a phrase, scanning your body for a reaction to a feared image, avoiding knives, bridges, children or churches, confessing the thought, and asking someone to reassure you that you are not that kind of person are all compulsions. Each one works for minutes and strengthens the loop. The screens at Harm OCD Test and Pure O OCD Test describe these patterns in detail, though neither diagnoses anything.

Where that loop has formed, the treatment with the strongest evidence is exposure and response prevention: deliberate contact with the feared thought while deliberately not doing the compulsion. In Foa and colleagues' randomized trial of 122 adults with OCD, exposure and ritual prevention produced a response in 62 percent of those treated, against 42 percent for clomipramine and 8 percent for placebo, and adding the drug to the therapy did not beat the therapy alone. The guide at ERP for OCD walks through how a hierarchy is built. Response prevention is the active part, and it is uncomfortable by design, which is why most people do it with a therapist.

This is the place to be plain about thought stopping. The old technique of shouting "stop", snapping a rubber band, or picturing a red light was taught for decades and has not survived scrutiny: it is suppression with a ritual attached, and it tends to increase both the thought and the sense that the thought is dangerous. We keep a page on it at Thought Stopping Techniques because people still search for it and deserve to know what replaced it. If a technique requires you to get rid of a thought, it is working on the wrong target, and the relief it produces is the same short-lived relief a compulsion produces.

One honest limit on the whole approach. Intrusive thoughts about harming yourself or someone else sit in a different category from other intrusions only when there is intent, planning, or an urge that feels difficult to resist. Ego-dystonic thoughts, the ones that horrify the person who has them, are the common kind and respond to the work described here. Thoughts that feel wanted, that come with plans, or that arrive alongside hopelessness need a clinician's assessment quickly rather than a worksheet, and so do intrusions that follow a trauma or arrive with voices or lost time. A therapist who treats OCD can help tell these apart; nobody should be making that call alone from a web page.

Use this sheet for one thought at a time. The point of writing the neutralizing down is that most people have never seen the full list of what they do to manage a single thought, and the list is usually longer and more expensive than they expected. The exposure step at the end should be small enough to be unpleasant rather than overwhelming: one minute with the thought on purpose, with the usual ritual left undone. The sheet is education and a planning aid, not a treatment protocol, and recurring intrusions that take up hours a day are worth bringing to someone trained in this work.

Reviewed by Michael Callans, MSW
Checked the Rachman and Radomsky findings against the cited papers, confirmed the exposure trial figures, and verified that the page describes our own worksheet rather than reproducing any clinical measure.

References

1. Rachman S, de Silva P. Abnormal and normal obsessions. Behav Res Ther. 1978;16(4):233-248.
2. Radomsky AS, Alcolado GM, Abramowitz JS, et al. Part 1: you can run but you can't hide: intrusive thoughts on six continents. Journal of Obsessive-Compulsive and Related Disorders. 2014;3(3):269-279.
3. Wegner DM, Schneider DJ, Carter SR, White TL. Paradoxical effects of thought suppression. Journal of Personality and Social Psychology. 1987;53(1):5-13.
4. Shafran R, Thordarson DS, Rachman S. Thought-action fusion in obsessive compulsive disorder. Journal of Anxiety Disorders. 1996;10(5):379-391.
5. Rachman S. A cognitive theory of obsessions. Behav Res Ther. 1997;35(9):793-802.
6. Foa EB, Liebowitz MR, Kozak MJ, et al. Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder. Am J Psychiatry. 2005;162(1):151-161.
7. Hayes SC, Strosahl KD, Wilson KG. Acceptance and Commitment Therapy: The Process and Practice of Mindful Change. 2nd ed. Guilford Press; 2012.

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