How to Overcome OCD Intrusive Thoughts

4 min read
Keara Valentine
By Keara Valentine
Intrusive thoughts are probably the most famous symptom of obsessive-compulsive disorder, or OCD. These unwanted thoughts pop up in your mind, whether or not they’re rational or in line with your values and beliefs.

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Everyone has this kind of thought once in a while. They picture having sex with a coworker, even though they’re married. They look at an annoying fellow commuter and think, “I could push him in front of the bus and no one would notice.”

For people without OCD, those moments pass as quickly as they come, but OCD forces you to fixate on those intrusive thoughts. It tells you those thoughts must be real and valid, demanding that you do something to make them go away. And when OCD is involved, that “something” is usually a compulsive behavior.

Intrusive thoughts make OCD feel inescapable. They’re in your mind and body, but you feel like you can’t control them. You know they’re not rational, but you feel compelled to let them direct your behavior.

Fortunately, there is a way to overcome those intrusive thoughts — and it doesn’t involve forcing them out of your mind.

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What are the types of intrusive thoughts?

When people picture the intrusive thoughts of OCD, they usually think of unwanted words and sentences like the ones described above. They don’t always realize that intrusive thoughts can also be:

  • ‌Disturbing images, like visions of germs crawling on your body or the mental picture of a commuter that you pushed in front of a train‌
  • Ideas and uncertainties that your mind feels like it has to deal with, like, “What if I killed someone and I don’t remember it?”
  • Physical sensations, such as the feeling of being contaminated by a public bathroom or the sense that your breathing has suddenly become irregular
  • Unwanted and possibly inaccurate memories, like wondering if you accidentally touched a child inappropriately while playing with them 
  • Unwanted impulses, like the desire to touch things a certain number of times or search the internet to make sure you don’t have the same biography as a serial killer

Different types of intrusive thoughts affect people differently, but they all have one thing in common: They cause anxiety and distress that can feel like too much to handle.

What’s the connection between intrusive thoughts and compulsions?

Your OCD brain tells you, “If I wash my hands five times in a row with this particular soap, I’ll stop feeling contaminated.” You do it, because otherwise you believe the anxiety will overwhelm you. Photo via Kevin Turcios/Unsplash

Intrusive thoughts prompt the compulsions of OCD. An intrusive thought can be so strong and persistent that you feel like you have to make it go away. 

Your OCD brain tells you, “If I wash my hands five times in a row with this particular soap, I’ll stop feeling contaminated.” It doesn’t matter whether your rational mind believes this to be a reasonable response. You do it, because otherwise you believe the anxiety will overwhelm you.

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Hand-washing is a classic example of a visible compulsion, like shutting the door multiple times or clearing the room of knives so your harm OCD won’t convince you that you want to stab someone. Not all compulsions are visible, though. Some are mental rituals, like listing all of the reasons you’re not a serial killer, or counting to 25 before you lock the door. 

Whether your compulsions are invisible or not, they temporarily relieve the distress of your intrusive thoughts, but they don’t solve the problem. Each time you engage in compulsive behavior, you unconsciously train yourself to do the same behavior the next time you have the same intrusive thought.

It’s a vicious cycle, but the right therapy can help you break it.

How does therapy help deal with intrusive thoughts?

The gold standard for OCD treatment, and for dealing with intrusive thoughts, is exposure and response prevention therapy, or ERP. This powerful behavioral approach teaches you how to tolerate intrusive thoughts without turning to compulsions.

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In ERP therapy, you work with a trained therapist who works with you to design exposure exercises specifically geared to your needs and goals. Each exercise puts you into a situation that usually generates anxiety-provoking intrusive thoughts. Instead of doing a compulsive action, you sit with the anxieties and worries and choose a different, more adaptive response.

In a single round of ERP therapy, you’ll usually work toward multiple goals, each one related to a different triggering situation. You’ll start with something moderately distressing and work your way up to those that are more intense, with the support and guidance of your therapist.

As you work through your ERP exercises, you learn that you can handle intrusive thoughts and the anxieties that go along with them. In time, most people find that their anxiety decreases and their intrusive thoughts become much less problematic. Sometimes, those intrusive thoughts even fade into the background.

At NOCD, you’ll find a skilled team of therapists who can help you fight intrusive thoughts with ERP therapy. Schedule your free 15-minute consultation today and start taking intrusive thoughts out of the driver’s seat.

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Keara Valentine

Keara E. Valentine, Psy.D., is a postdoctoral fellow at Stanford University School of Medicine in the OCD and Related Disorders Track, where she specializes in the assessment and treatment of OCD and related disorders. Dr. Valentine utilizes behavioral-based therapies including Cognitive Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP) with children, adolescents, and adults experiencing anxiety-related disorders.

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NOCD Therapists specialize in treating OCD

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Adriana Delgado

Adriana Delgado

Licensed Therapist, LMHC

My journey as a therapist has brought me in front of more and more cases of OCD, which has led to specialization in OCD treatment. My experience working at intensive in-home services for children & families, and intensive outpatient programs, has prepared me for even the biggest challenges. During sessions, I use Exposure and Response Prevention (ERP) therapy because it’s one of the most effective treatments for OCD, and works for any OCD subtype.

Alyse Eldred

Alyse Eldred

Licensed Therapist, LMFT

I’ve been a licensed therapist since 2017, and as an OCD specialist, I only use Exposure and Response Prevention (ERP) therapy. Research shows that ERP is the most effective OCD treatment available. I truly enjoy helping people understand themselves through ERP and I’m grateful to be part of a process that helps people gain control of their lives.

Andrew Moeller

Andrew Moeller

Licensed Therapy, LMHC

I've been a licensed counselor since 2013, having run my private practice with a steady influx of OCD cases for several years. Out of all the approaches to OCD treatment that I've used, I find Exposure and Response Prevention (ERP) therapy to be the most effective. ERP goes beyond other methods and tackles the problem head-on. By using ERP in our sessions, you can look forward to better days ahead.

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