Obsessive compulsive disorder - OCD treatment and therapy from NOCD

Intrusive Thoughts: More Than Words And How To Treat Them

5 min read
April Kilduff, MA, LCPC

You hear an awful lot about “intrusive thoughts” as one of the key components of obsessive-compulsive disorder (it’s the “obsessive” part). But did you know that intrusive thoughts can show up in many ways beyond just words in your mind? They can take the form of unwanted images, sensations, ideas, memories and urges. Let’s take a look at each along with real-world examples. 

unwanted thoughts, images, sensations. Intrusive
Intrusive thoughts are more than just word. They are images, thoughts, sensations and memories

OCD and Unwanted Intrusive Thoughts

This is what you are most used to thinking of when it comes to intrusive thoughts, simple statements that come to mind in basic sentences or even just highly charged words. 


  • “I’m contaminated after touching that public bathroom door with my bare hand!” 
  • “I’m an awful mom” because you aren’t 100% interested in playtime with your child
  • Slurs about other races

OCD and Unwanted Intrusive Memories

Real events can be part of OCD, in addition to imaginary scenarios the disorder dreams up for you. This is a particularly sneaky trick that OCD tries to play, because if it can root itself in something that actually happened. The real-life basis of an idea makes it seem like a more real problem for you to pay attention to (Hint: It’s not).


  • Remembering all the times you babysat kids and gave them baths but not being 100% certain you didn’t touch them inappropriately
  • Trying to gain perfect certainty about the details of a college sexual assault that took place while you were blacked out
  • Recalling over and over the time you made a social blunder in elementary school

OCD and Unwanted Intrusive Images

If you are a more visual thinker, your intrusive thoughts may appear as extremely vivid static images or mini-movies playing on the screen of your mind.


  • A flash of a scene of your loved ones bloodied on the floor as you murder them with a knife 
  • An image of the pictures on your wall not being displayed with perfect symmetry
  • A vision of germs crawling all over your body when feeling contaminated

OCD And Unwanted Intrusive Urges/Impulses

Sometimes intrusive thoughts aren’t verbal or visual but more physical. You may feel an urge to do something or act out in some way that is inconsistent with who you are as a person and the values you hold.


  • Standing on the balcony of a tall building and having the urge to jump 
  • The urge to tap things three times with both your left and right hands
  • The urge to try to grab the gun of any armed police/security officer standing nearby
    (an actual unwanted urge of your author)

OCD and Unwanted Intrusive Sensations

Perhaps you have noticed a sensation somewhere in your body that gave you pause, something that felt out of context or caused you to worry about what it meant that you felt it.


  • A sudden irregularity in your heartbeat while you are sitting on the couch watching TV 
  • A response in your groin during a same-sex sex scene in a movie when you identify as heterosexual
  • A sense of being emotionally contaminated with the “grossness” of your sister after touching something she touched

OCD and Unwanted Intrusive Ideas

These intrusive thoughts tend to show up as those pesky “What if?” questions that our brains just love to dream up and pitch to us at any given moment. 


  • “What if I pushed this guy next to me in front of the oncoming train?” 
  • “What if I don’t actually love my partner? What if I cheated on them and just blocked it from my mind?”
  • “What if there’s nothing after we die?

Different Types of Thoughts, Same Type of Treatment

Your intrusive thoughts may show up in just one form or in a mishmash of forms. Either way, you can get relief! Exposure and response prevention (ERP), a type of cognitive behavioral therapy (CBT) is considered the gold standard of treatment when it comes to OCD. 

A therapist trained to use ERP for OCD, such as all the therapists at NOCD, will review your intrusive thoughts with you to better learn how they show up for you, then tweak the tools and interventions so that they fit the way you think. 

For example, if your intrusive thoughts show up as actual verbal thoughts, then you will likely work with words during your exposure and response prevention – perhaps writing out the thought in big capital letters while you practice sitting with it & monitoring changes in your anxiety levels.You would continue to do this until those thoughts no longer bothered you or triggered any uncomfortable experiences. If your intrusive thoughts show up as visuals, you might look up similar images via Google Images or find video clips on YouTube (or perhaps draw them out if you have artistic talent). You would keep doing this until those visuals were no longer triggering for you. Exposures can also be developed to help trigger urges or old memories, with the purposeful plan of preventing unhelpful responses, i.e. compulsions

The brain is a very creative machine, leading to some creative expressions of OCD. When you can, try to appreciate the creative aspect involved — people with OCD are some of the most creative people I have met!

If you or someone you know is struggling with OCD, you can schedule a free call today with the NOCD clinical team to learn more about how a licensed therapist can help. At NOCD, all therapists specialize in OCD and receive ERP-specific training. ERP is most effective when the therapist conducting the treatment has experience with OCD and training in ERP.

April Kilduff, MA, LCPC

April Kilduff is a NOCD therapist who has exclusively treated OCD and anxiety disorders, as well as their intersection with the Autism spectrum, for over a decade. Her path to this career started with her own journey dealing with panic attacks, perfectionism and a couple phobias. When not working on exposures with members, you can find her at home reading books and hanging out with her two cats or out taking pictures and traveling the world.

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Taylor Newendorp

Taylor Newendorp

Network Clinical Training Director

I started as a therapist over 14 years ago, working in different mental health environments. Many people with OCD that weren't being treated for it crossed my path and weren't getting better. I decided that I wanted to help people with OCD, so I became an OCD therapist, and eventually, a clinical supervisor. I treated people using Exposure and Response Prevention (ERP) and saw people get better day in and day out. I continue to use ERP because nothing is more effective in treating OCD.

Madina Alam

Madina Alam

Director of Therapist Engagement

When I started treating OCD, I quickly realized how much this type of work means to me because I had to learn how to be okay with discomfort and uncertainty myself. I’ve been practicing as a licensed therapist since 2016. My graduate work is in mental health counseling, and I use Exposure and Response Prevention (ERP) therapy because it’s the gold standard of OCD treatment.

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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