Obsessive compulsive disorder - OCD treatment and therapy from NOCD

Do you have intrusive thoughts while driving? You’re not alone 

By Lauren Krouse

Feb 21, 20246 minute read

Reviewed byApril Kilduff, MA, LCPC

Driving can bring a barrage of unwanted thoughts. You might get flashes of nightmarish car accidents while navigating a street with lots of pedestrians, wonder what that bump was you just drove over in the dark, or worry about hitting an animal running in front of your car. 

While distressing and disturbing, intrusive thoughts like these are common. In fact, one study that surveyed students in thirteen countries across six continents found that 94% of them admitted to having intrusive thoughts (and because these thoughts can be hard to admit to, that’s likely an underestimate). 

With support and evidence-based strategies, you can regain your peace of mind and sense of safety on the road. But first, you’ll have to address these thoughts head-on. 

What are intrusive thoughts and when are they a problem?

Intrusive thoughts are just what they sound like: thoughts, images, feelings, sensations, and urges that you don’t want to have, but can’t stop from popping into your mind. What sets apart intrusive thoughts from other thoughts is that they feel bad, you have them against your will, and they’re often out of sync with what you truly value, want, or believe. 

While intrusive thoughts are a common human experience, they can also be a telltale sign of obsessive-compulsive disorder (OCD). OCD is a mental health condition that impacts 1 in 40 people at some point in their lives. It’s characterized by persistent, unwanted thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) aimed at relieving distress. 

Often, OCD-related thoughts center around a certain theme, such as the fear of causing harm or becoming contaminated with harmful bacteria. Intrusive thoughts can also be linked to other mental health conditions, like post-traumatic stress disorder (PTSD), which could arise after a traumatic event like a life-threatening car accident. 

When it comes to OCD, these thoughts aren’t just passing occurrences that make you feel a little uncomfortable or icky for a short time. To qualify for a diagnosis, these obsessions disrupt your day for more than an hour and cause significant problems in your ability to get by, according to the National Institute of Mental Health. Symptoms can start slowly, fade for a while, or get worse over time—especially when you’re stressed out, or sick. They can also lead you to avoid certain situations, like getting behind the wheel. 

What do intrusive thoughts while driving sound like? 

OCD-related intrusive thoughts while driving are often about a fear of causing harm due to negligence, like hitting someone while switching playlists in your car. You may be afraid of running over pedestrians, or causing traffic accidents. Sometimes, these symptoms are referred to as hit-and-run OCD

Intrusive thoughts while driving can be linked to many symptoms of OCD including obsessions, avoidance, compulsive checking, and reassurance seeking. Here’s what they can look like:

Obsessions 

  • Fears of hitting a pedestrian, cyclist, animal, or vehicle 
  • Fears of causing an accident due to carelessness 
  • Thoughts like Did I hit someone? Did I hit that person on the sidewalk? What if that bump on the road was a body under the wheels?

Avoidance 

  • Avoiding certain roads, highways, or intersections 
  • Avoiding driving at night or in pedestrian-heavy places  
  • Avoiding driving completely  

Compulsive checking 

  • Frequently checking your rearview mirror 
  • Frequently checking to see if the hand brake is on 
  • Repeatedly driving back to check if you hit anything or not

Seeking reassurance 

  • Telling yourself reassuring things like, “I would know if I hit someone, right?” or “Nothing happened so nobody got hurt.” or “Those sirens aren’t for me, they’re for someone else.”
  • Checking the news to verify there were no accidents where you’ve driven
  • Asking loved ones if they think you’re capable of doing a hit-and-run

Intrusive thoughts while driving can occur suddenly and seemingly for no reason. “Intrusive thoughts are normal, natural things. They’re not good or bad or right or wrong. They’re just a thing that happens to people,” says Patrick McGrath, PhD, chief clinical officer at NOCD. “The problem is not the intrusive thought—it’s the way we react to it.” 

Trying to control or stop intrusive thoughts often only brings more distress. There’s also the mind trap of believing that they’re a reflection of your reality and you must take action in relation to them. A common thought pattern is thought-action-fusion, or the belief that if you think you’re going to do something, you’re going to do it. “The issue is you’re treating intrusive thoughts as if they’re very meaningful, willful, and predictive of what’s going to happen in the future, and nothing could be further from the truth,” says Dr. McGrath. 

Intrusive thoughts are only thoughts, and it’s essential to view them that way. 

Talk therapy doesn’t work for OCD. This does.

NOCD clinicians are trained to treat OCD with the only solutions proven to work for over 80% of people.

How are intrusive thoughts while driving treated? 

Although intrusive thoughts while driving can be stressful, support is available. With help, you can begin to have unwanted thoughts less frequently and dial down their intensity. 

Here’s what to do: 

  • Don’t follow intrusive thoughts down a winding road. Don’t try to tease out the deeper meaning of intrusive thoughts or investigate whether they’re a symbol of bad things to come, as rumination could give them more power over you
  • Accept the thoughts. Ignore the impulse to push the thoughts away or take action to manage them. Trying not to think of something often only makes you think about it more. Instead, allow the thoughts to pass through your mind. 
  • Resist the urge to do compulsions. OCD will tempt you to give into compulsions as a way to rid yourself of distress and/or prevent a feared thing from happening. You have to behave your way out of OCD & this is the key to recovery. 

Sometimes, these steps alone are not enough to quell intrusive thoughts. If you find you can’t manage them on your own, contact a mental health professional for support. 

For OCD-related intrusive thoughts, exposure and response prevention (ERP) therapy is the gold standard treatment. ERP therapy can help you regain confidence behind the wheel by teaching you how to sit with intrusive thoughts without turning to compulsions to feel better. 

You won’t dive right into the most triggering situation. With the support of your therapist, you’ll begin by focusing on a moderately distressing situation such as leaving your block without circling back again, and work your way up to facing more intense situations like driving through crowded streets. 

“In my work with people in therapy, the goal is not to help them stop having intrusive thoughts but to teach people that they can handle having them,” says Dr. McGrath. 

In time, you can regain control over your life on the road and find your anxiety and intrusive thoughts begin to fade into the rearview mirror. 

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