Obsessive compulsive disorder - OCD treatment and therapy from NOCD

Should I tell people my intrusive thoughts? A therapist’s advice

By Grant Stoddard

Jul 17, 20238 minute read

Reviewed byPatrick McGrath, PhD

“How many thoughts does the average person have in a day?” 

In July 2020, Nature, a leading multidisciplinary science journal, published a paper that sought to answer this intriguing question: After scanning the brains of 184 study participants, the paper’s authors arrived at an average of 6.5 “thought transitions” per minute—a figure that remained consistent at different times, on two other days. Supposing we sleep around seven hours per night, that amounts to about 6,630 waking thoughts per 24-hour period. 

That’s a lot of thoughts! So it’s no surprise that we might occasionally have random, unwanted, bizarre, or distressing ones from time to time. Well, this is backed up by a 2014 study from Concordia University that found that 94% of people surveyed experience unwanted, intrusive thoughts, images, and/or impulses.  

Most people can dismiss those intrusive thoughts with relative ease—even if they directly oppose what that person really thinks and feels. But then, most of them don’t have Obsessive-Compulsive Disorder (OCD), a mental health condition that causes people to obsess about these prevalent cognitive glitches and persistently worry about them. People with OCD are so consumed by these mental glitches that they feel compelled to do something—anything—to feel better. 

They seek relief through compulsions, which can be mental or physical. Common compulsions include reassurance-seeking, hand-washing, checking, or avoidance. Often, they’ll also feel driven to share their harrowing thoughts with others—but can divulging intrusive thoughts do more harm than good in the long run? That’s what we’ll shed some light on today.  

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Understanding Intrusive Thoughts

First, we need to differentiate intrusive thoughts from harmful intentions. To be clear, intrusive thoughts are unwanted and distressing mental images, urges, or impulses that occur involuntarily in a person’s mind. They can be completely random, or they can involve particularly distressing themes, involving violent or sexual themes, or themes of self-harm

Having intrusive thoughts does not mean a person intends to act on them. In fact, people who experience intrusive thoughts—which is to say, just about everyone—often find them ego-dystonic, meaning they are inconsistent with their values and beliefs. That’s true of both the people who don’t have OCD and can instantly dismiss these intrusive thoughts, and the 1-2% of people who obsess about them.

When you can’t get an intrusive thought out of your head—a core experience for people with OCD—it can be incredibly anxiety-provoking, particularly if the theme of that thought involves harming yourself or someone else. Here’s an example: 

I had a thought about stabbing my partner while I was chopping vegetables. Does that mean that I want to do that? Why else would I have that thought?

To reduce the intolerable distress that comes with such an ego-dystonic thought, someone with OCD will reduce it by engaging in a compulsion. They might avoid being in the kitchen at the same time as their partner, stash all the knives out of arm’s reach, or share their obsession with their partner for reassurance that they could never actually do such a thing. 

These compulsions may succeed in reducing anxiety and distress, but only temporarily. By engaging in them, people with OCD are unwittingly strengthening the grip of the “OCD cycle”: a sequence of obsessions, anxiety, compulsions, and temporary relief that takes up time, causes distress, affects relationships, and can stop you from living your life on your own terms. 

Sharing intrusive thoughts: cathartic or compulsion? 

“It’s completely normal to tell someone you trust about an intrusive thought, just like you might wake up and recount a bizarre or upsetting dream you had,” says Dr. Patrick McGrath, Chief Clinical Officer at NOCD. “It’s human to divulge our internal experiences with the people we trust. It can be cathartic and stop you from feeling isolated, particularly if you don’t yet know that you have OCD.” 

There are, however, a few things to keep in mind to make sure that your sharing is healthy, and doesn’t become compulsive and counter-productive. “You’ve had this intrusive thought, you can’t shake it off, and you’re overwhelmed by it. You’re thinking: ‘What do I do? Who can help me? What can I do with this?’ But if you’re repeatedly asking someone else for reassurance about whether you’d actually act on an intrusive urge or whether it might have some deeper meaning, you’re pulling someone into your compulsion. That’s a textbook characteristic of OCD, and it only makes obsessions worse over time.”

Context is key

Dr. McGrath offers an example of how the urge to share an intrusive thought can backfire, given people’s difficulty differentiating intrusive thoughts from harmful intentions. “Imagine I just went up to someone at the mall, and I said to them: ‘You know, I’m really worried that I’m gonna molest a kid here. I don’t think I could ever do it, but I’m just so worried.’

“They’re going to run to security, right? I’ll go through a whole stressful ordeal, because they won’t understand what I’m saying because it lacks the context of my experience, and they lack knowledge about intrusive thoughts and OCD. I always suggest that if you share what’s going on with someone close to you, do it in the context of a therapy session. Bring that person into the session, and allow an experienced, qualified therapist to help explain what you’re talking about, what’s happening inside your head.”

Dr. McGrath says that if that’s not possible, you must give a partner, family member, or trusted confidante all the context you can. 

“You might say, ‘Listen: I’ve discovered I have something called Obsessive-Compulsive Disorder. That means that I have intrusive thoughts, images, or urges, and then I do these compulsions to reduce the anxiety they make me feel. I’ve been experiencing this particular intrusive thought, and these have been the compulsions that I’ve been doing to neutralize it. I understand how this disorder works, and I’m working to overcome it. I am not a danger to myself or anybody else. I want to assure you of that—even though my OCD tells me that maybe I am. I’m gradually learning how to handle the things that pop into my head so that I don’t have to do these compulsions anymore.’”

In fact, the approach you’ll be describing is part of what’s considered the gold standard treatment for OCD: exposure and response prevention therapy (ERP).  

Exposure and response prevention therapy (ERP) 

ERP is a type of therapy that was specifically developed to treat OCD, and has been shown to be effective for approximately two in three people with the condition. It’s based on the idea that by exposing yourself to the situations that trigger your obsessions and resisting the urge to perform compulsions in response, you can gradually learn to manage your anxiety and feel less distressed by them over time—perhaps learning to dismiss intrusive thoughts entirely.

In an ERP session, you work closely with a therapist who specializes in treating OCD with ERP. They’ll first help you identify your obsessions and compulsions, then create a step-by-step plan for you to confront these triggers and gradually face them without giving in to compulsions like reassurance-seeking or confession.

During your initial sessions, your therapist may start by exposing you to less distressing triggers and gradually progress to more challenging ones. They might use imagination, pictures, or real-life situations to create these exposures. Throughout the process, your therapist will support and guide you, helping you resist the urge to seek reassurance for your fears and doubts, only divulging your intrusive thoughts with others out of a desire to openly share your experiences and perspectives with people who are close to you. This allows your brain to learn that you don’t need reassurance from others in order to deal with your distressing intrusive thoughts, and that your anxiety about them will decrease and go away on its own.

The duration of treatment can vary depending on your commitment to ERP and the severity of your OCD symptoms. Generally speaking, ERP is an intensive therapy that involves regular sessions over several weeks or months. Many people start seeing improvements within a few weeks, but it’s essential to continue the treatment until you’ve achieved long-term management of your OCD symptoms.

ERP is highly effective in helping individuals manage their OCD in the long run. Research studies have shown that most people who undergo ERP experience significant reductions in their OCD symptoms and improved overall functioning. By facing their fears and resisting the urge to perform compulsions, individuals can learn new ways of responding to their obsessions and break the cycle of anxiety and compulsive behaviors.

Getting the help you need

If you think you might have OCD and want to learn how it’s treated with ERP, I encourage you to learn about NOCD’s accessible, evidence-based approach to treatment with the NOCD Care team to learn more about how we can help you. 

All of our therapists specialize in OCD and receive ERP-specific training. You can also get 24/7 access to personalized self-management tools built by people who have been through OCD and successfully recovered.

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