Transcription
[Music] Okay. Okay. So, I published a couple videos, you and I have worked on a couple videos about some of these methods for managing intrusive thoughts, which often include diffusion. It's this idea of like getting better at noticing your thoughts, kind of labeling them. Oh, thanks brain for that thought. Labeling them. Oh, there's my worry mind again. Stuff like that, right? These kind of typical diffusion techniques where you learn to separate yourself a little bit from your thoughts.
And I got a couple of questions from my audience. People, but what if they're dangerous? Like, what if these thoughts are dangerous? How could I just, you know, separate myself from them or allow them to keep running if they're dangerous? So, I brought in Dr. Cat Green, OCD specialist. Woohoo. To bring her brilliant wisdom and years of expertise to this topic. So, what do you think, Cat? What do we do about this?
Yeah, I mean, this comes up a lot. One of the reasons intrusive thoughts are intrusive is because they are scary. They're they're frightening and they're kind of laden with emotion. So whether it's in the context of diagnosed frank OCD or just significant anxiety and those intrusive thoughts, any of them that are feeling intrusive are going to feel scary. There's a couple of concepts and this is related to the diffusion tech. Intrusive thoughts have this quality uh of increased thought action fusion. So the idea that if I think it, it makes it more likely to happen. It makes it more real. So this is why these thoughts like what if I hurt someone? What if I jump in front of a bus? What if I drive off this bridge? What if like all of those thoughts feel number one they feel scary. Yeah. But then kind of this concept of thought action fusion, those sticky thoughts, intrusive thoughts tend to seem they carry some of this extra power that if I think it, it makes it more likely that it will happen. If I say it, oh my gosh, I'm just asking for it. Mhm.
And it's a really sneaky effective way for thoughts to stick around because if they can stay so scary that you can't see it, say it, do it, even think about it. I mean, they're just going to kick around, right? They're like, "Oh, yeah. I'm just going to keep coming back because I'm so scary you can't even approach me." So, if I had an intrusive thought like, "What if I'm wearing orange pants?" Like, that wouldn't be so scary and I wouldn't think there I wouldn't have like such strong fusion like, "Oh, I probably have to put on orange pants now." Like, it would just kind of be like, "Whatever, that's a weird thought. Moving on." But if I have a thought like, "Oh my gosh, what if I punch my kid?" That's like, "That feels so strong. It feels so scary. Like, I would hate it. I would I would be very upset if I did that. That would feel very dangerous to me." So then that thought, you're saying when someone has an intrusive thought, that thought action fusion makes it seem like the action is connected to that thought. Even though again, just like what am I wearing orange pants? It's just a thought.
That's exactly right. So that that kind of fear and intrusive thoughts tend to go after things people and I I think I talk about this in the course and other places. Intrusive thoughts tend to go after things that people really care about. Yeah. So if you like part of your life and livelihood depended on you not wearing orange pants, that thought might scare you, right? That that you might end up in this cycle of checking to be like, "Oh my gosh, what if that's true?" But that's usually in the context of intrusive thoughts. Again, it tends to be harm, right? Fear of being responsible for harm for other people or yourself or other kind of taboo things, right? What if I stab someone? What if I kill myself? Uh what if I, you know, touch someone inappropriately? All of these things, it tends to be things that, uh, rely on our values. So, relationships, being a good person, helping others, being responsible. If those are super important to you, that's where the intrusive thoughts tend to go after. And that again, it increases that fusion. It increases that emotional response because they seem scarier. And it gets a really effective way for those thoughts to stick around because they're like, I'm I'm so scary, you can't even approach me. Yeah. Right.
And so it it this brain this is more dangerous and your brain scans for danger all the time, which means it's going to pay more attention to the thing that seems more dangerous, which is going to make it louder. Well, and what happens is I mean it promotes this cycle then of reassurance seeking, right? So if you have this intrusive thought of, you know, what if I drop my baby on purpose, right? I mean, that's terrifying. And then if if you're not able to diffuse from that thought, if you're not able to give yourself a little space and say, "Whoa, ah, there it is." Right? That that annoying thought, whatever it is. Yeah. I mean, it's hard to just hold that. So, what happens is the thoughts like you got to go fix it or check it or avoid it. So, either don't pick up your baby or go check with your partner and say, "I wouldn't hurt the baby, right? I seem okay." Right? You get that little bit of reassurance, right? That's like, "No, of course not." And you're like, "Oh, I'm okay." It never lasts. The intrusive thoughts like, "Oh, don't worry. The reassurance will help." that lasts for like one minute and then you're like, "But they don't know this about me. I better go check again." Right? So then it it just builds and builds and builds. So you end up in that cycle that increases the perceived danger of the thought because then your brain's like, "I'm so dangerous. I had to go check with someone." So it just kind of it it builds over time. But the thoughts themselves, I think one of the hardest things in exposure by itself is saying maybe these thoughts aren't dangerous. And I'm, you know, I'm pretty hardline on my uncertainty. We'll we'll be like, I guess there's a tiny chance that the cod is dangerous, but all the evidence suggests probably not. So, are you willing to do an experiment where you recognize it? You separate, give yourself a little bit of space from it and see what happens.
H okay. So, if we look at the anxiety cycle, I'm stuck on my headphones. You're attached. No. If you like the anxiety cycle, basically anything we do right here, we have a stimulus interpretation like, oh, the stimulation might be an intrusive thought like, oh my gosh, what if I hurt my baby? Interpretation, oh my gosh, this could be dangerous. You get scared and anxious. Avoiding it would look like reassurance seeking or some kind of compulsive behavior. Can you give us some examples like what are some other forms of reassurance seeking or compulsive behaviors people engage with?
Yeah. So, and again, I I think of of avoidance. I think a model of safety behaviors, right? things that your your brain tells you you have to do to stay quote unquote safe, right? This was if you were afraid of water, right? You were sure you were going to drown, your brain, even if you know how to swim, your brain would say, "Okay, either just avoid the water, straight up avoidance, or you can go in if you hold someone's hand or you wear 12 floaties or whatever it is." Yeah. So, they I kind of think about those as safety behaviors. Avoidance, straight up avoidance as one. And then checking, right? Lots of check, check, double check is what we'll talk about. So, for example, if you're afraid, you have this intrusive thought, what if I drop my baby on purpose? Right? I'll I'll see people do a lot of scanning and checking to be like, am I holding them appropriately? Am I far enough from the stairs? Am I So, they're checking their body. They're checking their surroundings just to make sure. Yeah. And they get that little bit of relief where their brain's like, "Oo, that was close." And it rein that feeling of that was close reinforces the whole idea that it was dangerous to begin with. That was close. Who who knows what you would have done? in this cycle, right? So, you feel a little bit of relief when you do a safety behavior. You seek reassurance. You check, but then your brain that sends the message to your brain like, "Oh, that must have actually been dangerous. That thought must have actually been dangerous." And then your brain's like, "I'm going to make my human do that checking again. I'm going to make their anxiety go up." Right?
And one of the important things when we're talking about dangerous thoughts, and this is like it serves a like, yes, it is reassuring, but it's also reality. One of the first steps in treatment for intrusive thoughts is we call psycho education right learning about just you know we have our posters and our graphs and think just teaching how how the brain works how these thoughts start why they get stuck and I will often talk about number one how normal intrusive thoughts are right brains are weird they think weird things all the time but then also kind of the kinds of harm thoughts that are present in OCD are typically what we call egodistonic they're associated with a lot of fear fear. They're associated with a lot of distress. They're afraid of doing something versus if you have the thought like, "Wow, I'm going to punch someone. I actually really like punching people and I have a whole history of punching people." That's not an intrusive thought, right? What OCD likes to do is say, "But maybe you're about to start, but maybe you don't know blah blah blah blah blah." Has a whole narrative for that. But there there is kind of a a big difference if there's the fear of if I did it. And then I was able to be like, "But what if you did like it? maybe the same, but that that kind of it's a slippery slope. But in general, intrusive thoughts make you feel kind of scared of them and like there's a difference between wanting to hurt someone like I want to punch my boss and then you imagine it and you're like that would feel so good. Whereas if you're like what if I punch my boss and you imagine that you're like that would be terrible. But then OCD like so we could say there's a difference. Egoistonic means it goes against what you like, what you want, or what you believe, the kind of person you want to be. Right? So, it's it that's one kind of defining feature of dangerous thoughts. Like, if it feels like scary to you, then probably not likely that you're going to do that.
I love that you've got in quotes, right? Cuz we're So, here's what I cuz the thing is cuz I was seeing super sneaky. Yeah. The the thing is it's important to start with that, but I don't repeat it. So in treatment I'm not like but remember because often times we know it well and we know it in our head the reason when you look at your cycle everyone has tried just thinking something different everyone has tried just not thinking it and the problem is that it it when it's in that cycle right that behavior that relief just totally overrides whatever you thought right the brain's like forget that you said it wasn't dangerous but I felt that relief if you hadn't done that right I don't know what you're talking about but clearly it was dangerous so yeah I like to put that out there because it is just an important kind of fact. But in the cycle of OCD, OCD does all sorts of things with that. And it's like, well, maybe you actually do want to have it. You don't even have OCD. You've been making it up. I mean, these are so so so common. That kind of spiralally anxious cycle is a symptom itself. Okay. Right. Of like, oh, this is Yeah. Yeah. So like if you find yourself going in circles around a thought for a certain amount of time, it's a pretty good indication it's like an intrusive thought, not like a or an OCD cycle, not like a realistic.
Well, and this is I think the other kind of element is keeping in mind when these these thoughts come in and they stick one really frequent path and we I think you and I have even talked about this before OCD and this is I talk about OCD diagnosed but you know intrusive thoughts can have a lot of the same characteristics even without a diagnosis. the idea of a meaning making kind of cycle. So you get a thought, what if I, you know, what if I stab my partner, right? And then you're like, oh my gosh. And there's this thought initially of like, I better not come by the knives. I'm done cutting stuff. I need to have supervision. All the checking behaviors. But then there's additional this additional layer of like, why did you even have that thought? Oh my gosh, what does this mean about you? You had this thought. Maybe it is on purpose. Maybe you do want it. Maybe you don't. I mean, it it tends to go down this meaning making route that's there's no end. It's impossible to hit an end because even when you get to the end of like you're going to be alone forever, OCD is like well and right it can just keep going. Yeah. But so there's often these multiple layers that meaning making. So even as people are able to work on kind of not doing the more obvious avoidance. So like I'm afraid I'm going to stab my partner. I'm still going to cut avocados. Like I'm going to do which is fantastic and I'm so impressed and it's a huge gain. But then sometimes those intrusive thoughts will find a different ground to be like why do you even have these thoughts? What does it mean about you? And so you can see that reassurance seeking bleed into like am I a good person? Like is this the right person for me? Did I why am I it's it's kind of the constant self-doubt questioning kind of cycle. So that's the other thing that came to mind as we were talking. Yeah.
So it's really good to become more aware and to be able to label these thoughts like these are intrusive thoughts. Are there other behavioral or like active approaches people can take if they're having thoughts that seem dangerous like intrusive thoughts to danger?
Yeah, I mean I think again one of the exposures but like diffusing recognizing it but so there's all there's a lot of overlap between those kind of act techniques of diffusion act is a form of therapy where you're kind of trying to get a lot of space and observe what you want and then just exposure kind of facing fears even saying I think I'm not 100% sure but I think that's an intrusive thought so I'm not going to follow right away so you start introducing delays and listening to it, then it's essentially, you know, you're saying, "What would I how would I want to live this moment if I didn't have this really annoying bossy part of my brain, you know, threatening destruction all the time." And what you're trying to do is get yourself closer, right? Taking little steps to get closer to the life you want to be living, how you would live that moment if you weren't following all the rules of the specific intrusive thought, right? where you're like, "Okay, well, if I wasn't worried about stabbing my partner, I would be in the kitchen. I would turn on music while I worked. I would work with them in the kitchen." And then trying to break down kind of small small ways to approach it. Even just writing it down, again, you think about that thought action fusion. Writing it down the exact same sentence over and over and over and over and over and over and over again can actually be really helpful because at first it seems so scary. Yeah. And then over time you're like, "Oh, my hand hurts." Because you get a little tired of it instead of scared of it. maintain the same panic. Yeah. Yeah.
Okay. So, if someone if someone has an intrusive thought like, "Okay, what if I stab my partner?" Like, you're cutting I've had this thought like I'm in the kitchen. I'm walking around with my big chef knife and I'm like, "Oh, what if I stabbed someone? What if I cut myself? Like, what if I slip my wrist?" Right? And then like, "Oh, now because I cuz I have draining, I'm basically like, oh, that's an intrusive thought. Cool. Whatever. Lots of people have that. No big deal. Moving on. I'm going to go cut my avocado now." But if someone was like something that would reinforce that intrusive thought, what does that thought mean about me? Does that mean I'm a murderer? Like does that mean I'm gonna kill myself? What if I kill myself? What if I stab my partner? So that meaning making is like, okay, we don't need to make meaning. That's that's a common thing that happens, but we don't need to make meaning. Just cuz you have a thought doesn't mean anything about you. Research shows 95% of people have intrusive thoughts. Like no biggie. Okay. And then the behaviors that might fuel that thought are reassured seeking, avoiding behaviors, checking behaviors, right? Like checking with your partner. Would I actually stab myself? Would I actually stab you? Or being like, I'm I have to walk with the knife pointed down or any kind of like behavior. So the opposite of that would be approaching instead of an avoiding behavior. Can you give some examples of how you might do that in therapy? Like exposure in therapy in a therapeutic context?
Yes. So, this is something where I mean the more significant the intrusive thoughts are, and I've said this before, it is important to be working with someone trained in them to walk through those exposures cuz it's just hard. Not because the thoughts are dangerous and not because feeling scared is dangerous, but it's going to be more effective. You're going to have a more efficient way forward. It'll just So, for people who have done this a bunch of times might be able to help you do it a little faster. Yes. So, for example, if I've got someone who's afraid of stabbing someone with a knife, it's actually pretty common. ERP is exposure response prevention. It's kind of the gold standard for OCD. In ERP clinics, most provider, like it's pretty easy for me to find a knife in someone's desk. I can say, "Oh crap, I forgot my butcher knife. Does anyone have one?" And most ERP therapists will have it. They've got we, you know, all sorts of things because it's like, "Oh, okay. This is something comes up because if they're in your office, this actually why I love tellahalth is I can be in their ear while they're at home." But if they're in my office, I can't be at home cutting an avocado. We can do it in my office, right? So, it's one of these. And we're setting it up to say, "Okay, so the intrusive thought is going to be you're just going to stab Dr. Green while you do it, or you're going to slit your wrist while you do it." And so, we talk about what what they can tolerate, right? And we'll take these little steps towards it. Maybe I'm far across the room at the beginning as they're cutting, right? Slicing. I'm talk we're noticing where the intrusive thought is. And instead of saying, "And see, nothing bad's happening. See, nothing bad's happening. See, it's like you're just rolling with it. That thought's like, what if you just lose it and do that and you're doing it anyway, right? So, building that sense of self-efficacy and confidence that like I can make choices for myself. I can move towards my values even though, and this is something I know you talk a lot about, even though that thought is there, even though that feeling is there, I can't really like completely shove it out the door. Over time, it's going to go down. Yeah. Over time, it's not going to be as potent. But that, you know, then I'm moving closer in the room until I can be next to them, until I can be, you know, again, what do they want it to look like in real life? We're trying to get closer to that. We bring partners in all the time. We bring parents, partners, spouses, right? If other people are involved, we'll bring them in to say, "Okay, so what happens right now? What do we want to happen? And then what's kind of a stepped pathway to get there?" Yeah.
Interesting. Okay. So gradual exposure with help of a therapist is a great way to work through some of these thoughts, these fears of thoughts. Okay. So my favorite thing about what you just said was this idea of you build up trust in yourself to have a thought and still be okay and still keep doing what you were going to do anyway. Like you just get good. You're like, "Oh, look at how good I am." Right? I can just notice these thoughts and I can keep doing what I was doing. It's okay. Right? And just doing that by itself means we give the thoughts a name. We give them you know we talk about my brain, my worry bug. Bob, whatever it is, we talk about the that part of your brain, but that's not an independently thinking part of your brain. That's your brain. It's learned a habit. It's learned something that's like, "Oh, this is super dangerous." And so, the cool thing is it's not like your brain has the capacity to be like, "Well, I'm going to go against all the natural principles of anxiety coming down, right, and put in place some nefarious plan." Instead, like, it is forced as you treat it more like an intrusive thought. Be like, "Ah, yeah. Sometimes I'll have them tally how often it's coming in and that's all that's the only acknowledgement it gets. Oh, I didn't know you'd show up today, right? Uh your brain like that that limbic and amydala response has to change. That adrenaline response will go down. It is like that is a natural principle. Your brain is reacting like there's a bear about to eat you. And if it's not, that's a like adrenaline is a precious resource. It's not going to just continue pumping that out at the same rate. So, this is what's cool is just even in recognizing the thought, you're going to see some shift as you separate because your brain's like, "hm, you're really about to be eaten by a bear." You wouldn't be thinking, "I think I'm about to be eaten by a bear. I wonder if this is a dangerous thought, right?" Like, your brain knows you wouldn't do any of that. You'd just be running. And so, even that little bit of space, that little brave step forward of identifying a thought, trying to separate from a thought, saying, "I think this might be an intrusive thought." Right? That by itself is an exposure and it forces your brain over time with practice and practice and practice to go I'm gonna turn down that fear a little bit and a little bit and a little bit and it may not like a lot of people with intrusive thoughts have more of a fear response than people without intrusive thoughts. Yeah. Like that just it may not ever go down to zero. Yeah. But it doesn't interfere with your life the same way. Love it. Cool.
Any last thoughts about dangerous intrusive thoughts that we've missed?
I mean I think we it's been pretty pretty comprehensive. Yeah. No, I think if it like I I'm excited people are noticing and asking and they're going, "Okay." But it does feel like these are extra dangerous and that's how intrusive thoughts get to stay around because they separate themselves. Yeah. Well, Emma's talking about those thoughts talking about those. She's not talking about these thoughts. These are actually dangerous thoughts. So, I like people are recognizing that it feels different. But often, right, when they fall in this intrusive thought group, you're following the same kind of strategies. Yeah. Huh? Okay. Awesome. Cool.
Okay. Well, everyone, just so y'all know, Dr. Green has an amazing course on managing intrusive thoughts. It's right inside of my website, therapy in a nutshell.com. So, you can check that out. I'll make sure put a link to the description in the description. And there's also another course on health anxiety. So, if you have constant fears about the doctor, what used to be called hypocchondriism, hypocondry, hypochondriasis, hypochondriasis, yeah, health anxiety. She's got another great course on that as well. So, um, I'll definitely put the links to those in the description, but yeah, thank you so much for being here. Really appreciate your time today, everybody.
Yeah, of course. All right, take care.
Yep, you too. Hey, if you found any part of this video helpful, I'd really appreciate it if you could give it a thumbs up or comment below what you found was helpful. Also, if you can think of someone who might benefit from this video, if you could share it, that'll help them. But all of these things help tell the algorithm that this content is helpful for people and then they'll show it to more people who it can help. So really appreciate it. Thank you so much for being here. Take care.