Intrusive Thoughts & Obsessional Thinking
Understanding unwanted thoughts, rumination, uncertainty and mental compulsions.
Intrusive thoughts can be unwanted, disturbing or completely at odds with what you believe or want. You might find yourself repeatedly analysing what a thought means, questioning your feelings, seeking reassurance or trying to reach a level of certainty that never quite feels sufficient.
Sometimes a thought can become important simply because you can't seem to let it go. You may spend hours trying to work out what it means, checking how you feel about it, reviewing past events or looking for an answer that will finally make you feel certain. The more you try to resolve the thought, the more difficult it can become to leave it alone.
These patterns can be exhausting and can begin to affect your relationships, work and everyday life. Therapy can help you understand why certain thoughts have become so difficult to let go of and explore different ways of responding to them.
When thoughts get stuck
An intrusive thought becomes particularly difficult when it starts to feel important. You might begin asking yourself what it means, why you had it, whether it says something about you, or whether you can be certain that it won't happen.
This can lead to repeated analysis, mental checking, reassurance seeking, comparing possibilities or trying to work out how you really feel. These responses can feel as though they should help you reach an answer, but they can also keep your attention fixed on the thought and make it harder to move on.
Therapy can help you understand this cycle and develop different ways of responding to thoughts, uncertainty and anxiety, rather than continually trying to resolve them.
Why do I get intrusive thoughts?
Intrusive thoughts are a common part of human experience. Most people have thoughts, images or impulses that are unwanted, disturbing or completely at odds with what they believe or want.
Having a thought does not mean that you agree with it, want it to happen or that it tells you something important about who you are.
What can make intrusive thoughts particularly difficult is the significance we begin to attach to them. You might start asking yourself why you had the thought, what it means about you, whether it could happen, or whether you can be certain that it won't. You may then find yourself analysing, checking, seeking reassurance or trying to push the thought away.
The more important it feels to find a definite answer, the harder it can become to leave the thought alone.
These patterns can develop for different reasons, including anxiety, stress, difficult experiences or particular ways of responding to uncertainty. For some people, they can also form part of OCD. Therapy can help you understand what is happening and why certain thoughts have become so difficult to let go of.
Understanding your OCD without feeding it
It can be tempting to analyse an intrusive thought, check what it means, seek reassurance or repeatedly try to reach certainty. These responses can feel as though they should help, particularly when they briefly reduce anxiety, but they can also keep your attention fixed on the thought and make it harder to let go.
For some people, this pattern forms part of OCD and can involve predominantly mental compulsions. For others, similar cycles of rumination, reassurance seeking and uncertainty may be connected to anxiety or other difficulties. Understanding what keeps the cycle going can be more useful than trying to find the perfect answer to the thought itself.
My approach to these difficulties is not limited to managing the thoughts or reducing compulsions. Psychotherapy can also provide space to explore why particular thoughts have become so significant, how they connect with your sense of yourself and your relationships, and whether there are deeper patterns that contribute to the way you respond to uncertainty, anxiety or intrusive experiences.
Where appropriate, I incorporate evidence-based approaches such as ERP and ACT alongside this broader relational and depth-oriented work. These approaches can be particularly helpful in changing the patterns that keep intrusive thoughts going, but they are part of the therapy rather than the entirety of it.
Pure O and predominantly mental OCD
Some forms of OCD involve compulsions that are difficult to see from the outside. You may spend a great deal of time analysing your thoughts, checking how you feel, reviewing memories, testing your reactions, seeking reassurance or mentally trying to prove that something is or isn't true.
This is sometimes described as “Pure O”, although the term can be misleading because the compulsions are usually taking place mentally rather than being completely absent. The thoughts themselves can take many forms, including fears about relationships, harm, sexuality, morality, health or what your thoughts might mean about you.
Because these compulsions can be difficult to recognise, it can feel as though the problem is simply that you are having the wrong thoughts or that you need to understand them more fully. Therapy can help you recognise the patterns that keep the cycle going and develop a different relationship with uncertainty and intrusive thoughts.
ERP and ACT
Exposure and Response Prevention (ERP) is an evidence-based approach for OCD that involves gradually facing situations, thoughts or sensations that trigger anxiety or uncertainty while reducing the compulsive responses that usually follow.
Acceptance and Commitment Therapy (ACT) can complement this work by helping you develop a different relationship with difficult thoughts and feelings, rather than continually trying to control or eliminate them.
I incorporate these approaches into my broader relational and integrative practice where they are likely to be helpful. The way we work depends on your difficulties, your goals and what you want from therapy.