Intrusive Thoughts: Psychologist Answers Your Questions

hello everyone today i'm really excited to have  a special guest on the show her name is kat green   she is a the only board certified child  psychologist in the state of utah and   she specializes in ocd adhd learning disorders  and is really experienced in dealing with ocd   and intrusive thoughts so today we're going to be  asking her your questions about intrusive thoughts   and just so you know kat and i have worked  together to build a course on intrusive   thoughts it's on my website and you can find  more information in the link in the description   but it goes through the four main steps of  knowing what to do with intrusive thoughts   because intrusive thoughts can feel scary they  can feel a little bit overwhelming so check out   the link in the description if you'd like to learn  more about uh cat's course on how to take charge   of intrusive thoughts okay well let's get to these  questions thank you so much for being here today   thank you for taking the time to teach us all  about intrusive thoughts yeah i'm happy to be here   we asked for some questions and got a lot of  them do you want to start with some of these   really basic ones the most common ones yeah  by far the most common were were the questions   that actually that the course is kind of  intended to address and hopefully people   got answers to those questions as they went  through but i mean the big question of kind of   what are intrusive thoughts right like what does  that encompass and then in the course we talk   through images thoughts videos words they can  come in lots of different forms but just things   that they're uninvited they in there we call them  intrusive because they intrude on your life right   they come out of the blue sometimes and they're  just associated with a lot of distress right   they're just really uncomfortable and bothersome  a lot of people ask kind of what causes them   but especially like why me like why are they  so prevalent for me and i talked through in the   course that everyone almost everyone endorses  having intrusive thoughts even similar content   kind of across the board but there's a number  of factors that make them sticky so people who   tend to have higher anxiety certainly if they  kind of run in the ocd realm those thoughts   get stuck for a number of reasons part of it is  kind of neurobiological kind of predisposed to it   they get more thoughts they're just stickier  thoughts to begin with but usually intrusive   thoughts go after what people value what they  care about so if you really care about something   then the idea of violating a rule around that is  just horrifying and so then it kind of starts this   this cycle of wait why did i have that thought  what must it mean we've talked about this before   and so that kind of grows those intrusive thoughts  over time and then of course the big question for   everyone was what do i do about them right  like how do i make them stop right yes how   do i make them stop and go away and you know the  delightful answer in the course is you don't but   the good news is we can make them less scary  and less sticky and eventually they do kind of   learn to wax and wane and they just don't disrupt  your life as much and i talk about kind of four   steps right so identifying labeling at first  which is harder to do than it seems some of   the questions talked about like in the moment  you know how do i know if it's intrusive or not   i often tell people try and experiment if it feels  scary to call it intrusive try it let's see what   happens right if you're because it's it's like oh  but maybe if i don't listen this time something   terrible really will happen so the first thing  you're doing is labeling and saying i think   that's an uninvited guest right i don't i don't  think that's something i invited here i think   it's one of those intrusive thoughts and then i  always encourage people to figure out what does   the thought or the feelings that come with it what  do they want and almost always they want people to   avoid or they want people to engage with them kind  of leave their own life and what matters to them   to totally focus on that thought or feeling and  then you have to be able to take a step back and   say okay what do i want in this moment in the  course i talk about kind of being at life as a   party and you're kind of engaging the activities  and the relationships and the goals that you want   you just you can't force those thoughts back  out the door but as you kind of engage in your   life as you identify your goals kind of that  last step is saying okay i'm going to take   the step i'm going to move towards my goal even  though this intrusive thought is going to come   kicking and screaming and complaining and  tantruming it's gonna follow me around for a while   but still being willing to move towards that  goal kind of and maybe small steps at a time   yeah oh that's a great summary okay one  of the questions that came up a lot for   our audience is are intrusive thoughts  caused by or associated with trauma   so fiore says is there a connection between  intrusive thoughts and trauma even though   the thought that comes up is not directly related  to the traumatic experience why does this happen   yeah so there are a number of questions related to  just do they come from trauma or is it childhood   trauma or these kind of things it depends that's  like the famous fun answer the truth is most of   the time they don't right most of the time they're  not related to some specific past event or some   specific trauma if we're talking about kind  of broad intrusive thoughts as a as a group   there's kind of two caveats there i mean one is  in something like post-traumatic stress disorder   right where it's obviously  associated with a specific trauma   people with ptsd do experience intrusive  thoughts often directly related to an accident or   a military action or something like that that  they are related to that trauma but most people   can see the the connection there and generally  kind of childhood trauma or trauma in general   it does elevate your risk for kind of lots of  things right it does increase anxiety depression   intrusive thoughts kind of across the board but  it's typically not like a one-to-one ratio of   here's here was the trauma and here's  what's upsetting well yeah because trauma   increases kind of people's overall anxiety  and hyper vigilance right so they're going   to be a little bit more sensitive maybe to  intrusive thoughts or to anxiety in general   and that's one of the things that can cause  that intrusive thought cycle to spy yeah and it   could i mean we just have lots of lots of data  that you know trauma can also just interrupt   developmental processes and figuring out how  to process those like you were saying kind   of sensitivity so would you see that yeah and  in some ways the treatment is similar and in   some ways different right like with trauma  you do some kind of body calming and facing   and reprocessing those memories but with yeah with  intrusive thoughts it's different sorry go ahead   oh no you're your spot so the treatment for trauma  it means trauma focus cognitive behavior therapy   it's looking at the same things for its intrusive  thoughts there's an element of it there there's   some things that we do a little bit differently  if i'm working with kids or young adults who've   experienced trauma i do approach it slightly  differently but more in kind of how i set   things up i'm sensitive to to that specific event  and i'm aware of that as we're working through   those specifics but the the fundamental process  right those four steps as you can go through   this course are actually very similar yeah so to  deal with the intrusive thoughts specifically the   approach is is pretty similar across the board  but like you said in in trauma work in the case   of ptsd you are going to address a few things and  just be sensitive to that and obviously it depends   on the age of the person you're working with and  things like that too yeah for sure great okay you   ready for the next one i'm ready okay so a lot  of people asked how do you deal with intrusive   thoughts that are based in an actual problem  or a real threatening situation in the past   so this comes up often especially related to  trauma and in my general work with exposure   therapy and anxiety disorders you know a lot  of anxiety is related to actual threat and then   that system being completely hijacked right  right so i've worked with a lot of kids who   had you know have ocd and it's contamination  related these intrusive thoughts about getting   sick or vomiting may be associated with in the  past getting sick and vomiting right so these are   part of it is kind of understanding if it's one  of these unpleasant events or if it's an actually   threatening event in the past right if it's one  of these really unpleasant things that we went   through and don't want to go through again but  it's not like physically harmful to us versus   like vomiting is really embarrassing really  uncomfortable really awful but it's not actually   dangerous right thinking about vomiting isn't  actually going to hurt you like that thought   is not going to hurt you right yeah and i  so i think that's and that's a lot of the   a lot of the cases in intrusive let's see that's  a lot of the time kind of what we're looking at   with intrusive thoughts is it's something  that is embarrassing or really unpleasant   um or scary but it's not a situation that's kind  of life-threatening that's when we kind of move   into this ptsd group there is this group in the  middle i've worked with young adults before that   have intrusive thoughts about being bullied  or attacked concerned about being transgender   right and going to a big public university and  being afraid of being confronted or challenged   and part of what we do is we we practice right we  practice how you'd respond and we face those fears   but at some point there's also actual safety  training right this is when there's actually   a threat this is when you should not hold your  ground if if there's an actual physical threat   or danger we have to talk about those cues as  well right so it's in those situations we're just   it's working with people to say okay what what do  you want your life to look like how do we live it   and then where are the boundaries that we need to  be aware of you know where we actually move into   physical danger yeah yeah because because like  disordered anxiety at its essence is like feeling   in danger when you're actually safe and so there  is a non-disordered anxiety that's like feeling in   danger when you're actually in danger and that  you shouldn't be like oh i need to soothe my   anxiety it's more like oh i need to choose  to like escape or fight off my attacker or   hide or something like some action instead of  like oh i need to make this anxiety go away and   then there's this middle ground of like acceptable  risk of like oh like living my life involves risk   so will i accept that driving occasionally has  some danger involved right will i choose to drive   anyway right yeah and i think it's particularly  difficult for people that experience a lot of   anxiety or intrusive thoughts that middle ground  is hard right because you know your brain is kind   of operating from a side of over vigilance that  over threat you're talking about and you know that   but then you're kind of it takes some  time and some practice really to try   to push beyond that and say okay i think this is  an acceptable threat given all you know everything   i know this is what i want to move towards in my  life i think that middle ground is particularly   scary for people that are tend to be overly  anxious because you have to be willing to   hope or might be willing to hope that everything  you're thinking is right right that it's like   okay i think this is going to be fine and  there's you just you have to try it right   yeah and and with exposure therapy or trying  it right facing it if you really consistently   do that the anxiety generally goes down right  generally our goal is to move them towards yeah   your goal is to move move you towards just being  able to live your life usually it goes down for   some people it sticks around so some people still  feel a lot of anxiety or they might have a lot of   intrusive thoughts but at least their quality  of life's better because they're living the   way they want to be living they're not letting  anxiety make their choices yeah that's right   awesome okay okay so here's the next question what  does the content of intrusive thoughts mean about   me and then people asked other follow-up questions  is it related to unmet needs or does the content   point to an underlying issue i think this is a  really common question a lot of people have right   yes and we're both smiling because  we've had this this discussion where   you know if you've gone through the  course you know we've i talk about   this meaning making is actually one of the  most effective strategies that anxiety uses   right instead of you know anxiety bursts into the  scene a party crasher shows up and it's it's like   oh my gosh something terrible is going to  happen right you're going to stab someone   and then you're like oh my gosh why do i feel so  anxious and somehow it's amazing instead of the   party crasher being like because i showed up and  screamed at you the parking crash was like it's   because you're a bad person right and they're  like oh my gosh you're right i am a bad person   right it's this it's a very effective strategy  it gets you focused on oh my goodness what this   you know could mean about me and my existence and  humanity and then it completely sidesteps being   like wait a minute something about that intrusive  thought doesn't totally ring true so this this is   why we're smiling right is this what is it what  does it mean about me and this is you'll you'll   see this in the course having intrusive thoughts  doesn't mean really anything about you it makes   you a human having more intrusive thoughts  might mean that you have a little more anxiety   but the content specifically is often related to  you know things that you value so they scare you   right so things that you know i have worked with  a lot of folks that are you know physicians and   they're really worried about physical health and  so their intrusive thoughts take on the form of   you know getting fears of getting sick or getting  cancer or getting respiratory illness right and   it's not just physicians but people in general  like i i often see this kind of grouping right   i work with people who just love spending time  with with family and all they want to do is   kind of be the best parent they could be and they  have these intrusive thoughts about hurting their   kids right or these intrusive thoughts about being  attracted to kids and it just scares them to death   so the content of the thoughts you know what  it what people often feel like is it means that   they're just like a terrible person and what  it often just means is it it's something that   scares you because it's related to something  important to you and for some people they   really don't like they're like i don't know why  that's what bugs me so one of the things that   we we both kind of try to do is move away from  spending a lot of time in the corner at the party   talking about why that intrusive thoughts there  and why that specific one and why you and spending   more time being like yep there they are and then  trying to move towards kind of what you care about   yeah so so your advice would be i mean these  intrusive thoughts like a party crasher they   come in and they're like oh my gosh you are  a pedophile for example right i worked with   clients who had that thought and and then  because that thought brings anxiety someone   might make this meaning they might think  oh if i had this thought what if it's true   and then they feel even more anxiety which tells  their brain oh this thought's really important   which makes this thought louder and what you're  saying is really like if someone's bothered by a   thought it might it might say something about it  might not always say something about their values   like you care about kids or you care about keeping  people safe but it might not mean anything and   spending a lot of time meaning making or trying to  figure out what this means about you is actually   just really not a very good use of energy well and  this is i mean this ties to a concept kind of well   kind of within the anxiety literature this concept  of having a hard time tolerating uncertainty yeah   so that's one of the driving factors across any  sort of anxiety is this intolerance of uncertainty   and what happens with with people that are more  anxious right you have this thought come in   and if you can't explain it it's like i just have  to think it to death i have to be able to explain   it i must be certain that i know where it came  from and i can i can trace it all the way back to   the you know big bang like there's things that it  just this need for certainty to be absolutely sure   that you know where it came from so you know where  it's going and you know what it means about you   and the truth is any of us with more  anxiety are less comfortable with that   uncertainty our threshold for that is like not  my favorite thing and so particularly intrusive   in the world of intrusive thoughts that  tolerance of uncertainty comes up a lot   in the literature and in treatment and  just in people's general experience   yeah and that makes a lot of sense to me too  i hate uncertainty but i'm trying to be more   willing to experience it which is hard i know i  just want to know everything yeah yeah be sure   about it all that too much to ask probably not  but you know it doesn't work too well does it   yeah all right so are intrusive thoughts symptoms  of being stuck in the past that's interesting   yeah so this comes it's similar to kind of the  trauma piece and trying some of the content piece   not necessarily i mean i there are certain  sometimes if you're if you're prone to   intrusive thoughts you might have memories  that are sticky just like other thoughts right   if you experience lots of social anxiety you  may remember all the embarrassing things that   have happened and they seem to stick with you but  it doesn't necessarily mean it's it's unresolved   right it means that that's that's something that's  hard for you and our negative memories encode more   strongly than our positive memories and so this  is this is one of these things that it probably   doesn't mean that there's some unresolved thing  in the past it it might mean that you have an   ongoing fear but it doesn't necessarily i think  there's some danger in spending all of your time   trying to go back and figure out why instead  of saying okay well maybe i'll figure that   out maybe i won't there's that uncertainty  but i i'm gonna move towards what i want now   like there's this danger of getting stuck in  overthinking and over analyzing and trying to   solve everything in your head so much so that you  never take the question say well what do i want to   be doing moving forward yeah how do i want to be  landing i call it going down the rabbit hole right   which is like i'll often just pull people right  out of that they're like why and i'm like nope   right like we're just not going there it's just  not you know it's like the epitome of having to   sit with uncertainty because it's like maybe  there's an answer maybe there's not but what   most people find is as they put that on the shelf  and they kind of tolerate that not knowing exactly   it gives them a lot more bandwidth to then try  moving forward and then most people gain some   confidence and momentum and they may or may not  figure out a lot of people as they go through   these intrusive thoughts and work through  treatment are like oh i can kind of see how that   fits and some people are like i don't know why  this happened to me i don't know why this sticks   but they feel way more able to say but that's okay  i'm gonna move on and here's what's next and it   doesn't haunt them in the same way yeah awesome  okay what are different ways people experience   intrusive thoughts can they ever manifest as  ticks emotions or sensations yeah this was a great   question and i i think particularly because i work  with kids i actually see a lot of tick disorders   that are comorbid with ocd and adhd those actually  come together a lot we call the trifecta there's   actually a whole theme or kind of group in ocd  called terretic ocd so it's not necessarily that   the thoughts come as ticks but it's not uncommon  for people to experience kind of a discomfort or   urge a feeling instead of an intrusive thought and  then that tick comes kind of close on its heels as   more of a compulsion it's also not uncommon at all  for people with tourette's or ticks to find that   their their compulsions related to intrusive  thoughts or their behaviors blend with ticks   i see that all the color there's a proposal  to call them impulsions instead of compulsions   but i work with this a lot so it's it's something  that i see it's not something that takes me by   surprise again it's not necessarily the intrusive  thought that i see as a tick but i can often see   like an urge or just a discomfort that comes  as intrusive and then a tick kind of follows   it's the same i mean absolutely intrusive feelings  some people they they have a hard time separating   out the thought and the feeling and i encourage  people to work towards that i think there's some   some helpful insight there but from for some they  may just you mean like oh sorry you mean like to   clarify what what like to just be like oh what is  my sensation what is my thought and make those two   very like discreet things yes and then for some  people it may not be as discreet right but it   what it helps kind of do is kind of set the  whole the whole stage if you think about like   intrusive thoughts as a party crasher but  if you're like you know what i really don't   experience a thought that's also fine that doesn't  skip there's very little very little in the world   of intrusive thoughts that surprises me it could  absolutely if you think about a party crash it   could absolutely be a sensation right nausea is a  common one if you think of and maybe it comes in   this world of emetophobia right being afraid of  throwing up so that the nausea comes right with   the thought of like oh my gosh i don't want to  throw up for some people they may experience it   they may not know why panic attacks that  come out of the blue there there usually   are some thoughts kind of flying around there  which is usually i don't want this to happen   right it's actually fear of the fear which you've  talked about but absolutely the sensation can come   first right so physical sensation or emotion you  know whoever's kicking down the door at the party   it could definitely be any of those so so if  i'm understanding what you're saying it's like   something kind of comes in and we experience  randomness with our physical sensations like   we might have just a little wave of nausea come in  or we might have like someone with a tick disorder   might have this urge to clear their throat or  someone might have a thought like oh my gosh what   if i s like do something really stupid or what  if i hurt someone and then the the thing that's   similar is that in all those cases someone reacts  to that with like oh my gosh i can't believe i   felt that oh my gosh i can't believe i thought  that or oh i have to clear my throat right gotta   make this go away gotta suppress it gotta push it  gotta avoid it gotta make a big deal of it right   yeah and i mean any of them are associated  and i i think tick disorders it depends on if   for people that experience an intrusive  thought there there's a group that feel like   doing a tick helps kind of make it seem less real  or it won't happen so this is where it kind of   blends into this terretic ocd tics by themselves  may not be associated with a lot of distress or   fear so this is where it just kind of it depends  on the individual's experience but absolutely   with the sensations right for people that are  really concerned about their their health their   panic disorder they're constantly monitoring  their body and they detect anything like you   said these random sensations that we all have  and the body's like oh my gosh something's   off oh my gosh this means panic attack i mean  then it just kind of spirals from there yeah   okay so that trifecta you just described  ocd adhd and tick disorder those three   is there some sort of genetic or heritable  component what do we know about that   yeah so usually i mean all of those have a pretty  strong heritable component and so that you see   those genes kind of come together with some  regularity so yeah i mean there's certainly it's   often i i might be you know working with a family  and i know there's you know i know there's a   history of ocd i'm seeing the ocd symptoms i'm  hearing their school problems right and it can   be due to ocd right so it could certainly be due  to intrusive thoughts right i don't want to write   because i you know i don't feel like i'm doing  it right the first time and i have to rewrite and   rewrite and erase i'm going to make mistakes so  it could be related to intrusive thoughts but as   i'm i'm listening for other kind of things like  you know getting disciplined or missing work or   those things that may be more on the adhd side  and then ticks more often than not families will   say oh yeah they when i kind of describe what  they are oh yeah they do do that or you know   we do have a family member that does that again  it runs you know much more in men all well adhd   and tick disorders are much more common in men and  then ocd's kind of split between mm-hmm we don't   fully understand the genetic predispositions there  i mean it's it's not there's not a single gene   this is complex right but it is more like when  i look at someone with a case of ocd or family   history of ocd in the back of my mind i'm thinking  this is slightly more heritable slightly more   probably genetically predisposed than  something like anxiety or depression which has   slightly less heritability right yeah kind  of we call it specific heritability right so   you've got ocd it's you know anxiety or  depression it may be social anxiety to and   then the next generation generalized anxiety and  then for kids separation anxiety right it's kind   of this anxious temperament that can take a lot  of different diagnostic forms or kind of themes   ocd is a little bit more ocd to ocd to ocd that's  not a you know it's not a perfect match it's like   you said it's it's complex and it's certainly  not all heritable but it's more likely that   you'll see specific diagnosis of ocd which when  we talk about intrusive thoughts all anxiety has   some component of that intrusiveness or a lot of  people experience that ocd the themes that i talk   about in my course are much more common you know  in ocd kind of those groups of themes that we see   yeah and and that being said even with there being  a genetic component there's also a psychological   component like how when we change how we  think and we change how we act oh absolutely   like really impact how these evidence themselves  how they express right yeah absolutely it's one of   these that i you know i work with a lot of young  adults and they are in this stage and age where   they're you know in relationships and as they  get into their kind of later 20s they're thinking   about kids and i have a lot of people like oh my  gosh am i going to pass this to my kids and it's   like well yeah you're going to pass your genes  to your kids if they're your biological children   that's going to happen but it works i mean it  it's in no me you know it's by no means like a   a death sentence right it's not this is something  that you're aware of you might watch for it right   it is slightly more likely but it's certainly  not a hundred percent you know if you have kids   your kids will definitely have ocd and there's so  many things that you know vary and affect whether   or not ocd manifests and at what age how severe  it is and the cool thing like you're saying is   we can behaviorally intervene and adjust those  pathways those kind of default pathways in   the brain they may experience more intrusive  thoughts than other kids their age right but   you can also help them through it because that's  been a familiar experience and in fact there's   let's go to that yeah or yeah i mean we can talk  about that more yeah there's some questions about   kind of how to help kids you know with intrusive  thoughts and i i think this is something that   if you've had them yourself you're so sensitive  to how scary and isolating they can be and you   just feel like you know either you're going crazy  or no one understands or you sound like a weirdo   right or you'll be arrested if you say any of  these things and i yeah you know having having   done some work there if you're a parent kind of  done your own work on those intrusive thoughts and   found a way that you can walk through those four  steps right and separate out and live your goals   you're such a great resource for your kid  right to help them understand and i'm like   oh yeah these are normal you can kind of be this  this sounding board where they can voice those   and you're not like giving them a ton of attention  and horrified by them and just saying like oh yeah   it does sound like those thoughts are trying to  trying to bug you what what do you want to do   right so kind of helping them move towards their  own values so that's what i you know working with   with kids i wouldn't i try to model confidence  right like we got this we can handle it even if   your inside face is like oh my gosh i don't know  it's like that's okay that's like being a parent   right but outside we're modeling yeah we got this  that's a good question let me think about that   right and giving you some time to think about how  you want to approach it but just kind of being   open and collaborative with them mm-hmm yep yep  i'm making this course on um anxiety skills and   the first section is how to not make anxiety  worse and then the the end chapter on it is   like how to help someone else with anxiety and the  commandment is like thou shalt not freak out like   if someone else is anxious like don't get anxious  about their anxiety like it's okay like it's okay   to have anxiety like to feel this and experience  this like don't freak out it's okay i feel like   our society has this kind of a little bit narrower  tolerance for discomfort right now like we want   things to be comfortable like i can control  the temperature in my house i can control   like driving to places instead of having to walk  there and it's like i should be able to control   my feelings i shouldn't have to feel anxiety and  this is horrible if i do and if i pass it on to my   kids they'd be better off not ever being born it's  like no no it's okay like it's okay to experience   this like broad spectrum of feels and live life  too right yeah i mean because kids are all kids   are gonna feel all sorts of things yeah right  interesting thoughts and fear and distress are   just one of the things and that may be something  that your child experiences more of and they may   need some therapeutic support right you may need  to encourage you to work with a qualified mental   health professional who does work in intrusive  thoughts and ocd and kind of work as a team   but there there's lots of things that can  help right so i think we want to convey   confidence and hope and we can still be  validating and understanding what we don't want   one of my favorite mentors that i had on  fellowship right she would talk about like   a fragile egg she's like we don't wanna she's  like do you know what i'm hearing i'm hearing this   they're not a fragile egg like they're  they're spunky we got and i think it's   about conveying like you've got this even  though you absolutely have your own fears   and worries about how it's gonna go  that's okay but i think conveying to them   that yeah we got this we're gonna we're gonna  move forward and always instilling hope yeah   oh and you just you just i so i love that right  like just people can handle this like you can   handle feeling anxiety and be okay like our  culture talks about anxiety when we talk about   biopsychosocial it's biology psychology and then  our social environment contributes to how we think   about ocd and our environment is talking about  like our society talks about anxiety as if it's   this horrific thing this is terrible disorder  that if you feel anxiety you have a terrible   disorder and some people do have anxiety disorders  i'm not trying to minimize that but the way our   society talks about it invites more fear instead  of more normalization when most most people other   than like psychopaths most people experience  anxiety as a normal person that's what keeps   us from running naked down the freeway right  like you worry about social repercussions   right you worry about legal repercussions you  worry about getting hit by a car i i will often   talk about people talk to people about little a  anxiety or big anxiety little d depression and big   d depression right so understanding that you know  we there are anxiety disorders that are specific   right that we want to tackle and we have  treatment approaches but little lay anxiety like   is just an emotion like any of the other emotions  right like it just it you know deserves a part in   what is that movie that pixar movie oh inside  out inside out yeah yeah that's where it's going   yeah totally yeah um so you just you just brought  up something that i want to touch on even though   we hadn't talked about this previously but you  mentioned you know working with a licensed mental   health professional who's specifically  who understands ocd and i just want to   like one of the reasons for my audience one of  the reasons i'm interviewing dr green is because   i was not specifically trained in ocd treatment  and i've studied it and i've read a couple books   on it and i've gone to seminars on it but there's  a difference between like how the average kind of   general therapist would treat an anxiety situation  and how an ocd therapist ocd informed therapist   would would treat that and i would just say like  i can speak for my half of the world and that   when when people have kind of a general anxiety  approach they're going to talk to people about   like oh let's challenge that thought oh let's  confront that thought oh let's alter that thought   oh let's change that thought and how would an  ocd informed therapist treat an intrusive thought   uh or you could speak you could probably speak a  lot more to this and we're not trying to put down   therapists it's just that there are no i think  it's like i i refer out all the time for things   that i'm i'm not this is something you've seen me  do in trainings when i go to different groups like   you know you're trained in mft i do not do  couples therapy right like oh my gosh i am not   well suited to that i'm not trained in it i don't  treat substance use that's a specific specific   informed area of training that i don't do right  i do trauma work within my specialty populations   right but outside of that unless there's  no one else right i refer out so i don't   think it's a put down to therapists at all i  think everyone has things that they've really   developed competence in unfortunately intrusive  thoughts and ocd often go unrecognized they're   under diagnosed it can take you know 10  or 15 years for someone to say oh my gosh   that's what that is i i was i got this email from  this girl in pennsylvania her mom who was like   hey my daughter has been my daughter has been  seeing counselors for eight years she's 15 now   and she's terrified she's gonna get kidnapped and  they have been treating her for social anxiety   for x number of years and i said just i  i can't diagnose over email and i'm not   going to treat you over state lines but have you  considered an ocd like an intrusive thoughts ocd   diagnosis and she said oh yeah we looked into  that they said she doesn't have it well two   months later she ends up in the psych hospital  she gets a good diagnosis it was absolutely ocd   right she was getting treated for social anxiety  when it was ocd sorry yeah i had to interrupt   there but what happened at this time i one of  my first one of my first experiences kind of   seeing this right because i'd been you know  trained in ocd i had great supervisors but   even early in my graduate training you know i i  saw someone you know very psychologically minded   you know recognized what was going on with herself  you know and was afraid of harming herself and   other people and so previous therapists had  explicitly told her it's not ocd like she had   researched and said i think this is what  it is they said no and so she'd been i mean   hospitalized unnecessarily i mean just so much  distress around it and then you know at the end of   the year i was like well number one you have ocd  right so let's talk about what we do about that   and it's even though it's like okay i don't that's  kind of overwhelming but it feels like there's a   path you can go right there's somewhere you  can go from here so to circle back around i   think yeah i think it's really important  i think especially i work a lot with   with kids and teens and i think that's another  skill set right so you need to find someone that   can do both has experience doing both i think with  adults finding someone who specifically works with   ocd i i you know you do some acceptance of  commitment therapy that's kind of a big deal yeah   that's kind of one of my my primary models yeah so  i think more and more i think you know act act has   much more of an approach similar to what exposure  would be right slightly different packaging   but the general approach is you know separating  from the thought itself and instead of challenging   it and trying to beat it in a submission like  trying to change it they've tried all that like   if you've got a lot of intrusive thoughts you've  tried all those things so it's obviously it's   not working so it's taking a different approach  with the thoughts where you're with the thoughts   themselves right you're you're just allowing them  to kind of come and go and then in in exposure   response prevention therapy you're you're moving  you're kind of doing very specific behaviors   you're essentially inviting the party crasher over  and then practicing living life the way you want   to without doing what it wants you to do so yeah  yeah yeah and it's just it's a different approach   and it's evidence-based for ocd and and intrusive  thoughts in a way that a general therapist   might try to be helpful and be helpful in other  areas but not necessarily in a targeted way   in in fact general talk therapy if you don't have  someone who's doing i mean i would like to see   everyone doing evidence-based work in general  that's a that's a goal that i think we share   kind of general talk therapy is often kind of  directly harmful in ocd because it's it's giving   the thoughts tons of attention and reassurance and  you know if you talk to someone who's not familiar   with ocd and you're saying oh my gosh i you know  i'm worried that i'm going to stab someone you've   got them either going oh you must be really  violent or they just spend the whole session   sort of saying no you won't know you won't no  you won't which feels good in the moment but the   person leaves going wait i've tried telling myself  that too that doesn't work right it's still here   so i think it's just needing to be mindful of  kind of where your boundaries are and what your   familiarity is and then seeking out the training  you know as you're trying to expand okay you ready   for the next thought i mean the next question  we got three more how can i not have intrusive   thoughts during specific activities like amorphous  says i have intrusive thoughts sometimes in the   middle of meditating which is counterproductive to  the whole purpose of meditation that's my favorite   line is there a way to minimize the likelihood  of it happening while i'm meditating thank you   so here's the thing no because like intrusive  thoughts are called intrusive thoughts because   they're intruding so i would expect them when  you least want them this is why people start   withdrawing from activities that they know  are going to trigger them right they start   avoiding because they don't have anything  to do with it so no you can't control   when you have in fact they probably will  get worse the more you try to control them   it's particularly relevant in the world of  meditation because you know i'm not a good   person to talk about meditation like it takes a  lot of it takes a lot of my energy and like my   all of my inhibition and executive functioning  skills to like sit through exercises where i'm   sitting but one of the things i hate is when we  see particularly on media meditation portrayed   as clear your mind right and i'm like yeah  they are human how are you going to do that   right like it's just you can't clear your mind  right you're a verbal verbal person you've always   got stuff some people are able to get to a point  where you know maybe that is something they they   feel like they're in this very peaceful spot  but if you have a lot of intrusive thoughts i   wouldn't make it your life goal to be able to have  a totally clear mind that's probably not something   that's going to happen or that is comfortable  for you so this is something that we're working   towards saying okay how do i keep pushing through  what i want to do if i want to meditate okay the   tantruming intrusive thought has to come with me  and eventually i expect that it may come and go   maybe you'll have periods where it doesn't come  at all and then periods where it pops its head   back in but this is the the kind of whole idea  of intrusive thoughts is they're intruding right   there they're uninvited yeah they're going to show  up when you don't want them the most and you least   yeah did i say that backwards and they don't want  them the most okay so so and the thing i thought   that was interesting was like my understanding i'm  a terrible meditator as well like i just it's so   hard for me but my understanding of mindfulness  is not that we're forcing like you said   we're not forcing our mind to go to blank  slate it's rather we're getting better at   noticing like just stepping back a little bit and  being more aware of our thoughts without becoming   attached to them without making meaning about them  without labeling them as horrific or terrible or   good or bad or awesome or great or comfortable  right so when when i saw that i'm like oh   maybe step away from meditation and practice a  little bit more of the mindfulness the basics of   mindfulness well especially if that's something  that you're drawn towards right some of these   eastern traditions that where we have our roots in  this mindfulness i think that's a great approach   like if that's something that you really value i  think you pursue it but something like mindfulness   may kind of set you up a little better  to do the intrusive thought piece   yeah i would say so but maybe that's  just because i'm a terrible meditator okay is it normal to have intrusive thoughts  or worries about other specific events besides   those listed in the course so this includes  things like social anxiety a breakup or trying   to solve a problem yeah so i saw this come up a  lot and i tried to i mean obviously i intrusive   thoughts is most often associated with ocd right  when we're talking about this but the truth is i   in any anxiety and i tried to speak to this in the  course as well like a lot of worries are intrusive   right they're intrusive they're persistent  they're unwanted they're uninvited so i even   though there's some distinct characteristics about  ocd i think it's helpful to to think about lots of   different things you know if it's something  that it's showing up unannounced uninvited   it's you know vying for attention and control it's  trying to take you away from things that you value   right using fear tactics or those kind of things i  think you can think about it as intrusive thoughts   so i think you know social anxiety i think one of  the questions was like thinking about how things   went at a party the night before like absolutely  right that's the party crasher showing up like oh   my gosh did you see the look on their face and why  did you say that thing that way and you sound so   weird right like these are it's just kind of they  want you to go into a corner and just replay it   and rehash it over and over and just to make sure  that you're as weird as you thought you were like   yes yeah the same kind of thing if you're kind of  prone to intrusive thoughts it may be a breakup   that kind of sticks around although i'll say like  things like a breakup may stick around for anyone   regardless of the anxiety right there there may  be something involved just as part of the normal   process mm-hmm like it might just be like oh  it's just normal to think about these painful   experiences yeah and your brain to kind of roll  them over try and work through them or yeah yeah   we don't have to pathologize that necessarily like  that doesn't mean you're disordered like it might   just be your brain doing its thing yeah all of  this is just your brain doing its thing right that's it that's all the questions  i've got all right well that's i mean i   appreciated all the questions i thought they were  really interesting and i'm again i'm hoping the   course address is kind of the big hitters but  i mean obviously if there's others that come   up after people finish the course they're  like hey this you know their specifics i'm   happy to talk more about those or post stuff  whatever's helpful yeah so if you guys for those   of you in the audience or those of you taking  the course please go ahead and leave some more   questions if you have them down in the comments  below and we'll try to get them addressed as well   if more of them come up so yeah thank you so  much um for taking the time cat to talk with   us and share your expertise really appreciate it  yeah happy to be here okay well take care everyone you

Channel: Therapy in a Nutshell

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Keywords: therapy in a nutshell, intrusive thoughts, overthinking, unwanted thoughts, ocd, intrusive thoughts ocd, intrusive thoughts anxiety, intrusive thoughts and overthinking, OCD, ocd treatment, ocd symptoms, unwanted thoughts dr k, how to stop overthinking, obsessive compulsive disorder

Id: GeZa1OeEk-s

Length: 45min 0sec (2700 seconds)

Published: Thu Sep 30 2021