How To Cope With Intrusive Thoughts: Cognitive Behavioral Therapy and Putting Aside Time to Worry

Thursday, May 26, 2016 by Meg   •   Filed under Treatment Techniques

“Just stop thinking about it. Get over it.” 

If you hear this often from the people around you, tell them to screw off. Because I’m here to tell you that refusing to think those scary thoughts might be a huge mistake from a mental health standpoint. Instead of supressing them, you need time to focus on them. 

But why the hell would anyone put aside time to focus on scary thoughts, especially if they are not currently anxious?

It's not masochism. It's a part of Cognitive Behavioral Therapy. And there may be a solution that allows you to put off scary thought patterns without the side effects related to suppression, while improving your perception of control over your thoughts. 

Let’s take a ride. We’ll start with the bad news.

If You Try To Ignore The Thoughts, They Might Get Worse

Thought suppression, or refusing to think about the scary thoughts at all, may make mental health issues worse1 and lead to increases in anxiety and in the frequency of intrusive thoughts2,3.  In trauma cases, those who try to suppress thoughts may have increases in negative facial expressions, anxiety, distress and less confidence in their ability to control their thoughts, even without a PTSD diagnosis3.

And this doesn’t just happen in those with diagnosable mental illnesses. Even in non-anxious people, telling them to not think about something specific has the effect of making them think of just that thing. In one study, all participants were asked not to think about white bears, I assume because of their resemblance to “the man”. Those without anxiety were unable to avoid thinking of the bears, while those with anxiety issues had intrusive anxious thoughts of other types4

“I hate polar bears, panda bears suck, spiders are scary, don’t think about bears, there might be a spider in here…”

So while refusing to attend a thought after being told not to doesn’t work for anyone, those with a history of scary thoughts tend to revert back to those thoughts in times of stress because those pathways are so worn in the brain that the thoughts come automatically. Either way, none of the people in this study were able to reduce the thoughts when they were trying to suppress them. 

Your brain is like a teenager. Every time you tell it not to do something, rest assured it will do the exact opposite and cause considerable anxiety in the process. 

“I’ll think about bears if I want to, mom! I LOVE bears! They might be the most morally superior animal in the history of animals! In fact, I’m going to get one as a pet as soon as I move out of this house!”

Instead of suppression, distraction may help far more than trying to censor your brain. 

“Oh, I know bears are just fine, honey. But what about a pony? Do you like ponies? How about pizza?” 

Distraction  

The goal of distraction is not full on suppression. Instead it is a temporary way to reduce immediate anxiety until you are in a position to sit and focus on the thoughts in a safe place. Instead of saying “I will not think about bears,” you accept the thought as scary and try to find a way to shift focus in a more subtle way with the understanding that you can delve more deeply into it later. 

To start the process, you're going to have a little heart-to-heart with your brain:

“Hey, dude. You know how we're totally worried about freakingthefuckout on the plane next week? Let's set aside time to freak out about it in...say...one hour.”

Effective self-distraction requires cooperation from the left lateral prefrontal cortex6, an area of the brain involved in decision making, personality and social behavior. However this is also an area shown to be damaged in those with depression. This may explain why those with a history of major depression tend to have more difficulty with distraction, so be prepared with a number of different techniques that you can focus on.  

Writing tends to be a pretty good distraction, though many find that their ideas return to the scary thoughts as they do so. If you are able to keep your stress at a level that is acceptable to you, pull out a pen and paper and get to it. Reading may also be beneficial as a way to put your mind somewhere else temporarily. 

Relaxation exercises and listening to music as a distraction have been shown to be beneficial during times of stress, especially at the dentist’s office5. Actually the distraction research seems overwhelmingly focused on techniques to reduce dental fear. The dental chair is like the new super anxiety-producing stimuli now that we no longer live in a country at war (at least locally).  

Dentistry. It’s better than being shot at.  (Sometimes.)

At first, the thought may go away for fifteen minutes, then thirty, then an hour as you use these distraction techniques. And when it does come back (and it will), expect it, and accept it then too. It’s like teaching the brain that it's able to put it off, and that the thought is okay to have. Acceptance of the thought for what it is tends to reduce anxiety surrounding it, especially when you find a good distraction technique that you can use for a time if the symptoms get too severe. 

It’s really about control. Refusing to think about something is less realistic. Accepting thoughts as they come works better, especially when you know you can control your response to them. 

“Yeah, dude, you know that thing about losing my shit in the air? I think I'm going to postpone it until I get off the plane.”

Let’s say you’ve effectively distracted yourself during that plane ride, or on a car trip through a bear infested area. You are now at a hotel room or at home, a place where you can be alone to worry and attack the thought at its root. 

What now? 

Worry Time

While this may seem counterintuitive to one trying to avoid negative thoughts, Dr. David Burns reports that putting aside time to worry can ease the anxiety response in When Panic Attacks7. While his tactics focus on the ability to postpone the thoughts (discussed above), mindful acceptance techniques seem to work a little better in practice in terms of reducing the frequency of scary thoughts in the long term. 

So how do you do that? 

Purposeful Worrying

Okay, this is going to sound horrible, but stay with me. 

Effective worrying will involve sitting down and focusing on the thoughts that scare you. Some people use writing as a way to focus, and as a way to sort out their thoughts around the fear. Many write about why they think the thoughts exist, and what truth there is to them. They might also describe the thoughts in detail, particularly if there are images attached to them. Writing seems especially effective in dealing with traumatic memories (discussed more here)

But the worry technique that seems most effective is allowing yourself to think about all the negative scary thoughts that triggered the panic in the first place and purposefully increasing your anxiety response. Here, instead of writing or justifying thoughts, you simply focus on all the things that made you nervous, and take the racing heart, dry mouth and shaking hands as high as the response will go. Then you keep yourself there until the symptoms start to decrease. 

According to Dr. Ronald Siegel in The Mindfulness Solution, people are usually unable to maintain high levels of arousal to the same thought for very long8. Siegel also reports that embracing the thought, for however brief a period, may decrease the fear surrounding it over time. 

It's a type of exposure therapy, where you use your thoughts instead of a live tarantula. Some need to hold a furry spider until their brain recognizes that it's okay and short-circuits the system. Others need to focus on a scary thought during a period when it is okay to do so, and allow the body to respond as much as it wants to...until it's not afraid anymore.

Some time in your room visualizing a bear coming at you while flying coach on Southwest might have the effect of decreasing your panic the next time you start to have bear-related fear thoughts. While it might be temporarily uncomfortable, at least it’s better than the dentist. 

 

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Citations
  1. http://www.ncbi.nlm.nih.gov/pubmed/22170756
  2. http://www.ncbi.nlm.nih.gov/pubmed/12914812
  3. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1483905/#!po=81.0345
  4. http://www.ncbi.nlm.nih.gov/pubmed/9549608
  5. http://www.ncbi.nlm.nih.gov/pubmed/18310736
  6. http://www.ncbi.nlm.nih.gov/pubmed/16859413
  7. http://www.amazon.com/When-Panic-Attacks-Drug-Free-Anxiety/dp/076792083X
  8. http://www.amazon.com/Mindfulness-Solution-Everyday-Practices-Problems/dp/1606232940/



Topic-Relevant Resources

The Mindfulness Solution
Meditative and cognitive techniques for everyday use

When Panic Attacks
Detailed overview of cognitive behavioral techniques for changing negative thought patterns

Brain Lock: Free Yourself from Obsessive-Compulsive Behavior
Useful information and tools for addressing obsessive or scary thoughts and the behaviors that go with them.

The PTSD Workbook: Simple, Effective Techniques for Overcoming Traumatic Stress Symptoms
A useful tool in exploring personal trauma, with an emphasis on healing.

From Panic to Power: Proven Techniques to Calm Your Anxieties, Conquer Your Fears, and Put You in Control of Your Life
Techniques for reducing anxiety and living a happier, healthier life.



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