How To Deal With Intrusive Thoughts: Cognitive Behavioral Therapy and "What If?" Thinking

Monday, January 19, 2015 by Meg   •   Filed under Treatment Techniques

What-if thinking is an exercise described in detail by Dr. David Burns in When Panic Attacks1. For those who suffer with anxiety or panic attacks, this exercise can be immensely helpful with getting to the root of a scary thought pattern.  

I know, it sounds very Freudian, but I promise we won’t blame it all on your mother or sexual attraction to your father.

Freudian slip = when you say one thing but mean a mother…I mean another!! 

Why Getting To The Root of a Problem Matters

The underlying meaning to these patterns is sometimes important because there may be a deeper-rooted fear for certain negative thoughts. While someone with an overactive nervous system may feel anxious about all kinds of different things, someone with a deeper fear may have it manifest in a series of thoughts that are seemingly related, but not obvious in their root. If you can change that original underlying thought--which may be closer to a belief--you can avoid other thoughts cropping up later.

The what-if technique is essentially a list where you follow your train of thought to the worst case scenario. You begin by assuming that the negative thought you are having is true with a focus on what this would mean to you and your vision of yourself. 

Here's what you do:

  1. Identify what thought is causing you the most discomfort.
  2. Ask yourself, "What if that thought were true?" 
  3. Repeat.  

Say the thought that keeps coming up is, "I married the wrong person". There may also be a cluster of thoughts, such as, "I married the wrong person," "He doesn't really love me,” "He's going to leave me,” or “I shouldn’t be married.” In this case, just decide which one is most prominent.

Now, most people think that they married the wrong person at some point (I mean how long is he really going to let the freaking  garbage just SIT there), but once it becomes a scary thought, it isn't about irritation at mundane things. It is about fear.

For exercises like this, you need to first ensure that the thought does not have merit. If you have an abusive spouse, a partner who cheats on you or there are other circumstances that lead you to think the thought is actually true, consider your options, possibly using the cost benefit analysis. Changing your thought pattern won't make you happier or healthier if the problem is factual and ongoing. 

If you’re married to Rush Limbaugh for example, I would run for the hills. No wonder you’re nervous. “This is my life? This guy? I’ve already destroyed three radios! Our budget can’t afford more!”

Let's pretend for this scenario, that there are no factors to make you think it might be true. Your partner works hard, you care for each other, and you have a generally healthy relationship. Even your sex life doesn't totally suck, though even healthy, happy couples go through periods of total sexual suckiness (More here in Sexual Frustration and Happiness and What Penis Size Can Teach Us About Monogamy).

Let's check out a thought that can be examined for cause.

Cognitive Behavioral Therapy Exercises: The What-If Technique

Choose your thought and start a thread of questions, answering each as you go. 

  1. Your thought: “I married the wrong person.”
  2. “What does that mean?”  
  3. “If that thought is true, I will never be happy with him.” 
  4. “So what?” 
  5. “If I won't be happy, I have to leave him.” 
  6. “So what?” 
  7. “Then, I would be a single mother and no one else would ever want me.”
  8. “So what?” 
  9. “If that happens, I would be alone forever.”
  10. “And…"
  11. “I'd be worthless.”

This scenario is familiar to many counselors as lowered self esteem and relationship insecurity tend to be common themes in treatment. In the above scenario, this worthlessness is something that could be attacked directly, either through identifying why the sense of self is wrapped up in couple-dom, or by figuring out if the worthlessness may be a factor of modeling, such as a parent who had no self-worth except as dictated by their spouse. 

Let’s do another one. 

Say you have cluster of thoughts that includes, “I’m a terrible mother.” Does this have merit? Not usually. Do you kids run away from you when they get injured or do they run towards you for comfort? Do they avoid you at all costs or do they seek you out in the bathroom?  If the answer is the latter in these cases, you’re less likely to be a super crappy parent in reality. So let’s break down that thought.   

  1. “I’m a terrible mother.”
  2. “So?”“I have made so many mistakes that I am sure I have damaged my kids in some way.” 
  3. “So what?”
  4. “I hurt the people I love the most.  What kind of a person does that?”
  5. “Say you did hurt them. What does that mean to you now?” 
  6. “If they grow up with issues it’s all my fault. I don’t want them to suffer like I did.” 
  7. “And what if they do?”
  8. “They’ll be miserable. They’ll blame me like I blame my mom.” 
  9. “And?”
  10. “They’ll hate me!”
  11. “And?” 
  12. “I’ll end up alone, abandoned.” 
  13. “So?” 
  14. “Being without my kids later in life would be…horrible. I don’t want to die alone.”

Okay, so I lied about the mother blaming. I hate it when Freud sneaks in there all stealthy like a child after the last chocolate chip cookie. 

While these are not the only possible scenarios or causes for that particular thought in this context, the exercise is one that can be followed by individuals in order to see if there is a deep-rooted fear below a scary thought. Even thoughts like “I’m going to go crazy” can often be followed to a deeper fear of social embarrassment and loneliness.

Once an underlying cause is identified, people are more aware of what exactly they need to be attacking with cognitive behavioral techniques. For some, simply identifying the root allows them to let the other thoughts go, as they can now attribute them to their cause. Exercises like the motherhood example might also help people identify where their own issues stem from, as we tend to be most worried about things that happened to us in our pasts. If you have a fractured attachment with your parents, you are more likely to see signs of this in your own kids, not because it’s true, but because you will look harder for it. 

Another Take on What If

According to Lucinda Basset in From Panic To Power, you can also try to replace the what-if thought with one that is more positive. Instead of, "What if I'm not supposed to be married," try, "What if I am supposed to be married and we end up living a happy life together?" Instead of, "What if I'm a terrible parent," try, "What if I'm not a bad mom? What if my kids actually love me?"

It's like a combination of thought replacement and the what-if technique. Once you determine what those scary thoughts represent to you, it might be worth trying in order to attack the thoughts you no longer have use for.  

Motherhood, and intimate partnerships, are tricky games where guilt is a major player in doing it right. Our hormones adjust to ensure that we are as close to perfection as we can possibly be, with guilt as a reliable byproduct regardless of how awesome we are. 

Guilt is a great motivator, but it feels pretty crappy sometimes. If only mother nature had thought that shit though.  

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Topic-Relevant Resources

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.

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.

Mindsight: The New Science of Personal Transformation
New techniques for mindfully altering the wiring of your own brain, leading to increased happiness.

The Mindfulness Solution
Meditative and cognitive techniques for everyday use