A psychiatrist’s guide to coexisting with intrusive thoughts

On July 16, 988 will become America’s mental health hotline number. A separate, easy-to-remember crisis number can be a boon to those in distress, preventing irrevocable harm.

It's becoming increasingly clear that preventative measures for mental health can go a long way. The idea of prevention may even extend to the level of generating conscious thought. Psychologists from the Hebrew University of Jerusalem in Israel take prevention to the subconscious level in a study published July 14 in the journal PLoS Computational Biology.

In 2020, the National Institutes of Health found that 21 percent of American adults reckon with mental illness. However, the number of people who at some point confront unwanted or obsessive thoughts without psychiatric diagnosis is even higher. Intrusive thoughts can often produce a feedback loop of fear and anxiety. If most people at some point will meet an intrusive thought, then knowing how to respond to it is a crucial life skill.

Science in action — This small study examined how 80 people made word associations. Everyone read words on a screen and then typed an associated word. However, one group was discouraged from repeating associations, so they had to let go of words they’d previously chosen.

The researchers tracked how long it took for participants to come up with associated words and how well they created novel associations. In a relatively new approach, they used computational models to show how participants sidestepped repeated words.

The question is whether it's possible to control our thoughts in a proactive manner, without them coming to mind — and whether we actually do it all the time without knowing it.

The model showed that most people used a method called reactive control. They would think of a repeated association and then choose to reject it. However, the researchers note that while brains seek to reject this association, they unintentionally reinforce them by bringing it to mind before rejecting it.

“The reactive replacing model is, by definition, not very efficient,” psychologist Isaac Fradkin, the study’s first author, tells Inverse. “If you have a very distressing thought, and you have to think it in order to reject or replace it, some of the damage has already been done.” Even if one rejects an involuntary association, the distressing thought already flitted through.

The question is whether it's possible to control our thoughts in a proactive manner, without them coming to mind — and whether we actually do it all the time without knowing it.

On the other hand, those with shorter reaction times appeared to preempt this process. That is, they could lose the association without having to think about it.

“The question is whether it’s possible to control our thoughts in a proactive manner, without them coming to mind,” Fradkin continues. He also questions whether subconsciously our brains are always tangoing with these associations. Granted, spontaneous word associations are one thing, and trauma is another.

This research isn’t coming to a clinical setting just yet, but it’s a strong starting point according to psychiatrist and medical director Reilly Kayser at Columbia University’s Center for OCD and Related Disorders; he was not involved in the current study.

“I think the overarching theme is asking the question, ‘To what extent do we have control over our own thoughts?’ And if we do have some control, what does that control look like?” Kayser tells Inverse.

Why it’s a hack — While Fradkin’s research is in early, important stages, it speaks to the importance of addressing rumination and intrusive or obsessive thoughts.

There’s a distinction between those terms. Kayser says rumination, while it can be intrusive and unwanted, may come from a need to think through what’s seen as a problem. He uses the example of a party-goer who says something embarrassing, and can’t stop thinking about that instant for hours and days after, replaying what could’ve been different. He says that these thoughts are largely driven by the thinker, even if the thinker doesn’t want to be returning to them.

Kayser underscores that everyone, regardless of whether they have a psychiatric condition, experiences obsessive and intrusive thoughts. So, everyone could benefit from a coping mechanism when they come around. When treating OCD patients with hoards of intrusive thoughts, Kayser refers to one particular visualization.

“We encourage people to think of these intrusive thoughts as strangers at a party who drift into a room that you might happen to be in, you might engage with them for a little bit, but then eventually, they wander out the other door, and you may not really spend too much time engaging with them,” he says.

Preempting unwanted associations isn’t a conscious cognitive exercise, but Fradkin says the insight should inspire hope. “I find this idea that our brain has some unconscious mechanisms that try to filter unwanted thoughts hopeful and optimistic,” he says. It’s not entirely up to us to break an association, and our subconscious mind is working at it too.

How it affects longevity — Mental wellness is as important to longevity and life quality as physical wellness. Rumination and intrusive thoughts, if left untreated, can affect one’s relationships, ability to work, and basic functioning.

“Whether or not it's in the context of a disorder ... when intrusive, unwanted thoughts and obsessions get to the point where they’re interfering in your daily life, it really does impact someone’s quality of life,” Kayser says.

“Regardless of what people are dealing with, it’s usually easiest to do this with someone else helping,” Kayser says. Some comprehensive places he recommends where people can find help include the International OCD Foundation and the Anxiety and Depression Association of America.

Hack score — 🧠💭🧠💭🧠💭 (6/10 brains nonjudgmentally recognizing a distressing thought until it passes)