Yucky Thoughts and What to Do about Them

On long car rides when I was growing up, I would ride with my older brother in the back seat of our four-door sedan. My brother would invariably get bored and look for ways to bother me. One of his most effective tactics was slowly putting his index finger really close to my eye over and over again without touching me. I found this extremely difficult to ignore.

I would predictably get upset by this and yell to my parents, “Mom! Dad! Brad is bothering me!” And my brother, in his genius, would always have the same response: “I haven’t even touched her!” He had figured out a perfect way to drive me up the wall, and I had a hard time not letting it get to me. As an adult, I know that if I had just ignored him, he would have lost interest and gone back to his comic book, but by giving into his bullying, I gave him the power and value he wanted.

So why am I recounting this story from my childhood?

I often think of this memory when it comes to what are known as intrusive thoughts. An intrusive thought is an unwanted, unpleasant thought or image that pops into your mind, usually when you least expect it. Intrusive thoughts can come in the form of sexual, violent, or harmful thoughts, or they can be neutral, repetitive, meaningless, or annoying. They can be thoughts about getting sick, offending God, harming someone or yourself, wondering whether your partner is right for you or whether you love them, or any number of other upsetting themes that, if interpreted incorrectly, can interfere with who we believe we are and how we think we’ll behave.

We all have intrusive thoughts from time to time, and if we don’t know how to manage them, they can increase our anxiety and become more bothersome. For some people, these thoughts become so distressing that they develop into obsessive-compulsive disorder (OCD), a condition where intrusive thoughts occur frequently and feel impossible to dismiss.

Understanding why intrusive thoughts feel so powerful

Intrusive thoughts are just like my brother’s finger close to my eye, begging for my attention. When I responded to him and gave him my attention, his behavior got worse and more annoying. Similarly, the more attention you give intrusive thoughts by trying to push them away or worrying about them, the more power they’ll have in your life.

If you think, “Oh, that’s an odd thought” and move on without concern, knowing we all get weird thoughts, you’ll be fine. It’s when you start to delve into the thought as though it means something about you that you’re likely to fight it, give it power, and find it popping into your head more and more.

These thoughts might feel important, but in reality, they are just thoughts. The key distinction is that intrusive thoughts in OCD represent a signal error in the brain, not a reflection of your character or true desires. Many people who struggle with intrusive thoughts believe the thoughts say something meaningful about who they are or what they might do. This couldn’t be further from the truth.

In people with OCD, intrusive thoughts often feel significant because of a cognitive phenomenon called thought-action fusion, where having a thought feels morally equivalent to acting on it or as though the thought itself could make something bad happen. A comprehensive review of research on OCD published in Frontiers in Psychiatry explains that this belief, while common in OCD, is inaccurate. The content of intrusive thoughts has no predictive value for actual behavior.

The difference between normal intrusive thoughts and OCD

Everyone experiences intrusive thoughts occasionally. You might have a fleeting thought about swerving into oncoming traffic while driving, pushing someone off a platform, or saying something inappropriate in a quiet room. These are normal and don’t indicate anything concerning about your mental health or character.

The difference with OCD is not the presence of these thoughts, but how you respond to them. People without OCD typically dismiss these thoughts quickly without distress. People with OCD, however, become stuck in a cycle of responding to these thoughts as if they’re dangerous or meaningful.

This cycle typically looks like:

• An intrusive thought appears
• You interpret the thought as significant or threatening
• You feel intense anxiety or distress
• You engage in mental or physical behaviors to neutralize the thought or ensure it won’t come true
• The relief is temporary, and the thought returns stronger

OCD intrusive thoughts counseling focuses on breaking this cycle by changing how you relate to these thoughts. Rather than trying to eliminate them (which paradoxically makes them stronger), therapy helps you learn to coexist with unwanted thoughts without giving them significance or power.

Common themes of intrusive thoughts

Intrusive thoughts can center on virtually any topic, but certain themes are particularly common:

• Harm-related thoughts might involve fears of accidentally or intentionally hurting someone you love, thoughts about violence, or worries about being responsible for something terrible happening.
• Sexual intrusive thoughts can include unwanted sexual images, fears about your sexual orientation, or disturbing thoughts about inappropriate sexual behavior.
• Religious or moral intrusive thoughts (sometimes called scrupulosity) involve excessive worry about offending God, committing sins, or not being moral enough.
• Contamination thoughts focus on germs, illness, or being dirty, often leading to excessive washing or avoidance behaviors.
• Relationship intrusive thoughts involve constant questioning about whether you love your partner, whether they’re “the one,” or noticing “flaws” that make you question the relationship.
• Existential intrusive thoughts center on questions about reality, consciousness, or the meaning of existence in ways that create intense anxiety rather than philosophical curiosity.

It’s worth emphasizing that having these thoughts does not mean you want to act on them or that you’re a bad person. The distress you feel about these thoughts is actually evidence that they go against your values. People who would actually want to harm others, for example, don’t experience anxiety about having thoughts of harm.

Why fighting intrusive thoughts makes them worse

When you have an intrusive thought, your natural instinct might be to push it away, distract yourself, or try to prove to yourself that the thought isn’t true. These responses are completely understandable, but they actually reinforce the problem.

Here’s what happens neurologically: when you respond to a thought with fear or resistance, your brain tags that thought as important and threatening. Your brain’s job is to keep you safe, so once something is flagged as dangerous, your brain will keep bringing it to your attention to make sure you’re dealing with the “threat.” This is why the harder you try not to think about something, the more it appears in your mind.

Remember my brother’s annoying finger trick from the car? The more I reacted and gave it attention, the more he did it. If I had simply ignored him, he would have gotten bored and stopped. Intrusive thoughts work exactly the same way. When you fight them, analyze them, or try to push them away, you’re essentially giving them the reaction they’re seeking. Trying to suppress or avoid them paradoxically increases their frequency and intensity.

Additionally, when you engage in behaviors to neutralize or check these thoughts (mentally reviewing whether you might have done something wrong, seeking reassurance from others, avoiding situations that trigger the thoughts), you’re teaching your brain that these thoughts are indeed dangerous and that you need these behaviors to stay safe. This strengthens the OCD cycle.

What to do when intrusive thoughts appear

When intrusive thoughts pop up, you can notice that you had that thought and let it go. Don’t engage with it, try to get rid of it, or try to figure out what its presence means about you. You could say, “OK, fine, moving on now” and then re-engage in what you are doing. Remember, the less energy and focus you give an intrusive thought, the better. When you simply notice and accept these thoughts and move forward, you are telling the thought that it has no value in your life.

Here are some specific strategies:

• Label it accurately. When an intrusive thought appears, you might say to yourself, “That’s just an intrusive thought” or “There’s that OCD trying to get my attention again.” This creates distance between you and the thought and reminds you that it’s not meaningful.
• Practice acceptance instead of resistance. Rather than pushing the thought away, you can acknowledge its presence without judgment: “I’m having the thought that X might happen. That’s uncomfortable, but I don’t need to do anything about it.”
• Sit with the discomfort. The anxiety that accompanies intrusive thoughts typically peaks and then decreases on its own if you don’t engage in compulsive behaviors. Learning to tolerate this temporary discomfort is key to breaking the cycle.
• Refocus on what matters. After noticing the thought and choosing not to engage with it, redirect your attention to what you were doing or to something aligned with your values. This isn’t distraction (which is another form of avoidance), but rather a conscious choice to invest your energy in what matters rather than in the intrusive thought.
• Use humor when appropriate. Some people find it helpful to imagine their OCD as a ridiculous character or to respond to intrusive thoughts with exaggeration: “Oh yes, brain, that’s a totally reasonable thing to worry about. What else you got?” This can help reduce the thought’s power.

How ERP therapy helps with intrusive thoughts

For people whose intrusive thoughts have developed into OCD or are causing significant distress, professional treatment is highly effective. The gold standard treatment for OCD is Exposure and Response Prevention (ERP) therapy.

ERP therapy for intrusive thoughts works by gradually and systematically exposing you to the thoughts, images, or situations that trigger anxiety while preventing the compulsive behaviors you typically use to reduce that anxiety. This might sound counterintuitive or even scary, but it’s remarkably effective because it teaches your brain that these thoughts aren’t actually dangerous and that you don’t need to engage in compulsions to stay safe.

ERP therapy for intrusive thoughts involves working with a trained therapist to create a hierarchy of feared thoughts or situations, starting with those that cause moderate anxiety and gradually working up to more challenging ones. You’ll practice experiencing these thoughts without responding to them compulsively, which allows your anxiety to naturally decrease over time.

For example, someone with harm-related intrusive thoughts might start by writing out the thought they fear, then progress to sitting with the thought without seeking reassurance or mentally reviewing whether they would actually do such a thing. Over time, the thought loses its power because the brain learns through repeated experience that nothing bad happens when you don’t engage in compulsions.

Research demonstrates that ERP produces significant improvements in OCD symptoms for the majority of people who complete treatment, with benefits that last long after therapy ends. A comprehensive review published in the Indian Journal of Psychiatry found that approximately two-thirds of patients who received ERP experienced meaningful improvement in symptoms, with research indicating these gains are maintained for up to two years following treatment.

When intrusive thoughts require professional help

You have a choice in how you respond to intrusive thoughts. We have thoughts all day long about all kinds of things, and having a thought we like less than other thoughts doesn’t mean anything about us and also doesn’t mean we will act on the thought. When you have an intrusive thought, your response to that thought will determine whether you are deciding it is important or not.

Intrusive thoughts are not bothersome to some and are mildly annoying to others. And to some, they are enormously distressing and upsetting. If you are having intrusive thoughts that are increasing your anxiety or interfering with your daily life, OCD intrusive thoughts counseling can be extremely helpful.

Consider seeking professional support if:

• Intrusive thoughts are occurring frequently throughout the day
• You’re spending significant time trying to neutralize or counteract the thoughts
• You’re avoiding people, places, or activities because of intrusive thoughts
• The thoughts are interfering with work, relationships, or daily functioning
• You’re engaging in time-consuming rituals or compulsions in response to the thoughts
• You feel depressed or hopeless because of the thoughts
• You’re having difficulty distinguishing between thoughts that require attention and those that don’t

At Life Counseling Institute in both Willowbrook and Park Ridge, our therapists are trained in evidence-based approaches for treating OCD and intrusive thoughts. Counseling can help you view these thoughts as normal but not terribly important and help you find different strategies for responding to them effectively.

Building a different relationship with your thoughts

The goal of treatment isn’t to eliminate intrusive thoughts entirely. That’s neither possible nor necessary. Instead, the goal is to change your relationship with these thoughts so they no longer control your behavior or cause significant distress.

This means learning to see thoughts as mental events that come and go, rather than as facts that require action or as reflections of who you are. When you can observe a thought without fusing with it (believing it’s true or meaningful), you free yourself from the need to respond to every uncomfortable thought that enters your mind.

Many people find that as they practice responding differently to intrusive thoughts, the thoughts naturally decrease in frequency and intensity. This happens not because you’re trying to make them go away, but because your brain learns they’re not important enough to keep bringing to your attention.

More importantly, even when intrusive thoughts do occur, they no longer derail your day or prevent you from living according to your values. You can have the thought and still do what matters to you. This is true freedom from intrusive thoughts.

Frequently Asked Questions About Therapy for Intrusive Thoughts

Q: Are intrusive thoughts a sign that I’m a bad person or that I might act on them?

A: Absolutely not. Intrusive thoughts are not a reflection of your character, desires, or future behavior. In fact, the distress you feel about these thoughts indicates they go against your values. People who would actually want to harm others or engage in inappropriate behavior don’t experience anxiety about having thoughts related to these actions. The thoughts feel so disturbing precisely because they conflict with who you are.

Everyone has unwanted thoughts sometimes; what differs is how much significance you attach to them. Research consistently shows that the content of intrusive thoughts has no predictive value for behavior. These thoughts are more like mental spam or background noise than meaningful messages about who you are or what you might do.

Q: How is OCD different from just being a worrier or having anxiety?

A: While OCD and generalized anxiety can share some features, they’re distinct conditions. Generalized anxiety typically involves excessive worry about real-life concerns (finances, health, relationships) even if the worry is out of proportion to the actual likelihood or impact of these concerns. OCD, on the other hand, involves intrusive thoughts that feel nonsensical or out of character, followed by compulsive behaviors (mental or physical) aimed at neutralizing the anxiety or preventing feared outcomes.

People with OCD often recognize their thoughts are irrational but feel unable to dismiss them without performing compulsions. If you find yourself caught in cycles of intrusive thought followed by ritual behavior, feeling temporary relief, then experiencing the thought again, this pattern is more characteristic of OCD than general anxiety. A mental health professional can provide an accurate diagnosis and recommend appropriate treatment.

Q: I’ve had intrusive thoughts for years. Can ERP therapy still help me?

A: Yes, ERP therapy can be highly effective regardless of how long you’ve been experiencing intrusive thoughts or OCD symptoms. While it’s true that seeking treatment earlier can prevent the patterns from becoming deeply entrenched, research shows that ERP produces significant improvements even for people who have lived with OCD for decades. The brain remains capable of learning new patterns throughout life.

During ERP, you’ll essentially be retraining your brain’s response to intrusive thoughts and the situations that trigger them. Many people who have struggled for years report that they wish they had known about ERP sooner, but they’re grateful to finally have relief regardless of how long they waited to seek treatment. The most important factor in success isn’t how long you’ve had symptoms, but your willingness to engage with the treatment process.

Q: What if my intrusive thoughts are too disturbing or shameful to talk about with a therapist?

A: This is one of the most common concerns people have before starting OCD intrusive thoughts counseling, and it’s completely understandable. Please know that therapists who specialize in OCD have heard every type of intrusive thought imaginable. Thoughts about harm, violence, sexuality, blasphemy, or any other disturbing theme are not shocking to experienced OCD therapists. They understand these are symptoms of a disorder, not reflections of your character or secret desires.

In fact, being able to discuss your intrusive thoughts openly with a nonjudgmental professional is often one of the most relieving parts of treatment. Many people report that simply saying the thoughts out loud to someone who responds with understanding rather than horror begins to reduce the thoughts’ power. A good therapist will create a safe space where you can share these thoughts without fear of judgment, and they’ll help you understand why these particular thoughts have gotten stuck in your mind. Our Willowbrook and Park Ridge therapists are all educated to work with you in a non-judgmental way.

Q: Can I do ERP therapy on my own, or do I need a therapist?

A: While understanding the principles of ERP and practicing some elements on your own can be helpful, working with a trained therapist is strongly recommended for several reasons.

• First, a therapist can help you create an appropriate exposure hierarchy, starting with manageable challenges and gradually working up to more difficult ones. Attempting exposures that are too challenging too quickly can backfire and reinforce anxiety rather than reducing it.
• Second, a therapist can recognize when what looks like exposure is actually a subtle form of compulsion or reassurance-seeking. It’s surprisingly easy to turn exposure exercises into new rituals without realizing it.
• Third, OCD is tricky and can shift to new concerns or develop new compulsions when you start challenging old patterns. A therapist can help you recognize and address these shifts.
• Finally, having support and accountability significantly improves treatment outcomes. If you’re struggling with intrusive thoughts, investing in proper ERP therapy with a qualified professional will likely lead to better and faster results than trying to do it alone.

Q: Will medication help with intrusive thoughts, or is therapy enough?

A: Both medication and therapy can be effective for treating OCD and problematic intrusive thoughts, and for many people, a combination of both works best. Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed medications for OCD and can help reduce the frequency and intensity of intrusive thoughts and the urge to engage in compulsions.

However, medication alone typically doesn’t teach you the skills needed to respond differently to intrusive thoughts, which is why many treatment guidelines recommend combining medication with ERP therapy. Some people do well with therapy alone, while others benefit from medication to reduce symptoms enough that they can engage more effectively in therapy. The decision about whether to use medication should be made in consultation with a psychiatrist or prescribing physician who understands OCD treatment. Your therapist can also provide input about whether medication might be helpful in your particular situation, with the decision ultimately being up to you.

Q: How long does it take for ERP therapy to work?

A: Most people begin noticing improvements within the first few weeks of consistent ERP therapy, though the timeline varies based on the severity of symptoms, how long you’ve been experiencing them, and how consistently you practice. A typical course of ERP therapy involves weekly sessions for several months (often 12 to 20 sessions), though some people need more or less time.

Early in treatment, you might notice that while intrusive thoughts still occur, you feel less compelled to engage in rituals, or you’re able to resist compulsions more easily. As treatment progresses, you’ll likely find that the thoughts themselves occur less frequently and cause less distress. The skills you learn in ERP continue to benefit you long after formal treatment ends because you’ll have tools to respond effectively if intrusive thoughts increase during stressful periods. Many people find that even if thoughts occasionally return, they no longer have the same power because they know how to respond without getting caught in the OCD cycle.

You Might Also Find it Helpful to Read:

• Does Talking About Your Anxiety Help, or Hurt?
• Anxiety: Your Welcomed Guest
• Managing Your Anxiety by Becoming AWARE

 

Citations:

• Weiss, F., Schwarz, K., & Endrass, T. (2024). Exploring the relationship between context and obsessions in individuals with obsessive-compulsive disorder symptoms: A narrative review. Frontiers in Psychiatry, 15, 1353962. https://doi.org/10.3389/fpsyt.2024.1353962
• Hezel, D. M., & Simpson, H. B. (2019). Exposure and response prevention for obsessive-compulsive disorder: A review and new directions. Indian Journal of Psychiatry, 61(Suppl 1), S85-S92. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_516_18