How to Handle Intrusive Thoughts with CBT and DBT Skills
Intrusive thoughts are a common experience, even if they are not frequently discussed. These unexpected and unwelcome thoughts can arise suddenly and disrupt your mental state. However, it is important to remember that these thoughts do not define you, and you are not alone in managing them.
We can learn to let go of these thoughts with some helpful tools from Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT). Let’s dive in.
What Are Intrusive Thoughts, Anyways?
You know those moments when you're just living your life, enjoying your day, and then bam—a thought pops into your head that makes you think, "where did that come from?" That’s an intrusive thought. They’re random, often out of character, and can be a little unsettling.
Intrusive thoughts might look like:
Fear of hurting someone: You might randomly think about accidentally hurting a loved one, even though you’d never actually do that in real life. It's like a bad plot twist in your head that has no truth to it.
Worrying you forgot something important: Maybe you keep imagining you left your door unlocked or forgot to turn off the oven—even though you checked like three times. Your brain is playing tricks on you, but it feels so real.
Inappropriate or embarrassing thoughts: Suddenly picturing yourself saying something embarrassing or totally out of place in a meeting or with friends—like, why would you ever say that? These thoughts show up uninvited and just want to steal the spotlight.
How CBT Can Help
CBT teaches us how to change our mindset and handle thoughts that don’t serve you. Here are some CBT skills that can help:
Cognitive Restructuring: When an intrusive thought arises, it can be addressed by evaluating its validity. Ask yourself, “Is this thought grounded in reality, or am I engaging in excessive worry?” By challenging these thoughts, you can begin to see them for what they are—often exaggerated or unfounded concerns. For example, if you find yourself thinking, “I may have left the door unlocked,” you can counter this with, “Did I truly leave it unlocked, or is this just a worry seeking undue attention?”
Thought Defusion: In some cases, creating distance from intrusive thoughts is key. Instead of thinking, “I am a bad person for having this thought,” you can reframe it by stating, “I am having the thought that I am a bad person.” Though subtle, this shift creates a significant change in perspective, helping you view the thought as separate from your identity and reducing its emotional impact.
How DBT Can Help
DBT is all about staying calm in the storm, which is perfect when intrusive thoughts hit you like a wrecking ball. DBT skills help you manage your emotions and ride through the rough patches without losing yourself. Some DBT skills that can help are:
Mindfulness: Imagine sitting quietly, fully present in the moment, when a thought such as “What if I make a mistake?” arises. Instead of allowing it to disrupt your experience, you acknowledge the thought without attaching to it, letting it pass like a cloud drifting across the sky. DBT’s mindfulness skills emphasize observing intrusive thoughts with non-judgmental awareness, recognizing them without allowing them to take control. By maintaining focus on your breath—calmly inhaling and exhaling—you reinforce the practice of staying grounded in the present, allowing thoughts to come and go without being consumed by them.
Distress Tolerance: When anxiety from intrusive thoughts becomes overwhelming, DBT offers distress tolerance skills to help regulate intense emotions. One effective technique is the TIPP skill, which involves several steps to quickly reduce emotional arousal. First, applying cold water to the face, similar to a brief ice bath, can activate the body’s dive reflex and promote a calming effect. Similarly, just holding ice in your hands can help to distract with physical sensation from emotional pain.
Opposite Action: Sometimes intrusive thoughts drive you to avoid situations out of fear, but in DBT, opposite action is about challenging that impulse. When you're avoiding something because you're afraid of failure or making a mistake, DBT suggests taking deliberate steps toward what you're afraid of rather than retreating. This might involve gradually exposing yourself to the situation, even when the fear feels overwhelming, like giving a presentation when you're terrified of public speaking or having a tough conversation despite the anxiety it causes. The key is to actively engage in the feared activity while noticing and tolerating the fear, showing yourself that the worst-case scenario often doesn’t happen. By practicing this, you gradually reduce the power of avoidance and fear in your life. When situations are actually safe (even if scary) and showing up to the situation is going to get you closer to your goals, DBT skills can help you acknowledge the fear but refuse to let it dictate your actions, reclaiming control over how you live.
By employing DBT and CBT strategies, you can have the tools necessary to navigate intrusive thoughts with resilience! If you’re interested in learning skills, check out our weekly group, intensive outpatient, and individual therapy offerings.