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Intrusive Thoughts and Images: It is Time to Take the Power Back

Updated: Jan 14


- Teresa Jacobson, DBH, LPCC-S, NCC

January 21, 2023



Intrusive thoughts and intrusive images are arguably some of the most distressing mental health symptoms experienced. Intrusive thoughts can derail even the most grounded individual.


Ranging from flashbacks of traumatic events to vivid imagery of fears, or random, vivid disruptive possible occurrences, both intrusive thoughts and images can trigger a parade of horrifying thoughts and fears.


Intrusive Thoughts & Images


Intrusive thoughts can happen to almost everyone from time to time. These are random, involuntary, and unwanted thoughts that are unexpected and can range from odd to rather distressing, existing on a continuum. Some intrusive thoughts and intrusive images may seem benign, like random doubts that "pop" into one's mind, or a visual image that is uncomfortable, but doesn't overwhelm.


Other times, both intrusive thoughts and images can be associated with anxiety, depression, trauma, grief, eating disorders, or even obsessive-compulsive disorder, where when it can become so distressing that the images or thoughts prompt repetitive behaviors or compulsions to try to stop them from continuing. "They are also common in post-traumatic stress disorder, which can be triggered by a life-threatening or extremely stressful event, such as an accident or violent attack" (Bilodeau, 2021).


Intrusive images tend to be extremely vivid causing them to feel very real and horrifying in the moment. They include visual elements and often involve other sensations. Though intrusive images are most often connected to traumatic memories, they can also be elicited from fears or seeing something horrific play out in the future.


Intrusive images can be highly distressing, repetitive, and very disruptive. "Further, they are often sensed with a 'here-and-now’ quality; that is, the individual seems to relive the experience now without the impression that the sensory features are aspects of memories from the past" (Birrer, Michael, & Munich, 2007). Both intrusive images and intrusive thoughts can be easily triggered.


If a thought is unusual, bothersome, or hard to control, it can be intrusive. "An intrusive thought is usually very different from your typical thought" (Bilodeau, 2021). A troubling thought that is uncharacteristic, violent, repetitive, and disturbing can make someone extremely anxious. Some strategies include not fighting the thoughts, but instead learning to live with them.


Another commonality intrusive thoughts and intrusive images share involves avoidance. The more you resist the thoughts or images, the more they persist.


Helpful Strategies


Self-help strategies include first acknowledging the thought and identifying it as intrusive. This can be accomplished by saying to yourself, "this is just a thought I'm having; I don't want to do what it says and it is not what I believe." Or in the case of a flashback "this is a memory from the past, but I am safe now."


You can begin to take the power back, and reduce the distress by acknowledging the thought or image for what it is. Be sure you don't judge yourself for having a thought or image that may seem "strange". If you try to push your thought or image away or ignore it, it can become even more alarming and may take more control over you.


If you become overwhelmed or if the thought or image begins to disrupt your daily life, impact your ability to work, or interrupt your ability to do things you enjoy, it is advisable to seek help. Cognitive Behavioral Therapy (CBT) is very effective in helping people with intrusive thoughts, particularly when coupled with trauma-informed neuroscience techniques.


For intrusive images, imagery rescripting is a relatively new technique that can help reverse the disruptions to life. Adverse childhood or traumatic experience often precipitate intrusive images. In these instances, intrusive images can take the form of flashbacks, dreams or nightmares. "In imagery rescripting, participants imagine different responses to and outcomes of the original event and its aftermath" (Hagenaars & Arntz, 2012). "A new script might include somebody else entering the scene and bringing safety, or the participant being in power and preventing the trauma, or taking revenge on perpetrators." The result of imagery rescripting includes a decrease in anxiety and post-traumatic stress symptoms, as well as a greater decrease in anger guilt and shame, according to research.


Imagery rescripting involves vividly constructing an alternative, more positive outcome. "Common positive images involve fantasies of overcoming aggressors, humiliating enemies, being rescued, communicating with the dead, being comforted, and being treated compassionately" (Brewin, Gregory, Lipton & Burgess, 2010). "Fantasies often include impossible elements, such as superhuman feats and supernatural beings, or impossible transformations of the physical world." Imagery rescripting is often coupled with cognitive behavioral interventions.


"Mental imagery can be used in a multitude of ways within CBT, including as an assessment tool (e.g. imaginal reliving of a situation to identify automatic thoughts), within imagery-focussed techniques such as imaginal exposure or imagery rescripting, or as an additional component within techniques for which imagery is not itself the main focus, such as problem-solving or challenging negative automatic thoughts" (Blackwell, 2021). Imagery rescripting can have a profound impact on emotions, thoughts, beliefs and behavior.


Through the lens of someone who works with a wide-variety of adults, it is clear that intrusive thoughts and intrusive images can be extremely disruptive, frightening, and impairing. They are much more common than people realize.


The more we recognize and accept what is happening in our own minds and bodies, the more we can try to take the power back from the impairing fears that disrupt our daily lives.


If things get overwhelming, just remember help can be found by talking with a professional, where no topic is judged, and hope never ends.



 

Teresa Jacobson is a Doctor of Behavioral Health and Licensed Professional Clinical Counselor Supervisor who is counseling Ohio and Kentucky adults of all ages and life experiences via secure Telehealth/Video visits. A strength-based, person-centered multi-cultural counselor, with an existential philosophy, Teresa can be reached by emailing teresa@steppingtowardserenity.org, calling (513) 206-3026, or visiting https://www.steppingtowardserenity.org


 


References


Bilodeau, K. (2021, October 1). Managing intrusive thoughts. Harvard Health Publishing, retrieved from


Birrer, E., Michael, T., and Munsch, S. (2007). Intrusive images in PTSD and in traumatised and non-

traumatized depressed patients: A cross-sectional clinical study. Behavior Research and Therapy

45, 2053-2065.


Blackwell, S.E. (2021, February 1). Mental imagery in the science and practice of cognitive behaviour

therapy: Past, present, and future initiatives. Journal of Cognitive Therapy, 14, 160-181. Retrieved


Brewin, C.R., Gregory, J.D., Lipton, M., and Burgess, N. (2010). Intrusive images in psychological

disorders: Characteristics, neural mechanisms, and treatment implications. Psychological

Review, 117(1) 210-232. Retrieved from: https://www.ucl.ac.uk/icn/sites/icn/files/brewin10.pdf


Hagenaars, M.A. and Arntz, A. (2012). Reduced intrusion development after post-trauma imagery

rescripting: an experimental study. Journal of Behavior Therapy and Experimental Psychiatry 43,

808-814. doi:10.1016/j.jbtep.2011.09.005





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