What to Do When Your Client Suffers from Intrusive Thoughts that Cause Anxiety, Shame, Embarrassment, or Depression

By Martin Seif, PhD

Sometimes clients remain stuck on repetitive thoughts that cause them distress, even after you have analyzed the issue, given reassurance, helped with rational refutation, and offered a host of other techniques. These unwanted intrusive thoughts gain energy from paying too much attention to the content of the distressing thoughts, and not enough to the process by which they are maintained. Coping skills can actually work backwards by serving as covert compulsions, reinforcing the intrusion, and making the thought stickier and stronger. The key is to allow stuck thoughts without responding in traditional ways. Analysis, asking, “why it is happening now?” reassurance, anxiety management techniques, distractions, coping methods, lifestyle changes, breathing, or positive self-thoughts sometimes reinforce intrusions in the long run.

Instead, explain to the client that unwanted intrusive thoughts are reinforced by engaging with their content, which is actually a subtle form of fighting the thought. Instead of offering coping techniques, show that the quickest and most supportive route to achieving relief is by acknowledging their existence without responding to the message. We call this “disentangling from content.”

The following are some phrases you can use to teach clients how to disentangle from content.

• That’s a thought—a scary thought—but just a thought nonetheless.
• Yes, darned if you can’t know that for sure.
• Any thought can be tolerated—even that one.
• Nothing is certain, so our job is to allow the thought without fighting it.
• I can think of something worse…(!)
• Remember that arguing with a thought increases its strength.
• Change “what if” to “what is”: pivot your attention to what you hear, see, and smell right now in the moment.

This disentanglement allows clients to stop engaging with intrusive thoughts, and leads to relief from the distress they cause.

Martin N. Seif, PhD, cofounded the Anxiety and Depression Association of America, and was a member of its board of directors from 1977 through 1991. Seif is associate director of The Anxiety and Phobia Treatment Center at White Plains Hospital, faculty member at New York-Presbyterian Hospital, and is board certified in cognitive behavioral psychology from the American Board of Professional Psychology. He maintains a private practice in New York, NY, and Greenwich, CT, and is coauthor of What Every Therapist Needs to Know About Anxiety Disorders and Overcoming Unwanted Intrusive Thoughts.