Intrusive and impulsive thoughts are two cognitive processes that often are mistaken for one another. Though their characteristics may initially seem similar, they are distinctly different. Both intrusive thoughts and impulsive thoughts can lead to impairment in day-to-day functioning. Understanding these different ways of thinking can help reduce stigma, raise awareness, discover effective coping strategies, and increase support. 

Understanding Intrusive Thoughts: What Are They? 

Intrusive thoughts are recurring unwanted and distressing thoughts, images, or impulses that suddenly enter a person’s mind against their will. It is important to highlight that intrusive thoughts feel out of character; when an intrusive thought enters the mind, a person usually feels upset or disgusted because the intrusive thought does not feel aligned with their personality, beliefs, and values. The nature of recurrent intrusive thoughts can fuel feelings of anxiety and shame.   

Common Types of Intrusive Thoughts:  
  • Harm-related (fear associated with harming yourself or others, or images of graphic violence/horrific scenes)  
  • Being responsible for causing something terrible to happen accidentally (fire, burglary, hit and run)  
  • Excessive concern about germs/contamination  
  • Sexual-related (content that involves inappropriate or unconventional behaviors or experiences)  
  • Religious (excessive concern about right/wrong/morality/blasphemy)  
  • Preoccupation with having objects orderly or symmetric 
  • Persistent doubts about sexual orientation despite having a strong sense of identity  

It is noteworthy to mention that most people have experienced intrusive thoughts at some point in their lives. As humans, our brains are vast and can conjure up the most vivid thoughts and images. The majority of people have the ability to see the intrusive thoughts as senseless and easily dismiss them and move on. However, others can have a tendency to latch on to these intrusive thoughts and become preoccupied with attaching meaning to the thoughts or spending an excessive amount of time trying to rid themselves of the thoughts and subsequent anxiety. Maladaptive behavior refers to actions that disrupt everyday life or make it difficult to adapt to certain situations. So, if maladaptive behaviors associated with intrusive thoughts are becoming excessive and affecting your daily life—such as school, work, or social activities—it might be a sign of an anxiety disorder like obsessive-compulsive disorder, a mental health condition where a person experiences reoccurring unwanted intrusive thoughts, images, urges, or sensations better known as obsessions that cause intense anxiety. To cope with this anxiety or to prevent fear from coming true, they feel compelled to engage in repetitive behaviors or mental rituals (compulsions). 

Harm OCD: Common Examples

Picture this: Haley is driving home from work and suddenly has an intrusive thought: "Is it possible that I just accidentally hit someone while they were crossing the street?" Despite knowing that the road was clear, doubt consumes her mind. In response to this intrusive thought, Haley becomes overwhelmed with anxiety. She starts to excessively check her surroundings, constantly glancing at her mirrors to ensure she hasn't hit anyone. Even after reaching home safely, the thought continues to cause her distress. Haley gets out of her car and checks her car for new dents, or paint chips. She replays the scenario in her mind, obsessing over every detail of her drive, trying to reassure herself that she didn't harm anyone. Every time Haley goes for a drive, she is riddled with anxiety about accidentally hitting someone. Despite her rational mind telling her that she didn't hit anyone, the anxiety and uncertainty linger. Haely's daily life becomes disrupted as she avoids driving or takes unnecessarily long routes to minimize the risk of encountering pedestrians. She also seeks excessive reassurance from others and repeatedly checks news reports for any accidents that might match her intrusive thoughts.     

Effective Ways to Cope with Intrusive Thoughts: 
  • Mindfulness and Nonjudgmental Stance: Practice mindfulness techniques to observe your thoughts without judgment. Mindfulness can be a helpful practice to retrain your brain to come back in contact with the present moment and decrease engagement with intrusive thoughts. Acknowledge the intrusive thoughts as a symptom of OCD rather than facts, threats or something that defines you.   
  • Thought Defusion: Try labeling intrusive thoughts i.e. “I'm having the thought that” or “My OCD is telling me” to remind yourself that they are a product of anxiety rather than reflections of reality. This can help create distance between yourself and the thoughts, reducing their impact.  
  • Self-Compassion: Dealing with frequent intrusion can be unsettling. Remember to practice self-compassion to remind yourself that intrusive thoughts are not your fault and that you're doing the best you can to manage them. Treat yourself with the same empathy and understanding you would offer to a friend in a similar situation.  
  • Seek Support: Reach out to a therapist who specializes in OCD treatment. Cognitive-behavioral therapy (CBT), particularly exposure and response prevention (ERP) therapy, has been shown to be highly effective in treating intrusive thoughts. In some cases, medication may also be prescribed.  

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Understanding Impulsive Thoughts: What They Are and How to Manage Them 

Impulsive thoughts are thoughts that may seem spontaneous, reckless, or inappropriate given the circumstance. They can lead to acting immediately without considering the consequences and are commonly associated with attention-deficit/hyperactivity disorder (ADHD) and can be a symptom of mania or borderline personality disorder (BPD). 

Common Examples of Impulsive Thoughts: 
  • An impulse to buy items unnecessarily or despite financial situation  
  • An impulse to say something inappropriate in a social setting  
  • The thought of leaving or changing job/career without much consideration or planning 
  • An impulse to abruptly leave or cheat on one's partner  

Acting on these thoughts impulsively can lead to being in risky situations, impact important role functions (work, school, interpersonal relationships), and can have a negative financial impact.  

Effective Strategies for Managing Impulsive Thoughts: 
  • Mindfulness: Building awareness of thoughts, emotions, and bodily sensations can help attune you to what impulses may arise.  Take a moment to notice your thoughts and feelings without judging them. Pause before you respond.  
  • Delay the urge/distraction: When you feel the urge to act impulsively, try using a timed distraction to shift your focus. Try setting a timer for 15-20 minutes and do something productive for your mind. For example, engage in body scan, go for a mindful walk, get in-tune with your breath, write in a journal, or practice self-reflection.  
  • Distress tolerance skills: Engaging in distress tolerance skills can help you manage strong emotions. Here are some techniques to try: 
    • Hold ice or frozen oranges (anything cold) and observe the sensations. 
    • Engage in intense exercise. 
    • Focus on your breath and practice mindful breathing. 
    • Tense and relax your muscles, one group at a time. 
    • Use guided imagery. 
    • Make a pros and cons list. 
  • Seek support: Seeking therapy, particularly cognitive-behavioral therapy (CBT) and dialectical behavior therapy (DBT), can help you develop skills for managing impulsive thoughts and behaviors. In some cases, medication may be prescribed to help manage symptoms of impulsive thoughts.  

Intrusive vs. Impulsive Thoughts: How to Tell the Difference 

Impulsive and intrusive thoughts are often confused because they can both affect your daily life in similar ways. However, they are quite different in how they show up. To help you tell them apart, look for these key signs of how fear responses and behaviors are connected. 

A person that is experiencing an intrusive thought can identify that they are afraid of acting on their intrusive thought & that the thought is something that does not suit their personality, beliefs, or values. The distress that a person experiences when they have an intrusive thought always leads to behaviors such as avoidance, seeking reassurance, overuse of distractions, sleeping/napping to avoid intrusive thoughts from occurring, engage in excessive checking/counting/mental rituals, etc. On the other hand, a person that is experiencing an impulsive thought typically has little to no distress after the thought pops into their head and will typically act on the impulse without taking time to think it through.   

Let's look at these two examples:  

Intrusive Thought: I’m in my kitchen unloading the dishwasher after dinner. Suddenly, a vivid image pops into my head, stabbing myself in the eye with a pair of scissors. My heart begins to race, and my stomach begins to feel nauseous. I start questioning why I am having this thought even though I would never harm myself. I become anxious and think that I might accidentally act on this thought. I decide to leave the kitchen and ask my husband to finish putting the dishes up.   

Impulsive Thought: I’m walking down the street and see a bookstore that I’ve been to a few times. I'm not intending to buy anything today, but I go into the bookstore anyway. I spot a book that has an intriguing cover and title. Spur of the moment, I grab it off the shelf and check out without a chance for a rational thought to proceed. When I get home, I realize that I didn’t even get the chance to consider how my busy schedule may interfere with me starting a new book, yet alone finishing the two others that I have already started and that I am already overbudget for the month.  

Notice that the first example shows a fear-based response, while the second example highlights a lack of behavioral control. 

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Effective Treatment Approaches: What You Need to Know 

Distinguishing between these two thought processes is important because the treatment approach for each is completely different. For someone who has intrusive thoughts the best-known treatment approach is engaging in exposure response prevention (ERP). ERP refers to exposing yourself to the thoughts, images, objects, urges, and situations that make you anxious and/or trigger your intrusive thoughts. The “response prevention” part of ERP refers to responding to triggers differently; making an active choice to decrease giving into safety behaviors including compulsions – this involves refraining from doing anything to avoid, reduce, or control these internal experiences. Developing a mindful attitude of willingness, acceptance, and non-avoidance to experiencing anxiety is the basis of successful treatment of anxiety disorders.  

For treating impulsive thoughts we typically recommend Dialectical Behavior Therapy (DBT) and Urge Management. Being mindful of impulsive thoughts and behavior can lead to increased awareness and increased ability to control impulses.   

1. Building Self-Awareness

A crucial first step in addressing any maladaptive behavior is to build awareness. When we have insight into our behaviors, we have the opportunity to change them in a way that will be more conducive to living life in a way that aligns with our values. Take note of what your top values are. Nonjudgmentally become aware of if your values have been compromised by the severity of impulsive or intrusive thoughts. Have you noticed that your social functioning is being impacted by how much reassurance you ask for or how much you are avoiding social situations due to your intrusive thoughts? Have you noticed that your social functioning is being impacted by your inability to think before you speak or act? If you are, focusing on building awareness will be crucial for your journey to recovery. 

 Practical Tips for Developing Self-Awareness: 
  • Keep a Self-Monitoring Log: Identify triggers, fears if applicable, and how you typically respond to the trigger. 
  • Practice Mindfulness: For example, try labeling the thinking patterns, “I'm having the thought that…” or “I'm having the urge to…” or “I’m noticing…”   
  • Keep a Ban Book: Identify a behavior that you want to work on decreasing or building awareness into, and record how much you are giving into the behavior vs resisting the behavior. 
2. Engaging Your Support Network

Your support network can play an essential role in building awareness, accepting symptoms, and seeking effective treatment. Supports can practice providing empathy and understanding without judgement or criticism. As well as reminding individuals to use a skill that will help effectively navigate a strong emotion or urge. For example, supports can try stating, “I'm noticing that you are seeking reassurance right now, are you feeling anxious about ___?”  or “I understand how strong your urges are, it might be helpful to practice progressive muscle relaxation right now.”  If you're a part of someone’s support network, you can help by encouraging them to seek professional help on their journey to feeling better. And don't forget, you can also find support for yourself through local support groups. 

Navigating Impulsive and Intrusive Thoughts: Understanding Treatment Approaches and Coping Strategies 

While impulsive and intrusive thoughts can both impact how we function, they each have unique traits and require different treatments. Impulsive thoughts involve sudden urges or desires to act without fully considering the consequences, often driven by immediate gratification. In contrast, intrusive thoughts are unwanted, distressing, and repetitive in nature. They involuntarily enter a person's mind, typically causing significant distress and anxiety.  

Understanding the differences between impulsive and intrusive thoughts is crucial for developing appropriate coping strategies and seeking effective treatment. While impulsive thoughts may benefit from interventions aimed at improving impulse control and decision-making skills, such as cognitive-behavioral therapy (CBT) and dialectical behavioral therapy (DBT), intrusive thoughts often respond well to exposure and response prevention (ERP), specifically designed for obsessive-compulsive disorder (OCD). By addressing these thoughts with evidence-based treatments tailored to their specific characteristics, individuals can learn to manage their symptoms, and realign with their values leading to an improvement in overall well-being.

Further Reading: 

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