Intrusive Thoughts Are Normal

About this resource

Rachman and de Silva's 1978 study found that the intrusive thoughts reported by people without any clinical diagnosis were, in content, essentially indistinguishable from the obsessions of people with OCD: thoughts of harming loved ones, sexual intrusions, blasphemous images, impulses to shout or jump. Subsequent research has replicated this across cultures, with well over ninety percent of non-clinical participants reporting such intrusions. What differs in OCD and in anxiety is not the presence or content of intrusions but their frequency, the distress they cause, and above all the meaning attached to them. Normalising intrusions is therefore a foundational intervention: it removes the premise on which the catastrophic appraisal rests.

This handout presents that research in accessible terms, lists common intrusions reported by ordinary people so that the client can recognise their own, explains why the mind generates intrusive material (a threat-detection system scanning for the worst case), and describes the thought-suppression paradox demonstrated by Wegner: trying not to think about something increases its frequency. It closes by drawing the distinction between having a thought and endorsing it, and with a brief reflection section.

Use early with clients presenting with OCD, health anxiety, postpartum intrusions or generalized anxiety who are frightened or ashamed of the content of their thoughts. The professional version adds guidance on delivering the normalising message without it becoming a reassurance ritual, on using the therapist's own disclosure of ordinary intrusions judiciously, and on the small number of cases where content requires risk assessment rather than normalisation.

How to use it

1. Use once the client has disclosed at least one intrusion that troubles them. Many clients will not volunteer the most shameful content until they hear that it is common, so read the list of examples aloud and watch for recognition.
2. Present the research plainly: the same thoughts occur in people without OCD. Avoid saying 'so there is nothing to worry about', which is reassurance. Say instead that the thought is not the problem; the meaning is.
3. Run the white bear demonstration in session: ask the client not to think about a white bear for one minute and count how often it appears. Link this to their own efforts at suppression.
4. Complete the reflection section. The key question is: If this thought is normal noise, what does that change about what you need to do when it comes?
5. Follow with the Understanding OCD handout, or with exposure to the thought itself where appropriate.

References

• Rachman, S., & de Silva, P. (1978). Abnormal and normal obsessions. Behaviour Research and Therapy, 16(4), 233-248.
• Radomsky, A. S., Alcolado, G. M., Abramowitz, J. S., et al. (2014). Part 1: You can run but you can't hide: Intrusive thoughts on six continents. Journal of Obsessive-Compulsive and Related Disorders, 3(3), 269-279.
• Wegner, D. M., Schneider, D. J., Carter, S. R., & White, T. L. (1987). Paradoxical effects of thought suppression. Journal of Personality and Social Psychology, 53(1), 5-13.
• Rachman, S. (1997). A cognitive theory of obsessions. Behaviour Research and Therapy, 35(9), 793-802.