Frequently asked Questions
Q: What are intrusive thoughts, and how common are they?
A: Intrusive thoughts are characterized by being unwanted, distressing, interrupting the natural rhythm and content of normal thought processes, and are perceived as very difficult to control. They’re often ego-dystonic, meaning that they conflict with a person’s internal sense of self. For example, someone with OCD might get the thought, “What if I suddenly snap and behave violently toward myself or someone else?” Thoughts like this are generally very upsetting, as the person is horrified by the idea, and strongly values behaving in ways that don’t harm others.
Everyone experiences intrusive thoughts. However, people with OCD, anxiety, depression, PTSD, &/or other mental health concerns experience intrusive thoughts at a much higher intensity and frequency than the general population. Intrusive thoughts can be extremely distressing and even debilitating, reducing a person’s quality of life and interfering with their ability to get their basic needs met.
Q: What are compulsions?
A: Compulsions are anything we do to reduce the anxiety, shame, fear, horror, or disgust that are caused by the intrusive thought. Compulsions can be overt, like hand washing, reassurance seeking, or repeated checking behaviors. Compulsions are also frequently covert, such as when a person engages in mental rituals like scanning the environment for triggers, monitoring one’s thoughts or behaviors for mistakes or moral failings, self-doubt (disproportionate to the reality of a situation), rumination about the past, worry about the future, excessive analysis of every possible variable related to a situation, etc. Some people exclusively rely on covert mental compulsions (a type of OCD referred to as “Pure O”). Many people I work with are able to identify overt compulsions they engage in, but struggle to recognize covert compulsions. I prioritize assessing for covert compulsions, as awareness of compulsive behavior is central to reducing the suffering caused by intrusive thoughts.
Compulsions temporarily reduce distress caused by intrusive thoughts, but they ultimately fuel the OCD (or anxiety or depression, etc.) cycle, making us more vulnerable to intrusive thoughts overall.
Q: How do I make intrusive thoughts go away?
A: It is not possible to make intrusive thoughts go away entirely. What is possible is reducing their ability to “hook” us with their content ~ their power over us. Liberation is achievable through a combination of different strategies. Exposure and response prevention (ERP) allows us to slowly habituate our amygdalas to distressing thoughts through systematic desensitization to the trigger. When we avoid facing the trigger through engaging in compulsions (experiential avoidance), the amygdala learns that the thought must be dangerous, so should continue to be avoided, thus reinforcing the power of the unwanted thought. ERP helps us to rewire this pattern, progressively teaching the amygdala that it’s unnecessary to invoke a fear response related to an imagined threat. Cognitive behavioral therapy (CBT) is useful for freeing us from beliefs that are irrational or unhelpful in nature. The practice of applying a standard of reason to our thoughts and behavior using the scientific method is often necessary before ERP or other strategies can be effective. Acceptance and commitment therapy (ACT) helps us identify and commit to living by our values, unhook from unuseful thoughts, and focus our attention on what we can control rather than being impulse-driven (e.g. the analogy of getting caught in a rip tide - the solution is to swim with the current, not fight to make it straight to the shore). I have also found Internal family systems therapy (IFS) techniques to be beneficial for working with intrusive thoughts. If there are parts of us attaching to fears and irrational beliefs without our conscious awareness, this will likely impede the effectiveness of any therapeutic technique until resolved.
Intrusive thoughts resulting from PTSD are approached much differently from those with OCD, anxiety, or depression (although I apply these strategies with all of my clients to some degree). Unwanted images, sensations, and thoughts from PTSD are retraumatizing. When coaching people who have experienced trauma, I incorporate approaches primarily from neurobiologically-informed experiential therapy modalities. IFS is considered a relatively safe model because the client (including all parts of them) fully dictates the pace of the exploration. Somatic experiencing (SE) techniques such as resourcing, titration, and pendulation are extremely useful for allowing trauma to be processed in manageable increments. Accelerated experiential dynamic psychotherapy (AEDP) principles related to undoing aloneness through co-regulation are fundamental to transforming the way the nervous system is wired. Bioenergetic release of energy trapped in the body also offers the potential for profound healing experiences. In addition to utilizing these strategies, I incorporate unique approaches that I developed after seeing them be effective for myself and others. For example, many people have not been given permission to fully own their power - including their self-protective anger. I emphasize developing these capacities with all of my clients, but they are especially important when working with people with trauma histories (engaging the “fight” response).
Q: What are Body-focused repetitive behaviors (BFRBs)?
A: BFRBs include hair pulling (trichotillomania) and skin picking (excoriation). While these disorders are often considered “OCD related”, they are actually quite distinct in nature. BFRBs involve difficult-to-control impulsive behaviors, as opposed to the compulsive patterns that are associated with OCD. This means that when someone is struggling with BFRBs, such behaviors occur habitually in response to certain situations or triggers, and are reinforced by the pleasurable sensations of hair pulling or skin picking (vs. OCD, where compulsions serve the purpose of temporarily reducing distress caused by intrusive thoughts). When working with people struggling with the consequences of BFRBs, I use a function-based approach. Individual environmental and internal cues and triggers are taken into account, as well as the client’s experiences before, during, and after engaging in hair pulling or skin picking (etc). Habit reversal training is particularly useful with BFRBs, including increasing awareness around the behavior patterns, relaxation training, leveraging personal motivation for change, and implementing "competing response” strategies to more effectively manage the impulses underlying the behaviors.
Q: What is a wellness coach, and how are they different from licensed therapists?
A: Wellness coaches offer support + information to help empower clients to construct and implement a plan to work toward personalized goals. There are no degree or certification requirements to work as a coach, and no state licensing board involved that mandates things like continuing education units, supervision hours, exam requirements, and a system of accountability for clients if therapists behave unethically. Additionally, wellness coaches are not subject to HIPAA laws like licensed therapists are. Therapists are licensed mental health providers who diagnose and treat mental illnesses. In my capacity as a wellness coach, I do not diagnose &/or treat mental health disorders. I encourage you to first seek out the expertise of a licensed therapist, social worker, psychologist, or psychiatrist if you have not already received an OCD (or other) diagnosis and participated in the recommended treatment for the disorder.
My coaching services are geared toward those that have not fully resonated with the traditional avenues for overcoming intrusive thoughts. Throughout my own personal journey working to combat intrusive thoughts over many years of trying, I was not able to receive the relief I needed through utilizing the mental health system. What eventually helped me to gain freedom from intrusive thoughts was learning information and coping tools through my graduate degree program, personal exploration of the clinical literature and other sources of knowledge, and self-guided efforts to master the skills necessary for permanently conquering overwhelming intrusive thoughts. I aim to support and empower those who have similarly struggled to find full relief through the mental health system, who are motivated to supplement their wellness efforts with nontraditional coaching services from someone who has firsthand experience with independently navigating the process of overcoming intrusive thoughts.
Because of my experience working in the mental health field, I have incorporated the following practices into my work as a wellness coach: I collaborate with clients’ mental health and medical providers when necessary, and require that clients sign an informed consent form before I will consult with one of their care providers (or other members of their support team, such as family/loved ones). I store client information securely behind two locked barriers. I continue to educate myself on all things related to healing, not because I have to as a wellness coach, but because I am obsessed with psychology! For me, protecting clients’ confidentiality and ensuring compliance to other ethical practices has never been about conforming to an external regulation. I know what it’s like to be a client myself, and have always (and continue to) treat my clients the way I would want to be treated. As someone with OCD, I am diligent about maintaining ethical practices, because I recognize the harm that can be caused without due regard for people’s privacy and, frankly, human dignity.
DISCLAIMER: Wellness coaching is not intended to serve as a replacement for medical or mental health treatment. My sessions are offered as one component of your holistic plan for wellness and self-empowerment.