Controlling Intrusive Thoughts – Suppress, Repress, or Accept?by Carla Clark, PhD | August 9, 2015
The minds of those with mental health problems, as well as those without, can often be invaded by unwanted intrusive thoughts on a daily basis. Finding the best strategy for when a nasty intrusive thought comes to mind is a challenge many of us share, and for some of us it can ultimately make the difference between happiness and despair.
Suppression of intrusive thoughts
Quite simply, as defined in a recent review paper:
“Thought suppression is a conscious process whereby an individual attempts not to think about something… Acts of thought suppression are, by definition, conscious and volitional attempts to push a thought from one’s mind”
With this in mind, try not to think about the grime under your toilet seat. Haha, gross but gotcha! It’s near impossible NOT to think about it—YUK! This is the problem with attempting to prevent thoughts. Both experience and research are in agreement that suppressed thoughts can rebound. By trying to suppress intrusive thoughts, you can actually end up thinking about it more rather than less.
In fact, research has gone so far as to say that suppression of intrusive thoughts can actually lead to them being hyperaccessible. This hyperaccessibility, in turn, makes any stimuli related to the thought hypersalient. Basically, like the word toilet, anything related to the poorly suppressed thought becomes more noticeable. The final nail in the coffin is that these heightened intrusive thoughts and their triggers make it even harder to control related unwanted behaviors.
This is not good news for those with mental health problems, like obsessive compulsive disorder (OCD), depression, anxiety, or addiction. For example, while almost all addicted smokers wishing to quit report attempting to suppress thoughts of smoking, multiple studies suggest this suppression actually increases thoughts of smoking, cravings, and the act of smoking itself. Moreover, successful quitters were shown to use less thought suppression in day-to-day life than failed quitters.
Considering the sadly predictable aftermath of thought suppression’s rebound effect, it’s no surprise that people who frequently suppress thoughts are at higher risk of developing a wide range of psychopathologies. Thought suppression is certainly not a prime example of the easiest answer to a problem being the best one—it’s an awful solution! If you want to manage intrusive thoughts, don’t bother with actively trying to suppress your thoughts!
Repressive coping with intrusive thoughts
Wait, you might be thinking, I’m quite good at not thinking about stuff if I don’t want to. Well, you may be a “natural suppressor”, otherwise known as a repressor. Rather than actively trying to (and likely counterproductively) stop thinking a thought, repressors also intentionally avoid the negative intrusive thought. This often involves distracting attention elsewhere, and if need be, enhancing positive moods, thereby dampening the thought suppression rebound effect.
Here’s what the authors of the review paper had to say:
“In general terms, repressive coping seems to be an effective short term strategy for exercising control over negative or threatening thoughts, though the longer term consequences of repressive coping do not seem to be adaptive, being associated with increased mortality and poorer health outcomes amongst various cohorts.”
The example given in the paper is that of heart attack patients receiving a psychological stress intervention. Poorer health was found for patients using repressive coping strategies than anxious patients, presumably because their problem-avoiding strategies were foiled by the inherently problem-focused nature of the intervention.
Moreover, this is likely related to reports of repressor’s having superior self-deception abilities, involving unrealistic optimism and overly positive self-evaluation. This is reflected well in a study that showed that objective, physiological signs of anxiety measured in the lab (like heart rate and muscle tension) are out of touch with how anxious repressors subjectively feel.
Mindful management of intrusive thoughts
So how can we stop thinking certain intrusive thoughts without trying to stop thinking about them? One answer is mindfulness.
Mindfulness, i.e., non-judgemental present moment awareness—by definition and as proven through experimentation—is negatively correlated with thought suppression. In fact, the success of mindfulness practices in managing and reducing the occurrence of intrusive thoughts is partially mediated by inhibiting thought suppression. The goal is not to suppress or repress these unwanted thoughts as they arise, but to accept their place in your mind and make no effort to control, analyze or change them.
This is a lovely example of how the least obvious answer to a problem is sometimes the best one. For example, when comparing the mindful management of intrusive smoking thoughts to thought suppression, only mindfulness had beneficial effects on nicotine dependence and emotional functioning over the course of the study.
Mindfulness trains a more effective way of dealing with and reducing intrusive thoughts, likely through enhancing executive control-related brain functions (willpower one could say). With mindfulness-based cognitive therapy (MBCT) for example, mindfulness-based acceptance and lack of judgment have been suggested to facilitate both reductions in intrusive thoughts, as well as the reframing of thoughts and changing of related behaviors. Ultimately, mindfulness creates the space for the cognitive restructuring of how we think and behave—perfect for the control of intrusive thoughts.
What can we say with confidence from scientific findings? Suppression alone is a big fat no-no; repression may provide a patch-up job allowing you to happily go about your day relatively unscathed, although may come with a catch; while mindful management of thoughts may provide the most reliable route to blasting those intrusive thoughts from mind, with no negative ramifications reported thus far.
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