How to deal with intrusive thoughts and anxiety

The example I always give is whenever I'm at the subway, I get this weird fear, boy, it would really suck if I just fell in to the train tracks right now. And I often get that thought as the train is coming, and it's a scary thought, and at the same time, it's not dangerous. Zach, this is Dr. Ali Mattu. Welcome to the Psych Show. Hey, how are you, man? Good, doing well, doing well. What's going on? How can I help? Yeah, a year ago, I was diagnosed with a generalized anxiety disorder, GAD, and I had a panic attack, and I went to my psychologist and started working with him. This was when I was living in Vegas. And then we worked on a lot of things, that helped, and then I started having intrusive thoughts, and he helped me with that, too. And I think it's just good to go over what intrusive thoughts are and aren't, because I think that was the biggest issue for me, because they felt so real, and I was taking them too serious. There's so many reasons why people can experience intrusive thoughts, too. It can come from depression. It can come from anxiety. It can come from obsessive compulsive disorder. So I think this is a good thing for us to talk about. So what did you learn from your experience about what is an intrusive thought and what is not? When I was talking to my psychologist, Dr. Jim Jobin, in Vegas, and I was also reading a book, too, called Stopping Unwanted Intrusive Thoughts by Sally Winston, they were just talking about what an intrusive thought is, what it is. It's intrusive. It randomly pops up into your head. It's not a fact. Even though it may scare you, that's a sign that you don't want to act on it and don't want to do it. But it was so scary to me that it did feel real. Because in the book, they were saying, if you go to a subway, most of the time, they go, oh, what if I push that guy down or something like that? And the normal person is able to just brush it off, but the other person just starts questioning, like, why would I think that? What's wrong with that? Do I really want to do that? And that's the thing you have to understand. Yeah, you know, it's funny you mentioned the subway example, because when I'm working with folks, the example I always give is, and I lived in New York for a very long time, the example I always give is, whenever I'm at the subway, I get this weird fear, boy, it would really suck if I just fell in to the train tracks right now. And I often get that thought as the train is coming. And it's a scary thought. And at the same time, it's not dangerous. And I think that's a distinction that's hard for a lot of us, especially when we're really struggling with anxiety, is your thoughts might be scary, but they're not dangerous. You are the one who's in control of what you do. You control your actions. Your thoughts don't. And then there's a lot of ways that we can learn to deal with our thoughts and how we can change the way we react to them. But there's very little we can do to control what thoughts pop up in our mind. Random thoughts will always pop up in your mind, like you were just mentioning right now. Sometimes your mind just kind of produces garbage. And when you're anxious, we know that your thoughts are going to be more focused on a threat, and it's going to increase the likelihood of that threat. You will see more threats, and the threats will feel more real and more immediate. Do you think our brains produce intrusive thoughts just to kind of keep our caveman brain intact, or just to like test reality just in case something does happen? Yeah, I mean, that gets back to emotions, right? Like, why do they exist and why are they there? Like our caveman brain, the lizard brain, whatever you want to call it, it's there to keep us alive. It's there to make sure all the basic stuff is working. If you think of your brain as like these three layers, you've got the brain stem, which is just basic life functions, like breathing and all that kind of stuff. Right on top of that is this thing called the limbic system, and that's where your basic emotions and memory are. And the more advanced stuff is outside of that. That's your frontal lobe, all the stuff that allows language and really complex stuff to happen. So, that lizard brain stuff, it's in the middle there. It's all that basic emotion stuff, basic memory stuff. When we're anxious, our mind is just trying to keep us alive. It's trying to keep us safe. It's trying to keep us healthy. The problem with intrusive thoughts is often if we're experiencing too much of that emotion for some reason, or we are really scared of the thoughts that are being produced by our mind. Other people are able to just brush it off like, oh, that was weird. That's where I want to be. What is this thing? What is that? Why am I thinking like that? Right. It's something that psychologists call metacognition. It's how you think about your thoughts. And so, sometimes like judging it, like, wait, why am I thinking this? What's wrong with me? It can cause a lot of problems. You know, sometimes there are reasons why we might be experiencing intrusive thoughts. Maybe you're struggling with a lot of guilt about something. And guilt can be a symptom of depression, but let's say you're not depressed, but you're really keep thinking about this thing that you did, and you feel really guilty about it. The intrusive thoughts might be there as a reminder of, hey, this is something that happened, and you've got to figure out a way to deal with it. Or, an intrusive thought can also be related to a major stressor that you're facing. So, if you've got a big test coming up, and you keep thinking about it, and you don't feel prepared, that intrusive thought might be working to help you to take action on that. But, I'm guessing the kind of thoughts that you were experiencing were less so about these specific things that had, where there's like a clear relationship between this happened, and now I'm experiencing this thing. What was it more like for you? When I first had my panic attack, and I didn't know it was a panic attack, I went to the hospital, did all the tests, EKG, ultrasound, blood work, it all came back normal. And then from there, I think every little sensation in my body, I started to feel my pulse constantly. Oh my God, it's 90 beats per second. I'm freaking out. And I think ever since that panic attack, it just scared the living heck out of me. And then, once I got that under control, just not freaking out over every little, you know, I would take like a little brisk walk, and I'm like, oh my God, my heart's beating worse. What if I drop dead? Am I having a heart attack? And all that. I had like health anxiety for a little bit. And then the intrusive thoughts, they were just like random self-harming thoughts that my psychologist that we went over, he was telling me, yeah, thoughts are not real. If they were, you just wish, imagine a million dollars right now and see if that happens. If that happens, then we have a lot of plans to do. That's a really great example of something I've seen with a lot of folks I work with. So, starting with the panic attack, you know, panic is really about a fear of fear sensations. It's related to anxiety about those things going on inside of you, about that heart rate, about sweating, about feeling not normal, how you usually feel, and often a worry that is this going to lead to a panic attack? So, that's really common. And the other thing you're talking about, too, is these fears of self-harm, of doing something that you might regret. You know, the common thread I'm seeing here for you, but also for a lot of folks I work with is this loss of control and this fear of losing control, either of your body or of your mind, of your thoughts. And that can be really scary. It can be really scary to feel that way. The place that it sounds like you've gotten to is a place of realizing that, you know, your body goes up and down during the day based upon what you're doing. You climb some stairs, your heart's going to be racing. Or, depending on what you eat, you might have more gas, or your stomach might grumble, or things might not sit as well. And then the more we focus on them, the worse they tend to get, or the more aware you become of all these other weird things happening in your body. That's often what happens with panic. And then these weird self-harm thoughts, you know, we all get weird thoughts like that from time to time, and it's just not in our control. That's one thing we went over when I first started going to see a therapist, is just he gave me, you know, homework to take home. What you said earlier, that meta-something, is that the same as... Metacognition. Is that the same as cognitive distortion, because that's what we were talking about, like catastrophizing. Yeah, yeah, yeah. So, the cognitive distortions, there's a whole bunch of them, like catastrophizing is a big one. Mind reading is another one, like imagining how people are thinking about you. One of my favorites is emotional reasoning, is you believe this thing is true, but it might just be because you have a very strong feeling, like you're really anxious, so you feel like, oh, this thing has to be true. Cognitive distortions are the ways in which your mind warps information because of how it's feeling. Well, that also gets at different ways we can deal with intrusive thoughts. You know, one of the things that I like to tell people is it's about getting unstuck with your thoughts. Sometimes you can do things that will help you change your thoughts. Sometimes you can't, but what all of us can do is we can get less stuck with our thoughts. Well, that means a little bit of what you're talking about is noticing the patterns and noticing how, oh yeah, I always kind of catastrophize in this situation, or I always kind of think in this way. Sometimes, that can create a little bit of distance for us and help us to get unstuck with them. Sometimes, it's more about acceptance, and acceptance is not saying like, oh, this thought is great, I'm glad I'm having it. It's not that at all. It's about letting go of that tug of war that you're having with your thoughts, like not playing the game, saying like, I'm not going to fight this thought. This is just some weird random thought that I have, and thoughts are just thoughts. Sounds like a little bit of that is actually something that helped you. It's also something that always helps me when I get that weird thought when I'm on the subway. Then another one is finding a way to cope with those thoughts, coping statements. Thoughts might be scary, but not dangerous. That's one of my favorite coping statements. Sounds like this one that your therapist helped you with, like how many times have you intentionally made plans with the goal of canceling on someone? That got you into your head about, wait, wait, what have I done in this situation? When it comes to mind reading, so many times, we're good at giving advice to other people, but we don't give ourselves that advice. I like to tell people when they're struggling with mind reading, what would you tell your friend if they came to you with this fear? Everyone thinks I'm stupid because I muffled on this part of the speech. What would you tell your friend? Most of us would say, yeah, okay. Maybe some people notice that, but if they're judging you based on that one thing, are they the kind of person you want to care about? Whatever it might be, finding a way to be able to cope with that thought, that can help. The last thing I like to tell people is, okay, let's use it. Let's try to understand why you might be dealing with this intrusive thought. Sometimes, like what I was saying before, maybe people are dealing with a lot of guilt about something that happened, and they're having these intrusive thoughts, so we need to do something about them. We might need to change a situation. I'm just making this a giant list now, but another thing is, sometimes we need exposure, and that means testing out what actually happens. This we often do with conditions like obsessive compulsive disorder, where someone might have a fear that they're going to take a knife and they're going to hurt someone. We might do an exposure where someone is actually holding a knife, and then we see what happens. We see if they can tolerate the uncertainty of that, of not knowing what they're going to do. Then, the last thing that often comes up with intrusive thoughts is finding activities that you can get absorbed into to make it a little bit easier to not pay attention to those thoughts. For example, sometimes intrusive thoughts can keep us up late at night. Are there other things we can do late at night that will really absorb our mind, help us to get nice and tired, and make it a little bit easier to fall asleep? That was a massive list, but I'm just curious what from there was resonating with you, or what didn't resonate with you. It brings me back to that book I read. There's an audio, too, on YouTube, but Sally was talking about just the thoughts. It's not a message. It's not a red flag. It's not part of your unconscious that might leap out if you're not vigilant. It's just a thought, kind of like what you just said. That's just one of the big parts of understanding it. You think of other thoughts, and this one thought is just bothering you. If it's bothering you, you clearly don't want to do it, especially if you're having a panic attack over it. There's this treatment called acceptance and commitment therapy. It's one of the newer cognitive behavioral treatments out there. I say newer, but it's been around for a while now. A lot of research has been done on it. One of my favorite things about ACT, acceptance and commitment therapy, ACT. They hate it when you call it ACT, though. They always say it's about acting. It's about living. There's that disclaimer. One of my favorite things about ACT is they have all of these metaphors and these analogies that they use to help people get unstuck with their thoughts. One of my favorite ones is passengers on the bus. Have you heard this one before? I don't think I've shared this on the channel yet, but it's basically this idea that imagine that you are driving this bus. You control the bus, and you're driving on your route. You got to get from A to Z. You stop over, and you pick up some passengers, and they get on the bus, and they sit on the bus. Some of them are loud. Some of them are supportive of you. They're saying, hey, you're doing a great job. Some of them are super critical and saying, no, you're going the wrong way. What are you doing? You're an idiot. So to make a long story short, those people on the bus, those passengers, they represent your thoughts. And some of your thoughts are going to be supportive. Some of them aren't. But those thoughts can't do anything to change what you're doing. No passenger can cross that white line on the bus that divides you, the driver, from everyone who's on the bus. You're the one who chooses where the bus goes. You go on your route. And you can do that route despite whoever comes or goes on the bus, despite whatever thought you have on the bus. Yeah, that's a good way to look at it. Another question. Say there's two different people. I was talking about earlier. The one person that has that weird thought could be about anything like, oh, what if I push that guy in the subway? What if I'm transgender? What if, yada, yada, yada, all that. The person that's able to just brush it off and not worry about it versus the person that worries about it. I know it might be hard to answer very concisely. But what do you think the difference is between those two people? Is one person more of a deeper, analytical, creative thinker or just the other one able just to let things go easier? Yeah, that's a great question. And I've noticed that in my own work as well. My specialty is in anxiety. And there's so many ways in which people can experience anxiety and so many ways in which people can struggle with anxiety. So I can work with one person who might, their anxiety might be 100% just intrusive thoughts. And I can work with another person, their anxiety is 100% physical in their body. And then I can work with another person who doesn't experience it in their body, doesn't experience it through intrusive thoughts. They just avoid situations. Like their main anxiety problem is they just don't put themselves in any situation that makes them distressed. So to answer your question, part of it comes from biology. So temperament is how intensely you experience certain emotions. And all of us genetically inherit different temperaments. It doesn't mean you can blame one of your parents, but it does mean that your unique DNA makes you more or less vulnerable to experiencing certain emotions. I often say on the channel, the volume for some people is set higher for certain emotions and the volume for other people is set lower for different emotions. And that's just the gene pool. That's just how things are set up. So part of it is biology. So some of us are more vulnerable to experiencing different emotions. And then part of it also comes from your life experience. So people, I'd have to dig into the research to see if there's evidence to back this up. But this is something I've definitely noticed in my work is people who are much more verbal, people who read a lot, people who have a pretty good language skills, they tend to be a bit more vulnerable to worrying than people who might have less developed language. And I think there is a lot of data linking reading and literacy skills with more cognitive skills, like thinking skills. Apparently, college professors are really, really good at rationalizing their actions and behaviors because they're so verbal, almost to a degree where it's a problem because they can outthink any type of criticism that comes their way. Well, there's also a problem to that, which is you could be more vulnerable to having a lot of worries and things like that. So it could be that some people with certain language skills are just more vulnerable to experiencing worries. And another thing to say here is part of it can also be skill. So you've learned a lot through a lot of hard work how to approach your worries and how to approach that type of anxiety. Some people haven't had that experience. And if that's the case, then you might not know how to deal with worries. Or probably a better example is when we go through stuff the first time, we're going to experience more worries. We're going to experience more anxiety, and that's just normal. Your first breakup is horrible because you just haven't had the life experience yet of knowing that eventually you will feel okay again. So it's only more common and only natural to experience a ton of worries about that kind of stuff. Like you were saying, any other tips, not necessarily just for anxiety, but just, I guess, good de-stressor tips? Yeah, let's talk about that. So let's talk about stress. Let's talk about anger. And then let's talk about intrusive thoughts and some quick tips on what to do about that kind of stuff. The quickest tip I've got is check out the video I just put out last week, I think, or maybe a week before. It was Quick Anxiety Relief, something like that. So I go through some of my favorite ways to quickly reduce anxiety. So check that one out. And then I've got another one on, it's like a 90-second video on how to overcome stress, something like that. So I'll put links in this video to both of those. But let's talk that out. Let's talk about anger real quick because anger, I think, is one that a lot of us really struggle with. Is it healthy, like every so often, to express anger? Totally. Or can humans live without being, like, ever angry? 100%, I completely believe it is a necessary emotion, and I'll tell you why. Compared to every other emotion, anger is the most powerful way to break you out of your daily routine and get you to act. Anger is completely, completely normal when some kind of injustice has happened, when you are really being blocked from some type of goal that's important to you. Anger will get you out of your routine, and it will very quickly communicate to the other person that they've done something wrong in some way or something needs to happen that has to change. You're right, though, also, that too much anger is a problem. You're going to get really frustrated. And the other thing, too, with a high degree of anger is anger does kind of break you out of the mold, right? So it might, if you're experiencing so much anger that it's putting you at risk of doing something that might cause you harm or some other people harm, then anger can be a problem. Just, like, too much anxiety can make you feel paralyzed and keep you imprisoned in your life. Like, too much of any of these things can be a problem. So the first thing to kind of think about is the stereotype of anger, which is punch a pillow, something like that, get the anger out. That doesn't really work. What it does is it revs you up more. When you do that, when you're angry, it will rev you up more. It's a little bit different than going for a run or exercise or, like, doing, like, a kickboxing class or something like that. Those things are a little bit different because they're more focused. It gets your whole body going in an activity. Those kind of things can be fine. But doing something aggressive like punching a pillow or, like, hitting a wall or something like that or screaming, those kind of things don't really help out with anger. The better thing with anger is something called distress tolerance, which basically means doing things that give you a little bit of a break and kind of push away from the thing that's pissing you off for a little bit of time. So, for example, if you're yelling at someone, so, like, my wife and I, we get into a disagreement. I'm getting really pissed off. I will say I need a break. I'll be back later, and I'll go into my room, and I will watch something funny on YouTube, or I'll listen to music that chills me out, or I'll go for a walk outside. I need to get away from that thing. Let my body cool down, then I can go back, and then we can kind of deal with that situation or whatever it was. And then, well, let me just check in. How's that sitting with you in terms of your experience with anger? No, no, yeah, that's good. I feel like everyone should have those tools just to, you know, from a different perspective. Like you said, you're, you know, get served the wrong meal. You don't need to blow up and just go crazy. Yeah, yeah, you don't need to. And I do want you to listen to that anger and deal with it in some way. So, you know, you might want to say something to the waiter, and you don't have to blow up, and you don't have to yell at them. But if you keep ignoring that anger over and over again, that's when people can kind of snap. If that anger kind of goes unresolved, and you're not listening to it, does acting on this emotion, does it help you with your goals? You know, if you're at a really crowded restaurant, and it's like the meal you got is okay, it's not what you wanted, but you're still cool with it. Does acting on your anger help you? Well, like, okay, maybe they'll find you another meal. Maybe it's going to take longer. Maybe it's not worth it. Then maybe you don't even say anything, and you just kind of complain to your friend. But if it's like, let's say you're a vegetarian, and you got steak, like, you're probably not going to eat that. You probably need to act on that anger. So think about, like, does acting on it, does it help you? Does it help you reach your goals? And if so, then find some way to be able to express that or act on that. Similar thing with stress, Zach. You got to, there's a great TED Talk called How to Make Friends with Your Stress. And the gist of it is basically we have to understand what we're stressed about, and then do things that help us with that. That, like, stress isn't something we can ignore or get rid of, because then it's just like the intrusive thoughts. You can't get rid of those thoughts, just like you can't get rid of stress. The way we deal with stress is by understanding, okay, why am I stressed? Is it I'm unprepared? Is it because I need help? Is it because I'm confused? Is it because I did everything, and now I'm just kind of waiting for this thing to resolve itself? Like, what is it that is making you stressed, and then what can you do to deal with that? Like, if you're stressed because you don't know what to do, then you got to get help, right? If you're stressed because there's so much to do, then how can you get started and make a little bit of contact with this problem? If you're stressed because you're just waiting to get your grades back on something, and there's nothing you can do but wait, then, all right, what are some fun things you can do that will take your mind off stress for some time being until you get closer to that date? So, for stress, we got to understand what's going on, and then we have to deal with those problems, whatever they might be. For anxiety and how to chill out, you know, it's anything that is going to help you make contact with your anxiety in a healthy way, that's a good coping skill to use. So, for example, give me something that you might be stressed about, and let's see if we can come up with a good coping skill there. Just do the typical, like, you have a lot of homework to do or a test coming up or a project that you're kind of just handling, you know, I got to get this done. Right, right, okay. So, I got all this homework, I got this test coming up, I need to get started on it, I'm really anxious about it. So, a coping skill here, it's going to be whatever helps you to get closer to that homework. Whatever helps you to get closer to studying for that exam, that's going to be a good coping skill. So, for me, one of the things that helped me in college was kind of making a pact with one of my roommates, like, I got to do this one thing tonight. Hey, Frankie, I need you to, like, check in with me and help me to make sure I do that. And then he might make a pact with me, like, okay, I'll do that, I got to do this thing, like, we're going to, you and I, we're just going to get that done today. Like, for me, that was awesome. I need the accountability. The accountability doesn't stress me out more, it actually helps me. The worst thing for me is if I'm kind of, like, hiding in secret, avoiding my work, and just, like, watching Netflix, like, that's, like, danger zone, right? But there's other folks I know that I work with, like, what helps them, a good coping skill for them, watching something they've seen a million times on Netflix, putting it on, turning the volume down, but getting started on homework that is super easy for them. Like, just getting organized, just getting the ball moving, and then they can tackle harder and harder stuff, and then maybe they turn off the Netflix. Yeah, I feel like, for me, not just for school, or, you know, in general, just if I want to get something done, I feel like, just for me, is just being organized. Making sure, even when I, like, walk into my room, like, I make sure it's, like, vacuumed, and the bed is at least made, because I feel like walking into the room, when it's dirty and you have a lot of stuff to do, just adds on to it. I feel like just being organized in just everyday life is just, you know, even simple as just, I don't know, maybe you have to go to the gas station and pick up some ice cream. Yeah. Just be organized and do that. Don't just be like, oh, look at that, look at that restaurant, let me just stop there real quick, and then be like, oh, let me stop here, let me talk to this person. Right, right. Well, that's a really good example of what can be a coping behavior for some can be a safety behavior for another. So, coping behavior, good stuff that helps you to move forward and make contact with whatever goal you have. Safety behavior is something that you might do that makes you feel a little bit less anxious, but it's actually keeping you away from the thing you want to do. So, for some people, getting organized, getting cleaned up, getting everything in the right place, that actually helps them. It helps them to want to get work done. It helps them to know what work to do. It makes you feel accomplished. It makes you feel less overwhelmed. Other people, sometimes in my life I've done this where I'm like, oh, man, I got to write this paper today. All right, well, hold on. First, I'm just going to clean up my whole room. And then it's been like five hours and my room's clean, but I haven't made any contact with the work I need to do. So, that's where it's like trial and error and it's knowing ourselves and just thinking, all right, what's one small step I can take right now to move forward on my goals? And if you want to watch more episodes in this Call & Show series, check out the pop-up that's popping up right now to see all the episodes. Zach, thanks for being on the call.