How to manage intrusive thoughts

Something that is rarely addressed in early motherhood is the occurrence of intrusive thoughts. Simply put, they are thoughts that come to the forefront of our mind, keep coming back or are hard to push away and are negative in nature. They are incredibly common and everyone has them as they are a part of our mind’s self-defence system, where the mind creates a risky situation simulation to practice problem solving. Sometimes, for various reasons, this simulation can get stuck or transforms into our biggest nightmare that is hard to ignore or push away. These thoughts can have us believe that we have produced them consciously and that they define who we are as a person. In the worst case scenarios, intrusive thoughts can become so intense that the only relief seems to come from acting on them. As intrusive thoughts are often of violent actions toward self or a loved one or terrible accidents, they can be really scary, eliciting shame, guilt and anxiety. They are very common in postpartum mothers and if left unchecked, can lead to severe PND, PNA or PP psychosis. However, having these thoughts does not mean you will act on them or would ever act on them. 

If you’ve never experienced intrusive thoughts before getting pregnant and don’t have the tools to deal with them, they can be really scary and the associated shame and guilt often prevents new parents from sharing their experiences with others or from asking for help.

All new parents are susceptible to intrusive thoughts, especially when subjected to the combination of sleep deprivation, heightened stress levels, previous poor mental health history and lack of practical and emotional support, although I think that due to the hormonal tornado that birth mothers specifically are a subject to, make them even more vulnerable. I’ll be therefore focusing here on mothers in the fourth trimester (three months postpartum), although the tools can be applied to anyone, parent or not.

I would say the first most important tool to manage intrusive thoughts (IT) is EDUCATION.

Many people that are otherwise in a good mental health, are often able to manage their IT relatively easily once they understand what they are. Therefore, my advice number one is inform yourself, there are books, articles, videos and studies available out there to provide you with all the information you need. The most important part, I think, is for you to understand that these thoughts do not define you as a person and do not mean you are a bad mother.

The tool for managing IT I like the most is MINDFULNESS. The simple practice of letting your thoughts pass without identifying with them or running with the stories can be tricky to pull off when you are sleep deprived and highly stressed, so practice during calm periods is crucial to a success. If you dedicate just few minutes a day to mindfulness for two months, you will star noticing the effects, which grow in strength and effectiveness, the more you practice. A little every day is more effective than an hour once a week. Once your ability to ground yourself and observe your thoughts instead of engaging with them is committed to your muscle memory, it becomes easier to reach this resource when you are under stress. Nowadays, mindfulness is a household name and you can find free information everywhere.

Another technique you can use is SWAP, where you basically swap your negative IT for a positive thought. Awareness of thought flow is the first step, so mindfulness is still at the basis of it, but instead of letting the IT to pass, you can actively replace it with a better thought. This requires some practice, so to start with I recommend using a thought that is easy to hold, like singing out loud a cheerful song or telling a funny story. You can also think of a complex mathematical problem. Find anything that will occupy your whole mind. Calling someone (a helpline if there is no one to call) can really help too.

REFRAMING is another tool you can use. Lets you have a thought that says “I can’t stop my baby from crying, I am not a good mother.” You can reframe it to say this: “My baby cannot speak, his only way to communicate with me is to cry. I am here for my baby 24/7. I am a good mother.” You might need write down reframes for your most frequent ITs, so you can easily access them even when you are stressed and tired. You might need to read them out loud to drown out the ITs.

DISMISSING is basically disagreeing with your ITs. This mostly helpful once you are able to manage your ITs relatively well. When you become aware that IT is popping up, you can simply decide you do not believe it and will not engage and find something else to think about. You might need to do this few times before the thought gives up, but this is a technique I use nowadays and it works for me very well. This is how the process works for me: We are out with my son and he is on his scooter, I start to get an image flashing up of him going into the road and car hitting him. I check the speed and position of my son and am satisfied that such occurrence is highly unlikely. I thank the thought for raising the potential risk and tell it, that I have it in hand and start thinking about my shopping list. I might get couple more flashes, but I switch back to my shopping list immediately. 

AFFIRMATIONS are another way of keeping ITs at bay and many people find them very helpful. Once you identify your thoughts that are of often critical nature, you can counteract them with affirmations. I would start by making a list of those critical thoughts, i.e. I am a bad mother. I am not loveable. I am stupid. I don’t know what I am doing. I am not good enough. Then next to each negative statement write a positive one using I AM as the starting point, i.e. I am a good mother. I am loveable. I am smart. I am confident. I am good enough. Then make a list of just the positive statements and keep them with you to read out when ITs make an appearance, until you can remember them easily.

You can also use INVESTIGATION tool by asking yourself “Is this really true?” To start with, this tool is better practiced with a therapist or a good friend, who can offer other perspectives as there is a potential risk of your mind looking only for evidence confirming your original thoughts. Staying objective and questioning can be quite challenging in the heat of the sleep deprived hormone driven moment if you had not have a good practice before. A good indicator that some investigation is needed is the use of superlatives and generalisations. If you catch yourself thinking always, never, all, no one, the worst, the most etc. If you find yourself thinking in those terms, some self reflection and questioning is a good idea.

DISTRACTION also can be helpful. Watching a movie, listening to music, an activity that requires your focus, all these are good as long as the content is positive. Learning new skill like a language or playing tennis or knitting are good ways of employing the mind in a positive and constructive way.

Sometimes, there is a perfect storm of circumstances, like previous poor mental health, traumatic birth, stressful living conditions, addictions, relationship problems and/or health problems that lead to a severe case of IT, which might require a consistent professional help and perhaps even temporary MEDICATION. When such medication is provided alongside therapy, it can be an effective way to pull you out of your darkest moments. Many of these medicines can be taken while breastfeeding, so do talk to your doctor if you are struggling to manage your mental states by yourself. 

At its worst Intrusive thoughts can turn to compulsions and compulsive disorders, psychotic episodes and even development of schizophrenia. These outcomes are extreme and rare and often preventable if you seek help the moment you realise that you are struggling with managing ITs yourself.

Many mothers are afraid to speak up because they are worried their baby would be taken away. Let me assure you that here in the UK at least, removing baby from his mother is absolutely the last resort and that many measures are taken before it gets to that stage, including a mother and baby residential psychiatric unit, where mothers are offered intensive and focused support while keeping her and her baby safe together.

Intrusive thoughts are incredibly common and most people will experience them in some form in their lifetime, there is no shame in having them, just like there is no shame in breathing, both processes are part of being human. Most people never act on their intrusive thoughts, no matter how dark and repetitive they get. There is a lot of support for new mothers, so please do not hesitate to reach out. I hope this article will help you to manage your intrusive thoughts by yourself, but remember that you need to practise using these tools at the times you feel calm to make them truly effective and easy to use in the challenging times. Most importantly, know that you are not alone. ?