Controlling Intrusive Thoughts – Suppress, Repress, or Accept?




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.

Conclusions

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.

References

Bowen S, Witkiewitz K, Dillworth TM, Chawla N, Simpson TL, Ostafin BD, Larimer ME, Blume AW, Parks GA, & Marlatt GA (2006). Mindfulness meditation and substance use in an incarcerated population. Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors, 20 (3), 343-7 PMID: 16938074

Erskine JA, Georgiou GJ, & Kvavilashvili L (2010). I suppress, therefore I smoke: effects of thought suppression on smoking behavior. Psychological science, 21 (9), 1225-30 PMID: 20660892

Frasure-Smith N, Lespérance F, Gravel G, Masson A, Juneau M, & Bourassa MG (2002). Long-term survival differences among low-anxious, high-anxious and repressive copers enrolled in the Montreal heart attack readjustment trial. Psychosomatic medicine, 64 (4), 571-9 PMID: 12140346

Moss, A., Erskine, J., Albery, I., Allen, J., & Georgiou, G. (2015). To suppress, or not to suppress? That is repression: Controlling intrusive thoughts in addictive behaviour Addictive Behaviors, 44, 65-70 DOI: 10.1016/j.addbeh.2015.01.029

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Salkovskis PM, & Reynolds M (1994). Thought suppression and smoking cessation. Behaviour research and therapy, 32 (2), 193-201 PMID: 8155058

Shikatani B, Antony MM, Kuo JR, & Cassin SE (2014). The impact of cognitive restructuring and mindfulness strategies on postevent processing and affect in social anxiety disorder. Journal of anxiety disorders, 28 (6), 570-9 PMID: 24983798

Toll BA, Sobell MB, Wagner EF, & Sobell LC (2001). The relationship between thought suppression and smoking cessation. Addictive behaviors, 26 (4), 509-15 PMID: 11456074

Weinberger DA, Schwartz GE, & Davidson RJ (1979). Low-anxious, high-anxious, and repressive coping styles: psychometric patterns and behavioral and physiological responses to stress. Journal of abnormal psychology, 88 (4), 369-80 PMID: 479459

Wells A, & Roussis P (2014). Refraining from intrusive thoughts is strategy dependent: a comment on Sugiura, et al. And a preliminary informal test of detached mindfulness, acceptance, and other strategies. Psychological reports, 115 (2), 541-4 PMID: 25243365

Image via Sergey Nivens / Shutterstock.

Carla Clark, PhD

Carla Clark, PhD, is BrainBlogger’s Psychology and Psychiatry Section Editor and a scientific consultant, writer and researcher in fields including psychology and neuropsychology, as well as biotechnology, molecular biology and biophysical chemistry. She is also our newly appointed Digital and Social Media Manager. Follow her on Facebook or Twitter @GeekReports

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