Living with Intrusive Thoughts: Why Control Doesn’t Work and What Actually Helps

By the time someone searches for “how to manage intrusive thoughts,” they’ve usually tried everything they can think of. You might have tried ignoring the thought, distracting yourself, praying, analyzing it repeatedly and relentlessly, or searching for just the right answer that will finally give you peace. Maybe it helped for a while. But then the thought came back. And it felt just as urgent, just as awful, as the first time.

Many people live in this loop for years without realizing what’s actually going on. They may not have a diagnosis, or even suspect that what they’re experiencing could be part of obsessive-compulsive disorder. But if your thoughts feel intrusive, sticky, and impossible to resolve, and if you keep trying to get rid of them only to have them come back, you are not alone. There is a reason your strategies haven’t worked. And there is another way.

When Thoughts Won’t Let Go

Most people have strange or distressing thoughts from time to time. The difference in OCD is not whether you have these thoughts, but how they land and how they linger. In OCD, the thoughts tend to feel sticky. They create distress, confusion, and urgency. They seem to demand immediate attention, and trying to get relief from them often pulls you in deeper.

Some obsessive thoughts feel clearly wrong or out of character. These are often referred to as ego-dystonic because they don’t match your sense of self. You might think, What if I pushed someone in front of a train? or What if I’m attracted to a child? Even when you know these thoughts don’t reflect your values, they can create intense fear, guilt, or shame. You might try to avoid certain people, ask others for reassurance, or mentally replay memories just to make sure you haven’t done anything wrong.

But not all obsessive thoughts feel intrusive. Some feel familiar, even morally important. These are ego-syntonic obsessive thoughts.They seem aligned with your values or identity, which is whyyou may not even recognize them as part of a problem because they sound like responsible, thoughtful concerns. Still, they can be distressingif you feel unable to stop thinking about them or feel pressure to resolve them perfectly or if they take up a lot of time and prevent you from truly engaging with life.

You might get caught in loops like:

• What if I chose the wrong career and ruined my future?
• What if I’m leading someone on by staying in this relationship?
• What if I’m not doing enough to be a good person?
• What if I should be happier, and the fact that I’m not means something is wrong?

These thoughts don’t always feel intrusive in the traditional sense. They may feel justified, even necessary, yet they still create pressure, doubt, and anxiety, especially when the mind keeps circling back to them again and again without resolution.

While many people experience persistent worries, especially in conditions like Generalized Anxiety Disorder (GAD), obsessions in OCD tend to feel more urgent, sticky, and unresolved. Even when they seem morally important or connected to real concerns, they take on an intensity and repetitiveness that disrupts daily life. What distinguishes OCD is not just the content of the thought but the way it is experienced. It often feels like something that must be solved, neutralized, or understood before one can move on.

What these thoughts all have in common is that they are difficult to let go of. They carry a weight that pulls your focus and makes you feel like you have to act, understand, or fix something before you can move on.

From Obsessions to Compulsions

OCD is often misunderstood as a fear of germs or a need for things to be perfectly arranged. In reality, it can show up in many different ways. Its content can adapt endlessly to what matters most.

Some common examples include:

• Fear of harming others, even unintentionally
• Fear of being attracted to the “wrong” person, such as a child or family member
• Repetitive doubts about religious or spiritual violation
• Thoughts about getting sick, having a terminal illness, or developing psychosis
• Persistent questioning of one’s relationship or romantic attraction
• Needing to feel certain before making any decision
• Being stuck with a specific fear/obsession for a few days and then moving on to another theme

When an intrusive or obsessive thought shows up, it often triggers a surge of anxiety because it tends to target the things we care about most — like being responsible, kind, or staying true to our values.The thought may feel threatening, urgent, or morally important. You might feel a powerful need to do something in response in order to feel certain, to calm the anxiety, or to prevent something bad from happening. This is where compulsions come in.

Compulsions are any mental or behavioral actions you take to reduce the distress caused by a thought. Some are visible, like asking for reassurance, checking something repeatedly, or avoiding a situation altogether. Others are completely internal, like mentally reviewing a memory, analyzing your feelings, or trying to “cancel out” a bad thought. These behaviors may bring temporary relief.They may feel necessary or even reasonable.But over time, they reinforce the belief that the thought is dangerous and must be controlled (Hershfield & Corboy, 2013;Rachman, 1997).

If you find yourself doing something not because it feels genuinely helpful, but because it feels necessary to feel better or stay safe, it may be a compulsion

Over time, these responses become part of a larger pattern. The more you try to get rid of the thought, the more significant and threatening it starts to feel. This creates a self-reinforcing loop that keeps you stuck in the same anxious cycle, even when your efforts are meant to protect or reassure you.

The Cycle That Keeps You Stuck

Here’s what tends to happen:

1. A distressing thought appears.
2. Anxiety rises.
3. You do something to relieve the anxiety: a compulsion.
4. The anxiety goes down temporarily.
5. The brain interprets this pattern as evidence that the thought must have been important or dangerous.
6. The thought returns, and the cycle starts again.

Over time, this pattern strengthens itself. Each time you respond to the thought as if it needs to be solved or neutralized, you teach your brain that the thought is a threat. You stop relating to it as just a thought and start treating it as something more — something that must be controlled, resolved, or obeyed.

In other words, what keeps the cycle going is not the presence of the thought itself, but how you respond to it.

When you respond with urgency or avoidance, the thought gains power. It begins to define how you act, where you go, and what you feel safe doing. And that is what makes it feel so hard to let go.

Learning a New Way to Respond

By the time most people reach out for help, they’ve already spent years trying to manage their thoughts. What therapy offers is not a new way to fight the thought, but a new way to relate to it. You begin to pay less attention to whether the thought is true, important, or dangerous, and more attention to how you want to live in the presence of uncertainty. This shift can feel unfamiliar at first, but it creates space to move forward without needing every thought to be resolved.

Several therapies can help support this shift.

Exposure and Response Prevention (ERP)

ERP is one of the most effective treatments for OCD. It helps you gradually face feared situations without doing the compulsion. Over time, this teaches your brain that you can handle discomfort and that anxiety can rise and fall on its own.

It also gives you the chance to learn something new. You may discover that the feared outcome does not happen. Or that you can have a difficult thought without needing to neutralize it. You may find that the experience turns out to be less intense, less frequent, or less distressing than expected, which challenges the original assumptions and reduces the sense of threat. These experiences build confidence and make the thought feel less powerful (Craske et al., 2014).

Inference-Based Cognitive Behavioral Therapy (I-CBT)

I-CBT helps you understand how OCD pulls you into imagined fears that feel real. Often, it starts with a moment of obsessional doubt. It teaches you how to identify the moment when your mind shifts into imagined possibilities and how to come back to your common sense and lived experience. The goal is to help you stop treating imagined fears as real threats and start trusting what you already know (Julien et al., 2016; O’Connor et al., 2009).

Acceptance and Commitment Therapy (ACT)

ACT teaches you to stop fighting with your thoughts. Instead of trying to make them go away, you learn to notice them, let them pass, and stay focused on what matters to you.

In ACT, you practice making space for discomfort instead of resisting it. You learn to observe your thoughts with more compassion and less urgency. Over time, this builds psychological flexibility — the ability to stay with what’s hard without letting it dictate your behavior (Hayes et al., 1999).

Different people respond to different approaches, and the field is still learning what works best for whom. These treatments are not mutually exclusive. In fact, they are often integrated in therapy, especially when done thoughtfully and with skill. A trained therapist can help you understand your patterns and guide you in using the tools from each approach in a way that supports your growth, builds flexibility, and helps you stay connected to what matters most.

A Deeper Layer: Rebuilding Self-Trust

There are different ways of understanding what drives OCD. Some clinicians focus on difficulty tolerating uncertainty (Sarawgi et al., 2013). Others emphasize inflated responsibility or catastrophic misinterpretations of the meaning or importance of the thoughts (Rachman, 1998; Salkovskis, 1985). Others emphasize the role of inferential confusion, the tendency to trust imagined possibilities over present evidence (Julien et al., 2016,O’Connor et al., 2009). Each of these models highlights a different piece of the puzzle, offering valuable ways to understand what keeps OCD in place and how to interrupt the cycle.

In my experience, many people with OCD also struggle with something deeper: a loss of self-trust.

Over time, they stop trusting their memory, their feelings, their judgment, their intentions, and their ability to make sound decisions. Instead of acting from what they know to be true in their lived experience, they start deferring to their thoughts, to anxiety, or to the imagined possibility that something terrible might happen. Even when part of them senses that a thought might not be true, fear or doubt takes over. What gets lost is not only a sense of certainty but a deeper sense of who they are.

Therapy can help rebuild that trust. Not by resolving every question, but by helping people stop organizing their lives around the doubt. With support, they can begin to relate to their thoughts in a new way, choosing values-based action even when fear is still present. Over time, the thoughts tend to lose their grip, and when they do show up, people are more able to return to the present and respond with clarity.

You’re Not Alone

If you’re struggling with intrusive or obsessive thoughts, know that you’re not alone. These patterns can feel isolating, confusing, and overwhelming, especially when you don’t fully understand what’s happening or why you can’t just let the thoughts go.

OCD is treatable. Healing is not about finding the perfect thought or the perfect answer. It is about learning to live with more freedom, even when uncertainty is present. With the right support, this is possible.

References

Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet, B. (2014).

Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy, 58, 10–23. https://doi.org/10.1016/j.brat.2014.04.006

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999).

Acceptance and commitment therapy: An experiential approach to behavior change. Guilford Press.

Hershfield, J., & Corboy, T. (2020). The mindfulness workbook for OCD: A guide to overcoming obsessions and compulsions using mindfulness and cognitive behavioral therapy. New Harbinger Publications.

Julien, D., O’Connor, K., & Aardema, F. (2016). The inference-based approach to obsessive-compulsive disorder: A comprehensive review of its etiological model, treatment efficacy, and model of change. Journal of Affective Disorders, 202, 187-196.

O'Connor, K., Koszegi, N., Aardema, F., van Niekerk, J., & Taillon, A. (2009). An inference-based approach to treating obsessive-compulsive disorders. Cognitive and Behavioral Practice, 16(4), 420-429.

Rachman, S. (1997). A cognitive theory of obsessions. Behaviour Research and Therapy, 35(9), 793–802. https://doi.org/10.1016/S0005-7967(97)00040-5

Salkovskis, P. M. (1985). Obsessional-compulsive problems: A cognitive-behavioural analysis. Behaviour research and therapy, 23(5), 571-583.

Sarawgi, S., Oglesby, M. E., & Cougle, J. R. (2013). Intolerance of uncertainty and obsessive-compulsive symptom expression. Journal of behavior therapy and experimental psychiatry, 44(4), 456-462.