How to overcome obsessive thoughts

A few weeks ago, someone sent an email to our Ask Dr. Mayim column, and it seems to have struck a nerve with a lot of people. The question was about constantly going over past conversations to the point of spending years worrying about things said or done. You can read my full answer here, but the gist of it was I recommend a therapist to help with these kinds of perseverative thoughts. I also suggested that 12 step programs such as Al-Anon can help with thoughts like this if the person has been touched by the disease of alcoholism; sometimes these kinds of thoughts are driven by fear or excessive responsibility.

After we posted the Ask Dr. Mayim article, follow-up questions came pouring in about obsessing. So I recruited one of my oldest friends who is a licensed psychologist specializing in Cognitive Behavioral Therapy, Dr. Jacob Gisis, to help answer the most pressing ones. Here are Dr. G’s answers to some of your questions along with some of my input!

Mayim Bialik: I had recommended seeing a therapist, but in what specific ways can a therapist actually help with obsessive thoughts?
Dr. Jacob Gisis: I agree with your recommendation to see a therapist, and I’d specify even further that it ought to be a cognitive behavioral therapist. Someone who specializes in CBT is important because it’s the fastest and most efficient way to treat virtually all anxiety based disorders, which this is likely an example of.

Part of treating these kinds of difficulties is that we want to define a desired end state. And—this obviously reflects my background in neuroscience—we want to recondition the nervous system so that it actually produces that desired end state and an integral part of that is to generally relax it. So what most cognitive behavioral therapists would do, in appreciation of it being an anxiety based disorder, is to start by teaching a relaxation technique to decrease anxiety levels overall.

Once that relaxation is put in place, then the goal is to not feel like the individual has to review past experiences or memories. We want to help them be less interested in those thoughts when they come up. It’s not easy to do. It’s generally a gradual process. There’s training in terms of what to do with the mind when these things come up and there are various options.

My orientation is toward assisting my clients with deciding what they want to do with their minds instead. In other words, what experiences do they desire to have and what mental processes are going to facilitate them having those experiences? Oftentimes mindfulness, which tends to be defined as a non negatively judgmental present-focused awareness, is the goal and one path toward it involves focusing on sensory experience and then not judging it negatively. However, like I said, it is really up to the client to determine what they want to experience and then we usually work together to see to that.

The abbreviated way to describe that process is that there are ways to train your mind to direct yourself away from obsessing and it takes a certain amount of effort at first but then it becomes second nature.
It does require effort and with repetition you are establishing a new circuit; a new neural network. The nervous system is trained to engage in a new pattern that’s been repeated. We truly are creatures of habit!

Someone asked a related question about worrying and losing sleep over future conversations.
These kinds of thoughts are generally associated with anxiety as they involve considerations of hypothetical negative future events. Anxiety can be thought of as future fear. Treatment is similar to what I briefly outlined earlier. As it’s anxiety-inducing to review potentially negative future conversations and as anxiety and sleep are not friends, unfortunately, it’s quite common for sleep to be adversely affected.

Someone asked if this type of obsessing can be related to aging. This woman says her husband has started obsessing with the past and he’s in the beginning stages of Parkinson’s Dementia. And she also has a neighbor in her 70s who won’t speak to her because of something she said three years ago. Can this be related to aging or is it more that we see these things in dementia?
It can be. One way to think of that connection is as related to the neural pruning that occurs with aging. We have fewer nerve cells and fewer cognitive and behavioral patterns accessible to us as we age and as our brains degenerate. And if this kind of obsessing is something you are doing quite regularly because your anxiety is pushing you to do it and you don’t have much awareness of how to manage it because you’re not working with a cognitive behavioral therapist, then it’s quite likely to become a very dominant pattern.

Someone asked, “Why is worse at night when I am trying to fall asleep?”
It could be the case of idle mind. That you’re not actively focused on something else. Then, there is more room for your anxious parts to hijack control of your thinking parts.  Some people have elevated anxiousness related to darkness. At nighttime, our visual system, which is our primary sensory system, doesn’t work as well and we could feel more vulnerable and, therefore, more anxious.

Can this be indicative of a larger issue?
It is usually a symptom of an anxiety disorder, or commonly, Obsessive Compulsive Disorder.

Is there a “normal” amount of overthinking? When do you know it is a problem?
I would suggest that just about everyone overthinks at some time or another. I would suggest an even stronger statement that all of the dimensions of any mental health diagnosis—maybe with the exception of psychotic diagnoses—are relevant and exist in everybody to some extent. It’s not like people who carry these diagnoses have different brain parts than what others have.  It is just usually a matter of degree. Some criteria we look at to determine how problematic this is are: Is it getting in the way of other goals, occupational functioning, sleep, social functioning, your familial life? Usually those are the criteria that determine whether we consider this pathological or not.

Visit NIMH for more information on generalized anxiety disorder and Obsessive-Compulsive Disorder.