Intrusive thoughts sometimes increase at night, and may be a result of obsessive-compulsive disorder (OCD). Exposure and response prevention (ERP) therapy can help you learn to face your intrusive thoughts without resorting to compulsions, eventually easing the distress you feel when these thoughts arise.
The house is quiet, and you should be drifting off to sleep when all of a sudden, you’re struck with an intrusive thought, unpleasant image, or memory. Maybe you find yourself recalling a time in grade school when you embarrassed yourself, or something far more disturbing—like the thought of jumping off a building.
Intrusive thoughts can be disturbing, especially when they feel particularly vivid, or occur repeatedly. Some people can acknowledge these thoughts and move on, understanding that they’re random and unimportant. However, others find it more difficult to let go, feeling anxious or worried that the thoughts may mean something.
Although intrusive thoughts are a common experience for many, they can also be a sign of obsessive-compulsive disorder (OCD), a complex and chronic mental health condition. Read on to learn more about how to stop intrusive thoughts at night.
Why do I have intrusive thoughts at night?
Intrusive thoughts are unwanted, unpleasant, and often distressing thoughts that can also manifest as urges, sensations, feelings, or images. They may emerge from out of the blue, or they may happen as a result of a more obvious trigger. Intrusive thoughts can seize on violent or sexual themes, or take the form of memories—making you feel like you’re replaying the most embarrassing parts of your day, or life.
Intrusive thoughts can happen at any point during your day. But you may find that they occur more frequently right before bed, because there are often fewer distractions during that time. “Often we have other things going on that help us be distracted, like work, school, and friends,” says licensed therapist Tracie Ibrahim, LMFT, CST “When things get quiet, we tend to pay more attention to our thoughts.”
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The timing of your intrusive thoughts can be very inconvenient. After all, thinking about unpleasant or inappropriate memories, themes, or images is the last thing most of us want to be dwelling on while trying to get some much-needed rest. But, beyond the lost sleep you may be experiencing, the timing of your intrusive thoughts isn’t actually relevant to how serious they are.
“There is no significance to the content of intrusive thoughts or the times they occur,” says licensed therapist Melanie Dideriksen, LPC, CAADC. What matters is how you respond to them.
How to stop intrusive thoughts at night
In order to understand the best ways to deal with your intrusive thoughts at night, it can be helpful to understand why intrusive thoughts emerge—and why your initial responses may be making them worse.
Understanding OCD and intrusive thoughts
According to licensed therapist MaryBeth Overstreet, MA, LPC, while everyone experiences occasional intrusive thoughts, if these thoughts become persistent or difficult to shake, they may be a sign of OCD. In fact, they’re a common form of OCD obsessions. In response, you may find yourself performing compulsions—repetitive behaviors or mental acts to try to ease anxiety, or prevent a feared outcome from happening. These compulsions can take many forms from repeating words or counting in your head to excessive praying, ruminating, asking others for repeated reassurance, or avoiding certain situations, places, people, or stimuli that you think may trigger your intrusive thoughts.
If you’re not sure whether your intrusive thoughts are related to OCD, it can be helpful to consider whether you typically attempt to neutralize them through ritualistic behaviors of any kind. Keep in mind that not all compulsive behaviors are easy to identify. Mental compulsions, like rumination, may not seem obviously compulsive, since they only occur inside your head—but if you’re spending hours at a time engaging in these behaviors, it’s likely you have OCD.
Practice acceptance
While engaging with your intrusive thoughts through compulsions, mental investigation, or attempts to suppress them might seem helpful, it can actually make it harder to move on from these thoughts. OCD compulsions can provide temporary feelings of relief, but they ultimately prolong the OCD cycle, by reinforcing the idea that you need to respond to intrusive thoughts with these repetitive behaviors.
It can be tempting to want to explore why these thoughts are arising, and what they mean about you, but it’s more important to focus on how you respond. Overstreet says OCD can make “intrusive thoughts feel much more overwhelming and distressing,” because you want to assign meaning to these thoughts, images, urges, feelings, or sensations—but, most of the time they don’t actually mean anything about you. In fact, OCD thoughts are typically ego-dystonic, meaning they go against your core values and desires, which is why they cause internal conflict and feelings of distress.
Instead of trying to investigate what’s going on, or fight the thoughts you’re having, you can try practicing acceptance, by telling yourself: “So what if I’m having these thoughts? They don’t mean anything about me.”
When to seek further help
If acceptance feels like a struggle, and intrusive thoughts start to interfere with your daily functioning, taking up hours of your day—it can help to find a therapist who specializes in treating OCD.
Find the right OCD therapist for you
All our therapists are licensed and trained in exposure and response prevention therapy (ERP), the gold standard treatment for OCD.
Exposure and response prevention (ERP) therapy
Exposure and response prevention (ERP) therapy is a specialized type of cognitive behavioral therapy (CBT) designed to treat all types of OCD. It’s a highly effective way to reduce the impact of intrusive thoughts, because it disrupts the OCD cycle—teaching you to stop the behaviors that fuel these obsessions. An ERP therapist can work with you to help you gradually and intentionally face your most challenging intrusive thoughts, while resisting any urges to engage in compulsions, like reassurance seeking or thought suppression.
Your therapist will start by helping you identify any potential situations that trigger your intrusive thoughts. If bedtime is difficult for you, you might begin here—discussing exercises that can help you face this time of night (and the thoughts that emerge) without assigning meaning to these moments.
Let’s say you’re lying in bed, trying to fall asleep, when an intrusive thought pops into your mind: “What if I accidentally left the doors unlocked, and someone breaks in and hurts my family?” Naturally, your first impulse might be to engage in a compulsion, like re-locking your door, checking on your loved ones, or reassuring yourself that your family is safe. Instead, your ERP therapist would work with you to engage in response prevention—techniques for resisting these behaviors. This might look like setting a timer during which time you’d be asked to delay these compulsions, until the urge has passed. Or, you might be asked to practice sitting with uncertainty, by acknowledging your fear and attempting to accept the discomfort.
These exercises can be tricky—especially at first—but your therapist will help you work your way up to the more challenging scenarios, guiding you every step of the way. In time, you’ll learn to resist relying on compulsions, which removes much of the power from your intrusive thoughts. Eventually, the intensity of your anxiety will decrease, and your thoughts will fade into the background noise.
Bottom line
If intrusive thoughts at night are keeping you up and making it hard to fall asleep, it’s important to stop assigning meaning to these obsessions. Practicing acceptance, rather than trying to suppress or engage with the thoughts is an important first step. If you need more help, reach out to a therapist trained in OCD. ERP therapy can help you learn to move on more quickly from these thoughts, making them less impactful over time. You deserve to be able to enjoy your evenings, without the noise of distressing intrusive thoughts.
Key Takeaways
- Intrusive thoughts often show up at night, because there are less distractions during that time.
- If intrusive thoughts are persistent, and lead to compulsions, you may be dealing with OCD.
- Practicing acceptance can be an important step toward learning to move on from your intrusive thoughts.
- For additional help, consider ERP therapy—the most effective treatment for OCD—which helps you learn to resist compulsions as a way of reducing the power your thoughts have over you.