Intrusive Thoughts کیا ہیں؟ | Kristen McLoud, LCSW

Welcome back to Therapist Voices at ReachLink. I'm Jessica Herwitz and I oversee ReachLink's network of providers. Today, I'm so excited we have Kristen McCloud joining us. She is the owner and a psychotherapist at Mental Wholeness Psychotherapy. She's an LCSW licensed in New York, Florida and South Carolina. We are today going to be talking about all things anxiety, specifically intrusive thoughts. So, I hope that got some ears perked up. Kristen, thank you so much for being here. Before we really get into all the thoughts, tell us if you could just a little bit about yourself, your practice. Thank you so much for having me. So, I'm originally born and raised in Brooklyn, New York. That's where I started my practice. I kind of started out my career in a different field altogether. I was a client services manager for digital marketing company for a few years, many years outside once I got out of college and I just sort of realized that my calling was calling and decided to go back to school and luckily enough I had a great internship at Post Graduate Center for Mental Health and I think that really prepared me for where I am today.

After that, the rest is history. I just kept going and then I went off on my own. So, here I am. When did you open your group your practice? Oh, so it's still relatively I mean, I want to say very new, 4 years ago. So like yesterday. Yes. Yes, it's still I'm still working on it essentially, working on growing and learning all the things about being an owner of your own private practice. There's so much to learn. So they say and I know they do not teach us that stuff in grad school. I think these days it seems like there's more awareness of that, obviously, but definitely not a course in my day at least that was involved. So, kudos to you for figuring it out. Thanks. it's a learning curve, I think, you know. That I'm I like that you commented on your internship placement. I always feel like people either get lucky or they don't.

You might find your passion, your niche in where you were randomly placed, or you got a really good supervisor, or you totally got what you didn't want, and it was your last choice, and you didn't have that heads-up. So, tell us a little bit I know that you specialize the most or particularly working with all things anxiety. Particularly a lot of intrusive thoughts. I thought maybe you could hopefully tell us a little bit about intrusive thoughts. I know there's such a range for people of what that means, whether for them or what they've heard or experienced. And I wonder if there's often maybe some misconception of kind of what qualifies as an intrusive thought. Could you tell us a little bit about it? Sure, yeah. Well, I think with all anxiety disorders, right? When you're running down the line, you're going to come into contact with the intrusive thoughts, and what that looks like could be different for everybody, but essentially what that means is you're having a random thought that's entering your brain, and you're like, "Whoa, where did that come out of?"

And you're like, and usually it's something that's automatic, so we can also call them like automatic thoughts. It's constantly like a program running in the background that if you're triggered, I hate using that word, but if you're something goes on in your life or you're in a situation, then the automatic thought pops in, and it could be quite intrusive, it could be quite unsettling. It's usually it produces a lot of discomfort uh for the person experiencing it. It's not something you want to be thinking about, but you can't help it. Do intrusive thoughts typically, would you say come randomly or I know a lot a lot of people experience this postpartum. Is that most common for people that experience intrusive thoughts or is it typical for them to just kind of come out of nowhere? I want to say usually will stem from somewhere.

So if you experience trauma, like you said also postpartum, when you're going through a transition of some kind, that can be when these things start to really kick up. Or you could be someone who has experienced it for a lot of your lifetime, too, when you have a chronic anxiety disorder. We could see it in on both sides. Is it particularly common for clients to seek care when they're dealing with intrusive thoughts? The place that came from was I've been in this boat myself and I know even with a psychology and counseling background, I remember thinking, "Oh my gosh, did anyone hear that in my head? It's so awful." And I know again there are degrees for people, maybe it doesn't get that that intense, but is that a huge barrier, would you say, for people to seek help? I think a lot of people do struggle with that.

I've been in the same boat myself. I've had anxiety for most of my life, which is I think also what drove me to become a therapist and specialize in this area. But yeah, to go back to your question, it's something that we're ashamed of a lot of the time. How could I have that thought about myself or how could I have that thought about anything random going on? And it's just something that the shame can lead to us backing away from getting help. And so we're hoping more people will come find themselves on the couch across from you or a video. Do you do um telehealth as well? Yes, I do mainly telehealth. I don't have an office opened up yet, a physical space just yet, but that will be coming hopefully soon. Perfect. So then hopefully more people will be on your virtual couch across the street from you soon.

We in this conversation know how important or how debilitating this can be. Could you tell us a little bit about This is really what I especially don't know. Where do you go from there? Once someone comes to see you, they tell you what they're experiencing. And quite frankly, this is what I've always been afraid of. Oh my gosh, I'm going to have to now work through it. That's going to involve saying it out loud. How do you work with this issue? Yeah, so I think we begin with trying to figure out where that's stemming from. So let's say a client comes to me and they're having negative self-talk that's really rather intrusive. And we like to dive into that a little bit and just see if they are aware of the foundations of that. Where does the core belief come from? Right? It's usually stemming from childhood development into adolescence, maybe or traumatic factors and two, traumatic experience rather.

So we want to sort of get to the root cause and see if we can suss that out a little bit. And then the next step I would say is starting to acknowledge that they're there, right? So this is something that can be like you said very difficult in the beginning to really acknowledge that they're there, that this is a level of anxiety that's being drawn out from these intrusive thoughts, that it's affecting my functioning, it's affecting how I interact with people. How does it impact my life daily? So we kind of get to that as well, and then comes psychoeducation. Primarily using cognitive behavioral therapy techniques and dialectical behavioral therapy techniques, which are two really big words for we we want to just help you address the thoughts and learn coping skills for dealing with that and doing it daily and repeating those skills to learn them.

I am guessing what my initial, and I imagine I'm not the only one, my initial reaction with intrusive thoughts is something that goes like this. Uh, like get Nope, nope. Get out of my head. Didn't think that. Not addressing it. And I did, even with a counseling background, I did for a long time think that's probably what I'm supposed to do. I'm probably supposed to think it, not think it away or think it away. And I know that it's not true. I have heard people say before, and maybe this is a certain modality, I don't know of maybe even like thanking or acknowledging the thought. Is that a thing? Right. You can't ignore the boiling kettle on the stove. It's going to go off and it's going to annoy you until you see it there and do something about it, right? So, the more you put it off or tell yourself not to have the thought, the more you're inviting it back in, unfortunately. how that's how the brain is working.

If I tell you not to think about something, you're going to probably go think about it more. get more anxious about thinking about this. So, we can come to you and you can help us. And now, what step are we at? So, we're you've done some CBT. What's that experience like for the client? I imagine it's much more in-depth than working through a work issue or personal issue with something so vulnerable. I'm guessing this is not quick, short-term, necessarily. If it is a short-term thought that's developed from a work situation, for example, then it could be something that it's like very targeted. But, if you're someone who has intrusive thoughts about a vast, just a varying degrees, I'll say. Like, if you have different kinds of intrusive thoughts and it's affecting multiple areas of your life, then yes, I think it's taking a very detailed approach, which would essentially entail the person starting to log their thoughts.

I usually tell my clients get this app, or you can choose whatever app you want. There are so many out there now. So, I'll recommend that and something that they can hold on to and start to log their thoughts every day. That's the first one. I like to look at ones that are simple and easy to follow and then we can look back at the week and see how you've been feeling, how you've been thinking, and what you've done with that thought. How have you refrained it? How have you started to retrain your brain? Because it's something where you have to do it over and over again to develop the new groove, which I think is the most important part of the education. Speaking of educating, could you educate us a little bit on that rewiring, how that works? I was fortunate to have a mentor who was trained in CBT.

So, I that's where I can attribute a lot of this to. Shout out to Dr. Barry Panzer. Dr. Barry Panzer, thank you for giving us, Kristen. I owe it all to him. You know, he basically taught me all the processes here. But, the first I think you were asking I'm sorry, back to what you were asking was what was the next step after that? See, I got two steps ahead of myself and you were able to put me back on track. Yeah, what is the next step and then I'm so curious how the rewiring works. Oh, yes. Well, this is part of the rewiring because So, what I first tell my clients is if you want to start you have to retrain your brain. So, you have to flex the muscle often. And it has to happen multiple times a day. It's a lot of work. It is. And it can be annoying and it can be frustrating. First, acknowledging the thought is there even and acknowledging there is a problem, right?

There is something that's bothering me. Ooh, that hurts. You know, it stings. I even thinking about it myself now looking back at my own process. It's like I can feel it. And then you get in touch with the emotion, so we want to acknowledge how we're feeling. And that also gets logged in the app or on your piece of paper, whatever you feel comfortable with. And then now you're going to address the thought. We're going to learn about different kinds of thoughts like catastrophic thinking, for example. When we we catastrophize everything, everything is way more than it is, right? That guy cut me off on the highway, I need to catch up to him and teach him a lesson. I'm catastrophizing. It's the most horrible thing that's happened all day, right? And it's The client starts to realize, okay, it's not It's catastrophic thinking.

That's the thought label that we're giving it, right? So, we start to label and then we can teach the brain new tricks like reframing. And then slowing down this process for them helps them to be more in control. That was such a good example. It's And I feel like that's probably maybe a common the catastrophic thinking, a really common one. What are some other of those? What else is common that you see or what are some other like not to say labels, but labels? Yes. Fortune-telling. So, I just know I'm not going to get that job or I'm not going to get that opportunity or or mind-reading. I just know this person is thinking badly of me. I just know they they looked at me, they didn't like what I was wearing. So, once we start labeling those and you can see and I show the client and they're like, "Oh my gosh, this is so relatable."

And then they go down the line of all the thoughts and these are readily available on sites like Therapist Aid and stuff like that and you can find And so, it's once they see it, they go, "Oh my gosh, other people have this, too. It's not just me. I'm not the only one overgeneralizing and which is so feeling in itself. I mean, it's that's so huge. Giving it a name. Yes, and having other people that, you know, also have the same Sometimes in life with everything it just For myself at least, I know someone else, even if it's the smallest, weirdest thing. Especially if it's the smallest, weirdest thing that I think someone else feels that way, that is just so cathartic and the camaraderie with the person that you don't know that also has this is huge. I can imagine that just being so healing and so nice for you to see, I imagine, as the provider that it's clicking, that you're really That's I imagine when a lot of progress is about to happen.

Oh, yeah. The light bulbs start going off and it kind of motivates the client to now do the work, right? Because you have to see that it's a strategy that can work for you and believe in it before you start really doing it over and over again. absolutely picture that for people that, you know, it might not It might be so scary and who's really feeling motivated at the beginning. Then once you see where this treatment could be going I imagine that's when the motivation really comes back in. With catastrophic thinking and the fortune-telling, I know those are some examples. Are there very specific categories that intrusive thoughts tend to fit into like these two that we talked about? They can really fit into any of those. If you have an intrusive thought, again, it's different for everybody.

Those are just a few. There are, I think, oh my gosh, at least I don't know, 15 to 20 categories that I think probably Dr. Aaron Beck created at the start of CBT. When you're looking at intrusive thoughts, you're going to you're going to have them in various categories and sometimes it's going to be more than one at the same time, for example. That doesn't seem fair. I know. Well, essentially what I also tell my clients is the brain is trying to defend itself. It's categorizing your brain is categorizing the thoughts. As soon as something happens to you, you have an automatic thought because you categorized it. You saw something that was familiar that was maybe something that caused you harm. Maybe somebody didn't like you in the past. You categorized that. That looks the same, it must be the same.

But it's not, really. It's not always the same. Is this at all like a form of protection then in some way? Absolutely, yeah. That's how I would describe it. A defense mechanism, protection. It's just you're on overdrive now. Your brain is on overdrive with the thoughts and it's trying to protect itself by constantly maybe giving you an intrusive thought about something bad happening, for example. thought about an intrusive thought. Or that, right? Yeah. If you care deeply about mental health, whether as a therapist or someone seeking support, this message is for you. If you're a therapist listening and you're looking for more flexibility, more balance, or a way to expand your impact, ReachLink is growing. We've been building a community of thoughtful, dedicated clinicians who want to make care more accessible through telehealth without losing the human connection that matters most.

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So, this usually impacts, I know, like varying degrees, but significantly impacts people's functioning often. Does Do you see that on a large scale from not really impacting daily functioning all the way to not being able to function at all? Yeah, I think Right, it's it varies, it's on a scale. For some people, I think, who have or not only intrusive thoughts, but just random worrisome thoughts throughout the day, you could call those intrusive. That's definitely true. But yeah, it would happen to maybe for example, it could prevent you from doing things you don't even realize that you're stopping yourself from maybe going after that promotion because you're having the intrusive thoughts constantly that that you're not going to get it, right? So, it can actually impact you so so that you're when you're having negative self-talk constantly, you're probably not going to get the positive outcome.

Whereas, your brain will search for negativity. They'll scan the room for anything that could possibly happen that's bad. Whereas, if you start feeding your brain with positive possibilities constantly, then you start to change the narrative, and now your brain will look for positive things, and you will produce more positive things. You'll do more positive action. And so, that's Is that a lot of the work that you were doing in sessions, kind of identifying those things and working through I would say that's a lot of it, and just kind of going through real-life examples. And then we also incorporate mindfulness and relaxation techniques because without that with the thought processes, we can It's hard to talk to an intrusive thought if your body is in a tense a tense up state. So, imagine you're in like fight or flight mode.

It's a trauma response, really. It's very similar, I would say. And so, if your experiences, you're tense in your shoulders, you're tight all over the place, how are you really going to believe when your brain is telling you positive affirmations? You know what I'm saying? It's a little difficult to tell someone who's like all tensed up. makes perfect sense when as you're explaining it, it feels like, oh yeah, of course. Of course I wouldn't be able to I would be in fight or flight. I would not be able to do all this other stuff. What are some things that you encourage your clients to do in that regard with mindfulness? Do you do things in session? Yeah, we do things in session together if the client is open to it. We might do a guided meditation. We might do a visualization. We might do some progressive muscle relaxation, which really is like doing a quick body scan and going through all the muscle groups and then tensing and releasing each one so that your body can see the difference between tension and relaxation.

And believe it or not, that then it starts getting your brain actively thinking of and aware of all the body parts that are tense. Once you release that, now you're calmer. We also do deep breaths, which should give you instant relief. But what I also find is that has to be coupled with more psychoeducation because when people do the deep breathing, they tend to want to go [gasps] And that's not going to slow your heart rate down, right? So, we have to really practice that and slow it down. It's all about slowing it down. That makes a lot of sense. And I love hearing that you're then doing that in sessions if it's okay with people. Not necessarily just saying, all right, go home. Go home, do your work on your mindfulness. Go to your good luck. It's that's Yeah, that's not going to work, right?

Because I think it's too intimidating. I think if especially if you've never done it before, it sounds like oh what am I meditating now? What is this woo woo garbage? You know, it's it's helpful to Absolutely. explain it and and go through it together and they can see me doing it with them and and I'll give them some extra tips while I see them doing it. Does this topic, do intrusive thoughts morph into OCD? Is there a big separation? Is there a clear I seem to really be wanting to put things putting things into boxes today for some reason, but is there a clear like cut off of okay, this is really like an OCD tendency or this is more escalated? So yeah, intrusive thoughts is definitely part of the criteria. So yes, if it's something like OCD, then that's another additional probably diagnosis that's going along with the anxiety disorder or it it could be stand-alone.

It really can, you know, where you're obsessing about a particular thing over and over again, right? It's that's what it would look like, right? That's the obsessive nature of it. And then of course your behavior is basically to acquiesce to that intrusive thought. So whatever the intrusive thought is, now I have to do an action over and over again to compensate for that or to allow it to be there and to live alongside it. It absolutely makes sense and you You are very good at explaining all of this. Which I imagine your your clients must experience and appreciate as well. Who wants to bring up medication when we're talking about counseling and all of this, but is medication something that that you often or sometimes recommend when things get to a certain point of impairment for people? Absolutely, yeah.

I do have psychiatrists that, you know, I work with a lot that I'll refer to or the client is encouraged to take a look at some profiles and see who speaks to them. You know, it can be really helpful. You know, I even had a client who was like wondering, well, do I have to be on medication for the rest of my life? And does that mean that I need medication to stop thinking about all these horrible things or stop worrying and stop being getting anxious about it? And I said, well, no, not necessarily because I know people that have been on medication for short durations or maybe like a year or so. And they eventually wean off of it because they've learned the tools and they've retrained the brain and now they feel like they're capable. They're all their body and mind is together now. So really the importance of having the support of you at the same time if you're taking medication then to still be doing the work alongside.

That's generally I think the model that, you know, we've all known from working in clinics and things like that and then having those two go on simultaneously is usually recommended. And I think that's for a reason. I think because you're alongside each other, you're working with the thoughts and you're working with the body as you're taking your medication, you're learning the skills and then eventually I tell my clients I say, "And then you won't need to come to You know, my goal is for you not to see me anymore eventually, right? Even though I will miss you." Right. Right. But you will start to do that and then with your psychiatrist you'll probably start working on if it's again, if it's not a chronic serious mental disorder, then you'll start to taper off that as well whenever you're feeling ready and capable.

That probably is And I've had a lot of clients do that. That's probably a relief for people that are feeling like, "Oh my gosh, I can't start medication. I'm going to be on medication forever. I can't start therapy. I'm going to be doing this forever." Good for people to know that it's not always the case. Your practice has been a lot lately focused on life transitions, motherhood, caregiving. How do you see that with anxiety and intrusive thoughts, what you especially specialize with? I imagine those worlds collide. I have been seeing a lot of people lately who, like myself, you know, I gave birth 3 years ago, so I can really relate. You know, uh and I think for myself, dealing with anxiety before being a mom and then after being a mom or before a major life event and then after is two different things.

Right. So that. Or maybe they did, but I didn't hear it. You thought you had it together and, you know, then whoosh, something happens and oh, wait, okay, this doesn't feel right. So, my point being is that I'm seeing a lot of people right now who are kind of going through those kinds of transitions. I think just the state of the world, the coupled with people have aging parents, people are having children, people are starting new careers. There's a lot of change happening right now. And for better or for worse, and I think there's a lot of people who are feeling as I am and as everyone, I think, you know, it's definitely needed to revisit the coping skills and to figure out how to manage the transition, whatever that may be, if that makes sense. Absolutely makes sense. Definitely. I know I can go off on a tangent myself.

I'm the owner of that. That's an intrusive thought. There you go. Right there. Right there. We'll have to work on that after our talk. Once we meet, since we are both in Florida, sort of close to each other, we will work on all of that. That's good. Yes. I'm looking forward to it. So, thank you so much for being here, Kristen. I want to make sure that everyone knows everything, a lot of things that we've talked about today. I'm going to make sure we link any resources that that Kristen's going to share with us, especially those apps. I will also make sure that you know how to get in touch with her as well as us. But Kristen, do you mind telling us now what's the best way to get in touch with you? Should people visit your website or email you? My website is mentalholemess.com. You can just go right to the contact page or you can email me. You can find my, you know, my email address there as well. Well, thank you again so, so much. This is so helpful. I'm going to go read my intrusive thought handbook that's collecting collecting over there. Thank you a million times and everyone reach out to us, either one of us, especially Kristen. Thank you so much for having me. Thank you. Talk to you soon.