Got Anxiety? How intrusive thoughts become obsessions (part 2 of 2) |

Got Anxiety? How intrusive thoughts become obsessions (part 2 of 2)

Barry C. Barmann, Ph.D.
Mary B. Barmann, MFT

Editor’s note

This is the second in a two-part series from the Barmanns breaking down the anatomy of an obsession (i.e., how intrusive thoughts turn into obsessions).

Click here to read Part 1.

All of us have intrusive thoughts, some of which can seem horrific, depending on how they are interpreted.

And that’s the key — the manner in which a person tends to appraise (interpret) these thoughts or images. Those who suffer from anxiety tend to interpret intrusive thoughts in a manner that causes these thoughts to evolve into OBSESSIONS.

There are various forms of misinterpretations (“cognitive errors”) a person can make concerning the MEANING placed on an intrusive thought. The most common cognitive errors include the following:


Feelings of anxiety trigger overestimations regarding the probability of threat, as well as the severity of the outcome related to the PERCEIVED threat.

For example, when an intrusive thought enters one’s awareness which is related to harm, the individual will overestimate the likelihood and severity of a predicted outcome.

Thus, discovering a mole on one’s arm may be interpreted as representing a fatal form of skin cancer. A mis-appraisal of this nature can quickly result in a sense of anxious arousal, due to the meaning placed on this particular intrusive thought.


This cognitive error refers to the belief that if one thinks they have any degree of control over a harmful outcome related to their intrusive thought, they therefore become responsible for preventing this harm from occurring.

For example, one of our patients lives in an apartment that overlooks a busy intersection. At one corner there is a large tree with branches that occasionally obstruct the view of a stop sign at that intersection.

She called city officials and asked that they trim the branches, such that the stop sign could be easily seen by those who drive in that area. No action was taken, and the following week an accident occurred.

This individual believed that had she trimmed the branches herself, the accident would not have occurred. Because she had not performed this action, she felt SOLELY responsible for the accident. In addition, she interpreted her inaction as criminally negligent, EQUIVALENT to having removed the stop sign herself!


As a result of the great deal of importance placed on a particular intrusive thought, there emerges a strong need to control the thought associated with feelings of anxiety. Attempts at control include distraction, thought suppression, etc.

When engaging in these strategies, the person comes to realize these methods only result in increasing the frequency of their intrusive thoughts. Failed attempts to control intrusive thoughts is interpreted as evidence that these thoughts will result in “losing all control.”

This misinterpretation then triggers the belief that these intrusive thoughts must indeed be meaningful, since they continue to occur, despite going to great lengths to dismiss these thoughts.

In other words, if efforts at controlling these thoughts are ineffective, then there must be a good reason why they persist. What the person fails to realize is that their struggles at thought control are resulting in intensifying these intrusive thoughts. The solution, has now become the problem.


One of the most important cognitive errors responsible for turning intrusive thoughts into obsessions, is the belief that feeling a sense of uncertainty (which triggers anxiety) is associated with a future negative outcome. That is, feeling uncertain is a sign of forthcoming danger.

Consider a woman who has just become a mom for the first time. She has an intrusive image of molesting her infant while giving the baby a bath. For several weeks following this image, she continues to overanalyze the thought, tries to control the thought, replace it with a “pure” thought, etc.

Convinced, due to her misinterpretation that her thought means she has a hidden side to her personality which desires to harm defenseless children, she begins to engage in several different forms of “safety behaviors,” such as insisting that her husband bath and dress the child each day because she is “just too exhausted to perform these acts herself, due to lack of sleep.”

Having her husband perform these duties would allow her to “BE CERTAIN” that she will not harm her child.

Cognitive-Behavior Therapy, conducted by those who are specialists in the treatment of anxiety conditions, is directed at helping individuals acquire the tools necessary for:

Lowering the meaningfulness of intrusive thoughts, caused by misinterpretations related to these thoughts,

Eliminating rituals associated with the intrusive thoughts; and

Realizing that intrusive thoughts, no matter how horrific they may seem, when left unattended, will result in the nonoccurrence of predicted catastrophic outcomes.

Barry C. Barmann, Ph.D., is a Licensed Clinical Psychologist in Nevada and California. His wife, Mary B. Barmann, MFT, is a licensed Marriage and Family Therapist in California. Visit to learn more.

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