Intrusive thoughts and unwanted memories

Intrusive thoughts

Intrusive thoughts are feelings, memories, urges or even mental pictures that can pop into your mind at any time. A specific trigger can cause them, or they can seemingly come out of nowhere.

Many people have intrusive thoughts, and the odd one here and there is very normal; however, it can become a problem when you’re stuck in a cycle of negative thoughts, sometimes called rumination.

What does rumination look like?

Unlike your normal processing of emotions, if you’re ruminating, you’re more likely to:

• Focus on a problem for more than a few minutes, typically with a pessimistic viewpoint
• Have no movement towards accepting the situation, or end up being no closer to a workable solution to improve your mental state
• Feel blame, shame or guilt
• Feel worse than when you started out

Tackling intrusive thoughts and rumination

One tactic to help when you’re ruminating is to develop an If/Then plan. For example, if I feel this way, then I will do this thing to distract myself or try to solve the problem.

Rumination can affect you in a number of ways, so it’s important you take some time to identify how rumination affects your whole person and then come up with a plan for each effect. For example:

• Feelings – Do you feel overwhelmed, exhausted, bored or rushed?
• Physical reactions – Does your body feel tense or agitated?
• Actions – Do you procrastinate or spend a lot of time thinking rather than doing?
• Thinking – Are you only focusing on the problem, are you criticising yourself, or do you feel guilt or blame?

Once you understand how rumination affects you, you can then come up with a plan to mitigate each effect. For example:

• Feelings – If I feel overwhelmed, I will try and get outside my head by going for a walk in the park.
• Physical reactions – If I feel tense, I will stretch and intentionally relax my muscles.
• Actions – If I find myself procrastinating, I will give myself 10 minutes to try and think of practical solutions to my problem.
• Thinking – If I’m feeling guilty, I will do something physical to distract myself.

Unwanted memories

Unwanted memories are caused by triggers or dwelling on existing thoughts and can be a problem for many healthcare workers when the work has a direct link to their personal life or difficult memories. They’re also a key symptom of PTSD.

Here’s just a couple of examples of things in the medical field that could cause an unwanted memory:

• Sounds – machine beeping, call button noises or muffled sounds on CPAP machine

• Smells – rubber gloves, injectable morphine, cleaning solutions

• Trigger words/writing – CPAP, Covid, last goodbyes

• Emotions – helplessness, sadness, anger

• Similar situations – patient has the same name, same room or same outcome

Triggers or dwelling?

• A trigger is something that brings back a memory of an incident.
• Dwelling is an unhelpful thought process that results in you going over an incident repeatedly and never moving on.

Tackling memories caused by triggers

If you have an unwanted memory caused by a specific trigger, you can use the Then Vs. Now strategy to help.

1. Spot what’s triggering your unwanted memory.
2. Notice the similarity between the trigger and your unwanted memory.
3. Ask yourself ‘What’s happening now?’ or ‘How is what’s happening now different to the past/unwanted memory?’
4. Ask yourself ‘How’s the trigger different from the past?’

Tackling memories caused by dwelling thoughts

If you have an unwanted memory caused by a dwelling thought, you can also use a slightly different form of the Then Vs. Now strategy to help.

1. Remind yourself that the unwanted memory was in the past, and try and remember anything you did at the time that was helpful.
2. Focus on the now. What can you see? How is it different from your unwanted memory?
3. Focus on the things you can hear. How are they different from the unwanted memory?
4. Move and do. Focus on your freedom and how this is different to what was possible at the time during the unwanted memory.

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