“This timely self-help workbook will be valuable for people struggling to deal with intrusive

and anxious thoughts. It contains important information, a great deal of practical advice,
illustrative case reports, exercises, worksheets, and troubleshooting techniques. It will benefit
many readers and provide a useful resource for professionals. I strongly recommend it.”
—S.J. Rachman, emeritus professor at the Institute of Psychiatry, King’s College London;
and at the University of British Columbia, Vancouver

“David A. Clark, an internationally renowned and respected researcher and clinician

provides therapists and clients a state-of-the-art self-help guide to overcome unwanted
distressing thoughts that may catch therapists as well as clients. It helps the reader to develop
a better understanding of anxious thoughts regardless of the diagnosis, and then provides
them an excellent guide for effective self-coping skills based on scientifically proven
procedures and principles. It aims to make one his or her own therapist and reclaim their
freedom from being prisoners of their intrusive thoughts. Trust this workbook instead of
trusting your self-defeating anxious and intrusive thoughts.”
—Mehmet Sungur, professor of psychiatry at the University of Marmara, and president of
the International Association of Cognitive Psychotherapy

“At long last, we have a groundbreaking workbook compiled specifically for those
grappling with distressing, unwanted, and intrusive thoughts. David A. Clark has produced a
scholarly yet practical self-help manual that takes the reader systematically through a series
of highly practical skills drawn from the latest research and evidence-based interventions. The
book is well structured and is filled with information, self-assessments, exercises, and skills
development that are immensely useful and easy to follow. It is a must-read for those inflicted
with unwanted, intrusive thoughts, as well as clinicians attempting to haul patients from their
obsessional quagmire.”
—Chee-Wing WONG, PsychD, associate professor in the department of psychology at the
Chinese University of Hong Kong

“From a world-leading expert on intrusive thoughts, this book will guide you through a
series of exercises that will help you to understand your anxious thoughts, and importantly it
will help you to use new strategies to better respond to them. The book is based in the latest
cognitive and behavioral science as it applies to anxiety and mental intrusions, and promises
to be useful, whether you’re a mental health professional who helps people with anxiety-
related problems, or someone who struggles with unwanted intrusions yourself.”
—Adam S. Radomsky, PhD, professor of psychology, and director of the Anxiety and
Obsessive-Compulsive Disorders Laboratory at Concordia University in Montreal, Quebec,
Canada

“This book provides a detailed account of the nature and causes of unwanted intrusive
thoughts, images, memories, and feelings that produce fear, pain, and suffering. … This book
provides effective tools for dealing with intrusive cognitions, and it explains how to practice
these tools and why they are useful. At the same time, it provides examples of non-useful
strategies and describes why they are not effective. … David A. Clark is a clinician and
researcher with extensive experience and acknowledged prestige in the realm of emotional
disorders. The Anxious Thoughts Workbook is the result of a perfect combination of clinical
experience and excellence in research.”
—Amparo Belloch, PhD, professor of psychopathology, and head of the Unit for Research
and Treatment of Obsessions and Compulsions at the University of Valencia, Spain

“David A. Clark shares effective, step-by-step approaches for combatting upsetting

intrusive thoughts that contribute to anxiety, depression, and related problems. The book is
filled with rich examples, practical exercises, and evidence-based tools—making it easy to
learn the strategies. For anyone who struggles with anxiety, depression, or other problems
associated with unwanted mental intrusions, I highly recommend this book!”
—Martin M. Antony, PhD, professor of psychology at Ryerson University and coauthor of
The Shyness and Social Anxiety Workbook and The Anti-Anxiety Workbook

“The Anxious Thoughts Workbook by David A. Clark is an excellent step-by-step guide to

overcoming the feeling that you are trapped by unwanted intrusive thoughts. Based on the best
research, Clark takes us on a journey into the troubled mind and leads us out to setting aside
the thoughts that often limit our daily lives. Filled with helpful forms and powerful techniques,
this book will give you the tools to free you from your anxiety. Highly recommended.”
—Robert L. Leahy PhD, author of The Jealousy Cure

“If you have bothersome, repetitive, anxiety-producing thoughts, The Anxious Thoughts
Workbook is the solution. David A. Clark offers a proven, systematic solution to easing the
distress associated with intrusive and unwanted thoughts. The Anxious Thoughts Workbook is
based on the most recent and sophisticated scientific understanding of how we think, and
offers true hope and help. The book teaches practical strategies that can enable you to lessen
the self-critical, catastrophic, and negative thoughts that you may currently have. Clark is one
of the world’s leading experts on the connection between how we think and how we feel. The
Anxious Thoughts Workbook is for you if you want to feel less anxious and distressed, and
want to feel a greater sense of confidence and joy.”
—Dennis Greenberger, PhD, coauthor of Mind Over Mood

“I first became aware of David A. Clark’s work on intrusive thoughts as a master’s student
back in 1989 through his own groundbreaking studies in the early eighties. This book brings
together all the clinical experience, theoretical work, and research Clark has conducted
during his career to understand and develop effective strategies for different types of upsetting
intrusive thoughts. … A very welcome addition to the literature for those who suffer from
unwanted intrusive thoughts.”
—Mark Freeston, PhD, research director and doctorate in clinical psychology at
 Newcastle University, United Kingdom

Publisher’s Note
This publication is designed to provide accurate and authoritative information
in regard to the subject matter covered. It is sold with the understanding that the
publisher is not engaged in rendering psychological, financial, legal, or other
professional services. If expert assistance or counseling is needed, the services
of a competent professional should be sought.
Distributed in Canada by Raincoast Books
Copyright © 2018 by David A. Clark
 New Harbinger Publications, Inc.
5674 Shattuck Avenue
Oakland, CA 94609
www.newharbinger.com
Cover design by Amy Shoup
Acquired by Ryan Buresh
Edited by Brady Kahn
All Rights Reserved
Library of Congress Cataloging-in-Publication Data
Names: Clark, David A., 1954- author.
Title: The anxious thoughts workbook : skills to overcome the unwanted intrusive thoughts that drive anxiety, obsessions, and
depression / David A. Clark, PhD.
Description: Oakland, CA : New Harbinger Publications, Inc., [2018] | Includes bibliographical references.
Identifiers: LCCN 2017044314| ISBN 9781626258426 (pbk. : alk. paper) | ISBN 9781626258433 (pdf e-book) | ISBN 9781626258440
(epub)
Subjects: LCSH: Intrusive thoughts. | Anxiety--Prevention. | Affective disorders.
Classification: LCC RC531 .C5349 2018 | DDC 616.85/22--dc23 LC record available at https://lccn.loc.gov/2017044314
 Contents
Foreword v
Introduction 1
1. The Unsettled Mind 9
2. Clinging to Self-Control 27
3. Control Skills: Self-Discovery 41
4. Control Skills: Mental Detoxification 63
5. Control Skills: Letting Go 83
6. Control Skills: Mindful Self-Acceptance 103
7. Control Skills: Strategies That Work 117
8. Maximizing Positive Intrusions 135
Acknowledgments 153
Appendix: Troubleshooting Your Mental-Control Issues 155
Resources 165
References 169
 Foreword
Throughout my careful reading of this book, I kept having the same positive
thought: This is an excellent book. I wasn’t deliberately trying to have that
thought; it just kept popping into my head. It was a positive mental intrusion that
led to positive feelings.
Positive thoughts such as these are rarely a problem, but negative thoughts can
be. In standard cognitive behavior therapy (CBT), individuals learn how to
identify distressing thoughts in order to evaluate and, ultimately, modify their
inaccurate thinking. But, as David A. Clark describes, this process of evaluation
is not always helpful, especially when negative thoughts are highly repetitive
and unwanted. Throughout this workbook, Dr. Clark describes a different
process to address these intrusive thoughts more effectively as he illustrates
them with interesting and enlightening case examples.
When some people experience intrusive thoughts, they are able to shift their
attention to something else fairly easily. (These are the people for whom
standard CBT works very well.) Others, however, run into trouble, especially if
their mental intrusions have deep personal significance. Those suffering from
these more severe mental intrusions usually develop strategies to help control
their thinking, and the problem is that these coping behaviors usually end up
doing the opposite. After repeated and unsuccessful attempts to control or
suppress them, unintended intrusive thoughts can become toxic, making them a
real problem that must be dealt with in the real world.
This unique workbook teaches you what to do when your unwanted mental
intrusions are specifically associated with depression, anxiety, guilt, worry,
frustration, or obsessive-compulsive disorder. The strategies are based on
research from cognitive neuroscience and experimental social cognitive
psychology. The Anxious Thoughts Workbook contains systematic, clearly
explained self-help exercises, worksheets, and other clinical resources that will
help you gain control over distressing mental intrusions. Most importantly, they
will help prevent your distressing mental intrusions from becoming toxic,
allowing you to regain control of your runaway mind.
You can use this workbook on your own or in conjunction with psychotherapy
to help address the plague of distressing mental intrusions that you experience.
However you choose to use it, though, learning the strategies in The Anxious
Thoughts Workbook will help you regain control over not just your mind, but
also your life.

—JUDITH BECK
President, Beck Institute for Cognitive Behavior Therapy
Clinical Professor of Psychology, University of Pennsylvania School of
Medicine
 Introduction
Do you experience bouts of anxiety, depression, or other negative emotions that
seem to come out of the blue or are more intense than you would expect? If so,
this workbook was written for you. The Anxious Thoughts Workbook tackles the
problem of unwanted intrusive thoughts and how you can use the new science of
mental control to reduce negative feelings and promote positive emotion. Over
half the thoughts, images, and memories that pop into your mind are unexpected,
spontaneous mental intrusions (Christoff 2012). You don’t willfully produce
these thoughts, but they’re instantly drawn into your awareness without effort.
Daydreaming and mind wandering are two common examples of spontaneous
thought, but all of us experience hundreds of distinct intrusive thoughts
throughout the day. Often we are barely aware of these mental intruders. They
may be silly, stupid, or irrelevant thoughts that we don’t really notice. They are
insignificant noise in our head, and we easily ignore their presence.
But not all mental intrusions are meaningless head noise. Sometimes an
intrusive thought, image, or memory involves something that we find intensely
negative or threatening. These upsetting intrusions grab our attention, interrupt
our train of thought, and can be incredibly difficult to ignore (Clark and Rhyno
2005; Rachman 1981). We can develop a preoccupation with these negative
intrusions, so they become an important cause of sadness, anxiety, guilt, fear,
and frustration. In fact, negative intrusive thoughts are a significant problem for
people struggling with clinical disorders like major depression, generalized
anxiety, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder
(OCD), addictions, eating disorders, and the like. If intrusive thinking is a
normal part of brain function, you might be wondering how this type of thinking
becomes such a problem for many people.

Unwanted Thoughts and Emotional Distress

For a century, psychologists have assumed that the answer to emotional distress
lies deep in the human mind or psyche. Older forms of psychotherapy based on
Freudian theory considered unconscious conflicts the root of anxiety and
depression. Even the newer treatments, like cognitive behavioral therapy (CBT),
assume that core beliefs underlie psychological distress (A. T. Beck 1967; J. S.
Beck 2011). The Anxious Thoughts Workbook takes a different approach to
emotional disturbance. Here the focus is on the first unwanted thoughts that
burst into the mind and set in motion an uncontrollable cycle of increasing
distress. The key to understanding the cause of emotional pain and suffering is
found in our response to these initial thoughts.
This workbook focuses on unwanted mental intrusions and how we try to
control them. The central idea is that personal distress occurs when we consider
an intrusive thought a highly significant negative experience that must be
controlled (Rachman 2003). That is, we become convinced that we must not
dwell on a certain thought and so work hard trying to push the thought out of our
mind. But these mental-control efforts often end in failure, which then causes a
further increase in emotional distress and magnifies the personal significance of
the intrusion. This sets up a vicious cycle of increasing distress and unrelenting
thoughts that can feel like you’re losing your mind.
In The Anxious Thoughts Workbook, you will learn how to reverse this vicious
cycle by stripping distressing intrusive thoughts of their meaning and using
effective mental-control strategies. Some of the interventions are based on well-
researched psychological treatments like CBT (Greenberger and Padesky 2016),
mindfulness (Teasdale, Williams, and Segal 2014), and acceptance and
commitment therapy (ACT) (Hayes, Strosahl, and Wilson 2011). Other features
are derived from research in cognitive neuroscience and the social-clinical
psychology of directed mental control (Christoff 2012; Killingsworth and
Gilbert 2010; Rachman 2003; Wegner 1994b). To better understand the mental-
control perspective on personal distress, consider the following case illustration.

Meredith’s Story: A Struggle for Emotional Control

Meredith’s life was full; actually it was way too full! Her days flew by with the
demands of a full-time job, raising two school-aged children, caring for aging
parents, supporting a professional husband, and volunteering for charities. With
such comfort, security, and purpose, Meredith realized she was living a life of
privilege. But lately Meredith noticed increasing bouts of anxiety and despair
that hit her suddenly and lasted for hours.
When Meredith first started having these mood shifts, she blamed it on the
hassles and burdens of daily living. Certainly, her life was hectic, but deep down
she knew something had changed in her inner being. Everything now seemed to
bother her, and she had so little patience. She became more negative and self-
critical. She was filled with self-doubt and was worried about the future. To
Meredith and her family, it was clear she was experiencing some type of
emotional crisis and needed to regain control over her emotions.
Meredith started becoming more focused on how she was thinking and
feeling. When she had a negative thought like I’ll never get it all done, or This is
not good enough, she tried hard to push the thoughts from her mind. She
reminded herself to think positively and reassured herself that everything would
be fine. When worried, she angrily told herself to stop it. At the office, she tried
to distract herself with a heavy workload. But the more she tried to take control
of her thoughts and feelings, the worse she felt. The unwanted thoughts became
more frequent and distressing. She tried even harder to control the intrusions,
becoming convinced that if she didn’t change her attitude, she was about to bring
ruin on herself and her family. But after weeks of struggling with self-control,
Meredith gave up in despair. Despite her best efforts, nothing was working. She
was puzzled by her seeming helplessness and concluded that she needed
professional help.
Meredith realized she needed better control over her negative thoughts and
feelings if she hoped to turn her life around. After all, self-control is an
important ingredient of success and life satisfaction (Mischel 2014). But the
more Meredith tried to ignore the negative thinking and replace it with positive
thoughts, the more she felt anxious and depressed.
There are several reasons why Meredith failed in her efforts at mental and
emotional self-control. For one thing, she was overthinking the significance of
her negative intrusive thoughts. When thoughts like I’ll never get it all done or
I’m letting everyone down popped into her mind, they reminded Meredith that
her thoughts and feelings were out of control. She immediately started thinking
about the negative implications: that her seemingly poor mental control would
lead to dire consequences. She thought about how she was letting down her
family and coworkers, but most of all, she thought about how disappointed she
was in herself.
As well, Meredith was trying too hard to control her thoughts. The more these
negative intrusions interrupted her flow of thought, the harder she tried to ignore
them, to push them down. She became desperate to change her thinking, but the
harder she tried, the worse it got. She could not just let the thoughts sit in her
mind; she felt she had to do something to get rid of them.
Finally, as the intrusions became more frequent and disruptive, Meredith
found herself relying more and more on ineffective control strategies, like trying
to actively suppress the thoughts, distract herself with anything, or even yell at
herself for having such “stupid thoughts.” In the end nothing was working. Her
distress intensified, and Meredith wondered if she needed to take an extended
leave from work or even be hospitalized.
Like Meredith, you may be struggling to regain control over unwanted
distressing thoughts and feelings. You realize better self-control is needed, but
the harder you try, the more you feel upset and frustrated with your failed
efforts. This workbook can help you regain control over distressing thoughts and
feelings. As with Meredith, you may be overemphasizing the importance of
certain unwanted intrusive thoughts. Many of the exercises in this workbook will
teach you how to downgrade your interpretations of significance, let go of
excessive control effort, identify ineffective mental control, and adopt more
helpful mental-control strategies. Some of this work will be demanding and may
even seem counterintuitive.
You may be wondering how you can change the importance of these
distressing thoughts when they are causing such a problem in your life. It is
difficult to change our approach to self-control, so the workbook takes a gradual,
step-by-step learning perspective with lots of instruction on how to apply the
new science of mental control to your negative emotion. To get the most out of
the workbook, it’s important to understand its organization and how to make the
best use of the exercises and worksheets.

About This Workbook

There are numerous workbooks on how to overcome anxiety and depression, so
you may be wondering what is unique about The Anxious Thoughts Workbook.
There are some fundamental differences to this workbook.

It is the only workbook that focuses specifically on the unwanted

mental intrusions that trigger emotional distress.
It clearly specifies which mental-control strategies are the least
effective for intrusive thoughts and feelings.
It presents effective mental-control strategies that are derived from
research in cognitive neuroscience and social-clinical psychology.
It offers practical self-help interventions relevant for a broad range of
negative emotions.
It provides strategies that enhance positive intrusive thoughts and
boost momentary happiness.
 The workbook consists of eight chapters, each focused on a different aspect of
unwanted intrusive thoughts and feelings and their control. The chapters build on
each other, so you’ll find it most helpful to read them in the order presented. If
one of the chapters is especially relevant, you will want to spend more time in
that chapter. The first two chapters provide important background information
on the nature of unwanted intrusive thoughts and mental self-control. Chapters 3
through 7 provide guidance and instruction on how to adopt more effective self-
control skills over anxiety, depression, and obsessive states. These chapters are
filled with exercises and worksheets, so you’ll want to spend most of your time
in this part of the workbook. The final chapter focuses on a different aspect of
emotional self-control. In this chapter, you’ll learn how to use mental control to
boost positive intrusive thoughts, so you can experience more happiness in your
daily life.
If your experience with this workbook turns out to be disappointing, the
appendix can help you troubleshoot why your self-help work was less than
satisfactory. The appendix also provides information about special types of
intrusive thoughts and other psychological conditions, like anxiety disorders,
major depression, and obsessive compulsive disorder (OCD), that usually
require treatment by a mental health professional. If you are wondering if this
workbook is appropriate for the type of distressing thoughts and feelings that
you have, you should proceed immediately to the appendix, read the
information, and do the self-evaluation exercises offered there to help you
determine whether you should be seeking professional help.

Getting the Most from This Workbook

The Anxious Thoughts Workbook is a workbook designed to help you learn more
effective self-control of distressing intrusive thoughts and feelings. You’ll be
introduced to a unique approach to mental self-control, but for these skills to be
therapeutic, you’ll need to make a commitment to change. You may be tempted
to settle for just reading through this workbook. However, to get the most out of
it, you’ll need to double down and do the exercises. You’ll probably find some
interventions more helpful than others, so you’ll want to spend more time with
the helpful ones. As well, some skills are harder to learn than others, so you’ll
want to slow down and take your time with the related exercises. You’ll want to
make copies of some worksheets, so you can use them repeatedly. Other times,
you’ll write your responses right in the workbook, so you have a permanent
record of your work. Alternatively, you can download copies of the worksheets
and exercises at the website for this book: http://www.newharbinger.com/38426.
This is a great way to get extra copies of the worksheets in case you need more
worksheet space to do the exercises.
The workbook focuses mainly on depression, anxiety, and obsessive thinking.
Consequently, most of the case illustrations and examples involve these
emotional states, although some references are made to frustration, guilt, and
anger. Of course, the last chapter deals entirely with positive emotions like joy,
contentment, and satisfaction. The case illustrations are clinical composites
drawn on thirty-five years as a clinical psychologist treating individuals with
emotional disorders, and so specific details of each case and their experiences
with the workbook exercises are hypothetical presentations used to illustrate
practical application of clinical skills.
Your decision to begin reading this workbook is an important step toward
better emotional health. Your investment in this workbook demonstrates an
openness to change: recognition that you need a different approach to managing
negative emotion. A willingness to try something different and a determination
to work on self-improvement are important ingredients in making meaningful
change. So you are to be congratulated for exposing yourself to new possibilities
of change. But it’s important to keep your expectations realistic and to have
patience. Don’t expect big changes immediately. It will take time and repeated
practice to change your mental-control strategies. Here’s what to expect:

Change requires systematic work. Real change requires that you use the
new mental-control strategies in your daily life.

Change requires insight. First you need to discover your problematic

mental intrusions, how you interpret or understand them, and how you try
to control them. Thus you’ll need to do some self-assessment work initially,
so you can benefit from the control skills discussed in later chapters.

Everyone is different. The intrusive thoughts that bother you most and how
you respond to them will be unique to you. You may need to adapt the
exercises to match your needs and situation.
Practice, practice, practice. To gain real benefit from this new approach to
mental self-control, you need to practice the strategies over and over.
Trying something new once or twice rarely makes a difference. You’ll need
to practice your new skills again and again until they feel more natural.

Be patient and exercise self-compassion. The old saying “Rome wasn’t built
in a day” is a good motto for this workbook. Your struggle with troubling
thoughts and feelings may have persisted for many years. Transforming
your mind takes time. Progress may be gradual. It is important to be kind
and to adopt a compassionate, nonjudgmental attitude toward yourself
(Baer 2014). After all, you are taking responsibility for your health and
doing your best to deal with the distress in your life. Before turning to
chapter 1, here once more is what you can expect to learn from The Anxious
Thoughts Workbook:

To identify the negative intrusive thoughts, images, or memories that

drive your anxiety, depression, and other negative emotions.
To determine your tolerance for unwanted mental intrusions and
limited controllability.
To develop a personal understanding of the mental processes involved
in the persistence of distressing thoughts and feelings.
To dial down the personal significance and threat attributed to
problematic mental intrusions.
To relinquish ineffective mental-control strategies and adopt more
effective responses to your distressing intrusions.
To feel more confident in your mental self-control and less concerned
about losing control.
To maximize positive thought and emotion and to reduce the effects of
negative emotional states.

To determine whether you are meeting these learning objectives, you may
want to return to this list from time to time as you proceed through this
workbook. If you have not made the progress you would like against anxiety,
depression, obsessions, or other distressing conditions, make sure to read the
appendix and consider whether a mental health consultation might be beneficial.
From this workbook, you’ll gain fresh insights and learn more powerful self-
control strategies that can bring renewed strength and balance to your emotional
well-being. So it’s time to get started on your journey of self-improvement. It
begins with a better understanding of mental intrusions.
 Chapter 1

The Unsettled Mind

Think back to the last time you were bored. Maybe you were stuck in traffic,
mindlessly watching a TV program, or trapped in a tedious meeting at work. Can
you remember what you were thinking? Probably not, but it’s very likely you
were daydreaming or your mind was wandering from one thought to the next.
When bored, we are especially prone to intrusive thinking. Our mind switches
into an automatic mode which generates free-floating thoughts that are entirely
disconnected from each other and may have little relevance to our current
situation. It’s like our mind is always in an active, unsettled state, even when we
feel understimulated. Of course, there are other times when our free-floating, or
intrusive, thoughts take on a darker, more negative tone because they’re
triggered by a stressful or problematic situation. Our memory for this type of
thinking is sharper because these thoughts focus on issues more important to our
general well-being.
This chapter delves into the nature of unwanted mental intrusions and their
role in personal distress. From this discussion, you’ll gain a deeper
understanding of your anxiety, depression, or obsessionality, and why you may
be susceptible to mental intrusions. You’ll also discover that intrusive thinking
can be either a blessing or a curse in your quality of life. You’ll learn about the
origins of spontaneous thought and how it is necessary for normal brain
function. The chapter is full of self-assessment checklists and other exercises
intended to bring clarity to complex emotional states. You’ll want to work your
way slowly through this chapter, giving yourself time to fully absorb all of the
self-assessment material. This will give you a solid foundation for applying the
new science of mental control to your anxiety and depression. A good place to
start is with an example of one of the most obvious forms of emotionally
disturbing intrusive thoughts: obsessive doubt.

Daniel’s Story: Dealing with Doubt

Doubt is a natural form of human thought, but for Daniel, doubt had become
extreme and unreasonable. Practically any action or decision could trigger a
relentless cycle of doubt. When leaving the house, Daniel doubted whether the
water taps were completely off, if all the lights were switched off, or if the door
was securely locked. When doubt popped into his mind, Daniel imagined all
sorts of catastrophes caused by potential carelessness or mistakes. A water tap
not completely turned off could cause the house to flood; a door not securely
locked could invite intruders. Although Daniel realized his what ifs were highly
unlikely and often absurd, his doubting intrusions made him so anxious that he’d
compulsively check over and over to make sure everything was safe and secure.
He fought valiantly against the doubt and the urge to check, but nothing helped.
The checking was never totally convincing, however, and the more he did it, the
more intense the anxiety and doubt. Eventually, Daniel came to realize that his
doubt was a form of obsessive-compulsive disorder (OCD) and that he needed
professional help.
Like Daniel, your distressing intrusive thoughts may have taken on an
obsessive quality. If you are unsure, you can use the following checklist to
determine the obsessiveness of your mental intrusions. This checklist contains
some of the key characteristics of the obsessive thinking style. You can visit
http://www.newharbinger.com/38426 to download other copies of this
obsessive-thinking checklist to use with other distressing thoughts.

Exercise: Obsessive-Thinking
Checklist

In the space provided, record your repetitive

distressing thought, image or memory:

Next, place a checkmark (√) beside the statements

that describe your experience with this thought, image,
or memory. If a statement is irrelevant, leave it blank.

__________ 1. The same thought, image, or

memory pops into my mind over and over again.
__________ 2. It is very difficult to get the
intrusive thought out of my mind.
__________ 3. When I have the intrusive thought,
it makes me feel more upset or distressed.
__________ 4. I really don’t want to have the
intrusive thought.
 __________ 5. I’ve developed certain compulsive
rituals to deal with the intrusive thought, like
washing, checking, redoing, rereading, or
reordering.
__________ 6. I realize the intrusive thought is
excessive or even absurd.
__________ 7. I can’t ignore the intrusion; it
completely captures my attention.

If you checked off several of the statements,

especially numbers 1, 2, and 5, your
intrusive thinking may have obsessional
characteristics. The interventions presented
in this workbook are effective for obsessive
thinking. However, because obsessions are
a particularly difficult form of intrusive
thinking, you’ll need extra time with the
various mental-control exercises found in
this workbook. If you are seeing a mental
health therapist, you should mention your
findings from this exercise. If you’re reading
this workbook on your own and you suspect
you might have OCD, consider contacting a
mental health expert.

Daniel suffered intense levels of anxiety, and each time he could trace its
origin to an obsessive doubt. However, not all emotional distress can be
attributed to a single type of mental intrusion. Anxiety, depression, guilt,
frustration, and other negative emotions are often triggered by a variety of
unwanted intrusive thoughts, images, or memories. As a result, you may need a
more extensive assessment to discover the type and intensity of emotional
distress you experience with your unwanted mental intrusions. This chapter
provides some assessment tools to help you better understand your anxiety,
depression, and associated distressing intrusions.
 What’s Your Distress?
If you were drawn to The Anxious Thoughts Workbook because of anxiety or
depression, you need to know that you’re not alone in your struggles. Every
year, 40 million (18.1 percent of) American adults experience a clinical anxiety
disorder and 16.4 million adults (6.7 percent) have a diagnosable episode of
major depression (Kessler et al. 2005). Together, anxiety and depression are
responsible for a substantial amount of personal suffering and lost productivity
for one in five Americans. Depression is characterized by persistent feelings of
sadness or despair, loss of interest or pleasure, fatigue, low self-worth, and
diminished motivation (American Psychiatric Association 2013). Anxiety
disorders vary from a sudden surge in anxiety, called a panic attack, to a general
feeling of unease or apprehension. Worry is often a prominent feature of more
generalized anxiety. In some cases, anxiety or fear can be highly specific, such
as feeling anxious only in social situations because you fear that others will
evaluate you negatively. If you suspect you may have an anxiety or depressive
disorder, consult the appendix for further guidance and recommendations for
seeking treatment.
Even mild forms of anxiety or depression can significantly reduce life
satisfaction (Fava and Mangelli 2001). Whether your symptoms are mild or
intense, the mental-control strategies in this workbook can be helpful. The
following exercise will help you assess your symptom severity.

Exercise: Checklist of Depressive

and Anxious Symptoms

This checklist presents several prominent

symptoms of depressed and anxious moods.
Think back to how you’ve been feeling over
the last two weeks, and place a checkmark
(√) next to the descriptions in each column
that are relevant to your emotional
experience.
 Depressed Mood Anxious Mood

__________ Frequently have episodes that last __________ Experience frequent episodes that last
at least one hour of feeling sad, blue, down, empty, more than several minutes of feeling uneasy,
or discouraged apprehensive, or uncomfortable

__________ Generally feel a loss of interest or __________ Often think about threat, harm, or danger
enjoyment in daily activities happening to myself or significant others

__________ Often feel tired or have loss of __________ Often feel tense, physically aroused, or
energy for no apparent reason queasy when apprehensive

__________ Often think that my future looks __________ Will avoid situations that cause a feeling
bleak, hopeless, or meaningless of apprehension or threat

__________ Don’t feel engaged in meaningful __________ Am highly concerned about maintaining a
or fulfilling life goals sense of safety or comfort

__________ Struggle with low self-esteem or

__________ Tend to think of the worst-case scenario
lack of self-confidence

__________ Tend to focus on loss or failure in

__________ Consider myself to be a worrier
life experiences

__________ Tend to be pessimistic and highly __________ Feel excessively uncomfortable or

self-critical stressed when being evaluated

__________ Rarely experience happiness, joy, __________ Often feel anxious when unexpected
or contentment physical symptoms are experienced

__________ Consider myself a procrastinator __________ Often must work at calming myself down

__________ Consider myself a nervous, anxious

__________ Frequently lack motivation
person

Looking over the checklist, which symptoms

seemed more relevant to you, those
describing anxious mood or those describing
depressed mood? Did you check off many of
these symptoms or only a few? The more
 symptoms you checked off in a particular
column, the more intense your emotional
experience.

As you do the exercises in this workbook, you’ll want to return to this

checklist to evaluate your progress on symptom improvement. For now, this
checklist can help you determine your pace ahead. The more symptoms you
checked off, the more time and practice you’ll need with various workbook
exercises.

Distressing Thoughts and Feelings

Emotional distress includes many different types of unwanted thoughts and
feelings that extend beyond the core symptoms of anxiety and depression. For
example, Daniel struggled daily with intense anxiety because of his obsessive
intrusions of doubt, but he also experienced other negative emotions like guilt
and frustration over his failed self-control. Guilt was an important emotion that
drove his fear of making mistakes, and he often felt frustrated by his inability to
stop checking. These other unwanted thoughts and feelings were complementary
states of emotional distress.
Take a few minutes to complete the checklist in the next exercise to determine
whether you experience any complementary states of emotional distress. This
checklist includes a definition and clinical example of each mental and
emotional state. Unwanted mental intrusions and diminished mental control
feature prominently in each.

Exercise: Checklist of Distressing

Mental and Emotional States

Consider each of the symptoms below and

place a checkmark (√) next to the ones that
you often experience when feeling upset or
 distressed. If you experience a symptom
only occasionally or it does not cause much
distress, then leave it blank.

Symptom State Definition Example

Unwanted, unacceptable, and often irrational

Fearful of becoming
__________ recurring intrusive thoughts, images, or urges that feel
contaminated from objects
Obsessions uncontrollable and distressing even though you try not
touched by others
to give in to the thought

A process of negative, uncontrollable, and highly

distressing mental problem solving intended to reduce Thinking about your finances
__________
the uncertainty of one or more imagined future and whether you are saving
Worry
negative or threatening outcomes for yourself or enough for retirement
significant others

Thinking Why do I keep

A passive form of repetitive, uncontrolled negative
feeling so depressed? I have no
__________ thinking in which you revisit the same concerns about
right to feel so down. I don’t
Rumination the causes and consequences of your depression or
know what I’ll do if I can’t pull
some past stressful experience
out of this funk.

Highly focused attention on an imagined possibility Driving to work and suddenly

__________
of having committed an error or act of omission that questioning whether you
Excessive
could have unintended negative consequences for actually unplugged your hair
doubt
yourself or others straightener

Incessantly thinking about

Distressing and uncontrollable cyclical mental
how unfair it is that your
__________ preoccupation with your personal disadvantage or
coworker got the promotion and
Jealousy deprivation and its unfairness in comparison to one or
you’re still stuck in a boring
more others
lower-paying position

Recurring thoughts, images, or memories of a past Accidentally spilling coffee

__________
mistake, failure, or carelessness that is associated with on a friend’s new sofa and not
Guilt
significant regret, shame, or embarrassment telling her

A sudden realization that a valued goal or course of Being stuck in traffic and
__________
action is being thwarted by circumstances beyond realizing you’ll be late for an
Frustration
your personal control important appointment

Did you find many of the symptoms in this

 checklist relevant to your emotional distress?
And after all, who doesn’t have occasional
worry or ruminate on some past
disappointment? But if worry, rumination,
guilt, or any other symptoms feature
prominently in your distress, it’s important
that you focus on these experiences when
you practice this workbook’s interventions.
Again, you’ll want to return to this checklist
later in the book to review the troubling
thoughts and feelings you targeted in your
self-help work.

By completing the previous exercises, you have gained a deeper

understanding of your emotional distress. As Sir Francis Bacon said,
“Knowledge is power.” Your work on these exercises represents a small act of
self-empowerment.
Now it’s time to turn to unwanted intrusive thoughts and to consider how they
contribute to depression, anxiety, and obsessional states.

Hunting for Intrusions

Any thought, image, or memory can be an unwanted mental intrusion. The
unwanted intrusive thoughts associated with anxiety and depression are
characterized by

spontaneous occurrence in the mind; that is, without effort or intention

high unacceptability
an ability to get your attention
a capacity to interrupt concentration
their upsetting or distressing quality
being difficult to ignore, suppress, or dismiss

Whether a thought is an unwanted intrusion depends on your evaluation of the

thought. In fact, the actual thoughts we find unwanted and intrusive can be
unique to each of us. Daniel, for example, had numerous unwanted intrusive
thoughts, but they all dealt with the same theme: What if I forgot to do
something? Or What if I accidentally caused harm or injury to someone?
So my mental intrusions will be quite different from yours, but everyone
experiences unwanted negative intrusive thoughts, images, or memories. Of
course, the frequency and distressing quality of unwanted intrusions differs
greatly from person to person. The first task, then, is to discover the mental
intrusions at the heart of your own emotional distress and whether they are
linked together by a common theme.
Becoming more aware of intrusive thinking is challenging because these
thoughts often pop into the mind unexpectedly and then disappear before we
know it. However, the intrusions most relevant to personal distress are tightly
connected to our emotions, and if you’re aware of how you feel, you can work
back from the emotion to discover the intrusive thought that made you feel bad
in the first place. There is also considerable research showing that certain types
of thoughts are associated with specific mood states (Clark, A. T. Beck, and
Alford 1999). This relationship is reciprocal, so certain thoughts trigger certain
feelings and vice versa. Figure 1.1 illustrates this thought-feeling connection.

Sadness Thoughts of loss, failure, criticism and deprivation

Fear Thoughts of imminent danger

Anxiety Thoughts of threat, helplessness, and vulnerability

Anger Thoughts of injustice, wrongdoing, unfairness

Figure 1.1. The Thought-Feeling Connection

Now it’s time to discover the thought-feeling connections that occur when
you’re distressed.

Exercise: Thought-Feeling Record

 Over the next two weeks, use this thought-
feeling record to keep track of your
experiences of negative thoughts and
feelings. Note that thoughts can sometimes
take the form of images or memories
associated with your experiences of anxiety,
depression, or other negative emotions.
When you notice yourself having negative
thoughts and feelings, briefly note the
distressing situation or circumstance, and
then list the associated negative feelings.
Use the third column to record what you
were thinking while feeling distressed, and
then circle the first thought that went through
your mind. You can visit
http://www.newharbinger.com/38426 to
download copies of this thought-feeling
record.

Situation Feeling Negative Thinking

1.

2.

3.

4.

Developing a keen awareness of what you’re

thinking when feeling depressed or anxious
is a fundamental skill taught in cognitive
behavioral therapy (CBT) (Greenberger and
Padesky 2016). When upset, it’s more
 natural to be completely focused on the
emotion, and it may seem unnatural to ask
yourself, Okay, I’m feeling depressed right
now, so what am I thinking? But focusing on
your negative thoughts provides the answer
for overcoming emotional distress. Of
course, the mental-control approach goes
one step further. It asks you to identify the
first negative thought that intruded into your
mind and started your negative feeling. So in
the exercise, you not only identified your
negative thoughts but also circled the
thought that you believed first came into your
mind.

Daniel was very aware of his doubting intrusive thoughts, so he didn’t have to
do a thought-feeling record to know what they were. However, he also
experienced sudden periods of feeling blue or sad, which seemed to come
completely out of nowhere, so he completed a thought-feeling record to discover
the thought-feeling connection. After writing down several experiences of
feeling sad, he noticed they often occurred after he got stuck in obsessional
checking. His negative thinking went like this:

My OCD is getting worse.

I’ll never get better.
It’s hopeless.
I’m going to eventually get fired because I’m too slow.
I’m such a weak person.
I have no self-control.

As he captured more and more experiences of dysphoria, Daniel realized that

the thought I have no self-control was the initial unwanted intrusive thought that
led to feeling depressed. This was an important clue, which he used in building a
mental-control intervention for his OCD.
Did you have difficulty identifying what you were thinking when feeling
upset? Were you able to circle the first intrusive thought in the chain of thinking
that led to anxiety or depression? If you are struggling with this exercise, give
yourself time to practice identifying your intrusive thoughts before proceeding
further with this chapter.
I’ve provided CBT to hundreds of clients, and practically everyone finds
keeping a thought-feeling record difficult at first. So don’t give up if you’re
struggling with this exercise. With practice and patience, you can learn to
become more aware of your negative thinking. And like so many others, you’ll
find that heightened awareness of your thinking can have a therapeutic effect on
your negative emotions. Increased cognitive self-awareness is an important part
of greater self-control over unwanted thoughts and feelings. So I encourage you
to keep using this thought-feeling record as you continue with the workbook.

Mental Intrusions: An Aspect of Creativity

Cognitive neuroscientists tell us that around 50 percent of our thinking is
spontaneous, stimulus-independent thought such as daydreaming, mind-
wandering, unwanted mental intrusions, and the like (Christoff 2012). This type
of thinking is so common that it’s actually been called the brain’s default mode
of operation (Killingsworth and Gilbert 2010). The brain centers responsible for
spontaneous thought originate in the medial prefrontal cortex, posterior
cingulate/precuneus region, and the temporoparietal junction of the brain, with
extensive neural connections to other brain regions involved in self-control and
emotion regulation (Dixon, Fox, and Christoff 2014). Spontaneous intrusive
thinking, then, is not only normal but also essential to how the human brain
operates.
If you’ve been struggling with distressing intrusive thoughts, you might be
wondering if there’s something wrong with you. Nothing could be further from
the truth. Intrusive thinking, or what scientists call undirected thought, is
important for human survival. Having frequent positive intrusive thoughts, for
example, predicts resilience, growth, and life satisfaction (Baars 2010).
Spontaneous positive thinking also contributes to creativity, which is critical for
language, music, art, and the like (Wiggins and Bhattacharya 2014). So, being an
intrusive thinker is not a negative characteristic but rather a very positive and
enriching mental process. The goal is not to stop intrusive thoughts, if that were
even possible, but rather to harness your intrusions, that is, to learn how to
dampen down the effects of unwanted distressing intrusions and boost the
benefits of positive or inspirational spontaneous thought.
Is it possible you’ve been so focused on negative thoughts and feelings that
you’ve failed to recognize the benefits of your positive spontaneous thoughts?
Maybe intrusive thinking is playing a more adaptive role in your life than you
realize. For example, how often has a solution to a problem suddenly come to
you out of the blue? At times, you might actually call it “inspiration.” This
happens often as a writer. I might be struggling with a particular passage,
wondering how I can best convey a certain idea. Suddenly, out of nowhere, a
solution to my writing impasse pops into mind. Sometimes it’s a really good
solution, and other times it’s not such a good idea, but the point is, the sudden
appearance of an unintended thought—call it inspiration or a positive intrusive
thought—is important to the process. Our ability to think creatively, to generate
solutions to problems, or to come up with a good idea is dependent on the part of
our brain that engages in spontaneous unintended thought. So, if you are an
intrusive thinker, congratulations! You have an amazing mental ability, but your
challenge is to manage it wisely.
By now you might be asking yourself, Am I an intrusive thinker? Maybe
you’ve been feeling so anxious or depressed that you’ve been overlooking the
creative side of your intrusive thinking. Time to take a break from the negative
chatter in your mind and use the following exercise to shift your attention to the
possible positive, even creative, mental intrusions you may be experiencing
more often than you realize. How often do ideas suddenly come to you that
provide an answer to some work task? Or how often do you suddenly realize
how you should respond to an interpersonal problem in your family? How often
is intrusive thinking enriching your life, enabling you to deal with life’s
problems and challenges?

Exercise: Your Creative-Intrusions

Diary

Over the next week or two, use this

worksheet to record experiences in which a
positive, creative, or inspirational idea
spontaneously and unexpectedly pops into
your mind. In the left-hand column, write
 down the situation, circumstance, or problem
that you or someone you knew was facing.
In the right-hand column, write down the
sudden, unexpected thought or idea that
enabled you to successfully deal with it. If
you need more space to write, you can visit
http://www.newharbinger.com/38426 to
download a copy of this creative-intrusions
worksheet.

Creative Intrusions Worksheet

Situation, Circumstance, or Problem Creative Problem-Solving Intrusive Thought

1.

2.

3.

4.

5.

6.

7.

Were you able to capture any positive or

inspirational intrusions over the past week or
two? Are you surprised at how often
intrusive thinking actually helped you deal
with a problem, circumstance, or difficult
 situation?

Daniel always considered his intrusive thinking to be problematic. But at work

he often came up with important contrarian views at policy planning meetings.
He seemed to have an intuitive ability to discover possible unintended
consequences to the group’s decisions. These contrarian views often came to
him quite suddenly, seemingly out of the blue, with ease and conviction.
Like Daniel, you may be experiencing a dark, unintended side to your mental
intrusions but realize you also have this positive, adaptive side to your creative
mind. There is considerable similarity between positive intrusive thoughts and
negative intrusive thoughts (Edwards and Dickerson 1987). Therefore, it’s quite
possible to frequently experience both. As you continue with this workbook,
keep your creativity in mind, and remind yourself that your unwanted negative
intrusive thoughts may be a product of your creative and imaginative mind. The
final chapter focuses on boosting positive intrusions to promote happiness. In the
meantime, this workbook will focus on controlling unwanted distressing
thoughts.

The Ubiquity of Negative Intrusions

Unwanted and unpleasant mental intrusions are a fact of life for most people.
You may be surprised to learn that even fairly disturbing intrusive thoughts,
some of which you might consider to be disgusting, immoral, or repugnant, are
reported by the average person. For example, a study of hundreds of university
students from thirteen countries found that over 80 percent reported at least one
unwanted, mildly distressing intrusive thought over a three-month period about
contamination, doubt, harm or aggression, immoral sexual or religious concerns,
or being a victim of violence (Radomsky et al. 2014). It is now a well-
established finding that practically everyone has unwanted and distressing
mental intrusions (Clark and Rhyno 2005). What differs among us is the
frequency of our negative intrusions, the degree to which we can control them,
and the intensity of our distress.
You may have assumed you’re alone in your struggle with unwanted and
distressing thoughts and feelings. If you find it hard to believe that others
experience the same type of negative thinking, take some time to do the
following negative-intrusions survey. Select five or six close friends, family
members, or your spouse or partner, and ask them about their unwanted
thoughts, images, or memories.

Exercise: Take a Negative-

Intrusions Survey

Introduce this survey by asking the

participant, “Do you ever have negative or
upsetting thoughts, images, or memories
that suddenly pop into your mind for no
reason? You don’t want to have this thought,
image, or memory, you find it upsetting, and
you would like to stop thinking about it, but
it’s hard to get your mind off it. It may pop
into your mind quite randomly, and it may
take you by surprise.” Ask the person to
describe these negative intrusions, and then
use this worksheet to record the responses.

Name of Survey Participant Negative Intrusive Thoughts, Images, or Memories

1.

2.

3.

4.

5.

6.
 Did any of the survey participants deny
having unwanted and distressing mental
intrusions? If so, ask them if they’d be willing
to track their thoughts over the next couple
of days to determine if they experience more
negative intrusions than they may have
realized. Sometimes people initially deny
having negative thoughts, because they tend
to quickly forget about them. The thoughts
aren’t important, so they pay little attention to
them. After intentionally tracking their
intrusive thinking, however, they may be
surprised to discover a significant amount of
mental negativity.

As you’ll learn from this workbook, the existence of negative intrusive

thoughts and feelings is not the issue: what matters is how you deal with it.
Again, some people seem to be more aware of their intrusive thoughts than
others. This final section looks at whether some of us are more likely to
experience distressing mental intrusions than others.

Are You an Intrusive Thinker?

There are many reasons why some people have more frequent and distressing
intrusive thoughts than others. First, our life experiences can affect intrusive
thinking. Stressful or traumatic life experiences can cause us to have repeated
unwanted intrusive memories of the trauma for months or even years after the
event. Second, our mood state affects the type of unwanted thoughts that intrude
into our mind. If you’re in a sad or depressed mood, you’ll have more frequent
negative intrusions of loss and failure; if anxious, your unwanted intrusions will
focus on threat and danger; and if angry, you’ll have more spontaneous thoughts
about injustice and unfairness. Third, our personality affects whether we have
few or many negative mental intrusions. People who are more emotional, more
aware of their thoughts, and have greater difficulty controlling unwanted
thinking will experience more frequent and distressing mental intrusions
(Barahmand 2009; Munoz et al. 2013).
If people differ in their tendency to experience negative intrusive thoughts,
you might be wondering about your risk level for this type of thinking. The
following exercise can be used to estimate your natural propensity for intrusive
thinking.

Exercise: Your Intrusion Proneness

Checklist

Place a checkmark (√) beside the

statements that describe your experience
with intrusive thinking.

__________ I’m a creative, divergent thinker.

__________ I have experienced a past traumatic
event.
__________ I’ve had several major life problems
or concerns.
__________ I experience frequent negative mood
states.
__________ I consider myself an emotional
person.
__________ I often overanalyze or overthink
issues.
__________ I have difficulty controlling unwanted
thoughts.

If you checked three or more statements,

you might be more inclined to experience
frequent and distressing unwanted intrusive
thoughts. However, this does not mean you
 are destined to live a life of perpetual
distress, because there is probably a
positive, creative side to your thinking that is
being neglected.

If you’re prone to negative-thought intrusions, it’s important to be patient with

your progress through the workbook and to keep your goals realistic. You may
need to spend longer on certain exercises and cope with a higher level of
negative intrusive activity than someone with a lower risk factor. But wherever
you lie on the intrusion spectrum, you can expect to make progress in how you
deal with unwanted anxious, depressive, and obsessive thinking.

Wrap-Up
Like millions of people, you may be struggling with negative emotional states
like anxiety, depression, guilt, obsessions, anger, and the like. You may have
started reading this workbook because you experience intense and persistent
personal distress. Alternatively, your negative emotions may tend to be milder
and more sporadic. Regardless of where you lie on the personal-distress scale,
the key to better mental health starts with your unsettled mind. How we think
affects how we feel, so changing your thoughts can bring healing and wholeness
to your troubled emotions. In this chapter, you learned that

Distressing mental intrusions are unintended thoughts, images, or

memories that pop into our mind that are highly unacceptable, rich
in negative emotion, and difficult to control.
If your intrusive thinking is obsessive, you’ll need more time
practicing this workbook’s intervention strategies.
A better understanding of the symptoms associated with your distress
is critical for designing a self-help treatment that works for you.
Keeping a thought-feeling record is a useful tool for discovering the
negative intrusions that trigger feelings of anxiety, depression, guilt,
and other unpleasant emotions.
Our ability to think spontaneously is a fundamental characteristic of
brain function and necessary for our survival.
 Being an intrusive thinker may be linked to creativity; positive
intrusive thoughts are associated with higher life satisfaction and
well-being.
The vast majority of people have negative intrusive thoughts. Whether
you find your negative intrusions distressing or not depends on how
you manage this unwanted form of thought.

In this chapter, you’ve seen that anxiety, depression, and other distressing
emotional states are fueled by the presence of negative intrusive thoughts,
images, and memories. Being aware of your intrusions and their connection to
distress is an important part of the mental-control approach to distress. But
unwanted negative intrusions are only part of the story. The second major theme
of the workbook is mental control. We depend on mental self-control almost
continuously throughout our wakeful hours, but what do you really know about
mental control? How does it work and what are its limits? What happens when
we begin to question our capacity for self-control? Chapter 2 will examine these
and other issues.
 Chapter 2

Clinging to Self-Control
Have you ever wondered if you’re losing your mind? Maybe you said something
that you later regretted, or you behaved poorly and later felt really embarrassed,
but when it happened, you just couldn’t stop yourself. Or you’ve been having
these strange, upsetting thoughts that suddenly pop into your mind, and you
can’t stop dwelling on them. These are examples of failed attempts at self-
control, and we’ve all had many such experiences more often than we like. But
why is it so hard to direct our thoughts, feelings, and behavior in ways that are
right and good for us and others? Why does it seem easier to take a more
distressing, sometimes even self-destructive, path? These are the kind of
questions tackled by self-control researchers, which is the topic of this chapter.
As you’ve seen, the mind is an unsettled place, with hundreds of thoughts,
images, and memories spontaneously appearing and disappearing without
apparent direction or intent on our part. And yet, it’s obvious we can direct our
thoughts, choosing to concentrate our mental faculties on specific tasks,
problems, or situations. If we had no mental control, we’d be unable to
communicate with each other or interact with our external world. So how much
control do we have over our thoughts and feelings? Psychologists have been
researching this question for decades, and you’ll be surprised at their findings. It
turns out mental self-control may be more limited than you think.
This chapter explores various aspects of self-control and how you can begin to
understand the strengths and weaknesses of your own thought controllability. It
begins with what it means to have self-control, or willpower. Often when people
are depressed or anxious, they blame themselves, believing they lack the
willpower to get better, but willpower actually tends to fluctuate, so it’s
important to know what can strengthen or weaken it. This chapter then delves
into the subject of mental self-control, which is the ability to choose which
thoughts to concentrate on and which to ignore. You’ll learn what influences our
level of mental control, and you’ll confront one of the great paradoxes of the
human mind: the harder we try to not think about something, the more we’re
drawn to do the exact opposite, which is to think about it. It’s like the thought
grows in strength the more you try to resist it. You’ll also explore how the fear
of losing control contributes to anxiousness about your mental state. In addition
to providing background information, this chapter offers some self-exploratory
exercises to lay the foundation for learning more effective ways to promote self-
control.

Emma’s Story: Trapped in a World of Despair

Emma had been battling depression for months. Known for her high energy,
enthusiasm, and productivity, Emma experienced her first depression after
breaking off her engagement. The heartbreak she experienced was so profound,
it seemed to affect every area of her life. Day after day, she felt dejected, sullen,
and numb. She lost all interest in work and social activities. She felt unrelenting
fatigue, spending most evenings in bed, binge-watching movies. Emma knew
she was only making the depression worse by her withdrawal and inactivity. But
she couldn’t seem to muster the willpower to change. Her mind was flooded
with negativity like I don’t want to do anything and I’m just too exhausted.
These became Emma’s unwanted intrusive thoughts. She wanted to get back to
her old self, but she couldn’t seem to get beyond the intrusions. Once the I can’t
or I won’t thoughts took hold, she couldn’t shake them. She was convinced she
had no willpower, that she had become a helpless victim of her own negative
thoughts and feelings.
Emma was filled with self-blame for being stuck in depression. Her therapist
gave her lots of good advice, suggesting she increase her social contact, go to the
gym, and set realistic daily goals, but Emma couldn’t seem to follow through.
She berated herself for having no willpower and even questioned whether she
had enough strength to face the ordinary demands of life. Emma felt lost in a
land of despair with no will to leave.

How Willpower Works

When we can’t force ourselves to do something, we often blame it on weak
willpower. Psychologists use various terms for willpower, such as self-control or
self-regulation. Willpower is the ability to override natural and automatic
tendencies in the pursuit of some valued, long-term goal. This often involves
relinquishing short-term attractions and following society’s norms and rules
(Bauer and Baumeister 2011).
Willpower is essential for life as we know it. It’s a basic process involved in
common mental functions like decision making, reasoning, and intelligent
thought. Take a daily experience like getting to work. This simple act requires
enormous willpower. You must force yourself to leave a warm, comfortable bed
against your natural desire to fall back to sleep. You then venture into a cold,
dark house, go through the same self-care routine that you do every morning, eat
the same boring breakfast, and then battle crowded highways and streets to
arrive at a highly stressful job. You do all this to purchase the desired amenities
of life, satisfying the long-term goals of comfort and security for yourself and
your loved ones. This is only one simple example of how you exert self-control
in your daily life. Multiply this by the dozens of times throughout the day that
you choose a harder path in pursuit of prized goals and values. Clearly,
willpower is critical to your very survival.
This ability to exert self-control is rooted in a neural system called executive
function, which can be found in the prefrontal cortex (PFC), a part of the brain
also critical for goal attainment and emotion regulation (Wagner and Heatherton
2011). Willpower is possible because of PFC activation, which enables us to
inhibit unwanted thoughts, feelings, and behavior that would distract us from
pursuing our life goals and desires. The PFC also enables us to maintain our
focus on thoughts, emotions, and actions that advance our goals.
Willpower, of course, has its limits, and it varies in strength from one moment
to the next (Mischel 2014; Vohs and Baumeister 2011). Sometimes we feel
strong and able to resist our immediate impulses, whereas other times we
immediately cave in. Many factors can influence the strength of our willpower.
No doubt you can easily recall times when your self-control was weak. It may
take greater effort to remember times when you exerted strong self-control.
You can use the next exercise to record times when you demonstrated good
self-control. It could be something important, like forcing yourself to work on a
project you’d been procrastinating on, or it could be accomplishing a more
routine but boring task, like doing the laundry, tidying up the house, or washing
the car. If you have difficulty coming up with an example of exerting willpower,
take note of your activities over the coming week and select an occasion when
you forced yourself to do something to achieve a desired goal. Emma, for
example, always made sure she ate healthy food, even when she was feeling
depressed and unmotivated to eat.

Exercise: When Did You Exert

Strong Willpower?
 Write down a desired goal you forced
yourself to work on even when you had little
motivation to do it.

Were you able to identify an example of

exerting strong willpower? Can you come up
with more than one example? Before
working on other areas where you may have
less self-control, it is important to recognize
how often you have an adequate amount of
willpower to get things done in your life.

It’s not like you always take the easiest route and never make progress on
important life goals. Emma, for example, noted that she had strong self-control
over her diet because she felt passionate about good dietary habits, and she knew
she could continue to eat healthily because she’d been doing it for years. More
importantly, when Emma thought about her willpower over food, she felt
encouraged that she could make progress on other issues if only she used a more
effective self-control strategy.
Now that you’ve had a chance to reflect on your times of high self-control, it’s
important to consider other occasions when you’ve struggled with willpower.
Working on low self-control is especially important because avoidance,
procrastination, and goal abandonment are common features of anxiety,
depression, and other negative emotional states.
You can use the next exercise to record a personal goal—something you’d
like to start doing or stop doing—which you lack motivation or willpower to
achieve. It could be an important task at home or at work or a trivial activity that
you can’t get yourself to do. Emma knew she would probably feel a little better
if she went out with her friends, but she couldn’t force herself to contact even
her closest friend. Night after night, she procrastinated making the call, choosing
instead to stay at home alone.
 Exercise: When Have You Felt Your
Willpower Was Weak?

Write down a desired goal that you’ve been

unable to achieve because you can’t
overcome low motivation.

Was coming up with an example of weak

willpower easier than coming up with an
example of strong willpower? If so, don’t be
discouraged. If you are having difficulty
exerting self-control, it’s not because there’s
some flaw in your character. You’ve just
been reminded that you can exhibit strong
willpower with various activities in your daily
life.

It’s important to recognize that having low self-control is not something fixed
or unchangeable. Low self-control is actually a problem of motivation strategy,
which is something you can work on.

Looking at Your Motivation Strategies

Certain strategies that we use when we hope to achieve a goal actually diminish
our willpower even though we may not be aware of it at the time. Have you
considered that you might be relying on ineffective strategies to motivate
yourself?

Exercise: Weak Willpower-

Strategies Checklist
Choose a time when weak willpower was
particularly relevant to your personal
distress. Next, read through the following
statements and place a checkmark (√)
beside the statements that help to explain
your lack of willpower at the time.

__________ 1. I was spread too thin; trying to

exercise self-control over too many different things
at once.
__________ 2. I was not pursuing a valued or
well-defined goal.
__________ 3. I was focused on a goal that would
not produce much improvement in my current
situation.
__________ 4. I never really believed I could
attain the goal.
__________ 5. I was trying to motivate myself
while in a negative mood state.
__________ 6. I tried to make a change on my
own with little support from others.
__________ 7. I often engaged in self-criticism
while trying to reach the goal.
__________ 8. I chose to work on the goal when
physically exhausted.
__________ 9. I have neglected physical exercise,
so I have less energy.
__________ 10. I became quite emotional and
overly self-absorbed when trying to motivate
myself.
__________ 11. I tried to motivate myself by
focusing on distant or remote benefits of self-
control.
__________ 12. If possible, I choose to avoid self-
control opportunities as much as possible.
 Did you check off one or more statements? If
so, do you have a better sense of why
you’ve struggled with low motivation to
achieve your goal? Each statement reflects
a strategy that diminishes self-control. When
you have strong willpower, you’re using
more effective motivation strategies, but
when self-control is weak, you resort to
easier but less effective motivation strategies
(refer to the checklist items you endorsed).

Emma, for example, knew she needed to increase social contact with her
friends. But she ended up using ineffective strategies to deal with her low
motivation. For example, she didn’t really believe that more social activities
would improve her mood state (number 2), she was convinced she just wasn’t a
friendly person (number 4), she’d put off thinking about calling her friend until
after work when she was tired and most depressed (numbers 5 and 8), and she
berated herself for being such a terrible procrastinator (number 7). When it came
to motivating herself to be more sociable, Emma undermined her motivation by
adopting weak willpower strategies.
Emma decided to come up with a motivation action plan to achieve her goal
of increasing her social contact with friends. To come up with some strong
motivation strategies, Emma stated the opposite of numbers 2, 4, 5, 7, and 8. She
intentionally worked on

determining whether she did feel better after social interaction, thereby
changing her belief in the importance of being more sociable.
realizing she was capable of being friendly by taking note of times
when she acted friendly to others.
deciding that she would text her friend (about meeting for lunch)
earlier in the morning when she felt more rested and was in a
slightly better mood state.
countering her self-criticalness by reminding herself that she was
working on self-improvement and making some progress, but that it
would take time and she needed patience.
 Now that you have a better understanding of your willpower and your
motivation strategies, it’s time to put this knowledge to work with a new
motivation action plan to achieve your goal. For additional copies of the
Motivation Action Plan, visit http://www.newharbinger.com/38426.

Exercise: Motivation Action Plan

Write down a goal that you’ve been unable

to achieve because of low willpower (you
can name the goal you described earlier in
this chapter).

How have you been trying to achieve the desired goal?

What do you think you need to do to reach the desired goal?
Review your responses to the weak willpower-
strategies checklist, and revise your previous ineffective
motivation strategies to come up with a new list of
strong motivation strategies (hint: do the opposite of
what you’ve been doing). As a guideline, you may want
to review how Emma did this. Write down your new
strategies.

Once you’ve created your motivation action

plan, it’s time to put it into practice. You
might want to keep the action plan handy, so
you can refer to it whenever you’re reminded
of the desired goal.

Emma loaded her motivation plan on her smartphone as a to-do list, so she
could frequently check the list throughout the day. This way she could remind
herself to stop and take a minute to text her friends about meeting up after work
or about their plans for the weekend.
Motivating yourself to break the habit of avoidance and procrastination takes
effort and determination. But if you’re patient with yourself and take small steps,
using effective motivation strategies, you can make the changes that will help
reduce unwanted thoughts and feelings.
Of course, the willpower strategies we’ve been discussing are broadly relevant
to all forms of thought, behavior, and emotion. It’s important to remember that
willpower is strengthened with the use of motivation strategies that emphasize
the pursuit of high-valued goals in a rational, reasoned, and confident manner.
So work on improving your motivational strategies is an important pathway to
better emotional health and well-being.
The next section focuses in on mental self-control, which is especially useful
for the unwanted intrusive thoughts that contribute to your emotional distress.

The Mental-Control Paradox

Mental control refers to a conscious, directed effort to shift attention away from
unwanted thoughts, images, memories, sensations, feelings, or urges and toward
wanted mental events that will create a desired state of mind (Wegner and
Pennebaker 1993). For example, at this moment, you are using mental control to
read and understand this passage. You’re actively trying to concentrate on the
workbook and inhibit intrusive thoughts that might interrupt your concentration,
such as thinking about what you’ll have for lunch, something you heard on the
news, or an argument you had with your spouse last night.
To maintain attention and concentration, mental control must achieve two
aims: to maintain attention on wanted thoughts and to selectively inhibit
irrelevant, unwanted, and distracting thoughts. Effective mental control, then, is
a balancing act between attending to what we want to think about and inhibiting
or suppressing the irrelevant or unwanted distracting intrusions. Of course, we’re
not perfect in executing this mental balancing act. Sometimes we seem to have
good mental control, and then other times we can’t seem to concentrate, no
matter how hard we try. During those times when mental self-control seems to
be slipping, you may try even harder to focus on the wanted thoughts and
suppress what you don’t want to think. But how successful are you? No doubt
you’ve stumbled into one of the great mysteries of the mind, which can be called
the mental-control paradox.
 Most things we want to learn to do in life benefit from practice. For example,
the more you may practice at music, dance, sport, or any other skill, the better
you will get at it. And generally, the more we practice and the harder we work at
something, the greater the chance of our achieving important life goals. Well,
unfortunately, this is not the case when it comes to efforts at mental control.
There is considerable scientific evidence that the harder we try to control our
unwanted thoughts, the worse they get. It’s called an ironic mental process
(Wegner 1994a). If you don’t believe me, try the white-bear experiment. It
consists of two parts: thought retention and thought dismissal. For this
experiment, you’ll need a notepad and pencil along with a smartphone or other
timer.

Exercise: White-Bear Experiment:

Part 1. Thought Retention

Find a quiet place in your house where you

can sit comfortably without interruption. Now
close your eyes, take a couple of slow deep
breaths, and relax. After a minute or two of
relaxation, read the following thought-
retention instructions. Then set your timer for
two minutes and follow the instructions.

Thought-retention instructions: Close your eyes and force yourself to think

about a white bear. You should try as hard as you can to keep your mind focused
on a white bear. If other thoughts intrude into your mind so that you lose the
white-bear thought, simply note the interruption with a tally mark on a blank
sheet of paper, and then gently return your attention to the white bear. After the
two-minute interval, stop the experiment, open your eyes, and count up the
number of interruptions you experienced while trying to think about a white
bear.

If you’re like most people, you probably

 couldn’t think about the white bear
continuously for even two minutes. No doubt
you experienced several unwanted intrusive
thoughts that broke your concentration and
caused you to lose focus multiple times.
Notice that even though you were putting
great effort into mental control, you still
couldn’t maintain perfect attention on a very
simple idea for even two minutes.

The takeaway message from this exercise is twofold:

Mental control is far from perfect, even with great effort.

Concentration and attention are fluid, constantly shifting from one
thought to the next.

Now it’s time to do the second part of the white-bear experiment where you
try to eliminate a thought, which is called thought dismissal. Again you’ll need a
notepad and pencil along with your smartphone or other timer.

Exercise: White-Bear Experiment:

Part 2. Thought Dismissal

Again start by closing your eyes, taking a

couple of slow deep breaths, and relaxing.
After a minute or two, proceed with the
dismissal part of the experiment after
reading the following instructions.

Thought-dismissal instructions: Reset your timer or watch for two minutes,

close your eyes, and for the next two minutes, try not to think about a white bear.
You should try as hard as you can to suppress or prevent any thought of a white
bear from entering your mind. If the thought of a white bear intrudes into your
mind, make a tally mark on the sheet of paper, and then gently turn your
attention to other thoughts.

After completing this second phase of the

experiment, look at the number of times the
white-bear thought intruded into your mind
over the two-minute interval. If you’re like
most people, you probably found it even
harder to suppress the white-bear thought
(thought dismissal) than to intentionally think
about a white bear (thought retention).

With thought dismissal, the white bear became an unwanted intrusive thought.
Did you find that the harder you tried not to think about a white bear, the more
the bear came into your mind? If this was your experience, then you’ve
experienced the paradox of mental control (see figure 2.1). That is, the harder
you try to suppress an unwanted thought, the more it will intrude into your mind.

Figure 2.1. The Mental-Control Paradox

Over the last couple of decades, hundreds of psychological experiments have

shown that active attempts to directly inhibit or suppress unwanted thoughts are
ineffective, at best, and probably make the experience of negative distressing
thoughts worse (Rassin 2005; Wegner 1994a). The research indicates that trying
to suppress unwanted thoughts sometimes causes an immediate increase in their
frequency, whereas at other times it causes a resurgence of the intrusion after the
efforts to suppress the thoughts cease. Also, a number of factors can make the
negative effects of thought suppression worse; these include being in a negative
mood state, placing undue importance on the unwanted thought, or tending to
rely on thought suppression to deal with unwanted thoughts and feelings. The
bottom line is that trying too hard to not think about an unwanted, distressing
thought is most often futile and even counterproductive. Excessive mental
control effort often amplifies the intensity and persistence of negative emotional
states. This is why reducing mental-control effort is a major emphasis in this
workbook.
Emma had several intrusive thoughts relevant to her depression. One of the
most frequent was Poor me, I’m so unhappy and depressed. She interpreted this
thought as a sign of self-pity, and so it made her feel guilty. She tried to suppress
this thought by replacing it with more positive thinking or by criticizing herself
for being so self-centered. But these strategies didn’t help, and the harder she
tried to suppress her thoughts of how unhappy and depressed she was, the worse
they got. Emma was living out the paradox of mental control.
As you will see, the antidote to the mental-control paradox is learning to let
go, to take a more accepting approach to the unwanted thought. You can think of
your distressing intrusive thoughts like a net that entangles your mind. The
harder you struggle against the thought, the more trapped you become in your
mental torment. And as with being caught in a net, the best strategy for
unwanted intrusions is to stop struggling.
When it comes to mental control, how we perceive our ability to control our
thoughts plays an important role in how we feel. Given the counterintuitive
nature of mental control and its capacity to fuel intense personal distress, is it
any wonder that some people develop a fear of losing control?

Fear of Losing Control

This chapter opened with the question “Have you ever wondered if you’re losing
your mind?” Experiencing unwanted and distressing thoughts, images,
memories, or feelings, day in and day out, can make you begin to lose
confidence in your mental faculties. As you experience failures in self-control,
you may begin to worry that your loss of control could get worse. You might
wonder, What if I completely lose control, so I can no longer function or, worse,
my mind snaps and I cause harm to myself or my loved ones? In the extreme,
this fear of losing control can cause us to doubt our sanity. The question might
be Could I actually go insane and become incapable of looking after myself or
my family?
Fear of losing control is a common element in fear and anxiety, especially
panic disorder. Fear of losing control can directly increase feelings of anxiety
and personal vulnerability. It can also cause you to try even harder to control
unwanted intrusive thoughts and feelings, because you’re afraid that further
erosion of control could lead to a complete mental breakdown. So the adverse
effects of the mental-control paradox could be even greater for people who are
fearful of losing control. Fear of losing control can also intensify feelings of
uncertainty. Difficulty tolerating uncertainty is a major issue in anxiety
disorders, so anything that causes more uncertainty will increase anxious
feelings.
We each differ in the importance we place on mental self-control. If you’re
not so concerned about control of your thoughts and feelings, you may be
tolerant of a wandering mind and even unwanted intrusive thoughts. If you place
a high value on controlling your thoughts and feelings, then you may tend to feel
anxious about your failure to control unwanted mental intrusions. You may even
worry at times about your sanity because of unwanted and unusual thoughts that
frequently pop into your mind. As you can see, the more importance you place
on mental self-control, the greater the likelihood you’ll feel anxious when mental
control fails, like what happened in the white-bear experiment.
How comfortable are you with limited control over unwanted thoughts and
feelings? Are you able to let unwanted negative thoughts wander through your
mind, or do you feel like you’re in a battle to regain control over a renegade
mind? Are you afraid of losing control, especially mental self-control? The next
exercise will help you gauge your level of tolerance for unwanted spontaneous
thought.

Exercise: Your Tolerance of Mental

Uncontrollability

Below you’ll find five statements that deal

with key features of thought controllability.
Place a checkmark (√) beside the
statements that apply to you.

__________ I am often upset by recurring

negative thoughts, images, or memories that feel
 negative thoughts, images, or memories that feel
uncontrollable.
__________ I wonder if my mind could snap or if
I lack a normal amount of mental self-control.
__________ I believe my problem is lack of
willpower or self-control.
__________ I feel anxious when I can’t stop
myself from thinking certain unwanted thoughts.
__________ When I lose control of my thoughts,
I’m concerned that I might eventually act on them.

If you checked several statements, then it’s

likely you’ll find it difficult to accept limited
mental control over your unwanted thoughts
and feelings. You may be at greater risk for
fear of losing control. Maybe you’re feeling
entangled in that mental net mentioned
earlier. If so, you are taking the first step
toward freedom from this struggle.
Knowledge and insight is the first step in
learning how to work with the paradox of
mental control rather than against it.

Of course, there’s much more to learn that will help you regain confidence in
your mental health. But just knowing that greater mental effort can be
counterproductive is an important insight that can change how you deal with
your anxiety, depression, or obsessionality.

Wrap-Up
“The harder I try, the worse it gets.” If this is your sentiment, it’s likely you’re
feeling discouraged with your efforts to regain control of your life and eliminate
the long shadow of anxiety, depression, or obsessive thinking. No doubt, you’ve
been thinking that you lack willpower and that if you tried harder to discipline
your mind, your distress would disappear and life would be so much better. But
as you now understand, willpower can be erratic, and the paradox of mental
control makes no exceptions. Here are some takeaway thoughts from this
chapter:

Self-control, or willpower, involves the pursuit of long-term valued

goals by overriding natural tendencies to settle for immediate
comfort and ease.
Willpower is strengthened with the use of motivation strategies that
emphasize the pursuit of high-valued goals in a rational, reasoned,
and confident manner.
Developing an action plan to overcome procrastination or pursue
neglected life goals can improve your emotional state.
Mental control is a paradoxical process in which the harder you try to
suppress unwanted intrusive thoughts, the more problematic they
become, and excessive mental-control efforts often amplify
emotional distress.
Improving tolerance for unwanted spontaneous thought and accepting
the limits of mental self-control are the primary treatment objectives
of this workbook.

Don’t be discouraged. What you’ve been learning about intrusive thinking and
the limits of mental control can actually help you overcome anxiety, depression
and obsessive thinking. The chapters you’ve just read have provided you with
the knowledge you need to use the interventions that follow. It’s time to begin
working on the thoughts and feelings that give rise to your emotional
disturbance, which is the subject of the next chapter.
 Chapter 3

Control Skills: Self-Discovery

In the days before GPS and Google Maps, I remember getting hopelessly lost!
This often happened when foolishly trying to navigate an unfamiliar city without
a decent map in hand. At first, I felt annoyed by my carelessness, but the longer I
was lost, the more anxious I got. On a couple of occasions, I spent over an hour
trying to get my bearings. When that happened, anxiety gave way to fear,
confusion, and an intense feeling of helplessness. Do you recall the last time you
were really lost? I’m sure you’ll agree it’s a terrible experience. But the
momentary anxiety associated with being lost doesn’t compare to the anguish
felt when bewildered by unwanted distressing thoughts and feelings that persist
despite our best efforts at self-control.
If you’re feeling a little lost and discouraged by your emotional state, it’s
important to first figure out what’s wrong and then develop a plan that guides
you toward emotional wholeness and well-being. In the first two chapters, you
learned about unwanted intrusive thoughts and the limits of mental control, but
you might be wondering, How can this new knowledge help lessen my feelings of
anxiety, depression, or obsessiveness? To use the new science of mental control,
you’ll need a better understanding of the mental processes that drive your
emotional condition. You’ll need an individualized plan, a mental road map, to
give you some direction on how to overcome these distressing thoughts and
feelings.
Meaningful change begins with greater self-understanding. This chapter will
present a mental-control model to help you discover the unwanted mental
intrusions that trigger your negative emotions, search for maladaptive mental-
control efforts, and assess whether the significance or importance you give to the
intrusion is problematic. You’ll then combine all of this information to formulate
your own mental-control profile, which will be your road map for applying new
interventions to your emotional distress. But first, the story of a young woman
named Samantha will help to illustrate how all of this works.

Samantha’s Story: Crippled by Social Anxiety

Samantha, a twenty-one-year-old university student, had always been shy and
nervous around others, especially people she didn’t know. Interacting with peers
was especially anxiety provoking. Despite efforts to overcome her self-
conscious, nervous manner around others, the anxiety would eventually become
so overwhelming that she’d end up leaving early or avoiding social activities
altogether. Samantha experienced many anxious thoughts that all focused on a
fear of negative evaluation by others. Most often the anxiety began with the
intrusive thought You’re going to feel anxious and uncomfortable. That thought
alone was enough to set in motion a cycle of anxiety and worry about spending
time with others. Sometimes Samantha pictured people laughing about her
afterward and even mocking the way she talked. On other occasions, she’d
remember the time a guy had spoken to her and, out of sheer terror, she’d said
something ridiculous in response. Despite her attempts to suppress these anxious
mental intrusions and to convince herself that she’d be okay, the thoughts
persisted, and with them came an overwhelming sense of anxiety. Avoidance
became the only viable option. Samantha was convinced her future looked bleak,
dominated by loneliness, despair, and alienation from others.

The Mental-Control Model

Usually we treat spontaneous thinking as unimportant mental noise that we can
easily ignore. However, if you are anxious, depressed, or emotionally upset,
certain types of unwanted thoughts can become a focal point of your attention. If
you then misinterpret the intrusion as a highly significant threat to your
emotional health, you may try to directly control or suppress the unwanted
thought. This effort often fails, which stimulates other forms of pathological
thinking such as worry, rumination, obsessions, and the like, and you become
caught in a vicious cycle of escalating negative thought and feeling.
This vicious cycle of distress is apparent in Samantha’s experience of social
anxiety. When reminded of an upcoming social activity, Samantha has the
intrusive thought I can’t do this. I’ll be so anxious. It will be unbearable. She
becomes immediately aware of the intrusion because it’s a personally significant
thought. She’s convinced it’s a highly accurate prediction of how she’ll feel,
because this is what has happened in the past. Samantha can feel herself getting
anxious, just thinking about her social anxiety. So she then tries to suppress the
thought. She tells herself it’ll be okay; maybe she won’t feel so anxious this
time. But she doesn’t believe it. She tries to distract herself but can’t shake the
thought. Finally, she reacts with annoyance and anger, telling herself to stop
being so stupid. By now, though, she’s into full-blown anxiety, with unhealthy
worry about how she’ll manage the dreaded event.
Figure 3.1 outlines the key components of the mental-control model of
emotional distress.

According to this model, you first become mindful of an unwanted intrusive

thought, image, or memory. Next you misinterpret the intrusion as a highly
significant emotional threat. This leads to excessive efforts to inhibit or suppress
the unwanted thought. Paradoxically, your attempts at control actually draw
greater attention to the mental intrusion. This sets in motion other negative
thought processes like rumination, worry, and obsessive thinking. The result,
then, is an increase in personal distress. Of course, there is another possibility, as
you can see in figure 3.1: if you had considered the spontaneous intrusion a more
neutral or emotionally insignificant mental occurrence, then you’d be less
inclined to try and control the thought. As a result, your attention would be
drawn away from the intrusion, so your distress would actually decrease.
The next exercise will help you begin to consider how the various mental
processes described in the mental-control model might contribute to emotional
distress. If you’re not yet sure of the personal relevance of this model, you can
skip ahead and return to this exercise when you reach the end of the chapter. By
then, you’ll have a better understanding of your mental responses to intrusive
thoughts.

Exercise: Start Applying the Mental-

Control Model

To help you begin to apply the mental-

control model to understand your own
distress, answer the questions in the space
provided.

What intrusive thoughts, images, or memories

make you feel distressed?
What is so emotionally significant or important
about the intrusion?
How are you trying to suppress—that is, not think
about—the intrusion?
What other negative thought processes are
involved, such as rumination, worry, and so on?

This exercise represents your first attempt to

understand your emotional distress from the
mental-control perspective. You may want to
return to this exercise to revise your answers
after you’ve completed the remaining
 exercises in this chapter and have learned
more about the components of the mental-
control model.

The Mental-Control Perspective

You can gain a deeper understanding of your mental processes by looking at
them in terms of each component of the mental-control model. The first element
in the model is the occurrence of an unwanted intrusive thought, image, or
memory. Learning to detect your unwanted intrusions is the first step in applying
the mental-control model to your anxiety, depression or obsessions.

Detecting the Intrusion

The intervention strategies in this workbook require a heightened awareness
of problematic intrusive thoughts, images, or memories. While you’re probably
aware of other negative thinking, such as rumination, worry and self-critical
thoughts, these initial intrusive thoughts can be difficult to detect because of
their speed and spontaneity. Looking back on the thought-feeling record you
completed in chapter 1, were you able to pick out the mental intrusion from the
flow of negative thinking? If this proved too difficult, don’t be too concerned.
The next exercise of keeping a mental-intrusion diary will help improve your
awareness.
Cognitive behavioral therapists have long known that keeping a thought diary
is important for successful treatment of anxiety and depression (A.T. Beck et al.
1979; J. S. Beck 2011). Using this same approach, the process of breaking down
your negative emotional experience into its component parts can help you detect
your spontaneous distressing thought, or mental intrusion. Keeping a diary gives
you practice in writing about your distress (your negative feelings), the
associated circumstance, other negative thinking, and your response or efforts to
cope with the distress. By doing this type of structured journaling, the initial
mental intrusion becomes clearer. As an example, here’s what Samantha’s
mental-intrusion diary looked like.
Samantha’s Mental-Intrusion Diary

Distress
 Distress
Rating: 1 Awareness of Negative
Circumstance Response Intrusion
(mild) to 3 Thinking
(severe)

Several of my
cousins will be
there.
I don’t know
them very well.
My parents will I ended up leaving the
Thinking conversation with my 1. I’m going
anxious expect me to
about having to cousins and sitting with my to feel
(2), socialize with the
go to a family parents and older relatives. intensely
guilty, cousins.
gathering on the anxious and
frustrated The last family I pretended to feel sick
weekend uncomfortable.
gathering was so and left early.
stressful.
I remember
getting really
flushed in the face
and clamming up.

I don’t really
know these
people.
I’ll be expected
to contribute to
the conversation
about the project.
anxious Thinking I’ll probably 2. I’m about
(3), about a group get flushed in the I’ll have to go and to face one of
stressed, project meeting I face and start to endure the pain. the worst days
depressed must attend tremble. in my life.
Everyone will
notice I’m
anxious and
wonder what’s
wrong with me.
I just hate these
group projects.

Samantha recorded two distressing experiences that involved a surge of

anxiety. Both times, the anxiety was associated with anticipating a future social
interaction. Samantha’s first anxious experience involved thinking about going
to a family gathering. Notice that she rated her main emotion, anxiety, as
moderate. She was aware of a stream of negative thinking that involved how she
might feel while interacting with her cousins, who were all within her age range.
From this, Samantha was able to identify the initial unwanted intrusive thought
that ignited this fresh round of anticipatory anxiety: the expectation of
experiencing an intolerable state of anxiety. When she followed the same self-
monitoring process on the second occasion, she discovered a similar mental
intrusion. It was clear that Samantha’s distress was often triggered by sudden
anticipatory thoughts that she would have another bout of awful anxiety. No
wonder her automatic response was to try to minimize the influence of anxiety
on her life.
Now it’s your turn. Recall a recent upsetting experience and use the next
exercise to detect your mental intrusion.

Exercise: Your Mental-Intrusion

Diary

Starting in the column on the left, record the

type of distress and intensity of negative
emotion you experienced (such as feeling
sad, anxious, angry, guilty, and so on), and
rate it as 1 for mild, 2 for moderate, or 3 for
severe. Next, briefly describe the
circumstance that led to the distress, any
negative thinking you were immediately
aware of, and your response, or how you
dealt with the distress. From this information,
deduce the initial intrusive thought, and
record it in the space to the right of the table.
If you need additional space, you can visit
http://www.newharbinger.com/38426 to
download copies of this mental-intrusion
diary.

Mental-Intrusion Diary

Distress Rating: 1 (mild) to 3 (severe) Circumstance Awareness of Negative Thinking Response Intrusion

1.

1.
 1.

1.

Distress Rating: 1 (mild) to 3 (severe) Circumstance Awareness of Negative Thinking Response Intrusion

1.

2.

1.

You’ll want to make or download several

copies of the mental-intrusion diary so you
can continue to monitor your distressing
thoughts and feelings. The more distressing
experiences you record in the diary, the
more skilled you’ll get at detecting the initial
unwanted mental intrusion responsible for
your distress. Look for patterns in your
intrusive thinking. Is the same intrusive
thought happening repeatedly? Are you
experiencing any particular intrusive images
or memories when feeling anxious or
depressed? When getting started, don’t
worry about the accuracy of your recordings.
You’ll get better at identifying these initial
negative thoughts with practice.

If you are still having difficulty monitoring your negative thoughts and
feelings, you can use the following probes to help discover the critical intrusive
thoughts associated with your distress.

DISTRESS
 We are usually more aware of our feelings than our thoughts, so it’s helpful to
begin by asking, What am I feeling at this moment? If the emotion is sadness, the
intrusive thought will likely deal with personal loss or failure; if it is anxiety, the
intrusion will likely focus on threat or danger; if it is guilt, the intrusion will
likely center on personal wrongdoing; and if you’re feeling angry, the unwanted
mental intrusion will likely represent perceived injustice or unfairness.

CIRCUMSTANCE
Next ask yourself, What is happening around me that’s so upsetting? Often
our intrusive thoughts are triggered by the events, people, and situations we
encounter. Whatever you are doing at any moment will influence what you
think.

OTHER NEGATIVE THOUGHTS

Often we are aware of negative thinking when anxious or depressed, but these
thoughts occur in response to the initial intrusion. Ask yourself, What have I
been thinking over the last few minutes? By writing down these known negative
thoughts, you can trace your pattern of thinking back to the most likely theme of
the intrusion.

RESPONSE
How did I react or try to deal with the distress? is the final self-reflective
question. How you attempted to deal with the distress can indicate the type of
intrusive thought that initiated the anxious or depressive experience.
The mental-intrusion diary is one of the main assessment tools in the mental-
control approach to negative emotion. You’ll be using this diary as a clinical tool
for tracking the frequency of mental intrusions and distress. Your skill at
intrusion detection will improve the more you use the mental-intrusion diary. If
you’re continuing to have difficulty self-monitoring your unwanted thoughts and
feelings, it might be helpful to review chapter 1 to refresh your understanding of
intrusive thinking. If you’ve succeeded in identifying at least one or two
problematic intrusions, you’re ready to tackle the second step in the mental-
control approach: to discover how the importance placed on the intrusion affects
your level of anxiety, depression, or other negative emotion.
A Matter of Importance
One of the main tasks of our brain is to sort through a bombardment of
intended and unintended thought to determine which are most important to our
well-being and survival. We are doing this sorting and classifying continuously
with both automatic (unconscious) and more effortful (conscious) mental
processes, which leads to the assignment of attentional priority to our thoughts.
One of the most useful rules of information processing is that we pay attention to
the thoughts we consider most important to our physical and emotional well-
being.
For example, let’s say you’re doing something useful, and suddenly the
thought pops into your mind: Don’t forget tomorrow’s early morning meeting
with the manager. Instantly, you stop what you’re doing and enter the
appointment in your calendar, possibly programming an alert, so you won’t
forget it. Then you go back to the task at hand. What just happened in this
example? Suddenly you had an intrusive thought about the early morning
meeting. You immediately paid attention to this intrusion because you evaluated
the thought as highly significant. You don’t usually have early morning meetings
with your manager, and so there was a high probability you’d forget it if you
didn’t write it down. Given that the company was in the process of downsizing,
you knew it was in your best interest not to miss the appointment.
So how do we decide when an intrusive thought is so significant that we
should pay close attention to it? There are actually five criteria that determine the
personal significance of a thought: personal threat, responsibility, negative
effects, unexpectedness, and need to control. The best way to understand how
these criteria determine thought significance is to work on one of the intrusive
thoughts associated with your distress.

Exercise: Interpretation-of-
Significance Worksheet

Go back to your mental-intrusion diary and

select an unwanted mental intrusion you
identified with your distress. Write the
intrusion in the space below:
 Next, respond to these questions about the intrusion.

Do you associate a personal threat or a bad

outcome with the intrusion? Describe the threat or
negative consequence here:
Do you feel responsible for preventing this
negative consequence? If so, explain how you are
responsible:
Do you believe having the intrusive thought could
have a negative effect on you or others? If so,
explain how this would happen:
Does the intrusion seem more significant because
it happens frequently and is distressing? Answer
yes or no:
Is it important that you suppress, or not think
about, the intrusive thought? If yes, explain what
might happen if you lost control of the thought:

Your answers to these five questions explain

why the intrusive thought has gained such
personal significance. Given its importance,
can you now understand why it grabs your
attention when it pops into your mind? This
interpretation of significance plays a key role
in causing an escalation in your distressing
thoughts and feelings. We all automatically
pay more attention and respond more
vigorously to thoughts, images, memories, or
other ideas that we consider important in our
lives.

You can visit http://www.newharbinger.com/38426 to download other copies

of this interpretation-of-significance worksheet, so you can use it as a checklist
with other distressing thoughts. The mental-control perspective on anxiety and
depression teaches you how to reduce the significance attributed to these
disturbing intrusive thoughts. And you’ll soon be doing a lot of work on how to
change your interpretation of them. In the meantime, consider how Samantha
misinterpreted the significance of her intrusive thought I’m going to feel
intensely anxious and uncomfortable.
Samantha considered the intrusive thought personally threatening because
feeling anxious in social situations was just about the worst thing she could
imagine. She held herself responsible for concealing the anxiety from others.
She also believed that having the intrusive thought before a social event actually
increased the likelihood that she’d feel anxious at the event. She viewed her
anticipatory intrusive thoughts as a way of priming the anxiety pump. Although
most people wonder if they’ll feel anxious at an unfamiliar social event,
Samantha believed that the sheer frequency of her anxious intrusions reflected
their unusual importance in her life. In fact, Samantha became convinced that
eliminating the anticipatory intrusive thoughts was a key to reducing her anxiety
in social situations. As a result, intrusive thoughts of being anxious became one
of the most significant threats in Samantha’s life.
So far, this chapter has focused on two key components in the vicious cycle of
emotional distress: the occurrence of unwanted mental intrusions and the
misinterpretation of their significance. The final component from the mental-
control perspective is a heightened effort to directly suppress unwanted
distressing thoughts.

Intentional Mental Control

Once an unwanted intrusive thought is considered a highly significant threat,
it’s natural to try hard not to think about it (see figure 3.1). If you think back to
the white-bear experiment in chapter 2, remember that efforts to actively inhibit
an unwanted thought make you more susceptible to the mental-control paradox.
Increased efforts at avoidance draw even more attention to the unwanted
thought. Once your attention is focused on a particular negative intrusive
thought, other types of thinking, like worry and rumination, that are consistent
with the intrusive thought content, will also gain importance and flood your
mind. You become trapped in an ever more complex web of unhealthy thinking.
The end result is an increase in distress, which then primes more negative
intrusive thoughts, setting in motion a vicious cycle of emotional disturbance.
No wonder anxiety, depression, guilt, and other negative emotions can seem like
a speeding runaway train, impossible to control.
When looking at your own efforts at intentional mental control, there are two
characteristics that must be considered. First, how hard are you trying to inhibit
the unwanted thinking? And second, what actual strategies do you use to gain
control over unwanted thoughts and feelings? To understand why mental control
seems to be failing, it’s important to understand how each of these
characteristics plays out when you have a distressing intrusive thought.

HEIGHTENED MENTAL-CONTROL EFFORT

Effort is a critical feature of self-control. You can put a lot of effort or none at
all into controlling your intrusive thoughts. The next exercise will help you
evaluate what you are doing now.

Exercise: How Hard Do You Try to

Inhibit Intrusions?

To determine your mental-control effort,

review the intrusive thoughts recorded in
your mental-intrusion diary. Then respond to
these questions in terms of your experience
with unwanted intrusions.

In comparison to other thoughts that pop into your

mind, how much effort do you put into actively
inhibiting distressing intrusive thoughts? How
hard do you try not to think about the mental
intrusion? Place a checkmark (√) next to one of
these responses:

__________ Try really hard

__________ Try moderately hard
__________ Put slight effort into thought
inhibition
 __________ Do not try to inhibit the
intrusion

How often do you engage in active mental control

of intrusive thoughts? Place a checkmark (√) next
to one of these responses:

__________ Every time I have the intrusion

__________ Only when I’m feeling distressed
or upset
__________ Usually I don’t try to control the
intrusion
__________ I never try to control the
intrusion

How difficult would it be to completely stop

efforts to inhibit, dismiss, or not think about your
distressing intrusive thoughts? Place a checkmark
(√) next to one of these responses:

__________ Almost impossible

__________ Very difficult
__________ Somewhat difficult
__________ Not at all difficult

If you were inclined to check one of the first

two options in this set of questions, it’s likely
you are putting considerable effort into
mental control.

The more invested you are in mental controllability, the greater the risk of
falling victim to the paradox of mental control. To help you overcome this
problem, this workbook places a great deal of emphasis on learning to let go of
intentional control efforts. Chapter 5 offers exercises that will help you learn to
be more accepting and less invested in suppressing unwanted mental intrusions.
In the meantime, being aware that you may be overextending yourself in the
pursuit of mental control is another important step in transforming your
approach to unwanted thoughts and feelings.

MENTAL-CONTROL STRATEGIES
It’s also important to consider the strategies that you use to inhibit unwanted
intrusive thoughts. Research shows that once a mental intrusion is deemed
highly significant, it’s only natural to use some strategy to divert attention away
from the thought (Clark, Purdon, and Byers 2000; Wegner and Pennebaker
1993). So what mental-control strategies do you use to shut down thinking that’s
making you feel anxious, depressed, guilty, or frustrated? The next exercise will
help you figure this out.
First you’ll need to review your entries in your mental-intrusion diary as well
as the thought-feeling record in chapter 1. As you consider your experiences
with unwanted thoughts and feelings, can you remember your response to those
episodes and what you did to help yourself feel better?

Exercise: The Mental-Control

Strategies Questionnaire

Consider your experiences with distressing

intrusive thoughts and feelings. Then, on a
scale of 0 to 2, where 0 is never, 1 is
occasionally, and 2 is frequently, rate how
often you used each strategy listed here.
Also rate how you perceived the
effectiveness of each strategy, where 0 is
not effective, 1 is somewhat effective, and 2
is very effective.

Estimated Estimated
Control Strategy
Frequency Effectiveness
 1. Replace with another thought. 012 012

2. Try to reason with yourself. 012 012

3. Criticize yourself for thinking this way. 012 012

4. Seek reassurance from others. 012 012

5. Tell yourself to stop thinking this way. 012 012

6. Engage in an activity to distract yourself. 012 012

7. Analyze the meaning, why you are thinking like this. 012 012

8. Look for evidence that refutes the intrusive thought. 012 012

9. Repeat a phrase or action (for example, checking something) that counters

012 012
(neutralizes) the thought or reduces distress.

10. Actively suppress thinking about the intrusion. 012 012

11. Just accept the thought, let it float through your mind without engaging the
012 012
intrusion.

12. Try to reinterpret the intrusion as a more positive, helpful thought. 012 012

13. Try to relax, meditate, or breathe slowly. 012 012

14. Find humor in the situation. 012 012

15. Pray or focus on a comforting phrase or idea. 012 012

16. Try to reassure yourself that everything will be fine. 012 012

17. Perform a compulsive ritual (repeatedly wash hands, check, redo, or repeat
012 012
 17. Perform a compulsive ritual (repeatedly wash hands, check, redo, or repeat
012 012
actions).

18. Avoid things that might trigger the unwanted intrusion. 012 012

Based on your questionnaire responses,

which mental-control strategies are you
using most to deal with unwanted thoughts
and feelings? Are you relying on effective or
ineffective strategies? Are you surprised at
the limited extent of your mental-control
skills? If you previously concluded that you
tend to put a lot of effort into mental control
and now you realize your actual control
strategies are not very effective, do you now
understand why the paradox of mental
control is working against you?

Your assessment of your current state of mental self-control will be valuable

in determining how to apply the new self-control skills that this workbook will
introduce later. It is entirely possible that your anxiety, depression, or obsessions
have persisted because you are exerting too much effort with relatively
ineffective self-control strategies. But there is hope if you read on! This
workbook was designed to help people reverse their sense of helplessness when
facing distressing thoughts and feelings.
Before you begin to work on improving your self-control, however, it’s
important to integrate all the assessment work you’ve done in this chapter into a
mental-control profile that will guide your work in subsequent chapters.

Your Mental-Control Profile

This chapter started with a story about how easy it is to get lost in unfamiliar
places without a map or some kind of guidance system. Now it’s time to
construct a mental-control road map that will guide you through the remaining
exercises in this workbook. To help you stay on course, the mental-control
profile in the next exercise will help you integrate all the assessment information
you’ve collected in this chapter. It’s based on the mental-control model in figure
3.1.

Exercise: Your Mental-Control

Profile

Use the four text boxes to describe the

various mental processes involved in your
emotional distress. Begin by writing down
the most important unwanted mental
intrusions from the mental-intrusions diary.
In the next box, write a brief narrative on
what makes these intrusions personally
significant. You can base this description on
the answers you provided in the
interpretation-of-significance exercise. Then
list the mental-control strategies you use
with the intrusions by selecting the strategies
you circled the most in the mental-control
strategies questionnaire. Finally, consider
other negative thinking that characterizes
your experiences of distress. For example,
are there particular concerns that you worry
or ruminate on, or do you experience other
thoughts of self-criticalness, threat,
vulnerability, or blame? Note these in the
final text box.
 The work you’ve done on creating a mental-control profile helps you better
understand which mental processes are contributing to your emotional distress.
Using your mental-control profile as a guide, you will be able to use more
effectively the new intervention strategies presented in subsequent chapters to
reverse the adverse effects of failed mental control.

Wrap-Up
You can think of this chapter as a guided tour of your mind. If you have rushed
through it because you are eager to jump into the intervention strategies in
upcoming chapters, I encourage you to take a little extra time with this chapter
before moving on. You’ll find the upcoming intervention strategies more helpful
if you have taken time with the mental-control profile to assess your intrusions
and their control. In fact, this is so important that you may want to go back and
do any exercises that you skipped or redo any to which you gave little attention.
It will unlock a self-discovery process that will make subsequent chapters much
more meaningful.
To review, here are some of the key points outlined in this chapter:

Unwanted intrusive thoughts, their interpretation, and heightened

efforts to inhibit distressing thoughts and feelings are critical mental
processes in the persistence of emotional distress.
Learning to be more aware of unwanted mental intrusions associated
with experiences of anxiety, depression, or other negative emotion
is the first step in developing a mental-control perspective on
distress.
When you evaluate unwanted intrusive thinking as a highly significant
mental incursion, you will focus greater attention on these thoughts,
images, and memories.
Your self-assessment of the importance of mental control and its
strategies highlights how the paradox of mental control contributes
to emotional distress.
Constructing a personal mental-control profile will increase your
success with the workbook by focusing the intervention strategies
on the most important features of your negative thoughts and
feelings.

With your completed assessment tools and your mental-control profile in

hand, it’s time to start dealing more effectively with your distressing intrusive
thoughts and feelings. Chapter 4 explains how you can minimize the personal
significance of distressing mental intrusions, so you begin to treat them like
common spontaneous thought. We can call this mental detoxification, a process
that strips the distressing intrusion of the heightened meaning and significance
noted in your mental-control profile. When great personal significance is
attached to an unwanted thought, your attention will be drawn to it, so it
becomes a more powerful and disturbing idea. Detoxification is a critical
intervention in reforming your mental-control approach to the distressing
intrusions you discovered in this chapter.
 Chapter 4

Control Skills: Mental Detoxification

Can a thought be toxic? In brief, yes. Certain maladaptive ways of coping can
turn negative intrusive thoughts, images, or memories into frequent, highly
distressing cognitions that are toxic for your well-being. This is what happens
when we misinterpret the significance of our unwanted mental intrusions. When
we overestimate their emotional significance, we are more likely to lose control
of them. We turn some types of common spontaneous thought into toxic mental
flotsam that can wreak emotional havoc on our daily lives.
This chapter focuses on the misinterpretation of significance that characterizes
anxious and depressive intrusions. You’ll learn how to reevaluate their
significance, so you can take a more effective approach to unwanted distressing
thoughts and feelings. This process is called detoxification because you
eliminate the toxic nature of your negative thinking as you realign its perceived
significance. More specifically, mental detoxification is the process of learning
to accept the intrusion for what it really is: a spontaneous, unintended thought,
image, or memory that has less personal significance because it can be
considered the product of a highly imaginative brain. But before you learn how
to detoxify your distressing thoughts, meet Claire, a woman in her mid-fifties,
who was struggling with intense anxiety and worry over an impending surgery to
repair an abdominal aortic aneurysm. You’ll see how Claire’s anxiety was fueled
by the emotional significance of her intrusive thoughts about the surgery.

Claire’s Story: Facing Her Greatest Fear

Claire was worried about dying. She had never before faced major surgery, and
just thinking about it terrified her. The surgery was constantly on her mind.
Everything reminded her of the surgery, and the thoughts always focused on
some catastrophic outcome. She’d have an image of herself lying on the
operating table with doctors and nurses frantically working to save her life. She
had thoughts of the surgeon telling her the operation was unsuccessful, or she’d
suddenly think about the postoperative pain. She could imagine her husband and
adult children being shaken as they’re told she hadn’t survived the operation.
These unwanted mental intrusions set off a firestorm of worry in Claire’s mind.
The anxiety would build to the point where she couldn’t sleep, eat, or socialize.
The surgery-related intrusions became so toxic that Claire felt like she was
losing control over her own mind and emotions. Her doctor had warned her that
high preoperative anxiety would slow down her postoperative recovery, so
Claire knew she had to get a grip over her thinking, but how?

Toxic and Nontoxic Mental Intrusions

The first step in mental detoxification is to be clear on the unwanted thought,
image, or memory that is most responsible for your anxiety, depression, or other
negative emotion. This is your toxic intrusion. For Claire, any sudden, unwanted
thought of the surgery was toxic, so she realized that her toxic intrusion could be
summed up like this: This surgery will be the worst day of my life.

Exercise: Name a Toxic Negative

Intrusion

You’ve been tracking your unwanted

thoughts and feelings with the mental-
intrusion diary in chapter 3, so consult what
you recorded in the intrusion column to
select a thought you consider especially
emotionally upsetting. Choose one that does
the following:

Repeatedly triggers feelings of anxiety,

depression, or other distress
Is highly distressing
Elicits strong efforts of mental inhibition or
suppression
Activates a stream of other negative thinking like
worry or rumination
 Write your toxic intrusion here:
The next step in the detoxification process is to identify a negative intrusive
thought, image, or memory that you don’t find particularly distressing: a
nontoxic intrusion. At first, you might think that you don’t have any
nondistressing negative thoughts; that all your negative thoughts are upsetting.
But, in reality, all of us experience negative intrusions that we don’t find
distressing. For example, Claire had a daughter, Mary, who was unhappy about
her employment situation. Claire would often have an intrusive thought about
Mary’s unhappiness with her job, but this thought didn’t upset her. Instead, she
would remind herself that Mary is young and will eventually find a better job.

Exercise: Name a Nontoxic

Negative Intrusion

Choose a negative nondistressing intrusive

thought that you’ve had recently. Maybe
you’ve had an argument with a coworker and
then have intrusive thoughts about the
argument several hours later. The argument
was definitely unpleasant and your intrusive
thoughts about it are negative, but you’re not
feeling unduly distressed by the situation. In
this case, you’re treating your intrusive
reminders of the argument as normal
unpleasant thoughts, that is, nontoxic
intrusive thinking.

If you find it challenging to discover a negative but

nondistressing intrusive thought, here are some
questions that may help:

Are there any specific problems, situations, or

concerns in your life that are unpleasant but not
personally distressing? Think about something
unpleasant but fairly common, like a minor
stressor or daily hassle, such as a disagreement
 stressor or daily hassle, such as a disagreement
with someone, being late for a meeting or
appointment, paying bills, feeling slightly unwell
or tired, or some annoyance at your spouse or
children.
What do you think about when spontaneously
reminded of the unpleasant situation? What
thoughts pop into your mind about the minor
problem or negative situation?
When your mind wanders or you’re daydreaming
about this problem or unpleasant situation, what
are you thinking?

Write the nontoxic negative intrusion here:

If you still have difficulty coming up with a

nondistressing negative intrusion, you can
use the mental-intrusion diary introduced in
chapter 3 to monitor negative intrusions
associated with minor daily annoyances or
hassles. If you use the diary over several
days, you’ll probably catch a number of
common stressful experiences that trigger
some negative thinking. These negative
thoughts would be examples of nontoxic
negative intrusions as long as you don’t find
them particularly distressing.

It’s important to complete these two exercises before proceeding to the next
step in the mental detoxification process. For the other exercises in this chapter,
you’ll need to have both a toxic and a nontoxic negative intrusion to work on. If
you’re still struggling with this discovery task, you could ask your spouse or
close friend for some advice. Or if you’re seeing a mental health therapist or a
counselor, your therapist could use a therapeutic strategy called guided discovery
to help you identify these two types of thinking in your daily life.
 Toxic Intrusion: Interpretations of Significance
The next step in the detoxification process is to look back at your toxic intrusion
and write a short narrative on what’s so personally significant or important about
this unwanted thought, image, or memory. This is a called a toxic significance
narrative. Here is the toxic significance narrative that Claire wrote while doing
this exercise:

I know I’m responsible for these fearful intrusive thoughts

about the surgery. But the more I keep having the intrusions,
the more convinced I am that something terrible is going to
happen, such as dying on the operating table. Nothing is
more important in my life right now than this surgery, but
the more I keep having these terrible intrusive thoughts, the
more convinced I am they could be a bad omen, a sign of
terrible times ahead. I know I’ve got to stop thinking this
way, because it’s making me more anxious, which can’t be a
good emotional state when you’re facing surgery. The
intrusions remind me that the future is so uncertain, but it’s
this feeling of uncertainty that bothers me most. All of this
makes the spontaneous thoughts about surgery the most
important and personally upsetting thing that I can think
about right now. I’ve tried everything to calm my mind, but
nothing works. Nothing could be more important than to get
a better grip on my mental health.

As you begin to work on your toxic-significance narrative, don’t worry if you

can’t be as detailed in your narrative as Claire was. It can be challenging to find
the right words to describe what is so emotionally significant about a toxic
intrusive thought. Ask yourself, What’s so significant about this intrusive
thought that I pay so much attention to it and try so hard not to think about it?
You may also want to return to chapter 3 to review what you wrote about toxic
intrusions in the interpretation-of-significance exercise and in your mental-
control profile.

Exercise: Your Toxic-Significance

 Narrative

Think about why your negative thought,

image, or memory is so important. As you
look back to your last experience with the
unwanted distressing intrusion, answer the
following questions:

Does the intrusive thought cause you to question

something about yourself, that is, the type of
person you are?
Do you think that having the thought increases the
likelihood of some negative future outcome for
you or your loved ones?
Does the intrusion remind you of some horrible or
regretful event in the past?
How does the intrusive thought affect real-life
circumstances and experiences?
Why is it so important to inhibit or suppress the
intrusive thought?

Write your toxic significance narrative in the space provided.

Were you able to describe what makes the

unwanted intrusion so significant or
meaningful? If you were able to give a
detailed account, that’s great. But if the only
thing you could come up with for your
narrative is that the intrusion makes you feel
upset, that’s also fine for now.

Often what makes a thought important to us is its perceived negative effect.

You’re acknowledging that the intrusion is a significant threat because of how it
makes you feel. Because you feel this way, you’re compelled to pay attention to
it and try to control it, but then you fail and so the thought grows in significance
and distress. Later in the chapter, you’ll start learning how to detoxify your
distressing thoughts, but first it will help to examine how you tend to interpret
negative thoughts that do not distress you.

Nontoxic Intrusion: Interpretations of Insignificance

The next step is to examine the nondistressing negative intrusion that you named
earlier in the chapter and focus on why you’ve concluded that this intrusion is
personally insignificant. In this case, you’re making an interpretation of
insignificance. You’re telling yourself, Look, it’s okay to think this way. It’s
perfectly normal to have thoughts like this. Nothing bad will happen to me; these
thoughts will eventually stop. When you generate this neutral interpretation of a
negative intrusion, you are essentially normalizing the thought. You conclude
that the negative intrusion is nontoxic. You might treat it as trivial or even
meaningless.
As an example of neutral interpretation, here is what Claire wrote when she
examined her thoughts about her daughter’s dissatisfaction at work:

I feel bad that Mary is unhappy with her job, but I know
there is nothing I can do about it. I remind myself she is a
young, well-educated woman and that it is not uncommon
for even the most talented people to start out in a job they
don’t like. She’ll probably find a better job eventually. Lots
of people live well even when they are unhappy with their
current work. Me thinking about Mary’s employment
unhappiness will not help her with this problem. We can
never be certain about the direction our life will take. In
fact, this is one of the great advantages of being young;
there are still many years ahead to try new ventures. In the
end, controlling the intrusive thought is immaterial, because
whether I think about Mary’s employment or not, it changes
nothing.
 The example of Claire’s nondistressing interpretation may help you generate
an interpretation of insignificance for your own negative intrusive thought. Note
that Claire’s thoughts about her daughter’s dissatisfaction with her current
employment are definitely unintended intrusive thoughts, and they focus on a
negative issue; however, Claire didn’t feel upset when she was reminded of her
daughter’s employment dissatisfaction. This was because she didn’t consider the
thought to be a significant emotional threat. She was able to normalize the
negative intrusion.
The next exercise will help you discover how you’ve arrived at a neutral, or
insignificant, interpretation of a nontoxic mental intrusion.

Exercise: Your Nontoxic

Insignificance Narrative

Review your nontoxic negative intrusion from

the earlier exercise in this chapter. Then use
the following questions as a guide to
discover why you’ve concluded this negative
intrusion is not personally significant.

Did you perceive that the intrusive thought had no

implication for the future, whether positive or
negative?
Did you conclude there was no connection
between the imagined intrusive thought and real-
life experience, that is, that the thought did not
determine your experience?
Did you realize that there was little you could do
about the thought or that you had little or no
responsibility for what thoughts popped into your
mind?
Did you decide there was no sense in trying to
suppress or inhibit the intrusive thought, since it
had no influence on real life?
Did you conclude the intrusive thought had no
personal relevance to you, or that it meant nothing
 personal relevance to you, or that it meant nothing
about the type of person you are?

Write your nontoxic insignificance narrative in the space provided:

Were you able to produce a clear narrative

of why your nontoxic mental intrusion was
insignificant?

You may be wondering why I’ve been emphasizing how nondistressing

mental intrusions are interpreted. After all, it’s the distressing, toxic intrusions
that are responsible for your anxiety and depression. But there are a couple of
reasons why discovering nontoxic interpretations is important to the mental
detoxification intervention. First, it serves as a good reminder that you don’t
overreact to every negative thought that pops into your mind. Rather there are
many occasions when you have an unpleasant thought or memory and you
evaluate the thought in a perfectly rational, healthy manner. If you can do that
with your nontoxic intrusions, you’ll be able to use the same approach when the
distressing thought pops into your mind. And second, you can use your work in
this exercise as the standard for determining whether you’re making adaptive or
maladaptive interpretations. It can be your prototype, a type of mental yardstick,
to determine how far you’ve strayed from treating a distressing intrusive thought
as a normal, nonthreatening way of thinking.
Now that you’ve identified the problematic interpretation of the toxic
intrusion and the more normalized, benign interpretation associated with a
nondistressing negative thought, you can begin to use these insights to detoxify
your troubling thoughts.

The Toxification Process

By now you realize that when a negative thought pops into your mind, its fate
depends on whether you consider it a significant emotional threat or a normal,
benign random thought. This means that any thought can become distressing if
interpreted in a threatening way. In fact, there is probably someone who is very
distressed by the same negative thought that is not distressing to you. So you
could ask the question, how might someone troubled by your nontoxic negative
intrusion interpret it in a meaningful and threatening manner?
The next exercise requires some imagination. It asks you to turn your nontoxic
intrusive thought into a distressing mental experience. As an example of how to
do this, here is how Claire reinterpreted the significance of her earlier negative
thought about her daughter’s unemployment:

When I have the intrusive thought about Mary’s

employment, I feel upset if I think to myself, “What if Mary
never finds a fulfilling job and has to spend the rest of her
life working for this miserable company? Her unhappiness
and discouragement about work could ruin her life, possibly
even drive her into a clinical depression.” The fact that I
keep having these intrusive thoughts must mean something.
Maybe it’s a premonition that things are not going to work
out for Mary. Maybe I should be doing more to comfort her,
maybe give her advice on how to handle an unhappy job
situation. After all, I am her mother. It’s hard not knowing
what will happen with Mary; I have this queasy feeling it’s
not going to turn out well for her. I need to do something to
address these intrusive thoughts. If I don’t do something to
stop thinking like this, I won’t be able to have peace of mind;
besides Mary could really use my help now.

It is easy to see from Claire’s hypothetical interpretation how she was able to
turn a benign intrusive thought into something very distressing. All she did was
reinterpret the intrusion as a threat, as a sign that Mary wouldn’t succeed. Notice
she appraised the thought as a sign that she needed to do something to help
Mary. The intrusion also reminded her of feeling anxious about the uncertainty
of life and that the thought itself was a premonition of future unhappiness for
Mary. She concluded that she needed to pay attention to this intrusive thought:
she needed to exercise some control over it. In the end, it is easy to see how this
interpretation would turn the unhappy thought about her daughter’s
unemployment into a toxic mental intrusion.
You might be hesitant to do this exercise because the last thing you want is to
intentionally create another distressing thought. However, this probably won’t
happen, since what you are generating is only a hypothetical scenario. I
encourage you to spend some time on this. It will be well worth your time and
effort.

Exercise: How to Create Distress

Look back at your nontoxic negative

intrusion and imagine how a different
interpretation of the same thought could
create distress. Generate a hypothetical
interpretation of significance for your
nontoxic negative mental intrusion. Here are
some ways to think about the intrusion that
could make it more upsetting:

Exaggerate the negative, threatening, or upsetting

possibilities associated with the intrusive thought.
Focus on how you could be personally responsible
for everything associated with the intrusion.
Convince yourself that the repeated occurrence of
the thought means that it’s important and deserves
your utmost attention.
Imagine that having this intrusive thought
increases the likelihood of a negative outcome for
you or your loved ones.
Be convinced that you need to suppress or inhibit
the intrusive thought, or that if you fail in your
mental-control efforts, your anxiety or other
negative emotions will worsen.

Write down your hypothetical distressing interpretation of the nontoxic

intrusion:
 Were you able to come up with a
hypothetical distressing interpretation of your
negative thought? This exercise is useful
because it provides further insight into the
importance of the interpretation process.

One of the main ways to turn a negative thought into a distressing one is to
imagine terrible consequences for yourself or others if you continue to dwell on
the unwanted thought. This is a form of catastrophizing. It could go something
like this: I’ve got to stop thinking like this, or I’ll drive myself crazy; or If I don’t
stop thinking like this, I’ll get more depressed; or My life will be ruined.
Reacting to a thought as if it were a catastrophe is a sure way to create a highly
significant emotional threat.

Detoxifying Your Distressing Thoughts

You’ve now arrived at the heart of the mental detoxification intervention. From
the previous exercises, you’ve seen that interpreting a negative thought as an
emotionally significant threat increases its distressing quality. You’ve also seen
that reacting to a negative intrusion as an insignificant, benign, normal mental
occurrence reduces its associated distress. The challenge, then, is to change how
you understand or interpret the unwanted thoughts, images, or memories that
characterize your anxiety, depression, or obsessionality. The therapeutic
intervention of mental detoxification is a self-control skill that transforms a
significant negative intrusion into an insignificant mental occurrence.
The detoxification process consists of three steps that will help you develop a
new understanding of your distressing intrusive thought, image, or memory:

Decatastrophize the consequence.

Reality-test the connection you’re making between your intrusion and
daily life.
Write a detoxification narrative.

You’ll want to use all three steps to detoxify distressing mental intrusions that
are associated with your anxiety or depression. You’ll learn how to take these
steps in the next three exercises. It’s time to begin the process of stripping these
distressing intrusions of their significance and meaning.

Decatastrophizing
A series of questions in this first exercise will help you discover a different
perspective on the consequences of a distressing intrusive thought:

What’s the real probability that the catastrophe, the worst-case

outcome, will happen?
Are there any positive aspects to the intrusive thought that you’re
overlooking?
Is there evidence that the intrusive thought is only mildly distressing
and quite tolerable?

The goal is to redefine the implications of the unwanted thought in a more

realistic, normal fashion.
When Claire considered the first of these questions, the probability that she
would die from her surgery, she immediately realized that she was
catastrophizing. She was treating the intrusive thought as if she had a fifty-fifty
chance of survival when the actual survival and recovery rates were much
higher. So Claire readjusted her estimate of a catastrophic outcome to match
with the known medical facts. Next she asked the second question: had she been
overlooking any positive aspects to her intrusive thought? The answer was yes:
she could use intrusive thoughts about her surgery as a reminder of some
practical steps she needed to take to prepare for the surgery. For example, she
could expect a ten-to-fourteen-day stay in the hospital and would need help with
household chores for several weeks afterward. So instead of trying to push the
surgery intrusions from her mind, she focused her attention on what she needed
to do to get ready for her hospitalization. Finally, she worked on reinterpreting
the intrusion as only mildly distressing. For example, she wrote that it’s
completely normal to dread surgery; that no one likes the pain and limitation in
functioning that goes with weeks of recovery. She also reminded herself that the
surgery was a solution to a real-life health problem; that is, the abdominal
aneurysm. So instead of treating the surgery intrusion as representing the worst
day in her life, she realized it represented one of the most hopeful days of her
life. It was an answer to a medical problem that could end her life prematurely if
not dealt with.

Exercise: Decatastrophize the

Consequence

Go back to the first exercise in this chapter,

where you named a toxic intrusion. Write it
down here.

Now read each question to probe your understanding

of this intrusion’s consequence. Write your answer,
giving your decatastrophized, more realistic
perspective. Your answers should present a more
benign way to think about the unwanted intrusion.

What’s the real probability that the catastrophe, the worst-case outcome will
happen? Basing your more realistic estimate on hard facts—what you’ve really
experienced and not on what you imagine could happen—write down the actual
probability that this catastrophe will occur:
Are there any positive aspects to the intrusive thought that you’re
overlooking? Could these positive features mean that the thought is more normal
and less threatening than you’ve assumed? Write about any positive elements
that you can associate with the intrusive thought:
Is there evidence that the intrusive thought is only mildly distressing and quite
tolerable? Write down some of the less distressing possible outcomes:

Were you able to successfully

decatastrophize the thought? Maybe you
were able to generate a less catastrophic,
more realistic outcome, but you are finding it
hard to believe. Don’t worry about that for
now. It’s important for you to at least realize
that there is a less troubling way to view the
 intrusions. The next exercise will help
strengthen your belief in the
decatastrophized narrative.

After completing the decatastrophizing exercise, the next step is to deal

directly with the intrusive thought. Even after doing this exercise, it can be hard
to reject the view that having the unwanted thought increases the likelihood that
something bad will happen in real life. For example, Claire wondered if the
intrusive thoughts about her surgery were a type of premonition: because she
was thinking about the surgery so much and getting so upset, maybe this meant
catastrophe was more likely to happen.

Reality Check
If you believe there’s a strong connection between the intrusive thought and
what will happen in real life, you’ll automatically assume the thought is highly
important. However, if you can accept that intrusive thoughts that pop into your
head are the product of your imaginative brain, with no direct causal link to
negative events in the real world, then you can downgrade the significance of the
intrusion.
When Claire examined the connection between her surgery intrusions and her
everyday experience, she realized the two were quite separate. She could have an
intrusive thought about the surgery almost anywhere and at any time of day. For
example, she might be out shopping and start thinking about the surgery, or she
could be watching TV or even talking to a friend when the surgery intrusion
would pop into her mind. It was as if her mind were on a single track regardless
of her everyday experience. The intrusion was also clearly the product of her
imagination. Sometimes she’d imagine herself in the operating room or lying in
a hospital bed. She could imagine what the aneurysm looked like in her body.
Claire took this as evidence that these intrusive thoughts were simply a product
of a very active imagination.

Exercise: Give the Connection a

 Reality Test

Correct any faulty connections you’ve drawn

between the intrusive thought and real-life
consequences. Read the questions below to
probe the intrusion’s connection to real life.
Write your answers in the space provided to
make a realistic thought-event connection.

Is there any past experience that indicates the intrusive thought caused a
negative or unwanted experience? Write down the evidence that the intrusive
thought was unrelated to your everyday experience:
Is there any evidence that the intrusive thought is a product of your
imagination? Write down evidence that your intrusive thoughts are products of
your creative mind:

Like Claire, you may have come to similar

conclusions about the significance you’ve
placed on your distressing intrusive
thoughts. You realize you’ve been treating
them like an emotional catastrophe.

Now it’s time to generate a more realistic, balanced interpretation based on

the work you’ve done in these exercises. This last step involves developing a
detoxified interpretation of the distressing thought.

Detoxifying Your Interpretation

Coming up with an alternative interpretation or narrative that emphasizes
more realistic, benign, and normal aspects of the negative intrusion can be
difficult, especially if you’ve been treating the intrusion as a highly significant
threat for years and years. You’ll want to base this narrative on the work you’ve
done in the previous exercises. You may want to review the old interpretation of
emotional significance that you generated for the mental-control profile in
chapter 3 and consider how to revise this interpretation so it’s a nontoxic
explanation.
You may find it helpful to have a look at the detoxification narrative that
Claire wrote. Notice how it is a more realistic, balanced interpretation of her
distressing intrusion.

It’s perfectly normal to have negative intrusive thoughts

about surgery. How could anyone who is facing major
surgery not think about it? I can use the intrusive thought as
a reminder that I’m dealing with my health problem in the
most constructive way possible. I can think about all the
practical things I need to do to prepare for the surgery and
the long post-operative recovery period. Whether I have
these intrusive thoughts or not makes no difference to the
outcome of the operation or to my quality of life after. In
reality, this surgery is not the most difficult thing I’ve faced
in my life, and certainly a number of my friends have had to
deal with more dire health concerns, such as recurrence of
cancer. Rather than trying to inhibit the surgery intrusions,
I’ll welcome them in my mind as spontaneous reminders that
I’m taking good care of my health.

Notice that Claire didn’t reinterpret her thoughts about the unwanted surgery
as meaningless. Sometimes our mental intrusions really are truly meaningless,
but other times they are intrinsically more significant, and so you have to turn
them into positive aspects of your mental life. Claire decided to treat the
intrusions as positive, self-affirming reminders. This could also be the best
reinterpretation strategy for your distressing intrusion. Whether you reinterpret
the thought as meaningless or as a positive indicator, however, it’s important to
generate a reinterpretation that strips it of emotional significance.

Exercise: Write a Detoxification

 Narrative

Follow these suggestions and guidelines to

reinterpret your distressing intrusion:

Your reinterpretation should emphasize how the

intrusion is more neutral and less negative and
threatening than you’ve been assuming.
The narrative should be a reappraisal of the
intrusion, emphasizing evidence from your own
experience that it’s okay to consider it a normal
mental intrusion of minimal significance.
Think of the intrusion as a product of your
imagination with no direct connection to your real-
life experience. Just having the thought pop into
your mind can’t by itself cause terrible things to
happen to you or to your loved ones.
Notice how it’s possible to experience the
intrusive thought without letting it impact your
everyday life.
Since you have no choice on whether the intrusion
pops into your mind, can you turn the experience
into something positive that affirms your personal
integrity and value? For example, the intrusion
could be considered a sign that you are creative or
that you’re a sensitive and caring person or that
you have high moral standards.
Make sure that your nontoxic, normalized
narrative is consistent with your real-life
experience of the intrusion. You’ll have a hard
time convincing yourself of any interpretation that
isn’t plausible.

Now, with these considerations in mind, write your reinterpretation in the

space provided. Then compare your narrative with the interpretation of
insignificance that you generated for your nontoxic negative thought. The two
narratives should be quite similar. If not, consider how you can revise the
reinterpretation of your toxic intrusion so that it is less significant and
threatening.

Have you been able to construct a detoxified

explanation for your distressing intrusive
thought, image, or memory that minimizes its
emotional significance and importance? If
you’re still struggling with detoxification after
all this work, don’t give up. Mental
detoxification is one of the most important
intervention skills taught in the workbook.

Once you have a nontoxic perspective on the distressing intrusion, you’ll find
the workbook’s control strategies to be more effective. Don’t worry if you’re not
yet able to put your nontoxic interpretation into practice. Greater belief and
acceptance of this reinterpretation will come with time and effort. To help with
this process, use the self-help exercises presented in this final section.

Practicing Detoxification
Now that you’ve developed a healthier, more realistic perspective on your
distressing intrusive thought, it’s important to put it into practice. The only way
to use this detoxification intervention to reduce your anxiety or depression is to
practice catching the distressing intrusion and then responding to it with a
reinterpretation of the thought. Doing some reality testing in your daily life is a
great way to start doing this.

Reality Testing
Reality testing involves looking for evidence that confirms your
reinterpretation of the intrusion as a benign occurrence with minimal emotional
significance. This means that whenever you’re aware of the toxic intrusion, you
take a minute to look around and gather evidence that supports a reinterpretation
of the intrusion’s significance.
Imagine, for example, you’re flying and suddenly have the distressing thought
What if the plane crashes? You can feel a jolt of anxiety pierce your body.
Obviously, your automatic interpretation is I’m in danger of dying in a horrible
crash. So you look around and note that everyone else is calm, the airline
stewards are going about their work in a friendly and serene manner, and there
has been no change in how the plane functions. Clearly the objective external
evidence supports a reinterpretation of what’s happening, which is I’m having an
imaginative negative intrusive thought; I’m not in any more danger now than I
was a few minutes ago. Clearly my thinking is completely disconnected and
irrelevant to what is happening around me. In this case, you are using reality
testing to support the reinterpretation; that is, you’re noting that despite what’s
happening in your head, the external data indicates there has been no change in
your level of danger. The thought of crashing is a product of your imagination,
albeit a highly unpleasant bit of imaginative thinking.
It’s important to record any evidence that confirms your reinterpretation of the
distressing intrusion. Whenever you have an experience that reminds you that
the intrusion is benign, you can make note of it, perhaps in your Smartphone,
and then transfer this information into the workbook using the space in the next
exercise. This will become a list of evidence that the distressing thought is not a
significant personal threat; you’ll be able to review this list whenever you get
stuck on exaggerating the significance of the distressing intrusion.

Exercise: Capture the Moment

List evidence that you’ve collected from your

moment-by-moment experience to show that
the distressing intrusive thought is not a
significant personal threat.

Did you discover that the reality was different

from what you imagined would happen?
Reality testing can help strengthen your
belief that your distress is more a product of
 intrusive thinking than a product of the
current situation.

Obviously there are times when our circumstances are upsetting. But reality
testing helps you develop a more balanced perspective on your situation as you
practice catching your exaggerated interpretations of emotional significance.
You are using more objective data from your daily life to arrive at a realistic,
neutral interpretation that detoxifies your unwanted intrusive thoughts and
feelings.

Exposure-Based Detoxification
Another great way to practice your new understanding of the toxic intrusion is
to schedule time to intentionally focus on the thought. This therapeutic strategy
is based on imaginal exposure, an effective intervention for worry (Borkovec et
al. 1983). In this procedure, you set aside time to intentionally and repeatedly
think about your worries. You schedule at least thirty minutes each day to sit and
intentionally bring all your worries to mind and think intently on them. When
you do this, the distressing quality of the worry declines over time because you
feel more in control of the worry, gain new insights into the worry, or simply
become bored with the worry topic.
You can use this strategy to practice detoxifying your distressing intrusive
thought.

Exercise: Schedule Imagined

Exposure

Start by planning a daily thirty-minute

exposure session, choosing a location where
you’ll be comfortable and free from
distractions. Make sure you have with you
the description of the toxic intrusive thought
and the detoxified interpretation that you
completed earlier in this chapter.

Take the first two to three minutes to feel

physically relaxed. You can do this by focusing on
your breath and paying attention to the experience
of taking slow but full diaphragmatic breaths.
Next bring to mind the distressing intrusive
thought. You should try to experience the intrusion
as fully as possible, reflecting on its various
characteristics and implications.
Once the distressing thought is fully in your mind,
thoughtfully read aloud the detoxified
interpretation. Reflect on the various arguments
you made for considering the intrusion a normal
spontaneous thought with diminished significance.
Focus on the normality of the intrusion, its
imaginative elements, and the minimal
consequences to your everyday experience. Think
about your neutral reinterpretation of the intrusion
as deeply as possible.
After spending approximately five minutes on the
nontoxic interpretation, return to a focus on the
breath, taking a couple of minutes to relax your
body.
Repeat steps 2 and 3 several times throughout the
thirty-minute exposure session.
Expect your mind to wander. When you are
distracted by other thoughts, acknowledge the
distraction and then gently bring your attention
back to the intrusion and its reinterpretation.

Imagined exposure can be a very effective

procedure for stripping distressing thoughts
of their meaning, strengthening your belief in
your reinterpretation, and, as a result,
 reducing the anxiety, depression, or other
negative emotions associated with these
thoughts.

You’ll want to practice this intervention on a daily basis for at least two
weeks. If you’ve not been able to detoxify the intrusion in that time period, you
may need to continue with exposure sessions longer. Also, it’s possible you’ve
not quite generated a credible insignificance interpretation, so you may need to
spend more time revising your detoxification narrative.

Wrap-Up
The meaning we attach to the thoughts, memories, and ideas that suddenly pop
into our mind determines how they make us feel. If you suddenly have a thought
you consider brilliant, pleasant, or exciting, you’ll feel great. But if you have an
intrusive thought that you consider threatening, highly negative, or discouraging,
you’ll feel anxious, depressed, or guilty, or experience other negative emotions.
This chapter focused on the meanings or interpretations that can turn your
intrusive thoughts into highly distressing, toxic mental events. It emphasized
how to correct the meaning attached to distressing thoughts to give them less
emotional impact. Learning to reinterpret distressing intrusive thoughts includes

Discovering how you interpret particular intrusive thoughts, images,

or memories in a highly significant manner, so they become toxic
mental experiences.
Realizing you have negative intrusive thoughts that are not distressing,
because they are considered insignificant or meaningless. However,
these nontoxic intrusions have the potential to become highly
distressing if they are misinterpreted.
Constructing a reinterpretation of your toxic mental intrusions to make
them normal and benign or even insignificant. This is the most
important step in detoxifying your distressing thoughts and feelings.
Accepting the more benign or neutral meaning of your distressing
intrusion, as evidence from real-life supports your detoxified
interpretation, and repeated, intentional exposure to the intrusion
 reduces its impact.

Changing beliefs is an extraordinarily difficult task. Most of us adopt a certain

perspective and find it almost impossible to see things another way. Don’t be
surprised if you found the approach in this chapter difficult to use at first. It may
take time and patience to understand your unwanted distressing intrusive
thoughts in a more neutral manner. You should also feel encouraged, though, as
you’ve discovered that you already interpret many of your negative intrusive
thoughts in a healthy way. The challenge is to recognize this natural tendency to
attribute insignificance to many of your negative intrusions and respond
similarly when you have a toxic intrusive thought. No doubt you’ve made a good
start in this direction. Now it’s time to build on this learning and focus on the
second major contributor to anxiety or depression: the adverse effects of the
mental-control paradox.
 Chapter 5

Control Skills: Letting Go

Giving up on a struggle can be a difficult choice. It could be a stressful situation
in which stepping back from the problem would be best, but you’re afraid to let
go. Maybe it’s a longstanding relationship conflict, a difficult work environment,
or a chronic health problem. Letting go of control can be hard, and yet in some
situations, acceptance will lead to the better outcome. Take, for example, an
incident that happened to me several years ago. While swimming, I suddenly
found myself caught in strong current that was sweeping me further from shore.
I became panicky when I realized I couldn’t swim against the current. After
several minutes of futile swimming and encroaching physical exhaustion,
however, I took a chance and stopped struggling long enough to discover that I
could just barely touch bottom. I was actually safe but only discovered this when
I stopped trying to swim against the current.

Exercise: When Have You Let Go?

Have you had experiences in your life where

you discovered that relinquishing control and
accepting a particular situation was the best
option? Take a few minutes to recall some of
these experiences and list a couple in the
space provided.

You’ll be reminded of these experiences

later in the chapter.

Letting go of ineffective mental-control strategies is the focus of this chapter.

From chapter 4, you’ve learned how to reduce the personal significance of your
toxic mental intrusions, but before you can adopt more effective mental-control
strategies, you need to understand the limits of self-control and reduce your
reliance on mental-control strategies that aren’t working. This chapter builds on
what you learned in chapter 2 about the paradox of mental control, examining
the unique problems associated with self-control of unwanted thoughts and
feelings. It introduces the concept of trying too hard; that is, when you’re putting
too much effort into controlling unwanted thoughts. It will also talk about two
barriers to letting go of self-control: a tendency to overthink and a tendency to
hold erroneous assumptions about mental control.
As you work through this chapter, you will want to remind yourself of other
times when letting go of control in difficult situations did help you cope with
life’s problems. You can return to the previous exercise to review what you
recorded. This same approach can be applied to your unwanted distressing
thoughts and feelings. To begin, it will help to examine Leah’s problems with
mental self-control.

Leah’s Story: Haunted by Regrets

Leah struggled with self-doubt and regret. After twenty years in a marriage that
once had been a fairy tale romance, she decided to leave. As a highly successful
forty-four-year-old realtor and mother, Leah had accomplished much but felt
trapped in a dying and loveless marriage. The initial separation was followed by
a long litigation battle over child custody and spousal support payments. But
after three years, Leah prevailed, and she settled into her new life as a working
single mother. At first, she felt a renewed self-confidence and freedom, but as
the months passed, Leah found herself feeling more and more depressed.
Leah was hopeful she’d rediscover love after the divorce. As an attractive,
sociable, and extroverted young adult, she’d had many romantic relationships, so
hope burned strong that she’d find her true soul mate. But the dating scene had
changed dramatically since her youth, and Leah was having difficulty
connecting with men her age. As time passed, Leah became more and more
convinced she’d never find true love. The future looked bleak and lonely. When
feeling down, Leah started having intrusive thoughts of regret. Over and over in
her mind, she could hear these words: I’ve made a terrible mistake. I was better
off when I was married. How could I have been so stupid? I don’t have what it
takes to be loved.
The intrusions of regret started a cycle of negative, self-critical thinking that
caused Leah to feel a depth of despair that at times frightened her. She realized
the regretful intrusions were toxic, but no matter how hard she tried, she seemed
powerless to control them. She tried pushing the thoughts from her mind,
reassuring herself that she was better off than so many others or reminding
herself of times when her husband was mean and uncaring. But nothing helped.
Despite her strongest efforts at self-control, nothing stopped the relentless
intrusions from within.
Like Leah, you may be feeling discouraged by your efforts to control
distressing intrusive thoughts. No matter how hard you try to change your way
of thinking, you find the intrusions returning and, along with them, an
overwhelming distress. Leah was determined to get a better grip on her life, so
she spent long hours trying to analyze her feelings and understand her descent
into self-pity. But Leah was taking the wrong approach to her distressing
thoughts and feelings. She had never learned the art of letting go, and now one
of her greatest barriers to progress was a tendency to overthink things.

Too Much in Your Head

Are you a deep thinker? Are you keenly aware of your thoughts, often analyzing
the causes and consequences of what you are thinking? If so, you could be prone
to overthinking, or spending too much time in your own head. Overthinking
refers to an excessive tendency to monitor, evaluate, and control all types of
thinking (Janeck et al. 2003). Of course, our survival depends on being aware of
our thoughts, a capacity to evaluate them, and an ability to direct our thought
processes so we can reach important life goals. But overthinking takes this
natural feature of human thinking too far. Overthinkers tend to be highly
introspective and excessively concerned with controlling their thoughts and
feelings. Because of this inward focus, overthinking complicates efforts to deal
with negative states like obsessive thinking, worry, and rumination (Cartwright-
Hatton and Wells 1997).
Overthinkers often put too much effort into controlling their unwanted
thoughts, so they easily fall victim to the paradox of mental control, where more
effort equals less control. Overthinking can also contribute to a fear of losing
control. You may be wondering if you are an overthinker. The next exercise will
help you determine if you have a tendency to overthink.

Exercise: The Overthinking Test

Read each statement and check the ones
that apply to you. If you’re unsure, you could
ask a spouse, close friend, or family member
for their opinion.

__________ I can easily become aware of my

thoughts at any moment.
__________ I have a good understanding of how
my mind works.
__________ I often question or evaluate my
thoughts.
__________ I often focus on changing the way I
think about situations, other people, or myself.
__________ I’m keenly aware of becoming upset
by unwanted thoughts.
__________ I can be easily distracted by my
thinking.
__________ I often monitor what I am thinking.
__________ It’s important that I maintain control
over unwanted and distressing thoughts.
__________ I’m a highly intuitive, self-aware
individual.
__________ I’m a deep thinker.
__________ I’m a detailed person who has
difficulty just sitting with a problem.
__________ I tend to search for the deeper
meaning in everything.
__________ I have a strong need to know, to
understand.
__________ I have difficulty tolerating
uncertainty, ambiguity, and lack of clarity.

The more statements you checked as

applicable, the greater the likelihood that
overthinking is hindering your control of
 negative emotion. If you endorsed seven or
more statements, you may very well be
spending too much time in your head.

Leah often fell into the overthinking trap. When intrusions of regret flooded
her mind, she’d get caught in an endless cycle of analyzing their truthfulness,
because she wanted to think more positively. She had trouble getting to sleep at
night because of racing thoughts and so searched for a solution to achieve some
control over what she called her “runaway mind.” Although Leah’s insight and
intuitiveness served her well when dealing with interpersonal problems, her
heightened self-awareness was a liability when it came to unwanted thoughts
about the divorce. So to deal more effectively with runaway thinking, Leah
began catching herself when she slipped into overthinking. This helped her
realize she was trying too hard to control her thoughts and needed to let go of her
need to control.
If you’ve come to the conclusion that you often fall prey to overthinking, like
Leah you’ll want to work on spending less time in your head. The next exercise
can help you begin to reduce this problematic thinking style. It’s intended to help
you do two things: be more aware of the negative effects of overthinking and
practice catching times when you slip into an overthinking style. You might say
to yourself, There I go again. I’m getting trapped by overthinking. This isn’t
helpful.

Exercise: Overthinking Awareness

Review the mental-intrusion diary in chapter

3. You should be using this diary on a
regular basis to capture your unwanted
distressing intrusions. Reread each entry,
and in the response column, write the letters
OT if you notice that you had slipped into
overthinking when you responded to the
intrusion. Remember, overthinking refers to
 spending an excessive amount of time trying
to analyze the causes and consequences of
your distressing thoughts and feelings.

Now that you’ve marked your mental-

intrusion diary for instances of overthinking,
how often did you slip into this unhelpful way
of responding to your distress? Did the
overthinking have a negative effect on your
unwanted thoughts and feelings? In some
instances, did it seem helpful? You won’t be
motivated to change this coping strategy
unless you are convinced that overthinking
has a negative effect on your emotions.

If you still believe that thinking deeply about your intrusive thoughts is
important, you’ll need to spend extra time in the next section, which deals with
unhelpful beliefs about the need and importance of mental control. Another
strategy to counter overthinking is to practice taking a more relaxed approach to
mental control by allowing yourself periods of mind wandering and
daydreaming (see chapter 6 for further discussion). This involves accepting
whatever thoughts pop into your mind without evaluation, manipulation, or
control.
Regardless of how often you slip into the overthinking mode, letting go of
excessive mental control will reduce your personal distress. But letting go will
be impossible if you believe in the importance of strict mental control. The next
section talks about two core beliefs that could be reinforcing your investment in
mental control.

Debunking Mental-Control Myths

Again, trying hard to directly inhibit distressing intrusive thoughts often makes
matters worse. The harder we work at self-control, the more persistent our
negative thoughts and feelings are. When this happens, it is understandable that
we will intensify our effort, becoming even more convinced of the importance of
strict self-control. For example, as Leah’s thoughts of regret became more and
more uncontrollable, she only intensified her efforts to suppress these thoughts.
This is because she failed to understand the paradox of mental control: that the
harder you try, the less controllable the unwanted thought is. If you can relate to
this situation—if doubling down on control still seems like the answer—taking a
closer look at your beliefs about mental control could be beneficial. There are
two beliefs, in particular, that could stifle your use of effective strategies to
reduce anxiety and depression, so it’s important to debunk these mental-control
myths.

Belief Myth: More Control Is the Answer

Possibly you’ve concluded that more mental-control effort is necessary to deal
with distressing thoughts, because you believe you’re calmer and less distressed
when you’re in complete control. No doubt there are times when you’re in a
positive mood and you also feel a strong sense of self-control. However, many
variables influence our mood. And while a heightened sense of self-control
certainly contributes to overall life satisfaction and well-being, the influence that
our mental-control effort has over momentary mood changes may be less than
we think. Could you be giving too much weight to the contribution of strong
mental control in creating a positive mood?
Leah, for example, noticed that often her mood improved when she shifted her
thoughts from the past and focused on a current work task. However, sometimes
she just felt good for no apparent reason or without conscious effort to feel
better. And there were other times when efforts to focus on the moment or think
more positively utterly failed. What Leah learned from these experiences is that
mental control has a more precarious impact on mood than she had assumed.
More mental control was not always the answer for mood repair.
If you’re like most people, you’ve probably never examined whether making a
greater mental-control effort actually produces a better mood state. Often the
beliefs we hold about our thoughts and feelings are assumptions that we’ve
adopted serendipitously. However, given the negative effects of the mental-
control paradox, it’s important to have an accurate understanding of the
connection between mental-control effort and mood. The next exercise is
designed to help you carry out an investigation to determine whether you might
be overstating the influence of your mental-control effort on your daily mood.
 Exercise: Mood-and-Control Record

Over the next week, take note of times of

significant positive or negative mood. In the
column on the left, indicate whether it was a
positive mood or a negative mood, and rate
its intensity. In the column on the right, rate
the extent that your mood was due to a
conscious effort to suppress, inhibit, or direct
attention away from your thoughts. If you
need more space, visit
http://www.newharbinger.com/38426 to
download other copies of this mood-and-
control record.

Mood-and-Control Record

Mood State Rate Mental-Control Effort

(Label whether mood positive or negative; rate mood intensity (0 = no effort, 1 = slight effort, 2 =
from 1 = mild, 2 = moderate, 3 = strong.) moderate effort, 3 = strong effort)

1.

2.

3.

4.

5.

6.
7.

8.

9.

10.

If you kept a mood-and-control record over the last

week, congratulations! Rarely do we systematically test
our beliefs about the mind. Instead, we tend to assume
we know what affects our thoughts and feelings.
So what did you learn about the effects of mental-
control effort on your mood fluctuations? Respond to
these questions:

What’s the relationship between your mood state

and how much you try to control your thoughts?
Did you only feel good when your mental-control
effort was high and worse when mental-control
effort was low?
How effective were you at changing your mood
state by exerting greater mental-control effort?
Did a calm or positive mood ever happen without
conscious effort on your part?
Did you have spontaneous positive thoughts or
daydreams that made you feel good without any
effort on your part?
How often did you feel like you had strong mental
or emotional control without much conscious
effort on your part?

Intuitively, we all believe that more self-

control is better. But greater control effort is
not always the answer to better mood.
Recall the life experiences you noted at the
 beginning of this chapter. Often, greater
control effort is associated with more
distress, whereas letting go of mental-control
effort can have beneficial effects on your
mood state.

Belief Myth: Maybe You Will “Snap”

Another common belief that could be keeping you hooked into trying to
control your thoughts is the fear that if you don’t control them, you will lose
complete control or even “snap” and do something irrational (see chapter 2). Is
this one of your basic fears? Leah had a strong fear of losing control. She firmly
believed that she couldn’t let the intrusive thoughts of regret take over, because
they’d cause her to slip further into a depressive funk. So Leah fought hard
against these thoughts, fearful she was losing her grip. If, like Leah, you believe
that easing up on your mental-control efforts might push you toward a complete
loss of control, then letting go of control will seem particularly frightening. You
might question if taking a more relaxed approach to self-control could lead to
some type of mental catastrophe. Maybe you’ve actually asked yourself, Could I
snap? For you, the catastrophe might be experiencing runaway thoughts or
intense emotional distress or taking impulsive actions that could harm yourself
or others. Whatever the imagined catastrophe, the basic fear is that letting go
could make matters much worse.
Like before, it’s important to evaluate the accuracy of your belief by
collecting data from your daily experiences. You can take an evidence-based
approach to determine how close you’ve come to losing complete control over
your thoughts, feelings, or behavior. The next exercise asks you to recall
unpleasant past experiences of losing self-control. It could be loss of control
over thoughts, feelings, or behavior, which left you feeling that self-control was
in short supply.

Exercise: Memories of Lost Control

On a blank sheet of paper, make a list of

past experiences in which you seriously lost
control over your thoughts, feelings, or
behavior. These would include times when
you caused unintended and significant
inconvenience, to yourself or others. Based
on these experiences, answer each of the
following questions:

How often did you actually lose complete control,

and how often was the experience more like a
feeling that you were out of control?
Were there ways that you exercised some control
in these situations, but these responses were
overshadowed by the ways that you exercised poor
self-control?
Is it more accurate to describe these experiences as
times of low self-control or as times of complete
absence of control?
Did others think you were out of control?
Looking back, were the consequences of having
low self-control as devastating as you assumed
they would be at the time?

As you review your worst memories of losing

control, do you think your fears of losing
complete control are justified? Would it be
more accurate to describe your worst
experiences as times of low self-control
rather than complete loss of control? Even
during times of serious anger outbursts or
impulsivity, people normally continue to
exhibit some degree of directed action and
restraint. Do you agree that it’s more
accurate to remember these experiences as
times when you should have exercised more
control over what you said, how you felt, or
 how you behaved? You can use the findings
from this exercise to challenge your fear of
losing complete control. If the problem you
face is low self-control rather than complete
loss of control, then easing up on mental-
control effort at appropriate times will not
lead to the disastrous outcome you fear.

At this point, let me offer a caveat. Sometimes exercising poor self-control

can lead to grievous harm both for oneself and others. Humanity is full of rage,
anger, and hostility, which has caused much misery in the lives of hundreds of
millions worldwide. Note that the focus of this workbook is on how fear of
losing control and its associated tendency of overcontrol contribute to anxiety,
depression, obsessionality, and other negative emotions. If the major problem in
your life is poor self-control, impulsivity, or emotion dysregulation, you should
consider a different workbook that deals with these issues more directly. You’ll
find some recommended self-help materials in the resource section. If a loss of
control over feelings and behavior has caused serious problems in your personal
life, then you may also want to consider reaching out to a qualified psychiatrist,
psychologist, social worker, or other mental health professional.
Leah struggled with difficulty controlling her intrusive thoughts of regret, but
she also discovered from the previous exercises that greater mental control was
not the cure for her depressed mood or fears. Ironically, she actually had a
reputation for being quite calm and controlled under stress. Despite her personal
battle with the intrusive thoughts of regret, Leah learned that she was generally a
well-controlled person. She didn’t need to try harder to practice self-control.
Leah needed a different approach to deal with her thoughts of regret. But before
she could let go of control, it was also important for her to evaluate whether her
responses to her mental intrusions, that is, her actual control strategies, might
have unintended negative effects on unwanted thoughts and feelings.
By now, you too may be realizing that your issues with mental control are
more nuanced than you first realized. You may see that you get trapped in
overthinking sometimes; you may also recognize that you hold erroneous beliefs
about your level of self-control. Now it’s time to examine the third major feature
of mental self-control: the actual strategies you use to control distressing
intrusions.

Weak Control Strategies

We all have a tendency to seize on the most immediate control strategy when
feeling emotionally upset. We can’t just stand idly by and do nothing when faced
with distressing intrusive thoughts (Freeston et al. 1995; Purdon and Clark
1994). Unfortunately, our first control response is often our least effective
strategy. The next exercise includes a list of five common mental-control
strategies that you may use when you are upset.

Exercise: Weak-Strategies
Checklist

Consider each strategy and place a

checkmark (√) beside any that you tend to
use when responding to unwanted intrusive
thoughts and feelings. You might find it
helpful to consult your responses to the
mental-control strategies questionnaire in
chapter 3.

Control Strategy Explanation Example

When the thoughts of regret intruded,

Using multiple, unrelated Leah tried to think about her work,
__________ Unfocused
distractors to draw attention away supper plans, the weather, news events,
distraction
from a recurring intrusive thought anything to draw her attention toward
something else.

Making self-critical, Leah would feel frustrated when the

__________ Self-
disparaging comments for having intrusions returned and would tell herself
criticism
the intrusion to stop being so selfish and pitiful.

__________ Responding in ways to try to When she felt guilt and negativity over
Neutralization/compulsive counter or cancel the distress or her decision to leave the marriage, Leah
negative effects of an intrusive would sometimes try to recall a good
 Neutralization/compulsive
rituals negative effects of an intrusive would sometimes try to recall a good
thought decision she made.

Seeking information from

others or external sources to Leah would sometimes consult with
__________
reduce your concern about the her closest friends about whether she had
Reassurance seeking
unacceptability or feared made the right decision to divorce.
consequences of the intrusion

When regretful thoughts popped into

__________ Reasoning with yourself that
her mind, Leah tried to convince herself
Rationalizations everything will be all right
that she’d made the right decision.

Which strategies did you end up checking?

It’s likely these are your most immediate
responses when feeling upset. These control
strategies are among the least effective in
dealing with unwanted thoughts.

Most of us tend to overuse these strategies when feeling emotionally

distressed or overwhelmed (Wegner and Pennebaker 1993). But the checklist is
based on your impression of your mental-control strategies. You will need to
look more closely at each strategy to see how well it’s working for you. The first
of these strategies is unfocused distraction, which is probably the most common
response to distressing intrusive thoughts.

Unfocused Distraction
When we have distressing intrusive thoughts, we may naturally try to distract
ourselves by switching our attention to some other topic or idea. However, when
using distraction in this way, our natural tendency is to use an unfocused
strategy. For example, when Leah had intrusive thoughts of regret, she tried to
refocus her attention on work, her son, the evening meal, a planned weekend
activity with a friend, and the like, in an effort to keep out the intrusive thought.
When she had the intrusive thought I should never have left the marriage, she
immediately tried to think of something else, such as what she’d have for supper
that evening. Unfortunately, the unwanted thought returned fairly quickly, so
Leah tried to think of something else, such as what her son was doing at that
moment in school. Once again, the distraction was effective only momentarily,
and when it returned, Leah tried to think about her weekend. Over a very few
minutes, Leah might jump from one topic to the next in her effort to suppress
intrusive thoughts of regret.
Harvard psychologist Daniel Wegner (2011) calls this unfocused distraction
and shows that it is an ineffective way to control unwanted intrusive thoughts.
Wegner argues that the use of multiple distractors is a weak mental-control
strategy because the distressing intrusion becomes associated with many
ongoing thoughts and feeling states, so multiple distractors now act as a trigger
for the intrusion. In Leah’s case, supper, her son at school, and plans for the
weekend became reminders of the intrusive thoughts of regret because she
always tried to use them as distractors. Rather than diverting attention away
from the intrusion, they became cues to remind her of the unwanted thought.
Another problem is that when anxious or depressed, we tend to select negative
distractors because they are consistent with our mood state (Conway, Howell,
and Giannopoulas 1991). When Leah had bouts of depressed mood, she’d
respond to intrusions of regret by thinking about all the problems in her life or
all her personal faults. These negative distractors were even more powerful
reminders of the intrusion because they matched its emotional tone. Thus this
spontaneous self-distraction strategy becomes a weak approach to controlling
distressing thoughts.
How often do you slip into unfocused distraction when struggling with a
negative mood state? The next exercise is a great way to determine how much
you use unfocused distraction, and it provides a test of the utility of this
heightened mental-control effort. Called the alternate-days experiment, it was
first proposed for obsessive thinking (Rachman 2003).

Exercise: The Alternative-Days

Experiment

Plan to conduct the alternate-days

experiment over a two-week period. Start by
dividing your week into high mental-control
 and low mental-control days. For example,
you could select Monday, Wednesday,
Friday, and Sunday as low-control days and
Tuesday, Thursday, and Saturday as high-
control days. During low-control days,
devote as little attention as possible to
consciously controlling your emotional
thoughts and affect. During these days,
allow yourself to think or feel whatever
comes into your mind without consciously
trying to control what you are thinking or
feeling. That is, let go of your mental-control
effort. Then on high-control days, work on
paying close attention to your emotional
thoughts, and try hard to inhibit any
unwanted negative intrusive thoughts and
feelings. In particular, try to distract yourself
with many different ideas, thoughts, and
memories, letting your mind flit from one
topic to the next.

Use the next set of questions to reflect on the most

important aspects of your mental-control experience.
Record your responses at the end of the day in the
worksheet that follows, so you can compare the
effectiveness of unfocused distraction during high-
control days versus the effectiveness of letting go of
control on low-control days. You can also visit
http://www.newharbinger.com/38426 to download
other copies of the high mental control vs. letting go of
mental control worksheet.

Was using unfocused distraction on high-control

days more, less, or equally effective to letting go
of control on low-control days? Did you have
more, fewer, or an equal number of distressing
thoughts and feelings on the different days?
Was using unfocused distraction on high-control
 Was using unfocused distraction on high-control
days more stressful or frustrating than taking a
more relaxed approach to mental control?
Was your emotional state any better on high-
control days than on low-control days, or was it
worse? How much better or worse? If there was
little difference, is greater effort at control worth
it?
Can you think of any other advantages or
disadvantages to using unfocused distraction on
high-control days?

High Mental Control vs. Letting Go of Mental Control Worksheet

Days Effectiveness of High Mental-Control Effort Effectiveness of Low Mental-Control Effort

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Did you notice any benefits to exerting

greater mental control, or were the days of
low mental control any better? The alternate-
days experiment may seem tedious, but I
hope you found it helpful in highlighting the
 negative effects of unfocused distraction and
an excessive mental-control effort.

Many people actually feel better during low-control days, whereas others
come to realize that a greater control effort is not worth it; that the difference
between high-control days and low-control days is so negligible that it’s just not
worth the effort. Whatever your experience, the critical question is whether
trying hard to control your intrusive thoughts is more harmful than helpful.
As mentioned, when you use unfocused distraction to inhibit an unwanted
intrusion, the distractors can actually become reminders of the unwanted
intrusion. If this is happening to you, you can counter these effects by using a
more effective focused-distraction strategy discussed in chapter 7.

Other Weak Control Strategies

Four other mental-control responses listed in the weak-strategies checklist can
have a deleterious effect on unwanted thoughts and feelings: these are self-
criticism, neutralization or compulsive rituals, reassurance seeking, and
rationalization.

SELF-CRITICISM
Are you prone to self-criticism, especially when feeling down or discouraged?
Self-criticism is a natural response if you’ve been unsuccessful in bringing
distressing thoughts and feelings under control. One can easily end up making
self-disparaging remarks such as I’m being so weak or pitiful or lazy or pathetic.
You may be hoping that verbal self-punishment will motivate you to have better
control over your distress. In reality, this practically never works. In fact, self-
criticism is highly ineffective and only intensifies negative emotional states like
depression (Halvorsen et al. 2015). This type of response is often so automatic
that it can be hard to detect. We can slip into a fresh round of self-deprecation
before we even know it. You need to watch out for elevations in self-criticism.

NEUTRALIZATION OR COMPULSIVE RITUALS

 Neutralization or compulsive rituals can develop when the same distressing
intrusive thought keeps returning over and over again. The best example of
neutralization strategies can be seen in OCD: a person who fears she has become
contaminated by touching a dirty object, such as a doorknob, may compulsively
wash her hands in order to eliminate (that is, neutralize) the possibility of
contamination, thereby restoring a sense of safety and relief. Although most
common in OCD, neutralization can occur in other states that involve repetitive
distressing thoughts (Bjornsson and Phillips 2014).
To try to cancel out, or neutralize, the negative effects of her intrusive
thoughts of regret, Leah would form a clear image in her mind of important
positive life events, such as the day she decided which university to attend, her
decision to accept various job offers, the day she discovered she was pregnant,
or the birth of her son. Leah was hoping that vividly reliving these past positive
experiences would counter the distress and negativity felt over the divorce.
However, neutralization actually makes obsessive thinking worse by increasing
the intensity and importance of the unwanted thought (Clark 2004). So it’s
important to determine whether you commonly use neutralization or compulsive
rituals in response to recurring negative intrusions.

REASSURANCE SEEKING
How often have you been worried about something and turned to your spouse,
family member, or friend, and said, “How do you think it will go?” Maybe
you’ve discovered a skin rash, you’re concerned about possible melanoma, and
so you’ve scheduled an appointment with your family doctor. But as you wait
for the appointment, you become more anxious and worried about the possible
diagnosis. And so you find yourself asking others, “Do you think I’ll be okay?
Do you think it’s only a benign skin rash?” Of course, you’re looking for others
to say it will be fine. And when you hear those words, “It will be fine. It’s
probably nothing,” it’s like magic. You feel a sudden, but brief, sense of relief.
It’s as if hearing the reassurance over and over somehow makes it more likely
that you’ll hear good news from your doctor.
Such reassurance seeking is another maladaptive mental-control response to
unwanted thoughts and feelings. There are two major problems with it. First,
reassurance seeking is ineffective in relieving distress or reducing unwanted
intrusive thoughts. And second, it may actually intensify unwanted negative
thoughts and feelings (Salkovskis and Kobori 2015). The reason is that
reassurance seeking is a type of magical or superstitious thinking. For it to work,
you have to pretend that the person giving the reassurance knows the future. If
you’re asking a friend for reassurance about a medical test, you have to pretend
that she has expert knowledge of the disease and that she can predict the future.
Naturally, both of these preconditions are absurd, and so reassurance seeking
simply becomes a self-imposed mind game. Learning to kick the reassurance-
seeking habit is an important step toward letting go of excessive mental- control
efforts.

RATIONALIZATION
When distressed by intrusive thoughts, you may try to convince yourself with
the rationalization that Everything will be all right or Don’t worry, it’s going to
be okay; that any negative consequence associated with the intrusion won’t
happen. It’s a type of self-reassurance that doesn’t work, because such vague,
uncertain platitudes may be temporarily comforting but are hardly convincing.
For example, Leah would say to herself I’ll be fine; everything will turn out fine,
but she really couldn’t see how her future looked any brighter, so telling herself
this did little to squelch her distressing thoughts and feelings of regret. In the
end, rationalization is ineffective in dealing with the negative thoughts that fuel a
deep-seated uncertainty about the future.
The final exercise in this chapter is useful for increasing your sense of when
you may be using any of these four ineffective control strategies.

Exercise: Weak-Control Awareness

Go back to the entries you’ve made in your

mental-intrusion diary over the past couple
of weeks. Review the information you
recorded to determine whether any of your
responses to distress could be considered a
maladaptive control strategy. You can use
initials to identify each strategy such as SC
for self-criticism, NC for neutralization or
compulsive ritual, RS for reassurance
seeking, and RA for rationalization. If you
don’t have sufficient information in your
 mental-intrusion diary to do this exercise,
keep track of your intrusions over the next
week or two, paying close attention to your
response to the distress and whether you
were relying on any of the maladaptive
strategies.

Are certain maladaptive control strategies

particularly problematic for you? If so, the
frustration you feel over poor control of
intrusive thoughts and feelings may be due
to reliance on these ineffective strategies.

Leah came to the realization that the solution to her distress was to stop trying
so hard to control her thoughts and feelings, and instead to let go of control. This
was a refreshing perspective for her. Instead of blaming herself for poor control,
she began to see that her problem was more strategic in nature. With this insight,
she gained renewed hope that her life could get better if she adopted a new
approach to unwanted thoughts and feelings.
Now that you’re more aware of your own natural responses to mental
intrusions and the strategies you use, the next step is to learn more effective
ways to deal with your distressing intrusive thoughts and feelings.

Wrap-Up
Common sense tells us to try harder when we seem to be failing. And yet, when
it comes to distressing intrusive thoughts and feelings, trying harder sometimes
ends up causing more rather than less distress. The truth is that just the opposite
approach is needed for unwanted intrusions. Instead of buckling down on
control, it is the willingness to let go that is most critical. Indeed, letting go is
often the best option for many of life’s most intractable problems. However, it’s
easier said than done, and so this chapter highlighted many factors that can stand
in your way:
 Excessive awareness and analysis of your unwanted thoughts and
feelings leads to a greater investment in efforts to control them.
Learning to recognize when you are overthinking is an important
skill.
Holding on to misconceptions about the benefits of using strong
mental-control effort against intrusions is a barrier to letting go of
control.
Often the mental-control strategies that feel most natural, like
unfocused distraction, reassurance seeking, and rationalization, are
the least effective in reducing unwanted intrusive thoughts, images,
and memories.

The work you did in this chapter has helped you become more aware of your
coping strategies as well as any misguided beliefs that may be getting in the way
of positive personal change. This increased awareness is an important step in
transforming your approach to distressing intrusive thoughts and feelings. You
now know whether your self-help therapy should target overthinking, faulty
beliefs about mental control, or a reliance on ineffective control strategies. Like
Leah, the problem is not you but rather your approach to mental intrusions. It’s a
problem of strategy not biology. However, changing our mindful ways is not
easy. To be successful, an attitude of self-acceptance and compassion is needed,
which is the topic of the next chapter.
 Chapter 6

Control Skills: Mindful Self-Acceptance

Acceptance is a major contributor to life satisfaction. Philosophers, religious
icons, and other wise sages have shared this view throughout the ages. Most
often we think of acceptance in terms of coping with difficult life circumstances
that are beyond our control, such as a life-threatening illness, a relationship loss,
a natural disaster, a past trauma, a physical limitation, or adverse decisions made
by others. Life can take an endless number of twists and turns that can have
devastating effects on our quality of life. And in these circumstances, acceptance
plays a critical role in coping with adversity. Acceptance, though, doesn’t come
naturally to most people. Like letting go of control, it must be nurtured and
practiced in everyday living.
Michael J. Fox, the Hollywood actor, producer, and writer who was diagnosed
with Parkinson’s disease at age twenty-nine, is quoted as saying “Acceptance
doesn’t mean resignation; it means understanding that something is what it is
and that there’s got to be a way through it.” You also may know all too well the
hardships and disappointments of life. You may not have a devastating chronic
illness, but you have had adversities, maybe even tragedies, that have been
crushing. You may have done your best to cope with tragedy and come to realize
that you can’t change what happened or simply eliminate the pain and suffering
by sheer willpower. Possibly you are reminded of this truth by the life
experiences you recorded at the beginning of chapter 5. Acceptance, which is the
topic of this chapter, is that ability to acknowledge the unpleasantness, the losses
and the hurt, that comes into our life, unwanted and uninvited. The healing
power of acceptance is best summed up in the first few lines of the Serenity
Prayer, attributed to American theologian Reinhold Niebuhr: “God grant me the
serenity to accept the things I cannot change; courage to change the things I can;
and wisdom to know the difference.”
Is there some life difficulty or problem you’re facing that needs a strong dose
of acceptance?

Exercise: Where You Need to Find

Acceptance
 Take a moment to briefly record the life
problem or situation that is having the
greatest negative effect on your quality of
life.

Your most difficult life circumstance or problem:

Unwanted intrusive thoughts associated with

depression and anxiety often stem from
difficult or stressful life experiences. If your
distressing mental intrusions are linked to a
specific problem or situation in your life, your
work in this chapter will be helpful.

This chapter focuses on self-acceptance of negative thoughts and feelings,

which may be triggered by life stressors over which you have limited control. On
the other hand, you may have distressing intrusions that are unassociated with
any specific life stressor. Either way, your work on self-acceptance in this
chapter will transform your approach to mental and emotional control. You’ll
also learn how to use mindfulness to deal with personal distress and control over
unwanted mental intrusions.
Your ability to use self-acceptance and mindfulness depends on the progress
you’ve made so far in this book. Using self-acceptance and mindfulness will
help you do two important things: reduce the personal significance of your
intrusions and decrease your mental-control effort and reliance on ineffective
control strategies.
Psychologists have increasingly recognized that willingness, acceptance, and
mindfulness are beneficial for dealing with a variety of mental health issues as
well as promoting life satisfaction and well-being. Fortunately, you’re not
starting from scratch. The fact that you are reading this workbook shows a strong
element of willingness to deal with your emotional problems. The goal in this
chapter, then, is to sharpen your focus on self-acceptance and enhance its
contribution to your new mental-control approach to distress. To begin looking
at how this works, I want to return to Samantha, who was introduced in chapter
3.

Samantha’s Story: Learning to Accept

Despite her best intentions, Samantha seemed powerless to overcome her social
anxiety. Even the anticipation of a social encounter could cause the most intense
feeling of anxiety. These experiences would begin with the intrusive thought I’ll
be extremely anxious and then proceed to other negative thoughts like I’ll
embarrass myself and People will think there’s something wrong with me and
I’m such a loser for being so fearful. When that first reminder of anxiety popped
into her mind, Samantha tried hard to suppress the thought. She worked at
convincing herself that there was nothing to fear, that maybe she wouldn’t feel
so nervous this time. Sometimes she would ask her mother if she thought she’d
be okay if she went to a party. At other times, she tried to calm herself down by
meditating and thinking positive thoughts. But none of these strategies were
effective. The thoughts of being anxious came roaring back into her mind, and
with them came a sense of defeat and despair. Samantha was becoming more
and more frustrated by her negative emotions, and she longed for the day when
she could be anxiety-free. Samantha couldn’t accept herself as a socially anxious
person. Instead, she believed a personal transformation was required; she needed
to become calm and confident around others. But such a radical change seemed
impossible, and so she remained stuck in her anxious state.

What Is Self-Acceptance?
Self-acceptance means being willing to welcome thoughts and feelings we do
not want. Such self-acceptance is based on the recognition that everyone
experiences negative intrusive thoughts and feelings over which we have less
than desired control. Self-acceptance is not unlike accepting negative life
stressors or circumstances outside ourself. In both cases, our control is limited,
and we are forced to acknowledge that a certain degree of personal pain and
suffering is inevitable in this life. Of course, our ability to deal with distressing
intrusive thoughts improves if we reduce their personal significance, relinquish
excessive mental control, and utilize more effective control strategies. But these
interventions can have a positive effect on anxiety or depression only if we’re
able to exercise a certain level of self-acceptance. As an example, working on
self-acceptance played an important role in Samantha’s new approach to her
social anxiety.
Again, Samantha wanted to feel no anxiety in social situations, but after years
of trying to conquer her social fears, she came to the realization that she would
always feel some anxiety around others. For Samantha, self-acceptance meant
acknowledging her discomfort around others, her heightened self-consciousness,
and thoughts of negative evaluation by others. She realized she wasn’t going to
make a radical change in her personality and suddenly become a self-confident,
gregarious extrovert. The challenge for her was to accept in a nonjudgmental
manner the continued existence of unwanted anxiety and negative intrusions in
social settings. Instead of fighting her social anxiety, she needed to learn a better
way to manage her negative thoughts and feelings. So before meeting unfamiliar
people, Samantha needed to remind herself to accept her thoughts and feelings,
like this:

I know I’m going to feel anxious. Thoughts that I’m making

a bad impression and that others are thinking the worst of
me will flood my mind. I’ll feel awkward, and it will seem
like everyone is staring at me. It’s okay to think and feel this
way. I’ve learned new ways to deal with the anxiety and
intrusive thoughts. I need to work with my negative thoughts
and feelings. I need to be myself in these social situations: a
person who is shy and somewhat awkward around others.

To get to this place of self-acceptance, Samantha was using tools from a

therapeutic intervention called acceptance and commitment therapy (ACT).

Self-Acceptance and ACT

Many psychologists now use ACT as an effective intervention for anxiety and
depression (Hayes, Strosahl, and Wilson 2011; Roemer and Orsillo 2009). ACT
offers a different approach to our internal experience, that is, to our thoughts and
feelings. When distressed, there’s a tendency to treat unwanted negative
thoughts and emotions as if they were facts, to then try hard to suppress or even
avoid the experience, and to become so captivated by our private world that we
fail to follow through on actions that contribute to the fulfillment of cherished
goals and values. According to ACT, Samantha continues to struggle with social
anxiety because she treats the intrusive thought I’ll be so anxious, everyone will
think there’s something wrong with me as a fact rather than a thought. Because
of this, she tries to suppress the intrusion to quell her anxious feelings, and the
anxious intrusion returns, causing Samantha to conclude that her only option is
to avoid others. But the avoidance means she fails to make new friends, which is
an important personal goal. As a result, Samantha fails to live a full and
satisfying life, like making friends and enjoying social activities, because she
reacts to her anxious thoughts as a foregone reality rather than as unwanted
imaginations in her mind.
ACT offers a solution to this problem of avoidance: change how you relate to
unwanted thoughts and feelings. Rather than trying to suppress, control, or avoid
negative thoughts and feelings, ACT therapists work on helping you develop a
more open, nonjudgmental, and receptive attitude toward your negative inner
experience. In other words, you’re encouraged to practice self-acceptance: to
acknowledge that life is full of pain, suffering, and disappointment which often
cannot be eradicated through sheer effort and willpower (Leahy, Tirch, and
Napolitano 2011). Because life can be difficult, negative thoughts and feelings
are inevitable. The pathway to self-acceptance involves three interrelated parts:

Being kinder, more compassionate, and nonjudgmental toward your

inner self
Learning to be open, receptive, and comfortable with the experience
of unwanted thoughts and feelings
Viewing negative thoughts and feelings as unpleasant experiences that
you can work with rather than fight against

Until now, you may not have considered the importance of self-acceptance.
You may have learned to expect a certain amount of pain, suffering, and
disappointment in this life, but you’ve never really thought about it from the
perspective of self-acceptance. The next exercise provides an opportunity for
you to reflect on your own experience of self-acceptance. This exercise requires
that you spend time thinking about your past efforts to deal with a difficult life
problem. You’ll need a quiet, comfortable location where you can engage in
thirty to sixty minutes of reflection without interruption.
 Exercise: Reflections on Self-
Acceptance

Take the following steps to reflect on self-

acceptance, and use the worksheet to
record your observations:

Begin by thinking back to all the ways you’ve

tried to deal with a particular life problem; it can
be a problem that you wrote about at the beginning
of the chapter. If you don’t have a significant life
stressor or problem, think about some unwanted
thought or feeling you’ve struggled to accept. In
the left-hand column of the worksheet, list various
actions you’ve taken to deal with the life
difficulty, unwanted thought, or feeling; for
example, if the stressor is being diagnosed with
cancer, having obsessive thoughts of doubt, or
having recurring bouts of depression, think about
all the ways you’ve tried to deal with the problem.
Consider whether you adopted a kind and
nonjudgmental attitude toward yourself as you
tried to cope with this difficulty. Briefly describe
how you showed patience, kindness, and
understanding toward yourself in the second
column.
Then briefly explain in the third column how open
you were to unwanted thoughts and feelings as you
were dealing with the life difficulty. Did you feel
okay with the negative thoughts that popped into
your mind while dealing with the stress?
In the last column note the extent that you could
distance yourself from the negative thoughts
associated with the difficulty. Were you able to
treat any negative thoughts as simply unpleasant
thought occurrences, or did you become distracted
 thought occurrences, or did you become distracted
by or immersed in your negative thinking?

Self-Acceptance Worksheet

Action Taken to Deal with Degree of Openness to

Ability to Consider Negative Thoughts As
Unwanted, Difficult Life Self- Unwanted Thoughts
Tolerable, Unpleasant Mental Occurrences
Situation Compassion or Feelings

1.

2.

3.

4.

5.

As you look back on your attempts to deal

with your difficult life circumstance, were you
able to practice self-acceptance? Could you
accept the negative thoughts and feelings
that occurred when coping with the life
stressor, or did you feel like you were
fighting against these unwanted intrusions?

Samantha examined some of the ways she tried to deal with the problem of
social anxiety, and she realized self-acceptance was in short supply when trying
to cope. She was often impatient with herself and highly self-critical. She tried to
stop herself from thinking so negatively, but once the thoughts started, she easily
got sidetracked into thinking about how awful she felt when anxious around
others.
 From your work on this exercise, you too may have concluded that you’re not
very accepting of the negative experiences in your life. You’ve been more self-
critical than patient and self-compassionate in your attempts to deal with the
experiences that make you feel anxious or depressed. You may also have noticed
that you’re not very open and accepting of the negative intrusive thoughts,
images, or memories that pop into your mind. If this is your conclusion, then
you’ll want to work on promoting self-acceptance.

Promoting Self-Acceptance
When you have a healthy attitude of self-acceptance toward your unwanted
negative thoughts and feelings, you’ll find it easier to use the mental-control
strategies presented in chapter 7. Here are some self-help activities that can
boost self-acceptance.

Let Your Mind Wander

People who are self-accepting are also comfortable with the spontaneous,
creative part of the mind. On the other hand, if you have very low self-
acceptance, you may have difficulty tolerating any thoughts that are unexpected
and uncontrollable; you can become so concerned about mental control that even
letting your mind wander becomes an anxious experience. Mind wandering is a
normal thought process that everyone experiences daily, but people with low
self-acceptance can feel uncomfortable when not in control. Thus, ordinary
daydreaming, that is, letting your mind wander, becomes an experience that you
may avoid if possible.
Better self-acceptance begins with being receptive to letting your mind
wander—having an openness and tolerance for any thought that might pop into
your head. The next exercise is intended to help you develop a more accepting
attitude toward your creative mind, to relinquish directed mental control, and to
open your mind to whatever thoughts, images, or memories it may choose to
produce. Mind wandering, daydreaming, and other forms of spontaneous thought
are usually involuntary, often happening when we least expect it, so to promote
greater acceptance of spontaneous thought, it’s necessary to become intentional
about mind wandering. This exercise of intentional mind wandering will help
you build up tolerance of your free-floating, spontaneous mind.
 Exercise: Intentional Mind
Wandering

Over the next week, take a five-minute

pause several times a day to let your mind
wander. This mind-wandering pause can be
done anywhere. It’s like taking a few minutes
to relax or meditate, except in this case
you’re taking the time to daydream or let
your mind wander on any topic. Begin each
pause with a few relaxing breaths. Then
simply let your mind wander. Allow yourself
to think about whatever pops into your mind.
Don’t try to control what you think. That is,
don’t make yourself have certain thoughts
and don’t try to prevent other thoughts from
entering your mind. Just let yourself
daydream for the next five minutes or so. At
the end of this mind-wandering pause, take
a minute to very briefly note your experience
on the mind-wandering record. Next rate
your overall daily tolerance of the mind-
wandering experiences on a 0 to 10 scale,
where 0 means no tolerance with
spontaneous thoughts to 10 means
completely tolerant of the spontaneous
thoughts, images, or memories.

Mind-Wandering Record

Level of Tolerance/Comfort
Date Mind-Wandering Themes
(0 to 10 scale)

Sunday
Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

After spending a week engaged in intentional mind

wandering, how would you evaluate your efforts? As
the week progressed, were you more comfortable with
letting your mind wander? Did your level of self-
acceptance of a wandering mind improve with practice?
To gain more insight and understanding from this
exercise, take some time to answer these questions in
the space provided.

Did you have any negative or threatening thoughts

pop into your mind during your mind-wandering
pauses? If so, jot down the most negative thoughts:
If you had negative thoughts, how well did you
accept or tolerate them?
If you had negative thoughts, was there anything
about them that made them intolerable or difficult
to accept?
Did you have any positive or pleasant intrusions
that were associated with high tolerance and
comfort? If so, briefly describe them here:

If you want to spend more time with this

 exercise, you can visit
http://www.newharbinger.com/38426 to
download other copies of this mind-
wandering record.

People differ in their level of comfort with a wandering mind. Samantha, for
example, would have no difficulty with this exercise because her unwanted
intrusions were very specific to social situations. If you are comfortable with this
exercise, then you should proceed to the next exercise on focused mindful
acceptance. Alternatively, you may still be uncomfortable with mind wandering
because you fear what might happen if you were to let go of mental control. If
this is how you feel, you should continue to work with this mind-wandering
exercise until you feel more comfortable with an open mind.
It would be good to continue taking note of any unacceptable or distressing
thoughts you experience during intentional mind wandering, as you’ll want to
work on these intrusions in chapter 7. If you’ve increased your tolerance for a
wandering mind, you’re making progress toward increasing self-acceptance.

Practice Mindful Acceptance

One of the best ways to strengthen self-acceptance is to practice mindfulness,
which involves acknowledging the momentary presence of your unwanted
thoughts and feelings in a nonjudgmental, receptive manner. Focused mindful
acceptance requires a shift in your reaction when feeling distressed. Instead of
trying to control your thoughts and feelings, you passively observe how you are
thinking and feeling at that moment without any attempt to change your inner
experience. For example, Samantha could practice mindful acceptance of the
intrusive thought I’ll be so anxious when I meet these people by saying to
herself:

Oh, there’s that anxious thought again. Hello, anxious

thought. How are you today? I didn’t invite you into my
mind, but I see you’ve come anyway. Feel free to stick
around if you want. I have a lot of other things to do, so I
 can’t stop and spend a lot of time with you. Instead, my
attention must be focused on other activities, but you can
stay in the back of my mind. If you demand my attention, I’ll
only be able to acknowledge that you’re still in my mind, but
then I’ll have to get back to the important tasks of the
moment. I don’t mean to be rude, but you are an uninvited
guest in my mind, so you’ll have to put up with my passive
and divided attention.

Mindfulness is a popular psychological treatment for a variety of mental

health problems. If you’ve been trained in mindfulness, you can use these skills
to increase your self-acceptance of negative intrusive thoughts. If you’re
unfamiliar with the mindfulness approach, you’ll find recommended readings on
the topic in the resources section. Whether you’re a practitioner of mindfulness
or a novice, however, the next exercise can be useful for building up self-
acceptance. Mindful acceptance is a strategy you’ll want to practice regularly in
response to distressing intrusive thoughts and feelings. You can visit
http://www.newharbinger.com/38426 to download other copies of the mindful-
acceptance record used here.

Exercise: Mindful Acceptance

Practice mindful acceptance every day for a

couple of weeks, taking these steps
repeatedly throughout each day:

When aware of feeling distress or being upset, stop

what you are doing and focus your attention on
your inner experience. Ask yourself, What am I
thinking and feeling at this moment?
Next, imagine you are standing with your arms
held open, and you’re embracing these difficult,
unwanted thoughts, feelings, and sensations. You
willingly focus on them without trying to change
or alter in any way your inner experience at that
moment in time (Teasdale et al. 2014). You allow
 moment in time (Teasdale et al. 2014). You allow
yourself to fully experience the distressing
thoughts and feelings without judgment, without
self-criticism, but with ever-present kindness and
compassion toward yourself.
Hold your attitude of mindful observation for five
to ten minutes, and then resume your daily
activity.

At the end of each day, use the mindfulness-

acceptance record to rate your experience with this
strategy, based on your daily experience of practicing
mindful acceptance. First rate how often you practiced
mindfulness throughout the day; use a scale of 0 to 10,
where 0 means not at all (did not practice mindfulness
today) and 10 means you always practiced mindful
acceptance when you experienced distress. Then rate
the overall quality of your self-acceptance, or your
ability to tolerate distressing thoughts and feelings; use
a scale of 0 to 10, where 0 means you experienced no
self-acceptance (could not tolerate the negative
experience), and 10 means you experienced complete
self-acceptance (were able to embrace the negative
thoughts and feelings).

Mindful-Acceptance Record

Day of Week Rating of Mindful Practice (0 to10) Rating of Self-Acceptance (0 to 10)

Sunday

Monday

Tuesday

Wednesday
 Thursday

Friday

Saturday

After spending a couple of weeks on mindful

acceptance, review the records you’ve
completed. How often did you practice
mindful acceptance when feeling distressed?
With practice, did you notice whether you
were more accepting or more tolerant of
your unwanted thoughts and feelings?

If you’re practicing mindful acceptance, you should notice a change in how

you are dealing with your negative emotional experiences. Your efforts to inhibit
negative thoughts, images, or memories should diminish, and you should be
taking a more passive, open, and understanding approach to the unwanted
thoughts and feelings that intrude into your mind. In other words, you should
feel a rise in your general level of patience, tolerance, and compassion toward
yourself, as you realize that you are a person who experiences the full scope of
life, both the pleasant and the unpleasant.

Wrap-Up
No doubt you’re tired from warring against disturbing intrusive thoughts and
feelings. You’ve struggled hard to gain control over your distress, but the harder
you try, the worse you feel. Maybe you’ve gotten to the point where you’re fed
up with your apparent weakness and inability to pull yourself together. You’re
ready for something new, a fresh approach to your inner turmoil. But before you
can use the new strategies of mental control, it’s important to step back from the
distress and approach your troubled mind with a greater degree of compassion
and acceptance. Nothing good can be achieved by self-punishment and reproach.
Rather, tolerance and self-acceptance are the prerequisites for adopting a new
perspective on your anxiety or depression. Some of the key points in this chapter
are

Self-acceptance is the willingness to tolerate, even welcome,

unwanted intrusive thoughts and feelings.
Mindful self-acceptance is characterized by an open, nonjudgmental
approach to all inner experience.
Healthy mindful self-acceptance begins with an ability to experience a
wandering mind without fear or hesitation.
Mindful self-acceptance is strengthened by intentionally and
repeatedly embracing unwanted thoughts and feelings, allowing
yourself to fully experience them without judgment or self-
criticism, but with self-compassion.

Chapter 7 will introduce specific mental-control skills that you’ll find helpful
in dealing with anxiety, depression, obsessions, and other negative emotional
states. However, it’s important to continue cultivating an attitude of self-
acceptance. Detoxification, letting go of excessive and ineffective mental
control, and now self-compassion along with tolerance of negative intrusive
thoughts and feelings are important pillars of the new science of mental control.
You may need to return to previous chapters to refresh your understanding of
these important topics as you move on in this workbook. Keeping that in mind,
it’s time to learn four mental-control strategies that can transform your approach
to negative emotion.
 Chapter 7

Control Skills: Strategies That Work

Most of us find change difficult. Even when our efforts don’t produce the
outcome we desire, it’s not easy to switch strategies. Our continued reliance on
an ineffective coping strategy, for example, is often driven by the desire to avoid
short-term pain even at the expense of long-term gain. Say you have a problem
with a coworker who’s creating tension in the office. As the manager, it’s your
job to deal with the problem. But confrontation makes you anxious, so you say
nothing. The problem continues to fester, creating more stress in your daily work
life. The more effective strategy would be to meet with the coworker and deal
with the problem head-on. But that too is stressful, and so you continue to
manage conflict the old way, with procrastination and avoidance.
Just like when we face problems in the external world, we each have our
habitual ways of dealing with the inner world of the mind. Chapter 5 introduced
you to several common mental-control strategies that are relatively ineffective
for dealing with intrusive thoughts of anxiety and depression. Yet they may be
your go-to responses, because they sometimes produce short-term relief even if
the end result is long-term distress. Now it’s time to reverse the equation: to
adopt control strategies that produce genuine improvement in your emotional
well-being.
This is a chapter about change and how you can respond more effectively to
your unwanted mental intrusions. It focuses on four mental-control strategies
that have demonstrated effectiveness for dealing with unwanted thoughts and
feelings. First, to ensure that you’re ready to work on these new control skills,
you’ll briefly evaluate the progress you’ve made already through this workbook.
Then you’ll learn how to use the new mental-control strategies in your daily
experience of personal distress. But before getting started, I want to return to
Daniel from chapter 1. Daniel learned to deal more effectively with his
obsessions by undertaking radical change in his mental-control strategies.

Daniel’s Story: Deflating Excessive Doubt

If you recall from chapter 1, Daniel was often hounded by intrusive doubts over
whether he had made a mistake or had been careless in his actions and decision
making. When Daniel doubted whether he had locked the door, sent the correct
email, been truthful in his conversation, or shut down his computer, his main
response was to check over and over or try to reassure himself that everything
was all right. But these control strategies were ineffective; soon the doubt
returned, and with it came intense feelings of discomfort and uncertainty. So
Daniel needed a different approach to his obsessive doubt.
First Daniel learned that his anxiety was caused by a thought and not a real-
life situation. He was uncomfortable not because he was actually making
mistakes but rather because he was having an intrusive thought of doubt.
Second, he worked on reducing his compulsive checking, because checking was
only making the obsessive doubt worse. And third, he adopted imaginal
exposure as an alternative to compulsive checking. Daniel scheduled a thirty- to
forty-five-minute session of daily exposure in which he intentionally recalled
thoughts and memories of doubt.
In a typical exposure session, Daniel would think about whether he’d left the
house and hadn’t locked the door. He imagined driving to work with doubts
about whether he’d locked the door flooding his mind. He then thought about an
unlocked front door and what would happen if an intruder tried the door. As he
visualized this scenario, he thought more broadly about the doubts. If someone
really wanted to break into his house, would a locked door stop them? And what
would be the worst thing that could happen if an intruder did break in? How
would he handle being robbed?
Later in the chapter, you’ll learn about imaginal exposure and how to use this
strategy to deal with your own distressing mental intrusions. Imaginal exposure
is a highly effective strategy for obsessive thinking, but it can be useful for other
types of mental intrusions as well. Before we delve into any new mental-control
skills, though, you’ll want to spend time in the next section reviewing your
progress with the workbook.

A Gentle Reminder
By now you’ve invested considerable time and effort into changing how you
understand and cope with the intrusive thoughts, images, and memories that
contribute to your anxiety or depression. It’s my hope that you’ve felt some
relief from your personal distress by applying the following three pillars of the
new science of mental control:
 Detoxifying the emotional significance of unwanted mental intrusions.
Letting go of excessive mental-control efforts.
Boosting self-acceptance and tolerance for negative thoughts and
feelings.

I encourage you to take a few minutes to complete the next exercise to review
your progress. It’s a great way to look at the skills you’ve acquired from the
previous chapters and to identify areas of mental control that may require further
work.

Exercise: Checklist of Progress

Place a checkmark (√) beside the skills

you’ve achieved or leave blank if you believe
further work is needed. You can work more
on these skills by reviewing the chapters
noted in parentheses.

__________ I’m able to identify the key intrusive

thought, image, or memory associated with my
experiences of depression, anxiety, obsessions,
guilt, or frustration. (See chapters 1 and 3.)
__________ I realize my efforts to refrain from
(suppress) unwanted intrusive thoughts are
counterproductive. (See chapter 2.)
__________ I am no longer afraid of losing
control of my mind. (See chapter 2.)
__________ I understand how I attach unrealistic
importance to my unwanted mental intrusions; that
is, how I interpret the intrusion as a toxic mental
experience. (See chapters 3 and 4.)
__________ I have created my own mental-control
profile. (See chapter 3.)
__________ I now consider the distressing
intrusion less personally significant; that is, I’m
 able to detoxify the intrusion. (See chapter 4.)
__________ I can catch myself when I overthink
and correct this way of thinking (See chapter 5.)
__________ I’m able to let go of excessive mental-
control effort. (See chapter 5.)
__________ I’m aware of my reliance on
maladaptive control strategies. (See chapter 5.)
__________ I’ve developed a more accepting,
tolerant attitude toward unwanted distressing
thoughts and feelings. (See chapter 6.)
__________ I’ve found mindful self-acceptance
helpful. (See chapter 6.)

These statements represent the main

learning objectives of the first six chapters.
They are the skills you’ll need to adopt the
new mental-control strategies presented in
this chapter.

I hope that you are feeling encouraged. No matter how many statements you
checked off, it’s a reminder that you’ve made at least some positive changes in
how you approach intrusive thoughts and feelings. If you’ve left several
statements blank, let this be a gentle reminder that you may need to do more
work in these areas. You can either go back now to the relevant chapters to redo
some of the exercises or proceed with the current chapter. If you choose to do
the latter and then have difficulty practicing the new mental-control skills,
consider whether you should spend more time working on the earlier skills.
Daniel realized he still had a strong fear of losing control and had difficulty
letting go of excessive control over his doubting intrusions. These issues
interfered with his ability to stop his compulsive checking and to practice
imaginal exposure. So Daniel decided to do more work on correcting two
maladaptive beliefs: that he could lose complete control and that more mental-
control effort is better than less mental-control effort.
 Four Effective Control Strategies
Now that you’ve completed the skills self-audit, it’s time to consider four
effective mental-control strategies. You can expect some strategies to be more
helpful to you than others. I encourage you to do the exercises to learn how to
use each strategy, so you’ll have some personal experience before choosing the
strategies that work best for you.

Focused Distraction
The most effective control strategy for a wide range of distressing thoughts
and feelings is focused distraction, an intentional mental-control strategy in
which we shift our attention to a single highly engaging idea, memory, or
activity that diverts attention away from the unwanted intrusive thought (Wegner
1994b). Imagine you are waiting for the results of a medical test, and you keep
having the intrusive thought, What if the test is positive and I have cancer? In
response, you try to distract yourself, but your mind keeps wandering from one
topic to the next. This would be unfocused distraction (see chapter 5 for further
discussion). A more effective strategy is to focus your attention on a single idea
or task that brings you pleasure, such as thinking about spring gardening and
what you would like to plant. Naturally, thoughts of the medical test will
continue to recur, but each time you gently bring your attention back to the
garden. Using focused distraction, you avoid creating multiple cues for the
intrusion. Research on mental control indicates that the negative effects of
suppression diminish significantly when people use focused distraction (Najmi,
Riemann, and Wegner 2009).
If you’ve been using unfocused distraction as an automatic response to
distressing thoughts, then it will help to shift your distraction strategy to the
focused approach. Doing this will take some mental effort and practice.

DISTRACTOR LIST
The first step is to generate a list of potential distractors, because you can’t
leave distraction to chance, that is, wait until you have an intrusion and then pick
the first thought that pops into your mind as the distractor. If you did wait, then
you’d be more likely to select an ineffective distractor, especially if you’re in a
negative mood state. You’d then be forced to try another distractor, and before
long, you’d be back in unfocused distraction. To prevent this from happening,
you need to have a list of effective distractors to call on when having distressing
intrusive thoughts and feelings. The next exercise provides some guidance.

Exercise: The Distractor List

Use the worksheet to construct your list of

potential distractors. In the memories
column, record five to ten memories or past
experiences that involve success,
happiness, or something you value or
cherish. Next, list several pleasurable or
positive activities, hobbies, or leisure
pursuits, such as traveling, in the activities
column. Finally, write down some positive
daydreams, hopes, and aspirations in the
third column. You’ll want to choose
distractors that are engaging and that you
find absorbing when they enter your mind.
When adding a distractor to your list,
consider the following:

Does this thought, memory, or activity have high

personal value? Thoughts, memories, or activities
that represent something important to us are better
at holding our attention.
Is this a moderately challenging activity? Mental
or physical activities that are moderately
challenging are better at grabbing our attention.
Is the thought, memory, or activity associated with
success, positive expectation, and a strong sense of
personal control? If the answer is yes, it will be
more likely to capture your attention.
 Make sure you have several distractors in each category. If you have trouble
thinking of distractors, consider consulting with your partner, therapist, or
someone who knows you well.
Your Distractor List

Memories Activities Daydreams, Aspirations

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

If you’re like most people, you’ve probably

never evaluated your thoughts in terms of
their distractibility. When you do try to use
distraction, it’s on the spur of the moment, so
sitting down and planning your distraction
strategy may seem unnatural. But it’s
important to do if you’re serious about
correcting your tendency to choose less
 effective distractors.

Figure 7.1. The Focused-Distraction Strategy

When Daniel did this exercise, he knew he needed a list of excellent

distractors to call on when he had an intrusive thought of doubt, so he could
resist his checking compulsion. For memories, Daniel listed college graduation,
his wedding day, his first child’s birth, moving into his current house, a recent
news story that concerned him, and promotion to be a high-level manager at
work. His list of positive and pleasurable activities included a furniture-
refinishing project, golfing, a recent Caribbean cruise, barbecuing steaks on a
sunny summer day, and taking a leisurely drive. His most engaging daydreams
and aspirations were thinking about retirement, renovating his house, buying a
new car, visiting his son in Europe, spending a weekend skiing with some
friends, and planning a surprise birthday party for his best friend.

TAKING ACTION WITH DISTRACTION

Once you’ve created your distractor list, it’s time to put your plan into action.
Figure 7.1 illustrates how to use focused distraction to manage your mental
intrusions.
The focused distraction steps presented in figure 7.1 are not natural responses
to unwanted mental intrusions but very intentional responses. That is, instead of
reacting to a distressing intrusion the way you usually do, you choose to do this
instead. You first mindfully accept the intrusion and then remind yourself why
this intrusion is insignificant (nontoxic). Using focused distraction, you then
think deeply on a distractor that you’ve chosen from your distractor list. You
then focus on breathing and calm, and then move on to engage in a distracting
activity.
You’ll notice that the success of focused distraction depends on several other
effective control strategies besides generating a good distractor. Acceptance of
the intrusion, being reminded of its insignificance, briefly focusing on your
breath or some other calming response, and finally engaging in a distracting
activity are all elements in effective focused distraction. There are several
features of this strategy to keep in mind.

Practice, practice, practice. Focused distraction may look simple, but it’s
harder than you think. Don’t get discouraged if at first it doesn’t seem to
work. Keep practicing with a variety of distractors. Remember, the more
frequent and intense the mental intrusion, the more practice you’ll need.

Engage in acceptance and reinterpretation. Focused distraction can succeed

only if you’ve already learned to tolerate the unwanted intrusion and have
reappraised the thought, image, or memory as less personally significant
(that is, nontoxic).
Focus your reflection. As you turn your attention to the distractor, you will
need to bring to your mind detailed information, so you can fully
concentrate on the distractor. For distraction to work, you must be able to
retrieve enough information to become absorbed in your mental distractor.

Keep it brief. Focused distraction is a brief intervention. You’ll probably

find you can focus on the distractor for only five to ten minutes. As you are
thinking, you can switch your focus from the distractor to your breath,
taking slow, deep diaphragmatic breaths. Alternating your attention
between your breathing and the distractor will improve your ability to
concentrate on the distractor.

Expect intrusive interruptions. No doubt you’ll find that the unwanted

intrusion returns. This is to be expected. Simply welcome the intrusion, sit
with it for a couple of seconds, and then gently bring your attention back to
the distractor.

Get up and do something. It is important to end the focused distraction with

an activity. Sitting for prolonged periods and doing mental-control exercises
is not a good idea. Instead, it is important to reengage in your daily
activities.

Again, you’ll need to work at shifting from unfocused to focused distraction.

To encourage your efforts, you may want to keep a daily diary. The next
exercise is a useful way to keep track of your focused distraction experiences.

Exercise: Your Focused-Distraction

Diary

Take a few minutes each evening to reflect

on your daily experience with focused
distraction. Write down the date on the
worksheet, rate your experience that day
 with focused distraction, including the
frequency of focused distraction (how often
you attempted it), the distractibility level of
the distractors, overall success in reducing
frequency and duration of the intrusion, and
overall success in reducing negative mood.
Use a scale of 0 to 4, where 0 is none, 1 is
minimal, 2 is somewhat, 3 is moderate, and
4 is very much.

Frequency of Distractibility Level of Success in Reducing Frequency and Success in Reducing

Date Focused Distraction the Distractors Duration of Intrusion Negative Mood
(0 to 4) (0 to 4) (0 to 4) (0 to 4)

After the first week of practicing focused distraction,

take some time to review what you’ve written on your
focused-distraction worksheet. If you rated yourself in
the 0 to 2 range in the frequency column, then you’re
not practicing focused distraction enough to master this
mental-control strategy. This is especially true if you
had frequent unwanted intrusions during the week. It
means you are missing opportunities to practice focused
distraction.

The remaining three ratings in the focused-

distraction worksheet capture various
aspects of the effectiveness of your
 intervention. The second column is your
assessment of the distractibility quality of
your distractors. Were you using the most
potent distractors in response to your
unwanted intrusions? The third and fourth
columns refer to the success of the
distraction. Did you have fewer problems
with unwanted intrusions and did you
experience a reduction in personal distress
when you were using focused distraction? If
your ratings were consistently low in these
last columns, it may be due to insufficient
practice, or you may be relying on relatively
weak distractors with low distractibility
potential. If you want to continue tracking
your progress with focused distraction, you
can download other copies of this focused-
distraction diary by visiting
http://www.newharbinger.com/38426.

If you’re not pleased with your distraction efforts, you may want to try fixing
the problem before concluding it doesn’t work for you. For example, you may
need to identify more potent distractors that will capture your attention more
completely. Also, distraction is more likely to be effective after you’ve reduced
the significance of the intrusion, adopted an attitude of acceptance, and
developed a laissez-faire take-it-or-leave-it approach to its control.

Thought Postponement and Imaginal Exposure

The next two mental-control strategies are interrelated; you use them together
to effectively confront unwanted intrusive thoughts and feelings. Using these
two strategies is like being confronted with a difficult situation and telling
yourself, Bring it on! Throw your worst at me. I can take it! You’re taking that
same attitude toward your distressing intrusive thoughts and feelings, and it’s as
if you were talking back, Okay, intrusion. I can’t stop you from popping into my
mind. I realize that the harder I try to suppress you, the fiercer you become. I’ve
come to understand that you are far less significant and threatening than I first
thought. I accept that I’m stuck with you. So, bring it on. Let’s have it out right
here and now.
With thought postponement, the first of these two strategies, you tell yourself
not to respond to the intrusion when it pops into your mind but to save your
response for a later scheduled time when you will intentionally focus on the
intrusion. The second strategy, imaginal exposure, is the planned session when
you intentionally generate the intrusion. You first encountered imaginal
exposure in chapter 4 where it was introduced as a strategy to reinforce belief in
your nontoxic reinterpretation of an intrusive thought. In this chapter, you will
use imaginal exposure to reduce negative emotion associated with the thought.
You may want to review the section on exposure-based detoxification to refresh
your memory of the procedure.
Thought postponement and imaginal exposure were first proposed by Dr.
Thomas Borkovec at Pennsylvania State University and are now two of the most
effective components of CBT for worry (Clark and A. T. Beck 2012; Roemer
and Borkovec 1993). Imaginal exposure is an excellent mental- control strategy
for intrusive thoughts that are repetitive and highly anxiety-provoking. It’s well
suited for intrusions associated with obsessive thinking and worry. However, it’s
not appropriate for the mental intrusions that feature in depression or guilt.
Here’s a scenario to show you how thought postponement and imaginal
exposure can work together.

THOUGHT POSTPONEMENT EXAMPLE

Imagine you go to work one morning, and the entire office is abuzz with
rumors that the company is under threat of a hostile takeover. You know this
means a fresh round of layoffs, and as a fifty-five-year-old middle manager, you
are extremely vulnerable. Over the next few days as the uncertainty mounts, you
are plagued by unwanted intrusive thoughts of losing your job. The intrusion is
simple but gut-wrenching. The thought I’m going to lose my job hits you hard,
triggering a fresh round of worries about finances and unemployment, as you
imagine the shame and guilt you’ll feel when telling friends and family of your
calamity. To achieve control over the intrusion, you practice thought
postponement and imaginal exposure.
Whenever you have the intrusive thought of losing your job, you immediately
acknowledge the mental intrusion. You remind yourself that it’s okay to have
such thoughts; that it’s perfectly understandable given the circumstances. You
then tell yourself that tonight you’ll spend time thinking more deeply about
losing your job. If there is something different about your current experience of
the intrusion, you’ll write it down, so you’ll remember to think about this in your
imaginal-exposure session. You detoxify the intrusion in the following way:
Everyone in the office, including me, is worried about layoffs. Having this
intrusion doesn’t mean I’m more likely to get laid off. Instead I can use this
intrusive thought productively and take some positive steps to prepare for an
uncertain future. Millions of people have been laid off and have survived it. So
can I. You then tell yourself to get back to your work or whatever tasks you
were doing. If the intrusion returns again and again, you restate your intention to
think on it later.

IMAGINAL-EXPOSURE EXAMPLE
Because unwanted intrusions of job loss have been foremost in your mind,
you plan to spend thirty minutes each evening between 8:00 and 8:30
intentionally thinking about losing your job. You find a quiet place where you
won’t be distracted or interrupted. You begin the imaginal-exposure session with
two to three minutes of controlled diaphragmatic breathing to feel somewhat
relaxed and focused on the task at hand. You then bring to mind thoughts about
losing your job. You review any notes you might have taken during thought
postponement to make sure you’re generating different variations of the intrusive
job-loss theme. You might use visual imagery to imagine getting your pink slip.
You might imagine telling your wife and children that you’ve lost your job, and
think of the various consequences of losing your job, like job hunting, living off
your savings, being at home alone, and so on. As you think deeply about why
you might be the one to lose your job, you try to feel the anxiety,
discouragement, and sadness that you’d experience if this happened. If you get
distracted from the job-loss theme—if unrelated thoughts flit through your mind
—you gently bring your attention back to the distressing thought. You continue
thinking deeply about your potential job loss. At the end of thirty minutes, you
remind yourself that it’s time to stop and that tomorrow evening you can pick up
where you left off. You end the session with an extra five minutes of relaxed,
controlled breathing. After this, you engage in some meaningful activity that
brings you back to the present moment.
These two examples illustrate the basic steps that you should use any time a
distressing thought intrudes. Always practice thought postponement and
imaginal exposure together: when you have a distressing intrusive thought, you
immediately respond with thought postponement. You can use the thought-
postponement checklist in the next exercise to ensure that you are using this
mental-control procedure effectively. For further practice, you can also visit
http://www.newharbinger.com/38426 to download other copies of this thought-
postponement checklist.

Exercise: Thought-Postponement
Checklist

Two or three times a week, go through the

checklist to determine whether you’ve been
using thought postponement correctly. Place
a checkmark (√) beside the steps that you
are doing regularly. Leave blank any that
require more work, so you can improve your
thought postponement skills.

__________ Acknowledge the intrusion.

__________ Practice self-acceptance instead of
self-criticalness for having the intrusion (see
chapter 6).
__________ Use the mental-intrusion diary (from
chapter 3) to record the intrusion.
__________ Remind yourself that you’ll think
deeply on the intrusion later.
__________ Focus on the insignificance
reinterpretation you developed for the intrusion
(see chapter 4).
__________ Return your attention to the task at
hand.
__________ If the intrusion returns, repeat the
previous steps.
 Thought postponement is not an effective
mental-control strategy unless it’s followed
by imaginal exposure. Because of this, you’ll
want to work on both strategies
simultaneously. But don’t be surprised if your
first attempts with thought postponement
prove difficult. Like Daniel, you may need to
do more work on detoxification before you
can engage in thought postponement.

For imaginal exposure to be effective, you’ll need to schedule daily thirty-

minute exposure sessions for at least two weeks. It’s best to do this at a regular
time each day. You’ll need a quiet, comfortable location where you won’t be
interrupted. You’ll also want to keep your mental-intrusion diary handy as a
reminder of which thoughts you’ll need to recall.
Here are some guidelines for how to conduct your imaginal-exposure
sessions.

Begin the session with five minutes of relaxed diaphragmatic

breathing.
Bring the unwanted intrusion to your mind, consulting the entries
recorded in your mental-intrusion diary (from chapter 3).
Reflect on every detail of the intrusion, including possible
consequences.
Alternate your attention between your thoughts and the associated
feeling.
If your attention wanders, gently bring it back to the intrusion.
Stop at the end of thirty minutes, and remind yourself that tomorrow
you can pick up where you left off.
End the session with an extra five minutes of relaxed, controlled
breathing.

It will help to record the quality of your exposure sessions in an imaginal-

exposure record. Before doing the next exercise, you can visit
http://www.newharbinger.com/38426 to download additional copies of the
imaginal-exposure record.

Exercise: Imaginal-Exposure
Record

Complete this form at the end of each

imaginal-exposure session. Write down the
date, the duration of the session, and the
content of the intrusive thought. Then
indicate how clearly you recalled the
intrusion and the average level of distress
experienced during the exposure session.
Use a 0 to 10 scale to rate your recall ability,
where 0 is you were unable to think about
the intrusion and 10 is you could think about
the intrusion as clearly as when it
spontaneously pops into your mind. Use a 0
to 10 scale to rate your average distress
level, where 0 is you experienced no distress
during the session and 10 is you were as
distressed during the session as you are
when the intrusion occurs spontaneously.

Quality of Average Level of

Date of Duration of Session Intrusive Thought Content During Intrusion Recall Distress
Session (minutes) Imaginal Exposure
(0 to 10) (0 to 10)
 After two weeks of thought postponement
and imaginal exposure, review your entries
in the imaginal-exposure record. Were you
able to postpone your response to the
intrusion when it occurred spontaneously?
Did your level of distress decline the more
you engaged in intentional imaginal
exposure? Most people find that the
significance and distress associated with an
unwanted intrusive thought, image, or
memory changes dramatically when they
take control and intentionally generate the
thought.

Thought postponement and imaginal exposure were Daniel’s primary mental-

control strategies for his obsessions. He’d tell himself to hold off on the doubt
for now, and then in the evening he’d review all the times he’d doubted
throughout the day. Using thought postponement, he actually discovered that the
urgency and distress that he first experienced with the intrusion tended to
disappear by the time he got to his imaginal doubting session. He could think
much more clearly about the doubt during the exposure session, and he
discovered new ways to organize his daily activities to minimize the occurrence
of doubt.
Do you find that using postponement and intentional exposure is helping you
to cope better with your anxiety or obsessions? Imaginal exposure is a great way
to take control of distressing intrusive thoughts and feelings that involve
concerns about future threat and uncertainty. As a reminder, imaginal exposure
can make depression and guilt worse, so don’t use it with those types of
intrusions.

Self-Affirmation
 The final mental-control strategy, self-affirmation, involves recognizing your
positive qualities and attributes, so you view yourself as adaptively and morally
competent, good, and capable (Steele 1988; Wegner 2011). Describing yourself
in positive terms or receiving positive feedback about your value tends to
improve your mental control over unwanted thoughts (Koole and van
Knippenberg 2007). Self-affirmation is expected to be especially helpful for
negative intrusions associated with guilt and depression but only when it’s
preceded by detoxification of the intrusion. That is, thinking about yourself in
positive terms will only be therapeutic after you’ve been able to reinterpret the
significance and validity of the original negative intrusion. So how might you
tap into self-affirmation to control your negative intrusive thoughts?
Essentially there are two steps to the self-affirmation process in mental
control. The first step is to generate a list of positive characteristics and attributes
that you can recall when having unwanted intrusive thoughts. The second step is
to practice replacing the intrusive thought with a self-affirmation reminder
during periods of distress.

Exercise: Positive-Attributes
Worksheet

To build a self-affirmation list, start by

considering important areas of your life.
Write down two to three of your positive
attributes within each of these domains, as
they are listed on the worksheet: work,
family or intimate relationships, friendships
and social sphere, health and physical
fitness, leisure, recreation, and fun,
community and citizenship, and spirituality or
religious faith. For example, when you think
of family, you might describe your positive
attributes as being loving, trustworthy, loyal,
and understanding. Next, rate each attribute
for how much you believe it applies to you.
Use a 1 to 10 scale, where 1 is you believe
 you have this attribute only minimally, to 10
is you believe you are very strong in this
attribute. Finally, provide some specific
examples of how you express this attribute.
If you tend to be quite negative and self-
critical, you can ask your partner, a friend, or
even your therapist to help you with this
exercise.

Rating Attribute
List of Positive Attributes Specific Examples of Attribute
(0 to 10)

Work:

Family/Intimate Relationships:

Friendships/Social Sphere:

Health/Physical Fitness:

Leisure/Recreation/Fun:

Community/Citizenship:

Spirituality/Religious Faith:

Once you’ve completed the positive-

attributes worksheet, review the attributes
you listed in the worksheet and circle the
ones that you rated as strongly relevant.
These are the attributes you’ll want to use as
replacement thoughts when you experience
distressing intrusive thoughts.
 Now you are ready to begin using self-affirmation to counter distressing
thoughts. When you feel upset by an intrusive thought, you focus on one of your
highlighted attributes and take a few minutes to reflect on personal experiences
that reflect this attribute. Say honesty is one of your attributes, and you have
depressive intrusive thoughts like I’m failing at everything. When this thought
pops into your mind, you remember that you’re an honest person. But when you
think of honesty, you’ll need to recall the many ways you’ve been an honest
person; that is, to feel affirmed, you will need to elaborate on your positive
attribute (see examples in the positive-attributes worksheet). This is the only way
that self-affirmation can counter the distressing intrusion.
Daniel, for example, listed reliability in his job as one of his positive
attributes. So, when he had a doubting intrusion, he brought to mind the many
ways he’s been a reliable employee for more than twenty years. He recalled
occasions when he responded to the request of coworkers for assistance. Having
concrete examples of reliability meant that Daniel could think deeply about this
positive attribute. This insured that his self-affirmation became an effective
distractor from his distressing intrusive thought.
Self-affirmation along with the other strategies introduced in this chapter can
help you manage your unwanted intrusive thoughts. But these strategies are most
effective when combined with the control skills discussed in chapters 3 through
6: self-discovery, mental detoxification, letting go, and mindful self-acceptance.
At this point, you may want to look back at the mental-control profile you
created in chapter 3 and at the work you completed in subsequent chapters. Are
you using the right tools to manage your negative emotions, or do you need to go
back and work on other skills?
As this chapter closes, you’ve completed the workbook’s presentation of the
mental-control approach to personal distress. If you have done all the exercises
and worksheets, then you’ve been engaged in a different approach to anxiety,
depression, guilt, frustration, and other negative emotions. If you’ve been
applying these mental-control strategies and yet feel dissatisfied with the results,
you may need to do some troubleshooting (see the appendix).

Wrap-Up
This chapter highlighted some of the most effective mental-control strategies for
dealing with unwanted thoughts and feelings associated with anxiety,
depression, and obsessions:
 Focused distraction, or shifting attention to a single competing
thought, memory, or activity, is an effective strategy for breaking
the grip of prolonged distressing intrusive thoughts and memories.
Using thought postponement and imaginal exposure to intentionally
confront distressing thoughts and feelings is an excellent approach
for reducing the emotional intensity of intrusions related to
obsessions, anxiety, and worry.
The self-affirmation strategy, which involves focusing intently on
your positive attributes, can counter the negative effects of
unwanted mental intrusions associated with depression, guilt, and
other negative emotions.

You’ve been working on taking a new approach to decreasing your unwanted

distressing intrusive thoughts and their associated feelings. However,
psychologists increasingly realize that reducing negative thoughts and feelings is
not enough to enhance life satisfaction. Building positive thoughts and feelings
is also critical for improving your quality of life. Chapter 8 considers how the
mental-control approach can be redirected to capitalize on the spontaneous
mental intrusions that make possible momentary states of positive affect or
happiness.
 Chapter 8

Maximizing Positive Intrusions

Who wouldn’t want to feel more positive and less negative? Positive emotions
like joy, affection, contentment, and pride make us feel energized and more
engaged in life. Moreover, happy people have better physical and mental health,
they are more successful in life, have more satisfying relationships, and are
better able to cope with life’s challenges (Lyubomirsky, King, and Diener 2005).
No wonder pursuit of life satisfaction is such an important human endeavor. And
yet, taking hold of happiness can be difficult and elusive for so many people.
When positive feelings do arise, they can evaporate quickly, leaving us feeling
empty and disappointed. Often our efforts to prolong positive thoughts and
feelings end far too quickly. Before we know it, the negativity returns and we
must wait for another moment of positive feeling to break through the stresses
and burden of daily living.

Exercise: What Is Happiness?

What does happiness mean to you? Take a

couple of minutes to respond to these
questions.

What is happiness?
What would need to happen in your life to have
more positive thoughts and feelings?

At the end of the chapter, you’ll return to

these questions to see if your answers have
changed.
 Decades of social science research have shed new light on the topic of
happiness, or what psychologists now call subjective well-being or life
satisfaction (Diener 2000; Diener et al. 1999). Happiness involves a general
evaluation of life, the level of satisfaction attained in various life domains like
work and family, and the experience of positive and negative mood (Diener
2000). Happy people are very satisfied with their life, they experience frequent
and intense positive moods and less negative emotion, they feel mildly positive
most of the time, and they feel quite content, even fulfilled, in their work,
family, leisure time, and other aspects of their life. As well, they tend to be more
optimistic, feel in control, and generally are worry-free (Cummins and Nistico
2002; Lyubomirsky, King, and Diener 2005). And yet, people differ greatly in
their tendency to be positive or feel satisfied in life. Genetic and personality
differences play an important role in determining whether you’re a happy or
unhappy person. Like Soon-Yi in the following example, you may be struggling
with negativity and unhappiness and wonder if life satisfaction and well-being
are truly elusive for you.

Soon-Yi’s Story: A Life of Quiet Discontent

Soon-Yi felt frustrated but at the same time perplexed by her chronic
unhappiness. No matter what she did or how hard she tried to think positively,
she continued to feel a depth of unhappiness that defied explanation. Soon-Yi
was the first to admit that she had no excuse for her low mood and
dissatisfaction. As a thirty-two-year-old business executive with a large
multinational insurance company, she was successful, prosperous, and healthy.
She had several close friends and was in a committed relationship. Despite her
comfortable life and many successes, happiness eluded Soon-Yi. She read an
endless number of self-help books that told her to think positively, be more
grateful for the blessings in her life, invest more time in the lives of others,
dedicate herself to love and relationships, and the like. But despite this sound
advice and Soon-Yi’s best efforts, happiness still seemed fleeting at best.
Clearly, her approach was not working. A different strategy was needed.
Like Soon-Yi, you may be committed to being more positive, but you’re
struggling. Discontent and pessimism come more naturally, and no matter what
you do, you always seem to return to the negative. If you’ve experienced
difficult life circumstances, had a traumatic loss in your life, or have a
diagnosable mental health condition, your unhappy state is understandable. But
if this is not the case, you may find the inability to live joyfully hard to
understand.
Whatever the cause, you’ll find in this chapter another important pathway to
achieving less negativity in thought, feeling, and action. For you need to work
not only on reducing negativity but also on encouraging the positive. This
chapter emphasizes one skill essential to improving life satisfaction, that is, the
ability to harness positive intrusive thoughts and feelings. It will give you
several steps to increase your focus on the positive. The starting point is
discovering the magnitude of your natural tendency to experience happiness,
which is called baseline happiness. Next, you will learn how to harness your
daily experiences of spontaneous positive thought and feeling to improve your
general well-being. Finally, you will learn how reflection, memory cueing, and
gratitude can enrich the inner world of spontaneous pleasant thought.
Living a more satisfied life, of course, is not just a matter of strategy. We all
have a different starting point when it comes to our potential to nurture positive
well-being and greater satisfaction in life.

How Positive Are You?

Like most people, you may feel mildly positive much of the time, but your
positive mood fluctuates and may be quite transient compared to feelings of
negativity (Diener, Lucas, and Scollon 2006; Fredrickson and Losada 2005).
Alternatively, you may be struggling to feel even an occasional moment of
happiness. Research indicates there are large differences among people in their
tendency for positive affect (Diener et al. 1999). It may be that like Soon-Yi,
you’ve concluded you’re destined for a life of misery. Your experiences of
positive feelings tend to be infrequent and rather tepid, and when life difficulties
occur, it takes you longer to bounce back. No doubt you’ve tried hard to cheer
up or “think more positively,” but nothing seems to work, and you’re practically
ready to give up. Regardless of where you find yourself on the positivity scale,
there are two important facts to keep in mind.
One is that our feelings change quickly from one moment to the next (Diener,
Lucas, and Scollon 2006). Even the happiest person has some negative emotion,
and people who are depressed can have occasional moments of positive feeling.
This means that we can influence our emotions for better or worse, regardless of
whether our natural inclination is to be positive or negative. The other important
fact to remember is that we each have a different starting point on the positivity
or happiness scale. Because of this difference you need to measure your progress
against yourself rather than other people. The critical question to ask yourself is
this: Since committing myself to a greater concern about my emotional health,
am I experiencing more or less positive emotion in my life?
Before you can start using the positive skills in this chapter, you’ll need a
better sense of your natural inclination for happiness, or a positive outlook: your
positivity baseline. This is the general level of happiness you experience without
any conscious effort to feel better. You can use the following checklist to obtain
a rough estimate of your positivity baseline.

Exercise: The Positivity Checklist

Below is a series of statements that deal

with general life experiences. Read each
statement and place a checkmark (√ ) next
to it if it describes you, and leave it blank if it
doesn’t.

__________ Generally I feel satisfied with my life.

__________ I often experience feelings of joy,
contentment, pride, and amusement.
__________ I’m generally optimistic about my
future.
__________ I rarely worry about the future.
__________ My negative feelings, like guilt,
sadness, anxiety and anger, are infrequent.
__________ I experience a high level of meaning
and satisfaction from my work.
__________ Most of the time I feel in control of
my life.
__________ I have close and loving relationships.
__________ My life is full of meaning and
purpose.
__________ I consider myself a good person with
as much worth and value as others.
 When completing the checklist, did you feel like the
items described you well, or did they seem completely
opposite to your character? It can be difficult to do this
type of self-evaluation, because most of us would like
to check all the boxes. However, it’s important to be
honest with yourself. If you checked six or more
statements, it’s likely you’re a generally happy or
positive person.

If you found it difficult to check any

statements, you probably tend toward
negativity. But don’t feel discouraged if your
positivity score is low. You can use the skills
in this chapter to raise your happiness level.
It may take more effort to improve your
mood to the middle range of the positivity
scale than it would if your baseline was
initially higher, but nevertheless, you can
increase your positivity.

The important point is that you are making progress on your commitment to
improve your emotional life. Soon-Yi, for example, found that only two
statements applied to her: she felt that her work was meaningful and that she had
control over her life most of the time. Although this gave her a low positivity
baseline, the checklist helped Soon-Yi adopt more realistic targets for increasing
her happiness level. It also showed her which areas of her life needed
improvement.
The remainder of this chapter focuses on two aspects of happiness alluded to
in the checklist: boosting the frequency of positive emotion and reducing the
frequency of negative feelings. If you were unable to check the statements I
often experience feelings of joy, contentment, pride, and amusement and My
negative feelings, like guilt, sadness, anxiety and anger, are infrequent, then you
will find the positivity skills discussed below especially relevant.

Catching Your Positive Feelings

 Catching Your Positive Feelings
A Canadian bank once ran the tagline, “You’re richer than you think.” What if
you had more positive emotion, that is, more moments of happiness, than you
realized? Everyone experiences moments of happiness—sudden and unexpected
waves of good feeling—although some people experience more than others. You
may have noticed that these flashes of positive emotion elicit a momentary spike
of happiness. Actually, these bursts of positive emotion play a critical role in
personal well-being because they boost self-confidence and energize us to deal
with the demands of daily living. Therefore, increasing the frequency and impact
of positive intrusive thoughts and feelings is an important pathway to greater
happiness and well-being.
Unfortunately, experiences of spontaneous positive emotion tend to be brief,
sometimes disappearing the instant we ask, Why do I feel so good? If you could
process these naturally occurring positive mood shifts more deeply, however,
they would have a bigger impact on your level of happiness. To get the most
from these positive feelings, the first step is to pay more attention to sudden
moments of pleasant emotion. This can be done by journaling the naturally
occurring happy moments that intrude into your daily life.
Soon-Yi discovered she was experiencing more positive emotion than she had
realized. To improve her awareness of these spontaneous expressions of positive
thought and feeling, she kept a happiness journal over a two-week period.
Although it took time to hone her journaling skills, Soon-Yi learned to record
times when she felt good, the types of thoughts that flooded her mind during
those times, and the positive emotions that best described her experience. She
discovered that her positive emotion experiences often involved pride, interest,
and challenges, that most of her positive emotion was happening at work, and
that it usually involved intrusive thoughts of inspiration and achievement. To
improve her level of happiness, Soon-Yi needed to work on developing a greater
appreciation of her positive moments and to expand her range of positive
experiences beyond achievement.
Soon-Yi did two things to improve her awareness of daily happiness. First,
she tracked moments of positive feeling by writing them in her happiness
journal. Second, she worked on paying closer attention to the intrusive thoughts
associated with her pleasant feelings; these positive mental intrusions are
thoughts, images, and memories with pleasant, amusing, or uplifting themes that
cause a heightened sense of well-being. The thought content of positive mental
intrusions is practically limitless and tends to be unique to each of us and our life
experiences. Unlike negative intrusive thoughts, our unexpected and
spontaneous positive intrusions are wanted mental interruptions. Here are some
examples:

Awareness of the beauty, goodness, or vitality of the moment

A memory of past experience of success, love, fun, reward, or
accomplishment
A sudden inspiration, moment of creativity, or resolution to a problem
or challenge
Recognition of being accepted, affirmed, or loved by others
Appreciation of your own positive personal characteristics
A sense of gratitude for life
A hopeful expectancy for the future

Like Soon-Yi, you may be experiencing positive thoughts but you aren’t fully
aware of their presence in your mind. The next exercise will help.

Exercise: Emphasizing the Positive

Think back to the last time you felt happy.

Write down two or three recent positive
thoughts, fantasies, or memories that
suddenly popped into your mind during that
experience of happiness.

First positive mental intrusion: __________

Second positive mental intrusion: __________
Third positive mental intrusion: __________

If you were able to come up with positive

mental intrusions, great! But don’t be too
concerned if you were unable to recall a
recent positive intrusive thought. We tend to
remember the thoughts that are consistent
 with our mood state, so if you’ve been
feeling down, anxious, or frustrated, it’s likely
you’re paying far more attention to negative
thoughts and feelings than to positive ones.
You are probably having some positive
intrusions, but they are not getting your
attention.

The best way to raise your awareness of positive thoughts and feelings is to
keep a happiness journal. If you find this hard to do at first, remember that
you’re working on boosting your level of life satisfaction and contentment, and
one of the best ways to get started is to increase your awareness and appreciation
of momentary happiness. Keeping a positivity journal can help you achieve
better balance in your emotional state.

Exercise: Your Positivity Journal

Record your experiences of momentary

positive feeling on the worksheet. Write
down the date and time, and then in the next
two columns, briefly describe the
circumstance in which it occurred and the
main thought, image, or memory that
popped into your mind when feeling happy.
In the final column, describe your feelings in
terms of joy, peace, contentment, pride,
elation, satisfaction, love, excitement, or
another word that best describes the
pleasant feeling you experienced.

Date and Where I Was, With Whom, Doing Positive Intrusive Thought, Image, or Pleasant Feeling
Time What Memory Experienced
 After you’ve made several entries in the
positivity journal, take a few minutes to
review and evaluate your journaling
experience. Was it difficult to break down
your positive emotion into the different
categories of situations, intrusive thoughts,
and feelings? Were you able to identify the
positive mental intrusions that were key to
your momentary happiness? As your skill at
journaling improves with practice, your
awareness of momentary pleasant emotion
will increase.

Learning to pay more attention to positive intrusions is so important to

creating happiness and well-being that I recommend you continue with this
journaling exercise throughout the remainder of this chapter. In fact, the
positivity skills discussed next are based on having greater awareness of positive
intrusive thoughts and feelings. You can visit
http://www.newharbinger.com/38426 to download more copies of this positivity
journal.

Active Reflection
Being aware of your positive thoughts and feelings is a good beginning. To have
a lasting impact on your sense of life satisfaction, however, it is also important to
fully appreciate the positive moment and to process pleasant thoughts and
feelings as deeply as possible, to maximize their emotional impact. Think of it as
squeezing as much as you can out of your moments of positivity. Few of us do
this naturally. Instead we get caught up in the cares of our day or pay more
attention to all the negativity that floods our mind. It takes real effort and
determination to increase your awareness and appreciation of positivity. This can
be accomplished by learning the skill of active reflection, which has three
components, or steps, summarized by the acronym STP: stop, think, and ponder.
Soon-Yi found active reflection of her positive intrusive thoughts and feelings
to be difficult at first. Reflecting on the negative came more naturally to her, and
it seemed strange and somewhat phony to practice the three steps of active
reflection. But with practice, Soon–Yi experienced its benefits.
This first step—Stop—is based on your work in the positivity journal. Stop
refers to the act of identifying positive intrusive thoughts and feelings the instant
you are conscious of them. The second step—Think—involves the use of
mindfulness-based strategies to pay full attention to the positive intrusive
thought, image, or memory. The third step—Ponder—consists of various
cognitive strategies to more fully understand the positive intrusion and its
implication for the self. The next exercise offers a method you can use regularly
to develop your active-reflection skills. You can actively reflect in response to a
sudden feeling of positive emotion or do it later when reviewing your positivity
journal. Note that it’s important to keep your active-reflection sessions brief, so
this skill becomes an automatic response to spontaneous positive emotion. After
five minutes or so of active reflection, return to whatever activity you were
doing before being interrupted by the spontaneous occurrence of positive
thoughts and feelings.

Exercise: Active Reflection

When first aware of a positive feeling, either

pause for three to five minutes to engage in
active reflection or record the experience in
your positivity journal for later use. Follow
these steps when practicing active reflection
of positive intrusive thoughts and feelings:

Stop. Begin by finding a quiet place with minimal

distractions. Sit in a comfortable chair and take
slow, deep diaphragmatic breaths for thirty
seconds. Focus your attention on the breath and
allow your entire body to relax. Give yourself
enough time to establish a state of calm, so you
 can focus on the pleasant feeling.
Think. Once you feel calm, recall the positive
intrusive thought, image, or memory associated
with the pleasant feeling. Be mindful of every
aspect and detail of the positive image or memory
you are recalling. If your attention drifts from the
positive thought, gently bring it back to the
intrusion.
Ponder. As you recall the positive intrusion, it is
important to deeply reflect on it in order to
maximize its effect on your emotional state. As
you recall the positive intrusive thought, ask
yourself these questions: What does this thought
say about me as a person—that is, my worth and
value as a human being? Where did this thought
come from? Why did I have this positive thought,
image, or memory? What does the positive
intrusive thought mean about my potential, my
future, and quality of life? Does the thought reflect
how others see me: how I am accepted and valued
by others? What does the intrusive thought say
about my potential for success, for making a
meaningful contribution to society?

At the end of your brief active-reflection session, use

the following worksheet to record your experience with
active reflection. In the first column, write the date. In
the second column, write down the pleasant thoughts,
images, or memories that you were recalling. Finally, in
the third column, briefly note whether you could think
deeply about the positive intrusive thought and whether
this had a beneficial effect on your mood state.

Active-Reflection Worksheet

Date Positive Thinking Targeted for Reflection Outcome of Active Reflection

1.
 1.

2.

3.

4.

5.

Completing the worksheet will help motivate

you to practice active reflection. It’s also a
resource you can use to evaluate your
progress. Are you getting better at
increasing your sensitivity to the positive
thoughts and feelings throughout your day?
To continue practicing this skill, you can visit
http://www.newharbinger.com/38426 to
download other copies of the active-
reflection worksheet.

Active reflection may seem awkward at first, so I recommend that you

practice several times a day to improve your skill level. You can think of this
skill as taking a five-minute break to dwell on positive mental interruptions. It
will work best if you do active reflection when momentary happiness occurs.
Soon-Yi tried to incorporate active-reflection breaks during the workday, but it
proved difficult because of all the interruptions and work pressures. So she wrote
down her uplifting moments in her positivity journal and then spent twenty
minutes each night actively reflecting on her daily entries. You can boost the
impact of positive intrusive thoughts and feelings by continuing to practice
journaling and active reflection on a daily basis. Don’t let your spontaneous
positive thoughts and feelings become missed opportunities for momentary
happiness!
 Positive Reminiscence
One of the most powerful ways to encourage positive thoughts and feelings is by
cueing them with an external or internal stimulus (a cue) that prompts specific
thought content. For example, if you wanted to think about an enjoyable
vacation you had last summer, you might look at vacation pictures. The photos
would serve as a cue, prompting you to recall pleasant thoughts and feelings
associated with the vacation. Music typically has a powerful cueing effect on our
emotions. How often have you heard a familiar song from your youth and
instantly felt a warm wave of nostalgia? But you don’t have to leave cueing to
chance.
Reminiscing about happy experiences from our past is one way to cue positive
thoughts and feelings. Often this happens only when we’re socializing with close
friends or family. But there is no reason why we can’t reminisce when alone.
Researchers have found that intentionally recalling past positive events can
increase our level of happiness (Chancellor, Layous, and Lyubomirsky 2015). If
this is true, why not use positive memory recall as another strategy to boost your
level of life satisfaction? Here are the steps for structuring a positive reminiscing
session:

Create a list of cues that you can use to prime positive memories.
Schedule twenty to thirty minutes to do positive reminiscing in a quiet
place where you can feel relaxed.
Choose a cue, such as vacation pictures, a favorite piece of music, a
photo of a close friend, or something else, and spend several
minutes looking at the photo, listening to the music: taking in the
experience that the cue elicits.
Let positive memories come to your mind in response to the cue. Let
yourself daydream, reflecting on the pleasant memory. Use your
active-reflection skills to more deeply recall the memory and then
record your experience on the worksheet in the next exercise.

This next exercise will help you enrich your positive reminiscing experiences.

Exercise: Cueing Positive Memory

 Begin by writing down two to three specific
cues in the related memory categories listed
in the first column of the worksheet. These
can be pictures, pieces of music, movies or
videos, pieces of writing, a text, a Facebook
post, or any object that serves as a cue for a
positive memory. Choose one of these cues,
and schedule a reminiscing session. Use the
session to reflect deeply on the memory, and
then write about your positive recollections in
the second column. Rate your enjoyment
level—how much you enjoyed or didn’t enjoy
reminiscing on a particular memory. Use a
scale of -5 to 5, where -5 is very
unenjoyable, 0 is neutral, and 5 is very
enjoyable. This information will help you
decide which cues work best for you.
Continue to practice these memory sessions
regularly until you sense they are having a
positive effect on your mood state. Then
practice this skill intermittently to reinforce
positive feelings and overcome low mood.

Enjoyment Level
List of Cues Positive Recollections
(-5 to +5)

Pictures:

Music:

Movies/videos:

Written material:
 Objects:

People:

Were you able to recall pleasant memories

that were enjoyable and that generated
momentary happiness? As you review your
memory sessions, make note of the
memories that were particularly enjoyable.
These are the memories you’ll want to recall
when feeling blue and need a nudge in the
positivity direction.

It’s important to develop a variety of positive memories you can use to boost
happiness. You can’t expect your mood to improve by recalling the same thing
over and over. You should have a mixture of pictures, music, videos, and objects
that can prime a selection of cherished memories.
Soon-Yi didn’t spend much time thinking about the past. She was very
focused on the present and all the demands and pressures of her job. Even when
she needed to relax, she never spent time reminiscing. So positive reminiscing
was not a natural strategy for mood improvement. She had a difficult time at first
coming up with a list of positive memory cues, but finally she was able to think
of a couple of songs from her university days, some pictures of her last trip to
Korea with a close friend, a T-shirt she got for completing her first 10-kilometer
race, and some positive Facebook comments from her last posting.
After trying out these different cues, Soon-Yi found that music was most
effective in priming positive memories of her youth, so she began using music as
the cue for regular reminiscing sessions. Three to four times a week, Soon-Yi
would set aside time in the evening to remember positive past experiences. With
time she began to look forward to these sessions and noticed that her mood was
more positive after she engaged in reminiscing. Her attitude was changing as
well. She began to appreciate her life more and to realize she had much to be
thankful for. Having a more positive perspective on herself and her life did much
to raise Soon-Yi’s general level of happiness and well-being. She began to feel
more gratitude for the kindness that others had shown her.
Over time, cueing positive feelings can have a positive effect on your level of
happiness and well-being even if it’s not something that seems natural to you at
first. So I encourage you to continue with this practice in addition to using active
reflection and keeping a journal that emphasizes the positive moments in your
life.

The Gratitude Effect

No doubt you’ve felt gratitude for an unexpected act of kindness, but have you
ever considered the importance of this feeling? Gratitude is the recognition of
receiving a benefit from someone’s act of kindness (Lambert, Graham, and
Fincham, 2009). We realize this kindness was given freely; we did nothing to
earn it or deserve it. The expression of gratitude is also associated with increased
positive emotion and well-being: a simple exercise like taking time once a week
to list five or more things in your life for which you are thankful can
significantly increase positive feelings (Emmons and McCullough 2003).
Soon-Yi learned she could increase her positive thoughts and feelings even
more if she practiced thankfulness, by taking time to reflect on the life
experiences recorded in her positivity journal and reminiscing sessions.
Although she was stressed and unhappy most of the day, spending much of her
time focused on daily hassles, Soon-Yi managed to schedule time each week to
make a gratitude list and then communicate feelings of gratitude to her parents,
close friends, and boyfriend. Together with other positivity skills, Soon-Yi
discovered that authentic expressions of gratitude improved her general sense of
well-being and life satisfaction.
Like Soon-Yi, feelings of gratitude might be in short supply in your daily life.
If so, you are missing out on the positive effects of this powerful emotion.
Rather than feel guilty about your lack of gratitude, why not do something about
it by keeping a blessings diary, as described in the following exercise?

Exercise: The Blessings Diary

Periodically throughout the day, stop to

consider whether some act of kindness has
 been extended toward you. It could be
something significant or trivial, like a person
letting you take a parking space rather than
grabbing it for herself. In the second column
of the blessings diary, make note of these
acts of kindness or of complimentary
comments that others have made. As well,
take some time at the end of the day to
consider your life more generally. As you
think about your life in comparison to others,
and what you are thankful for—such as good
health, loving relationships, meaningful work,
strong family ties, a faith community,
freedom, and the list could go on—write
these blessings in the third column. Over
time, you can expand on this diary of
blessings. If you need more space, you can
visit http://www.newharbinger.com/38426 to
download other copies of the blessings
diary.

Date Acts of Kindness or Complimentary Comments from Others Blessings in My Life

After spending a couple of weeks on the

blessings diary, take some time to review the
diary. Are you surprised at the level of
kindness shown toward you by others? As
you read through the third column, are there
more positive features to your life than you
realized?
 You can continue to use the blessings diary to help you practice the art of
being grateful, and as you do this, you’ll experience more positive emotion.

Happiness Reconsidered
Now that you’ve completed the work in this chapter, you can see that happiness
is really an attitude, a state of mind. Feeling positive emotions like joy, interest,
and amusement is only part of what it means to experience full life satisfaction.
To reinforce the insights you’ve gained from this chapter, you may want to take
a few minutes to do the following exercise.

Exercise: What Does Happiness

Mean to You?

Do you remember exploring the question

“What is happiness?” at the beginning of this
chapter? After reading this chapter and
working on the exercises, consider how you
would answer these questions now.

What is happiness?
What would need to happen in your life to have
more positive thoughts and feelings?

Do you notice any differences between your

two sets of answers? Have you changed
your view on happiness as a result of your
work in this chapter? Possibly you never
realized you had naturally occurring bursts of
 positive thoughts and feelings that could be
used to enhance a greater sense of life
satisfaction. Or, you’ve learned that you
need to take time to reflect on the positive
experiences in your daily life, or intentionally
recall good memories, or practice the art of
gratitude.

It’s important not to miss the good in your life because of your focus on the
stresses and burdens of everyday life. In all of this, it’s hoped that you’ve
discovered a new pathway to creating an emotional life less dominated by
negativity and more attuned to positive thoughts and feelings.

Wrap-Up
Although people differ greatly in their life satisfaction, none of us needs to be
stuck in a perpetual state of unhappiness. You can capitalize on your
spontaneous moments of positive intrusive thoughts and feelings, using the
strategies taught in this chapter:

Know your baseline level of positivity to determine your general

inclination for happiness or unhappiness.
Begin making changes to increase daily positive thoughts and
feelings. This starts by journaling momentary experiences of
happiness to heighten your sensitivity to positive intrusive thoughts
and feelings.
Use active reflection to more deeply appreciate positive intrusive
thoughts, daydreams, and memories, so you can maximize their
influence on your daily mood.
Schedule time to reminisce on pleasant past memories, which will
prime positive mental intrusions.
Regularly express gratitude for the gifts, benefits, and kindness you’ve
received in this life.
 As this workbook draws to a close, I hope you have found a greater sense of
well-being and life satisfaction. If you are still feeling discouraged with your
efforts to use the workbook strategies, the appendix can help you troubleshoot
your mental-control issues. But whatever outcome you’ve achieved with this
workbook, I encourage you to be persistent with your efforts and to not give up.
As Confucius said, “It does not matter how slowly you go as long as you do not
stop.”
 Acknowledgments
My understanding of emotional disorders has been informed by many wise and
talented teachers, researchers, clinical supervisors, coinvestigators, and
colleagues whom I have been privileged to know over my years as an academic
and clinical psychologist. Several of these individuals are leading experts in
cognitive behavioral treatment of psychological disorders, and their contribution
to the ideas expressed in this workbook is substantial. For more than thirty years,
I’ve had the honor of working with Dr. Aaron T. Beck, the father of cognitive
therapy. He has inspired, challenged, and taught me much about mental health
problems and their treatment. I count it an honor to call him a mentor,
collaborator, and friend. I am also grateful to Professor S. Rachman and Dr.
Padmal de Silva for their groundbreaking research on intrusive thoughts and for
their mentorship during my graduate training.
There are a host of other clinical researchers whose innovative thinking,
research, and creative therapy have made a significant contribution to the
treatment of distressing, intrusive thoughts and feelings. This work spans various
clinical domains, such as cognitive behavioral therapy, mindfulness, and
acceptance and commitment therapy, as well as research into intrusive and
repetitive thought, intentional mental control, the neural basis of unintended
thought, and positive psychology. As such, this workbook is indebted to the
work of Jon Abramowitz, Aaron T. Beck, Judith Beck, Brad Alford, Amparo
Belloch, Mark Freeston, Randy Frost, Steven Hayes, Robert Leahy, S. Rachman,
Adam Radomsky, Paul Salkovskis, Zindel Segal, Gail Steketee, John Teasdale,
Daniel Wegner, Adrian Wells, and Mark Williams. I am also grateful to an
especially talented group of graduate students, who collaborated with me on
research into intrusive thinking and its control—Brendan Guyitt, Catherine
Fraser, Mujgan Inozu, Christine Purdon, Gemma García-Soriano, and Adrienne
Wang.
The ideas for The Anxious Thoughts Workbook have been percolating in my
own mind for several years. However, this workbook would not be possible
without the help and encouragement of others. I am grateful to my agent, Bob
Diforio, who provided valuable expertise, advice, and unwavering support
during preparation of this manuscript. He has been a valued advocate throughout
this process, and I look forward to working together in the future. I want to thank
Ryan Buresh, my acquisitions editor at New Harbinger, for the confidence he
has shown in this project from its inception. Ryan, along with Clancy Drake,
also provided valuable feedback on organization, style, and structure, which
substantially improved the clarity, functionality, and message of the workbook.
I am also grateful for the opportunity to work with so many thoughtful and
sensitive clients, who have taught me much about the real world of personal
control. But most of all, I am indebted to my partner of four decades, Nancy
Nason-Clark, a scholar and author in her own right, who has been a stalwart
companion in life’s journey. Nancy generously contributed to this workbook
with her creativity, encouragement, and editorial wisdom. Without her
involvement, this project would be greatly diminished.
 Appendix

Troubleshooting Your Mental-Control Issues

This appendix is for you if

You have come here right from the introduction because you would
like to determine whether your negative thinking is the type of
unwanted mental intrusion responsive to the self-directed skills
presented in this workbook.
You have not made the progress you hoped for after working through
this workbook.
You are a therapist interested in using this workbook with a client.

Learning mental-control skills is hard work. If you are not satisfied with your
progress after completing The Anxious Thoughts Workbook, you may need to
give yourself more time by practicing the skills taught in this workbook. But
sometimes the type of thoughts you are experiencing won’t respond well to self-
help, and you will need a therapist’s intervention. And sometimes self-help is not
enough because you suffer from an underlying clinical condition, like major
depression, OCD, or an anxiety disorder. This may or may not already be
diagnosed.
Whether you have begun the work in this book or not, this appendix can help
you determine whether you will benefit from the help of a skilled therapist or
other resource in addition to the work you do here.

Are Your Mental Intrusions Wanted or Unwanted?

Ambivalence can undermine the effectiveness of self-directed mental control.
This occurs when a negative intrusive thought, image, or memory has elements
of being unwanted and wanted at the same time. For example, a negative thought
pops into your mind, and you’d rather not have the thought (that is, it’s
unwanted), but then you end up dwelling on the negative thought as if you
wanted to be thinking negatively. At other times, you’ll hold on to your negative
intrusions because you think they help you achieve a desired outcome. People
can intentionally worry because they think it will help them solve a problem.
When this happens, a distressing intrusive thought becomes wanted. To get a
feel for wanted intrusions, consider the following examples.

You’re annoyed with your children and so you keep thinking about
how you might have failed as a parent.
A friend or coworker made a critical remark, and you keep thinking
about it, wondering why she said such a thing.
You’re feeling depressed, and so you keep thinking about how you’ve
failed in life.
You’ve had an argument with your partner, and all you can think
about is how unfair he’s been treating you.
You’re anxious about a job interview, and you keep thinking about all
the ways you make a poor impression on others.

It’s important to remember that not all negative thinking is an unwanted

mental intrusion. Once a negative thought, image, or memory becomes
intentional, it will be more difficult to use this workbook’s self-directed
interventions. This is because you’ll have a harder time reappraising the thought
as insignificant, letting go of control, accepting the intrusion, and using more
effective mental-control strategies. So it’s important to know how much a
negative thought is wanted, especially if you’re finding it difficult to use the
mental-control skills in this workbook.
Are you welcoming distressing thoughts, images, or memories into your
mind? Samantha struggled terribly with this question when she had anxious
intrusive thoughts about social situations. At first, the thought I’m going to feel
anxious was an unwanted intrusion. However, sometimes she would dwell on
the thought, intentionally trying to think about being anxious and how to calm
herself down. On these occasions, what started as an unwanted intrusive thought
became a wanted, intentional way of thinking. When your intrusive thoughts
become wanted, a mental health professional trained in cognitive behaviorial
therapy, mindfulness, and/or acceptance and commitment therapy could help
you modify the mental-control interventions offered in this workbook to better
address the increased personal investment in the distressing thought.
Are you wondering if you’re more invested in your negative or anxious
thinking than you first realized? The next exercise allows you to gauge the
extent to which your distressing thoughts are wanted or unwanted.
 Exercise: The Intrusion
Wantedness Checklist

Begin this exercise by being aware of times

over the next few days when you have a
distressing intrusive thought, image, or
memory. Each time this happens, place a
checkmark ( √ ) in the box next to any
wantedness statements that apply to your
experience of the thought on that occasion.
Leave the box blank if the statement does
not apply to your experience.

Occasions of Having
Intrusion
Wantedness of Intrusion 1 2 3 4 5

1. I intentionally tried to think about the thought, image, or memory.

2. The thought was pleasant, pleasurable, or associated with a positive emotion.

3. The intrusion helped me achieve a desired goal or outcome.

4. The thought was highly acceptable to me.

5. The thought was consistent with the type of person I am; that is, it was
consistent with my character or how I see myself.

After completing the wantedness checklist

over several days, review your entries and
count the number of boxes you checked. If
most of the statements were checked on
several occasions, it’s likely that a high
 degree of intentionality or wantedness is
associated with the intrusive thought.

The strategies in this workbook are more difficult to use with wanted
distressing thoughts, so you should consider whether therapist-assisted treatment
would be more appropriate. Tell your therapist you seem to get caught up in the
intrusion so that it becomes a wanted, highly intentional way of thinking. This
will help your therapist design a treatment plan that considers your elevated
personal investment in negative thinking.

Diagnosable Distress
Self-directed treatment is much more difficult if your anxiety, depression,
obsessions, or another form of distress is highly intense and interferes in your
ability to function. Mental health professionals use various guidelines to
determine if a person’s distress meets criteria for a diagnosable psychiatric
disorder. If you are suffering from a diagnosable condition, then medication and
more formal psychological treatment might be necessary. Of course, knowledge
about mental control and its strategies can be useful with diagnosable conditions,
but they may be more effective if incorporated in psychotherapy or systematic
counseling. Although you may be trying hard to develop your mental-control
skills, working on distressing intrusive thoughts on your own is not advisable
when you are struggling with a diagnosable clinical condition.
Only a state-licensed mental health professional has the diagnostic knowledge
and assessment tools to determine if your distress qualifies as a clinical disorder.
The following checklist is provided to assist you in deciding whether you should
obtain a mental health consultation.

Exercise: Detecting Diagnosable

Distress

These statements represent different

 aspects of emotional distress. Place a
checkmark ( √ ) next to any statements that
describe your experience with distress.

__________ When I am upset, I tend to feel

intense emotional distress.
__________ My distress can last for days or even
weeks at a time.
__________ When I feel upset, it’s very difficult to
pull myself out of it.
__________ When I’m distressed, I can do very
little; it greatly interferes in my ability to function.
__________ I can’t sleep for several nights when
feeling upset.
__________ I avoid many things to prevent feeling
upset.
__________ When distressed, I become intensely
critical of myself or others.
__________ I have a significant problem with
anger.
__________ I have thoughts of hurting myself or
others when I’m upset.
__________ I can isolate myself from friends and
family for days when I’m upset.

As you read through the checklist, did many of these statements describe your
experience with personal distress? The more statements you checked, the greater
the likelihood that your distress represents a clinical condition like major
depression, an anxiety disorder, OCD, post-traumatic stress disorder, or the like.
This is especially true if you’ve completed the workbook and found it hard to
apply its interventions to your distressing intrusive thoughts and feelings. You
can still use the mental-control strategies offered here, but you may find them
more effective if they become part of a therapy or counseling program. The
resources section provides a list of self-help books written for specific disorders
as well as informative websites that can assist you in contacting qualified mental
health professionals.
 High-Risk Intrusive Thoughts
This workbook’s strategies were not intended for use with high-risk intrusive
thoughts, or distressing thoughts that are associated with a high risk of causing
harm to self or others. If you have these types of thoughts, you should not
attempt self-directed treatment but instead seek professional consultation as soon
as possible. The following sections present various types of high-risk mental
intrusions that require therapist-assisted treatment.

Suicidal Thoughts
When depressed, we can feel intense emotional pain. If you’ve been
struggling with a serious depression, you may find the workbook helpful as a
supplement to your therapist-delivered treatment. Medication, evidenced-based
psychological treatment, or some combination of these can be highly effective
for depression. However, this workbook’s interventions are not designed to
address suicidal thoughts associated with depression.
Suicidal thoughts are common with depression. When you are depressed,
thoughts of death or of harming yourself can occur as unbidden intrusive
thoughts, and these intrusions are high risk because people who are depressed
often see their future as hopeless, they may believe that death is the only solution
to life problems, and their wish to die may be stronger than their wish to live.
Moreover, intrusive suicidal thoughts when someone is depressed can lead to
suicidal plans and attempts. Therefore, if you or a loved one is depressed and
experiencing suicidal thoughts, you should seek professional help immediately.
Sometimes thoughts can be mislabeled as “suicidal thoughts” when they do
not really represent a desire to end your life. Not everyone who has thoughts of
death is suicidal. For example, someone with anxiety may have the intrusive
thought What if I lose control and harm myself? In that case, the person has a
strong wish to live but is fearful of losing control. There is no hopelessness
about the future, nor does the anxious person consider suicide a solution to life’s
problems. While the thought may be a very distressing one, it qualifies as a low-
risk unwanted intrusion that can be treated with this workbook’s strategies.
For example, for many years, a woman named Valeria struggled with anxiety
and worry, but recently the anxiety took an unusual twist that took her by
complete surprise. After hearing about the suicide of a young mother, Valeria
started having frequent intrusive thoughts, such as What drove this mother to
suicide? and Could I just snap one day and kill myself, leaving my children
alone and abandoned by their mother? At first Valeria easily dismissed the
thoughts from her mind, saying to herself These are just crazy, stupid thoughts.
But the intrusions kept returning, and with them came a mounting sense of
anxiety. It seemed like every unwanted occurrence of the intrusive thought was
proof that she could lose control of her mind. Despite her anxiety, Valeria loved
life. She cherished the time with her family and enjoyed the challenges of work.
It was because of this engagement in life that she found her self-harm intrusions
so threatening. Thus, Valeria’s suicidal intrusions were low risk; they were truly
unwanted mental intrusions and well suited for this workbook’s strategies.

Violent and Aggressive Thoughts

We live in a violent society, with acts of aggression perpetuated daily at
home, work, and in the community. Every year, millions of people are victims of
violence, experiencing personal pain and suffering that can last a lifetime. All
too often, violence and aggression happens in the home with devastating effects
on parents, children, and partners. All forms of abuse whether physical, sexual,
verbal or emotional have an adverse psychological effect on its victims. Thus,
stopping violence must be of paramount importance in our society.
Anger, violence, and aggression often begin with an intrusive thought. The
thought that you’re being treated unfairly, manipulated, challenged, or
threatened can trigger a process that culminates in violence. It can start with a
benign intrusive thought like That’s not right, but then it quickly escalates into
I’ve got to take charge, do something about this, to set matters right. I can’t let
this person take advantage of me.
When spontaneous intrusive thoughts begin a cascading course of increasing
anger and aggression toward others, it’s important to first ensure the safety of
others. This may involve reporting a violent family member to law enforcement.
If you recognize violent and angry behavior in yourself, it’s important to seek
professional help before you cause harm to another person. Even if you’re able
to deescalate before becoming physically aggressive, your anger and verbal
abuse will cause significant harm.
Accountability is critical in cases of anger and aggression, so trying to deal
with your anger-related intrusions through self-help is inappropriate. A therapist
is needed who can give expert guidance and provide monitoring tools, so you
can work on your anger and aggression. Thoughts of fairness, justice, and power
that lead to anger and aggression are high-risk intrusions that should not be left
to self-directed mental-control intervention.

Delusional Thoughts
Sometimes intrusive thoughts are a profound misrepresentation of reality—so
much so that the sufferer has difficulty knowing the difference between what is
real and what is unreal. This problem became apparent for Marquis, who started
having intrusive thoughts that he was unintentionally offending people, even
strangers, simply by being present. If he walked into a grocery store, he
immediately started thinking he had offended people who simply glanced at him.
He became absolutely convinced that he had offended total strangers just by
walking by them. So Marquis tried to avoid eye contact with people whenever he
was in public. Of course, there was absolutely no evidence that people were
offended, but this did not stop Marquis from believing he’d offended people.
Marquis was confused, unable to discern reality from his distorted beliefs. His
thinking was delusional and causing significant personal distress and inability to
function. The good news is that Marquis began thinking more clearly about his
intrusive thoughts once he saw a psychiatrist and started taking the correct
medication. His perception of reality improved, and he was better able to
evaluate his thoughts and beliefs.
If you find yourself firmly committed to an intrusive thought even though
there is considerable evidence to the contrary, like Marquis, you may be
suffering from delusional thinking. This workbook’s mental-control strategies
are not effective for this type of thinking. A psychiatric consultation is necessary
in such cases. Often, medication can help clear up the confusion, misguided
thinking, and distorted beliefs that characterize delusions. With the help of
medication, you may be able to implement some of this workbook’s control
strategies. In the meantime, consider delusions another form of high-risk
intrusive thinking that requires mental health intervention.

Dangerous and Misguided Fantasies

The imaginative power of the human brain is one of our greatest assets. We
can create fantasies, daydreams, and imagined role-plays that are a great source
of interest and pleasure. Of course, fantasies are significant in sexual arousal,
and our great interest in movies and storytelling would not be possible without
imagination. But sometimes our fantasies can become dark and destructive for
ourselves, and if acted on, harmful to others. It is possible to spend too much
time in fantasy, which then impedes our ability to interact in the real world. At
other times, we may become overly preoccupied with a certain type of fantasy,
especially sexual fantasy, which takes us to places that are self-destructive. Still
other types of fantasies, such as sexual attraction to children or violent sexual
encounters, are illegal and victimize others when encouraged.
What all these different types of fantasies have in common, especially the
dark and destructive type, are three characteristics:

A strong association with pleasure

A high degree of intentionality or wantedness
A specific behavioral consequence

For example, an individual with sadistic sexual fantasies experiences pleasure

from imagining violent sex with another person. He may actively seek out
pornographic sites with violent sex and spend considerable time purposefully
imagining these types of sexual encounters. It may eventually affect his behavior
in the form of rough sex with partners.
Even if there is a certain degree of unwanted intrusiveness to your fantasies,
this workbook’s strategies are inappropriate for this type of thinking, and it is
extremely difficult to change this type of thinking without professional help.
Because pleasure is so strongly aroused by our fantasies, there is little interest in
considering the intrusions insignificant. Therefore, self-directed mental control is
inappropriate.
If your fantasies are tainted by dark, destructive, immoral, or even illegal
elements, it is important that you seek out professional treatment before harm
comes to you or others. These are high-risk intrusions that cannot be left to self-
help intervention alone. Disclosure and accountability are important treatment
elements for this type of cognitive activity.
Of course, sometimes people have unwanted intrusive thoughts or images that
they consider repugnant and disgusting, such as an intrusive thought like Am I
sexually attracted to children? In this case, the question is a horrifying, fearful
thought. There is no sexual arousal associated with the intrusion, but instead
there are feelings of anxiety, fear, and moral disgust. You may feel intense guilt
and shame because the thought is such a violation of your moral code. If so, the
intrusion is low risk, and this workbook’s strategies are well suited for this type
of problem. However, if the shame, guilt, or anxiety caused by these unwanted
sexual intrusions is intense, you will need professional guidance to effectively
use these mental-control skills.

Therapist-Assisted Mental Control

The Anxious Thoughts Workbook was written for people who want to work
independently on their distressing thoughts and feelings. However, mental health
professionals can also use this workbook as a client resource to boost the
effectiveness of treatment. If your therapist has recommended this workbook,
she may select certain exercises for you to emphasize and then incorporate this
work into your therapy program. This workbook can also be used for therapy
homework assignments as well as provide guidance and organization to your
therapy.
At this point, you may be wondering if you should be relying on self-help
alone or whether you should use the workbook with the assistance of a therapist.
If you have not made the progress you hoped for after working through this
workbook, the next exercise can help you decide whether you should seek out a
therapist to assist you with these interventions.

Exercise: A Help-Seeking Guide

Place a checkmark ( √ ) beside each

statement that applies to your experience
with The Anxious Thoughts Workbook.

__________ For several weeks, I’ve been trying to

use the mental-control strategies in chapter 7, but
my anxiety, depression, obsessions, guilt, or other
distressing emotion remains unchanged.
__________ My distressing thoughts are more like
the high-risk intrusive thoughts discussed in this
appendix.
__________ Despite working through the
 exercises in chapters 1 and 4, I remain highly
invested in my intrusive thoughts. That is, I still
believe these negative thoughts are significant,
meaningful ideas that must be suppressed.
__________ I remain convinced that I must try
harder to control my distressing mental intrusions.
__________ I am struggling with self-acceptance
and have little tolerance for my distressing
intrusive thoughts.
__________ I keep getting drawn back into one of
the weak or ineffective mental-control strategies
discussed in chapter 5.
__________ My negative thoughts, ideas, and
memories are becoming more frequent and
upsetting despite my best efforts to use the
workbook strategies.

How many of the statements did you

endorse? Even if you checked only one
statement, you might consider using the
workbook as a supplement to therapy.

It’s possible you’ll get more from the workbook if it’s incorporated into your
therapy. The advantage of using the workbook in this way is that a therapist can
tailor the mental-control interventions so they target unique aspects of your
distressing thoughts and feelings. Making fundamental changes in how we think
and feel is the hardest work anyone can undertake. Sometimes it is possible to do
this work alone, but other times professional help is needed. What’s important is
that you give yourself the best possible opportunity to recover from your
emotional distress. Whether you have tried this workbook’s interventions with
only limited success or you are unsure about learning these new skills on your
own, consider whether you might get more benefit by working with a mental
health professional.

Wrap-Up
 Wrap-Up
After reading this appendix, you might be wondering if you’re getting the most
from The Anxious Thoughts Workbook. In the end, the best test is how you feel.
Have you been able to use the workbook interventions to reduce your emotional
distress? If not, and you would like to obtain greater distress relief, consider
troubleshooting your mental-control efforts. Several problems were highlighted
in this appendix that may be undermining your efforts to change.

Consider whether your distressing thoughts are more wanted than

unwanted. You’ll find the workbook strategies more difficult to use
when your intrusive thoughts are intentional, highly accepted forms
of thought.
Consider whether you might be struggling with a clinical disorder like
major depression, an anxiety disorder, or OCD. If so, you can
expect self-directed treatment to be less successful than working
with a mental health professional.
If your distressing thoughts are high-risk intrusions that have serious
negative consequences to yourself or others, then taking a self-help
approach to mental control is not appropriate. Thoughts of suicidal
intent, anger and aggression, confusion of reality, and misdirected
fantasies are best treated by a mental health professional.
Consider whether you might get more out of this workbook by using it
as a client resource tool during a course of psychotherapy.

If this workbook’s strategies have not led to significant improvement in your

mental and emotional state, I hope the information, recommendations, and
exercises provided in this appendix have been helpful in your troubleshooting
efforts. I also encourage you to review the resources section to see if any of these
additional self-help materials might be especially appropriate for your type of
personal distress. Many of these resources are more focused and disorder-
specific than this workbook, and they tackle negative thoughts and feelings from
a different perspective.
 Resources

Selected Websites: Information on Evidence-Based Psychological

Treatments
These websites provide information on the nature of various psychological
problems as well as treatment information for anxiety, depression, obsessions,
and other emotional conditions. Many provide online tools that can help you find
certified practitioners in your region.

Academy of Cognitive Therapy, Philadelphia; http://www.academyofct.org

Association for Behavioral and Cognitive Therapies (ABCT), New York;

http://www.abct.org

Association for Contextual Behavioral Science, Jenison, MI;

http://www.contextualscience.org

Beck Institute for Cognitive Behavior Therapy, Bala Cynwyd, PA;

http://www.beckinstitute.org

Center for Mindfulness in Medicine, Health Care, and Society, University of

Massachusetts Medical School; http://www.umassmed.edu/cfm

Canadian Association of Cognitive Behaviour Therapies (CACBT), Quebec

City; http://www.cacbt.ca

Selected Websites: Information on Mental Health and Its

Treatment
These websites provide a wide range of information on mental health issues,
 including diverse treatment approaches to mental health problems.

American Psychological Association (APA), Washington, DC;

http://www.apa.org

Anxiety and Depression Association of America (ADAA), Silver Spring,

MD; http://www.adaa.org

Canadian Psychological Association (CPA), Ottawa; http://www.cpa.ca

National Institute of Mental Health (NIMH), Bethesda, MD;

http://www.nimh.nih.gov

Recommended Reading
The Anger Management Workbook: Use the STOP Method to Replace Destructive Responses with Constructive Behavior, by W. R. Nay.
2014. New York: Guilford Press.

The Anxiety and Worry Workbook: The Cognitive Behavioral Solution, by D. A. Clark and A. T. Beck. 2012. New York: Guilford Press.

Anxiety Free: Unravel Your Fears Before They Unravel You, by R. L. Leahy. 2009. Carlsbad, CA: Hay House.

Beat the Blues Before They Beat You: How to Overcome Depression, by R. L. Leahy. 2010. Carlsbad, CA: Hay House.

The Dialectical Behavior Therapy Skills Workbook, by M. McKay, J. C. Wood, and J. Brantley. 2007. Oakland, CA: New Harbinger
Publications.

Getting over OCD: A 10-Step Workbook for Taking Back Your Life, by J. S. Abramowitz. 2009. New York: Guilford Press.

Get Out of Your Mind and into Your Life: The New Acceptance and Commitment Therapy, by S. C. Hayes. 2005. Oakland, CA: New
Harbinger Publications.

Mind over Mood: Change How You Feel by Changing the Way You Think, 2nd ed., by D. Greenberger and C. A. Padesky. 2016. New
York: Guilford Press.

The Mindfulness and Acceptance Workbook for Anxiety, 2nd ed., by J. P. Forsyth and G. H. Eifert. 2016. Oakland, CA: New Harbinger
Publications.

The Mindfulness and Acceptance Workbook for Depression, by K. D. Strosahl and P. J. Robinson. 2008. Oakland, CA: New Harbinger
Publications.

The Mindful Way Workbook: An 8-Week Program to Free Yourself from Depression and Emotional Distress, by J. Teasdale, M. Williams,
and Z. Segal. 2014. New York: Guilford Press.

The Mood Repair Toolkit: Proven Strategies to Prevent the Blues from Turning into Depression, by D. A. Clark. 2014. New York: Guilford
Press.

Overcoming Obsessive Thoughts: How to Gain Control of Your OCD, by C. Purdon and D. A. Clark. 2005. Oakland, CA: New Harbinger
Publications.
Overcoming Unwanted Intrusive Thoughts, by S.M. Winston and M.N. Seif. 2017. Oakland, CA: New Harbinger Publications.

The Practicing Happiness Workbook, by R. Baer. 2014. Oakland, CA: New Harbinger Publications.

The Worry Cure: Seven Steps to Stop Worry from Stopping You, by R. L. Leahy. 2005. New York: Three Rivers Press.

Worry Less, Live More: The Mindful Way Through Anxiety Workbook, by S. M. Orsillo and L. Roemer. 2016. New York: Guilford Press.
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David A. Clark, PhD, is a practicing clinical psychologist and professor

emeritus at the University of New Brunswick, Canada. He is author or coauthor
of numerous scientific articles and nine books on depression, anxiety, and
obsessive-compulsive disorder (OCD), including The Mood Repair Toolkit, The
Anxiety and Worry Workbook (with Aaron T. Beck), and Overcoming Obsessive
Thoughts (with Christine Purdon). A founding fellow and trainer consultant with
the Academy of Cognitive Therapy, and fellow of the Canadian Psychological
Association, Clark resides in Canada.
Foreword writer Judith Beck, PhD, is director of the Beck Institute for
Cognitive Therapy, clinical associate professor of psychology in psychiatry at
the University of Pennsylvania, and past president of the Academy of Cognitive
Therapy. The daughter of influential founder of cognitive therapy, Aaron T.
Beck, Beck resides in Bala Cynwyd, PA. She is author of The Beck Diet
Solution.