What Are Intrusive Thoughts and Why Do They Feel So Disturbing? with OCD Therapist Katey Olson

What Are Intrusive Thoughts and Why Do They Feel So Disturbing?

If you've ever had a thought pop into your head that felt completely out of nowhere — disturbing, scary, totally out of character — and then immediately spiraled into what does this mean, why am I thinking this, is something wrong with me — this episode is for you.

I sat down with OCD and anxiety therapist Katey Olson to break all of this down. What intrusive thoughts actually are, why some people get so stuck in them, the difference between anxiety and OCD, and what it actually looks like to respond to these thoughts in a way that helps instead of making things worse.

First — What Are Intrusive Thoughts?

Intrusive thoughts are unwanted thoughts that just pop in, unannounced, without you asking for them. They are a completely normal human experience. Nobody is immune to them.

The difference is that most people can have an intrusive thought, think that was weird, and move on with their day. For people who struggle with anxiety or OCD, it doesn't work that way. The thought comes in and immediately the questions start. What if that's true? Why am I thinking this? What does this say about me? Is something wrong with me?

And that's where things start to get sticky.

Intrusive thoughts tend to attack the things you value most. They're ego dystonic — meaning they feel completely out of line with who you are and how you normally think and behave. That's actually exactly why they feel so disturbing. They're not reflecting something dark inside you. They're hitting on the things you care about most deeply. Your brain is trying to protect you, even if it's doing it in the most unhelpful way possible.

The Difference Between Anxiety and OCD

This is one of the most common questions Shannon hears in her community — is this anxiety, or could it be OCD? And the honest answer is that there's a lot of overlap.

Both anxiety and OCD involve intrusive thoughts. Both can involve a lot of mental noise, safety behaviors, and avoidance. The key difference with OCD is the obsessive pattern — getting deeply, repeatedly stuck on one specific doubt — and the compulsions that follow.

With OCD, an intrusive thought comes in and the obsessive doubt starts. What if this is really true? What if I could actually do that? And then compulsions kick in to try to find certainty or lower the anxiety. These compulsions are often mental — seeking reassurance, trying to neutralize the thought, replaying things over and over — not always the visible behaviors people typically associate with OCD like checking locks or washing hands.

With anxiety, the intrusive thoughts tend to be more varied and tied to things that feel like they could realistically happen. There are still safety behaviors and avoidance, but the obsessive stuck-ness around one specific fear is more of an OCD hallmark.

The reason correct diagnosis matters is because while the treatments have a lot in common, they're different enough to make a real difference.

Treatment — ERP, CBT, and ICBT

For anxiety and panic, exposure therapy and CBT are common approaches — along with things like acceptance and commitment therapy, which is really about changing your relationship with anxiety rather than eliminating it.

For OCD, the gold standard treatment is ERP — exposure and response prevention. You expose yourself to the fear and resist the compulsion. Over time, the obsessive cycle loses its grip.

But Katey also uses inference-based CBT, or ICBT, with her OCD clients — and it's worth knowing about because it takes a completely different approach. Instead of exposing you to the fear, ICBT works by helping you understand that your obsessive doubt is pulling you into an imaginary space where the rules of reality don't apply. You're drawing conclusions and building a whole narrative that feels completely believable — but when you look at your actual, immediate reality, none of it is actually there. It's an unraveling of the story your brain has been telling you. And for people who aren't ready or willing to do exposures, it can be the thing that changes everything.

The Problem Isn't the Thought — It's How You Respond to It

This is the part that matters most.

The goal of treatment is never to eliminate intrusive thoughts entirely. They're a normal part of being human, and chasing a life without them is a losing game. What we're actually working on is your relationship with those thoughts — how you interact with them when they show up.

Katey uses an analogy that I love: people are going to knock on your door all day long. Some are there to drop something off. Some are trying to sell you something. But you don't have to let everyone in. You can see them, acknowledge them, and send them on their way without opening the door. Intrusive thoughts work the same way. You don't have to take every thought seriously. You don't have to figure it all out. You can just say — not for me, goodbye — and let it pass.

The skill is getting familiar enough with your intrusive thoughts that when they show up, you recognize them instead of being blindsided by them. You can even start to expect them in certain situations. And when something is predictable, it starts to lose some of its power.

When the Thought Comes With a Feeling

Here's where things get really hard — and Katey and I both wanted to name this directly.

When an intrusive thought shows up alone, without a physical sensation attached to it, it's easier to let it go. When it comes with a wave of anxiety, your body responding like something is actually happening to you right now — that's when everything gets fused together and feels impossible to separate.

Your body doesn't know the difference between an imagined threat and a real one. It responds the same way either way. So when you have a disturbing intrusive thought and your heart starts racing and your stomach drops, it feels like confirmation — this must be a really big deal if my body is reacting like this.

It's not. Your body is just doing its job. And your job in that moment isn't to figure out the thought — it's to bring yourself back to regulation.

Not by forcing yourself calm. Not by doing ten rounds of box breathing until you hit some predetermined level of okay. Just by creating space. Stepping back from the thought, reorienting to what's right in front of you, and trusting that your body already knows how to come back to baseline. Because it does. It's done it every single time before.

Building Self-Trust

This came up toward the end of our conversation and I didn't want to gloss over it, because I think it's everything.

Self-trust isn't something you can think your way into or build with a five-step plan. It's built through experience. Through having an intrusive thought, spiraling a little, and finding yourself on the other side of it completely fine. Through going out, feeling anxious, and coming home okay. Through letting yourself feel something difficult without fixing it and noticing — I survived that.

Every single one of those moments is a deposit in your self-trust account. And over time, those deposits build into something that no intrusive thought can shake — the deep knowing that no matter what your brain throws at you, you can get through it.

What About the Really Disturbing Ones?

Katey wanted to speak directly to anyone whose intrusive thoughts come with vivid images, or whose thoughts feel so dark and out of character that they can't imagine ever making peace with them.

You are not broken. Those thoughts do not reflect who you are. There is nothing deep inside you that needs to be uprooted or urgently examined. It is your brain doing a thing — a very human, very common thing — and you do not have to assign it meaning.

The intensity and frequency of those thoughts does decrease over time as you practice disengaging from them. It takes patience, and sometimes it takes support. But it does change.

You can find Katey

at @kateyolsontherapy on Instagram

and at kateyolsontherapy.com.

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