In the RTÉ Guide, Prof. Eddie Murphy shares his mental health and well-being advice with a reader.

Intrusive thoughts

Mary writes: "I have emailed you to see if you can help. I’ve suffered with anxiety all my life. I never really knew what it was – I just thought I was shy – until, at 17, it hit me hard for two years. I struggled on and went to third level, I never got help and instead I ‘grinned and bore it.’ Often, I was overcome by such shame and guilt.  

"Eventually, I thought a new start would do the trick and I went to Canada. Unfortunately, my anxiety worsened and I had to come home. I was devastated and it triggered three years of suffering, I am almost 30 now and have just about got life going.

"In the past few months, however, I feel like my old problem is creeping back in on me slowly but surely. I have intrusive, negative thoughts, which leave me feeling paralysed with shame and guilt. I want to deal with this problem. I want the life I always dreamt of and know I deserve, but I can’t do it if I don’t face my anxiety head on.

Thanks, Mary." 

upset woman
Psychological assessment may be useful in situations where a medical diagnosis is not immediately clear

Prof. Eddie replies: Mary, I really appreciate you writing to me and trusting me with our story. A number of things come to mind straight away: You write about experiencing anxiety all your life, with moments where you were overwhelmed by your anxiety and the quality of your life deteriorated.  

Too often, we don’t realise that our GP can play a role in identifying appropriate help with mental health. They can also do a physical and blood work-up to check that your anxiety isn’t being caused by an underlying ailment. Starting out with a mental health intervention, be it psychology, medication or counselling, I think a professional assessment is critical.  

The benefits of assessment 
Accurately diagnosing mental health conditions can be challenging even for doctors with many years of experience, and this has implications for providing effective care.

Psychological assessment may be useful in situations where a medical diagnosis is not immediately clear and/or may involve multiple medical considerations.

Psychological assessment can also be helpful with people who are struggling in different areas of their lives, particularly in situations where past treatments have been sub-optimal or ineffective. 

What keeps the problem going?
Anxiety can be effectively treated with Cognitive Behavioural Therapy (CBT). Psychology likes to focus on what keeps a particular problem going. Targeting the thoughts and behaviours that sustain a problem is key. 
What are the intrusive thoughts that hold you back, Mary? They are key to the guilt and shame that you are experiencing.

Remember, you are not your thoughts. All of us have intrusive and upsetting thoughts, but your challenge is to create a toolkit to manage these. CBT will show you how to recognise and challenge intrusive thoughts. Other methods will show you how to recognise the intrusive thoughts but not engage with them. 

Your thoughts are thoughts, not facts. Intrusive thoughts can be associated with Obsessive Compulsive Disorder (OCD), but I strongly advise you to have a professional assessment. Check out too.
Some people with OCD struggle with compulsions – i.e. behaviours, for example, excessive hand-washing, while others deal with unwanted and intrusive thoughts. Your challenge is to take back control of your intrusive thoughts.  

Eddie Murphy
"Anxiety can be effectively treated with Cognitive Behavioural Therapy (CBT)," says Eddie.

See through OCD’s scare tactics
OCD is the fear network of the brain sending a signal that something is wrong and needs to be dealt with now. OCD’s power lies in feared consequences that are important to a person. Believe me, somewhere within every obsession lies a positive core value.

For example, if OCD taunts you with images and thoughts about offending God, then religion or spirituality is important to you. If your OCD forces you to review all the ways your family could be hurt, then your family is a central priority in your life.

There is a checklist of common intrusive thoughts that my patients find helpful. There are numerous thoughts on this list regarding losing control and acting out violently or sexually. Research found that when this list is shown to a non-clinical sample of people, approximately 90% of them will agree to having experienced at least some of the intrusive thoughts.

When the non-clinical group is asked how bothered they are by experiencing these intrusive thoughts, they are most often only mildly bothered by them. In contrast, when this same list is shown to individuals diagnosed with OCD, a similar percentage of the sample will have experienced the intrusive thoughts but the big difference is how much distress they evoke. For those meeting criteria for OCD, there will be a much higher level of emotional distress when these same intrusive thoughts surface.

What keeps OCD going is not the experience of intrusive thoughts but one’s reaction to them. The more you dislike experiencing intrusive thoughts and try to suppress or fight with them, the greater the frequency of intrusive thoughts you will experience. The very act of trying to ‘not have’ a bothersome thought guarantees it resurfacing. 

Finally, Mary, to be human means you will experience deeply upsetting, intrusive and odd thoughts. Freedom from OCD is not about stopping the mind from offering up strange and occasionally disturbing thoughts, but learning how to tell the spam from the urgent email in your mind and so more easily engaging with the real world.