Paula M Naranjo/Parent Editor
By Juli Fraga and Karen Kleiman
Intrusive thoughts can be terrifying. Exercises, like distancing, can reduce parents’ anxieties.
Soon after her first baby was born in 2014, Crystal McAuley started having catastrophic thoughts about her infant’s health. Throughout the day, random thoughts popped up like tiny speech balloons, each one filled with a newfound fear: “What if the baby overheats?” “What if he stops breathing?”
McAuley, 38, shared her concerns with her husband, who told her the baby was healthy. His reassurance, however, didn’t shut down the worry-filled thoughts that looped over and over in her mind. “It was hard to make them stop,” McAuley recalled. And then they changed course: “I started having visions of pulling my car into the opposite lane of traffic, but I didn’t want to die or harm my infant.”
McAuley was experiencing intrusive thoughts, which are unwelcome, negative thoughts, or images that seem to come out of nowhere and are highly upsetting, psychologists say.
“Occasionally, everyone experiences senseless intrusive thoughts,” said Jonathan Abramowitz, Ph.D., a professor of clinical psychology and an anxiety researcher at the University of North Carolina at Chapel Hill. On a turbulent flight, for example, we may see images of the plane crashing, even if we’re not afraid of flying. If we’re driving a friend’s new car, we may have thoughts about getting into an accident.
Most times, we don’t give those thoughts much attention, but when stress arises and responsibilities mount, it can be harder to ignore them, Dr. Abramowitz explained. And with the added strain of the Covid-19 pandemic, many parents are preoccupied with worries about their children becoming ill and dying from the virus, he said.
McAuley said the pandemic has sent her anxiety into a tailspin. “I feel like a new mom again. At unpredictable times, I imagine one of my children falling down a steep ravine or dying in a violent accident.”
While intrusive thoughts can be a sign of a perinatal mood disorder, such as postpartum anxiety or postpartum obsessive-compulsive disorder, a 2006 study conducted by Dr. Abramowitz and his colleagues followed 85 participants (43 mothers and 42 fathers) from the second trimester of pregnancy to three months postpartum. Of those who participated in the study, 91 percent of mothers and 88 percent of fathers experienced upsetting intrusive thoughts about their newborn.
According to Dr. Abramowitz, it’s not uncommon for new parents to think of the baby falling down the stairs, choking or drowning in the bathtub. One parent told Dr. Abramowitz he imagined “sticking a pencil in the soft spot of his baby’s head.”
Disturbing thoughts and images like these can bewilder new parents. Not to mention, mothers who envision harming their babies may misinterpret their thoughts as ominous signs about their mothering abilities. “I felt like a prisoner inside my own mind,” said McAuley, who worried that if she told her doctor what she was thinking, her baby would be taken away.
While intrusive thoughts can be terrifying, the problem lies in how we interpret them, Dr. Abramowitz said. Labeling such notions as “negative” causes the brain to give them more weight, which is why parents who judge their invasive thoughts often struggle to let them go.
Dr. Abramowitz and his colleague, Nichole Fairbrother, Ph.D., a psychologist and researcher at the University of British Columbia, said intrusive thoughts pop up in new parenthood for a reason. In their research, the psychologists found that the immense responsibility parents feel for keeping their newborns alive can bring on disturbing thoughts about harm striking their babies, especially during the first six months of their children’s lives.
Dr. Fairbrother said: “I remember gazing at my baby’s delicate hands and thinking, ‘I could just cut those right off with the garden clippers,’ but because I’m an anxiety researcher, I wasn’t upset by it.”
Even though intrusive thoughts might seem puzzling, Dr. Fairbrother said, they’re often adaptive. “If a mother worries about the stroller rolling into traffic, she’s going to grip the handle more tightly,” she explained.
For parents bothered by their intrusive thoughts, certain exercises and steps can reduce the anxiety they create. A few suggestions:
One way to disarm intrusive thoughts is to recognize that they don’t define who you are. Repeating the bothersome thought in a singsong voice or saying it aloud, over and over again can help, said Stefan Hofmann, Ph.D., a clinical psychologist and anxiety researcher at Boston University. This behavioral technique, known as distancing, can unhook thoughts from emotions, helping the mind to change direction. No longer seeing the thoughts as a threat, parents begin to realize that “thoughts are nothing more than just thoughts,” Dr. Hofmann explained.
“A mother may think about pushing the stroller down the stairs, but that doesn’t mean she’ll act on it,” he said.
Trying to ignore intrusive thoughts and upsetting feelings only makes them louder. Carla Naumburg, Ph.D., a clinical social worker and parent coach, said acknowledge intrusive thoughts by practicing a mindfulness exercise called noticing, which is paying attention, without judgment to our thoughts and feelings as they arise.
Notice them by telling yourself, “There’s that thought again. Isn’t it interesting?” or “Look at that worry popping up. I know that one,” Dr. Naumburg suggested. Practicing this technique can help turn intrusive thoughts into something to be curious about, instead of something to fear.
Because of shame and stigma, parents may hide their intrusive thoughts, even from trusted friends. But empathic loved ones can help, said Pooja Lakshmin, M.D., a perinatal psychiatrist and clinical assistant professor of psychiatry at the George Washington University School of Medicine.
A 2017 study found that positive peer support can help bolster maternal competence, which can ease the transition to motherhood. “Social support can normalize and validate that all parents experience intrusive thoughts, which can take the sting out of parental shame,” Dr. Lakshmin shared.
Because of the coronavirus pandemic, many in-person support groups for new parents aren’t taking place. However, online groups can help new mothers connect with their peers. Postpartum Support International provides a list of online support groups for expectant and new parents.
For a select number of mothers, intrusive thoughts speed up, coming on like tidal waves throughout the day. “The thoughts felt like an impulse I couldn’t control,” McAuley said. She tried to ease her worries by hovering over her infant, looking out for any sign of distress. When he was asleep, she checked on him at least 20 times each night just to make sure he was breathing.
Behaviors like these can be a sign of Postpartum Obsessive-Compulsive Disorder, a maternal mental illness characterized by compulsive behaviors such as excessive cleaning, repetitive hand washing or checking on the baby repeatedly.
Mothers who suffer from postpartum depression, or PPD, and postpartum anxiety, or PPA, can also experience intrusive thoughts, said Samantha Meltzer-Brody, M.D., a professor of psychiatry at the University of North Carolina at Chapel Hill. While symptoms of OCD and PPD can overlap, Dr. Meltzer-Brody said frequent, severe and persistent thoughts are often a sign of OCD.
For some mothers, the pandemic worsens their fears. “Mothers may be focused on contamination or exposure to Covid,” Dr. Meltzer Brody explained. While most new mothers share those concerns, women with severe intrusive thoughts can’t put their worries about the coronavirus to rest. “For these moms, the thoughts are persistent and disabling,” she said.
Dr. Lakshmin said when unrelenting scary thoughts interfere with a mother’s ability to care for herself or her baby than the mother should seek professional help, which can include psychotherapy, group support and medication, when necessary.
When her son was 9 months old, McAuley became pregnant again. With her husband’s encouragement, she told her obstetrician about the anxiety and cascade of frightening images that wouldn’t stop. She was referred to a psychiatrist who diagnosed her with postpartum anxiety.
Receiving the diagnosis, she said, helped her recognize that she wasn’t alone. “My therapist normalized my thoughts and feelings, which helped me realize anxiety wasn’t a never-ending trap, but something I could learn to cope with.”
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