Intrusive Thoughts and Memories in PTSD, Anxiety, and Depression

Distressful and unwanted memories and thoughts are symptoms of trauma reactions, depressive disorders, and anxiety disorders. These can be preoccupying and debilitating, interfering with the performance of daily activities and even leading to suicidality. PTSD, or Post-traumatic Stress Disorder, which develops during exposure to overwhelming trauma, is hallmarked by the presence of distressful memories and intrusive thoughts about the traumatic event. A great deal of the management of this condition involves coping with both the unwanted memories and negative thoughts related to the trauma that intrude upon one’s daily life. People with other conditions such as Bipolar Disorder also must cope with intrusive memories and thoughts, but do not always experience these as distressful even though their level of functioning may be seriously impacted by them.

Bipolar Disorder is characterized by periods of mania in which there is heightened energy, impulsivity, poor judgment, increased pleasure-seeking and the possibility of psychotic symptoms such as hallucinations and delusions. Thoughts and memories are said to “race” during manic episodes and to be uncontrollable. This type of unwanted mental activity interferes with usual activity and can lead to poor decisions and regrettable behaviors. On the other hand, the other extreme of Bipolar Disorder, depression, causes distressful and negative preoccupations colored by hopelessness and helplessness. Intrusive and depressive thoughts impair motivation, coping, judgment and insight and can lead to suicidality. Many of the unwanted thoughts that occur in depressive episodes are concerned with negative future events and possibilities. Similarly, unwanted memories in depression are typically about distressful past events.
 

People who experience intrusive but positive thoughts and memories may not feel impaired although they may be. Manic episodes, for example, may involve intrusive thoughts about pleasure-seeking, the overestimation of one’s abilities or talents or the desirability of certain behaviors that cause problems socially, occupationally or in some other realm of one’s life. The negative impact of a manic state is often not known until when, in retrospect, the affected individual is able to gain a more stable perspective. Similarly, those who experience hypomania, an elevated and expansive mood which is less severe than mania, may have intrusive thoughts and memories that are positive and preoccupying to the point of causing problems in one’s daily life. Those with hypomania tend to become focused upon goals and future often at the expense of tending to the present.
 

Individuals with Depressive Disorders such as Major Depression must routinely cope with distressful thoughts and memories and a great deal of treatment for depression is focused upon challenging and changing negative mental activity. In severe depression, for example, thoughts can become preoccupied with death and dying and can lead to suicidal feelings and self-harming behaviors. Those with suicidal thinking report these thoughts as unwanted, intrusive, distressful and persistent.
 

Addressing unwanted and intrusive mental activity in therapy helps reduce the distress associated with it. Cognitive Behavioral Therapy, for example, examines the negative beliefs one holds and seeks to replace those with more optimistic ones. Learning to monitor and change negative thinking is a well-researched and beneficial way to cope with chronic depression and its unwanted negative thoughts and memories. It also highlights the power of mental activity in our daily lives and demonstrates the impact of our mental activity upon our daily functioning. Working to actively challenge and change beliefs and thoughts is a significant part of treatment for trauma reactions and other Anxiety Disorders as well.
 

The interruption of unwanted thoughts and memories can be achieved with various approaches and techniques. In anger management, for example, the use of self-talk to soothe and calm oneself is a common strategy used to de-escalate and alter one’s mood. Thoughts are actively changed so one may better control the urge to express anger. Similarly, the use of visualization and meditation techniques in stress management illustrates choosing more positive mental activity to replace an undesirable one. The building of such coping skills supplement other forms of treatment such as supportive counseling and medication for many who cope with the disorders described here.