Overcoming Intrusive Thoughts: Managing Anxiety and Fear of Illness

I hope to improve some thoughts?

Hello Dr.
Ding,
I have been experiencing symptoms of obsessive thinking for about 7 to 8 years, with fluctuations in severity.
In recent years, I have often worried about contracting sexually transmitted infections (STIs) or HIV.
I feel anxious when using public restrooms, fearing that I might accidentally touch the toilet or trash can and contract a disease.
Recently, I have also become concerned when I see trash cans on the street, worrying that they might be collected along with restroom waste, and that touching them could lead to infection.
Even if I don't feel like I've touched something, I find myself obsessively wondering if I might have, which causes me distress.
I frequently worry about indirect factors leading to infection.
My fear of HIV makes me anxious about coming into contact with needles or anything that might have blood on it.

I engage in intimate activities with my boyfriend, and sometimes I worry about the possibility of contracting STIs from those interactions.
My boyfriend has mentioned that his mother worked in a hotel, and although he claims it was in an administrative capacity, I can't help but think far ahead, wondering if he might have been born with an STI or something similar.
It seems like I tend to overthink many situations, worrying excessively about health and death.
At times, I feel really frustrated with myself for feeling this way, as if I am weak and unable to cope.
I find it difficult to live in the moment because I am constantly preoccupied with uncontrollable worries, which can be quite depressing.
I have sought counseling at my school's counseling center for a while and have switched counselors, but the new counselor's sessions were cut short due to the winter break.
I would like to ask the doctor what efforts I can make during this time to achieve some improvement.
Additionally, I sometimes struggle to assess the effectiveness of the counseling sessions.
There are moments when I feel uncomfortable, as if I am being forced to confront my deepest feelings or to acknowledge thoughts that I am unsure are truly mine.
I am uncertain whether this is helping my situation.
Is there a way for me to evaluate the effectiveness of the counseling I am receiving?
Thank you for taking the time to read my questions.

Xiao Xiao, 20~29 year old female. Ask Date: 2014/01/21

Dr. Ding Shuyan reply Psychiatry

Hello, based on your experience, it seems that obsessive thoughts are indeed difficult to eliminate.
If you have time during the winter break, it might be beneficial to visit a nearby hospital and seek a doctor's opinion.
Generally speaking, counseling can be helpful for us, but the depth of the issues addressed and the aspects that can be resolved vary.
In the end, we may reflect on whether the time and effort invested were worthwhile.
However, when it comes to human issues, factors such as connection and feelings must also be considered.
Some therapists resonate well with us, leading to good progress in therapy, while others may feel awkward; this sometimes does not necessarily correlate with the therapist's skills or experience.
If a therapist makes you uncomfortable, you can express this to them.
An experienced therapist should handle it carefully to avoid resistance.
If the feelings remain negative, it is also acceptable to switch therapists.
However, keep in mind that treatment for obsessive-compulsive symptoms does not yield immediate results.
Frequent changes in therapists may ultimately lead to stagnation, and time may slip away unnoticed.
Exploring a reputable religion can also be beneficial.
Listening to teachings that address our struggles can continuously provide us with the courage and confidence to face these obsessive symptoms and help avoid negative thinking.
Some religions offer excellent explanations and practices for reducing personal attachments, which I believe can have effects similar to cognitive behavioral therapy, and it is worth trying.
For groups that require constant donations or significant time commitments, it’s best to avoid them for now, as we are still students with limited money and time.
Wishing you all the best.
Sincerely, Dr.
Ding Shuo-Yan.

Reply Date: 2014/01/21

More Info

Dealing with intrusive thoughts, especially those related to anxiety and fears of illness, can be a challenging experience. Your concerns about potential infections, particularly regarding sexually transmitted diseases (STDs) and HIV, are not uncommon among individuals who experience obsessive-compulsive tendencies. It’s important to recognize that these thoughts, while distressing, are often a manifestation of anxiety rather than a reflection of reality.

Firstly, it’s crucial to understand that intrusive thoughts are a common symptom of anxiety disorders, including obsessive-compulsive disorder (OCD). These thoughts can create a cycle of fear and anxiety, leading to compulsive behaviors aimed at reducing that anxiety. For instance, your fear of touching public restroom fixtures or encountering trash bins stems from a heightened sense of vulnerability and the desire to avoid perceived threats. This is a classic example of how anxiety can distort our perception of risk.

To manage these intrusive thoughts, consider the following strategies:
1. Cognitive Behavioral Therapy (CBT): This is a highly effective treatment for anxiety and OCD. CBT helps individuals identify and challenge irrational thoughts, replacing them with more balanced and realistic perspectives. Working with a therapist trained in CBT can provide you with tools to manage your fears more effectively.

2. Exposure and Response Prevention (ERP): This is a specific type of CBT that involves gradual exposure to the feared object or situation while refraining from engaging in compulsive behaviors. For example, you might start by touching a clean surface in a public restroom and gradually work your way up to more challenging situations. This process can help desensitize you to your fears over time.

3. Mindfulness and Acceptance: Practicing mindfulness can help you become more aware of your thoughts without judgment. Instead of trying to suppress or fight your intrusive thoughts, acknowledge them as just thoughts—temporary and not necessarily reflective of reality. Techniques such as meditation, deep breathing, or yoga can enhance your ability to stay present and reduce anxiety.

4. Limit Information Seeking: It’s common for individuals with anxiety to seek reassurance or information about their fears. However, this can often exacerbate anxiety. Try to limit the amount of time you spend researching health-related topics or discussing your fears with others, as this can reinforce the cycle of anxiety.

5. Medication: If your symptoms are significantly impacting your daily life, it may be worth discussing medication options with a psychiatrist. Selective serotonin reuptake inhibitors (SSRIs) are often prescribed for anxiety and OCD and can help reduce the intensity of intrusive thoughts.

Regarding your experience with counseling, it’s normal to feel uncertain about the effectiveness of therapy, especially in the beginning. Here are some indicators that may help you assess whether your counseling is beneficial:
- Progress Over Time: While therapy can be uncomfortable, especially when confronting deep-seated fears, you should also notice some progress over time. This could be in the form of reduced anxiety levels, improved coping strategies, or a greater understanding of your thoughts and feelings.

- Feeling Understood: A good therapeutic relationship is built on trust and understanding. If you feel that your therapist listens to you and validates your experiences, this is a positive sign.

- Homework and Practice: Effective therapy often involves practicing skills outside of sessions. If your therapist assigns you tasks or exercises to work on between sessions, this can indicate a proactive approach to your treatment.

- Open Communication: If you feel uncomfortable or unsure about the process, it’s important to communicate this with your therapist. A good therapist will welcome your feedback and adjust their approach to better suit your needs.

In conclusion, managing intrusive thoughts and anxiety requires a multifaceted approach that may include therapy, mindfulness practices, and possibly medication. It’s essential to be patient with yourself as you navigate this journey. Remember, seeking help is a sign of strength, and with the right support and strategies, you can work towards a more balanced and fulfilling life.

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