Managing Intrusive Thoughts: Seeking Better Mental Health Solutions

Controlling one's thoughts?

I am currently employed and have been on various antipsychotic medications for a long time, but I still cannot control my thoughts.
For example, when watching a movie, I find myself overthinking, which leads me to speak out loud, resulting in emotional instability.
I have been seeing a psychiatrist at a mental health hospital in the southern region for 5 to 6 years, and aside from prescribing medication, there has been no other approach.
I feel that this is an invasive form of treatment, treating patients merely as subjects for medication control.
The psychological therapy at my hospital is not as advanced as yours, and the doctors do not proactively refer patients or communicate with the therapists about the specific circumstances for treatment.
I do not have a history of acute psychotic episodes.
I am currently considering whether changing doctors would be beneficial if they can prescribe medication, or if I should go to a medical center.
To be honest, I also plan to volunteer at a large hospital and pursue further education for a year, so I believe hospitalization is not the only option and may not be the best approach.
I know there are clinics and therapists available, but it seems that hospitals do not refer to these clinics.
I hope the doctor can provide some valuable advice.

c, 20~29 year old female. Ask Date: 2014/06/01

Dr. Ding Shuyan reply Psychiatry

Hello, regardless of the psychological distress, psychotherapy can be helpful; the issue lies in the extent of that help, as well as our own problems and conditions, determining whether psychotherapy is the best choice.
As we age, the effectiveness of psychotherapy tends to diminish.
For someone approaching fifty like me, psychotherapy may yield diminishing returns, while listening to teachings from monks or pastors might be somewhat beneficial.
Additionally, psychotherapy tends to be more helpful for psychological distress caused by stress.
In cases of hereditary mental illnesses, psychotherapy often plays a more supportive role, with medications generally providing quicker and more effective changes.
There are relatively few psychologists in hospitals, and their workload is quite heavy, which limits the availability of psychotherapy for everyone; honestly, it often comes down to luck.
It's not that physicians are unwilling to arrange appointments, but resources are indeed limited.
In Taiwan, medical visits do not operate like in the U.S.
with scheduled appointments—each patient is seen for about an hour, and every patient is treated as if they are undergoing psychotherapy, which can be quite expensive.
Taiwan's National Health Insurance is convenient but quite inexpensive.
When patients walk in to register, physicians must see them and cannot refuse.
In a half-day clinic, a physician may see dozens of patients, leaving only a few minutes for each, making it difficult for psychotherapy to be widely accessible in hospitals.
Lastly, one should not underestimate the effectiveness of medications; for certain mental illnesses, the efficacy of medications is well-established.
Many patients receiving home care are often reluctant to visit hospitals for consultations, let alone for psychotherapy.
They receive long-acting injections from home care nurses, which stabilizes their condition, but if they refuse medication treatment, their condition can deteriorate within days or weeks.
Many psychiatrists have religious beliefs and strongly support psychotherapy; they do not solely rely on medications, nor do they aim to control patients with drugs, as you mentioned.
The main issue is that under limited resources, the choices for what is best for the patient become very constrained.
Best wishes for everything,
Dr.
Ding Shuo-Yan

Reply Date: 2014/06/01

More Info

Managing intrusive thoughts can be a significant challenge, especially when you are dealing with long-term mental health issues and medication management. It sounds like you have been on a journey with your mental health, and it’s commendable that you are actively seeking solutions and considering various options for your treatment.

Firstly, it’s important to acknowledge that intrusive thoughts are a common experience for many individuals, particularly those with anxiety disorders, obsessive-compulsive disorder (OCD), or other mental health conditions. These thoughts can be distressing and may interfere with daily functioning, as you have described. The fact that you find yourself distracted during activities like watching movies indicates that these thoughts are indeed intrusive and can lead to emotional instability.

You mentioned that you have been on various antipsychotic medications for several years, and while medication can be beneficial for managing symptoms, it is not always a complete solution. It’s understandable to feel frustrated if you perceive that your treatment has not evolved beyond medication management. In many cases, a combination of medication and psychotherapy can yield better results. Cognitive Behavioral Therapy (CBT), for example, is particularly effective for managing intrusive thoughts and anxiety. It focuses on identifying and challenging negative thought patterns and developing coping strategies.

If you feel that your current psychiatrist is not providing the level of care you need, it may be worthwhile to seek a second opinion or to find a new provider who is more aligned with your treatment goals. Transitioning to a different psychiatrist or a mental health facility that offers a more integrated approach to care could provide you with fresh perspectives and treatment options. You mentioned considering a larger medical center; this could be a good move, as they often have more resources, including access to a multidisciplinary team of professionals, such as psychologists, social workers, and occupational therapists.

Additionally, if you are interested in therapy, it’s crucial to find a therapist who is experienced in treating intrusive thoughts and can work collaboratively with your psychiatrist. Communication between your psychiatrist and therapist is essential for creating a cohesive treatment plan. If your current facility does not facilitate this communication, it may be beneficial to seek out a practice that does.

Volunteering at a hospital or pursuing further education can also be beneficial for your mental health. Engaging in meaningful activities can provide a sense of purpose and help reduce feelings of isolation. However, it’s important to ensure that you are in a stable place mentally before taking on new responsibilities.

Lastly, consider incorporating self-care practices into your daily routine. Mindfulness, meditation, and relaxation techniques can help manage anxiety and intrusive thoughts. These practices can be effective in grounding you and reducing the emotional impact of intrusive thoughts.

In summary, it’s essential to advocate for your mental health needs. If you feel that your current treatment is not effective, exploring new options, whether that be a different psychiatrist, a new therapy approach, or additional support systems, can be beneficial. Remember, you are not alone in this journey, and there are resources available to help you manage intrusive thoughts and improve your overall mental health.

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