Intrusive Thoughts and Cognitive Restructuring

Negative and irrational thought patterns are a regular feature of bipolar disorder and can occur in depression, mixed states, mania and hypomania. Negative self-talk is a common symptom of depression.

Taking these thoughts as true can send us into a spiral of self-loathing. Dark intrusive thoughts can lead to self-harm and suicide. Irrational thoughts can lead to an increase in paranoia and feed delusions

These false beliefs are called cognitive distortions. They most commonly come in the form of:

Catastrophising – a common feature of anxiety i.e. what if’s, always expecting the worst.
Overgeneralisation – believing a negative event will happen again just because it has once
Blaming – assigning basic causes to complex problems
Personalisation – attributing negative things people do and say to being about you
Black and white, all or nothing thinking, with no middle ground
Thoughts that begin with “I should…”

We don’t have to be slaves to these thoughts, they don’t have to control us. We can reframe our thoughts and disarm them. This is called cognitive restructuring.

This is one method that has works for me.

Notice the thought
Observe it neutrally, as a separate thing from your self
Pause, take a deep breath
Challenge the thought: Is this accurate? Is this a feeling or a fact? Is this likely to happen? Would I apply this standard of judgement to somebody else? How would I help a friend with this? Replace “I should” with I could.
Can there be an alternative explanation? Can I get another perspective on this?
Try saying the thought out loud, or write it down. Talk to someone else for their perspective.
Replace negative thought with neutral or positive thought
Gratitude – remember the things you have to be grateful for. Write them down as a reminder if that helps.

If there are thought patterns, delusions, fears or topics that occur regularly for you, try writing down how you feel about it when you are depressed, hypomanic, or manic. Then when you are well, in a balanced mood, you can write down how you feel about those thoughts to compare when you are unwell. Compare your thoughts with your balanced perspective to see how they match up so you can challenge the authenticity of the irrational or negative thought.

Cognitive restructuring – reframing our thoughts, takes practice. It is something you will get better at, so don’t give up if you are not getting the results you want straight away. You are re-wring your brain, forging new neural pathways. This takes time and repetition.

Get used to checking in with your thoughts, learn to observe them rather than react to them.

Sometimes I visualise a negative thought as floating past in my minds eye, like it’s floating down a stream or passing by on a cloud. This separates the thought from me, I do not need to acknowledge or listen to it.

With practice I have come to notice these irrational, intrusive thoughts for what they are, manifestations of my illness. I think of them as a little bipolar devil piping up, wanting to cause trouble. But I don’t have to listen, I have the power to say “No thanks, not today little monster”

“Not today Satan, not today.”

Cognitive Behaviour Therapy teaches how to identify and reframe negative and irrational thought patterns as well as Dialectical Behaviour Therapy, which challenges black and white thinking and teaches emotional regulation.