Q. For quite some time now, I am getting intrusive thoughts especially at the end of the night. I have developed insomnia and stay wide awake till dawn. In moments like that I believe I have the power to be destructive and sometimes it shakes me up and it can be difficult to carry on with my regular day to day activities after that.

What do I do?

- Troubled

Dear Troubled,

I understand that you have intrusive thoughts, insomnia (What kind of insomnia? Wake up early in the morning and can't fall back to sleep or can't fall asleep at all?), fear of becoming destructive and difficulty during day to day functioning. I'm also reading in between the lines and some of my responses may be based on those assumptions.

You didn't mention about the contents of those intrusive thoughts and how they are relevant to your personal life experiences. Are those thoughts yours or implanted from outside? Is this fear of becoming destructive directly linked to angry/negative thoughts which seem to run automatically in your head or is it a fear of losing control on a behavioural level?

If so, I would like to know what this anger/negative feeling is about and how are you coping otherwise with that strong emotion in your day to day life. What you have stated here seems to be just the tip of the iceberg and a lot has remained untold.

Intrusive thoughts can happen in Obsessive Compulsive Disorders. Emotionally charged memories can trigger automatic brain circuits and get a life of its own, independent of voluntary control. This can generate a sense of loss of control over the thought process and eventually will spill over to the fear of losing control over behaviour.

Feelings-thoughts-actions are chained activities of the brain, one leading to the other. We have very little control over our feelings because it comes from an experiential level. However, REBT (rational emotive and behaviour therapy), EFT (emotional freedom techniques etc.) can increase awareness of the feelings (depending on the capacity of the client) and thereby develop healthier skills to cope with those difficult feelings before they get automatically translated into destructive thoughts or actions. 

The fear of becoming destructive needs to be further explored. Is it a fear of self-destruction (suicidal ideation or thoughts), explosive outburst or aggression towards others? Our thoughts are usually based on our subjective perception, old experiences, biases, preconceived ideas, knowledge etc.

If the connection between emotion-thought-behaviour makes sense and there is no suspicion of delusion or hallucination, I would imagine therapy sessions to explore the origin of these automatic intrusive thoughts would be beneficial. However, therapy is usually a lengthy process and takes time to bring any noticeable result.

In order to improve day to day functioning, the sleep problem needs to be addressed first. Improving the sleep hygiene, eliminating stimulants (tea, coffee, cigarettes etc. in the evening) or excessive physical activities before going to bed might be helpful. Some sedatives or hypnotics may bring quicker relief to symptoms.

If the general mood level suggests a concurrent depressive disorder, then antidepressants are also indicated for symptom relief. Antipsychotics might be considered after exploring the content and nature of thoughts to a greater extent.

These psychiatric medications will work as a temporary crutch to carry on life. The long term goal should include psychotherapy, which is based on open, free, honest communication between client and therapist after adequate trust and safety has been established in the relationship. 

So, please consult a psychiatrist or mental health worker for necessary help.