Impulsive thoughts to harm yourself or others, confusing delusional thoughts, thoughts commanding you to do things — all of these are terrifying to experience. A breakdown in the thought process is a hallmark of schizophrenia. When does an intrusive thought become delusional and something a person might act upon? If a person has disturbing violent thoughts, are they dangerous?
Host Rachel Star Withers, who has schizophrenia, shares her personal struggles with disturbing, intrusive, violent thoughts. Rachel is joined by guest Kassie Love, who is a marriage and family therapist specializing in working with people having unusual thoughts or experiences.
Therapist Kassie Love, MMFT/MPH
Hi there! My name is Kassie Love. In my line of work as a mental health provider, I’ve come to understand that what most people really want is to be heard and supported. Nobody wants to feel like they’re being judged or criticized, especially when they open up in therapy. My patients often tell me they appreciate my compassionate and relatable approach, which they find both valuable and effective. Learn more at www.kassielove.com.
Rachel Star Withers creates videos documenting her schizophrenia, ways to manage and let others like her know they are not alone and can still live an amazing life. She has written Lil Broken Star: Understanding Schizophrenia for Kids and a tool for schizophrenics, To See in the Dark: Hallucination and Delusion Journal. Fun Fact: She has wrestled alligators.
To learn more about Rachel, please visit her website, RachelStarLive.comm.
Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, “Mental Illness is an Asshole and other Observations,” available from Amazon; signed copies are also available directly from the author.
Gabe makes his home in the suburbs of Columbus, Ohio. He lives with his supportive wife, Kendall, and a Miniature Schnauzer dog that he never wanted, but now can’t imagine life without. To learn more about Gabe, please visit his website, gabehoward.com.
Producer’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.
Rachel Star Withers: A note of warning: In this episode of Inside Schizophrenia, we discuss disturbing and intrusive thoughts involving violence and self-harm.
Announcer: You’re listening to Inside Schizophrenia. Hosted by Rachel Star Withers, an advocate who lives openly with Schizophrenia. We’re talking to experts about all aspects of life with this condition. Welcome to the show!
Rachel Star Withers: Welcome to Inside Schizophrenia, a Healthline Media podcast. I’m your host, Rachel Star Withers, here with my amazing co-host Gabe Howard. Sudden, impulsive thoughts to harm yourself or others. Confusing, delusional thoughts, thoughts commanding you to do things. All of these are terrifying to experience. A breakdown in the thought process is a hallmark of schizophrenia. But what about intrusive thoughts? When does an intrusive thought become delusional and something a person might act upon? Today we’re going to be discussing disturbing and unusual thoughts and schizophrenia. As someone with schizophrenia, this is one of the scariest things to open up about, because I’m afraid that if I tell people I have these thoughts, then they will immediately consider me dangerous. Which begs the question: am I dangerous if I have disturbing thoughts? Joining us later in the show is marriage and family therapist Kassie Love, who specializes in working with people having unusual thoughts or experiences.
Gabe Howard: So, let’s jump right in. Rachel, what are intrusive thoughts?
Rachel Star Withers: I thought I knew, I mean, isn’t it in the word intrusive thoughts, thoughts that just pop into your head that you don’t really think are yours? If you’ve ever been, like, driving down the road and you suddenly had this thought like, I should just swerve, that’s a common one that people have and not people with schizophrenia that people have. That’s what’s really important, is that everybody, for the most part, will have at some point in their life, this random little inappropriate thought that you don’t even know where it comes from. So intrusive thoughts tend to be unexpected thoughts or images that just pop into your head, that are strange and can be very distressing. Um, they’re usually unwanted and unpleasant. Content could be aggressive, it could be violent, it could be sexual. It could also just be like, weird. Just like stuff that you’re like, why would I what? Like, why would I do that? Just something that’s abnormal for your character.
Gabe Howard: The real reality of this is, is it’s something that you don’t want, but you can’t control, and you’re afraid that you’re going to act on. I know that we’ve learned in obsessive compulsive disorder that some of these thoughts can cause real problems. Like, for example, you hit a pothole. But the obsessive thought, the intrusive thought is, was it a pothole? Could I have hit a person? And this, of course, makes you turn around and go check. Now, of course, you realize it was a pothole and that provides relief. But think of the number of speed bumps, potholes, and things that you could hit every single day. And if you’re constantly turning around and doing this, it could make you late for work. You’re probably not going to tell your employer that the reason that you’re late for work is because you thought you hit somebody. So as far as your employer is concerned, you’re just late for work. That’s just one analogy and one way that these intrusive thoughts can cause real damage to somebody’s life.
Rachel Star Withers: Are intrusive thoughts considered a symptom of schizophrenia? And if you’re asking me, I’m like, yeah, I have very intrusive thoughts. There’s some of the things that worry me the most because they’re very intense and strong when they hit me. A thought that distresses me a lot, that I have almost daily, is to smash my head into the wall. And I usually get it when I’m walking down the stairs of my house, which happens, you know, multiple times a day. Just randomly going about my day. And then I suddenly have this intense smash your head into the wall, almost as if it’s like someone hollering at, for me to do it, and this intense urge. And it’s every time it happens, I’m like, whoa, no, I’m not going to do that. It happens a lot. It’s very out of the blue, and I’ll even be around people and it’ll happen where it’ll just randomly.
Rachel Star Withers: I’ll have something like bash your face into this. One I struggled with for many years was cut your face off. Um, and this is the reason we had the warning at the beginning of this episode. But I wanted to be real. That, that’s a common thought, and it worried me. I didn’t want that thought, but I couldn’t. I couldn’t make it go away, and then it almost gets stuck in my head, and it had images that came with it. And every time I looked in the mirror, I saw myself without my face. And it really it took over. A thought that I’m really ashamed to talk about is and it only happened once, but it bothered me. It was so distressing. I was walking behind one of my family members, and I suddenly I got the thought to like, to push them down and, um, stomp on them. It was so jarring like it. It literally terrified me that the thought was in my head. And I mean, this was years ago and I still feel bad about it. That’s how much it’s bothered me.
Gabe Howard: Rachel that that that sounds absolutely terrible. And I have known you for years, and I know that you wouldn’t push anybody down and stomp on them. So, I think that’s a really great example of an intrusive thought because it’s so out of character for you. It’s nothing that you would do, but it’s also something that you can’t control. You’ve been dealing with this for a long time. It’s if you are. You are well in recovery. You’re able to talk about this. You’ve gotten a lot of support and a lot of help. And you’ve clearly developed coping skills. But I, I think our audience would like to understand this from, from month one, from, from year one. How did you understand they were intrusive thoughts? How were you able to cope with them? How were you able to not respond to them? How were you able to identify it as an intrusive thought and run interference so that you’re not smashing your head against the wall?
Rachel Star Withers: And I’m being very real in this. The very specific one of smash your head into the wall started when I was young. And the answer is I, I did it. And that’s been a, uh, I’ve done it multiple times. And I once gave myself a concussion and kind of blacked out from it. And when it happens, it’s a very intense urge to do it. Now, I can say I haven’t done it in years, but I, I have that. And I don’t want to say a command thought, but it is. It’s an intrusive, intense urge, thought to do it almost daily. The good thing about all that is that, yeah, I’m really used to it. I’ve had it for so long that when it happens now I’m not like, whoa, whoa, dude, I think not? It’s, you know, it pops up in my head and I acknowledge it, and I’m just kind of like, not going to do that. That came out of nowhere. It’s distressing. And when it happens, I’m not going to lie. I look at the wall, you know, and I’m usually, you know, within hitting distance of it. It’s an impulse, and I’ve been able to learn to recognize it by the fact that it’s so common with me. And that’s the part that’s scary because sometimes they come up and they’re not common. Uh, last year I started having these very strange thoughts, and they’re very distressing. And they were basically. You are a fat pig. You’re ugly. You need to slice off the fat.
Rachel Star Withers: And those were very disturbing to me because that’s not something I would say. I would never in my life call someone a fat pig. So, the fact that the thoughts in my own head said that were bizarre to me, and like that was distressing because I’m thinking, that’s not my language. That’s literally like somebody else’s thoughts. That is a symptom of schizophrenia, thought insertion. And then it’s like a spiral downward because then I’m like, well, oh no. If I’m thinking I have someone else’s thoughts inserted into my head, now I am going crazy. The thing I did was I told my therapist and they were she was like, yeah, we need to up your meetings with me. I was seeing her by twice a month at that time, and she was like, nope, we’re going to see you every week now, and you’re going to give me updates on these thoughts, and I want you to tell me exactly what they were. That helped so much just and it’s embarrassing to say, but I told her, I said, well, this is what it was, and this is what happened. And this is how I felt about it. And, you know, we kind of start doing coping mechanisms and, and things like that
Gabe Howard: As I’m as I’m listening to your story, Rachel, the part that strikes me is that you were able to get help. You were able to tell somebody that you were thinking these things and be able to get help for it, because I got to tell you, I don’t think the average person would be able to look somebody in the eyes and say, hey, I was thinking about pushing down a family member and stomping on their head, or I’m having violent thoughts of hurting myself. Or even I, I still think the average person would not sit down with a therapist, even a friend or a confidant and say, hey, I keep calling myself a fat pig. And I don’t understand why. Most people internalize these things, because of course, if they tell somebody, they could get committed, right? Hey, I’m having these, these, these, these thoughts of pushing somebody down. Okay, well, that’s a 72-hour hold. I’m calling the police. Once again, because of the stigma of schizophrenia, people tend to overreact or not provide the help that people are needed.
Gabe Howard: I, I have to ask, Rachel, how were you able to overcome that? I don’t think there’s anybody listening to this who thinks, okay, I’m going to go and ask my loved one if they’re thinking about pushing me down and stomping me on the head, right? Like I don’t even know how to broach the subject with somebody that I care about. I wouldn’t even know how to tell somebody if I was having that issue. I think this does have to be a complicating factor, and I I’m not trying to call you out, but you kind of glossed over it. You were like, oh, I was thinking all of these violent, obsessive thoughts, and I was having these intrusive things, and I was thinking about hurting myself and others. And then I just got help. I how I, I, I’m laughing because I, I’m uncomfortable in a way. Right. It’s I, I’m putting myself in the shoes of somebody asking their loved one that they need help or asking for help themselves. And if I’m this uncomfortable just being in the conversation, I can only imagine the monumental task of seeking help for this.
Rachel Star Withers: What I did was I told my therapist, so understand I was lucky because I was already seeing a therapist that I trust, that I have built that rapport with. I wasn’t worried that she was going to freak out. I knew that she would take it seriously, and she did. It was okay, this is this is not normal for you, Rachel. We need to address this and start meeting more. I was able to get help so easily because of the fact that I was already getting help. And if you haven’t started on that journey, I would say, yeah, it takes a lot to find someone who you can be open with. That’s a red flag. If someone tells me that they’re having urges to hurt other people. I mean, we live in a day and age where that’s the kind of thing you need to report. So, if you’re saying, well, Rachel, should someone report me? If the therapist, when I was telling her those things, had she said, you know what, Rachel? I do feel you are a danger to yourself or others. Then. Yeah. Being hospitalized for that time might have been what was best for me.
Gabe Howard: We can see the double-edged sword in this right, where if I ask for help and you have me committed, I’m never going to ask for help again. Which of course is going to exacerbate the problem. But if you ask for help and you need a psychiatric commitment and you don’t get it, that exacerbates the problem. And of course, really, really bad things can happen. People need to feel comfortable to bring these things up, and we don’t want to overreact, but we also don’t want to underreact. When your loved one comes to you and says this, or when you’re sharing this, you may need hospitalization, but you also may not. It’s not a one size fits all, but I got to tell you that nuance makes people uncomfortable because most of society believes that the minute somebody with schizophrenia is having an any thoughts that surround violence in any way, that’s an immediate commitment. That’s an immediate 911 call. And that’s not true.
Rachel Star Withers: It’s hard to admit that about yourself. And when I’m talking about this notice, I’m very self-aware. As you know, schizophrenia progresses and you might be in a psychotic state. It’s harder for you to notice. Your thoughts. Like what? What is irrational? What’s not based in reality? And that, that’s when you might begin to act on certain things. And I think that’s why it’s so important to track your symptoms, to keep up with these things, to know yourself and know. Hey, wait a second, my thoughts have changed. And I track mine religiously because of this. It’s very easy to, for me to figure out when I’m kind of going into a psychotic episode because there’s, like, subtle changes in the way I think. One of the most noticeable ones is I start talking to myself, like in third person. Like I start thinking, okay, Rachel, you need to go do this now. Okay, Rachel, act normal. That’s always like a red flag for me is if I tell myself to act normal, that usually means. Uh oh. Uh oh. I’m not acting normal. Uh, something has started to come loose in my brain.
Gabe Howard: Are these intrusive thoughts? I guess that’s where I’m getting a little confused. What you’re describing sounds very much like the symptoms of schizophrenia that people are very well aware of, but you describe them at the top of the show as a different symptom altogether.
Rachel Star Withers: Yes. So intrusive thoughts are normally connected with other disorders, predominantly obsessive compulsive disorder. And this is very important because there’s actually a link they found between schizophrenia and obsessive compulsive disorder. Around 30% of people with schizophrenia may also have symptoms of OCD. And your thought might start in your mind as an intrusive thought, and then it slowly becomes a delusional thought. The example of me cutting my face off. Unfortunately, I was plagued with the images and this went on for months, until I started the cuts. And if I were to like, lay it out on a timeline, you could see, okay, this is an intrusive thought. It’s bothering Rachel. It’s becoming more frequent to the point that I start believing it. And now I start the cuts. I think this is a really good point when it comes to schizophrenia. Is that for certain delusional beliefs, we might be able to stop them before they become delusional. So, if you’re having intrusive thoughts and you’re noticing you’re having the same ones over and over, it’s been postulated that there is an actual shift where it goes from neurotic to psychotic.
Gabe Howard: In a way, I understand the mechanism and what you’re saying. It’s sort of a slow build. It exists on a spectrum. And how it can turn into something worse if untreated. So, in that way, I’m aligned. But, I got to tell you, it’s a confusing thing, because not being able to control your thoughts is a hallmark of schizophrenia. And in many ways, it sounds like more of the same. Why are they breaking it out into two separate things? Is it just for easy tracking? Is it for early intervention? Is it to understand that there’s different mechanisms at work for treatment opportunities?
Rachel Star Withers: Intrusive thoughts are intrusive, so they bother the person. And the thinking behind it is that with schizophrenia you’re not as bothered by it, which honestly upsets me because I’m very bothered by it. And I think that’s misleading. But there’s a point in theory that yes, if I obsess over something, if I have schizophrenia, I’m going to start to believe it and then I’m going to act upon it. They say that OCD is marked by compulsive behavior, whereas schizophrenia is marked by impulsive behavior. Which I got to say, I describe my thoughts as being very strong impulses, like right away when I read that in different articles, I was like, oh crap, I, I am, it is like to me when I get the thought, it’s a very strong impulse to act on it.
Gabe Howard: When I take it away from schizophrenia, an example that I always hear is when you’re standing at someplace high and you get that, that that little bit of, hey, I could jump and then immediately like, no, no, don’t do that. And it’s described over and over again in pop culture, people talk about it. You’re leaning over the edge and you’re just like, and you’re looking down and you’re like, I could jump. But then you immediately know that it’s wrong. I know there are no perfect analogies, so please, audience understand it’s not exactly the same thing. There’s a much, much different mechanism in schizophrenia. But for an analogy, is that a good example?
Rachel Star Withers: Absolutely. I think that’s perfect. Um, because I take it to the next level. I mean, I think that’s part of the fun of looking down from heights, you know, is that kind of that little bit of fear you have if you’re leaning over a ledge and you’re just like, whoa. And some people, love that fear that’s just kind of like a fun game. Just like roller coasters being up in the air, being thrown around like there’s a little bit of fun to it. For me personally, I have I don’t like heights, and I stay away from ledges because I don’t trust myself. That could probably be the good marker between, um, an obsessive compulsive thought and a schizophrenia thought. The fact that I don’t trust myself. I very well might just jump without thinking. To say I don’t trust myself over something like that is probably scary. But it’s also, I think it’s important. And it’s me managing my schizophrenia, knowing what are my own boundaries? Stay away from ledges because I might run off the ledge. Um. If loved ones are listening out there. I don’t want you to be scared. I just want you to kind of understand that there’s a lot going on in people’s heads and there’s stuff going on in everyone’s. Everyone has inappropriate thoughts, things you shouldn’t think, things that you’re going to be ashamed about if you had to tell other people. With schizophrenia though, I, it’s important to break these thoughts down to help you yourself as a patient, understand them, understand why you’re having them, because that can help them to not become so distressing to you.
Gabe Howard: Rachel, I know we talked a little bit about how you made them go away, but what does the research show? What are some things that folks can try to help make them go away? Understanding, of course, that if there was a magic cure, this podcast wouldn’t be needed because everybody would be.
Rachel Star Withers: If a pill comes out tomorrow that takes away these thoughts, I will take it, Gabe. Sign me up. I am all about it. But, yeah, it’s not that easy. Uh, yes. Sometimes medication can help with these, especially if they’re more delusional type thoughts. Different antipsychotics can help with that. Different medications for OCD might also help. That’s something you might want to speak to your psychiatrist about. Hey, I have been having these type of intrusive thoughts, and sometimes they can do a medical adjustment, and that could help the problem. The hallmark of treatment is going to be cognitive behavioral therapy, which we’ve talked about on this show. And there’s different ways there’s different styles of that. One is in a controlled setting a therapist might expose you to your triggers, and you learn to react to them. You learn how to think differently, or when you have those thoughts, to kind of take them out of that setting and make them more manageable. And I hate giving this tip, Gabe. I hate it because it’s for every, tip for everything in life.
Rachel Star Withers: Self-care. You hear that phrase, it’s like, okay, every single thing in life, like a tip is self-care. You know, you’re not getting enough sleep, self-care. Your kids are brats, self-care. But that comes up a lot. Self-care. If I’m not doing well, as far as my sleeping, uh, my eating, mentally, I go down so quickly and my thoughts become very odd. I take sleeping pills, I have as needed sleeping pills to be clear, and I take them if I haven’t slept in 2 or 3 days because mentally I’m going to go downhill very, very quickly and I probably already have. But that’s just something I have to be aware of.
Gabe Howard: Rachel, thank you for being so candid, and I. I always have to joke. You’re right. Self-care is everywhere. But it’s simple because it works. And I do think that we should pay more attention to it. But. But I’m curious, can this go away? Is there a treatment out there that will make these stop 100%? Is that a reasonable goal?
Rachel Star Withers: It’s possible that they could stop. It’s possible that a medication change that you might learn some new therapy, that they could just kind of go away on their own. All of those things are possible. But making them go away, might not be the goal. Because that absolutely might not happen. What should be the goal is managing it is that you still feel you’re in control. So yes, that thought pops up in your head, hey, smash your head into the wall. But no, I’m not going to do that. Kind of acknowledge it. Like that was weird I thought that. That’s a beautiful wall. It does not need a hole in it, and my head doesn’t need a bump on it and just kind of go about your day. Rationalize it out in a way. Like, that’s the goal is to feel you are in control. Some people use mindful meditation, and I know you hear meditation. You say, ugh. At least I always do. I roll my eyes the minute someone tells me to meditate. But it doesn’t have to be like, uhmmmm. You know, you’re sitting there with like jewels and crystals and whatnot. Meditation also can be as simple as you have this intrusive thought that is disturbing you and unusual, and you just kind of stop, ground yourself like, okay, let me just practice my breathing.
Rachel Star Withers: That is also considered meditation, taking a second and being like, okay, I need to pause. I need to step away from what just happened. Another thing, and this is my go-to for almost any problem in life, Gabe, distraction. Distracting yourself. I have so many toys around. I have so many fidgety things, so much stuff. And then, of course, my dog. Animals are great for distractions. They tend to pull you out of your mind if you just like, pet and play with a little animal. A lot of these things are can help you not be so bothered by the thoughts. Externalizing the thought is important. Talking to someone about it, that takes away a lot of the power. I didn’t like telling my counselor those things about me. When I when I did, I was crying because I was so ashamed to admit those things, but when I did, I felt so much better. And by like the third time we had to talk about the thoughts in a session, I was like, okay, so I had this, this, this and this and this, and I’m like listing them out like, like it’s nothing kind of kind of like I am on this show because I got so used to talking about them and they almost kind of come off as ridiculous. I would never hurt my loved one. Gabe, you’ve met most of my family. I am very protective of them and we get along great. So, the idea that I would hurt anyone like that is. It’s just it’s not going to happen.
Gabe Howard: It’s extraordinarily out of character,
Rachel Star Withers: Yeah.
Gabe Howard: Which I have to imagine adds to the scariness of it.
Rachel Star Withers: But a reframing. It also comes off as silly because you’re like, well, Rachel would never do that. That’s almost like, no, she wouldn’t do that. No, I’m not going to do that. I’m not going to jump off that ledge. Like what? No, that’s a long way down. That wouldn’t end well. I’m not a superhero. Like that’s. No. I do believe that making them silly kind of helps. It does take the sting out. Um, however, I don’t want to say that we’re not taking them seriously. It is still, these are very serious thoughts, but it’s ways to learn to manage them.
Rachel Star Withers: And we’re back discussing disturbing, intrusive, unusual thoughts in schizophrenia.
Gabe Howard: Rachel, thank you so much for sharing your experience and of course, the hints and tips that you learned along the way. But in order to fill out this episode, we wanted to have a mental health professional come on and share things from a more medical perspective. And we’re very, very fortunate to have Kassie Love. Kassie is a marriage and family therapist, and she uses cognitive behavioral therapy, dialectical behavioral therapy, and meditation and mindfulness practices to help people with unusual thought patterns, including people with schizophrenia, who have the same concerns that we’ve been covering in this episode. So, let’s go ahead and roll that interview now.
Rachel Star Withers: Today I’m excited to be speaking with marriage and family therapist Kassie Love. Thank you for joining us today.
Kassie Love, MFT/MPH: Hi, Rachel, and it’s great to be on the show.
Rachel Star Withers: What attracted you to working in the mental health field?
Kassie Love, MFT/MPH: So, honestly, it’s kind of a second career for me. Um, I say my first one was really raising my young. I have three young kids. I have a degree in public health and did some grant writing type work. And I have an older, um, sister who’s really open about, um, struggles with, um, postpartum depression. So, when she got in this place where she, was not functioning very well, I was helping support her, um, through it and, you know, giving her coping strategies and ideas. And then one day she, um, said, you know, a lot of the things that you say to me, um, my therapist has the exact same ideas. Have you ever thought about being a therapist? And I said, I would love to be a therapist. I went back to school and, you know, here I am.
Rachel Star Withers: Awesome. Now, during your therapy, you have also branched out from just depression and family to working with people with schizophrenia, bipolar and other serious mental disorders. What attracts you to working with severe mental disorders?
Kassie Love, MFT/MPH: So, when I did, um, my training work, I have a specialized degree in medical family therapy. Um, so my training experience occurred. I live in the Atlanta, Georgia area, at Emory University, in a primary care like, family medicine clinic. And people with more severe and persistent mental illnesses are kind of more frequent fliers of primary care and often maybe use those resources to support their mental health. So, that was my exposure to it. And luckily I had the support resources of being plugged in with psychiatry. I was able to be on the floor right away and talk with a person’s, you know, primary care physician, psychologists on staff. So, it was a great and supportive experience to get all of that skill set. Whereas, you know, therapists may not always have those opportunities or skill sets. So, and to be honest, it just clicked well and enjoyed doing that type of therap. I knew right away there was a need for therapists in private practice settings to serve individuals who have these experiences and their families. Um, because I was actively trying to work to plug people in, and I realized there was this misconception going on that, oh, those types of people are served when they’re inpatient or when they’re in hospitals or facilities. Um, but the whole segment of people, they were functioning and trying to get support around that and their families trying to get support, um, before all of those other things that we don’t want happen, like inpatient treatment and things that we’d like to prevent, there just wasn’t enough resources serving that.
Rachel Star Withers: Thank you very much. We recently did an episode on stigma, even in the medical community, and how hard it is for people with schizophrenia to even find therapists. That so often we’re actually turned away from basic therapy because the therapists, like you said, they don’t feel they have the skill set.
Kassie Love, MFT/MPH: Mm-hmm
Rachel Star Withers: Leaving us the only option, psychiatrists and psychologists, which a lot of times don’t work on coping skills.
Kassie Love, MFT/MPH: Mm-hmm.
Rachel Star Withers: So, thank you very much for noticing that that is a very big need in the mental health community.
Kassie Love, MFT/MPH: Right? Right. Um, and, and I always kind of take the perspective, like, I don’t feel like in the realm of psychotherapy that therapists necessarily, um, want to shut out serving people with this realm of unusual thoughts or experiences. I think there’s a lack of training opportunities. If you feel like you want to work with higher need, but you don’t know what are the resources out there to learn and understand and be supported? Um, I think it’s a big barrier, honestly for therapy and to kind of open the door for more people to do this type of work.
Rachel Star Withers: What exactly are intrusive thoughts?
Kassie Love, MFT/MPH: So, I would categorize, um, intrusive thoughts in that realm of unusual thoughts or experiences. I have some clients that come to me that use the terms psychosis. If you want to use that terms and identify with it, that’s fine. I use unusual thoughts or experiences, typically. Or I had a client, and I told that client I’m going to steal that one, describe it as extra thoughts or experiences.
Rachel Star Withers: Okay.
Kassie Love, MFT/MPH: So, I would categorize intrusive thoughts as thoughts that, um, an individual identifies with as not wanting and feeling like they don’t want to be present. And sometimes in the realm of unusual thoughts or experiences, um, I think individuals would identify some of those as intrusive, but not all of them. But for people who have extra thoughts and experiences, unusual ones, um, I recognize that not all of them feel intrusive to individuals.
Rachel Star Withers: And I think with schizophrenia that that’s where it gets difficult if you’re talking about symptoms because I’m even I, I’m like what’s the difference between an intrusive thought and a delusional thought or a command thought?
Kassie Love, MFT/MPH: Mm-hmm.
Rachel Star Withers: Hearing voices. Is that does that fall under thoughts? And I think even if it’s confusing for, for a lot of the medical community being someone with schizophrenia, it’s very confusing. It’s like hard to even say, what do I classify this thought as?
Kassie Love, MFT/MPH: Right? Auditory hallucinations, for example, there can be some conflicting literature out there on does an auditory hallucination have to appear as an external type sound?
Rachel Star Withers: Mm-hmm.
Kassie Love, MFT/MPH: Um, or can that be identified as a sound coming from within a person’s mind? And as a clinician, I’ll say sometimes it can be hard to piece out what someone identifies as an auditory hallucination or a delusion, an unusual thought. And it does seem like they kind of get mixed together. Um, so it’s not as clearly defined, um, as, you know, we’d like it to be just for diagnostic purposes. So, it does make it a challenge. But yeah, the idea of the intrusive thought, I would personally say, in working with this client population that those seem, um, like some of the most distressing of the thoughts that an individual has and cause some of the most anxiety and depressed mood. Um, and is where the coping skills work, uh, you know, really comes in best use. And I think the command type, um, thoughts may be, you know, I often hear of those as feeling most intrusive. Um, and one of the reasons, um, you know, I put that spectrum out there that maybe all of them don’t feel intrusive is one thing I see, um, in working with this client population is that, um, sometimes people have had these thoughts for a very long time. They feel like part of their identity, and maybe get a sense of comfort from having some of these thoughts around. So that can be a grieving process for clients. And they’re trying to grapple with, well, this is something I’ve known for a very long time. It’s something I identify with and get a source of comfort from. So, there’s lots of, um, nuances in there, lots of emotions and lots of different realities for people.
Rachel Star Withers: So, let’s say you have a client come to you who has schizophrenia, and they’re very bothered by strange, unusual thoughts. How do you start that treatment?
Kassie Love, MFT/MPH: Some of the first things I do is assess where you are in your treatment, what types of therapies and things like that have you had before? Um, and I think psychoeducation, giving people that opportunity around understanding what schizophrenia can be like for many people. What are the symptoms, what is the range of symptoms? It’s just important for people to have access to the information. That way they can make the best decisions about what feels like it fits well for them as a person. Family therapy is really a gold standard for schizophrenia spectrum. So, to whatever extent it’s appropriate for the client and their comfort, I invite family and support the family, as the client wants. So, that’s where I start is like the psychoeducation piece. And in that includes a discussion about the range of medications, um, how they can be helpful. And honestly, a discussion about, um, a lot of these medications have some serious side effects to grapple with because I think that’s a reality if you’re going in, um, to just kind of anticipate and understand that something that we’ll be working on, coping skills around the medication and the side effects and how you can be your best functioning self? Recognizing that, yes, the medications can be helpful for like toning down the volume of some of the thoughts and experiences, but there might be some other things that we have to do and help you in functioning with tiredness or, uh, work functioning, things like that. And if they’re experiencing a lot of distress around, um, the thoughts and experiences at that moment and when they present, then we go straight into what are coping skills that you can use in the moment. And by doing that, you know, hopefully we’re toning down some of the anxiety that tends to present, uh, because it’s this loop, um, being anxious and having depressed mood, um, feeds into those unusual thoughts and experiences. And the more of those you have, the more it feeds in back into the anxiety depression.
Rachel Star Withers: Can you give me an example of a coping skill for having intrusive thoughts?
Kassie Love, MFT/MPH: Say you’re a person that has maybe a lot of anxiety that you feel like presents when you have more of these, like, unusual thoughts, experiences. I’d like to help clients put scales together. So, rating scales. So, for example, we’ll do anxiety depression on a 0 to 3 with a zero being what feels average for you. Sometimes people use the word normal. And then we talk about what are the behaviors? If you’re feeling average and not very anxious or depressed, what does that look like for you? What would you be doing? And I start there at the behaviors instead of saying, like, what are you thinking when you’re not anxious? Um, because behaviors are easier to notice for people and easier to measure, and they’re also easier for others, like family to give you feedback on. Because they don’t necessarily know what you’re thinking, but they know what you’re doing. So, if you think, well, when I feel average, better, um, not so anxious, maybe I notice I’m taking more walks. Um, I don’t feel like I’m arguing as much, um, you know, with family members or I’m participating in more family events, or I notice that I go to church more often on the weekends. So, we talk about that, and then we talk about, okay, when I’m more anxious, feeling really bad, you know, what do I what am I doing? I’m staying in bed for a lot of hours, sleeping more than normal. Um, and then I also do that rating scale underneath that 0 to 3 for unusual thoughts, experiences, extra thoughts. Um, so a zero. Um, for a lot of people, the reality it’s not going to be I’m not having any of those thoughts or experiences. It might be I’m having them. Um, but I feel like I’m functioning well. I feel like I’m noticing them. And then I can still work. I can still participate. So, at the opposite end of that scale is okay when you feel like those thoughts and experiences are out of control for you, maybe they feel very intrusive. You, you can’t help but notice them. What does that look like?
Rachel Star Withers: When you said the 0 to 3 scale. But zero didn’t mean having no thoughts. Zero meant you’re functioning well with the thoughts. I thought that was a very important, um, point there. Thank you very much for saying that.
Kassie Love, MFT/MPH: Right? Right. Yeah. And I talk to clients and their families. That too, about leveling expectations about medication use. So, then we talk about the coping skills. And the idea is to work in sessions on okay, what is a one and two for you? What are the behaviors that are kind of warning signs that you’re starting to get more anxious, or that those thoughts and experiences are starting to increase for you? And in doing that, in figuring out what your warning signs are, that maybe you’re headed in a direction you don’t feel is best for you. Um, we pair that with, okay, this is the time to use your coping skills. Um, so say when I’m starting to notice, I’m getting more anxious. Well, then I’m going to exercise a little bit more on my lunch break.
Kassie Love, MFT/MPH: If I’m working virtually at home, that’s when I’m going to commit. You know, this week, um, I’m going to walk outside for ten minutes on my lunch break because I’m noticing I’m getting more anxious, or I’m noticing these thoughts or, you know, increasing more often and a lot of the same coping skills to decrease. You know, being anxious or depressed also ends up end up being the ones that are effective for the thoughts. Because like I mentioned, it’s often the feedback loop where, um, having those feelings around your mood and anxiety feeds into those experiences.
Rachel Star Withers: Um, for our listeners, um, who have schizophrenia, a lot of times we have thoughts that frighten us, thoughts that we don’t want to share because we’re afraid that people will think bad of us. We might be ashamed about those thoughts. What’s your advice for how can we start to get help? And a lot of us, we don’t want to say, hey, we’re having thoughts about hurting ourselves or others. We’re afraid we’re going to get, like, locked up, or that the doctors immediately going to call the police
Kassie Love, MFT/MPH: Right.
Rachel Star Withers: It. What’s your advice on how do we start to get help for that?
Kassie Love, MFT/MPH: Right. Um, and that’s a reality, right? I recognize that as a clinician. And the idea of self-harm, suicidality, that’s a reality too, um, when you have schizophrenia. No, it does not mean that, um, most people with schizophrenia have this, but it does occur at higher rates, unfortunately. So, there are therapists out there that are skilled and, um, working in more self-harm, suicidality type behaviors and that could have, um, probably better resources and coping techniques. The idea is, how can we support you to do your best functioning here without a higher level of care if it’s not needed? And I think one of the real most important things in getting in therapy with a therapist is, and this would go for just anyone. Um, be with someone that you feel good. Um, initially in session. Someone that you think is compassionate, understanding, um, you know, gets you. And, of course, if it could be someone that has some experience in, um, the idea of unusual thoughts, um, you know, if you call it psychosis, that would be, you know, wonderful.
Rachel Star Withers: How can our listeners learn more about you, therapist Kassie Love?
Kassie Love, MFT/MPH: I’m pretty easy, so my name is Kassie Love. That’s K A S S I E, and then L O V E. And so, it’s KassieLove.com. So, I’m always happy to provide like resources around treatment, even if that’s not with me. I practice in the state of Georgia. Because I do think it’s a really important need for individuals and their families.
Rachel Star Withers: Thank you so much for working in this area and working with people like me with schizophrenia and other serious mental disorders. It is very much in need. And thank you for, um, stepping up, and thank you for inspiring others to do the same.
Kassie Love, MFT/MPH: Right. And I want to thank you for this podcast and this information. I think the more that’s out there that just normalizes and shares and contributes, um, to the idea. Um, right. We still grapple with that stigma that people with schizophrenia are treated in hospitals or in specific types of facilities, and, oh, they’re not well functioning.
Rachel Star Withers: Yeah.
Kassie Love, MFT/MPH: That is just a stigma, that is far from reality. Yes, it is a reality for some. And I really focus on recovery-oriented care. What are your goals and how can we help you accomplish that while we’re using the coping skills? So, just you shedding light on the fact that, hey, these experiences, um, do happen. Um, but it doesn’t mean you can’t be functioning. It doesn’t mean there aren’t resources out there for you to grow and thrive.
Rachel Star Withers: Awesome. That is so true. Well, thank you so much for speaking with us today, Kassie. It was absolutely wonderful.
Kassie Love, MFT/MPH: Thank you so much for the time, yeah. This was great.
Gabe Howard: Rachel, as always, great job. As I was listening to the interview, I remembered the client who described them as, quote, extra thoughts, unquote. How did that hit you? Do you like it being described that way?
Rachel Star Withers: I love that, and partly because we’re so used to schizophrenia having positive and negative symptoms. Meaning positive is stuff that’s added on hallucinations, delusions, negative, meaning, um, thought disorder, deficits and whatnot. So, the idea of extra thoughts like that fits perfectly to me. If I have schizophrenia, of course I’m going to have these extra thoughts, just like my hallucinations and things. It’s just added on. I kind of like it because it’s also that’s like a non-scary way to talk about it. Did you have any extra thoughts? Did you have any thoughts that were like out of the ordinary added on with your schizophrenia this week? And I like that.
Gabe Howard: Rachel, obviously you’ve had your own experiences in handling this. What were your general takeaways from the interview? Did you learn anything hew? Was there anything that struck you as odd?
Rachel Star Withers: When I asked her how she would start the therapy. When you’re dealing with these types of situations, I loved that, she said she starts with education, with the psychoeducation like, okay, before we can even treat somebody, you need to understand what’s happening. I wish so many times when I saw a psychiatrist, psychologist in the past that they would have educated me. A lot of times they just listen and kind of like they’re writing on their little notepad and they’re checking boxes. Then they prescribe medication and it’s like, all right, goodbye. And they don’t actually talk to me, and they don’t say, hey, you’re having this hallucination. What this is, is a you’re hearing voices. You’re hearing, you know, this is a normal part of schizophrenia. Education is so important. And just like this show, talking about the fact that, yes, people have these intrusive thoughts, it’s a normal part of life. And there’s a point where they can become a problem. And just saying those things, takes a huge burden off the person who’s experiencing them. Now that I understand what it is that I’m up against, it’s a lot easier to treat it. When she said that the family needs to be involved as she gets the family involved if possible early on. If this was, like, Rachel could rule the world. Um, and they said, Rachel, how would you every new person diagnosed with schizophrenia, how would you deal with that? I think that should be the answer is education and if possible, getting the family, the loved ones in and educating them, being very clear this is what’s happening. This is what you need to look for. This is what’s a symptom of schizophrenia. So, that’s how you like, manage it together as a family.
Gabe Howard: Rachel, it’s no surprise to me that that you really relate to education. You’ve made an entire career and an entire podcast giving people the information that they need to make reasonable and better choices about their care and their loved ones’ care.
Rachel Star Withers: It’s very reassuring when the therapist, Kassie Love, talked about the different scales and she had a 0 to 3 scale. About whether you’re having certain anxiety, whether you’re having thoughts, hallucinations, delusions, and if you were to pose that scale to me, I would assume zero meant none. I’m having zero delusions. And what she said, though, was that zero just meant you were functioning well. Zero meant, yeah, you’re still having those things, but you’re managing them. Changing what we consider normal. For the most part, I would think normal is not having these horrible thoughts pop into my head, but having the diagnosis of schizophrenia, I need to learn the norm is not not having hallucinations and delusions. The norm for me is managing my schizophrenia, managing my hallucinations, my delusions, my thought problems, all of that. Managing them well and still functioning in society. That is my new norm.
Gabe Howard: And obviously that’s easier said than done. I don’t want anybody to hear that it’s simple, but it’s a worthy goal. It’s a hard goal. It’s a difficult goal, but it is a worthy goal that we all should be striving for.
Rachel Star Withers: In this episode, I’ve spoken very frank about the disturbing thoughts that I have. I’m ashamed that I have them. I feel like that makes me a horrible person. The thoughts scare me. Admitting that I have them is scary. I fear how my therapist will react, how people around me would react if they actually knew the specific content, how graphic they could be. And I don’t know if it makes it better or worse that I have no control over them. Um, because that’s a scary thought also. That wait, I don’t have control over these horrifying graphic things that pop into my head. Am I dangerous for having these thoughts? No, no I’m not. Being real about what’s going on inside of my head is how you learn to deal with them. If you’re struggling with having disturbing, obsessive, unusual, intrusive, delusional thoughts, get help. Talk to someone. See a therapist. See a medical professional. You are not a horrible, dangerous person. Everyone has inappropriate thoughts at times and you are someone who is dealing with a serious mental disorder. Of course, you’re going to have extra thoughts. It’s not ideal, but it is okay. We just have to find ways to manage our schizophrenia and manage these thoughts. Thank you so much for listening to this episode of Inside Schizophrenia. Please like, share, subscribe and rate our podcast and we’ll see you next time here on Inside Schizophrenia, a Healthline Media podcast.
Announcer: You’ve been listening to Inside Schizophrenia, a podcast from Psych Central and Healthline Media. Previous episodes can be found at psychcentral.com/is or on your favorite podcast player. Your host, Rachel Star Withers, can be found online at RachelStarLive.com. Co-host Gabe Howard can be found online at gabehoward.com. Thank you and we’ll see you next time.