(De)toxifying Your Thoughts

The Anxious Thoughts Workbook   by David A. Clark, PhD.

The Anxious Thoughts Workbook by David A. Clark, PhD.

If you struggle a lot with anxious thoughts, you might feel like you need a mental detox.

I don’t mean the kind that requires drinking tons of juice or buying fancy supplements—sorry, but that’s probably pseudoscience. Mental detoxification is a term that David A. Clark, PhD, the author of one of my favorite mental health workbooks, uses to refer to the process of learning how to be less attached to your negative thoughts, making them less “sticky” and letting them come and go more peacefully. 

Dr. Clark’s advice is based on a paradox that those of us who have struggled with anxiety are all too familiar with—we are desperate to get rid of these anxious thoughts, but in trying to do so, we pretty much guarantee that they’re going to stick around and get even worse!

In The Anxious Thoughts Workbook, which you’re almost guaranteed to see me pull out at some point if you’re my client, Dr. Clark lays out a seven-step process for learning mental detoxification. Here’s an overview. This will make almost zero sense right now, but fear not! We’ll come back to each step in full, gory detail.

Seven Steps to Mental Detoxification

1. Name a toxic intrusive thought

2. Name a nontoxic intrusive thought

3. Write a toxic-significance narrative

4. Write a nontoxic insignificance narrative

5. Toxify your nontoxic thought

6. Detoxify your toxic thought 

7. Write a detoxification narrative

Sidenote: wow, the word “toxic” looks really weird to me right now.

Let’s jump right in! For best results, grab a notebook or piece of scrap paper and a pen. Or open up a note on your phone or computer.

Step 1: Name a toxic intrusive thought

What’s a toxic intrusive thought? From the workbook:

Can a thought be toxic? In brief, yes. Certain maladaptive ways of coping can turn negative intrusive thoughts, images, or memories into frequent, highly distressing cognitions that are toxic for your well-being. This is what happens when we misinterpret the significance of our unwanted mental intrusions. When we overestimate their emotional significance, we are more likely to lose control of them. We turn some types of common spontaneous thought into toxic mental flotsam that can wreak emotional havoc on our daily lives.

“Toxic Mental Flotsam” may be a great band name, but it’s a terrible thing to have to deal with. One important thing to note, though—like many therapists who use Acceptance & Commitment Therapy as their primary approach, Dr. Clark believes that intrusive negative thoughts aren’t necessarily “bad,” “wrong,” or evidence of mental illness or dysfunction. They’re actually quite normal; everyone has them. The key is to deal with them in ways that let them come and go rather than stick and cause us pain. They’re a lot like that plaque stuff that builds up in our teeth and gums when we don’t floss. Bacteria = totally fine. Letting bacteria build up for months or years because flossing is boring and sucks = not great. Not great at all.

To choose your toxic intrusive thought, think of a thought that:

1. Repeatedly triggers feelings of anxiety or depression

2. Is highly distressing

3. Makes you want to shut it down or push it away

4. Sets off a cascade of other negative thoughts

Here’s my example: I will never be truly healthy again.

Whenever I have this thought related to my past cancer treatment, I feel anxious and depressed about my future. It’s really distressing and I wish I could get rid of the thought, but I usually can’t. When I have this thought, a number of other thoughts usually follow close behind: My boobs are fake. I could have a recurrence, and if I do, it’ll be metastatic. I’ll probably die of this. I’ve wasted so much time. Everyone else is doing stuff I can’t do because I got sick. I’m probably the reason my family is so stressed. My bones will be ruined because of early menopause. I’ll probably be completely useless by the time I’m 50. And on and on it goes!

Write down your own toxic thought.

Step 2: Name a Nontoxic Intrusive Thought

Thinking about that cool toxic thought? Awesome, now let’s switch gears for a moment. This step might actually be a bit harder—identify a negative thought that comes up for you pretty often, but that doesn’t feel so sticky and distressing. You might feel bad when you think about this thought, but you don’t get attached to it the way you do with your toxic thought. 

Here are some questions that might help identify a nontoxic intrusive thought:

1. Are there any problems or situations in your life that are unpleasant but not personally concerning? This could be something fairly common, like a minor stressor, a disagreement with someone, feeling annoyed at your loved ones, or a non-serious medical issue such as a cold or allergies.

2. What thoughts pop into your head when you think about this problem or situation?

3. When your mind wanders or you’re daydreaming about this problem or situation, what are you thinking?

Here’s my example: When I drive home from work, the traffic is usually pretty bad and even though I try to entertain myself with music during my commute, I still often have a pretty miserable time. I notice thoughts such as I hate this traffic, This is such a waste of time, and If only they wouldn’t shut down so many roads all the time, it wouldn’t be this bad.

Write down your own nontoxic thought.

Step 3: Write a toxic-significance narrative

Now we’re going back to that toxic thought from step 1. Reread the thought you wrote down.

A toxic-significance narrative is your interpretation of why this toxic thought is so personally significant to you. It’s what keeps this thought so sticky, keeps you feeling like you need to pay attention whenever this thought comes up.

Here are some questions to ask yourself to figure out your toxic-significance narrative:

1. What does this thought say about the type of person you are? Does it make you question something about yourself?

2. What does this thought have to say about your future? Do you think that it increases the chances of something bad happening to you or your loved ones?

3. Does this thought remind you about something really painful from the past?

4. How does having this thought affect your day-to-day life? How does it get in your way? What does it keep you from doing?

5. What makes it so important to get rid of this thought?

Here’s my example:

When I have the thought that I’ll never be truly healthy again, it makes me feel like I’ve learned nothing from the experience of surviving cancer and that I’m just as weak and pathetic as I always feared I was. I feel like having this thought will just make it likelier that I’ll fail to take care of my health and bring more stress to my loved ones’ lives. When this thought comes up, I start thinking about the trauma of surgery, of finding out I have cancer, of having to call and tell my mom, of how horrible it was to have to relearn how to walk, move my arms, and be active after my surgery. I often become so upset that I can’t go out and do what I’d planned, which is usually exactly the sort of things that help maintain my health. Sometimes I end up crying or just being lazy in my room for hours. I feel like I need to get rid of these thoughts to move on from my treatment and stop being such a burden on everyone in my life. Nobody wants to still be hearing about this. I should just be grateful I’m alive.

Write down your own toxic-significance narrative.

Step 4: Write a nontoxic insignificance narrative

Almost halfway there! 

Now, we’re going to look at our nontoxic intrusive thoughts again, and examine what makes them so nontoxic. If your toxic thought was very personally significant and felt very important to pay attention to, your nontoxic thought is just the opposite:

“In this case, you’re making an interpretation of insignificance. You’re telling yourself, ‘Look, it’s okay to think this way. It’s perfectly normal to have thoughts like this. Nothing bad will happen to me; these thoughts will eventually stop.’ When you generate this neutral interpretation of a negative intrusion, you are essentially normalizing the thought. You conclude that the negative intrusion is nontoxic. You might even treat it as trivial or even meaningless.”

For your nontoxic insignificance narrative, you’ll describe what allows you to treat this thought as insignificant. Some questions to ask yourself:

1. Do you feel like this thought doesn’t have anything in particular to say about who you are as a person?

2. Do you believe that whether or not you happen to have this thought has no bearing on what happens in the future?

3. Do you assume that there isn’t much you can do about this thought, and that you’re not personally responsible for the fact that it popped up?

4. Did you decide that it’s not important to try to get rid of this thought, since it’s not limiting you or affecting you very much in any meaningful way?

Here’s my example:

Driving in traffic sucks, so it makes sense that I’d have a number of negative thoughts about it. I’m pretty sure just about everyone has these types of thoughts about rush hour, so I don’t think it means anything about the type of person I am. Whether or not I notice and think negatively about the traffic has nothing to do with how much traffic it is, how quickly I get home, or even what I’ll do when I get home or next time I have to drive. I don’t think there’s anything I specifically did that caused this thought; I have to drive home, and there don’t seem to be any practical ways to avoid rush hour traffic. The thoughts are unpleasant, but they’re not actually hurting me or limiting my life, so it would be a waste of valuable energy to try to shut them down. Besides, I need to focus on the road as much as I can, not on suppressing thoughts.

Write down your own nontoxic insignificance narrative.

Step 5: Toxify your nontoxic thought.

Now that you have that nice nontoxic thought, let’s straight-up fuck it up!

(Don’t worry, this is not likely to actually make you depressed or anxious—you’ll realize how exaggerated it is.)

This next step asks you to think about your nontoxic thought as if it were your toxic thought from before. Dr. Clark calls this part of the exercise “How to Create Distress.” A useful skill if there ever was one!

Here’s how to turn a thought toxic:

1. Exaggerate the negative, threatening, or upsetting possibilities associated with the intrusive thought.

2. Focus on how you could be personally responsible for everything associated with the intrusive thought.

3. Convince yourself that the repeated occurrence of the thought means that it’s important and deserves your upmost attention.

4. Imagine that having this intrusive thought increases the likelihood of a negative outcome for you or your loved ones.

5. Assume that you need to get rid of this intrusive thought as soon as possible, and that if you fail to get rid of it, your anxiety or depression will get even worse.

Here’s how I applied this to my rush hour example:

If I keep getting upset or annoyed about the traffic, I could get so distracted I could cause a crash. Or I could just keep getting more and more miserable until I can barely stand driving at all, and then I have no idea how I’d get to and from work or do almost anything I enjoy. I’ll have to switch to commuting by bike, but that’s a half-hour ride each way, and what about really hot or cold weather, or snow or storms? I don’t understand what’s wrong with me that I keep having these thoughts while driving. I must just be a really anxious or irritable person. Maybe I’m just not cut out for the responsibility of going to work every day. I feel like if people knew how much I thought about this, they’d think I’m completely inept. I seem to think about this every single time I drive home, so obviously it’s a problem. I need to find a way to stop having these thoughts while driving. Maybe I could just start staying really late at work—but it would have to be at least two hours after the office closes, because that’s how long the traffic stays bad. I’d have to stop going to the pool to swim after work, or making dinner plans with friends until after 7. 

Write down your own distressing interpretation of the nontoxic thought you identified.

A Brief Aside

Something you might have noticed is that in these exercises, we’re not necessarily talking about the content of the things you’re having anxious thoughts about. We’re talking about the thoughts themselves. This distinction can be difficult to grasp at first, but it’s integral to the way therapy works. As I mentioned earlier, toxic thoughts are toxic because of the way we react to them, not because of any quality inherent to them.

It’s tempting to assume that these thoughts stick because they’re so high-stakes. Indeed, as you’re doing this exercise, your toxic thought probably concerns something with major implications for your life or health; your nontoxic thought is probably pretty banal, like mine.

But here’s the interesting thing: I didn’t choose “My cancer could come back” is my toxic thought, even though that’s arguably a way bigger deal than the thought that I won’t be quite as healthy as I would’ve been if I’d never had cancer. I didn’t choose it because that’s not what really bothers me. For me, the thought of cancer recurrence is actually a nontoxic thought. It seems completely normal to me as a survivor, and while it hurts, I tend to just let it go. It doesn’t mean much to me, to have that thought.

This is why Dr. Clark explains:

One of the main ways to turn a negative thought into a distressing one is to imagine terrible consequences for yourself or others if you continue to dwell on the unwanted thought. …Reacting to a thought as if it were a catastrophe is a sure way to create a highly significant emotional thought.

If this doesn’t quite make sense yet, don’t worry—it takes time. For now, on to the next step.

Step 6: Detoxify your toxic thought.

Now that we’ve imagined what it would be like if we thought about our nontoxic thoughts in the same personalizing, catastrophizing ways we think about our toxic thoughts, it’s time to flip that process around and detoxify.

Cognitive behavioral therapy (CBT) gives us a whole set of tools for defusing painful thoughts. Here, we’ll apply two of them: decatastrophizing and reality testing

Decatastrophizing is particularly useful if your toxic thought is centered on imagining terrible future possibilities. It helps you shift your perspective a bit, without forcing you to try to “get rid” of the overly negative interpretation entirely.

Here are three questions to ask yourself to decatastrophize:

1. What’s the real probability that the worst-case scenario will happen?

2. Are there any positive aspects to this intrusive thought? (Note: this is not the same as trying to find a silver lining in the outcome you’re afraid of. This is asking about having the thought itself.)

3. Is there any evidence that this intrusive thought is only mildly distressing and actually tolerable?

Here’s my example:

I don’t actually know how likely it is that I’ll ‘never be healthy again’ because I haven’t actually defined what that even means. For example, there are plenty of unhealthy people who have never had a serious illness. Sometimes that’s due to lifestyle, and sometimes it’s just genetics, trauma, poverty, or otherwise bad luck. I know many cancer survivors who are physically active and able to do the things that matter. Many even say that their illness pushed them to take better care of their health because they stopped taking it for granted. I’m definitely one of those people, which makes it even more unlikely that I’m going to face avoidable health problems. On the bright side, having these fears about my health helps motivate me to stay active, eat well, and keep up with my appointments. Although these thoughts are painful, if you really look at it, I’m not ‘losing’ all that much time to dealing with them. Maybe it’s okay to sometimes just cry and worry about my health. My life is still full and I’m still moving forward, thoughts or no thoughts.

Write down your own decatastrophizing answers.

The second tool, reality testing, is especially useful if you feel like your toxic thoughts significantly affect your real-life outcomes. If you think that way, you’re naturally going to assign a lot of significance to these thoughts. But how much power do they really have to shape reality? (Needless to say, I’m not a believer in the “law of attraction” and neither are most scientifically-minded mental health professionals.)

Here are two questions to ask yourself:

1. Do you have any past experiences that show that intrusive thoughts directly caused a negative consequence? Is there any evidence that the thought is unrelated to what actually happens to you or your loved ones?

2. Is there any evidence that the intrusive thought is a product of your imagination, rather than an indicator of what will realistically happen?

Here’s my example:

Although focusing on my negative thoughts about my health can be a barrier sometimes, I don’t really see any evidence that it’s kept me from taking care of my health as much as I can. Instead, I can see that I’ve been active, doing physical activities I enjoy and eating nutritious food that feels good to me. In the past, I’ve feared things that never seemed to actually happen, even if some of my fears do come true. That seems inevitable when you have a lot of fears. I also don’t really have any specific reasons to assume that my health will forever be wrecked because I had cancer. That’s more likely to be coming from my sometimes-overactive imagination, and the fact that my brain is doing what brains do and generating scary possibilities for me to protect myself from. It’s not necessarily coming from a rational place, and that’s valid and okay.

Write out your own reality test.

Step 7: Write a detoxification narrative. 

This is where you pull it all together and write out a new way to think about your formerly-toxic thought. It’s okay if this narrative doesn’t “feel” real right now—thoughts like this feel more real over time, as you intentionally rehearse them. Who knew! Thoughts have to be rehearsed sometimes, just like a play or musical piece.

Rehearse your new thoughts like they’re your next hit single.

Rehearse your new thoughts like they’re your next hit single.

For this final narrative, you’ll reinterpret your toxic thought through the lens of your nontoxic thought, and of the detoxification exercises you just completed. It might help to reread what you wrote for step 4.

Here are some guidelines for writing this narrative:

1. Emphasize how the intrusive thought is more neutral and less threatening than you’ve been assuming.

2. Emphasize the evidence you’ve found that this intrusive thought is perfectly “normal” and that you don’t need to assign high significance to it.

3. Think of the intrusive thought as a product of your imagination—something that can’t actually cause things to happen out in the world.

4. Notice how you’re able to experience the intrusive thought without significant impact to your everyday life.

5. Begin from the premise that you can’t choose to turn off this thought—or else you would’ve done so already. Since you’re probably going to be having this thought for a while, see if you can find a way to use it in a positive way—for instance, to remind yourself of what’s important and to prompt yourself to take meaningful action.

6. Make sure that your new narrative is consistent with your actual experience—otherwise this won’t feel plausible to you at all. Don’t sugarcoat things or overlook actual problems going on in your life. (For instance, I kept it pretty real about how I do in fact sometimes mope in my room and cry because of my intrusive thoughts.)

Here’s my example:

It seems completely normal to worry about my future health when I’ve had fucking cancer at such a young age. In fact, while the thought that I’ll never be truly healthy is painful, I can use it as a reminder to make sure that I’m doing what is in my control—and getting rid of this thought definitely isn’t. Nothing about having this thought actually keeps me from doing what I need and want to do. Hell, I could be working out and still thinking ‘I’ll never be healthy’—but what I’ve found is that this thought rarely comes up when I’m actually out there living my life. It’s mostly something my brain invents to occupy itself when I’m idle, lonely, or bored. The fact that I have this thought doesn’t actually mean anything about my future health, and all evidence points to the high probability that I’ll live a long, good life. 

Write out your own detoxification narrative.

That’s it!

I mean, just kidding. That’s obviously not it. This narrative might not feel nearly as real or attention-grabbing for you as your old, toxic narrative. That’s okay. It takes time and practice to rewrite our mental scripts in this way. You can always come back to and reread what you’ve written for this exercise, but it can be even more helpful to just go through it again.

I’ve created a worksheet you can use with this article. It’s a fillable PDF, so you can either print it out or fill it out on your phone, tablet, or computer. Download it here.

Happy detoxing!