In the summer of 2016, I was struggling with flaring anxiety and poor mental health overall. I had just come back from a year abroad in Italy, and I was experiencing reverse culture shock that was incredibly triggering. On top of the frequent panic attacks I was having, I was dealing with something else that was equally frightening: intrusive thoughts.

With more regularity, I found myself thinking about things like, “What would it feel like to be stabbed by that knife right now?” or “What would happen if I got hit by a car?” I’d always been curious about things, but these thoughts felt far beyond regular morbid curiosities. I was completely terrified and confused.

On one hand, no matter how awful I was feeling mentally, I knew I didn’t want to die. On the other hand, I was questioning what it would feel like to be in pain or potentially endangered enough to die.

These horribly unsettling thoughts were a large part of the reason I finally went to see a psychologist. However, I waited until the summer was over and I was back finishing my senior year of college, scared to admit I needed help.

When we met, she, thankfully, agreed that I should go on anti-anxiety medicine and see her regularly. I felt so relieved that she had suggested exactly what I, too, thought I needed.

She immediately referred me to a psychiatrist, as psychiatrists are able to diagnose and prescribe medicine, who came to my campus to see students twice a month. I had to wait about a month for an appointment, and the days ticked by slowly as the frightening thoughts continued to circulate in my head.

When the day finally came to see the psychiatrist, I blurted out everything I was thinking and feeling. I was diagnosed with a panic disorder, a mental illness I’d never heard of before, and put on a daily dose of 10 milligrams of Lexapro, an antidepressant, which I still take to this day.

Then, when I mentioned the terrifying thoughts I was having, she provided me with the relief and clarity I needed. She explained that I was experiencing intrusive thoughts, which are totally normal.

In fact, the Anxiety and Depression Association of America (ADAA) reports that an estimated 6 million Americans experience intrusive thoughts.

The ADAA defines intrusive thoughts as “stuck thoughts that cause great distress.” These thoughts can be violent, socially unacceptable, or just out of character.

The difference in my case was that, due to my panic disorder, I was fixating on these thoughts, whereas others might be like, “Oh, that was weird” and brush them off. It’s no surprise given that my panic disorder itself is composed of anxiety, panic, low-grade depressive episodes, and obsessive tendencies. When you obsess over intrusive thoughts, it can be debilitating.

The American Psychological Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defines “obsessions” as “recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance as intrusive and inappropriate, and that cause marked anxiety and distress.”

The revolutionary thing my psychiatrist told me is that my disturbing thoughts didn’t equate to desired actions. I could think something over and over again, but that didn’t mean I wanted to act on it, consciously or unconsciously. Instead, my intrusive thoughts were more like curiosities. More importantly, I couldn’t control when or if they popped into my head.

Dr. Juli Fraga, a licensed psychologist based in San Francisco, works with many patients that experience intrusive thoughts. (Note: She has never treated me as a patient.)

“Most often, I try to help them understand the nature of the thought and the feeling it may represent. I also try to use ‘grounding’ statements to see if the worry settles down. If it does not, it’s a potential sign of anxiety,” she tells Healthline.

However, some people may still blame or criticize themselves for intrusive thoughts, thinking it means there’s something deeply wrong with them. This can cause even more anxiety.

This is a common issue for postpartum women. Understandably exhausted, many women will have intrusive thoughts like, “What if I just threw my baby out of the window?”

Terrified of thinking something so awful about their child, these women may be frightened to be alone with their children or feel extreme guilt.

In reality, Psychology Today reports that new moms often have these scary thoughts because parents are wired to look out for threats to their child. But obviously, for new mothers it can be disturbing and isolating.

Fraga explains the most common misconception of these thoughts: “that the thought, especially if it’s a worrisome one about harming yourself or someone else makes you a ‘bad’ person.” Having these thoughts doesn’t mean you have a mental health condition either.

While some women can immediately dismiss these thoughts and move on, others will fixate on them, just like I do. Sometimes, this is a sign of postpartum depression, which affects millions of women each year.

Either way, postpartum women should remember that the existence of these disturbing thoughts isn’t proof that you want to hurt your child. However, you should talk to your healthcare provider if you’re concerned.

Even though you can’t always control when or if intrusive thoughts pop into your head, you can control how you react to them. For me, knowing that my intrusive thoughts weren’t things I wanted to act on really helped me cope.

Now, when my brain produces an unsettling, disturbing thought, more often than not I will make a note of it and come up with a plan for what to do.

Oftentimes, I find myself taking a seat and really grounding my feet on the floor and my hands on the chair arms or on my legs. Feeling the weight of my body in the chair allows me to recenter and observe the thought move away.

Also, when I meditate and exercise regularly, the intrusive thoughts tend to appear less often.

You can try using a variety of techniques aimed to help change the way you react to intrusive thoughts and cope better. The AADA suggests viewing these thoughts as if they’re clouds. As quickly as one will come, it’ll also float away.

Another strategy is to accept and allow the thought to be present while you try to continue whatever it is you were doing previously. Acknowledge the thought as intrusive and as something that may come back. The thought itself can’t hurt you.

How to deal with intrusive thoughts

  • Focus on the present by paying attention to what’s around you and grounding yourself in a chair or on the floor.
  • Try to continue whatever it was you were doing before the intrusive thought appeared.
  • Acknowledge the thought as being intrusive.
  • Remind yourself that a thought can’t hurt you and isn’t always actionable.
  • Don’t engage with the intrusive thought or try to dissect it.
  • Allow the thought to pass by through observation instead of panic.
  • Know that you’re in control of what you do and a thought is just a curiosity.
  • Meditate regularly if you can.
  • Consider taking medication if you and your doctor think it’s necessary.
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At the same time, avoid habits that can feed the thought. The ADAA explains that engaging with the thought and trying to figure out what it means, or attempting to push the thought from your mind, will likely have a negative effect. Observing the thought as it passes while not engaging it is key here.

While intrusive thoughts themselves aren’t dangerous, if you believe you’re experiencing something more, such as postpartum depression or suicidal thoughts, and may be a danger to yourself or others, seek help immediately.

Fraga explains that a thought crosses the line, “When someone can’t discern between a ‘thought’ and an ‘action,’ and when the thoughts interfere with one’s ability to function at home, work, and in personal relationships.”

Even if you don’t feel this way but would like to discuss how intrusive thoughts are affecting you, speak with a psychologist or psychiatrist.

As for me, I still notice myself having intrusive thoughts at times. However, knowing they’re nothing to be concerned about makes them, thankfully, usually much easier to brush off. If I’m having an off day in which my panic disorder is flaring, it can be more difficult, but that fear is nowhere near as prominent as it once was.

Taking my anti-anxiety medicine daily and forcing myself to be present and grounded in the moment have made a world of difference when dealing with intrusive thoughts. I’m forever grateful that I found the strength to stand up, admit I needed help, and follow through on the changes I had to make. While it was incredibly hard to do, it truly has made all the difference.

Sarah Fielding is a New York City–based writer. Her writing has appeared in Bustle, Insider, Men’s Health, HuffPost, Nylon, and OZY where she covers social justice, mental health, health, travel, relationships, entertainment, fashion and food.