What to Do When Your Client Can’t Stop the Intrusive Thoughts Causing Panic
By Felix Murad, M.Ed., LPC-S, Licensed Professional Counselor-Supervisor (Texas & Washington)
The honest answer is the one neither of you wants: you don’t make them stop. A clinician’s guide to using skills instead of reassurance.
Your client is panicking. “Make it stop. Tell me I’m not going to do it. Just tell me why I keep thinking this.” Every instinct you have, and every reflex training has installed in you to be helpful, is screaming to soothe, to reassure, to explain the thought away.
Resist all of it.
The most important thing to understand in this moment is that the thing your client is begging for is the thing keeping them stuck. “Stop the thoughts” is not a goal you can grant, and reassurance is not a kindness; it’s a compulsion you’d be performing on their behalf. Here’s what to do instead, and the language to do it with.
A quick note: this is clinical education for trained professionals, not a substitute for supervision or for OCD-specific training. Individuals seeking therapy for OCD or intrusive thoughts can visit OCD therapy at Murad Counseling. If a client is in crisis, 988 (call or text) is available.
First: understand why “stop the thoughts” is the wrong target
You can’t white-knuckle a thought out of existence, and the harder you try, the worse it gets. This isn’t motivational; it’s mechanical. Thought suppression produces a paradoxical rebound: trying not to think something makes it more frequent and more salient, and that finding holds up across the controlled literature, not just Wegner’s original white-bear studies (Wegner et al., 1987; Abramowitz, Tolin, & Street, 2001). So when you promise a client you’ll help them stop the thoughts, you are promising to make them worse. That’s the answer neither of you likes.
The reframe you offer instead: we are not going to stop the thoughts. We’re going to change your relationship to them so they lose their grip. And you can take some of the threat out of the room immediately with psychoeducation, because the thoughts themselves are not the problem. Intrusive thoughts are close to universal; in a study across six continents, about 94% of people reported having them, and the content people find most repugnant is among the least common, not the most (Radomsky et al., 2014). What separates a passing intrusion from a clinical obsession isn’t the thought. It’s the appraisal, the catastrophic meaning assigned to it, and the struggle that follows (Salkovskis, 1985; Rachman, 1997).
Catch your own reassurance reflex before it fires
Here’s the uncomfortable part: the urge to reassure is usually about your discomfort, not the client’s need. A panicking client activates your nervous system, and reassurance is how you discharge your own anxiety while telling yourself you’re helping.
But reassurance (“you’d never actually do that,” “that’s not who you are,” “it’s just anxiety, it doesn’t mean anything”) buys ten seconds of relief and then deepens the trap. It confirms the thought was a genuine threat that required neutralizing, and it trains the client to come back for the next dose. It is, functionally, a compulsion you’re supplying. And it’s slippery: covert reassurance counts too: analyzing the content with them, debating whether the thought is “true,” helping them mentally check. The discipline is this: do not answer the obsessional question, even when asked directly, even when the reassuring answer seems harmless and kind. Especially then.
(This is why your own regulation is the first skill, the same point that governs in-session de-escalation. A dysregulated clinician reassures.)
Validate the distress, never the content
Refusing to reassure is not the same as being cold, and new clinicians collapse the two. You can and should validate how genuinely awful this feels and how hard it is to sit with, without validating, analyzing, or arguing the content of the thought.
The move sounds like: “This is really painful, and I can see how frightening it is. And you’re doing something genuinely hard right now by staying with it instead of running.” That’s empathy for the suffering. What you don’t do is follow it with “…and I’m sure you’d never act on it,” which yanks you right back into reassurance. Validate the person and the pain. Leave the content alone.
For the panic in the room: present-moment as willingness, not escape
When the client is acutely panicking, lend them your regulated nervous system first, then guide them into the present: feet on the floor, the breath, the five senses, the simple act of naming what’s actually in the room.
But frame it precisely, because this is where clinicians accidentally teach avoidance. Grounding is not a trick to make the thought or the panic go away; deployed that way, it’s just another neutralizing ritual. It’s a way to come back to the present and allow the wave to be there. Panic is a false alarm that crests and passes on its own; fighting it is what sustains it. So the instruction isn’t “do this until it stops.” It’s “let’s be here while this moves through. You don’t have to do anything about it.”
Teach defusion: unhook without trying to delete
Defusion helps the client see a thought as a thought rather than as a command, a prophecy, or a truth. The classic moves: “I’m having the thought that…” prefacing; naming it (“ah, there’s the harm thought”); watching it like a leaf carried downstream; noticing it without obeying it.
One caution that separates skilled ACT work from cargo-cult ACT: defusion can be hijacked into covert suppression. If the client does the leaves-on-a-stream exercise in order to make the thought leave, the agenda of elimination has snuck back in through the side door, and you’ve built another compulsion. The purpose of defusion is to unhook and create room for willingness; it is supposed to be indifferent to whether the thought stays or goes. Watch for the client (and yourself) using the skill as a weapon against the thought.
Willingness: the actual engine
Here is the mechanism everything else serves. The client gets better not by winning against the thought but by dropping the struggle and being willing to have the thought and the anxiety present without neutralizing them (Hayes, Strosahl, & Wilson, 2012). That willingness is the inhibitory-learning process underneath exposure work: the client learns the thought isn’t dangerous and the anxiety is survivable precisely because they didn’t perform the compulsion that usually cuts the experience short (Craske et al., 2014). Stop neutralizing, and new learning becomes possible.
This is also why the approach is evidence-based rather than philosophical: ACT has randomized-trial support for OCD, including head-to-head against an active comparison (Twohig et al., 2010). The research base names the lever explicitly: experiential avoidance, the unwillingness to stay in contact with the intrusion and the anxiety, is much of what turns a normal intrusion into a clinical obsession (Radomsky et al., 2014). Willingness is the antidote, and it’s the opposite of reassurance.
Round it out with self-as-context, the observing part of the client that notices the thought is not itself endangered by it (“you’re the sky; the thought is weather”), and values and committed action: keep moving toward what matters with the thought present, rather than letting the thought dictate behavior. The aim is a life lived in the presence of the thoughts, not a life spent waiting for them to leave.
The nuance you cannot skip: no reassurance is not no assessment
This one matters enough that I’ll be blunt about it. Withholding reassurance does not mean withholding risk assessment. When a client reports a suicidal or harm-themed intrusion, you still assess genuine risk carefully, because OCD does not immunize anyone, comorbidity is common, and a real intrusive obsession and genuine ideation can coexist in the same person. The discipline of not reassuring is about refusing to feed the compulsion; it is not permission to assume “it’s just an obsession” and skip the assessment. Hold both at once: assess thoroughly, then respond to a confirmed ego-dystonic obsession as an obsession (skills, not reassurance), and to genuine ideation as risk. The full version of that differential is in the suicide-risk piece; don’t run this skill without it.
And know your edge: if the thoughts are pervasive, distressing, and driving compulsions, you’re likely looking at OCD, where ERP and ACT are the indicated treatments. If you’re not trained in them, that’s a referral or a consultation, not something to improvise.
Frequently asked questions
Isn’t refusing to reassure cruel when someone is panicking? No. Reassurance is the cruelty that wears a kind face, because it keeps the client sick. The compassionate move is to validate the distress, lend your calm, and teach the skills that actually free them. Warm and non-reassuring are fully compatible.
Is telling them intrusive thoughts are normal just reassurance by another name? No, and the line is sharp. Normalizing the universality of intrusions is psychoeducation, delivered once, as information. Answering the specific obsessional doubt (“but will I actually do it?”), especially on demand and repeatedly, is reassurance. The tell: if you’re answering the doubt to relieve the anxiety, it’s a compulsion.
What if I slip and reassure? You will, early on. Notice it, and you can even name the pattern with the client (“I just answered the doubt for you. Let’s notice how that gave a little relief, and why we don’t want to keep doing it”). That’s a teaching moment, not a failure.
How do I actually get good at not reassuring? It’s a reflex, and you can’t read your way out of a reflex. You get good by being observed catching it in real time and corrected, which is what supervision is for.
Before your next anxious-thought session, sit with these
- When a client begs you to make it stop, whose distress are you actually trying to relieve in the moment you reach for reassurance?
- Can you tell the difference, in your own sessions, between psychoeducation and reassurance, or do they blur exactly when the client is most distressed and most insistent?
- You’d never tell a phobic client to keep avoiding the thing they fear. Why is offering reassurance about an intrusive thought any different?
You can’t read your way out of a reflex
Everything above is learnable, but the reassurance reflex in particular doesn’t yield to reading; it yields to being caught in the act and corrected. The fastest way to stop accidentally reinforcing your clients’ OCD is to have someone watch you work and flag the moment you reach for the reassuring answer. That’s the kind of observed, skill-level supervision I do with clinicians building anxiety and OCD practices.
Crisis resources: 988 Suicide & Crisis Lifeline: call or text 988 (24/7).
Felix Murad, M.Ed., LPC-S, LMHC, CMHC, NCC, Licensed Professional Counselor-Supervisor. Licensed in Texas, Washington, New Hampshire, and Florida (telehealth). This article is professional education for clinicians and is not clinical or medical advice, nor a substitute for individualized assessment, OCD-specific training, supervision, or emergency care.
References
Abramowitz, J. S., Tolin, D. F., & Street, G. P. (2001). Paradoxical effects of thought suppression: A meta-analysis of controlled studies. Clinical Psychology Review, 21(5), 683–703.
Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy, 58, 10–23.
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.
Rachman, S. (1997). A cognitive theory of obsessions. Behaviour Research and Therapy, 35(9), 793–802.
Radomsky, A. S., Alcolado, G. M., Abramowitz, J. S., Alonso, P., Belloch, A., Bouvard, M., … Wong, W. (2014). Part 1-You can run but you can’t hide: Intrusive thoughts on six continents. Journal of Obsessive-Compulsive and Related Disorders, 3(3), 269–279.
Salkovskis, P. M. (1985). Obsessional-compulsive problems: A cognitive-behavioural analysis. Behaviour Research and Therapy, 23(5), 571–583.
Twohig, M. P., Hayes, S. C., Plumb, J. C., Pruitt, L. D., Collins, A. B., Hazlett-Stevens, H., & Woidneck, M. R. (2010). A randomized clinical trial of acceptance and commitment therapy versus progressive relaxation training for obsessive-compulsive disorder. Journal of Consulting and Clinical Psychology, 78(5), 705–716.
Wegner, D. M., Schneider, D. J., Carter, S. R., & White, T. L. (1987). Paradoxical effects of thought suppression. Journal of Personality and Social Psychology, 53(1), 5–13.