Intrusive Thoughts

fourth trimester intrusive thoughts mental health postpartum postpartum recovery psychology Apr 24, 2023

Intrusive thoughts are unwanted or unconscious thoughts that pop into our conscious mind. During the postpartum period, they are often related to accidental harm or intentional harm to baby, and can feel very disruptive, frightening, and isolating for new parents to experience. Dr. Sarah Lea and Psychologist, Bsc, MACP, RPsych and Co-Founder of Mama Psychologists Chelsea Bodie discuss this phenomenon and how to best support patients that may be struggling with it.



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[00:00:50] Dr. Sarah Lea: Good morning Chelsea. Thanks for joining me.

[00:00:52] Chelsea Bodie: Thank you so much for having me today.

[00:00:54] Dr. Sarah Lea: I'm super excited to have you on our podcast to be talking about [00:01:00] such a very important topic, intrusive thoughts.

[00:01:03] Chelsea Bodie: Yeah. So important and so common, right? I think a lot of people are scared to say it out loud, but I think the research shows like 70%, like minimum of mom's experience, intrusive thoughts. So they're saying like upwards to a hundred percent.

[00:01:16] Dr. Sarah Lea: Oh, for sure. For sure. So yeah, so important. I'm wondering if perhaps you could start by just introducing yourself to us and telling us a little bit about who you are and why you and I are gonna talk about this topic today.

[00:01:28] Chelsea Bodie: Sounds good. I sometimes I do say we, cause I'm usually with Caitlin. Yeah. So if you hear the we, think of it as like the royal we . But so I'm Chelsea. I'm one half of Mama Psychologist, so I co-founded it with my colleague and best friend Caitlin. So we are moms to four kids, five and under. So we're in the thick of toddlehood together, and I'm also a registered psychologist in Alberta, Canada. That's a little bit about my professional background. But really, I guess honestly what brought us here and what made us [00:02:00] so passionate about this topic is Caitlin and I both had some really rough postpartum experiences and so Caitlin suffered from significant postpartum anxiety. She had a lot of trouble even like leaving her house, driving, those kind of things. And then with my firstborn, we had a three and a half month NICU stay. So it just threw my world upside down. And when we were in the thick of postpartum, we were both like, we are quote unquote, equipped to handle this. We have the training, we've worked with families for years and we are floundering, like how, where are all these resources and for the mental health of new moms? And we felt like it was really lacking. So in our postpartum fog, we're like, do you wanna do this together and reach some like local local people? And we both just jumped in and started doing Mama Psychologists and here we are three years later, still do, still doing it and trying to educate and share as much information about these topics as we can.

[00:02:57] Dr. Sarah Lea: Yeah, it's amazing. And I will share that we [00:03:00] got the opportunity to connect, oh my gosh, two years ago now maybe more. Yeah. And and shared a podcast of your experiences with Caitlin. So I will link that in the show notes if folks wanna hear your experiences with postpartum. Cuz I think it's so important for it to be normalized that we all go through it.

[00:03:16] Chelsea Bodie: Yeah, absolutely. No, and even it's so different, even when you have more than one child. I remember bringing my daughter home. My son was about two and a half. He's sobbing, she's sobbing, I'm sobbing. It's just it's not a pretty picture. And it's sometimes, it's hard to admit that and hard to share that.

[00:03:31] Dr. Sarah Lea: Oh, absolutely. Yeah. So let's dive in and can you just start by telling us what intrusive thoughts are?

[00:03:38] Chelsea Bodie: Absolutely. So intrusive thoughts are basically unwanted or unconscious thoughts that pop into our conscious mind, and they're often related to accidental harm or intentional harm. So this could be under things such as a really common, categories of intrusive thoughts would be accident or injury. So dropping the baby. Something happening to baby. Sickness or [00:04:00] health related things. So baby getting sick needing to go to the hospital, even death related, right? If they got sick and they died, violence from self or from others. So this could be like if you're holding baby and you're in the kitchen and you're like, oh my gosh, what if I like dropped a knife in that, cut baby and hurt baby.

[00:04:14] Or what if somebody else came in and tried to kidnap my baby? Just different things like that. And often the least talked about is like sexual thoughts related to harm. To your child. So this could be things such as from yourself or from somebody else as well. So that can be really hard for parents to talk about.

[00:04:33] Dr. Sarah Lea: Yeah. Oh my gosh. It's when you say that, I, with my first definitely had postpartum anxiety and had like very specific intrusive thoughts and they were all around like dropping the baby, pushing a stroller out into traffic. And then SIDS, like sleep related stuff. Yeah. Yeah, totally. And it's just oh my gosh, they're so vivid. Right.

[00:04:53] Chelsea Bodie: Yes. Yeah. They can be. And they're often unwanted, uncontrolled, right? It just happens. And so it can feel really disruptive [00:05:00] and very scary for new parents to experience, especially if they haven't been talked about it before. Cuz it's like, how do, what's happening? Like why are these thoughts coming up for me? But research shows that intrusive thoughts are actually rooted in like an evolutionary basis. So we wanna be heightened, right? We wanna have, be more aware of the dangers that are in our environment to protect our baby. Now sometimes those aren't always constructive it's sometimes it's just nice to know that these are actually rooted. There's a reason for these thoughts coming up and happening.

[00:05:29] Dr. Sarah Lea: Yeah. And I think it's like an interesting example Alicia gave was, like worrying about your baby drowning in the bath. That's a protective don't leave your baby alone in the bath. But if you're unable to bathe your baby because you're so scared, yeah. So it's really interesting that it's rooted in biology and evolution, which totally makes sense, but it doesn't necessarily make those really bad ones any less scary.

[00:05:51] Chelsea Bodie: No, for sure. For sure. And you nailed it, right? We want these thoughts to feel disruptive. We want them to feel uneasy. We want to think about the - [00:06:00] think about the dangers and what's going on, but we don't want them to be so disruptive that we can't do things right? Like we've had moms where they're so afraid of dropping their baby down the stairs that they can't go down the stairs and they might like scoot on their bums or just not, they create their life so they don't have to do those things. And obviously if it gets to that realm, then definitely that's like an area where we're like, okay, that's time to get support, time to look for help and time to try to figure out ways to manage it a little bit differently so that it's not so disruptive in your life and you can recognize it and move forward.

[00:06:30] Dr. Sarah Lea: Yeah. Yeah. Oh man. I'm like reflecting back to my time. How do you recommend, like providers talk to patients and clients about intrusive thoughts? Do they, do you talk about them before they happen? Should you prepare people to expect they might come? What would you recommend folks do?

[00:06:48] Chelsea Bodie: I think it depends where you're at in that relationship. Obviously, if you can do it before that's best, that's great. I think that opens the doorway to those conversations later on. So you know, when you are working with somebody who has interests of thoughts, they feel more [00:07:00] comfortable like sharing that with you. However, sometimes that's not possible, right? Sometimes we have a new relationship or you meet them afterwards and in those scenarios, I definitely recommend just being as blunt and as straightforward as you can, right? Because I think sometimes when we use like euphemisms or if we're using like different language, it's easy to get a skirt around the question, whereas it's this is a really common issue that new moms experience, parents experience, and this is what it: have you had this happen? And I think that it gives that opportunity to be like, okay, here's some normalization, some psychoeducation around it, right? But also like we can talk about it. That's okay.

[00:07:36] Dr. Sarah Lea: Yeah. I think it's so true. Normalizing is so important because people are just so vulnerable and scared during that new postpartum period when your body's changed, your life is turned upside down. You're not sleeping your hormones all over the place. And just to know that you're not alone in what you're going through.

[00:07:55] Chelsea Bodie: Oh, absolutely. Yeah. We hear from parents all the time. That's one of the most common things is I had no [00:08:00] idea this could happen or, I had no idea that it was so common and everyone else is going through this as I'm sitting, rocking my baby at 3:00 AM thinking I'm going like insane. I'm not understanding where my feelings and thoughts are coming from.

[00:08:11] Dr. Sarah Lea: Yeah, it's so true. It's something that we definitely need to talk about more. And so I'm glad we're talking about it.

[00:08:17] Chelsea Bodie: Yes. No, absolutely. I think it's getting more common, especially as postpartum anxiety starts to become more common. We talk about it a little bit more than we did. I know postpartum depression was the big one, and now we are talking about some other mood disorders. But I think they almost come hand in hand. Like we see them coming together, even though that's not necessarily the case, but I think it's allowed people to really start providing space for that conversation about intrusive thoughts.

[00:08:40] Dr. Sarah Lea: Yeah. Yeah, exactly. I think when I, back to my experience, I I had postpartum anxiety and I think it would've led to depression had I not gotten it treated. But it's interesting because we didn't I had my first, who is now nine. I had to think about that. We didn't talk about postpartum anxiety as much back then. Or O [00:09:00] C D. So we've definitely come a long way.

[00:09:03] Chelsea Bodie: Yeah. It's so good. And I think it provides, so that, like that space to be like, you know what? I'm struggling and I'm not doing well and I need that support, right? And I think the kinda mentality before was like: You're a new mom. Of course you feel this way. Like of course you would struggle this way. Whereas now it's a little bit more, there's more opportunity to be like, okay, you feel that way, but you don't. Like you don't have to just suffer in silence.

[00:09:26] Dr. Sarah Lea: Yeah. To that, what do you recommend folks? So say they're, having a visit with a patient or client and they disclose they're having intrusive thoughts, what do you recommend in terms of, like how to figure out if they are, impacting their life in a, more significant way that might need treatment versus sort of some recommendations for people who are having intrusive thoughts, but they're still able to function.

[00:09:47] Chelsea Bodie: Yeah. I think it's asking that question, right? Is it preventing you from doing anything? Do you feel like it's so scary that you know you can't do something that you normally could do? And phrasing it in that way where it's allowing them to be like, it's there, it's not there. What's coming up for [00:10:00] me? For people that are managing it well, it's often just giving them space to talk about it if they need to, but also being like, Hey, You know what, you're doing the things you need to do. You're acknowledging the intrusive thoughts. That's great. We can always revisit it if we need to or keep, continue to check in on it to ensure that it's staying that way.

[00:10:17] For people who it is more intrusive. I have a little cycle that I like to help for like framework, in working through the intrusive thoughts. So one is encouraging them to label the thoughts as intrusive. We wanna name it to tame it, which sounds cheesy but it's so true. There's sometimes it's empowering to be like, I know what's happening to me and I know what this is and I can call it something. Then it's giving, helping practice, give themselves permission to have these thoughts. They're uncontrollable. It doesn't mean you're a bad mom, it doesn't mean you're a bad parent. It doesn't mean you don't love your child, or you're thinking of all these bad scenarios. It's actually often the opposite, right? You're, you have these thoughts because you love them and you wanna keep them safe. Yeah. So it doesn't make you bad, and I think it's important to highlight that. And then providing [00:11:00] space for those, and this is more into that kind of CBT area, but providing space to be like the thoughts can come and go. My thought is just a thought. It doesn't have to define me. So teaching them how to be like, okay, these thoughts come and go, right? Especially if they are managing okay. Maybe they're not thriving, but they're not necessarily shuttered into their house, for example. But providing space for that. And then we love mama mantras, so you know, things you can tell yourself. This thought does not make me a bad mom. This thought is a, in a way, it's a caring thought. And just like really providing space and opportunity for them.

[00:11:32] Dr. Sarah Lea: Oh my gosh, I love mantras. I think they're so helpful. Especially if you start to feel overwhelmed, you can go back to that, if your sort of mind is spinning. Okay. So name it to tame it. So just label it as an intrusive thought. Yeah. And just almost give yourself permission to have those thoughts. Is that what you said?

[00:11:47] Chelsea Bodie: Yeah. Yeah.

[00:11:49] Dr. Sarah Lea: And then, yeah. Just that CBT sort of this doesn't make me a bad mother. It makes me a caring mother.

[00:11:56] Chelsea Bodie: Absolutely. And then, and of course like if they are, you can do all those other [00:12:00] things of like, mm-hmm, are you caring for your needs? Which is often the first thing to go when you have a new baby, right? You're not really caring for yourself, and then you don't really have the bandwidth to even work through these things. So some of it can, you can go back and dig into some of that, or if it's just about the intrusive thoughts or what you have time for, right? Yeah. Obviously appointments don't the time to do the things that we do sometimes or providers have different times. It's just, I think yeah, acknowledging it for them if it's limited time and just saying, hey, like it's not, it doesn't make you bad.

[00:12:30] Dr. Sarah Lea: Yeah, I think so much of supporting mental health is just normalizing it, right? If folks are still able to function and get by. And I think also you just, you hit like on such a huge point, which is new moms and, new parents are sometimes neglectful in looking after themselves. Like they're not sleeping, they're not like taking any time for themselves. It's just baby. Baby, baby, house, like. Totally. And it's so important to not just normalize that, but also encourage them to have a little bit of time to themselves. [00:13:00]

[00:13:00] Chelsea Bodie: Yeah, and whatever that looks like. And I know self-care is such an annoying word now because it's a buzzword. I know I'm trying to figure out a different term. But I really think of it as going back to basic needs, right? Are you meeting your basic needs in the day? And if you're not, how can we be intentional about that? And maybe it's not every day in the newborn stage, right? You don't have to shower every day, if that feels like too much. Eating, drinking, I'm not gonna say rest cuz that's also annoying when you're a new parent. What outta your basic needs, can we really focus on. So you have an opportunity to have that executive functioning coming back online a little bit.

[00:13:34] Dr. Sarah Lea: Yeah. Yeah. It's such a, it's such a good point. I have this I remember being like, yes, I showered today, I brushed my teeth. Like really basic stuff. It's really important.

[00:13:44] Chelsea Bodie: I don't have spit up on my pants cuz I changed them finally. Yeah. Yeah. For three days, right? Like most simple things that's aren't simple when you're in it, but can make such a big difference.

[00:13:55] Dr. Sarah Lea: Yeah, for sure. And then, as a physician I've supported folks with, postpartum mental health [00:14:00] and so I'm just wondering your take, when somebody is, to the point where it is impacting their function as a physician we may consider, medications and many family physicians are very comfortable starting basic, anti-anxiety or anti-depressant medications. What other tools do you recommend for folks that are having more severe interference with their function in addition to medication? So I always say medication is just a tool to help you build the other skills.

[00:14:25] Chelsea Bodie: Yeah, absolutely. If possible, working with a therapist, I think is gonna be the biggest combo, right? Of course, medication, to therapy. Totally. Always have that combo, if that's possible. Obviously somebody trained in perinatal can be really helpful, cause they're gonna have that knowledge base of, what intrusive thoughts are and be just have that just a little bit more awareness piece. And so if that's an option, I think that's definitely really important, especially since, if it is intruding their daily life, they're probably not having that quality of life. That being said, if therapy isn't necessarily an option, cause it financial time, all of those [00:15:00] factors that go into it then we definitely recommend trying to utilize those online resources like or, those online communities as if they're vetted. Yeah. If they have a good like resource. So we always tell practitioners like have some really good resources that you trust and that you feel are quality resources so you can share those. If they can't get into an appointment, can they at least look at some of this online and have access to it that way?

[00:15:25] Dr. Sarah Lea: Yeah. Yeah, I would agree. For sure. I personally took medication then also went to someone with expertise in, in postpartum. And for me that was really helpful. Like very quick turnaround to feeling way more myself. What would you recommend? Can you share some of your trusted resources that you might have, including, I know you guys have some resources too, but just sharing what's available. And that's the nice thing about virtual stuff, right? It doesn't, like you're in Alberta, but folks can still access a lot of what you guys have, including your book.

[00:15:55] Chelsea Bodie: Yeah, absolutely. So obviously. Yes, of course. No, but [00:16:00] that's their website, sorry. Postpartum International is a wonderful resource. That's a starting point. Unfortunately there's not any major websites in Canada that I'm super familiar with that are quite as inclusive as that website. So we always recommend Postpartum International for sure, because they go over everything. They have free support groups. They also have a directory of like perinatal professionals that have signed up with them. So you can always look for a professional in your area as well, if that's an option. If it's more so looking for a therapist, we always recommend Psychology Today which is often lots of Canadian therapists will be on it, so it's a good way to see what are they trained in, how do you connect with them? What are their service fees and all of that, so you can have a picture of who might be a good option for you. And then obviously I'm sure you've heard of her, Karen Kleiman is also a wonderful resources, I hope I'm saying her last name right now.

[00:16:52] Dr. Sarah Lea: Yeah, I dunno. I know her.

[00:16:53] Chelsea Bodie: So she wrote the book Good Moms Have Scary Thoughts, so yeah. Yeah. I'm probably saying her last name wrong.

[00:16:59] Dr. Sarah Lea: No, that's [00:17:00] okay. I know the book, but I haven't read it actually.

[00:17:02] Chelsea Bodie: It's actually a picture book more so it's like a cartoon type book. So it's more so for that like normalization keys, of like intrusive thoughts. But she's a great resource. Her website is more so for professionals, so you can always look at her if you are a professional. But if you're a person who's just looking for those resources, her books are great!

[00:17:21] Dr. Sarah Lea: Oh, cool. That's really good to know. Another one I will recommend to folks, although I haven't navigated it a ton, is Pacific Postpartum. It's one that's based outta Vancouver, I believe. Yeah. And a colleague actually here in Victoria who's very passionate about postpartum mental health has built, and then this is for folks local to Victoria like peer led postpartum support groups.

[00:17:45] Chelsea Bodie: Oh, amazing. I'll have to look it up. I would love to look at that. That's great.

[00:17:48] Dr. Sarah Lea: Yeah. Yeah. Okay. So that's really helpful. Is there anything else that you think we should touch on, about intrusive thoughts? We talked about what they are, how common they are how important it's to normalize them.

[00:17:58] Chelsea Bodie: I would just say the red [00:18:00] flag, like when is it like a medical emergency? Yeah. And so for us, when the intrusive thoughts don't feel disturbing, so the opposite of what you're probably feeling is when it's considered a medical emergency. So that's when you need to connect with either the emergency room or with your care provider or your birth support team, whoever you're working with in terms of a postpartum from a healthcare standpoint is when, when you should go and find out, find some help because if they aren't feeling like un unnatural or if they aren't feeling like it's something that wouldn't happen, then we wanna make sure that, you're not getting into that kind of postpartum psychosis kind of area.

[00:18:38] Dr. Sarah Lea: Yeah. Yeah. That's scary. And it does ha, it's rare, but it does happen. So that's an important thing to point out as well.

[00:18:44] Chelsea Bodie: Absolutely.

[00:18:45] Dr. Sarah Lea: Yeah. Awesome. So I'm gonna repeat what you said cuz I thought it was really good because it's a tool that like if you're with a client or a patient and you don't have much time, just a few tips you can give. So name it to tame it. Call it an intrusive thought. See, look, I'm forgetting already. What was the next thing you said?

[00:18:59] Chelsea Bodie: [00:19:00] Provide space. That it doesn't make you a bad person or a bad parent for having these. Yeah. And I think tied into that is that psychoeducation piece, right? If you have that time to just talk about it a little bit. Yeah. Talk about what it is and why it happens. Sometimes even that's enough reassurance that it's gonna deescalate how that person is feeling. So even if you only have five minutes and you're like, Hey, let's just learn about this together.

[00:19:22] Dr. Sarah Lea: Yeah. Yeah, it's so true. And it's crazy. Like what you can actually accomplish in just a few minutes, right? If you just sit down and have a really focused and direct conversation we always say information is so empowering for people. And just that normalizing it is so key. Yeah. Absolutely. Yeah. And then can you share some of your mantras again in case folks wanna have them to recommend to people? We'll credit you of course.

[00:19:44] Chelsea Bodie: Oh man, that's ok. Yes, so intrusive thoughts don't make me a bad mom. This is actually a loving or caring or protective thought. I always give a few adjectives so they can adjust it to how they want to. And also my thoughts are not facts. It's my, one of my [00:20:00] absolute favorites because it's like I can have these thoughts, but that define me. That doesn't necessarily mean it who I am. I don't have to buy into it if I don't want to. So my thoughts are not facts is one of my favourites. Yeah.

[00:20:12] Dr. Sarah Lea: Yeah. That's so great. Yeah. And then just remembering red flags as a provider, if you're seeing someone who they're not finding the thoughts, disturbing they're not they're thinking it's something that like could happen or those sort of red flags, then absolutely reach out for more support. And if you're not sure who to call, like I would, call a psych like most cities and centers have psychiatrists on call. So if you're a care provider and you're dealing with this that would be my recommendation.

[00:20:40] So say you're a massage therapist or physio and your client discloses this to you, I would recommend calling. That is a time when it would be appropriate. If you have any, there's no concerns about confidentiality when safety is concerned, right? So if there's a concern about the safety of the mom or the baby, I would absolutely call the care provider. If you needed direction. Yeah I'm, I can't [00:21:00] imagine that ever happening, but if it were to happen, I would wanna make sure that care provider felt safe and empowered to reach out to ask for help.

[00:21:07] Chelsea Bodie: Yeah, absolutely. No, it's so important. And it can be intimidating, right? As a provider even to be like making that decision and making that call and trying to do what's best. And supervision is always great if that's an option too, if you're not as comfortable with the perinatal world, I think that can be just reassuring. Hey, you're doing a great job too. Or, you're catching these things and you're sharing these things. If you feel like you need that to build that confidence up to make those calls. I'm a big supporter of supervision.

[00:21:33] Dr. Sarah Lea: Yeah. No, exactly. Awesome. Thank you so much for having this conversation with me. Can you, if folks are interested in learning more about you or your book, can you let them know where to find you?

[00:21:44] Chelsea Bodie: Absolutely. So we are mainly on Instagram, so at Mama Psychologist. We do have a website as well, We pretend we know what we're doing on TikTok, but we don't actually know what we're doing, so you can find us there occasionally. And [00:22:00] then of course, yeah, our book, Not Your Mother's Postpartum Book is written as an encyclopedia, for moms to talk about some of these really common, really frequent struggles that we hear about in our practice all the time, and that we experienced ourselves as new moms. And so we really wanted to create this resource where it's twofold. One, they could just flip to the issue that they're struggling with and not having to read a whole book on the issue. Let's be honest, who has time for that all the time, especially when you're sleep deprived. It also has exercises with each chapter so they can, practitioners can use it if they want to help provide support to their, the clients that they're working with, but also the person who's looking at it can actually tailor it and make it their own and really dive into some of these if they aren't able to always connect with a particular support person to be able to do that.

[00:22:49] Dr. Sarah Lea: Yeah, that's great. It's such a great resource to have for folks and I will make sure that we link everything in the show notes for people if they wanna learn more about it. Thank you. Yeah. Awesome. Thanks so much for joining [00:23:00] me today.

[00:23:01] Chelsea Bodie: Thank you for having me. It was great to talk about.

[00:23:04] Dr. Sarah Lea: Always a pleasure and an important topic.


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