When "What If" Creates Anxiety, Ask Yourself "What Is."

One of the biggest ways anxiety shows up is in “What If” questions: “What if I fail?” “What if something bad happens?” “What if x, y, or z.”

What if statements tend to create other what if statements, often spiraling out of control and leading you down a what-if-rabbit-hole that creates tension, anxiety, and feelings of overwhelm. 

For pregnant women, anxiety can show up in fears around the safety of their babies: “What if I miscarry?” “What if the baby is harmed by that glass of wine I had before I found out I was pregnant?” “What if my water breaks in the middle of an important meeting?” “What if I need an emergency C-section?”

For postpartum women, these anxious thoughts can come on like rapid fire, creating feelings of guilt and shame: “What if I drop the baby?” “What if we get in a car crash?” “What if I accidentally harm my baby?” “What if I don’t really love my baby because I’m having these awful thoughts?” “What if I’m not cut out to be a mom?” 

When thoughts like this occur, it’s important to recognize how common these anxious thoughts actually are. 

They are especially common postpartum. We call it Postpartum OCD (or Perinatal OCD, which includes during pregnancy) because of the persistent and obsessive nature of the intrusive thoughts. 

Postpartum OCD is one of the most common things I see in my clinical therapy practice. 

Unfortunately, not a lot of people (even some really great doctors!) are aware of this perinatal disorder. 

OBGYNs get very minimal training in mental health disorders. And psychiatrists get very minimal training in perinatal mental health diagnoses. Thus, this disorder often flies under the radar despite being very common and easily treatable. 

Consequently, so many moms who deal with intrusive thoughts about the safety of their children are often afraid to speak up about them due to fear that they will be judged or deemed unfit to care for their babies. Sadly, I’ve worked with several women who have been sent to the ER upon disclosing they are experiencing these scary what if thoughts. 

The ER or psychiatric unit is not the place for mamas with what if thoughts. Moms with what if thoughts are not going crazy, nor are they a threat to themselves or their children. 

We don't know exactly why intrusive thoughts happen in some moms, but the theory is that it happens to people who are "wired" toward some level of anxiety and is in part due to maternal instincts and the natural drive to protect going a little overboard.

The first step to treating Perinatal OCD is developing an understanding that these thoughts are just a symptom of an anxiety disorder. When you can label a what if thought as just an intrusive thought, it loses some power and feels less scary. Thoughts are just thoughts. They are not always reality. 

Thoughts do not equal action.

Try this exercise: 

Raise your right hand. Keep it in the air while you repeat out loud the following words, 

“I cannot raise my right hand. I cannot possibly raise my right hand. There’s no way I can possibly raise my right hand. What if I can never raise my right hand?”

Were you able to keep your hand raised as you said you couldn’t do it? Your hand didn’t immediately drop simply because you had the thought you couldn't raise it, right? See! Those are just thoughts, not reality. Simply thinking a thought doesn’t make it true.

And it’s the same with intrusive thoughts. They are just thoughts, not reality, and there is no concern that you will act upon these intrusive thoughts. (Hence, no need for hospitalization or panic when a mama opens up about the scary thoughts she’s been having.) 

Sometimes it’s tough to convince yourself that these are just intrusive thoughts because they are not completely irrational. Car accidents do happen; babies do roll off changing tables. But just remind yourself that these instances are highly unlikely, especially when you are committed to being careful. 

When intrusive thoughts occur, label them as intrusive thoughts, then move on to asking yourself what IS, rather than what if. 

What IS true: You love your baby. You want to protect your baby. You take good care of your baby. You can be careful. 

You can respond to what if thoughts by focusing on the facts. You can be cautious. You can make good decisions. You can try your best to avoid danger. You can be committed to keeping your children safe, but the reality is, nobody can protect anyone else 100% of the time. We live in an imperfect world and don’t have total control. 

Most moms experience a decrease in anxiety once they are able to recognize intrusive thoughts and focus on the facts. Thoughts are just thoughts. 

It’s hard to say when the intrusive thoughts will go away completely, but knowing what they are and developing mindfulness tools and stress reduction strategies can help make them more bearable. Stress and lack of sleep tend to exacerbate intrusive thoughts, so it’s vital to develop an arsenal of coping strategies to stay balanced. 

Ultimately, the thoughts should decrease over time but you don't have to suffer waiting for that to happen. If intrusive thoughts feel relentless and these strategies don’t seem to help, talk to your doctor (or one who is specifically trained in maternal mental health) about medications that can help. Typically SSRIs, which are safe during pregnancy and breastfeeding, are useful. If you are already on an SSRI, you may need a higher dose. 

For more information or support, check out episode 114 of the Finding Your Village podcast, or the book Good Moms Have Scary Thoughts.