Racing Thoughts in Adults: Causes, Symptoms, and Treatment

Attention Deficit Hyperactivity Disorder (ADHD)

ADHD is marked by inattention, hyperactivity, impulsivity, and emotional dysregulation. However, since these symptoms also occur in people with bipolar disorder, healthcare providers may initially find it difficult to determine which diagnosis fits best. In fact, there is a strong comorbidity between both, with 5-32% of adults with ADHD also having a diagnosis of bipolar disorder.^[2]

Yet there is a telltale sign to distinguish these conditions. Symptoms of ADHD tend to vary with the time of day, with racing thoughts potentially peaking at nighttime and worsening insomnia. In comparison, racing thoughts in bipolar disorder are typically mood-dependent. Rather than following a daily rhythm, symptoms fluctuate depending on mania, depression, and emotional stability.^[2]

Bipolar Disorder

Bipolar I disorder is diagnosed when someone experiences an elevated mood for at least one week. They must also experience three or more of the following symptoms:^[4]

• Diminished need for sleep
• Increased goal-directed activity
• Reckless behaviors
• Pressured speech
• Grandiosity
• Distractibility
• Racing thoughts 

Another form of bipolar disorder is known as “hypomania,” which is a milder form of mania. It does have essentially the same diagnostic criteria as bipolar 1, although it’s non-psychotic and doesn’t last for as long. Racing thoughts are also a common hypomanic symptom.^[4]

Emotional Dysregulation

As mentioned, research finds that racing thoughts occur for people with insomnia disorder, ADHD, bipolar disorder, and anxiety. These conditions share common factors known as “affective dysregulation” and “hyperarousal.” In simple terms, these issues imply that some people struggle to manage their emotions effectively and are in a persistent state of perceived threat.^[5]

As a result of this physiological instability, people may experience racing thoughts alongside physical and emotional symptoms of dysregulation (ups and downs, alertness, and a fast heart rate). While it can be relieving to get a diagnosis of a mental health condition, recognizing the presence of underlying dysregulation may be equally, if not more, useful. It allows people to better understand where racing thoughts are coming from and gives a clear indicator of what treatment should involve.

Later, we’ll discuss how people can learn emotional regulation skills to reduce their symptoms.

Stress and Anxiety

When it comes to anxiety and stress, racing thoughts are a commonly reported symptom, alongside moodiness, irritability, and changes in sleep.^[6] Your racing thoughts may be caused by anxiety if you also experience some of the following symptoms:^[7]

• Excessive worrying for at least six months
• Having difficulty controlling your worries and concerns
• Experiencing restlessness or feeling on edge
• Becoming easily fatigued
• Struggling to concentrate or experiencing your mind going blank
• Irritability
• Muscle tension
• Sleep disturbance
• Impairments to work and/or social life because of symptoms

Up to 20% of adults experience a form of anxiety disorder every year, leading to excessive concerns about health, the future, family, or finances. Anxiety and racing thoughts can have a significant toll on daily life; however, a great deal is known about anxiety, so there are lots of treatment options available.^[7]

Coping with Racing Thoughts At Home

Getting a diagnosis and finding a therapist doesn’t happen instantly. This is where coping strategies, which can be practiced at home, can be invaluable. For instance, you could try some of the following strategies to manage racing thoughts:^[3]

• Use mindfulness and grounding techniques
• Acknowledge your thoughts, but let them go
• Use a journal to “brain dump” your thoughts
• Engage in movement and physical exercise
• Prioritize good sleep hygiene
• Step back from some responsibilities if necessary

While these tips are helpful for curbing your symptoms in the moment, they may not address the emotional dysregulation that could underpin them. Emotional regulation for racing thoughts involves:^[8]

• Accepting emotions that come up for you, for example, I’m feeling stressed and panicked
• Acknowledging emotions as though they were coming from a person you love and care about deeply. For instance, My panic and stress are valid, I’m going to take care of myself
• Connecting with what caused the emotion and empathizing with yourself. For example, I’m feeling stressed because I have a lot on my to-do list
• Pausing and noticing what the emotion is wanting you to do. Such as, My stress is making me want to quit my job completely
• Reappraising the thing that caused an emotional response to change it. For instance, Perhaps my standards don’t need to be so high, I could leave that task till next week
• Engaging in activities that soothe and tend to the emotion in healthy ways. For example, I’m going to go for a run this evening to channel my stress and get an early night so I can rest

A therapist can also help you with emotional regulation. Honing this ability can be tremendously helpful, as prolonged dysregulation can lead to reduced satisfaction in relationships, lower well-being, and missing out on opportunities.^[8]

Therapy for Racing Thoughts

While there isn’t one specific therapy for racing thoughts, there are many options that can address them. Psychotherapy works by targeting this type of thought, as well as any other cognitive symptoms, such as memory problems and dissociation. Each therapeutic approach has a different focus, but the best fit for you comes down to where your racing thoughts come from and any other symptoms you might have.

For example, you may wish to explore:

• Cognitive behavioral therapy (CBT): CBT for racing thoughts focuses on any core beliefs, automatic assumptions, and errors in logic that may be contributing to your distress. This could involve challenging “black and white” thinking, assumptions about the future without proof, and core beliefs that are rigid and limiting.^[9]
• Humanistic therapies: These vary in their exact techniques but share the belief in our ability as people to “self-actualize,” heal, and grow if we get the right kind of support. Humanistic therapists don’t typically give guidance, but they can help you unpack what may be driving your poor mental health to enable you to make necessary changes.
• Psychodynamic therapy: This approach focuses on the past and any repeating patterns that you may be enacting unconsciously. While it doesn’t give immediate relief for symptoms like racing thoughts, it can address the historic experiences and inner conflicts that underpin your symptoms and help resolve them over time.

As well as these main approaches, other effective therapies include somatic therapy  (addressing the mind-body connection), EMDR (reprocessing traumatic memories), and art therapy (expressing emotions creatively).

Medication for Racing Thoughts

While psychotherapy can address the emotions and experiences at the root of your condition, medication may be necessary to address your symptoms from a physical angle. However, if medication is appropriate for your needs, the prescription for racing thoughts will differ depending on their cause.

We provide a quick breakdown of the various medications used for different conditions that can lead to rapid thoughts:

• ADHD: Treating ADHD usually involves either stimulants (amphetamines or methylphenidates) or non-stimulants (antidepressants or alpha agonists). Each works slightly differently to manage dopamine, serotonin, or adrenal receptors in the brain.^[10]
• Bipolar disorder: Lithium is the primary mood-stabilizer used for people with bipolar disorder, though experts still don’t know exactly how it works. If your symptoms are more severe, you may also be prescribed an atypical antipsychotic such as risperidone or olanzapine.^[4]
• Anxiety: Medications for treating anxiety include antidepressants (both SSRIs and SNRIs), antipsychotics (if necessary), and benzodiazepines (though dependency is a concern).^[7]
• Insomnia: If your insomnia is chronic and no other treatments are working, you may be prescribed medication on a short-term basis. Potential prescriptions include antidepressants, sedating antihistamines, melatonin supplements, anticonvulsants, and benzodiazepines.^[11]

Before being prescribed medication for things like anxiety and insomnia, healthcare providers are likely to encourage people to try other treatment methods, like therapy. If you have any concerns about taking medication for racing thoughts, make sure you speak to your healthcare provider.