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OCD: Why Intrusive Thoughts Happen and How to Break the Cycle · RECOVERable: Mental Health and Addiction Experts Answer Your Questions

• 0:13
  SPEAKER_00: OCD would come out in the form first of these intrusive experiences, these thoughts, ideas, images, impulses, or feelings that again come in out of nowhere.
• 0:22
  SPEAKER_01: OCD specialist Jenna Overbaugh breaks down how obsessive compulsive patterns work and practical ways to take back control.
• 0:30
  SPEAKER_00: They've just lived their whole entire lives for 35 years thinking that every single thought that I had, I endorsed it, I signed, stealed, and delivered it.
• 0:37
  SPEAKER_00: But you can absolutely have a thought and it just be weird mental spam.
• 0:45
  SPEAKER_01: Welcome to Recoverable.
• 0:47
  SPEAKER_01: I'm your host, Terry McGuire.
• 0:48
  SPEAKER_01: This podcast is brought to you by recovery.com, the best place to find mental health and addiction treatment for anyone anywhere.
• 0:56
  SPEAKER_01: Find the right treatment for you or someone you love at recovery.com.
• 1:01
  SPEAKER_01: Today's focus is OCD.
• 1:03
  SPEAKER_01: Think of anxiety as your body's alarm system.
• 1:06
  SPEAKER_01: If there's a fire, you want to be alerted, right?
• 1:08
  SPEAKER_01: It's essential.
• 1:09
  SPEAKER_01: But imagine if that alarm goes off every time you cook or blow out a candle.
• 1:14
  SPEAKER_01: That's what happens with obsessive compulsive disorder.
• 1:17
  SPEAKER_01: It can take over your body's alarm system so that instead of only warning you about true dangers, it responds to any trigger as a terrifying catastrophic threat.
• 1:27
  SPEAKER_01: Today we are joined by Jenna Overbaugh, a leading OCD expert who brings genuine compassion, clarity, and real-world hope back to a condition that's still really misunderstood.
• 1:38
  SPEAKER_01: Jenna, welcome.
• 1:39
  SPEAKER_01: Hi, thank you so much for having me.
• 1:40
  SPEAKER_01: I'm very excited to have this conversation because uh we've all heard of OCD, but I don't know that many people really understand it because they just think it's being excessively neat.
• 1:51
  SPEAKER_00: Correct.
• 1:52
  SPEAKER_00: And I think that's the easy manifestation that you see on media with character depictions on TV shows and in movies, but it's because those are usually more socially acceptable.
• 2:02
  SPEAKER_00: Whereas OCD in its truest form can come in so many different ways, including egodystonic and unwanted harm-intrusive thoughts and a lot of scary, weird experiences that aren't necessarily as socially acceptable or as media ready.
• 2:16
  SPEAKER_00: So that's usually what we think of when we think of OCD as perfection and hand washing, but it's so much more than that.
• 2:22
  SPEAKER_01: Ego dystonic is not a term most of us know.
• 2:25
  SPEAKER_01: What does that mean?
• 2:26
  SPEAKER_00: Ego dystonic means that it conflicts with your values.
• 2:28
  SPEAKER_00: So that's why OCD and some anxiety features are so scary and feel so threatening because you have these weird experiences and emotion or a weird intrusive thought.
• 2:39
  SPEAKER_00: And it's this experience of, oh my gosh, why did I just have that thought?
• 2:43
  SPEAKER_00: Oh my gosh, what does that mean about me?
• 2:45
  SPEAKER_00: Because it conflicts with your values.
• 2:46
  SPEAKER_00: It's not something that you enjoy, it's not something that you fascinate about.
• 2:49
  SPEAKER_00: You very much don't like that experience.
• 2:51
  SPEAKER_00: And that's what we call ego dystonic.
• 2:53
  unknown: Okay.
• 2:54
  SPEAKER_01: So on your website, you said you have sat with the hardest, most debilitating OCD cases out there.
• 3:00
  SPEAKER_01: What do you mean by that?
• 3:01
  SPEAKER_00: What I mean by that is I worked in a residential treatment setting.
• 3:05
  SPEAKER_00: So I worked at uh Rogers Memorial Hospital where they had 28 beds of the most debilitating, most complex cases of OCD and anxiety in the world.
• 3:13
  SPEAKER_00: So they can't sometimes brush their teeth.
• 3:16
  SPEAKER_00: They can't sometimes go to the bathroom.
• 3:18
  SPEAKER_00: Their activities of daily living are extremely debilitated and limited.
• 3:22
  SPEAKER_00: I worked with people who drank bleach, for instance, because they were so afraid that they got contaminated.
• 3:27
  SPEAKER_00: I worked with people who self-harmed, even though they didn't want to.
• 3:31
  SPEAKER_00: I've worked with people who couldn't get out of burning buildings, for instance, because they needed the next step that they took to feel just right, or they needed to pray a certain number of times.
• 3:40
  SPEAKER_00: And so in residential, it was just the most debilitating cases, people who could not function.
• 3:46
  SPEAKER_00: And they also often had a lot of comorbid conditions too.
• 3:49
  SPEAKER_00: So really severe depression, really severe trauma.
• 3:51
  SPEAKER_00: Those are the kinds of cases that I worked with for nearly 10 years.
• 3:55
  SPEAKER_01: Those are extreme, correct?
• 3:57
  SPEAKER_01: Correct.
• 3:57
  SPEAKER_01: So most of the people watching this and learning about OCD, whether or not they have it, maybe someone in their life does, are going to be talking about a milder form.
• 4:06
  SPEAKER_01: Is that the correct way to say it?
• 4:07
  SPEAKER_00: Correct.
• 4:08
  SPEAKER_00: We could see that as just a more mild form.
• 4:10
  SPEAKER_00: And it can still be extremely debilitating as long as it is impacting your day-to-day living and causing distress and impairment.
• 4:16
  SPEAKER_00: That is still what we would consider a disordered relationship with these experiences and still could be OCD.
• 4:22
  SPEAKER_00: But of course, there are varying levels of severity.
• 4:25
  SPEAKER_01: So you treat people with OCD as a therapist and you have experienced OCD.
• 4:30
  SPEAKER_01: How does that double lens help you help people?
• 4:34
  SPEAKER_00: For the longest time, I just experienced anxiety.
• 4:37
  SPEAKER_00: What a lot of people would say is anxiety, nothing too debilitating.
• 4:40
  SPEAKER_00: But when I had my son back in 2018, I experienced what a lot of people would resonate with is called a brain-breaking moment, kind of this moment where your brain just breaks.
• 4:50
  SPEAKER_00: You have this really scary intrusive thought that you can kind of boil everything back down to.
• 4:55
  SPEAKER_00: And for me, it was trying to put socks on my newborn son.
• 4:59
  SPEAKER_00: He was just so fragile, so tiny, and I loved him more than anything.
• 5:04
  SPEAKER_00: And I had this intrusive thought when I went to go put socks on him.
• 5:07
  SPEAKER_00: What if I snap his ankles?
• 5:09
  SPEAKER_00: And just this graphic image of his little body contorting in such a way.
• 5:13
  SPEAKER_00: And then it just snowballed from there.
• 5:16
  SPEAKER_00: I was unable to do socks, shoes, coats, diapers, spend any alone time with him.
• 5:21
  SPEAKER_00: And that was really debilitating for a very long time.
• 5:23
  SPEAKER_00: I got therapy about two years after.
• 5:25
  SPEAKER_00: And since then, I feel like I know OCD from such a more personal angle.
• 5:30
  SPEAKER_00: I'm able to really resonate with people as far as how emotional it can feel.
• 5:34
  SPEAKER_00: Sometimes people who have OCD, they just say, it feels so real.
• 5:38
  SPEAKER_00: Like I know I should be resisting these compulsions, but it feels so real.
• 5:42
  SPEAKER_00: It feels so irresponsible.
• 5:44
  SPEAKER_00: And before my own personal experience, I don't think that I could really resonate with that.
• 5:49
  SPEAKER_00: I kind of came at it from the lens of, well, you know what you should be doing.
• 5:52
  SPEAKER_00: So why aren't you doing it?
• 5:53
  SPEAKER_00: Um, but after experiencing it myself, I really did have this experience of wow, you can truly know all of the things.
• 6:01
  SPEAKER_00: And you just love that thing so much, whether it is your family or, you know, your integrity as a person or your career at work or your baby, whatever it is, you love that thing so much that it almost defies everything else that you know to be true.
• 6:16
  SPEAKER_00: And it's really debilitating.
• 6:18
  SPEAKER_00: And I'm so glad now that I'm on the other side that I can help people from both sides of the table.
• 6:22
  SPEAKER_01: I'm glad we get to see someone on the other side.
• 6:25
  SPEAKER_01: So that I would imagine one of the thoughts you can have is I'll never ever stop having these thoughts.
• 6:31
  SPEAKER_01: Exactly.
• 6:32
  SPEAKER_00: A lot of people do worry that they're never gonna stop having these thoughts.
• 6:35
  SPEAKER_00: And I try really hard to normalize that.
• 6:38
  SPEAKER_00: I think one thing that people really need to understand is that intrusive thoughts, weird, scary thoughts, are a naturally occurring human experience.
• 6:47
  SPEAKER_00: We often uh talk about in my work with clients and with students, we've done research to show that everyone experiences intrusive thoughts.
• 6:55
  SPEAKER_00: Research shows up to 99% of individuals endorse having intrusive thoughts.
• 6:59
  SPEAKER_00: They say that they have these experiences.
• 7:01
  SPEAKER_00: I would say that even the 1% who say that they don't probably just didn't understand the question or were afraid of being honest.
• 7:07
  SPEAKER_00: Uh, but we recognize these as evolutionary kind of constructs that just like anxiety, just like sadness, these are normally naturally occurring human experiences.
• 7:17
  SPEAKER_00: But of course, when it comes to OCD, we tend to think instead of where someone else can maybe just shrug off those experiences or shrug off that scary thought and move on with their day, somebody with OCD is going to say, just like I did, what does that mean about me?
• 7:30
  SPEAKER_00: Oh my gosh, I hate that thought.
• 7:32
  SPEAKER_00: I want to get rid of that thought.
• 7:33
  SPEAKER_00: And it's like quicksand.
• 7:34
  SPEAKER_00: It's very paradoxical.
• 7:36
  SPEAKER_00: The more you want to get rid of it, the more it happens.
• 7:39
  SPEAKER_01: So, what is the biggest misconception about OCD that you are hoping to dispel or correct today?
• 7:45
  SPEAKER_00: The biggest misconception, I think, is still that media misconception that OCD exists only or even primarily in the form of hand washing and fear of germs or needing everything to be perfect.
• 7:56
  SPEAKER_00: We hear, I think, a lot less of it these days, but still not as infrequently as I would like to see.
• 8:03
  SPEAKER_00: We see a lot of people still saying things like, oh my gosh, I'm so OCD about my pantry, or I'm so OCD about needing my shoes to be lined up.
• 8:09
  SPEAKER_00: And that does a lot of damage to the OCD community.
• 8:12
  SPEAKER_00: It just perpetuates this idea that it's almost this quirk or this personality characteristic that's in endearing in some form or fashion.
• 8:20
  SPEAKER_00: And that's absolutely not the case.
• 8:21
  SPEAKER_00: It's really important that people can see themselves in these scary, intrusive thoughts that come in out of nowhere.
• 8:27
  SPEAKER_00: I can't tell you how many times a day on social media or an email someone tells me, you know, Jenna, I've had these weird, scary thoughts my whole entire life.
• 8:36
  SPEAKER_00: I thought that I was crazy.
• 8:37
  SPEAKER_00: I couldn't tell anybody about it.
• 8:39
  SPEAKER_00: I finally have a name for it and I don't feel like I'm crazy anymore.
• 8:43
  SPEAKER_00: That's the experience that people need to have.
• 8:46
  SPEAKER_01: Thank you.
• 8:46
  SPEAKER_01: We're going to talk more about language because it's not just saying I'm so OCD, but the use of the word obsessive seems to be expanding.
• 8:55
  SPEAKER_01: I just keep hearing or obsessed.
• 8:57
  SPEAKER_01: I'm just obsessed with that.
• 8:58
  SPEAKER_01: And I think, oh, if you knew what obsessed with that meant, I don't think you'd be so playful with it when you're talking about a sweater or something.
• 9:06
  SPEAKER_00: Right.
• 9:06
  SPEAKER_00: And I think it will eventually, if it's kind of gaining traction now, I hope that eventually we get to be as particular and as cautious with words like that as we are about the word crazy.
• 9:16
  SPEAKER_00: Like I I remember kind of flippantly using that word or hearing other people use that word flippantly, like, oh my gosh, that drives me crazy, or I feel like I'm going crazy, but now I feel like we're a little bit more sensitive to that, knowing what we know about, you know, psychotic disorders and just being more sensitive in general.
• 9:31
  SPEAKER_00: But similar to, you know, oh my gosh, I want to, I want to kill myself, or you make me, you know, just kind of flippantly saying it.
• 9:37
  SPEAKER_00: I think we're getting to a point where we're more careful, but I think we still have a long way to go.
• 9:42
  SPEAKER_01: Agreed.
• 9:43
  SPEAKER_01: So we're going to start with a lightning round of myth or fact questions to address some of the misconceptions out there.
• 9:47
  SPEAKER_01: And there's just about 10 of them.
• 9:49
  SPEAKER_01: Myth or fact, Jenna.
• 9:50
  SPEAKER_01: OCD is fundamentally a personality quirk centered around neatness and organization.
• 9:55
  SPEAKER_00: That is a myth.
• 9:56
  SPEAKER_00: It is definitely not a personality quirk.
• 9:58
  SPEAKER_00: It is a very serious mental health condition.
• 10:00
  SPEAKER_00: And while it definitely can come out in the form of hand washing and needing everything to be neat and orderly, it's extremely debilitating.
• 10:06
  SPEAKER_00: And the people who experience it do not like having the experience of it.
• 10:10
  SPEAKER_00: They want anything but to have those experiences.
• 10:13
  SPEAKER_00: So definitely myth.
• 10:14
  SPEAKER_01: Myth or fact.
• 10:15
  SPEAKER_01: Most adults living with OCD are fully aware that their intrusive thoughts and compulsions are irrational.
• 10:21
  SPEAKER_00: I would say that is a fact.
• 10:22
  SPEAKER_00: There are some spectrum of individuals who do kind of have more absent insight or poor insight, but for the most part, people are very aware that I know this is crazy.
• 10:31
  SPEAKER_00: I know this is silly, but I feel like I have to do it no matter what.
• 10:34
  SPEAKER_00: So I would say fact.
• 10:35
  SPEAKER_01: Myth or fact.
• 10:36
  SPEAKER_01: Having an intrusive taboo thought means a person secretly desires to act on it.
• 10:40
  SPEAKER_00: That is a myth.
• 10:42
  SPEAKER_00: So actually, what happens in obsessive-compulsive disorder is individuals are having these scarier taboo thoughts and they're so scared of it.
• 10:50
  SPEAKER_00: They're so scared of having that intrusive thought.
• 10:53
  SPEAKER_00: As we've talked about, it's ego dystonic.
• 10:55
  SPEAKER_00: So what that means is that it's very incompatible with their character.
• 10:58
  SPEAKER_00: It's not connected to their values whatsoever.
• 11:01
  SPEAKER_00: It's very against their values.
• 11:02
  SPEAKER_00: So that would be absolutely meh.
• 11:05
  SPEAKER_01: Does it make one question if their values are real or true if they start having thoughts about violating them?
• 11:13
  SPEAKER_00: It can absolutely make somebody doubt what is their values.
• 11:16
  SPEAKER_00: In fact, a lot of times in other countries, OCD is referred to as the doubt disorder.
• 11:21
  SPEAKER_00: And so I work with a lot of people who, in fact, doubt whether they have OCD, which is, I always say, so on brand, right?
• 11:27
  SPEAKER_00: That they're doubting that they have the doubt disorder.
• 11:30
  SPEAKER_00: And so it can make you doubt anything from did I check the stove?
• 11:34
  SPEAKER_00: Is the stove off?
• 11:34
  SPEAKER_00: Do I love my family?
• 11:36
  SPEAKER_00: Do I even have OCD?
• 11:37
  SPEAKER_00: Are my hands clean enough?
• 11:38
  SPEAKER_00: To what even are my values?
• 11:40
  SPEAKER_00: Do I actually love my son enough?
• 11:42
  SPEAKER_00: If I do love my son, why am I having these thoughts about them?
• 11:45
  SPEAKER_00: So it can be really debilitating and just a mental spiral.
• 11:48
  SPEAKER_01: Myth or fact.
• 11:49
  SPEAKER_01: Exposure and response prevention or ERP therapy is the gold standard psychological treatment for OCD.
• 11:55
  SPEAKER_00: That is a fact.
• 11:55
  SPEAKER_00: Uh, that is the gold standard treatment, which means it is our go-to.
• 11:58
  SPEAKER_00: It is what we would recommend most of our family members, and it is very effective for the most part.
• 12:02
  unknown: Okay.
• 12:03
  SPEAKER_01: Myth or fact, people with OCD could simply stop their rituals if they exerted enough willpower.
• 12:09
  SPEAKER_00: That is a myth.
• 12:10
  SPEAKER_00: And so that is something that we need to work on in treatment.
• 12:13
  SPEAKER_00: And ideally, with a licensed uh professional counselor or professional licensed therapist that would work with you on why we're doing the things that we're doing, build some more self-efficacy, build some more motivation, and build the mental muscle of being able to resist these really difficult compulsions.
• 12:28
  SPEAKER_00: It's not quite as simple as just stop.
• 12:30
  SPEAKER_00: A lot of times, if people just wanted to stop, they definitely would.
• 12:33
  SPEAKER_00: So they need some more work in that area before they can just stop.
• 12:36
  SPEAKER_01: A myth or fact.
• 12:37
  SPEAKER_01: OCD symptoms typically first emerge during childhood, adolescence, or early adulthood.
• 12:42
  SPEAKER_00: That is true.
• 12:43
  SPEAKER_00: So while it's not true necessarily for everybody, for the most part, especially with the people that I've worked with, I can almost all of the time go back to some kind of childhood, early experience.
• 12:52
  SPEAKER_00: And, you know, even if everything got worse, say in adulthood with some traumatic stressor that happened in adulthood, they can almost always point back to some tendencies or some symptoms that they experienced either as a child or as an adolescent.
• 13:05
  SPEAKER_01: Myth or fact, stress is the root cause of OCD.
• 13:08
  SPEAKER_00: I would say that is a myth.
• 13:09
  SPEAKER_00: And so while stress can definitely contribute to the onset or the manifestation of OCD, we find that it's very much a nature and nurture type of situation.
• 13:18
  SPEAKER_00: So research shows there's actually a genetic predisposition, a vulnerability, so to speak.
• 13:22
  SPEAKER_00: So while stress can definitely influence the onset of OCD, I would say that there's not just one cause.
• 13:29
  SPEAKER_01: So nature nurture, is OCD hereditary?
• 13:32
  SPEAKER_00: OCD can be hereditary.
• 13:33
  SPEAKER_00: So they've done tons of research with twin studies, so on and so forth to show that it does tend to run in families.
• 13:39
  SPEAKER_00: And so it doesn't necessarily mean that if you have OCD, then your parents have it, or if you have it, then your children will have it.
• 13:45
  SPEAKER_00: It's a little bit more complex than that with related conditions, so on and so forth.
• 13:49
  SPEAKER_00: But for the most part, we do see that people who have OCD tend to more than those who don't, it tends to run in the family.
• 13:56
  SPEAKER_01: Myth or fact, constantly reassuring a loved one that their worst fear will not happen is an effective way to lower their anxiety long term.
• 14:04
  SPEAKER_00: That is a myth.
• 14:05
  SPEAKER_00: And so I love what you said, which is long term.
• 14:07
  SPEAKER_00: What's going to happen is when you give your loved one reassurance, just superficially telling them that everything is going to be okay, they don't have anything to worry about, that doorknob is clean, whatever it might be.
• 14:17
  SPEAKER_00: It's going to act as a ritual, which means it's going to very temporarily make them feel better, say for a couple of seconds or a couple of minutes, maybe even a couple of days, but it just reinforces the OCD cycle, which makes it worse in the long run.
• 14:29
  SPEAKER_00: So while it might work in the short term, it is absolutely making everything worse and just fueling OCD's fire for the long run.
• 14:36
  SPEAKER_01: So seeking reassurance can be a compulsion in and of itself.
• 14:39
  SPEAKER_00: Seeking reassurance could be a ritual.
• 14:41
  SPEAKER_00: And so seeking reassurance would be the response of how you would respond to an obsession.
• 14:46
  SPEAKER_00: So an obsession would be what's going on before you do the compulsion, kind of what's causing the anxiety.
• 14:52
  SPEAKER_00: So someone might obsess over this thought that they had.
• 14:55
  SPEAKER_00: You know, what does that mean about me?
• 14:57
  SPEAKER_00: Why did I have that thought?
• 14:58
  SPEAKER_00: Those are kind of the questions and the anxiety-inducing piece of it.
• 15:01
  SPEAKER_00: But the ritual or the compulsion in this situation, seeking reassurance, would be what somebody does to negate that anxiety.
• 15:08
  SPEAKER_00: So that would be the compulsion.
• 15:09
  SPEAKER_01: Myth or fact.
• 15:10
  SPEAKER_01: You can validate a loved one's emotional distress without validating their OCD obsession.
• 15:15
  SPEAKER_00: I love this.
• 15:16
  SPEAKER_00: This is absolutely a fact.
• 15:17
  SPEAKER_00: So I teach my clients and my students a lot that there is a way to get support without what we call being accommodated.
• 15:24
  SPEAKER_00: And so support is great.
• 15:25
  SPEAKER_00: Support sounds like you've got this, I'm here for you.
• 15:28
  SPEAKER_00: Maybe even sometimes it seems like not doing the compulsion, you know, saying, I love you.
• 15:32
  SPEAKER_00: I'm not, I'm not going to answer that question.
• 15:34
  SPEAKER_00: That might be supportive, even though it feels kind of cold in the moment.
• 15:38
  SPEAKER_00: Accommodation would be something that is directly reinforcing the OCD, like doing a check-in compulsion for your loved one, giving them reassurance or helping them avoid something.
• 15:48
  SPEAKER_01: So other people can be pulled in and become a part of the ritual.
• 15:52
  SPEAKER_00: Absolutely.
• 15:52
  SPEAKER_00: OCD does not just pick on one person.
• 15:54
  SPEAKER_00: It often, if there are loved ones involved, friends, spouses, um, family members living in the home, it can be a huge problem for the entire family and they get directly sucked into the cycle.
• 16:05
  SPEAKER_01: Myth or fact, caregivers must set personal boundaries and prioritize their own mental health to effectively support someone with OCD.
• 16:12
  SPEAKER_00: That is a fact.
• 16:13
  SPEAKER_00: It's very, very important.
• 16:14
  SPEAKER_00: Uh 99%, I want to say 90 to 99% of family members and loved ones say that they do give into these family accommodations.
• 16:21
  SPEAKER_00: So it's very common just wanting to support your loved one and not knowing any different, but it is absolutely part of the treatment protocol to help them learn to be more supportive without accommodating, set those boundaries, and get the mental health that they need for themselves.
• 16:33
  SPEAKER_01: Now we're going to get into the longer questions.
• 16:35
  SPEAKER_01: So you don't have to answer so short.
• 16:37
  SPEAKER_01: I appreciate it.
• 16:38
  SPEAKER_01: What is OCD really?
• 16:40
  SPEAKER_00: OCD is obsessive-compulsive disorder.
• 16:42
  SPEAKER_00: So I always say that it's really a two-part problem.
• 16:45
  SPEAKER_00: So we have obsessions, which are intrusive thoughts, ideas, images, impulses, or feelings.
• 16:51
  SPEAKER_00: Um, kind of these experiences that come in out of nowhere.
• 16:54
  SPEAKER_00: They're uninvited.
• 16:55
  SPEAKER_00: They're intrusive, is really the best way to describe it.
• 16:58
  SPEAKER_00: And they are egodystonic.
• 16:59
  SPEAKER_00: So again, they go against the person's values.
• 17:02
  SPEAKER_00: These are not things that make people feel good.
• 17:04
  SPEAKER_00: These are not things that people fantasize about.
• 17:06
  SPEAKER_00: These are things that are experiences very taboo, very shameful, very scary, very weird.
• 17:10
  SPEAKER_00: They do not want them.
• 17:12
  SPEAKER_00: Um, but then you also have compulsions, which are these behaviors that you do either physically or could be mental.
• 17:18
  SPEAKER_00: And I'm happy to talk about that too, but something that you are doing to feel better about the anxiety that you experience from those obsessions.
• 17:26
  SPEAKER_00: So they can be physical, like hand washing, checking, um, just rearranging things in your environment.
• 17:32
  SPEAKER_00: It can also be seeking reassurance from other people, can be avoidance, just simply avoiding the thing that you're scared of.
• 17:39
  SPEAKER_00: And it can also be mental.
• 17:40
  SPEAKER_00: So things like replaying conversations that happened.
• 17:43
  SPEAKER_00: And there's a subtype called hit and run OCD, where you can obsess over did I hit someone with my car?
• 17:48
  SPEAKER_00: Did I hit someone with my car?
• 17:50
  SPEAKER_00: Would be the obsession.
• 17:51
  SPEAKER_00: The compulsion might be reviewing the route that you've done in your head over and over again to try to reimagine if you could have hit someone.
• 17:58
  SPEAKER_00: Did you see blood?
• 17:59
  SPEAKER_00: Did you hear someone screaming?
• 18:01
  SPEAKER_00: Um, so there are just so many different compulsions that somebody could do.
• 18:05
  SPEAKER_00: But if it's going to be OCD, according to the diagnostic and statistical manual, where what we use to diagnose mental health conditions, it would also have to cause distress.
• 18:14
  SPEAKER_00: So pretty self-explanatory.
• 18:16
  SPEAKER_00: It is impairing your day-to-day life as well.
• 18:19
  SPEAKER_00: And then also, according to the DSM, you're supposed to be spending an hour or more on these obsessions and compulsions.
• 18:26
  SPEAKER_00: But I always say that's really hard to quantify.
• 18:28
  SPEAKER_00: It's really hard to quantify these mental compulsions.
• 18:31
  SPEAKER_00: It's really hard to quantify avoidance, for instance.
• 18:34
  SPEAKER_00: So I don't get too hung up on that.
• 18:35
  SPEAKER_00: But it is debilitating.
• 18:36
  SPEAKER_00: It's one of the most debilitating uh mental health conditions, but it's also one of the most treatable, which is why I love to do this work so much.
• 18:44
  SPEAKER_00: Oh, I want to hear all about that.
• 18:45
  SPEAKER_01: So you said you don't want to get hung up on it, but that hour thing.
• 18:48
  SPEAKER_01: An hour at a time, an hour in a day.
• 18:50
  SPEAKER_01: What does it mean?
• 18:51
  SPEAKER_00: According to the DSM, it would be an hour of the day.
• 18:54
  SPEAKER_00: So that could be added up, it could be a little bit at a time, but I've certainly worked with people who do get stuck in compulsions for an hour plus.
• 19:00
  SPEAKER_00: I've worked with people who would shower for so long that the hot water ran out and they got hypothermia because they were stuck under the cold water.
• 19:08
  SPEAKER_00: So it can be pretty severe.
• 19:10
  SPEAKER_00: Uh, but I always tell people if this is distressing you and if it's impacting your day-to-day life, go and get treatment for it.
• 19:16
  SPEAKER_00: Go and get the help and services that you need.
• 19:18
  SPEAKER_00: You don't need to wait and clock.
• 19:20
  SPEAKER_00: Is it actually taking me an hour?
• 19:22
  SPEAKER_01: Right.
• 19:22
  SPEAKER_01: Understood.
• 19:23
  SPEAKER_01: What are the different types of OCD that you see most?
• 19:26
  SPEAKER_00: So OCD can really latch onto anything.
• 19:29
  SPEAKER_00: It's really only limited to your imagination.
• 19:31
  SPEAKER_00: But some of the most common and talked about subtypes that we talk about or themes that we see in OCD are harm OCD.
• 19:38
  SPEAKER_00: So that would be when individuals have obsessions and compulsions around harm.
• 19:42
  SPEAKER_00: So harming someone else, either accidentally or on purpose.
• 19:45
  SPEAKER_00: You can also experience self-harm OCD.
• 19:48
  SPEAKER_00: So these intrusive thoughts of, oh my gosh, would I ever want to hurt myself?
• 19:51
  SPEAKER_00: What if I did?
• 19:52
  SPEAKER_00: Would I ever actually do that?
• 19:54
  SPEAKER_00: And again, these are things that people don't want to do.
• 19:56
  SPEAKER_00: These are very scary thoughts.
• 19:59
  SPEAKER_00: These are very scary and outside of their realm of want and needing and desires.
• 20:04
  SPEAKER_00: Uh, there's also, like I mentioned, hit and run OCD, where you can feel like you absolutely hit someone with your car.
• 20:10
  SPEAKER_00: Maybe it's a child or an animal or a family.
• 20:13
  SPEAKER_00: And so you do compulsions around that.
• 20:15
  SPEAKER_00: We know about contamination OCD.
• 20:17
  SPEAKER_00: So fears of either contaminating other people or yourself becoming contaminated.
• 20:22
  SPEAKER_00: There's also just right OCD, this feeling that either everything in your environment has to be just right, or even your body or your feelings have to be just right.
• 20:31
  SPEAKER_00: I've worked with people who can't get out of a burning building because they have to, every step has to be just right.
• 20:37
  SPEAKER_00: And if it's not just right, they have to redo it.
• 20:39
  SPEAKER_00: Uh, there's also religious OCD.
• 20:42
  SPEAKER_00: There's similarly scrupulosity OCD, uh, moral OCD.
• 20:45
  SPEAKER_00: So this is obsessions and compulsions around religion and moral standing and responsibility, things of that nature.
• 20:52
  SPEAKER_00: I could go on and on.
• 20:53
  SPEAKER_00: Uh, there's also sexual intrusive thoughts.
• 20:55
  SPEAKER_00: So it's really taboo.
• 20:57
  SPEAKER_00: It's often not talked about, but these are individuals who are usually the most the these are the most sweet, the most kind, the most caring, the most gentle individuals, but they sometimes will have these very unwanted, very intrusive, sexual intrusive thoughts.
• 21:11
  SPEAKER_00: I've worked with a lot of moms, for instance, or parents in general, they're afraid of giving their children a bath for, for example, because they're afraid, oh my gosh, what if I actually look at his private?
• 21:21
  SPEAKER_00: Or, oh my gosh, what would that mean about me?
• 21:24
  SPEAKER_00: A really common one too is when a parent is so they are, you know, changing their children's diaper.
• 21:30
  SPEAKER_00: They instead of just using one or two wipes, they have to use 10 wipes because they're afraid, oh my gosh, what if my finger touches and what does that mean?
• 21:37
  SPEAKER_00: And again, research shows that these individuals are the least likely to act on any of these experiences.
• 21:43
  SPEAKER_00: They avoid their children, they avoid things for this reason, and that's why they're so ego dystonic and unwanted.
• 21:49
  SPEAKER_00: But those are just some of the examples of how it can come out, but it can come out in so many other forms.
• 21:53
  SPEAKER_01: What is pure O O C D?
• 21:55
  SPEAKER_00: Pure O, I'm so glad that you brought that up.
• 21:57
  SPEAKER_00: So a lot of times people do experience obsessive compulsive disorder, but they don't necessarily resonate with these physical compulsions like hand washing or seeking reassurance.
• 22:07
  SPEAKER_00: And so what they do struggle with are these mental and unobservable compulsions.
• 22:11
  SPEAKER_00: So Dr.
• 22:12
  SPEAKER_00: Stephen Phillipson actually.
• 22:13
  SPEAKER_00: Coined the term pure O because in his practice, he was seeing all these individuals in group really struggling with OCD, but they weren't doing these typical behaviors of hand washing and seeking reassurance or looking everything up online.
• 22:26
  SPEAKER_00: And so he really identified that these compulsions and rituals could be done mentally in an unobservable fashion.
• 22:33
  SPEAKER_00: And so again, compulsions can be either physical or mental and unobservable.
• 22:38
  SPEAKER_00: So they often do get missed.
• 22:40
  SPEAKER_00: But some good examples of pure O compulsions would be things like rumination.
• 22:45
  SPEAKER_00: So rumination is a really big one.
• 22:47
  SPEAKER_00: Just more generally, that's trying to analyze your thoughts, trying to figure out your thoughts.
• 22:52
  SPEAKER_00: A lot of times these concepts and OCD, there's no answer to them.
• 22:56
  SPEAKER_00: You know, am I going to go to heaven or am I going to go to hell?
• 22:59
  SPEAKER_00: Did I wash my hands enough?
• 23:00
  SPEAKER_00: OCD is never satisfied.
• 23:02
  SPEAKER_00: And so we get stuck in this rumination, trying to answer questions that don't have answers.
• 23:07
  SPEAKER_00: There's really no end to these answers.
• 23:09
  SPEAKER_00: And so we just get stuck in these mental loops.
• 23:12
  SPEAKER_00: We're focused on the problem, not necessarily the solution.
• 23:15
  SPEAKER_00: And so rumination is a really big one that a lot of people struggle with.
• 23:18
  SPEAKER_00: There's also just cognitive avoidance, like, oh my gosh, I don't want to think about that.
• 23:23
  SPEAKER_00: You know, don't want to think about that.
• 23:24
  SPEAKER_00: Don't bring that up whatsoever.
• 23:25
  SPEAKER_00: Can't even go there.
• 23:26
  SPEAKER_00: But of course, don't think about a white elephant, right?
• 23:29
  SPEAKER_00: Don't think whatever you do, don't think about a white elephant.
• 23:31
  SPEAKER_00: You end up thinking about it more.
• 23:33
  SPEAKER_00: It just has this backfire effect, self-assurance.
• 23:36
  SPEAKER_00: I washed my hands enough.
• 23:38
  SPEAKER_00: That's okay.
• 23:38
  SPEAKER_00: You know, you did that four times.
• 23:40
  SPEAKER_00: God is going to love you because you did that prayer four times.
• 23:42
  SPEAKER_00: That just feels better for a very short period of time, but ultimately makes everything worse.
• 23:47
  SPEAKER_00: So, really anything that you're doing to make yourself try to feel better about these obsessions and compulsions, it can sometimes work for just a couple of minutes, but you end up having to do more of it.
• 23:57
  SPEAKER_01: So if you see someone use 10 wipes to use your example or wash their hands, stay in the shower until the water's gone, all those examples you used, you might notice that.
• 24:08
  SPEAKER_01: You might say, Oh, something's up here.
• 24:10
  SPEAKER_01: I'm thinking of a partner or a family member.
• 24:13
  SPEAKER_01: If they're having those thoughts, if they're ruminating, if they're having to, you know, do something a certain number of times that that is in their head, do they go untreated because nobody knows there's something going on or something wrong?
• 24:26
  SPEAKER_00: They definitely can go untreated because if you're not aware of these behaviors, you might not see that anything is going on.
• 24:32
  SPEAKER_00: And especially a lot of times therapists are relying on the patient's self-report.
• 24:36
  SPEAKER_00: So I am washing my hands this a number of times, or I do go back and check this thing however many times before work.
• 24:43
  SPEAKER_00: If the person who's struggling with it doesn't know that it's a problem, chances are they've been doing it that way their whole lives.
• 24:49
  SPEAKER_00: They've been ruminating a lot their whole lives.
• 24:51
  SPEAKER_00: They've always reviewed conversations to make sure they didn't say anything offensive.
• 24:55
  SPEAKER_00: They don't necessarily know that it's a problem.
• 24:57
  SPEAKER_00: Right.
• 24:57
  SPEAKER_00: And so they don't know to bring it to anybody's attention.
• 25:00
  SPEAKER_00: So that's why this type of education and type of awareness is so important.
• 25:03
  SPEAKER_00: I always look for there are some physical signs.
• 25:06
  SPEAKER_00: I would always, especially in residential, if somebody was kind of frozen in time, you know, if they were just like sitting and kind of lost in thought for a really long time, they weren't really moving, that might be a good indicator that they were kind of lost in this ruminative thought.
• 25:19
  SPEAKER_00: Or there are always some other compulsions too that people might do, like even some sneaky avoidance or looking things up online.
• 25:26
  SPEAKER_00: But it can be really tricky for the person and for the provider if you don't know what's going on.
• 25:31
  SPEAKER_00: It's really hard to bring it to the surface.
• 25:34
  SPEAKER_01: Absolutely.
• 25:34
  SPEAKER_01: I don't know that I mean when I think of if I had that, I don't know that I would think I need to see a doctor about this.
• 25:41
  SPEAKER_01: I'd think this is just how I am.
• 25:42
  SPEAKER_01: Just how your brain is.com.
• 25:50
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• 25:56
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• 26:00
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• 26:03
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• 26:09
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• 26:19
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• 26:25
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• 26:29
  SPEAKER_01: So I've heard you say treat OCD like an allergy, not a diet.
• 26:33
  SPEAKER_01: What does that mean?
• 26:34
  SPEAKER_00: A lot of times people, when they are working on treatment, and I know that we'll get into treatment eventually, they tend to say to themselves, you know, I've been really good at resisting my compulsions all week.
• 26:45
  SPEAKER_00: And so on Saturday and Sunday, I can just let it go.
• 26:48
  SPEAKER_00: Or I did that really awesome exposure with my therapist in session.
• 26:51
  SPEAKER_00: Like I deserve to just, you know, let loose.
• 26:53
  SPEAKER_00: I don't need to do my homework this week.
• 26:55
  SPEAKER_00: I think that that can be really detrimental to people because OCD doesn't take time off.
• 27:00
  SPEAKER_00: OCD, you know, if you do this really great exposure, you know, which is great with you and your therapist, it's going to be really good for your treatment and your progress overall.
• 27:08
  SPEAKER_00: But if you just go back and you go back to old ways, OCD isn't going to get the hint.
• 27:14
  SPEAKER_00: We really do need to break the cycle and be consistent with it.
• 27:16
  SPEAKER_00: And so I always say to treat it more like an allergy, meaning that if you have even a little bit of that compulsion, it could mean bad news, right?
• 27:24
  SPEAKER_00: It's not like, okay, like I was good for a couple of days.
• 27:27
  SPEAKER_00: So I can treat myself and just take a break or I can treat myself and do this compulsion that feels really good.
• 27:33
  SPEAKER_00: It's no, we have to treat it like an allergy.
• 27:35
  SPEAKER_00: We have to really treat it as like I can't have that.
• 27:38
  SPEAKER_00: I'm not just like restricting myself of that for a short period of time during therapy, like we might with a diet.
• 27:45
  SPEAKER_00: This is an allergy.
• 27:46
  SPEAKER_00: This is something I am the type of person I'm not able to jump onto Google and research stuff.
• 27:50
  SPEAKER_00: It's not good for me.
• 27:51
  SPEAKER_00: And if I do, I know what happens.
• 27:54
  SPEAKER_00: That's what I mean when I say to treat it like an allergy versus a diet.
• 27:57
  SPEAKER_01: Interesting.
• 27:57
  SPEAKER_01: Great metaphor.
• 27:59
  SPEAKER_01: Explain why using OCD as a synonym for things like neatness minimizes the condition for people who really suffer from it.
• 28:07
  SPEAKER_00: Using that language minimizes the condition because it again perpetuates this idea that it exists in these very clean, polished, media ready portrayals.
• 28:15
  SPEAKER_00: And that can definitely happen, but it's supposed to be debilitating.
• 28:19
  SPEAKER_00: These are things that people would not be, you know, waving it with a poster board saying, I experience these things and these things are part of my personality.
• 28:28
  SPEAKER_00: I'm proud of it.
• 28:29
  SPEAKER_00: These are things that people really find debilitating and very shameful to talk about.
• 28:33
  SPEAKER_00: So even with their most loved ones, they find it very, very shameful to talk about.
• 28:37
  SPEAKER_00: And again, I think of those individuals who struggle with the harm-intrusive thoughts and the sexual intrusive thoughts that they are terrified to tell anybody about and that they just think that they're crazy for.
• 28:48
  SPEAKER_00: And they feel so isolated, so ashamed about.
• 28:50
  SPEAKER_00: And as long as we are using that language, it detracts from those individuals getting the help that they need.
• 28:56
  SPEAKER_01: What are the symptoms of OCD?
• 28:58
  SPEAKER_00: OCD would come out in the form first of these intrusive experiences, these thoughts, ideas, images, impulses, or feelings that again come in out of nowhere.
• 29:07
  SPEAKER_00: These would be things that you don't want to have.
• 29:09
  SPEAKER_00: So, oh my gosh, why did I just have that thought?
• 29:11
  SPEAKER_00: What does that thought mean about me?
• 29:13
  SPEAKER_00: And then we would have these compulsions as well.
• 29:15
  SPEAKER_00: So either physical things that you're doing with your body could be hand washing, checking, seeking reassurance online or from a loved one, or it can be mental rumination, mentally reviewing conversations or events, and then just a lot of distress and anxiety and impairment about that.
• 29:30
  SPEAKER_00: So again, another symptom that somebody would probably resonate with a lot is just this relentlessness of the thoughts, just feeling like it's thought after thought and intrusive thought after intrusive thought, like the intrusion, the intrusions just feel like they're happening all day, every day.
• 29:45
  SPEAKER_01: So one of the most searched phrases on the internet is isn't everyone a little OCD?
• 29:51
  SPEAKER_00: I can see where somebody would say that, but what we need to really break apart here is the D part in OCD.
• 29:59
  SPEAKER_00: And so we have obsessive, compulsive, and then disorder.
• 30:02
  SPEAKER_00: So I would agree that everyone probably experiences some degree of intrusive thoughts every once in a while to a very low degree of severity, to a very low degree of frequency.
• 30:14
  SPEAKER_00: But when it comes to the disorder piece, that's where we get into the distress and the impairment and the hour plus a day.
• 30:21
  SPEAKER_00: Everyone does experience intrusive thoughts.
• 30:24
  SPEAKER_00: Everyone does experience anxiety.
• 30:25
  SPEAKER_00: The disorder piece is what not everybody experiences.
• 30:28
  SPEAKER_00: The disorder piece is the distress that you experience as a result of these symptoms, the impairment that you experience from these symptoms and how much time it takes.
• 30:38
  SPEAKER_01: Why does the brain generate disturbing intrusive thoughts in the first place?
• 30:42
  SPEAKER_01: And why do they stick for some people?
• 30:44
  SPEAKER_00: The brain is so complicated.
• 30:46
  SPEAKER_00: I always say that the brain is the most complex piece of machinery that we have and or that we have to access at all in the world, right?
• 30:53
  SPEAKER_00: We don't know how our phones work completely.
• 30:56
  SPEAKER_00: We don't know how planes work or how big, complex machinery works.
• 31:00
  SPEAKER_00: The more complex it works, the more mistakes can happen.
• 31:03
  SPEAKER_00: I always give the analogy when it comes to Amazon, how complicated that warehouse must be.
• 31:08
  SPEAKER_00: I get duplicate packages all the time.
• 31:09
  SPEAKER_00: I get packages that aren't mine, these like random packages from three doors down.
• 31:15
  SPEAKER_00: Mistakes happen when you have such complex machinery.
• 31:17
  SPEAKER_00: And that's what happens in the brain sometimes.
• 31:20
  SPEAKER_00: So there's just so many different wires going on, so many different messages, so much input and output.
• 31:25
  SPEAKER_00: Of course, it makes sense that every once in a while one of those thoughts wouldn't make sense.
• 31:29
  SPEAKER_00: I don't know exactly where the statistic came from, but there's just online this research statistic floating around, like however many thoughts we have per day, right?
• 31:37
  SPEAKER_00: 50,000, 60,000, I don't know what it is.
• 31:39
  SPEAKER_00: There's no way that all of those thoughts would make sense, would be pleasant.
• 31:44
  SPEAKER_00: And so it just makes sense that with such a complex piece of machinery as our brains, something is gonna go out of whack.
• 31:49
  SPEAKER_00: There's gonna be some thoughts that aren't pleasant.
• 31:52
  SPEAKER_00: I also really believe that there is some evolutionary kind of basis for these intrusive thoughts.
• 31:57
  SPEAKER_00: If we were to think of hundreds and hundreds of years ago, a mom who has an intrusive thought about her baby not breathing in the middle of the night, she goes and checks on her baby.
• 32:06
  SPEAKER_00: That baby's probably gonna be more likely to live and pass on those genes, right?
• 32:10
  SPEAKER_00: And so they do pass, they do seem to have some kind of evolutionary benefit.
• 32:15
  SPEAKER_00: Although, of course, we live in a day and age now where we don't need to be checking our stoves all the time.
• 32:20
  SPEAKER_00: We don't need to be washing our hands all the time like that.
• 32:22
  SPEAKER_00: So to say that it's evolutionary and it's basis doesn't give anybody permission to continue doing the things that they're doing compulsion-wise, but it just helps give some groundwork as to like why this could make sense.
• 32:33
  SPEAKER_00: It's our brain's way of alerting us to what we care most about.
• 32:36
  SPEAKER_01: What's the relationship between OCD and anxiety?
• 32:39
  SPEAKER_00: The best way that I could describe the difference between OCD and anxiety is anxiety feels like the looming thunderstorm in the background.
• 32:48
  SPEAKER_00: It's never really like obviously debilitating.
• 32:52
  SPEAKER_00: Maybe sometimes it is, but it's kind of just always there and it's looming in the background and it's obnoxious and it's there and it's doom and gloom.
• 32:59
  SPEAKER_00: Whereas OCD feels like a lightning strike right in front of your face.
• 33:03
  SPEAKER_00: So it just feels very sudden, it feels very imminent, it feels very dangerous.
• 33:08
  SPEAKER_00: And I don't necessarily treat them any different.
• 33:10
  SPEAKER_00: I always tell my clients and my students, I don't really care what it is that you're anxious about.
• 33:15
  SPEAKER_00: When we look at anxiety, we think of things that are more practical, more day-to-day, more down-to-earth, like anxiety about relationships or anxiety about bills, anxiety about the state of the world.
• 33:26
  SPEAKER_00: Whereas typically with OCD, we would look at things that are more outlandish, right?
• 33:30
  SPEAKER_00: Like I could get COVID from having a conversation with someone over the phone who has COVID, or, you know, God needs me to say this prayer 20 times.
• 33:38
  SPEAKER_00: I don't really care what someone is anxious about.
• 33:40
  SPEAKER_00: My job is to get them to be only as anxious as the facts warrant.
• 33:44
  SPEAKER_00: So I don't really care whether someone is anxious about contamination or their relationship or bills or whatever.
• 33:49
  SPEAKER_00: I look at it from a more functional perspective.
• 33:51
  SPEAKER_00: My job is to get you to be only as anxious as the facts warrant.
• 33:55
  SPEAKER_00: So they can definitely be very similar.
• 33:57
  SPEAKER_00: Sometimes people would argue that the content is a little bit different, but I look at the person as far as what are the compulsions or safety behaviors that we're doing?
• 34:05
  SPEAKER_00: What are the ways that you're limiting your life because of OCD or anxiety?
• 34:09
  SPEAKER_00: And how do we fix that?
• 34:10
  SPEAKER_01: Okay.
• 34:11
  SPEAKER_01: So we've talked about evolutionary, we've talked about some other things, but the direct question, what causes OCD?
• 34:17
  SPEAKER_00: OCD is very much a nature and nurture type of mental health condition.
• 34:21
  SPEAKER_00: So it can be hereditary.
• 34:23
  SPEAKER_00: There is this tendency for there to be this genetic predisposition or vulnerability.
• 34:27
  SPEAKER_00: So meaning if you have it, then likely someone else in your family has it or has some kind of related condition, so on and so forth.
• 34:33
  SPEAKER_00: But that's not always 100% the case.
• 34:36
  SPEAKER_00: So you could definitely have this predisposition.
• 34:38
  SPEAKER_00: And because you had great modeling and nothing really too stressful happened to you, or you were taught adaptive coping, that might never show up in your day-to-day life.
• 34:47
  SPEAKER_00: But think of it as a loaded gun.
• 34:49
  SPEAKER_00: If you have this loaded gun with the predisposition genetically, and then something really stressful happens in your life, or, you know, just you are modeled learning in a certain way from your family or so on and so forth, that could shoot off that gun.
• 35:03
  SPEAKER_00: That could pull the trigger and you would have this onset of OCD.
• 35:07
  SPEAKER_01: So by the time someone gets to a point where they realize like something's going on here and it's really interfering with my life, and they come to a therapist who treats OCD, maybe if they have an idea, it's that.
• 35:18
  SPEAKER_01: What are the ways you diagnose it?
• 35:20
  SPEAKER_01: What are the questions you ask?
• 35:22
  SPEAKER_01: How do you get from, okay, you know, you're you're very distressed by what's going on in your mind to here's your diagnosis?
• 35:29
  SPEAKER_00: There are lots of different diagnostic exam questions that we could ask them and interview questions that we could ask them to help decipher whether this is most likely described as or explained by OCD versus anxiety versus post-traumatic stress disorder or some other form of a mental health condition.
• 35:44
  SPEAKER_00: But when it comes to OCD, what we're looking for is what kind of thoughts are you having?
• 35:48
  SPEAKER_00: How frequently are you having these thoughts?
• 35:50
  SPEAKER_00: What is your relationship to those thoughts?
• 35:52
  SPEAKER_00: And we're looking for them to say things like, I hate these thoughts.
• 35:56
  SPEAKER_00: I don't want them.
• 35:56
  SPEAKER_00: Like these are very scary to me.
• 35:58
  SPEAKER_00: I would never do anything like this.
• 36:00
  SPEAKER_00: I do anything I can to not have these types of experiences.
• 36:03
  SPEAKER_00: And then we're looking for, okay, what is your response to these thoughts?
• 36:07
  SPEAKER_00: So we start to collect some information about these compulsions.
• 36:09
  SPEAKER_00: Do they do anything in their environment?
• 36:11
  SPEAKER_00: Do they seek reassurance from their family members?
• 36:14
  SPEAKER_00: Are they spending a lot of time asking Chat GPT or AI for reassurance?
• 36:18
  SPEAKER_00: What are the things that they're doing?
• 36:20
  SPEAKER_00: And then, of course, we ask them, you know, talk to me about how much distress this causes you in your day-to-day life and what other ways is this impacting your activities of daily living, your sleep, your functioning with work, your family.
• 36:30
  SPEAKER_00: And then how much time do you do you find yourself spending on these obsessions and convulsions every day?
• 36:36
  SPEAKER_01: So if someone's listening or watching this conversation and they're either thinking, that might be me or that might be them.
• 36:44
  SPEAKER_01: What are the steps to take to um recognize that this is something valid and medical and treatable?
• 36:53
  SPEAKER_00: There are so many great resources online.
• 36:55
  SPEAKER_00: The International OCD Foundation is a really great place to start if someone is really starting from ground zero and doesn't know much about OCD or doesn't know much about the treatment or anything like that.
• 37:04
  SPEAKER_00: And so the International OCD Foundation is wonderful for that.
• 37:07
  SPEAKER_00: I would also say that they should look into exposure and response prevention.
• 37:11
  SPEAKER_00: So a lot of times I hear people wondering about hypnosis or EMDR or talk therapy or, you know, some type of body type of therapy.
• 37:21
  SPEAKER_00: And, you know, if it's working for you, then great.
• 37:24
  SPEAKER_00: That's working for you.
• 37:24
  SPEAKER_00: But for the most part, and especially if it was one of my family members, for sure, I would want them to be with somebody who specializes in exposure and response prevention.
• 37:33
  SPEAKER_00: And it's really important that they're doing it the right way.
• 37:36
  SPEAKER_00: Exposure and response prevention can be fun.
• 37:39
  SPEAKER_00: It doesn't have to just be scary.
• 37:41
  SPEAKER_00: I really don't want people to think that it's just this fear factor type of experience where you're holding knives against your therapist's throat.
• 37:47
  SPEAKER_00: It's not like that whatsoever.
• 37:48
  SPEAKER_00: It can be really fun.
• 37:50
  SPEAKER_00: It's basically having you push yourself outside of your comfort zone, reduce these compulsions, and get your life back.
• 37:55
  SPEAKER_00: So definitely looking more into it.
• 37:57
  SPEAKER_00: You know, having that sense of community too is really important.
• 38:01
  SPEAKER_00: So the International OCD Foundation, they have groups, they have other directories where you can connect with other people who struggle because OCD is very shameful for people who experience it.
• 38:10
  SPEAKER_00: It feels very isolating.
• 38:11
  SPEAKER_00: It feels like they're the only ones who are going through it.
• 38:13
  SPEAKER_00: And I think that in and of itself can be so healing to hear, like, oh my gosh, there's someone else out there who also has that thought.
• 38:20
  SPEAKER_00: I'm not crazy.
• 38:21
  SPEAKER_00: This isn't just me.
• 38:22
  SPEAKER_00: There's something that's so invigorating and just refreshing about knowing that you're not alone.
• 38:27
  SPEAKER_01: We're gonna do an entire episode after this on that ERP or exposure response prevention therapy.
• 38:34
  SPEAKER_01: What in a in a short description, what happens in ERP therapy?
• 38:38
  SPEAKER_00: ERP is basically boiling down to three things.
• 38:42
  SPEAKER_00: I always tell people it boils down to one, pushing yourself outside of your comfort zone, two, reducing your safety behaviors, compulsions or rituals, whatever you want to call them.
• 38:50
  SPEAKER_00: And then three, reducing avoidance.
• 38:52
  SPEAKER_00: And so what your therapist is gonna do is look at all the obsessions that you're experiencing, look at all the compulsions that you're doing, look at all the ways that you are not living your life the way that you want to.
• 39:03
  SPEAKER_00: What are the things that you would want to be doing or that you would be doing more of if OCD weren't part of the equation?
• 39:09
  SPEAKER_00: And a good therapist will work with you to develop what we call our values-based exposures, not just having you do scary things for the sake of doing scary things, but really challenging you to get outside of your comfort zone in a way that's challenging but manageable.
• 39:23
  SPEAKER_00: So it's really scary for people at first, but I think anything is less scary than continuing to give over your life to OCD.
• 39:32
  SPEAKER_01: So it was clear in doing the research for this that internet searches, people are really looking for tactics and ways to manage this versus theory about it.
• 39:41
  SPEAKER_01: So, how does someone with OCD manage their intrusive thoughts?
• 39:46
  SPEAKER_00: I think a lot of people will go to, okay, how do I manage the thoughts?
• 39:50
  SPEAKER_00: How do I stop the thoughts?
• 39:51
  SPEAKER_00: How do I get the thoughts to go away?
• 39:54
  SPEAKER_00: And unfortunately, I can see why they would want to, because as someone who's experienced it herself, that's all we want.
• 39:59
  SPEAKER_00: We want the thoughts to go away.
• 40:01
  SPEAKER_00: We just want it to stop.
• 40:02
  SPEAKER_00: We feel like if I could just get this thought to go away, I could move on with my life.
• 40:05
  SPEAKER_00: But unfortunately, it's just going to be like quicksand.
• 40:08
  SPEAKER_00: The more you want the thoughts to go away, the more you're actually engaging with it.
• 40:12
  SPEAKER_00: It's kind of like a bully in that way.
• 40:14
  SPEAKER_00: It doesn't even care what kind of attention you give it.
• 40:17
  SPEAKER_00: OCD just wants your attention, even if it's negative attention in the form of go away.
• 40:21
  SPEAKER_00: I don't want you to be here.
• 40:22
  SPEAKER_00: And so what I work with my clients on instead is okay, what are the ways that you are engaging with the OCD?
• 40:28
  SPEAKER_00: There are lots of ways that somebody could engage with the OCD, these physical compulsions, mental compulsions, avoiding, resisting the thoughts, judging the thoughts, wanting the thoughts to go away.
• 40:38
  SPEAKER_00: So we list out all the ways that they're engaging with the thoughts, and then we work on what's called non-engagement.
• 40:43
  SPEAKER_00: And it's it's not something that anybody can just do.
• 40:45
  SPEAKER_00: It's going to be in small little trickles and they build this muscle over time, but essentially accepting the thoughts and letting the thought be there, uh, not being judgmental about the thought, having what we call radical acceptance for all thoughts and just letting them be there.
• 40:59
  SPEAKER_00: So letting the thought be there and still doing the things that you need and want to do on a day-to-day basis.
• 41:05
  SPEAKER_00: So essentially letting the thought come up, we nod to it.
• 41:08
  SPEAKER_00: And as much as we want to do the compulsion, we try really hard to not do that.
• 41:12
  SPEAKER_00: And we move forward with our day anyway.
• 41:13
  SPEAKER_00: That gives the brain the message that that thought is irrelevant, even though it feels really relevant.
• 41:19
  SPEAKER_01: That sounds really hard.
• 41:20
  SPEAKER_00: It is really hard.
• 41:21
  SPEAKER_00: And it takes some time for people to get there.
• 41:23
  SPEAKER_00: And so that's why therapy works the way that it works.
• 41:26
  SPEAKER_00: You don't just do that in the first session.
• 41:28
  SPEAKER_00: So it comes with some time and it comes with a lot of collaboration, hopefully, from the person.
• 41:34
  SPEAKER_00: And it can feel really irresponsible to just let these thoughts go.
• 41:38
  SPEAKER_00: It can feel like you're missing something.
• 41:40
  SPEAKER_00: It can feel like you're a bad person.
• 41:42
  SPEAKER_00: It can feel like if I don't act on this thought, like, how do I not act on the thought that I might hurt my child?
• 41:48
  SPEAKER_00: Or how do I not act on the thought that I could have hit someone with my car?
• 41:52
  SPEAKER_00: How do I just stay in this relationship where I'm not 100% sure that they're the right person for me?
• 41:56
  SPEAKER_00: It can feel so irresponsible, but it's also really important to do the groundwork to help people really understand that this has nothing to do with the hit and run.
• 42:06
  SPEAKER_00: It has nothing to do with the stove.
• 42:08
  SPEAKER_00: It has nothing to do with germs.
• 42:09
  SPEAKER_00: It is the doubt disorder.
• 42:11
  SPEAKER_00: This is a glitch in the brain where your brain doesn't tolerate doubt very well.
• 42:15
  SPEAKER_00: Your brain wants certainty.
• 42:17
  SPEAKER_00: Your brain wants 100%.
• 42:19
  SPEAKER_00: Your brain has a hard time with things that don't feel good enough.
• 42:22
  SPEAKER_00: And that's the mechanism that we need to change.
• 42:25
  SPEAKER_00: Not necessarily this thought in your brain that you harmed your child.
• 42:28
  SPEAKER_00: That's just one form that it's coming out in.
• 42:29
  SPEAKER_00: So there's a lot of groundwork that leads up to it.
• 42:32
  SPEAKER_00: But working with the right therapist, they'll help it be manageable for you.
• 42:36
  SPEAKER_00: They'll be on your on your same team.
• 42:38
  SPEAKER_01: So after therapy, if you in fact have, you know, successfully, I don't think it's a completed it thing, but if you've you've gone through therapy for OCD, what's different for you on a day-to-day basis?
• 42:50
  SPEAKER_01: And how much of a relief is it to not be so consumed with those thoughts and actions?
• 42:56
  SPEAKER_00: The biggest change that you're going to experience is that you're not doing as many compulsions, hopefully, because that is what's basically throwing logs onto the fire.
• 43:04
  SPEAKER_00: Think about all these compulsions that you're doing if you have OCD.
• 43:06
  SPEAKER_00: It's like logs onto a fire.
• 43:08
  SPEAKER_00: And so every time you do a compulsion, whatever that might be for you, it is throwing logs onto the fire.
• 43:13
  SPEAKER_00: It's making it str it's making it stronger, it's making it harder to eventually extinguish.
• 43:18
  SPEAKER_00: And so in treatment, we work on reducing those compulsions.
• 43:21
  SPEAKER_00: We don't just put out the fire.
• 43:22
  SPEAKER_00: It doesn't work like that.
• 43:23
  SPEAKER_00: We have to stop throwing logs onto it and it eventually will come down on its own.
• 43:27
  SPEAKER_00: And so you're gonna get more time back by not doing these compulsions.
• 43:31
  SPEAKER_00: I would say hopefully that you don't have as many intrusive thoughts and that you don't have them as vividly, but that's gonna maybe take some time, right?
• 43:38
  SPEAKER_00: Because just because you stop throwing logs on the fire doesn't mean that it goes out right away.
• 43:42
  SPEAKER_00: It kind of burns for a little bit longer and it just needs you to continue doing what you're supposed to be doing.
• 43:48
  SPEAKER_00: Um, but I would say that absolutely people can look forward to that as a goal too, that they don't get rid of the thoughts completely.
• 43:55
  SPEAKER_00: That would be like getting rid of sadness.
• 43:58
  SPEAKER_00: We don't get rid of sadness forever.
• 43:59
  SPEAKER_00: It's a naturally occurring human experience.
• 44:01
  SPEAKER_00: It's just that when we do experience these things, we're much better able to cope with it and not continue to throw logs on that fire and make it worse.
• 44:09
  SPEAKER_01: How long does a typical course of treatment for somebody with OCD take?
• 44:14
  SPEAKER_00: It could totally depend.
• 44:15
  SPEAKER_00: And one of the most common questions that I do get is how long is this going to take?
• 44:18
  SPEAKER_00: How long is this going to take?
• 44:19
  SPEAKER_00: But I always tell my clients that it really isn't a matter of how long because you could be in therapy for six months and never resist a single compulsion.
• 44:28
  SPEAKER_00: If you are just there in therapy for six months and you're washing your hands all the time and you are asking reassurance all the time and you're going back and you're reviewing all those routes that you took when you were driving and you're constantly looking everything up on Google and nothing has changed, nothing is going to change.
• 44:44
  SPEAKER_00: But if you are in therapy for three months and as much as you don't want to, you're willing to experience discomfort and you're willing to break the cycle and you're willing to break down those compulsions, even though it's very hard, you're going to experience a lot of progress.
• 44:58
  SPEAKER_00: And so I would look at it less as how long it takes.
• 45:02
  SPEAKER_00: I would look at it instead of how consistently are you willing to resist your compulsions, even when it's hard.
• 45:07
  SPEAKER_01: So another internet question.
• 45:08
  SPEAKER_01: How does someone know if they have OCD or severe anxiety?
• 45:12
  SPEAKER_00: Somebody who is experiencing these symptoms, they would be able to determine whether they have OCD or severe anxiety based on the intrusiveness of their thoughts.
• 45:22
  SPEAKER_00: So again, are they experiencing it more like a lightning bolt?
• 45:25
  SPEAKER_00: Like it's happening right now and it's imminent and it feels very real, very sudden right now?
• 45:29
  SPEAKER_00: Or is it more of this kind of looming in the background?
• 45:32
  SPEAKER_00: Now, people can experience both.
• 45:34
  SPEAKER_00: Absolutely.
• 45:35
  SPEAKER_00: Uh back in the previous version of the diagnostic and statistical manual, OCD was an anxiety-related condition.
• 45:41
  SPEAKER_00: It's no longer that.
• 45:42
  SPEAKER_00: I don't know that I necessarily agree with that.
• 45:45
  SPEAKER_00: So again, I'm less interested in what it is that you're anxious about.
• 45:49
  SPEAKER_00: I'm less interested in the anxiety piece, you know, more practical, more day-to-day anxieties, more down-to-earth anxieties or concepts versus OCD.
• 45:57
  SPEAKER_00: We tend to think of them as being more outlandish, more out there.
• 46:01
  SPEAKER_00: But I don't, I don't really care what someone is anxious about.
• 46:03
  SPEAKER_00: It's not, it's what I'm interested in is what are the compulsions that you're doing?
• 46:08
  SPEAKER_00: What are the safety behaviors that you're doing?
• 46:09
  SPEAKER_00: How do we get a grip on that?
• 46:10
  SPEAKER_00: How do we start to reduce that?
• 46:12
  SPEAKER_00: And how do we start to push you outside of your comfort zone?
• 46:15
  SPEAKER_00: Tell me about the OCD cycle.
• 46:17
  SPEAKER_00: The OCD cycle starts first when you experience this intrusive thought, idea, image, impulse, or feeling.
• 46:23
  SPEAKER_00: And I always envision that as not even really part of the cycle because people who don't have OCD experience that all the time.
• 46:30
  SPEAKER_00: Where we, people with OCD and anxiety, tend to get sucked into this cycle, is we experience those naturally occurring intrusive experiences as our problem, as significant somehow.
• 46:41
  SPEAKER_00: So we can experience them as being significant somehow by taking responsibility for the thought.
• 46:47
  SPEAKER_00: Oh my gosh, what does that mean about me that I had that thought?
• 46:50
  SPEAKER_00: Uh, we can tend to just judge the thought, like, oh my gosh, that was such a gross thought, or that was a bad thought instead of just being neutral about it.
• 46:57
  SPEAKER_00: We can tend to want to control our thoughts, meaning we tend to want to just have good vibes only.
• 47:02
  SPEAKER_00: Like we just want to be calm all the time.
• 47:03
  SPEAKER_00: We just want to have good thoughts, um, no room for bad or disgusting thoughts or anything like that.
• 47:09
  SPEAKER_00: And then we also want to get rid of any bad thoughts, right?
• 47:12
  SPEAKER_00: We just, again, want everything to be calm, cool, and collected.
• 47:14
  SPEAKER_00: And so when you have those experiences, when you start to draw significance from these thoughts, of course you're gonna be anxious.
• 47:22
  SPEAKER_00: We don't like to experience anxiety.
• 47:24
  SPEAKER_00: And so we do something to negate or get rid of that anxiety that's gonna be in the compulsions, right?
• 47:29
  SPEAKER_00: So when it comes to compulsions, those are those physical or mental experiences that we do to get rid of the anxiety that we feel from obsessions.
• 47:36
  SPEAKER_00: And they work temporarily, they provide some relief very temporarily.
• 47:40
  SPEAKER_00: But what happens and what most people don't realize is that that relief just basically reinforces that initial thought in the first place.
• 47:47
  SPEAKER_00: And so if I have this obsession that I hit someone with my car and then I go back and I check my route to make sure I didn't hit anybody, my brain gets the message good thing you went and checked that route, because otherwise you could have really killed someone.
• 48:02
  SPEAKER_00: And so you can see how it just makes that thought stronger and more convincing next time.
• 48:08
  SPEAKER_00: Another example, just to run through the cycle again really quickly, intrusive thought that uh I could have gotten you sick by shaking your hands.
• 48:15
  SPEAKER_00: Oh my gosh, I could get you sick.
• 48:17
  SPEAKER_00: A lot of times people might have that thought, but they might not think twice about it.
• 48:20
  SPEAKER_00: They would shrug it off, they would keep going.
• 48:22
  SPEAKER_00: But what if I'm drawing significance from that?
• 48:24
  SPEAKER_00: Oh my gosh, I'd be such a bad person.
• 48:26
  SPEAKER_00: That's so irresponsible of me.
• 48:28
  SPEAKER_00: I should have washed my hands before I shook your hand.
• 48:30
  SPEAKER_00: Oh my gosh, I'm such a bad person.
• 48:31
  SPEAKER_00: Of course, I'm gonna start to feel anxious about that.
• 48:33
  SPEAKER_00: If I'm so anxious that I do a compulsion, I confess to you, oh my gosh, you know, my son started school two or three weeks ago.
• 48:39
  SPEAKER_00: I'm so sorry.
• 48:40
  SPEAKER_00: Like, you know, it alleviates some of that feeling of moral irresponsibility.
• 48:44
  SPEAKER_00: Okay, well, now you know, right?
• 48:46
  SPEAKER_00: Now you know, now I'm in the clear.
• 48:48
  SPEAKER_00: It temporarily alleviates that anxiety that I feel from potentially contaminating you, but it just gives my brain the message good thing you told her that, because otherwise you would have been on the hook.
• 48:58
  SPEAKER_00: Otherwise, you would have been a really bad person.
• 49:00
  SPEAKER_00: And so now I'm gonna have to, next time I experience that, I'm gonna have to confess even more.
• 49:05
  SPEAKER_00: And I'm just walking around with this moral irresponsibility constantly because I'm constantly reinforcing it.
• 49:10
  SPEAKER_00: So, regardless of what it is that someone's dealing with, whatever theme, the cycle works exactly the same way.
• 49:16
  SPEAKER_01: Drawing significance is such an interesting phrase that really it's like it's it might be the same thing that's happening to other people, but you, because of this disorder, it's huge to you.
• 49:28
  SPEAKER_00: Right.
• 49:28
  SPEAKER_00: We experience it differently.
• 49:29
  SPEAKER_00: And I'll give another example.
• 49:30
  SPEAKER_00: The other day, my son, he's eight and a half, and he again just started school.
• 49:34
  SPEAKER_00: We just adopted a dog.
• 49:36
  SPEAKER_00: And so they're just playing, they're laughing, they're so sweet.
• 49:39
  SPEAKER_00: And OCD often does come in those moments where everything is just so sweet and so good, it's too good to be true.
• 49:44
  SPEAKER_00: And so my son was wearing this nice bright white shirt, and I remember having this intrusive thought of, oh my gosh, he's gonna come home bloody from a school shooting.
• 49:54
  SPEAKER_00: Just random, totally random, totally intrusive.
• 49:57
  SPEAKER_00: I didn't do anything to conjure up that thought.
• 49:59
  SPEAKER_00: I wasn't even necessarily triggered by anything.
• 50:01
  SPEAKER_00: It just popped into my head.
• 50:03
  SPEAKER_00: And luckily, I'm at the point now where I can see that thought, I can observe that thought and be like, that's weird.
• 50:09
  SPEAKER_00: And I can kind of shrug it off and I can move on with the rest of my day.
• 50:13
  SPEAKER_00: Not that I like the thought, not that I accept it, not that I endorse it, not that I'm okay with my son getting blood on his shirt from a school shooting, but I'm not going to engage with that thought because I know that it's just a thought.
• 50:24
  SPEAKER_00: I know that I don't need to do anything with that.
• 50:28
  SPEAKER_00: Somebody with OCD, however, is going to have that thought.
• 50:31
  SPEAKER_00: Oh my gosh, why did I just have that thought come in my head about my son?
• 50:35
  SPEAKER_00: Does that mean something bad is going to happen to him today?
• 50:37
  SPEAKER_00: Is that a premonition?
• 50:38
  SPEAKER_00: If I don't keep him home from school, what if something bad happens and then it's all my fault?
• 50:41
  SPEAKER_00: And then they might keep their son home from school.
• 50:43
  SPEAKER_00: They might seek reassurance from their husband about it.
• 50:46
  SPEAKER_00: It can be two totally different experiences.
• 50:48
  SPEAKER_01: My heart is breaking for the person who would go there automatically and repeatedly.
• 50:55
  SPEAKER_00: And I mean, that's an average second in someone's life who has OCD.
• 50:59
  SPEAKER_00: I it is something that I used to struggle with, and I'm so sure so many parents would resonate with this because OCD latches on to three things.
• 51:07
  SPEAKER_00: OCD latches onto what you love more than anything in the whole entire world.
• 51:11
  SPEAKER_00: It latches onto what you feel most responsible for, and it latches onto what you can't tolerate uncertainty about.
• 51:17
  SPEAKER_00: That's why it comes back to that ego dystonic nature because it's so not what we would want.
• 51:22
  SPEAKER_00: It's absolutely against our values, it's absolutely against everything that we would ever want to have happen.
• 51:27
  SPEAKER_00: Um, but when you start to do the work that you know that these thoughts don't mean anything and you don't have to do anything, you can just let them come and go when you experience truly the natural nature of thought that it can come and it can go, and you don't have to do anything about it.
• 51:40
  SPEAKER_00: That's really beautiful.
• 51:41
  SPEAKER_00: And that's what treatment's all about.
• 51:42
  SPEAKER_01: Yeah.
• 51:43
  SPEAKER_01: And you said that OCD is one of the most treatable conditions.
• 51:46
  SPEAKER_00: Yes, absolutely.
• 51:47
  SPEAKER_00: It is one of the most treatable conditions.
• 51:49
  SPEAKER_00: While it might feel scary on the surface, it really does just come down to learning and it comes down to having a better relationship with these thoughts.
• 51:57
  SPEAKER_00: And even though it can be so debilitating, exposure and response prevention is actually more effective for OCD than any other treatment for any other condition, which I think is absolutely fantastic.
• 52:05
  SPEAKER_00: And so, one thing that people are also really astounded to learn, they've done research to show they kind of divided people into three groups.
• 52:12
  SPEAKER_00: Let's just give people exposure and response prevention.
• 52:15
  SPEAKER_00: Let's give people medication, and then let's give people medication and exposure and response prevention.
• 52:20
  SPEAKER_00: So the combined therapy, what we've actually found is that while medication plus the treatment is a is the best, just the treatment, exposure and response prevention isn't that much less effective.
• 52:31
  SPEAKER_00: And so what we find is the treatment for OCD is so effective in terms of exposure and response prevention.
• 52:37
  SPEAKER_00: While medication can absolutely help and be life-saving, the treatment in terms of exposure and response prevention does the bulk of that work, especially when it's done correctly.
• 52:45
  SPEAKER_01: So if ERP is so effective for treating OCD, how do you get people to take that step and recognize that what's going on in their heads is actually a disorder and something that can be remedied and reduced?
• 52:59
  SPEAKER_00: I think it comes in the form of education like this.
• 53:02
  SPEAKER_00: I think it comes in the form of actually calling it out and talking about things other than just OCD in the form of contamination and needing everything to be perfect.
• 53:10
  SPEAKER_00: There are just so many people out there who are experiencing harm-intrusive thoughts, who are experiencing these sexual unwanted intrusive thoughts or images, who experience things like relationship OCD, who experience magical thinking.
• 53:22
  SPEAKER_00: There are so many subtypes and themes that we haven't even gone over, but they finally see themselves in it and they think, oh my gosh, I thought it was just me.
• 53:30
  SPEAKER_00: Oh my gosh, I thought it was just me.
• 53:31
  SPEAKER_00: And that's really the tipping point.
• 53:32
  SPEAKER_00: That's what we have to work on first.
• 53:34
  SPEAKER_00: If somebody just continues to experience these things, but not ever have a name for it and they think that they're the only one, there's not much that can be done.
• 53:41
  SPEAKER_00: But thanks to resources like this and more education online, we're able to reach people.
• 53:46
  SPEAKER_00: And once they do that, once they realize that there is such an effective treatment for it, then hopefully they can get into the right spot.
• 53:53
  SPEAKER_01: Is it harder for people to recognize uh OCD when it is the internal mental kind of compulsions versus the activities?
• 54:02
  SPEAKER_00: Absolutely.
• 54:03
  SPEAKER_00: We don't talk nearly enough about the mental compulsions.
• 54:05
  SPEAKER_00: So I think we're doing a little bit of a better job at that, thanks to things like social media.
• 54:10
  SPEAKER_00: Social media for all of its uh negative qualities, I think it does a really great job for people who can't access treatment and in providing education, so on and so forth.
• 54:19
  SPEAKER_00: But things like rumination, replaying conversations or replaying events that have happened, this self-assurance, trying to logic your way out of a thought.
• 54:27
  SPEAKER_00: OCD is not going to respond to logic because there's always gonna be a what if.
• 54:32
  SPEAKER_00: So a lot of times people will try to negotiate or debate with their OCD to try to like logic their way out of it because they do feel like it's so irrational.
• 54:40
  SPEAKER_00: But that is just like bull, it's it's just like arguing with a bully.
• 54:44
  SPEAKER_00: It's arguing with a with a toddler.
• 54:45
  SPEAKER_00: They don't want to be right.
• 54:47
  SPEAKER_00: They just want your attention.
• 54:48
  SPEAKER_00: And so there's just always gonna be one more, but what if.
• 54:51
  SPEAKER_00: So it's definitely harder for individuals to get the treatment that they need.
• 54:54
  SPEAKER_00: But hopefully with resources like this, we're becoming more aware of it and people listening are becoming more aware of it.
• 54:59
  SPEAKER_01: What immediate mental shift should someone make when a frightening, intrusive thought pops into their head?
• 55:04
  SPEAKER_00: When an immediate thought pops into their head, I would really want people to try to consider, okay, let's let's not try to get rid of it right away.
• 55:12
  SPEAKER_00: Let's try not to, oh my gosh, I have to get rid of that thought.
• 55:16
  SPEAKER_00: Oh my gosh, what does that mean about me?
• 55:18
  SPEAKER_00: Try to say, I'm having the thought that dot, dot, dot.
• 55:22
  SPEAKER_00: Instead of, oh my gosh, what if Eli gets in a school shooting today?
• 55:26
  SPEAKER_00: Say, I'm having the thought that Eli could get into a school shooting today.
• 55:30
  SPEAKER_00: It's very subtle and it doesn't feel like it would make that much of a difference, but it really does defuse you.
• 55:35
  SPEAKER_00: So people who have OCD, they're very fused to their thoughts.
• 55:39
  SPEAKER_00: They think that the thought is them and vice versa.
• 55:41
  SPEAKER_00: That if I have the thought, it must be true.
• 55:43
  SPEAKER_00: If I have the thought, it must have come from me, and that's not true whatsoever necessarily.
• 55:48
  SPEAKER_00: And so by simply saying, I'm having the thought that I offended someone or I'm having the thought that I could be contaminated versus I offended someone or I am contaminated, it puts you in this position of distance.
• 56:01
  SPEAKER_00: It allows you to observe the thought from a little bit less of an emotional standpoint.
• 56:05
  SPEAKER_00: So you don't necessarily have to act on it right away.
• 56:08
  SPEAKER_01: Defuse.
• 56:08
  SPEAKER_01: And I'm thinking of diffuse.
• 56:10
  SPEAKER_01: I mean those I've never put those words together and thought of it that way.
• 56:13
  SPEAKER_00: Yeah.
• 56:13
  SPEAKER_00: So defuse.
• 56:14
  SPEAKER_00: That's what this is, is it's D-E-F-U-S-E.
• 56:17
  SPEAKER_00: So actually to defuse yourself from the thought.
• 56:19
  SPEAKER_00: And it's an experience that so many people will resonate with.
• 56:22
  SPEAKER_00: They feel so fused to their thoughts.
• 56:24
  SPEAKER_00: I've worked with so many high-functioning individuals, their kids in the background.
• 56:28
  SPEAKER_00: You can tell they're from a very, you know, they're they're very well off.
• 56:32
  SPEAKER_00: But these 35 plus year old individuals, when I tell them that not every single mental experience that you have, not every thought that you have came from you.
• 56:40
  SPEAKER_00: Like it, like you can have a thought, and it doesn't mean that you want to have that thought.
• 56:46
  SPEAKER_00: Right.
• 56:46
  SPEAKER_00: You know, that they and they're astounded.
• 56:48
  SPEAKER_00: They've just lived their whole entire lives for 35 years, thinking that every single thought that I had, I endorsed it, I signed, dealed, and delivered it.
• 56:55
  SPEAKER_00: That was from me.
• 56:56
  SPEAKER_00: And of course, if if then you have scary thoughts and you think that those are your responsibility, that's terrible for you.
• 57:02
  SPEAKER_00: It's so shameful.
• 57:04
  SPEAKER_00: But you can absolutely have a thought and it just be weird mental spam.
• 57:08
  SPEAKER_00: If that is possible.
• 57:10
  SPEAKER_01: Mental spam.
• 57:11
  SPEAKER_01: That's such a great phrase.
• 57:12
  SPEAKER_01: It's just what we do to our inboxes every morning.
• 57:15
  SPEAKER_01: It's like, nope, nope, nope, nope, nope.
• 57:16
  SPEAKER_00: Yeah.
• 57:17
  SPEAKER_00: And again, I see it as that just like a weird misfiring in the circuitry.
• 57:21
  SPEAKER_00: Back to the Amazon example of the warehouse.
• 57:24
  SPEAKER_00: As the complexity of a machine increases, the likelihood of mistakes also increase.
• 57:30
  SPEAKER_00: Just because there's so much wiring that can go on.
• 57:33
  SPEAKER_00: And again, if we're having upwards of 50,000, 60,000 thoughts a day, it's wild to expect that every single one of those would be pleasant and calm and positive and aligned with us.
• 57:43
  SPEAKER_01: Yes, in alignment with our values and desires.
• 57:47
  SPEAKER_01: Interesting.
• 57:48
  SPEAKER_01: What is family accommodation with OCD and how do well-meaning family members accidentally become part of the ritual?
• 57:54
  SPEAKER_00: Well-meaning family members, of course, become part of the OCD cycle because it's in our nature to want them to feel better.
• 58:00
  SPEAKER_00: It's in our nature to not want them to be sad, to not want them to be anxious, to try to make their lives easier if we can.
• 58:07
  SPEAKER_00: And so it starts out really well-meaning and it's always coming from a good place.
• 58:11
  SPEAKER_00: But when it comes to OCD, unfortunately, that accommodation just tends to act like a ritual or a compulsion.
• 58:18
  SPEAKER_00: And so a really good example would be things like, you know, making sure that your family member has their preferred hand soap for hand washing.
• 58:26
  SPEAKER_00: Or uh, if someone is really late for work because they're showering, then you'll be late for your job so that you can take them to work or take them to school.
• 58:35
  SPEAKER_00: Or just even simply telling them, you know, everything is going to be okay.
• 58:38
  SPEAKER_00: You're not that dirty, or you lined up everything perfect, or, you know, I checked the stove for you.
• 58:43
  SPEAKER_00: You're fine.
• 58:44
  SPEAKER_00: Just basically doing things for them, rearranging your life in such a way to make the OCD easier.
• 58:50
  SPEAKER_00: But again, it just works as a compulsion.
• 58:51
  SPEAKER_00: It works very temporarily, but it just gives the message that, you know, hey, this was important.
• 58:57
  SPEAKER_00: This was dangerous.
• 58:59
  SPEAKER_00: And so it's just going to make it worse for next time.
• 59:01
  SPEAKER_01: So give us some language if we are in relationship with somebody with OCD and they are used to coming to us for any of those reinforcements.
• 59:12
  SPEAKER_01: What do we say or do instead?
• 59:14
  SPEAKER_00: If someone is at ground zero with this, I would say, you know, hey, I've been reading more about this and I love you so much that I care to read more about this.
• 59:24
  SPEAKER_00: I care so much that I actually learned that these little things that we've been doing and maybe give some examples that it might be making your OCD worse.
• 59:32
  SPEAKER_00: I know it probably helps in the short term, but it's actually making it worse in the long run.
• 59:35
  SPEAKER_00: So I want to work with you.
• 59:38
  SPEAKER_00: It should be ideally a collaborative process.
• 59:40
  SPEAKER_00: You're not just ripping them cold turkey and you're not forcing them to do it and uh basically saying, you know, I want to support you in a way that doesn't make your OCD and anxiety worse.
• 59:49
  SPEAKER_00: How can we work on that together?
• 59:51
  SPEAKER_00: So I'm here for you and I'm happy to help support you.
• 59:54
  SPEAKER_00: But here are the ways of things that are gonna have to change.
• 59:58
  SPEAKER_00: You know, I'm as of next week, I'm no longer going to buy you your specific soap.
• 1:00:02
  SPEAKER_00: If you want your specific soap, then you're gonna have to pay for it, or you're just gonna have to use the family soap.
• 1:00:08
  SPEAKER_00: I'm no longer going to check the stove for you five times.
• 1:00:11
  SPEAKER_00: Starting next week, I'm only gonna check four times, or I'm only gonna check two times, whatever that looks like.
• 1:00:16
  SPEAKER_00: So ideally, it would be a really collaborative process and being able to make boundaries and set those boundaries and maintain those boundaries.
• 1:00:24
  SPEAKER_00: But, you know, it's going to have to come eventually in the form of no longer uprooting your entire life and your entire family routine to give into these compulsions for the person because that's what it is.
• 1:00:35
  SPEAKER_01: So if somebody has been watching or listening to this and they are going to leave with one takeaway about OCD, what do you hope that it is?
• 1:00:42
  SPEAKER_00: I hope that they take away that they are definitely not the only one who is experiencing this.
• 1:00:47
  SPEAKER_00: There is no type of OCD or no thought that anybody has ever told me that I haven't heard of before.
• 1:00:55
  SPEAKER_00: And I promise you, as isolating as it feels and as crazy as you feel, there are so many other people out there who have had the same exact thoughts, who have had the same exact experiences.
• 1:01:06
  SPEAKER_00: I can tell you right now, any time that I've been really deep and really vulnerable myself about what I think are my craziest intrusive thoughts, I cannot tell you the influx of people who message me and say, oh my gosh, me too.
• 1:01:17
  SPEAKER_00: I'm the only one.
• 1:01:19
  SPEAKER_00: And so as much as you think that your OCD is the exception and that you have the scariest thoughts, I promise you that's not the case.
• 1:01:25
  SPEAKER_00: I promise you that if you were to work with somebody who understands this condition, they're gonna listen to what you have to say and not bat an eye.
• 1:01:32
  SPEAKER_00: And this is so treatable.
• 1:01:34
  SPEAKER_00: You do not have to continue to live your life this way.
• 1:01:36
  SPEAKER_00: And life on the other side is so possible.
• 1:01:38
  SPEAKER_00: You deserve to be able to do the things that you need and want to do.
• 1:01:43
  SPEAKER_00: And I always say the best route through this is make your world bigger, and OCD will have no choice but to get smaller.
• 1:01:50
  SPEAKER_00: What that means is do the things that you need and want to do.
• 1:01:53
  SPEAKER_00: Do some of the things that you used to enjoy or that you've wanted to try.
• 1:01:57
  SPEAKER_00: And by natural consequences, OCD is gonna get smaller.
• 1:02:02
  SPEAKER_00: Excellent.
• 1:02:03
  SPEAKER_00: Thank you so much.
• 1:02:04
  SPEAKER_00: Thank you.
• 1:02:05
  SPEAKER_01: So we will be back next week, and we're gonna do a deep dive into ERP so that you can really understand how the treatment is given how it works and how it helps with OCD.
• 1:02:16
  SPEAKER_01: Please join us.