Podcast appearances and mentions of jon hershfield

In this episode of the Anxiety Society podcast, hosts Cali Werner and Dr. Elizabeth McIngvale are joined by Jon Hershfield, MFT, the Director of The Center for OCD and Anxiety, for a compelling discussion on the rise of anxiety in today's world. Together, they dive into the uncomfortable truths about how anxiety takes root in our daily lives and uncover actionable strategies to break its hold. From the transformative power of mindfulness to the life-changing tools of dialectical behavior therapy ( DBT). This episode offers fresh perspectives and practical insights for anyone ready to reclaim their peace of mind and live a more empowered life. Don't miss this eye-opening conversation!Key Points:[0:00] - Introduction to Anxiety Society Podcast Cali and Dr. McIngvale introduce the Anxiety Society podcast, sharing their mission to dive deep into the topics surrounding anxiety in an honest and raw way. [4:00] - The Rise of Anxiety in Society The hosts discuss how society's collective anxiety has escalated, offering insight into how and why anxiety has become so pervasive.[4:14] - What is DBT?Jon H. explains the principles of Dialectical Behavior Therapy and how it integrates mindfulness.[13:00] - Breaking Free from Anxiety's Grip Cali and Dr. McIngvale delve into actionable steps to overcome anxiety, emphasizing the importance of shifting perspectives and tackling it head-on. [20:00] - The Role of Mindfulness in Managing Anxiety Mindfulness techniques are explored as a practical tool to manage and reduce anxiety symptoms. [27:05] - Mindfulness Practices for AnxietyPractical mindfulness strategies from DBT that listeners can apply immediately.[39:32] - Breaking Down Common MythsAddressing misconceptions about mindfulness and its role in anxiety treatment.[30:00] - Dealing with Anxiety Triggers The conversation shifts to understanding specific triggers of anxiety and strategies for managing them in daily life.[52:21] - Final Thoughts and ResourcesWrapping up with actionable advice and an invitation to explore additional resources on the podcast website.Quotable Moments:- [4:30] "We are not just talking about anxiety, we are living it, and that's where the real conversation begins." - Dr. Elizabeth McIngvale- [13:30] "Anxiety isn't something we can simply 'fix.' It's about learning how to coexist with it, to understand it, and ultimately to change our relationship with it." - Cali Werner- [30:45] "Mindfulness gives us the ability to pause, to breathe, and to regain control in the midst of our most anxious moments." - Dr. Elizabeth McIngvaleLinks Mentioned:-Shepherd Pratt: https://www.sheppardpratt.org/why-sheppard-pratt/our-experts/details/jon-hershfield-mft/- Website: [Anxiety Society Podcast: https://anxietysocietypodcast.com- Instagram: [@TheAnxietySocietyPod: https://instagram.com/TheAnxietySocietyPodThank you for tuning into this powerful episode of the Anxiety Society podcast. If you found these insights helpful, please subscribe to the podcast on your favorite platform and leave a review to help others find this message.Mentioned in this episode:World Class Treatment For A Worldwide NeedThe OCD Institute of Texas provides compassionate individualized treatment for anxiety, OCD and related disorders with a diverse team of dedicated specialists.

In episode 457 I chat with Jon Hershfield, MFT. Jon is the director of Sheppard Pratt's The Center for OCD and Anxiety.  In this episode we discuss what is a residential treatment center, who can benefit from residential treatment, what a day in the life in residential looks like, the duration of a residential stay, therapy at residential centers, art therapy, yoga, mindfulness, having a team around you, the use of family therapy, and much more. Hope it helps.   Show notes: https://theocdstories.com/episode/jon-457 The podcast is made possible by NOCD. NOCD offers effective, convenient therapy available in the US and outside the US. To find out more about NOCD, their therapy plans and if they currently take your insurance head over to https://go.treatmyocd.com/theocdstories Join many other listeners getting our weekly emails. Never miss a podcast episode or update: https://theocdstories.com/newsletter   Thanks to all our patrons for supporting our work. To sign up to our Patreon and to check out the benefits you'll receive as a Patron, visit: https://www.patreon.com/theocdstoriespodcast 

Our mental health series is sponsored by Terri and Andrew Herenstein.In this episode of the 18Forty Podcast, we wrap up our mental health series by talking to Dr. Yael Muskat, director of Yeshiva University's Counseling Center, and her longtime colleague Dr. Martin Galla about the mental health challenges at the forefront of early adulthood.Young people in the Jewish community are not immune from today's mental health crisis. They have their own, equally pressing versions of those same problems. In this episode we discuss:How do experts deal with the mental health of college students “in between” childhood and adulthood?What mental health challenges to the Jewish world in particular need to address?How can young adults handle the mental health turmoil that can come with dating?Tune in to hear a conversation about how we can get to a place where sound mental health enables spiritual growth. Interview with Dr. Muskat begins at 7:13.Interview with Dr. Galla begins at 55:46.Dr. Yael Muskat, Psy.D., is the Director of the Counseling Center at Yeshiva University and has over 20 years of clinical experience. After graduating from Yeshiva University, she received a Master's in Special Education from Columbia University and a Doctorate in Clinical Psychology from Long Island University, C.W. Post. Dr. Muskat continued her clinical training by completing a Post Doctorate Leadership Fellowship at Westchester Institute for Human Development. Dr. Martin Galla is a former associate director at the Yeshiva University Counseling Center, where he worked for 13 years. References:Hold Me Tight: Seven Conversations for a Lifetime of Love by Sue JohnsonThe Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma by Bessel van der KolkThe Mindfulness Workbook for OCD: A Guide to Overcoming Obsessions and Compulsions Using Mindfulness and Cognitive Behavioral Therapy by Jon Hershfield and Tom CorboyEinstein's Dreams by Alan LightmanBerakhot 12b

Join your host, Nicole Morris, LMFT and Mental Health Correspondent, as we welcome Jon Hershfield, LMFT, to our family table. Jon is well known leader in the OCD treatment field and broader community, and today he's here for you, fam! Amongst many helpful books, presentations, and interviews Jon has participated in, he has written a book called When A Family Member Has OCD, which is particularly pertinent to us, fam! So join us while we highlight some helpful nuggets from that book, dispel some common OCD myths, play a few rounds of Never Have I Ever - OCD Edition courtesy of some help from ChatGPT, and share top recommendations for family members and warriors with lived experience battling OCD.

In this episode, I talk about one of biggest mindset shifts I've ever had around OCD and my brain in general - and why I think there's so much to be grateful for despite having scary thoughts. I talk about ... A post from Dr. Laura Johnson (@ocddoodles on Instagram), inspired by a concept in a book by Jon Hershfield (@ocdbaltimore on Instagram) The ways in which we are all funny, unique, and creative despite having scary thoughts How our brains and perspectives are different from those who do not have OCD Click below to find Dr. Laura Johnson's original Instagram post referenced throughout this episode:https://www.instagram.com/p/CIx1j5xjiy4/

Kimberley: Welcome, everybody. This is a very exciting episode. I know I'm going to learn so much. Today, we have Caitlin Pinciotti and Shala Nicely, and we're talking about when OCD and PTSD collide and intertwine and how that plays out. This is actually a topic I think we need to talk about more. Welcome, Caitlin, and welcome, Shala. Caitlin: Thank you. Shala: Thanks. Kimberley: Okay. Let's first do a little introduction. Caitlin, would you like to go first introducing yourself? Caitlin: Sure thing. I'm Caitlin Pinciotti. I'm a licensed clinical psychologist and an assistant professor in the Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine. I also serve as a co-chair for the IOCDF Trauma and PTSD and OCD SIG. If people are interested in that special interest group as well, that's something that's available and up and running now. Most of my research specifically focuses on OCD, trauma, and PTSD, and particularly the overlap of these things. That's been sort of my focus for the last several years. I'm excited to be here and talk more about this topic. Kimberley: Thank you. You're doing amazing work. I've loved being a part of just watching all of this great research that you're doing. Shala, would you like to introduce yourself? Shala: Yes. I'm Shala Nicely. I am a licensed professional counselor, and I specialize in the treatment of OCD and related disorders. I am the author of Is Fred in the Refrigerator?: Taming OCD and Reclaiming My Life, which is my story, and then co-author with Jon Hershfield of Everyday Mindfulness for OCD: Tips, Tricks, and Skills for Living Joyfully. I also produce the Shoulders Back! newsletter. It has tips and resources for taming OCD. Kimberley: Shoulders Back! was actually the inspiration for this episode. Shala, you recently wrote an article about post-traumatic OCD or how PTSD and OCD collide. Can you tell us about your story, particularly going back to, I think you mentioned, May 2020, and what brought you to write that article? Shala: Sure, and thank you very much for having Caitlin and me on today because I really appreciate the opportunity to talk about this and to get more information out in the world about this intertwined combination of PTSD and OCD. In May of 2020, I moved to a new house, the house that I'm in now. Of course, we had just started the pandemic, and so everybody was working at home, including me. The house that I moved into was in a brand new neighborhood. While the houses on this side of me were completed, the houses behind me and on that side were not completed. I didn't think anything of that when I moved in. But what I moved into was a situation where I was in a construction zone all the time. I was working at home, so there was no escape from it. One day I was walking behind my house, where most of the houses were in the process of being built and there were no sidewalks. As I was walking down the street, I saw, down at the end of the street, a big forklift come down the street where I was walking with my two little dogs backwards at a really high rate of speed, and the forklift driver seemed to be looking that way, and he was going that way. It happened so fast because he was going so quickly that all of a sudden I realized he was going to hit us, my dogs and me, and there was no place for us to go because we were on the road because there was nowhere else for us to be. I screamed bloody murder, and he heard me. I mean, that's how loud I screamed, and he stopped. That was not all that pleasant. I was upset. He was not happy. But we moved on. But my brain didn't move on.  After that incident, what I noticed was I was becoming really hypervigilant in my own house and finding the construction equipment. If I go outside, I tense up just knowing that construction equipment is there. Over time, my sleep started becoming disturbed. I started to have flashbacks and what I call flash-forwards, where I would think about all these horrible things that could happen to me that hadn't happened to me yet but could. I'd get lost in these violent fantasies of what might happen and what I need to do to prevent that.  I realized that I seemed to be developing symptoms of PTSD. This is where being a therapist was actually quite helpful because I pulled the DSM open one night and I started going through symptoms of PTSD. I'm like, “Oh my gosh, I think I have PTSD.”  I think what happened, because having a forklift driver almost hit you, doesn't seem like that could possibly cause PTSD. But if you look at my history, I think that created a link in my brain to an accident I was in when I was four where I did almost die, which is when my mom and I were standing on the side of a road, about to cross. We were going to go between two parked cars. My mom and I stepped between two parked cars, and there was a man driving down the road who was legally blind, and he mistook the line of parked cars where we were standing as moving traffic. He plowed into the end of all the parked cars, which of course made them accordion in, and my mom and I were in the middle of that. I was very seriously injured and probably almost died. My mom was, too. Several months in the hospital, all of that.  Of course, at that point—that was 1975—there was no PTSD, because I think— Caitlin, you can correct me—it didn't become a diagnosis until 1980. I have had symptoms—small, low-level symptoms of PTSD probably on and off most of my life, but so low-level, not diagnosable, and not really causing any sort of problems. But I think what happened in my head was that when that forklift almost hit me, it made my brain think, “Oh my gosh, we're in that situation again,” because the forklift was huge. It was the same scale to me as an adult as that car that I was crushed between was when I was four. I think my brain just got confused. Because I was stuck with this construction equipment all day long and I didn't get any break from it, it just made my brain think more and more and more, “Boy, we are really in danger.” Our lives are basically threatened all the time.  That began my journey of figuring out what was going on with me and then also trying to understand why my OCD seemed to be getting worse and jumping in to help because I seemed to get all these compulsions that were designed to keep me safe from this construction equipment. It created a process where I was trying to figure out, "What is this? I've got both PTSD now, I've got OCD flaring up, how do I deal with this? What do I do?" The reason why I wanted to write the article for Shoulders Back! and why I asked Caitlin to write it with me was because there just isn't a lot of information out there about this combination where people have PTSD or some sort of trauma, and then the OCD jumps in to help. Now you've got a combination of disorders where you've got trauma or PTSD and OCD, and they're merging together to try to protect you. That's what they think they're doing. They're trying to help you stay safe, but really, what they're doing is they're making your life smaller and smaller and smaller.  I wanted to write this article for Shoulders Back! to let people know about my experience so that other people going through this aren't alone. I wanted to ask Caitlin to write it with me because I wanted an expert in this to talk about what it is, how we treat it, what hope do we have for people who are experiencing this going forward. THE DIFFERENCE BETWEEN OCD AND PTSD (AND POST-TRAUMATIC OCD)  Kimberley: Thank you for sharing that. I do encourage people; I'll link in the show notes if they want to go and read the article as well. Caitlin, from a clinical perspective, what was going on for Shala? Can you break down the differences between OCD and PTSD and what's happening to her? Caitlin: Sure. First, I want to start by thanking Shala again for sharing that story. I know you and I talked about this one-on-one, but I think really sharing personal stories like that obviously involves a lot of courage and vulnerability. It's just so helpful for people to hear examples and to really resonate with, “Wow, maybe I'm not so different or so alone. I thought I was the only one who had experiences like this.” I just want to publicly thank you again for writing that blog and being willing to share these really horrible experiences that you had.  In terms of how we would look at this clinically, it's not uncommon for people to, like Shala described, experience trauma and have these low-level symptoms for a while that don't really emerge or don't really reach the threshold of being diagnosable. This can happen, for example, with veterans who return home from war, and it might not be until decades later that they have some sort of significant life event or change. Maybe they've retired, or they're experiencing more stress, or maybe, like Shala, they're experiencing another trauma, and it just brings everything up. This kind of delayed onset of PTSD is, for sure, not abnormal.  In this case, it sounds like, just like Shala described, that her OCD really latched onto the trauma, that she had these experiences that reinforced each other. Right now, I've had two experiences where being around moving vehicles has been really dangerous for me. Just like you said, I think you did such a beautiful job of saying that the OCD and PTSD colluded in a way to keep you “safe.” That's the function of it. But of course, we know that those things go to the extreme and can make our lives very small and very distressing.  What Shala described about using these compulsions to try to prevent future trauma is something that we see a lot in people who have comorbid OCD and PTSD. We're doing some research now on the different ways that OCD and trauma can intersect. And that's something that keeps coming up as people say, “I engaged in these compulsions as a way to try to prevent the trauma from happening to me again or happening to someone else. Or maybe my compulsions gave me a sense of control, predictability, or certainty about something related to the trauma.” This kind of presentation of OCD sort of functioning as protection against trauma or coping with past trauma as well is really common. STATISTICS OF OCD AND PTSD Kimberley: Would you share a little bit about the statistics between OCD and PTSD and the overlap? Caitlin: Absolutely. I'm excited to share this too, because so much of this work is so recent, and I'm hopeful that it's really going to transform the way that we see the relationships between OCD and PTSD. We know that around 60% of people who have comorbid OCD and PTSD tend to have an experience where PTSD comes first or at the same time, and the OCD comes later. This is sort of that post-traumatic OCD presentation that we're talking about and that Shala talked about in her article.  For folks who have this presentation where the PTSD comes first and then the OCD comes along afterwards, unfortunately, we see that those folks tend to have more severe obsessions, more severe compulsions. They're more likely to struggle with suicidality or to have comorbid agoraphobia or panic disorders. Generally speaking, we see a more severe presentation when the OCD comes after the PTSD and trauma, which is likely indicative of what we're discussing, which is that when the OCD develops as a way to cope with trauma, it takes on a mind of its own and can be really severe because it's serving multiple functions in that way. What we've been finding in our recent research—and if folks want to participate, the study will still be active for the next month; we're going to end it at the end of the year, the OCD and Trauma Overlap Study—what we're finding is that of the folks who've participated in the study, 85% of them feel like there's some sort of overlap between their OCD and trauma. Of course, there are lots of different ways that OCD and trauma can overlap.  I published a paper previously where we found that about 45% of people with severe OCD in a residential program felt that a traumatic or stressful event was the direct cause of their OCD on setting. But beyond that, we know that OCD and trauma can intersect in terms of the content of obsessions, the function of compulsions, as we've been talking about here, core fears. Some folks describe this, and Shala described this to this, like cyclical relationship where when one thing gets triggered, the other thing gets triggered too.  This is really where a lot of the research is focusing on now, is how do these things intersect, how often do they intersect, and what does that really look like for people? Kimberley: Thanks. I found in my practice, for people who have had a traumatic event, as exactly what happened to Shala, and I actually would love for both of you maybe to give some other examples of how this looks for people and how it may be experienced, is let's say the person that was involved in the traumatic event or that place that the traumatic event was recent that recently was revisited just like Shala. Some of them go to doing safety behaviors around that person, place, or event, or they might just notice an uptick in their compulsions that may have completely nothing to do with that. Shala, can you explain a little bit about how you differentiated between what are PTSD symptoms versus OCD, or do you consider them very, very similar? Can you give some insight into that? SYMPTOMS OF OCD & PTSD  Shala: Sure. I'll give some examples of the symptoms of OCD that developed after this PTSD developed, but it's all post-traumatic OCDs. I consider it to be different from PTSD, but it is merged with PTSD because it's only there because the PTSD is there.  For instance, I developed a lot of checking behaviors around the doors to my house—staring, touching, not able to just look once before I go to bed, had to be positively sure the doors were locked, which, as somebody who does this for a living, who helps people stop doing these compulsions, created a decent amount of shame for me too, as I'm doing these compulsions and saying, “Why am I not taking my own advice here? Why am I getting stuck doing this?”  But my OCD thought that the construction equipment was outside; we're inside. We need to make sure it stays outside. The only way we do that is to make sure the door stays locked, which is ridiculous. It's not as if a forklift is going to drive through my front door. As typical with OCD, the compulsions don't make a lot of sense, but there's a loose link there. Another compulsion that I realized after a time was probably linked with PTSD is my people-pleasing, which I've always struggled with. In fact, Kimberley, you and I have done another podcast about people-pleasing, something I've worked really hard on over the years, but it really accelerated after this. I eventually figured out that that was a compulsion to keep people liking me so that they wouldn't attack me. That can be an OCD compulsion all by itself, but it was functioning to help the PTSD.  Those would be two examples of compulsions that could be OCD compulsions on their own, but they would not have been there had the PTSD not been there. Kimberley: Caitlin, do you want to add anything about that from symptoms or how it might look and be experienced? Caitlin: Sure, yeah. I think it's spot on that there's this element of separation that we can piece apart. This feels a little bit more like OCD; this feels a little bit more like PTSD, but ultimately they're the same thing, or it's the same behavior.  In my work, I usually try to, where I can, piece things apart clinically so that we can figure out what we should do with this particular response that you're having. When it comes to differentiating compulsions, OCD compulsions and PTSD safety behaviors, we can look towards both the presentation of the behavior as well as the function of it.  In terms of presentation, I mean, we all know what compulsions can look like. They can be very rigid. There can be a set of rules that they have to be completed with. They're often characterized by a lot of doubting, like in Shala's case, the checking that, “Well, okay, I checked, but I'm not actually sure, so let me check one more time.” Whereas in PTSD, although it's possible for that to happen, those safety behaviors, usually, it's a little bit easier to disengage from. Once I feel like I've established a sense of safety, then I feel like I can disengage from that. There doesn't tend to be kind of that like rigidity and a set of rules or magical thinking that comes along with an OCD compulsion.  In terms of the function, and this is where it gets a little bit murky with post-traumatic OCD, broadly speaking, the function of PTSD safety behaviors is to try to prevent trauma from occurring again in the future. Whereas OCD compulsions, generally speaking, are a way to obtain certainty about something or prevent some sort of feared catastrophe related to someone's obsession. But of course, when the OCD is functioning along with the PTSD to cope with trauma, to prevent future trauma, that gets a little bit murkier.  In my work, like I said, I try to piece apart, are there elements of this that we can try to resist from more of an ERP OCD standpoint? If there's a set of rules or a specific way that you're checking the door, maybe we can work on reducing some of that while still having that PTSD perspective of being a little bit more lenient about weaning off safety behaviors over time. TREATMENT FOR OCD AND PTSD Kimberley: It's a perfect segue into us talking about the treatment here. Caitlin, could you maybe share the treatment options for these conditions, specifically post-traumatic OCD, but maybe in general, all three? Caitlin: Absolutely. The APA, a few years back, reviewed all the available literature on PTSD treatments, and they created this hierarchy of the treatments that have the most evidence base and went down from there. From their review of all the research that's been done, there were four treatments that emerged as being the most effective for PTSD. That would be broadly cognitive behavioral therapy and cognitive therapy. But then there are two treatments that have been specifically created to target PTSD, and that would be prolonged exposure or PE, and cognitive processing therapy or CBT. These all fall under the umbrella of CBT treatments, but they're just a little bit more specific in their approach. And then, of course, we know of ACT and EMDR and these other treatments that folks use as well. Those fall in the second tier, where there's a lot of evidence that those work for folks as well, but that top tier has the most evidence.  These treatments can be used in combination with OCD treatments like ERP. There are different ways that folks can combine them. They can do full protocols of both. They could borrow aspects of some treatments, or they could choose to focus really on if there's a very clear primary diagnosis to treat that one first before moving on to the secondary diagnosis. TREATMENT EXAMPLES FOR POST-TRAUMATIC OCD Kimberley: Amazing. Shala, if you're comfortable, can you give some examples of what treatment looked like for you and what that was like for you both having OCD and PTOCD?  Shala: Yes, and I think to set the ground for why the combined treatment working on the PTSD and the OCD together can be so important, a couple of features of how all this was presenting for me was the shift in the focus of the uncertainty. With OCD, it's all about an intolerance of uncertainty and not knowing whether these what-ifs that OCD is getting stuck on are true or going to happen. But what I noticed when I developed PTSD and then the OCD came in to help was that the focus of the uncertainty shifted to it's not what if it's going to happen. The only what-if is when it was going to happen because something bad happening became a given.  The uncertainty shifted to only when and where that bad thing was going to happen, which meant that I had lower insight. I've always had pretty good insight into my OCD, even before I got treatment. Many people with OCD too, we know what we're doing doesn't make any sense; we just can't stop doing it. With this combined presentation, there was a part of me that was saying, “Yeah, I really do need to be staring at the door. This is really important to make sure I keep that construction equipment out.” That lowered insight is a feature of this combined presentation that I think makes the type of treatment that we do more important, because we want to address both of the drivers, both the PTSD and the OCD. The treatment that I did was in a staged process. First, I had to find a treatment provider, and Caitlin has a wonderful list of evidence-based treatment providers who can provide treatment for both on her website, which is great. I found somebody actually who ended up being on Caitlin's list and worked with that person, and she wanted to start out doing prolonged exposure, which I pushed back on a little bit. Sometimes when you're a therapist and you're being the client, it's hard not to get in the other person's chair. But I pushed back on that because I said, “Well, I don't think I need to do prolonged exposure on the original accident,” because that's what she was suggesting we do, the accident when I was four. I said, “Because I wrote a book, Is Fred in the Refrigerator? and the very first chapter is the accident,” and I talked all about the accident. She explained, “That's a little bit different than the way we would do it in prolonged exposure.” What's telling, I think, is that when I worked on the audiobook version of Fred—I was doing the narration, I was in a studio, and I had an engineer and a director; they were on one side of the glass, I'm on the other side of the glass—I had a really hard time getting through that first chapter of the book because I kept breaking down. They'd have to stop everything, and I had to get myself together, and we had to start again, and that happened over and over and over again.  Even though I had relived, so to speak, this story on paper, I guess that was the problem. I was still reliving it. That's probably the right word. Prolonged exposure is what I needed to do because I needed to be able to be in the presence of that story and have it be a story in the past and not something that I was experiencing right then.  I started with prolonged exposure. After I did that, I moved on to cognitive processing therapy because I had a lot of distorted beliefs around life and the trauma that we call “stuck points” in cognitive processing therapy that I needed to work through. There were a good 20 or so stuck-point beliefs. “If I don't treat people perfectly nicely, they're going to attack me somehow.” Things that could be related directly to the compulsions, but also just things like, “The world is dangerous. If I'm not vigilant all the time, something bad is going to happen to me.” I had to work on reframing all of those because I was living my life based on those beliefs, which was keeping the trauma going.  I recreated a new set of beliefs and then brought exposure in to work on doing exposures that helped me act as if those new beliefs were the right way to live. If my stuck point is I need to be hypervigilant because of the way something bad is going to happen to me, and I'm walking around like this, which was not an exaggeration of really how I was living my life when this was all happening—if I'm living like that, if I'm acting in a hypervigilant way, I am reinforcing these beliefs. I need to go do exposures where I can walk by a dump truck without all the hypervigilance to let all that tension go, walk by it, realize what I've learned, and walk by it again.  It was a combination of all these and making sure that I was doing these exposures, both to stop the compulsions I was doing, like the door checking, but also to start living in a different way so that I wasn't in my approach to life, reinforcing the fact that my PTSD thought the world was dangerous.  I also incorporated some DBT (dialectical behavior therapy) because what I found with this combination was I was experiencing a lot more intense emotions than I'd really ever experienced in having OCD by itself. With OCD, it was mostly just out-of-this-world anxiety, but with the combination of PTSD and OCD, there were a lot more emotional swings of all sorts of different kinds that I needed to learn and had to deal with. Part of that too was just learning how to be in the presence of these PTSD symptoms, which are very physiological. Not like OCD symptoms aren't, but they tend to be somewhat more extreme, almost panicky-like feelings. When you're in the flashbacks or flash forwards, you can feel dissociated, and you're numbing out and all of that. I'm learning to be in the presence of those symptoms without reacting negatively to them, because if I'm having some sort of feelings of hypervigilance that are coming because I'm near a piece of construction equipment and I haven't practiced my ERP (Expsoure & Response Prevention) for a while, if I react negatively and say, “Oh my gosh, I shouldn't be having these symptoms. I've done my therapy. I shouldn't be having these feelings right now,” it's just going to make it worse. Really, a lot of this work on the emotional side was learning how to just be with the feelings. If I have symptoms, because they happen every now and then—if I have symptoms, then I'm accepting them. I'm not making them worse by a negative reaction to the reaction my PTSD is having.  That was a lot of the tail end of the work, was learning how to be okay with the fact that sometimes you're going to have some PTSD symptoms, and that's okay. But overreacting to them is going to make it worse.  Kimberley: Thank you so much for sharing that. I just want to maybe clarify for those who are listening. You talked about CPT, you talked about DBT, and you also talked about prolonged exposure. In the prolonged exposure, you were exposing yourself to the dump truck? Is that correct? Shala: In the prolonged exposure, I was doing two different things. One is the story of the accident that I was in. Going back to that accident that I thought I had fully habituated to through writing my book and doing all that, I had to learn how to be in the presence of that story without reliving it while seeing it as something that happened to me, but it's not happening to me right now. That was the imaginal part of the prolonged exposure.  This is where the overlap between the disorders and the treatment can get confusing of what is part of what. You can do the in vivo exposure part of prolonged exposure. Those can also look a lot like just ERP for OCD, where we're going and we're standing beside a dump truck and dropping the hypervigilant safety behaviors because we need to be able to do that to prove to our brain we can tolerate being in this environment. It isn't a dangerous environment to stand by a jump truck. It's not what happened when I was four. Those are the two parts that we're looking at there—the imaginal exposure, which is the story, and then we've got the in vivo exposures, which are going back and being in the presence of triggers, and also from an OCD perspective without compulsive safety behaviors. Kimberley: Amazing. What I would clarify, but please any of you jump in just for the listeners, if this is all new to you, what we're not saying is, let's say if there was someone who was abusive to you as a child, that you would then expose yourself to them for the sake of getting better from your PTSD. I think the decisions you made on what to expose yourself were done with a therapist, Shala? They helped you make those decisions based on what was helpful and effective for you? Do either of you want to speak to what we do and what we don't expose ourselves to in prolonged exposure? Caitlin: Yeah. I'm glad that you're clarifying that too, because this is a big part of PE that is actually a little bit different from ERP. When somebody has experienced trauma, when they have PTSD, their internal alarm system just goes haywire. Just like in Shala's example, anything that serves as a reminder or a trigger of the trauma, the brain just automatically interprets as this thing is dangerous; I have to get away from it.  In PE, a lot of what we're doing is helping people to recalibrate that internal alarm system so that they can better learn or relearn safe versus actual threat. When you're developing a hierarchy with someone in PE, you might have very explicit conversations about how safe is this exposure really, because we never want to put someone in a situation where they would be unsafe, such as, like you described, interacting with an abuser.  In ERP, we'd probably be less likely to go through the exposures and say, “This one's actually safe; I want you to do it,” because so much of the treatment is about tolerating uncertainty about feared outcomes. But in PE, we might have these explicit conversations. “Do other people you know do this activity or go to this place in town?” There are probably construction sites that wouldn't be safe for Shala to go to. They'd be objectively dangerous, and we'd never have her go and do things that would put her in harm's way. Kimberley: Thank you. I just wanted to clarify on that, particularly for folks who are hearing this for the first time. I'm so grateful that we're having this conversation again. I think it's going to be so eye-opening for people. Caitlin, can you share any final words for the listeners? What resources would you encourage them to listen to? Is there anything that you feel we missed in our conversation today for the listeners? Caitlin: I think, generally, I like to always leave on a note of hope. Again, I'm so grateful that Shala is here and gets to describe her experience with such vulnerability because it gives hope that you can hear about someone who was at their worst, and maybe things felt hopeless in that moment. But she was able to access the help that she needed and use the tools that she had from her own training too, which helped, and really move through this.  There isn't sort of a final point where it's like, “Okay, cool, I'm done. The trauma is never going to bother me again.” But it doesn't have to have that grip on your life any longer, and you don't need to rely on OCD to keep you safe from trauma.  There are treatments out there that work. Like it was mentioned, I have a directory of OCD and PTSD treatment providers available on my website, which is www.cmpinciotti.com that folks can access if they're looking for a therapist. If you're a therapist listening and you believe that you belong in this directory, there's a way to reach out to me through the website.  I'd also say too that if folks are willing and interested, participating in the research that's happening right now really helps us to understand OCD and PTSD better so that we can better support people. If you're interested in participating in the OCD and trauma study that I mentioned, you can email me at OCDTraumaStudy@bcm.edu. I also have another study that's more recent that will help to answer the question of how many people with OCD have experienced trauma and what are those more commonly endorsed ways that people feel that OCD and trauma intersect for them. That one's ultra-brief. It's a 10-minute really quick survey, NationalOCDSurvey@bcm.edu and I'm happy to share that anonymous link with you as well/ Kimberley: Thank you. Thank you so much. Shala, can you share any final words about your experience or what you want the listeners to hear? Shala: One thing I'd like to share is a mistake that I made as part of my recovery that I would love for other people not to make. I'd like to talk a little bit about that, because I think it could be helpful. The mistake that I made in trying to be a good client, a good therapy client, is I was micro-monitoring my recovery. “How many PTSD symptoms am I having? Well, I'm still having symptoms.” I woke up in the middle of the night in a panic, or I had a bad dream, or I had a flash forward. “Why am I having this? I must not be doing things right.” And then I took it a step further and said, “It would be great if I could track the physiological markers of my PTSD so I can make sure I'm keeping them under control.” I got a piece of tracking technology that enabled me to track heart rate and heart rate variability and sleep and all this stuff. At first, it was okay, but then the technology that I was using changed their algorithm, and all of a sudden my stats weren't good anymore, and I started freaking out. “Oh my gosh, my sleep is bad. My atrophy is going down. This is bad. What am I doing?” I was trying with the best of intentions to quantify, make sure I'm doing things right, focus on recovery. But what I was doing was focusing on the remaining symptoms that were there, and I was making them worse.  What I have learned is that eventually, things got so bad—in fact, with my sleep—that I got so frustrated with the tracking technology. I said, “I'm not wearing it anymore.” That's one of the things that helped me realize what I was doing. When I stopped tracking my sleep, when I let go of all of this and said, “You know what? I'm going to have symptoms,” things got better.  I would encourage people not to overthink their recovery, not to be in their heads and wake up in the morning and ask, “How much PTSD am I having? How much OCD am I having? If I could just get rid of these last little symptoms, life would be great,” because that's just going to keep everything going.  I'll say this year, two has been a challenging one for me. I've been involved in three car accidents this year; none of them my fault. One of my neighbors, whom I don't know, called the police on me, thinking I was breaking into my own house, which meant that a whole army of police officers ended up at my house at nine o'clock at night. That's four pretty hard trauma triggers for me in 2023.  Those kinds of things are going to happen to all of us every now and then. I had a lot of symptoms. I had a lot of PTSD symptoms and a lot of OCD symptoms in the wake of those events, and that's okay. It's not that I want them to be there, but that's just my brain reacting. That's my brain trying to come to terms with what happened and how safe we are and trying to get back to a level playing field.  I think it's really important for anybody else out there who's suffering from one or the other, or both of these disorders to recognize we're going to have symptoms sometimes. Just like with OCD, you're going to have symptoms sometimes. It's okay. It's the pushing away. It's the rejecting of the symptoms. It's the shaming yourself for having the symptoms that causes the symptoms to get worse.  Really, there is an element of self-compassion for OCD here. I like having bracelets to remind me. This is the self-compassion bracelet that I've had for years that I wear. By the way, this is not the tracking technology. I'm not using tracking technology anymore. But remembering self-compassion and telling yourself, “I'm having symptoms right now, and this is really hard. I'm anxious; I feel a little bit hypervigilant, but this is part of recovery from PTOCD. Most people with PTOCD experience this at some point. So I'm going to give myself a break, give myself permission to feel what I'm feeling, recognize how much progress I've made, and, when I feel ready, do some of my therapy homework to help me move past this, but in a nonhypervigilant, nonmicro monitoring way.” As I have dropped down into acceptance of these symptoms, my symptoms have gotten a lot better. I think that's a really important takeaway. Yes, we want to work hard in our therapy, yes, we want to do the homework, but we also want to work on accepting because, in the acceptance, we learn that having these symptoms sometimes is just a part of life, and it's okay.  I would echo what Caitlin said in that you can have a ton of hope if you have these disorders, in that we have good treatment. Sometimes it takes a little bit longer than working on either one or the other, but that makes sense because you're working on two. But we have good treatment, and you can get back to living a joyful life.  Always have hope and don't give up, because sometimes it can be a long road, especially when you have a combined presentation. But you can tame both of these disorders and reclaim your life. Kimberle: You guys are so good. I'm so grateful we got to do this. I feel like it's such an important conversation, and both of you bring such wonderful expertise and lived experience. I'm so grateful. Thank you both for coming on and talking about this with me today. I'm so grateful. Shala: Thank you for having us. Caitlin: Yes, thank you. This was wonderful. Kimberley: Thank you so much, guys. RESOURCES:  The two studies CAITLIN referenced are: OCD/Trauma Overlap Study: An anonymous online survey for any adult who has ever experienced trauma, and can be accessed at https://bcmpsych.sjc1.qualtrics.com/jfe/form/SV_0j4ULJv3DxUaKtE or by emailing OCDTraumaStudy@bcm.edu National OCD Survey: An anonymous 10-minute online survey for any U.S. adult who has ever had OCD, and can be accessed at https://bcmpsych.sjc1.qualtrics.com/jfe/form/SV_9LdbaR2yrj0oV7g or by emailing NationalOCDSurvey@bcm.edu

We've all seen depictions of obsessive-compulsive disorder (OCD) in pop culture: characters like Sheldon Cooper from “The Big Bang Theory” or Detective Adrian Monk from “Monk.” Their compulsions are portrayed as annoying, but ultimately it just makes people with OCD appear quirky. However, those depictions don't even scratch the surface of what OCD really is. Imagine being obsessed with images of violence or death or being worried that you might actually be a bad person and are doomed to hell. Often, there is nothing cute or quirky about OCD in the real world. Join us as Shala Nicely, a woman who lives with OCD, explains the truth about OCD and shares the challenges it has caused in her life. To learn more -- or read the transcript -- please visit the episode page. Our guest, Shala Nicely, LPC, is the author of Is Fred in the Refrigerator? Taming OCD and Reclaiming My Life and coauthor with Jon Hershfield, MFT of Everyday Mindfulness for OCD: Tips, Tricks & Skills for Living Joyfully. She is a counselor and cognitive behavioral therapist in metro Atlanta, specializing in the treatment of OCD & related disorders and anxiety disorders. Shala produces the Shoulders Back! Tips & Resources for Taming OCD newsletter and blogs for Psychology Today, offering an inside perspective on life with OCD. She is currently working on her third book, a murder mystery called In Neptune's Orbit, about the true price of secrets we keep from ourselves. Our host, Gabe Howard, is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, "Mental Illness is an Asshole and other Observations," available from Amazon; signed copies are also available directly from the author. Gabe makes his home in the suburbs of Columbus, Ohio. He lives with his supportive wife, Kendall, and a Miniature Schnauzer dog that he never wanted, but now can't imagine life without. To book Gabe for your next event or learn more about him, please visit gabehoward.com. Learn more about your ad choices. Visit megaphone.fm/adchoices

#52: Jon Hershfield, MFT — The Relationship of Mindfulness and OCD Jon Hershfield has been an expert in the field of mental health, specifically in OCD since 2009. He was the director of the OCD and Anxiety Center of Greater Baltimore, associate director of the UCLA Pediatric OCD Intensive Outpatient Program, and clinician at the OCD Center of Los Angeles. Now, he is the director of the Center for OCD and Anxiety at Sheppard Pratt. He is also both an author and co-author for books relating to OCD. In this episode we talk about:  ◾️ Mindfulness and OCD ◾️ Training your mind and other techniques for managing OCD ◾️ Judgement and self-criticism and how to counter it Find Jon here: ocdbaltimore.com @ocdbaltimore Find Zach here: zachwesterbeck.com @zach_westerbeck

Today we are talking all about ERP Scripting with Shala Nicely. Welcome back, everybody. We are on Week 2 of the Imaginals and Script Series. This week, we have the amazing Shala Nicely on the show. She's been on before. She's one of my closest friends and I'm so honored to have her on.  For those of you who are listening to this and haven't listened to any of the previous episodes, I do encourage you to go back to last week's episode because that is where we introduce the incredible Krista Reed and she talks about how to use scripts and imaginals. I give a more detailed intro to what we're here talking about if this is new for you. This will be a little bit of a steep learning curve if you're new to exposure and response prevention. Let me just quickly explain. I myself, I'm an ERP-trained therapist, I am an OCD Specialist, and a part of the treatment of OCD and OCD-related disorders involve exposing yourself to your fear and then practicing response prevention, which is reducing any of the safety behaviors or compulsions you do in effort to reduce or remove whatever discomfort or uncertainty that you feel. Now, often when we go to expose ourselves to certain things, we can't because they're not something we can face on a daily basis or they're often very creative things in our mind. This is where imaginals and scripts can come in and can be incredibly helpful.  If you want a more detailed understanding of the steps that we take regarding ERP, you can go to CBTSchool.com, which is where we have all our online courses. There is a course called ERP School that will really do a lot of the back work in you really understanding today's session. You don't have to have taken the course to get the benefits of today's session because a lot of you I know already have had ERP or are in ERP as we speak, or your clinicians learning about ERP and I love that you're here. Honestly, it brings me so much joy. But that is there for you if you're completely lost on what's going on today, and that will help fill you in on the gold standard treatment for OCD and the evidence-based treatment for OCD and OCD-related disorders.  That being said, let's get on with the good stuff. We have the amazing Shala Nicely. I am so honored again to have you on. You are going to love how applicable and useful her skills and tools are. Let's just get straight over to Shala.  Kimberley: Welcome, Shala. I am so happy to have you back. I know we have a pretty direct agenda today to talk about imaginals versus scripting in your way in which you do it. I'd love to hear a little bit about, first, do you call it imaginals or do you call it scripting? Can you give me an example or a definition of what you consider them to be? SHALA'S STORY OF ERP SCRIPTING  Shala: Sure. Well, thank you very much for having me on. Love to be here as always. I'll go back to how I learned about exposure when I first became a therapist. I learned about exposure being two different things. It was either in vivo exposure, so in life. Meaning, you go out and do the thing that your OCD is afraid of that you want to do, or it was imaginals where you imagine doing the thing that you want to do that your OCD is afraid to do. Research shows us that the in vivo is more effective, but sometimes imaginals is necessary because you can't go do the thing for whatever reason. But I don't think about it like that anymore. That's how I learned it, but it's not how I practice it.  To help describe what I do, I'll take you back to when I had untreated OCD or when I was just learning how to do ERP for myself because I think that would help it make sense what I do. When I was doing ERP, I would obviously go out and do all the things that I wanted to do and my OCD didn't want me to do. What I found was that I could do those things, but my OCD was still in my head, getting me to have a conversation about what we were doing in my mind. I might go pick up a discarded Coke can on the side of the road because it's “contaminated,” and I would then go either put it in the trash, which would be another exposure because that would be not recycling. There are layers of exposures here. But my OCD could be in my head going, “Well, I don't think that one is contaminated. It doesn't look all that contaminated because it's pretty clean and this looks like a clean area so I'm sure it's not contaminated. What do you think, Shala?”  “Oh, I agree with you.” “Well, we threw it away, but I bet you, these people, they're going to get wherever we threw it. They're actually going to sort it out and it's going to get recycled anyway.” There was this carnival in my head of information about what was going on.  I determined what I was doing because I was doing the exposure, but I wasn't really getting all that much better. I was getting somewhat better but not all that much better. What I realized I was doing is that I'm having these conversations in my head, which are compulsive. In my recovery journey, what I was doing was I was going to a lot of trainings, I was reading a ton of books, and I talk about this in Is Fred in the Refrigerator?, my memoir, because this was a pretty pivotal moment for me when I read Dr. Jonathan Grayson's book, Freedom from Obsessive Compulsive Disorder. I know you're having him on this series as well. I read his book and he talks so much in there about writing scripts to deal with the OCD—writing scripts about what might happen, the worst-case scenario, living with uncertainty, and all that kind of stuff. That really resonated with me and I thought, “Aha, this is what I need to be doing. I need to be doing ERP scripting instead of having that conversation in my head with the OCD. Because when I'm doing exposure and I'm having a conversation with OCD in my head, I'm doing exposure and partial response prevention. I am preventing the physical response, but I'm not at all preventing the mental response, and this was slowing down my recovery.” The way I like to think of imaginals—you think about imagine like imagination—is that the way I do imaginal exposures, which I just call ERP scripting, is that I'm dealing with OCD's imagination. People with OCD are exceptionally creative. If you're listening to this and you think, “Well, not me,” for proof, all you have to do is look at what your OCD comes up with and look how creative it is. You guys share the same brain, therefore, you are creative too. All that creativity. When you have untreated OCD, it goes into coming up with these monstrous scenarios of how you're harming others or harming yourself. You're not ever going to be able to handle this anxiety or uncertainty or icky feeling or whatever, and it builds these scary stories that get us stuck.  WHAT IS ERP SCRIPTING?  What I'm trying to do with imaginal exposure or scripting is I'm trying to deal with OCD's imagination because in the example I gave, I was picking up the Coke can and my OCD was using its imagination to try to reassure me all the ways this Coke can was going to be okay or all the ways this Coke can was going to eventually get recycled. I needed to deal with that. Really, the way I do ERP Scripting for myself and for my clients is I'm helping people deal with OCD's imagination in a non-compulsive way. For me, it is not a choice of in vivo or imaginal; it is in vivo with imaginal, almost always, because most people that I see anyway are doing what I did. They are doing physical compulsions or avoidance and they're up in their head having a conversation with their OCD about it. I'm almost always doing in vivo and imaginals together because I'm having people approach the thing that they want to do that OCD doesn't want them to do, and I'm having them do scripts. The Coke can may or may not be contaminated. The fact that it's sitting here and it looks pretty clean may or may not mean that it's got invisible germs on it. I don't know. The Coke can may or may not get recycled, it may or may not end up in recycling, but somehow contaminate the whole recycling thing that has to throw all that other recycling away because it touched it. I'm trying to use my imagination to make it even worse for the OCD so that we're really facing these fears.  That's how I conceptualize imaginal exposure. It's not an AND/OR it's an AND for me. Some people don't need it and if they don't need it, fine. But I find it's very helpful to make sure that people are doing full response prevention in that they're permitting both the physical and the mental compulsive response. DOES EVERYONE NEED ERP SCRIPTING?  Kimberley: Does everyone need ERP scripting? When you say some people don't need it, what would the presentation of those people be? Shala: That for whatever reason, they are good at not having the conversation with OCD in their heads. This is the minority of people anyway that I work with. Most people are pretty good at having compulsive conversations with OCD because the longer you have untreated OCD, the more you end up taking your physical compulsions and pulling them inward and making the mental compulsion so that you can survive. If you can't really do all that physical checking at your office because people are going to see you, you do mental checking. That's certainly what I did. People become good at doing this stuff in their head and it becomes second nature. It can be going on. I talk about this a lot in Fred, I could do compulsions while I was doing anything else because I could do them in my head. Most people are doing that and most people have been doing that for long enough by the time they see somebody like me that if I just say, “Well, stop doing that,” I mean I'm never going to see them again. They're not going to come back because they can't stop doing that. That's the whole reason they called me.  I'm giving them something else to do instead. It's a competing response to the mental compulsions because they don't know how to stop that. They're not aware of what they're doing, they don't know how to stop the process, so I'm giving them something to do instead of that until they build the mental muscles to be able to recognize OCD trying to get them to have a conversation and just not answer that question in their head. But it takes a long time to develop that skill. It took me a long time anyway.  Some people, for whatever reason though, are good at that. If they don't need to do the scripting, great. I think that's wonderful. They don't have to do it. The strongest response you can ever have to OCD is to ignore it completely, both physically and mentally. If you can truly ignore it in your head, you don't even need to do the scripting. It's a stronger response to just do what you want to do that upsets OCD and just go on with your day. HOW TO DO ERP SCRIPTING?  Kimberley: Amazing. So How do you do ERP Scripting? If you're not one of those people and OCD loves to come up with creative ideas of all the things, what would be your approach? You talked about imaginals versus scripting. Can you play out and show us how you do it? Shala: I mean, I guess imaginals in the traditional way that it is defined versus scripting. The way I would do it is we would design the client and I would design whatever their first exposure is going to be. Let's say that it would be touching doorknobs. They're going to be in their location and I'm going to be in my location. They're going to be wherever we've decided they're going to touch the doorknobs. Maybe it's to the outside of their house, for instance. I'm there on video with them and we have them touch the doorknob.  And then I asked them, “Well, what is OCD saying about that?”  “Well, OCD says that I need to go wash my hands.”  I will say, “Well, are you going to go do that?”  “No.”  I'm like, “Well, let's tell OCD that.”  “Okay, OCD, I'm not going to wash my hands.”  “Now what's OCD saying?”  “Well, OCD is saying that I'm contaminated.”  “Well, let's say I may or may not be contaminated.”  So far, we've got, “I'm not washing my hands and I may or may not be contaminated.” Okay, now I'll ask them their anxiety level. When they say, “Gosh, I'm at a four,” I'll say, “Is that good?” They'll often say, “No, I wish it were zero.” I'll be like, “I'm sorry, what? What did you say? You want your anxiety to be zero? I must have misheard that. Is four good?” Finally, they understand, “Oh, well, four is not good because we could be higher.”  “What would be better than four?”  “Anything above a four.”  I'm working with them on that. We might start to throw some things in the script. I want to be anxious because this is how I beat my OCD, so bring it on.  I'll ask again, “What's your OCD saying?”  “Well, it's saying that I'm going to get some terrible disease.”  “Well, you may not get a terrible disease.” I'm questioning back and forth the client as we're working on this, until we've got enough of a dialogue about what's going on in their head that we can then create a script. A script might look something like, “Well, I may or may not be contaminated. I may or may not get a dread disease, but I'm not washing my hands and I'm going to do this because I want my life back. It makes me anxious and I may or may not get a dread disease.” And then we'll focus in on what's bothering OCD most. Maybe it's, at the beginning, the dread disease. “Well, I may or may not get a drug disease. I may or may not get a dread disease. I may or may not get a dread disease. I may or may not get a dread disease.” We might sing it, we say it over and over and over and over and over again, and look for what the reaction from the OCD is. If the OCD is still upset, then we still go after that. If it starts moving, “Well, what's OCD saying now?” “Well, OCD is saying now that if I get a dread disease, then I won't be able to do this thing that I have coming up that I really want to do.” “Well, okay, I may or may not get a dread disease and I may or may not miss this important event as a result.” We add that in.  We do that and do that and do that and do that for whatever the period is that we've decided is going to be our exposure period. And then we stop and then we talk about it. What did we learn? What was that like and what did you learn? Really focusing on how we did more than we thought we could do. We withstood more anxiety than we thought we could withstand. What did we learn about what the OCD is doing? I'm not so concerned about what the anxiety is doing. I mean, I want it to go up. That's my concern. I'm not all that concerned about whether it comes down or not. I do want it to go up. We talk about what we learned about the anxiety that gosh, you can push it up enough and you can handle a lot more than you thought you did. That would be our exposure.  And then we would plan homework and then they would do that daily, hopefully. I have forms on my website that people can then send me their daily experience doing these exposures and I send them feedback on it, and that's what we're working on. We're working on doing the thing that OCD doesn't want you to do that you want to do, and then working on getting better and better at addressing all of the mental gymnastics in your head.  Now, if somebody touches the doorknob and they're like, “Okay, I can do this,” and then their anxiety comes up and comes back down and they can do it without saying anything, great, go touch doorknobs. You don't need to do scripting. Often, I don't know if somebody needs to do that until we start working on it. If they don't need to do the scripting, great. We don't do the scripting. Makes things easier. But often people do need to. That's generally how I do it. Obviously, lots of variations on that based on what the client is experiencing.  Kimberley: This is all thing, you're not writing it down. Again, when you go back to our original training, for me, it was a worksheet and you print it out, you'd fill out the prompts. Are you doing any of this written or is this a counter to the mental compulsions in your head? Shala: None of this is written. The only time I would write it out is after that first session. When you're really anxious, your prefrontal cortex isn't working all that well, so you may have trouble remembering what we did, remembering the specific things that we said, or pulling it up for yourself. When you're doing your exposure, you're so anxious. I might type out some of what we said, the main things, send it to the clients, and have that. But really to me, scripting is an interactive exercise and I want my clients to be listening to what the OCD is saying for the sole purpose of knowing what we're going to say. Because when we start doing exposure, what we're often trying to do is keep pace with the OCD because it's got a little imagination engine running and it's going to go crazy with all the things that it's going to come up with. We're trying to stay on that level and make sure we're meeting all its imagination with our own imagination. As we get better and better at this, then I'm teaching people how to one-up the OCD and how to get better than the OCD as it goes along. But it's a dynamic process. I don't have people read scripts because the script that we wrote was for what was going on whenever we wrote the script. Different things might be going on this time. What we're trying to do is listen to the OCD in a different way. I don't want people listening to it in a compulsive way. I want people listening to it in a, “I've got to understand my foe here and what my foe is upset about so I can use it against it.” That's what we're doing. There might be key things, little pieces we write down, but I'm not having people write and read it over and over. Now, there's nothing wrong with that. It's just not what I do. Everybody has a different way to approach this. This is just my way.  Kimberley: Right. I was thinking as you were talking, in ERP School, I talk about the game of one-up and I actually do that game with clients before I do any scripting or imaginals or exposures too. They tell me what their fear is, I try and make it worse. And then I ask them to make it even worse, then I make it even worse, because I'm trying to model to them like, we're going here. We're going to go all the way and even beyond. If we can get ahead of OCD and get even more creative, that's better.  Let's play it back and forward. You talked about touching a doorknob and all of the catastrophic things that can happen there. What about if someone were to say their thoughts are about harming somebody and they have this feeling of like, I've been trained, society has trained me not to have thoughts about harming people or sexual thoughts and so forth? There's this societal OCD stigmatizing like we don't think those things. We should be practicing not thinking those things. What would you give as advice to somebody in that situation?  Shala: I would talk a lot about the science about our thoughts, that the more that you try to push a thought away, the more it's going to be there. Because every time you push a thought away, your brain puts a post-it note on it that says, “Ooh, she pushed this thought away. This must be dangerous. Therefore, I need to bring it up again to make sure we solve it.” Because humans' competitive advantage—we don't have fur, we don't have fangs, we don't have claws, we don't run very fast—our competitive advantage is problem-solving. The way we stay alive is for cave people looking out onto savannah and we can see that there are berries here, there, and yawn. But that one berry patch over there, gosh, you saw something waving in the grass by it and you're like, “I'm going to notice that and I'm going to remember that because that was different, but I also don't want to go over there.” Your brain is going to remember that like, “Hmm, there was something about that berry patch over there. Grass waving could be a tiger. We need to remember that. Remember that thing, we're not going to go over there.” We're interacting with thoughts in that way because that's what kept us alive.  When we get an intrusive thought nowadays and we go, “Ooh, that was a bad thought. I don't know. I should stay away from that,” our brain is like, “Oh, post a note on that one. That one is like the scary tiger thought. We're going to bring that up again just to make sure.” Every time we try to push a thought away, we're going to make it come back. We talk a lot about that. We talk a lot about society's norms are whatever they are, but a lot of society's norms are great in principle, not that awesome in practice. We don't have any control over what we think about. The TV is filled with sex and gore, and violence. Of course, you're thinking those things. You can't get away from those images. I think society has very paradoxically conflicting rules about this stuff. Don't think about it but also watch our TV show about it.  I would talk about that to try to help people recognize that these standards and rules that we put on ourselves as humans are often unrealistic and shame-inducing and to help people recognize that everybody has these thoughts. We have 40, 60, 80,000 thoughts a day. I got that number at some conference somewhere years ago. We don't have control over those. I would really help them understand the process of what's going on in their brain to destigmatize it by helping them understand really thoughts are chemical, neuronal, whatever impulses in our brain. We don't have a lot of control over that and we need to deal with them in a way that our brain understands and recognizes. We need to have those thoughts be present and have a different reaction to those thoughts so your brain eventually takes the post-it note off of them and just lets them cycle through like all the other thoughts because it recognizes it's not dangerous.  HOW FAR CAN YOU GO IN ER SCRIPTING?  Kimberley: Right. I agree. But how far can you go in ERP Scripting? Let's push a little harder then. This just happened recently actually. I was doing a session with a client and he was having some sexual pedophilia OCD obsessions playing up, “I'll do this to this person,” as you were doing like I may or may not statements and so forth. And then we played with the idea of doing one up. I actually went to use some very graphic words and his face dropped. It wasn't a drop of shock in terms of like, “Oh my gosh, Kimberley used that naughty word.” It was more of like, “Oh, you are in my brain, you know what I'm thinking.” And then I had to slow down and ask him, “Are there any thoughts you actually aren't admitting to having?” Because I could see he was going at 80% of where OCD took him, but he was really holding back with the really graphic, very sexual words—words that societally we may actually encourage our children and our men and women not to say. Do you encourage them to be using the graphic language that their OCD is coming up with? Shala: Absolutely. I'm personally a big swearer.  That's another thing I talk about in-- Kimberley: Potty mouth. Shala: I'll ask clients, “What's your favorite swear word? Let's throw swear words in here.” I want to use the language that their OCD is using. If I can tell that's the language their OCD is using, well, let's use that language. Let's not be afraid of it.  The other thing I do before I start ERP with anyone is I go through what I consider the three risks of ERP so they understand that what happens during our experience together is normal. I explain that it's likely we're going to make their anxiety worse in the weeks following exposure because we're taking away the compulsions bit by bit, and the compulsions are artificially holding back the anxiety. I explained that their OCD is not going to roll over because they're doing ERP therapy now. Nobody's OCD is going to go, “Oh gosh, Shala is in ERP. I think I'll just leave her alone now.” No, the OCD is going to ratchet it up. You're not doing what you're supposed to do, you're not doing your compulsions, so let's make things scarier. Let's make things more compelling. Let me be louder. Your OCD can get quite a bit worse once you start doing ERP because it's trying to get you back in line. When somebody is in an exposure session and their OCD is actually going places, they never even expected them to go, and I'll say that's what we're talking about, “That's just the OCD getting worse, that's what we wanted. This is what we knew was going to happen.” We're going to use that against the OCD to help normalize it. Then I also explain to people that people with OCD don't like negative emotions more than your average bear, and we tend to press all the negative emotions down under the anxiety. When you start letting the anxiety out and not doing compulsions, then you can also get a lot more emotions than you're used to experiencing so that people recognize if they cry during the exposures, if it's a lot scarier than they thought, if they have regret or guilt or other feelings, that's just a normal part of it. I explain all that. When things inevitably go places where the client isn't anticipating they're going to go like in a first exposure, then they feel this is just part of the process. I think it makes it so that it's easier to go those graphic places because you're like, “Yeah, we expected OCD to go the graphic place because it's mad at you.” Kimberley: It normalizes it, doesn't it?  Shala: Yeah. Then we go to the graphic place too. I tell clients that specifically because this is a game and I really want them to understand this is what your opponent is likely to do so that they feel empowered so we can go there too and trying some to take the shame out of it. When you said the graphic word and your client had a look on their face and it was because how did you even know that was in my head, because you were validating that it's okay to have this thought because you knew it was going to be there. I think that's a really important part of exposure too. HOW LONG DO YOU USE ERP SCRIPTING FOR?  Kimberley: So, how long do you do ERP Scripting for? Let's say they're doing this in your session or they're at home doing their assigned homework. Let's say they do it for a certain amount of time and then they have to get back to work or they're going to do something. But those voices, the OCD comes back with a vengeance. What would you have them do after that period of time? Would they continue with this action or is there a transition action or activity you would have them do? Shala: That's a great question. It depends a lot on really the stage of therapy that somebody is in and what is available to them based on what they're going to be doing. Oftentimes, what I will ask people to do is to try to do the exposure for long enough that you've done enough response prevention that you can then leave the exposure environment and not be up in your head compulsively ruminating. Because if you were doing exposure for 20 minutes, you've done a great job, but then you leave that exposure and you are at a high enough anxiety level where it feels compelling. Now you have to fix the problem in your head even though you just did this great exposure. Then we're just going to undo the work you just did. I try to help people plan as much as they can to not get themselves in a situation where they're going to end up compulsively ruminating or doing other compulsions after they finish. But obviously, we can't be perfect. Life happens.  I think some of the ways you can deal with that, if you know it's going to happen, sometimes they'll ask people to make recordings on their phone and they just put in their earpieces or their earbuds or whatever and they can just listen to a script while they're doing whatever they're doing. Nobody has to know what they're doing because so many people walk around with EarPods in their ears all the time anyway. That's one way to deal with it.  Another way to deal with it is to try to do the murmuring out in your head as best as you can. That's really hard because they're likely to just get mixed up with compulsive thoughts. You can try to focus your attention as much as you possibly can on what you're doing. That's going to be the strongest response. It's hard for people though when they get started to do that. But if you can do that, I think that's fine, and I think just being compassionate with yourself. “Okay, so I am now sitting here doing some rituals in my head. I'm doing the best I can.” If you're not in a situation where you can fully implement response prevention in your head because you're in a meeting and you got to do other stuff and you've got this compulsive stuff running in the background, just do the best you can. And then when you're at a place where you can do some scripting, some more exposure to get yourself back on top of the OCD, then do that. But be really compassionate.  I try to stress this to all my clients. We are not trying to do ERP perfectly because if you try to do it perfectly, you're doing ERP in an OCD way, which isn't going to work. Just be kind to yourself and recognize this is hard and nobody is going to do it perfectly. If you end up in a situation where you end up doing some compulsions afterwards, well, that's good information for us. We'll try to do it differently or better next time, but don't beat yourself up.   Kimberley: It's funny you brought that up because I was just about to ask you that question. Often clients will do their scripting or their imaginal and then they have an obsession, “What if I keep doing compulsions and it's not good to do compulsions?” Would you do scripting for that? Shala: Oh yeah. I may or may not do more compulsions than I used to be doing. I may or may not get really worse doing this. I may or may not have double the OCD that I had when I started seeing trauma. This may or may not become so bad that they have to create a hospital just to help me all by myself. We try to just create stuff to deal with that. But also, I'm injecting one up in the OCD, I'm injecting some humor, how outlandish can we make these things? I try to have “fun” with it. Now I say “fun” in quotes because I know it's not necessarily fun when you're trying to do this, but we're trying to make this content that OCD is turning into a scary story. We're trying to make it into a weapon to use against the OCD and to make this into a game as much as we can. Kimberley: I love it. I'm so grateful for you coming on. Is there anything that you want the listeners to know as a final piece for this work that you're doing? Shala: Sure. I think that there are so many different ways to do exposure therapy. This is the way that I do it. It's not the only way, it's not necessarily the right way; it's just the way I do it and it's changed over the years. If we were to record this podcast in five years or 10 years, I probably will be doing something slightly different. If your therapist is doing something differently or you're doing something differently, it's totally fine. I think that finding ERP in a way that works for you, like finding how it works for you and what works best for you is the most important thing. It's not going to be the same for everybody. Everybody has a slightly different approach and that's okay.  One thing that people with OCD can get stuck on, and I know this because I have OCD too, is we can be black and white and say there's one right way. Well, she does it this way and he does it that way and this is wrong and this is right. No, if you're doing ERP, there are all sorts of ways to do it, so don't let your OCD get into the, “Well, I don't think you're doing this right because you're not doing this, that, or the other.” Just work with your therapist to find out what works best for you. If what I've described works well for you, great. And if it doesn't, you don't have to do it. These are just ideas. Being really kind and being really open to figuring out what works best for you and being very kind to yourself I think is most important. Kimberley: Amazing. Tell us where people can get more information about you. Tell us about your book. I know you've been on the podcast before, but tell us where they can get hold of you. Shala: Sure. They can get a hold of me on my website, ShalaNicely.com. I have a newsletter I send out once a month that they can sign up for called Shoulders Back! Tips & Resources for Taming OCD. In it, I feature blogs that I write or podcast episodes, other things that I'm doing. It's all free where I'm talking about tips and resources for taming OCD. I have two books: Everyday Mindfulness for OCD that I co-wrote with Jon Hershfield and Is Fred in the Refrigerator? Taming OCD and Reclaiming My Life, which is my memoir. It is written somewhat like a suspense novel because as all of you know who have OCD, living with untreated OCD is a bit like living in a suspense novel. My OCD is actually a character in the book. It is the villain, so to speak. The whole book is about me trying to understand exactly what is this villain I'm working against. Then once I figure out what it is, well, how am I going to beat it? And then how am I going to live with it long term? Because it's not like you're going to kill the villain in this book. The OCD is going to be there. How do I learn to live in a world of uncertainty and be happy anyway, which is something that I stole from Jon Grayson years ago. I stole a lot from him. That's what the book is about. Kimberley: It's a beautiful book and it's so inspiring. It's a handbook as much as it is a memoir, so I'm so grateful that you wrote it. It's such a great resource for people with OCD and for family members I think who don't really get what it's like to be in the head of someone with OCD. A lot of my client's family members said how it was actually the first time it clicked for them of like, “Oh, I get it now. That's what they're going through.” I just wanted to share that. Thank you so much for being on the show. I'm so grateful to have you on again. Shala: Thank you so much for having me. It was fun.

In today's episode, Gina answers a listener question regarding OCD related intrusive, looping thinking. Gina goes through a number of strategies for coping with and solving the issue of obsessive compulsive thinking. Strengthening our mindfulness practice and being willing to tolerate the discomfort of our anxiety are some of the ways you can get on top of your intrusive thinking. Listen in for all the details! Please visit our Sponsor Page to find all the links and codes for our awesome sponsors! https://www.theanxietycoachespodcast.com/sponsors/ Thank you for supporting The Anxiety Coaches Podcast. Find even more peace and calm with our Supercast premium access membership! https://anxietycoaches.supercast.com/ Here's what's included for $5/month: ❤ New Ad-Free episodes every Sunday and Wednesday ❤ Access to the entire Ad-free back-catalog with over 600 episodes ❤ Premium meditations recorded with you in mind ❤ And more fun surprises along the way! All this in your favorite podcast app! To learn more go to: https://www.theanxietycoachespodcast.com Join our Group Coaching Full or Mini Membership Program  Learn more about our One-on-One Coaching What is anxiety? Quote: To react to OCD is to jump into compulsions. To respond to OCD is to observe what your mind is doing and choose your next step. –Jon Hershfield & Tom Corboy Learn more about your ad choices. Visit megaphone.fm/adchoices

Jon Hershfield, MFT, author of The Mindfulness Workbook for OCD, joins us to discuss obsessive-compulsive disorder. Hershfield is director of The Center for OCD and Anxiety at Sheppard Pratt in Towson, MD. He specializes in the use of mindfulness and cognitive behavioral therapy (CBT) for obsessive-compulsive disorder (OCD) and related disorders. He is also author of Overcoming Harm OCD, When a Family Member Has OCD, and The OCD Workbook for Teens, and coauthor of Everyday Mindfulness for OCD. Visit our website at www.newharbinger.com and use coupon code 'Podcast25' to receive 25% off your entire order. Buy the Book: New Harbinger - https://bit.ly/3SCXWgf Amazon - https://www.amazon.com/dp/1684035635/ Barnes & Noble - https://www.barnesandnoble.com/w/1113893446 IndieBound - https://www.indiebound.org/book/9781684035632

In episode 353 I interviewed Jon Hershfield. Jon is a psychotherapist and the director of The Center for OCD and Anxiety, at Sheppard Pratt. He is the author of six OCD books. We discuss what's new with Jon, his new book, Borderline Personality Disorder (BPD), OCD and BPD, common overlaps in traits, causes of BPD, how BPD may complicate therapy for OCD and how to navigate this, Dialectical behaviour Therapy (DBT), words of hope and much more. Hope it helps.  Show notes: https://theocdstories.com/episode/jon-353  The podcast is made possible by NOCD. NOCD offers effective, convenient therapy available in the US and outside the US. To find out more about NOCD, their therapy plans and if they currently take your insurance head over to https://go.treatmyocd.com/theocdstories

Today I was joined by Jon Hershfield, MFT (The Peaceful One), to talk about mindfulness, meditation, and how to use them in OCD and anxiety recovery. I always like talk with Jon (TPO) and today was no different as he was able to go into mindfulness at length and give… Continue reading The post #118- So, What's All This Mindfulness Stuff About With Jon Hershfield, MFT appeared first on FearCast Podcast.

Jon Hershfield, MFT is the Director of The Center for OCD and Anxiety at Sheppard Pratt in Baltimore Maryland. He is the author of several books on OCD and is prominent figure in the world of OCD treatment. In this interview, we talk about his book for teens the ocd workbook for teens: mindfulness & cbt skills to help you overcome unwanted thoughts & compulsions  with illustrations by Sean Shinnock, New Harbinger Publications.  Jon Hershfield has provided a workbook that provides both an explanation of  the treatment of OCD and relevant exercises presented in a very adolescent friendly fashion. This is a valuable resort for clinician, parent and teen. 

Finding the Thing is a podcast about living as your best most authentic self, embracing difficulties, uncertainty and finding love and happiness within. If you love Brene Brown, or Glennon Doyle's We Can Do Hard Things, give us a listen. Think of our show like Ted Talks Daily but with Shannon and Emily weekly. Shannon shares with Emily her experience at the International OCD Foundation's Annual Conference in Denver, Colorado. Shannon discusses her own social anxiety and feelings of imposter syndrome. Shannon talks about doing a ROCD group and presenting on Harm OCD. Shannon describes meeting Jenna Overbaugh from the podcast All The Hard Things and NOCD while having something stuck in her teeth. Shannon shares the incredible opportunities of meeting all the awesome folks in the OCD world such as Jon Grayson, Nathan Peterson, Kevin Foss from FearCast Podcast, Jon Hershfield, Denis Asselin, Lisa Coyne (my favorite person) and the individuals and their families suffering with the disorder. Please listen in while Shannon gets real about this amazing and challenging professional experience. www.iocdf.org https://fearcastpodcast.com

SUMMARY:  Today, I share what to do when you get “bad” news.  This episode will share a recent situation I got into where I had to use all of my mindfulness and self-compassion tools.  Check it out! Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com.  CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors.  Go to cbtschool.com to learn more.  Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two).   EPISODE TRANSCRIPTION  This is Your Anxiety Toolkit - Episode 288.  Welcome back, everybody. We literally just finished the six-week series on managing mental compulsions. My heart is full, as full as full can be. I am sitting here looking into my microphone and I just have a big, fat smile on my face. I'm just so excited for what we did together, and I felt like it was so huge. I have so many ideas of how I want to do something similar in the future with different areas. And I will. Thank you so much for your feedback and your reviews. I hope it was as helpful as it was for me, even as a clinician. I found it to be incredibly helpful, even as a supervisor, supervising my staff. I have nine incredible staff who are therapists, who help treat my clients and we constantly keep referring back during supervision of like, “Do you remember what Lisa said? Do you remember what Reid said? Listen, let's consider what Jon said or Jon Hershfield said, or Shala Nicely said.” It was just so beautiful. I'm so grateful. If you haven't listened, go back and listen to it. It's a six-week series and ugh, it was just so wonderful. I keep saying it was just so wonderful. So, if you go back, I did an introduction, Episode 282. And then from there, it was these amazing, amazing experts who just dropped amazing truth bomb after amazing truth bomb. So, that's that. Today, I am going back to the roots of this podcast. And I'm sharing with you-- for those of you who have been listening for a while, we usually start the episode with a segment called the “I did a hard thing” segment. This is where people write in and tell me a hard thing that they've done. If you go to my website, which is KimberleyQuinlan-lmft.com. There on the podcast page is a place to submit your “I did a hard thing.” And today's “I did a hard thing” is from yours truly. I just had to share this story with you. I feel like it's an important story to tell you guys, and I wanted to share with you that I'm not just talking the talk over here, I'm walking the walk. So, today's episode is called When You Get Bad News. I'm just going to leave it at that. Before we get started, I would love to leave you and share with you the review of the week. This is from hannabanana3131, and they said: “Fantastic mental health podcast. Such an amazing podcast. I have learned so many useful tools for dealing with my anxiety and OCD. And Kimberley is such a loving, compassionate coach - I feel like she's rooting for me every step of my healing journey,” and she's left a heart emoji. Thank you so much, hannabanana. I love, love, love getting your reviews. It does help me so much. So, if you have a moment of time and the podcasts are helpful for you, that is the most helpful thing you can do back. When we get reviews, then when people who are new come over and see it, it actually makes them feel like they can trust the information we're giving. And in today's world, trust is important. There is so much noise and so many people talking about OCD and anxiety, and it's easy to get caught up in nonsense stuff. And so, I really want to build a trust factor with the listeners that I have. So, thank you so much for doing that. Okay. It's funny that hannabanana says, “I feel like she's rooting for me,” because the “I did hard thing” is me talking about my recent experience of having a root canal. Worse than a root canal. So, let me tell you a story now. I'm not just telling you this story to tell you a story. I'm telling you this story because I want to sometimes-- when we do the “I did a hard thing” segment, it's usually very, very short and to the point, but I'd actually like to walk you through how I got through getting some really bad news. So, let's talk about it. And I'll share. I'm not perfect. So, there were times when I was doing well and there was times when I won't. So, for those of you who don't know, which I'm guessing is all of you, I have very bad gums. My gums, I inherited bad gums. It comes in my family. I go in every three months for a gum routine where they do a deep cleaning or they really check my gums to make sure there's not receding too much. And because of that, I take really good care of my teeth. And because of that, I usually have very little dental issues. I never had a cavity. I've never had any cracks or any terrible swollen problems. That just isn't my problem. My problem is gums and it's an ongoing issue that I have to keep handling. So this time, I go in, I get my x-rays, and the doctor comes in. And I have this really hilarious dentist who has not got the best bedside manner, but I do love him and he has been with me through some really tough times that when I found out I have a lesion on my brain, I fully broke down in front of him and he was so kind and gave me his cell phone number. He was just so lovely. But he comes in and he rubs his hands together and says, “What are we doing here today, Kimberley?” And he looks at the x-rays and I kid you not, he says, “Holy crap!” Literally, that was his response, which is pretty funny, I think. From there, I proceed to go into some version of a panic attack. I'm like, “What? What's wrong? What do you see? What happened?” And I think that was pretty appropriate for me to do that. So, I want to validate you. When you get big news, it's normal to go into a fight or flight, like what's going on, you're hypervigilant, you're looking around. Now, he waited about 45 seconds to answer my question. I just sat there in a state of panic while he stared at the x-rays on the wall. And these 45 seconds, I think, was the longest 45 seconds of my life because he wouldn't answer me. And I was just like, “Tell me what's wrong. What's wrong?” So, he turns around and he says, “Kimberley, you have a dead tooth.” And I'm like, “What? A dead tooth? What does that even mean?” And he says, “You have a tooth infection that is dormant. Do you have any pain? Do you have a headache? What's going on?” And I'm like, “Nothing, nothing. I'm fine. Everything is fine.” And so, he proceeds to immediately in this urgent, panicky way, call in his nurses, “Bring me this, bring me that, bring me this, bring me that. Bring me this tool, bring me this chemical or medicine or whatever.” And they're all poking at me and prodding at me and they're trying to figure it out. And he's like, “I cannot figure out what this is and why it's here.” So, bad news. Just straight-up bad news. Now, the interesting thing about this is, it's hard to be in communication with someone, particularly when they're your doctor and they appear to be confused and panicking. Not that he was panicking, but he was acting in this urgent way. That's a hard position to be in. And if you've ever been in a position like that, I want to first validate you. That's scary. It is a scary moment that your trusted person is also panicking. Just like when you're on an airplane and it's really bumpy. But if you see that the air hostesses are giggling and laughing, you're like, “Okay, it's all good.” But when you see their faces looking a little nervous, that's a scary moment. So, first of all, if you've been in that position, that's really, really hard. What he then proceeded to tell me is, “Kimberley, this tooth has to come out. It has to come out immediately. We cannot wait. It's going to cost a god-awful amount of money. And this has to happen right away.” Now in my mind, you guys know me, I am really, really strict about scheduling. I have a schedule. I'm not compulsive about it, but I run two businesses. I have a podcast, I have two children. I have a medical illness. I have to manage my mental illnesses all the time. So, I have to be really intentional with my calendar. So, this idea that immediately, everything has to change was a little alarming to me. But what I remember thinking, and this is one of the tools I want to offer you for today, is being emotionally flexible is a skill. And what we want to do in those moments, and this is what I practiced was, “Okay, Kimberley, this is one of those moments where your skills come in handy. Thank God for them.” How can you be flexible here? Because my mind wanted to go, “You got to pick up the kids and you've got to do this and you've got to a meeting tomorrow and you've got clients and you can't do this. This can't happen this week.” But my mind was like, “I'm going to practice flexibility.” In addition to that, when things change really quickly, we tend to beat ourselves up like, “Such and such is going to hate me. They're going to be mad at me. They're going to think I'm a loser for having to change the schedule.” And I just gently said to myself, “Kimberley, we're going to be emotionally flexible here and we're going to let everybody have their emotions about it.” So, the kids get to have their emotions about everything changing and my clients get to have their emotions about it too. And having to cancel the meetings, they get to have their emotions. Everyone's allowed to have their emotions about the fact that many, many things are going to be canceled in the next few days. And that has been such a work of art for me, but it has been so beautiful for me to say, instead of me going, “No, no, no, I can't do this,” because I don't want them to have feelings and I don't want them to think this about me, now I'm just like, everyone gets to have their feelings. They get to feel disappointed. They get to feel angry. They get to feel annoyed. They get to feel irritated. They get to feel sad. Everybody gets to feel their feelings about it because that's a part of being a human. That's one of the tools I want you to think about. Just play with these ideas. You've just come off the six-week series. These are some more ideas to play with. But then from there, I had about 36 hours where I had to wait for this surgery. And during that time, I had to have an x-ray where I was told, and this is the real bad news, is this infection, actually, this is gross. So, trigger warning, guys. The infection actually ate through a part of my jaw bone. I know. Isn't that crazy? The infection was so bad and it was right at this area where I guess nerves come out of your jaw. There's this tiny hole right at the front, around the sides where the nerves come out of your jaw and up into your lips and the infection spread and was all over that area. I know that is gross, but it's also really scary. So, not only did I have to think about all of the changes, but he, the doctor, the dentist had made me very aware that this surgery has to go really well, and that if he pushes too hard or he pulls too hard with a tooth or he had to put in a-- there's these words I don't even know, but like a canal, like some kind of fixture so that he can create a new tooth because I had to have a tooth completely pulled out. He was like, “If I push it in too far, I actually may hit this nerve, which could be very, very bad.” So, this uncertainty felt horrible to me. And of course, I'm going to have these intrusive thoughts like, “What if I never get to speak again? What if I lose a feeling in my gums and what if he pushes hard and this is terminal? What if, what if, what if, what if?” And so, my skill here, and we've learnt this from managing mental compulsions, is bring it back to the present. Until there's a problem, we don't solve them. So, that's what I kept doing. “It's not happening now. Kimberley, it's not happening now. It's not happening now,” even though it's a real threat, even though it's going to be something I have to face, because sometimes our fears are like, “What if something happens?” But it's just a what-if. There's no actual event that you know for certain is going to happen. This was like, “Yeah, you're going to do this in literally 30 hours and all of these risks are here.” You guys have probably got stories like this, where you've gone in for some brain surgery or any surgery where there's a risk, but this risk was pretty huge. He was very concerned. I think appropriately concerned. So, here I am for 30 hours, managing this stuff where I'm like, “Okay, this could go really well or this could go really bad, like really, really bad.” I giggle just because it makes me nervous just to think about it. That's a nervous giggle that you just heard me. I don't know. I often giggle when I'm nervous. But it's a big deal. So, I, in these moments, had to weigh up, go back to what Lisa Coyne was talking about. I was like, “Okay, values versus fear. Which one do I consult with?” I had reached out to the dentist to say, “You know what, let's just not do this. I'm not in any pain. Let's just keep it there. Let's just not.” And his response was like, “That's not even an option. If you've already got this much damage, this could get worse and be very, very problematic.” So, I didn't even have the option to back out. I had to do this. And so, as I proceeded forward, I had to keep being aware like what Jon Hershfield talked about and Dr. Grayson and Dr. Reid Wilson, and Shala. I had to really allow all the intrusive thoughts to come like, “Yup. Possible. Yup, that's possible too. Yup, that's possible too. Maybe it does. Maybe it will. Not going to give it my attention right now. I see you're back again. Good one, bro. Hi there, I see you. I fully accept the uncertainty.” That was me for l30 hours, literally bringing in every tool I have. The cool thing is it was a hugely busy week. And because I have been really doubling down on my mindfulness skills over the last few months, that actually really helped. Every time I noticed that I was getting anxious, I was like, “Okay, what does the keyboard feel under my fingers?” I have these fiddles that I play with and I'm like, “Okay, what does this feel like? This rubber feel like, or this metal feel like, and so forth?” So, that was really helpful. The day of the surgery, I go in and I'm fully anxious. I'm going to the bathroom. I'm needing to pee. I feel dizzy. I'm not allowed to be on my medication. Oh, and that's the other thing, is this maybe the-- what do you call it? The silver lining. Just a little update for you guys, is there is a small chance, because this infection has been here for a long time and we haven't actually detected it yet, that it may be the reason for all my POTS symptoms. As some of you may know, I have postural orthostatic tachycardia syndrome. It is a chronic illness related to dysautonomia. It causes me to faint and have headaches and nausea and dizziness and blood pooling and it's the worst. And there is a chance that that might be why. So, I'm half scared and half excited all day, which is a lot to handle. But as the day is moving forward, I'm getting more and more nervous and I start to feel the urge to start to seek reassurance. I start to observe the urge to Google. I start to observe the urge to ask the doctors many, many, many, many questions. And when I say it, I'm saying that very intentionally. I observed the urge, which is I didn't do those behaviors. I just noticed the urge that kept showing up. “Ooh, let's try and get this anxiety to go away. Ooh, let's try and get that anxiety to go away.” Knowing that when it's my turn to sit in that chair, I will ask specific questions. So, I'm not saying you can't ask your doctors questions, but that was key for me, was to observe the urge to seek reassurance, observe the urge to go into avoidance. I'm not going to make this story too much longer, but what I will say, I want to tell you the funniest part of this story. I'm in the doctor's office because I had to go in for this very fancy x-ray that does all your nerves because he was afraid he was going to hit one. He's showing me the x-ray and I'm literally looking at it. He's showing me cross-sections of my jaw. And you guys, it was so scary. You can see the hole that it's created. You can see the infection and how it's deteriorated the bone. It was so scary. And so, he puts his hand on my-- and I'm like, at that point, “Is there any way we could get away with not doing this? Because this is really scary.” He puts his hand on my hand, he says, “I'm going to go and take care of all of these last patients I have so I can give you 100% of my attention and I will be back.” You guys, this is the funniest thing ever. So, the dental nurse is there watching me. My heart is through the roof. My blood pressure is all over the place. She stands in front of me and she says, “Miss Kimberley, don't be worried. We've watched all the YouTube videos.” And I swear to you, every piece of panic that I had went out the window for that small second and I laughed so hard. She said, “In fact, that's where the doctor is right now. He's just going to watch the YouTube video one more time.” And I just died laughing. Now for some of you, that may have actually been really anxiety-provoking. But for me, it was exactly what I needed. I needed someone to make this so funny. And it was so funny. I swear to you, every time I think of it, the way she says it in her accent was the most hilarious thing ever. It was so perfectly timed. The delivery was perfect and I burst out laughing. He comes back in-- this is the end of the story. I'm not going to drag it out for too much longer. I promise. But he comes back in, and I just wanted to share with you, because I know last week with Lisa, I had a really emotional moment, and I think it was really tied to this. As he was putting in the IV – because I had to be knocked out. He said he couldn't take a risk of me moving. So, he knocked me out for the surgery – tears just rolled out of my eyes. And I wasn't going to be ashamed of it. And what came up for me was, I said, “Please, sir.” I said “Sir,” which I think is so funny, because I know him by his first name. “Please, sir. Please just take care of me.” And for me, tears were rolling down my face, but that was an act of compassion for myself. Instead of me saying-- because I know two years ago, or even six months ago, I probably would've said, “Please, don't kill me,” or “Promise me nothing bad would happen.” But there was this act of compassion that just flowed out of me, which was like, “Please, sir. Please take care of me.” And it was coming from this deep place of finally in my life, being able to ask to be taken care of. And I've been working on this, you guys, for about a year, is having the ability to actually ask for help has been something I've really sucked at and it's something I've worked so hard at. And for me, that was groundbreaking, to ask for help. Now you could say it was me pleading with him, but it wasn't. It was me. It was an act of compassion. It was an act of saying, “I'm scared. I'm not asking you to take my fear away. I'm just asking you to hold me in a place of kindness and compassion and nurturing and care.” And that for me was profound. So, I just wanted to share that with you. I know that it might not be as skills-based as some of the other episodes, but I love sharing with you hard things and I love sharing with you that I'm a human, messy human who's doing the best they can and is imperfect too. But I just wanted to give you a step-by-step one. It's okay if it's hard and there are skills that you can use and we can get through hard things. It's a beautiful day to do hard things, I always say that. And so, I wanted to just record this and share with you the ups and the downs of my week and help you maybe if there's a time where you've gotten bad news on ways that you might manage it. Now, what I do want to end here with is, I understand my privilege here. I understand my privilege of getting bad news and being able to get medical care and have a lovely dentist and a lovely nurse who makes funny jokes. And sometimes the news doesn't end well, and I get that. I want to honor you that there is no right way to get bad news. And the grief process of getting bad news is different for everybody. This was more of an anxiety process, but I want to honor to you that if you're going through some hard thing in your life where you've gotten bad news, I want to also offer you the opportunity to grieve that and I want to honor that this is really, really a hard thing to go through. So, I really want to make sure I make space for you with that because my experience is not your experience, I'm sure. So, that's it, guys. That's what to do when you get bad news. That's my experience of getting bad news and I hope it's been helpful. We are embarking on some shifts here with the podcast. I am so inspired to be more focused on just delivering the tools to you and being a safe place for you and being a bright, shiny light for you. And so, I'm doing a lot of exploring on how I can do that. So, if you ever-- again, please do feel-- if you want to give some thoughts, please do reach out, send me an email. If you're not on my newsletter list, please do go and sign up. I'll leave you a link in the show notes, or you can go to CBTSchool.com and sign up for the newsletter and you can reply there as well or you can leave a review. All right. I love you guys. Have a wonderful day. It is a beautiful day to get bad news and do the hard thing. I love you. Have a great day.

SUMMARY:  In this weeks podcast, we have my dearest friend Shala Nicely talking about how she manages mental compulsions.  In this episode, Shala shares her lived experience with Obsessive Compulsive Disorder and how she overcomes mental rituals. In This Episode: How to reduce mental compulsions for OCD and GAD. How to use Flooding Techniques with Mental Compulsions Magical Thinking and Mental Compulsions BDD and Mental Compulsions Links To Things I Talk About: Shalanicely.com Book: Is Fred in the Refridgerator? Book: Everyday Mindfulness for OCD ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com.  CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors.  Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 284. Welcome back, everybody. We are on the third video or the third part of this six-part series on how to manage mental compulsions. Last week's episode with Jon Hershfield was bomb, like so good. And I will say that we, this week, have Shala Nicely, and she goes for it as well. So, I am so honored to have these amazing experts talking about mental compulsions, talking about what specific tools they use.  So, I'm not going to take too much time of the intro this time, because I know you just want to get to the content. Again, I just want to put a disclaimer. This should not replace professional mental health care. This series is for educational purposes only. My job at CBT School is to give you as much education as I can, knowing that you may or may not have access to care or treatment in your own home. So, I'm hoping that this fills in a gap that maybe we've missed in the past in terms of we have ERP School, that's an online course teaching you everything about ERP to get you started if you're doing that on your own. But this is a bigger topic. This is an area that I'd need to make a complete new course. But instead of making a course, I'm bringing these experts to you for free, hopefully giving you the tools that you need.  If you're wanting additional information about ERP School, please go to CBTSchool.com. With that being said, let's go straight over to this episode with Shala Nicely.  Kimberley: Welcome, Shala. I am so happy to have you here. Shala: I am so happy to be here. Thank you for having me. Kimberley: Okay. So, I have heard a little bit of your views on this, but I am actually so excited now to get into the juicy details of how you address mental compulsions or mental rituals. First, I want to check in with you, do you call them mental compulsions, rituals, rumination? How do you address them? Shala: Yeah. All those things. I also sometimes call it mental gymnastics up in your head, it's all sorts of things you're doing in your head to try to get some relief from anxiety. Kimberley: Right. So, if you had a patient or a client who really was struggling with mental compulsions, whether or not they were doing other compulsions as well, how might you address that particular part of their symptomology? Shala: So, let me answer that by stepping back a little bit and telling you about my own experience with this, because a lot of the way I do it is based on what I learned, trying to manage my own mental rituals. I've had OCD probably since I was five or six, untreated until I was 39. Stumbled upon the right treatment when I went to the IOCDF Conference and started doing exposure mostly on my own. I went to Reid Wilson's two-day group, where I learned how to do it. But the rest of the time, I was implementing on my own. And even though I had quite a few physical compulsions, I would've considered myself a primary mental ritualizer, meaning if we look at the majority, my compulsions were up in my head. And the way I think about this is I think that sometimes if you have OCD for long enough, and you've got to go out and keep functioning in the world and you can't do all these rituals so that people could see, because then people will be like, “What's wrong with you? What are you doing?” you take them inward. And some mental compulsions can take the place of physical compulsions that you're not able to do for whatever reason because you're trying to function. And I'd had untreated OCD for so long that most of my rituals were up in my head, not all, but the great majority of them.  Exposure & Response Prevention for Mental Compulsions So, when I started to do exposure, what I found was I could do exposure therapy, straight up going and facing my fears, like going and being around things that might be triggering all I wanted, but I wasn't necessarily getting better because I wasn't addressing the mental rituals. So, basically, I'm doing exposure without response prevention or exposure with partial response prevention, which can make things either worse or just neutralize your efforts. So, what I did was I figured out how to be in the presence of triggers and not be up in my head, trying to do analyzing, justifying, figuring it out, replaying the situation with a different ending, all the sorts of things that I would do over and over in my head. And the way I did this was I took something I learned from Jonathan Grayson and his book, Freedom From OCD. I know you're having him on for this series too. And he talked about doing all this ERP scripting, where you basically write out the worst-case scenario, what you think your OCD thinks is going to happen and you write it in either a worst-case way or an uncertainty-focused way. And what I did was after reading his book, I took that concept and I just shortened it down, and anything that my OCD was afraid of, I would just wrap may or may not surround it.  So, for instance, an example that I use in Is Fred in the Refrigerator?, my memoir, Taming OCD and Reclaiming My Life was that I used to-- when I was walking through stores like Target, if I saw one of those little plastic price tags that had fallen on the ground, if I didn't pick it up and put it out of harm's way, I was afraid somebody was going to slip and fall and break their neck. And it would be on some security camera that I just walked on past it and didn't do anything. So, a typical scrupulosity obsession. And so, going shopping was really hard because I'm cleaning up the store as I'm shopping. And so, what I would do is I would either go to Target, walk past the price tag. And then as I'm just passing the price tag, I would say things. And in Target, I obviously couldn't do this really out loud, mumble it out loud as best, but I may or may not cause somebody to kill themselves by they're going to slip and fall on that price tag because I didn't pick it up. I may or may not be an awful, terrible rotten human being. They may or may not catch me and throw me into jail. I may or may not rot in prison. People may or may not find out what a really bad person I really am. This may or may not be OCD, et cetera, et cetera, et cetera.  And that would allow me to be present with the obsessions, all the what-ifs – those are basically what-ifs turned into ‘may or may nots' – without compulsing with them, without doing anything that would artificially lower my anxiety. So, it allowed me to be in the presence of those obsessive thoughts while interrupting the pattern of the mental rituals. And that's really how I use ‘may or may nots' and how I teach my clients to use ‘may or may nots' today is using them to really be mindfully present of what the OCD is worried about while not interacting with that content in a way that's going to make things worse. So, that's how I developed it for myself. And I think that-- and that is a tool that I would say is an intermediary tool. So, I use that now in my own recovery. I don't have to use 'may or may nots'. It's very often at all. If I get super triggered, which doesn't happen too terribly often, but if I get super triggered and I cannot get out of my head, I'll use 'may or may nots'.  But I think the continuum is that you try to do something to interrupt the mental rituals, which for me is the 'may or may nots'. You can also-- people can write down the scripts, they can do a worst-case scenario. But eventually, what you're trying to get to is you're trying to be able to hear the OCD, what-ifs in your head and completely ignore it. And I call that my shoulders back, the way of thinking about things. Just put your shoulders back and you move on with your day. You don't acknowledge it.  What I'll do with clients, I'll say, “If you had the thought of Blue Martian is going to land on my head, I mean, you wouldn't even do anything with that thought. That thought would just go in and go out and wouldn't get any of your attention.” That's the way we want to treat OCD, is just thoughts can be there. I'm not going to say, “Oh, that's my OCD.” I'm not going to say, “OCD, I'm not talking to you.” I'm not going to acknowledge it at all. I'm just going to treat it like any other weird thought that we have during the day and move on.  Your question was, how would you help somebody who comes in with mental rituals? Well, first, I want to understand where are they in their OCD recovery? How long have they been doing these mental rituals? What percentage of their compulsions are mental versus physical? What are the kind of things that their OCD is afraid of? Basically, make a list or a hierarchy of everything they're afraid of. And then we start working on exposure therapy. And when I have them do exposures, the first exposure I do with people, we'll find something that's-- I start in the middle of the hierarchy. You don't have to, but I try. And I will have them face the fear. But then I'll immediately ask them, what is your OCD saying right now? And they'll tell me, and I'll say, “I want you to repeat after me.” I have them do this, and everyone that I see hates this, but I have them do it. Standing up with their shoulders back like Wonder Woman, because this type of power pose helps them. It changes the chemistry of your body and helps you feel more powerful.  OCD thinks it's very powerful. So, I want my clients to feel as powerful as they can. So, I have them stand like Wonder Woman and they repeat after me. Somebody could-- let's just say we are standing near something red on the floor. And I'll say, “Well, what is your OCD saying right now?” And they'll say, “Well, that's blood and it could have AIDS in it, and I'm going to get sick.” I'll say, “Well, that may or may not be a spot of blood on the floor. I may or may not get sick and I may or may not get AIDS, but I want to do this. I'm going to stay here. OCD, I want to be anxious, so bring it on.”  And that's how we do the exposure, is I ask them what's in their head. I have them repeat it to me until they understand what the process is. And then I'm having them be in the presence of this and just script, script, script away. That's what I call it scripting, so that they are in the presence of whatever's bothering them, but they're not up in their head. And anytime something comes in their head, I teach them to pull it down into the script. Never let something be circulating in your head without saying it out loud and pulling it into the script.  I will work on this technique with clients as we're working on exposures, because eventually what we'll want to do is instead of going all over the place, “That may or may not be blood, I may or may not get AIDS, I may or may not get sick,” I'll say, “Okay, of all the things you've just said, what does your OCD-- what is your OCD scared of the most? Let's focus on that.” And so, “I may or may not get AIDS. I may or may not get AIDS. I may or may not have HIV. I may or may not get AIDS,” over again until people start to say, “Oh, okay. I guess I don't have any control over this,” because what we're trying to do is help the OCD habituate to the uncertainty. Habituate, I know that'd be a confusing word. You don't have to habituate in order for exposure to work due to the theory of inhibitory learning, but we're trying to help your brain get used to the uncertainty here. Kimberley: And break into a different cycle instead of doing the old rumination cycle.  Shala: Yes. And so then, I'll teach people to just find their scariest fear. They say that over and over and over again. Then let's hit the next one. “Well, my family may or may not survive if I die because if I get a fatal disease and I die and my family may or may not be left destitute,” and then over and over. “My family may or may not be left destitute. My family may or may not be left destitute, whatever,” until we're hitting all the things that could be circulating in your head.  Now, some people really don't need to do that scripting because they're not up in their head that much. But that's the minority of people. I think most people with OCD are doing something in their head. And a lot of people aren't aware of what they're doing because these mental rituals are incredibly subtle at times. And so, as people, as my clients go out and work on these exposures, I'll have them tell me how it's going. I have people fill out forms on my website each day as they're doing exposures so I can see what's going on. And if they're not really up in their head and they don't really need to do the ‘may or may nots', great. That's better. In fact, just go do the exposure and go on with your life. If they're up in their head, then I have them do the 'may or may nots'. And so, that's how I would start with somebody.  And so, what I'm trying to do is I'm giving them what I call a bridge tool. Because people who have been mental ritualizing for a long time, I have found it's virtually impossible to just stop because that's what your mind is used to doing. And so, what I'm doing is I'm giving them a competing response. And I'm saying here, instead of mental ritualizing, I'd like you to say a bunch of 'may or may nots' statements while standing up and say them out loud while looking like Wonder Woman. Everybody rolls their eyes like, “Really?” But that's what we do as a bridge tool. And so, they've lifted enough mental weights, so to speak, with this technique that they can hear the OCD and start to disengage and not interact with it at all. Then we move to that technique. Flooding Techniques for Mental Rumination Kimberley: Is there a reason why-- and for some of the listeners, they may have learned this before, but is there a reason why you use 'may or may nots' instead of worst-case scenarios? Shala: For me, for my personal OCD recovery journey, what I found with worst-case scenario is I got too lost in the content. I remember doing-- I had had a mammogram, it had come back with some abnormal findings. I spent the whole weekend trying to do scripting about what could happen, and I was using worst-case scenario. Well, I end up in the hospital, I end up with breast cancer, I end up dead. And by the end of the weekend, I was completely demoralized. And I'm like, “Well, I don't bother because I'm going to be dead, because I have breast cancer.” That's where my mind took it because I've had OCD long enough that if I get a really scary and I start and I play around in the content, I'm going to start losing insight and I'm going to start doing depression as a compulsion, which is the blog we did talk about, where you start acting depressed because you're believing what the OCD says like, “Oh, well, I might as well just give up, I have breast cancer,” and then becoming depressed, and then acting like it's true. And then that's reinforcing the whole cycle.  So, for me, worst-case scenario scripting made things worse. So, when I stayed in the uncertainty realm, the ‘may or may nots' that helped because I was trying to help my brain understand, “Well, I may or may not have breast cancer. And if I do, I mean, I'll go to the doctor, I'll do what I need to do, but there's nothing I can do about it right now in my head other than what I'm doing.” Some people like worst-case scenario and it works fine for them. And I think that works too. I mostly use 'may or may nots' with clients unless they are unable through numbing that they might be doing. If they're unable to actually feel what they're saying, because they're used to turning it over in their head and pulling the anxiety down officially, and so I can't get a rise out of the OCD because there's a lot of really little subtle mental compulsions going on, then I'll insert some worst-case scenario to get the anxiety level up, to help them really feel the fear, and then pull back into 'may or may nots'. But there's nothing wrong with worst-case scenario. But for me, that was what happened. And I think if you are prone to depression, if you're prone to losing insight into your OCD when you've got a really big one, I think that's a risk factor for using that particular type of scripting.  Magical Thinking and Mental Compulsions  Kimberley: Right. And I found that they may or may not have worked just as well, except the one thing, and I'm actually curious on your opinion on this and I have not had this conversation, is I find that people who have a lot of magical thinking benefit by worst-case scenario, like their jinxing compulsions and so forth, like the fear of saying it means it will happen. So, saying the worst-case is the best exposure. Is that true for you? Shala: I have not had to use it much on my own magically. I certainly had a lot of magical thinking. Like, if I don't hit this green light, then somebody's going to die. But I think the worst-case scenario, I could actually work well in that, because if you use the worst-case scenario, it can make it seem so ridiculous that it helps people let go of it more easily. And I think you can do that with 'may or may nots' too. I'll try to encourage people to use the creativity that they have because everybody with OCD has a ton of creativity. And we know that because the OCD shares your brain and it's certainly the creative stuff And to one-up the OCD, you use the scripting to be like, “Gosh, I may or may not get some drug-disease and give it to my entire neighborhood. I may or may not kill off an entire section of my county. We may or may not infect the entire state of Georgia. The entire United States may or may not blow up because I got this one disease. So, they may or may not have to eject me off the earth and make me live on Mars because I'm such a bad person.” This ‘may or may not' is in all this crazy stuff too, because that's how to win, is to one up the OCD. It thinks that's scary, let's go even scarier. But the scary you get, it also gets a little bit ridiculous after a while. And then the whole thing seems to be a little bit ridiculous. So, I think you can still use that worst-case stuff with may or may not. Kimberley: Right. Okay. So, I mean, I will always sort of-- I know you really well. I've always held you so high in my mind in just how resilient and strong you are in doing this. How might you, or how do you help people who feel completely powerless at even addressing this? For you to say it, it sounds very like you're just doing it and it's so powerful. But for those who are really struggling with this idea of like, you said, coming out of your head, can you speak to how you address that in session if someone's really struggling to engage in 'may or may nots' and so forth? Shala: Yeah. Well, thank you for the kind words, first off. I think that it's really common for people with OCD by the time they get to a therapist to feel completely demoralized, especially if they've been to multiple therapists before they get to somebody who does ERP. And so, they feel like they're the victim at the hands of a very cruel abuser that they can't get away from. And so, they feel beaten down and they don't know how to get out of their heads. They feel like they're trapped in this mental prison. They can't get out. And if somebody is struggling like that, and they're doing the 'may or may nots' and the OCD is reacting, which of course, it will, and coming back at them stronger, which I always warn people, this is going to happen. When you start poking at this, the OCD is going to poke back and poke back even harder, because it wants to get you back in line so it can keep you prisoner.  So, what I'll often do in those situations, if I see somebody is really feeling like they have been so victimized, that they're never going to be able to get over this, is the type of script I have them do is more of an empowerment script, which could sound like this: “OCD, I'm not listening to you anymore. I'm not doing what you want. I am strong. I can do this.” And I might add some 'may or may nots' in there. “And I want to be anxious. Come on, bring it on. You think that's scary? Give me something else.”  I know you're having Reid Wilson on as part of this too. I learned all that “bring it on” type stuff and pushing for the anxiety from him. And I think helping people say that out loud can be really transformative. I've seen people just completely break down in tears of sort of, “Oh my gosh, I could do this,” like tears of empowerment from standing up and yelling at their OCD.  If people like swearing, I also just have them swear at it, like they would really swear at somebody who had been abusing them if they had a chance, because swearing actually can make you feel more powerful too, and I want to use all the tools we can. So, I think scripting comes in a number of forms. It's all about really taking what's in your head, turning it into a helpful self-talk and saying it out loud. And the reason out loud is important for any type of scripting is that if you're saying it in your head, it's going to get mixed up with all the jumble of mental ruminating that's going on. And saying it out loud makes it hard for you to ruminate. It's not impossible, but it's hard because you're saying it. Your brain really is only processing one thing at a time. And so, if you're talking and really paying attention to what you're saying, it's much harder to be up in your head spinning this around.  And so, adding these empowerment scripts in with the 'may or may nots' helps people both accept the uncertainty and feel like they can do this, feel like they can stand up to the OCD and say, “You've beaten me enough. No more. This is my life. I'm not letting you ruin it anymore. I am taking this back. I don't care how long it takes. I don't care what I have to do. I'm going to do this.” And that builds people up enough where they can feel like they can start approaching these exposures. Kimberley: I love that. I think that is such-- I've had that same experience of how powerful empowerment can be in switching that behavior. It's so important. Now, one thing I really want to ask you is, do you switch this method when you're dealing with other anxiety disorders – health anxiety, social anxiety, panic disorder? What is your approach? Is there a difference or would you say the tools are the same? Shala: There's a slight difference between disorders. I think health anxiety, I treat exactly like OCD. Even some of the examples I gave here were really health anxiety statements. With panic disorder-- and again, I learned this from Reid and you can ask him more about this when you interview him. But with pain disorder, it's all about, I want to feel more shorter breath, more like their elephant standing on my chest. I want my heart to be faster. But I'm doing this while I'm having people do exercises that would actually create those feelings, like breathing through a little bit of cocktail straw, jogging, turning up a space heater, and blowing it on themselves. So, we're trying to create those symptoms and then talk out loud and say, “Come on, I want more of this. I want to feel more anxious. Give me the worst panic attack you've ever had.” So, it's all about amping up the symptoms.  With social anxiety, it's a little bit different because with social anxiety, I would work on the cognitions first. Whereas with OCD, we don't work on the cognitions at all, other than I want you to have a different cognitive relationship with your disorder and your anxiety. I want you to want the anxiety. I want you to want the OCD to come and bother you because that gives you an opportunity to practice. That's the cognitive work with OCD. I do not work on the cognitive work on the content. I'm not going to say to somebody, “Well, the chance you're going to get AIDS from that little spot of blood is very small.” That's not going to be helpful  With social anxiety, we're actually working on those distorted cognitions at the beginning. And so, a lot of the work with social anxiety is going to be going out and testing those new cognitions, which really turns the exposures into what we call behavioral experiments. It's more of a cognitive method. We're going out and saying, “Gosh, my new belief, instead of everybody's judging me, is, well, everybody is probably thinking about themselves and I'm going to go do some things that my social anxiety wouldn't want me to do and test out that new belief.” I might have them use that new belief, but also if their anxiety gets really high and they're having a hard time saying, “Well, that person may or may not be judging me. They may or may not be looking at me funny. They may or may not go home and tell people about me.” But really, we're trying to do something a little bit different with social anxiety. Kimberley: And what about with generalized anxiety? With the mental, a lot of rumination there, do you have a little shift in how you respond? Shala: Yeah. So, it's funny that the talk that Michelle Massi and others gave at IOCDF-- I think it was at IOCDF this year about what's the difference between OCD and GAD is they're really aligned there. I mean, I treat GAD very similarly the way I treat OCD in that people are up in their heads trying to do things. They're also doing other types of safety behaviors, compulsive safety behaviors, but a lot of people GAD are just up in their head. They're just worried about more “real-life” things. But again, a lot of OCD stuff can be real-life things. I mean, look at COVID. That was real life. And people's OCD could wrap itself around that. So, I treat GAD and OCD quite similarly. There are some differences, but in terms of scripting, we call it “worry time” in GAD. It's got a different name, but it's basically the same thing. Kimberley: Right. Okay. Thank you for answering that because I know some folks here listening will be not having OCD and will be curious to see how it affects them. So, is that the practice for you or is there anything else you feel like people need to know going in, in terms of like, “Here is my strategy, here is my plan to target mental rituals”? What would you say? Shala: So, as I mentioned, I think the 'may or may nots' are bridge tool that are always available to you throughout your entire recovery. My goal with anybody that I'm working with is to help them get to the point where they can just use shoulders back. And the way that I think about this is what I call my “man in the park” metaphor. So, we've all probably been in a park where somebody is yelling typically about the end of the world and all that stuff. And even if you were to agree with some of the things that the person might say from a spiritual or religious standpoint, you don't run home and go, “Oh my gosh, we got to pack all our things up because it's the end of the world. We have to get with all of our relatives and be together because we're all going to die.” We don't do that. We hear what this guy's saying, and then we go on with our days, again, even if you might agree with some of the content. Now, why do we do that? We do that because it's not relevant in our life. We realize that person probably, unfortunately, has some problems. But it doesn't affect us. We hear it just like when we might hear birds in the background or a car honking, and we just go on with our day. That's how we want to treat OCD. What we do when we have untreated OCD is we run up to the man in the park and we say, “Oh my gosh, can I have a pamphlet? Let me read the pamphlet. Oh my gosh, you're right. Tell me more, tell me more.” And we're interacting with him, trying to get some reassurance that maybe he's wrong, that maybe he does really mean the end of the world is coming soon. Maybe it's going to be like in a hundred years. Eventually, we get to the point where we're handing out pamphlets for him. “Here, everybody, take one of these.” What we're doing with 'may or may nots' is we're learning how to walk by the man in the park and go, “The world may or may not be ending. The world may or may not be ending. I'm not taking a pamphlet. The world may or may not be ending.” So, we're trying to not interact with him. We're trying to take what he's saying and hold it in our heads without doing something compulsive that's going to make our anxiety higher. What we're trying to do is practice that enough till we can get to the point where we can be in the park with the guy and just go on with our day. We hear him speaking, but we're really-- it's just not relevant. It's just not part of our life. So, we just move on. And we're not trying to shove him away. It's just like any other noise or sound or activity that you would just-- it doesn't even register in your consciousness. That's what we're trying to do.  Now I think another way to think about this is if you think-- say you're in an art gallery. Art galleries are quiet and there are lots of people standing around, and there's somebody in there that you don't like or who doesn't like you or whatever. You're not going to walk up to that person and tap on their shoulder and say, “Excuse me, I'm going to ignore you.” You're just going to be like, “I know that person is there. I'm just going to do what I'm doing.” And I think that's-- I use that to help people understand this transition, because we're basically going from 'may or may nots' where we're saying, “OCD, I'm not letting you do this to me anymore,” so we are being really aggressive with it, to this being able to be in the same space with it, but we're not talking to it at all because we don't need to, because we can be in the presence with the intrusive thoughts that the OCD is reacting to, just like the presence of all the other thousands of thoughts we have each day without interacting with them. Kimberley: That's so interesting. I've never thought of it that way.  Shala: And so, that's where I'm trying to get people because that is the strongest, strongest recovery, is if you can go do the things that you want to do, be in the presence of the anxiety and not do compulsions physical or mental, you don't give anything for OCD to work with. I have a whole chapter in my memoir about this after I heard Reid say at one of the conferences, “We need to act as though what OCD is saying doesn't matter.” And that was revolutionary to me to hear that. And that's what we're trying to do both physically and mentally. Because if you can have an obsession and focus on what you want to focus on, do what you want to do, you're not giving OCD anything to work with. And typically, it'll just drain away. But this takes time. I mean, it has taken me years to learn how to do this, but I went untreated for 35 years too. It may not take you years, but it may. And that's okay. It's a process. And I think if you have trouble trying to do shoulders back, man in the park, use 'may or may nots'. You can use the combination. But I think we're trying to get to the point where you can just be with the OCD and hear it flipping out and just go on with your day. OCD, BDD, and Mental Rituals  Kimberley: In your book, you talk about the different voices. There is a BDD voice and an OCD voice. Was it harder or easier depending on the voice? Was that a component for you in that-- because the words and the voice sound a little different. I know in your memoir you give them different names and so forth, which if anyone hasn't read your memoir, they need to go right now and read it. Do you have any thoughts on that in terms of the different voices or the different ways in which the disorders interact? Shala: That's a really great question because yes, I think OCD does shift its voice and shift its persona based on how scared it is. So, if it's a little bit scared, it's probably going to speak to you. It's still going to be not a very nice voice. It might be urgent and pleading. But if it's super scared, I talk about mine being like the triad of hell, how my OCD will personify into different things based on how scared it is. And if it's super scared and it's going to get super big and it's going to get super loud in your head because it's trying desperately to help you understand you've got to save it because it thinks it's in danger. That's all its content. Then I think-- and if you have trouble ignoring it because it's screaming in your head, like the man in the park comes over with his megaphone, puts it right up against your ear and starts talking, that's hard to ignore. That's hard to act like that's not relevant because it hurts. There's so much noise.  That's when you might have to use a may or may not type approach because it's just so loud, you can't ignore it, because it's so scared. And that's okay. And again, sometimes I'll have to use that. Not too terribly often just because I've spent a long time working on how to use the shoulder's back, man in the park, but if I have to use it, I use it. And so, I think your thought about how do I interact with the OCD based on how aggressive it's being also plays into this. Kimberley: I love all this. I think this is really helpful in terms of being able to be flexible. I know sometimes we want just the one rule that's going to work in all situations, but I think you're right. I think that there needs to be different approaches. And would you say it depends on the person? Do you give them some autonomy over finding what works for them, or what would you say?  Shala: Absolutely. If people are up in their heads and they don't want to use 'may or may nots', I'll try to use some other things. If I really, really think that that's what we need right now, is we need scripting, I'll try to sell them on why. But at the end of the day, it's always my client's choice and I do it differently based on every client. For some clients, it might be just more empowering statements. For some clients where it's more panicky focused, it might be more about bringing on your anxiety. Sometimes it might be pulling self-compassion in and just saying the self-compassion statements out loud. So, it really does vary by person. There's no one-size-fits-all, but I think, I feel that people need to have something to replace the mental ritualizing with at the beginning that they've been doing it for a long time, just because otherwise, it's like, I'm giving them a bicycle, they've never ridden a bicycle before and I won't give them any training wheels. And that's really, really hard. Some people can do it. I mean, some people can just be like, “Oh, I'm to stop doing that in my head? Okay, well, I'll stop doing that in my head.” But most people need something to help them bridge that gap to get to the point where they can just be in the presence with it and not be talking to it in their heads. Kimberley: Amazing. All right. Any final statements from you as we get close to the end? Shala: I think that it's important to, as you're working on this, really think about what you're doing in your head that might be subtle, that could be making the OCD worse. And I think talking and being willing to talk about this to therapists about putting it all out there, “Hey, I'm saying this to myself in my head, is that helpful or harmful?” Because OCD therapy can be pretty straightforward. I mean, ERP, go out and face your fears, don't do rituals. It sounds pretty straightforward. But there is a lot of subtlety to this. And the more that you can root out these subtle mental rituals, the better that your recovery is going to be.  And know too that if you've had untreated OCD for a long time, you can uncover mental rituals, little bitty ones, for years after you get out of therapy. And that's okay. It doesn't mean you're not in recovery. It just means that you are getting more and more insightful and educated about what OCD is. And the more that you can pick those little things out, just the better your recovery will be. But we also don't want to be perfectionistic about that like, “I must eliminate every single mental ritual that I have or I'm not going to be in a good recovery.” That's approaching your ERP like OCD would do. And we don't want to do that. But we do want to be mindful about the subtleties and make sure to try to pull out as many of those subtle things that we might be doing in our heads as possible.  Kimberley: Amazing. Thank you. Tell us-- again, first, let me just say, such helpful information. And your personal experience, I think, is really validating and helpful to hear on those little nuances. Tell us where people can hear about you and the amazing projects you've got going on. Shala: You can go to ShalaNicely.com and I have lots of free blog posts I've written on this. So, there are two blog posts, two pretty extensive blog posts on 'may or may nots'. So, if you go on my website and just search may or may not, it'll bring up two blog posts about that. If you search on shoulders back or man in the park, you'll find two blog posts on how to do that technique. I also have a blog post I wrote in the last year or so called Shower Scripting, which is how to do ERP, like just some touch-up scripting in the shower, use that time. So, I would say go to my website and you can find all sorts of free resources. I've got two books. You can find on Amazon, Everyday Mindfulness for OCD, Jon Hershfield and I co-wrote. And we talk about ‘may or may nots' and shoulders back and some of the things in there just briefly. And then my memoir, Is Fred in the Refrigerator?: Taming OCD and Reclaiming My Life, is also on Amazon or bookstores, Audible, and that kind of thing.  Kimberley: I wonder too, if we could-- I'm going to put links to all these in the show note. I remember you having a word with your OCD, a video? Shala: Oh yes, that's true. Kimberley: Can we link that too? Shala: Yes. And that one I have under my COVID resources, because I'm so glad you brought that up. When the pandemic started, my OCD did not like it, as many people who have contamination OCD can relate to. And it was pretty scary all the time. And it was making me scared all the time. And eventually, I just wrote it a letter and I'm like, “Dude, we're not doing this anymore.” And I read it out loud and I recorded it out loud so that people could hear how I was talking to it.  Kimberley: It was so powerful. Shala: Well, thank you. And it's fun to do. I think the more that you can personify your OCD, the more you can think of it as an entity that is within you but is not you, and to recognize that your relationship with it will change over time. Sometimes you're going to be compassionate with it. “Gosh, OCD, I'm so sorry,” You're scared we're doing this anyway. Sometimes you're going to be aggressive with it. Sometimes you just ignore it. And that changes as you go through therapy, it changes through your life. And I think that recognizing that it's okay to have OCD and to have this little thing, I think of like an orange ball with big feet and sunglasses is how I think about it when it's behaving – it makes it less of an adversarial relationship over time and more like I have an annoying little sibling that, gosh, it's just not going to ever not be there, but it's fine. We can live together and live in this uncertainty and be happy anyway. Kimberley: I just love it. Thank you so much for being here and sharing your experience and your knowledge. It's so wonderful. Shala: Thank you so much for having me.

SUMMARY:  In this weeks podcast, we have my dearest friend Shala Nicely talking about how she manages mental compulsions.  In this episode, Shala shares her lived experience with Obsessive Compulsive Disorder and how she overcomes mental rituals. In This Episode: How to reduce mental compulsions for OCD and GAD. How to use Flooding Techniques with Mental Compulsions Magical Thinking and Mental Compulsions BDD and Mental Compulsions Links To Things I Talk About: Shalanicely.com Book: Is Fred in the Refridgerator? Book: Everyday Mindfulness for OCD ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com.  CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors.  Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 284. Welcome back, everybody. We are on the third video or the third part of this six-part series on how to manage mental compulsions. Last week's episode with Jon Hershfield was bomb, like so good. And I will say that we, this week, have Shala Nicely, and she goes for it as well. So, I am so honored to have these amazing experts talking about mental compulsions, talking about what specific tools they use.  So, I'm not going to take too much time of the intro this time, because I know you just want to get to the content. Again, I just want to put a disclaimer. This should not replace professional mental health care. This series is for educational purposes only. My job at CBT School is to give you as much education as I can, knowing that you may or may not have access to care or treatment in your own home. So, I'm hoping that this fills in a gap that maybe we've missed in the past in terms of we have ERP School, that's an online course teaching you everything about ERP to get you started if you're doing that on your own. But this is a bigger topic. This is an area that I'd need to make a complete new course. But instead of making a course, I'm bringing these experts to you for free, hopefully giving you the tools that you need.  If you're wanting additional information about ERP School, please go to CBTSchool.com. With that being said, let's go straight over to this episode with Shala Nicely.  Kimberley: Welcome, Shala. I am so happy to have you here. Shala: I am so happy to be here. Thank you for having me. Kimberley: Okay. So, I have heard a little bit of your views on this, but I am actually so excited now to get into the juicy details of how you address mental compulsions or mental rituals. First, I want to check in with you, do you call them mental compulsions, rituals, rumination? How do you address them? Shala: Yeah. All those things. I also sometimes call it mental gymnastics up in your head, it's all sorts of things you're doing in your head to try to get some relief from anxiety. Kimberley: Right. So, if you had a patient or a client who really was struggling with mental compulsions, whether or not they were doing other compulsions as well, how might you address that particular part of their symptomology? Shala: So, let me answer that by stepping back a little bit and telling you about my own experience with this, because a lot of the way I do it is based on what I learned, trying to manage my own mental rituals. I've had OCD probably since I was five or six, untreated until I was 39. Stumbled upon the right treatment when I went to the IOCDF Conference and started doing exposure mostly on my own. I went to Reid Wilson's two-day group, where I learned how to do it. But the rest of the time, I was implementing on my own. And even though I had quite a few physical compulsions, I would've considered myself a primary mental ritualizer, meaning if we look at the majority, my compulsions were up in my head. And the way I think about this is I think that sometimes if you have OCD for long enough, and you've got to go out and keep functioning in the world and you can't do all these rituals so that people could see, because then people will be like, “What's wrong with you? What are you doing?” you take them inward. And some mental compulsions can take the place of physical compulsions that you're not able to do for whatever reason because you're trying to function. And I'd had untreated OCD for so long that most of my rituals were up in my head, not all, but the great majority of them.  Exposure & Response Prevention for Mental Compulsions So, when I started to do exposure, what I found was I could do exposure therapy, straight up going and facing my fears, like going and being around things that might be triggering all I wanted, but I wasn't necessarily getting better because I wasn't addressing the mental rituals. So, basically, I'm doing exposure without response prevention or exposure with partial response prevention, which can make things either worse or just neutralize your efforts. So, what I did was I figured out how to be in the presence of triggers and not be up in my head, trying to do analyzing, justifying, figuring it out, replaying the situation with a different ending, all the sorts of things that I would do over and over in my head. And the way I did this was I took something I learned from Jonathan Grayson and his book, Freedom From OCD. I know you're having him on for this series too. And he talked about doing all this ERP scripting, where you basically write out the worst-case scenario, what you think your OCD thinks is going to happen and you write it in either a worst-case way or an uncertainty-focused way. And what I did was after reading his book, I took that concept and I just shortened it down, and anything that my OCD was afraid of, I would just wrap may or may not surround it.  So, for instance, an example that I use in Is Fred in the Refrigerator?, my memoir, Taming OCD and Reclaiming My Life was that I used to-- when I was walking through stores like Target, if I saw one of those little plastic price tags that had fallen on the ground, if I didn't pick it up and put it out of harm's way, I was afraid somebody was going to slip and fall and break their neck. And it would be on some security camera that I just walked on past it and didn't do anything. So, a typical scrupulosity obsession. And so, going shopping was really hard because I'm cleaning up the store as I'm shopping. And so, what I would do is I would either go to Target, walk past the price tag. And then as I'm just passing the price tag, I would say things. And in Target, I obviously couldn't do this really out loud, mumble it out loud as best, but I may or may not cause somebody to kill themselves by they're going to slip and fall on that price tag because I didn't pick it up. I may or may not be an awful, terrible rotten human being. They may or may not catch me and throw me into jail. I may or may not rot in prison. People may or may not find out what a really bad person I really am. This may or may not be OCD, et cetera, et cetera, et cetera.  And that would allow me to be present with the obsessions, all the what-ifs – those are basically what-ifs turned into ‘may or may nots' – without compulsing with them, without doing anything that would artificially lower my anxiety. So, it allowed me to be in the presence of those obsessive thoughts while interrupting the pattern of the mental rituals. And that's really how I use ‘may or may nots' and how I teach my clients to use ‘may or may nots' today is using them to really be mindfully present of what the OCD is worried about while not interacting with that content in a way that's going to make things worse. So, that's how I developed it for myself. And I think that-- and that is a tool that I would say is an intermediary tool. So, I use that now in my own recovery. I don't have to use 'may or may nots'. It's very often at all. If I get super triggered, which doesn't happen too terribly often, but if I get super triggered and I cannot get out of my head, I'll use 'may or may nots'.  But I think the continuum is that you try to do something to interrupt the mental rituals, which for me is the 'may or may nots'. You can also-- people can write down the scripts, they can do a worst-case scenario. But eventually, what you're trying to get to is you're trying to be able to hear the OCD, what-ifs in your head and completely ignore it. And I call that my shoulders back, the way of thinking about things. Just put your shoulders back and you move on with your day. You don't acknowledge it.  What I'll do with clients, I'll say, “If you had the thought of Blue Martian is going to land on my head, I mean, you wouldn't even do anything with that thought. That thought would just go in and go out and wouldn't get any of your attention.” That's the way we want to treat OCD, is just thoughts can be there. I'm not going to say, “Oh, that's my OCD.” I'm not going to say, “OCD, I'm not talking to you.” I'm not going to acknowledge it at all. I'm just going to treat it like any other weird thought that we have during the day and move on.  Your question was, how would you help somebody who comes in with mental rituals? Well, first, I want to understand where are they in their OCD recovery? How long have they been doing these mental rituals? What percentage of their compulsions are mental versus physical? What are the kind of things that their OCD is afraid of? Basically, make a list or a hierarchy of everything they're afraid of. And then we start working on exposure therapy. And when I have them do exposures, the first exposure I do with people, we'll find something that's-- I start in the middle of the hierarchy. You don't have to, but I try. And I will have them face the fear. But then I'll immediately ask them, what is your OCD saying right now? And they'll tell me, and I'll say, “I want you to repeat after me.” I have them do this, and everyone that I see hates this, but I have them do it. Standing up with their shoulders back like Wonder Woman, because this type of power pose helps them. It changes the chemistry of your body and helps you feel more powerful.  OCD thinks it's very powerful. So, I want my clients to feel as powerful as they can. So, I have them stand like Wonder Woman and they repeat after me. Somebody could-- let's just say we are standing near something red on the floor. And I'll say, “Well, what is your OCD saying right now?” And they'll say, “Well, that's blood and it could have AIDS in it, and I'm going to get sick.” I'll say, “Well, that may or may not be a spot of blood on the floor. I may or may not get sick and I may or may not get AIDS, but I want to do this. I'm going to stay here. OCD, I want to be anxious, so bring it on.”  And that's how we do the exposure, is I ask them what's in their head. I have them repeat it to me until they understand what the process is. And then I'm having them be in the presence of this and just script, script, script away. That's what I call it scripting, so that they are in the presence of whatever's bothering them, but they're not up in their head. And anytime something comes in their head, I teach them to pull it down into the script. Never let something be circulating in your head without saying it out loud and pulling it into the script.  I will work on this technique with clients as we're working on exposures, because eventually what we'll want to do is instead of going all over the place, “That may or may not be blood, I may or may not get AIDS, I may or may not get sick,” I'll say, “Okay, of all the things you've just said, what does your OCD-- what is your OCD scared of the most? Let's focus on that.” And so, “I may or may not get AIDS. I may or may not get AIDS. I may or may not have HIV. I may or may not get AIDS,” over again until people start to say, “Oh, okay. I guess I don't have any control over this,” because what we're trying to do is help the OCD habituate to the uncertainty. Habituate, I know that'd be a confusing word. You don't have to habituate in order for exposure to work due to the theory of inhibitory learning, but we're trying to help your brain get used to the uncertainty here. Kimberley: And break into a different cycle instead of doing the old rumination cycle.  Shala: Yes. And so then, I'll teach people to just find their scariest fear. They say that over and over and over again. Then let's hit the next one. “Well, my family may or may not survive if I die because if I get a fatal disease and I die and my family may or may not be left destitute,” and then over and over. “My family may or may not be left destitute. My family may or may not be left destitute, whatever,” until we're hitting all the things that could be circulating in your head.  Now, some people really don't need to do that scripting because they're not up in their head that much. But that's the minority of people. I think most people with OCD are doing something in their head. And a lot of people aren't aware of what they're doing because these mental rituals are incredibly subtle at times. And so, as people, as my clients go out and work on these exposures, I'll have them tell me how it's going. I have people fill out forms on my website each day as they're doing exposures so I can see what's going on. And if they're not really up in their head and they don't really need to do the ‘may or may nots', great. That's better. In fact, just go do the exposure and go on with your life. If they're up in their head, then I have them do the 'may or may nots'. And so, that's how I would start with somebody.  And so, what I'm trying to do is I'm giving them what I call a bridge tool. Because people who have been mental ritualizing for a long time, I have found it's virtually impossible to just stop because that's what your mind is used to doing. And so, what I'm doing is I'm giving them a competing response. And I'm saying here, instead of mental ritualizing, I'd like you to say a bunch of 'may or may nots' statements while standing up and say them out loud while looking like Wonder Woman. Everybody rolls their eyes like, “Really?” But that's what we do as a bridge tool. And so, they've lifted enough mental weights, so to speak, with this technique that they can hear the OCD and start to disengage and not interact with it at all. Then we move to that technique. Flooding Techniques for Mental Rumination Kimberley: Is there a reason why-- and for some of the listeners, they may have learned this before, but is there a reason why you use 'may or may nots' instead of worst-case scenarios? Shala: For me, for my personal OCD recovery journey, what I found with worst-case scenario is I got too lost in the content. I remember doing-- I had had a mammogram, it had come back with some abnormal findings. I spent the whole weekend trying to do scripting about what could happen, and I was using worst-case scenario. Well, I end up in the hospital, I end up with breast cancer, I end up dead. And by the end of the weekend, I was completely demoralized. And I'm like, “Well, I don't bother because I'm going to be dead, because I have breast cancer.” That's where my mind took it because I've had OCD long enough that if I get a really scary and I start and I play around in the content, I'm going to start losing insight and I'm going to start doing depression as a compulsion, which is the blog we did talk about, where you start acting depressed because you're believing what the OCD says like, “Oh, well, I might as well just give up, I have breast cancer,” and then becoming depressed, and then acting like it's true. And then that's reinforcing the whole cycle.  So, for me, worst-case scenario scripting made things worse. So, when I stayed in the uncertainty realm, the ‘may or may nots' that helped because I was trying to help my brain understand, “Well, I may or may not have breast cancer. And if I do, I mean, I'll go to the doctor, I'll do what I need to do, but there's nothing I can do about it right now in my head other than what I'm doing.” Some people like worst-case scenario and it works fine for them. And I think that works too. I mostly use 'may or may nots' with clients unless they are unable through numbing that they might be doing. If they're unable to actually feel what they're saying, because they're used to turning it over in their head and pulling the anxiety down officially, and so I can't get a rise out of the OCD because there's a lot of really little subtle mental compulsions going on, then I'll insert some worst-case scenario to get the anxiety level up, to help them really feel the fear, and then pull back into 'may or may nots'. But there's nothing wrong with worst-case scenario. But for me, that was what happened. And I think if you are prone to depression, if you're prone to losing insight into your OCD when you've got a really big one, I think that's a risk factor for using that particular type of scripting.  Magical Thinking and Mental Compulsions  Kimberley: Right. And I found that they may or may not have worked just as well, except the one thing, and I'm actually curious on your opinion on this and I have not had this conversation, is I find that people who have a lot of magical thinking benefit by worst-case scenario, like their jinxing compulsions and so forth, like the fear of saying it means it will happen. So, saying the worst-case is the best exposure. Is that true for you? Shala: I have not had to use it much on my own magically. I certainly had a lot of magical thinking. Like, if I don't hit this green light, then somebody's going to die. But I think the worst-case scenario, I could actually work well in that, because if you use the worst-case scenario, it can make it seem so ridiculous that it helps people let go of it more easily. And I think you can do that with 'may or may nots' too. I'll try to encourage people to use the creativity that they have because everybody with OCD has a ton of creativity. And we know that because the OCD shares your brain and it's certainly the creative stuff And to one-up the OCD, you use the scripting to be like, “Gosh, I may or may not get some drug-disease and give it to my entire neighborhood. I may or may not kill off an entire section of my county. We may or may not infect the entire state of Georgia. The entire United States may or may not blow up because I got this one disease. So, they may or may not have to eject me off the earth and make me live on Mars because I'm such a bad person.” This ‘may or may not' is in all this crazy stuff too, because that's how to win, is to one up the OCD. It thinks that's scary, let's go even scarier. But the scary you get, it also gets a little bit ridiculous after a while. And then the whole thing seems to be a little bit ridiculous. So, I think you can still use that worst-case stuff with may or may not. Kimberley: Right. Okay. So, I mean, I will always sort of-- I know you really well. I've always held you so high in my mind in just how resilient and strong you are in doing this. How might you, or how do you help people who feel completely powerless at even addressing this? For you to say it, it sounds very like you're just doing it and it's so powerful. But for those who are really struggling with this idea of like, you said, coming out of your head, can you speak to how you address that in session if someone's really struggling to engage in 'may or may nots' and so forth? Shala: Yeah. Well, thank you for the kind words, first off. I think that it's really common for people with OCD by the time they get to a therapist to feel completely demoralized, especially if they've been to multiple therapists before they get to somebody who does ERP. And so, they feel like they're the victim at the hands of a very cruel abuser that they can't get away from. And so, they feel beaten down and they don't know how to get out of their heads. They feel like they're trapped in this mental prison. They can't get out. And if somebody is struggling like that, and they're doing the 'may or may nots' and the OCD is reacting, which of course, it will, and coming back at them stronger, which I always warn people, this is going to happen. When you start poking at this, the OCD is going to poke back and poke back even harder, because it wants to get you back in line so it can keep you prisoner.  So, what I'll often do in those situations, if I see somebody is really feeling like they have been so victimized, that they're never going to be able to get over this, is the type of script I have them do is more of an empowerment script, which could sound like this: “OCD, I'm not listening to you anymore. I'm not doing what you want. I am strong. I can do this.” And I might add some 'may or may nots' in there. “And I want to be anxious. Come on, bring it on. You think that's scary? Give me something else.”  I know you're having Reid Wilson on as part of this too. I learned all that “bring it on” type stuff and pushing for the anxiety from him. And I think helping people say that out loud can be really transformative. I've seen people just completely break down in tears of sort of, “Oh my gosh, I could do this,” like tears of empowerment from standing up and yelling at their OCD.  If people like swearing, I also just have them swear at it, like they would really swear at somebody who had been abusing them if they had a chance, because swearing actually can make you feel more powerful too, and I want to use all the tools we can. So, I think scripting comes in a number of forms. It's all about really taking what's in your head, turning it into a helpful self-talk and saying it out loud. And the reason out loud is important for any type of scripting is that if you're saying it in your head, it's going to get mixed up with all the jumble of mental ruminating that's going on. And saying it out loud makes it hard for you to ruminate. It's not impossible, but it's hard because you're saying it. Your brain really is only processing one thing at a time. And so, if you're talking and really paying attention to what you're saying, it's much harder to be up in your head spinning this around.  And so, adding these empowerment scripts in with the 'may or may nots' helps people both accept the uncertainty and feel like they can do this, feel like they can stand up to the OCD and say, “You've beaten me enough. No more. This is my life. I'm not letting you ruin it anymore. I am taking this back. I don't care how long it takes. I don't care what I have to do. I'm going to do this.” And that builds people up enough where they can feel like they can start approaching these exposures. Kimberley: I love that. I think that is such-- I've had that same experience of how powerful empowerment can be in switching that behavior. It's so important. Now, one thing I really want to ask you is, do you switch this method when you're dealing with other anxiety disorders – health anxiety, social anxiety, panic disorder? What is your approach? Is there a difference or would you say the tools are the same? Shala: There's a slight difference between disorders. I think health anxiety, I treat exactly like OCD. Even some of the examples I gave here were really health anxiety statements. With panic disorder-- and again, I learned this from Reid and you can ask him more about this when you interview him. But with pain disorder, it's all about, I want to feel more shorter breath, more like their elephant standing on my chest. I want my heart to be faster. But I'm doing this while I'm having people do exercises that would actually create those feelings, like breathing through a little bit of cocktail straw, jogging, turning up a space heater, and blowing it on themselves. So, we're trying to create those symptoms and then talk out loud and say, “Come on, I want more of this. I want to feel more anxious. Give me the worst panic attack you've ever had.” So, it's all about amping up the symptoms.  With social anxiety, it's a little bit different because with social anxiety, I would work on the cognitions first. Whereas with OCD, we don't work on the cognitions at all, other than I want you to have a different cognitive relationship with your disorder and your anxiety. I want you to want the anxiety. I want you to want the OCD to come and bother you because that gives you an opportunity to practice. That's the cognitive work with OCD. I do not work on the cognitive work on the content. I'm not going to say to somebody, “Well, the chance you're going to get AIDS from that little spot of blood is very small.” That's not going to be helpful  With social anxiety, we're actually working on those distorted cognitions at the beginning. And so, a lot of the work with social anxiety is going to be going out and testing those new cognitions, which really turns the exposures into what we call behavioral experiments. It's more of a cognitive method. We're going out and saying, “Gosh, my new belief, instead of everybody's judging me, is, well, everybody is probably thinking about themselves and I'm going to go do some things that my social anxiety wouldn't want me to do and test out that new belief.” I might have them use that new belief, but also if their anxiety gets really high and they're having a hard time saying, “Well, that person may or may not be judging me. They may or may not be looking at me funny. They may or may not go home and tell people about me.” But really, we're trying to do something a little bit different with social anxiety. Kimberley: And what about with generalized anxiety? With the mental, a lot of rumination there, do you have a little shift in how you respond? Shala: Yeah. So, it's funny that the talk that Michelle Massi and others gave at IOCDF-- I think it was at IOCDF this year about what's the difference between OCD and GAD is they're really aligned there. I mean, I treat GAD very similarly the way I treat OCD in that people are up in their heads trying to do things. They're also doing other types of safety behaviors, compulsive safety behaviors, but a lot of people GAD are just up in their head. They're just worried about more “real-life” things. But again, a lot of OCD stuff can be real-life things. I mean, look at COVID. That was real life. And people's OCD could wrap itself around that. So, I treat GAD and OCD quite similarly. There are some differences, but in terms of scripting, we call it “worry time” in GAD. It's got a different name, but it's basically the same thing. Kimberley: Right. Okay. Thank you for answering that because I know some folks here listening will be not having OCD and will be curious to see how it affects them. So, is that the practice for you or is there anything else you feel like people need to know going in, in terms of like, “Here is my strategy, here is my plan to target mental rituals”? What would you say? Shala: So, as I mentioned, I think the 'may or may nots' are bridge tool that are always available to you throughout your entire recovery. My goal with anybody that I'm working with is to help them get to the point where they can just use shoulders back. And the way that I think about this is what I call my “man in the park” metaphor. So, we've all probably been in a park where somebody is yelling typically about the end of the world and all that stuff. And even if you were to agree with some of the things that the person might say from a spiritual or religious standpoint, you don't run home and go, “Oh my gosh, we got to pack all our things up because it's the end of the world. We have to get with all of our relatives and be together because we're all going to die.” We don't do that. We hear what this guy's saying, and then we go on with our days, again, even if you might agree with some of the content. Now, why do we do that? We do that because it's not relevant in our life. We realize that person probably, unfortunately, has some problems. But it doesn't affect us. We hear it just like when we might hear birds in the background or a car honking, and we just go on with our day. That's how we want to treat OCD. What we do when we have untreated OCD is we run up to the man in the park and we say, “Oh my gosh, can I have a pamphlet? Let me read the pamphlet. Oh my gosh, you're right. Tell me more, tell me more.” And we're interacting with him, trying to get some reassurance that maybe he's wrong, that maybe he does really mean the end of the world is coming soon. Maybe it's going to be like in a hundred years. Eventually, we get to the point where we're handing out pamphlets for him. “Here, everybody, take one of these.” What we're doing with 'may or may nots' is we're learning how to walk by the man in the park and go, “The world may or may not be ending. The world may or may not be ending. I'm not taking a pamphlet. The world may or may not be ending.” So, we're trying to not interact with him. We're trying to take what he's saying and hold it in our heads without doing something compulsive that's going to make our anxiety higher. What we're trying to do is practice that enough till we can get to the point where we can be in the park with the guy and just go on with our day. We hear him speaking, but we're really-- it's just not relevant. It's just not part of our life. So, we just move on. And we're not trying to shove him away. It's just like any other noise or sound or activity that you would just-- it doesn't even register in your consciousness. That's what we're trying to do.  Now I think another way to think about this is if you think-- say you're in an art gallery. Art galleries are quiet and there are lots of people standing around, and there's somebody in there that you don't like or who doesn't like you or whatever. You're not going to walk up to that person and tap on their shoulder and say, “Excuse me, I'm going to ignore you.” You're just going to be like, “I know that person is there. I'm just going to do what I'm doing.” And I think that's-- I use that to help people understand this transition, because we're basically going from 'may or may nots' where we're saying, “OCD, I'm not letting you do this to me anymore,” so we are being really aggressive with it, to this being able to be in the same space with it, but we're not talking to it at all because we don't need to, because we can be in the presence with the intrusive thoughts that the OCD is reacting to, just like the presence of all the other thousands of thoughts we have each day without interacting with them. Kimberley: That's so interesting. I've never thought of it that way.  Shala: And so, that's where I'm trying to get people because that is the strongest, strongest recovery, is if you can go do the things that you want to do, be in the presence of the anxiety and not do compulsions physical or mental, you don't give anything for OCD to work with. I have a whole chapter in my memoir about this after I heard Reid say at one of the conferences, “We need to act as though what OCD is saying doesn't matter.” And that was revolutionary to me to hear that. And that's what we're trying to do both physically and mentally. Because if you can have an obsession and focus on what you want to focus on, do what you want to do, you're not giving OCD anything to work with. And typically, it'll just drain away. But this takes time. I mean, it has taken me years to learn how to do this, but I went untreated for 35 years too. It may not take you years, but it may. And that's okay. It's a process. And I think if you have trouble trying to do shoulders back, man in the park, use 'may or may nots'. You can use the combination. But I think we're trying to get to the point where you can just be with the OCD and hear it flipping out and just go on with your day. OCD, BDD, and Mental Rituals  Kimberley: In your book, you talk about the different voices. There is a BDD voice and an OCD voice. Was it harder or easier depending on the voice? Was that a component for you in that-- because the words and the voice sound a little different. I know in your memoir you give them different names and so forth, which if anyone hasn't read your memoir, they need to go right now and read it. Do you have any thoughts on that in terms of the different voices or the different ways in which the disorders interact? Shala: That's a really great question because yes, I think OCD does shift its voice and shift its persona based on how scared it is. So, if it's a little bit scared, it's probably going to speak to you. It's still going to be not a very nice voice. It might be urgent and pleading. But if it's super scared, I talk about mine being like the triad of hell, how my OCD will personify into different things based on how scared it is. And if it's super scared and it's going to get super big and it's going to get super loud in your head because it's trying desperately to help you understand you've got to save it because it thinks it's in danger. That's all its content. Then I think-- and if you have trouble ignoring it because it's screaming in your head, like the man in the park comes over with his megaphone, puts it right up against your ear and starts talking, that's hard to ignore. That's hard to act like that's not relevant because it hurts. There's so much noise.  That's when you might have to use a may or may not type approach because it's just so loud, you can't ignore it, because it's so scared. And that's okay. And again, sometimes I'll have to use that. Not too terribly often just because I've spent a long time working on how to use the shoulder's back, man in the park, but if I have to use it, I use it. And so, I think your thought about how do I interact with the OCD based on how aggressive it's being also plays into this. Kimberley: I love all this. I think this is really helpful in terms of being able to be flexible. I know sometimes we want just the one rule that's going to work in all situations, but I think you're right. I think that there needs to be different approaches. And would you say it depends on the person? Do you give them some autonomy over finding what works for them, or what would you say?  Shala: Absolutely. If people are up in their heads and they don't want to use 'may or may nots', I'll try to use some other things. If I really, really think that that's what we need right now, is we need scripting, I'll try to sell them on why. But at the end of the day, it's always my client's choice and I do it differently based on every client. For some clients, it might be just more empowering statements. For some clients where it's more panicky focused, it might be more about bringing on your anxiety. Sometimes it might be pulling self-compassion in and just saying the self-compassion statements out loud. So, it really does vary by person. There's no one-size-fits-all, but I think, I feel that people need to have something to replace the mental ritualizing with at the beginning that they've been doing it for a long time, just because otherwise, it's like, I'm giving them a bicycle, they've never ridden a bicycle before and I won't give them any training wheels. And that's really, really hard. Some people can do it. I mean, some people can just be like, “Oh, I'm to stop doing that in my head? Okay, well, I'll stop doing that in my head.” But most people need something to help them bridge that gap to get to the point where they can just be in the presence with it and not be talking to it in their heads. Kimberley: Amazing. All right. Any final statements from you as we get close to the end? Shala: I think that it's important to, as you're working on this, really think about what you're doing in your head that might be subtle, that could be making the OCD worse. And I think talking and being willing to talk about this to therapists about putting it all out there, “Hey, I'm saying this to myself in my head, is that helpful or harmful?” Because OCD therapy can be pretty straightforward. I mean, ERP, go out and face your fears, don't do rituals. It sounds pretty straightforward. But there is a lot of subtlety to this. And the more that you can root out these subtle mental rituals, the better that your recovery is going to be.  And know too that if you've had untreated OCD for a long time, you can uncover mental rituals, little bitty ones, for years after you get out of therapy. And that's okay. It doesn't mean you're not in recovery. It just means that you are getting more and more insightful and educated about what OCD is. And the more that you can pick those little things out, just the better your recovery will be. But we also don't want to be perfectionistic about that like, “I must eliminate every single mental ritual that I have or I'm not going to be in a good recovery.” That's approaching your ERP like OCD would do. And we don't want to do that. But we do want to be mindful about the subtleties and make sure to try to pull out as many of those subtle things that we might be doing in our heads as possible.  Kimberley: Amazing. Thank you. Tell us-- again, first, let me just say, such helpful information. And your personal experience, I think, is really validating and helpful to hear on those little nuances. Tell us where people can hear about you and the amazing projects you've got going on. Shala: You can go to ShalaNicely.com and I have lots of free blog posts I've written on this. So, there are two blog posts, two pretty extensive blog posts on 'may or may nots'. So, if you go on my website and just search may or may not, it'll bring up two blog posts about that. If you search on shoulders back or man in the park, you'll find two blog posts on how to do that technique. I also have a blog post I wrote in the last year or so called Shower Scripting, which is how to do ERP, like just some touch-up scripting in the shower, use that time. So, I would say go to my website and you can find all sorts of free resources. I've got two books. You can find on Amazon, Everyday Mindfulness for OCD, Jon Hershfield and I co-wrote. And we talk about ‘may or may nots' and shoulders back and some of the things in there just briefly. And then my memoir, Is Fred in the Refrigerator?: Taming OCD and Reclaiming My Life, is also on Amazon or bookstores, Audible, and that kind of thing.  Kimberley: I wonder too, if we could-- I'm going to put links to all these in the show note. I remember you having a word with your OCD, a video? Shala: Oh yes, that's true. Kimberley: Can we link that too? Shala: Yes. And that one I have under my COVID resources, because I'm so glad you brought that up. When the pandemic started, my OCD did not like it, as many people who have contamination OCD can relate to. And it was pretty scary all the time. And it was making me scared all the time. And eventually, I just wrote it a letter and I'm like, “Dude, we're not doing this anymore.” And I read it out loud and I recorded it out loud so that people could hear how I was talking to it.  Kimberley: It was so powerful. Shala: Well, thank you. And it's fun to do. I think the more that you can personify your OCD, the more you can think of it as an entity that is within you but is not you, and to recognize that your relationship with it will change over time. Sometimes you're going to be compassionate with it. “Gosh, OCD, I'm so sorry,” You're scared we're doing this anyway. Sometimes you're going to be aggressive with it. Sometimes you just ignore it. And that changes as you go through therapy, it changes through your life. And I think that recognizing that it's okay to have OCD and to have this little thing, I think of like an orange ball with big feet and sunglasses is how I think about it when it's behaving – it makes it less of an adversarial relationship over time and more like I have an annoying little sibling that, gosh, it's just not going to ever not be there, but it's fine. We can live together and live in this uncertainty and be happy anyway. Kimberley: I just love it. Thank you so much for being here and sharing your experience and your knowledge. It's so wonderful. Shala: Thank you so much for having me.

SUMMARY: Covered in This Episode: What is a Mental Compulsion?  What is the difference between Mental Rumination and Mental Compulsions?  How to use Mindfulness for Mental Compulsions How to “Label and Abandon” intrusive thoughts and mental compulsions  How to use Awareness logs to help reduce mental rituals and mental rumination  Links To Things I Talk About: Links to Jon's Books https://www.amazon.com/ Work with Jon https://www.sheppardpratt.org/care-finder/ocd-anxiety-center/ Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com.  CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors.  Go to cbtschool.com to learn more.  To learn about our Online Course for OCD, visit https://www.cbtschool.com/erp-school-lp. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free, and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION I want you to go back and listen to that. That is where I walk you through Mental Compulsions 101. What is a mental compulsion, the types of mental compulsions, things to be looking out for. The reason I stress that you start there is there may be things you're doing that are mental compulsions and you didn't realize. So, you want to know those things before you go in and listen to the skills that you're about to receive. Oh my goodness. This is just so, so exciting. I'm mind-blown with how exciting this is all for me. First of all, let's introduce the guest for today. Today, we have the amazing Jon Hershfield. Jon has been on the episode before, even talking about mental compulsions. However, I wanted him to status off. He was so brave. He jumped in, and I wanted him to give his ideas around what is a mental compulsion, how he uses mental compulsion treatment with his clients, what skills he uses. Little thing to know here, he taught me something I myself didn't know and have now since implemented with our patients over at my clinic of people who struggle with mental compulsions. I've also uploaded that and added a little bit of that concept into ERP School, which is our course for OCD, called ERP School. You can get it at CBTSchool.com.  Jon is amazing. So, you're going to really feel solid moving into this. He gives some solid advice. Of course, he's always so lovely and wise. And so, I am just so excited to share this with you. Let's just get to the show because I know you're here to learn. This is episode two of the series. Next week we will be talking with Shala Nicely and she will be dropping major truth bombs and major skills as well, as will all of the people on the series. So, I am so, so excited.  One thing to know as you move into it is there will be some things that really work for you and some that won't. So, I'm going to say this in every episode intro. So, all of these skills are top-notch science-based skills. Each person is going to give their own specific nuanced way of managing it. So, I want you to go in knowing that you can take what you need. Some things will really be like, yes, that's exactly what I needed to hear. Some may not. So, I want you to go in with an open mind knowing that the whole purpose of this six-part series is to give you many different approaches so that you can try on what works for you. That's my main agenda here, is that you can feel like you've gotten all the ideas and then you can start to put together a plan for yourself. Let's go over to the show. I'm so happy you're here. ----- Kimberley: Welcome, Jon. I'm so happy to have you back. Jon: Hi, Kimberley. Thanks for having me back. Difference Between Mental Compulsions and Mental Rumination  Kimberley: Okay. So, you're first in line and I purposely had you first in line. I know we've had episodes similar to this in the past, but I just wanted to really get your view on how you're dealing with mental compulsions. First, I want to check in, do you call them “mental compulsions” or do you call it “mental rumination”? Do you want to clarify your own idea? Jon: Yeah. I say mental compulsions or mental rituals. I use the terms pretty interchangeably. It comes up at the first, usually in the assessment, if not then in the first post-assessment session, when I'm explaining how OCD works and I get to the part we say, and then there's this thing called compulsions. And what I do is I describe compulsions as anything that you do physically or mentally to reduce distress, and this is the important part, specifically by trying to increase certainty about the content of the obsession.  Why that's important is I think we need to get rid of this myth that sometimes shows up in the OCD community that when you do exposures or when you're triggered, you're just supposed to freak out and deal with it, and hopefully, it'll go away on its own. Actually, there are many things you can do to reduce distress that aren't compulsive, because what makes it compulsive is that it's acting on the content of the obsession. I mean, there might be some rare exceptions where your specific obsession has to do with an unwillingness to be anxious or something like that. But for the most part, meditation, breathing exercises, grounding exercises, DBT, certain forms of distraction, exercise – these can all reduce your physical experience of distress without saying anything in particular about whether or not the thought that triggered you is true or going to come. So, once I've described that, then hopefully, it opens people up to realize, well, it could really be anything and most of those things are going to be mental. So then, we go through, “Well, what are the different mental ways?” We know the physical ways through washing hands and checking locks and things like that. But what are all the things you're doing in your mind to convince yourself out of the distress, as opposed to actually working your way through the distress using a variety of distress tolerance skills, including acceptance? Kimberley: Right. Do you do the same for people with generalized anxiety or social anxiety or other anxiety disorders? Would you conceptualize it the same way? Mental Compulsions for General Anxiety Disorder vs OCD  Jon: Yeah. I think for the most part, I mean, I do meet people. Some people who I think are better understood as having generalized anxiety disorder than OCD, and identifying with that concept actually helps them approach this problem that they have of dealing with uncertainty and dealing with worry and dealing with anxiety on close to home, regular everyday issues like finance and work and health and relationships and things like that. And there's a subsection of that people who, if you treat it like OCD, it's really helpful. And there's a subsection if you treat it like OCD, they think, “Oh no, I have some other psychiatric problem I have to worry about right now.” I'm a fan of treating the individual that the diagnostic terms are there to help us. Fundamentally, the treatment will be the same. What are you doing that's sending the signal to your brain, that these ideas are threats as opposed to ideas, and how can we change that signal? Exposure & Response Prevention for Mental Compulsions  Kimberley: Right. I thank you for clarifying on that. So, after you've given that degree of psychoeducation, what do you personally do next? Do you want to share? Do you go more into an exposure option? Do you do more response prevention? Tell me a little bit about it, walk me through how you would do this with a client. Jon: The first thing I would usually do is ask them to educate me on what it's really like to be them. And so, that involves some thought tracking. So, we'll use a trigger and response log. So, I keep it very simple. What's setting you off and what are you doing? And I'll tell them in the beginning, don't try too hard to get better because I want to know what your life is really like, and I'll start to see the patterns. It seems every time you're triggered by this, you seem to do that. And that's where they'll start to reveal to me things like, “Well, I just thought about it for an hour and then it went away.” And that's how I know that they're engaging in mental review and rumination, other things like that. Or I was triggered by the thought that I could be sick and I repeated the word “healthy” 10 times. Okay. So, they're doing thought neutralization. Sometimes we'll expand on that. One of the clinicians in my practice took our thought records and repurposed them as a mental behavior log. So, it's what set you off. What did you do? What was the mental behavior that was happening at that time? And in some cases, what would've been more helpful? Again, I rely more on my patients to tell me what's going on than on me to tell them “Here's what's going on,” so you get the best information. Logging Mental Rituals  Kimberley: Right. I love that. I love the idea of having a log. You're really checking in for what's going on before dropping everything down. Does that increase their distress? How do they experience that? Jon: I think a lot of people find it very helpful because first of all, it's an act of mindfulness to write this stuff down because it's requiring you to put it in front of you and see it, which is different than having it hit you from inside your head. And so, that's helpful. They're seeing it as a thought process. And I think it also helps people come to terms with a certain reality about rumination that it's not a hundred percent compulsion in the sense that there's an element of rumination that's habitual. Your mind, like a puppy, is conditioned to respond automatically to certain things that it's been reinforced to do. And so, sometimes people just ruminate because they're alone or sitting in a particular chair. It's the same reason why people sometimes struggle with hair-pulling disorder, trichotillomania or skin picking. It's these environmental cues. And then the brain says, “Oh, we should do this now because this is what we do in this situation.” People give themselves a really hard time for ruminating because they've been told to stop, but they can't stop because they find themselves doing it.  So, what I try to help people understand is like, “Look, you can only control what you can control. And the more that you are aware of, the more you can control. So, this is where you can bring mindfulness into it.” So, maybe for this person, there's such a ruminator. They're constantly analyzing, figuring things out. It's part of their identity. They're very philosophical. They're not thinking of it as a compulsion, and many times they're not thinking of it at all. It's just happening. And then we increased their awareness, like, “Oh, okay. I got triggered. I left the building for a while. And then suddenly, I realized I was way down the rabbit hole, convinced myself that's something terrible. So, in that moment I realized I'm supposed to stop, but so much damage has been done because I just spent a really long time analyzing and compulsing and trying to figure it out.”  So, strategies that increase our awareness of what the mind is doing are extraordinarily helpful because imagine catching it five seconds into the process and being able to say, “Oh, I'm ruminating. Okay, I don't need to do that right now. I'm going to return my attention to what I was doing before I got distracted.” Kimberley: Right. I love the idea of this, the log for awareness, because a lot of people say, “Oh, maybe for half an hour a day.” Once they've logged it, they're like, “Wow, it's four hours a day.” I think it's helpful to actually recognize this, like how impactful it is on their life. So, I love that you're doing that piece. You can only control what you can control. What do you do with the stuff you can't control? Jon: Oh, you apply heavy doses of self-criticism until you hate yourself enough to never do it again. That's the other mental ritual that usually happens and people realize, “Oh, I've been ruminating,” and they're angry at themselves. “I should know better.” So, they're angry at themselves for something they didn't know they were doing, which is unfair. So, I use the term, I say, “label and abandon.” That's what you do with all mental rituals. The moment you see it, you give it a name and you drop it. You just drop it on the floor where you were, you don't finish it up real quick. You don't analyze too much about it and then drop it. You're just like, “Oh, I'm holding this thing I must not hold,” and you drop it. Label and abandon. What people tend to do is criticize then label, then criticize some more and then abandon. And the real problem with that is that the self-criticism is in and of itself another mental ritual. It's a strategy for reducing distress that's focused on increasing certainty about the content of the obsession. The obsession, in this case, is “I'm never going to get better.” Now I know I'm going to get better because I've told myself that I'm being fooled and that I'll never do that again. It's not true. But then you wash your hands. They aren't really clean either. So, none of our compulsions really work. Self-Compassion for Mental Compulsions  Kimberley: Doesn't have to make sense.  Jon: Yeah. So, I think bringing self-compassion in the moment to be able to recognize it and recognize the urge to self-criticize and really just say like, “Oh, I'm not going to do that. I caught myself ruminating. Well done.” Same thing we do when we meditate. Some people think that meditation has something to do with relaxation or something to do with controlling your mind. It's actually just a noticing exercise. Your mind wanders, you notice it. “Oh, look at that, I'm thinking.” Back to the breath. That's a good thing that you noticed that you wandered. Not, “Oh, I wandered, I can't focus. I'm bad at meditating.” So, it's really just changing the frame for how people are relating to what's going on inside.  One, eliminating self-criticism just makes life a lot easier. Two, eliminating the self-criticism and including that willingness to just label the thought pattern or the thought process and drop it right where it is. You can start to catch that earlier and earlier and earlier. So, you're reducing compulsions. And you'll see that the activity, the neutralizing, the figuring it out, the using your mental strength against yourself instead of in support of yourself, you could see how that's sending the signal to the brain. “Wait, this is very important. I need to keep pushing it to the forefront.” There's something to figure out here. This isn't a cold case in a box, on a shelf somewhere. This is an ongoing investigation and we have to figure it out. How do we know? Because they're still trying to figure it out. Kimberley: Right. How much do you think insight has to play here or how much of a role does it play? Jon: Insight plays a role in all forms of OCD. I mean, it plays a role in everything – insight into our relationships, insight into our career aspirations. I think one of the things I've noticed, and this is just anecdotal, is that the higher the distress and the poorer the distress regulation skills, often the lower the insight. Not necessarily the other way around. Some people have low insight and aren't particularly distressed by what's going on, but if the anxiety and the distress and the discomfort and disgust are so high that the brain goes into a brownout, I noticed that people switch from trying to get me to reassure them that their fears are untrue to trying to convince me that their fears are true. And to me, that represents an insight drop and I want to help them boost up their insight. And again, I think becoming more aware of your mental activity that is voluntary – I'm choosing to put my mind on this, I'm choosing to figure it out, it didn't just happen. But in this moment, I'm actually trying to complete the problem, the puzzle – becoming more aware that that's what you're doing, that's how you develop insight. And that actually helps with distress regulation. Kimberley: Right. Tell me, I love you're using this word. So, for someone who struggles with distress regulation, what kind of skills would you give a client or use for yourself? Jon: So, there are many different skills a person could use. And I hesitate to say, “Look, use this skill,” because sometimes if you're always relying on one skill and it's not working for you, you might be resistant to using a different skill. In DBT, they have something called tip skills. So, changing in-- drastic changes in temperature, intense exercise, progressive muscle relaxation, pace breathing. These are all ways of shifting your perspective. In a more global sense, I think the most important thing is dropping out of the intellectualization of what's happening and into the body. So, let's say the problem, the way you know that you're anxious is that your muscles are tense and there's heat in your body and your heart rate is elevated. But there are lots of circumstances in your life where your muscles would be tense and your heart rate will be up and you'll feel hot, and you might be exercising, for example.  So, that experience alone isn't threatening. It's that experience press plus the narrative that something bad is going to happen and it's because I'm triggered and it's because I can't handle the uncertainty and all this stuff. So, it's doing two things at once. It's dropping out of the thought process, which is fundamentally the same thing as labeling and abandoning the mental ritual, and then dropping into the body and saying, “What's happening now is my hands are sweaty,” and just paying attention to it. Okay, alright, sweaty hands. I can be with sweaty hands. Slowing things down and looking at things the way they are, which is not intellectual, as opposed to looking at things the way they could be, or should be, or might have been, which again is a mental ruminative process. Kimberley: Right. Do you find-- I have found recently actually with several clients that they have an obsession. They start to ruminate and then somewhere through there, it's hard to determine what's in control and what's not. So, we want to preface it with that. But things get really out of control once they start to catastrophize even more. So, would you call the catastrophization a mental rumination, or would you call it an intrusive thought? How would you conceptualize that with a client? They have the obsession, they start ruminating, and then they start going to the worst-case scenario and just staying there. Jon: Yeah. There's different ways to look at it. So, catastrophizing is predicting a negative future and assuming you can't cope with it, and it's a way of thinking about a situation. So, it's investing in a false project. The real project is there's something unknown about the future and it makes you uncomfortable and you don't like it. How do you deal with that? That's worth taking a look at. The false project is, my plane is going to crash and I need to figure out how to keep the plane from crashing. But that's how the OCD mind tends to work. So, one way of thinking about catastrophizing is it's a tone it's a way-- if you can step back far enough and be mindful of the fact that you're thinking, you can also be mindful of the fact that there is a way that you're thinking. And if the way that you're thinking is catastrophizing, you could say, “Yeah, that's catastrophizing. I don't need to do that right now.”  But I think to your point, it is also an act. It's something somebody is doing. It's like, I'm going to see this through to the end and the hopes that it doesn't end in catastrophe, but I'm also going to steer it into catastrophe because I just can't help myself. It's like a hot stove in your head that you just want to touch and you're like, “Ouch.” And in that case, I would say, yeah, that's a mental ritual. It's something that you're doing.  I like the concept of non-engagement responses. So, things that you can do to respond to the thought process that aren't engaging it directly, that are helping you launch off. Because like I said, before you label and abandon. But between the label and abandon, a lot of people feel like they need a little help. They need something to drive a wedge between them and the thought process. Simply dropping it just doesn't feel enough, or it's met with such distress because whenever you don't do a compulsion, it feels irresponsible, and they can't handle that distress. So, they need just a little boost.  What do we know about OCD? We know that the one thing you can't do effectively is defend yourself because then you're getting into an argument and you can't win an argument against somebody who doesn't care what the outcome of the argument is. The OCD just wants to argue. So, any argument, no matter how good it is, the OCD is like, “Great, now we're arguing again.” How to Manage Mental Compulsions  Kimberley: Yeah. “I got you.” Jon: Yeah. So, what are our options? What are our non-engagement response options? One, which I think is completely undersold, is ignoring it. Just ignoring it. Again, none of these you want to only focus on because they could all become compulsive. And then you're walking around going, “I'm ignoring it, I'm ignoring it.” And then you're just actually avoiding it. But it's completely okay to just choose not to take yourself seriously. You look at your email and it's things that you want. And then in there is a junk mail that just accidentally got filtered into the inbox instead of the spam box, and mostly what you do is ignore it. You don't even read the subject of it. You recognize that in the moment, it's spam and you move on as if it wasn't even there. Then there's being mindful of it. Mindful noting. Just acknowledging it. You take that extra beat to be like, “Oh yeah, there's that thought.” In act, they would call this diffusion. I'm having a thought that something terrible is going to happen. And then you're dropping it. So, you're just stepping back and be like, “Oh, I see what's going on here. Okay, cool. But I'm not going to respond to it.” And then as we get into more ERP territory, we also have the option of agreeing with the uncertainty that maybe, maybe not. “What do I know? Okay. Maybe the plane is going to crash. I can't be bothered with this.” But you have to do it with attitude because if you get too involved in the linguistics of it, then it's like, well, what's the potential that it'll happen? And you can't play that game, the probability game.  But it is objectively true that any statement that begins with the word “maybe” has something to it. Maybe in the middle of this call, this computer is going to explode or something like that. It would be very silly for me to worry about that, but you can't deny that the statement is true because it's possible. It's maybe. So, just acknowledging that, be like, “Okay, fine. Maybe.” And then dropping it the way you would if you had some thought that you didn't find triggering and yet was still objectively true.  And then the last one, which can be a lot of fun, can also be overdone, can also become compulsive, but if done well can make life a little bit more fun, is agreeing with the thought in an exaggerated humorous, sarcastic way. Just blowing it up. So, you're out doing the OCD. The OCD is very creative, but you're more creative than the OCD. Kimberley: Can you give me examples? Jon: Well, the OCD says your plane is going to crash. He said, your plane is going to crash into a school. Just be done with it, right? And that kind of shock where the bully is expecting you to defend yourself and instead, you just punched yourself in the face. He's like, “Yeah, you're weird. I'm not going to bother you anymore.” That's the relationship one wants with their OCD. Kimberley: That's true. I remember in a previous episode we had with, I think it was when you had brought out your team book about saying “Good one bro,” or “brah.” Jon: “Cool story, brah.” Yeah.  Kimberley: Cool story brah. And I've had many of my patients say that that was also really helpful, is there's a degree of attitude that goes with that, right? Jon: Yeah. And because again, it's just a glitch in the system that, of course, you're conditioned to respond to it like it's serious. But once you realize it is, once you get the hint that it's OCD, you have to shift out of that, “Oh, this is very important, very serious,” and into this like, “This is junk mail.” And if you actually look at your junk mail, none of it is serious. It sounds serious. It sounds like I just inherited a billion dollars from some prince in Nigeria. That sounds very important. I Kimberley: I get that email every day pretty much.  Jon: Yeah. But I look at it and immediately I know that it's not serious, even though the words in it sound very important.  Kimberley: Yeah. So, for somebody, I'm sitting in the mind of someone who has OCD and is listening right now, and I'm guessing, to those who are listening, you're nodding and “Yes, this is so helpful. This is so helpful.” And then we may finish the episode and then the realization that “This is really hard” comes. How much coaching, how much encouragement? How do you walk someone through treatment who is finding this incredibly difficult? Jon: I want to live in your mind. In my mind, let that same audience member is like, “This guy sucks.” Kimberley: My mind isn't so funny after we start the recording. So, you're cool. Jon: Who is this clown? Again, it's back to self-compassion. I'm sure people are tired of hearing about it, but it's simply more objective. It is hard. And if you're acting like it shouldn't be hard or you're doing something wrong as a function, it's hard because you're doing something wrong, you're really confused. How could that be? You could not have known better than to end up here. Everything that brought you here was some other thought or some other feeling, and you're just responding to your environment. The question is right now where you have some control, what are you going to do with your attention? Right now, you're noticing, “Oh man, it's really hard to resist mental rituals. It's hard to catch them. It's hard to let go of them. It's hard to deal with the anxiety of thinking because I didn't finish the mental ritual. Maybe I missed something and somebody's going to get hurt or something like that because I didn't figure it out.”  It is really hard. I don't think we should pretend that it's easy. We should acknowledge that it's hard. And then we should ask, “Okay, well, I made a decision that I'm going to do this. I'm going to treat my OCD and it looks like the treatment for OCD is I'm going to confront this uncertainty and not do compulsions. So, I have to figure out what to do with the fact that it's hard.” And then it's back to the body. How do you know that it's hard? “Well, I could feel the tension here and I could feel my heart rate and my breath.” So, let's work with that. How can I relate to that experience that's coming up in a way that's actually helpful? The thing that I've been thinking about a lot lately is this idea that the brain is quick to learn that something is dangerous. Something happens and it hurts, and your brain is like, “Yeah, let's not do that again.” And you might conclude later that that thing really wasn't as dangerous as you thought. And so, you want to re-engage with it. And you might find that's really hard to do, which is why exposure therapy is really hard because it's not like a one-and-done thing. You have to practice it because the brain is very slow to learn that something is safe, especially after it's been taught that it's dangerous.  But that's not a bad thing. You want a brain that does that. You don't want a brain that's like, “Yeah, well, I got bit by one dog, but who cares? Let's go back in the kennel.” You want a brain that's like, “Hold on. Are you sure about this?” That whole process of overcoming your fears, I think people, again, they're way too hard on themselves. It should take some time and it should be slow and sluggish. You look like you're getting better, and then you slip back a little bit, because it's really just your brain saying, “Listen, I'm here to keep you safe, and I learned that you weren't, and you are not following rules. So, I'm pulling you back.” That's where that is coming from. So, that's the hard feeling. That's the hard feeling right there. It's your brain really trying to get you to say, “No, go back to doing compulsions. Compulsions are keeping you safe.” You have to override that circuit and say, “I appreciate your help. But I think I know something that you don't. So, I'm going to keep doing this.” And then you can relate to that hard feeling with like, “Good, my brain works. My brain is slow and sluggish to change, but not totally resistant. Over time, I'm going to bend it to my will and it will eventually let go, and either say this isn't scary anymore or say like, ‘Well, it's still scary, but I'm not going to keep you from doing it.'” Kimberley: Right. I had a client at the beginning of COVID I think, and the biggest struggle-- and this was true for a lot of people, I think, is they would notice the thought, notice they're engaging in compulsions and drop it, to use your language, and then go, “Yay, I did that.” And then they would notice another thought in the next 12 seconds or half a second, and then they would go, “Okay, notice it and drop it.” And then they'd do it again. And by number 14, they're like, “No, this is--” or it would either be like, “This is too hard,” or “This isn't working.” So, I'm wondering if you could speak to-- we've talked about it being “too hard.” Can you speak to your ideas around “this isn't working”? Jon: Yeah. That's a painful thought. I think that a lot of times, people, when they say it isn't working, I ask them to be more specific because their definition of working often involves things like, “I was expecting not to have more intrusive thoughts,” or “I was expecting for those thoughts to not make me anxious.” And when you let go of those expectations, which isn't lowering them at all, it's just shifting them, asking, well, what is it that you really want to do in your limited time on this earth? You're offline for billions of years. Now you're online for, I don't know, 70 to 100 if you're lucky, and then you're offline again. So, this is the time you have. So, what do you want to do with your attention? And if it's going to be completely focused on your mental health, well, that's a bummer. You need to be able to yes, notice the thought, yes, notice the ritual, yes, drop them both, and then return to something.  In this crazy world we're living in now where we're just constantly surrounded by things to stimulate us and trigger us and make us think, we have lots of things to turn to that aren't necessarily healthy, but they're not all unhealthy either. So, it's not hard to turn your attention away from something and into a YouTube video or something like that. It is more challenging to shift your attention away from something scary and then bring it to the flavor of your tea. That's a mindfulness issue. That's all that is. Why is one thing easier than the other? It's because you don't think the flavor of your tea is important. Why? Because you're just not stimulated by the firing off of neurons in your tongue and the fact that we're alive on earth and that we've evolved over a million years to be able to make and taste tea. That's not as interesting as somebody dancing to a rap song. I get that, but it could be if you're paying a different kind of attention. So, it's just something to consider when you're like, “Well, I can't return to the present because it doesn't engage me in there.” Something to consider, what would really engage you and what is it about the present that you find so uninteresting? Maybe you should take another look. Kimberley: Right. For me, I'm just still so shocked that gravity works. Whenever I'm really stuck, I will admit, my rumination isn't so anxiety-based. I think it's more when I'm angry, I get into a ruminative place. We can do that similar behavior. So, when I'm feeling that, I have to just be like, “Okay, drop away from, that's not helpful. Be aware and then drop it.” And then for me, it's just like, “Wow, the gravity is pulling me down. It just keeps blowing my mind.” Jon: Yeah. That's probably a better use of your thought process than continuing to ruminate. But you bring up another point. I think this speaks more closely to your question about when people say it's not working. I'm probably going to go to OCD jail for this, but I think to some extent, when you get knocked off track by an OCD trigger, because you made me think of it when you're talking about anger. Like, someone says something to you and makes you angry and you're ruminating about it. But it's the same thing in OCD. Something happens. Something triggers you to think like, “I'm going to lose my job. I'm a terrible parent,” or something like that. You're just triggered. This isn't just like a little thought, you're like, “Oh, that's my OCD.” You can feel it in your bones. It got you. It really got you.  Now, you can put off ruminating as best you can, but you're going to be carrying that pain in your bones for a while. It could be an hour, could be a day, could be a couple of days. Now, if it's more than a couple of days, you have to take ownership of the fact that you are playing a big role in keeping this thing going and you need to change if you want different results. But if it's less than a couple of days and you have OCD, sometimes all you can do is just own it. “All right, I'm just going to be ruminating a lot right now.” And I'm not saying like, hey, sit there and really try to ruminate. But it's back to that thing before, like your brain is conditioned to take this seriously, and no matter how much you tell yourself it's not serious, your brain is going to do what your brain is going to do. And so, can you get your work done? Try to show up for your family, try to laugh when something funny happens on TV, even while there's this elephant sitting on your chest. And every second that you're not distracted, your mind is like, “Why did they say that? Why did I do that? What's going to happen next?” And really just step back from it and say like, “You know what, it's just going to have to be like this for now.” What I see people do a lot is really undersell how much that is living with OCD. “I'm not getting better.” I had this happen actually just earlier today. Somebody was telling me, walking me through this story that was just full of OCD minds that they kept stepping on and they kept exploding and they were distressed and everything. And yet, throughout the whole process, the only problem was they were having OCD and they were upset. But they weren't avoiding the situation. They weren't asking for reassurance and they weren't harming themselves in any way. They were just having a rough time because they just had their buttons pushed. It was frustrating because they wouldn't acknowledge that that is a kind of progress that is living with this disorder, which necessarily involves having symptoms.  I don't want people to get confused here and say like, “This is as good as it gets,” or “You should give up hope for getting better.” It's not about that. Part of getting better is really owning that this is how you show up in the world. You have your assets and your liabilities, and sometimes the best thing to do is just accept what's going on and work through it in a more self-compassionate way. Kimberley: Right. I really resonate with that too. I've had to practice that a lot lately too of accepting my humanness. Because I think there are times where you catch yourself and you're like, “No, I should be performing way up higher.” And then you're like, “No, let's just accept these next few days are going to be rough.” I like that. I think that that's actually more realistic in terms of what recovery really might look like. This is going to be a rough couple of days or a rough couple of hours or whatever it may be. Jon: Yeah. If you get punched hard enough in the stomach and knock the wind out of you, that takes a certain period of time before you catch your breath. And if you get punched in the OCD brain, it takes a certain amount of time before you catch your breath. So, hang on. It will get better. And again, this isn't me saying, just do as many compulsions as you want. It's just, you're going to do some, especially rumination and taking ownership of that, “Oh man, it's really loud in there. I've been ruminating a lot today. I'll just do the best I can.” That's going to be a better approach than like, “I'm going to sit and track every single thought and I'm going to burn it to the ground. I'm going to do it every five seconds.” Really, you're just going to end up ruminating more that way. Kimberley: Right. And probably beating yourself up more. Jon: Exactly. Kimberley: Right. Okay. I feel like that is an amazing place for us to end. Before we do, is there anything you feel like we've missed that you just want people to know before we finish up? Jon: I guess what's really important to know since we're talking about mental compulsions is that it's not separate from the rest of OCD and it's not harder to treat. People have this idea that, well, if you're a compulsive hand-washer, you can just stop washing your hands or you can just remove the sink or something like that. But if you're a compulsive ruminator about whether or not you're going to harm someone or you're a good person or any of that stuff, somehow that's harder to treat. I've not found this to be the case. Anecdotally, I haven't seen any evidence that this is really the case in terms of research. You might be harder on yourself in some ways, and that might make your symptoms seem more severe, but that's got nothing to do with how hard you are to treat or the likelihood of you getting better. Most physical rituals are really just efforts to get done what your mental rituals are not doing for you. So, many people who are doing physical rituals are also doing mental rituals and those who aren't doing physical rituals. Again, some people wash their hands. Some people wash their minds. Many people do both. A lot of this stuff, it has to do with like, “I expect my mind to be one way, and it's another.” And that thing that's making it another is a contaminant, “I hate it and I want to go away and I'm going to try to get it to go away.” And that's how this disorder works. Kimberley: Right. It's really, really wonderful advice. I think that it's actually really great that you covered that because I think a lot of people ask that question of, does that mean that I'm going to only have half the recovery of someone who does physical compulsions or just Googles or just seeks reassurance? So, I think it's really important. Do you feel like someone can overcome OCD if their predominant compulsion is mental? Jon: Absolutely. They may even have assets that they are unaware of that makes them even more treatable. I mean, only one way to find out. Kimberley: Yeah. I'm so grateful to you. Thank you for coming on. This is just filling my heart so much. Thank you. Jon: Thank you. I always love speaking with you. Kimberley: Do you want to share where people can find you and all your amazing books and what you're doing? Jon: My hub is OCDBaltimore.com. That's the website for the Center for OCD and Anxiety at Sheppard Pratt, and also the OCD program at The Retreat at Sheppard Pratt. And I'm on Instagram at OCDBaltimore, Twitter at OCDBaltimore. I don't know what my Facebook page is, but it's out there somewhere. I'm not hard to find. Falling behind a little bit on my meme game, I haven't found anything quite funny or inspiring enough. I think I've toured through all of my favorite movies and TV shows. And so, I'm waiting for some show that I'm into to inspire me. But someone asked me the other day, “Wait, you stopped with the memes.” Kimberley: They're like, nothing's funny anymore. Jon: I try not to get into that headspace. Sometimes I do think that way, but yeah, the memes find me. I don't find them. Kimberley: I love it. And your books are all on Amazon or wherever you can buy books, I'm imagining. Jon: Yes. The OCD Workbook For Teens is my most recent one and the second edition of the Mindfulness Workbook for OCD is also a relatively recent one. Kimberley: Amazing. You're amazing. Thank you so much. Jon: Thank you.

SUMMARY: Welcome to the first week of this 6-part series on Mental Compulsions.  This week is an introduction to mental compulsions.   Ove the next 6 weeks, we will hear from many of the leaders in our feild on how to manage mental compulsions using many different strategies and CBT techniques.  Next week, we will have Jon Hershfield to talk about how he using mindfulness to help with mental compulsions and mental rituals. In This Episode: What is a mental compulsion? Is there a different between a mental compulsion and mental rumination and mental rituals? What is a compulsion? Types of Mental Compulsions Links To Things I Talk About: How to reach Jon https://www.sheppardpratt.org/care-finder/ocd-anxiety-center/ ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com. CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors. Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION This is Your Anxiety Toolkit - Episode 282 and the first part of a six-part series that I am overwhelmed and honored to share with you – all on mental compulsions. I have wanted to provide a free resource on mental compulsions for years, and I don't know why, but I finally got enough energy under my wings and I pulled it off and I could not be more excited. Let me tell you why. This is a six-part series. The next six episodes will be dedicated to managing mental compulsions, mental rituals, mental rumination. I will be presenting today the first part of the training, which is what we call Mental Compulsions 101. It will talk to you about all the different types of mental compulsions, give you a little bit of starter training. And then from there, it gets exciting. We have the most incredible experts in the field, all bringing their own approach to the same topic, which is how do we manage mental compulsions? We don't talk about mental compulsions enough. Often, it's not addressed enough in treatment. It's usually very, very difficult to reduce or stop mental compulsion. I thought I would bring all of the leaders, not all of them, the ones I could get and the ones that I had the time to squeeze into this six-part series, the ones that I have found the most beneficial for my training and my education for me and my stuff. I asked very similar questions, all with the main goal of getting their specific way of managing it, their little take, their little nuance, fairy tale magic because they do work magic. These people are volunteering their time to provide this amazing resource. Welcome to number one of a six-part series on mental compulsions. I hope you get every amazing tool from it. I hope it changes your life. I hope you get out your journal and you write down everything that you think will help you and you put it together and you try it and you experiment with it and you practice and you practice because these amazing humans are so good and they bring such wisdom. I'm going to stop there because I don't want to go on too much. Of course, I will be starting. And then from there, every week for the next five weeks after this one, you will get a new take, a new set of tools, a new way of approaching it. Hopefully, it's enough to really get you moving in managing your mental compulsion so you can go and live the life that you deserve, so that you can go and do the things you want without fear and anxiety and mental compulsions taking over your time. Let's do this. I have not once been more excited, so let's do this together. It is a beautiful day to do hard things and so let's do it together. Welcome, everybody. Welcome to Mental Compulsions 101. This is where I set the scene and teach you everything you need to know to get you started on understanding mental compulsions, understanding what they are, different kinds, what to do, and then we're going to move over and let the experts talk about how they personally manage mental compulsions. But before they shared their amazing knowledge and wisdom, I wanted to make sure you all had a good understanding of what a mental compulsion is and really get to know your own mental compulsions so you can catch little, maybe nuanced ways that maybe you're doing mental compulsions. I'm going to do this in a slideshow format. If you're listening to this audio, there will be a video format that you can access as well here very soon. I will let you know about that. But for right now, let's go straight into the content. Who is Kimberley Quinlan? First of all, who am I? My name is Kimberley Quinlan. A lot of you know who I am already. If you don't, I am a marriage and family therapist in the State of California. I am an Australian, but I live in America and I am honored to say that I am an OCD and Anxiety Specialist. I treat all of the anxiety disorders. I also treat body-focused repetitive behaviors, and we specialize in eating disorders as well. The reason I tell you all that is you probably will find that many different disorders use mental compulsions as a part of their disorder. My hope is that you all feel equally as included in this series. Now, as well as a therapist, I'm also a mental health educator. I am the owner, the very proud owner of CBTSchool.com. It is an online platform where we offer free and paid resources, educational resources for people who have anxiety disorder orders or want to just improve their mental health. I am also the host of Your Anxiety Toolkit Podcast. You may be watching this in a video format, or you may actually be listening to this because it will also be released. All of this will be offered for free on Your Anxiety Toolkit Podcast as well. I wanted to just give you all of that information before we get started so that you know that you can trust me as we move forward. Here we go. What is a Mental Compulsion? First of all, what is a mental compulsion? Well, a mental compulsion is something that we do mentally. The word “compulsion” is something we do, but in this case, we're talking about not a physical behavior, but a mental behavior. We do it in effort to reduce or remove anxiety, uncertainty, some other form of discomfort, or maybe even disgust. It's a behavior, it's a response to a discomfort and you do that response in a way to remove or resist the discomfort that you're feeling. Now, we know that in obsessive-compulsive disorder, there are a lot of physical compulsions. A lot of us know these physical compulsions because they've been shown in Hollywood movies. Jumping over cracks, washing our hands, moving objects – these are very common physical compulsions – checking stoves, checking doors. Most people are very understanding and acknowledge that as being a part of OCD. But what's important to know is that a lot of people with OCD don't do those physical compulsions at all. In fact, 100% of their compulsions are done in their head mentally. Now, this is also very true for people with generalized anxiety. It's also very true for some people with health anxiety or an eating disorder, many disorders engage in mental compulsions. Mental Compulsion Vs Mental Ritual? For the sake of this series, we use the word “mental compulsion,” but you will hear me, as we have guests, you will hear me ask them, do you call them “mental compulsions”? Some people use the word “mental ritual.” Some people use the word “mental rumination.” There are different ways, but ultimately throughout this series, we're going to mostly consider them one and the same. But again, just briefly, a mental compulsion is something you do inside of your mind to reduce, remove, or resist anxiety, uncertainty, or some form of discomfort that you experience. Let's keep moving from here. What is a Compulsion Now, who does mental compulsions? I've probably answered that for you already. Lots of people do mental compulsions. Again, it ranges over a course of many different anxiety disorders and other disorders, including eating disorders. But again, generalized anxiety, social anxiety, phobias, health anxiety, post-traumatic stress disorder. Some of the people with that mental disorder also engage in mental compulsions. Predominantly, we talk a lot about the practice of mental compulsions for people with obsessive-compulsive disorder. The thing to remember is it's more common than you think, and you're probably doing more of them than you guessed. I'm hoping that this 101 training will help you to be able to identify the compulsions you're doing so that when we go through this series, you have a really good grasp of where you could practice those skills. Now, often when people find out they're doing mental compulsions, they can be very hard on themselves and berate and criticize themselves for doing them. I really want to make this a judgment-free and punish-free zone where you're really gentle with yourself as you go through this series. It's very important that you don't use this information as a reason to beat yourself up even more. So let's make a deal. We're going to be as kind and non-judgmental as we can, as we move through this process. Compassion is always number one. Do we have a deal? Good. Types of Mental Compulsions Here is the big question: Are there different types of mental compulsions? Now, I'm going to proceed with caution here because there is no clear differentiation between the different compulsions. I did a bunch of research. I also wrote a book called The Self-Compassion Workbook For OCD. There is no specific way in which all of the psychological fields agree on what is different types of mental compulsions. There are some guidelines, but there's no one list. I want to proceed with caution first by letting you know this list that we use with our patients. Now, as you listen, you may have different names for them. Your therapist may use different terminology. That's all fine. It doesn't mean what you have done is wrong or what we are doing is wrong. To be honest with you, this would be a 17-hour training if I were to be as thorough as listing out every single one. For the sake of clarity and simplicity, I've put them into 10 different types of mental compulsions. If you have ones that aren't listed, that doesn't mean it's not a mental compulsion. I encourage you to just check in. If you have additional or you have a different name, that's totally okay. Totally okay. We're just using this again for the sake of clarity and simplicity. Here we go. 1. Mental Repeating The first mental compulsion that we want to look at is mental repeating. This is where you repeat or you make a list of individual items or categories. It can also involve words, numbers, or phrases. Often people will do this for two reasons or more, like I said, is they may repeat them for reassurance. They may be repeating to see whether they have relief. They may be repeating them to see if they feel okay. They may be repeating them to see if any additional obsessions arise, or they may be repeating them to unjinx something. Now, that's not a clinical term, so let's just put that out there. What I mean by this is some people will repeat things because they feel like the first time something happened, it was jinx. Like it will mean something bad will happen. It's been associated with something bad, so they repeat it to unjinx it. We'll talk more about neutralizing compulsions here in a second, but that's in regards to mental repeating. You may do it for a completely different reason. Don't worry too much as we go through this on why you do it. Just get your notepad out and your pencil out and just take note. Do I do any mental repeating compulsions? Not physical. Remember, we're just talking about mental in this series. 2. Mental Counting This is where you either count words, count letters, count numbers, or count objects. Again, you will not do this out loud. Well, sometimes you may do it out loud in addition to mental, but we're mostly talking about things you would do silently in your head. Again, you may do this for a multitude of reasons, but again, we want to just keep tabs. Am I doing any mental counting or mental counting rituals? 3. Neutralization Compulsions or Neutralizing Compulsions What we're talking about here is you're replacing an obsession with a different image or word. Let's say you are opening your computer. As you opened the computer, you had an intrusive thought that you didn't like. And so in effort to neutralize that thought, you would have the opposite thought. Let's say you had a thought, a number. Let's say you've had the number that you feel is a bad number. You may neutralize it by then repeating a positive number, a number that you like, or a safe number. Or you may do a behavior, you may see something being done and you have a negative thought. So then, you recall a different thought or a prayer, it could be also a prayer, to undo that bad feeling or thought or sensation. Now, when it comes to compulsive prayer, that could be done as a neutralization. In fact, I almost wanted to make prayer its own category, because a lot of people do engage in compulsive prayer, particularly those who have moral and scrupulous obsessions. Again, not to say that all prayer is a compulsion at all, but if you are finding that you're doing prayer to undo a bad thought or a bad feeling or a bad sensation or a bad urge – when I say bad, I mean unwanted – we would consider that a neutralization or a neutralizing compulsion. 4. Hypervigilance Compulsions Now again, this is the term we use in my practice. Remember here before we proceed that hypervigilance is an obsession, meaning it can be automatic, unwanted, intrusive, but it can also be a compulsive behavior. It could be both or it could be one. But when I talk about the term “hypervigilance compulsions,” this is also true for people with post-traumatic stress disorder, is it's a scanning of the environment. It's a scanning, like looking around. I always say with my clients, it's like this little set of eyes that go doot, doot, doot, doot really quick, and they're scanning for danger, scanning for potential fear or potential problems. They also do that when we're in a hypervigilance compulsion. We may do that with our thoughts. We're scanning thoughts or we're scanning sensations like, is this coming? What's happening? Where am I feeling things? You may be scanning and doing hypervigilance in regards to feeling like, am I having a good thought or a bad thought or a good feeling or a bad feeling? And then making meaning about that. You may actually also be hypervigilant about your reaction. If let's say you saw something that usually you would consider concerning and this time you didn't, you might become very hypervigilant. What does that mean? I need to make sure I always have this feeling because this feeling would mean I'm a good person or only good things will happen. The last one again is emotions, which emotions and feelings can sometimes go in together. Hypervigilant compulsion is something to keep an eye out. It could be simple as you just being hypervigilant, looking king around. Often this is true for people with driving obsessions or panic disorder. They're constantly looking for when the next anxiety attack is coming. 5. Mental Reassurance We can do physical reassurance, which is looking at Google, asking a friend like, are you sure nothing bad will happen? We can do physical, but we can also do mental reassurance, which is mentally checking to confirm an obsession is not or will not become a threat. This is true for basic like we already talked about and some checking and repeating behaviors. You may mentally stare at the doorknob to make sure it is locked. You may mentally check and check for reassurance once, twice, five times, ten times, or more. If the stove is off or that you are not having arousal is another one, or that you are not going to panic. You may be checking to get reassurance mentally that your fear is not going to happen. Again, some people's fear is fear itself. The fear of having a panic attack is very common as well. Again, we're looking for different ways that mentally we are on alert for potential danger or perceived danger. 6. Mental Review We've talked a lot about behaviors that we're doing in alert of anxiety. Mental review is reviewing and replaying past situations, figuring out the meaning of internal experiences, such as, what is the meaning of the thought I had? What is the meaning of the feeling I had? What is the meaning of that sensation? What does that mean? What is the meaning of an image that just showed up intrusively and repetitively in my mind? What is the meaning of an urge I have? This is very true for people with harm obsessions or sexual obsessions. When they feel an urge, they may review for hours, what did that mean? What does that mean about me? Why am I having those? And so the review piece can be very painful. All of these are very painful and take many, many hours, because not only are you reviewing the past, which can be hard because it's hard to get mental clarity of the past, but then you're also trying to figure out what does that mean about me or the world or the future. So, just things to think about. To be honest, mental review could cover all of the categories that we've covered, because it's all review in some way. But again, for the sake of clarity and simplicity, I've tried to break them up. You may want to break them up in different ways yourself. That is entirely okay. I just wanted to give you a little category here on its own. 7. Mental Catastrophization This is where you dissect and scrutinize past situations with potential catastrophic scenarios. Now, I made an error here because a lot of people do this about the future as well. But we'll talk about that here in a little bit. Mental catastrophization, if you have reviewed the past and you're going over all of the potential terrible situations. This is very true for people who review like, what did I say? Was that a silly thing to say? Was that a good thing to say? What would they think about me? Mental catastrophization is reviewing the past, but is also the future and reviewing every possible catastrophic scenario or opportunity that happened. Whether it happened or not, it doesn't really matter when it comes to mental compulsions. Usually, when someone does a mental compulsion, they're reviewing maybe's, the just in case it does happen, I better review it. 8. Mental Solving Very similar, again, which is anticipating future situations with or without potential what-if scenarios. Very similar to catastrophization compulsions. This is where you're looking into the future and going, “What if this happens? What if that happens? What if this happens? Well, what if that happens?” and going through multiple, sometimes dozens of scenarios of the worst-case scenarios on what may or may not happen. Again, it usually involves a lot of catastrophizing. But again, these are all safety behaviors. None of this means there's anything wrong with you or that you're bad or that you're not strong. Remember, our brain is just trying to survive. In the moment when we are doing these, our brain actually thinks it's coming up with solutions, but what we have to do, and all of the guests will talk about this, is recognize. Most of the time, the problem isn't actually happening. We're just having thoughts that it's happening. Again, this is reviewing thoughts of potential what-if scenarios. 9. Mental Self-Punishment I talk a lot about this in my book, The Self-Compassion Workbook For OCD. Mental self-punishment is a compulsion, a mental compulsion that is not talked about enough. One is criticizing, withholding pleasure, harshly disciplining yourself for your obsessions or even the compulsions that you've done. Often, we do this as a compulsion, meaning we think that if we punish ourselves, that will prevent us from having the obsession or the compulsion in the future. The fact here is beating yourself up actually doesn't reduce your chances of having thoughts and feelings and sensations and behaviors or urges. But that is why we do them. It's to catch when you are engaging in criticizing or withholding or punishing compulsions. 10. Mental Comparison Again, not a very common use of compulsions, but this is one I like to talk about a lot. Most of my patients with OCD and with anxiety will say that they know for certain that they compare more than their friends and family members who do not have anxiety disorders. I've put it here just so that you can catch when you are engaging in mental comparison, which is comparing your own life with other people's life, or comparing your own life with the idea that you thought you should have had for your life. So, an idea of how your life was supposed to be. This is a compulsive behavior because it's done again to reduce or remove a feeling or a sensation or a discomfort of anxiety or uncertainty you have around your current situation. It's really important to catch that as well because there's a lot of damage that can be done from comparing a lot with other people or from a fantasy that you had about the way your life should or shouldn't look. Again, we will talk about this in episodes, particularly with Jonathan Grayson. He talks a lot about this one. I just wanted to add that one in as well. They're the main top 10 mental compulsions. Again, I want to stress, these are not a conclusive list that is the be-all and end-all. A lot of clinicians may not agree and they may have different ways of conceptualizing them. That is entirely okay. I'm never going to pretend to be the knower of all things. That is just one way that we conceptualize it here at our center with our staff and our clients to help patients identify ways in which they're behaving mentally. Something to think about here, though, is you may find some of your compulsions are in more than one category. You might say, “Well, I do mental comparison, but it's also a self-punishment,” or “I do mental checking, but it's also a form of reassurance.” That's okay too. Don't worry too much about what section it should be under. Again, it's very fluid. We want you just to be able to document. It doesn't matter what category it is particularly. I really just wanted this 101 for you to do an inventory and see, “Oh, wow, maybe I'm doing more compulsions than I thought.” Because sometimes they're very habitual and we are doing them before we even know we're doing them. I just want to keep reminding you guys it's okay if it looks a little messy and it's okay if your list is a little different. The main question here as we conclude is: How do I stop? Well, the beauty is I have the honor of introducing to you some of the absolute, most amazing therapists and specialists in the planet. I fully wholeheartedly agree with that. While I wish I could have done 20 people, I picked six people who I felt would bring a different perspective, who have such amazing wisdom to share with you on how to manage mental compulsions. Now, why did I invite more than one person? Because I have learned as a clinician and as a human being, there is not one way to treat something. When I first started CBT School, I was under the assumption that there is only one way to do it and it's the right way or the wrong way. From there, I have really grown and matured into recognizing that what works for one person may not work for the next person. As we go through this series, I may be asking very, very similar questions to each person. You will be so amazed and in awe of the responses and how they bring about a small degree of nuance and a little flare of passion and some creativity of each person and bring in a different theme. I'm so honored to have these amazing human beings who are so kind to offer their time, to offer this series, and help you find what works for you. As you go through, I will continue reminding you, please keep asking yourself, would this work for me? Am I willing to try this? The truth is, all of them are doable for everybody, but you might find for your particular set of compulsions specific tools work better. So trial them, see what works, be gentle, experiment. Don't give up. It may require multiple tries to really find some little win. Please, just listen, enjoy, take as many notes as you can, because literally, the wisdom that is dropped here is mind-blowing. I've been treating OCD for over a decade and I actually stopped a few things after I learned this and went straight to my staff and said, “We have to make a new plan. Let's implement this. This is an amazing skill for our clients. Let's make sure we do it.” Even I, I'm a student of some of these amazing, amazing people. How do I stop? Stay tuned, listen, learn, take notes, and most importantly, put it into practice. Apply. That's where the real change happens. Now, before we finish, please do note this series should not replace professional healthcare. This or any product provided by CBT School should be used for education purposes only, so please take as much as you can. If you feel that you need more support, please reach out to a therapist in your area who can help you use these tools and maybe pick a part. Maybe there's a few things that you need additional help with, and that is okay. Thank you, guys. I am so excited to share this with you. Have a wonderful day.

In episode 297 I interviewed Kimberley Quinlan. Kim is a Licensed Marriage and Family Therapist who treats people with OCD and related disorders, Eating Disorders and Body Focused Repetitive Disorders. She runs her own podcast called Your Anxiety Toolkit. She also runs CBTschool.com.  In this episode we talk about her new book ‘The Self-Compassion Workbook for OCD', the roadblocks to self-compassion, applying self-compassion to Exposure and Response Prevention therapy (ERP), some of the exercises and practices in the book, why Jon Hershfield wrote the foreword to the book, Kim guides us through a self-compassion practice, how self-compassion can help you lean into fear, setting boundaries as an act of self-compassion, feeling like you don't deserve compassion, we discuss self-criticism, when Kim has had to practice self-compassion for herself recently, and much more. Hope it helps.    Show notes: https://theocdstories.com/episode/kim-quinlan-compassion-297 The podcast is made possible by NOCD. To find out more about NOCD, their therapy plans and if they currently take your insurance head over to https://go.treatmyocd.com/theocdstories

In episode 294 I interviewed Jon Hershfield. Jon is a psychotherapist and the director of The Center for OCD and Anxiety, at Sheppard Pratt. He is the author of six OCD books, including his most recent book the 2nd edition of, “The mindfulness workbook for OCD”. I chat with Jon about what's new with him, what is false memory OCD, real event OCD, the problem with compulsively reviewing memories or thoughts, how this theme of OCD links into moral scrupulosity, some of the compulsions linked to this theme, dealing with the uncertainty, rumination, when you're worried to go to therapy, mindfulness around this theme, why the difference between a false memory or a real one doesn't matter and why we shouldn't try to figure it out, why drinking alcohol can make OCD worse, and much more. Hope it helps. Show notes: https://theocdstories.com/episode/jon-hershfield-false-memory-294 The podcast is made possible by NOCD. To find out more about NOCD, their therapy plans and if they currently take your insurance head over to https://go.treatmyocd.com/theocdstories Next monthly zoom hangout with Stuart is on 2nd October. Come chat about the show. Pay what you can/want: https://www.eventbrite.com/e/169814805655 See you then. 

This is Your Anxiety Toolkit - Episode 197. Welcome to Your Anxiety Toolkit. I'm your host, Kimberley Quinlan. This podcast is fueled by three main goals. The first goal is to provide you with some extra tools to help you manage your anxiety. Second goal, to inspire you. Anxiety doesn't get to decide how you live your life. And number three, and I leave the best for last, is to provide you with one big, fat virtual hug, because experiencing anxiety ain't easy. If that sounds good to you, let's go. Welcome back, you guys. So grateful to have this precious time with you. Thank you so much for coming and spending your very, very precious time with me. As we do this together, it's exciting, we're almost at 200 episodes. You guys, I cannot believe it. I am pretty, pretty proud of that, I'm not going to lie. Today's episode is with the amazing Jon Hershfield. He's been on the show multiple times and I have been really reflecting and thinking about how important it is for us to practice response prevention and how that is so, so important for everybody who has any type of anxiety, whether that be an anxiety disorder like OCD, social anxiety, specific phobia, generalized anxiety. Even for myself, I've been reflecting on any time I'm responding to fear and responding to discomfort. It's just a topic that I want to continue to address because I think from you guys, I just continue to see how much it's a struggle for you. As I thought about continuing education on tools you can use, I thought, who else can I have none other, but Jon Hershfield to talk about using mindfulness to manage compulsions. Now we talk about compulsions like mental compulsions and rumination. We talk about reassurance-seeking, avoidance, any kind of physical compulsion. We also talk about how to practice mindfulness so that it doesn't become a compulsion. And so I'm just so grateful to have John give us his very valuable time and to talk with you guys about these amazing concepts. I'm not going to spend too much more time doing the introduction. You guys know how amazing Jon Hershfield is. He has some amazing books. He has The Mindfulness Workbook for OCD, and he has Everyday Mindfulness that he co-authored with Shala Nicely, and The Teen OCD Workbook, and Harm OCD book. He's just written amazing books. So please do go out and support him. He does share all that information at the end of the show, and I can't wait for you guys to listen. In the meantime, please do go and leave a review. It helps us to reach more people. I'm going to be quiet now and let you listen to Jon's wisdom. Have a wonderful day. ----- Kimberley: All right, welcome. I am so happy to have the amazing Jon Hershfield with us again today. Jon: Thanks for having me. You make me sound like Spiderman of the OCD world. Kimberley: You are the Spiderman of the OCD world. I love it. Jon: What does that mean? Kimberley: Yeah, it's true. Well, that's a good thing. I know my son is probably jumping up and down at the idea of me meeting the Spiderman of something. Thank you for coming on. I really wanted to invite you on, of course, because I love the work that you're doing regarding mindfulness in OCD. I really wanted to talk about how we can use mindfulness, particularly to address compulsion, because a big part of Exposure and Response Prevention is the response prevention piece. I would really love to pick your mind on how you implement mindfulness as a part of that and also address some of the misunderstandings that happen regarding mindfulness. So, let me first ask you, just for those who don't know or new to the show, how would you give a definition? How would you explain mindfulness, particularly in the respect of treatment? Jon: It's interesting because we all make this same grammatical error. I do it too. We say we use mindfulness as if mindfulness was an act or an action or a thing that you use as opposed to a perspective that you take. So I'm thinking about what mindfulness means. Usually, the definition we hear is “Paying attention to the present moment as it is without judgment and without the desire to change it.” And that's a great definition. It's escaping me at the moment who actually coined that exact language, but I think it applies to most mindfulness concepts. But I don't like that it starts with the word “paying” because it still implies that you're doing something. I think mindfulness is actually the perspective that you have when you're paying attention to the present moment. If you want to play around with the words, it's really noticing the fullness of the mind – mindfulness, right? It's a position that you take as opposed to a thing that you do. Right now, I'm sitting here in my desk chair. I'm aware of the sensation of my body in the chair, hearing my voice in the headphones and I have coffee and tasting that coffee. These are all things that I'm noticing and I'm being mindful of. The other part of mindfulness that I think is important to understand is that, in a state of mindfulness, you're best able to observe the difference between an experience – I just listed for you a bunch of experiences – and a story. A story is a narrative. It's the meaning and the webs that we weave around those experiences. So it's me thinking I'd had too much coffee today, right? That's a story about the taste of coffee in my mouth right now and its significance, but they're two separate things. When we're treating something like OCD, which is very much about being pulled away by your mind into these narratives, these fear-based narratives – to be able to drop out of the narrative and into the experience would be to take a mindful perspective, or in colloquial terms “to use mindfulness.” But I think a lot of times when we say “using mindfulness,” we associate that with stopping what we're doing and focusing on the breath, or pulling out an app and doing a meditation, or trying to execute change in our environment by being mindful. When in fact, mindfulness is very much the opposite of that. It's not about executing change. It's actually about stepping back and seeing the way things really are. Kimberley: Right. I love this. So would you say in this perspective that mindfulness is not adding something on, it's just dropping down into what was already there? Jon: Yes. I would agree with that. Kimberley: I like that. So how might we use this, particularly in terms of managing anxiety or uncertainty or any other discomfort? Can you give me a walk-through of what that might sound like or look like for somebody who is practicing mindfulness? Jon: Well, one of the things you might think about, when somebody feels triggered, something happens. You've touched something you think is contaminated or you've become aware of an unwanted, intrusive thought, a harming thought, or something like that. Then you have an experience in the brain and in the body that alerts you to the fact that you're under attack, that you're distressed, something is wrong and it needs to be fixed. What most people do is they immediately go into the story of, “This is bad. I'm triggered. I need to get away from this trigger. How do I make this feeling go away? Because it's unpleasant.” Of course, it's unpleasant because it's your brain's way of trying to help you jump into action to get away from the things that could harm you. So it's natural that we want to get rid of this feeling. And then we do these things called compulsions that reliably, in the short term, get rid of these feelings. If you know anything about OCD as you do, it's like you get stuck in that loop. The more you compulse, the more you really feel the responsibility towards your obsessions as they arise. In that space, between the trigger and the compulsion, there's an experience you're having. A person who has been practicing mindfulness or who is mindfully aware can show up to that experience in the same way they might show up to other experiences, again, without having to make it go away. So you render the compulsion less important because you're willing to be in the presence of that triggering experience. If you were to take this to the mat and think about, “Well, what happens when you're meditating and you get an itch?” what is the instruction? It's not, “Well, just scratch it so you can be more comfortable.” It's usually, “Okay, well, notice what itching is like. Notice what it's like to be sitting, which is what you're doing, and then have your attention pulled away from the sitting to the sensation of itching, to be able to say, ‘Oh, that's itching.'” Now at some point, we all break and we start scratching ourselves all over it because it's too much, but that's fine. But that's not the first instruction. The first instruction is simply notice itching. And then if you're capable of letting go of that and going back to what you were doing before you got distracted by the itch, you'd go back to your breath or whatever the anchor of your meditation might've been. It's the same thing in real life. You're minding your own business. You're trying to read a book and then you have an intrusive thought that something terrible is going to happen. And then you notice that experience of this mental itching and you're, “Okay, that's happening.” And then you have a choice. You can drop down out of that back into your book, or you can dwell on it, ruminate on it, try to figure it out, try to figure out a way to make it go away, and then give yourself permission to go back to your book. Kimberley: So, we call it in my practice, my staff have called it “itch surfing.” Jon: Itch surfing. Yeah. Kimberley: I always laugh when I say “itch surfing.” So, let's say you have the presence of a thought that's really concerning, right? It's triggering. And you're trying to be mindful, but you're also not trying to step across the line to where you are ruminating or being compulsive related to that. How might someone differentiate between the two? Jon: So there's a couple of things to consider here. One is that a lot of people will say, mindfulness is about watching your thoughts come and go. There's a good reason why we use that metaphor, that idea of sitting at the bank of the stream and watching the leaves go by. But it's not really accurate in the sense that it's more about just noticing thoughts coming and going. Watching thoughts coming and going implies that you're supposed to sit there and stare at them and give them special attention. You're supposed to remember, right? It's a perspective. It's not an act. You're supposed to remember like, “Oh yeah, it was a thought coming and going. Okay, that's cool.” And then let go of it. Ruminating is when you're digging up that thought for the purpose of trying to figure it out to digest it. You're trying to act on the thought and get certainty about it. It's a very active thing you're doing when you're ruminating. To be mindful would really be the opposite of that. It would be to notice that you're ruminating and stop. Because the whole point, if you're being mindful, it's not that you're executing change on your environment, but you're simply noticing what's coming up. So it was really impossible to be mindful and ruminate at the same time because that would be like being mindful while trying to figure out some problem. So the instruction would be to notice that urge to ruminate, to notice what's coming up for you in your body, that experience of, “I really want to figure this out,” and then to allow that experience to be there, and again, drop back down into your anchor. In real life, it's whatever you were doing before you got distracted. In meditation, it's whatever your anchor is – the breath, the feeling of your body in the seat. Kimberley: So it'd be like using the metaphor of, if you're sitting at the edge of the stream and you're just watching the leaves come and go, that would be mindfulness. But ruminating or being hyper-aware would be like watching the leaf after it's way, way, way, way down the river, but you're still giving that attention and missing what's right in front of you? Jon: Yeah. It's easy to make that mistake because you could feel like you're being mindful. You could say like, “Well, I'm just watching this leaf and seeing how far it goes.” But in fact, when you're doing that, you're missing everything that's happening in the present moment, all those other leaves that are going by. A lot of times, people think of themselves as being very negative because they get distracted by negative thoughts, and the thought comes down the stream and they follow it. And while they're falling, those negative thoughts, all sorts of other nice things are happening – the smell of their breakfast or the warmth of the sun or whatever it might be. But they're not noticing that stuff because they're immersed in tracking that negative experience that they had. They think of their lives as being negative instead of thinking of their lives as just being whatever it happens to be in any given moment. Kimberley: Right. Talk about, if you will, hyper-awareness, because I think sometimes people think they're being mindful, and I think it's going to be very similar maybe in your answer, but I just want to be really clear for people who I've heard struggle with. They're trying to be mindful, but it becomes hyper-awareness. Do you have any thoughts on that? Jon: A lot of this, I think, comes down again to language. Most of us are trained to say things like “Sit with uncertainty,” which sounds like a good idea, but the implication for some is that you're literally sitting and there's literally uncertainty in front of you. It's like sitting on your head and you're immersed in it and you're dwelling on it. So it gets translated as “Dwell on uncertainty,” and feel bad as long as you can feel bad. Actually, I interviewed Jon Abramowitz who some of you may know in a lecture series here at Sheppard Pratt not too long ago. He said he likes to say, “Act with uncertainty instead.” I really like that because to me, that is still mindfulness. You're doing something, you notice you became distracted, cool. That's what that's like. Now I'm going to go back to what I was doing before I got distracted. I'm going to act with the uncertainty instead of sitting, letting the uncertainty sit on my head. I think it's such an important distinction because to be mindful of your thought process is to be aware of it. But it's not the same thing as to be trying to figure it out or be certain about it. That would be the opposite of mindfulness. And so the whole instruction, if you've had a lot of experience meditating, it might sound something like you wander away from your anchor and you start trying to figure out what's wrong with your life. And then you go, “Oh yeah, thinking.” And then you go back to your anchor. No meditation teacher is going to tell you like, “Well, just notice that you're trying to figure it out and keep trying to figure it out and try to get to some sort of outcome.” That really would go against the larger project. Kimberley: Yeah. I mean, for me, if I were to explain it, if I were out and about, and let's say another emotion showed up, like shame or guilt or something, my practice is just to go, “Oh, hi, Shame.” I think actually in the last episode, you were here talking about teens and you were like, “That's cool, bruh,” or whatever it was, but that's observing it and allowing it to be there. But then there's a redirect to the present. Would you agree that's a method that you use? I mean, again, we're saying it's not a doing, but talk to me about whether that's something that you would apply to. Jon: I would absolutely apply that. I mean, at the end of the day, we're coming up with fancier and fancier ways of politely and compassionately saying, “Let it go.” We might have all the different ways of saying “It's okay to let it go,” where we understand that it's very painful to have these experiences and that makes it difficult to let it go. We don't mean let it go, like, “Oh, you're being silly.” I mean literally, it arrived and you allowed that, and now it's leaving and you can allow that to let it go. To become aware that you have an urge to ruminate or an urge to do some other compulsion and to let that urge be a thing, don't sit there and stare at the urge and wait for it to go away. just be like, “Oh, that's happening.” Just like shame arises or guilt arises. And then just gently note it and allow it to be, and you don't have to do anything. It's really a beautiful thing. The shame and the guilt and the urge to ruminate and the urge to wash, it'll go away in its own time. You don't have to be actively involved in it. Kimberley: Right. It's like mindfulness underneath there. A major component is non-attachment, to not be attached to it or the story we tell about it or what it means and all the things. Jon: I mean, if you look at that and the concept of diffusion, they have specific skills for trying to make that happen. I think people can argue over like, “Well, what are the mechanics of building those skills? And could there be some compulsivity involved in that?” I mean, I think there's some people that certainly could. If you're going around saying, “It's just the thought, it's just the thought, it's just the thought,” that's not exactly what we're getting at when we talk about diffusion. But the end game is diffusion, it's being able to say, “I'm having a thought that...” What we want is to be able to do that without having to say it, without having to remind ourselves. But instead, simply have the experience that the thought arises much the same way the credits in a movie arise on a screen. Okay, yeah, that is the thought. And then you get to decide, “Do I want to engage with this or let it go?” If it's an obsessive thought that you've been grappling with, that you've decided is your OCD because you keep trying to get certainty about it, well then the instruction is going to be to drop it, not to play with it. Kimberley: Right. Yeah. I think that this was a lesson for me early in my mindfulness game. Mindfulness is not just that heady, heady meaning like only a cognitive skill. It's like you talk about dropping down, and it's a behavioral skill as well. It's not just sitting still and thinking, thinking, thinking, thinking your way out of discomfort. It's also a doing. It's a body thing as well, instead of it just being heady. I think that's where we get into trouble, right? We start to try to think our way out of problems or our way out of discomfort. Jon: Look at checking OCD, for example, like OCD where there's a lot of checking compulsions. What happens is there's this experience of not being complete, something missing or something being lost. And rather than own that experience and be able to say, “That's something that just came up for me and I'm willing to allow that,” the instinct is to get rid of that experience by engaging in the checking compulsion. So, mindfulness plays an important role in being able to say, “I'm aware of this urge to check, and that's fine. I have all kinds of urges throughout the day. I don't have to give in to this urge.” You don't have to do anything about it. Like you were saying, that's an experience you have in the body, like a sense that the body is craving a change and your willingness to allow that craving. Again, not to sit there and stare at it and wait for it to go away, but just simply just know that it is there and then go onto the next thing. Kimberley: Right. I think that this is true in so many compulsions. Would you use the same skill? Would you use the same concepts regarding reassurance-seeking compulsions? Jon: Yeah. Well, reassurance-seeking is really just another form of checking, isn't it? It's like you have a sense that you know something, just like you have a sense that your door is locked when you go back to make sure. In the case of reassurance-seeking, you're going to a person or the internet to try to make sure. But again, it's that experience of dis-ease, right? Not feeling ease with your experience and wanting to change. Instead of resisting that by doing compulsions, you're saying, “I'll allow it.” I've been using this coping skill with the client. I might have mentioned that they prefer “allow” rather than “accept” because accept felt, I don't know, it felt different to them. We can use whatever language you want, but I liked it. I've noticed that as a coping statement. If something comes up, like, “I want to change it,” and they're like, “Nope, I'll allow it.” And then now you're free. Kimberley: Open the gates to it. Jon: Yeah. Kimberley: Right. I like that a lot. The same goes for avoidance, right? Do you want to share how you might drop into mindfulness when it comes to avoiding, whether you're about to avoid or you're already in avoidance? What would your thoughts be there? Jon: Well, it's like observing your inner magnet, right? Something is pulling you in a direction. It might be pulling you away from something or pulling you towards it. And again, what does that feel like for you? What does that experience in the body? And rather than telling yourself “Accept it, accept it, I got to accept it, and push, push, push, push, push,” can you just notice where the resistance is? Can you let go of that, that part of you that's resisting? you want to go to this party, but it's overstimulating and you might say something embarrassing and there's something there that might be triggering for you or something like that. But you want to go. As you're approaching it, do you notice that resistance? Do you notice that push-pull in your body? And again, can you allow it? Can you say, “Worth it, investment return, worth it.” Very quickly, not spending a lot of time on it. Again, I think cognitive therapy gets a bad rap a little bit in the OCD world because it can so easily turn into mental rituals, trying to assess the probabilities and things like that. But just a pinch, like a pinch of salt, a pinch of cognitive therapy where you're able to say, “Come on now, this is a black and white thinking. I can handle this.” If you're allowed to do that. Kimberley: It's funny that you say that because I was actually just about to ask you, like, go back to your story. Remember at the beginning, you were talking about the stories we tell ourselves. And I think in avoidance, there are so many stories that take us away from mindfulness. So I was actually going to ask you. Do you want to share how you would maybe implement a cognitive skill there? Jon: So, if you're being mindful, it means that you're aware that you're thinking. And if you can be aware that you're thinking, you can also be aware of the tone of thinking. This is especially useful if you're trying to quickly assess. Are you ruminating? Are you engaged in mental rehearsal? Are you thought-neutralizing? What is the mental behavior? If you're noticing the way that you're thinking and that tone, you might be able to pick up historically if that tone has been helpful or not, or if it usually ends in you feeling like you have to do compulsions. Take catastrophizing, for example. You're saying, “Something in the future is definitely going to go badly and I'm not going to be able to handle it.” Now, if you're aware and you're mindful, you know you're thinking, and then you know that that's what you're thinking, and you know that that's catastrophizing, you can simply say, “Yeah, that's catastrophizing. I don't need to do that right now.” Very simple. “I can't predict the future.” You don't have to go into “Everything will be fine,” or “The probability is that this is going to go my way.” Again, we want to spend as little time there as possible because we don't want to get wrapped up in arguing with the OCD, but to just call it out and say like, “I can't predict the future. I'm going to just go with this and see what happens.” And then when you make that choice, notice what that feels like. Can you allow that or not? And if you can't, that's okay. You can go find something else that you can allow. Kimberley: Right. I will always remember many, many years ago, probably even when we worked together, a client of mine, and they gave me permission to tell this story, but I won't, of course, disclose any information. But they always said they can feel the shift in their body. And that was them being mindful. They said as if they were holding onto the sides of their chair. So even though they weren't sitting in a chair, they could feel this shift in their body of clenching. You can't see me on the video. You can see me on the video, but listeners can't. But just this wringing of the hands or clinging of the hands, and that her being able to just identify that slight shift in her body was enough to be able to shift out of that avoidance or resistance. I think just being aware and mindful of that, I think, is a big piece of the pie. Jon: So, it's knowing the quality and the tone and the texture of your internal experience. That's essential for being able to pick out and resist mental compulsions. Ruminating is not just thinking about something because you like to think about it. Ruminating is very much like, there's a puzzle and you've put all the pieces together but one, and now you can't find that one piece that it's somewhere. Maybe it's on the floor, it's under your desk. You know what that feeling is like. It's so intense. And that mental quality is what's going on with the person who's ruminating. And that's what they have to let go of, or be able to experience to let go of the ruminating. If you can't truly appreciate the tone and texture of your mind that “Sometimes when I'm thinking this way, it feels like this, sometimes when I'm thinking this way, it feels like that,” it's just very difficult to trust yourself enough to call out the mental compulsion as they happen. Kimberley: Yeah. I love this so much. I think it's so important that we do address it. So, in all, I know there has-- we have addressed this, but I want to make sure we're really clear. Do you believe that someone can mindfully ruminate? Jon: I think it's an oxymoron because to be mindful is to remember that everything going on inside is an object of attention, and to ruminate is to really engage in a changed behavior. So it's really the opposite of mindfulness. There are types of meditations like traditional meditation. You have an anchor. You notice when you're not paying attention to the anchor, you return your attention. Then there's other types of meditations that might involve free-floating, like free-associating. Notice that this thought then connected to that thought, then connected to that thought. That is a kind of meditation. And you could argue that there's a kind of mindful awareness of where things are going when you're doing that. I still wouldn't call that ruminating though, because ruminating is done with purpose. It's done with a specific intention. It's not just watching where your thoughts land. Now, if you have OCD and you're learning to meditate, I certainly wouldn't recommend you do the type of meditation where you just watch your thoughts bounce around each other. But if you're a more experienced meditator and you want to do that free-associating of watching each thought arise and fall and rise and fall and connect to other thoughts and feelings, that can be fun. But it's not ruminating. To ruminate would be to intentionally try to figure out or try to get certain about your obsessive content. And I don't think that there's any mindful way to do that because it is literally the antithesis of mindfulness, in my opinion. Kimberley: Right. No, and that's how I was trained on it as well. I think the thing that I often will say to clients is, anything can become compulsive. Treatment can become compulsive. If you were to technically look at the term, engaging in compulsive treatment isn't actual treatment because it's going in the direction of doing compulsions, which is not the technical term for treatment. Jon: It's tricky with exposures. For example, I encounter people all the time who are doing checking compulsions but calling them exposures. “I have a fear of something. So I'm going to go over and pretend to do that thing and expose myself to that fear by being in this scary situation. And then it's going to go away and then I'll know that I'm not going to do that thing.” Well, that wasn't an exposure. It might've been hard, but it really wasn't ERP. I usually tell people not to do ERP when they want to. That's usually suspicious of that. And also to consider what the point of it is. Like, if your OCD is getting between you and some valued behavior, that's a good reason to go do that ERP. But if it's not, and it just exists in your head, you don't have to go ahead and be ready to go find any ERP to do. You're allowed to just live your life. That's allowed. Kimberley: Right. Jon: Yeah. I think that the other thing that happens with rumination that I think is very confusing and hard for people to appreciate is that, though, I wouldn't say you can mindfully ruminate. You can certainly be lost in thought and you can certainly ruminate without full awareness of what you're doing, because a lot of it is habit, right? Rumination, some compulsions, they can become habitual, but most of them are pretty easy to tease apart from habits. But mental behavior is a little bit trickier, I think. In the same way that a person who's-- let's say they have difficulty with biting their nails, and they always bite their nails when in front of the computer. The computer becomes the cue to bite their nails. The hands go up to their face. They start chewing on their nails. They're not necessarily thinking, “Oh, I'm going to bite my nails now.” It's just happening. And then they might become aware of it. And if they're working on it, then they might use a habit blocker or some other strategy that they might remember to be mindful of the urge to bite it and come up with another strategy. The same thing happens in the mind where if you're someone who's used to engaging in compulsive rumination in different contexts of your life, there are going to be things that actually cue you to do it without you paying attention. You might not notice that, but it's like, “Oh, every time I'm in this chair, I start to ruminate.” The goal here in terms of improving your mental health situation would be to take ownership of the moment that you become aware of what you're doing. Not to beat yourself up for ruminating, because again, your mind was like, “Oh, are we sitting in that chair? Okay, sure. Let's bring up that topic and start reviewing it.” And you can't take responsibility for something you can't control. You might argue, “Okay, well, that's not really rumination because you're not the one trying to control it,” but it has all the same words. You're just lost in this thought of like, “Well, I know this thought must not be true because of this and that, plus my therapist said this and I read in a book, blah, blah, blah, blah.” You don't know that you've left the building. You still think you're sitting in the chair. But then, boom, you become aware. You suddenly remember, “Wait a minute, I'm a guy sitting in a chair, having a thought, and wait, I'm trying to figure out if my obsessions are true. Nope. Not going to do that. That's rumination. Okay, good. Where was I?” Let it go. But I think people can get very self-critical, really hard on themselves, and say, “I can't stop thinking, I can't stop ruminating.” In part, some of that is then taking responsibility for something that's-- it's just habit. It's just the brain has been trained to just start revving up the engine. That's all right. You'll catch it earlier and earlier and earlier if you practice. Kimberley: Right. Okay. Is there anything else that you feel we haven't covered in this area? I mean, of course, we haven't covered everything, but is there anything that you really want to drive home here in this conversation? Jon: Well, I guess one thing that's been on my mind is, we talk a lot about how thoughts aren't the problem, right? If you're being mindful, thought as a thought is a thought. And if you have mastery over your OCD, whatever, a thought about what day it is or a thought about hurting your baby, they're just thoughts. It's no big deal. And to some extent, that's true. We don't treat OCD by treating what thoughts people have. We address how they're relating to those thoughts and what behaviors they're choosing in response to that experience. But in the interest of remembering self-compassion too, I think it's important to recognize that it may also be the case that people with OCD are more predisposed to the average person to receive certain types of thoughts in a certain way. So even though those thoughts are normal events, it is normal for you to have thoughts about all of the potentials in human existence, all of the different things. We can kill and have sex with all of these things. It's totally normal to have thoughts about them. But it might also be that when you have that thought, it hits you in a way that immediately generates an urge or a moral responsibility to address it. And yes, mindfulness can help because it can help. You both recognize the arising of the thought as an object of consciousness and the arising of that desire to do something about it as an object of consciousness. But it's also worth noting that it's just hard to have OCD sometimes. And every once in a while, you're just going to get sucker-punched by it. And that's not because you've done something wrong, it's because your brain is conditioned or wired to receive some thoughts in that way. And that can be something that you develop mastery over. But I think when we take all of the emphasis on behavior and none of the emphasis on perspective or predisposition, some people feel like they're not being heard. Kimberley: Yeah. Thank you for saying that. I think that that's been largely the feedback I have gotten as well. If people are struggling and they don't want to struggle, and they're trying to navigate this thing, that feels like an absolutely crazy puzzle that, like you said, they don't even have all the pieces. They don't even have half the pieces yet. So I totally really loved that you said that. I love the idea of compassionate responsibility, which is, we can take responsibility for our experience with the absence of self-criticism. I think we sometimes think that owning this and experiencing this has to mean you have to beat yourself up and that it has to be like “You should've done better” kind of thing. But I do not like that. Jon: Well, you've recently written a book on the subject, and I could go on and on about self-compassion. We could do a whole other episode on it. But I do want to end on this note, which is, a lot of what mindfulness means is simply being honest, and we often lie to ourselves about our experiences. We say, “I should have known better,” but when you look at it, there's no way to have known better, that everything you've done is preceded by a thought or an urge or an emotion and we can track this back very, very far. I'm not making the case for no free will or not taking responsibility for anything. I'm just saying self-criticism is inherently dishonest. I say, “I'm a bad person.” That's a story. That's not an objective fact. I say, “I feel terrible.” That's an experience. That's honest and that's also mindful. Kimberley: Right. I love it. Thank you so much. I'm so grateful. I wanted to navigate all this, but I didn't want to do it on my own. So, thank you for coming on and helping me because you're just so good at explaining this stuff, and I really appreciate the way that you conceptualize this. So thank you. Jon: Well, I appreciate you inviting me. I always love hanging out. Kimberley: Yeah. Are there any projects or things you've got going on that you want to share with us? Jon: Well, right now, we're working really hard at The Center for OCD and Anxiety at Sheppard Pratt. We have some new team members and so we're helping a lot of people that way. Not too long ago, we launched the residential program, the OCD program at the retreat here at Sheppard. We've had a few people come in and out of that program. It's really exciting because it's just a different way of working, working as a team on one or two cases at a time and seeing them every day. That dynamic is new and exciting for us. And then book-wise, the OCD Workbook for Teens is out there. The second edition of Mindfulness Workbook for OCD is out there. I just started working on a new one that I'm co-writing with a friend on how to combine ERP and DBT. Kimberley: That's fantastic. Jon: Yeah. So, dealing with relentless thoughts and painful emotions. Kimberley: Nice. That would be so important. Jon: Yeah, I hope so. Kimberley: Oh, without a doubt, DBT is such an important piece of the work, particularly when those emotions are really strong. So that's super exciting. We'll make sure all of those links to that are in the podcast notes so people can check that. Thank you again. Jon: Thank you. ----- Please note that this podcast or any other resources from cbtschool.com should not replace professional mental health care. If you feel you would benefit, please reach out to a provider in your area. Have a wonderful day, and thank you for supporting cbtschool.com.

This is Your Anxiety Toolkit - Episode 195. Welcome to Your Anxiety Toolkit. I'm your host, Kimberley Quinlan. This podcast is fueled by three main goals. The first goal is to provide you with some extra tools to help you manage your anxiety. Second goal, to inspire you. Anxiety doesn't get to decide how you live your life. And number three, and I leave the best for last, is to provide you with one big, fat virtual hug, because experiencing anxiety ain't easy. If that sounds good to you, let's go. Kimberley: Hello there. I have with me a very special friend who is going to talk about something so important. So, so important. I am so excited to have with us Shala Nicely. Oh my goodness, thank you for coming back onto the show. Shala: Thank you so much for having me. I love being here. Kimberley: Oh my goodness. Okay. So, probably the reason that I have been so adamant about getting you onto this episode is this topic that we are going to talk about is probably one of the topics that comes up the most with my patients and clients that nobody is talking about. Shala: Yes. Kimberley: Nobody. And I am seeing it more and more and more and more and more, which is why I wanted to have you on. So, thank you. Shala: Yeah. Kimberley: Thank you. Okay. So, you wrote a blog about depression as a compulsion. Can you tell us what does that mean? Shala: Yes. I'll start off by saying that this is one of the many subtleties of OCD. Sometimes OCD takes a long time to figure out. I spent years becoming a therapist. I spent years thinking about my own experience and when I was writing my memoir Is Fred in the Refrigerator?. It wasn't until after Fred was published, that I figured out this particular compulsion that I had been doing. By identifying it, it's been able to help me make a huge difference in my recovery, and that's why I wanted to share it and write the blog. Kimberley: Right. It's so important. I mean, I can't tell you, I've been practicing for many, many years and I only came across this in the last year or two. But the more I get to know it and the more I understand it, I'm just like, I feel like I see it in almost all the cases in some way. So, go ahead. Tell us what it is. Tell us what it looks like. Shala: So, I'll give you an example that I used in Fred, which is, when I was in my twenties, I was convinced I'd given myself HIV aids because I had gotten cut with a broken beer bottle at a party and I had spent all this time in my head arguing with OCD about whether or not that you can transmit HIV aids through that. It went on for months and months and months. While I was doing all this ritualizing in my head, trying to figure this out and prove to myself I didn't have this disease, which this was years and years and years ago, the treatments for HIV aids are much better now, they weren't. This was 25 years ago. I know people with OCD are still frightened of it. I was really frightened of it back then because there weren't very many treatments for it. And so I would spend all day long thinking about how I had given myself a fatal disease and how I was going to die. And then I started acting as though I had a fatal disease that there weren't good treatments for and I was going to get it and die. So I would go into situations and put on a happy face and smile, but in my head, I was thinking, “Oh, this is the last time I'm going to be doing this. Oh, this is so sad. Just wait until people find out what is really going on with me.” So I would focus in those situations on how awful this was and how depressed I was and how this was going to be the last time I was going to do it. So, I was actually acting as though what OCD was telling me, which is that I'd given myself fatal disease, was true. And the depression that came from that became the compulsion because I took that emotion and I acted on that emotion. So I started acting depressed, making depressed choices, living in a depressed lifestyle, having a depressed attitude as I went out into the world because I had given in completely to what OCD was saying. When I realized that, again, this was after I'd written the story, after it had been published, and I started seeing this in my clients. I started recognizing I still did some of this. I'm like, “Wait a minute, it's the depression itself, which was really propping all this up.”  It's really a very subtle form of compulsion that if you don't recognize it can sabotage your ERP work. Kimberley: Yeah. I would admit as a young intern of treating OCD, I think if I saw this, I would have stopped ERP and focused on depression and really worked on that, which is not a bad solution, but without really recognizing it under the lens of OCD, right? So, I would have seen it as separate. I love it. Let me explain how I've seen it a lot. Once I've shown them your article, patients and clients have said, “I recognize in the moment that I'm having uncertainty. I try doing a compulsion to make the uncertainty go away and that doesn't work. So, going into depression is our easy way to just exit out of uncertainty. It's the worst-case scenario. That's where I'm going to hang out.” That has been so helpful for people to be able to recognize that. It's a response to not wanting to be uncertain. Shala: And I think it's important to differentiate between depression that comes secondary to having a diagnosis of OCD from this, because a majority of people with OCD will end up with some form of depression at some point, because it's just so debilitating. It's the 10th most debilitating condition in the world. So people will end up depressed just because of how exhausting it is to manage this monster in your head all day long. But that's very different than being depressed because you've decided to believe that the OCD is true because you cannot figure it out otherwise. And OCD just wants certainty. It doesn't care what kind of certainty it gets. If it can't get certainty, for instance, that I don't have HIV aids, it's just going to go the other way and say, “Well, I'm going to get certainty that she does have it,” and then go from there and then becoming depressed as a result of that obsession. So, I think that's really important for people to understand. You can have both going on at the same time too, which makes this even more tricky. Kimberley: Yeah. Even more tricky, but even great to know that we can differentiate the two now, because we'll talk later about how to manage that. Now, this is where I want to look at insight because, in your blog, you talk about insight. I think that's an important piece of this, right? Because when you first have the onset of OCD, you might recognize that this is like ego, what we would call egodystonic, like this stuff. “I know it's not true, but I keep fearing it's true.” Can you share how insight impacts this specific situation? Shala: Yes. In fact, it was Jon Hershfield who introduced the two of us years ago, who helped me put this insight about insight together, because I was talking with him about this depression is a compulsion. What he pointed out is that typically, when an OCD obsession starts, you're doing compulsions to try to prove that it's false. If you can't get that to work, which of course you can't because there's no way to prove all this stuff that I see he's worried about, then sometimes you can start going the opposite way and trying to prove that it's true. Really that's the difference between insight. When you're trying to prove that it's false, then you know that what OCD is saying in some part of you is nonsense. “I don't have HIV aids, come on.” Not like in a reassuring way, just there's a part of you that still recognizes, “Yeah, this is super scary, but this is OCD reacting to an intrusive thought. This isn't actually a real problem.” So, you've got that insight there. You're still stuck, but you got insight. When you start trying to prove it's right, that's when you've lost insight. When you really give in to everything that OCD is saying, really hook, line, and sinker, and you don't have any insight anymore. That's really when this depression as a compulsion becomes a big problem. The longer that a particular obsession is maintained by doing compulsions, the more likely you are to lose insight, the longer it's been going on. Kimberley: And this is where it's hard, isn't it? Because we know the whole story of when you stare at something for too long, it starts to look weird and distorted. I think that's very much true here. I think it's true of depression in general and in this subtle compulsion. When we look at things as negative, we notice more and more things that are negative. Is that what you feel to be true here? Or is it just the same story that you hear over and over? Share with me how that might sound in your head. Shala: I think it starts to sound like a soundtrack for my life because most of my rituals became internal. And the way I see mental rituals, it's physical rituals taken inside. So you can't do things physically because you don't want people to see or whatever. So you start pulling it inside. The more that I would do that, the more I would argue with OCD, of course, the more I'm strengthening in it. So the more I hear it and the more I argue, it just expands to fill every waking moment. It really becomes a soundtrack playing 24 hours a day because I was doing those mental rituals. And then the longer that that went on, the more likely I was to start becoming depressed because I was losing insight, which then also further reinforces this cycle. Kimberley: So interesting and so helpful. One thing that you talk about is emotions as a ritual. Can you share how this may play out with other emotions such as – you've written guilt and shame, regret and grief? Shala: Yes. So what I'm going to do to describe this is I'm going to take you through the OCD cycle in some anatomical details, so to speak, so we can piece together how this is all happening. So you have an intrusive thought. That is not OCD because everybody has intrusive thoughts. The OCD is the next stage where OCD reacts to the intrusive thought – “Why did I have this? What does this mean? Am I going to do it? Am I going to make it come true because I have the thought?” That reaction, that's the OCD. Of course, that makes you feel anxious. And then if you haven't had treatment, you typically do some form of compulsion, something to try to get certainty about what the OCD is bothering you about, because this is all based on an intolerance of uncertainty. And OCD just picks content that you care about and puts uncertainty about it in your mind and then gets you stuck in that cycle. When you do a compulsion, it tells your brain that this is a dangerous thought, “This intrusive thought I had is dangerous,” and you need to keep doing something about it. These steps just repeat on an endless loop. And then what happens is that when it repeats on the loop long enough, the acceptance of the scary thoughts that OCD is presenting causes you to experience the emotions that you would feel if those stories were true. Those emotions tend to be things like depression, as we've talked about, guilt, regret, shame, grief, and others. And then in classic cognitive behavioral therapy perspective where our emotions and our thoughts and our actions all come together in this triangle, the emotions then dictate how we act, so we begin to act depressed or guilty or regretful or shamed or grief-stricken. Those emotions can then become compulsions because they're driven specifically by believing the content of the OCD, by acting like what OCD is saying is true. That's the definition of doing compulsions. So that's how emotions can become part of the compulsion cycle because you start acting as though they're true. Kimberley: Right. This is so true and this is where I see it play out a lot, is when people have an intrusive thought that they've done something wrong, and then they feel... Because they start to believe it, they go into regret and then they go into confessing, right? Then they'll go into like, “Well, I have to confess it because I've done something wrong,” instead of that they had a thought that they did something wrong. Or that they feel such deep guilt that they're saying things like, “I'm a terrible person. I'm terrible. And I'm so guilty. What kind of human am I?” because of a thought like you've just described, how then that plays out and keeps playing out over and over again. Let's play out because we haven't really talked about this, but what would the action be as a result to regret? It would be reassurance seeking or confessing. What else would you say? Shala: Maybe going back in your mind and trying to undo it and, “Gosh, what would it be like if it had only gone like this?” Almost like a wishing compulsion that I think [14:22 inaudible] talks about in his book. All sorts of things like that. Kimberley: What about guilt? Similar, but what about guilt? Shala: I think with guilt, it's a lot of self-punishment as a ritual. “I'm bad. I did something bad.” With guilt and shame, guilt is, “I did something bad,” shame is, “I am bad.” I think in this case, those can get conflated together and people just start punishing themselves. “Well, I don't deserve this because I did this bad thing,” or “I am this bad person.” They start being very uncompassionate with themselves and treating themselves like they're this horrible human being. Kimberley: Right. And that's a big part of how I see it play out is that the self-punishment is pleasure withholding, like you don't deserve the nice-- it could be as subtle as you can't have the nice brand of crushed tomatoes. You have to have the crappy brand because you don't deserve good things or you don't deserve the nice sheets or so forth. And that will make you feel-- when there's no pleasure in your life, you get depressed, right? I think that's a very subtle way that OCD plays out. I've heard lots of people will say, or the flip side is they'll say something like, “Oh, because I have harm thoughts about my child, I have to buy them the best diapers,” which is treating yourself as if you've done something wrong. Shala: Yes. You're making up. Kimberley: You're making up for something that you had a thought about, right? Shala: Yeah. Kimberley: Right. It's so subtle. What about grief? Can you kind of give an example of that? Shala: I think with grief, it's pre-planning things. So, for instance, I'm not kidding you, I've pre-planned my funeral in my head – “Well, this is what it's going to be like. It's going to be so sad and I wonder if this will happen and that will happen,” as though it's an event two weeks from now on my calendar, Shala's funeral. So I think it's almost like you act like the loss has occurred already and you begin to start going through the grieving process. People with OCD tend to be really empathic people, so it's really easy to go there. It's easy to put yourself in that, “Oh, so-and-so has died. This horrible thing has happened. Let me go ahead and get into that grief state,” because we're just good at being able to put ourselves in other people's shoes to imagine what something would feel like, and to feel it as though it were happening. Kimberley: It's so good. All right. So-- Shala: Can I say one more thing? Kimberley: Of course. Shala: Sometimes I think of these as fake emotion. They're not, right? But they're OCD-induced emotions. Kimberley: They're manufactured. Shala: They're manufactured. They don't actually fit the truth of the situation. I'm not saying they're fake like, gosh, the shame you're feeling or the guilt you're feeling isn't real. Certainly it's a real emotion, but I think it is induced completely by the OCD, as opposed to being induced by a situation that has happened in life. Kimberley: I agree. And that's where that insight is really important, right? Is to be able to catch that. I fully agree with you. I'm so glad that you recognize that because people will say it feels real, right? It feels real. And then I'll always follow up with like, “But it's not a fact.” But still, it's important to have that conversation. Now, I want to just jump in here. Before we talk about how to break this cycle, how might this play out with just Right OCD? Shala: I can give you an example from yesterday about this. Kimberley: All right. Shala: I decided I was going to get these floating shelves and hang them on the wall. It requires using a drill and all sorts of things, which I can do, but I'm not very good at it. I also, I guess, was sort of distracted and I'd had problems with one of them and with the drill, as I went downstairs to do the other one. I put the shelf a couple of inches too high because I used the wrong mark on the wall, probably because I was exhausted from having drilled drywall over the place and making a huge mess upstairs. Once I got the shelf installed, I'm like, “Oh, what's that little mark on the wall? Oh, that was where it was supposed to be, a couple of inches higher.” I am not redoing it because it made a huge mess in the wall and it's going to have to stay there. My OCD put this little feeling in my stomach. “That's just too high. It's wrong. It's horrible.” I could feel it. Like, I feel it right in my solar plexus, this little tightening, like, “Oh, we can't stand this.” What I decided to do, because I am not moving that, I just say, “OCD, this is great. I am so glad that shelf is at that level. I'm glad, number one, because it's upsetting you. But number two, it actually probably is a good level because I have a big dog who likes to bounce around on the couch. This is above the couch. If it's actually too low, he's probably going to knock his head on it and knock it over. We're just going to live with it. There are some good things about it being at this level, just like there's some good things about it being at another level. I'm just going to smile and be happy every time I see that shelf.” So, when I see the shelf now, I really try to have good, positive, happy emotions about the shelf being at that level and tell myself, “We're not changing it. OCD, if you don't like it, fabulous.” Kimberley: Right. But originally, was it that you would slip into a depression as a compulsion? Shala: Yes. So, what happens with Just Right OCD that can have this same thing go on is we look at the shelf every day and go, “Oh, it's ruined the house. The house is not perfect because the shelf is in the wrong place. If we could just move the shelf down.” And then you envision moving it down, but then you think, “Oh my gosh, it's going to open up more holes in the drywall, and then I'll have to fix that. I can't do that. If I'd only been paying more attention.” Everybody can't see this because they're not watching the video of this, but if you can see my posture, it's like-- Kimberley: It is. You're getting low. Shala: Like, “I screwed up and now it's bad and I'm depressed.” And then every time you look at it, you have those regretful thoughts and you think about, “Gosh, how I'd like to change that.” And that causes more regret. And then that fuels the whole emotions as a compulsion cycle. Kimberley: Which is interesting. I think this is true for any subtype. And you may correct me on this. The thought that I hear the most is, “This is going to bother me forever.” That's where I feel like the depression as the compulsion set seen as like, “You'll never have happiness again. This is going to be the worst.” And then you go actually, like you sunk down into that. You sunk in and you stayed into that kind of mindset. Is that an example you would give as well? Shala: Yeah. I think with any Just Right OCD, it's this feeling that life is somehow ruined because this thing is wrong. Ruined means forever. It's all blurry, black and white like you were saying. So it feels not only unfixable, but unbearable, and then giving into that and then acting as though this unbearable thing has happened, then becomes the emotions as a compulsion. I think this is probably pretty common within the whole Just Right OCD thing, is having so much regret that it's not right, then act as though that regret were true. Kimberley: Right. Well, okay. So, that's the perfect segue, is how do we break this cycle? How do we intervene? Where do we intervene in the cycle? Shala: The way that we intervene in this cycle, through exposure and response prevention obviously, is doing the acting as though the content that OCD is threatening you about or bothering you about is irrelevant. Let me start out by first saying how people tend to make mistakes doing this because I think this is important. So, as we know with exposure and response prevention, we're exposing ourselves to the uncertainty of the obsession while not doing compulsions. If you have emotions as a compulsion, depression as a compulsion, you can do an exposure. Think you're not doing compulsions because you're using scripting to get out of your head. You're not asking for reassurance. You're not doing your physical compulsions. But you're still bummed out, regretful, ashamed. So you're doing it while in your head, really spending a lot of time in that emotion. So you're really doing exposure without response prevention. You're doing some response prevention, but you're not doing enough response prevention. So the exposures don't work very well. People can get stuck in this cycle where they're doing ERP over and over and over again and they think that they're getting rid of all these components and they're not getting better. It's probably because something like this is going on in the background where they're still, at some level, believing this and acting as though it were true. So, that's where people make mistakes. What we really need to do here is find that little bit of joy because it's there. It's probably been so covered up by the OCD, the depression, whatever other negative emotions you're experiencing, that you don't think it's there, but it is there. You can take yourself back to when you were really happy about whatever it is, like, say that you think you're going to harm your children. And you can remember times that you were with your kids where this wasn't bothering you. So, you take yourself back to that and you think, “How was I acting? What was I doing? How was I feeling?” You find that and you go do those activities and you focus on that joy. So, when the OCD says, “Oh no, we can't, we can't. You're irresponsible. We were going to kill them. We're going to harm them. We have to focus on how bad we are,” you're like, “Nope, I'm going to focus on how much fun my kid is having in the pool. Isn't this great? It's a sunny day. Really enjoying it. It feels so nice to be out here. Look how happy my kids are.” You just find all of the joy you can and you focus on the joy. What we're trying to do here is act as though the content is irrelevant. So, if you're acting like it's relevant, you're standing in the pool with your kids going, “Oh my gosh, this is terrible. I'm going to kill them. They're happy now. But just wait until I kill them and their mother finds out or whatever, that it was me.” Or you can be in the pool like, “This is great. I love spending time with my kids. This is awesome. Look how much fun they're having. They're doing so well with their swimming. They're having a great time. They could probably stay in here until they turn blue. This is great.” You're acting like all that stuff in your head about the fact that you might harm them doesn't matter. And that's the essence of good exposure. It really takes this finding joy because you want to do the opposite of what OCD is saying. OCD says you should act depressed, regretful, ashamed. So you say, “I'm going to do the opposite of that. I'm going to act happy, jubilant, carefree.” And that's how we do these exposures. It's not easy, but if you get good at it, it can be really revolutionary in terms of your recovery. Kimberley: I love this. So, I'm thinking of one particular person right now, and it's a follower actually. What would you say, because I love everything you're saying. What would you say to the person who then may start to do that as a compulsion too? Shala: Yes. I think that OCD can turn anything into compulsion. Kimberley: It's so skilled. There's such skill. So Shala: Yeah. I think that that is a potentiality for anything that we do with ERP. We are not doing this to make your anxiety go away. In fact, you're going to be more anxious while you're trying to find this joy because you don't deserve to be joyful. It is not responsible to be joyful. It is tempting fate to be joyful. So you're going to be-- Kimberley: Irresponsible is the word. Shala: Yeah. You're going to be having maybe 5% joy and 95% anxiety if you're doing this right. If you make this compulsive, you're doing it to reduce anxiety. I'm so glad you brought that up. That is what we're looking for here, is this is going to make you more anxious. And the more that you do it and really find the joy and act like you're having fun anyway, eventually, the anxiety will subside. Who knows when? It may take hours, days, weeks, months, whatever. But that is not the goal. The goal is to be in the situation while being anxious. And the more anxiety, the better, right? Because that means you're giving your brain a good learning experience. That means that you're doing things that help you tame OCD and reclaim your life. Kimberley: Right. Thank you so much for sharing that because that's such a crucial piece – to be able to integrate joy and anxiety in the very same moment. If you could do that, you're winning, right? You've won, because OCD wants you to integrate anxiety and depression at the same time. So, I love that that is the way to give OCD birth ultimately, is to show that you can do that. I love it. So, let's talk about one more thing. I want to be respectful of your time. Someone has had OCD for a long time, obviously, because this has gotten so stuck. They're having a lot of this depression as a compulsion. We're asking them to find things that used to bring them joy or look back to a time where they could integrate anxiety and joy at the same time. What are your thoughts around “Fake it till you make it”? Is that an approach that you would consider? I know you've talked about other ways. Would you like to share your thoughts on it? Shala: Yeah. I mean, there's nothing inherently wrong with the “Fake it till you make it” stand, except for if you're saying you're faking it, you're saying that there is no happiness there. And that's almost giving in to the OCD once again. So, what I like is a different way of phrasing it, which comes from a woman named Heather Hansen who wrote a great book called The Elegant Warrior. We've both been on her podcast. What she says is, “Show it till you grow it.” I love that because that acknowledges that the positive emotions are there. The OCD is sitting on them and squishing them and you can't feel them, but they are there. That also reinforces this notion that the OCD, this is a bunch of content it's making up. It doesn't feel like that, but these are things that it has imposed upon your life to make you worry about them. But you've got this great life that sort of smushed down underneath it. And you just need to find a little bit of what that great life used to be and find that and grow that. It's almost like if you think of a black canvas and then there's a little pinprick of light, sunlight and it comes through as like a ray. And then the ray comes through and it starts to makes the black cloth start to have the hole, get bigger and the sunlight gets bigger. And then the sunlight comes through and eliminates everything. That's what we're talking about here. It's just a pinprick. It's a tiny bit, but it's really there. If you say you fake it till you make it, you're not giving yourself the empowerment you deserve, that it is in you. It is there. You just don't feel it because of the OCD. Kimberley: Right. It is. It's like a muscle that you grow. I agree with that. I think that that is exactly perfect for it because, like anything, if you're trying to get 100% joy, you won't get any joy. But if you give yourself permission-- because we can get perfectionistic about this and be like, “Well, no, this used to bring me so much joy.” So I think you're right. It's just little baby steps and little baby pinpricks is the way. Shala: I'm so glad you brought that up because like all of us with OCD can make things compulsive. We can also try to do our therapy perfectly and try to do these exercises and go out and be like, “But I wasn't totally happy. I did have some intrusive thoughts. I did feel some depression.” Yes, of course. You're going to. So, I think recognizing this is a process and what we're trying to do is find the 1%, the 0.05%, the 3%, the 15%, whatever it is of joy and focus on that. Yeah, you're going to have those depressed feelings. They've been there for a while. By the time you have depression or other emotions as a compulsion, it's probably been there a while. So, this process of ERP is also going to take a while and it's challenging and it's hard. So, you're not going to go out and do this perfectly. You're not going to go have some awesome experience with your kid. You're going to be acting as though you're having an awesome time. You're going to be trying to focus on that in your head. But the vestiges of the OCD and those other emotions are going to be there. Let it be there. We're not with this trying to shove those away necessarily and not feel them. What we're trying to do is focus on the ones that actually match the ERP, which is, if I'm going to go focus on being with my kids and having fun, that's what I'm going to focus on. Not this other stuff that's going on over there. But give yourself permission to have this be a messy process because it is and do it imperfectly because you're going to, because everybody does. It's going to take a while, because it took a while for all of us with this to get there. It's going to take a while to unravel it. And then even after you unravel it, it can still come back. I still have to watch for this one. If I get triggered with something that is a really high-level item for my OCD, I have to work on this sometimes too, because it's easy for me to sink back down to this because I did it for so many years. Kimberley: Which I'm so grateful that you share that because I think that for those-- and I want to make sure I just did it before we finish up and I want to hear about what you're up to these days is, the treatment for this is actually similar to the treatment of just depression too. You're working double shifts here, but in a good way. You're working on two things using the same tool. So, do you have any feedback on that? Shala: Yeah, that's a really good point. I hadn't thought about it like that before, but it's very much a behavioral activation approach. Behavioral activation is used in the treatment of depression to help people start to put activities back in their lives that gave them pleasure and that gave them some feelings of mastery. And that's what we're trying to do with the added component of “And let's focus on that pleasure. Let's focus on that feeling of mastery. Those other feelings are going to be there, but let's focus on the way life used to be before the depression came in.” So, yeah, it is a very behavioral activation type approach here. Kimberley: Oh my gosh. I love it so much. It's so good. I feel like everyone needs to be trained in this specific area because it's such an important area that gets missed and missed and missed and missed. So, you're like brilliant, brilliant in my mind, as you already know. Shala: Well, thank you very much. Kimberley: Okay. Is there anything you want to add before you tell us the way we can find out about you? Shala: I don't think so. I think we've covered everything. Kimberley: Okay. Tell us where people can hear about you, your blog, and all the amazing things you're doing. Shala: They can go to shalanicely.com. On that website, you can sign up for my newsletter, which is called Shoulders Back!: Tips and resources for taming OCD. I send it out every couple of weeks and it has some sort of new resource I've created or been a part of every time I send it out, free resources to help people learn how to effectively tame OCD and reclaim their lives. So, that is where you can go. If you want to read more about this, this particular blog is on my Psychology Today blog. It's called The Subtle OCD Compulsion that you might not know you're doing. Again, you can go on my website and it'll link back to all the Psychology Today blogs as well. Kimberley: What about your book? Shala: Yes. So, both books, Is Fred in the Refrigerator?: Taming OCD and Reclaiming My Life and Everyday Mindfulness for OCD: Tips, Tricks, and Skills for Living Joyfully, which I co-wrote with Jon Hershfield. You can learn more about those on my website or on Amazon or anywhere that you buy books. They're both available on audiobooks as well. Kimberley: Right. Let me do a plug for your book because I have had so many of my patients say it's the first time they wanted to hand their book to everybody because it was exactly how it felt for them. I have so many clients who bought a copy for themselves and a copy for their parents because their parents were like, “Oh, this is what it's like to be you. Now, I finally get it.” So, I'm so grateful you did that beautiful book. Shala: Well, thank you. That's the whole reason I wrote Is Fred in the Refrigerator? because I wanted people to understand how it feels to have OCD. If you have OCD, I wanted you to understand that you're not alone and that there is hope that you can get better. You can tame OCD and you can reclaim your life. Kimberley: Right. Oh my God, thank you so much for being on today. Shala: Thank you so much for having me. It was fun. Kimberley: Such important information. I can't say it enough. So, so important that we're addressing this more. I think that this can open it up to everybody having a better understanding. Shala: Thank you again. Website: shalanicely.com Is Fred In the Refrigerator: https://www.amazon.com Everyday Mindfulness for OCD: https://www.amazon.com Psychology Today blog ----- Please note that this podcast or any other resources from cbtschool.com should not replace professional mental health care. If you feel you would benefit, please reach out to a provider in your area. Have a wonderful day, and thank you for supporting cbtschool.com.

Welcome back to another episode of Your Anxiety Toolkit Podcast. Today I am so happy to have Jon Hershfield on with us. Jon is an author and the Director of the Center for OCD and Anxiety at Sheppard Pratt. The second edition of his book, The Mindfulness Workbook for OCD, has just been released and his new book, The Mindfulness Workbook for Teens, is scheduled for release in March. We had a great conversation about both books and Jon shares many of the OCD mindfulness tools that he describes in his books that are used to enhance treatment. In this interview, Jon explains why he wanted to write a book for teens and how he decided to approach the topics of mental health, OCD, and mindfulness in a way that would be relatable to teens and young adults. He discusses in more detail some of the topics in his book including how to understand your diagnosis, how to respond to intrusive thoughts, and how to incorporate meditation and mindfulness into your daily life. Jon also shares some OCD mindfulness tools that he describes in The Mindfulness Workbook. These include thoughts are thoughts, not threats; feelings are feelings, not fact, and sensations are sensations, not mandates to act. He shares that mindfulness really involves calling things what they are. Towards the end of this interview, we discuss Exposure and Response Prevention and the difference between habituation and inhibitory learning. He shares with us the five things we should consider when doing ERP with the goal of inhibitory learning. This is a great interview full of so many wonderful mindfulness tools to help you manage your OCD. I hope you enjoy! The Mindfulness Workbook for OCD: A Guide to Overcoming Obsessions and Compulsion Using Mindfulness and Cognitive Behavioral Therapy The Center for OCD and Anxiety IG @ocdbaltimore If you have some time, I would love it if you would please go and leave me an honest review wherever you listen to podcasts – Apple Podcasts, Spotify, Podbean, or Stitcher. This would really be helpful to me in achieving my goal for 2021 of being able to reach and help more people. Thank you so much! ERP School, BFRB School and Mindfulness School for OCD are open for purchase. Click here for more information. Additional exciting news! ERP School is now CEU approved which means that it is an accredited course for therapists and mental health professionals to take towards their continuing education credit hours. Please click here for more information.

Learn all things OCD with the OCD Whisperer Podcast.   This week I interview Jon Hershfield from The Center for OCD and Anxiety in Baltimore.  He can be found on his website, Instagram, and Twitter.  To get one of his OCD books on amazon, click here. ***   IG @ocdwhisperer  Resources for OCD eBk: How to Stop Compulsive Rumination + 30 day journal   _____ Disclaimer: This podcast is for educational purposes.  Though I am a licensed marriage and family therapist in California & specialize in OCD and Anxiety Disorders, this does not replace therapy.    See you in the next episode!   Keep going in the meantime.   *Episodes come out out bi-weekly.

In episode 259 I chat with Jon Hershfield. Jon is a psychotherapist and the director of The Center for OCD and Anxiety, at Sheppard Pratt. He is the author six OCD books, including his most recent book the 2nd edition of “The mindfulness workbook for OCD”, and his upcoming book “The OCD Workbook for Teens”. In this episode I chat with Jon about what’s new with him, The mindfulness workbook for OCD, what the book about, what’s new with this 2nd edition, Jon’s personal experiences with meditation and mindfulness, why he broke the book down by themes. We discuss The OCD workbook for teens, what it’s about, Sean Shinnock’s illustrations in the book, exercises in the book, how he works with teens, staying in the present moment, dealing with uncertainty, living joyfully, and much much more. Hope it helps.  Show notes: https://theocdstories.com/episode/jon-hershfield-mindfulness-workbook-for-ocd-259 This episode is sponsored by OCD Jacksonville and Natural Life. Shop the Fearless collection of apparel and gifts here https://www.naturallife.com/collections/fearless-giveback-collection. Use code “FEARLESS” at the checkout for 20% off the Fearless range. To find out more about OCD Jacksonville click here: https://ocdjacksonville.com/

TRIGGER WARNING! This will have a detailed recap of what my intrusive thoughts are likeIt's funny, because I said this was going to be faster, but it ended up becoming longer than the first episode.Here I discuss in detail how I cope with my potential Harm OCD and it's effectiveness!The Book: Overcoming Harm OCD: Mindfulness and CBT Tools for Coping with Unwanted Violent Thought by Jon Hershfield

Confidence and certainty are two concepts that we wrestle with in the course of anxiety and OCD treatment. On this episode, I was honored to interview Jon Hershfield, The Great and Powerful, and he discussed the differences between the two concepts, why we should be seeking confidence over certainty in… Continue reading The post Certainty and Confidence with Jon Hershfield, MFT appeared first on FearCast Podcast.

Confidence and certainty are two concepts that we wrestle with in the course of anxiety and OCD treatment. On this episode, I was honored to interview Jon Hershfield, The Great and Powerful, and he discussed the differences between the two concepts, why we should be seeking confidence over certainty in… Continue reading The post Certainty and Confidence with Jon Hershfield, MFT appeared first on FearCast Podcast.

On this episode of Sanity, Dr. Jason Duncan and Dr. Jonathan Grayson dive into OCD, defining and differentiating it from other mental disorders and “normal” behavior. They discuss the core features of the disorder, which are obsessions and compulsions, and provide multiple examples of how obsessions and compulsions might look in a clinical setting. Dr. Grayson introduces the topic of uncertainty and how it is the core of the problem for those living with OCD due to its contribution to avoidance and behaviors interfering with quality of life. Interestingly, once individuals learn to live with uncertainty as part of OCD treatment, they are actually more tolerant of it than those in the general public. They review treatment for OCD, including exposure and response prevention, and Dr. Grayson identifies common pitfalls with diagnosing and treating OCD, such as the end goal not including tolerance of uncertainty. Numerous client examples are provided along with rationales for Dr. Grayson's treatment approach for specific obsessions or compulsions. Resources: Grayson Center http://laocdtreatment.com/ Book - Freedom from Obsessive Compulsive Disorder https://www.amazon.com/Freedom-Obsessive-Compulsive-Disorder-Personalized-ebook/dp/B0049U4KGM Book - Is Fred in the Refrigerator https://www.amazon.com/Fred-Refrigerator-Taming-Reclaiming-Life-ebook/dp/B07CQ66T6F Book - Everyday Mindfulness for OCD by Jon Hershfield and Shala Nicely, with foreword by Alec Pollard https://www.amazon.com/gp/product/B06XGRB72W/ref=dbs_a_def_rwt_bibl_vppi_i0 Other books by Jon Hershfield https://www.amazon.com/Jon-Hershfield-MFT/e/B00GNT1XVW%3Fref=dbs_a_mng_rwt_scns_share Podcast - The OCD Stories https://theocdstories.com/ International OCD Foundation https://iocdf.org/ Vienna Beat by Blue Dot Sessions (www.sessions.blue)

In this special episode of The OCD Stories podcast I interviewed Jon Hershfield. Jon is a psychotherapist who specialises in the treatment of Obsessive Compulsive Disorder. He is the author five OCD books, including his most recent book “Overcoming Harm OCD”. I got Jon on the show to address some questions around the Coronavirus and moral scrupulosity OCD. Hope it helps.  Show notes: https://theocdstories.com/podcast/jon-hershfield-coronavirus-covid-19-moral-scrupulosity-ocd

Welcome back to another episode of Your Anxiety Toolkit. You guys, you are going to love this episode with one of my favorite poets of all time, The Poetry Bandit. Jon Lupin, aka The Poetry Bandit joins us today to tell us his story about sobriety, OCD, relationships, mental health and how poetry has helped him through.  This is a story about honesty, vulnerability, and commitment. The Poetry Bandit shares his story and together we talk about some of the hidden meanings of his poetry. Jon and I got to read a few of his poetry pieces and talk about how he manages his anxiety, OCD, and sobriety while being a father, employee, friend and poet.  If you get a chance, check out The Poetry Bandit's books of poetry. The links are below.   Encyclopedia of a Broken Heart: Poems You Only Love Me When I'm Suffering: Poems My Sober Little Moon Jon's Instagram @the_poetrybandit Please join the IOCDF for a COVID-19 & OCD Live Townhall. Saturday March 28th at 2 PM EST. Bring your questions for Kimberley, Ethan Smith, Jon Hershfield, and Stuart Ralph. https://www.facebook.com/IOCDF/ Kimberley did a FREE Self-Compassion webinar on The Peace of Mind Foundation's FB page. https://www.facebook.com/peaceofmindfoundation/ Did you know that we were listed in the top 10 OCD podcasts to follow in 2020? https://blog.feedspot.com/ocd_podcasts/

You are listening to The Best of AT Parenting Survival Podcast, a replay of one of our top episodes. The show will be taking a two week break for the holidays. Enjoy the "Best Of." New episodes will be back starting January 7th, 2020.This podcast is for informational purposes only and should not be used to replace the guidance of a qualified professional.Visit my website at www.ATparentingSurvival.comInterested in my AT Parenting Community Membership? Click below to join us!http://www.atparentingcommunity.com Sign up for my weekly email newsletter:https://pages.convertkit.com/740ba8cd83/92109b7172Take one of my online classes:To view the entire online school library, go to:http://anxioustoddlers.teachable.comClasses include:How to Crush Social Anxietyhttp://anxioustoddlers.teachable.com/p/crush-social-anxietyParenting Kids with OCD http://anxioustoddlers.teachable.com/p/child-ocdCrush Moral OCD in Kidshttp://anxioustoddlers.teachable.com/p/moral-ocdTeaching Kids to Crush Anxietyhttp://anxioustoddlers.teachable.com/p/crush-anxiety Helping Kids with Anxiety or OCD Through Difficult Behaviorshttp://anxioustoddlers.teachable.com/p/difficult-behaviorsHelping Kids Who are Scared to Sleephttp://anxioustoddlers.teachable.com/p/scared-to-sleepHandling Sensory-Based Anxietyhttp://anxioustoddlers.teachable.com/p/sensory-anxietyLibrary of Live Anxiety and OCD Classes (20 hours of class replays)http://anxioustoddlers.teachable.com/p/libraryUltimate list of helpful anxiety products:https://www.anxioustoddlers.com/reduce-child-anxiety/ To join my private Facebook group visit:https://www.facebook.com/groups/ATparentinganxiouskids/For a list of my books visit:https://www.amazon.com/Natasha-Daniels/e/B011K5IIWAJoin the fun on my YouTube channel:https://www.youtube.com/c/anxioustoddlers78 Other social places I hang out:http://www.facebook.com/anxioustoddlershttp://www.pinterest.com/anxioustoddlershttp://www.twitter.com/anxioustoddlershttp://www.instagram.com/anxioustoddlers*** See acast.com/privacy for privacy and opt-out information.

In episode 197 of The OCD Stories podcast I chat with Jon Hershfield. Jon is a psychotherapist who specialises in the treatment of Obsessive Compulsive Disorder. We talk about what is existential themed OCD, common obsessions and compulsions, ERP for this theme, how families can support their loved one with OCD, and much much more. Hope it helps.  Show notes: https://theocdstories.com/podcast/jon-hershfield-existential-themed-ocd

In episode 195 of The OCD Stories podcast I chat with Jon Hershfield and Shala Nicely. Jon and Shala are both therapists who specialise in OCD. They co-wrote a book called “Everyday mindfulness for OCD: Tips, Tricks, and Skills for Living Joyfully”.  Show notes: https://theocdstories.com/podcast/jon-hershfield-shala-nicely-meditation-and-mindfulness-for-people-with-ocd

100th Episode Virtual Party! Welcome to another episode of Your Anxiety Toolkit Podcast.  This episode is a very special one for us.  We are celebrating out 100th Episode and we are having a VIRTUAL PARTY! At this party, we want you to celebrate this wonderful community of brave and courageous people who stand by each other as we go through hard things and we do hard things. For this virtual party, we invited some of our favorite guests and asked them to share some wisdom, a funny story or dance the night away with us.  First up, we have Ethan Smith who was on Ep. 53 (How Advocacy “Keeps Me Well”: Interview with Ethan Smith OCD Advocate) and he starts the evening off in the most glamorous way.  Sheva Rajaee who was Ep 45 (FIVE Roadblocks to Anxiety Recovery (w/ Sheva Rajaee) shares a wonderful story about Octopi and how adaptable they (and we) are.   Chris Tronsdon who was on Ep 97 (The Emotional Stages of Recovery – Rebuilding Life After OCD with Chris Tronsdon) shared a wonderful and inspiring story of having Obsessive Compulsive Disorder (OCD) and then led us into a fabulous dance.  Nathalie Maragoni from Ep 65 shared her love for our community and how proud she is of us all.  Shala Nicely from Ep 16 (Guilt, Shame and being “SO OCD” with CBT ROCKSTAR Shala Nicely), Ep 36 (This EASY tool Might Change Your Way of Coping with Anxiety with Shala Nicely) and Ep 78 (Tips To Help You Share Your Mental Illness With Others) Shared her words of wisdom and also has a wonderful and generous gift she is sharing with the OCD community.  Catherine DeMonte from Ep 95 (Love vs. Fear with Catherine DeMonte) shared a wonderful piece about how we must choose love over fear and allow love to lead us.  Catherine always has beautiful things to share with us.  Jon Hershfield from Ep 42 (Dispelling The Myths About Managing Anxiety and Obsessive Compulsive Disorder) And Ep 85 (Harm OCD with Jon Hershfield) as always brings humor and wit to our interactions.   Michelle Massi from Ep 84 (How to Manage Social Anxiety (with guest, Michelle Massi, LMFT) Beautifully shares what she loved about being on Your Anxiety Toolkit Podcast and we 100% cannot wait to have you back on Michelle.  Alegra Kastens, our fabulous and hard-working CBT School assistant gives us a huge dose of inspiration and support with her beautiful words of hope and faith.  Thank you, Alegra!  Of course, no party is complete without Jeremy Quinlan from Ep 99 (Making The Choice to Embrace Panic with Jeremy Quinlan) who shows us late and always causes trouble.  Thank you, Jeremy, for showing your handsome face!   The lovely and wise Zoe Gillis from Ep 19 (Nature just might be the ULTIMATE Mindfulness Tool with Zoe Gillis) shared how she experiences parties and brings a unique and thoughtful approach to our 100th episode (always making me think outside the box). And, true to form, Patrick McGrath from Ep 64 (Don’t Try Harder, Try Different with Patrick McGrath) brings his hilarious jokes and firm direction for those who are working on anxiety and recovery.   And, last but not least, Chrissie Hodges from Ep. 67 (Grieving the Losses of Mental Illness) shares a powerful message for those who are in the throes of anxiety and OCD recovery.  I just adore her thoughts and wisdom.   I cannot thank you all enough for all of your support and excitement. Thank you for joining us for this virtual party!  I have loved every minute of this podcast...all the minutes of recording, editing, and preparing.  Thank you so much, CBT School community! Here is to another 100! 

My guest this week is therapist and OCD specialist Jon Hershfield. Jon is doing an incredible amount of work to improve the lives of those who struggle with obsessive-compulsive disorder through his therapy practice, writing, and public talks. In this episode we discussed his excellent new book, Overcoming Harm OCD: Mindfulness and CBT Tools for Coping with Unwanted Violent Thoughts.

My guest this week is therapist and OCD specialist Jon Hershfield. Jon is doing an incredible amount of work to improve the lives of those who struggle with obsessive-compulsive disorder through his therapy practice, writing, and public talks. In this episode we discussed his excellent new book, Overcoming Harm OCD: Mindfulness and CBT Tools for Coping with Unwanted Violent Thoughts. The form of Harm OCD that the book and our conversation focus on is what I've referred to as "Malevolence OCD," because it involves the fear not just of harming someone, but of being an evil person. (See this related blog post: Am I a Monster?) Topics we covered included: What Harm OCD is, and how it's relatively common The relief in knowing that what one is dealing with is a form of OCD The right treatment for Harm OCD Fears in Harm OCD: violence against others, self-harm, violence against children, and having a violent identity Common compulsions in Harm OCD The problem with trying to prove that obsessive fears are untrue, vs. the power of accepting uncertainty The role of avoidance and compulsive confessing in OCD The triggering effect of news about violent events and #metoo Distinguishing fear of self-harm from desire to harm oneself or others Fear of going insane Learning to live with the “spam email of the mind” False memory OCD What our brain learns from avoidance and reassurance Inhibitory learning versus habituation How Exposure and Response/Ritual prevention (ERP) works The role of mindfulness in OCD treatment Flooding scripts as a way to practice not doing compulsions The possibility of reassurance from exposures Lack of public awareness about Harm OCD Here's the Vice article that Jon mentioned: The Many Obsessions That Can Haunt a Person with OCD. Jon also said he has several blog posts on his website about Harm OCD; here's Part 1 of a series: Harm OCD Part 1. Jon is the co-author of Everyday Mindfulness for OCD and The Mindfulness Workbook for OCD, and author of When a Family Member Has OCD and Overcoming Harm OCD. (A portion of each sale made through these affiliate links will be used to support the podcast, at no additional cost to you.) Jon Hershfield, MFT, is the director of The OCD and Anxiety Center of Greater Baltimore in Hunt Valley, MD. He specializes in the mindfulness-based and cognitive behavioral treatment of obsessive-compulsive disorder and is licensed in the states of Maryland, Virginia, and California. Jon has authored or co-authored four well-reviewed books on treating OCD. He is a frequent presenter at the annual conferences of both the International OCD Foundation and the Anxiety and Depression Association of America, and a professional contributor to multiple online OCD-related support groups and blogs. Find Jon on his website, Twitter, Facebook, and Instagram.   If you're struggling with Harm OCD, also consider joining our Malevolence OCD Facebook group.

Overcoming Harm OCD with Jon Hershfield Welcome back to another episode of Your Anxiety Toolkit Podcast.  Today we have a special guest, Jon Hershfield, LMFT.  Jon has been on the show already and is a favorite among the CBT School-ers. Today, Jon and I talk about how to manage specific obsessions related to violence and physical harm.  In OCD terms, we call it Harm Obsessions or Harm OCD (if you meet the requirements for a diagnosis of Obsessive Compulsive Disorder or OCD). In this episode, Jon answers some important questions such as:  Does everyone have Harm Obsessions, thoughts, impulses or images?  Why do these Harm Obsessions bother some people and not others?  What is the difference between a Harm OCD  and having thoughts about harm?  Are people with Harm OCD any different than those who have other types of OCD?  How do we treat Harm OCD?  This was such a fun episode and I really hope it helps those with harm obsessions, thoughts, images, impulses, and urges (Harm OCD). Fore more information on Jon's latest book, Overcoming Harm OCD: Mindfulness and CBT Tools for Coping with Unwanted Violent Thoughts, click HERE. For more information on Jon Hershfield, visit: Website: Ocdbaltimore.com Twitter: @cbtocd IG: @ocdbaltimore FB: @JonHershfield GOOD NEWS!……WE HAVE A HUGE SURPRISE!  On January 28th, 2019, we are offering our FREE webinar called “10 THINGS YOU NEED TO KNOW ABOUT OCD.”  This is a FREE online video course explaining exactly what OCD is, how to treat it and what complicating factors can occur during the process.    This free webinar will run daily at 6pm PST for one week ONLY.  If you are not able to attend the free webinar, no stress! There will be a free replay sent to your inbox the day after signing up. I cannot wait to share this FREE educational resource with you.   CLICK HERE TO SIGN UP!  ALSO, ERP School is COMING BACK!   Exposure and Response Prevention School is an online course that teaches you the tools and skills I teach my clients in my office.  Let me tell you a little bit about it.  The course is a video-based course that includes modules on:  The science behind ERP  Identifying YOUR obsessions and your compulsions  The different approaches and types of ERP, including gradual exposure, writing scripts, interoceptive exposures and how to get creative with ERP  Mindfulness tools to help you manage anxiety, panic and uncertainty  Troubleshoot common questions and concerns  BONUS 6 videos of the most common subtypes of OCD, including Harm OCD. The course also includes many downloadable PDF’s and activities to help you navigate how to best apply ERP to your specific obsessions and compulsions.   We are so excited to finally share ERP with you and would love to have you join us and the CBT School Community.  It’s a beautiful day to do hard things!  If you are worried about doing it alone, please don’t fear.  We meet bi-monthly on the Facebook group and on Instagram to talk about questions you may have.  Click HERE to sign up.

Many parents don’t understand Harm OCD. It goes unnoticed, undetected and misinterpreted. Harm OCD makes kids worry they might hurt someone else. They might get them sick. They might accidentally harm them. They might do something to cause a catastrophe. You might have a child who is afraid to touch their nose or their private parts in fear they will contaminate someone else. You might see them washing their hands over and and over and assume that they are afraid of getting sick – when in reality they are afraid of getting other people sick. Many kids with Moral OCD often have themes of Harm OCD. Today I am talking to the expert on Harm OCD, Jon Hershfield. He is the author of the newly released book Overcoming Harm OCD as well as When a Family Member has OCD and Everyday Mindfulness for OCD. *** This podcast is for informational purposes only and should not be used to replace the guidance of a qualified professional.Visit my website at www.ATparentingSurvival.comInterested in my AT Parenting Community Membership? Click below to join us!http://www.atparentingcommunity.com Sign up for my weekly email newsletter:https://pages.convertkit.com/740ba8cd83/92109b7172Take one of my online classes:To view the entire online school library, go to:http://anxioustoddlers.teachable.comClasses include:How to Crush Social Anxietyhttp://anxioustoddlers.teachable.com/p/crush-social-anxietyParenting Kids with OCD http://anxioustoddlers.teachable.com/p/child-ocdCrush Moral OCD in Kidshttp://anxioustoddlers.teachable.com/p/moral-ocdTeaching Kids to Crush Anxietyhttp://anxioustoddlers.teachable.com/p/crush-anxiety Helping Kids with Anxiety or OCD Through Difficult Behaviorshttp://anxioustoddlers.teachable.com/p/difficult-behaviorsHelping Kids Who are Scared to Sleephttp://anxioustoddlers.teachable.com/p/scared-to-sleepHandling Sensory-Based Anxietyhttp://anxioustoddlers.teachable.com/p/sensory-anxietyLibrary of Live Anxiety and OCD Classes (20 hours of class replays)http://anxioustoddlers.teachable.com/p/libraryUltimate list of helpful anxiety products:https://www.anxioustoddlers.com/reduce-child-anxiety/ To join my private Facebook group visit:https://www.facebook.com/groups/ATparentinganxiouskids/For a list of my books visit:https://www.amazon.com/Natasha-Daniels/e/B011K5IIWAJoin the fun on my YouTube channel:https://www.youtube.com/c/anxioustoddlers78 Other social places I hang out:http://www.facebook.com/anxioustoddlershttp://www.pinterest.com/anxioustoddlershttp://www.twitter.com/anxioustoddlershttp://www.instagram.com/anxioustoddlers*** See acast.com/privacy for privacy and opt-out information.

Millions of people are affected by obsessive-compulsive disorder, or OCD—not just those who have the condition, but their loved ones. My guest this week is psychologist Dr. Belinda Seiger, who specializes in evidence-based treatment of OCD. We focused on how OCD affects families, the best way to treat OCD, and how effective treatment also improves a person's closest relationships. It was a fruitful discussion as we explored many OCD-related topics including: The definition of OCD Why it's such a devastating condition The many types of OCD The need for certainty Approaches that don’t help, like reassurance The ironic approach that effectively treats OCD Taking small steps toward recovery Common reactions to a family member’s OCD The importance of education for family members Disgust OCD Seeking reassurance as an OCD hallmark Frequent frustration in response to OCD The relief families experience following successful treatment Anxiety vs. OCD Health anxiety The difficulty in understanding another person’s OCD Fear of harm and Malevolence OCD OCD as a “bully in the brain” The illogic of OCD Involving family members directly in treatment What to do if a family member isn’t ready to start treatment How to respond when a family member isn’t following the treatment guidelines The need for a “why” to get over OCD The vulnerability in others knowing about a person’s OCD The key role of communication Depression as a result of OCD Dealing with one’s own anxiety about a loved one’s OCD Support groups Online support for families The problem with family accommodation in OCD OCD-related school refusal Seeing OCD as separate from oneself The importance of seeking treatment from an OCD specialist Belinda referenced the International OCD Foundation, which I often refer people to for information about the condition and to find a therapist. Here's their website: IOCDF. Belinda Seiger has been a licensed therapist for over 20 years working with teens, emergent young adults, and families. She completed her master's degree at Columbia University and her PhD at NYU, and has specialized training in working with gifted, twice exceptional (2E) populations, as well as ADHD, substance overuse and addictions, and individuals in highly competitive academic and professional environments. Belinda also completed advanced training in OCD treatment at the University of Pennsylvania Perelman School of Medicine, at the same center where I worked for 4 years (the Center for the Treatment and Study of Anxiety) as well as at the Child & Adolescent OCD, Tic, Trich, and Anxiety Group (COTTAGe), a speciality clinic for children. Her clinical practice is located in Princeton, NJ, where she provides psychotherapy for children, adolescents, and adults with a wide range of anxiety and OCD concerns, and with teens making the transition to college and beyond. She also provides training to assist parents and caregivers in managing their child's anxiety and OCD at home. To find out more about Belinda's psychotherapy practice, visit her website: OCDAnxietyHelp.com, call 609-288-8110, or email her at atcprinceton@gmail.com. For individuals who are seeking online OCD-related information and support, check out the OCD Talk blog, written by author and advocate Janet Singer. Janet wrote a memoir that detailed her son's recovery from severe OCD, and I contributed to the book with general information about OCD: Overcoming OCD: A Journey to Recovery. For families who are dealing with OCD, I often recommend Jon Hershfield's excellent book, When a Family Member Has OCD.  (Please note that a percentage of purchases made through these affiliate links will be used to support the podcast, with no additional cost to you.)

In episode 153 of The OCD Stories podcast I interviewed Jon Hershfield. Jon is a psychotherapist who specialises in the treatment of obsessive compulsive disorder. He is the author four books and in this episode he talks about his new book “Overcoming Harm OCD: Mindfulness and CBT Tools for Coping with Unwanted Violent Thoughts". Hope it helps. Show notes: https://theocdstories.com/podcast/jon-hershfield-overcoming-harm-ocd    

Ep.42 Dispelling The Myths About Managing Anxiety and Obsessive Compulsive Disorder Jon Hershfield Shares How To Have A Wise Relationship With Thoughts, Feelings, and Sensations You guys know how much I LOVE breaking down ALL THINGS ANXIETY and then deliver it in easy and helpful ways.  In today's episode, I am THRILLED to share Jon Hershfield's wisdom with you.  He is a genius at breaking things down into easy-to-understand ways. For this episode, I reached out to some trusted and respected Mental Health Professionals for input.    I asked if they could share some of the unskilled advice that some of their clients have received from their previous therapists or medical professionals. During our time together, Jon addressed how some advice for anxiety can be problematic and Jon shared his INCREDIBLE knowledge and wisdom on how to manage anxiety and obsessions in a mindful and rational way. We discuss topics such as: Why can't I just distract myself from the thoughts? Can I just Listen to music to drown out the thoughts? Can I imagine a Stop Sign when having intrusive thoughts or worrying? What about squashing thoughts like a bug? If I think it, is it my unconscious mind trying to tell me something? My Doctor told me that I just need one really heavy period for this anxiety to pass My Doctor told me my Anxiety is due to not being breastfed I understand I can get these scary thoughts to go away by thinking positive and using The Law of Attraction. About Jon: Jon is the author of  When a Family Member Has OCD: Mindfulness and Cognitive Behavioral Skills to Help Families Affected by Obsessive-Compulsive Disorder .    Hershfield is also the Co-Author of Everyday Mindfulness for OCD: Tips, Tricks, and Skills for Living Joyfully with Shala Nicely and The Mindfulness Workbook for OCD: A Guide to Overcoming Obsessions and Compulsions Using Mindfulness and Cognitive Behavioral Therapy with Tom Corboy.  Jon has a private Practice in Baltimore and uses Cognitive Behavioral Therapy (CBT) for the treatment of Anxiety and Obsessive Compulsive Disorder (OCD) OCDbaltimore.com  The OCD and Anxiety Center of Greater Baltimore Twitter: CBTOCD Facebook: @JonHershfield Click here to read about how Mindfulness can help you.

Are you tired of feeling like anxiety always has the reins?  This tool might be exactly what you are looking for and can be a powerful complement to the work you are already doing with anxiety. The tool is called "Shoulders Back!" and our AMAZING CBT ROCKSTAR guest is Shala Nicely! Shala explains how she came across this tool and how she uses it, both in her own life and with her clients with anxiety and Obsessive Compulsive Disorder (OCD).   The reason I LOVE this tool so much is that it is easy, empowering and science-based. Here are the links we discussed! Don't forget to check out Shala and Jeff Bell's E-course to help you with motivation for ERP for OCD. Click here for Shala and Jeff's E-Course Beyond The Doubt. Amy Cuddy Ted Talk talks about using a Power Pose Everyday Mindfulness Book (Written with Jon Hershfield)

In episode 90 I interviewed Jon Hershfield and Shala Nicely. Jon Hershfield and Shala Nicely talked about their new book “Everyday mindfulness for OCD: Tips, Tricks, and Skills for Living Joyfully”. Enjoy!  Show notes: http://theocdstories.com/podcast/jon-hershfield-and-shala-nicely-everyday-mindfulness-for-ocd This week's episode is sponsored by the Anxiety and Stress Disorders Institute of Maryland. If you are in the Baltimore area and are looking for treatment head over to anxietyandstress.com. Get exclusive podcasts and content by becoming a member of the podcast find out more here >> To your success, Stuart and The OCD Stories team

In episode 88 I interviewed Jon Hershfield. Jon is a pyschotherapist based in Maryland who specialises in the treatment of obsessive compulsive disorder. He is the author of three books “The mindfulness workbook for OCD” and “When a family member has OCD”. This episode is dedicated to supporting and helping family members of those with OCD. To one, support themselves, and two, support their loved ones with OCD more effectively.  Show notes: http://theocdstories.com/podcast/jon-hershfield-when-a-family-member-has-ocd Get exclusive podcasts and content by becoming a member of the podcast find out more here >> To your success, Stuart and The OCD Stories team

Hello everyone! I am excited to share this months podcast, as we are joined by what I call a CBT SUPERSTAR, Sara Vicendese.  Sara is a Licensed Marriage and Family Therapist who specializes in Cognitive Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP) in addition to traditional PsychoDynamic therapy. This podcast is based on the phrase, "It takes a village to raise a child".   This phrase is used often to explain the importance of community when raising a thriving and successful child.  We believe that you can create your own "micro-village" to help you along with your recovery. Today we talk about ways to create YOUR "Village" (in whatever form you think is helpful) to help you with your on personal recovery.  We discuss how to find the correct treatment, access the most helpful resources and how to include your family members, friends or partners in your recovery, in a healthy and helpful way. Below is a basic layout of our conversation.  Enjoy!!!  Today we talk about ways to create YOUR "Village".  What is the most effective form of treatment for OCD, and how do I find a therapist who provides it? Sara talks about the difference between Cognitive-Behavioral Therapy (CBT) including Exposure and Response Prevention (ERP) and psychodynamic “talk” therapy, specifically focusing on: How to interview your therapist: what questions to ask, how to ask them, and the importance of interviewing therapists without assuming that everyone with a degree is going to be the right fit. How to know what kind of therapy you're in. How do you find a good ERP Therapist Check out IOCDF.org for a list of therapists who are trained in CBT and Exposure and Response Prevention (ERP). Once in contact with a therapist, ask if they know what ERP is? Ask what books they rely on when treating OCD? (This might allow you to screen them for their knowledge) Ask if they have they worked with OCD before and for how long? Where did they get their training How do you know your current therapy is or isn't working? Sara writes, “A lot of dynamic therapists will stress that things can “get worse before they get better,” encouraging clients to wait months – or even years – to see the benefits of their work. It's true that in any therapy, including ERP, you will likely feel worse before you start to feel better…but if months go by and you aren't experiencing any reduction in symptoms OR if you notice – at any time – that you are getting significantly worse, it is likely time to move on.” What advice do you have for those who cannot find an ERP therapist in their area? Or, for those who can only afford a therapist in-network who does not know about ERP? There are some awesome workbooks out there for OCD. (Mindfulness Workbook for OCD, The OCD Workbook, Trichotillomania: An ACT-enhanced Behavior Therapy Approach Workbook) Ask your non-ERP therapist to read these workbooks (depending on your symptoms) ahead of time and go through them together in session. There are also so awesome online forums (Yahoo groups are GREAT) or online resources such as IOCDF.org, OCD stories etc (See my resources page for more info) Also consider the potential for Skype or teletherapy (always ask the therapist if they are legally allowed to see you from the state they are licensed in, depending on where you life)  What advice do you have for those who want to start ERP treatment, but currently have a non-ERP therapist? Sara writes: “There are really two options here; you can leave your current therapist and start with an ERP therapist, OR you can explore the potential of seeing both at the same time.” Sara discusses the importance of collaboration and making sure that both therapists are in regular touch with each other – to prevent each therapist from working against each other. Sara encouraged therapists to coordinate care and maintain the effectiveness of both. What advice do YOU give to the family members of those who are struggling with mental health issues such as Obsessive Compulsive Disorder (OCD) and Body Focused Repetitive Behaviors (BFRB's) or Eating disorders? Living with, and loving, someone with these disorders can be extremely challenging and it's critical that all members of the family are as healthy as possible for everyone to thrive. Jon Hershfield's book is great in this situation, as psycho-education is so important. Sara discusses the importance of involving family in treatment as appropriate (assuming family is supportive and including them wouldn't be detrimental to treatment). Sara also discussed how she often recommends that family members seek out their own support – either through support groups or personal therapy. Kimberley discusses to use of the Family Accommodation Scale (FAC) to identify ways the family are accommodating the OCD compulsions. Click here for a link to the Family Accommodation Scale. Is there a kind of therapy can benefit the spouse or parent or family member of someone with OCD or other anxiety disorder, or a BFRB? Individual therapy (and/or support groups) for the family member can be very successful. In addition, there is great benefits from continuing to be educated about the loved ones disorder and get consultation on the best ways to support them though their recovery process. What can a sufferer do when their family member or friend is not supportive of their recovery? This is a tough, but important, question. Being unsupportive can take many different forms, from simply not understanding / participating in treatment to (on the other extreme end) working against treatment or purposely interfering with it. Someone who is not supportive of treatment is someone who is, in some way, colluding with the illness. Maybe recovery would mean that their life will be more difficult for them, or perhaps the treatment itself is hard to tolerate. Sara discusses how she often see families where more than one member is suffering from the disorder – however, only one is diagnosed and in treatment. If one partner is going through ERP, that can stress the relationship if the other partner has similar undiagnosed issues. Sometimes people aren't supportive of recovery because it is hard at first and requires more energy/work than they are willing to put in. I can think of an example where a parent consistently disrupted treatment for their child because they didn't want to see them in distress and the increased anxiety in the household during exposures made them uncomfortable. A highly anxious parent may have as much trouble with their child's exposures as the child – for their own reasons. In most cases, most people get on board given enough time and education. That said, we are faced with tough decisions if our loved ones / friends interfere with treatment. Again, it is important that loved ones be brought into treatment, encouraging them to get their own support, and even the option of moving on from the relationship if it is keeping the sufferer stuck. Sara Vicendese has a private practice in Westwood, CA.  Learn more about Sara on her website at http://saravicendese.com/ You may also see the unedited video interview here  

Jon was diagnosed with OCD at age 14. He had grown up hearing about family members who also suffered from this disease. A practicing psychotherapist, Jon Hershfield truly understands the impact of this disease on an individual and on their family and friends. Jon discusses strategies for “managing the ups and downs of living with and loving someone with OCD”. … Read more about this episode...

In episode 6 of The OCD Stories podcast I interviewed Jon Hershfield. Jon is the author of two books on OCD and a therapist who specialises in OCD treatment. Show notes: Jon’s OCD Story (1:30) What Jon did before he retrained into therapy (7:10) Risk and OCD (9:00) What mindfulness is, and how can it be used to treat OCD (11:40) Mindfulness and ACT (14:45) Jon’s tips to stay on track with mindfulness training (16:15) Using mindfulness for anger (22:00) Good meditations for beginners (26:40) How to meditate even though you are getting intrusive thoughts (31:50) How mindfulness can work alongside ERP (39:20) Jon’s tip for starting and sticking with ERP (44:20) The acceptance script and how to use it (51:20) Mental reviewing, scenario bending, mental rehearsal and mental hoarding (1:00:30) The one bit of advice Jon would give if he only had 30 seconds (1:12:00) Jon’s new book “When a family member has OCD” (1:14:15) What Jon would have written on his billboard (1:16:40) Find out more about Jon: Jon's website - OCDBaltimore.com Jon on Twitter - @CBTOCD The mindfulness workbook for OCD (Amazon UK/Amazon USA) When a family member has OCD (Amazon UK/Amazon USA) Resources mentioned: OCD Georgia talk Peaceful warrior film Dr James Claiborn Headspace 10% happier app and book (Amazon UK/Amazon USA) IOCDF Shala Nicely To your success, Stuart and The OCD Stories team Get exclusive podcasts and content by becoming a member of the podcast find out more here >>