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Manifesting. Cleanses. The Law of Attraction. Jaclyn Steinmann tried it all, believing that if she could just control her thoughts — keep them positive and “high vibration” — she could finally quiet the chaos in her mind. But the more she chased perfect thinking, the worse her OCD got.In this interview, Jaclyn shares how popular self-help and spiritual practices didn't just fail to help — they fed her OCD. Real change didn't begin until she let go of those ideas and started evidence-based treatment like ERP. This is her journey, and what she's learned through trial, error, and research.If you feel you've tried everything and nothing's worked, you're not alone. Like Jaclyn, many people with OCD don't see real progress until they start evidence-based treatment. At NOCD, our therapists specialize in Exposure and Response Prevention, the gold standard for OCD care. To learn more, book a free 15-minute call at https://learn.nocd.com/YTResources Jaclyn mentioned on the episode:https://www.sciencedirect.com/science/article/abs/pii/S187620182400248Xhttps://michaelshermer.com/sciam-columns/quantum-quackery/https://www.amazon.com/Toxic-Positivity-Keeping-World-Obsessed-ebook/dp/B094VCFSZW?dplnkId=13f82e2f-da33-4ef5-9199-bdc566458a38&nodl=1https://www.tandfonline.com/doi/full/10.1080/09505431.2013.768222?scroll=top&needAccess=true Hosted on Acast. See acast.com/privacy for more information.
Alix Behar remembers the day everything almost collapsed. OCD had taken over her relationship, flooding her with intrusive thoughts, compulsive confessions, and endless reassurance-seeking. One morning, a single text nearly ended it all — her boyfriend said he couldn't take it anymore. It felt like OCD was winning, again. But that breaking point became the start of something new. In this powerful story, Alix shares how Exposure and Response Prevention therapy helped her take her life back — and saved her relationship. Struggling with OCD? NOCD therapists are specialized to treat OCD themes of all kinds. To book a free 15-minute call, visit us at https://learn.nocd.com/podcastFollow us on social media:https://www.instagram.com/treatmyocd/https://twitter.com/treatmyocdhttps://www.tiktok.com/@treatmyocd Hosted on Acast. See acast.com/privacy for more information.
Tracie Ibrahim knows firsthand how OCD can quietly wreck a person's day. In college, reading meant going forward, then backward, then forward again — just to feel “right.” As a mom, grocery trips were derailed by terrifying, intrusive thoughts. At work, simple emails turned into obsessive loops of rewriting and rereading. In this video, she shares what untreated OCD did to her focus, her routines, and her sense of control — and how Exposure and Response Prevention therapy helped her reclaim her time.If you're struggling with OCD, our NOCD therapists might be able to help. They are specially trained in ERP therapy — the most effective treatment against OCD. To learn about treatment options, book a free 15-minute call at https://learn.nocd.com/podcastFollow us on social media:https://www.instagram.com/treatmyocd/https://twitter.com/treatmyocdhttps://www.tiktok.com/@treatmyocd Hosted on Acast. See acast.com/privacy for more information.
Send us a textEver double-checked that your door was locked, even though you knew it was? That momentary doubt is normal—but what happens when these urges become overwhelming and constant? Drawing distinct lines between everyday quirks and clinical conditions, we untangle the often confused Obsessive-Compulsive Disorder (OCD) and Obsessive-Compulsive Personality Disorder (OCPD).The key distinction is profound: OCD manifests as intrusive, unwanted thoughts triggering repetitive behaviors to reduce anxiety. These thoughts feel foreign to the person experiencing them—what psychologists call "ego-dystonic." Despite recognizing their irrationality, people with OCD feel powerless to stop the cycle that consumes at least an hour daily. Most shocking is the 11-year average delay between symptom onset and treatment, largely due to shame and misdiagnosis.By contrast, OCPD represents a pervasive personality pattern centered on orderliness, perfectionism, and control. Unlike OCD, people with OCPD typically view their traits as rational or even virtuous—they're "ego-syntonic." This fundamentally different self-perception drives treatment differences: while OCD responds well to Exposure and Response Prevention therapy and medication, OCPD requires longer-term approaches focused on building flexibility and self-awareness.We examine how cultural context complicates recognition of OCPD, as traits like diligence and meticulousness often receive positive reinforcement. Someone might excel professionally while struggling significantly in relationships due to rigidity and control needs. Consider how our society's emphasis on productivity and perfection might blur the line between dedication and disorder—when do high standards become harmful?Whether you're a mental health professional seeking clarity or someone trying to understand these conditions better, this episode provides the framework to distinguish between unwanted symptoms and ingrained personality traits, guiding the path toward appropriate support and treatment. Want to know if you're ready for your Licensing Exam. Take our free exam today!If you need to study for your national licensing exam, try the free samplers at: LicensureExamsThis podcast is not associated with the NBCC, AMFTRB, ASW, ANCC, NASP, NAADAC, CCMC, NCPG, CRCC, or any state or governmental agency responsible for licensure.
Montana thought he understood OCD — until he got married. His wife, Mackenzie, had been living with obsessive-compulsive disorder since she was a teenager, but it wasn't until they built a life together that he began to see the full impact. From hidden rituals to overwhelming fear, contamination spirals, and constant anxiety, OCD slowly took over their home. With two young kids, military life, and cross-country moves in the mix, their marriage was pushed to the edge.In this raw and honest conversation, Mackenzie and Montana share how OCD strained their relationship, reshaped their parenting, and nearly tore their family apart. It wasn't until everything felt like it was falling apart that therapy — specifically Exposure and Response Prevention — gave them the tools to rebuild. Together, they show what it really looks like to fight OCD as a team and how getting the right help can truly save a relationship and a family.Want to try ERP therapy like Mackenzie? NOCD offers proven, specialized treatment for OCD. Start your journey by visiting https://learn.nocd.com/podcastFollow us on social media:https://www.instagram.com/treatmyocd/https://twitter.com/treatmyocdhttps://www.tiktok.com/@treatmyocd
Uma Chatterjee is a neuroscientist who studies the brain circuitry behind OCD — and she's also someone who lived with the disorder at its most severe. In this talk, she breaks down the actual biology behind intrusive thoughts and compulsions, from overactive brain regions like the orbitofrontal cortex to the role of neurotransmitters like serotonin, dopamine, glutamate, and GABA. She explains how genetics and stress can prime the brain for OCD, why certain thoughts feel so “sticky,” and what's really happening when the brain misfires and flags harmless ideas as dangerous.But this isn't just science for science's sake — it's about hope. Uma shares how Exposure and Response Prevention therapy (ERP) can actually retrain the brain's alarm system through neuroplasticity, helping people tolerate anxiety without relying on compulsions. For the most up-to-date science on OCD and its treatment, this video is must watch.To learn more about science-backed OCD treatment and to find an OCD-specialized therapist, visit us at NOCD: https://learn.nocd.com/podcastWatch Uma's interview on the Get to know OCD podcast: https://youtu.be/1NaxMoYhXZ4You can follow Uma's latest research here: https://umarchatterjee.com/research/She also hosts her own podcast: https://podcasters.spotify.com/pod/show/umarchatterjeeFollow us on social media:https://www.instagram.com/treatmyocd/https://twitter.com/treatmyocdhttps://www.tiktok.com/@treatmyocd
Send Lauren a text! In this episode, I focus on how parents can find qualified therapists who treat OCD in children and teens, understand ERP therapy (the gold standard in OCD treatment) and support their child's recovery journey.✨ What's Bringing Me More ZenTune in till the end of the episode to discover my new favorite protein-packed snack that helps me through mid-day energy slumps! Click here to see where you can buy this snack for yourself
Anxiety doesn't just affect your mind—it impacts your body and even your ability to stay consistent with fitness. In this episode we take a deep dive into the world of Mental Health with Cali Werner, Licensed Clinical Social Worker and fellow podcaster of Anxiety Society! Some of the subjects we cover are: Pre-performance anxiety: How it sabotages your progress and how to stay present.Imposter syndrome: Why comparison leads to spiraling and how to reframe negative thoughts.Boundaries and asking for help: Breaking free from toxic traits like avoiding support.Intrusive thoughts & OCD: How exposure therapy and reframing can lead to clarity.Mental illness stigma in fitness: Why it's time to embrace emotions (good and bad) and move forward.
Obsessive-Compulsive Disorder (OCD) presents in a wide range of subtypes and intensities—and effective treatment requires skill, sensitivity, and a deep understanding of the underlying mechanisms. In this compelling Podcourse, I'm joined by Dr. Johann D'Souza, a clinical psychologist and OCD specialist, to explore the science and art of Exposure and Response Prevention (ERP) therapy through the lens of traditional values. This episode contains hypothetical scenarios and examples that some listeners may find explicit or sensitive. These discussions are for illustrative purposes only and not intended to offend or shock. Listener discretion is advised. Purchase this Podcourse here! Check out my Coping with Political Stress Ebook Workbook Dr. D'Souza offers a comprehensive and practical breakdown of how ERP works, how to tailor it to the individual client, and how to apply it across various OCD subtypes—including contamination, harm, scrupulosity, and taboo fears. He also shares how integrating a values-based framework into ERP can build trust with clients and support long-term recovery. This episode will equip mental health professionals with an in-depth understanding of how to design ERP hierarchies, conduct imaginal exposures ethically and effectively, and overcome treatment barriers like poor insight, family accommodation, and avoidance. You'll also learn how to use storytelling, mindfulness, and exposure mapping to optimize outcomes and empower clients to become their own therapists. If you're a clinician looking to expand your OCD treatment toolkit and appreciate the importance of aligning therapy with client values, this Podcourse is for you. By listening to this episode, you'll be able to: Develop client-centered exposure and response prevention (ERP) exercises for at least four OCD subtypes, design response prevention strategies for common compulsions, and create effective ERP hierarchies to guide treatment progression. Apply principles of graduated exposure and response prevention to optimize client outcomes, while evaluating factors that contribute to less effective treatment, such as family accommodation and overvalued ideation. Differentiate between OCD subtypes and assess how ERP can be tailored to address specific obsessional fears, while demonstrating strategies to enhance client adherence and long-term success. Need continuing education contact hours? If so, then be sure to check out my $5 Podcourses. Check out the other CE courses - Holistic Counseling Bundle, the Art of Breathwork and How to Resolve the Parent Trap! Learn more about Dr. Johann D'Souza and his work at Values First Therapy. Please note that The Therapy Show with Lisa Mustard is for informational and entertainment purposes only and not a substitute for professional medical or mental health advice. Always consult with your therapist, doctor, or physician before implementing any suggestions from this show. Lisa Mustard, a licensed marriage and family therapist, provides insights that should not replace medical or psychiatric advice. Your unique situation requires personalized attention from a healthcare professional.
Daily panic attacks. Anxiety so crippling he could barely function. The fear that if he told anyone what was happening in his mind, they'd think he was crazy. That was Sean Patton's reality growing up. OCD wasn't just about organizing things or washing hands — it was a relentless loop of intrusive thoughts and compulsions that dictated his life. It got so bad he dropped out of high school, avoided doorways, people, places, and conversations that might expose his struggles. But what Sean didn't realize at the time was that the very thing causing his pain would eventually become the foundation of his greatest strength.Comedy became Sean's way of fighting back. What started as a defense mechanism— using humor to mask the chaos inside — turned into a career where he could be unapologetically honest about his experiences. On stage, he found power in telling the stories he once tried to hide, turning his most terrifying thoughts into punchlines that resonated with audiences who had their own hidden battles. In this sit-down interview, Sean opens up about his journey with OCD, the misconceptions about mental health, and how laughter became his therapy. Chapters:0:00 Intro2:05 Meet Sean Patton4:03 How OCD affected Sean early in his life9:42 How Sean dealt with his OCD11:08 Is psychedelics good for OCD?16:25 Misrepresentation of OCD in movies and shows20:45 Is OCD beneficial?23:15 Sean's comedic act about OCD26:47 Fear that OCD will evolve27:50 “It's Okay”29:36 OCD ebbs and flows32:13 Why Sean talks about OCD in his comedy39:21 Facing OCD fears head-on42:39 The best compliment Patrick gets46:26 Destigmatize OCD and other mental health struggles49:21 Sean's comedic act about OCD superstitions54:09 Why does OCD have to feel so real?58:05 How to find SeanStruggling with OCD? NOCD may be able to help. We specialize in Exposure and Response Prevention therapy — the gold standard in OCD care. To learn about treatment, book a free 15-minute call at https://learn.nocd.com/podcastFollow us on social media:https://www.instagram.com/treatmyocd/https://twitter.com/treatmyocdhttps://www.tiktok.com/@treatmyocd
When we try to control every thought that enters our mind, we unknowingly give it more power. The harder we fight intrusive thoughts or uncomfortable feelings, the more they seem to persist. Brenna Posey, a member of NOCD, shares how this cycle kept her stuck and how she learned — through therapy and experience — that true freedom comes from allowing thoughts to come and go without reacting to them.Learning to sit with uncertainty is one of the most challenging but life-changing skills for managing OCD. In this video, Brenna explains why resisting anxiety only fuels it and how changing your response can break the cycle. She also offers practical strategies to help you step away from compulsions and regain control —not over your thoughts, but over how you respond to them.Exposure and Response Prevention therapy helped Brenna manage her OCD, and it might do the same for you. If you want to explore treatment options with our team, book a free 15-minute call at https://learn.nocd.com/podcastFollow us on social media:https://www.instagram.com/treatmyocd/https://twitter.com/treatmyocdhttps://www.tiktok.com/@treatmyocd
Chrissy Cammarata is a pediatric psychologist who has worked in academic medical centers, and now in a private practice catering to kids, teens and young adults for the past 15 years. Her specialty focused on the overlap between anxiety and eating disorders. Her practice conducts evidence-based assessments before and during treatments to assess symptom severity and progress. Her approach to recovery involves a combination of Exposure and Response Prevention and other Cognitive Behavioral strategies, as well as Acceptance and Commitment Therapy. In this episode we talk about: ◾️ How eating disorders can be confused with anxiety and OCD ◾️ Avoidant restrictive food intake disorder (ARFID) vs. Anorexia ◾️ Facing fears & phobias in everyday life Find Chrissy here: brandywinepsych.com Find Zach here: zachwesterbeck.com/ocd-coaching @zach_westerbeck Discover the transformative power of my Concierge OCD Coaching program, where personalized support meets proven strategies to help you overcome intrusive thoughts and reclaim your life. Experience up to two one-on-one coaching sessions each week, tailored resources designed specifically for your journey, and a customized roadmap that guides you every step of the way. Plus, enjoy text support between sessions to keep you on track and motivated. This isn't just coaching; it's a life-changing opportunity to unlock your potential and embrace a calmer, happier existence. Don't wait—take the first step toward your transformation and apply now: Disclaimer: Nothing here is medical advice. Please do your own research. The information above is just for informational and educational purposes. If you require assistance with any mental health or medical issue, please contact your healthcare provider for any medical care or medical advice.
In episode 459 I chat with Nicole Morris, LMFT. Nicole is a therapist and host of the OCD Family podcast. We discuss her therapy story, her view of OCD, Inference-Based CBT (I-CBT), Exposure and Response Prevention Therapy (ERP), her podcast and favourite guests, words of hope and much more. Hope it helps. Show notes: https://theocdstories.com/episode/nicole-459 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
Today, I'm going to talk about living ERP (Exposure and Response Prevention) and how this isn't just a one-and-done thing. You can't just dip in and get out. Many people think of ERP as a specific exercise or a series of tasks that you need to complete and then you're done. But the truth is, ERP is so much more than that. It's not just a series of moments; it's really a lifestyle change. Here's a little preview of what we'll cover: What is ERP (Exposure and Response Prevention)? A practical example of living with ERP
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In episode 442 therapist Jonny Say interviews myself, Stuart, about my work as a therapist with children and adolescents. We discuss how I adapt Exposure and Response Prevention therapy (ERP) and Acceptance and Commitment Therapy (ACT) for children and teens with OCD, the other therapies I integrate, self-compassion, how parents can help their children with OCD, what I would tell my younger self, and much more. Hope it helps. Show notes: https://theocdstories.com/episode/stuart-442 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 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
In episode 441 I chat with Madina Alam. Madina is a licensed mental health therapist, and director of therapist engagement at NOCD. We discuss her therapy journey, Exposure and Response Prevention therapy (ERP) as a tool for life, explaining ERP, working for NOCD, coming up with exposure ideas in session, homework, when ERP works really well what she notices, experiences of being on the TV show the Bachelor and dealing with the pressure, and much more. Hope it helps. Show notes: https://theocdstories.com/episode/madina-441 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 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
In episode 440 I chat with Jack who has kindly agreed to share his OCD story with us. We discuss his OCD story, an early parental loss, he shares themes of harm OCD, sexual orientation OCD, and peadophile themed OCD. Jack talks about substance use to mask the pain, how numbers played a part in his compulsions, being in an abusive relationship, he mentions suicide, attending The OCD Camp, doing Acceptance & Commitment Therapy (ACT) and Exposure and Response Prevention therapy (ERP). Jack discusses secondary spikes, what else helps him, self-compassion and much more. Hope it helps. Show notes: https://theocdstories.com/episode/jack-440 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 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
Dr. Tatyana Mestechkina is a licensed clinical psychologist practicing in New York, New Jersey, and Florida. She is the founder and clinical director of Cognitive Behavioral Therapy for Better Living, which is also the approach she uses in treating patients, together with Acceptance and Commitment Therapy. She specializes in treating OCD, even in the purely obsessional subtype (Pure-O), and anxiety disorders such as generalized, social, panic, health, and phobias. Her clients are often ones that face concerns related to perfectionism, body-image, mood challenges, and postpartum/perinatal issues. In this episode we talk about: ◾️ Processing thoughts and feelings when facing compulsions ◾️ Positively changing your relationship with your brain ◾️ Reframing emotions when resisting compulsions Find Tatyana here: @ocdanxietyexpert cbtforbetterliving.com Find Zach here: zachwesterbeck.com @zach_westerbeck Use promo code: ZACH https://www.restoredminds.com/offers/SrL78mUq?coupon_code=ZACH This podcast is made possible by NOCD. NOCD offers effective, affordable, and convenient OCD therapy. NOCD therapists are trained in Exposure Response Prevention, or ERP, therapy, the gold standard treatment for OCD. With NOCD, you can do virtual, live face-to-face video sessions with one of their licensed, specialty-trained therapists, and they accept most major insurance plans. If your insurance isn't covered, mention discount code ZACH100 for a special $100 rate for the next two months. To find out more about NOCD, visit zachwesterbeck.com/virtual-ocd-therapy/ to book a free 15-minute call. Zach Westerbeck is not a licensed medical professional. Zach Westerbeck is not trained in diagnosing psychological or medical conditions. Zach Westerbeck is not a substitute for medical care or medical advice. If you require assistance with any mental health or medical issue, please contact your health care provider for any medical care or medical advice. Zach Westerbeck makes no guarantees of any kind that the information or services provided by Zach Westerbeck will improve the client's situation. This podcast should not be considered medical advice. Please seek professional assistance from a licensed professional. Zach Westerbeck (https://zachwesterbeck.com/virtual-ocd-therapy/) Virtual OCD Therapy - Zach Westerbeck I've partnered with NOCD to bring you effective, affordable and convenient OCD therapy.
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Two things are true: 1) I am unqualified to speak on ERP and OCD and 2) I am sharing my thoughts about ERP for those that still want to hear them even though I am unqualified. What is ERP (Exposure & Response Prevention)? How helpful is it for those with relationship anxiety? What are its strengths and limitations? In this episode, I'll share my thoughts on this treatment. Join me for Both Feet In - Abridged: https://www.anxiouslovecoach.com/both-feet-in-abridged If you need immediate support, write me a Wisio. I'll make you a 7-10 minute custom video response. Here: https://wisio.com/anxiouslovecoach We will be bumping up to 2 calls a month on Patreon when we hit 250 patrons — one for Q&A and one for meditation practice! Our next call is Sunday, February 11th at 8am PST/11am EST. https://patreon.com/anxiouslovecoach Who we are: Natalie Kennedy @Anxiouslovecoach Time Stamps: 5:04 What is ERP (exposure response therapy)? 9:34 The dangers of disassociating 13:00 What is polarity work? 20:00 Compassionate self-inquiry
"Now the Lord is the Spirit, and where the Spirit of the Lord is, there is freedom."~ 2 Corinthians 3:17How often do we hear that someone is "obsessed" with a new show or that they keep a clean home because they're "a little OCD"? The reality is that the burden of OCD weighs heavily on millions of people who suffer with this disorder, and on those who love them. How can we understand OCD and its effects on faith? And, even more importantly, how can we support those who are working on healing from OCD - or seek help and support ourselves?In Episode 39 of "This Whole Life," Kenna welcomes Dr. Katherine Posch, a licensed clinical psychologist specializing in Obsessive Compulsive Disorder (OCD) and anxiety disorders. They tackle the complexities of OCD and its terrible cycle. Dr. Posch emphasizes evidence-based treatments, including Exposure and Response Prevention therapy, and offers a hope-filled way forward for those struggling with religious OCD or scrupulosity. Through personal experiences and professional expertise, the episode offers hope, understanding, and practical guidance for those impacted by OCD - and for all of us who can be stuck in a place of fear and anxiety. Freedom is real and possible!Katherine Posch, Psy.D., LP is a licensed clinical psychologist at Renew Behavioral Health in Minneapolis, Minnesota. She is a graduate of the University of Texas at Austin and earned her Doctor of Psychology in Clinical Psychology from Baylor University. She completed a clinical internship at George E. Wahlen Veterans Hospital in Salt Lake City, Utah and a Postdoctoral Fellowship in PCBH/Health Psychology at Hennepin Healthcare Medical Center in Minneapolis, Minnesota. Find out more about Katherine's work at renewbehavioralmn.com.Episode 39 Show NotesThe International OCD Foundation & their provider directoryChapters:0:00: Introduction and Highs & Hards15:17: What is OCD?26:15: Treating OCD & discovering hope39:19: Approaching OCD related to faith & religious practice47:51: Supporting a loved one struggling with OCD53:45: Challenge By ChoiceThank you for listening! Visit us online at thiswholelifepodcast.com, and send us an email with your thoughts, questions, or ideas.Check us out on Instagram & FacebookInterested in more faith-filled mental health resources? Check out the Martin Center for IntegrationMusic: "You're Not Alone" by Marie Miller. Used with permission.
When OCD Paws at Your Love for Pets: A Dive into ERP & ACT In this episode, I discuss how OCD and anxiety can sometimes latch onto our pets. I talk about ... Examples of obsessions people with OCD might have regarding pets Examples of how to incorporate Exposure and Response Prevention when you have pets Examples of how to practice Acceptance and Commitment Therapy Strategies when you have pets Check out The OCD & Anxiety Recovery Blueprint HERE!
Cari Stubbs is a trauma-informed therapist with her master's in Clinical Mental Health Counseling. As a counselor, she is passionate about working with individuals and couples in their journey toward healing from trauma, depression, anxiety, life-changes, and other mental health barriers. Her desire is to empower others to unearth their authentic and whole self through curiosity, awareness, and action. Cari typically pulls from an integrated approach with traditional talk therapy, trauma-informed therapy, person-centered, and strength-based approaches as my foundations. She is trained in both EMDR and ERP (Exposure and Response Prevention therapy), the gold standard for OCD. Her husband, Trey Stubbs, was my very first guest on this show! In this episode, Cari and I discuss the concepts of EMDR, a trauma-informed therapy: what it is, what is involved, and how it can be a healing treatment for those affected by trauma. We discuss some of the complexities of validation with trauma and how we can best support others who have experienced trauma in their lives. We define some basic terms and Cari shares about what she does to take care of herself when working in a highly emotionally-charged career. For more information about Cari or if you are interested in scheduling a session with her, you can email her at cari@sojourncounselingco.com or visit her website at sojourncounselingco.com/cari. Follow me @joshkorac on TikTok, Instawgram, and YouTube for video clips, podcast previews, and more mental health content! If you are in a mental health crisis, please call 988 or go to your nearest emergency room. If you are from Colorado and are interested in scheduling a session, please reach out at sojourncounselingco.com/josh or josh@sojourncounselingco.com. New episodes every Wednesday (with exceptions!) while the show is in season!
Think about this: have you ever tried to find peace and meaning through your spiritual practices, like meditation or prayer, only to have nagging, bothersome thoughts and habits that just won't leave you alone? This is the intersection of OCD and spirituality, and it's a complex place where your quest for spiritual connection and the constant demands of OCD come together. In today's episode of The OCD Whisperer Podcast, I'm joined by Lucy Grantz. Lucy is a licensed marriage and family therapist who specializes in therapy for teens and adults struggling with OCD. During our conversation, we discussed the intersection of OCD and spirituality. We share personal experiences of how spiritual practices can become compulsions for individuals with OCD, such as over-reliance on tarot card readings or healers. We emphasize the importance of distinguishing between engaging in spiritual practices for connection and joy versus using them as compulsions to alleviate anxiety. Our conversation also touches on the rigidity of OCD and the need for grounding. In This Episode [01:17] The relationship between OCD and spiritual practices [04:09] Compulsive behaviors related to tarot cards and astrology [07:09] The impact of OCD on manifestation and law of attraction [08:03] How spiritual practices can become compulsions for individuals with OCD [08:57] How OCD can affect the practice of meditation [09:46] Thoughts as manifestations [17:29] Recognizing the pattern of OCD [21:11] Finding flexibility in spiritual practices [22:43] Compulsions and over-reliance on spiritual practices [23:38] Compulsive over-processing and fixation on the problem [24:11] Finding a balance between helpful practices and compulsions Notable Quotes [03:11] “I don't want to make it sound like anything I think is bad about any of these spiritual practices, but when OCD latches on, it can start to be compulsive, and that's what we want to avoid, but that's what happened to me for a long time trying to solve my own OCD before I knew I had OCD.” - Lucy [18:54] “With the law of attraction, that whole thing was like, well, I'm not manifesting what I want. So what's wrong with how I'm thinking about it? Or like I have this one bad thought and what will that mean for what I manifest?” - Lucy [24:53] “I think it's not black and white, you know. I think with this whole thing we're trying to get back to that life is gray. OCD wants it to be one or the other but there are no rights and wrongs. Everything can be helpful and it's about us finding our own path and who we really are and our own grounding versus being in a compulsion.” - Lucy Our Guest Lucy Grantz is a Licensed Marriage and Family Therapist in Minnesota, specializing in helping teens and adults overcome Obsessive Compulsive Disorder and Anxiety. Drawing from her own experience with OCD, she is dedicated to supporting others through their struggles. Lucy specializes in mental compulsions, using Inference-Based Cognitive Behavioral Therapy, and collaborates with renowned expert Frederick Aardema. Her background in Buddhism and mindfulness adds a unique dimension to her therapy, and she is well-versed in Exposure and Response Prevention as well as rumination-focused CBT. Resources & Links Kristina Orlova, LMFT https://www.instagram.com/ocdwhisperer/ https://www.youtube.com/c/OCDWhispererChannel https://www.korresults.com/ https://www.onlineocdacademy.com Lucy Grantz https://www.linkedin.com/in/lucy-grantz-80110626/ https://www.pivotpsychmn.com/about **Disclaimer** Please note, while our host is a licensed marriage and family therapist specializing in OCD and anxiety disorders in the state of California, this podcast is for educational purposes only and should not be considered a substitute for therapy. Stay tuned for bi-weekly episodes filled with valuable insights and tips for managing OCD and anxiety. And remember, keep going in the meantime. See you in the next episode!
The Essential Oil Revolution –– Aromatherapy, DIY, and Healthy Living w/ Samantha Lee Wright
Today we are happy to have Cristina Chua, MSW on The Essential Oil Revolution. Cristina is an expert in helping people reclaim their life from OCD and anxiety. Her technique is grounded in trauma and neuroscience informed care, emotional regulation and mindful self compassion. She loves incorporating aromatherapy into her personal practice and work with her patients. What You Will Learn: What inspired Cristina to start working as a therapist and coach for people with OCD? The problems with “gold standard” treatments, especially when they don't work. What is OCD and how does it manifest? The different types of OCD and what various themes of them are. What goes on in the brain of someone with OCD and how the amygdala hijacks one's executive functioning. What are the Havening Techniques and how Cristina uses them in her work with OCD. How Cristina incorporates aromatherapy into her work with OCD clients. The difference between training the brain to tolerate uncertainty and using coping strategies to live life with less fear. How Cristina's approach is different from the “gold standard” treatment for OCD, ERP (Exposure and Response Prevention) and how her approach with this new emerging tool is viewed by conventional psychiatry. The importance of the emerging science on the Havening Technique and essential oils. Closing questions: What Cristina does for daily self-care and what she feels we should ditch and replace with instead to have a more nourishing or healthier life. Essential Oil Hacks: How Cristina incorporates essential oils in her personal life and for everyday use. Cristina Chua, MSW Bio: In addition to being a coach, Cristina is a Licensed Clinical Social Worker who earned her MSW from Silberman School of Social Work and a BA in International Relations from Brown University. She has worked in family counseling, as a trauma therapist, as a social worker in a youth empowerment program for immigrant youth, and as a trainer. Cristina brings her knowledge of Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) into her coaching work. She is also a Certified Havening Techniques® Practitioner. This is a gentle, neuroscience-based approach that helps people heal from trauma, anxiety, and stressful life circumstances. Furthermore, Cristina is a mindfulness and yin yoga practitioner who has been inspired by the teachings of Tenzin Wangyal Rinpoche, Thich Nhat Hahn, and Jon Kabit-Zinn (the founder of Mindfulness Based Stress Reduction-MBSR). As a dancer, Cristina has continued to be interested in how the creative process can be used for transformation and healing. She studied voice, breathing and the Alexander Technique with the wonderful Jean McClelland. She enjoys combining her knowledge of mindfulness techniques and the creative process to support her clients in getting unblocked and into the flow of their lives. Where to Find Cristina and Learn More About Her Work: Cristina's Website Listen to Cristina Explain “What is a Compulsion?" More Information and the Science of the Havening Technique My Post on the Science of the Havening Technique An Introduction to the Havening Technique Havening website CPR for the Amygdala Handout Healing in Your Hands Book Videos on the Havening Technique Intro to the Havening Touch Intro to CPR for the Amygdala How the Amygdala Designs our Days Daily Resilient Brain Care Program Learn more about your ad choices. Visit megaphone.fm/adchoices
Join host, Nicole Morris, LMFT and Mental Health Correspondent, as she welcomes back Psychiatrist and OCD Specialist, Dr. Ryan Vidrine, MD. for Part II of our medication conversation. Ryan graciously shares his thoughts on some hot topics, including differential diagnostic considerations for psychosis and other mental health disorders, as well as sharing the emerging research around psychedelics in the treatment of different mental health disorders. Additionally, Nicole and Ryan share in a discussion around other treatments that quench for OCD, including Inference-Based CBT and Exposure and Response Prevention. So join us for Part II, fam, because there's always a seat at the table for you.
Every time I tell Joanna Hardis how much her book, Just Do Nothing: A Paradoxical Guide to Getting Out of Your Way, has impacted me, her jaw drops. She truly can't seem to believe how deeply her unique approach and perspective to getting out of one's way is resonating with readers.Join us for this episode of the Write the Damn Book Already podcast as Joanna shares her incredible journey from self-doubt to powerful author. Discover how her unique perspective on overcoming obstacles can inspire you to write your own damn book. Plus, learn from her experiences as a therapist-turned-author, and find out how she tackles the challenges of writing and marketing with wisdom and insight that will resonate with every aspiring writer. ABOUT JOANNA Joanna Hardis, LISW-S, is a cognitive behavioral therapist based in Cleveland, Ohio. Committed to using evidence-based treatments, Joanna helps people get “unstuck.” Through her private practice as well as virtual workshops on distress tolerance, Joanna shows people how to respond to being uncomfortable by giving them the knowledge and tools they need to move forward. She may drop a favorite Yiddish word (or two) during a session, and her goal is always for her clients not to need her anymore. She has been quoted in The Today Show, Self, and Well and Good magazines. She received her B.S. at Cornell University and her M.S.S.A. at Case Western Reserve University. She earned her certification from the Cleveland Center for Cognitive Therapy in 2000, SPACE (Supportive Counseling for Anxious Childhood Emotions) Certification in 2016, and she's one of a handful of clinicians with the highest training in Exposure and Response Prevention for OCD in Northeast Ohio. In her spare time, Joanna enjoys powerlifting, doing anything with her three kids, traveling, and getting sucked into bad Reality TV. WHAT JOANNA'S READINGOutline by Rachel CuskThe Guest by Emma Cline CONNECT WITH JOANNAInstagram: instagram.com/joannahardisWebsite: joannahardis.comBook: Just Do Nothing: A Paradoxical Guide to Getting Out of Your Way RESOURCES MENTIONEDBook Outlines Made Simple: A Pay-What-You-Can WorkshopThe Anxious Truth Podcast episode Joanna recently appeared on (Episode 272)Thanks so much for listening! If you enjoyed this episode, don't forget to subscribe and leave a review!To see all the ways we can work together to get your book written, published, and launched, visit publishaprofitablebook.com/work-with-elizabeth
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On this week's episode, we are joined by licensed marriage and family therapist Lauren Rosen, who specializes in OCD, anxiety and eating disorders. Lauren shares her personal experience with OCD and how it led her to pursue a career helping others with the disorder. She discusses various manifestations of OCD beyond the stereotypical cleanliness obsession and how it impacts people's daily lives through mental compulsions, reassurance seeking and avoidance. Lauren provides advice on how friends and family can better support those with OCD by validating their feelings rather than trying to fix their uncertainty. More about Lauren:Lauren Rosen, LMFT, is a psychotherapist and the director of The Center for the Obsessive Mind, an outpatient clinic serving individuals in California, Florida, Utah, Nevada and Oregon. Lauren specializes in treating OCD, Anxiety Disorders & Eating Disorders and supports people using Mindfulness-Based Cognitive Behavioral Therapy, Exposure & Response Prevention and Acceptance and Commitment Therapy. Lauren has her BA and MA in Psychology from UCLA and Antioch university. She trained at the OCD Center of LA and is a certified Intuitive Eating Counselor. In addition to her work as a therapist, Lauren co-hosts the Purely OCD Podcast and does social media advocacy.Connect with Lauren!Instagram: @theobsessivemindWebsite: https://theobsessivemind.com/Podcast: https://purelyocd.com/Connect with Brianna!Instagram: @mombossinaustinLinkedIn: linkedin.com/in/briannademikeFollow the Podcast on Instagram: @badassbasicbitchLove the podcast? We would love if you would leave a review!Thank you to this week's sponsor, Factor! Head to factormeals.com/bbb50 and use code bbb50 to get 50% off.
It's my pleasure to bring on Alex Bishop, a registered counsellor and IFS (Internal Family Systems) therapist, onto the podcast today. Alex has struggled with Relationship OCD/Relationship Anxiety, and disorganized attachment, and can speak deeply on the experience of pushing a partner away. In this episode, we discuss his story with overcoming ROCD, how parts work relates to relationship anxiety, the IFS model for overcoming doubts, fears, and "the ick" associated with ROCD, and some of the limitations of ERP therapy for overcoming ROCD specifically. If you have been feeling stuck, this episode will be SO validating for you, and can help you get on the path to free yourself from the overwhelming shame and anxiety! Find Alex over at @forloveweheal on Instagram. Links: PATREON CALL w/ live Q+A: August 3rd at 10AM PST https://www.patreon.com/AnxiousLoveCoach Time Stamps: 3:00 - Alex's experience with ROCD 16:42 - The importance of knowing your patterns when you have relationship anxiety 19:00 - How Alex used parts work/CBT 23:00 - How psychedelics can help with relationship anxiety 26:12 - Creating aliveness for yourself in your relationship 31:00 -Therapeutic routes to help with ROCD 42:50 - The causes of attraction obsessions 56:10 - Having different experiences that we label the same thing 57:50 - The limitation of ERP: Exposure and Response Prevention
In this episode, I talk about how and why Exposure and Response Prevention works. I discuss.. - an overview of Exposure and Response Prevention (ERP) - the Habituation model - the Inhibitory Learning model - enhancing the effectiveness of ERP - and so much more Head to my website at www.jennaoverbaughlpc.com to sign up for my free e-mail newsletter, grab your free "Imagine Your Recovered Life" PDF, and download your free “5 Must Know Strategies for Managing Anxiety and Intrusive Thoughts” video + access expertly crafted masterclasses just for you. Course and more coming soon! Remember: this podcast is for informational purposes only and may not be the best fit for you and your personal situation. It shall not be construed as mental health or medical advice. The information and education provided here is not intended or implied to supplement or replace professional advice of your own professional mental health or medical treatment, advice, and/or diagnosis. Always check with your own physician or medical or mental health professional before trying or implementing any information read here. Jenna Overbaugh, LPC
In this episode, I talk about the ways in which OCD and anxiety can make us misinterpret our thoughts as being significant. I discuss.. - specific ways we can misinterpret thoughts in OCD and anxiety - common cognitive distortions in OCD and anxiety - how to practice mindfulness, acceptance, and general Exposure and Response Prevention related to these issues - overcoming fear and uncertainty - and so much more Head to my website at www.jennaoverbaughlpc.com to sign up for my free e-mail newsletter, grab your free "Imagine Your Recovered Life" PDF, and download your free “5 Must Know Strategies for Managing Anxiety and Intrusive Thoughts” video + access expertly crafted masterclasses just for you. Course and more coming soon! Remember: this podcast is for informational purposes only and may not be the best fit for you and your personal situation. It shall not be construed as mental health or medical advice. The information and education provided here is not intended or implied to supplement or replace professional advice of your own professional mental health or medical treatment, advice, and/or diagnosis. Always check with your own physician or medical or mental health professional before trying or implementing any information read here. Jenna Overbaugh, LPC
In this episode, I talk about the difference between courage and confidence, as well as how to apply it to Exposure and Response Prevention for OCD and anxiety. I discuss.. - basic definitions of courage and confidence and highlights of their distinctions - Exposure and Response Prevention and how courage + confidence relate to facing fears - how to balance courage and confidence in OCD and anxiety recovery - overcoming challenges and building resilience - and so much more Head to my website at www.jennaoverbaughlpc.com to sign up for my free e-mail newsletter, grab your free "Imagine Your Recovered Life" PDF, and download your free “5 Must Know Strategies for Managing Anxiety and Intrusive Thoughts” video + access expertly crafted masterclasses just for you. Course and more coming soon! Remember: this podcast is for informational purposes only and may not be the best fit for you and your personal situation. It shall not be construed as mental health or medical advice. The information and education provided here is not intended or implied to supplement or replace professional advice of your own professional mental health or medical treatment, advice, and/or diagnosis. Always check with your own physician or medical or mental health professional before trying or implementing any information read here. Jenna Overbaugh, LPC
In episode 385 I chat with Madelaine Sanfilippo. Madelaine is a licensed Marriage and Family therapist in the state of California and Head of Groups at The Center for Anxiety and OCD. We discuss her OCD story, what is a group, how does group therapy differ from individual therapy, the benefits of group therapy, when is group therapy right for you, the flow and process of group therapy, Exposure and Response Prevention therapy (ERP) within a group therapy setting, who wouldn't be suitable for group therapy, and much more. Hope it helps. Show notes: https://theocdstories.com/episode/madelaine-385 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 Thanks to all our patrons for supporting our work. This podcast episode is available as a video recording on our Patreon. To sign up to our Patreon and to check out the other benefits you'll receive as a Patron, visit: https://www.patreon.com/theocdstoriespodcast
Welcome back, everybody. Thank you for joining me again this week. I'm actually really excited to dive into another topic that I really felt was important that we address. For those of you who are new, this actually might be a very steep learning curve because we are specifically talking about a treatment skill or a tool that we commonly use in CBT (Cognitive Behavioral Therapy) and even more specifically, Exposure and Response Prevention. And that is the use of imaginals or what we otherwise call scripts. Some people also use flooding. We are going to talk about this because there are a couple of reasons. Number one, for those of you who don't know, I have an online course called ERP School. In ERP School, it's for people with OCD, and we talk about how to really get an ERP plan for yourself. It's not therapy; it's a course that I created for those who don't have access to therapy or are not yet ready to dive into therapy, where they can really learn how to understand the cycle of OCD, how to get themselves out of it, and gives you a bunch of skills that you can go and try. Very commonly, we have questions about how to use imaginals and scripts, when to use them, how often to use them, when to stop using them, when they become compulsive and so forth. In addition to that, as many of you may not know, I have nine highly skilled licensed therapists who work for me in the state of California and Arizona, where we treat face-to-face clients. We're actually in Los Angeles. We treat patients with anxiety disorders. I also notice that during my supervision when I'm with my staff, they have questions about how to use imaginals and scripts with the specific clients. Instead of just teaching them and teaching my students, I thought this was another wonderful opportunity to help teach you as well how to use imaginals and why some people misuse imaginals or how they misuse it. I think even in the OCD community, there has been a little bit of a bad rap on using scripts and imaginals, and I have found using scripts and imaginals to be one of the most helpful tools for clients and give them really great success with their anxiety and uncertainty and their intrusive thoughts. Here we are today, it is again a start of another very short series. This is just a three-week series, talking about different ways we can approach imaginals and scripts and how you can use it to help manage your intrusive thoughts, and how you can use it to reduce your compulsions. It is going to be three weeks, as I said. Today, we are starting off with the amazing Krista Reed. She's been on the show before and she was actually the one who inspired this after we did the last episode together. She said, “I would love to talk more about imaginals and scripts.” I was like, “Actually, I would too, and I actually would love to get some different perspectives.” Today, we're talking with Krista Reed. Next week, we have the amazing Shala Nicely. You guys already know about Shala Nicely. I'm so happy to have her very individual approach, which I use all the time as well. And then finally, we have Dr. Jon Grayson coming in, talking about acceptance with imaginals and scripts. He does a lot of work with imaginals and scripts using acceptance, and I wanted to make sure we rounded it out with his perspective. One thing I want you to think about as we move into this series or three-part episode of the podcast is these are approaches that you should try and experiment with and take what you need. I have found that some scripts work really well with some clients and others don't work so well with other clients. I have found that some scripts do really well with one specific obsession, and that doesn't do a lot of impact on another obsession that they may have. I want you just to be curious and open and be ready to learn and take what works for you because I think all of these approaches are incredibly powerful. Again, in ERP School, we have specific training on how to do three different types of scripts. One is an uncertainty script, one is a worst-case scenario script, and the last is an acceptance script. If you're really wanting to learn a very structured way of doing these, head on over to CBTSchool.com and you can sign up for ERP School there. But I hope this gets you familiar with it and helps really answer any questions that you may have. Alright, let's get over to the show. Here is Krista Reed. Kimberley: Welcome back, Krista Reed. I am so happy to have you back on the show. Krista: Thank you. I am elated to be able to chat with you again. This is going to be great. Kimberley: Yeah. The cool thing is you are the inspiration for this series. Krista: Which is so flattering. Thank you. IMAGINAL OR SCRIPT? Kimberley: After our last episode, Krista and I were having a whole conversation and you were saying how much you love this topic. I was like, “Light bulb, this is what we need to do,” because I think the beautiful piece of this is there are different ways in which you can do imaginals, and I wanted to have some people come on and just share how they're doing it. You can compare and contrast and see what works for you. That being said, number one, do you call it an imaginal, do you call it a script, do you think they're the same thing, or do you consider them different? Krista: I do consider them differently because when I think about script, I mean, just the word script is it's writing, it's handwriting in my opinion. I mean, scripture is spoken. That's something a little bit different, but scripting is writing. When I think of an imaginal, that is your imagination. I know that I already shared with you how much I love imaginals because in reality, humans communicate through stories. When we can, using our own imagination, create a story to combat something as challenging as OCD, what a powerful concept. That's exactly why I just simply love imaginals. Kimberley: I can feel it and I do too. There's such an important piece of ERP or OCD recovery or anxiety recovery where it fills in some gaps, right? Krista: Yes, because imaginals, the whole point, as we know, it's to imagine the feared object or situation. It could evoke distress, anxiety, disgust. Yet, by us telling those stories, we're poking the bear of OCD. We're getting to some of that nitty gritty. Of course, as we know that, not every obsession we can have a real-life or an in vivo exposure. We just simply can't because of the laws of science, or let's be real, it might be illegal. But imaginals are also nice for some people that the real-life exposure maybe is too intense and they need a little bit of a warmup or a buy-in to be able to do the in vivo exposure. Imaginal, man, I freaking love them. They're great. Kimberley: They're the bomb. Krista: They really are. HOW TO DO IMAGINALS FOR OCD Kimberley: You inspired this. You had said, “I love to walk your listeners through how to do them effectively. I think I remember you saying, but correct me if I'm wrong, that you had seen some people do them very incorrectly. That you were very passionate because of the fact that some people weren't being trained well in this. Is that true or did I get that wrong? Krista: No, you absolutely got it right. Correct and incorrect, I think maybe that is opinion. I'll say that in my way, I don't do it that way. That's a preference. But this is an inception. We're not putting stories into our clients' minds. The OCD is putting these stories into our clients' minds. If you already have a written-out idea of a script, of like fill in the blanks, you are working on some kind of inception, in my opinion. You are saying that this is how your story is supposed to be. That's so silly. I'm not going to tell you how your story is supposed to be. I don't know how your imagination works. When we think of just imagination, there's so many different levels of imagination. Let's say for instance, if I have somebody who comes into my office who is by trade a creative writer, that imaginal is probably going to be very descriptive, have a lot of heavy adjectives. Just the way it's going to be put together is going to be probably like an art in itself because this is what that person does. If you have somebody who comes in and creativity is not something that is part of a personality trait, and then I have a written fill-in-the-blank thing for them, it's not going to be authentic for their experience. They're going to potentially want to do what I, the therapist, might want them to do. It's not for me to decide how creative or how deep that person is to go. They need to recognize within themselves, is this the most challenging? Is this the best way that you could actually describe that situation? If that answer is yes, it's my job as a therapist to just say okay. Kimberley: How would one know if it's the most descriptive they could be? Is it by just listening to what OCD has to say and letting OCD write the story, but not in a compulsive way? Share with me your thoughts. Krista: I think that that's almost like a double-edged sword because that of itself can almost go meta. How do I know that my story is intense enough? Well, on the surface we can say, “Is it a hard thing to say.” They might say yes, and then we can work through. But if I'm really assessing like, “Is it hard enough, is it hard enough,” and almost begging for them to provide some type of self-reassurance, they might get stuck in that cycle of, is this good enough? Is this good enough? Can it be even more challenging? Another thing I love about imaginals is the limit doesn't exist, because the limit is just however far your imagination can take you. Let's say that I have a session with a client today and they're creating an imaginal. I'm just going to give a totally random obsession. Maybe their obsession is, “I am afraid that I'm going to murder my husband in his sleep,” harm OCD type stuff, pretty common stuff that we do with imaginals. They do the imaginal and they're able in session to work through it. It sounds like it was good. In the session, what they provided was satisfactory to treatment. And then they come back and say, “I got bored with the story,” which a lot of people think that that's a bad thing. That's actually a good thing because that's letting you know that you're not in OCD's control of that feared response and you're actually doing the work. However, they might still have the obsession. I was like, “Okay, so you were able to work through this habituate or get bored of that. Now, let's create another imaginal with this obsession.” Because it's all imagination, the stories, you can create as many as you possibly can or as you possibly want to. I'm actually going to give you a quote. He's a current professor right now at Harvard. He is a professor of Cognitive and Educational Studies. If you look this guy up, his name is Dr. Howard Gardner—his work is brilliant. He has this fantastic quote that I think is just a bomb when it comes to imaginal stuff. His quote is: “Stories constitute the single most powerful weapon in a leader's arsenal.” Think about that. What a powerful statement that is. Isn't that just fantastic? Because we can hear that as the stories OCD tells us as being hard. Okay, cool story, bro, that is your weapon OCD, but guess what? I'm smarter than you and I brought a way bigger gun and this gun isn't imaginal and I'm going to go ahead and one up you. If I come back that next week in my therapist's office and I'm able to get bored with that, I can make a bigger gun. Kimberley: I love that. It's true, isn't it? I often will say, “That's a good story. Let me show you what I've got.” It is so powerful. Oh my gosh. Let's actually do it. Can you walk us through how you would do an imaginal? Krista: This is actually something that I created on my own taken from just multiple trainings and ERP learning about imaginals, because one of the things that I was realizing that a lot of clients were really struggling with is almost over-preparing just to do the imaginal. Sometimes they would write out the imaginal and then we would work through that. But what I was finding is sometimes clients were almost too fixated on words, reading it right, being perfect, that they were almost missing out on the fact that these are supposed to be movies in our mind. Kimberley: Yeah. They intellectualize it. Krista: Exactly. I created a super simple format. I mean, we really don't have a lot of setup here. It's basically along the lines of the Five Ws. What is your obsession and what is your compulsion? Who is going to be in your story? Who is involved? Where is your story taking place? When is your story taking place? And when is already one of those that's already set because I tell people we can't do anything in the past; the past has already existed. You really need to be as present as possible. But the thing is that you can also think. For instance, if my obsession is I'm going to murder my husband in his sleep tonight, part of that might be tonight, but part of that might also be, what is going to be my consequence? What is that bad thing that's going to happen? Because maybe the bad thing isn't necessarily right now. Maybe that bad thing is going to be I'm not going to have a relationship with my children and what if they have grandchildren? Or what if I'm going to go to hell? That might not necessarily exist in the here and now, but you're able to incorporate that in the story. When is an interesting thing, but again, never in the past, needs to start in the present, and then move forward. And then also, I ask how. How is where I want people to be as descriptive as possible. For instance, if I say, and this is going to sound gritty, you're fearful that you're going to murder your husband tonight. Be specific. How are you going to murder your husband? Because that's one of the things that OCD might want us to do. Maybe it is just hard enough to say, “I'm going to murder my husband.” But again, we're packing an arsenal here. Do you want to just say that? Because I can almost guarantee you OCD is already telling you multiple different ways that it might happen. Which one of those seems like it might be the hardest? Well, the hardest one for me is smothering my husband with a pillow. Okay, that's going to be it. That's literally my setup. That's literally my setup, is I say that. Actually, I have one more thing that I have to include. I have all that as a setup and then I say, “Okay, at the very end, you are going to say this line, and it's, ‘All of this happened because I did not do the compulsion.'” If I were going along with the story of I murdered my husband, I suffocated him with a pillow, and in my mind, the worst thing to happen is I don't have a relationship with my kids and grandchildren, and the compulsion might be to pray—I'll just throw that out—the last line might be, “And now, I don't have a relationship with my children or grandchildren all because I decided to not pray when the thought of murdering my husband came up in my mind.” That is the entire setup. And then I have my clients get their phones out and push record. They don't have to do a video, just an audio is perfectly fine. I know some therapists that'll do it just once, but I actually do it over and over again. Sometimes it could be a five-minute recording, it could be a 20-minute recording, it could be a 40-minute recording. The reason for that being is if we stop just after one, we might be creating accommodation for that client, because I want my clients to be in that experience. That first time they tell that story after that very brief setup, they're still piecing together the story. Honestly, it's really not until about the third or fourth time that they've repeated that exact same story that they're really in it. I am just there and every time they finish—I'll know they finish because they say, “And this happened all because da da da da da”—I say, “Okay, what's your number?” That means what's your SUDS? And they tell me they're SUDS. I might make a little bit, very, very minimal recommendations. For instance, if they say, “I murdered my husband,” I say, “Okay, so this time I want you to tell me how you murdered your husband.” Again, they say the exact same story, closing their eyes all over again, this time adding in the little bit that I asked for. We do that over and over and over again until we reach 50% habituation. Then they stop recording. That is what they use throughout the week as their homework, and you can add it in so many different ways. Again, keeping along with this obsession of “I'm afraid I'm going to kill my husband tonight,” I want you to listen to that with, as you probably have heard this as well, just one AirPod in, earbud, whatever, keep your other ear outside to the world. This is its way to talk back to OCD. Just something along the lines of that. I want you to the “while you're getting ready for bed.” Because if the fear exists at night and your compulsions exist at night, I want you to listen to that story before you go to bed. It's already on your mind. You're already in it, you're already poking the bear of OCD. It's like, “Okay, OCD, you're going to tell me I'm going to kill my husband tonight? Well, I'm going to hear a story about me killing my husband tonight.” Guess what? The bad thing's going to happen over and over and over again. It's such a powerful, powerful, powerful thing. Because it's recorded, you can literally listen to it in your car. You can listen to it on a plane. You can listen to it in a waiting room. I mean, there's no limit. Kimberley: It's funny because, for those of you who are on social media, there was this really big trend not long ago where they're like what they think I'm listening to versus what I'm actually listening to, and they have this audio of like, “And then she stabbed her with the knife.” It's exactly that. Everyone thinks you're just listening to Britney Spears, but you're listening to your exposure and it's so effective. It's so, so effective. I love this. Okay, let's do it again because I want this to be as powerful as possible. You did a harm exposure. In other episodes, we've done a relationship one, we've done a pedophile one. Let's pick another one. Do you have any ideas? Krista: What about scrupulosity? Kimberley: I was just going to say, what about scrupulosity? Krista: That one is such a common one for imaginals. We hear it very frequently, “I'm going to go to hell,” or even thinking about different other religions like, “Maybe I'm not going to be reincarnated into something that has meaning,” or “It's going to be a bad thing. Maybe I'm insulting my ancestors,” or just whatever that might be. Let's say the obsession is—I already mentioned praying—maybe if I don't read the Bible correctly, I'm going to go to hell. I don't know. Something along the lines of that. If that's their obsession, chances are, there's probably somebody that maybe they have a time where they're reading the Bible or maybe that we have to add in an in vivo where they're going to be reading or something like that. A setup could potentially be, what is your obsession? “I'm afraid that any time I read my Bible, I'm not reading it correctly and I'm going to go to hell.” What is your compulsion? “Well, my compulsion is I read it over and over and over again and I reassure myself that I understand it, I'm reading it correctly.” Who's going to be in your story? This one you might hear just, “Oh, it's just me.” Really, OCD doesn't necessarily care too much if anybody else is in this story. Where are you? “I'm in my living room. It's nighttime. That's when I read my Bible.” When is this taking place? “Oh, we can do it tonight.” Let's say it's tonight. Interestingly enough, when you have stuff that's going to go to hell, that means, well, how are you getting to hell to begin with? Because that's not just something that can happen. Sometimes in these imaginals, the person has to die in order to get there, or they have to create some type of fantastical way of them getting to hell. I actually had a situation, this was several years ago, where the person was like, “Well, death doesn't scare me, but going to hell scares me,” because, in some cultures and some religions, it's believed that there are demons living amongst us and so forth. “It's really scary to think about, what if a demon approaches me and takes me immediately to hell and I don't get to say goodbye to my family, my family doesn't know.” Just even like that thought. We were able to incorporate something very similar to that. Just to make up an imaginal on the spot, it could be, I'm reading my Bible. I'm in my living room, I'm reading my Bible, and the thought pops up in my brain of, did you read that last verse correctly? I decide to just move on and not worry about reading my Bible correctly. Well then, all of a sudden, I get a knock at the door and there's these strange men that I've never seen in my life, and they tell me that they're all demons, and that because I didn't review the Bible correctly, I'm going to go to hell. I would go on and on and probably describe a little bit more about my family not missing me, I don't get to see my kids grow up, I don't get to experience life, the travel, and the stuff that's really important to me, incorporate some of those values. I don't get to live my value-based life. And then at the very end, I was summoned and taken to hell by demons, all because I had the thought of reading my bible correctly and I decided not to.” Kimberley: I love it, and I love what I will point out. I think you use the same model as me. We use a lot of “I” statements like “I did this and I did that, and then this happened and then I died,” and so forth. The other thing that we do is always have it in present tense. Instead of going, “And then this happens, and then that happens,” you're saying as if it's happening. Krista: Yeah. Because you want it to feel real to the person. In all honesty, and I wonder what your experience has been, I find some of the most difficult people to do imaginals with our children. Even though you would think, “Oh, they're so imaginative anyways,” one of the biggest things I really have to remind kids is, I want you to be literally imagining yourself in that moment. Again, I see this with kids more than adults, but I think it just depends on context and perspective. We'll say, “Well, I know that I'm in my living room,” or “I know that I'm in your office, so this isn't actually happening to me in this moment.” You almost have to really work them up and figure out, what's the barrier here? What are you resisting? Kimberley: That's a good question. I would say 10 to 20% of clients of mine will report, “I don't feel anything.” I'll do a Q and A at the end of this series with common questions, but I'm curious to know what your response is to a client who reads like, “I kill my baby,” or “I hurt my mom,” or “I go to hell,” or “I cheat on my husband,” or whatever it is, but it doesn't land. What are your thoughts on what to do then? Krista: A couple of things pop up. One, it makes me wonder what mental compulsions they're doing. And then it also makes me wonder, are we going in the right direction with the story? Because again, like I mentioned before, if a client comes back and they've habituated to one thing, but they're still having the obsession, well, guess what? We're just telling stories. Because the OCD narrative is typically not just laser-focused—I mean, it can be laser-focused, but usually, it has branches—you can pick and choose. I'm going to go ahead and guarantee, that person who is terrified of killing their husband ensure they're not going to see their grandchildren and children. I'm going to go ahead and waiver that there's probably other things that they're afraid of missing. Kimberley: Yes. That's what I find too, is maybe we haven't gotten to the actual consequence that bothers them. I know when I've written these for myself, we tend to fall into normal traps of subtypes, like the fear that you'll harm somebody or so forth. But often clients will reveal like, “I'm actually not so afraid that I'll harm somebody. I'm really afraid of what my colleagues and family would think of me if I did.” So, we have to include that. Or “I'm afraid of having to make the call to my mom if I did the one thing.” I think that that's a really important piece to it, is to really double down on the consequence. Do you agree? Krista: Oh, I agree a hundred percent. You got to figure out what is that core fear. What are you really, really trying to avoid? With harming somebody, is it the consequences that might happen afterwards? Is it the feeling of potentially snapping or losing control? Or is it just knowing that you just flat out, took the life of somebody and that that was something that you were capable of? I mean, there's so many different themes, looking at what does that feared self like, what does that look like, and maybe we didn't hit it last time. Kimberley: Right. Krista: I know this is going to sound silly and I tell my clients this every once in a while, is I'm not a mind reader. What I'm asking you, is that the most challenging you can go and you're telling me yes, I'm going to trust you. I tell them, if you are not pushing yourself in therapy to where you can grow, I'm still going to go to bed home and sleep tonight just fine. But I want you to also go home and go to bed and sleep just fine. But if you are not pushing yourself, because we know sleep gets affected super bad, not just sleep, but other areas, you're probably going to struggle and you might even come back next week with a little bit more guilt or even some shame. I don't want anybody to have that. I want people to win. I want people to do well in this. I know this stuff is scary, but I'm going to quote somebody. You might know her. Her name is Kimberley Quinlan. She says, “It's a beautiful day to do hard things.” I like to quote her in my practice every once in a while. Kimberley: I love her. Yes, I agree with this. The way you explained it is so beautiful and it's logical the way you're explaining it too. It makes sense. I have one more question for you. Recently, I was doing some imaginals with a client and they were very embarrassed about the content of their thoughts. Ashamed and guilty, and horrified by their thoughts. I could see that they were having a hard time, so I gave them a little inch and I went first. I was like, “Alright, I'm going to make an assumption about what yours is just to break the ice.” They were like, “Oh yeah, that's exactly what it is.” There was a relief on their face in that I had covered the bases. We did all of the imaginal and we recorded it and it was all set. And then at the end I said, “Is there anything that we didn't include?” They reported, “Yeah, my OCD actually uses much more graphic words than what you use.” I think what was so interesting to me in that moment was, okay, I did them the favor by starting the conversation, but I think they felt that that's as far as we could go. How far do you go? Krista: As far as we need. Kimberley: Tell me what that means. Krista: Like I mentioned before, the limit does not exist and I mean, the limit does not exist. This is going to sound so silly. I want you to be like a young Stephen King before he wrote his first novel and push it. Push it and then go there. Guess what? If that novel just doesn't quite hit it, write another one, and then another one, and let's see how far you can go. Because OCD is essentially a disorder of the imagination, and you get to take back your imagination by creating the stories that OCD is telling us and twisting it. I mean, what an amazing and powerful thing to be able to do. I'm sure you're the same in that you know that there's a lot of specialists that don't believe in imaginals, don't like imaginals, especially when it comes to issues with pedophilia OCD. I think we also need to not remind our clients because that would be reassurance, but to tell these specialists, we're not putting anything into our client's heads that aren't there to begin with. Just like you said, if your client is thinking like real sick, nasty core, whatever, guess what? We're going to be going there. Are you cutting off the heads of babies in your head? Well, we're going to be talking about stories where you're cutting off the heads of babies. If that's what's going on, we're going to go there. Kimberley: What's really interesting, and this was the example, is we were talking about genitals and sexual organs and so forth. We're using the politically correct term for them in the imaginal. Great. Such a great exposure. Vagina and penis, great. Until again, they were like, “But my OCD uses much more graphic words for them.” I'm like, “Well, we need to include those words.” Would you agree your imaginals don't need to be PC? Krista: I hope my clients watch this, and matter of fact, I'm going to send this to them, just to be like, no, no. Krista's imaginals with her clients. Well, not my imaginals. Imaginals that are with my clients. Woah, sometimes I'm saying bye to my client. I'm like, “I think I need a shower.” Kimberley: Again, when people say they don't like imaginals or they think that it's not a good practice, I feel like, like you said, if OCD is going to come up with it, it gives an opportunity to empower them, to get ahead of the game, to go there before it gets there so that you can go, “Okay, I can handle it.” I would often say to my clients, “Let's go as far as we can go, as far as you can go, so that you know that there's nothing it can come up with that you can't handle.” Krista: I think that where it gets even more complex is when we're hitting some of the taboo stuff. Not only pedophilia, but something like right now that I'm seeing a lot more of in my office is stuff relating to cancel culture. This fear that what if I don't use somebody's pronouns correctly? What if I accidentally say an inappropriate racial slur? I will ask in session and I'll be super real. It's hard for me to hear this stuff because this goes outside of my values. Of course, it goes outside of their values. OCD knows that. That's why it's messing with them. I'll say, “Okay, so what is the racial slur?” My clients are always like, “You really want me to say it?” I said, “We're going to say it in the imaginal.” I realized how hard that is to stomach for therapists. But in my brain, the narrative that OCD is pushing, whether it is what society views as OCD or taboo OCD, it doesn't matter. We still have to get it out. It is still hard for that client. If that's hard for that client to think of an imaginal or a racial slur, it is almost the exact same amount of distress for somebody maybe with an imaginal that I'm afraid I'm getting food poisoning. We, as clinicians, just because we're very caring and loving people, sometimes we can unintentionally put a hierarchy of distress upon our clients like, okay, I can do this imaginal because this falls with my values, but I don't know if I can do this imaginal because pedophilia is something that's hard for me to do and I don't want to put my client through that. Well, guess what? Your client is already being put through that, whether you like it or not. It's called OCD. Kimberley: Right. Suppressing it makes it come on stronger anyway. Love that. I think that the beauty of that is there is a respectful value-based way of doing this work, but still getting ahead of OCD. Is that what you're saying? Krista: Absolutely. OCD tries to mess with us and think, what if you could be this person? Well, like I mentioned before, if a story is like a weapon, well, I'm going to tell a story to attack OCD because it's already doing it to me. Kimberley: Yeah. Tell us where people can hear more from you, get your resources because this is such great stuff. Krista: Thank you. I'd say probably the best way to find me and my silly videos would be on my Instagram @anxiouslybalance. Kimberley: Amazing. And your private practice? Krista: My private practice, it's A Peaceful Balance in Wichita, Kansas. The website is apbwichita.com. Kimberley: Thank you so much. I'm very grateful for you for inspiring this whole series and for also being here as a big piece of the puzzle. Krista: Thank you. I'm grateful for you that you don't mind me just like this. I'm grateful for you for letting me talk even though clearly, I'm not very good at it right now. You're amazing. Kimberley: No, you're amazing. Thank you. Really, these are hard topics. Just the fact that you can talk about it with such respect and grace and compassion and education and experience is gold. Krista: Thank you. At the end of the day, I really truly want people to get better. I know you truly want people to get better. Isn't that just the goal? Kimberley: Yeah. It's beautiful. Krista: Thank you.
Bonnie Grossman is a licensed therapist who is trained in EFT (tapping), Family Constellations, Energy healing, Transpersonal Psychology, Eposure and Response Prevention, Cognitive Behavioral Terapy, and Radical Forgiveness. She's a strong believer in her patients' road to recovery, a path that she guides them to through sessions that are tailorfit to their backgrounds. In this episode, we talk about: ◾️ Trusting yourself ◾️ Cultivating bravery ◾️ Bonnie's perspective on what recovery is Find Bonnie here: pathwaystt@gmail.com Find Zach here: zachwesterbeck.com @zach_westerbeck
Welcome. This is Week 4 of the Sexual Health and Anxiety Series. I have loved your feedback about this so far. I have loved hearing what is right for you, what is not right for you, getting your perspective on what can be so helpful. A lot of people are saying that they really are grateful that we are covering sexual health and anxiety because it's a topic that we really don't talk enough about. I think there's so much shame in it, and I think that that's something we hopefully can break through today by bringing it into the sunlight and bringing it out into the open and just talking about it as it is, which is just all good and all neutral, and we don't need to judge. Let's go through the series so far. In Episode 1 of the series, we did sexual anxiety or sexual performance anxiety with Lauren Fogel Mersy. Number two, we did understanding arousal and anxiety. A lot of you loved that episode, talking a lot about understanding arousal and anxiety. Then last week, we talked about the sexual side effects of anxiety and depression medication or antidepressants with Dr. Sepehr Aziz. That was such a great episode. This week, we're talking about sexual intrusive thoughts. The way that I structured this is I wanted to first address the common concerns people have about sexual health and intimacy and so forth. Now I want to talk about some of the medical pieces and the human pieces that can really complicate things. In this case, it's your thoughts. The thoughts we have can make a huge impact on how we see ourselves, how we judge ourselves, the meaning we make of it, the identity we give it, and it can be incredibly distressing. My hope today is just to go through and normalize all of these experiences and thoughts and presentations and give you some direction on where you can go from there. Because we do know that your thoughts, as we discussed in the second episode, can impact arousal and your thoughts can impact your sexual anxiety. SEXUAL OCD OBSESSIONS Let's talk a little bit today about specific sexual intrusive thoughts. Now, sexual intrusive thoughts is also known as sexual obsessions. A sexual obsession is like any other obsession, which is, it is a repetitive, UNWANTED—and let's emphasize the unwanted piece—sexual thought. There are all different kinds of sexual intrusive thoughts that you can have. For many of you listening, you may have sexual intrusive thoughts and OCD that get together and make a really big mess in your mind and confuse you and bring on doubt and uncertainty, and like I said before, make you question your identity and all of those things. In addition to these intrusive thoughts, they often can feel very real. Often when people have these sexual intrusive thoughts, again, we all have intrusive thoughts, but if they're sexual in nature, when they're accompanied by anxiety, they can sometimes feel incredibly real, so much so that you start to question everything. SEXUAL SENSATIONS Now, in addition to having sexual intrusive thoughts, some of you have sexual sensations, and we talked a little bit about this in previous episodes. But what I'm really speaking about there is sensations that you would often feel upon arousal. The most common is what we call in the OCD field a groinal response. Some people call it the groinal in and of itself, which is, we know again from previous episodes that when we have sexual thoughts or thoughts that are sexual in nature, we often will feel certain sensations of arousal, whether that be lubrication, swelling, tingling, throbbing. You might simply call it arousal or being turned on. And that is where a lot of people, again, get really confused because they're having these thoughts that they hate, they're unwanted, they're repetitive, they're impacting their life, they're associated with a lot of anxiety and uncertainty, and doubt. And then, now you're having this reaction in your body too, and that groinal response can create a heightened need to engage in compulsions. As we know—we talk about this in ERP School, our online course for OCD; we go through this extensively—when someone has an obsession, a thought, an intrusive thought, it creates uncertainty and anxiety. And then naturally what we do is we engage in a compulsion to reduce or remove that discomfort to give them a short-term sense of relief. But then what ends up happening is that short-term relief ends up reinforcing the original obsession, which means you have it more, and then you go back through the cycle. You cycle on that cycle over and over again. It gets so big. It ends up impacting your life so, so much. INTRUSIVE SEXUAL URGES Now, let's also address while we're here that a lot of you may have intrusive sexual urges. These are also obsessions that we have when you have OCD or OCD-related disorders where you feel like your body is pulling you towards an action to harm someone, to do a sexual act, to some fantasy. You're having this urge that feels like your body is pulling you like a magnet towards that behavior. Even if you don't want to do that behavior, or even if that behavior disgusts you and it doesn't line up with your values, you may still experience these sexual OCD urges that really make you feel like you're on the cusp of losing control, that you may snap and do that behavior. This is how impactful these sexual intrusive thoughts can be. This is how powerful they can be in that they can create these layers upon layers. You have the thoughts, then you have the feelings, then you have the sensations, you also have the urges. Often there's a lot of sexual intrusive images as well, like you see in front of you, like a projector, the image happening or the movie scene playing out that really scares you, concerns you, and so forth. And then all of those layers together make you feel absolutely horrible, terrified, so afraid, so unsure of what's happening in and of yourself. TYPES OF SEXUAL OCD OBSESSIONS Let's talk about some specific OCD obsessions and ways in which this plays out. Now, in the OCD field, we call them subtypes. Subtypes are different categories we have of obsessions. They don't collect all of them. There are people who have a lot of obsessions that don't fall under these categories, but these subtypes usually include groups of people who experience these subtypes. The reason we do that is, number one, it can be very validating to know that other people are in that subgroup. Number two, it can also really help inform treatment when we have a specific subtype that we know what's happening, and that can be very helpful and reduce the shame of the person experiencing them. 1. SEXUAL ORIENTATION OBSESSIONS OR SEXUAL ORIENTATION OCD It used to be called homosexual OCD. That was because predominantly people who were heterosexual were reporting having thoughts or sexual intrusive thoughts about their sexual orientation—am I gay, am I straight—and really struggling with having certainty about this. Again, now that we're more inclusive and that I think a lot more people are talking about sexuality, that we have a lot less shame, a lot more education, we scrapped the homosexual OCD or homosexual obsessions or subtype category. Now we have a more inclusive category, which is called sexual orientation OCD. That can include any body of any sexual orientation who has doubt and uncertainty about that. Now remember when we started, we talked about the fact that sexual intrusive thoughts are usually unwanted, they're repetitive and they don't line up with our values. What we are not talking about here is someone who is actually questioning their sexual orientation. I know a lot of people are. They're really exploring and being curious about different orientations that appeal to them. That's way different to the people who have sexual orientation OCD or sexual orientation obsessions. People with OCD are absolutely terrified of this unknown answer, and they feel an incredible sense of urgency to solve it. If you experience this, you may actually want to listen back. We've got a couple of episodes on this in the past. But it's really important to understand and we have to understand the nuance here that as you're doing treatment, we are very careful not to just sweep people under the rug and say, “This is your OCD,” because we want to be informed in knowing that, okay, you also do get to question your sexual orientation. But if it is a presentation of sexual orientation OCD, we will treat it like that and we will be very specific in reducing the compulsions that you're engaging in so that you can get some relief. That is the first one. 2. SEXUAL INTRUSIVE THOUGHTS ABOUT FAMILY OR SEXUAL INTRUSIVE THOUGHTS ABOUT INCEST Incest sexual OCD or that type of subtype is another very common one. But often, again, one that is not talked about enough in fear of being judged, in fear of having too much shame, in fear of being reported. When people have these types of obsessions, they often will have a thought like, “What if I'm attracted to my dad?” Or maybe they're with their sibling and they experience some arousal for reasons they don't know. Again, we talked about this in the arousal and anxiety episode, so go back and listen to that if you didn't. They may experience that, and that is where they will often say, “My brain broke. I feel like I had to solve that answer. I had to figure it out. I need to get complete certainty that that is not the case, and I need to know for sure.” The important thing to remember here is a lot of my patients, I will see and they may have some of these sexual intrusive thoughts, but their partners will say, “Yeah, I've had the same thoughts.” It's just that for the person without OCD, they don't experience that same degree of distress. They blow it off. It doesn't really land in their brain. It's just like a fleeting thought. Whereas people with OCD, it's like the record got stuck and it's just repeating, repeating, repeating. The distress gets higher. The doubt and uncertainty get higher. Therefore, because of all of this bubbling kettle happening, there's this really strong urgency to relieve it with compulsions. 3. SEXUAL INTRUSIVE THOUGHTS ABOUT GOD OR ABOUT A RELIGIOUS LEADER This is one that's less common, or should I say less commonly reported. We actually don't have evidence of how common it is. I think a lot of people have so much shame and are so afraid of sinning and what that means that they may even not report it. But again, this is no different to having thoughts of incest, but this one is particularly focused on having sexual thoughts about God and needing to know what that means and trying to cleanse themselves of their perceived sin, of having that intrusive thought. It can make them question their religion. It can make them feel like they have to stop going to church. They may do a ton of compulsive prayer. They may do a ton of reassurance with certain religious leaders to make sure that they're not sinning or to relieve them of that uncertainty and that distaste and distress. These are all very common symptoms of people who have sexual intrusive thoughts about God. 4. BESTIALITY OBSESSIONS These are thoughts about pets and animals, and it's very common. It's funny, as we speak, I am recording this with a three-pound puppy sitting on my lap. We just got a three-pound puppy. It is a Malti-Poo puppy dog, and he's the cutest thing you've ever seen. But it's true that when you have a dog, you're having to take care of its genitals and wipe it up and its feces and its urine and clean and all the things, and it's common to have sexual intrusive thoughts about your pet or about your dog or your cat. Some people, again, with bestiality obsessions or bestiality OCD, have a tremendous repetitive degree of these thoughts. They're very distressing because they love their dog. They would never do anything to hurt their dog, but they can't stop having these thoughts or these feelings or these sensations, or even these urges. Again, all these presentations are the same, it's just that the content is different. We treat them the same when we're discussing it, but we're very careful with addressing the high level of shame and embarrassment, humiliation, guilt that they have for these thoughts. Guilt is a huge one with these sexual obsessions. People often feel incredibly guilty as if they've done something wrong for having these obsessions. These are a few. 5. PEDOPHILIA OBSESSIONS Now, for someone who has intrusive sexual thoughts and feelings and sensations and urges about children (POCD), they tend to be, in my experience, the most distressed. They tend to be, when I see them, the ones who come in absolutely completely taken over with guilt and shame. A lot of the time, they will have completely removed themselves from their child. They feel they're not responsible. They won't go near the parks. They won't go to family's birthday parties. They're so insistent on trying to never have these thoughts. Again, I understand. I don't blame them. But as we know, the more you try not to have a thought, what happens? The more you have it. The more you try and suppress a thought, the more you have it. That can get people in a very stuck cycle. SEXUAL OCD COMPULSIONS Let's move on now to really address different sexual OCD compulsions. Now, for all sexual obsessions, or what I should say is, for all obsessions in general, there are specific categories of compulsions and these are things again that we do to reduce or remove the discomfort and certainty, dread, doubt, and so forth. 1. Trigger Avoidance This is where you avoid the thing that may trigger your obsession or thought. Avoiding your dog, avoiding your child, avoiding your family member, avoiding people of the sexual orientation that you're having uncertainty about. 2. Actual Sex Avoidance We talked about that in the first episode. We talked a lot about how people avoid sex because of the anxiety that being intimate and sexual causes. 3. Mental Rumination This is a really common one for sexual intrusive thoughts because you just want to solve like why am I having it? What does it mean? You might be ruminating, what could that mean? And going over and over and over that a many, many time. 4. Mental Checking What you can also be doing here is checking for arousal. Next time you're around, let's say, a dog and you have bestiality obsessions, you might check to see if you're aroused. But just checking to see if you're aroused means that you get aroused. Now that you're aroused, you're now checking to see what that means and trying to figure that out and you're very distressed. We can see how often the compulsion that the person does actually triggers more and more and more distress. It may provide you a moment or a fleeting moment of relief, but then you actually have more distress. It usually brings on more uncertainty. We know that the more we try and control life, the more out of control we feel. That's a general rule. That's very much the case for these types of obsessive thoughts. 5. Pornography Use A lot of people who have sexual orientation OCD in particular, but any of these, they may actually use pornography as a way to get reassurance that they are of a certain sexual orientation, that they are not attracted to the orientation that they're having uncertainty about, or they're not attracted to animals or God or a family member because they were aroused watching pornography. That becomes a form of self-reassurance. There's two types of reassurance. One is reassurance where we go to somebody else and say, “Are you sure I wouldn't do that thing? Are you sure that thing isn't true? Are you sure I don't have that? I'm not that bad a person?” The other one is really giving reassurance to yourself, and that's a very common one with pornography use. SEXUAL INTRUSIVE THOUGHTS PTSD There are some sexual intrusive thought examples, including specific obsessions and subtypes, and also compulsions. But one sexual intrusive thought example I also wanted to address is not OCD-related; it's actually related to a different diagnosis, which is called PTSD (post-traumatic stress disorder). Often for people who have been sexually assaulted or molested, they too may experience sexual intrusive thoughts in the form of memories or images of what happened to them or what could have happened to them. Maybe it's often some version of what happened to them, and that is a common presentation for PTSD. If you are experiencing PTSD, usually, there is a traumatic event that is related to the obsession or the thoughts. They usually are in association or accompanied by flashbacks. There are many other symptoms. I'm not a PTSD specialist, but there's a high level of distress, many nightmares. You may have flashbacks, as I've said. Panic is a huge part of PTSD as well. That is common. If you have had a traumatic event, I would go and see a specialist and help them to make sure that they've diagnosed you correctly so that you can get the correct care. SEXUAL INTRUSIVE THOUGHTS TREATMENT If you have OCD and you're having some of these sexual intrusive thoughts, the best treatment for you to go and get immediately is Exposure and Response Prevention. This is a particular type of cognitive behavioral therapy where you can learn to change your reaction, break yourself out of that cycle of obsessions, anxiety, compulsions, and then feed yourself back into the loop around and around. You can break that cycle and return back to doing the things you want and have a different reaction to the thoughts that you have. PEOPLE ASK HOW TO STOP SEXUAL INTRUSIVE THOUGHTS? Often people will come to me and say, “How do I stop these sexual intrusive thoughts?” I will quickly say to them, “You don't. The more you try and stop them, the more you're going to have. But what we can do is we can act very skillfully in intervening, not by preventing the thoughts, but by changing how we relate and respond to those thoughts.” For those of you who don't know, I have a whole course on this called ERP School. ERP is for Exposure and Response Prevention. I'll show you how you can do this on your own, or you can reach out to me and we can talk about whether if you're in the states where we're licensed, one of my associates can help you one-on-one. If you're not in a state where I belong, reach out to the IOCDF and see if you can find someone who treats OCD using ERP in your area. Because the truth is, you don't have to suffer having these thoughts. There is a treatment to help you manage these thoughts and help you be much more comfortable in response to those thoughts. Of course, the truth here is you're never going to like them. Nobody likes these thoughts. The goal isn't to like them. The goal isn't to make them go away. The goal isn't to prove them wrong even; it's just to change your reaction to one that doesn't keep that cycle going. That is the key component when it comes to sexual intrusive thoughts treatment or OCD treatment. That's true for any subtype of OCD because there are many other subtypes as well. That's it, guys. I could go on and on and on and on about this, but I want to be respectful of your time. The main goal again is just to normalize that these thoughts happen. For some people, it happens more than others. The goal, if you can take one thing away from today, it would be, try not to assign meaning to the duration and frequency of which you have these thoughts. Often people will say, “I have them all day. That has to mean something.” I'm here to say, “Let's not assign meaning to these thoughts at all. Thoughts are thoughts. They come and they go. They don't have meaning and we want to practice not assigning meaning to them so we don't strengthen that cycle.” I hope that was helpful for you guys. I know it was a ton of information. I hope it was super, super helpful. I am so excited to continue with this. Next week, we are talking about menopause and anxiety, which we have an amazing doctor again. I want to talk about things with people who are really skilled in this area. We have a medical doctor coming on talking about menopause and the impact of anxiety. And then we're going to talk about PMS and anxiety, and that will hopefully conclude our sexual health and anxiety series. Thank you so much for being here. I love you guys so much. Thank you from me and from Theo, our beautiful little baby puppy. I will see you next week.
A Parenting Resource for Children’s Behavior and Mental Health
Parenting is one of the most significant factors that impact a child's mental health. Unfortunately, there's a tendency that your parenting skills can worsen your child's Obsessive-Compulsive Disorder (OCD) or other mental health disorders.There are cases when parents are unaware they are already contributing to their child's OCD. Thus, it's a must to educate parents about these things. Don't feed your child's OCD.Let's flip the script and help parents understand that there are ways to improve their child's OCD.How OCD works in the brainEverything is about the brain. It's all about how we use the brain to unlearn things, learn what we should do, and learn how to calm the brain. So everything starts with the brain. When we use brain-informed techniques, we use techniques that improve kids and families.When we speak of negative reinforcement, what happens is that we reinforce a behavior that is more likely to happen again. Then it becomes a habit. That's what happens with OCD. Negative beliefs, worries, unwanted thoughts, intrusive thoughts, and fears are reinforced.That's what obsessions, compulsions, and rituals are all about. They don't even have to make sense. Parents must let go of the idea that this has to make sense because that's not the case. It doesn't make sense to them, and it won't make sense to you, either.It even scares the children when you ask them if it makes sense and, if it does, how it makes sense. So what should be done is to avoid reinforcement. We shouldn't reinforce their worries or fears, especially when they're already overwhelmed by them.The more we push back, the more your child's brain says, "The bad thing didn't happen."We push our kids to feel distressed whenever we reinforce these unwanted and intrusive thoughts, worries, or fears. However, we must remember that the more we push back, the more we stop feeding the barking dog.The same can be said for anxiety, depression, and other mental health problems. The more we push back, the more your child's brain says, "Oh, the bad thing didn't happen. The worry didn't happen. I can do this." So it works by pushing down these behaviors, and eventually, we get to extinguish them.Undoubtedly, the journey to treating your child's OCD will be long and challenging. But it's going to be worth everything. That's why it doesn't make sense why around 30% of people drop out of Exposure and Response Prevention (ERP).OCD is such a tyrant. It takes over not just the child struggling with his mental health but also the whole family, who has to work around and learn about OCD.Exposure and Response Prevention teaches parents how not to reinforce desired behaviorsWe've been emphasizing how badly we must stop reinforcement from stopping feeding your child's OCD. We can better accomplish this through Exposure and Response Prevention, which teaches parents how not to reinforce desired behaviors. Instead, strengthen their autonomy and coping skills. One of the most freeing things parents can get is the feeling after extinguishing these behaviors, worries, and fears. Parents must be supportive of their children because they're the CEOs of their families and also because they are the first role models of their children.And so, when they feel like someone understands them, that's a big deal. Hence, parents should have a positive attitude. They should be ready to do what should be done for the betterment of their children. There is no “magic wand”Parents should know that there is no magic wand because there's this common notion that Selective Serotonin Reuptake Inhibitors (SSRI) or some medication will reduce the discomfort their child is experiencing. It can reduce discomfort, but not entirely.With anxiety and OCD, there will always be physical discomfort. That's why
A Parenting Resource for Children’s Behavior and Mental Health
Although Obsessive-Compulsive Disorder (OCD) is considered to be treatment-resistant, parents shouldn't lose hope. Don't let fear or worries ruin your family's life. Treatments are available for you, effectively stopping OCD in its tracks.There's always room for growth. You can find professional care that will save you thousands of money and long years of pain and worried thoughts. Now, let's talk about these treatments to help us stop OCD symptoms. The more you give in to OCD, the more it gets reinforcedIt's essential to consult with mental health professionals, especially OCD experts, as they are the ones who can significantly help you and your kids. So, do whatever you need to do to get that mental healthcare provider.Remember that the more we give in to OCD, the more it gets reinforced and the harder it is to treat. That's when your kid's OCD becomes treatment-resistant, although it doesn't have to be because there are treatments that work and have been proven to be effective. The BrainBehaviorResetTM Program helps calm the brain and make families happy in various ways. So we need to reset the brain by calming it down and then undergo this program. We'll also be releasing our supplement line called Neurotastic, which will help treat OCD, so watch out for that.Using science-backed tools to calm the brain is essential, and it gives us better resultsIt's vital that patients use science-backed tools in calming the brain, as relying on scientifically proven tools gives us better results in treating OCD.We create wiggle room and then couple it with other types of mindfulness-based or evidence-based practices because sometimes, something as simple as breathwork is hard for somebody with OCD for various reasons.Most of the time, they're physically and cognitively jacked up, and the idea of calming down sickens them. When they do that, they might even have a nauseous parasympathetic response, so we have to be mindful.We want to ensure that the techniques and treatments our kids are getting are safe and gentle, which is essential. So we help them through various brain-based activities that calm and regulate the nervous system. Then, we come in with new learning through Exposure and Response Prevention (ERP)How OCD hijacks the brain and how to deal with itWe've mentioned that Exposure and Response Prevention therapy does much for the brain. But we also have to couple it with a lot of psycho-education about how OCD hijacks the brain. Educating parents is necessary to inform them about their tendencies to accommodate and reinforce OCD.Many services and activities could be done to help a person feel more in control. But more than that, the first and most crucial part of treating and stopping OCD symptoms is understanding what's happening.You can't address OCD if you don't entirely understand it. If you don't know how sneaky OCD is, the next thing you know is you're already answering the questions your kid has about OCD. The fear is, “If we don't do x, this bad thing will happen.”Worried or anxious thoughts invade your kid's mind when they have OCD. They fear that something terrible will happen if they don't do something.There are OCD cases that highlight a kid's good performance in school, at home, or elsewhere. But you only sometimes know whether high-performing kids are mentally healthy because they might be able to direct it well. Of course, their perfectionist tendencies will save them academically, but we can see the signs when we look back.Sometimes, our kids say scary and quite worrisome statements that don't necessarily make sense. However, this shouldn't be treated like such a bad thing because, through their statements, we get a glimpse of their thoughts.No matter where you are in your journey, we have...
A Parenting Resource for Children’s Behavior and Mental Health
More often than not, parents are warned how hard it is to treat cases of obsessive compulsive disorder (OCD). However, we've already established in our previous episode that we shouldn't lose hope because there are solutions.We also briefly mentioned that the best approach parents should do to help their kids is Exposure and Response Prevention. So if you aren't treating yours or your kid's OCD with this therapy, you're wasting your time. Let's dismantle all these reasons commonly imposed upon us about how people with OCD won't get better because we can, in fact, get better with OCD. What is Exposure and Response Prevention?Exposure and Response Prevention (ERP) is a type of psychotherapy that is specifically designed for people struggling and diagnosed with obsessive compulsive disorder. Although, it can also be used for phobias and anxiety.As one of the most effective forms of treatment for OCD, it will help reduce your kid's anxieties under the guidance of a therapist in order to manage your OCD symptoms. Why talk therapy is a waste of timeCalming down the brain is important especially before coming in with therapy. OCD hijacks the brain, which then hijacks families. It's a tyrant and it doesn't care about you. You just so irrationally can't get in there with rational thought. That's why talk therapy is deemed to be a waste of time and money. Some people waste thousands of dollars for such treatment. Most importantly, they will waste hope, good feelings, and positivity. The importance of a good intakeTherapists are very strategic specifically when it comes to teaching you to stretch and get those safe exposures. They might start with the little things that you are not even aware of. As part of the process, you have to make a list of your intrusive thoughts, compulsions, or rituals that may be surprising to you. Once you get in there, you're going to be able to find a nest of things. A good intake is part of the process to better understand where these things are showing up. So we look for triggers throughout the therapeutic process to be able to teach our kids how to not give into their OCD.Kids should be able to stand up for themselves, to be in charge of their OCD, and to test the boundaries. But what's even more important is to teach parents not to accommodate it because without the right verbiage, you basically walk on landmines and you don't want to do that. Around 30% of people drop out of therapy because they have to really push hard, and it's going to be uncomfortable. In fact, many parents are worried and afraid about their kids and how their kids will be in distress. But actually, it's only going to be momentary. It all boils down to having the right tools and the right resources, reinforcing them, and having the right verbiage. In our BrainBehaviorResetTM Program, we have our own workbook where parents and kids do that. We test the boundaries and we expose them in a safe manner. No matter where you are in your journey, we have resources to help you:Mentioned in this episode:Is It ADHD or Something Else? Take the Quiz to find out!➡️ Join our FREE Natural Parenting Community to receive science-backed resources for your child and family. Join here - https://www.facebook.com/groups/naturalparentingsolutions/ ➡️ Get help from Dr. Roseann and her team. Apply here. https://drroseann.com/apply ➡️ “Is it ADHD or something else?” Take the quiz. To take the quiz, just text the word "quiz" to 13Alertmore. Then you'll know whether your child has ADHD or something else.
A Parenting Resource for Children’s Behavior and Mental Health
Obsessive compulsive disorder (OCD) is said to be one of the most challenging mental health conditions to treat because it is treatment resistant.To better understand what's going on with kids struggling with OCD, we must first know how to provide them help, and how to get the best treatment. I'm here to help you dispel common myths and misconceptions about OCD.Obsessive compulsive disorder is often misdiagnosed The first and common reason as to why obsessive compulsive disorder is treatment resistant is misdiagnosis. Obviously, if your kid's condition is misdiagnosed, they won't be able to get the right treatment. In line with this, having the wrong treatment also causes the resistance of your kid to treatments.Oftentimes, people with OCD opt for cognitive behavioral therapy or talk therapy. However, the best recommendation for treatment which has been proven to be effective is Exposure and Response Prevention which will be discussed in another episode. The more we form a habit, the more likely it is to stay.The first thing we need to do is to make sure that we have a proper diagnosis for our kids. Like what we've said, proper diagnosis is important in getting the right treatment.When we don't get that right diagnosis, we end up feeding the barking dog. Parents inadvertently accommodate their kids' constant questioning. But we have to remember that the more we form a habit, the more likely it is to stay. It's similar to your sleeping patterns becoming a habit. We get used to the things we usually do. In this case, if we keep accommodating our kids, their actions will just get reinforced every time. With OCD, we have something called negative reinforcement. It's the same thing as the rich get richer and the poor get poorer. The more we do something, the more likely it will happen. Conversely, the less we do it, the less likely it's going to happen. The more you read, the better you get rid of your OCD ways. The same way that the more we engage in the obsessive thinking, intrusive thoughts, compulsions, and rituals, the more likely it's going to happen. If you can visualize you have an intrusive thought, what happens?Intrusive thoughts make it difficult for people with OCD to function in their daily lives. They can visualize these thoughts. Case in point, a kid keeps on asking his mom if it's going to rain because he's worried he'll be struck by lightning. That's what an intrusive thought is like for kids.Once the kid's mother confirms that it's going to rain, the kid does everything in his power to avoid the lightning strike. There's this high level anxiety prior to the confirmation of his mom. Then, the anxiety shoots down once the kid visualizes that intrusive thought.What happens every time the mother confirms the kid's question, the baseline goes up. And so, there's a need for more reinforcement for the baseline to go down to the point of extinguishment or until it gets into a normal range. Exposure and response prevention is the key.Reinforcement requires persistence to unlearn old habits and learn new healthy habits. This is best done through exposure response prevention. When you're able to do it, what happens is that the brain has this recognition of whether or not something is going to happen or not. And so, the brain begins to relax once it's reassured. As we've previously discussed in other episodes, the best way to calm the brain is through neurofeedback or PEMF.Most people waste so much time on medication, but then there's no progress with their condition. I highly recommend the exposure response prevention as it is the most effective treatment out there. But we have to always take into consideration proper diagnosis to ensure proper treatment because once your...
A Parenting Resource for Children’s Behavior and Mental Health
If your anxious kid has been going to therapy for a long time but it seems to be ineffective, then your kid might be suffering from obsessive compulsive disorder (OCD) and not anxiety. OCD and anxiety are two disorders that are closely tied to each other but at the same time, they're different and separate from each other. And thus, the need to distinguish between the two since there's not enough discussion about it when in fact, it's important.We have nowhere to go but upWhen someone comes in and gets diagnosed with OCD, I don't look at that problem negatively. Parents have to be reminded that we have nowhere to go but up instead of scaring them and labelling it as the worst case scenario.Although before starting Exposure Response Prevention, I felt like there was a better success rate with people having heroin addiction as compared to those diagnosed with OCD.Sometimes, neurofeedback and other therapies are just not enough to stop these intrusive thoughts that creep into the minds of people with OCD. Just imagine how this would significantly affect a kid with OCD who has been hijacked with fear. When we answer questions, we're reinforcing their irrational fearsWhat most parents don't know is that they've been feeding OCD whenever they entertain and answer questions. They have been unintentionally and unknowingly reinforcing irrational fears into the brain of their kid.There's no need to freak out because there's a solution for you besides neurofeedback and therapies, and that is Exposure and Response Prevention. We will also be releasing a supplement line for OCD which you might want to watch out for.The difference between OCD and anxietyMany miss the difference between OCD and anxiety in terms of understanding. While OCD often starts with a nexus of anxiety, anxiety has a real worry. In line with this, the basis of OCD is from a minor part of reality but generally, it is completely irrational whereas anxiety is the basis of reality. Obsessive compulsive disorder or what we've been calling as OCD stems from irrational fears or uncontrollable and intrusive thoughts. The obsessions are all in an effort to avoid something bad from happening.With anxiety, it's centred more on worries about things. And so, you can still have a brain that is looping and not turning off but it can be very real. There are many nuances to OCD thoughts which result in people seeking therapy. On the outside, particularly for kids, they might have worried questions, or they might be pulling back and be afraid of trying new things. There are many ways of identifying OCD.If you're unsure if your kid has OCD or anxiety, it's best to seek help from a licensed mental health professional who would be able to identify and assess your kid's mental health condition. Whatever you wish to do, make sure you seek help because both OCD and anxiety can be treatment resistant.Kids are afraid to share what their obsessions areTo reiterate and emphasize, people suffering from OCD have these uncontrollable and irrational fears and such intrusive thoughts are just too much to handle, especially for younger kids. Kids are afraid to share what their obsessions are, because they're often very dark and scary. Instead of sharing these obsessive thoughts, they usually say things to reject engaging in a conversation with their parents or they just ignore.Understanding is a vital part of getting your kids to talk to you about their obsessions. For some, it's going to be a tougher task to take but we all know parenting is hard and there are many ups and downs. But remember that no matter what is going on with your kid and family, whether it's anxiety, or OCD, it's gonna be okay. Just take one step toward a solution. Watch out for more episodes as we
Ask David: Featuring Matt May, MD What causes anxiety? Is recovery permanent? What if the cognitive distortions aren't helpful? Do hormones cause anxiety and depression? What's the role of vitamins and nutrition? How do Exposure and Response Prevention work? And many more answers to your questions! In today's podcast, three shrinks discuss many intriguing questions about anxiety from individuals who attended one of Dr. Burns' free workshops on anxiety sponsored by PESI more than a year ago. Several of the questions were answered on the podcast, and a great many more are answered in the show notes below. But first, Rhonda opened the podcast by reading an endorsement from a listener named Rob, with a link. Here it is! Hi Dr. Burns: I'm a long-time listener/reader, first-time caller. I stumbled upon this endorsement for Feeling Good today, and I thought it was worth sharing with you. I can't think of a better endorsement for a book. I hope you enjoy it! "I've replaced my copy close to ten times, as I keep lending it to friends who never give it back." https://girlboss.com/blogs/read/feeling-good-david-burns-review Have a great day! Rob Thanks, Rob! And now, for the many excellent questions submitted by listeners like you! Many were answered in depth on the podcast, but you'll see that all questions have written answers as well. When you talk about someone recovering, is that free of panic attacks and anxiety forever, or a great decrease in symptoms but you will always be an anxious person to a certain extent? Especially for someone who has fundamentally been anxious since they were young so not episodic but continuous. David's Answer. Some people are anxiety-prone, and that is likely due to a genetic cause. I am like that, for example. Once you are 100% free of any form of anxiety, like my public speaking anxiety, you need to continue with exposure, or the old anxiety will try to come creeping back in. So, I do public speaking all the time! What if your client/patient understands the Cognitive Distortions but doesn't believe them to be true? David's Answer. It is hard for me to comprehend what you mean. But I will say this. Anxiety and depression and other negative feelings result 100% from distorted negative thoughts. And the exact moment when you stop believing the thought that's triggering your anxiety or depression, you will almost instantly feel relief. And here's the precise answer to your question. When someone says, “I understand the distortions but it doesn't help,” they still believe their negative thoughts. Resistance, too, is an issue. Nearly 100% of therapeutic failure results from jumping in and trying to help the patient without first comprehending the many reasons why the patient will fight against the therapist's efforts to “help.” Has research been done on the possible relationship in hormone levels in women and anxiety or depression? Especially during pregnancy, post pregnancy, and those going through menopause? Also, can negative thoughts also depend on the person's nutrition? Could it be that vitamins that are lacking? David's Answer. First, I am not aware of any convincing evidence linking hormone levels with depression, anxiety, irritability, or any other negative feelings. However, we can say with certainty that whatever the cause, which is unknown, distorted thoughts will always be present and will be the trigger for the negative feelings. In or near the first chapter of my most recent book, Feeling Great, I describe case of post pregnancy depression, and you can take a look and see the mother's negative thoughts clearly. And you will also see that the moment she crushed those thoughts, her depression disappeared! People want to “biologize” emotional problems, and I started out as a “biological psychiatrist” and researcher, but found the biological explanations to be erroneous and unhelpful. Could you please give a brief overview about Exposure with Response Prevention for OCD treatment. Thank you! David's Answer. Sure, these are tools that can be helpful, along with many other kinds of tools, in the treatment of anxiety, including OCD. They are not, for the most part, treatments. I use four models in the treatment of every anxious patient: the Motivational, Cognitive, Exposure, and Hidden Emotion Models. Exposure is facing your fears and enduring the anxiety until the anxiety subsides and disappears. Response Prevention is refusing to give in to the superstitious rituals OCD users when anxious, like counting, arranging things in a certain way, and so forth. END OF QUESTIONS DISCUSSED LIVE ON THE PODCAST The answers to the questions below were written by Dr. Burns but not discussed on the Podcast. Questions can I ask to overcome the Cognitive Distortion “jumping to conclusions”? That is the toughest for me. David's Answer. I would need a specific example. Jumping to Conclusions includes a vast array of topics and negative thoughts. Fortune Telling and Mind Reading are the most common forms of Jumping to Conclusions. Feelings of hopelessness always result from Fortune Telling. All forms of anxiety always result from Fortune Telling as well. Social Anxiety typically includes Mind-Reading, and Mind-Reading is almost universal in relationship conflicts. In addition, I never treat a distortion, an emotion, a diagnosis, or a problem. I treat human beings systematically, using the T E A M algorithm. Matt's Answer. There are many methods in TEAM that can be applied in the form of a question. These methods and how they are carried out, depends on the circumstances and the specific thoughts a person is having. Below are some examples of negative thoughts (NT's) and the types of questions that might help overcome them. (NT): ‘Something really bad is going to happen' (Be Specific Technique): ‘Like what? What's going to happen?' NT: ‘I'll fail my biology test' What-If Technique: ‘What if I failed my biology test, why would I be worried about that? (write down any new thoughts) What if those things happened, too, what then? (write down any new thoughts) What's the absolute worst thing that could happen? (write this down). Measurement: How certain am I, that these things will happen? On a scale from 0 – 100%, how likely are each of these predictions, in the form of negative thoughts, to occur? Socratic Outcome Resistance: What do each of these negative thoughts say about my values that I can feel proud of? (write these down) What is appropriate about how I'm feeling and thinking? (write these down) What are the advantages of having these thoughts? (write these down). What would I be afraid of, if I didn't have this thought? (write these down) Pivot Question: Given the many positive values related to worrying, the advantages of doing so, the disadvantages of a carefree existence and the many reasons why my worry is appropriate, why would I change this? Forgetful Clone (Double-Standard Amnestic Technique for Outcome Resistance): What would you say, to a dear friend, in an identical situation, when they asked these questions: ‘I'm really worried about failing my biology test, would you be willing to help me? (if ‘yes', then continue) … Don't I need to keep worrying? Won't that protect me from failing? Don't I need to worry, so that I'm highly motivated to succeed? Don't I need to worry, so I avoid making mistakes? Don't I need to worry, to maximize my rate of learning new material? Won't I get lured into a false sense of security, if I stop worrying? Won't I jinx it, if I get too confident? What would you recommend to me? How much do you think I should worry? I am prepared to do so … would it be helpful for me to go into a sustained panic, at this time?' Cost-Benefit Analysis: Is worrying about failure worth the price? How would you weigh the advantages of worrying about failure against the disadvantages? What are the pro's and con's? How would you divide 100 points, to reflect the power of these two arguments? Examine the Evidence, Motivational: What evidence is there that worrying improves academic performance, concentration and learning? What evidence is there that worrying worsens academic performance, concentration and learning? Magic Dial Question: ‘‘Should I remain maximally worried, at all times, forever? (If not, keep going) 'What amount of worry is best, for me, in this moment?', ‘How about future moments? How frequently do I need to worry and for how long?' Process Resistance for Activity Scheduling, Worry Breaks/Cognitive Flooding, Self-Monitoring/Response Prevention: ‘Would it be alright to ignore my worry most of the time and only focus on it during scheduled times? Let's say I could learn how to be extremely calm and focused most of the day, without worry … would I be willing to worry as intensely as possible, for ten minutes, three times per day, to achieve this? When my worry comes up at other times, would I be willing to observe and record that event, then return to the task on my schedule? Socratic Questioning: Am I absolutely certain that this thought is true, that I will fail? How do I know that I will fail? What specific questions will be on the Biology test that I will get wrong? What number grade will I get? A 60? 58? 39?', ‘Would I bet money on my getting precisely that grade? Why not?'. Examine the Evidence (cognitive): ‘What evidence is there that I will fail? What evidence is there that I will pass? Reattribution: Let's say that I fail. Would that be entirely my fault? Are there any other factors, outside my control, that might have contributed to this outcome? My genetics, for example? Or the nature of the world, into which I was born? Did I choose my genetics? Did I choose the world into which I was born, when I was born, my parents, teachers, etc.? Could any of these factors have played any role in the outcomes in my life? Other examples of Inquiry-based methods, using different NT's: Negative Thought: ‘People will be angry and judge me, if I fail' Interpersonal Downward Arrow: ‘What kind of people are they, if they judge me and look down on me, when I fail? How would I feel towards those types of people? Is it possible I feel angry? How do I express that feeling? What ‘rule' am I following, in my relationships?' Outcome Resistance: What's good about me, for feeling anxious, rather than angry? What are the advantages of keeping my feelings inside? What would I be afraid of, if I expressed my feelings? Process Resistance, 5-Secrets: Would I be willing to spend the time to learn the skills required to express my feelings, including anger, to people, in a way that made them feel good? Negative Thought: ‘I'll get sick and die' Be Specific: ‘When? What time of day will that occur? What illness is going to kill me?' Negative Thought: ‘I'll lose my mind, crack up and go crazy' Examine the Evidence: Has that ever happened to me? When was the last time? When you are working with clients, how do you handle it when they can challenge their thoughts very convincingly using a variety of techniques, state that they can see the logic in their restructured thought BUT they are still experiencing heightened anxiety and state that this hasn't helped them? David's Answer. They still have a strong belief in their negative thoughts. It is 100% untrue that they have “challenged them very convincingly.” Here's an example. Let's say you have an intense fear of glass elevators. You will say, “I can see that they are unsafe, but I am still terrified of going in one.” The moment you get on the elevator your belief that you are in danger will suddenly skyrocket to 100%. In other words, you still believe your negative thoughts. Of course, it is nearly always easy to overcome phobias, including an elevator phobia. As stated above, I use four models in treating every anxious patient. Simplistic formulas are just that—Simplistic! Treating humans is not like changing the oil in your car! Matt's Answer: I am hard pressed to add anything of value to David's awesome response, above. I might just reiterate that the Cognitive model, challenging the logic behind negative, anxiety-producing thoughts, is the least powerful of the approaches we have to anxiety. It is necessary, but almost always insufficient. Exposure, motivational methods and Hidden emotion are the real heavy-hitters. Until trying these, it is likely that the negative thoughts can be disproven ‘intellectually' but not at the emotional level. How do you work with clients who state they are anxious all the time, experience strong somatic symptoms (body sensations) and cannot identify specific thoughts. They don't catastrophize these somatic symptoms but really, really dislike them and want them gone! David's Answer. I just ask them to make up some negative thoughts. That works well. For example, they may have the belief that the anxiety must be avoided because it may never disappear, or may believe that they are on the verge of going crazy, and so forth. Matt's Answer, Anxiety can cause people's brains to shut down, experiencing the ‘deer in the headlights' phenomenon. Try to identify just one upsetting thought, then use the ‘what-if' technique to expand on that. You'll be off and running! How do you do techniques with a person who has active suicidal thoughts? David's Answer. I don't “do techniques.” I find out if they're actively suicidal and in danger. If I know for certain that the person is safe, I treat them like human beings, with T E A M. I'm not a formula person. Each person will be different, and will respond to different methods. My books and podcasts are chock full of examples of actively suicidal people who responded. Matt's Answer. I let them know that I don't have the skill to help them unless I know they're safe. If I'm worried for their safety, I'll be afraid to use aggressive methods that may be required for them to recover. I'd need them to convince me of their safety before agreeing to work with them. If they can do so, I offer TEAM. If not, I ask if they're willing to escalate the level of their care, e.g. to meet with me while hospitalized in a safe setting. I don't work with patients who are at risk of harming themselves because I don't believe in my ability to be helpful to them. Is it really okay to keep continuing the experimental technique when the patient does not want to continue? And, what if the therapist is not confident and something goes wrong in this situation? David's Answer. I would need a specific example, but you are right that 75% or so of therapists are afraid of exposure and will not use it, fearing that something will “go wrong!” Matt's Answer. It's important to identify the resistance before initiating the method of exposure and to talk it through. Why would they not want to continue? What are they afraid of, if they get really anxious, during exposure? Write this down. Then, surrender, acknowledging that these are some excellent reasons to avoid exposure, in which case we can't help them with their anxiety. Perhaps there's something else they want help with? If they can convince you, and themselves, that exposure is precisely what they want to do, and they're willing to keep doing it, even if it makes them very anxious, it's appropriate to push a bit, in the moment of their doing exposure, to bolster them and help them through the rough patch. That said, I always give my patients a way out, if they don't want to continue. That's their choice, I just want them to be aware of the consequences, including a worsening of their anxiety. When doing experimental method, or the exposure method for example with who has sweating issue, how do you handle the hyper-vigilance he would have with people around, especially if someone actually laughed at him? David's Answer. I would use the Feared Fantasy Technique, and Self-Disclosure. I would likely go with the patient into the real world to do these things, and have done so on hundreds of occasions. How would you work with someone who suffers from Selective/Situational Mutism? David's Answer. I have not run into that in my clinical practice. But 100% of the time, I would want to know what the patient's agenda is. I would also want to know if there are powerful motivational factors that need to be addressed, looking at the whole person rather than the symptom. How different are Team CBT treatments for teens as compared to adults? David's Answer. My experience is limited, but I would say no difference, really. I have loved working with teens, even though my main focus was on adults. When working with little kids, I think you need to incorporate play and games, although the basic concepts are the same. For example, you can do Externalization of Voices with puppets, the “Bad, Mean Self” and the “Positive, Loving Self,” or some such. We have featured shrinks who work with kids on many times on our podcasts. Thanks for joining us today! Matt, Rhonda, and David
In episode 364 I chat with Jenny who has kindly agreed to share her story with us. We discuss her OCD story including themes false memory OCD and relationship OCD. Jenny shares her experience of Exposure and Response Prevention therapy (ERP), depression, how her fiancé responds in a helpful way to her OCD, and so much more. Hope it helps. Show notes: https://theocdstories.com/episode/jenny-364 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
In episode 360 I interviewed Penny who has kindly agreed to share her OCD story with us. In this episode we discuss her story, sexual orientation themed OCD, relationship themed OCD, figuring out it's OCD, getting married, Exposure and Response Prevention therapy (ERP), working on issues in the relationship without OCD blowing them out of proportion, yoga, a reading of something she wrote, and much more. Hope it helps. Show notes: https://theocdstories.com/episode/penny-360 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
In This Episode: Andrew GottWorth shares his story of having Obsessive Compulsive Disorder (OCD) and how ERP allowed him to function again. addresses the benefits of ERP and how ERP is for Everyone How Exposure & response prevention can help people with OCD and for those with everyday stress and anxiety Links To Things I Talk About: Andrew's Instagram @justrught 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 308. Welcome, everybody. I am really pumped for this episode. We have the amazing Andrew Gottworth on for an interview where he just shared so many nuggets of wisdom and hope and motivation. I think you're going to love it. But the main point we're making today is that ERP is for everyone. Everyone can benefit from facing their fears. Everyone can benefit by reducing their compulsive behaviors. Even if you don't technically call them compulsions, you too can benefit by this practice. Andrew reached out to me and he was really passionate about this. And of course, I was so on board that we jumped on a call right away and we got it in, and I'm so excited to share it with you. Thank you, Andrew, for sharing all your amazing wisdom. Before we head into the show, let's quickly do the “I did a hard thing” for the week. This one is from Christina, and they went on to say: “Thought of you today, and you're saying, ‘It's a beautiful day to do hard things,' as I went down a water slide, terrified, as I'm well out of my comfort zone.” This is such great. They're saying that's on their holiday, the first time they've taken a holiday in quite a while. “It's difficult, but I'm doing it. I'm trying to lean into the discomfort.” This is so good. I love when people share their “I did a hard thing,” mainly, as I say before, because it doesn't have to be what's hard for everybody. It can be what's hard for you. Isn't it interesting, Christina is sharing a water slide is so terrifying? Christina, PS, I'm totally with you on that. But some of the people find it thrill-seeking. And then I'm sure the things that Christina does, she might not have anxiety, but other people who love to thrill seek find incredibly terrifying. So, please don't miss that point, guys. It is such an important thing that we don't compare. If it's terrifying, it's terrifying, and you deserve a massive yay. You did a hard thing for it. So, thank you, Christina. Again, quickly, let me just quickly do the review of the week, and then we can set back and relax and listen to Andrew's amazing wisdom. This one is from Anonymous. Actually, this one is from Sydneytenney, and they said: “Incredible resource! What an incredible resource this podcast is! Thank you for sharing all of this information so freely… you're truly making a difference in so many lives, including mine! (I am also reading through your book and I LOVE it. You nailed it in marrying OCD with self-compassion - what a gift!!!)” So, for those of you who don't know, I wrote a book called The Self-Compassion Workbook for OCD. If you have OCD and you want a compassionate approach to ERP by all means, head over to Amazon or wherever you buy books and you can have the resource right there. All right, let's get over to the show. Kimberley: Okay. Welcome, Andrew Gottworth. Thank you so much for being here. Andrew: Yeah. So, happy to be here. Really excited to chat with you for a bit. Kimberley: Yeah. How fun. I'm so happy you reached out and you had a message that I felt was so important to talk about. Actually, you had lots of ideas that I was so excited to talk about. Andrew: I might bring some of them up because I think, anyway, it's related to our big topic. Erp Is For Everyone Kimberley: Yeah. But the thing that I love so much was this idea that ERP (Exposure and Response Prevention) is for everyone. And so, tell me, before we get into that, a little bit about your story and where you are right up until today and why that story is important to you. Andrew: Yeah. So, there's a lot, as you work in the OCD field that it takes so long between first experiencing to getting a diagnosis. And so, with the knowledge I have now, I probably started in early childhood, elementary school. I remember racing intrusive thoughts in elementary school and being stuck on things and all that. But definitely, middle school, high school got worse and worse. So, fast forward to freshman year of college, it was really building up. I was really having a lot of issues. I didn't know what it was and really didn't know what it was for nine, 10 years later. But I was having a really hard time in college. I was depressed. I thought I was suicidal. Learning later, it's probably suicidal ideation, OCD just putting thoughts of death and jumping up a building and jumping in a lake and getting run over and all that. But I didn't want to talk about it then, I think. Andrew's Story About Having Obsessive Compulsive Disorder A bit about me, I come from Kentucky. I count Louisville, Kentucky as the Midwest. We have a bit of an identity crisis, whether we're South Midwest, East Coast, whatever. But still there, there's a culture that mental health is for “crazy people.” Of course, we don't believe that. So, my tiptoe around it was saying, “I'm having trouble focusing in class. Maybe I have ADHD.” And that's what I went in for. For some reason, that was more palatable for me to talk about that rather than talk about these thoughts of death and all that. And so, I did an intake assessment and thankfully I was somewhat honest and scored high enough on the depression scale that they were like, “Hey, you have a problem.” And so, ended up talking more. So, back in 2009, freshman year of college, I got diagnosed with depression and generalized anxiety disorder, but completely missed the OCD. I think they didn't know about it. I didn't know about it. I didn't have the language to talk about it at the time because I didn't have hand washing or tapping and counting and these other things that I would maybe see on TV and stuff, which – yeah, I see you nodding – yes, I know that's a common story. So, I entered therapy in 2009, and I've been in therapy and non-medication ever since. But I had problems. I still had problems. I would make progress for a bit. And then I just feel like I was stuck. So, I ended up being in three mental hospitals. One, when I was doing AmeriCorps up in Milwaukee, Wisconsin, and had a great experience there. Two, three days up there at Rogers, which I'm very grateful for. And then stabilized moving forward. So, I ended up-- I dropped outta college. I dropped out of AmeriCorps. I then went back to college and again went to a mental hospital in Bowling Green, Kentucky. I was at Western Kentucky University, stabilize, keep going. Learning lessons along the way, learning cognitive distortions and learning talk therapy, and all these. So, let's keep fast-forwarding. Another mental hospital in Atlanta, Georgia. There's a long-term outpatient stay, Skyline Trail. I'm thankful for all of these places along the way. And I wish somewhere along the way, I knew about OCD and knew about ERP, our big topic for the day. So, finally, gosh, I can't quite remember. I think 2018, a few years ago, still having problems. I had gone from full-time at work to part-time at work. I was just miserable. I would get into my cubicle and just constantly think, I'm not going to make it. I got to go home. I got to find an excuse to get out of here early. I just need to stay sick or I got to go home, or something came up. And so, every day I'd have an excuse until I finally was like, “I'm going to get found out that I'm not working full-time. I'm going to jump the gun, I'll voluntarily go down in part-time.” So, that worked for a bit until OCD kept going. And then I quit. I quit again. And at that point, I was like, “I've failed. I've quit so many things – college, AmeriCorps.” I was a summer camp counselor and I left early. “Now this job. I need something.” So, I went again to find more help. And finally, thankfully, someone did an intake assessment, came back, and said, “Well, one problem is you have OCD.” I was like, “What? No, I don't have that. I don't wash my hands. I'm not a messy person. I'm not organized.” Gosh, I'm so thankful for her. Kimberley: Yeah, I want to kiss this person. Andrew: Yeah. But here's the duality of it. She diagnosed me with it. I am forever grateful. And she didn't do ERP. She didn't know it. So unbelievably thankful that I got that diagnosis. It changed my life. And then I spent several weeks, maybe a few months just doing talk therapy again. And I just knew something didn't feel right. But I had this new magical thing, a diagnosis. And so, my OCD latched onto OCD and researched the heck out of it. And so, I was researching, researching, researching, and really starting to find some things like, “Oh, this isn't working for me. I've been doing the same type of therapy for a decade and I'm not making progress.” Unbelievably thankful for the Louisville OCD Clinic. So, at this point in this story-- thanks for listening to the whole saga. Kimberley: No, I've got goosebumps. Andrew: I'm unemployed, I have my diagnosis, but I'm not making any progress. So, I go, “Throw this in as well. Not really that important.” But I go to an intensive outpatient program in Louisville before the OCD clinic. And I remember this conversation of the group therapy leader saying, “I need you to commit to this.” And I said, “But I don't think this is helping me either,” because the conversation was about relationships, my relationship was great. It was about work, I wasn't working. It was about parents, my parents were great. They were supporting me financially. They're super helpful and loving and kind. It's like, “None of this is external.” I kept saying, “This is internal. I have something going on inside of me.” And she said, “Well, I want you to commit to it.” I said, “I'm sorry, I found a local OCD clinic. I'm going to try them out.” So, I did IOP, I did 10 straight days, and it is a magical, marvelous memory of mine. I mean, as you know, the weirdest stuff, oh gosh. Some of the highlights that are quite humorous, I had a thing around blood and veins. And so, we built our hierarchy, and maybe we'll talk about this in a bit, what ERP is. So, built the hierarchy, I'm afraid of cutting my veins and bleeding out. So, let's start with a knife on the table. And then the next day, the knife in the hand. And then the next day, the knife near my veins. And then we talked about a blood draw. And then the next day, we watched a video of a nurse talking about it. Not even the actual blood draw, but her talking about it. So, of course, my SUDs are up really high. And the nurse says in the video, “Okay, you need to find the juiciest, bumpiest vein, and that's where you put it in.” And my therapist, pause the video. She said, “Perfect. Andrew, I want you to go around to every person in the office and ask to feel the juiciest, bumpiest veins.” Oh my gosh. Can you imagine? Kimberley: The imagery and the wording together is so triggering, isn't it? Andrew: Right. She's amazing. So, she was hitting on two things for me. One, the blood and veins, and two, inconveniencing people. I hated the inconveniencing people or have awkward moments. Well, hey, it's doing all three of these things. So, I went around. And of course, it's an OCD clinic, so nobody's against it. They're like, “Sure, here you go. This one looks big. Here, let me pump it up for you.” And I'm like, “No, I don't like this.” Kimberley: Well, it's such a shift from what you had been doing. Andrew: It's totally different. I'll speak to the rest because that's really the big part. But ERP over the next few years gave me my life back. I started working again. I worked full-time. Went part-time, then full-time. Got into a leadership position. And then for a few other reasons, my wife and I decided to make a big jump abroad. And so, moved to Berlin. And I have a full-time job here and a part-time disc golf coach trainer. And now I'm an OCD advocate and excited to work with you on that level and just looking at where my life was four or five years ago versus now. And thanks to our big-ticket item today, ERP. Kimberley: Right. Oh, my heart is so exploding for you. Andrew: Oh, thank you. Kimberley: My goodness. I mean, it's not a wonderful story. It's actually an incredibly painful story. Andrew: You can laugh at it. I told it humorously. How Andrew Applied Erp For His Ocd Kimberley: No. But that's what I'm saying. That's what's so interesting about this, is that it's such a painful story, but how you tell it-- would I be right in saying like a degree of celebration to it? Tell me a little bit about-- you're obviously an ERP fan. Tell me a little bit about what that was like. Were you in immediately, or were you skeptical? Had you read enough articles to feel like you were trusting it? What was that like for you? Because you'd been put through the wringer. Andrew: Yeah. There's a lot to talk about, but there are a couple of key moments when you mention it. So, one, we're going through the Y-BOCS scale, the Yale-Brown Obsessive Compulsive Scale, something like that. So, she asks me one of the questions like, how often do you feel like a compulsion to do something and you don't do the compulsion? “Oh, never. I've never stopped. But you can do that?” It was just this moment of, “What do you mean?” If it's hot, I'm going to make it colder. If it's cold, I'm going to make it warmer. If I'm uncomfortable, I'm going to fidget. I'm a problem solver. Both my parents were math teachers. I was an all-A student and talk about perfectionism and “just right” OCD maybe in this context as well. But also, I love puzzles. I love solving things. And that was me. I was a problem solver. It never occurred to me to not solve the problem. And so, that was a huge aha moment for me. And I see it now and I talk about it now to other people. Am I Doing Erp “Just Right”? But another part of ERP with the just right is, am I doing ERP right? Am I doing it right? Am I doing ERP right? And of course, my therapist goes, “I don't know. Who knows? Maybe, maybe not.” So, depending on where you want to go with this, we can talk about that more. So, I think in general, I hated that at the time. I was like, “I know there is a right way to do it. There is. I know there is.” But now, I even told someone yesterday in our Instagram OCD circles, someone was posting about it, and I said exactly that, that I hated this suggestion at first that maybe you're doing it wrong, maybe you're not. I will say, as we talk about ERP for everyone, someone who maybe is going to listen to this or hears us talking on Instagram and wants to do it on their own, this idea of exposing yourself to something uncomfortable and preventing the response – I don't know if this is wrong, but I will say for me, it was not helpful. In my first few weeks, I would do something like-- I was a little claustrophobic, so I maybe sit in the middle seat of a car. It's good I'm doing the exposure. I'm preventing the response by staying there. I didn't get out. But in my head, I'm doing, “Just get through this. Just get through this. I hate this. It's going to be over soon. You'll get through it and then you'll be better. Come on, just get through it. Oh, I hate this. Ugh. Ugh.” And then you get to the end and you go, “Okay, I made it through.” And of course, that didn't really prevent the response. That reinforced my dread of it. And so, I would say that's definitely a lesson as we get into that. Kimberley: And I think that brings me to-- you bring up a couple of amazing points and I think amazing roadblocks that we have to know about ERP. So, often I have clients who'll say early in treatment, “You'd be so proud I did the exposure.” And I'd be like, “And the RP, did that get included?” So, let's talk about that. So, for you, you wanted to talk about like ERP is for everyone. So, where did that start for you? Where did that idea come from? Andrew: I would say it's been slow going over the years where-- I don't know how to say this exactly, but thinking like, there must be higher than 2% of people that have OCD because I think you have it and I think you have it and I think you have it, and noticing a lot of these things. And so, maybe they're not clinical level OCD and maybe it's just anxiety or I think, as I emailed you, just stress. But it's this-- I just wonder how many friends and family and Instagram connections have never had that aha moment that I did in my first week of IOP of, “Oh, I cannot try to solve this.” And so, I see people that I really care about and I joked with my wife, I said, “Why is it that all of our best friends are anxious people?” And I think that comes with this care and attention and that I've suffered and I don't want anyone else to suffer. And so, I see that anxiety in others. But getting back to what I see in them, maybe someone is socially anxious so they're avoiding a party or they're leaving early, or-- I mean, I did these two, avoided, left early, made sure I was in either a very large group where nobody really noticed me or I was in a one-on-one where I had more control. I don't know. So, seeing that in some other friends, leaving early, I just want to say to them, you can stay. It's worked for me. It really has. This staying, exposing yourself to the awkwardness of staying or maybe it's a little too loud or it's too warm. And then let that stress peak fall and see, well, how do you feel after 30 minutes? How do you feel after an hour? I want to scream that to my friends because it's helped me so much. I mean, you heard how awful and miserable it was for so long and how much better. I'm not cured, I think. I'm still listening to your six-part rumination series because I think that's really what I'm working on now. So, I think those physical things, I've made tremendous improvement on blood and veins and all that. But that's also not why I quit work. I didn't quit working. I didn't quit AmeriCorps because there's so much blood everywhere. No, it's nonprofits, it's cubicles. But it was this dread that built this dread of the day, this dread of responding to an email. Am I going to respond right? Oh no, I'm going to get a phone call. Am I going to do that? Am I going to mess this up? And because I didn't have that response prevention piece, all I had was the exposure piece, then it's-- I can't remember who said it, but like, ERP without the RP is just torture. You're just exposing yourself to all these miserable things. Kimberley: You're white-knuckling. Andrew: Yeah. And it's-- I love research. I am a scientist by heart. I'm a Physics major and Environmental Studies master's. I love research and all this. And so, I've looked into neuroplasticity, but I also am not an expert. Correct me if I'm wrong, but from what I hear, you're just reinforcing that neural pathway. So, I'm going into work and I dread it. I'm saying, “I hate this. I can't wait to go home. I hate this.” So, that's reinforcing that for the next day. And tomorrow I go in and that dreads bigger, and the next day the dreads bigger. And so, seeing that in other colleagues who are having a miserable time at work is just getting worse and worse and worse. But I also can see that there are parts they enjoy. They enjoy problem-solving, they enjoy helping students, they enjoy the camaraderie. And so, I want to help them with, well, let's see how we can do ERP with the things you don't like and so you're not building this dread day after day and you can do the things you value. Seems like you value us coworkers, seems like you value helping the students, seems like you value solving this problem, and that's meaningful. But I'm watching you get more and more deteriorated at work. And that's hard to do that in others. ERP Is For Everyone Kimberley: Yeah. I resonate so much from a personal level and I'll share why, is I have these two young children who-- thankfully, I have a Mental Health degree and I have license, and I'm watching how anxiety is forming them. They're being formed by society and me and my husband and so forth, but I can see how anxiety is forming them. And there's so many times-- I've used the example before of both my kids separately were absolutely petrified of dogs. And they don't have OCD, but we used a hierarchy of exposure and now they can play with the neighbor's dogs. We can have dogs sitting. And it was such an important thing of like, I could have missed that and just said, “You're fine. Let's never be around dogs.” And so, it's so interesting to watch these teeny tiny little humans being formed by like, “Oh, I'm not a dog person.” You are a dog person. You're just afraid of dogs. It's two different things. Andrew: Yeah. So, it's funny that my next-door neighbor, when I was young, had a big dog. And when we're moving into the house for the very first time, very young, I don't know, four or something, it ran into the house, knocked me over, afraid of dogs for years. So, same thing. Worked my way up, had a friend with a cute little pup, and then got to a scarier one. And also, funnily to me, my next-door neighbor, two in a row, were German, and they scared me, the scary dog, German. And then the next one was the “Stay off my lawn, don't let your soccer ball come over.” So, for years, I had this like, “I'm not going to root for Germany in sports. I don't like Germany.” And then here I am living in Germany now. Kimberley: Like an association. Andrew: Yeah. So, I think fear association, anxiety association. And then I'm also playing around with this idea, maybe do a series on Instagram or maybe another talk with someone about, is it anxiety or is it society? And so, talking about things that were made to feel shame about. So, I don't know if you can see on our webcam that I have my nails painted. I would never have done this in Kentucky. So, growing up in this, I remember vividly in elementary school, I sat with my legs crossed and someone said, “That's how a girl sits. You have to sit with your foot up on your leg.” So, I did for the rest of my life. And then I wore a shirt with colorful fish on it, and they said, “Oh, you can't wear that, guys don't wear that.” So, I didn't. I stopped wearing that and all these things, whether it's about our body shape or femininity or things we enjoy that are maybe dorky or geeky. I just started playing Dungeons and Dragons. We have a campaign next week. And I remember kids getting bullied for that. I don't know if you agree, but I see this under the umbrella of ERP. So, you're exposing yourself to this potential situation where there's shame or embarrassment, or you might get picked on. Someone might still see these on the train and go, “What are you doing with painted nails?” And I'm going to choose to do that anyway. I still get a little squirmy sometimes, but I want to. I want to do that and I want that for my friends and family too. And I see it in, like you said, in little kids. A lot of my cousins have young kids and just overhearing boys can't wear pink, or you can't be that when you grow up, or just these associations where I think you can, I think you can do that. Kimberley: I love this so much because I think you're so right in why ERP is for everyone. It's funny, I'll tell you a story and then I don't want to talk about me anymore, but-- Andrew: No, I want to hear it. That's fine. Kimberley: I had this really interesting thing happen the other day. Now I am an ERP therapist. My motto is, “It's a beautiful day to do hard things.” I talk and breathe this all day, and I have recovered from an eating disorder. But this is how I think it's so interesting how ERP can be layered too, is I consider myself fully recovered. I am in such good shape and I get triggered and I can recover pretty quick. But the other day, I didn't realize this was a compulsion that I am still maybe doing. I went to a spa, it was a gift that was given to me, and it says you don't have to wear your bathing suit right into the thing. So, I'm like, “Cool, that's fine. I'm comfortable with my body.” But I caught myself running from the bathroom down into the pool, like pretty quickly running until I was like, that still learned behavior, it's still learned avoidance from something I don't even suffer from anymore. And I think that, to speak to what you're saying, if we're really aware we can-- and I don't have OCD, I'm open about that. If all humans were really aware, they could catch avoidant behaviors we're doing all the time that reinforces fear, which is why exposure and response prevention is for everybody. Some people be like, “Oh, no, no. I don't even have anxiety.” But it's funny what you can catch in yourself that how you're running actually literally running. Andrew: Literally running. Yeah. Kimberley: Away. So, that's why I think you've mentioned how social anxiety shows up and how exposure and response prevention is important for that. And daily fears, societal expectations, that's why I think that's so cool. It's such a cool concept. Andrew: Yeah. And so, help me since I do consider you the expert here, but I've heard clinically that ERP can be used for OCD but also eating disorder, at least our clinic in Louisville serves OCD, eating disorder, and PTSD. And so, I see the similarities there of the anxiety cycle, the OCD cycle for each of those. So, then let's say that's what ERP is proposed for. But then we also have generalized anxiety and I think we're seeing that. I've heard Jenna Overbaugh talk about that as well. It's this scale between anxiety to high anxiety to subclinical OCD, to clinical OCD, and that ERP is good for all of that. So, we have those, and then we get into stress and avoidant behavior. So, I have this stressful meeting coming up, I'll find a way to skip it. Or I have this stressful family event, I'll find a way to avoid it. And then you get into the societal stuff, you get into these. And so, I see it more and more that yes, it is for everyone. Kimberley: Yeah. No, I mean, clinically, I will say we understand it's helpful for phobias, health anxiety, social anxiety, generalized anxiety. Under the umbrella of OCD are all these other disorders and, as you said, spectrums of those disorders that it can be beneficial for. And I do think-- I hear actually a lot of other clinicians who aren't OCD specialists and so forth talking about imposter syndrome or even like how cancel culture has impacted us and how everybody's self-censoring and avoiding and procrastinating. And I keep thinking like ERP for everybody. And that's why I think like, again, even if you're not struggling with a mental illness, imposter syndrome is an avoidant. Often people go, procrastination is an avoidant behavior, a safety behavior or self-censoring is a safety behavior, or not standing up for you to a boss is an opportunity for exposure as long as of course they're in an environment that's safe for them. So, I agree with you. I think that it is so widespread an opportunity, and I think it's also-- this is my opinion, but I'm actually more interested in your opinion, is I think ERP is also a mindset. Andrew: Yeah. Kimberley: Like how you live your life. Are you a face-your-fear kind of person? Can you become that person? That's what I think, even in you, and actually, this is a question, did your identity shift? Did you think you were a person who couldn't handle stresses and now you think you are? Or what was the identity shift that you experienced once you started ERP? Andrew: Yeah. That's a good question. I've had a few identity shifts over the years. So, I mentioned-- and not to be conceited, although here I am self-censoring because I don't want to come across as conceited anyway. So, I was an all-A student in high school, and then OCD and depression hit hard. And so, throughout college, freshman year I got my first B, sophomore year I got my first C, junior year I got my first D. And so, I felt like I was crawling towards graduation. And this identity of myself as Club President, all-A student, I had to come to terms with giving up who I thought I could be. I thought I could be-- people would joke, “You'll be the mayor of this town someday, Andrew.” And I watched this slip away and I had to change that identity. And not to say that you can't ever get that back with recovery, but what I will say is through recovery, I don't have that desire to anymore. I don't have that desire to be a hundred percent. I'm a big fan of giving 80%. And mayor is too much responsibility. I don't know, maybe someday. So, that changed. And then definitely, through that down downturn, I thought, I can't handle this. I can't handle anxiety, I can't handle stress. People are going to find out that this image I've built of myself is someone who can't handle that. So, then comes the dip coming back up, ERP, starting to learn I can maybe but also-- I love to bounce all over the place, but I think I want to return a bit to that idea that you don't have to fix it. You don't have to solve the problem. I think that was me. And that's not realizing that I was making it harder on myself, that every moment of the day I was trying to optimize, fix, problem-solve. If you allow me another detour, I got on early to make sure the video chat was working, sound was okay. And I noticed in my walk over to my computer, all the things my brain wanted me to do. I call my brain “Dolores” after Dolores Umbridge, which is very mean to me. My wife and I, Dolores can F off. But I checked my email to make sure I had the date right. Oops, no, the checking behavior. Check the time, making sure, because we're nine hours apart right now. “Oh, did I get the time difference right?” I thought about bringing over an extra set of lights so you could see me better. I wanted to make sure I didn't eat right before we talked, so I didn't burp on camera, made sure I had my water, and it was just all these-- and if I wasn't about to meet with an OCD expert, I wouldn't have even noticed these. I wouldn't have even noticed all of these checking, fidgeting, optimizing, best practicing. But it's exhausting. And so, I'm going to maybe flip the script and ask you, how do you think other people that are not diagnosed with OCD, that are just dealing with anxiety and stress can notice these situations in their life? How do they notice when, “Oh, I'm doing an avoidant behavior,” or “I'm fixing something to fix my anxiety that gives me temporary relief”? Because I didn't notice them for 10 years. Kimberley: Yeah. Well, I think the question speaks to me as a therapist, but also me as a human. I catch every day how generalized anxiety wants to take me and grab me away. And so, I think a huge piece of it is knowledge, of course. It's knowledge that that-- but it's a lot to do with awareness. It's so much to do with awareness. I'll give you an example, and I've spoken about this before. As soon as I'm anxious, everything I do speeds up. I start walking faster, I start typing faster, I start talking faster. And there's no amount of exposure that will, I think, prevent me from going into that immediate behavior. So, my focus is staying-- every day, I have my mindfulness book right next to me. It's like this thick, and I look at it and I go, “Okay, be aware as you go into the day.” And then I can work at catching as I start to speed up and speed type. So, I think for the person who doesn't have OCD, it is, first, like you said, education. They need to be aware, how is this impacting my life. I think it's being aware of and catching it. And then the cool part, and this is the part I love the most about being a therapist, is I get to ask them, what do you want to do? Because you don't have to change it. I'm not doing any harm by typing fast. In fact, some might say I'm getting more done, but I don't like the way it makes me feel. And so, I get to ask myself a question, do I want to change this behavior? Is it serving me anymore? And everyone gets to ask them that solves that question. Andrew: So, I think you bring up a good point though that I'm curious if you've heard this as well. So, you said you're typing fast and you're feeling anxious and you don't like how that feels. I would say for me, and I can think of certain people in my life and also generally, they don't realize those are connected. I didn't realize that was connected. In college, I'm wanting to drop out, I drop out of AmeriCorps, I drop out of summer camp. I'm very, very anxious and miserable and I don't know why. And looking back, I see it was this constant trying to fix things and being on alert. And I got to anticipate what this is going to be or else is going to go bad. I need to prevent this or else I'm going to have an anxious conversation. I need to only wear shorts in the winter because I might get hot. Oh no, what if I get hot? And it was constantly being in this scanning fear mindset of trying to avoid, trying to prevent, trying to-- thinking I was doing all these good things. And I saw myself as a best-practice problem solver. It's still something I'm trying to now separate between Dolores and Andrew. Andrew still loves best practices. But if I spend two hours looking for a best practice when I could have done it in five minutes, then maybe that was a waste. And I didn't realize that was giving me that anxiety. So, yeah, I guess going back to I think of family, I think of coworkers, I think of friends that I have a suspicion, I'm not a therapist, I can't diagnose and I'm not going to go up, I think you have this. But seeing that they're coming to me and saying, “I'm exhausted. I just have so much going on,” I think in their head, it's “I have a lot of work.” Kimberley: External problems. Andrew: Yeah. I may be seeing-- yeah, but there's all this tension. You're holding it in your shoulders, you're holding it here, you're typing fast and not realizing that, oh, these are connected. Kimberley: And that's that awareness piece. It's an awareness piece so much. And it is true. I mean, I think that's the benefit of therapy. Therapists are trained to ask questions so that you can become aware of things that you weren't previously aware of. I go to therapy and sometimes even my therapist will be like, “I got a question for you.” And I'm like, “Ah, I missed that.” So, I think that that's the beauty of this. Andrew: I had a fun conversation. I gave a mental health talk at my school and talked about anxiety in the classroom, and thanks to IOCDF for some resources there, there's a student that wanted to do a follow-up. And I thought this was very interesting and I loved the conversation, but three or four times he was like, “Well, can I read some self-help books, and then if those don't work, go to therapy?” “No, I think go to therapy right away. Big fan of therapists. I'm not a therapist. You need to talk to a therapist.” “Okay. But what if I did some podcasts and then if that didn't work, then I go to therapy?” “Nope. Therapy is great. Go to therapy now.” “Should I wait till my life gets more stressful?” “Nope. Go now.” Kimberley: Yeah, because it's that reflection and questioning. Everyone who knows me knows I love questions. They're my favorite. So, I think you're on it. So, this is so good. I also want to be respectful of your time. So, quick rounded out, why is ERP for everybody, in your opinion? Andrew: How do we put this with a nice bow on it? Kimberley: It doesn't have to be perfect. Let's make it purposely imperfect. Andrew: Let's make it perfectly imperfect. So, we talked before about the clinical levels – OCD, eating disorder, PTSD, generalized anxiety disorder. If you have any of those, take it from me personally, take it from you, take it from the thousands of people that said, “Hey, actually, ERP is an evidence-based gold standard. We know it works, we've seen it work. It's helped us. Let it help you because we care about you and we want you to do it.” And then moving down stress from work, from life. You have a big trip coming up. There's a fun scale, home's rocky, something stress inventory. I find it very interesting that some of them are positive, outstanding personal achievement like, “Oh, that's a stressful thing?” “Yeah, It can be.” And so, noticing the stressful things in your life and saying, “Well, because of these stressful things are the things I'm avoiding, things I'm getting anxious about, can I learn to sit with that?” And I think that mindfulness piece is so important. So, whether you're clinical, whether you're subclinical, whether you have stress in your life, whether you're just avoiding something uncomfortable, slightly uncomfortable, is that keeping you from something you want to do? Is that keeping you-- of course, we-- I don't know if people roll their eyes at people like us, “Follow your values, talk about your values.” Do you value spending time with your friends, but you're avoiding the social gathering? Sounds like ERP could help you out with that. Or you're avoiding this, you want to get a certification, but you don't think you'll get it and you don't want to spend the time? Sounds like ERP could help with that. We're in the sports field. My wife and I rock climbing, bouldering, disc golf. You value the sport, but you're embarrassed to do poorly around your friends? Sounds ERP can help with that. You value this thing. I think we have a solution. I've become almost evangelical about it. Look at this thing, it works so well. It's done so much for me. Kimberley: Love it. Okay, tell me where-- I'm going to leave it at that. Tell me where people can hear about you and get in touch with you and hear more about your work. Andrew: Mainly through Instagram at the moment. I have a perfectly imperfect Instagram name that you might have to put down. It's JustRught but with right spelled wrong. So, it's R-U-G-H-T. Kimberley: That is perfect. Andrew: Yeah. Which also perfectly was a complete accident. It was just fat thumbs typing out my new account and I said, “You know what, Andrew, leave it. This works. This works just fine.” Kimberley: Oh, it is so good. It is so good. Andrew: Yeah. So, I'm also happy I mentioned to you earlier that my wife and I have started this cool collab where I take some of her art and some of the lessons I've learned in my 12-plus years of therapy and we mix them together and try to put some lessons out there. But I'm currently an OCD advocate as well. You can find me on IOCDF's website or just reach out. But really excited to be doing this work with you. I really respect and admire your work and to get a little gushing embarrassed. When I found out that I got accepted from grassroots advocate to regular advocate, I said, “Guys, Kimberley Quinlan is at the same level as me.” I was so excited. Kimberley: You're so many levels above me. Just look at your story. That's the work. Andrew: The imposter syndrome, we talked about that earlier. Kimberley: Yeah, for sure. No, I am just overwhelmed with joy to hear your story, and thank you. How cool. Again, the reason I love the interviews is I pretty much have goosebumps the entire time. It just is so wonderful to hear the ups and the downs and the reality and the lessons. It's so beautiful. So, thank you so much. Andrew: I will add in, if you allow me a little more time, that it's not magic. We're not saying, “Oh, go do ERP for two days and you'll be great.” It's hard work. It's a good day to do hard things. I think if it was easy, we wouldn't be talking about it so much. We wouldn't talk about the nuance. So, I think go into it knowing it is work, but it is absolutely worth it. It's given me my life back, it's saved my relationships, it's helped me move overseas, given me this opportunity, and I'm just so thankful for it. Kimberley: Yeah. Oh, mic drop. Andrew: Yeah. Kimberley: Thank you again.
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