Speaker 1: This is the Anxiety Bites podcast and I am your host,
Speaker 1: Jen Kirkman. Welcome to another episode of Anxiety Bites. I
Speaker 1: am your host Jen Kirkman. Now today we are talking
Speaker 1: about o c D, obsessive compulsive disorder. I did do
Speaker 1: an episode a few months ago with my friend Andy Kindler,
Speaker 1: who is a comedian who suffers from o c D,
Speaker 1: and it was great to get his perspective of what
Speaker 1: it feels like for him, how it moved through his life,
Speaker 1: what it felt like in his body when he was
Speaker 1: having o c D experiences, what he's come to now
Speaker 1: after getting treatment. But I also wanted to talk to
Speaker 1: someone who is a specialist in o c D so
Speaker 1: we could really dial down into the nitty gritty of
Speaker 1: what exactly is obsessive compulsive disorder and what are the many,
Speaker 1: many ways that it can manifest. And I'm sure in
Speaker 1: this interview we have only scratched the surface. But what
Speaker 1: I enjoyed in my conversation with Kimberly Quinlan is that
Speaker 1: she talks about what is perhaps the most normal O
Speaker 1: c D symptom is unwanted thoughts, and I actually, if
Speaker 1: you had asked me, I would have thought it was
Speaker 1: more the handwashing and the you know, germ phobia, contamination phobia,
Speaker 1: and she said, while those are pretty common, what most
Speaker 1: people rushed to seek treatment for are the unwanted thoughts.
Speaker 1: Thoughts that they might harm someone they love, Thoughts that
Speaker 1: they might uh, you know, harm a child, that they
Speaker 1: might harm their partner, someone in their family. And it's
Speaker 1: it's difficult to talk about because it sounds like the
Speaker 1: minute you say that, right, someone should luck you up
Speaker 1: and throw away the key. And what has been discovered
Speaker 1: in o c D treatment is that people who have
Speaker 1: these thoughts are the least likely people to do anything
Speaker 1: about it, because what they're worried about is what if,
Speaker 1: because they it is the last thing they want to
Speaker 1: do is to harm someone, especially someone they love. And
Speaker 1: it's really debilitating and it disturbs people and it's it's tough.
Speaker 1: So she talked all about having a sense of humor
Speaker 1: about it and how that is actually part of the treatment.
Speaker 1: That it may seem like it's such a big deal
Speaker 1: to be having these thoughts, but again, the key component
Speaker 1: of it that makes it obsessive compulsive disorder and that
Speaker 1: makes it harmless is that it is an intrusive unwanted thought,
Speaker 1: and so you may find this very interesting if this
Speaker 1: is something this is something that you've been living with,
Speaker 1: you've been afraid to talk about it. Hopefully this really
Speaker 1: brings it home for you that it is normal, common,
Speaker 1: very treatable. And so a little bit more about my
Speaker 1: guest today, kim Really Quinlan. Her website is linked in
Speaker 1: the show notes. She does compassionate, science based treatment for
Speaker 1: O c D, anxiety disorders, and eating disorders. We didn't
Speaker 1: even get into anxiety disorders and eating disorders today, but
Speaker 1: of course you can go to her website and learn
Speaker 1: more about it. Today we really just focused on obsessive
Speaker 1: compulsive disorder involving obsessions and compulsions. And again, an obsession
Speaker 1: is an intrusive and unwanted thought that creates significant anxiety
Speaker 1: and discomfort, and a compulsion is an overt or covert
Speaker 1: behavior done in an attempt to reduce the discomfort of
Speaker 1: the intrusive thoughts and feelings. And so even though Kimberly
Speaker 1: Quinland practices out in California, she does have her own
Speaker 1: kind of online school where you can take courses to
Speaker 1: get treated for obsessive compulsive disorders. So again that's in
Speaker 1: the show notes, but her CBT school dot com has
Speaker 1: online resources for obsessive compulsive disorder, anxiety disorders, hair pulling,
Speaker 1: skin picking. She has online video courses Mindfulness for o
Speaker 1: c D and o c D online course Overcoming Anxiety
Speaker 1: and Panic, a time management course. So check that all out.
Speaker 1: Because even if you are unable to find a therapist
Speaker 1: in your area or get to a therapist, you can
Speaker 1: begin doing some of the exposure therapy work by taking
Speaker 1: a course. So let's get right to it, because Kimberly
Speaker 1: is she really knows her stuff. She's totally brilliant, and
Speaker 1: I think you will enjoy learning about exactly what o
Speaker 1: c D is and what it isn't. All right, I'm
Speaker 1: gonna start out with what I think you know, hopefully
Speaker 1: not too basic and boring of a question. But can
Speaker 1: you just define o c D obsessive compulsive disorder? Sure? No,
Speaker 1: that's not a basic question at all. It's actually a
Speaker 1: really important question because to have o c D you
Speaker 1: need to have a certain criteria of things. So number one,
Speaker 1: you have to have obsessions. But obsessions aren't like I
Speaker 1: love lego, or I love sweaters, or I love or
Speaker 1: your cookies like I'm obsessed with binge watching Netflix, like
Speaker 1: it's not. That is what an obsession is. But in
Speaker 1: the terms of o c D, an obsession is usually
Speaker 1: an intrusive, repetitive, and unwanted. So it has to have
Speaker 1: those three pieces um and it usually shows up in
Speaker 1: the form of a thought, but it can also show
Speaker 1: up in the form of a feeling or a sensation
Speaker 1: or an image that keeps popping up into your brain
Speaker 1: um or it could even be an urge. This sort
Speaker 1: of urged comes up and overwhelms your body. So you
Speaker 1: have to have that first criteria to have the obsession,
Speaker 1: and you have to have a compulsion. Now, a compulsion
Speaker 1: is a behavior that we do um to reduce or
Speaker 1: remove uncertainty or anxiety or any form of discomfort even
Speaker 1: maybe even discussed. A big misconception is that that compulsion
Speaker 1: has to be physical, so we know sort of Hollywood
Speaker 1: o c D, which is like jumping over cracks, washing
Speaker 1: your hands, counting objects. They're all great portrayals of having
Speaker 1: o c D. But there are other ways in which
Speaker 1: people can do compulsions that are actually completely unseen by
Speaker 1: the eye. Like one really big one is mental compulsions.
Speaker 1: Mentally ruminating and and resolving and trying to solve problems
Speaker 1: in your mind. Another one is simply avoidance. So some people,
Speaker 1: a lot of people unfortunately who have O c D,
Speaker 1: will go to a doctor and they'll say, you don't
Speaker 1: have a CD. I don't see you doing anything. I
Speaker 1: don't see you doing any behavior. But this person has
Speaker 1: avoided of their life, right, And that's the compulsion that
Speaker 1: they do. And the other one is reassurance seeking, So
Speaker 1: they're constantly googling or asking for reassurance from a person,
Speaker 1: you know, did this happen, could it happen, will it happen?
Speaker 1: Did I do something wrong? So, so there are many
Speaker 1: ways in which a compulsion can show up, um, that
Speaker 1: our society isn't aware of. And then the deep part
Speaker 1: disorder what I mean, that's just the name of an
Speaker 1: obsessive compulsive disorder? So is there anything in the deep
Speaker 1: part that makes it the disorder like that you have
Speaker 1: to look for? Yeah, Well, to be diagnosed with a
Speaker 1: c D, it has to disrupt your life and you're
Speaker 1: functioning to a degree that is problematic. Um. You know,
Speaker 1: some people will often say like they have some symptoms
Speaker 1: of obsessive and compulsive they have to be haveviors, but
Speaker 1: it's not to the degree in which it is disordered,
Speaker 1: meaning there is now lack of order. Um that it's
Speaker 1: not debilitating their life taking away their functioning. So the
Speaker 1: people that I see how usually coming in there doing
Speaker 1: it for more than one or two hours a day.
Speaker 1: Most of the time it's taking up many, many, many
Speaker 1: hours of their day to the degree where they've lost
Speaker 1: some functioning. So that's sort of where the wood disorder
Speaker 1: comes into play. And that's true for any disorder, anorexier depression,
Speaker 1: it's usually you know, the symptoms have started to impact
Speaker 1: my well being. And do you like the name obsessive
Speaker 1: compulsive disorder? Does that work for you in terms of, um,
Speaker 1: what what it is that you know, the people you
Speaker 1: treat and what they have, and what it's called. Do
Speaker 1: you find that that's an accurate description of it? A
Speaker 1: lot of people with o c D find that the
Speaker 1: disorders name actually describes even the treatment right and the
Speaker 1: way in which we treat it, because it helps identify
Speaker 1: that there are multiple components of this disorder and that
Speaker 1: we have to look at each component in order to
Speaker 1: treat them really well. So I you know, we look
Speaker 1: at other terms like anorexia nervosa, it's like that doesn't
Speaker 1: even that's just syllables match together to make a certain word,
Speaker 1: Like it doesn't really even make any sense. But with
Speaker 1: this case, it does help us to identify the two
Speaker 1: core pieces that are showing up and you have to
Speaker 1: have both. And then it also it helps us to
Speaker 1: sort of put forward a plan. Um. So, I mean,
Speaker 1: I think that the problem with it, if we were
Speaker 1: to look at both sides of the coin, is because
Speaker 1: it's so misunderstood and stigmatized. I know a lot of
Speaker 1: people who don't like the term because of the stigma
Speaker 1: that go with it. But in terms of the correctness
Speaker 1: of the name, I think it's wonderful. And you are
Speaker 1: an O c D specialist, and I've heard you said,
Speaker 1: I've listened to some other interviews you've done that that
Speaker 1: there's very few of you in that sense to kind
Speaker 1: of I mean, I'm putting words in your mouth. You
Speaker 1: didn't say like this, but like you kind of know
Speaker 1: what they're doing, you know, is it hard? Um? Tell
Speaker 1: me what makes you? Tell me? Um? Tell me what
Speaker 1: sets you apart from other people that think they're treating
Speaker 1: O c D and and why it's important to I
Speaker 1: don't know. I guess go see someone like you as
Speaker 1: opposed to just any kind of therapist or anxiety specialists. Yeah. Well,
Speaker 1: what I will say before I start is, thankfully, over
Speaker 1: the last decade that I've been specializing in it, we've
Speaker 1: had such growth of more therapists. So you know, there's
Speaker 1: so many therapists now who are trained and correctly you know,
Speaker 1: supervised and so forth. So thankfully that's going in the
Speaker 1: right direction. But the O c D community has still
Speaker 1: a crisis on their hand. It still takes seven to
Speaker 1: fourteen years to get correctly diagnosed. That's a lot of years.
Speaker 1: So that means that these people have sought treatment from
Speaker 1: some other kind of therapist, maybe even doctor, and the
Speaker 1: person has not even named what they have as o
Speaker 1: c D, or they've been named with o c D,
Speaker 1: but they're they're not getting the right help with it both.
Speaker 1: So a lot of people will be declined the diagnosis
Speaker 1: and therefore can't get the treatment because of the misinformation
Speaker 1: around the compulsions. Right, like you don't have O c D.
Speaker 1: You can't your room's messy, you can't have O c D. Right, So,
Speaker 1: like what you were saying before they they're not noticing,
Speaker 1: they're not know speed on the other compulsions. Yeah, yeah,
Speaker 1: So there's that group there, the other group who get
Speaker 1: told they have a c D but then may be
Speaker 1: referred to a form of treatment that you know, out
Speaker 1: of the goodness of their soul, have tried to help,
Speaker 1: but often what they're using is techniques that actually make
Speaker 1: the compulsion and the disorder worse. So with the treatment
Speaker 1: of O c D, we actually purposely face our fears.
Speaker 1: That's the gold standard treatment. It's called exposure and response prevention.
Speaker 1: But if you're not trained in that naturally, any human
Speaker 1: I'm sure before you listen to this episode or knew
Speaker 1: anything about O c D, naturally your instincts would be, oh,
Speaker 1: if you have a fear that sounds really painful, you
Speaker 1: should avoid it. More like, can we figure out a way,
Speaker 1: Like there are even apps that have been created to
Speaker 1: help people take photos of their stove so that they
Speaker 1: know for certain they have turned their stove off or
Speaker 1: they've locked their door. And instinctually that makes sense, right, like, well,
Speaker 1: if you know you've locked your door, you shouldn't worry.
Speaker 1: But those behaviors actually act as compulsions. And keep the
Speaker 1: disorder going. So it's it goes against the recovery. And
Speaker 1: so that's where there's sort of there was a crisis
Speaker 1: and we are working our way out of it in
Speaker 1: edge acting mental health and medical professionals to to direct
Speaker 1: people to the correct care because it can go so wrong.
Speaker 1: We'll be right back. I haven't talked to anyone yet
Speaker 1: about exposure therapy. It's been casually mentioned in other episodes
Speaker 1: I've done, but the focus wasn't that, so I didn't
Speaker 1: really follow that trail. And I know that it's it's
Speaker 1: probably obviously different with every anxiety disorder, and but weird
Speaker 1: it's been brought up has been episodes that are more
Speaker 1: centered on panic attacks and things like that. Um, so
Speaker 1: I'm sort of familiar with it in terms of what
Speaker 1: I've done for panic attacks. But can you tell us
Speaker 1: what is exactly you said exposure and what response prevention?
Speaker 1: Tell us what exposure response prevention is? Sure? So, Um,
Speaker 1: Exposure and response prevention we call it e r P
Speaker 1: for short, is where we so go back to the
Speaker 1: obsessive and compulsive parts, so we expose them to their obsession. Right,
Speaker 1: So that's pretty easy, right, you identify your fear, we
Speaker 1: find a way to face your fear. Back in the day,
Speaker 1: we only used to do exposure. We go, okay, if
Speaker 1: you're afraid of dogs, go and hang out with dogs,
Speaker 1: or if you're afraid of germs, go and touch germs.
Speaker 1: But what we found there was that's manly really fifty
Speaker 1: of the work, because then they just go and do
Speaker 1: all these compulsions to undo their fear or reduce or
Speaker 1: remove their fear. So the response prevention is where once
Speaker 1: you've exposed yourself to your fear, the response prevention is
Speaker 1: targeting eliminating those compulsive behaviors. So not only would you,
Speaker 1: you know, touch germs or be around germs, but then
Speaker 1: you would reduce and remove the compulsive hand wash or
Speaker 1: the rumination, or the reassurance seeking or the googling and
Speaker 1: that kind of behavior. So both must be a part
Speaker 1: of treatment for the treatment to be really successful. So
Speaker 1: if I come to you, um, how soon do we
Speaker 1: get into exposure therapy? Is it session one? Usually session
Speaker 1: two or three, depending on the complexity of the case.
Speaker 1: So we always want to do a thorough assessment, make
Speaker 1: sure we have the right diagnosis. We also want to
Speaker 1: do a ton of education because let me ask you,
Speaker 1: how how excited are you about facing your worst fear?
Speaker 1: Not excited? No, I mean I think of ump. I'll
Speaker 1: say a couple of my worst fears. I think I'm
Speaker 1: pretty excited about them because I don't need them in
Speaker 1: my life, so they don't debilitate me. But I used
Speaker 1: to have a fear flying and I was not excited
Speaker 1: to face that, but I did. So that's the thing.
Speaker 1: So anyone, I always say to my patients, like, no
Speaker 1: one wants to see me, no one likes to come
Speaker 1: visit me, no one likes to come and be my client.
Speaker 1: But they want to get better and so that's why
Speaker 1: they do. And so I have to do a lot
Speaker 1: of education about what is o c D, what is
Speaker 1: exposure and response prevention to build trust with them because
Speaker 1: I'm going to ask them to do the thing they
Speaker 1: absolutely don't want to do rightfully. So um, and that's
Speaker 1: probably the thing that frightens them the most. And usually
Speaker 1: o c D attacks the things we value the most.
Speaker 1: So if you value your relationships, it will target your relationships.
Speaker 1: If you love your job, it'll target your job. If
Speaker 1: you will love your children, it'll target your children. So
Speaker 1: because I'm asking them to do really scary things and
Speaker 1: things they value. I do give them some time and education,
Speaker 1: but I also emphasize the faster we can start getting
Speaker 1: you to face your fear, the quicker you recover. And
Speaker 1: so it's sort of a little dance that we do
Speaker 1: together of trust and courage and repair and encourage and
Speaker 1: like it's an encouragement, it's it's a dance that we
Speaker 1: do together. And I just realized in my example I
Speaker 1: gave about you know, I had a fear of flying,
Speaker 1: and I did do some exposure therapy for that. I'm
Speaker 1: not really talking about O c D. So tell me,
Speaker 1: Like I had to visitly, get exposed to an airplane,
Speaker 1: get on it, touch you know whatever, touch the outside
Speaker 1: of the airplane, first, had to look at it. But again,
Speaker 1: I wasn't dealing with an O c D issues, dealing
Speaker 1: with the phobia. So what are you being exposed to
Speaker 1: in obsessive compulsive disordered people? Like, what are they being
Speaker 1: exposed to when they seek exposure therapy? If someone's having
Speaker 1: um intrusive thoughts, emotions, or urges, which maybe we should
Speaker 1: define that before you tell me how you do it. Um,
Speaker 1: I'd love to know because I'm assuming the exposure therapy
Speaker 1: is different than like for a phobia. Right. So there
Speaker 1: are multiple different categories of types of o c D. Again,
Speaker 1: majority of people know about contamination o c D, which
Speaker 1: is the fear of germs and bodily fluids and so forth,
Speaker 1: things like that. Um. Other people know about symmetry obsessions, right,
Speaker 1: which is like lining things up and making sure things
Speaker 1: are very straight and perfectionist stick right. Um. Other people
Speaker 1: know about checking obsessions around danger. You know, will I
Speaker 1: put the you know, if I don't unplug my um
Speaker 1: my hair curlor, will the house set on fire? And
Speaker 1: I'll be responsible for you know, terrible terrible things. Um.
Speaker 1: So we know about those, but in fact they're the
Speaker 1: lesser concerns that we see in our practice. Right. We
Speaker 1: see a lot of people have obsessions around, um, harming people,
Speaker 1: and this is a very common one. Usually when I
Speaker 1: do interviews like this, I get like an influx of
Speaker 1: emails from people going, oh my god, I never thought
Speaker 1: I had O c D until you said, like these
Speaker 1: obsessions because no one had conceptualized them as o c D.
Speaker 1: So harm O c D is actually really common one.
Speaker 1: It Usually obsession is what if I harm somebody that
Speaker 1: I love or person in my life. The thing to
Speaker 1: remember again is the thought is unwanted, repetitive and distressing.
Speaker 1: Like we talked about, so people who have harm obsessions
Speaker 1: are probably like the sweetest people in the world. The
Speaker 1: thought of this is so just heartbreaking, and for them
Speaker 1: it's repetitive, like it's all day in their head, in
Speaker 1: their head, in their head. And so for E. RP.
Speaker 1: For that example, we would expose them too often the
Speaker 1: people that they're having thoughts about, right, and then the
Speaker 1: response prevention would be not to do those safety behaviors
Speaker 1: like you know, okay, so don't do the safety behaviors
Speaker 1: that they used to do to try to stop the thoughts, right, yes,
Speaker 1: so you know, And exposure can be just about very
Speaker 1: simple like go and be with the people that you're
Speaker 1: afraid of being with. In some cases it needs to
Speaker 1: be more aggressive if they've got very severe O C
Speaker 1: d um of you know, having them chop vegetables because
Speaker 1: for them, they have avoided knives for months or years
Speaker 1: in fear that they are not responsible with a knife
Speaker 1: like that they're just gonna go crazy and run down
Speaker 1: the hall and stab their husband or something exactly exactly.
Speaker 1: So we also have people with sexual obsessions, particularly around orientation.
Speaker 1: So let's say if you're heterosexual, you may be fear
Speaker 1: that am I You have a lot of uncertainty around
Speaker 1: am I gay or straight? Again, think of O c D.
Speaker 1: We call it the uncertain disorder. It usually thrives on uncertainty, right,
Speaker 1: So the more uncertain you are, the more anxiety you feel,
Speaker 1: so you may have fears around that. In that case,
Speaker 1: we would expose you to the thoughts or the feelings
Speaker 1: or the sensations, and then you would practice not engaging
Speaker 1: in avoidance safety behaviors or ruminaty of safety behaviors. So
Speaker 1: there's just a couple of examples. There's probably twenty common
Speaker 1: ones that could be related to religion. Um. It could
Speaker 1: be related to existential like the obsession around what's the
Speaker 1: point of life? Um. There are many ways in which
Speaker 1: these obsessions can target. It could be a relationship obsession.
Speaker 1: A lot of people with relationship obsessions ruminate on whether
Speaker 1: they will cheat on their partner, or ruminate on whether
Speaker 1: they've picked the quote unquote right one. Um. And then
Speaker 1: again and for some people listening, they may maybe like,
Speaker 1: but I do a little bit of that right. So
Speaker 1: it's important to know that people who don't have o
Speaker 1: c D maybe having these same fears, but not at
Speaker 1: the at the degree of repetition or extremely how extreme
Speaker 1: it is, and then you're able to manage that uncertainty.
Speaker 1: For people with o c D, they've very much struggle
Speaker 1: to stop doing compulsions around the obsession. And that's when
Speaker 1: we would intervene and with someone with like, for example,
Speaker 1: the relationship obsession, you know, interests of thoughts about relationships.
Speaker 1: It's not even based in any real thing I assume
Speaker 1: where it's like, you know, actually this isn't working out
Speaker 1: for me. We have different life goals. I mean, it's
Speaker 1: really not based in the same reality that someone who goes,
Speaker 1: oh I have that. Sometimes it's like is it that
Speaker 1: like you could be with the perfect partner and having
Speaker 1: no problems, but your mind is just going and going yea.
Speaker 1: So from this is a little bit of psycho clinical talk,
Speaker 1: but there is a term called ego dys tonic and
Speaker 1: egosyn tonic. So for people with o c D, their
Speaker 1: obsession is clinically ego dys tonic, meaning the obsession doesn't
Speaker 1: line up with their values. So just as you were saying.
Speaker 1: Often a client will come to me crying, sobbing in disbelief,
Speaker 1: and they'll say, it makes no sense. I love my
Speaker 1: child so much, but I can't stop thinking that maybe
Speaker 1: I'll harm them. So you can see that it doesn't
Speaker 1: line up with their values, and that's why it's so distressing,
Speaker 1: because it's so confusing. Ecosyntonic is where you have a
Speaker 1: thought or a feeling or a sensation and urge that
Speaker 1: does line up with your values, right um. And so
Speaker 1: people with O c D, their obsessions are usually egodis
Speaker 1: tonic um. So if that helps sort of clarify, they
Speaker 1: usually will say, like, it makes no sense. I really
Speaker 1: do care for my partner. I don't know understand why
Speaker 1: I'm having these obsessions about cheating or I love. It
Speaker 1: could be again religion, like I am so committed to
Speaker 1: my religion, but I keep having this intrusive image of
Speaker 1: a sin or so for we'll continue the interview on
Speaker 1: the flip side of a quick message from our sponsors.
Speaker 1: As part of my anxiety journey, I I've dabbled in
Speaker 1: some O c D thoughts. I know exactly what an
Speaker 1: intrusive thought feels like, and it's terrible. You know, how
Speaker 1: does someone know who's just sitting at home hearing this
Speaker 1: the difference between that and what it would be like
Speaker 1: to be maybe schizophrenic and you're hearing voices saying go
Speaker 1: push this woman in front of the subway. So how
Speaker 1: does someone know? I mean, I would assume the difference is,
Speaker 1: like you said, it's they don't want these thoughts. They're
Speaker 1: not like excited by them. Um, so does that mean
Speaker 1: that people who are going to harm people like the
Speaker 1: thoughts feel different? Like, how does someone know and they're
Speaker 1: if they're just listening? Well, I think I think number
Speaker 1: one don't if if listeners. If I could offer one
Speaker 1: piece of advice is don't try and figure that one
Speaker 1: out on your own. Um, try and seek out somebody
Speaker 1: who can do a good assessment on you. Because one
Speaker 1: thing to know is if you have anxiety, you will
Speaker 1: most likely at some point think you're crazy. Like they
Speaker 1: just go together. It feels you feel like a crazy person.
Speaker 1: I have anxiety myself, like, so you're not really probably
Speaker 1: the best person as an anxious person to assess yourself.
Speaker 1: I would always encourage you to go to try, just
Speaker 1: even if it's just for the assessment. And just get
Speaker 1: the assessment so you know specifically what you meet criteria for.
Speaker 1: The other thing is is because O c D is
Speaker 1: around uncertainty and targets uncertainty. Often people with O c
Speaker 1: D or some of the other anxiety disorders then question
Speaker 1: the diagnosis. A part of their obsessive and compulsive disorder
Speaker 1: is questioning whether or not they have O c D
Speaker 1: and maybe that this is just a mistake and they
Speaker 1: really are a killer or they really are a pedophile, right,
Speaker 1: so that that in and of itself is also a
Speaker 1: symptom of O c D. Most people who meet criteria
Speaker 1: for a c D question their diagnosis at some point.
Speaker 1: So in terms of doing an exposure therapy, so let's say, okay,
Speaker 1: we're ready to do it. Um, you know, I'm like
Speaker 1: the woman used you know an example of a woman
Speaker 1: who's sitting there thinking, ruminating over is this the right
Speaker 1: relationship from your something, or someone who's worried about harming someone?
Speaker 1: If do you give them suggestions of what to do
Speaker 1: and then they go home and do it alone, or
Speaker 1: does exposure therapy like does anyone ever have their therapist
Speaker 1: with them in the situation or you send them out
Speaker 1: on their own kind of thing. Listen, and I say
Speaker 1: to all my patients this was pre COVID, of course,
Speaker 1: but I always say to them, like the walls of
Speaker 1: this office when I used to be face to face
Speaker 1: have seen everything, Like all the exposures have been done
Speaker 1: in this room. So yes, we do it often, we
Speaker 1: will do it together because I want to be able
Speaker 1: to coach the person through the rise and fall of discomfort.
Speaker 1: So it's like a wave, right, You'll do the exposure
Speaker 1: and then if you practice response prevention, you're going to
Speaker 1: have to ride out a big wave of anxiety, similar
Speaker 1: to I'm sure you felt on your the airplane, right
Speaker 1: is right, And so yes, we'll do that in session.
Speaker 1: But we are pretty clear at the front end of
Speaker 1: treatment like this is homework heavy therapy. Recovery isn't going
Speaker 1: to therapy once a week. Recovery is doing around forty
Speaker 1: to ninety minutes of exposure and response prevention a day,
Speaker 1: right a day. So and that doesn't have to mean
Speaker 1: you have to schedule it and do nothing. You could
Speaker 1: be doing exposures while you wash the dishes, or you
Speaker 1: could be doing a lot of what we do is
Speaker 1: you know, here is a great example, um to use
Speaker 1: the harm exagm pull. If let's say you have a
Speaker 1: fear of harming your baby or your husband or your
Speaker 1: wife or so forth. Is as you're washing the dishes,
Speaker 1: you could sing to the happy Birthday song like I'm
Speaker 1: gonna hurt my my husband to day doo da or
Speaker 1: whatever you mean, Like you can you can be exposing
Speaker 1: yourself to the obsession in your mind while you drive
Speaker 1: to work, while you have a shower, and so forth. Right, um,
Speaker 1: The work of exposure therapy is to change the way
Speaker 1: you respond to a thought. So instead of responding to
Speaker 1: it with importance and and terror and you know that
Speaker 1: it has to be solved right away, we actually solve
Speaker 1: it by either treating it with no importance at all
Speaker 1: or making fun of it being creative. People with OCD
Speaker 1: and anxiety are usually super creative people, so we'd be
Speaker 1: creative with it. And like you said before, you could
Speaker 1: do exposure therapy by being around the people you're afraid
Speaker 1: you're going to harm. But now it sounds like in
Speaker 1: the homework section, you're washing your dishes and you're exposing
Speaker 1: yourself to your own thoughts. Right okay? And I love
Speaker 1: this because I love the notion of not giving the
Speaker 1: thoughts importance. And you know, like we hear this all
Speaker 1: the time in so many different ways. You know, if
Speaker 1: we're doing mindful meditation, we don't have to latch onto
Speaker 1: the thoughts and get distracted in anxiety. We don't have
Speaker 1: to believe the thoughts that we're dying right now during
Speaker 1: this panic attack. So it all always boils down to
Speaker 1: the same thing that we have, um, maybe not control
Speaker 1: over the thoughts coming in, but we can control how
Speaker 1: we react to them. It's always about that, right, And
Speaker 1: what I love about this is it's so counter intuitive,
Speaker 1: as was as his panic disorder recovery is like, I'm sorry,
Speaker 1: did you not hear me? I am thinking of harming
Speaker 1: my husband? And it's like, no, no, you're not thinking
Speaker 1: of harming your husband. You're obsessively worrying what if I
Speaker 1: did that? Almost the way that like if you're in
Speaker 1: church or something and you have this thought like what
Speaker 1: if I just screamed fuck right now, you know, in
Speaker 1: the middle of Christmas Eve Mass, And you know, I
Speaker 1: think the average person has had those weird little moments
Speaker 1: and then it goes away. Actually, I just had a
Speaker 1: session with a patient where I said exactly this, which is,
Speaker 1: your thoughts aren't the disorder, you're The disorder comes when
Speaker 1: we respond to them as if they're super important and
Speaker 1: need to be taken away and stopped. But people without
Speaker 1: O c D have the same O c D thoughts
Speaker 1: that people with O c D have. Um, Yes, there's
Speaker 1: some cognitive and and actual physiological differences in the brain,
Speaker 1: but the main thing is they go, huh, that was
Speaker 1: the weird thought, and then they go on with their day.
Speaker 1: People with O c D have the thought and they go,
Speaker 1: this must mean something really important. And I think it
Speaker 1: is my responsibility to make sure this doesn't happen right,
Speaker 1: And so that in again in that little places where
Speaker 1: we intervene mean and go, let's have some fun with
Speaker 1: this again. I love like I always joke with clients
Speaker 1: like no one wants to see me, Like it's it's
Speaker 1: terrible to have to see Kimberley because it means you
Speaker 1: have to do really hard things, and you're going to
Speaker 1: have to face some really hard things. But we can
Speaker 1: also find some really great, creative fun ways to do this. Right.
Speaker 1: If you're afraid of screaming out fuck you, could you know,
Speaker 1: write the word out if you're afraid of certain things,
Speaker 1: you can, you know, get your I've had clients right
Speaker 1: full scripts about their obsessions and turn it into art.
Speaker 1: I've had people, you know, turned it into poetry, purposely
Speaker 1: staring their fear in the face. You know it's funny.
Speaker 1: I'm in comedy and I'm a writer, and I've been
Speaker 1: doing it the whole time. I've had anxiety. And I
Speaker 1: treated my anxiety with such reverence, you know that. It
Speaker 1: was like, never the two shall meet. There shall be
Speaker 1: no laughter or creativity about my anxiety. And there wasn't
Speaker 1: until a few years ago. Finally, literally decades, I was like, oh, okay,
Speaker 1: maybe I'll apply a sense of humor to it, which
Speaker 1: is why I wanted to start this podcast. And I
Speaker 1: had the psychiatrist who was the guy that prescribed my
Speaker 1: medication for twenty years, and seriously a lot of the
Speaker 1: time he would say things that I would go home
Speaker 1: and just get so upset about because I think he
Speaker 1: went to school for this. I need a more serious doctor.
Speaker 1: This is he is not. He is bad at his
Speaker 1: job and people are going to die because of him.
Speaker 1: And now I realized he was trying to appeal to
Speaker 1: my creative side. And he was right. So it's like
Speaker 1: I kept thinking he was saying do something easy, because
Speaker 1: he was saying do something creative, and it's not easy,
Speaker 1: Like you have to first admit that you were wrong
Speaker 1: about how you're thinking about this, and I guess I
Speaker 1: just I don't know. I didn't want to be wrong
Speaker 1: about it, or I just thought if I tried this
Speaker 1: silly thing and it doesn't work, them really screwed you know. Yeah,
Speaker 1: well now, actually, I mean I want to validate you,
Speaker 1: because fear is a response to danger for and that's
Speaker 1: what we've developed, we've grown on all these years because
Speaker 1: of that. Right when the wilder beast ran at us,
Speaker 1: fear showed up and we knew to run. And so
Speaker 1: when our brain, now in this evolved world, shows up
Speaker 1: with fear and there isn't an imminent danger, we it
Speaker 1: naturally we're going to be like, let's take this really serious,
Speaker 1: Like this is what kept us alive for so many
Speaker 1: years and has allowed us to evolve, so it must
Speaker 1: be important and worthy of our attention. So it's hard
Speaker 1: to flip the switch on that, right, It's it's hard
Speaker 1: to treat fear like it's a thought. Um that is
Speaker 1: kind of intuitive. So it does take some time and
Speaker 1: trust to sort of make that step, but once you
Speaker 1: make it, then you're often you're running. So with o
Speaker 1: c D, like, is there a spectrum you know, it's
Speaker 1: like to like least severe to most severe or is
Speaker 1: it like, oh, you can have some of the symptoms
Speaker 1: but not all of them, or is it different than
Speaker 1: other anxiety disorders in that way. No, so yes, we
Speaker 1: have like mild, moderate, and severe, but no, one obsession
Speaker 1: is different than the other. In fact, we treat them
Speaker 1: all the same. Um. The severity is very much person dependent,
Speaker 1: so it really just see, so it doesn't matter really
Speaker 1: what the symptom is. It's all the same. Like you said,
Speaker 1: reaction to uncertainty. Yeah yeah, so um, again, it depends
Speaker 1: on the degree in which it debilitates you. So some
Speaker 1: patients my essay, I have a small fear of germs.
Speaker 1: COVID was a big trigger for a lot of people
Speaker 1: like I have a small fear of germs, but I
Speaker 1: can handle it. What really bothers me is this other
Speaker 1: obsession whereas and and often this is something to think about.
Speaker 1: Two is, when I used to run groups for O
Speaker 1: c D in my internship, you would have a group
Speaker 1: of eight people with eight different types of o c D,
Speaker 1: and the guy over here who's having hum obsessions or
Speaker 1: pedophilia obsessions, or sexual obsessions like more of those, like
Speaker 1: things that we don't know about. He would sit across
Speaker 1: from the guy with contamination and be like, I wish
Speaker 1: I had contamination. I could totally handle contamination. That would
Speaker 1: be so much easier. And the guy with contamination is
Speaker 1: sitting across from him, going, what if I had your
Speaker 1: type of o c D that would be so much easier.
Speaker 1: So I think the thing to remember is the suffering
Speaker 1: is the same for all of it, right, It's all
Speaker 1: the same degree of suffering, and that it's you have
Speaker 1: to tolerate high levels of uncertainty, high levels of anxiety.
Speaker 1: Often there's a lot of shame associated um so no,
Speaker 1: we treat them all equally. So when you say uncertainty,
Speaker 1: I mean obviously that's life is the most uncertain thing.
Speaker 1: When you see that O c D targets uncertainty, like,
Speaker 1: what exactly does that mean? So let me dig down
Speaker 1: the person who says, you know, I'm ruminating, I'm obsessing
Speaker 1: over if my husband is the right person for me.
Speaker 1: I mean unlike the the more quote normal person who's like, oh,
Speaker 1: I think that sometimes. Like to me, that seems like
Speaker 1: the quote normal person is having some moments of uncertainty,
Speaker 1: whereas the O. C D person it's not real uncertainty.
Speaker 1: So am I getting this wrong? Like what what do
Speaker 1: you mean by it targets uncertainty? Well, similar to like
Speaker 1: you talked about with the egodystonic piece, right is, clients
Speaker 1: will often say like I don't wanna hurt that person
Speaker 1: or I don't want you know, I really love my partner.
Speaker 1: So they may even have some really great ground in
Speaker 1: knowing who they are in that moment, but it's the
Speaker 1: uncertainty that really gets them. Oh of like what I
Speaker 1: don't know if I will or not. I don't know
Speaker 1: what the future will hold, And that uncertainty is really painful, right,
Speaker 1: And it's repetitive. It's not just like I don't know,
Speaker 1: it's like I don't know, I don't know, I don't know.
Speaker 1: You've got to solve it. You've got to solve like
Speaker 1: in their head, it's like think of it like um
Speaker 1: in if you had the radio station in the background saying,
Speaker 1: but what if you want to what if you want
Speaker 1: to what if you want to what if this isn't right?
Speaker 1: What if bad things are going to happen? What if?
Speaker 1: And it's all uncertainty based, right, It's it's often focusing
Speaker 1: on you might lose control and bad, bad, bad things
Speaker 1: are going to happen and so um. And that's true
Speaker 1: for any anxiety disorder, but for people again with O
Speaker 1: c D, it tends to be more repetitive and disregulating, right,
Speaker 1: because when you have that degree of discomfort, naturally your
Speaker 1: instincts will be, well, let's just solve this, let's figure
Speaker 1: it out. But when you figure it out with a
Speaker 1: compulsion means you've treated the thought like it's important, which
Speaker 1: means now your brain thinks it's important and you're stuck
Speaker 1: in a loop. So if someone has a c D,
Speaker 1: um that isn't the obvious kind of washing my hands
Speaker 1: and checking the stove. If it's more like the ruminations
Speaker 1: like what if? What if? What if? What could like
Speaker 1: their worst day look like like they call in sick
Speaker 1: to work and they just sit in bed and kind
Speaker 1: of ruminate all day until like they can't eat sleep.
Speaker 1: I mean, is that kind of what happens? The best
Speaker 1: way a client multiple clients have explained this, but a
Speaker 1: client once said to me, it's like you have a
Speaker 1: jigsaw puzzle and your entire life is depending on whether
Speaker 1: you can finish the jigsaw puzzle, and no matter what
Speaker 1: you can do, you cannot get the pieces to match.
Speaker 1: Like in your mind it feels like if I just
Speaker 1: get these pieces to go in riot and I get
Speaker 1: the final piece, and then I can have relief, but
Speaker 1: they can't find it. And then what they're tolerating with
Speaker 1: it is not just uncertainty. It's the distress of that
Speaker 1: and the and the frustration of that, and then it
Speaker 1: becomes also about the you know, sort of it targets
Speaker 1: your identity, like what does it mean about you? If
Speaker 1: you keep having these thoughts? You must be a terrible
Speaker 1: person who thinks about sexual thoughts like this all day?
Speaker 1: What kind of human are you? And because you can't
Speaker 1: solve the puzzle, you're left with this massive mess of
Speaker 1: just thinking, and so it could be just laying in
Speaker 1: bed ruminating. For many people, it's repetitive actions, like asking
Speaker 1: reassurance over and over and over and over and over again,
Speaker 1: even though you know they've answered it as soon as
Speaker 1: you ask the question. The uncertainty just comes right back.
Speaker 1: And it's not just like, oh, maybe uncertainty, it's like
Speaker 1: urgent uncertainty. Anxiety bites will be right back after a
Speaker 1: quick little message from one of our sponsors. I don't
Speaker 1: mean it's like where does this come from? But is
Speaker 1: there a known reason why, like someone may develop O
Speaker 1: c D as opposed to like a phobia of driving
Speaker 1: or something like that. Is there any kind of genetic
Speaker 1: reason or nature nurture thing both, So we understand there
Speaker 1: is a nature and a nurture components. So genetics are
Speaker 1: very strong. If you have a family member with O
Speaker 1: c D, you're more likely. But the truth is, I
Speaker 1: think of we think of an umbrella, and the umbrella
Speaker 1: is what we call O c D related disorders. So
Speaker 1: O c D is under there, as is panic disorder,
Speaker 1: health anxiety, phobias, hair pulling, skin picking. So there are
Speaker 1: many other disorders that fall under the obsessive compulsive umbrella,
Speaker 1: and often genetically you will have one or more of
Speaker 1: those disorders. Social anxieties another one. Um. So yes, there
Speaker 1: is a genetic component. There's also a nurture component in
Speaker 1: that if you were raised with very of course, like
Speaker 1: strict rules and and strong, very strong beliefs that that
Speaker 1: can can impact it. What we know scientifically about the
Speaker 1: brain of someone with OCD is think about everyone can
Speaker 1: just imagine in your brain is a pair of brakes
Speaker 1: and an accelerator, right, and everybody has intrusive thoughts, right,
Speaker 1: But for the person with o c D, they their
Speaker 1: brake system is not connected very well, and so it's
Speaker 1: really hard to pump the brakes on those thoughts, and
Speaker 1: their accelerator is a little overreactive or overactive, and so
Speaker 1: when you have those thoughts, it presses the accelerator really
Speaker 1: really fast. Imagine, Um, this is not physiologically correct. As
Speaker 1: you know, we don't have brakes and accelerators in our brains,
Speaker 1: but imagine our brain has an accelerator. So when you
Speaker 1: have no CD and you have a thought, it's like
Speaker 1: they've pushed the brakes and they're going strong, like really loud,
Speaker 1: really repetitive and so forth. So that we know that
Speaker 1: this physio logical pot is happening in their brain as
Speaker 1: well for reasons, yet we don't understand. Yeah, do you
Speaker 1: think that, Like, I mean, it sounds like every anxiety
Speaker 1: disorder when it gets down to it is fear of
Speaker 1: the unknown. It's like a big existential crisis that we
Speaker 1: all have, right, we all have our different disordered ways
Speaker 1: of dealing with it, and for some people aren't even
Speaker 1: bothered by this. You know, who knows. But do you
Speaker 1: think if if we had certainty in life, like if
Speaker 1: we had every answer we wanted, that we would just
Speaker 1: find a way to still have all of our anxieties
Speaker 1: and O c D, Like, I'm sure that wouldn't be
Speaker 1: enough either, right, or that would be the cause of
Speaker 1: our stress or something. Well, and let me use O
Speaker 1: c D as the perfect example. So let's say there's
Speaker 1: another kind of o c D called need to know
Speaker 1: o c D, and so it's often love I never
Speaker 1: heard of this. Yeah, there's many different subtypes, but one
Speaker 1: is called need to know. So it's not even that
Speaker 1: there's a danger involved. It's just that their brain is saying,
Speaker 1: but I just need to know. So like example might
Speaker 1: be the one that I was given when I was
Speaker 1: in training. Is like, let's say someone has the need
Speaker 1: to know about a certain brand of toilet, Like it
Speaker 1: could be as random as that, but the urgency and
Speaker 1: the urge to find out the answer is so strong
Speaker 1: and so uncomfortable. I don't want to minimize this is
Speaker 1: so painful. They just have to go and find out,
Speaker 1: like I just have to know. So they go and
Speaker 1: they check and they get the name of the toilet
Speaker 1: or they get the name of whatever it is that
Speaker 1: their obsession has targeted. And so, okay, I got it.
Speaker 1: I relieved it right. But it only takes one millisecond
Speaker 1: for the brain to go, are you sure? Are you sure?
Speaker 1: So imagine you go okay. Like health anxiety is another
Speaker 1: example of this, Oh what if I'm dying of cancer?
Speaker 1: So you go and you get the m R I,
Speaker 1: and then all that has to happen is as you're
Speaker 1: walking out of the doctor's office, he says, yours healthy
Speaker 1: as can be. All you have to do is have
Speaker 1: the thought, well, what if the doctor missed it MHM,
Speaker 1: or what if the m R machine wasn't working well
Speaker 1: that day, or what if um I didn't answer a
Speaker 1: question correctly? And that meant like it only takes one
Speaker 1: thought to undo all of the certainty that you've got.
Speaker 1: And that's a very typical experience of O c D.
Speaker 1: It sounds like a real control issue two in the
Speaker 1: sense of like, if I do this correctly, I will
Speaker 1: get the absolute right answer and then I can rest well.
Speaker 1: Most anxiety disorders are caught up in what we call
Speaker 1: cognitive errors or cognitive distortions, and often one of the
Speaker 1: most is black and white thinking like it's has to
Speaker 1: be all good or all bad, right, So so those
Speaker 1: distorted thoughts can often fuel our urgency to get certainty
Speaker 1: or relief. Does o c D ever get confused with
Speaker 1: other disorders? Like do people get misdiagnosed You've mentioned I
Speaker 1: think that you know in the seven to fourteen years
Speaker 1: to get it right, Like, what are common things people
Speaker 1: get misdiagnosed with? It could be unfortunately anything Commonly, a
Speaker 1: d h D is a common one because people will
Speaker 1: report difficulty with concentrating, you know, racing thoughts. You know,
Speaker 1: it's very common for that to be and vice versa.
Speaker 1: People who have actual diagnosis of a d h D
Speaker 1: can sometimes be diagnosed with anxiety as well. UM. So
Speaker 1: often a d h D sometimes bipolar UM, often mostly
Speaker 1: generalized anxiety. They'll get a generalized anxiety diagnosis. UM. You know,
Speaker 1: it could be any diagnosis right that they could be
Speaker 1: misdiagnosed with. Most commonly, what I hear is more of
Speaker 1: the dismissive like you don't have a disorder, you just
Speaker 1: think too much, or you know, like you need to
Speaker 1: you know, you need to eat this whole grain diet
Speaker 1: and this this sort of quirkiness will go away. So
Speaker 1: it's more of that kind of thing. And so what
Speaker 1: are some treatments for o CD? We've talked about exposure therapy?
Speaker 1: Is there like a most successful or is it a
Speaker 1: company you know, is there a great medication for their
Speaker 1: What are you seeing people who are really recovering? What
Speaker 1: are they doing? Right? So, the gold standard treatment for
Speaker 1: our c D is exposure and response prevention. However, if
Speaker 1: you can match that with an S s R at
Speaker 1: an o c D dose, that's your golden combination. If scientifically,
Speaker 1: if you had to choose between medication and e m P,
Speaker 1: you would choose EMP. It has better outcomes, right, UM,
Speaker 1: But that's what we know at this date and time.
Speaker 1: But what we've really learned in the last decade is
Speaker 1: there also these supplemental treatments that can elevate the EMP
Speaker 1: and the medication and they are mindfulness practice as you've
Speaker 1: mentioned um all, So acceptance and commitment therapy UM, which
Speaker 1: is an amazing supplement to e P which helps you
Speaker 1: to number one, practice some very under the lens of
Speaker 1: my mindfulness skills, but also helps you to define what
Speaker 1: your values are. So instead of doing compulsions, you would
Speaker 1: engage in value based behaviors UM, which is really wonderful.
Speaker 1: App Like another way for us to frame e m
Speaker 1: P is not only we're not going to take away
Speaker 1: your discomfort and just let you sit in terrible nous,
Speaker 1: We're actually going we're going to actually pivot towards the
Speaker 1: thing that you value and you want in your life. UM.
Speaker 1: So that's really wonderful. There's new research now around adding
Speaker 1: dialectical behavioral therapy UM, which is for those who struggle
Speaker 1: with regulation. So so we're getting these new sciences every
Speaker 1: day that sort of helps supplement and complement the work UM.
Speaker 1: But at the end of the day, what I would
Speaker 1: say to to anyone with O c D is EP
Speaker 1: he has to be the focus because if you aren't
Speaker 1: facing your fear UM, it's likely you're avoiding it. And
Speaker 1: if you're avoiding it, you're doing that compulsion right and
Speaker 1: you're like feeding it exactly. And and so in the
Speaker 1: acceptance and Commitment therapy, I love. That is that What
Speaker 1: does the word commitment means? That? Is that like the
Speaker 1: defining your values part? Like, yeah, so the commitment pieces
Speaker 1: not just committing to the values, but committing to the
Speaker 1: actual experience. So there's a lot of radical acceptance in there.
Speaker 1: It's committing to staying in the present and staying with
Speaker 1: the feeling instead of running away from the feeling. So
Speaker 1: commitment can take multiple can be multiple aspects to it, right,
Speaker 1: So imagine you're uncomfortable. You have to commit to being uncomfortable.
Speaker 1: You have to commit to not doing the compulsions. You
Speaker 1: have to commit to your values, like, there are many
Speaker 1: things that you commit to in that moment. I'm assuming
Speaker 1: you do a lot of um helping people get acquainted
Speaker 1: with uncertainty or to the point where they're tolerating uncertainty
Speaker 1: and getting comfortable with it. Is that sort of the
Speaker 1: goal in all of this on yes, I mean I yes,
Speaker 1: I will preface is last year I wrote a book
Speaker 1: UM called the Self Compassion Workbook for a cd UM
Speaker 1: published stud New Parbenter Publications. I wrote that book because
Speaker 1: number one EP sucks and it's really hard and no
Speaker 1: one wants to do it, and so it is also
Speaker 1: important that you sort of what I say is you
Speaker 1: wrap the exposure in self compassion. So I'm not doing
Speaker 1: saying that as a plug. I'm saying it as more
Speaker 1: of because it sucks so bad and because it's so
Speaker 1: heavy lifting kind of therapy, it is important that you
Speaker 1: also have a gentle, compassionate approach to it. Um that
Speaker 1: tends to keep morale up and motivation up. I think
Speaker 1: it's a huge piece of the work as well. So
Speaker 1: the compassion part isn't saying, you know, take a break.
Speaker 1: It's like, you're gonna do this thing, but we're going to. No,
Speaker 1: compassion doesn't say take a break. That's the misconception of compassion.
Speaker 1: So let me let me just quickly say, so compassion,
Speaker 1: if you really dropped into the compassionate person inside you,
Speaker 1: it never it doesn't say take And of course if
Speaker 1: you're sick and you're exhausted, yes it would say that.
Speaker 1: But when it comes to fear, the wise compassionate part
Speaker 1: would say, I got you. Let's face this fear like this.
Speaker 1: By facing this fear, you get your life back. Let's
Speaker 1: do that. That's the compassionate act um. So no, at
Speaker 1: the beginning of the book, as a whole chapter on
Speaker 1: like compassion is not unicorns and fairies. It's facing fear
Speaker 1: and writing waves of really uncomfortable ship. But it's so
Speaker 1: rewarding and so empowering if you can do that. It
Speaker 1: sounds like it's just the opposite of like beating yourself up,
Speaker 1: like you loser, What do you mean you're gonna check
Speaker 1: your stove again? Like come on, normal people don't do this,
Speaker 1: Like that's not a compassionate approach. No, it's very supportive
Speaker 1: and almost coaching, like I call it like the kind coach.
Speaker 1: It it's saying instead of saying like get down and
Speaker 1: give me twenty your loser, it's saying, you can do
Speaker 1: this just one one more minute. You can do it
Speaker 1: to stay on, stay with it just a little longer.
Speaker 1: We got to like hang on. It's it's that kind
Speaker 1: of thing. And so in your work, how I don't
Speaker 1: mean like how long does this take? But you know
Speaker 1: someone out there who's like, Okay, I'm gonna go start
Speaker 1: going in there be for my O, C D. What
Speaker 1: can they look forward to if they put in the work.
Speaker 1: I mean, well, they feel monumentally better in a year. Yeah,
Speaker 1: So yes, you should definitely see an improvement by a year.
Speaker 1: So as a typical host of treatment for a CD,
Speaker 1: I don't like to kind of give dates because everybody
Speaker 1: is different and if you've got um extra a diagnosis,
Speaker 1: it takes a long But under science they say twenty
Speaker 1: four sessions and you should have some pretty massive change. Right.
Speaker 1: That's great. Yeah, But I even go as far as
Speaker 1: to say, like, the way that we do treatment is
Speaker 1: very gradual. We don't throw you under the bus. We
Speaker 1: start baby steps and you get you know, you get
Speaker 1: the hang of it, and then you go for it.
Speaker 1: Then what we do is we usually do a huge
Speaker 1: inventory of all the compulsive behaviors you do, and we
Speaker 1: just work our way up them, right, like start easy,
Speaker 1: and you work your way cross out the list, cross
Speaker 1: out the list. So often when people start crossing out
Speaker 1: these compulsions, that in and of itself is rewarding, like, wow,
Speaker 1: I'm doing it right, like I'm starting so as I
Speaker 1: think real recovery is really looking at that list and
Speaker 1: getting it all the way down. But a lot of
Speaker 1: people will be shocked at how even the first exposure
Speaker 1: of going wow, I didn't do that compulsion and I
Speaker 1: faced my fear, or maybe I even had the full
Speaker 1: on panic attack and I survived. That in and of
Speaker 1: itself will change how they view themselves. They'll feel more empowered,
Speaker 1: like it's a it's it's hard work, but it's so
Speaker 1: empowering and it's so like it's badass work. Yeah. I
Speaker 1: know in my own work that my self esteem would
Speaker 1: just leap when when I was able to say I
Speaker 1: did this thing. And sometimes I have to not belittle
Speaker 1: myself and go, yeah, you got on a plane. Good
Speaker 1: for you. So it's like no, no, no, this is
Speaker 1: I'm a big girl. This is a big deal, Like
Speaker 1: I have to celebrate that. You know. Um, of course
Speaker 1: it's easy to do something you're not afraid of, but like,
Speaker 1: I'm even more badass than the people on this plane
Speaker 1: that aren't afraid because it is easy for them, but
Speaker 1: you know, I had to reframe it that way. And
Speaker 1: and so lastly, what should people look for, you know,
Speaker 1: when they're looking for, um, a therapist to help them
Speaker 1: with their O c D. I mean, there's no messing around,
Speaker 1: like that person has to have O c D in there.
Speaker 1: I don't I don't mean title, but but it can't
Speaker 1: be like, oh, I just you know, I do everything
Speaker 1: like that's not going to work, is it. No? No, No,
Speaker 1: We Like I said, a thorough assessment can determine how
Speaker 1: much you can recover, right, And the truth is, um,
Speaker 1: it's also how honest you are. So often you know,
Speaker 1: I have staff that work for me and we're constantly consulting.
Speaker 1: Is a lot of times people don't even want to
Speaker 1: tell their therapist about their thoughts because they're so ashamed.
Speaker 1: So the more the more you could be honest with
Speaker 1: your therapist, reach out and get a O c D
Speaker 1: therapist who treats using e r P. And if you
Speaker 1: can really just sort of oh, let it come out, like,
Speaker 1: just really be honest with them, you can make massive,
Speaker 1: massive changes. Um. So absolutely yeah. It does require, um first,
Speaker 1: knowing you have O c D and be an assessed correctly,
Speaker 1: but then it does require some work for sure. The
Speaker 1: crossover between talking about these things and the world I
Speaker 1: was in before of comedy is that I say things
Speaker 1: on stage that I think in my private mind, and
Speaker 1: I I know it's going to be relatable because I
Speaker 1: know I'm not special. So if I thought it, so
Speaker 1: does everybody. And it's like a magic trick you're doing
Speaker 1: when you say confessional things and then people go, oh
Speaker 1: my god, I thought I was the only one. And
Speaker 1: I can't believe the things I say that people come
Speaker 1: up and go, I thought I was the only one.
Speaker 1: I want to go, really, you really didn't think anyone
Speaker 1: else thought this? You know. It's like and so it
Speaker 1: seems like in that same way, I mean, there's really uh,
Speaker 1: it's like there's really nothing anyone could say that would
Speaker 1: shock the therapist. Right, it's like there's no the worst
Speaker 1: I thought you're having anyone out there. I mean, I
Speaker 1: hate to say, you're probably not that special, right, No, No,
Speaker 1: I I I love I'm a big goofy this way,
Speaker 1: but I love like the first few sessions where I say, like,
Speaker 1: I guarantee you won't shock me, and they say, oh,
Speaker 1: but you haven't heard my thoughts, like you know, like ah,
Speaker 1: and they when I always just love that moment when
Speaker 1: they do tell me, and I'm like, nah, I had better,
Speaker 1: like like I've read worse. Like I think that that
Speaker 1: is so true. I think it's shocking to people that
Speaker 1: there are more. I think because often the content of
Speaker 1: their obsessions are pretty scary. But no, there's there's nothing
Speaker 1: I haven't heard, right, Um, and there's always those people
Speaker 1: who are so overjoyed that they're not the only one,
Speaker 1: which just shows you how much work we've got to
Speaker 1: do with stigma around mental health. You have this course
Speaker 1: that we were talking about before we started recording. Can
Speaker 1: you just tell me a little bit about that, right? Yeah, So, Um,
Speaker 1: I have a private practice, so I see clients face
Speaker 1: to face. But what was happening is I was having
Speaker 1: an influx of people who I couldn't help. They they
Speaker 1: lived in out of this country, out of the state,
Speaker 1: or so forth, or the fact that therapy is expensive, um,
Speaker 1: and so out of sort of a sense of desperation,
Speaker 1: I decided I'd make a course basically explaining exactly how
Speaker 1: I would tell my clients the process. Remember we kind
Speaker 1: of talked about like the first session is explaining what
Speaker 1: is the e O CIT, what is e r P
Speaker 1: how you would put together like the list of all
Speaker 1: the compulsions. So it's called e ar P School. Um
Speaker 1: CBT school is the name of the website, but e
Speaker 1: r P School is the course, and it basically helps
Speaker 1: teach you how to put together a plan where they
Speaker 1: can start facing their own fears in their own time,
Speaker 1: in their pajamas, if that's how they want to do
Speaker 1: it from home. It was really great during COVID because
Speaker 1: you know, it was hard to get access to care.
Speaker 1: So yeah, it's it's I'm just so proud of it
Speaker 1: and happy to offer it. I'm so glad you do. Yeah,
Speaker 1: and anything we can do in our pajamas, I think
Speaker 1: is just really exactly Well. Thank you so much for
Speaker 1: enlightening me. And I'm hoping a lot of people hear
Speaker 1: this and they go, oh my god, I don't have
Speaker 1: this major major craziness. I'm oh my god, I can
Speaker 1: maybe live a full life and get some recovery. Oh
Speaker 1: my god, I'm not so special, but you're special. But
Speaker 1: you know what I mean, You're you're special. But that
Speaker 1: was a lot of good information, wasn't it. I hope
Speaker 1: you're feeling a lot better if you relate to any
Speaker 1: of these symptoms and you've been avoiding getting treatment and
Speaker 1: just thinking something's really really wrong with you. No. No,
Speaker 1: So here are some of the takeaways from my chat
Speaker 1: with Kimberly Quinlan. To have o c D, you must
Speaker 1: have a certain criteria of things. First and obsession, which
Speaker 1: is defined by an intrusive repetitive and unwanted thought. Second,
Speaker 1: a compulsion the behavior that we do to reduce or
Speaker 1: remove uncertainty or anxiety or discomfort usually due to those thoughts.
Speaker 1: And third, it's a disorder, which means that the obsessions
Speaker 1: and compulsions are disrupting your life and you're functioning to
Speaker 1: a problematic degree. An obsession usually shows up in the
Speaker 1: form of a thought, but it can also show up
Speaker 1: in the form of a feeling or a sensation or
Speaker 1: an image that keeps popping up in your brain, or
Speaker 1: it could be an urge that comes up and overwhelms
Speaker 1: your body. A common misconception about compulsions is that they
Speaker 1: have to be physical, like washing your hands, but many
Speaker 1: compulsions can't be seen by the eye, and one of
Speaker 1: the biggest is a mental compulsion ruminating trying to resolve
Speaker 1: problems in your mind, and another compulsion is avoidance. People
Speaker 1: are often misdiagnosed by doctors unfamiliar with this, who think
Speaker 1: that people with o c D are only displaying physical compulsions.
Speaker 1: There has been recently a growth of therapists who specifically
Speaker 1: treat O c D, but the community is still in
Speaker 1: crisis as it takes seven to fourteen years for someone
Speaker 1: with o c D to get correctly diagnosed. There are
Speaker 1: apps that have been created for people with o c D.
Speaker 1: For example, you can take a picture of your stoves
Speaker 1: so that you know for certain you've turned it off
Speaker 1: or that you've locked your door, but that still acts
Speaker 1: as a compulsion and it keeps the disorder going, and
Speaker 1: a lot of these apps are giving people the opposite
Speaker 1: of recovery skills. The gold standard for o c D
Speaker 1: treatment is exposure and response presentation known as e r P.
Speaker 1: I don't think the word presentation is correct. I think
Speaker 1: it's exposure and response prevention. And I don't know why
Speaker 1: I wrote yes, it's prevention, not presentation. Forgive me, it'll
Speaker 1: be correct on my website. So the gold standard treatment
Speaker 1: for o c D is exposure and response prevention known
Speaker 1: as the RP. You would think that I subconsciously have
Speaker 1: a presentation do or something. No, I really don't know
Speaker 1: whether word came up um. In e ARP, the patient
Speaker 1: is exposed to their obsession, they identify their fear, they
Speaker 1: find a way to face their fear, and then the
Speaker 1: response prevention is that once as patient has been exposed
Speaker 1: to the fear, the RP targets eliminating the compulsive behaviors,
Speaker 1: but both must be a part of treatment for recovery
Speaker 1: to be successful. O c D attacks the things that
Speaker 1: we value the most, So if you value your relationships,
Speaker 1: you'll have o c D around your relationships. If you
Speaker 1: love your job, you could have o c D around
Speaker 1: your job. There are multiple categories of o c D.
Speaker 1: The majority of people are only familiar with contamination o
Speaker 1: c D the fear of germs or something like symmetry
Speaker 1: obsession or checking obsessions around danger, like if I don't
Speaker 1: unplug my hair curl, or I'll set the house on
Speaker 1: fire and be responsible for terrible things. The physical compulsion
Speaker 1: types of o c D are the lesser concerns that
Speaker 1: most therapists c But most O c D patients have
Speaker 1: an obsession around harming people. They're terrified that they're going
Speaker 1: to harm someone they love. It's an unwanted, repetitive and
Speaker 1: distressing thought. People with harming obsessions are usually the sweetest
Speaker 1: people in the world, and the thought of harming others
Speaker 1: is heartbreaking to them, but the thoughts are repetitive all
Speaker 1: day long in their head. Some people can have o
Speaker 1: c D related to religion. It could be an existential
Speaker 1: obsession like what's the point of life? O c D
Speaker 1: is a disorder of uncertainty. The more uncertain someone is,
Speaker 1: the more anxiety they feel. Some people in a relationship
Speaker 1: have an obsession with ruminating on what if they cheated
Speaker 1: on their partner or did they pick the right person,
Speaker 1: or even thinking, you know what if I'm gay and
Speaker 1: I thought I was straight this whole time. It sounds normal,
Speaker 1: but for someone with o c D, this is an
Speaker 1: extreme degree of repetitive thoughts about all of this, which
Speaker 1: causes them to do safety behaviors and compulsions to control
Speaker 1: their obsession. There are terms called ego dis tonic and
Speaker 1: ego syn tonic, so people with o c D have
Speaker 1: obsessions that are clinically egodsk tonic, meaning that the obsession
Speaker 1: doesn't line up with their values. For example, the patient
Speaker 1: who would never harm their child but has intrusive thoughts
Speaker 1: about harming their child. It's distressing because it's so confusing.
Speaker 1: If you think that you have o c D from
Speaker 1: listening to this episode, don't try to figure it out
Speaker 1: on your own. Sec a therapist who can do a
Speaker 1: good assessment on you, because if you have anxiety, you're
Speaker 1: not the best person to assess yourself. Often people with
Speaker 1: o c D even question their diagnosis, and part of
Speaker 1: their o c D becomes obsessing on wondering whether or
Speaker 1: not they really have o c D. Maybe the diagnosis
Speaker 1: is a mistake and they're really a serial killer or
Speaker 1: a pedophile. That is a classic symptom of o c
Speaker 1: D as well. The work of exposure therapy is to
Speaker 1: change the way that someone responds to a thought. Instead
Speaker 1: of responding to an intrusive thought with importance and terror
Speaker 1: and the urge to solve it right way, the work
Speaker 1: is to treat the thought with no importance at all
Speaker 1: and even make fun of it to be creative. People
Speaker 1: with o c D usually are very creative people, and
Speaker 1: developing o c D has a nature and nurture component.
Speaker 1: Genetics are strong, and if you are raised with strict
Speaker 1: rules and strong beliefs, that kind of nurturing can impact
Speaker 1: o c D. Think of the brain as having a
Speaker 1: pair of brakes and an accelerator like a car, and
Speaker 1: for the o c D person, their brake system is
Speaker 1: not connected very well and it's hard to pump the
Speaker 1: brakes on their intrusive thoughts. There is an umbrella of
Speaker 1: o c D related disorders, and o c D falls
Speaker 1: under panic disorder, help anxiety, phobias, hair pulling, skin picking,
Speaker 1: and social anxiety. O c D is often misdiagnosed as
Speaker 1: a d h D, bipolar and most often generalized anxiety.
Speaker 1: The most common misdiagnosis is, unfortunately, from doctors who can
Speaker 1: be dismissive and tell patients things like you just think
Speaker 1: too much. The best treatment for o c D is
Speaker 1: exposure and response prevention, as well as an SSRI, which
Speaker 1: is an antidepressant at an o c D dopes. Mindfulness,
Speaker 1: practice and acceptance and commitment therapy are great solutions as well.
Speaker 1: And having compassion towards working on your o c D
Speaker 1: doesn't mean taking a break and nets ferries and unicorns. Wise,
Speaker 1: compassion says, I got you. Let's face this fear. But
Speaker 1: by facing this fear, you're going to get your life back.
Speaker 1: Let's do that. The work of overcoming o c D
Speaker 1: is about facing fear and riding waves of really uncomfortable shit.
Speaker 1: But it's so rewarding and empowering. If you can do it,
Speaker 1: the average person can see a pretty massive change in
Speaker 1: their o c D in about sessions or within a year.
Speaker 1: You cannot shock your therapist with your thoughts. They've heard
Speaker 1: it all before. You're unique, but your thoughts aren't. Can
Speaker 1: Really wrote a book called the Self Compassion Workbook for
Speaker 1: o c D, and you can get it by going
Speaker 1: to the link in the show notes. And Kim Really
Speaker 1: also has an online school to help people with o
Speaker 1: c D called e r P School. You can face
Speaker 1: your fears in your own time, in your pajamas, and
Speaker 1: again that link is in the show notes. Who I
Speaker 1: learned a lot today. I hope you did too. Again,
Speaker 1: just want to normalize everything for everybody before they take
Speaker 1: that step in in um getting some help with anything.
Speaker 1: At least I want you to not feel so afraid
Speaker 1: going into taking your next step. You can email the
Speaker 1: show at Anxiety Bites Weekly at gmail dot com, and
Speaker 1: please give the show five star reviews on Spotify or
Speaker 1: Apple Podcasts. Tell a friend tweet about it. My Twitter
Speaker 1: is at Jen Kirkman. My Instagram is at Jen Kirkman.
Speaker 1: I love when people tag me in their social media.
Speaker 1: Then I can retweet in then more people find out
Speaker 1: about the show. Thank you all so much for listening.
Speaker 1: And again, yes, anxiety bites, but you're in control. For
Speaker 1: more podcasts for My heart Radio, visit the I heart
Speaker 1: Radio app, Apple podcast, or wherever you listen to your
Speaker 1: favorite shows.