WEBVTT - The ABC'S of OCD 0:00:08.520 --> 0:00:11.360 This is the Anxiety Bites podcast and I am your host, 0:00:11.520 --> 0:00:18.040 Jen Kirkman. Welcome to another episode of Anxiety Bites. I 0:00:18.040 --> 0:00:22.360 am your host Jen Kirkman. Now today we are talking 0:00:22.400 --> 0:00:25.759 about o c D, obsessive compulsive disorder. I did do 0:00:25.800 --> 0:00:29.600 an episode a few months ago with my friend Andy Kindler, 0:00:29.640 --> 0:00:32.240 who is a comedian who suffers from o c D, 0:00:32.400 --> 0:00:36.120 and it was great to get his perspective of what 0:00:36.240 --> 0:00:41.600 it feels like for him, how it moved through his life, 0:00:41.680 --> 0:00:43.440 what it felt like in his body when he was 0:00:43.920 --> 0:00:48.440 having o c D experiences, what he's come to now 0:00:48.479 --> 0:00:50.919 after getting treatment. But I also wanted to talk to 0:00:50.960 --> 0:00:53.559 someone who is a specialist in o c D so 0:00:53.680 --> 0:00:56.880 we could really dial down into the nitty gritty of 0:00:57.040 --> 0:01:01.880 what exactly is obsessive compulsive disorder and what are the many, 0:01:01.920 --> 0:01:05.640 many ways that it can manifest. And I'm sure in 0:01:05.640 --> 0:01:09.360 this interview we have only scratched the surface. But what 0:01:09.520 --> 0:01:14.520 I enjoyed in my conversation with Kimberly Quinlan is that 0:01:16.319 --> 0:01:21.760 she talks about what is perhaps the most normal O 0:01:22.000 --> 0:01:27.600 c D symptom is unwanted thoughts, and I actually, if 0:01:27.600 --> 0:01:30.319 you had asked me, I would have thought it was 0:01:30.360 --> 0:01:35.200 more the handwashing and the you know, germ phobia, contamination phobia, 0:01:35.280 --> 0:01:39.399 and she said, while those are pretty common, what most 0:01:39.440 --> 0:01:44.160 people rushed to seek treatment for are the unwanted thoughts. 0:01:44.240 --> 0:01:47.520 Thoughts that they might harm someone they love, Thoughts that 0:01:47.600 --> 0:01:51.600 they might uh, you know, harm a child, that they 0:01:51.640 --> 0:01:54.680 might harm their partner, someone in their family. And it's 0:01:54.840 --> 0:01:57.440 it's difficult to talk about because it sounds like the 0:01:57.520 --> 0:01:59.960 minute you say that, right, someone should luck you up 0:02:00.000 --> 0:02:04.200 and throw away the key. And what has been discovered 0:02:04.320 --> 0:02:07.280 in o c D treatment is that people who have 0:02:07.440 --> 0:02:10.160 these thoughts are the least likely people to do anything 0:02:10.240 --> 0:02:14.600 about it, because what they're worried about is what if, 0:02:14.880 --> 0:02:17.320 because they it is the last thing they want to 0:02:17.480 --> 0:02:22.360 do is to harm someone, especially someone they love. And 0:02:22.440 --> 0:02:28.080 it's really debilitating and it disturbs people and it's it's tough. 0:02:28.440 --> 0:02:32.600 So she talked all about having a sense of humor 0:02:32.680 --> 0:02:36.600 about it and how that is actually part of the treatment. 0:02:36.760 --> 0:02:40.200 That it may seem like it's such a big deal 0:02:40.200 --> 0:02:44.240 to be having these thoughts, but again, the key component 0:02:44.320 --> 0:02:46.680 of it that makes it obsessive compulsive disorder and that 0:02:46.760 --> 0:02:51.560 makes it harmless is that it is an intrusive unwanted thought, 0:02:52.560 --> 0:02:54.760 and so you may find this very interesting if this 0:02:54.840 --> 0:02:57.959 is something this is something that you've been living with, 0:02:59.280 --> 0:03:02.600 you've been afraid to talk about it. Hopefully this really 0:03:02.680 --> 0:03:07.200 brings it home for you that it is normal, common, 0:03:08.240 --> 0:03:11.320 very treatable. And so a little bit more about my 0:03:11.320 --> 0:03:15.040 guest today, kim Really Quinlan. Her website is linked in 0:03:15.040 --> 0:03:18.720 the show notes. She does compassionate, science based treatment for 0:03:18.840 --> 0:03:21.720 O c D, anxiety disorders, and eating disorders. We didn't 0:03:21.760 --> 0:03:25.960 even get into anxiety disorders and eating disorders today, but 0:03:26.000 --> 0:03:28.400 of course you can go to her website and learn 0:03:28.440 --> 0:03:32.320 more about it. Today we really just focused on obsessive 0:03:32.320 --> 0:03:37.240 compulsive disorder involving obsessions and compulsions. And again, an obsession 0:03:37.320 --> 0:03:41.320 is an intrusive and unwanted thought that creates significant anxiety 0:03:41.360 --> 0:03:45.120 and discomfort, and a compulsion is an overt or covert 0:03:45.200 --> 0:03:49.000 behavior done in an attempt to reduce the discomfort of 0:03:49.040 --> 0:03:54.480 the intrusive thoughts and feelings. And so even though Kimberly 0:03:54.560 --> 0:03:59.920 Quinland practices out in California, she does have her own 0:04:01.120 --> 0:04:04.800 kind of online school where you can take courses to 0:04:04.920 --> 0:04:09.040 get treated for obsessive compulsive disorders. So again that's in 0:04:09.080 --> 0:04:13.040 the show notes, but her CBT school dot com has 0:04:13.120 --> 0:04:17.599 online resources for obsessive compulsive disorder, anxiety disorders, hair pulling, 0:04:17.680 --> 0:04:21.880 skin picking. She has online video courses Mindfulness for o 0:04:22.000 --> 0:04:25.360 c D and o c D online course Overcoming Anxiety 0:04:25.360 --> 0:04:29.320 and Panic, a time management course. So check that all out. 0:04:29.360 --> 0:04:32.440 Because even if you are unable to find a therapist 0:04:32.440 --> 0:04:34.680 in your area or get to a therapist, you can 0:04:34.720 --> 0:04:41.080 begin doing some of the exposure therapy work by taking 0:04:41.120 --> 0:04:45.920 a course. So let's get right to it, because Kimberly 0:04:46.120 --> 0:04:49.600 is she really knows her stuff. She's totally brilliant, and 0:04:49.720 --> 0:04:52.880 I think you will enjoy learning about exactly what o 0:04:53.040 --> 0:04:58.840 c D is and what it isn't. All right, I'm 0:04:58.839 --> 0:05:00.719 gonna start out with what I think you know, hopefully 0:05:00.760 --> 0:05:04.480 not too basic and boring of a question. But can 0:05:04.560 --> 0:05:09.000 you just define o c D obsessive compulsive disorder? Sure? No, 0:05:09.160 --> 0:05:11.000 that's not a basic question at all. It's actually a 0:05:11.080 --> 0:05:16.640 really important question because to have o c D you 0:05:16.960 --> 0:05:20.080 need to have a certain criteria of things. So number one, 0:05:20.240 --> 0:05:24.320 you have to have obsessions. But obsessions aren't like I 0:05:24.400 --> 0:05:27.160 love lego, or I love sweaters, or I love or 0:05:27.240 --> 0:05:31.039 your cookies like I'm obsessed with binge watching Netflix, like 0:05:31.120 --> 0:05:35.680 it's not. That is what an obsession is. But in 0:05:35.720 --> 0:05:38.880 the terms of o c D, an obsession is usually 0:05:39.000 --> 0:05:43.960 an intrusive, repetitive, and unwanted. So it has to have 0:05:44.000 --> 0:05:47.200 those three pieces um and it usually shows up in 0:05:47.240 --> 0:05:49.880 the form of a thought, but it can also show 0:05:49.960 --> 0:05:52.839 up in the form of a feeling or a sensation 0:05:53.560 --> 0:05:56.080 or an image that keeps popping up into your brain 0:05:56.839 --> 0:05:59.440 um or it could even be an urge. This sort 0:05:59.440 --> 0:06:02.160 of urged comes up and overwhelms your body. So you 0:06:02.200 --> 0:06:04.880 have to have that first criteria to have the obsession, 0:06:05.760 --> 0:06:08.960 and you have to have a compulsion. Now, a compulsion 0:06:09.160 --> 0:06:12.760 is a behavior that we do um to reduce or 0:06:12.839 --> 0:06:17.920 remove uncertainty or anxiety or any form of discomfort even 0:06:17.960 --> 0:06:23.320 maybe even discussed. A big misconception is that that compulsion 0:06:23.440 --> 0:06:25.960 has to be physical, so we know sort of Hollywood 0:06:25.960 --> 0:06:28.520 o c D, which is like jumping over cracks, washing 0:06:28.560 --> 0:06:32.760 your hands, counting objects. They're all great portrayals of having 0:06:32.760 --> 0:06:35.480 o c D. But there are other ways in which 0:06:35.480 --> 0:06:39.080 people can do compulsions that are actually completely unseen by 0:06:39.120 --> 0:06:43.000 the eye. Like one really big one is mental compulsions. 0:06:43.160 --> 0:06:47.680 Mentally ruminating and and resolving and trying to solve problems 0:06:47.680 --> 0:06:53.880 in your mind. Another one is simply avoidance. So some people, 0:06:54.920 --> 0:06:57.720 a lot of people unfortunately who have O c D, 0:06:57.839 --> 0:06:59.560 will go to a doctor and they'll say, you don't 0:06:59.640 --> 0:07:02.760 have a CD. I don't see you doing anything. I 0:07:02.800 --> 0:07:06.120 don't see you doing any behavior. But this person has 0:07:06.160 --> 0:07:11.040 avoided of their life, right, And that's the compulsion that 0:07:11.080 --> 0:07:14.720 they do. And the other one is reassurance seeking, So 0:07:14.840 --> 0:07:19.320 they're constantly googling or asking for reassurance from a person, 0:07:19.520 --> 0:07:22.200 you know, did this happen, could it happen, will it happen? 0:07:22.520 --> 0:07:24.760 Did I do something wrong? So, so there are many 0:07:24.800 --> 0:07:27.640 ways in which a compulsion can show up, um, that 0:07:27.960 --> 0:07:31.960 our society isn't aware of. And then the deep part 0:07:32.520 --> 0:07:35.560 disorder what I mean, that's just the name of an 0:07:35.600 --> 0:07:38.760 obsessive compulsive disorder? So is there anything in the deep 0:07:38.760 --> 0:07:41.440 part that makes it the disorder like that you have 0:07:41.560 --> 0:07:45.320 to look for? Yeah, Well, to be diagnosed with a 0:07:45.560 --> 0:07:48.680 c D, it has to disrupt your life and you're 0:07:48.680 --> 0:07:52.880 functioning to a degree that is problematic. Um. You know, 0:07:53.080 --> 0:07:56.800 some people will often say like they have some symptoms 0:07:56.960 --> 0:08:01.000 of obsessive and compulsive they have to be haveviors, but 0:08:01.120 --> 0:08:04.120 it's not to the degree in which it is disordered, 0:08:04.160 --> 0:08:07.320 meaning there is now lack of order. Um that it's 0:08:07.320 --> 0:08:10.240 not debilitating their life taking away their functioning. So the 0:08:10.280 --> 0:08:13.600 people that I see how usually coming in there doing 0:08:13.600 --> 0:08:16.520 it for more than one or two hours a day. 0:08:17.080 --> 0:08:19.720 Most of the time it's taking up many, many, many 0:08:19.800 --> 0:08:22.560 hours of their day to the degree where they've lost 0:08:22.560 --> 0:08:25.280 some functioning. So that's sort of where the wood disorder 0:08:25.320 --> 0:08:30.280 comes into play. And that's true for any disorder, anorexier depression, 0:08:30.760 --> 0:08:33.720 it's usually you know, the symptoms have started to impact 0:08:33.800 --> 0:08:37.120 my well being. And do you like the name obsessive 0:08:37.160 --> 0:08:41.160 compulsive disorder? Does that work for you in terms of, um, 0:08:41.320 --> 0:08:45.080 what what it is that you know, the people you 0:08:45.160 --> 0:08:48.160 treat and what they have, and what it's called. Do 0:08:48.200 --> 0:08:51.520 you find that that's an accurate description of it? A 0:08:51.559 --> 0:08:54.360 lot of people with o c D find that the 0:08:54.400 --> 0:08:58.640 disorders name actually describes even the treatment right and the 0:08:58.720 --> 0:09:01.760 way in which we treat it, because it helps identify 0:09:01.840 --> 0:09:05.320 that there are multiple components of this disorder and that 0:09:05.360 --> 0:09:07.600 we have to look at each component in order to 0:09:07.679 --> 0:09:11.360 treat them really well. So I you know, we look 0:09:11.400 --> 0:09:14.360 at other terms like anorexia nervosa, it's like that doesn't 0:09:14.360 --> 0:09:18.880 even that's just syllables match together to make a certain word, 0:09:19.280 --> 0:09:21.160 Like it doesn't really even make any sense. But with 0:09:21.280 --> 0:09:25.120 this case, it does help us to identify the two 0:09:25.400 --> 0:09:28.360 core pieces that are showing up and you have to 0:09:28.440 --> 0:09:31.000 have both. And then it also it helps us to 0:09:31.040 --> 0:09:34.920 sort of put forward a plan. Um. So, I mean, 0:09:35.080 --> 0:09:37.080 I think that the problem with it, if we were 0:09:37.120 --> 0:09:40.080 to look at both sides of the coin, is because 0:09:40.120 --> 0:09:43.760 it's so misunderstood and stigmatized. I know a lot of 0:09:43.760 --> 0:09:47.520 people who don't like the term because of the stigma 0:09:47.600 --> 0:09:50.040 that go with it. But in terms of the correctness 0:09:50.080 --> 0:09:53.400 of the name, I think it's wonderful. And you are 0:09:53.559 --> 0:09:56.120 an O c D specialist, and I've heard you said, 0:09:56.280 --> 0:09:58.920 I've listened to some other interviews you've done that that 0:09:58.960 --> 0:10:01.000 there's very few of you in that sense to kind 0:10:01.000 --> 0:10:03.199 of I mean, I'm putting words in your mouth. You 0:10:03.200 --> 0:10:04.600 didn't say like this, but like you kind of know 0:10:04.679 --> 0:10:11.040 what they're doing, you know, is it hard? Um? Tell 0:10:11.080 --> 0:10:15.360 me what makes you? Tell me? Um? Tell me what 0:10:15.400 --> 0:10:18.040 sets you apart from other people that think they're treating 0:10:18.040 --> 0:10:21.880 O c D and and why it's important to I 0:10:21.880 --> 0:10:24.280 don't know. I guess go see someone like you as 0:10:24.320 --> 0:10:29.480 opposed to just any kind of therapist or anxiety specialists. Yeah. Well, 0:10:29.640 --> 0:10:33.360 what I will say before I start is, thankfully, over 0:10:33.440 --> 0:10:36.400 the last decade that I've been specializing in it, we've 0:10:36.440 --> 0:10:40.280 had such growth of more therapists. So you know, there's 0:10:40.360 --> 0:10:44.040 so many therapists now who are trained and correctly you know, 0:10:44.120 --> 0:10:47.440 supervised and so forth. So thankfully that's going in the 0:10:47.520 --> 0:10:52.920 right direction. But the O c D community has still 0:10:52.960 --> 0:10:55.560 a crisis on their hand. It still takes seven to 0:10:55.720 --> 0:10:59.720 fourteen years to get correctly diagnosed. That's a lot of years. 0:10:59.720 --> 0:11:04.160 So that means that these people have sought treatment from 0:11:04.240 --> 0:11:07.880 some other kind of therapist, maybe even doctor, and the 0:11:07.920 --> 0:11:11.760 person has not even named what they have as o 0:11:11.840 --> 0:11:14.000 c D, or they've been named with o c D, 0:11:14.040 --> 0:11:17.480 but they're they're not getting the right help with it both. 0:11:18.040 --> 0:11:21.280 So a lot of people will be declined the diagnosis 0:11:21.320 --> 0:11:24.600 and therefore can't get the treatment because of the misinformation 0:11:24.640 --> 0:11:27.319 around the compulsions. Right, like you don't have O c D. 0:11:27.960 --> 0:11:31.960 You can't your room's messy, you can't have O c D. Right, So, 0:11:32.120 --> 0:11:34.600 like what you were saying before they they're not noticing, 0:11:34.720 --> 0:11:39.000 they're not know speed on the other compulsions. Yeah, yeah, 0:11:39.040 --> 0:11:42.440 So there's that group there, the other group who get 0:11:42.480 --> 0:11:44.360 told they have a c D but then may be 0:11:44.559 --> 0:11:49.920 referred to a form of treatment that you know, out 0:11:49.920 --> 0:11:52.959 of the goodness of their soul, have tried to help, 0:11:53.080 --> 0:11:56.880 but often what they're using is techniques that actually make 0:11:56.960 --> 0:12:01.600 the compulsion and the disorder worse. So with the treatment 0:12:01.720 --> 0:12:07.400 of O c D, we actually purposely face our fears. 0:12:07.480 --> 0:12:11.520 That's the gold standard treatment. It's called exposure and response prevention. 0:12:11.960 --> 0:12:15.760 But if you're not trained in that naturally, any human 0:12:15.920 --> 0:12:19.200 I'm sure before you listen to this episode or knew 0:12:19.200 --> 0:12:22.600 anything about O c D, naturally your instincts would be, oh, 0:12:22.640 --> 0:12:25.120 if you have a fear that sounds really painful, you 0:12:25.160 --> 0:12:29.120 should avoid it. More like, can we figure out a way, 0:12:29.160 --> 0:12:32.920 Like there are even apps that have been created to 0:12:33.000 --> 0:12:37.000 help people take photos of their stove so that they 0:12:37.160 --> 0:12:39.720 know for certain they have turned their stove off or 0:12:39.760 --> 0:12:42.920 they've locked their door. And instinctually that makes sense, right, like, well, 0:12:42.960 --> 0:12:45.679 if you know you've locked your door, you shouldn't worry. 0:12:45.720 --> 0:12:50.160 But those behaviors actually act as compulsions. And keep the 0:12:50.240 --> 0:12:54.600 disorder going. So it's it goes against the recovery. And 0:12:54.679 --> 0:12:57.600 so that's where there's sort of there was a crisis 0:12:57.640 --> 0:12:59.559 and we are working our way out of it in 0:12:59.760 --> 0:13:04.880 edge acting mental health and medical professionals to to direct 0:13:05.000 --> 0:13:07.960 people to the correct care because it can go so wrong. 0:13:10.760 --> 0:13:19.400 We'll be right back. I haven't talked to anyone yet 0:13:19.440 --> 0:13:23.280 about exposure therapy. It's been casually mentioned in other episodes 0:13:23.320 --> 0:13:26.000 I've done, but the focus wasn't that, so I didn't 0:13:26.040 --> 0:13:30.120 really follow that trail. And I know that it's it's 0:13:30.200 --> 0:13:36.160 probably obviously different with every anxiety disorder, and but weird 0:13:36.160 --> 0:13:38.880 it's been brought up has been episodes that are more 0:13:38.880 --> 0:13:43.240 centered on panic attacks and things like that. Um, so 0:13:43.440 --> 0:13:45.200 I'm sort of familiar with it in terms of what 0:13:45.280 --> 0:13:48.960 I've done for panic attacks. But can you tell us 0:13:49.080 --> 0:13:54.679 what is exactly you said exposure and what response prevention? 0:13:55.400 --> 0:14:00.640 Tell us what exposure response prevention is? Sure? So, Um, 0:14:00.840 --> 0:14:03.640 Exposure and response prevention we call it e r P 0:14:03.880 --> 0:14:07.000 for short, is where we so go back to the 0:14:07.040 --> 0:14:13.360 obsessive and compulsive parts, so we expose them to their obsession. Right, 0:14:13.520 --> 0:14:16.840 So that's pretty easy, right, you identify your fear, we 0:14:16.960 --> 0:14:20.240 find a way to face your fear. Back in the day, 0:14:20.280 --> 0:14:22.720 we only used to do exposure. We go, okay, if 0:14:22.720 --> 0:14:24.840 you're afraid of dogs, go and hang out with dogs, 0:14:24.920 --> 0:14:27.280 or if you're afraid of germs, go and touch germs. 0:14:27.640 --> 0:14:30.080 But what we found there was that's manly really fifty 0:14:30.400 --> 0:14:32.040 of the work, because then they just go and do 0:14:32.080 --> 0:14:35.200 all these compulsions to undo their fear or reduce or 0:14:35.200 --> 0:14:39.720 remove their fear. So the response prevention is where once 0:14:39.760 --> 0:14:43.200 you've exposed yourself to your fear, the response prevention is 0:14:43.240 --> 0:14:48.680 targeting eliminating those compulsive behaviors. So not only would you, 0:14:49.440 --> 0:14:52.920 you know, touch germs or be around germs, but then 0:14:53.000 --> 0:14:57.200 you would reduce and remove the compulsive hand wash or 0:14:57.240 --> 0:15:01.800 the rumination, or the reassurance seeking or the googling and 0:15:01.840 --> 0:15:04.840 that kind of behavior. So both must be a part 0:15:04.920 --> 0:15:08.640 of treatment for the treatment to be really successful. So 0:15:08.680 --> 0:15:11.480 if I come to you, um, how soon do we 0:15:11.560 --> 0:15:16.640 get into exposure therapy? Is it session one? Usually session 0:15:16.760 --> 0:15:21.200 two or three, depending on the complexity of the case. 0:15:21.240 --> 0:15:24.040 So we always want to do a thorough assessment, make 0:15:24.080 --> 0:15:27.040 sure we have the right diagnosis. We also want to 0:15:27.080 --> 0:15:30.320 do a ton of education because let me ask you, 0:15:30.600 --> 0:15:34.200 how how excited are you about facing your worst fear? 0:15:34.680 --> 0:15:40.000 Not excited? No, I mean I think of ump. I'll 0:15:40.000 --> 0:15:43.040 say a couple of my worst fears. I think I'm 0:15:43.040 --> 0:15:45.800 pretty excited about them because I don't need them in 0:15:45.840 --> 0:15:49.240 my life, so they don't debilitate me. But I used 0:15:49.240 --> 0:15:52.920 to have a fear flying and I was not excited 0:15:52.960 --> 0:15:55.400 to face that, but I did. So that's the thing. 0:15:55.520 --> 0:15:58.240 So anyone, I always say to my patients, like, no 0:15:58.280 --> 0:16:01.240 one wants to see me, no one likes to come 0:16:01.360 --> 0:16:03.800 visit me, no one likes to come and be my client. 0:16:04.080 --> 0:16:06.120 But they want to get better and so that's why 0:16:06.200 --> 0:16:08.160 they do. And so I have to do a lot 0:16:08.240 --> 0:16:11.920 of education about what is o c D, what is 0:16:12.040 --> 0:16:16.160 exposure and response prevention to build trust with them because 0:16:16.240 --> 0:16:18.560 I'm going to ask them to do the thing they 0:16:18.640 --> 0:16:23.320 absolutely don't want to do rightfully. So um, and that's 0:16:23.360 --> 0:16:26.400 probably the thing that frightens them the most. And usually 0:16:27.080 --> 0:16:30.480 o c D attacks the things we value the most. 0:16:30.600 --> 0:16:34.400 So if you value your relationships, it will target your relationships. 0:16:34.760 --> 0:16:36.800 If you love your job, it'll target your job. If 0:16:36.840 --> 0:16:39.480 you will love your children, it'll target your children. So 0:16:40.240 --> 0:16:42.760 because I'm asking them to do really scary things and 0:16:42.800 --> 0:16:45.680 things they value. I do give them some time and education, 0:16:46.120 --> 0:16:49.440 but I also emphasize the faster we can start getting 0:16:49.480 --> 0:16:52.840 you to face your fear, the quicker you recover. And 0:16:52.840 --> 0:16:54.720 so it's sort of a little dance that we do 0:16:54.800 --> 0:17:00.280 together of trust and courage and repair and encourage and 0:17:00.720 --> 0:17:04.560 like it's an encouragement, it's it's a dance that we 0:17:04.600 --> 0:17:07.280 do together. And I just realized in my example I 0:17:07.320 --> 0:17:09.160 gave about you know, I had a fear of flying, 0:17:09.160 --> 0:17:11.920 and I did do some exposure therapy for that. I'm 0:17:11.960 --> 0:17:14.800 not really talking about O c D. So tell me, 0:17:15.359 --> 0:17:18.480 Like I had to visitly, get exposed to an airplane, 0:17:18.520 --> 0:17:21.679 get on it, touch you know whatever, touch the outside 0:17:21.720 --> 0:17:24.440 of the airplane, first, had to look at it. But again, 0:17:24.720 --> 0:17:26.600 I wasn't dealing with an O c D issues, dealing 0:17:26.640 --> 0:17:29.679 with the phobia. So what are you being exposed to 0:17:30.920 --> 0:17:34.960 in obsessive compulsive disordered people? Like, what are they being 0:17:34.960 --> 0:17:38.040 exposed to when they seek exposure therapy? If someone's having 0:17:39.440 --> 0:17:42.840 um intrusive thoughts, emotions, or urges, which maybe we should 0:17:42.880 --> 0:17:45.440 define that before you tell me how you do it. Um, 0:17:45.480 --> 0:17:47.920 I'd love to know because I'm assuming the exposure therapy 0:17:47.960 --> 0:17:53.399 is different than like for a phobia. Right. So there 0:17:53.440 --> 0:17:58.800 are multiple different categories of types of o c D. Again, 0:17:59.280 --> 0:18:03.920 majority of people know about contamination o c D, which 0:18:03.960 --> 0:18:07.800 is the fear of germs and bodily fluids and so forth, 0:18:07.800 --> 0:18:12.480 things like that. Um. Other people know about symmetry obsessions, right, 0:18:12.640 --> 0:18:15.400 which is like lining things up and making sure things 0:18:15.400 --> 0:18:19.600 are very straight and perfectionist stick right. Um. Other people 0:18:19.640 --> 0:18:23.480 know about checking obsessions around danger. You know, will I 0:18:23.520 --> 0:18:27.040 put the you know, if I don't unplug my um 0:18:27.080 --> 0:18:29.320 my hair curlor, will the house set on fire? And 0:18:29.359 --> 0:18:33.360 I'll be responsible for you know, terrible terrible things. Um. 0:18:33.400 --> 0:18:36.639 So we know about those, but in fact they're the 0:18:36.760 --> 0:18:40.720 lesser concerns that we see in our practice. Right. We 0:18:40.920 --> 0:18:47.359 see a lot of people have obsessions around, um, harming people, 0:18:48.000 --> 0:18:50.679 and this is a very common one. Usually when I 0:18:50.720 --> 0:18:53.280 do interviews like this, I get like an influx of 0:18:53.359 --> 0:18:55.960 emails from people going, oh my god, I never thought 0:18:56.000 --> 0:18:58.560 I had O c D until you said, like these 0:18:58.560 --> 0:19:01.879 obsessions because no one had conceptualized them as o c D. 0:19:02.160 --> 0:19:04.440 So harm O c D is actually really common one. 0:19:04.960 --> 0:19:08.159 It Usually obsession is what if I harm somebody that 0:19:08.240 --> 0:19:12.159 I love or person in my life. The thing to 0:19:12.240 --> 0:19:18.920 remember again is the thought is unwanted, repetitive and distressing. 0:19:19.000 --> 0:19:22.040 Like we talked about, so people who have harm obsessions 0:19:22.640 --> 0:19:26.320 are probably like the sweetest people in the world. The 0:19:26.359 --> 0:19:32.800 thought of this is so just heartbreaking, and for them 0:19:33.119 --> 0:19:35.720 it's repetitive, like it's all day in their head, in 0:19:35.720 --> 0:19:38.320 their head, in their head. And so for E. RP. 0:19:38.560 --> 0:19:41.920 For that example, we would expose them too often the 0:19:41.960 --> 0:19:45.960 people that they're having thoughts about, right, and then the 0:19:46.000 --> 0:19:49.480 response prevention would be not to do those safety behaviors 0:19:49.520 --> 0:19:52.960 like you know, okay, so don't do the safety behaviors 0:19:52.960 --> 0:19:56.800 that they used to do to try to stop the thoughts, right, yes, 0:19:57.960 --> 0:20:02.120 so you know, And exposure can be just about very 0:20:02.160 --> 0:20:04.280 simple like go and be with the people that you're 0:20:04.320 --> 0:20:07.320 afraid of being with. In some cases it needs to 0:20:07.359 --> 0:20:10.200 be more aggressive if they've got very severe O C 0:20:10.359 --> 0:20:14.560 d um of you know, having them chop vegetables because 0:20:14.600 --> 0:20:17.719 for them, they have avoided knives for months or years 0:20:18.320 --> 0:20:21.359 in fear that they are not responsible with a knife 0:20:21.400 --> 0:20:23.720 like that they're just gonna go crazy and run down 0:20:23.720 --> 0:20:27.520 the hall and stab their husband or something exactly exactly. 0:20:27.960 --> 0:20:32.840 So we also have people with sexual obsessions, particularly around orientation. 0:20:33.000 --> 0:20:36.920 So let's say if you're heterosexual, you may be fear 0:20:37.080 --> 0:20:40.360 that am I You have a lot of uncertainty around 0:20:40.640 --> 0:20:44.119 am I gay or straight? Again, think of O c D. 0:20:44.520 --> 0:20:50.360 We call it the uncertain disorder. It usually thrives on uncertainty, right, 0:20:50.400 --> 0:20:54.199 So the more uncertain you are, the more anxiety you feel, 0:20:55.000 --> 0:20:57.080 so you may have fears around that. In that case, 0:20:57.119 --> 0:20:59.600 we would expose you to the thoughts or the feelings 0:20:59.680 --> 0:21:03.200 or the sensations, and then you would practice not engaging 0:21:03.240 --> 0:21:08.159 in avoidance safety behaviors or ruminaty of safety behaviors. So 0:21:08.240 --> 0:21:12.120 there's just a couple of examples. There's probably twenty common 0:21:12.160 --> 0:21:15.720 ones that could be related to religion. Um. It could 0:21:15.760 --> 0:21:20.720 be related to existential like the obsession around what's the 0:21:20.800 --> 0:21:25.720 point of life? Um. There are many ways in which 0:21:25.960 --> 0:21:29.359 these obsessions can target. It could be a relationship obsession. 0:21:29.720 --> 0:21:32.800 A lot of people with relationship obsessions ruminate on whether 0:21:32.840 --> 0:21:36.480 they will cheat on their partner, or ruminate on whether 0:21:36.560 --> 0:21:40.840 they've picked the quote unquote right one. Um. And then 0:21:41.800 --> 0:21:44.959 again and for some people listening, they may maybe like, 0:21:45.000 --> 0:21:48.000 but I do a little bit of that right. So 0:21:48.200 --> 0:21:50.600 it's important to know that people who don't have o 0:21:50.720 --> 0:21:54.480 c D maybe having these same fears, but not at 0:21:54.520 --> 0:21:58.720 the at the degree of repetition or extremely how extreme 0:21:58.760 --> 0:22:02.000 it is, and then you're able to manage that uncertainty. 0:22:02.240 --> 0:22:05.200 For people with o c D, they've very much struggle 0:22:05.320 --> 0:22:09.440 to stop doing compulsions around the obsession. And that's when 0:22:09.440 --> 0:22:12.520 we would intervene and with someone with like, for example, 0:22:12.560 --> 0:22:16.600 the relationship obsession, you know, interests of thoughts about relationships. 0:22:17.359 --> 0:22:20.080 It's not even based in any real thing I assume 0:22:20.119 --> 0:22:23.080 where it's like, you know, actually this isn't working out 0:22:23.119 --> 0:22:25.120 for me. We have different life goals. I mean, it's 0:22:25.160 --> 0:22:30.000 really not based in the same reality that someone who goes, 0:22:30.000 --> 0:22:32.080 oh I have that. Sometimes it's like is it that 0:22:32.160 --> 0:22:34.840 like you could be with the perfect partner and having 0:22:34.840 --> 0:22:38.080 no problems, but your mind is just going and going yea. 0:22:38.720 --> 0:22:42.359 So from this is a little bit of psycho clinical talk, 0:22:43.240 --> 0:22:47.159 but there is a term called ego dys tonic and 0:22:47.359 --> 0:22:51.920 egosyn tonic. So for people with o c D, their 0:22:51.960 --> 0:22:57.680 obsession is clinically ego dys tonic, meaning the obsession doesn't 0:22:57.720 --> 0:23:01.800 line up with their values. So just as you were saying. 0:23:02.440 --> 0:23:07.200 Often a client will come to me crying, sobbing in disbelief, 0:23:07.240 --> 0:23:11.119 and they'll say, it makes no sense. I love my 0:23:11.320 --> 0:23:15.760 child so much, but I can't stop thinking that maybe 0:23:15.760 --> 0:23:18.600 I'll harm them. So you can see that it doesn't 0:23:18.640 --> 0:23:22.040 line up with their values, and that's why it's so distressing, 0:23:23.000 --> 0:23:27.240 because it's so confusing. Ecosyntonic is where you have a 0:23:27.320 --> 0:23:29.600 thought or a feeling or a sensation and urge that 0:23:29.680 --> 0:23:33.120 does line up with your values, right um. And so 0:23:33.720 --> 0:23:37.080 people with O c D, their obsessions are usually egodis 0:23:37.119 --> 0:23:41.400 tonic um. So if that helps sort of clarify, they 0:23:41.520 --> 0:23:45.240 usually will say, like, it makes no sense. I really 0:23:45.280 --> 0:23:47.640 do care for my partner. I don't know understand why 0:23:47.640 --> 0:23:51.239 I'm having these obsessions about cheating or I love. It 0:23:51.280 --> 0:23:53.879 could be again religion, like I am so committed to 0:23:53.920 --> 0:23:58.000 my religion, but I keep having this intrusive image of 0:23:58.160 --> 0:24:03.280 a sin or so for we'll continue the interview on 0:24:03.320 --> 0:24:06.359 the flip side of a quick message from our sponsors. 0:24:12.600 --> 0:24:17.439 As part of my anxiety journey, I I've dabbled in 0:24:17.520 --> 0:24:19.760 some O c D thoughts. I know exactly what an 0:24:19.760 --> 0:24:23.480 intrusive thought feels like, and it's terrible. You know, how 0:24:23.560 --> 0:24:27.040 does someone know who's just sitting at home hearing this 0:24:28.680 --> 0:24:31.560 the difference between that and what it would be like 0:24:31.720 --> 0:24:35.879 to be maybe schizophrenic and you're hearing voices saying go 0:24:36.080 --> 0:24:38.320 push this woman in front of the subway. So how 0:24:38.359 --> 0:24:40.639 does someone know? I mean, I would assume the difference is, 0:24:40.680 --> 0:24:43.880 like you said, it's they don't want these thoughts. They're 0:24:43.920 --> 0:24:47.080 not like excited by them. Um, so does that mean 0:24:47.119 --> 0:24:49.600 that people who are going to harm people like the 0:24:49.640 --> 0:24:51.800 thoughts feel different? Like, how does someone know and they're 0:24:51.840 --> 0:24:55.160 if they're just listening? Well, I think I think number 0:24:55.240 --> 0:24:59.240