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Inside the Mind: Unraveling OCD
136 Plays11 months ago
Explore the world of OCD in this interview with therapist Stephanie Landrum. Gain expert insights, practical strategies, and a compassionate perspective on navigating life with obsessive-compulsive disorder. Whether you're personally affected or seeking understanding, join us for an impactful conversation on the journey into the complexities of OCD.
About today's guest:
Stephanie Landrum is a licensed professional counselor in the state of Georgia and a national certified counselor. She is the owner of Mind in Bloom Counseling in the Metro Atlanta area and has been practicing for the last 10 years. She specializes in work with clients ages 16-45 who struggle with anxiety, OCD, stress and burnout, life transitions, self-esteem and perfectionism.
Resources:
International OCD Foundation: https://iocdf.org/
Book recommendations: https://www.mindinbloomcounseling.com/resources/favorite-book-recommendations
Other media resources: https://www.mindinbloomcounseling.com/resources/ocd-and-anxiety-resources-media-resources
Postpartum Support International OCD Support Group: https://www.postpartum.net/get-help/psi-online-support-meetings/#perinata-ocd
Get in touch with Stephanie:
Website: www.mindinbloomcounseling.com
Instagram: @mindinbloomcounseling
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Transcript
Introduction to Season Two
00:00:11
Speaker
Welcome back to season two of Outside of Session. I'm your host, licensed clinical social worker, and therapist BFF, Julie Hilton. This season, I'm interviewing some incredible guests who also happen to be experts in their fields. Mental health,
Overview of Season Themes
00:00:29
Speaker
motherhood, spirituality, and so much more, I can't wait for their stories to be told. These are all the conversations I'm having outside of session.
00:00:49
Speaker
Hey everyone, welcome back to this week's episode of Outside of Session. Today
Introducing Stephanie Landrum
00:00:53
Speaker
I'm sitting down with Stephanie Landrum to talk all things OCD. I really enjoyed this conversation with Stephanie because I learned so much from her about OCD that even I didn't know as a therapist. She is just such a wealth of knowledge and I was just so grateful for her time and just all of the knowledge that she shared with me today. I think you're really going to like this episode.
00:01:14
Speaker
A little more about Stephanie, she is a licensed professional counselor in the state of Georgia and a national certified counselor. She is the owner of Mind and Bloom counseling in the Metro Atlanta area and she's been practicing for the last 10 years. She specializes in working with clients aged 16 to 45 who struggle with OCD, as well as anxiety, stress and burnout, life transitions, self-esteem and perfectionism.
00:01:39
Speaker
And of course, I'll link all of Stephanie's information so that you can get in contact with her. You can follow her on social media as well as all the resources that she shared during this episode. I'll link all of that in the show notes so that you can get in touch with her if you have any other questions or you want to keep learning from her. So with all of that being said, here we go talking with Stephanie about OCD. Stephanie, good morning. Good morning. How are you? Thank you so much for being here today.
00:02:09
Speaker
Yeah, I'm excited to be here. I'm really looking forward to today's conversation because I'll be honest, I don't know a lot about OCD when it comes to the clinical definition of it. So I feel like I have a lot to learn from you today and I'm really excited about that. Yeah, I think that can be kind of a common thing. Like it's not like most graduate schools kind of go in and do nuanced work with OCD. So I think that's a pretty common thing. So I'm excited too. Yeah.
00:02:38
Speaker
So I wanted to start by, I think it's always helpful and I've started a couple of other episodes this way too with other therapists about their topic.
Understanding OCD: Signs and Symptoms
00:02:46
Speaker
And I think it's helpful for listeners to think of it this way because a lot of people when they're starting therapy, they don't already have a diagnosis of OCD. They may not have ever heard of it or ever even considered it before.
00:02:59
Speaker
What do people typically express their concern to be that later on you realize that, okay, so these are some OCD tendencies or a clinical diagnosis? Like how do people describe what their quote unquote issue is and what they're aware of when they typically reach out to you for therapy?
00:03:19
Speaker
Yeah, so I'll hear kind of a couple of different things. It's not always exactly the same, but a lot of things I'll hear is I have so much anxiety and I've tried all these things and nothing helps. And, you know, spending hours a day focusing on, usually there's like common themes that they're focusing on. So the anxiety circles around specific things or they said, you know, I've done therapy before and my anxiety is still just really bad.
00:03:49
Speaker
That's kind of one. And when we really look into it, you know, I'll use kind of a diagnostic form, it's called the Y box and it goes through and it asks about obsessions and compulsions. Okay. Some other things that I'll see are people coming in with depression. So if you think about it, this is something that, you know, I've had clients describe as
00:04:13
Speaker
like I'm being tortured by my thoughts. And studies have shown that it takes a person an average of 17 years to get adequate help for OCD. So if you think about, yeah, it's a crazy long time. And that sometimes is just they've been in therapy and it's been missed or misdiagnosed. Sometimes people just don't seek treatment until then.
00:04:43
Speaker
And so, you know, you think about, you know, if you were in pain for 17 years, like you probably would be depressed too. So that's something that I'll kind of see under that. Oh, sorry. Go ahead. I'm sorry. Go ahead. So depression is almost because of not getting the help you that you need. Depression develops.
00:05:06
Speaker
Yeah. It's kind of, I see it as more as like a secondary, like the OCD was there and later on the depression pops up because they're just like, Oh my gosh, I'm being tortured by these thoughts and I just don't want to do it anymore. Like I can't handle having these obsessive thoughts or my life is so impacted and they fall into a depression, which I mean, it makes a ton of sense. Um, at least on my end, it makes sense. Um,
00:05:31
Speaker
So yeah, and then the third thing that I'll see a lot that kind of goes along with it is people report panic attacks. So sometimes it is actual panic disorder along with it. And sometimes it's just, it's so bad that they're having, you know, panic attacks alongside of that.
OCD vs Anxiety: Key Differences
00:05:51
Speaker
So those would be things that, you know, people coming in, I would see, you know, some of the most typical things walking in.
00:06:01
Speaker
Yeah. So that was another thing that I get confused about too is what is the relationship between anxiety and OCD and how is it linked, but how is it differentiated? Like, can you speak a little bit just to like, how do you know if it's anxiety or OCD? Because it sounds like though they're so intertwined, right?
00:06:24
Speaker
Yes, so they can be and then there's pieces that are definitely separate. So in 2013, when they came out with the DSM-5, anxiety and OCD used to kind of be along together and they got separated.
00:06:39
Speaker
So can you explain what the DSM-5 is really quickly just in case anybody doesn't get it? Yeah, so it's the Diagnostic Statistical Manual. It's basically the Bible for what we use to diagnose. It's what holds all of the criteria that we have to look at in order to make a definitive diagnosis of a mental health issue.
00:07:05
Speaker
Yes. It gives all the really clinical terms and you know, you have to have this many for this and this many for that. So yeah, it's, it's all of our reference to ruling out a diagnosis or confirming one. So, um, but yeah, so it got moved over, um, and now it's not necessarily related or an anxiety related disorder. It's, it's in its own little category. Um, and so,
00:07:32
Speaker
Part of that, or the biggest definitive thing between anxiety and OCD is the compulsions. And that's where it gets really tricky. So anxiety can have obsessions, it can have intrusive thoughts, but it does not have the compulsory part. Anxiety also tends to be a little bit more futuristic in nature, but OCD or obsessions might be around
00:08:02
Speaker
different categories. And I'm not sure if you want me to kind of go into like definitions now or would that be helpful to kind of go through? Okay. Um, so I am referencing a definition that I thought was was pretty simplistic and straightforward. And it comes from the International OCD Foundation. And I just want to go through obsessions and compulsions to kind of explain those a little bit more to give an idea of what we're looking at. So
00:08:32
Speaker
obsessions are thoughts, images, or impulses that occur over and over again.
00:08:38
Speaker
and feel outside of the person's control. So people with OCD don't want to have these thoughts. They find them disturbing. And most of the time, people know that they're not logical. Whereas anxiety, they more fall in line with that. So something that I may use while I'm talking here that you may hear and other things are egosyntonic versus egotistonic. So something that's egosyntonic falls in line with
00:09:07
Speaker
your values, your morals, it very much is what you believe. Something egotistonic is I don't align with that. So an example might be I'm having an obsession that I want to harm somebody. I don't want to have that thought. I don't want to harm somebody. That would be an example of something egotistonic and something that somebody with OCD would experience. And something like that is also really hard to like
00:09:37
Speaker
say out loud, like nobody wants to go to their therapist and say, I want to harm somebody, but I don't want to harm someone and feel like they're going to be understood. Oh my gosh. That, that reminds me. I remember being in undergrad, so I had no mental health training at that point, right? Like I don't even think I was a social work major at the time. Um, because I changed my major so many times in college, but I had this really, really good friend and all of a sudden she started having these intrusive thoughts of hurting kids.
00:10:08
Speaker
And it freaked her out so bad because her logical mind was like, I would never, I love children. Like where are these thoughts coming from? And I remember her describing them as these are not mine. Yeah.
00:10:21
Speaker
Yeah. And that is so typical. At that point, I didn't know how to help her. I didn't know anything about diagnosing at the time. So she ended up seeing a really good therapist and they diagnosed her with OCD. And I remember being very confused at the time because I was like, at that point I was like, she's not repetitively washing her hands. What does that even mean? You know, that she, but, but she explained it. She was like, I'm having obsessive thoughts, but it's exactly what you're describing as ego, dystonic of
00:10:48
Speaker
they did not align with her values and she never would actually have acted on them. But it was terrifying to her. It was so scary for these intrusive thoughts to be just like coming out of nowhere and they hit her all of a sudden. So is that kind of what you're describing as? Yeah, yeah, definitely. I mean, that's spot on. That's like a classic.
00:11:07
Speaker
classic intrusive obsessive thought around harm. Um, so yeah, it's something that a lot of people are afraid to share with a therapist or a medical provider because, you know, they're like, I'm going to sound crazy or they're going to send me somewhere. And in reality, like, no, if you have someone who works with OCD, this is something we hear often and, and we know you don't want to do these things and we can help you work through them. So,
00:11:33
Speaker
Um, I know they're scary, but there is help for that. So, um, it's something that's pretty common. Yeah. I think that's good for people to hear too, because if they, if they are in that position, um, it's good just to hear that coming in, the right therapist is not going to judge the right therapist is going to say, I know exactly what you're talking about. We say that all the time and normalize it in a way to make it seem like, no, we don't, we don't judge. We don't think any differently about you. We're so glad you're here to address this.
00:12:03
Speaker
Yes, yes, you're spot on. That's the same thing to another big one with the postpartum kind of nature of things, something that can kind of pop up. Typically OCD kind of comes up for people around the ages 8 to 12 or around adulthood, the beginning of adulthood.
Postpartum OCD and Specialized Treatment
00:12:28
Speaker
Sometimes something traumatic can bring it on, sometimes something like pregnancy.
00:12:34
Speaker
can or you know having your baby can can bring it on so postpartum OCD is a thing and you know a lot of times things will surround
00:12:42
Speaker
around the baby with that. And that's really scary, especially to a new mom going, oh my gosh, I'm having these thoughts of harming my baby. But I love them so much. And how could this be? And if I tell someone, they may take my baby. So it's something that's really treatable, too, especially within that population. But it is. I mean, I think that's one of the biggest barriers to care is the content of those intrusive thoughts for people. So yeah.
00:13:12
Speaker
So the other thing with OCD is kind of back to the obsession definition is anxiety isn't the only thing that can necessarily follow the obsession. You can have fear, disgust, uncertainty, and doubt. And so those are other emotions that might come up with
00:13:33
Speaker
that it's important to look at, because we also might treat those a little bit differently. And so one big thing, too, is if people are coming in, they're like, oh, I'm so OCD. I like to have my shoes straight and my clothes color-coded. A lot of times, that's not necessarily OCD. And I think that's where we've kind of, in social media and then culturally, we're like, oh, we kind of just use it loosely. Yeah, TikTok therapy.
00:14:01
Speaker
Yeah. So I think the biggest thing is, you know, how much distress is something causing? Does it impact your ability to function? Is where we look at, you know, is it OCD or not? Because I think it is common, too, that, you know, everybody might have some intrusive thoughts or things that are minimally obsessive. It's to what impact, to what extent, to keep in mind. Okay.
00:14:29
Speaker
So some common obsessions, just to kind of touch on those, you know, of course this would be something to go through more with your therapist that you're working with. Things around contamination, so like bodily fluids, germs, dirt, chemicals. There's violent obsessions, so fear of harming yourself or others.
00:14:49
Speaker
responsibility obsessions, so fear of being responsible for something like, you know, if I left this stove on it would cause a fire or if I'm not careful enough and I didn't, you know, move this thing out of the way somebody could trip on it and fall down the stairs.
00:15:08
Speaker
There is perfectionism related obsession. So that is more about evenness or exactness, needing to know and remember things often kind of random things. Fear of losing objects. This is where some hoarding stuff can kind of come in. Fear of making mistakes and then
00:15:29
Speaker
The last couple of obsessions. So this is another kind of one that a lot of people don't feel comfortable sharing, but sexual obsessions. So acting on a sexual related impulse, sexually harming someone or aggressive sexual behaviors. There's something called scrupulosity. So it's around religious or moral obsession. So fear of offending your God.
00:15:54
Speaker
fear of things around the religious piece and doing those just right. And then Yeah, that one can be really tricky, right? Like, so like, I mean, number one, trying to figure out what
OCD's Intersection with Religion and Upbringing
00:16:09
Speaker
kind of falls in line with like the normal
00:16:14
Speaker
beliefs of the religion versus what would be kind of an OCD piece of it and trying to kind of navigate that fine line. So that one can be kind of tricky, but shows up a lot for people. Yeah. Yeah. I think I said that that's so interesting because I feel like so many of my clients have started to work through different levels of religious trauma.
00:16:36
Speaker
And I don't think it's necessarily that they're seeking me out to work on that necessarily, but we start looking at all the childhood trauma, because I work a lot with complex trauma. And religion is so often hand in hand if they've got, you know, they're really emotionally unavailable, strict parents, but they grew up in a really high control religious environment.
00:17:02
Speaker
that we're realizing how much shame was used and how rigid things were. And I don't know that I've never even thought about that, about OCD playing a part and maybe the parents parenting. You know, like maybe if they had obsessive thoughts about religion, how they were maybe projecting that onto their children. Yeah, yeah. And then that kind of becomes
00:17:27
Speaker
the expectation for the kiddos and pass, passed along. So yeah, I mean, that can be, you know, I've seen that in different contexts from, you know, people who were able to go to church can no longer walk in the doors, you know, we've kind of worked on that where, you know, they've been able to go back to their church or place a religion.
00:17:50
Speaker
And so, you know, it could be something during the service where they can't focus or that they're doing throughout the day. So, you know, people might feel like they have to pray after, you know, anything is done, you know, that way. So it is hard, like you said, I mean, I think some of these religious communities where things are so strict and looking at, you know, what was the expectation, kind of teasing apart, you know, what's trauma? What's OCD? What's, what are all these things kind of coming together and, and still respecting, you know,
00:18:20
Speaker
that person's belief system. So that's a tricky one. Yeah, that's really interesting. What was that word again that you used? Scrupulosity. Yeah, no, it's kind of a fun word, but probably not a super exciting definition.
00:18:40
Speaker
So the last couple are identity obsessions. So excessive concern with one's sexual orientation or gender identity. And then other ones that kind of fit a miscellaneous section are relationship related obsessions. So excessive concern about if your partner is the one, you know, if there's flaws, things like that.
00:19:04
Speaker
obsessions around death or existence. And then real event slash false memory obsessions. So concern about what has happened in the past and the impacts they've had. And once again, this is not just a little bit of worry. It's excessive concern. It's probably coming up on a daily basis. It's hard to make it go away. And then there's a compulsion that follows. So
00:19:30
Speaker
But those are just the obsessions. I know that was quite a list, but I mean, I think that just shows you how complex OCD can be because that's just one section of it and it falls in a lot of different places. Yeah, absolutely. So as far as compulsions, once again, taking the definition from the IOCDF website,
00:19:54
Speaker
Compulsions are repetitive behaviors or thoughts that a person uses with the intention of neutralizing, counteracting, or making their obsessions go away. So usually people with OCD realize this is only a temporary solution, but they don't have a better way to cope. And so those feelings that are coming up, these compulsions give them minimal relief, but it's temporary and they'll take it versus just kind of being tortured ongoing.
00:20:23
Speaker
So those can include rituals or the compulsions and those can be, you know, actual things like from tapping, placing things, washing hands to something that is kind of tricky, like a mental compulsion that we don't see. So the problem with that is
00:20:45
Speaker
If a client does not share something that's a mental compulsion, we may not know that they're doing a compulsion. They may not know that they're doing a compulsion. So I think sometimes that's where it gets missed is those tricky mental compulsions. So, you know, something I've seen a lot kind of float around is something called like Pure O OCD.
00:21:08
Speaker
And that's not really a thing. There's always a compulsion. And what that is, is those are those mental compulsions that we're not seeing. Oh, so the Pure O would be only the obsession without the compulsion. But you're saying if it's true OCD, there's always a compulsion with it. Right. And those are the ones that we're probably lumping into the mental compulsions that we're just not seeing.
00:21:32
Speaker
So, you know, I've seen this as anything from somebody trying to reassure or try to make logic out of the nonsense because really it is illogical and it is just, you know, you're trying to reason, well, oh, okay, if this doorknob is contaminated and I touched it and then maybe my germs won't be on
00:21:53
Speaker
my hand and I won't get somebody sick or if they got sick then they hit you know and it's all this reasoning that you could go on and on forever um but it's compulsory they they get some sort of relief or temporary relief from kind of trying to reason through it um and so that would be kind of what the mental compulsion an example of one of the mental compulsions so interesting i never would have thought of that
00:22:17
Speaker
It's hard. It's something to you have to, you know, and as a clinician, like you've got to ask these questions because and provide the psychoeducation because if the client doesn't truly understand what a compulsion is, you may just go on missing it. And you can start doing, you know, with exposure and response prevention, one of the treatments, you could go on doing something and and you might kind of hit a plateau or like, Hey, this
00:22:41
Speaker
we're not able to get past this part or this doesn't seem to be working and the client may be doing a mental compulsion and you don't know and so you kind of have to dig in and find out and that might sometimes is the reason why things don't progress.
00:22:57
Speaker
So
Misdiagnosis and Treatment Approaches for OCD
00:22:58
Speaker
I know we're going to talk about this a little bit more about what makes OCD treatment different. But before we really dive into that, I'm even thinking about, are there times in therapy where OCD has been, it's not caught or it's misdiagnosed, it's just anxiety.
00:23:15
Speaker
where the therapy actually comes up with a like I'm thinking about if if a therapist even said like, when you touch the door handle instead of going to wash your hands, can you sit with it and think about I'm okay or something like that. And that actually is feeding into the mental compulsion that they you know what I mean. And so it's not actually getting you out of the cycle of not having the obsession to start with is trying to counteract it with a
00:23:46
Speaker
like a logical reasoning, work through it in a different way. Like, am I making sense? Yes, no, you're totally spot on and which is, which is why normal, like, you know, or some forms of treatment for just normal anxiety or generalized anxiety disorder are not going to work for OCD because really you're doing just another compulsion. Like saying, I'm okay can be a compulsion. Like if the person's like, I'm okay, I'm okay, I'm okay. That's a compulsion. Um,
00:24:12
Speaker
So yeah, you have to be really careful with that And you know doing just general like relaxation exercises things like that like that's not gonna take care of it either So yeah, and I can definitely go more into that when we talk about it, but that is another reason why it's so important to kind of figure out what you're doing because clients that I have that have generalized anxiety and
00:24:35
Speaker
and OCD, we have to approach one in one way and then one in another way. And it's really important to kind of section off what is related to what and what's an OCD concern versus just that anxiety concern. Gotcha. OK. So as far as compulsions, I'll go through kind of the common compulsions just really quickly.
00:25:03
Speaker
washing and cleaning. So washing your hands excessively or in a certain way. And sometimes that's, you know, a certain number, you know, people may wash until their hands are burning or bleeding. Excessive showering, you know, there are people that they may be in the shower for hours or have rituals during showering. Cleaning things in their house or other places and doing things to avoid contacts with contaminants.
00:25:32
Speaker
Checking compulsions, so checking that you did not harm yourself or others, that nothing terrible happened, you didn't make a mistake. You might check parts of your body for different things. Repeating, so repeating specific activities, so going in and out of doorways, up and down from chairs, body movements like tapping, touching, blinking.
00:26:00
Speaker
activities in multiple, so doing a task like three times because it's good, right, a safe number, kind of whatever your brain has told you to do with that. And then the last two, so mental compulsions, like we talked about, so mentally reviewing events to prevent harm, you may pray, you may count.
00:26:22
Speaker
there's different thoughts to like kind of cancel or undo. So you might replace a bad word with a good word to cancel it out. And then the last kind of miscellaneous compulsions are putting things in order or doing things until it quote unquote feels right, feels just right. That's a big one that I hear a lot that they're like, I don't know, I just do something or it doesn't just feel right. And people may ask for reassurance. That's a big one.
00:26:51
Speaker
that I see with families or friends that are involved with the person with OCD, is there reassurance seeking? Did I touch that? Is there germs on that? Am I sick? Or avoidance? Like, oh, I can't go here. I can't do this. So those are kind of the compulsions that's just an overview. Of course, they can go way more in depth, but those would be examples. And once again, excessive, repetitive, and following those obsessions.
00:27:20
Speaker
Yeah, that's also interesting. Hey, everyone, I just wanted to pause for a quick moment to say thank you so much for all the love and support that you're showing outside of session. If you haven't already, do me a huge favor and hit the subscribe button. Give me a five star review and share this podcast with all of your friends. Help me take this show to another level. Now back to today's episode.
00:27:52
Speaker
So let's talk about the treatment for OCD and how it's different from anxiety treatment. Like what do you want people to know about that? So it's important to find a provider that has had training with OCD and two of the big things to kind of look out for. So the gold standard, I guess, quote unquote,
00:28:15
Speaker
is exposure and response prevention, which is a type of cognitive behavioral therapy. The other one that's a little bit newer in the United States that I'm starting to learn about is ICBT. It's inference-based cognitive behavioral therapy. It's like a totally different way of kind of looking at OCD treatment
00:28:36
Speaker
And then acceptance and commitment therapy can kind of be added into exposure and response prevention, too. So those are kind of ones to keep an eye out for. But I was specifically trained in exposure and response prevention. So you can see a lot of kind of takes on it. But overall, exposure and response prevention looks at kind of what it says. So you create a fear hierarchy of the things that you have anxiety, fear,
00:29:05
Speaker
discussed all those kinds of things about in relation to your obsessions. And you start working from kind of the quote unquote easiest to the hardest and you expose yourself to these situations. So an example might be, you know, if you have a contamination obsession, you go and you touch doorknobs and you don't wash your hands and or use hand sanitizer and you sit with the anxiety around the uncertainty of having those germs on your hands.
00:29:35
Speaker
Exposure and response prevention looks at two things. So one of the things is habituation. So you expose yourself to something that provokes your anxiety and you sit with it and you realize eventually your anxiety has to go down. You can't be out of 10 with your anxiety forever and ever and ever.
00:29:54
Speaker
the inhibitory learning piece works with the idea that when you're exposed to something, the worst case scenario probably isn't going to happen. So, you know, going back to the door handle with the germs, you're probably not going to get sick from touching a door handle and not washing your hands. You may or may not, I mean, there's always uncertainty,
00:30:17
Speaker
Like things always happen. Like we can't predict the future and we can't control everything. So there's a piece of learning to sit with that uncertainty as well. So over the course of our work with ERP,
00:30:32
Speaker
we're exposing ourselves to these things and we're preventing any sort of compulsion. So not doing the mental rituals or compulsions, not avoiding and not doing any physical compulsions, which is super, super, super hard work. And that can be a really, really hard buy in for people, especially if they go the average of the 17 years without getting treated and they're
00:30:57
Speaker
feeling tortured by their thoughts. Like the last thing that they're wanting to do is probably say, you want me to go do all the things I've been trying to avoid for the last 17 years? So that's super hard and I get it. So how does that work in therapy? Because I mean, if the, if the compulsion is to use hand sanitizer in therapy, you just sit with it. And the thing that you want to do is not use the hand sanitizer, right?
00:31:25
Speaker
but what if it is a mental compulsion? Like how do you stop that? Like if your compulsion is to usually tell yourself, I'm okay, I'm okay, I'm okay. Like how do you work on stopping, stopping? You know? Yeah, yeah, that's a great question. So I use an exercise with my clients to kind of get a point across. And so what I'll typically do is I'll tell them, I want them to,
00:31:54
Speaker
not think about a yellow Jeep for 30 seconds. And so I'll put on a timer and we'll sit there. And after the 30 seconds, I'll say, well, how many times did you think about that yellow Jeep? And most of the time I get at least a couple of times. So the idea behind that is when you tell yourself not to think about something or not to do something, you try to push it away. It only comes back full force.
00:32:19
Speaker
So some of this is incorporating kind of some mindfulness practice, or at least that's what I use to kind of be able to watch those thoughts, but not attach to them and not let them kind of become part of you. And so sometimes it's, you know, back to your example of, you know, okay, doorknob, maybe I have hand sanitizer in my room, we sit and we
00:32:46
Speaker
think about, you know, the germs on our hands, and we try to amp up the anxiety. So back to your example, as far as the mental compulsions, it would kind of be more of just noticing those thoughts coming in and not attaching and giving them the attention that you normally would. And so that might also be, you know, we're not going to say, I'm okay three times, we're going to do something different. Or, you know, some other examples might be,
00:33:13
Speaker
we're going to sing something, you know, you're kind of trying to change stuff up in your brain. We're trying to break these just automatic thoughts and behaviors that we've created. So we can get kind of creative with that. But the biggest thing is we also don't want to push
00:33:31
Speaker
the anxious thoughts away because they'll come back with a vengeance. Right. Right. That's really interesting. And I like the mindfulness piece of it too, because then you can be mindful of, okay, telling myself I'm okay feels like it's present. Like I feel like I want to say that, but being able to be mindful to say because that usually soothes me and I'm trying to learn how to soothe myself in a different way. Is it kind of like that?
00:33:57
Speaker
a little bit, we don't necessarily want to soothe ourselves when we're doing ERP practice. If anything, we want the anxiety. And that's the perspective that we get people to say, it sounds crazy, right? Like, why would you say I want more anxiety or I want more fear? And you do because it allows you to
00:34:16
Speaker
Sit with it and realize and that's where the mindfulness piece comes into like you can notice anxiety from a distance and you can notice it without letting it just take a hold of you and let you spiral and that is another hard buy-in to be like oh my gosh because we're so used to you know anxiety especially if it causes physical sensations for you and
00:34:38
Speaker
that's really hard to sit with, which is also why we start on our fear hierarchy. We start on the least distressing part and we work our way up because you're kind of practicing sitting with more and more and more until you feel like, okay, I've got this. And usually I see clients that, especially their bottom fears or hierarchy topics, once they start doing them,
00:35:07
Speaker
It's like they're like, Oh my gosh, I've got this. Like that was kind of hard, but it's more that fear of before we start like, Oh, I can't do this. And, and, but they see that they can, which is, is really awesome. Yeah. Even if you have the best OCD therapist in the world, I think there's two other things to consider. Number one, and I'm sure this applies to you, you know, with your work with trauma and everything as well, like.
00:35:32
Speaker
A lot of stuff goes back to that therapist-client relationship. Do you connect with your therapist? Do you trust them? Because if you don't, you're not going to share half this stuff anyways and you're not going to trust them.
00:35:43
Speaker
to work with you in the way that they need to. And so that is so important. I mean, don't go one time and be like, oh, that's it. Your first time, it's hard. It's a stranger. But I think trying someone for a few times, if you're like, oh, this is just not a good fit, don't be afraid to go and find somebody who you do have that connection and rapport with. That is so important. And the other piece, I'm not a medical provider, but I will say,
00:36:11
Speaker
And I try to do things without encouraging clients to use medication. Like if we can do it without it, great. But I think especially something like OCD and it kind of being, they think with some brain structures and things like that, going to a psychiatrist and one that even works with OCD, getting on medication during treatment can be really helpful and can help us also move through. I mean, that's obviously an individual
00:36:40
Speaker
preference and whatever you and your providers decide. But that is another thing that I've seen to be helpful with clients. Yeah. So do you have any tips for anybody that might be listening today that maybe they are the person like you described that they've
00:36:57
Speaker
They've been in and out of therapy for 16 years and maybe some things have been helpful, but it hasn't really gotten to the root of the issue because maybe OCD had never even been mentioned before. And they're probably just feeling really discouraged like this is something that I have to live with forever, which again, like you said earlier, probably is leading to some
00:37:16
Speaker
Depressive symptoms right because like if you have told you if you've like resigned yourself to this is just Me and it's never gonna get any better like that would be super Discouraging and depressing right so do you have any like tips for those kind of listeners? To give them a little bit of hope and a little bit of direction for maybe how they can approach Trying again, but but doing something different Yeah, so
00:37:42
Speaker
OCD can be so defeating. And I think the problem with it too is it's not like something that you necessarily say, okay, well, if I do all these things and you know, I do them all this way, my OCD will go away and I'll never come back. A lot of times it's something that, you know, if somebody has been diagnosed with OCD, it's something that
00:38:01
Speaker
you know, may pop up, even though if they get it to a point where it's not really an issue anymore, it may pop up during really stressful times. You know, I may see it in my clients that have anxiety. When their anxiety goes up, a lot of times I'll see their OCD symptoms kind of go up. So I think normalizing that that is something that may happen. It doesn't mean that you're broken. It doesn't mean that there's something totally wrong with you. But if you work
00:38:26
Speaker
with a therapist who does ERP, you're also going to learn how to do this stuff outside of session and throughout your life where you can kind of say, Oh, my OCD, you know, I had a setback or a flare up and I'm going to do some ERP and get it back down to where it needs to be. Or, Oh, maybe I need to contact my provider and get back on medication. Um, you know, especially if you're someone that had OCD at some point in your life and you have a baby that, you know, you're at higher risk for kind of developing that postpartum. Um,
00:38:56
Speaker
But yeah, I mean, if you've been going along for 16, 17 years and you're like, Oh my gosh, I just, I'm definitely not where I want to be. Things haven't been going better. Like look at those different things. Like see what might be missing. Talk to your providers and say, Hey, you know, I'm not,
00:39:11
Speaker
okay with where I'm at, you know, maybe it's time for a provider switch, maybe it's time to try a different type of therapy. But there is hope. And you know, another
Support and Resources for OCD
00:39:21
Speaker
good resource for people to kind of check out, like, I don't think anyone should, you know, self diagnose for sure, you know, talk to someone, but something that has some good literature and things that might be helpful to look into is the IOCDF.
00:39:36
Speaker
dot org is the International OCD Foundation. They have all kinds of facts and explanations and there's a provider directory so you can look at somebody for somebody that's trained in ERP or ICBT through there. So that's always a great resource to kind of look into. I mean, you're thinking about so many different diagnoses I look at as a spectrum, right?
00:40:04
Speaker
And I think that's one of the, it's almost like a double-edged, TikTok is a double-edged sword. Because I think on one hand that there's a lot of different things that are, like there's just a lot more conversations about mental health, which I think is really helpful, but it's also a lot of misinformation as well. And so I think that people definitely want to relate. And so when somebody posts something about,
00:40:31
Speaker
narcissism or OCD or I've been seeing a lot about ADHD lately and just recorded an episode on that as well. But I think that people see a small part of themselves and they're not getting the full range of what the diagnoses actually entails, right? So what are your thoughts on people that have OCD symptoms?
00:40:56
Speaker
but maybe they aren't at the level of a clinical diagnoses and like probably some of your more severe clients that it's more debilitating, right? Like what would you suggest for people that maybe they're like right on the line? I think it depends on how much does it bother you and how much does it impact your day to day life? So if it's, you know,
00:41:22
Speaker
you're having trouble going to work or school or you know sleep is impacted you know kind of these big things like that's obviously something to talk to someone about but you know I think to a level there can be
00:41:38
Speaker
you know, some obsessive obsessions or compulsions that, you know, people are okay with, and they don't really cause dysfunction. And they're like, Okay, you know, it's doable, but maybe something to kind of keep an eye on and say, Okay, look, if this progresses, I'm going to reach out to someone. I mean, I'm, I'm always for being more proactive, like, don't let it get to your, you know,
00:41:59
Speaker
on the couch crying because you're so miserable. We can be proactive and it's a lot easier to do that versus you're suffering for years and years.
00:42:10
Speaker
So did that kind of answer your question? Yeah. I think that that's, that's a really good answer is it depends on how distressing it is because sometimes people see, um, online, these people that have like super organized kitchens and pantries and they're like, it drives me crazy. If it's not like this, that is very different. That just means you have good organizational skills and you like a clean house, but it doesn't mean that you're missing work.
00:42:39
Speaker
and can't get your other responsibilities done until everything is absolutely perfect, right? So I think it depends on how much it's causing emotional distress, like you were saying, like crying on the couch or impairing your functioning and being able to get your other responsibilities done, right?
00:42:57
Speaker
Yes. So the other thing, and I liked the example you used, like if you're organizing your kitchen pantry, like if someone pulled you away from that, like if you had to go do something else, number one, could you leave? Or if someone did pull you away, like what would happen? So somebody with true OCD, like
00:43:13
Speaker
if everything has to be, like there's an obsession around symmetry or, you know, something within that cabinet, like that person isn't going to be able to be dragged away from their pantry or if they are, they're not going to be able to do anything else because they're going to be so consumed by anxiety, fear, whatever about that pantry. And so I think that's where it kind of crosses it. Yes. Yes. So it's a whole different level. You know, I think those people that it's like, Oh, it drives me crazy to not have it organized. It's more like, no, you just really like to have,
00:43:44
Speaker
you know, organization in your home. And yeah, I mean, I got it. Like, it's stressful to have your house messy and chaotic and kids throwing toys everywhere. But you know, is it debilitating? I think that's where, you know, and like you said, that's where the spectrum falls. Like, okay, this person has some, you know, minor obsessions around their pantry stuff or the compulsory need to organize. But when does it cross that threshold? And a therapist might be able to kind of help you decipher, how bad is that? And that's
00:44:13
Speaker
you know, some of the things that we look at the Y box, the thing, the assessment tool that I use, it does kind of go into, you know, how many hours a day are you obsessing or engaging compulsions, like how we assess for all of that. So that's a really good gauge to which a therapist should be able to, to go through with you. And that's usually one of the first steps in treatment is to assess for all of that.
00:44:36
Speaker
Yeah, I like that a lot. So I posted on Instagram yesterday that we were going to be recording this episode today and just to see if anybody had any specific questions for you. And I had someone ask if you have a loved one that has OCD, how do you help them? If you see that they're having behaviors or thoughts and you know that they're kind of like going through that, like, how can you support a loved one? I guess is the biggest question.
00:45:07
Speaker
Yeah, that's a huge one, especially if you're living with family or your partner and if they're involved in your compulsions, which we see a lot. And the biggest thing, you know, usually my adults can kind of communicate that to their partner or family members. And I don't work as much with, you know, kids. I don't have as much with that, you know, as far as families, but usually they're included with that.
00:45:36
Speaker
but making sure they're not doing something called symptom accommodation. So, you know, if it's something like somebody wants something clean because of contamination with germs, they're giving them Clorox wipes or they're helping them wipe it down or they're reassuring them. So they're saying, Oh, did I turn that light off? Do you think I turned that light off? And the parent or the partner's going, Oh yeah, you did, or I saw I did, or they're letting them call them. So, you know, it may seem like,
00:46:05
Speaker
you're torturing your child or your partner or whoever more by not letting them ask for reassurance, but it's actually the opposite because each time you provide reassurance or you help with a compulsion or you feed into their obsessions, you're reinforcing that and it's keeping them stuck in that feedback loop. So once again, IOCDF has a good
00:46:31
Speaker
section on that for families that you could reference. But I think also, whoever the therapist, they might have specific things. And ERP requires a lot of outside homework, too. So something I might say to my clients is, we're going to work on this. And mom, dad, partner, whoever is not allowed to do X, Y, and Z.
00:46:53
Speaker
It's pretty common for people with OCD to have people in their life kind of looped into that and it's become the norm because who wants to see their loved one anxious and struggling? And if they see when they engage that it reduces their anxiety, like who wouldn't do that? So I mean, it totally makes sense. But that is one thing that I would say getting on board with that work.
00:47:17
Speaker
So if, if the advice is don't lean into it, don't offer that reassurance of yes, you turned off the light. Um, what's a good response instead? So that could range. That's very good. Strictly. I think, but it could range from, you know, I can't answer that too. It sounds like you're having an obsession to
00:47:43
Speaker
offering, you know, we'll sit without anxiety, you know, depending on how involved I think the person wants to be. And maybe that's a conversation you have with your loved one of how, how do you and the therapist want me to handle that? Like, what's the best way? Because, you know, some of these things could end up being compulsory, because if somebody has it in their mind, well, if they say this, then that means X, Y, and Z. And it doesn't even have to make sense. And so
00:48:11
Speaker
you know, going back to the therapist to rule out that anything would be kind of compulsory, um, is the best idea. But I think sometimes just, you know, I can't answer that or, you know, putting it back on their loved one, essentially. I like that a lot because you're not, you're not requiring yourself to offer tough love necessarily, but it's just a reminder of, um, I'm not going to, I'm not going to be a party that helps you lean further into your obsession.
00:48:42
Speaker
Right. Right. Like I don't, I don't want to be a part of your, of a cycle that I know is really, really painful for you. Yes, exactly. Because the ultimate goal is to go through a bit more suffering to get to the other side, to have less suffering and to be where you can get back to day to day things. And you're not asking for reassurance and your family also doesn't have to be a part of this anymore. So, um, yeah, it is.
00:49:09
Speaker
It is hard, but once everyone gets on board with that, it's helpful. Yeah, that's a hard boundary to hold, but knowing that the intention is still really good and it's bigger picture, right? I'm not gonna offer you at an immediate comfort because that's not actually a comfort really and truly it just seems like it is, but we're looking at bigger picture. I want you to not have to live with these thoughts anymore. Right, right.
00:49:39
Speaker
Is there anything else you want people to know about OCD? Anything else we didn't cover? The only last things I would say is OCD is totally treatable. You've just got to do some work and kind of find providers who have what you need, but some other good resources for those of you that maybe either aren't ready to start therapy or
00:50:06
Speaker
you know, finances or concern or you just don't have access for some reason or another. Like I keep mentioning, the IOCDF is a great website, but there is a therapist who has a podcast. She also has resources on her site, but her name is Kimberly Quinlan and her
00:50:27
Speaker
Podcast is the anxiety toolkit and she really goes into lots of stuff around anxiety, perfectionism, OCD. She has a lot of big names in the field of OCD on there that she's interviewed. That's a podcast that I feel like is even really helpful to have alongside of somebody going through treatment because
00:50:50
Speaker
at least a lot of my clients have kind of, you know, said that it's been helpful to have the validation that they're not alone, reminders of what they need to be doing because it's ongoing work. She's really awesome. She has a cool Australian accent. She's really cool. She also has a workbook. And
00:51:12
Speaker
It's on one of my blog posts. Let me look really quickly. It's the self compassion workbook for OCD. Lean into your fear, manage your emotions and focus on recovery by Kimberly Quinlan. Um, and she adds the mindful self compassion aspect into it, which I feel like is good. It kind of softens the ERP a little bit cause it can feel a little, um,
00:51:37
Speaker
rough around the edges. So I like that she uses that. So that's a good one. The other one that can be helpful but is a little bit more dry and maybe a little bit more clinical in nature is getting control overcoming your obsessions and compulsions by Leigh Behr. It's B A E R
00:52:02
Speaker
All these you can find on Amazon. Yeah, I'll make sure I link all of these in the show notes too so that people can go look them up. Okay, cool. And then the last one is, good moms have scary thoughts, a healing guide to the secret fears of new mothers by Karen Klyman. That's a good one for postpartum moms. I think it kind of normalizes all those scary intrusive thoughts that pop up after having a baby.
00:52:32
Speaker
some of the go to to look at just kind of self help type stuff. But ideally, you know, if you can work with a therapist trained, you know, it shouldn't take super, super long, not like years and years of therapy. And you could
00:52:49
Speaker
See some improvement and relief. I think it's totally worth it. Absolutely. Yeah. Thank you so much for all of that. One last question before we close the one that I asked all of my guests if if you could go back and tell your younger self one thing at this point in life.
Stephanie's Advice to Her Younger Self
00:53:05
Speaker
What would that be So that's such a hard question. If it's just one thing, but I, you know, I think
00:53:14
Speaker
Sunday around life is really hard and you may feel like giving up or running and hiding into a corner of a room, but you're strong and you can handle hard things just because life can be so hard sometimes. I think we all, you know, no matter what you're struggling with and it's just, but we're all capable of amazing things. And I think we underestimate our ability to think we can handle some things. So,
00:53:42
Speaker
Yeah, I love talking to women that have finally like found themselves and they know themselves so well. And we think back on, there's just no way to have that school, I think as a young adult or a teenager or adolescent, you know, like we come into the world not knowing ourselves at all and coming from a place of a lot of doubt most of the time. But getting to the other side of it to be able to say like, no, you got this, you're going to be just fine. I think that's such like a comfort to our younger parts.
00:54:11
Speaker
Yes, and it can be so hard to see though too in the middle of the hardest things like what I can't I can't feel this way or I can't do this. So I think having that sort of way when things are calmer to to reference back to and you know going I have done hard things and I can continue to do hard things. So yeah, which I think falls in line with
00:54:31
Speaker
people who have OCD, you know, anxiety, other things. Like it's hard work. Therapy is hard work, whether you're working on trauma or OCD. And sometimes things get worse before they get better because you are doing those hard things, but you can find healing on the other side, which is so powerful. Yeah, absolutely. Stephanie, thank you so much for being here today. I appreciate it so much. Thank you for having me. I've had a fun time. Yeah. Well, that's all we have for you guys today. I hope everyone has a good week and we will talk to you next time. Bye.
00:55:04
Speaker
Thanks for tuning in to this episode of Outside of Session. Remember, while I am a licensed therapist, this podcast is not a substitute for individual therapy. The contents of this episode are for educational and entertainment purposes only. If you are having a mental health emergency, please dial 911 for immediate assistance or dial 988 for the suicide and crisis lifeline.