December 20, 2023 • 51 mins
In this enlightening episode of the Heal Your Roots Podcast, we dive deep into the world of Obsessive-Compulsive Disorder (OCD) with the esteemed Dr. Katie Manganello, a Licensed Psychologist renowned for her expertise in OCD treatment. With a blend of personal insights and professional acumen, Dr. Manganello and our host, Kira Yakubov Ploshansky, unravel the complexities of OCD, offering a beacon of understanding and hope for those grappling with this often misunderstood condition.
Key Highlights of the Episode:
- Journey to Specialization in OCD Treatment:
Dr. Manganello shares her evolution as a psychologist, shaped by personal experiences and a heartfelt commitment to aid others. She reflects on her motivations in pursuing a doctoral degree, underlining the transformative power of advanced studies in psychology. - Demystifying OCD:
The discussion navigates through the intricacies of OCD, emphasizing the critical need to distinguish it from anxiety disorders for efficacious treatment. Dr. Manganello delineates the nuances of OCD symptoms, such as intrusive thoughts and compulsive behaviors, enhancing understanding for both therapists and those living with OCD. - Unpacking Misconceptions and Subtypes of OCD:
The episode illuminates various OCD manifestations, including fears related to contamination, harm, and social perception. A poignant segment discusses the distressing nature of intrusive thoughts related to pedophilia, distinguishing between ego-dystonic and ego-syntonic thoughts. - Innovative Treatment Approaches:
Focusing on Exposure and Response Prevention Therapy, Dr. Manganello and Kira explore this cutting-edge treatment, highlighting its efficacy in confronting and managing OCD symptoms. The conversation underscores the importance of therapist-client collaboration and the gradual escalation of exposure therapy. - Navigating OCD in Relationships:
An insightful discussion on how OCD can permeate relationships, with practical strategies for involving partners and family members in the therapeutic journey. The episode stresses the value of empathy and understanding in responding to compulsive behaviors within relationships. - Challenges in OCD Diagnosis and Treatment:
Dr. Manganello addresses the hurdles in accurately diagnosing and treating OCD, advocating for increased awareness and education among clinicians. The role of the International OCD Foundation as a vital resource is spotlighted, offering support and guidance for both individuals with OCD and therapists.
The episode wraps up with the exciting announcement of Dr. Katie Manganello joining Heal Your Roots Wellness, where she will be available for sessions. This episode is a must-listen for anyone seeking a deeper understanding of OCD and its impacts, or for those on their own journey of mental health exploration and healing.
Tune in to this episode: For an enlightening exploration of OCD, its treatment, and the personal journeys of those dedicated to making a difference in the field of mental health. This episode promises to be a valuable resource for both mental health professionals and those affected by OCD.
Check out the rest of the Heal Your Roots Podcast episodes at our website.
Learn more about Heal Your Roots Wellness
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Welcome back to Heal Your RootsPodcast. On today's episode, we
have Dr. Katie Mangan lol alicensed psychologist and expert
in obsessive compulsivedisorder. In this episode, Katie
shares her insights andapproaches and evidence based
treatment plans for helpingthose struggling with OCD.
Katie, thank you so much forjoining us for today.
(00:20):
Hi, thanks so much for havingme. I'm so excited. Absolutely.
So we usually just dive rightinto learn more about the
therapist before we learn aboutyour expertise and specialty. So
can you share a little bit aboutyour origin story of how you
became a therapist? And kind ofwhat inspired you to do that?
Sure. Yeah. So you know, Ialways found psychology to be
(00:45):
interesting, I think like mostpeople typically do, you know,
when you're in high school, andyou're taking all the different
classes, thinking about what youwant to do in college. And so
you know, I'm just somebodywho's a natural problem solver,
I like to be helpful and findsolutions to things. And I too,
can relate to some of the issuesthat my clients experience in
(01:07):
several people in my life thatare important to me, the
struggle at some point in theirlife with a lot of things. So in
having, you know, my ownrelations to some of these
issues, as well as other peoplethat are important to me. I was
interested in, you know,pursuing a career where I could
move forward with doing that forpeople.
(01:28):
Yeah, I feel like therapistsalways have some kind of link or
thread, whether it's personalwithin themselves or a family
member, that makes us feel like,oh, I want to learn more about
this or like, become someone whohelps other people through the
same issues, for sure. And socan you share a little bit about
your journey of becoming alicensed psychologist?
(01:50):
Yes. So it's been a longjourney. So I went to I'm
originally from the Harrisburgarea in Pennsylvania. And then I
moved to Redding, Pennsylvania,where I went to undergrad at
Alvernia. University. So Istudied psychology and my major
and I minored in philosophywhile I was there. Yeah. Which
(02:12):
was really fun. Yes. Yeah, Iknow, I wish I had more time and
the ability to dig into thatstuff a little bit more. But
with this journey, I only had somuch time for that. So. So then
I applied to grad school, and Igot my masters first. And so
then I moved to Philadelphia, Igot my masters from the
(02:34):
Philadelphia College ofOsteopathic Medicine. And so I
got that degree in mental healthcounseling. And then I also went
to pee calm PCOS for my doctorof clinical psychology. So
that's the short version.
Journey was like, I've been allover Pennsylvania, getting a lot
of education around psychology.
(02:57):
So within that time, I've done alot of different kinds of
trainings. I mean, at somepoint, I've worked in pretty
much every kind of mental healthsetting. I've had experience in
partial hospitalization centersI've had experienced in
intensive outpatient,residential, typical inpatient,
veterans, hospitals, privatepractice. So I've seen kind of
(03:23):
the spectrum of how mentalhealth can show up in different
settings. So yeah,wow. So that's a wide range.
That's a lot of differentsettings and perspectives to get
and how people get help, andthey're treated. It's
incredible. Yeah, what what madeyou want to be a licensed
psychologist versus like alicensed therapist? Like, what
(03:43):
was that kind of thought processto go the next step to become a
doctor?
Yeah. Well, and that's a goodquestion, because that's
something I definitely struggledwith along this journey.
Because, yeah, why? Why do youwant to go for a lesson? So I
think, another part of that too,is I'm just so curious. And I
(04:06):
always feel like if I can go theextra mile, like, why not and
just learn the next thing that Ican. And I'm so glad that I did.
I mean, there was a point whereI was in my master's program,
and I was like, this a lot,like, do I like to go the next,
you know, next step up, and Iapplied to my school because I
(04:26):
was like, you know, what, if Iget in here, then it's just,
it's meant to me and then I did.
And I was like, Alright, we'regonna go with and I'm really,
really so glad that I did.
Because looking back at where Iwas, skill set wise, as well as
just my age and where I was as aperson. At that point, I think
(04:48):
that I would have really donejust myself a disservice if I
stopped there. So I'm glad thatI kept going because I have
learned so much more and becomejust so much more confident and
I'm more I think just who I amas my own professional self in
going through the doctoralprogram. So, you know, there's
(05:08):
been some weighing of the upsand downs and pros and cons of
it. But yeah, that's kind ofultimately what, what led me
there.
That's awesome. I rememberhaving the same thoughts. I'm
like, When is this gonna beover? It's such a long process,
but it is definitely worth itonce you're on the other side
and the other hump of it. It'slike, all right, like, I guess
it was worth it.
(05:30):
Right, yeah. And I mean, if Ican provide all of the skills
that I can learn, I'd ratherjust have it all in my toolkit
and be able to work with all ofthe things and for me, too, it
was a matter of if I stop, I'mprobably not going to ever go
back. So I just kept pushingthrough and going, going going
and didn't take any breaks. Andnow here we are, and it's over.
(05:53):
And that's great self awareness,right to know that about
yourself.
Yeah, you definitely need theself awareness and going through
this.
Absolutely. And so since you'vebeen through all these different
settings, you've gone throughthat program. What is kind of
like your focus and specialtynow that you work with clients?
Yes. So right now my specialtyis working with obsessive
(06:18):
compulsive disorder and otherrelated anxiety disorders.
That's the majority of thepopulation that I work with, I
initially came into the fieldthinking that I wanted to work
with SMI, like serious mentalillness, that would include
things from, you know, likeschizophrenia, bipolar disorder,
(06:38):
certain personality disorders,actually, OCD can even be
considered SMI, depending on theseverity of it. But so that's
kind of what I came in thinkingI was going to do. And I had
experience in working with thatpopulation. And actually, I do
love working with thatpopulation. Like that's still
important to me. I guess thereason that I kind of ended up
(07:00):
going towards OCD was because Ididn't really know anything
about OCD. But I was in an smiclass in grad school, and I was
trying to figure out what one ofmy next training rotations was
going to be. And one of myteachers suggested, well, have
you ever thought about doing anykind of rotation with OCD? And I
(07:21):
was like, Well, no, I haven'tbecause I don't really know
anything about it. Besides whatwe learned in the basic intro
psychopathology class. So I waslike, alright, well, let's just
see what it's all about. And thereason she brought it up is
because there can be so muchoverlap with OCD presentation,
as well as psychotic relateddisorders. So that that kind of
(07:43):
got me curious, I got into it.
And that's also the OCDpopulation. Unfortunately,
clinicians don't know enoughabout it. But ultimately, they
usually find themselves in aprivate practice setting because
it is like a specialty area.
Whereas working withschizophrenia, bipolar, you
(08:06):
know, other versions of SMI, youdon't necessarily see that as a
presenting problem in a privatepractice setting. Now, that
doesn't mean you aren't evergoing to see anybody with those
presenting issues. But usually,if they are presenting with
those issues, they are in ahigher level of care to start.
(08:28):
And then if they want to work onthings, after those types of
things are managed, then theymay end up coming to a private
practice setting. And OCD cancertainly present itself in a
way like I said, that can youknow, clinicians can be unsure
what it is. And they might thinkthat it's a psychotic related
disorder or something moresevere, and they are in the
(08:48):
hospital or they are in a higherlevel of care. And then they end
up getting kind of referred intothese more specialty practice is
so interesting. Okay. Yeah, Ididn't know see, like I only
also had the intro to pathologyin grad school, and didn't know
much past that. Like, I feellike I might be able to identify
and then be able to refer outwhat I wouldn't be able to, like
(09:10):
have that specialized treatmentplan or knowledge to help
somebody through that because itis very different than just, I
don't want to say just anxietyto diminish that but an anxiety
disorder outside of OCD.
Mm hmm. For sure.
And so for listeners who maybehave some misconceptions about
OCD, would you be able to sharea little bit about like, what
(09:34):
that means and like how youwould really diagnose somebody
with that versus someone whomight have some traits or
tendencies or sometimes peopleuse it kind of just throw it
around when it's not actuallywhat's going on. Yes,
so this is something that I amsuper passionate about, not only
just kind of explaining this to,you know, anybody who comes
(09:56):
across OCD, but also really Ifind it to be so so Important
for clinicians to understandthis because even if we can get
people to a point where they canat least recognize it and then
refer out then that's great. Buta lot of times people think that
OCD is just regular anxiety. Andthen clinicians are responding
to the OCD in a way that isactually majorly making the OCD
(10:19):
a lot worse. So, some things toconsider. So why don't I just
kind of like ask you this, ifyou're comfortable? So when you
think of OCD, what do you thinkof like, what kind of
presentation are youenvisioning?
So I'm thinking of obsessionsand compulsions? Right? Like
there is a lot of thoughtprocess in like spiraling and
(10:39):
then compulsions, like abehavior attached with it that
is like continuously going on.
And if they don't do thisparticular behavior, then that
kind of creates more anxiety,and more stress within them. Mm
hmm. Yes. And so that's, that'sright. And when you think like,
what are some of thosebehaviors? Like, what does it
(11:01):
usually kind of look like whensomebody has OCD? Like, what do
you kind of think of?
I mean, like, the stereotypicalis kind of around like germs or
having to check somethingmultiple times in a row, right?
Like a very obvious behavior. Iknow sometimes I've had clients
who, and I wanted to talk tothis about just pure Oh, or just
(11:21):
like obsessions, or justcompulsions, like one or the
other, like, even having tosearch something a million
times. Like there's a repetitivenature to it. But I think the
stereotypically is likerepeating something over and
over to make themselves feel alittle bit more at ease. Yes,
exactly. So the Yes, usuallypeople think it's hand washing,
(11:44):
it's checking things over andover again, it's perfectionism
being organized, that kind ofthing, which is all true. Those
all can fall under the OCDumbrella. However, that is about
this much of it when there'slike this much of it going on.
So to give some background likelet's get specific, so OCD is
(12:05):
defined in our diagnosticmanual. The DSM five is it's so
it's broken up into two pieces.
It's the obsessions, like yousaid, and then it's compulsions.
So obsessions are defined asrecurrent and persistent
thoughts or urges or images thatare experienced that sometime
during the disturbance asintrusive and unwanted, which is
(12:27):
really important, and that inmost individuals cause marked
anxiety or distress. Also, underthe obsessive criteria, the
individual attempts to ignore orsuppress the thoughts, urges or
images, or to neutralize themwith some other thought or some
other kind of action, whichleads into the compulsive part.
(12:48):
So compulsions are defined asrepetitive behaviors or mental
acts that the individual feelsdriven to perform in response to
an obsession or according to therules that must be applied
rigidly. The behaviors or mentalacts are aimed at preventing or
reducing anxiety or distress, orpreventing some dreaded event or
(13:10):
situation. However, thesebehaviors or mental acts are not
connected in a realistic waywith what they're designed to
neutralize or prevent or areclearly excessive. Now, those
are, you know, that's ourdefinition that we get from the
DSM. The way that I like to kindof think of it is, and I draw
(13:32):
this picture for pretty mucheverybody that I talked to about
this. So we want to kind ofthink of it as here's our bell
curve. And we're going to use asuds scale, which is Su D S, it
stands for subjective unit ofdistress scale, you're probably
familiar. So here's our zero.
(13:56):
Here's our 100. Do you see that?
Okay.
Yeah.
Okay. So, basically, anobsession is the fear that
you're experiencing. So that'sthe, you know, the thing that
you're trying to really get ridof. So usually something
triggers the fear, which bringsthe anxiety up. So here's our
(14:19):
trigger, the anxiety goes up.
You're freaking out, right?
You're really worrying and whatdo you so let's use an example.
Okay. Now, a phobia is a littlebit different from OCD, but this
will be a good example to kindof use so let's say that you
have a dog phobia, because Iknow you don't have one more
(14:43):
time do you do Okay, sure. So,Toby, all right, and let's say
envision yourself walking downthe street down the sidewalk,
and up comes somebody with aGerman Shepherd they're walking
with okay. And you start to feelreally nervous. What do you do?
How do you want to handle thatsituation?
I mean, me personally, I wouldprobably freeze first. And then
(15:08):
maybe cross the street, go tothe other side and continue
walking, like get as far away aspossible and keep going.
Exactly.
So you are going to do somethingto try to make that anxiety go
away, which could be that, youknow, the flight, fright freeze
kind of situation. So, in thatsituation, you kind of said
(15:28):
like, the freeze first and thenprobably like, flight, runaway
kind of thing. And that's whatmost people will say. So here's
our interaction with the dog,the anxiety goes up, we start
thinking, Oh, my gosh, what canI do to make this anxiety go
down, I'm going to cross thestreet. And when I crossed the
street, that was a littleuneven, the anxiety goes down.
(15:52):
And when it goes down, we'relike, all right, I'm good. Keep
walking, everything's fine.
Except for what happens in thatmoment is you have now trained
your brain to think thatwhatever this trigger was, is
actually a dangerous situation.
And there's always a level ofuncertainty to it, it could have
been a dangerous situation. Butthat's what OCD does, it clings
(16:14):
to any level of uncertainty thatit possibly can. So basically,
you just taught your brain,Alright, that was bad, because
as soon as I escaped it, I feltimmediately better. And what
happens with that is, the morewe do those things, the more we
avoid it, the more we engage inany kind of compulsion, that is
(16:34):
what snowballs it and feeds itand it becomes bigger and bigger
and bigger. So again, obsessionis that fear, the compulsion is
pretty much anything you aredoing to make it go down. That
could be avoidance, that couldbe reassurance seeking, that
could be really anything, again,that's going to try to alleviate
(16:55):
that fear associated with theobsession. So whereas you think
maybe it's harmless, that youcross the street, but the more
it's happening, now, maybeyou're not going on your walks
anymore in the morning, becauseyou know, that person walks with
their job. Or maybe youpurposely are like, let's go 20
minutes later, instead of, youknow, the same time, which could
(17:18):
then make you late for work, andthen it's impacting your life,
right? And then it could turninto, Oh, my friend invited me
over and they just got a newpuppy. And I am not going to go
to the party with my friendsanymore, because I'm avoiding
the dog. So you get the gist. Imean, it can start out small,
but gradually, it really kind ofgrows and grows and grows. So
(17:40):
now, I'm like, what was yourinitial question? Because we
were talking about likemisconceptions out there, right.
Yeah, finding what OCD is. Yeah.
So what, what some of themisconceptions are around this
is that, like we said, it'susually like, around germs, or
like having things lined upperfectly, which those themes
(18:02):
certainly exist, but there's alot of different subtypes that
fall under the OCD umbrella. So,most commonly, there's the
perfectionistic obsessions thatpeople know about.
contamination, contamination isone of the big OCD fears that
everybody knows about. So theway that a contamination fear
could kind of show up is thecore fear might be something
(18:25):
like, I'm afraid that I willdie. And so the way that that's
manifesting is that I am afraidto get sick, meaning there's the
contamination, if I get sick, Icould potentially die. So what
I'm going to do to try tocontrol that or alleviate that
is, anytime I touch somethingwith germs on it, I need to go
(18:47):
wash my hands. Now, that's alsojust one example. contamination
can manifest in a lot ofdifferent ways. But that's just,
you know, a kind of a broadexample for people to
understand. So those are theobvious ones, but less obvious
ones are obsession, they can bekind of taboo. So some of them
can be related to harm, danger,loss, embarrassment, sexual
(19:11):
obsessions, sexual obsessions,around children, religious
obsessions, the superstitious ormagical obsessions. I think
sometimes people hear of that,like the, you know, can't step
on a crack break your mom's backin the day. And like helping
body focused obsessions so thatcan look like a lot of different
(19:34):
things. I think the mostimportant thing in in being able
to assess for OCD and for peopleto understand differences
between just being like handwashing or you know, whatever it
might be, is that OCD is egodistant onic which means it's
not in line with your values. Ifit If something is ego syntonic,
(19:59):
that means it is in line withyour values. So let's say that
somebody loves children andlike, they really want to be a
mom, or they, you know, theyreally enjoy being a nanny or
any of those kinds of things,right? Like they, they really
value being able to spend timewith kids and nurturing and that
kind of thing. Yeah. Now what'sreally unfortunate is this could
(20:21):
manifest in, you know, havingfears around, like, how to feel
like OCD. So that could besomething where it's like, okay,
I go to the park, and I'mhanging out, I see kids running
around, and an intrusive thoughtpops in my head. Now, everybody
has intrusive thoughts. Prettymuch everybody has intrusive
(20:45):
thoughts, right? The differencebetween somebody who has an
intrusive thought with OCD isthat they cling to it, and then
it starts to spiral. Whereastypically, somebody might have
the thought, Oh, look at thatkid, like, they're really cute,
and then be like, That wasweird. Like, that'd be weird for
me to like, take that thoughtany farther. And then they just
(21:05):
kind of shake it off and movewith it. But somebody with OCD
might be like, Oh my gosh, thatwas weird of me. Why did I even
have that thought? Like, am I apervert, maybe I should stay
away from kids. And then it cankind of spiral right then maybe
they're avoiding going to parks,maybe they lose their job
nannying, because they'reavoiding going to work, you
know, any of these kinds ofthings, because they are afraid
(21:27):
of that happening. So the bigdifference between this and
being an actual person who'sdiagnosed with a pedophilic
disorder is that egodisenchanted versus ego
syntonic. So somebody who isdiagnosed with a pedophilic
disorder is like, actuallyaroused by children, and they
will act on that kind of urge.
(21:49):
Whereas the OCD is, I'm havingthe thoughts and I'm scared in
the last thing I want is forthis to happen, but they're so
afraid that it could potentiallyhappen that they might lose
control and do something sounthinkable to that.
So I'm hearing the difference isnot that they're fully going
through it, but they're scaredif they allowed themselves to
(22:10):
that that might be something andthat they're like, scared Oh,
could develop into that. So nowthey're obsessed around having a
thought that they could becomethat versus actually having
that,that yeah, rather than actually
engaging in behaviors of likecatching children or doing
anything that's actually likeinappropriate and leading to
legal ramifications, or anactual diagnosis of a pedophilic
(22:32):
disorder.
Okay, so for example, right?
Like, I'm just thinking, like,sometimes when I'm driving,
right, like a random thought inmy head might pop up, like, Oh,
my God, like, what if I likerammed into the car in front of
me. And something horrible wouldhappen? What would be like, a
version of like, that thresholdof OCD then versus like, Oh,
(22:54):
that's horrible. I don't want tothink about this. And then just
like change the station on theradio, and just try to like,
move on with my life.
Right. So that would be probablyrelated to a harm subtype. And I
actually have worked with peopleto the point where this has
gotten so bad that we call itactually hit and run OCD, where
(23:16):
people are afraid that theyeither are going to like,
wrecked their car wreck intosomebody, or that they might hit
a pedestrian or something likethat. So I've met people where
instead of just like, oh, that'suncomfortable to think about,
let me distract myself and carryon. It could manifest in a way
where they are constantlychecking their rearview mirrors,
(23:38):
you know, making sure that theyhave specific like safety
behaviors, whereas it's like,well, I need to make sure that I
have the music on loud enoughthat I am always distracted.
Whereas like, when somebody hasan insurance on, they're like,
Oh, that's weird, shake it off,listen to some music, and then
your brain starts thinking ofother things. That's a more
typical kind of way that peoplethink about things when random,
(24:00):
intrusive thoughts come up. Ifsomebody also has OCD around
this, they might avoid drivingin general, they might just not
drive any more. I know with somepeople that they it OCD really
likes to claim to control right,that's all about those
compulsions trying to controlsituations. So sometimes it
(24:20):
might be well, I don't want tobe in a car as a passenger
because I don't have controlover the driving. Or maybe they
would rather only be a passengerbecause they don't want that
control of being the person whohid it. So again, that's why we
really always have to do athorough assessment because we
want to really understand thefunction of the behavior. We
(24:43):
always want to really understandthat core underlying fear that
it's related to.
So what would be differentbecause you know, I've have have
a lot of clients who come in foranxiety around like attachment
like anxious attachments, andthey might Do kind of repetitive
behaviors around dating, right?
Like, let's say if they broke upwith somebody they get obsessed
(25:05):
with, like looking at theirInstagram stories or like
looking at certain things. Andit always like confuses me in a
way where it's like almost liketorturing themselves. Like, if
they want to feel better, theywould stop looking at it, but
instead they obsess, knowingthat it's going to create more
distress for them. How wouldthat be like considered towards
(25:25):
that? Or is that more of justlike, anxious thoughts and like
anxiety? Sothere is a fine line, I would
say between sometimes therebeing because really, pretty
much. I'm hesitant to I'mhesitant to say that all anxiety
disorders engage in some form ofcompulsions, but most of them
(25:47):
are doing something to try toalleviate it. compulsions just
tend to kind of like manifestmore intensely and show up more.
Which brings me to your questionabout like the pure Oh, that's
like a whole other topic. Butcompulsions can even be mental
like as explaining, like mentalacts, that could be reviewing
memories, like, you know, goingback and thinking of, you know,
(26:08):
did I do this? Did I do that?
These kinds of things, thedifference is that the
compulsions should take around,and more often do take more than
like an hour each day andcausing significant distress,
impairing their functioning. Sowhat you're explaining, with the
(26:30):
example with relationships, thatin the end, that anxious
attachment, that can certainlybe caused as a part of the
issues with attachment. Right?
OCD doesn't just appear out ofnowhere, something that is
related to it. And that can kindof like, bring them to that
being their obsession or thatcore fear. But yeah, I mean, the
(26:54):
thing is, is, they probably knowthat is going to cause more
distress. But when you're havingthat part of your brain
activated, you're no longerthinking logically, you can not
out logic, OCD, which is why wehave to do exposures in exposure
and response prevention istreatment versus just like, a
typical cognitive restructuringof like, you know, that doesn't
(27:18):
make sense, right? Becausepeople will be like, yeah, no, I
get it. But it doesn't matter.
Because when I'm in thatheadspace, that's what I need to
do. And the reason they're doingis because they are getting some
sense of like relief in thecompulsion, because remember our
picture here, right? It isbringing it down a little bit,
because maybe if they'rechecking in, they're seeing,
(27:40):
okay, that person didn't go on adate this week. Okay, sounds
like that's good. But thenthey're like, but I need to keep
making sure that that's, youknow, yeah, yeah, it can be
really, really painful forpeople. It's really it can be
very distressing.
Yeah. No, I appreciate you goingthrough these like very specific
examples, I think this will bereally helpful for listeners to
(28:01):
like differentiate as well. Andso since you mentioned some of
the approaches or treatments,can you elaborate a little bit
more of like, what does helplike, what does work with
clients who are struggling withOCD versus like cognitive
behavioral therapy for strictlyanxiety? And like different
approaches that you use when youwork with people? Yes.
(28:23):
So the, you know, our goldstandard evidence based
treatment for OCD is exposureand response prevention. So we
call it ERP. So the reason thatwe are doing ERP versus a more
basic version of CBT, isessentially, it has more of a
(28:47):
behavioral approach to it, notto say that there's no cognitive
interventions, but it's mostlybehavioral. And some of that is
because with the cognitiveinterventions with OCD, your
brain can just, you know, like,talk yourself out of anything.
It doesn't you're, you know, itcan even get to a point where if
you're doing cognitiverestructuring, and in looking
(29:09):
for evidence for and against,like, even that can turn it into
a ritual or a compulsion. So,it's better to just allow those
thoughts to exist and carry onand do our exposures. But so the
reason I say a more basic kindof CBT is because exposure and
response prevention is stillcognitive behavior therapy. It's
(29:30):
just the cognitive behaviortherapy is so broad, it's
another one of these umbrellasand then under that we have like
sub therapies or third wavetreatments. So, so ERP kind of
falls under the cognitivebehavioral umbrella. So the way
that ERP is set up is exposuretargets, the obsessions, and the
(29:53):
compulsions are targeted withthe response prevention. So
essentially what we would do intreatment is As we do, again, a
thorough assessment of what arethe subtypes? How are they
showing up? What's the functionof the behavior? What are the
core fears. And then with that,we make our treatment plan,
which is essentially ourhierarchy, which is going to
(30:14):
list several exposure ideas,things that we would do to kind
of target the fears. And then wewould also have Response
Prevention items as well. Sowhat that might look like is,
let's bring it back to our dogphobia. Okay. So the reason we
(30:35):
do exposures is not necessarilyto torture people. But what it
is meant to do is that we wantto purposely bring that anxiety
up and sit with it withoutengaging in any kind of
compulsions or safety behaviors,because what's going to happen
is we will eventually habituateto it. That is how we're kind of
(30:57):
re programming your brain. So ifyou allow it to exist, and not
fight and not do anything, itwill eventually come down. But
it can be really distressing.
Yes, yes, on its own. And that'swhat's hard for people to sit
with. Because when you're inthat feeling, it feels like it's
not ever going to go go away,and you need to do anything you
(31:17):
can to escape it. But once youkind of learn that, it's a
feeling I'm working through, andI'm gonna allow it to just kind
of exist, it'll kind of go downon its own. And that's a double
process. Because as that'shappening, you are building your
distress tolerance skills.
You're learning to sit withthings that are uncomfortable.
So that's the point of theexposures are response
(31:39):
prevention. So an exposure forour dog situation could be, I'm
going to watch videos of dogs,I'm going to watch videos of
people getting bit by dogs, orI'm going to then go pet my dog
or my friends puppy at theirhouse. It can even just be like
listening to a dog barking, itall depends. And it's all very
(32:00):
individualized on the person's,again, our suds scale. So I
might say, how sudsy does itfeel for you to go pet your
friend's puppy? And they mightsay on a zero to 100 scale?
Well, that's about a 50. Okay,well, how much would it be if
you were watching a video ofdogs running around in a field?
Oh, that's like only a 20. Okay,so we might start out lower, and
(32:23):
then kind of build our ourselvesup to it, we don't ever want to
just immediately throw them intoit. I mean, it's a, it exists,
it's called flooding, right? Butthat is not necessarily the
approach that we're using. Ialways take the approach of
being collaborative, like, theclient is the expert on them,
(32:44):
and I am the expert on thetreatment, we have to work
together. And I'm never going toforce somebody to do something
they don't want to do. It's yourgoals, we're going to do what
you're willing to do. And wewant the exposures to be a
stress not a strain. So itshould be hard, should be
difficult, but not to the pointwhere you cannot handle it,
because then you're never gonnago back and do it again.
(33:06):
Yeah, we don't want to go into apanic state, it's more of just
like, a safe discomfort.
Well, you know, what in thething is, is that they can
panic. I think that's anotherthing is people are like, I
can't let that happen. We canbecause we know that a panic
attack is incrediblyuncomfortable. Okay. My goal is
(33:28):
never to be like, let's send youinto a panic attack, unless we
are maybe doing panic treatment,which is a whole different
story. But the goal is to justkind of like, bring up the
discomfort and teach them like,whatever is going to show up
like I can handle it, I can sitwith it. So where it is, it's
not necessarily my goal to havea panic attack, we have to
remember that there'suncertainty. And if it happens,
(33:51):
like okay, we sit with it, wedeal with it, you know. So, so
yeah, so that's our exposureexample, a response prevention
example could be. So again,that's taking away our
compulsions. So if you areavoiding by walking on the other
side of the sidewalk, theexample could be okay, I'm then
(34:14):
going to take that away. And I'mgoing to still just go to work
the same time, as I usuallywould. So with the response
prevention example. Basically,you're going to want to cut out
any of the kind of compulsionsthat you're doing. So with the
dog thing you would want toleave for work the same time as
you normally would, instead ofbeing like, let me wait 20
(34:36):
minutes kind of thing. Or ifit's a hand washing, let's say
somebody feels like they need towash their hands five times. Or
they need to use five pumps ofsoap, we would say, All right,
let's cut it back to two pumpsof soap or like two times we
wash our hands and thengradually kind of bring it down
from there. Andso how do you find clients? Are
they receptive to this or doesit ever like make them feel
(34:57):
uncomfortable hearing that Partof the treatment is going to be
the exposure or the response tothings that obviously make them
very uncomfortable.
Yes, I mean, people definitelycan be very afraid to do this
kind of treatment. This is atreatment that requires a
certain level of motivation. Imean, we, we really, there's
(35:19):
some things we do to kind ofprepare people for it. So part
of it is assessing formotivation. Where are you at?
Like, what are you willing todo? And really building up your
reasons for why, why do you wantto do this. And let's remember
that when we're doing theseexposures, when they're
uncomfortable, Oh, you want todo it, because you no longer are
going to work, you got fired,your relationship with your
(35:42):
partner is, you know, reallygoing downhill, you no longer
are spending time with yourfamily, you're secluding
yourself to your house 24/7You're depressed, you know,
like, these are the reasons wewant to do this kind of
treatment. So motivation isimportant. But another thing I
tried to do is kind of explainto them what I had just told you
(36:03):
is that I try to meet peoplewhere they're at, I'm never
going to force them to dosomething they don't want to do.
I might like, you know, push alittle and be like, oh, let's
like kind of do this right. Butlike, ultimately, like, Yeah,
I'm not going to force anybodyto do anything that they don't
want to do. We start out lower,we're always agreeing on the
(36:24):
exposures that we're doing. Andagain, it's not like throwing
you in the deep end, it's like,let's stick our foot in the cold
water. And we kind of buildourself up from there. So I
always try to make that reallyapparent, and really reinforced
that it is a collaborativeprocess.
Sure. So there's comfort inknowing that they still have
(36:44):
that level of control. Right,knowing that like, this is
something that both of you areagreeing on. If this feels too
extreme, we can go down to alower level work through that
until we can feel ready to go tothe next level and continue on
because because it's sonegatively impacting their life.
This is it's worth it right,like putting in the work so that
they can have a higher qualityof life as they work through
(37:07):
these levels. Yes. And so Iknow, at least when we talked
separately, you mentioned likebringing in other people into
session sometimes whether that'sa partner or a family member to
kind of help support thatprocess. Can you share, like
what that kind of looks like inthe in the treatment?
Yes, so it totally depends onagain, this is so
(37:28):
individualized, it depends onwho we're bringing in and why a
lot of times we're bringing in,well, this is more so with
children, but with children,we're bringing in their parents,
because they're almost alwaysaccommodating their behaviors.
So we are doing a lot of familywork if it's with a child who
has OCD. Let's say I liked yourexample you gave of like the
(37:49):
anxious attachment and in likelooking through Instagram, let's
say somebody's coming in, andthey actually have like a
relationship OCD kind of thing.
That could look like Oh, I'mafraid I'm gonna cheat on them,
or oh, I'm afraid they're gonnacheat on me. I think a lot of
times, I mean, it can be either.
Usually, if it's the one whereit's like, Oh, I'm gonna cheat
on them. It might be morerelated to scrupulosity like I'm
(38:12):
a bad person kind of thing.
Whereas I think that otherrelationship OCD, right? How it
can kind of manifest and I'mafraid they're gonna cheat on me
kind of thing. Or they'll dosomething wrong in the
relationship, or Oh, my gosh, Ijust committed my whole life to
being with this person. What ifit doesn't work out? Right, that
uncertainty, so that wouldreally impact your relationship
(38:33):
with your partner? If you'reconstantly like, oh, my gosh, I
went to work, what if theyhooked up with their co worker
or something like that? So itmight show up of them texting
their partner all the timechecking their location on their
phone? You know, asking forreassurance like what you do at
work? Did you hook up with thatperson? Did you talk to them?
(38:54):
Give me a list of all your coworkers. And now I'm gonna stalk
them on Facebook, like any ofthese guys, when I say stock,
not necessarily actually stalkthem. But look them up, learn
information about them,whatever. So really, if that's
the case, it's probablyimpacting their relationship, we
would bring the partner in andexplain to them how the
(39:17):
treatment works, and explain tothem that they're actually
engaging in the compulsion withthat person, if they are
consistently like, here's mylocation, no, I'm not doing
this. No, I'm not doing that,you know. So we might have them
say, okay, instead of givingthem like 20, different forms of
reassurance. And again, wewouldn't be buying from the
(39:38):
actual client on this. They needto be willing to do it as well.
But if if everybody isunderstanding of what we're
doing and why it's likely goingto be okay, partner, instead of
sharing your location, let'sremove that. And if they say, oh
my gosh, will you give it backto me? Like I only agreed that
because that was the partnermight say something, we want
(40:04):
them to kind of respond withempathy because this is a huge
struggle. And you we always wantto keep empathy in mind because
sometimes this treatment reallycan come across as like,
torturous if it's not done in acompassionate way. So they say
something along the lines of Iunderstand you're really
(40:24):
struggling with this right now.
Like, I'm sorry, we agreed thatI'm not going to give you my
location. That's it. I'm notgiving it to you. Whereas they
might be tempted to do it.
Otherwise, to kind of show themokay. Yeah, like, this is what
I'm doing. Or they might say,you know, did you get lunch with
(40:44):
that coworker today? You theycould respond with, again, like
some empathy, but also,depending on the person, even
some humor and like someuncertainty statements, like, I
guess you'll just have to guessand think about if I did or not
like, I don't know, maybe theydid. Maybe I did it. Oh, gosh.
And again, these things can thatcould be a more sudsy type of
(41:07):
response. Yeah. Yeah, totallyjust depends on where the person
is at with things. But yeah,that's an example of how it can
show up with them, you know, ina relationship kind of setting.
Wow. So that's tough. So I thinkthere's a lot of, it's almost
like stern love, right? Like,because you're doing it, because
(41:31):
you love them, and you want themto work through and you want to
help this treatment, knowing inlike, the short term, it is kind
of emotionally painful to workthrough that. But for the
greater good, right. So like,it's a team effort. And both
people have to like clearly beon board. And I think
emphasizing how you're seeingthat empathy and like
(41:52):
compassion, peace, becausewithout it, it could feel kind
of cruel.
It can. Yes. And that's a reallygood summary of it. And yeah,
people, we really do need to getother people on board, depending
on how in mesh, thesecompulsions are other ways that
it might show up. If you know,aside from that relation type
relationship type of examplecould be a lot of times, you
(42:16):
know, I think this is a morecommon example to have people
like, I need to check the stove,that kind of thing. So sometimes
people might be like, I'm notgoing to check the stove, right?
Like, I'm not doing mycompulsion, but like, Hey, babe,
can you go check? Things likethat, where they'll be like,
Yeah, okay, you go in and checkto make sure the candles are
(42:37):
blown out, or whatever it mightbe. So like, even those are
examples of, okay, like, Nope,we're just going to shut the
door and give it our best gueststhat I think I blew him out. And
that's it. We're leaving,whatever that that could look
like. So yes, this can be a hugeimpact on family members and
other kinds of relationships,which is why I had sent you
(42:57):
beforehand, those bookrecommendations because there
are support groups. There arelots of book recommendations,
they can come in to individualtherapy. I also sent you the
international OCD Foundationwebsite. So the international
OCD foundation is an incredibleresource for individuals who
(43:18):
have OCD, as well as their, youknow, partners, family members,
etc. And so I go to thisconference, I've gone the last
two years, and I plan tocontinue going. And last year, I
actually presented on it whichat the conference, which was
really fun. Yeah. But it's areally cool Foundation, because
(43:40):
it's not one of these thingswhere you just go to a
conference, and therapists arethere to learn about their
continuing education credit. Italso it's for therapists, it's
for therapists who might haveOCD. It's for family members,
parents, partners, friends, inpeople with OCD, and they have
different kinds of like,lectures, activities, different
(44:03):
resources for all the differentpeople that come to it. It's
really, really cool. Yes, sothat's always an option too, for
people who want to eithersupport someone with OCD or
somebody who has OCD to lookinto those kinds of resources.
Wow, that's incredible. I'venever heard of a conference
where it's that inclusive of notjust separate for like the
(44:24):
professionals treating orsomeone struggling with it, but
like everybody, so it must belike lots of different like,
whether it's seminars orresources or just like ways that
they express this to helpeverybody across the board.
Yeah, it's really cool. And Ithink that it's so inclusive
because the OCD community is soI think like tight knit and in
(44:46):
almost like protective of eachother because there it's so
misunderstood. Like it reallypeople don't get it. So once
they finally get that diagnosis,like on average, it takes way I
wrote my thing down here It cantake 14 to 17 years for someone
to receive the appropriate OCDdiagnosis. Wow. Like think about
(45:08):
that 14 to 17 years of going totreatment providers trying
millions of psychiatrists,psychologists, other kinds of
therapists, different kinds oftherapies, different kinds of
medications, and you'resuffering all that time without
actually knowing what yourproblem is. And then once you
get the the correct diagnosis,and you go through treatments,
(45:30):
like, this makes so much sense.
But for a lot of people, ittakes a very long time. And so
once they get that, it's like,okay, I found my people, right.
So I think that that's, that's areally big reason why iocdf is
so inclusive of everybody, andreally, they do their best to
help everyone out. Wow,that's incredible. Do you have
(45:52):
an idea or know why it takesthat long for someone to get the
proper, like diagnosis andtreatment for that?
Yeah, because clinicians don'tknow how to assess for it. They
don't understand that, you know,people like you, you just gave
an example. And like you said,the person who you're explaining
with anxious attachment mightnot even have OCD, it might look
(46:14):
similar, but it might not meetcriteria, but it could just come
across as they have an anxiousattachment. And that's it. And
it's just anxiety. Right? Itdoesn't people don't necessarily
always think like, oh, that'sactually OCD. I think a really
big example that I feel isreally important to talk about
is so when we're assessing forhomicide, ality or suicidality,
(46:40):
a lot of times people with harmor suicidal type obsessions can
completely be mislabeled and getin, you know, get themselves
hospitalized, when really theirfear might be. Okay. Yes, I'm
having these thoughts of, ofdying by suicide or doing
something very harmful tomyself. But that doesn't mean I
(47:00):
want to do it. You know, itmeans that I'm afraid that I
would lose control and do it.
Versus if somebody just says, Doyou have thoughts of suicide?
They could say, yes. And it'sbecause I'm so depressed that I
want to find a way out of this,which would be actual ideation
versus an obsession, which it'slike, Yes, I'm having these
thoughts all the time. I'mdistressed by them, like, I'm so
(47:22):
afraid that I would do somethingto myself, that's different. You
know, so people can end up inthe wrong treatment setting,
they can end up beinghospitalized for something
that's completely not related towhat they're experiencing, which
in itself can be. Now you have atrauma related to this, and you
experienced this really horriblesituation. I mean, I can't tell
(47:43):
you how many people I've heard,say these things. I mean, people
come in all the time. Andthey're like, Wow, I've been in
therapy for years talking aboutthese things, and got to the
point where I am on leave ofabsence for work. And then I
come in here, and I likecompletely turn it around.
(48:06):
Wow. So I'm just hearing a hugegap in knowledge for even mental
health clinicians to be able toproperly assess, diagnose and
treat this, that's causing,unfortunately, a lot of harm for
clients who are struggling foryears and years and decades,
(48:26):
even until they meet someonelike you, who has all this
proper knowledge and expertiseto help people find relief. Wow.
Yes, and that's why I'm sopassionate about this, and why I
really find it into disseminatepractice, because, at my very
least, like one of my missionsis to just have everybody know
(48:47):
how to spot it, not everyone isgoing to treat it, that's fine
to be able to know how to spotit so that you can refer them to
the appropriate providers.
Wow, this has been soinformative. I mean, we're
definitely gonna have to haveyou back on to even just like,
be able to help people identifythis as clinicians or, um, like,
(49:09):
if you have seminars orworkshops that you're doing, I
mean, this is definitely goingto be really important
information for people to getand especially for clinicians to
help people and their clientswork through this. For
sure, that's why I sent youthose measures to which we
didn't even get into but that'sfine. They're just things that
are helpful tools for cliniciansto have an even just look at so
(49:32):
they can understand it to anextent, you know, so I would be
happy to I love talking aboutthis stuff. So it would be it
would be great.
Absolutely. And so some excitingthings can you share if there's
anything new coming up for youor for listeners to hear how
they can reach out to you towork with you?
Yes, so I speaking of theInternational OCD foundation, so
(49:56):
I am planning I don't haveconcrete plans yet. So We'll
stay tuned. But I'm planning topotentially present at that
conference again this year, it'sgoing to be in Orlando, Florida
in July. So that's somethingYeah, that's really exciting. I
definitely encourage anybodywho's interested in this to just
kind of play around with theirwebsite, there's so much out
(50:18):
there. And so I'm also going tobe coming on board with heal
your roots. And so if you wouldlike to work with me, I have
some limited availability forpeople to come on board and I
can work with you. And I alsowork at the anxiety and OCD
Treatment Center, which is inWilmington, Delaware. So if you
(50:39):
really struggle with telehealth,and you want to come in person,
I also am working there so I canbe reached. Either way. Awesome.
Yeah,I'm so excited. This is like a
little surprise at the end ofthe episode. And maybe we'll let
this let everybody know in thebeginning, but we're super
excited and thankful to have youjoin Heal Your Roots Wellness, I
(51:00):
think you're going to be atremendous asset to our team and
be able to help so many peoplewho may be struggling with this.
So I'm excited. Thank you somuch for being on and joining
our team and I'm excited forthis episode to air me
to I can't wait to see it. AndI'm really excited to share it
(51:20):
and to join, Heal Your RootsWellness. And it'll be a really
fun experience for us to be ableto collaborate more on this.
Absolutely. So if anyone isinterested in working with
Katie, you can head over to ourwebsite, heal your roots
wellness.com and schedule aconsultation and we can kind of
go from there. So thanks so muchfor being on with us, Katie.
Yes, thank you so much forhaving me.
Welcome back to Heal Your RootsPodcast. On today's episode, we
have Dr. Katie Mangan lol alicensed psychologist and expert
in obsessive compulsivedisorder. In this episode, Katie
shares her insights andapproaches and evidence based
treatment plans for helpingthose struggling with OCD.
Katie, thank you so much forjoining us for today.
(00:20):
Hi, thanks so much for havingme. I'm so excited. Absolutely.
So we usually just dive rightinto learn more about the
therapist before we learn aboutyour expertise and specialty. So
can you share a little bit aboutyour origin story of how you
became a therapist? And kind ofwhat inspired you to do that?
Sure. Yeah. So you know, Ialways found psychology to be
(00:45):
interesting, I think like mostpeople typically do, you know,
when you're in high school, andyou're taking all the different
classes, thinking about what youwant to do in college. And so
you know, I'm just somebodywho's a natural problem solver,
I like to be helpful and findsolutions to things. And I too,
can relate to some of the issuesthat my clients experience in
(01:07):
several people in my life thatare important to me, the
struggle at some point in theirlife with a lot of things. So in
having, you know, my ownrelations to some of these
issues, as well as other peoplethat are important to me. I was
interested in, you know,pursuing a career where I could
move forward with doing that forpeople.
(01:28):
Yeah, I feel like therapistsalways have some kind of link or
thread, whether it's personalwithin themselves or a family
member, that makes us feel like,oh, I want to learn more about
this or like, become someone whohelps other people through the
same issues, for sure. And socan you share a little bit about
your journey of becoming alicensed psychologist?
(01:50):
Yes. So it's been a longjourney. So I went to I'm
originally from the Harrisburgarea in Pennsylvania. And then I
moved to Redding, Pennsylvania,where I went to undergrad at
Alvernia. University. So Istudied psychology and my major
and I minored in philosophywhile I was there. Yeah. Which
(02:12):
was really fun. Yes. Yeah, Iknow, I wish I had more time and
the ability to dig into thatstuff a little bit more. But
with this journey, I only had somuch time for that. So. So then
I applied to grad school, and Igot my masters first. And so
then I moved to Philadelphia, Igot my masters from the
(02:34):
Philadelphia College ofOsteopathic Medicine. And so I
got that degree in mental healthcounseling. And then I also went
to pee calm PCOS for my doctorof clinical psychology. So
that's the short version.
Journey was like, I've been allover Pennsylvania, getting a lot
of education around psychology.
(02:57):
So within that time, I've done alot of different kinds of
trainings. I mean, at somepoint, I've worked in pretty
much every kind of mental healthsetting. I've had experience in
partial hospitalization centersI've had experienced in
intensive outpatient,residential, typical inpatient,
veterans, hospitals, privatepractice. So I've seen kind of
(03:23):
the spectrum of how mentalhealth can show up in different
settings. So yeah,wow. So that's a wide range.
That's a lot of differentsettings and perspectives to get
and how people get help, andthey're treated. It's
incredible. Yeah, what what madeyou want to be a licensed
psychologist versus like alicensed therapist? Like, what
(03:43):
was that kind of thought processto go the next step to become a
doctor?
Yeah. Well, and that's a goodquestion, because that's
something I definitely struggledwith along this journey.
Because, yeah, why? Why do youwant to go for a lesson? So I
think, another part of that too,is I'm just so curious. And I
(04:06):
always feel like if I can go theextra mile, like, why not and
just learn the next thing that Ican. And I'm so glad that I did.
I mean, there was a point whereI was in my master's program,
and I was like, this a lot,like, do I like to go the next,
you know, next step up, and Iapplied to my school because I
(04:26):
was like, you know, what, if Iget in here, then it's just,
it's meant to me and then I did.
And I was like, Alright, we'regonna go with and I'm really,
really so glad that I did.
Because looking back at where Iwas, skill set wise, as well as
just my age and where I was as aperson. At that point, I think
(04:48):
that I would have really donejust myself a disservice if I
stopped there. So I'm glad thatI kept going because I have
learned so much more and becomejust so much more confident and
I'm more I think just who I amas my own professional self in
going through the doctoralprogram. So, you know, there's
(05:08):
been some weighing of the upsand downs and pros and cons of
it. But yeah, that's kind ofultimately what, what led me
there.
That's awesome. I rememberhaving the same thoughts. I'm
like, When is this gonna beover? It's such a long process,
but it is definitely worth itonce you're on the other side
and the other hump of it. It'slike, all right, like, I guess
it was worth it.
(05:30):
Right, yeah. And I mean, if Ican provide all of the skills
that I can learn, I'd ratherjust have it all in my toolkit
and be able to work with all ofthe things and for me, too, it
was a matter of if I stop, I'mprobably not going to ever go
back. So I just kept pushingthrough and going, going going
and didn't take any breaks. Andnow here we are, and it's over.
(05:53):
And that's great self awareness,right to know that about
yourself.
Yeah, you definitely need theself awareness and going through
this.
Absolutely. And so since you'vebeen through all these different
settings, you've gone throughthat program. What is kind of
like your focus and specialtynow that you work with clients?
Yes. So right now my specialtyis working with obsessive
(06:18):
compulsive disorder and otherrelated anxiety disorders.
That's the majority of thepopulation that I work with, I
initially came into the fieldthinking that I wanted to work
with SMI, like serious mentalillness, that would include
things from, you know, likeschizophrenia, bipolar disorder,
(06:38):
certain personality disorders,actually, OCD can even be
considered SMI, depending on theseverity of it. But so that's
kind of what I came in thinkingI was going to do. And I had
experience in working with thatpopulation. And actually, I do
love working with thatpopulation. Like that's still
important to me. I guess thereason that I kind of ended up
(07:00):
going towards OCD was because Ididn't really know anything
about OCD. But I was in an smiclass in grad school, and I was
trying to figure out what one ofmy next training rotations was
going to be. And one of myteachers suggested, well, have
you ever thought about doing anykind of rotation with OCD? And I
(07:21):
was like, Well, no, I haven'tbecause I don't really know
anything about it. Besides whatwe learned in the basic intro
psychopathology class. So I waslike, alright, well, let's just
see what it's all about. And thereason she brought it up is
because there can be so muchoverlap with OCD presentation,
as well as psychotic relateddisorders. So that that kind of
(07:43):
got me curious, I got into it.
And that's also the OCDpopulation. Unfortunately,
clinicians don't know enoughabout it. But ultimately, they
usually find themselves in aprivate practice setting because
it is like a specialty area.
Whereas working withschizophrenia, bipolar, you
(08:06):
know, other versions of SMI, youdon't necessarily see that as a
presenting problem in a privatepractice setting. Now, that
doesn't mean you aren't evergoing to see anybody with those
presenting issues. But usually,if they are presenting with
those issues, they are in ahigher level of care to start.
(08:28):
And then if they want to work onthings, after those types of
things are managed, then theymay end up coming to a private
practice setting. And OCD cancertainly present itself in a
way like I said, that can youknow, clinicians can be unsure
what it is. And they might thinkthat it's a psychotic related
disorder or something moresevere, and they are in the
(08:48):
hospital or they are in a higherlevel of care. And then they end
up getting kind of referred intothese more specialty practice is
so interesting. Okay. Yeah, Ididn't know see, like I only
also had the intro to pathologyin grad school, and didn't know
much past that. Like, I feellike I might be able to identify
and then be able to refer outwhat I wouldn't be able to, like
(09:10):
have that specialized treatmentplan or knowledge to help
somebody through that because itis very different than just, I
don't want to say just anxietyto diminish that but an anxiety
disorder outside of OCD.
Mm hmm. For sure.
And so for listeners who maybehave some misconceptions about
OCD, would you be able to sharea little bit about like, what
(09:34):
that means and like how youwould really diagnose somebody
with that versus someone whomight have some traits or
tendencies or sometimes peopleuse it kind of just throw it
around when it's not actuallywhat's going on. Yes,
so this is something that I amsuper passionate about, not only
just kind of explaining this to,you know, anybody who comes
(09:56):
across OCD, but also really Ifind it to be so so Important
for clinicians to understandthis because even if we can get
people to a point where they canat least recognize it and then
refer out then that's great. Buta lot of times people think that
OCD is just regular anxiety. Andthen clinicians are responding
to the OCD in a way that isactually majorly making the OCD
(10:19):
a lot worse. So, some things toconsider. So why don't I just
kind of like ask you this, ifyou're comfortable? So when you
think of OCD, what do you thinkof like, what kind of
presentation are youenvisioning?
So I'm thinking of obsessionsand compulsions? Right? Like
there is a lot of thoughtprocess in like spiraling and
(10:39):
then compulsions, like abehavior attached with it that
is like continuously going on.
And if they don't do thisparticular behavior, then that
kind of creates more anxiety,and more stress within them. Mm
hmm. Yes. And so that's, that'sright. And when you think like,
what are some of thosebehaviors? Like, what does it
(11:01):
usually kind of look like whensomebody has OCD? Like, what do
you kind of think of?
I mean, like, the stereotypicalis kind of around like germs or
having to check somethingmultiple times in a row, right?
Like a very obvious behavior. Iknow sometimes I've had clients
who, and I wanted to talk tothis about just pure Oh, or just
(11:21):
like obsessions, or justcompulsions, like one or the
other, like, even having tosearch something a million
times. Like there's a repetitivenature to it. But I think the
stereotypically is likerepeating something over and
over to make themselves feel alittle bit more at ease. Yes,
exactly. So the Yes, usuallypeople think it's hand washing,
(11:44):
it's checking things over andover again, it's perfectionism
being organized, that kind ofthing, which is all true. Those
all can fall under the OCDumbrella. However, that is about
this much of it when there'slike this much of it going on.
So to give some background likelet's get specific, so OCD is
(12:05):
defined in our diagnosticmanual. The DSM five is it's so
it's broken up into two pieces.
It's the obsessions, like yousaid, and then it's compulsions.
So obsessions are defined asrecurrent and persistent
thoughts or urges or images thatare experienced that sometime
during the disturbance asintrusive and unwanted, which is
(12:27):
really important, and that inmost individuals cause marked
anxiety or distress. Also, underthe obsessive criteria, the
individual attempts to ignore orsuppress the thoughts, urges or
images, or to neutralize themwith some other thought or some
other kind of action, whichleads into the compulsive part.
(12:48):
So compulsions are defined asrepetitive behaviors or mental
acts that the individual feelsdriven to perform in response to
an obsession or according to therules that must be applied
rigidly. The behaviors or mentalacts are aimed at preventing or
reducing anxiety or distress, orpreventing some dreaded event or
(13:10):
situation. However, thesebehaviors or mental acts are not
connected in a realistic waywith what they're designed to
neutralize or prevent or areclearly excessive. Now, those
are, you know, that's ourdefinition that we get from the
DSM. The way that I like to kindof think of it is, and I draw
(13:32):
this picture for pretty mucheverybody that I talked to about
this. So we want to kind ofthink of it as here's our bell
curve. And we're going to use asuds scale, which is Su D S, it
stands for subjective unit ofdistress scale, you're probably
familiar. So here's our zero.
(13:56):
Here's our 100. Do you see that?
Okay.
Yeah.
Okay. So, basically, anobsession is the fear that
you're experiencing. So that'sthe, you know, the thing that
you're trying to really get ridof. So usually something
triggers the fear, which bringsthe anxiety up. So here's our
(14:19):
trigger, the anxiety goes up.
You're freaking out, right?
You're really worrying and whatdo you so let's use an example.
Okay. Now, a phobia is a littlebit different from OCD, but this
will be a good example to kindof use so let's say that you
have a dog phobia, because Iknow you don't have one more
(14:43):
time do you do Okay, sure. So,Toby, all right, and let's say
envision yourself walking downthe street down the sidewalk,
and up comes somebody with aGerman Shepherd they're walking
with okay. And you start to feelreally nervous. What do you do?
How do you want to handle thatsituation?
I mean, me personally, I wouldprobably freeze first. And then
(15:08):
maybe cross the street, go tothe other side and continue
walking, like get as far away aspossible and keep going.
Exactly.
So you are going to do somethingto try to make that anxiety go
away, which could be that, youknow, the flight, fright freeze
kind of situation. So, in thatsituation, you kind of said
(15:28):
like, the freeze first and thenprobably like, flight, runaway
kind of thing. And that's whatmost people will say. So here's
our interaction with the dog,the anxiety goes up, we start
thinking, Oh, my gosh, what canI do to make this anxiety go
down, I'm going to cross thestreet. And when I crossed the
street, that was a littleuneven, the anxiety goes down.
(15:52):
And when it goes down, we'relike, all right, I'm good. Keep
walking, everything's fine.
Except for what happens in thatmoment is you have now trained
your brain to think thatwhatever this trigger was, is
actually a dangerous situation.
And there's always a level ofuncertainty to it, it could have
been a dangerous situation. Butthat's what OCD does, it clings
(16:14):
to any level of uncertainty thatit possibly can. So basically,
you just taught your brain,Alright, that was bad, because
as soon as I escaped it, I feltimmediately better. And what
happens with that is, the morewe do those things, the more we
avoid it, the more we engage inany kind of compulsion, that is
(16:34):
what snowballs it and feeds itand it becomes bigger and bigger
and bigger. So again, obsessionis that fear, the compulsion is
pretty much anything you aredoing to make it go down. That
could be avoidance, that couldbe reassurance seeking, that
could be really anything, again,that's going to try to alleviate
(16:55):
that fear associated with theobsession. So whereas you think
maybe it's harmless, that youcross the street, but the more
it's happening, now, maybeyou're not going on your walks
anymore in the morning, becauseyou know, that person walks with
their job. Or maybe youpurposely are like, let's go 20
minutes later, instead of, youknow, the same time, which could
(17:18):
then make you late for work, andthen it's impacting your life,
right? And then it could turninto, Oh, my friend invited me
over and they just got a newpuppy. And I am not going to go
to the party with my friendsanymore, because I'm avoiding
the dog. So you get the gist. Imean, it can start out small,
but gradually, it really kind ofgrows and grows and grows. So
(17:40):
now, I'm like, what was yourinitial question? Because we
were talking about likemisconceptions out there, right.
Yeah, finding what OCD is. Yeah.
So what, what some of themisconceptions are around this
is that, like we said, it'susually like, around germs, or
like having things lined upperfectly, which those themes
(18:02):
certainly exist, but there's alot of different subtypes that
fall under the OCD umbrella. So,most commonly, there's the
perfectionistic obsessions thatpeople know about.
contamination, contamination isone of the big OCD fears that
everybody knows about. So theway that a contamination fear
could kind of show up is thecore fear might be something
(18:25):
like, I'm afraid that I willdie. And so the way that that's
manifesting is that I am afraidto get sick, meaning there's the
contamination, if I get sick, Icould potentially die. So what
I'm going to do to try tocontrol that or alleviate that
is, anytime I touch somethingwith germs on it, I need to go
(18:47):
wash my hands. Now, that's alsojust one example. contamination
can manifest in a lot ofdifferent ways. But that's just,
you know, a kind of a broadexample for people to
understand. So those are theobvious ones, but less obvious
ones are obsession, they can bekind of taboo. So some of them
can be related to harm, danger,loss, embarrassment, sexual
(19:11):
obsessions, sexual obsessions,around children, religious
obsessions, the superstitious ormagical obsessions. I think
sometimes people hear of that,like the, you know, can't step
on a crack break your mom's backin the day. And like helping
body focused obsessions so thatcan look like a lot of different
(19:34):
things. I think the mostimportant thing in in being able
to assess for OCD and for peopleto understand differences
between just being like handwashing or you know, whatever it
might be, is that OCD is egodistant onic which means it's
not in line with your values. Ifit If something is ego syntonic,
(19:59):
that means it is in line withyour values. So let's say that
somebody loves children andlike, they really want to be a
mom, or they, you know, theyreally enjoy being a nanny or
any of those kinds of things,right? Like they, they really
value being able to spend timewith kids and nurturing and that
kind of thing. Yeah. Now what'sreally unfortunate is this could
(20:21):
manifest in, you know, havingfears around, like, how to feel
like OCD. So that could besomething where it's like, okay,
I go to the park, and I'mhanging out, I see kids running
around, and an intrusive thoughtpops in my head. Now, everybody
has intrusive thoughts. Prettymuch everybody has intrusive
(20:45):
thoughts, right? The differencebetween somebody who has an
intrusive thought with OCD isthat they cling to it, and then
it starts to spiral. Whereastypically, somebody might have
the thought, Oh, look at thatkid, like, they're really cute,
and then be like, That wasweird. Like, that'd be weird for
me to like, take that thoughtany farther. And then they just
(21:05):
kind of shake it off and movewith it. But somebody with OCD
might be like, Oh my gosh, thatwas weird of me. Why did I even
have that thought? Like, am I apervert, maybe I should stay
away from kids. And then it cankind of spiral right then maybe
they're avoiding going to parks,maybe they lose their job
nannying, because they'reavoiding going to work, you
know, any of these kinds ofthings, because they are afraid
(21:27):
of that happening. So the bigdifference between this and
being an actual person who'sdiagnosed with a pedophilic
disorder is that egodisenchanted versus ego
syntonic. So somebody who isdiagnosed with a pedophilic
disorder is like, actuallyaroused by children, and they
will act on that kind of urge.
(21:49):
Whereas the OCD is, I'm havingthe thoughts and I'm scared in
the last thing I want is forthis to happen, but they're so
afraid that it could potentiallyhappen that they might lose
control and do something sounthinkable to that.
So I'm hearing the difference isnot that they're fully going
through it, but they're scaredif they allowed themselves to
(22:10):
that that might be something andthat they're like, scared Oh,
could develop into that. So nowthey're obsessed around having a
thought that they could becomethat versus actually having
that,that yeah, rather than actually
engaging in behaviors of likecatching children or doing
anything that's actually likeinappropriate and leading to
legal ramifications, or anactual diagnosis of a pedophilic
(22:32):
disorder.
Okay, so for example, right?
Like, I'm just thinking, like,sometimes when I'm driving,
right, like a random thought inmy head might pop up, like, Oh,
my God, like, what if I likerammed into the car in front of
me. And something horrible wouldhappen? What would be like, a
version of like, that thresholdof OCD then versus like, Oh,
(22:54):
that's horrible. I don't want tothink about this. And then just
like change the station on theradio, and just try to like,
move on with my life.
Right. So that would be probablyrelated to a harm subtype. And I
actually have worked with peopleto the point where this has
gotten so bad that we call itactually hit and run OCD, where
(23:16):
people are afraid that theyeither are going to like,
wrecked their car wreck intosomebody, or that they might hit
a pedestrian or something likethat. So I've met people where
instead of just like, oh, that'suncomfortable to think about,
let me distract myself and carryon. It could manifest in a way
where they are constantlychecking their rearview mirrors,
(23:38):
you know, making sure that theyhave specific like safety
behaviors, whereas it's like,well, I need to make sure that I
have the music on loud enoughthat I am always distracted.
Whereas like, when somebody hasan insurance on, they're like,
Oh, that's weird, shake it off,listen to some music, and then
your brain starts thinking ofother things. That's a more
typical kind of way that peoplethink about things when random,
(24:00):
intrusive thoughts come up. Ifsomebody also has OCD around
this, they might avoid drivingin general, they might just not
drive any more. I know with somepeople that they it OCD really
likes to claim to control right,that's all about those
compulsions trying to controlsituations. So sometimes it
(24:20):
might be well, I don't want tobe in a car as a passenger
because I don't have controlover the driving. Or maybe they
would rather only be a passengerbecause they don't want that
control of being the person whohid it. So again, that's why we
really always have to do athorough assessment because we
want to really understand thefunction of the behavior. We
(24:43):
always want to really understandthat core underlying fear that
it's related to.
So what would be differentbecause you know, I've have have
a lot of clients who come in foranxiety around like attachment
like anxious attachments, andthey might Do kind of repetitive
behaviors around dating, right?
Like, let's say if they broke upwith somebody they get obsessed
(25:05):
with, like looking at theirInstagram stories or like
looking at certain things. Andit always like confuses me in a
way where it's like almost liketorturing themselves. Like, if
they want to feel better, theywould stop looking at it, but
instead they obsess, knowingthat it's going to create more
distress for them. How wouldthat be like considered towards
(25:25):
that? Or is that more of justlike, anxious thoughts and like
anxiety? Sothere is a fine line, I would
say between sometimes therebeing because really, pretty
much. I'm hesitant to I'mhesitant to say that all anxiety
disorders engage in some form ofcompulsions, but most of them
(25:47):
are doing something to try toalleviate it. compulsions just
tend to kind of like manifestmore intensely and show up more.
Which brings me to your questionabout like the pure Oh, that's
like a whole other topic. Butcompulsions can even be mental
like as explaining, like mentalacts, that could be reviewing
memories, like, you know, goingback and thinking of, you know,
(26:08):
did I do this? Did I do that?
These kinds of things, thedifference is that the
compulsions should take around,and more often do take more than
like an hour each day andcausing significant distress,
impairing their functioning. Sowhat you're explaining, with the
(26:30):
example with relationships, thatin the end, that anxious
attachment, that can certainlybe caused as a part of the
issues with attachment. Right?
OCD doesn't just appear out ofnowhere, something that is
related to it. And that can kindof like, bring them to that
being their obsession or thatcore fear. But yeah, I mean, the
(26:54):
thing is, is, they probably knowthat is going to cause more
distress. But when you're havingthat part of your brain
activated, you're no longerthinking logically, you can not
out logic, OCD, which is why wehave to do exposures in exposure
and response prevention istreatment versus just like, a
typical cognitive restructuringof like, you know, that doesn't
(27:18):
make sense, right? Becausepeople will be like, yeah, no, I
get it. But it doesn't matter.
Because when I'm in thatheadspace, that's what I need to
do. And the reason they're doingis because they are getting some
sense of like relief in thecompulsion, because remember our
picture here, right? It isbringing it down a little bit,
because maybe if they'rechecking in, they're seeing,
(27:40):
okay, that person didn't go on adate this week. Okay, sounds
like that's good. But thenthey're like, but I need to keep
making sure that that's, youknow, yeah, yeah, it can be
really, really painful forpeople. It's really it can be
very distressing.
Yeah. No, I appreciate you goingthrough these like very specific
examples, I think this will bereally helpful for listeners to
(28:01):
like differentiate as well. Andso since you mentioned some of
the approaches or treatments,can you elaborate a little bit
more of like, what does helplike, what does work with
clients who are struggling withOCD versus like cognitive
behavioral therapy for strictlyanxiety? And like different
approaches that you use when youwork with people? Yes.
(28:23):
So the, you know, our goldstandard evidence based
treatment for OCD is exposureand response prevention. So we
call it ERP. So the reason thatwe are doing ERP versus a more
basic version of CBT, isessentially, it has more of a
(28:47):
behavioral approach to it, notto say that there's no cognitive
interventions, but it's mostlybehavioral. And some of that is
because with the cognitiveinterventions with OCD, your
brain can just, you know, like,talk yourself out of anything.
It doesn't you're, you know, itcan even get to a point where if
you're doing cognitiverestructuring, and in looking
(29:09):
for evidence for and against,like, even that can turn it into
a ritual or a compulsion. So,it's better to just allow those
thoughts to exist and carry onand do our exposures. But so the
reason I say a more basic kindof CBT is because exposure and
response prevention is stillcognitive behavior therapy. It's
(29:30):
just the cognitive behaviortherapy is so broad, it's
another one of these umbrellasand then under that we have like
sub therapies or third wavetreatments. So, so ERP kind of
falls under the cognitivebehavioral umbrella. So the way
that ERP is set up is exposuretargets, the obsessions, and the
(29:53):
compulsions are targeted withthe response prevention. So
essentially what we would do intreatment is As we do, again, a
thorough assessment of what arethe subtypes? How are they
showing up? What's the functionof the behavior? What are the
core fears. And then with that,we make our treatment plan,
which is essentially ourhierarchy, which is going to
(30:14):
list several exposure ideas,things that we would do to kind
of target the fears. And then wewould also have Response
Prevention items as well. Sowhat that might look like is,
let's bring it back to our dogphobia. Okay. So the reason we
(30:35):
do exposures is not necessarilyto torture people. But what it
is meant to do is that we wantto purposely bring that anxiety
up and sit with it withoutengaging in any kind of
compulsions or safety behaviors,because what's going to happen
is we will eventually habituateto it. That is how we're kind of
(30:57):
re programming your brain. So ifyou allow it to exist, and not
fight and not do anything, itwill eventually come down. But
it can be really distressing.
Yes, yes, on its own. And that'swhat's hard for people to sit
with. Because when you're inthat feeling, it feels like it's
not ever going to go go away,and you need to do anything you
(31:17):
can to escape it. But once youkind of learn that, it's a
feeling I'm working through, andI'm gonna allow it to just kind
of exist, it'll kind of go downon its own. And that's a double
process. Because as that'shappening, you are building your
distress tolerance skills.
You're learning to sit withthings that are uncomfortable.
So that's the point of theexposures are response
(31:39):
prevention. So an exposure forour dog situation could be, I'm
going to watch videos of dogs,I'm going to watch videos of
people getting bit by dogs, orI'm going to then go pet my dog
or my friends puppy at theirhouse. It can even just be like
listening to a dog barking, itall depends. And it's all very
(32:00):
individualized on the person's,again, our suds scale. So I
might say, how sudsy does itfeel for you to go pet your
friend's puppy? And they mightsay on a zero to 100 scale?
Well, that's about a 50. Okay,well, how much would it be if
you were watching a video ofdogs running around in a field?
Oh, that's like only a 20. Okay,so we might start out lower, and
(32:23):
then kind of build our ourselvesup to it, we don't ever want to
just immediately throw them intoit. I mean, it's a, it exists,
it's called flooding, right? Butthat is not necessarily the
approach that we're using. Ialways take the approach of
being collaborative, like, theclient is the expert on them,
(32:44):
and I am the expert on thetreatment, we have to work
together. And I'm never going toforce somebody to do something
they don't want to do. It's yourgoals, we're going to do what
you're willing to do. And wewant the exposures to be a
stress not a strain. So itshould be hard, should be
difficult, but not to the pointwhere you cannot handle it,
because then you're never gonnago back and do it again.
(33:06):
Yeah, we don't want to go into apanic state, it's more of just
like, a safe discomfort.
Well, you know, what in thething is, is that they can
panic. I think that's anotherthing is people are like, I
can't let that happen. We canbecause we know that a panic
attack is incrediblyuncomfortable. Okay. My goal is
(33:28):
never to be like, let's send youinto a panic attack, unless we
are maybe doing panic treatment,which is a whole different
story. But the goal is to justkind of like, bring up the
discomfort and teach them like,whatever is going to show up
like I can handle it, I can sitwith it. So where it is, it's
not necessarily my goal to havea panic attack, we have to
remember that there'suncertainty. And if it happens,
(33:51):
like okay, we sit with it, wedeal with it, you know. So, so
yeah, so that's our exposureexample, a response prevention
example could be. So again,that's taking away our
compulsions. So if you areavoiding by walking on the other
side of the sidewalk, theexample could be okay, I'm then
(34:14):
going to take that away. And I'mgoing to still just go to work
the same time, as I usuallywould. So with the response
prevention example. Basically,you're going to want to cut out
any of the kind of compulsionsthat you're doing. So with the
dog thing you would want toleave for work the same time as
you normally would, instead ofbeing like, let me wait 20
(34:36):
minutes kind of thing. Or ifit's a hand washing, let's say
somebody feels like they need towash their hands five times. Or
they need to use five pumps ofsoap, we would say, All right,
let's cut it back to two pumpsof soap or like two times we
wash our hands and thengradually kind of bring it down
from there. Andso how do you find clients? Are
they receptive to this or doesit ever like make them feel
(34:57):
uncomfortable hearing that Partof the treatment is going to be
the exposure or the response tothings that obviously make them
very uncomfortable.
Yes, I mean, people definitelycan be very afraid to do this
kind of treatment. This is atreatment that requires a
certain level of motivation. Imean, we, we really, there's
(35:19):
some things we do to kind ofprepare people for it. So part
of it is assessing formotivation. Where are you at?
Like, what are you willing todo? And really building up your
reasons for why, why do you wantto do this. And let's remember
that when we're doing theseexposures, when they're
uncomfortable, Oh, you want todo it, because you no longer are
going to work, you got fired,your relationship with your
(35:42):
partner is, you know, reallygoing downhill, you no longer
are spending time with yourfamily, you're secluding
yourself to your house 24/7You're depressed, you know,
like, these are the reasons wewant to do this kind of
treatment. So motivation isimportant. But another thing I
tried to do is kind of explainto them what I had just told you
(36:03):
is that I try to meet peoplewhere they're at, I'm never
going to force them to dosomething they don't want to do.
I might like, you know, push alittle and be like, oh, let's
like kind of do this right. Butlike, ultimately, like, Yeah,
I'm not going to force anybodyto do anything that they don't
want to do. We start out lower,we're always agreeing on the
(36:24):
exposures that we're doing. Andagain, it's not like throwing
you in the deep end, it's like,let's stick our foot in the cold
water. And we kind of buildourself up from there. So I
always try to make that reallyapparent, and really reinforced
that it is a collaborativeprocess.
Sure. So there's comfort inknowing that they still have
(36:44):
that level of control. Right,knowing that like, this is
something that both of you areagreeing on. If this feels too
extreme, we can go down to alower level work through that
until we can feel ready to go tothe next level and continue on
because because it's sonegatively impacting their life.
This is it's worth it right,like putting in the work so that
they can have a higher qualityof life as they work through
(37:07):
these levels. Yes. And so Iknow, at least when we talked
separately, you mentioned likebringing in other people into
session sometimes whether that'sa partner or a family member to
kind of help support thatprocess. Can you share, like
what that kind of looks like inthe in the treatment?
Yes, so it totally depends onagain, this is so
(37:28):
individualized, it depends onwho we're bringing in and why a
lot of times we're bringing in,well, this is more so with
children, but with children,we're bringing in their parents,
because they're almost alwaysaccommodating their behaviors.
So we are doing a lot of familywork if it's with a child who
has OCD. Let's say I liked yourexample you gave of like the
(37:49):
anxious attachment and in likelooking through Instagram, let's
say somebody's coming in, andthey actually have like a
relationship OCD kind of thing.
That could look like Oh, I'mafraid I'm gonna cheat on them,
or oh, I'm afraid they're gonnacheat on me. I think a lot of
times, I mean, it can be either.
Usually, if it's the one whereit's like, Oh, I'm gonna cheat
on them. It might be morerelated to scrupulosity like I'm
(38:12):
a bad person kind of thing.
Whereas I think that otherrelationship OCD, right? How it
can kind of manifest and I'mafraid they're gonna cheat on me
kind of thing. Or they'll dosomething wrong in the
relationship, or Oh, my gosh, Ijust committed my whole life to
being with this person. What ifit doesn't work out? Right, that
uncertainty, so that wouldreally impact your relationship
(38:33):
with your partner? If you'reconstantly like, oh, my gosh, I
went to work, what if theyhooked up with their co worker
or something like that? So itmight show up of them texting
their partner all the timechecking their location on their
phone? You know, asking forreassurance like what you do at
work? Did you hook up with thatperson? Did you talk to them?
(38:54):
Give me a list of all your coworkers. And now I'm gonna stalk
them on Facebook, like any ofthese guys, when I say stock,
not necessarily actually stalkthem. But look them up, learn
information about them,whatever. So really, if that's
the case, it's probablyimpacting their relationship, we
would bring the partner in andexplain to them how the
(39:17):
treatment works, and explain tothem that they're actually
engaging in the compulsion withthat person, if they are
consistently like, here's mylocation, no, I'm not doing
this. No, I'm not doing that,you know. So we might have them
say, okay, instead of givingthem like 20, different forms of
reassurance. And again, wewouldn't be buying from the
(39:38):
actual client on this. They needto be willing to do it as well.
But if if everybody isunderstanding of what we're
doing and why it's likely goingto be okay, partner, instead of
sharing your location, let'sremove that. And if they say, oh
my gosh, will you give it backto me? Like I only agreed that
because that was the partnermight say something, we want
(40:04):
them to kind of respond withempathy because this is a huge
struggle. And you we always wantto keep empathy in mind because
sometimes this treatment reallycan come across as like,
torturous if it's not done in acompassionate way. So they say
something along the lines of Iunderstand you're really
(40:24):
struggling with this right now.
Like, I'm sorry, we agreed thatI'm not going to give you my
location. That's it. I'm notgiving it to you. Whereas they
might be tempted to do it.
Otherwise, to kind of show themokay. Yeah, like, this is what
I'm doing. Or they might say,you know, did you get lunch with
(40:44):
that coworker today? You theycould respond with, again, like
some empathy, but also,depending on the person, even
some humor and like someuncertainty statements, like, I
guess you'll just have to guessand think about if I did or not
like, I don't know, maybe theydid. Maybe I did it. Oh, gosh.
And again, these things can thatcould be a more sudsy type of
(41:07):
response. Yeah. Yeah, totallyjust depends on where the person
is at with things. But yeah,that's an example of how it can
show up with them, you know, ina relationship kind of setting.
Wow. So that's tough. So I thinkthere's a lot of, it's almost
like stern love, right? Like,because you're doing it, because
(41:31):
you love them, and you want themto work through and you want to
help this treatment, knowing inlike, the short term, it is kind
of emotionally painful to workthrough that. But for the
greater good, right. So like,it's a team effort. And both
people have to like clearly beon board. And I think
emphasizing how you're seeingthat empathy and like
(41:52):
compassion, peace, becausewithout it, it could feel kind
of cruel.
It can. Yes. And that's a reallygood summary of it. And yeah,
people, we really do need to getother people on board, depending
on how in mesh, thesecompulsions are other ways that
it might show up. If you know,aside from that relation type
relationship type of examplecould be a lot of times, you
(42:16):
know, I think this is a morecommon example to have people
like, I need to check the stove,that kind of thing. So sometimes
people might be like, I'm notgoing to check the stove, right?
Like, I'm not doing mycompulsion, but like, Hey, babe,
can you go check? Things likethat, where they'll be like,
Yeah, okay, you go in and checkto make sure the candles are
(42:37):
blown out, or whatever it mightbe. So like, even those are
examples of, okay, like, Nope,we're just going to shut the
door and give it our best gueststhat I think I blew him out. And
that's it. We're leaving,whatever that that could look
like. So yes, this can be a hugeimpact on family members and
other kinds of relationships,which is why I had sent you
(42:57):
beforehand, those bookrecommendations because there
are support groups. There arelots of book recommendations,
they can come in to individualtherapy. I also sent you the
international OCD Foundationwebsite. So the international
OCD foundation is an incredibleresource for individuals who
(43:18):
have OCD, as well as their, youknow, partners, family members,
etc. And so I go to thisconference, I've gone the last
two years, and I plan tocontinue going. And last year, I
actually presented on it whichat the conference, which was
really fun. Yeah. But it's areally cool Foundation, because
(43:40):
it's not one of these thingswhere you just go to a
conference, and therapists arethere to learn about their
continuing education credit. Italso it's for therapists, it's
for therapists who might haveOCD. It's for family members,
parents, partners, friends, inpeople with OCD, and they have
different kinds of like,lectures, activities, different
(44:03):
resources for all the differentpeople that come to it. It's
really, really cool. Yes, sothat's always an option too, for
people who want to eithersupport someone with OCD or
somebody who has OCD to lookinto those kinds of resources.
Wow, that's incredible. I'venever heard of a conference
where it's that inclusive of notjust separate for like the
(44:24):
professionals treating orsomeone struggling with it, but
like everybody, so it must belike lots of different like,
whether it's seminars orresources or just like ways that
they express this to helpeverybody across the board.
Yeah, it's really cool. And Ithink that it's so inclusive
because the OCD community is soI think like tight knit and in
(44:46):
almost like protective of eachother because there it's so
misunderstood. Like it reallypeople don't get it. So once
they finally get that diagnosis,like on average, it takes way I
wrote my thing down here It cantake 14 to 17 years for someone
to receive the appropriate OCDdiagnosis. Wow. Like think about
(45:08):
that 14 to 17 years of going totreatment providers trying
millions of psychiatrists,psychologists, other kinds of
therapists, different kinds oftherapies, different kinds of
medications, and you'resuffering all that time without
actually knowing what yourproblem is. And then once you
get the the correct diagnosis,and you go through treatments,
(45:30):
like, this makes so much sense.
But for a lot of people, ittakes a very long time. And so
once they get that, it's like,okay, I found my people, right.
So I think that that's, that's areally big reason why iocdf is
so inclusive of everybody, andreally, they do their best to
help everyone out. Wow,that's incredible. Do you have
(45:52):
an idea or know why it takesthat long for someone to get the
proper, like diagnosis andtreatment for that?
Yeah, because clinicians don'tknow how to assess for it. They
don't understand that, you know,people like you, you just gave
an example. And like you said,the person who you're explaining
with anxious attachment mightnot even have OCD, it might look
(46:14):
similar, but it might not meetcriteria, but it could just come
across as they have an anxiousattachment. And that's it. And
it's just anxiety. Right? Itdoesn't people don't necessarily
always think like, oh, that'sactually OCD. I think a really
big example that I feel isreally important to talk about
is so when we're assessing forhomicide, ality or suicidality,
(46:40):
a lot of times people with harmor suicidal type obsessions can
completely be mislabeled and getin, you know, get themselves
hospitalized, when really theirfear might be. Okay. Yes, I'm
having these thoughts of, ofdying by suicide or doing
something very harmful tomyself. But that doesn't mean I
(47:00):
want to do it. You know, itmeans that I'm afraid that I
would lose control and do it.
Versus if somebody just says, Doyou have thoughts of suicide?
They could say, yes. And it'sbecause I'm so depressed that I
want to find a way out of this,which would be actual ideation
versus an obsession, which it'slike, Yes, I'm having these
thoughts all the time. I'mdistressed by them, like, I'm so
(47:22):
afraid that I would do somethingto myself, that's different. You
know, so people can end up inthe wrong treatment setting,
they can end up beinghospitalized for something
that's completely not related towhat they're experiencing, which
in itself can be. Now you have atrauma related to this, and you
experienced this really horriblesituation. I mean, I can't tell
(47:43):
you how many people I've heard,say these things. I mean, people
come in all the time. Andthey're like, Wow, I've been in
therapy for years talking aboutthese things, and got to the
point where I am on leave ofabsence for work. And then I
come in here, and I likecompletely turn it around.
(48:06):
Wow. So I'm just hearing a hugegap in knowledge for even mental
health clinicians to be able toproperly assess, diagnose and
treat this, that's causing,unfortunately, a lot of harm for
clients who are struggling foryears and years and decades,
(48:26):
even until they meet someonelike you, who has all this
proper knowledge and expertiseto help people find relief. Wow.
Yes, and that's why I'm sopassionate about this, and why I
really find it into disseminatepractice, because, at my very
least, like one of my missionsis to just have everybody know
(48:47):
how to spot it, not everyone isgoing to treat it, that's fine
to be able to know how to spotit so that you can refer them to
the appropriate providers.
Wow, this has been soinformative. I mean, we're
definitely gonna have to haveyou back on to even just like,
be able to help people identifythis as clinicians or, um, like,
(49:09):
if you have seminars orworkshops that you're doing, I
mean, this is definitely goingto be really important
information for people to getand especially for clinicians to
help people and their clientswork through this. For
sure, that's why I sent youthose measures to which we
didn't even get into but that'sfine. They're just things that
are helpful tools for cliniciansto have an even just look at so
(49:32):
they can understand it to anextent, you know, so I would be
happy to I love talking aboutthis stuff. So it would be it
would be great.
Absolutely. And so some excitingthings can you share if there's
anything new coming up for youor for listeners to hear how
they can reach out to you towork with you?
Yes, so I speaking of theInternational OCD foundation, so
(49:56):
I am planning I don't haveconcrete plans yet. So We'll
stay tuned. But I'm planning topotentially present at that
conference again this year, it'sgoing to be in Orlando, Florida
in July. So that's somethingYeah, that's really exciting. I
definitely encourage anybodywho's interested in this to just
kind of play around with theirwebsite, there's so much out
(50:18):
there. And so I'm also going tobe coming on board with heal
your roots. And so if you wouldlike to work with me, I have
some limited availability forpeople to come on board and I
can work with you. And I alsowork at the anxiety and OCD
Treatment Center, which is inWilmington, Delaware. So if you
(50:39):
really struggle with telehealth,and you want to come in person,
I also am working there so I canbe reached. Either way. Awesome.
Yeah,I'm so excited. This is like a
little surprise at the end ofthe episode. And maybe we'll let
this let everybody know in thebeginning, but we're super
excited and thankful to have youjoin Heal Your Roots Wellness, I
(51:00):
think you're going to be atremendous asset to our team and
be able to help so many peoplewho may be struggling with this.
So I'm excited. Thank you somuch for being on and joining
our team and I'm excited forthis episode to air me
to I can't wait to see it. AndI'm really excited to share it
(51:20):
and to join, Heal Your RootsWellness. And it'll be a really
fun experience for us to be ableto collaborate more on this.
Absolutely. So if anyone isinterested in working with
Katie, you can head over to ourwebsite, heal your roots
wellness.com and schedule aconsultation and we can kind of
go from there. So thanks so muchfor being on with us, Katie.
Yes, thank you so much forhaving me.
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