Obsessive-Compulsive Disorder is so vast and perplexing, Valerie and Helen devoted two episodes to OCD. They discovered a complex and harrowing mental illness often trivialized and misunderstood by those who don’t have it. To legitimize the severity of the disorder, they turned to the experts. In Part Two, their searching questions are answered by a seasoned OCD professional, Dr. Ginny Fullerton. Her encyclopedic knowledge of OCD encompasses causes, symptoms, diagnosis, treatment methods and breakthroughs, along with profound insights for individuals battling OCD, their families and loved ones. To supplement this invaluable education, Helen and Valerie urge audiences to listen to Episode 45, which features the miraculous story of Mel, a woman who had OCD from early childhood into her adult life, and who made a heroic recovery.
Find Valerie and Helen at https://mentalhealthhopeandrecovery.com
Show Notes:
- International OCD Foundation — https://hiocdf.org
- Family Accommodation Behaviors — https://ysph.yale.edu/familyaccommodationocd/about/
- When a Loved One Won’t Seek Mental Health Treatment: How to Promote Recovery and Reclaim Your Family’s Well-Being by C. Alec Pollard PhD, Melanie VanDyke PhD, Gary Mitchell LCSW, Heidi J. Pollard RN, MSN, Gloria Mathis PhD
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OCD: The Reality, the Research, the Recovery—Part Two
Episode 46
Helen Sneed: Welcome
Helen Sneed: Welcome to our award winning podcast, Mental Health Hope and Recovery. I'm Helen Sneed.
Valerie Milburn: And I'm Valerie Milburn.
Helen Sneed: We both have fought and overcome severe chronic mental illnesses. Our podcast offers a unique approach to mental health conditions. We use practical skills and inspirational true stories of recovery. Our knowledge is up close and personal.
Valerie Milburn: Helen and I are your peers. We're not doctors, therapists or social workers. We're not professionals. But we are experts. We are experts in our own lived experience with multiple mental health diagnoses and symptoms. Please join us on our journey.
Helen Sneed: We live in recovery, so can you.
Valerie Milburn: This podcast does not provide medical advice. The information presented is not intended to be a substitute for or relied upon as medical advice, diagnosis or treatment. The podcast is for informational purposes only. Always seek the advice of your physician or other qualified health providers with any health related questions you may have. Well Helen, let's begin our second episode on Obsessive Compulsive Disorder. You know, OCD is one of the few illnesses neither one of us has had and it's proved to be one of the most complex. We learned so much in Part one from our guest Mel, a true expert on ocd. Her expertise is based on her own heroic battle to overcome a ocd, a battle that began in her childhood and lasted until adulthood. She now lives a life in recovery with OCD. Now, to get a full picture of OCD, we urge our listeners to tune in to episode 45, part one of this topic.
Helen Sneed: Valerie, you're right. There is so much to learn about ocd. Mel's story is an inspiration, but for me it was also an education in the grave and destructive symptoms of the disorder that I was not aware of. One of the things we have tried to do is legitimize this illness to promote wide understanding and empathy for those who have it. I often hear someone say, oh, I have a touch of ocd. No they don't. People who don't understand it can trivialize it without meaning to, when in fact it's a very serious and debilitating illness. As J.J. keeler said, OCD is not a disease that bothers, it is a disease that torments. Today we are so fortunate to have a professional expert to guide us through these many aspects of ocd.
Valerie Milburn: Yes, we are so fortunate to have a wonderful guest on today's episode. In Part one, Mel joined us to give us the peer perspective as she shared her lived experience with OCD. And today Dr. Jenny Fullerton will be joining us to give us the professional perspective. Let me introduce you to Dr. Fullerton. Jenny Fullerton, Ph.D. founded Capital OCD and Anxiety Practice in 2016 after nearly a decade of specialized clinical experience. Dr. Fullerton earned her master's degree and Ph.D. in clinical psychology at the University of Houston following her residency at the Johns Hopkins University School of Medicine. With her early career experience at Baylor College of Medicine, the Menninger OCD Clinic, and the McLean OCD Institute, she developed expertise with OCD and anxiety across all ages and levels of care. Dr. Fullerton is a Clinical Associate professor in the Departments of Psychology and Educational Psychology at the University of Texas at Austin. Dr. Fullerton serves on the Board of OCD Texas. She is committed to broadening awareness of treatments that work. She will be joining us shortly, bringing us the professional perspective.
Helen Sneed: We are so fortunate to have her to begin with, what is ocd? The National Institute of Mental Health says OCD is often a long lasting disorder in which a person has uncontrollable, reoccurring thoughts, obsessions and behaviors, compulsions that he or she feels the urge to repeat over and over. The basic formula is deceptively simple. Obsessive thoughts obsessions lead to repetitive behaviors Compulsions what are the symptoms of ocd? The onset
Helen Sneed: of symptoms begins gradually and varies throughout life. Usually it begins in teen or young adult years, sometimes in childhood. The International OCD foundation defines what is necessary for a diagnosis of Obsessive compulsive Disorder. They state, a cycle of obsessions and compulsions must be so extreme that it consumes a lot of time, more than an hour every day, causes intense distress or gets in the way of important activities that the person values. First, there are obsession symptoms. Obsessions are thoughts, images or impulses that occur over and over again and feel outside of a person's control. Individuals with OCD do not want to have these thoughts and find them disturbing. In most cases, people with OCD realize that these thoughts are illogical. Obsessions are typically accompanied by intense and uncomfortable feelings such as fear, disgust, uncertainty and doubt or a feeling that things have to be done in a way that is just right. In the context of ocd, these intrusive thoughts come frequently and trigger extreme anxiety that gets in the way of day to day functioning. Here are some common obsession symptoms in OCD. Contamination Obsessions such as fear of coming into contact with perceived contaminated things People Dirt Violent obsessions Fear of acting on an impulse to harm oneself or others Excessive concern with violent or horrific images in the mind Responsibility obsessions Fear of being responsible for something terrible happening a fire or a car wreck Forgetting to lock the door or turn off the stove Perfectionism Related obsessions Excessive concern with performing tasks perfectly or correctly and a fear of making mistakes Sexual obsessions Unwanted thoughts or images related to sex such as fears of acting on an inappropriate sex related impulse or of aggressive sexual behavior Religious and moral obsessions Fear of offending God or damnation an excessive concern with right and wrong Identity Obsessions such as excessive concern with one's sexual orientation or gender identity and there are others Relationship related obsessions Obsessions about death and existence now number two are compulsion symptoms. Compulsions are repetitive behaviors or thoughts that a person uses with the intention of neutralizing, counteracting, or making their obsessions go away. People with OCD realize this is only a temporary solution, but without a better way to cope, they rely on compulsions. Nonetheless, compulsions can also include avoiding situations that trigger obsessions. Compulsions often can be beyond reason and often don't relate to the issue they're intended to fix. Now here are some common compulsion symptoms in OCD. Washing and cleaning Excessive hand washing, sometimes until the hands are raw Refusing to shake hands because it will trigger more obsessive thoughts Checking Checking that nothing terrible happened or that the person was the cause or made a mistake Checking the door or stove Unable to stop for hours and sometimes even unable to leave the house Repeating Repeating routine activities such as going in and outdoors getting up and down from chairs Body movements such as tapping, touching, blinking Activities in multiples such as three times because three is a good number Mental compulsions Praying to prevent harm Counting such as the number of slats in the blinds or tiles on the floor and there are other compulsions putting things in order telling, asking or confessing to get reassurance and most significant suicidal ideation or behavior when compulsive actions don't allay the extreme torment or fear.
Valerie Milburn: I'm really glad you mentioned mental compulsions because you know, Mel made a very important point and I'd like to share a quote from her about internal mental compulsions. Here's her quote from the outside looking in, you wouldn't necessarily be able to tell I had OCD because of all the compulsions I am doing are internal. They are such things as thinking loops, ruminating
Valerie Milburn: mentally reviewing past events or conversations in minute detail down to the last syllable, or reassuring myself constantly, praying excessively, etc. Now, I think it's important to share that quote from Mel and give listeners some examples of this type of OCD as the checking locks and contamination OCD often gets all the attention when in fact these types of internal obsessions are common and less understood.
Helen Sneed: Well, I appreciate your bringing that up because again, it's just a misconception that we're trying to correct today. Day the severity of these symptoms that we're talking about varies over a lifetime. Obsessive thoughts and compulsions can also vary over time. Symptoms get worse when under greater stress, times of transition change, loss, trauma or physiological changes such as fluctuations in hormones. At their most severe, symptoms are extremely disabling or even life threatening. What are the causes of ocd? First, there's biology, changes in chemistry or brain functions. Genetics. No specific gene, of course, but there may be a genetic cause for a predisposition for OCD that runs in families and learning OCD can be learned from watching a family member who has it. What are the risk factors, family history, stressful life events, and other mental health disorders which I want to explain. Because it can be extremely difficult to diagnose ocd, the symptoms can be similar to a number of other illnesses such as anxiety, depression, schizophrenia, Tourette syndrome. There is much comorbidity. Also dual diagnosis with substance use and other psychiatric illnesses.
Valerie Milburn: Now for some statistics on OCD. First, prevalence in the United States, about 1.2 of adults experience OCD symptoms in a given year, and 2.3% experience it at some point in their lives. That's over 5 million Americans, or approximately 1 in 40 adults. OCD affects females at three and a half times the rate it affects males. The International OCD foundation estimates that 1 in 200 children and teens in the US or about 500,000 youth, have OCD. OCD can appear at any age, but it usually first surfaces between the ages of 8 and 12 or in late teens and early adulthood. Now, Helen, here's a statistic that you and I both found startling. OCD is considered one of the top 10 leading causes of disability, and that's including medical and psychiatric conditions.
Helen Sneed: I really didn't see that one coming. It's a great surprise to me. But here's the thing about treatment of ocd. There is no cure, but OCD has proven to be very treatable. Up to 80% of people who receive treatment experience significant improvement in their symptoms. Treatment can diminish symptoms, so they don't rule a person's life. In OCD Part 1, we cover treatment methods in detail, so please visit episode 45 for our full coverage of these critical healing approaches. Now, the therapeutic relationship is key to treating ocd. Talk therapy, including cognitive behavioral therapy and medication, or both, are most frequently recommended. The gold standard of treatment is exposure and response prevention, erp. It's a form of cognitive behavioral therapy that gradually exposes people to their fears and prevents compulsive behaviors. Now, this leads to the most interesting aspect of OCD treatment that I've come across. For many people with ocd, the most effective approach is to focus not on the obsessive thoughts which come first, but to work on the compulsive behaviors that are a response to the thoughts. This is predicated on the understanding that actions are easier to curtail than thoughts. That performing the compulsions not only doesn't provide much relief, but the repetitive actions can actually make the obsessive thoughts more powerful
Helen Sneed: and more embedded in the brain. The person learns to tolerate the unceasing thoughts and to focus not on thinking but on behavior. And as the compulsive behaviors lessen, so does their impact on the brain. Typically, the thoughts diminish over time. Other methods include education, medication, skills, group therapy, and a host of other possibilities, all in episode 45.
Valerie Milburn: So a bit on medication for some people. As you said, a combination of cognitive behavioral therapy and medication is the most effective treatment. Now, antidepressants are often the first medications prescribed for ocd, and that doesn't mean necessarily that depression is present, it's just that antidepressants are often an effective treatment for OCD and antianxiety treatment drug is sometimes used to treat OCD as well. Now I get to talk about breakthroughs. You know, this treatment breakthrough topic is one of my favorite. I get to geek out over research for a second. But I mainly did that in the previous episode where I discussed two current breakthroughs in depth. I encourage again everyone to listen because that's one of my favorite topics. But I'm going to give a quick summary of the research here. One treatment breakthrough is in the area of non invasive invasive brain stimulation that uses magnetic fields. And the other breakthrough is based on targeting a different neurotransmitter in the brain to achieve more effective medication delivery. Both are extremely promising in reducing the symptoms of ocd.
Helen Sneed: Now, something of great significance in the treatment and recovery from ocd, of course, is relationships. I think we all can see now that OCD can be extremely hard on relationships for both sides, the individuals with OCD and the various people in their lives. The debilitating symptoms and behaviors are mystifying, frustrating and intrusive to people who don't have or understand the disorder. For the person suffering from ocd, the repetitive compulsive symptoms can destroy the possibility of friendship or close relationships of any kind. Another obstacle is the shame for having the illness and performing such bizarre behaviors. But nowhere is OCD more disruptive than within the family.
Valerie Milburn: Valerie fortunately, there is an abundance of helpful information available for family members and caregivers of those living with ocd. And one of the best sources of information is one you've already mentioned, Helen, and it is the International OCD foundation website, ocdf.org and that's the international OCD foundation website iocdf.org and I will have that information in our show Notes. There are also many excellent books on ocd. And you know, getting this information. This education is really the best first step for family members and caregivers because education is so powerful. I know that psychoeducation for me has been vital to the recovery from and ongoing management of my mental health condition. Now, in part one, we explore the strategies and skills for family members and caregivers in depth. And a few of those important strategies are to offer support by helping your family member find the right treatment and encouraging that treatment. It's also very important for family members and caregivers to get support and help for themselves. One of the most important things I learned about as I did my research on information for family members and caregivers is something called family accommodation behaviors. Learning to recognize and reduce these family accommodation behaviors is one of the most powerful ways to support someone who is living with ocd. Family accommodation behaviors are things families do that enable OCD symptoms. Research shows that how a family responds to the OCD may help fuel OCD symptoms. And the more the family members can learn about their responses to OCD and the impact they have on the person with ocd, the more the family becomes empowered to make a difference. So learning about these family accommodation behaviors is doing just that, learning about one's response to ocd. And I will have all the information about family accommodation behaviors in our show notes for this episode. And now a final statistic, this one on recovery.
Valerie Milburn: While OCD can be lifelong, the prognosis is better in children and young adults. Among children and young adults, 40% recover entirely by adulthood. And overall, with treatment, as Helen mentioned, 80% of people with OCD have a marked improvement in symptoms. So on that upbeat Note, let's welcome Dr. Fullerton to our conversation. So welcome, Dr. Fullerton. Thank you so much for joining us.
Speaker B: Hi. Thank you so much for having me. This is a treat.
Valerie Milburn: We're so glad you're here. Thank you for sharing your time and your expertise.
Helen Sneed: And listen, we really are so grateful because we have lots of questions.
Valerie Milburn: We do.
Speaker B: I will do my best.
Valerie Milburn: Let's just jump right in. How did you become interested in treating ocd?
Speaker B: Yeah, so my interest really ended up evolving over my training and early career. I was excited about everything, mental health. And being in Houston for my training, I had the opportunity to pursue a really broad range of experiences, pretty much all with the cognitive behavioral approach. So I was set up really nicely for the OCD world. But, yeah, I mean, I worked with adults mostly, though, worked with kids with anxiety, ptsd, medical conditions, neurodevelopmental differences. I mean, I was. I was very privileged to have a lot of opportunities. I didn't know that I was going to end up specializing in OCD until later, but I Really, I really got a sense very early on that I wanted to help people face their fears. I was ready to get in the trenches and help them overcome things that they should never have to be going through and help them tap into their courage. So, yeah, I was on postdoc and was recommended for a psychologist position at the Menager Clinics OCD Clinic. And I jumped at the chance and got the job. And I just. Once you enter the OCD world, it's kind of hard to turn back. So I just fell in love with it.
Helen Sneed: Well, we're so glad that you're doing it. I think that. Well, we kind of talked about this. Many people find OCD difficult to understand. I'm sure you run into this all the time. Have you found an effective to define it to a layman or woman?
Speaker B: Yeah, it. That's a really great question. I mean, you described it beautifully. I think people have a hard time connecting and relating because it is so often a problem that doesn't make sense, like, make sense to someone who doesn't have ocd. And there are. There's so many misconceptions. So I'm usually like, armed and ready to. If I'm having a conversation with ocd, you know, about OCD with some. Somebody to. To clarify what. It's not like you were saying obsessions are unwanted and distressing. They're not preferences, you know, these are not thoughts that someone's having that indicate their true wishes or intentions. They're usually terrifying. It's like a terrifying what if thought. So, you know, what someone might see is hand washing, but it might be really connected to this obsession. What if I get sick or someone might have this obsession? What if I harm somebody if I'm not careful enough? What if I do something inappropriate? That doesn't mean they're actually more likely to do something inappropriate. They're terrified of doing something that would be, you know, inappropriate or wrong in their eyes. So that's. I mean, that's, you know, kind of one of the things is really trying to give examples like this is what it can look like as this cycle is starting to unfold. And then with compulsions like these are rituals that someone feels like they really must do and it's the only way to possibly resolve something or restore a sense of safety or relief, even if it's just for a few seconds. And they probably know that it doesn't make sense and it's not logical. People with OCD can absolutely be very logical and get that there's not a connection between the obsessions and compulsions. Just reasoning doesn't work. So, you know, you can explain why this connection doesn't make sense till you're blue in the face. It doesn't matter. That doesn't help. So I guess, like, sometimes I think, like, okay, this can all be very confusing if you don't understand ocd. But I think most of us understand what it's like to be scared and what it's like to have a really intense fear. So let's say there's somebody with OCD who has an obsessive fear of causing harm to someone they love and they have an intrusive thought and they walk through a doorway, and then they have to repeat that action and maybe repeat a bunch of things in their minds because it's
Speaker B: just so distressing and unbearable. That might not make sense to you. If you don't have ocd, you would probably just like, shake off having that thought. But the OCD suffer, their brain is activated. It's like everything in them feels just as strongly as though, like if you were just kind of watching your loved one in a. In serious danger. So if you were watching somebody in serious danger and all your alarm bells were going off, it might make more sense to you that you would obey some kind of urge to take some kind of action. And, and that's, that's what the OCD sufferer is going through in that, in those moments.
Valerie Milburn: That's a great analogy you just gave for somebody to be able to relate to their whole body being on alert about something. I love that analogy. That, that's really. I mean, I can connect to that. So a question about your practice, just because it'll give us a sense of the, the overall scope, what age range of individuals have you treated and the gender breakdown that you've seen.
Speaker B: I would say that the age range and gender breakdown pretty well matches the prevalence rates. I mean, I've worked with kids as young as three. That's not the most common age, but it happens. And their parents, of course, if there's a three year old, I'm doing a lot of parent work and, you know, on up to, to maybe 70s. So, you know, OCD is an equal opportunity kind of diagnosis. And if somebody is ready for support, I'm here. I would say the gender breakdown is probably close to even, but maybe slightly more females.
Helen Sneed: Well, I am. Okay, here's one of our big questions. Please explain what causes ocd? I'm sure that this is an enormous question, but everyone's so curious about it. You know, how does this happen to people?
Speaker B: Well, I would say it's no one's fault to start off with. OCD is a neurobiological disorder, and that doesn't exactly explain how it happens. But we do know there are. There are neurological differences in brain activation and communication between different brain structures. So there's a, you know, there's a start to understanding it from that framework. And we know there's a genetic component to this. Many individuals with ocd, especially if they are kids, have a family history of ocd, but we also see that the genetics don't explain everything. So there are some other potential causes that are. That are out there. So, for example, children might suddenly develop OCD symptoms as part of a constellation of a sudden onset of problems after a strep or viral infection. And this is incredibly stressful for kids and these families. It's referred to as pandas, which is a mouthful. PANDAS stands for Pediatric autoimmune Neuropsychiatric disorders associated with Streptococcal infections, or pans, if it's not associated with strep. And so I definitely work with kids diagnosed with PANDAS in my practice. And there's more and more research coming out about it, including the medical side of the interventions, like kids getting treated with antibiotics or ivig, other medical treatments. And even if they are getting the autoimmune dysregulation addressed medically, there still might be residual OCD symptoms even past the inflammation episode. And so that's where we come in. The work that I do to treat OCD is not significantly different. Even if PANDAS is responsible for the onset of it.
Helen Sneed: The treatment is pretty much the same, regardless of the cause.
Speaker B: Exactly. There might be some differences, but as far as, like, the. The bulk of it, it's pretty similar. And then, you know, all kinds of people just might have a predisposition. There could be a family history, there could be an anxious temperament. And then sometimes there might be, like, a trauma or a significant stressor. And. And that's what happens right before you see the onset of OCD symptoms. So those are some of the. Some of the causes. I wish we knew exactly why for everybody.
Helen Sneed: Well, you'll know. You'll know someday. And now here. Okay, what. Tell us what symptoms can confirm the diagnosis of ocd? Or maybe I should ask, what do you
Helen Sneed: see that helps you confirm that this is indeed a person with ocd? And does it vary from patient to patient?
Speaker B: Oh, yes, yes, the symptoms can vary quite a lot. I mean, the simplest answer is Are there obsessions and compulsions? If I see obsessions and compulsions, okay, we have OCD and they're impairing and interfering and causing distress. Of course, it is important to keep in mind that compulsions can be mental, sometimes solely mental. And so there have been many people who presented to my practice who have worked with a generalist and, and their OCD was, was missed, you know, thought of as anxiety or something else because, you know, the provider didn't, you know, didn't check, didn't ask or know, you know, the questions to ask to look for patterns like a lot of mental checking or a lot of mental reviewing, mental reassuring, mental replaying. I mean, there's, there's so many things that one can do internally and a lot of times the person struggling with ocd, unless they are in engaging in patterns that are like classic representations of ocd, they might not know they have ocd. They could be engaging in a lot of mental compulsions, but not know that that's how their thoughts are functioning. And so they don't know to report that to the provider. So it, it is, it is important to, to ask the questions and get an understanding of the thoughts. I can usually picture the OCD cycle like the something that triggers the obsessional doubt or fear, and then I'm going to look for a compulsive response to that and I'll know that it's a compulsion also if it provides a little bit of a sense of relief. But there are gold standard assessments to understand and to also get more of a comprehensive look at the different kinds of OCD symptoms that might be present. So the Yale Brown Obsessive Compulsive Scale, and there's a children's version of this, a, a lot of symptoms like, I think 67 items broken down between obsessions and compulsions. So you can see there are, there really are a lot of examples of how this can present. Someone might have one or two or they might have 30, you know, obsessional themes and themes. Yeah.
Valerie Milburn: What other disorders does OCD resemble? And do you see a lot of comorbidity?
Speaker B: It can resemble a lot of different disorders. I think you mentioned some of them. And yes, there is a high amount of comorbidity. So, you know, I guess I'll answer the first question first. What can it resemble? Let's see. So one that is very commonly confused with it is OCPD or Obsessive Compulsive Personality Disorder. So in ocpd, there might be a high level of perfectionism. Usually you're going to see that preoccupation with doing things the right way, maybe some rigidity, but they, someone with OCPD usually sees their behaviors, even if they would be described as ritualistic, they see those as necessary and correct. This is the right way to do things. Whereas someone with ocd, they don't want to, they don't want to do those things. These are rituals that, that, like I said, often don't make a lot of sense. So that's one distinction. But people can confuse like perfectionism and think that it's always going in the OCD bucket. And you also see a kind of rigidity and different behavior patterns with autism. And so, you know, you're probably with. Individuals on the spectrum might see like inflexibility and maybe strong preferences for sameness. Also. This is. There's also like a high comorbidity rate between OCD and autism. So there could be both in this case. But, but you know, it. There is a difference between someone who is, you know, neurodivergent, who is engaging in some behaviors that a neurotypical person would find to be unusual, and if, but if they're functional and they seem necessary to the autistic person, then we don't want to mislabel those patterns as, as OCD if they don't also match the obsession and compulsion cycle. And another common one that's confused with it is, well, all kinds of anxiety disorders, but generalized anxiety disorder. So, so with generalized anxiety disorder, there, there tends to be a lot of worrying, a lot of kind of diffuse, broad content worrying about everyday matters.
Speaker B: And, and there's a lot of variety. Everyday stressors. That's not usually what it looks like with ocd. You can, like there are those, those, those items and subtypes and they tend to fall within those themes. So that's one way to distinguish between, between those things. And not to mention, like, if you have ocd, there's, there also might be a higher risk for other obsessive compulsive spectrum disorders. And I listed some. There's more like impulse control disorder, commonly comorbid. Mood disorders are commonly comorbid. You're at a higher risk for other things basically if you have ocd.
Helen Sneed: Okay, well that's, oh, that's, that's a, that's a whole lot of trouble for someone, you know, trying to deal with all that all sort through all of them, you know, the strands. You're going to know all about treatment methods. Can you just give us some ideas of some. That you have found to be the most, you know, efficacious and what they might be.
Speaker B: Yes. So, and I, you know, I tend to focus on the psychology world, the therapy, because that's what I do. So. But, but I'm proud to say that cbt, cognitive behavioral therapy, including exposure and response prevention, is the gold standard. And that's even when it's compared with medication. Of course, both are often recommended, particularly if OCD is in the moderate to severe range. So that might look like someone working with a psychologist to engage in ERP work, also maybe working with psychiatry to take medication. Usually it's an SSRI is the first line medication intervention for ocd. So I, you, you described ERP a bit. I can describe a little bit more about what it looks like, what the E and the R really look like. Okay, yeah. So with the exposure part, this is in a planned, deliberate and repeated way, facing your fears head on. So it starts with identifying things that might trigger the obsessional fear or distress, disgust, whatever the emotion is. But, but in a way, starting with ways that always feel manageable, this is not a fear factor. No one's going to make anybody do something they're not ready to do in treatment, but making plans to choose to approach things that might otherwise be avoided or feel scary. And sometimes we get creat to contrive examples just to make it more palatable. And so there's this plan to start approaching something that's fearful. So for example, if someone has dirt contamination anxiety, there might be a plan to gradually approach things that they might consider dirty, like picking something, like picking a wrapper up off of the floor. If they considered the floor to be dirty, and let's say they had a, a compulsion that they normally engaged in, which is to wipe off their hands or sanitize their hands or wash their hands. This is where the response prevention comes in. So rather than planning to do those things, it's the exposure experience would involve resisting the urge to hand wash, Letting that distress, that discomfort associated with touching something that had touched the floor, be there, ride that wave. And what people will generally experience is a reduction in that distress. And that's what we want to see, is that people learning over time how to, you know, how, how to regulate, how to cope, how to get through it without having to perform that compulsion because it, what comes up must come down. Anxiety is not going to last forever. And there might be some expectations that this is going to be like the end of everything. If I don't perform the compulsions, you don't get A chance to violate that expectation if you just always do the compulsions. Right. So ERP allows a person a chance to learn a different way and, you know, form new pathways and live by their values instead of what their fear is telling them they must do. So. Yeah. So evidence shows ERP is an effective treatment for ocd. It's not always easy, so sometimes we bring in other techniques to support the acceptability of it and the chance of success. I don't know if you guys are familiar with acceptance and commitment therapy, but taking SO one. One process or component that's emphasized a lot in ACT or Acceptance and Commitment therapy are values. So before we're going to get into this hard work of approaching things that feel really scary, you want to connect with why it matters, like, how are you going to. How is this going to help you? What's the purpose of this? We're not just going to do things that are scary for no
Speaker B: reason, but there must be some meaning in this for you because you're here and you've been suffering. So. So what's. Where's the why? I guess essentially, basically. And then learning to. The acceptance part is learning to accept and be open to internal experiences. And the more someone can learn to better manage what they're experiencing internally, they can respond more. More skillfully, like when it shows up, so they can live the life that they ultimately want to live. So that's the. The nuts and bolts of the ERP thing. The ERP isn't the only answer. There are. There are more developments and treatments being researched. One that I'm very passionate about is space or supportive parenting for anxious childhood emotions. And this is a treatment developed by Ellie Lebowitz at the Yale Child Study Center. And the. This treatment is very different in that it's focused on supporting kids and adolescents with ocd, but through the parents. So the intervention, while the child or the adolescent is my client, essentially I'm working with the parents to change their behavior. And this is all about addressing, increasing family support and addressing that kind of problematic pattern you mentioned, Helen, with family accommodation. And it's just really lovely to see that when a young person is not ready to engage in therapy, or maybe they are, but. But there's more that can be done with the family, that there is an alternative. Family members can still help their loved ones. Even if, let's say, you have a teen or something who's really not up for engaging in treatment. I think we know that it can be like that.
Helen Sneed: Yes.
Valerie Milburn: Yes. Well, I'm so glad you brought that up. I did not know about space and I'm glad you shared that with us. Is there any other breakthrough that is that I didn't bring up that's on the horizon?
Speaker B: So another psychological intervention is inference based cbt. This is taking more of a cognitive approach. There are some promising studies that are already out there and I think they're currently undergoing a randomized control trial to compare it with erp. But again, it's a. But it's a viable alternative. It's not first line, but it might end up there. It's a viable alternative if someone's not ready to engage in the exposure and response prevention work.
Helen Sneed: These are exciting times. So exciting with all this treatment. It's so helpful. All that you have told us is just broadening everyone that's listening to you, everyone that can hear you's perspective on this very baffling illness. So what does recovery look like for a person who's, who's been fighting OCD and, and is, you know, what, what, what can, what recovery, I guess, could a person work towards or enjoy?
Speaker B: Of course. Well, I think people can look forward to getting their lives back because with proper treatment, someone with OCD can absolutely lead a full and productive life. OCD can be overcome because the ways to overcome it are usually not intuitive. That's why I emphasize the proper treatment part. And, and that usually involves finding an OCD specialist. But I, you know, I tell people when, you know, they're maybe first coming to me and first getting diagnosed and so scared and don't know what to do with their, their brains that have been giving them such a hard time. And I say, hey, I've been, I've been doing this for a while at this point and I'm pretty sure I would have burned out a long time ago if this treatment wasn't so effective. We, we know what works and of course we need to learn how to help more and more people. But there is absolutely hope and, and treatment for OCD can be pretty time limited. Some of the, some of the protocols, not that I think people always fall into the boxes that they're in, in research studies, but some of the protocols are like a 12 to 15 week, you know, duration of treatment. And I see, I see a range. There are people who present for treatment and that is absolutely attainable. That like significant change can be accomplished in that amount of time. And then the more complex things are, we might need more time than that.
Valerie Milburn: That, yeah, that, that's fast. That's a lovely thought that you can accomplish a lot in 12 to 15 weeks and you believe a lot can be accomplished that fast. So you've mentioned a lot of things that families and caregivers can do to help support their loved one. Is there anything that you advise
Valerie Milburn: against for family members and caregivers?
Speaker B: I agree with everything you said in the beginning, especially the get educated part and your introduction to family accommodation and the importance of addressing that. One way I will describe an accommodation to someone is what's something that you do for your family member with OCD that you wouldn't otherwise do. Whether that's participating directly in a ritual with them or modifying what you do, not going to restaurants and anymore or things like that. So I will say though that sometimes people. Very well intentioned. I love that people are reading and learning about OCD and family accommodation but sometimes that leads to kind of like a sudden change that maybe parents want to make without giving warning to the person with OCD and without thinking it's through. And there are, are obviously going to be risks associated with that approach just like any kind of big sudden change. So I mean of course like it is, it is better to change and reduce high levels of family accommodation but that's where treatment comes in. So there's the space approach and there are reading materials and also space providers to support family members with that and then a more recent similar approach that might be a better fit. The OCD sufferer is an adult is Dr. Alec Pollard's family well being approach. And it has a similar mindset around holding boundaries and reducing accommodations in a very loving and supportive way. And that's the important part. It needs to be in a loving and supportive way.
Valerie Milburn: Right. I'll put that book in our show notes as well.
Helen Sneed: Yeah, do I might put it in my library right away. Now I guess, you know we're called Mental health Hope and recovery. So we always want to sort of have the, the, the ultimate question be what makes you hopeful for people who are fighting OCD today? You've, you've touched on some things but, but and you say probably if there wasn't hope you wouldn't still be doing this. But what, what makes you hopeful for the future of someone that's got it?
Speaker B: I would say, gosh. I mean, so I mean the fact that there are so many specialists now, I mean we always need more. But there are, there is so much awareness about OCD and treatment. There is still a, a good way to go to, I think further improve awareness about OCD in the sense of community around it. You mentioned IOCDF as a terrific resource, and I wholeheartedly agree. I can't not go to the IOCDF Annual conference. Even when I consider not going, I go. And it's like every summer. And it's so beautiful because not only is there a professional track, there's a community track. And getting to see adults with ocd, kids with ocd, all these people, people come together and have a sense of community around it. I mean, that's only going to help, right? And sharing and networking and, you know, social media. There's. There are plenty of problems with social media, but there are good people on social media putting out content that, that helps inform others. And, and sometimes that might be a person's only opportunity to, you know, to see this kind of information. And, and I will say one. One indicator of hope beyond the. The. Some of the other things that we've been talking about is that we are seeing a slow trend, a slow reduction in the delay to getting diagnosed with ocd. So a few years ago, we used to say it's 12 to 15 years from onset to diagnosis, which is a really long time to be suffering with it. Now it might be seven to nine years. We would really like to see that delay shrink, but it is trending in that direction, and I think that's an indication of hope.
Valerie Milburn: That's very.
Helen Sneed: Yeah, very, very exciting to hear you and, well, to hear everything that you've had to say. This has just been just an embarrassment of riches. This afternoon to have you with us. With those optimistic words, we will bring our topic to a close. Having learned so much today from Dr. Jenny Fullerton, we've now concluded our extensive investigation of OCD Part 2. Due to Dr. Fullerton's remarkable body of knowledge and experience and her ability to articulate it so clearly, we all come away with a much
Helen Sneed: much deeper comprehension of the disorder. She has invaluable contributions to our chief goals for this episode. Fostering understanding, compassion, and hope for those struggling with ocd. Today, on behalf of them and those who love and care for them, we offer our boundless gratitude to Dr. Fullerton and Valerie. Now, would you please guide us in a mindfulness exercise?
Valerie Milburn: Yes, I will. We will close today's episode in our traditional way with a mindfulness exercise. What is mindfulness? I always give a definition. Mindfulness is a mental state achieved by focusing one's awareness on the present moment while calmly acknowledging and accepting one's feelings, thoughts, and bodily sensations without judgment. You know, research shows that practicing mindfulness increases our ability to focus and concentrate when we are mindful. We are focusing and concentrating on the current moment. And this increases our overall ability to focus and concentrate. So let's do it. Let's get mindful. Close your eyes if you can. If you're walking or driving, please adapt this exercise in a way that it's safe for your surroundings. Let's settle in and breathe as always. Let's begin with a few diaphragmatic breaths. When I do this on my own to start my mindfulness and meditation practice, I take 10 diaphragmatic breaths. Whether your eyes are opened or closed, let's steady our breathing. Let's breathe. Inhale through your nose, expanding an imaginary balloon in your stomach as you inhale. Exhale through your mouth, pulling your stomach in as you do so. Forcefully exhale again. Inhale through your nose, expanding that imaginary balloon in your stomach as you do so. Drop your shoulders. Exhale through your mouth, pulling in your stomach, exhaling forcefully. Keep this slow, steady breath going. Imagine that you are in your bed, just waking after a long, restful sleep. Visualize your room. Notice what the sunlight is like, or perhaps there are small lights on somewhere. Just focus completely on the light in the room. As you are waking, visualize getting out of bed and going about your normal morning routine. Focus completely on what you are doing. What are you holding? What are your movements? Concentrate only on the current task. Take in your surroundings. What room are you in? What can you see? Keep going through your morning routine. Focus completely. Concentrate. Be intensely in the moment of what you are doing now. Think about going through the rest of your day focusing on everything you were doing in the moment you were doing it. How would a day like this feel? Now? Think of one thing in your day ahead. Maybe it's something challenging. Maybe it's something joyful.
Valerie Milburn: joyful. Think of one thing in your day ahead. Commit to doing this one thing mindfully. If your eyes are closed, please open them and gently bring yourself back to the room. Thank you for doing this mindfulness exercise with me.
Helen Sneed: Oh, thank you, Valerie. That was great. As always, as we bring the episode to a close, we want to extend again our deepest gratitude to mel in episode 45 and Dr. Ginny Fullerton in episode 46 for taking us on the extensive journey to understanding OCD. And thanks to all of our listeners around the world for traveling with us. In our next episode, Valerie and I are making a full investigation into the multi layered deep relationships among family members, caregivers and loved ones, and the individual fighting psychiatric illnesses. We'll have a roster of guests from various backgrounds they will represent numerous perspectives. Perspectives, diverse insights and life challenging events experienced within the private community of relationships surrounding mental health survival. So please join us for this powerful two part episode. Until then, I leave you with our favorite word. Onward.