OCD: The Reality, the Research, the Recovery—Part Two

[00:00:01] The following podcast is part of the Mind Body Spirit.fm podcast network.

[00:01:10] Helen and I are your peers. We're not doctors, therapists or social workers.

[00:01:15] We're not professionals but we are experts.

[00:01:18] We are experts in our own lived experience with multiple mental health diagnoses and symptoms.

[00:01:25] Please join us on our journey.

[00:01:28] We live in recovery. So can you?

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[00:01:35] The information presented is not intended to be a substitute for or relied upon as medical advice, diagnosis or treatment.

[00:01:43] The podcast is for informational purposes only.

[00:01:46] Always seek the advice of your position or other qualified health providers with any health-related questions you may have.

[00:01:56] Well, Helen, let's begin our second episode on Obsessive Compulsive Disorder.

[00:02:02] You know, OCD is one of the few illnesses neither one of us has had.

[00:02:08] And it's proved to be one of the most complex.

[00:02:11] We learned so much in part one from our guest, mel, a true expert on OCD.

[00:02:18] Her expertise is based on her own heroic battle to overcome OCD.

[00:02:24] A battle that began in her childhood and lasted until adulthood.

[00:02:29] She now lives a life in recovery with OCD.

[00:02:33] Now to get a full picture of OCD, we urge our listeners to tune in to episode 45 part one of this topic.

[00:02:44] Valerie, you're right. There is so much to learn about OCD.

[00:02:48] 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.

[00:02:58] And so one of the things we had tried to do is legitimize this illness

[00:03:02] to provide to promote wide understanding and empathy for those who have it.

[00:03:08] I often hear someone say, Oh, I have a touch of OCD.

[00:03:13] No, they don't.

[00:03:15] People who don't understand it can trivialize it without meaning to.

[00:03:19] When in fact, it's a very serious and debilitating illness.

[00:03:24] As JJ Keyler said, OCD is not a disease that bothers.

[00:03:29] It is a disease that torments.

[00:03:32] So today we are so fortunate to have a professional expert to guide us through these many aspects of OCD.

[00:03:39] Yes, we are so fortunate to have a wonderful guest on today's episode.

[00:03:46] In part one, Mel joined us to give us the peer perspective as she shared her lived experience with OCD.

[00:03:53] And today, Dr. Jenny Fullerton will be joining us to give us the professional perspective.

[00:03:59] Let me introduce you to Dr. Fullerton.

[00:04:02] Jenny Fullerton, PhD founded Capital OCD and anxiety practice in 2016.

[00:04:09] After nearly a decade of specialized clinical experience,

[00:04:14] Dr. Fullerton earned her master's degree in PhD in clinical psychology at the University of Houston following her residency

[00:04:21] at the Johns Hopkins University School of Medicine with her early career experience at Baylor College of Medicine,

[00:04:28] the Meninger OCD Clinic and the McClain OCD Institute.

[00:04:33] She developed expertise with OCD and anxiety across all ages and levels of care.

[00:04:40] Dr. Fullerton is a clinical associate professor in the Department of Psychology and Education

[00:04:45] Psychology at the University of Texas at Austin.

[00:04:49] Dr. Fullerton serves on the board of OCD Texas.

[00:04:53] She is committed to broadening awareness of treatments that work.

[00:04:57] She will be joining us shortly bringing us the professional perspective.

[00:05:03] We are so fortunate to have her.

[00:05:06] To begin with, what is OCD?

[00:05:10] The National Institute of Mental Health says, OCD is often a long-lasting disorder in which a person has uncontrollable, reoccurring thoughts, obsessions

[00:05:21] and behaviors, compulsions that he or she feels the urge to repeat over and over.

[00:05:28] The basic formula is deceptively simple, obsessive thoughts, obsessions lead to repetitive behaviors, compulsions.

[00:05:38] What are the symptoms of OCD?

[00:05:41] The onset of symptoms begins gradually and varies throughout life.

[00:05:45] Usually, it begins in teen or young adult years if sometimes in childhood.

[00:05:51] The International OCD Foundation defines what is necessary for a diagnosis of obsessive compulsive disorder.

[00:05:59] They stay. A cycle of obsessions and compulsions must be so extreme that it consumes a lot of time more than an hour every day.

[00:06:09] Causes intense distress or gets in the way of important activities that the person values.

[00:06:16] First, there are obsessions symptoms.

[00:06:19] Obsessions are thoughts, images or impulses that occur over and over again and feel outside of a person's control.

[00:06:29] Individuals with OCD do not want to have these thoughts and find them disturbing.

[00:06:34] In most cases, people with OCD realize that these thoughts are illogical.

[00:06:40] Obsessions are typically accompanied by intense and uncomfortable feelings, such as fear, disgust, uncertainty and doubt.

[00:06:49] Or a feeling that things have to be done in a way that is just right.

[00:06:54] In the context of OCD, these intrusive thoughts come frequently and trigger extreme anxiety that gets in the way of day to day functioning.

[00:07:04] Here are some common obsessions symptoms in OCD.

[00:07:10] Contamination of sessions such as fear of coming into contact with perceived contaminated things, people, dirt, violent obsessions.

[00:07:20] Fear of acting on an impulse to harm oneself or others.

[00:07:24] Excessive concern with violent or horrific images in the mind.

[00:07:29] Responsibility obsessions.

[00:07:31] Fear of being responsible for something terrible happening your fire or car wreck.

[00:07:36] Forgetting to lock the door or turn off the stove.

[00:07:40] Profectionism related obsessions.

[00:07:42] Excessive concern with performing tasks perfectly or correctly.

[00:07:46] And a fear of making mistakes.

[00:07:49] Sexual obsessions.

[00:07:51] Unwanted thoughts or images related to sex, such as fears of acting on an inappropriate sex-related impulse or of aggressive sexual behavior.

[00:08:02] Religious and moral obsessions.

[00:08:05] Fear of offending God or damnation.

[00:08:08] An excessive concern with right and wrong.

[00:08:12] Identity obsessions.

[00:08:13] Such as excessive concern with one sexual orientation or gender identity.

[00:08:19] And there are others relationship related obsessions of sessions about death and existence.

[00:08:26] Now, number two are compulsion symptoms.

[00:08:31] Compulsions are repetitive behaviors or thoughts that a person uses with the intention of neutralizing, counteracting, or making their obsessions go away.

[00:08:41] People with OCD realize this is only a temporary solution.

[00:08:45] But without a better way to cope, they rely on compulsions nonetheless.

[00:08:50] Compulsions can also include avoiding situations that trigger obsessions.

[00:08:56] Compulsions often can be beyond reason and often don't relate to the issue they're intended to fix.

[00:09:03] Now here are some common compulsions symptoms in OCD.

[00:09:07] Washing and cleaning.

[00:09:09] Excessive hand washing sometimes until the hands are raw, refusing to shake hands because it will trigger more obsessive thoughts.

[00:09:17] Checking.

[00:09:18] Checking that nothing terrible happened or that the person was the cause or made a mistake.

[00:09:24] Checking the door or stove, unable to stop for hours and sometimes even unable to leave the house.

[00:09:31] Repeating.

[00:09:32] Repeating routine activities such as going in and out doors, getting up and down from chairs.

[00:09:38] Body movements such as tapping, touching, blinking.

[00:09:42] Activities in multiple such as three times because three is a good number.

[00:09:48] Mental compulsions.

[00:09:50] Praying to prevent harm.

[00:09:52] Counting such as the number of slats and the blinds or tiles on the floor.

[00:09:56] And there are other compulsions, putting things in order.

[00:09:59] Telling, asking or confessing to get reassurance.

[00:10:05] And most significant suicidal ideation or behavior when compulsive actions don't delay the extreme torment or fear.

[00:10:15] 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.

[00:10:26] Here's her quote.

[00:10:28] 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.

[00:10:39] They are such things as thinking loops, remanating, mentally reviewing past events or conversations in my new detail down to the last syllable.

[00:10:50] Or reassuring myself constantly, praying excessively, etc.

[00:10:55] And I think it's important to share that quote from Mel and give listeners some examples of this type of OCD.

[00:11:02] As the checking locks and contamination OCD often gets all the attention.

[00:11:07] When in fact, these types of internal obsessions are common and less understood.

[00:11:15] Well, I appreciate you're bringing that up because again, it's just a misconception that we're trying to correct today.

[00:11:23] The severity of these symptoms that we're talking about varies over a lifetime.

[00:11:30] Obsessive thoughts and compulsions can also vary over time.

[00:11:36] Symptoms get worse when under greater stress, times of transition, change, loss, trauma or physiological changes such as fluctuations in hormones.

[00:11:47] At their most severe symptoms are extremely disabling or even life threatening.

[00:11:54] What are the causes of OCD?

[00:11:57] First, there's biology, changes in chemistry or burning functions, genetics.

[00:12:04] No specific gene, of course, but there may be a genetic cause for a predisposition for OCD that runs in families.

[00:12:13] And learning OCD can be learned from watching a family member who has it.

[00:12:20] What are the risk factors?

[00:12:22] Family history, stressful life events and other mental health disorders which I want to explain because it can be extremely difficult to diagnose OCD.

[00:12:33] The symptoms can be similar to a number of other illnesses such as anxiety, depression, schizophrenia, Tourette syndrome.

[00:12:41] There is much comorbidity also, you know, dual diagnosis with substance use and other psychiatric illnesses.

[00:12:56] Now for some statistics on OCD, first prevalence in the United States about 1.2 of adults experience OCD symptoms in a given year.

[00:13:05] And 2.3% experience it at some point in their lives.

[00:13:11] That's over 5 million Americans or approximately 1 in 40 adults.

[00:13:17] OCD affects females at 3.5 times the rate it affects males.

[00:13:24] The International OCD Foundation estimates that 1 in 200 children and teens in the US, or about 500,000 youth, have OCD.

[00:13:35] 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.

[00:13:46] Now Helen here's a statistic that you and I both found startling.

[00:13:52] OCD is considered one of the top 10 leading causes of disability and that's including medical and psychiatric conditions.

[00:14:03] I really didn't see that one coming.

[00:14:07] It's a great surprise to me, but here's the thing about treatment of OCD.

[00:14:13] 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.

[00:14:25] Treatment can diminish symptoms so they don't rule a person's life.

[00:14:28] In OCD part 1 we cover treatment methods in detail, so please visit episode 45 for our full coverage of these critical healing approaches.

[00:14:39] Now the therapeutic relationship is key to treating OCD.

[00:14:44] Top therapy, including cognitive behavioral therapy, and medication, or both, are most frequently recommended.

[00:14:53] The goal standard of treatment is exposure and response prevention, ERP.

[00:15:00] It's a form of cognitive behavioral therapy that gradually exposes people to their fears and prevents compulsive behaviors.

[00:15:09] Now this leads to the most interesting aspect of OCD treatment that I've come across for many people with OCD.

[00:15:18] 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.

[00:15:29] This is predicated on the understanding that actions are easier to curtail than thoughts.

[00:15:35] The performing the compulsion's not only doesn't provide much relief, but the repetitive actions can actually make the obsessive thoughts more powerful and more embedded in the brain.

[00:15:47] The person learns to tolerate the unceasing thoughts and to focus not on thinking but on behavior.

[00:15:54] And as the compulsive behaviors less and so does their impact on the brain.

[00:15:59] Typically the thoughts diminish over time.

[00:16:02] Other methods include education, medication skills, group therapy and a host of other possibilities all in episode 45.

[00:16:13] So a bit on medication for some people as you said, a combination of cognitive behavioral therapy and medication is the most effective treatment.

[00:16:23] Now anti depressants are often the first medications prescribed for OCD.

[00:16:27] And that doesn't mean necessarily that depression is present.

[00:16:31] It's just that anti depressants are often an effective treatment for OCD.

[00:16:37] An anti anxiety drug is sometimes used to treat OCD as well.

[00:16:43] Now I get to talk about breakthroughs, you know, this treatment breakthrough topic is one of my favorite.

[00:16:49] 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.

[00:17:00] 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.

[00:17:08] One treatment breakthrough is in the area of non-invasive brain stimulation that uses magnetic fields.

[00:17:14] And the other breakthrough is based on targeting a different neurotransmitter in the brain to achieve more effective medication delivery.

[00:17:24] Both are extremely promising in reducing the symptoms of OCD.

[00:17:32] Now something of great significance in the treatment and treatment and recovery from OCD, of course, is relationships.

[00:17:40] I think we all can see now that OCD can be extremely hard on relationships.

[00:17:45] For both sides, the individuals with OCD and the various people in their lives.

[00:17:51] The debilitating symptoms and behaviors are mystifying, frustrating, and intrusive to people who don't have or understand the disorder.

[00:18:00] And for the person suffering from OCD, the repetitive, compulsive symptoms can destroy the possibility of friendship or close relationships of any kind.

[00:18:10] Another obstacle is the shame for having the illness and performing such bizarre behaviors.

[00:18:17] But nowhere is OCD more disruptive than within the family.

[00:18:21] Valerie?

[00:18:23] Fortunately, there is an abundance of helpful information available for family members and caregivers of those living with OCD.

[00:18:30] And one of the best sources of information is when you've already mentioned Helen, and it is the International OCD Foundation website.

[00:18:40] IOCDF.org, and that's the International OCD Foundation website, IOCDF.org, and I will have that information in our show notes.

[00:18:50] There are also many excellent books on OCD, and getting this information, this education is really the best first step for family members and caregivers,

[00:19:01] because education is so powerful. I know that psycho education for me has been vital to the recovery from and ongoing management of my mental health condition.

[00:19:14] 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.

[00:19:30] It's also very important for family members and caregivers to get support and help for themselves.

[00:19:40] And 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.

[00:19:49] Learning to recognize and reduce these family accommodation behaviors is one of the most powerful ways to support someone who is living with OCD.

[00:19:59] Family accommodation behaviors are things families do that enable OCD symptoms.

[00:20:05] Research shows that how a family response to the OCD may help fuel OCD symptoms and the more the family members can learn about their responses to OCD.

[00:20:17] And the impact they have on the person with OCD, the more the family becomes empowered to make a difference.

[00:20:23] So learning about these family accommodation behaviors is doing just that learning about one's response to OCD.

[00:20:31] And I will have all the information about family accommodation behaviors in our show notes for this episode.

[00:20:40] And now a final statistic, this one on recovery.

[00:20:44] While OCD can be lifelong, the prognosis is better in children and young adults among children and young adults 40% recover entirely by adulthood.

[00:20:58] And overall with treatment as Helen mentioned 80% of people with OCD have a marked improvement in symptoms.

[00:21:07] So on that upbeat note, let's welcome Dr. Fullerton to our conversation. So welcome Dr. Fullerton. Thank you so much for joining us.

[00:21:18] Hi, thank you so much for having me. This is a treat.

[00:21:22] We're so glad you're here.

[00:21:24] Thank you for sharing your time and your expertise and let's read we really are so grateful because we have lots of questions.

[00:21:31] And we do and I've been the best. Let's just jump right in. How did you become interested in treating OCD?

[00:21:39] Yeah, so my interest really ended up evolving over my training and early career.

[00:21:45] I was excited about everything mental health and being in Houston for my training.

[00:21:50] I had the opportunity to pursue a really broad range of experiences pretty much all with the cognitive behavioral approach.

[00:21:56] So I was set up really nicely for the OCD world. But yeah, I mean, I worked with adults mostly though work with kids with anxiety PTSD medical conditions, neuro developmental differences. I mean, I was very privileged to have a lot of opportunities.

[00:22:12] I didn't know that I was going to end up specializing in OCD until later.

[00:22:19] But I really, I really got a sense very early on that I wanted to help people face their fears.

[00:22:25] 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.

[00:22:34] So yeah, I was on postdoc and was recommended for a psychologist position at the Menagre clinic, OCD clinic.

[00:22:43] And I jumped at the chance and got the job and I just want to enter the OCD world. It's kind of hard to turn back. So I just fell in love with it.

[00:22:54] Well, we're so glad that you're doing it.

[00:22:57] 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.

[00:23:07] Is there have you found an effective way to define it to a layman or woman?

[00:23:14] Yeah, it's a really great question. I mean, you described it beautifully.

[00:23:18] 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.

[00:23:32] And there are so many misconceptions. So I'm usually like armed and ready to if I'm having a conversation with OCD about OCD with somebody

[00:23:42] to clarify what it's not, like you were saying, obsessions are unwanted and distressing. They're not preferences.

[00:23:51] You know, these are not thoughts that someone's having that indicate their true wishes or intentions, but usually terrifying. It's like a terrifying what if thought.

[00:24:01] So, you know, what someone might see is hand washing, but it might be really connected to this obsession. What if I get sick?

[00:24:10] Or someone might have this obsession, what if I could harm somebody, if I'm not careful enough? What if I do something inappropriate?

[00:24:17] That doesn't mean they're actually more likely to do something inappropriate. They're terrified of doing something that would be inappropriate or wrong in their eyes.

[00:24:25] So that's, I mean, that's kind of one of the things is really trying to give you examples like this is what it can look like as this cycle is starting to unfold.

[00:24:36] And then with compulsions, 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.

[00:24:48] 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.

[00:25:05] So, you know, you can explain why this connection doesn't make sense till you're blowing the face. It doesn't, it doesn't matter that doesn't, that doesn't help.

[00:25:13] 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.

[00:25:28] 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 just so distressing and unbearable.

[00:25:45] 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 stuff for their brain is activated it's like everything in in in them feels just as strongly as though like if you were just kind of watching your loved one in a serious danger.

[00:26:05] 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.

[00:26:18] And that's what the OCD stuff for us going through in those moments.

[00:26:22] 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's really, I mean I can connect to that.

[00:26:37] So, question about your practice just because it'll give us a sense of the overall scope.

[00:26:43] What age range of individuals have you treated and the gender breakdown that you've seen?

[00:26:49] I would say that the age range is an end gender breakdown pretty well matches the prevalence rates.

[00:26:59] I mean, I've worked with kids as young as three, not the most common age but it happens and their parents of course if there's a three year old and doing a lot of parent work.

[00:27:11] And you know, on up to maybe 70s so you know OCD is an equal opportunity kind of diagnosis and if somebody is ready for support I'm here.

[00:27:26] I would say the gender breakdown is probably close to even but maybe slightly more females.

[00:27:35] Well, I am okay here's one of our big questions please explain what causes OCD.

[00:27:43] I'm not sure that this is a enormous question but everyone so curious about it you know that has just happened to people.

[00:27:51] While it's say it's no one's fault to start off with.

[00:27:56] OCD is a neurobiological disorder and that doesn't exactly explain how it you know how it happens but we do know there are there are neurological differences in brain activation and communication between different brain structures.

[00:28:12] So there's a you know there's a start to understanding it from that framework.

[00:28:16] 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.

[00:28:30] So there are some other potential causes that are out there so for example children might suddenly develop OCD symptoms.

[00:28:42] As part of a constellation of a certain onset of problems after a strep or viral infection and this is incredibly stressful kids and these families.

[00:28:52] It's referred to as pandas which is a mouthful pandas stands for pediatric autoimmune neuropsychiatric disorders associated with strep to cochocal infections or pan if it's not associated with strep.

[00:29:08] And and so I definitely work with 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.

[00:29:22] Like kids getting treated with antibiotics or IVIG met you know other medical treatments and even if they are getting the autoimmune dysregulation.

[00:29:35] And a dressed medically there still might be residual OCD symptoms even past the inflammation episode and so that's where we come in though the work that I do to treat OCD is not significantly different even if pandas is responsible for the onset of it.

[00:29:56] And then treatment is pretty much the same regardless of the cause exactly exactly there might be some differences but as far as like the bulk of it it's pretty similar.

[00:30:09] 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 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 may new exactly why for everybody.

[00:30:30] Well you'll know you'll know someday and now here okay what tell us what symptoms can confirm the diagnosis of OCD maybe I should ask what do you see that helps you confirm that this is indeed up a person with with OCD and does it very from patient to patient.

[00:30:53] 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.

[00:31:07] You know okay we have OCD and they're imparing and interfering causing distress of course.

[00:31:14] 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 you know have worked with the generalist and and their OCD was was missed you know thought of as anxiety or something else.

[00:31:35] Because you know the provider didn't you know didn't check didn't ask or no you know the questions to ask to look for patterns like a lot of mental checking or a lot of mental refueing mental reassuring mental we're playing I mean there's.

[00:31:50] There's so many things that one can do internally and a lot of times the person struggling with OCD and unless they are 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.

[00:32:09] And so they don't know to report that to the provider so it is important to ask the questions and get an understanding of the thoughts I can usually picture the OCD cycle like the something that triggers the obsession all.

[00:32:27] And then I'm going to look for a compulsive response to that and 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.

[00:32:42] And I 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.

[00:32:54] A lot of some like I think 67 items broken down between obsessions and compulsion so you can see there are there really a lot of examples of how this can present someone might have one or two or they might have 30.

[00:33:09] You know, obsessional themes.

[00:33:16] What other disorders does OCD resemble and do you see a lot of comorbidity.

[00:33:25] A can resemble a lot of different disorders I think you mentioned some of them and yes there is a high amount of comorbidity so.

[00:33:37] You know I guess I'll I'll answer the first question first what can it resemble.

[00:33:43] It's let's see so one that is very commonly confused with it is OCD or obsessive compulsive personality disorder.

[00:33:52] So in OCD 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.

[00:34:04] But they someone with OCD PD usually sees their behaviors even if they would be described as ritualistic they see those as like necessary and correct like this is the right way to do things.

[00:34:16] Where someone with OCD they don't want to you know they don't want to do those things these are these are rituals that like I said often don't don't make a lot of sense so that's one distinction but people can confuse like perfectionism and think that it's always.

[00:34:31] Going in the OCD bucket.

[00:34:36] And you also see kind of rigidity and different behavior patterns with autism and so you know you're probably but with individuals on this spectrum might see like inflexibility and maybe strong preferences for sayingness also this is there's also like a high comorbidity rate which mean OCD and autism so there could be both.

[00:34:58] In this case but you know if there is a difference between someone who is you know neurodivergent who's engaging in some behaviors that are neurodethical person would find to be unusual and if but if they're functional and they've seen necessary to the autistic person then we don't want to mislabel those patterns as.

[00:35:19] As a CD if they don't also match the obsession and compulsion cycle.

[00:35:26] And another common one that's confused with it is well all kinds of things I did disorders but generalized things I did disorder so with generalizing anxiety disorder there there tends to be a lot of worrying a lot of kind of diffuse broad content worrying about everyday matters.

[00:35:43] And there's a lot of variety everyday stressors that's not usually what it looks like with those CD you can like they're those those items and subtypes and they tend to fall within those.

[00:35:55] So that's one way to distinguish between between those things and not to mention like if you have a CD 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 to more.

[00:36:11] Probably come more than mood disorders or commonly come orbit you're at a heris for other things basically if you have a CD.

[00:36:19] Okay, well that's.

[00:36:22] Oh that's that's a that's a whole lot of trouble for someone you know trying to deal with all the 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.

[00:36:38] Yes, so and I you know I tend to focus on the psychology world that therapy because that's what I do.

[00:36:48] So but I'm proud to say that CBT, cognitive behavioral therapy including exposure in response prevention is the gold standard and that's even when it's compared with with medication of course both are often recommended particularly if.

[00:37:06] OCD is in the moderate to severe range so that might look like someone working with the psychologist to engage in ERP work.

[00:37:18] Also, maybe working with psychiatry to take medication usually it's an SSRI is the first line medication intervention for OCD.

[00:37:29] 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 arm really look like.

[00:37:39] 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.

[00:37:57] Discuss whatever the emotion is but but in a way starting with ways that always feel manageable this is not fear factor.

[00:38:07] No one's going to make anybody do something they're not ready to do in treatment.

[00:38:11] But making plans to choose to approach things that might otherwise be avoided or feel scary and sometimes we get creative to contrive examples just to make it more palatable.

[00:38:23] And and so there's these this plan just started approaching something that's fearful so for example if someone is has like dirt contamination anxiety.

[00:38:34] There might be a plan to gradually approach things that they might consider dirty like picking something like picking a wrapper above of the floor if they considered the floor to be dirty and let's say they had.

[00:38:46] Compulsion that they normally engage in which is to wipe off their hands or sanitizer hands or wash their hands.

[00:38:53] 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 to hand wash letting that distress that discomfort associated with touching something that had touched the floor be there right that wave.

[00:39:16] And what people will generally experience is a reduction in that distress and that's what you want to see is that people learning over time.

[00:39:26] How to you know how to 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.

[00:39:43] You don't get a chance to violate that expectation if you just always do the compulsions right so ERP allows a person to chance to learn a different way and and you know form new pathways and live by their values instead of what their fear is telling them they must do.

[00:40:01] So yeah so Evan has shows ERP is an effective treatment for OCD it's not always easy so sometimes we we bring in other techniques to support the acceptability of it and the chance of success.

[00:40:13] So I don't know if you guys are familiar with acceptance and commitment therapy.

[00:40:19] But taking so one one process or component that's emphasized a lot in act or acceptance and commitment therapy are values.

[00:40:28] So before we're going to get into this hard work of approaching things that feel really scary.

[00:40:35] 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 reason.

[00:40:44] But there must be some meaning in this for you because you're here and you've been suffering.

[00:40:50] 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.

[00:40:59] And that 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.

[00:41:11] So that's 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.

[00:41:22] One then I'm very passionate about is space or supportive parenting for anxious childhood emotions and this is a treatment developed by L. E. 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 those CD but through the parents so the intervention while the child or the adolescent is my client essentially I'm working with the parents change their behavior.

[00:41:51] And this is all about addressing increasing family support and addressing that kind of problematic pattern you mentioned Helen with family accommodation.

[00:42:01] 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.

[00:42:09] But there's more that can be done with the family that there isn't alternative family members can still help their loved ones even if let's say you have a teen or something who's really not.

[00:42:21] We're engaging in instruments.

[00:42:25] I think we know they can be like that yes yes.

[00:42:28] So I'm so glad you brought that up.

[00:42:30] I did not know about space and I'm glad you shared that with us.

[00:42:35] Is there any other breakthrough that is that I didn't ring up that's on the horizon?

[00:42:41] So another psychological intervention is in front space CBT this is taking more of a cognitive approach.

[00:42:52] There have that 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.

[00:43:01] But again, it's a you know it's a viable alternative. It's not first line, but it might end up there.

[00:43:09] It's a viable alternative if someone's not ready to engage in the exposure and response prevention work.

[00:43:15] Well, exciting times.

[00:43:17] 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.

[00:43:31] So what does recovery look like for a person who's been fighting OCD and it's you know is what what what what recovery I guess could a person work towards.

[00:43:45] Or you know of course, I think people can look forward to getting their lives back because with proper treatment.

[00:43:53] Someone with OCD can absolutely lead a full and productive life.

[00:44:00] OCD can be overcome because of the ways to overcome it are usually not intuitive.

[00:44:07] That's why I emphasize the proper treatment part.

[00:44:11] And that usually involves finding an OCD specialist, but you know I tell people when you know there may be first coming to me and first getting diagnosed

[00:44:20] and so scared and don't know what to do with their brains that have been giving them such a hard time.

[00:44:27] And I say hey, 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.

[00:44:37] We we know what works and of course we need to learn how to help more and more people.

[00:44:43] But there is absolutely hope.

[00:44:46] And and treatment for OCD can be pretty time limited some of the.

[00:44:52] Some of the protocols not that I think people always fall into the boxes that they're in a research studies.

[00:44:59] But some of the protocols are like a 12 to 15 week you know duration of treatment.

[00:45:06] And I see a 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.

[00:45:17] And then the more complex things are we might need more time than that.

[00:45:22] Yeah, that that's fast.

[00:45:24] That's a lovely thought that you can accomplish a lot in 12 to 15 weeks and and you believe a lot can be accomplished that fast.

[00:45:33] So you've mentioned a lot of things that families and caregivers can do to help support their loved ones.

[00:45:41] Is there anything that you advise against for family members and caregivers.

[00:45:47] I agree with everything you said in the beginning, especially the get educated part.

[00:45:53] And your your introduction to family accommodation and the importance of addressing that one way I will I will describe an accommodation to someone is.

[00:46:03] And what's something that you do for your family member with OCD that you wouldn't otherwise do.

[00:46:09] Whether that's participating directly in a ritual with them or modifying what you do not like not going to restaurants anymore or things like that.

[00:46:18] So I will say, though, sometimes people very well intention 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.

[00:46:32] Without getting warning to the person with OCD and without thinking it through and there are obviously going to be risks associated with that approach just like any kind of big sudden change.

[00:46:49] 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.

[00:47:01] 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 when the OCD suffer.

[00:47:15] Is an adult is Dr. Alec Pollard's family well being approached and it has a similar mindset of around like holding boundaries and reducing accommodations in a very loving and supportive way and that's the important part.

[00:47:31] It needs to be in a loving and supportive way.

[00:47:34] Right, I'll put that book in our show notes as well.

[00:47:37] Yeah, I'll do it.

[00:47:38] I might put it in my library right away.

[00:47:41] Now, I guess you know we're call mental health, open recovery so we always want to sort of have the ultimate question be what makes you hopeful for people who are fighting OCD today you've touched on some things but but and you say probably if there wasn't hope you wouldn't be still doing this.

[00:48:03] But what what makes you hopeful for the future of someone that's got it.

[00:48:09] I would say gosh, I mean so I mean the fact that there are so many specialists now.

[00:48:16] I mean we always need more but there are there is so much awareness about OCD and treatment.

[00:48:23] There is still a good way to go to I think further improve awareness about OCD.

[00:48:30] And the sense of community around it you mentioned I was CDF as a terrific resource and I pull heartedly agree.

[00:48:40] I can't not go to the IOCDS annual conference even when I consider not going I go.

[00:48:47] And it's like every summer and it's so beautiful because not only is there professional track there's a community track and getting to see you know adults with those CD kids with those CD all these people come together and have a sense of community around it I mean that's only going to help right.

[00:49:07] 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.

[00:49:19] 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.

[00:49:28] 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.

[00:49:38] 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.

[00:49:56] 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.

[00:50:04] That's very exciting to hear you and well to hear everything you've had to say this has just been and just an embarrassment of riches this afternoon to have you with us with those optimistic words we will bring our topic to a close.

[00:50:24] Having learned so much today from Dr. Jenny Fullerton we've now concluded our extensive investigation of OCD part two.

[00:50:33] 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 deeper comprehension of the disorder she has.

[00:50:48] In valuable contributions to our chief goals for this episode fostering understanding compassion and hope for those struggling with OCD today.

[00:51:00] On behalf of them and those who love and care for them we offer our boundless gratitude to Dr. Fullerton.

[00:51:09] And Valerie now would you please guide us in a mindfulness exercise yes I will we will close today's episode in our traditional way with a mindfulness exercise.

[00:51:21] What is mindfulness I always give a definition mindfulness is a mental state achieved by focusing ones awareness on the present moment while calmly acknowledging and accepting ones feelings thoughts and bodily sensations without judgment.

[00:51:39] 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.

[00:51:52] And this increases our overall ability to focus and concentrate so let's do it let's get mindful.

[00:52:01] 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.

[00:52:12] 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.

[00:52:24] Whether your eyes are open or closed let's study our breathing.

[00:52:30] Let's breathe inhale through your nose expanding an imaginary balloon in your stomach as you inhale.

[00:52:40] Exhale through your mouth pulling your stomach in as you do so forcefully exhale.

[00:52:50] Again inhale through your nose expanding that imaginary balloon in your stomach as you do so drop your shoulders.

[00:53:00] Exhale through your mouth pulling in your stomach exhaling forcefully.

[00:53:08] Keep this slow steady breath going imagine that you are in your bed just waking after a long restful sleep visualize your room.

[00:53:28] Notice what the sunlight is like or perhaps there are small whites on somewhere just focus completely on the light in the room as you are waking.

[00:53:48] Visualize getting out of bed and going about your normal morning routine focus completely on what you are doing.

[00:54:07] What are you holding? What are your movements concentrate only on the current task take in your surroundings.

[00:54:31] What are you doing? What can you see keep going through your morning routine focus completely concentrate.

[00:54:49] Beat intensely in the moment of what you were doing.

[00:55:09] Now think about going through the rest of your day focusing on everything you were doing in the moment you were doing it.

[00:55:19] How would a day like this feel now think of one thing in your day ahead?

[00:55:40] Maybe it's something challenging maybe it's something joyful think of one thing in your day ahead.

[00:55:52] Commit to doing this one thing mindfully. If your eyes are closed please open them and gently bring yourself back to the room.

[00:56:09] Thank you for doing this mindfulness exercise with me.

[00:56:15] Oh thank you Valerie that was great as always.

[00:56:19] 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.

[00:56:41] 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.

[00:56:55] We'll have a roster of guests from various backgrounds. They will represent numerous perspectives, diverse insights and light-challenging events experienced within the private community of relationships surrounding mental health survival.

[00:57:12] So please join us for this powerful two-part episode.

[00:57:17] Until then I leave you with our favorite word on word.

[00:57:31] Since 1977 Omega Institute in New York's beautiful Hudson Valley has hosted some of the best spiritual teachers and social visionaries sharing their messages of hope, healing and transformation.

[00:57:44] On the dropping in podcast hosted by Emmy Award-winning producer, Kelly Alpert, you will enjoy in-depth interviews and conversations with people like Pemichodron, Jack Cornfield, John Cabbagezin and many others.

[00:57:56] On the MindbodySpirit.fm podcast network, also check out the video series on Spotify.