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Aaron: So Michael in thinking about OCD and
working with people who struggle with it,
What's your sense of it?
Do you see it exist in a in a continuum,
a range of severity would you say? Michael: Absolutely.
Aaron: You know a lot of times
people will come in, people will be concerned about
thoughts,
worries that they're concerned about things,
that they're anticipating happening, or that they become convinced are
going to happen or that they've things that they've done,
and I think often you find that
these are worries that
that they recognize as not being realistic. Michael: Um-hm.
Aaron: They know they're not, that these fears
are not about to come to pass, that they're not going to, they're not
at high risk of having
these intense worries
come true, and yet they can't stop obsessing about them,
thinking about them. Michael: Right.
Aaron: You know this is is so
so difficult. What were your, what are your thoughts on
how you like to frame that?
Michael: I think a lot of times it is really gratifying clinically
when people come in and a lot of what they thought about it, they know it's not real,
they feel it is so absurd. Why are they so consumed with this? And a lot of times
don't even tell the people closest to them.
So there's sort of like an AHA moment I've seen a lot of times.
I think a lot of people with OCD also, I mean
it is in the anxiety spectrum. They probably have generalized anxiety
disorder a lot of times anyway
or anxiety issues that are sort of I think at a baseline that
people might always have, but what I've ... this is what I've seen in practice,
The OCD symptoms are exacerbated when there's a lot of stress
especially when there is a lot of stress in someone's
life. and ... Aaron: I think you said even before that sometimes you can almost seem dormant,
almost seem like
it's not there, maybe even for long periods of time, Michael: Yes.
Aaron: Maybe for years. Michael: Yes Aaron: But then when major life changes occur,
major stressors, family
loss or divorce or job change or move,
the OCD can really kick up, escalate in intensity.
Michael: Right. it is painful to see because I think,
it's so frustrating because, I, most people realize will,
they all realize that that is not a reality. to what they are feeling.
Aaron: That's the important thing to
note too, is that, that
often people will worry that they're going crazy,
worried that one of the things in OCD is
sometimes people have obsessive thoughts or that they're going to do harm to
somebody or do harm even to a
family member, and ... Michael: To me that's the hallmark.
Aaron: Yeah and that there is no, they have no,
there is no likelihood that this is going to happen. It's sorta
just a destructive intrusive thought,
and they confuse it with sort of a psychotic break, or
concern that they're going to act on this and
that this means they're going crazy, or this means that they're bad people.
It's none of those things. I think the literature shows that
basically never, will
somebody with OCD with these kind of
fears about or thoughts about harming someone
or harming themselves, or harming a family member,
absent other
other issues, other disorders or psychosis,
is not gonna happen, and yet it it adds
to this sense of guilt and sense of shame,
sense of being
crazy, so that's a big part of
the processes is, is separating those.
Michael: Correct. I also think, I mean it is almost always think it starts,
when I've seen clients as they're frightened by the intrusive thought,
then they're sort of embarrassed
about it, and then they realize it's absurd, and
sometimes you know they go into this whole world, they don't talk to anybody
about it and that's why I think therapy ...
I know it's helpful just to illuminate what's going on. It's also helpful,
you know, using cognitive behavioral techniques or
ERP or something, that something could be done about it as well.
And I i think that really is to give people hope and the other
universal one I have seen over and over is the classic thinking you've been
running people down in your car. I literally think
every single person I treated for OCD has had at some time
that, that intrusive thought. Aaron: Right and so
the other so-so the other sort of classic examples, the
person can't leave the house because they
worry that they had left the stove on, or they left
and, and has to check and recheck,
and sometimes can be staring at the stove,
and seeing all the dials turned to off
knowing that, that they're off but somehow not believing what they're
seeing,
and having to then come back to recheck, to
touch it, to look at it, to see it, so it's very very debilitating,
very hard, and hard of course on
family members who get enlisted into this
into this process. But so I think in
in therapy one of the very
illuminating things in the side it gives
the patient hope is the realization that
they actually, that these
compulsive behaviors that they engage in to
eliminate or attempt to eliminate the anxiety, which really don't work well at
all,
only work very temporarily,
but that by by
going through the difficult process of staying
with the obsession or by by
by exposing themselves to that
risk or fear of not washing, or not checking,
or not doing that ritualistic behaviors that
they would typically rely on,
in allowing themselves to go into that
unpleasant and difficult space,
that over time
and with support, they come through
to the other side and realize that
there are much better ways to deal with this, that
overtime if I can have the courage to face this,
the natural physiological
process that the authors referred to
decreases, you know,
physiologically we're wired to be anxious and stressed
under duress, and when we're
threatened.
But if we stay with that threat
or stay in the presence of that threat and nothing happens to us,
physiologically, we're wired to have that anxiety
diminish, So that's the same process. Michael: We also made a very good point in the
introduction of so using, metaphorically,
the obsessions. It's like they are a bully... Aaron: Right. Mihael: ... and I think what do
we all learn on the playground that you sort of face the bully,
you don't walk away because it is simply going to get worse, you're going to get
bullied more.
So I guess if you take that metaphor, it's sort of like going into the eye of the storm and
just facing it... Aaron: Right. Michael: ...and and the bully
will, will go away. Aaron: Right. And the bully [obsession] is saying
you're going to hurt your child,
you ran over somebody driving,
you've can't contracted some disease, you're
dirty, you need to wash, you know, you and and
it's simply an
accosting, teasing,
threatening bully. It needs to be
pushed back against, and
it can't be ignored because it's too powerful and too strong
and to urgent in its
behavior, but it can be
confronted, and challenged, and
overcome. Michael: Right. Aaron: ...and that's what we wanna
help the patient do. Michael: I just want to say there's a lot of psychoeducation
that goes in
with this too because so many people have suffered with this,
you know, I think we have this idea, why is this so hard for me to overcome
and I think, as you said, it's physiological. Like if
one had diabetes or some disease they,
somebody wouldn't necessarily be beating themselves up about that.
You know, I should be able to somehow you know, you need medication to overcome
that and you can't do it [by strength of will];
I really think helping people realize, you know, that this
this is chemical, you know your system,
you know unfortunately you have this [OCD],
and this is how you have to treat it, that there is really hope,
and because it really is just, its i painful to watch. I'm sure you've seen that,
you know, in clinical practice. when people are dealing with this. I just want to say one thing
quickly.
We had discussed this, with a lot of people use the word OCD,
if they're trying to set their... Aaron: Well there is an OCD sort of
personality...
Michael: Right Aaron: which is sort of not necessarily OCD but...
Michael: Right. Aaron: if you have a very
strong commitment to order and structure and leading,
which is obviously in a continuum. Michael: Right.
Aaron: The other piece about OCD that's important is that it really
has a lot of positive
qualities, not that OCD itself has positive qualities, but people
that contend with this
are often, you know, extremely reliable,
extremely responsible,
follow the rules,
do it the right way, show up on time,
a lot of things that are quite positive.
So I I guess that's another thing
to keep them. Michael: So keep that and lose the inner torment.
Aaron: Exactly. Michael: Would be good.
Michael: Thanks. Aaron: Thank you.