Brittany Goff (3:19)

Yeah, thanks so much for having me, guys.

Patrick Cassell (3:23)

So as soon as Patrick was done reading the bio, I was like, oh no, hot potato. We've got to start the conversation somewhere. I kind of want to start the conversation if you're comfortable with this. Where, like our email thread picked off because you and I emailed a bit when I asked if you wanted to come on. And it was really interesting to me how much our OCD stories overlapped and like how we've had some similar OCD experiences. So are. If you're comfortable, do you mind with us starting with kind of your experience with OCD and then we'll get into your professional experience and expertise?

Brittany Goff (4:00)

No, absolutely. So I was diagnosed with OCD maybe about when I was like 26 or so. So is there any, like, anything in specific that I guess is there like leading point that you want me to go off? I'm trying to remember, like what exactly we talked about in our email. I know we talked about like special interest and ocd.

Patrick Cassell (4:28)

Yeah, let's start there. Like, I think one of the things that we connected on was how special interests in OCD tended to overlap, but also just a sensitivity in ocd. Like I know you've spent some time living in Thailand and one of my, one of my special interests. It sounds weird, but it's a, it's a justice. Special interest for about a decade of my life, from when I was 14 to about 24, was looking at the child sex trafficking trade in Thailand specifically. And I know that's something that has also been a special interest for you. And then one of the things that we talked about was how OCD can kind of take hold of some of these special interests and turn them against us. And that's actually come up in some of the other conversations we've had with guests on here, how OCD will kind of target those parts of our lives that we care about. So I was curious for you and your experience kind of, I guess this whole overlap of how OCD and special interests sometimes intersect or just how OCD is targeted, some of the high value parts of your life.

Brittany Goff (5:42)

Yeah, which is exactly what happened with me. You know, I knew I had ocd, but I wasn't aware of the Autism piece until maybe about just a couple years ago or so. So when I was living in Thailand and I witnessed this for the first time, my justice sensitivity just was off the charts. And I couldn't really understand why it wasn't as bothersome to other people or why it affected me more than it affected other people. So a lot of this started to create a lot of obsessional stories around just like, being too much or being too sensitive and, you know, when your special interest is in something like human trafficking or something, you know, pretty, like, sad or just, yeah, awful. I started to create stories about myself, like OCE stories on like, doubting my own, like, morals or intentions, which is funny because, like, a lot of it was, you know, because of a heightened social justice. But I started to create stories, OCD stories about like, you know, could I potentially be a sociopath Because I'm so obsessed with these things, which is just like so opposite from what was actually happening. It was, I had way too much empathy rather than no empathy and, you know, other little details throughout my life kind of like added to that story. Like, you know, when I was younger, I was told that, you know, I was criticized by my family members about the way that I express empathy. I was criticized for, you know, sharing relatable experiences with people as a way to try to relate. You know, accused of like, trying to dominate the conversation or being selfish. So, you know, when you have all these very like, little experiences, they start to add up. And like, that's why I really got into ICBT is because it looks at like the logic behind the OCD and like those personal experiences that you have and how they start to influence how you see the world now and creating a lot of those obsessional stories that I had.

Patrick Cassell (7:48)

Yes. So this is new language that I haven't heard a lot, but I'm really liking it as I'm hearing you use it. Obsessional stories. Is that part of inference based OCD to talk about obsessional stories or is that that Britney language?

Brittany Goff (8:02)

Or.

Patrick Cassell (8:02)

I just don't really like. It's that language.

Brittany Goff (8:06)

It's ICBT language. Um, so they refer to. ICBT refers to the obsession. So there's the obsession and the compulsion. It refers to the obsession as the obsessional story or the OCD story or obsessional narrative. And the obsessional narrative, it's full of different logical reasons as to what makes up somebody's ocd, which was very different from what I was originally trained and taught with OCD is that OCD is random. It doesn't make any sense to not really go into the content because it's seen as like rumination.

Patrick Cassell (8:41)

Yeah. The mind getting stuck. Like that's the. Often the narrative around ocd. The mind has gotten stuck and it's now mal functioning. But you're saying, actually let's look at why the OCD and the OCD stories make sense based on this person's life. Okay, that's fascinating.

Brittany Goff (8:58)

Yeah. And it's, it's just very different from like the exposure and response prevention modality. And it's looking at like the process of how OCD unfolds for the person because it's so different from person to person. Like why does one person get contamination OCD and then like another person is not bothered by it that at all and they get like relationship ocd? Well, it's because OCD is not random. It's based on these different reasoning categories is what I CBT refers to them as. And looking at the process of how it unfolds, which is a much more validating process, I feel like, than not really going into the content and focusing more on response prevention and the compulsions.

Patrick Cassell (9:45)

And I can't remember if we maybe already did this in the bio, but for those listening icbt, inference based cbt. And can you explain what the inference base. Because I feel like that's connected to this idea of obsessive stories.

Brittany Goff (10:01)

Yeah. So ICBT doesn't refer to thoughts as intrusions or.

Patrick Cassell (10:08)

Huh.

Brittany Goff (10:09)

It refers to these thoughts as inferences because they're being created based on this, based on our prior knowledge experience and the different reasoning categories that it goes through. So it refers to. So it's called inference based cognitive behavioral therapy because, you know, it believes that these aren't intrusions. Like these are inferences that we're creating based on our own prior experiences.

Patrick Cassell (10:36)

Okay, that's really interesting. So one thing that I talk a lot about sensory stuff and something that I talk a lot about is like our senses are so integrated into our personhood, like who we sense ourselves to be as people. And I think a lot of us grow up in ways where we learn to distrust our sensory perceptions and our sensory experiences, which I think leads to a really profound loss of self trust. I'm curious, do you see a connection between like having a kind of, I don't want to say faulty sensory perception, but it's like we have a sensory perception of the world that doesn't match the feedback we're getting. Right. Like I might think it's too hot or it's too cold in Here. And I get feedback. No, it's not.

Brittany Goff (11:23)

Or like it's too spicy. No, it's not.

Patrick Cassell (11:26)

Or like, why is it loud for me but it's not loud for others? So there's all this invalidation of our sensory experience, which I think leads to a loss of self trust. Would you say that predisposes a person to make faulty inferences or, Or. I don't even know if you would use the word faulty. You might.

Brittany Goff (11:41)

Yeah, I, I use the term faulty inferences.

Patrick Cassell (11:44)

Okay.

Brittany Goff (11:46)

Sorry, can you repeat.

Dr. Neff (11:48)

Yeah.

Patrick Cassell (11:48)

The connection to like, sensory, like our experience of sensory and difficulty trusting our perceptions of ourself and the world, and then the development of faulty inferences and obsessive stories. Do you see a connection there for. A potential connection there for autistic people?

Brittany Goff (12:06)

Yeah. And, you know, one of the reasons that I gravitate more towards ICBT is because the idea behind it is to actually gain certainty in yourself through your sentences, which is a very different approach from.

Patrick Cassell (12:21)

I love that. I love that so much. I just want to pause to be like, I can't proudly capture what you just said, but to regain a sense of trust in yourself.

Brittany Goff (12:34)

Yeah. I mean, because, you know, when you have ocd, it's the doubting disorder. It makes you doubt yourself. It makes you doubt everything. And icbt, it's not using an approach of having to sit on the uncertainty because you don't need to sit in the uncertainty. Like, ICBT is doing the opposite. It's actually teaching you how to be more certain in yourself through, through your senses and like, using your sensory perception to make the decision if this is OCD or if this is not ocd, if this is something worth paying attention to or if this is just one of those. One of those OCD stories that are coming in. So.

Patrick Cassell (13:10)

Yeah.

Brittany Goff (13:11)

And you know, when you're autistic and your sensory experience doesn't match the world, it's not uncommon for autistic people to start to create stories about, like, why that's happening. Especially if you're late, diagnosed or not diagnosed at all. Like, for example, just right. Ocd.

Patrick Cassell (13:30)

Right.

Brittany Goff (13:30)

Like, so somebody puts on a shirt and it doesn't feel just right. Well, let's look at like, the sensory component here. Instead of like, having that person sit and habituate to that uncomfortable feeling, have them change clothing. Like, and when they, when they don't have that awareness that you're autistic. Right. You don't understand why your clothes, like, hurt your skin. So use then. So then it's not Uncommon for people to go on to create stories about that. Like, if they don't have the awareness that they're autistic and experiencing like sensory differences, oftentimes their brains will try and fill in the gaps and try and make sense of what's happening. Because oftentimes like we have that very bottom up processing where we use a lot of like prior knowledge and experiences to kind of like determine concepts of like what we see in the world. And oftentimes like that, that bottom of processing, that reasoning can get faulty and it becomes hijacked and then the person go, goes on to doubt themselves and then that doubt then turns into an obsessional story. So for example, like with just right, the trigger might be like an uncomfortable shirt. Well then they're going to go into the doubt of like, what if I can't handle this feeling? Or what if this feeling never stops? And then they'll go into the OCD story and then they'll do the compulsion to relieve the anxiety from it. So yeah, I really love ICBT specifically because it focuses on like the sensory experiences.

Patrick Cassell (15:01)

Yeah, yeah, that sounds so powerful. Okay, so we've talked a little bit about sensory. I'm curious because I know this is something that you talk about in your work. Some of the idea of like the neurodivergent traits that perhaps because I mean the statistics are pretty astounding, right? Like both for autistic people and adhd, OCD is a decently common co occurrence. Beyond like, I know that there are some genetic underpinnings to that, but beyond that, do you see other neurodivergent traits beyond how we process sensory information? Kind of predisposing us to obsessive stories and predisposing us to ocd. Like I think you mentioned rsd.

Brittany Goff (15:47)

Yes, I do. I think Patrick's camera went out. Oh, there he is. Okay. So yeah, I, I actually do see a lot of different neurodivergent traits kind of like kick off obsessional stories. So for example, you know, say somebody has rejection sensitivity and they don't necessarily understand why they have that because they're either not diagnosed or late diagnosed. And then they go on to create stories about their relationships which can then turn into relationship ocd. So also masking is a big part as well. So if somebody is masking their whole life and they don't know that they're masking. For me, what happened was like I always knew that I was doing something. I just didn't know what it was. I knew that I could never Be myself and that I had to kind of like put on a mask towards different people. But I never knew why I was doing that. And because I didn't know why, I started to create stories about like, my intentions being an imposter or fraud, having a hidden agenda, obsessional stories about my morals, and even like obsessional stories about farming other people. Because I didn't know why I was doing this. And like I said, I knew I was doing something. I just couldn't figure out what it was. Also, so autistic meltdowns as well. So I had frequent thoughts and stories about losing control or snapping or snapping and harming someone or driving my car off a bridge or jumping off a building and anything he was losing control or like, for example, like shouting something out in public. Well, I realized that a lot of those stories were actually coming from like having autistic meltdowns. And I didn't realize I was having autistic meltdowns. I just knew that I was losing control. And so then I started to kind of like apply that into other areas. And that's where, you know, OCD kind of snowballed and grew from there to some other neurodivergent traits. Is for me at least a lot of my autoimmune disorders related to being autistic triggered a lot of stories about like, my health, which then turned into health ocd because a lot of doctors couldn't figure out what was wrong with me, which, you know, not an uncommon thing when you are autistic. And because doctors couldn't figure out what was wrong with me, I started creating stories trying to figure out, just trying to fill in the blanks of like, what was going on with me.

Patrick Cassell (18:23)

Absolutely.

Brittany Goff (18:24)

Another one is having a heightened sense of social justice. I often see can create like OCD stories around like scrupulosity, morals, the person's integrity, or having hyperempathy as an autistic person, hyper empathy for me at least, like gave me this very over inflated sense of like responsibility for other people because I would often like mistake other people's emotions, emotions as my own. And that would lead to a lot of like, people pleasing behaviors that I would end up, you know, getting in situations that I didn't necessarily want to be in, helping other people or just exhausting myself doing way too much. Because, you know, if somebody tells me that they need help with something because they just got their house foreclosed on, they lost their car, they don't have any money, I start to feel all of those emotions as if it's like actually happening be and like when you don't know you're autistic, like that's really confusing. And so I kind of interpret those emotions as mine. So I'd be like, you know, you can have all my stuff, come stay at my house, like have my car. And then like 20 minutes later I'll turn around and be like, why did I just give a stranger all my belongings? See, there's a lot different traits of just being autistic that kind of like kick off obsessional narratives.

Patrick Cassell (19:47)

Well, and this is interesting, this is overlapping. So I work with a lot of kind of newly discovered people in their journey. And I, and it's such a powerful thing to witness and, and I remember it for myself of like there was, and what I was actually working on in therapy at the point that I got to discovery was that there were thousands of things about my experience, about myself I didn't understand. And what I was working to get to was a place of acceptance of I'm never going to understand why I am this way. Like, I, I, I'll probably never recover a trauma narrative that's been repressed that explains why I am this way. Um, that's kind of what I was, what my obsessive story was around that because it was the thing that like, well, maybe that would explain why I am the way I am. Um, so I was coming to work toward acceptance of that. And then autism discovery, it just felt like it answered a thousand questions. And I think that this is probably so common for those of us who are late in life identified or for autistic people who just maybe they were identified early in life but they were never given the education about like, this is what a sensory meltdown is, this is what a shutdown feels like. This is what disassociation is. This is what, this is how your brain works, this is how your body works, that there is so much confusion about our experience of being human that it makes so much sense we would develop obsessive stories to fill in the gaps.

Brittany Goff (21:17)

I mean that's what our brain just like naturally does. As, you know, most autistic people have that like bottom up thinking process and when we don't have answers to things, we try and fill in the blanks and try and figure out why. And I had a very similar experience as you when it comes to like wondering if you had like some suppressed trauma. Um, I had a, you know, similar obsessive stories around it and also like obsessive stories about being a sociopath again. So really start you question. Like, it's no wonder why we have issues with our identity, like having ocd, because we're not always given, like, the tools and the resources when you are autistic or have ADHD or neurodivergent into understanding some of those things. And I think a lot of those stories kind of kick in as us trying to understand them.

Patrick Cassell (22:09)

Yeah, yeah, that's a, that's a very, like, gentle kind of take on OCD is like the brain is trying to help you.

Brittany Goff (22:18)

It's.

Patrick Cassell (22:19)

It's not. It's hurting you, but it's trying to help you by. By. It's trying to fill in the story. Yeah, it's interesting. I, I will take that concept for a lot of things. I haven't thought about taking that concept for OCD before because mostly I treat OCD like this. I just want to swat it away. So it's really interesting to hear you talk from such a different framework.

Megan (22:41)

It almost sounds like. And this is how I'm experiencing it, like my own OCD about identity, about confusion, about why am I struggling with the things that look so natural to everyone else. Going through my discovery phase, filling in the gaps almost feels like it's comforting in a way. Like it's creating some sense of comfort and relief to say, like, this is why. This is. This is the reason you're experiencing A, B and C when you maybe don't have the education or the language or the resource to put to that actual experience. In a lot of ways, we do.

Brittany Goff (23:16)

Everything to avoid uncertainty.

Patrick Cassell (23:18)

Right.

Brittany Goff (23:18)

And, you know, reading these stories gives us certainty. So I can absolutely see what you're saying, Patrick. I mean, I, I experience the same thing as well. I just never put it into words the way that you did.

Patrick Cassell (23:32)

I think about how, like the kind of the trope of how like, autistic children will ask why or adults, like, we, we like. I remember my dad has this story of like, I just asked why all the time. And he has this one story that I think is really funny. I had asked why, and he was in the middle of explaining whatever question I'd asked, and then I interrupted him and I said, dad, why are you talking? And we just, we need to know why. We need to know the context. And part of what I'm, I, I'm deducing from what you're saying, Brittany, is when we answer that why we're helping build self trust. We're helping kind of bridge the gaps of understanding so those obsessive stories don't come in and so, you know, for the parents out there, for partners out there, for anyone who, you know, is caring for another autistic person, when you answer that, why you are, you are actually doing something pretty powerful in their, in their life, in their brain.

Brittany Goff (24:34)

Oh, absolutely.

Megan (24:35)

Yeah.

Brittany Goff (24:36)

And it's funny that you give that example because, like, in my training that I'm putting together for autism and OCD is I talk a lot about, like, you know, giftedness and, you know, our ability to always ask why. Like, we're always, like, we ask why for things, for, you know, clarification for understanding. And oftentimes, like, the responses that we get to that are not productive, at least they weren't for me. Like, you know, being in school, being told, like, you're disrupting the class, like, stop asking those questions. Like, why can't you just follow along with the directions? And you know that of course that's those, those are small little things. But when you experience that, like on a daily basis, like, it's no wonder so many of us develop things like rejection sensitivity.

Patrick Cassell (25:23)

Yeah, absolutely. Absolutely. Yeah. Yeah. I was just having a conversation with someone and I really liked this framework where they were talking about how a lot of times our efforts to self advocate get shut down and because people don't like the way we self advocate. And I think the question of asking why, asking clarified questions, that is a way a lot of autistic people self advocate. But it's often a form of self advocacy that has gotten trained out of us or gotten shut down. Yeah, yeah.

Megan (26:00)

So we had someone on here two weeks ago, two episodes ago, I don't know time, who knows who was talking about creating a neurodivergent affirming framework for erp. And I've heard you say, now, ICBT very different than erp. Can you talk about the differences too? I mean, in terms of for those who are listening, who are like, I've only heard of certain ways to manage or support OCD symptoms.

Brittany Goff (26:26)

Yeah. So ERP and ICBT differ in a couple of different ways. So earlier I mentioned erp. The foundation of that is, you know, thoughts are intrusion. There are the random. They don't make any sense. We don't go into the content. And it's about purposely provoking anxiety for things that we fear while implementing response prevention techniques to prevent the person from engaging in a compulsion. So regardless of what therapy that you're using, there's a sequence to ocd. It comes in five different steps. Actually, can I share my screen to. I'm a very visual person. So am I able to add raming to. To show you guys? Okay.

Patrick Cassell (27:19)

We really need a. Patrick, start promoting our podcast as a, like, podcast video because we have so many guests that come on who are also visual thinkers.

Megan (27:28)

Right.

Patrick Cassell (27:28)

I love this.

Megan (27:29)

Brittany, figure out a way to zoom in on that just because I know people who are watching. Yeah, perfect.

Brittany Goff (27:36)

That's great.

Megan (27:37)

Yeah.

Brittany Goff (27:38)

So no matter what treatment modality that you're using is, there's a certain sequence in ocd. It's the same predictable sequence literally every single time, like, no matter what the subtype is. So we have the trigger, then we have the obsessional doubt, then we have the consequence of the doubt, and then we have the anxiety and then the compulsion. So erp, like I said earlier, it focuses on purposely provoking anxiety to prevent the person from responding. So it treats OCD at the level of the compulsion. So the very last step of the sequence, so icbt, it actually treats OCD at the second step instead of the fifth one. So it focuses on the obsessional doubt and resolving the obsessional doubt. So if somebody's able to resolve the obsessional doubt, the other steps go away. So there's nothing a need to purposely provoke anxiety to. To get better from OCD anymore. Like, that was, you know, ERP has been the gold standard for many years, been extremely helpful for a lot of people. So there's no treatment that's better or worse. It's just really. It's just a different way of looking at ocd. So ERP focuses on more of, like, the behavioral aspect. But when you treat the cognitive portion like the behavior isn't there, like, the person just doesn't do their compulsions anymore. They just stop doing it and resume back to what their life is. So they don't have to purposely put themselves in those situations anymore to get past the fear.

Patrick Cassell (29:16)

This is so fascinating. So, yeah, for folks who are listening, who aren't seeing the visual, there's kind of. There's this typical OCD cycle that's talked about where there's the trigger, the obsession, or. And I like how you're calling it the obsessional doubt, the anxiety grows and then the compulsion. And so, yeah, all the treatments I've classically heard about for OCD intervene at, okay, if we stop that doing the compulsion, stop doing the behavior, we'll learn to handle the distress of the anxiety as it's building. And what you're saying is here we want to actually intervene at that moment of obsessional doubt, that moment where an obsessive story has Come online and we want to build self trust. I'm, I'm guessing is what is, is part of that of like, how do I so this like the contamination. Okay, maybe my hands are contaminated. So how would someone work like, yeah, how would you help a client build self trust in that process? Are there like questions they would ask themselves in that moment or like, what, what's that process look like?

Brittany Goff (30:26)

Yeah, so there are questions that you can ask them. There is. So when it comes to utilizing your senses, ICBT talks a lot about imagination versus perception. And so an imagined thought is when we don't have any direct evidence in the here and the now to support that it's actually happening. So like we can't see it, we can't hear it, we can't feel it, we can't smell it. So none of our senses are getting hit. So then it talks about like the opposite of imagination is our perception. So what we can see, hear, smell, feel, and taste. So when we want to use reality sensing. So say somebody has an obsessive doubt of what if I just like snap and punch my boss in the face? They can use their senses by asking themselves, okay, do you see yourself punching your boss right now? Like, do you physically see yourself doing it? Do you hear your boss like shouting because you just got punched in the face? So if nothing is like hitting on that person's sensory experience, like, that's how they can determine, okay, this is OCD story versus, like, hey, this is something that I should actually pay attention to. So that's kind of how they use their senses in a way of like determining if it's OCD versus if it's not ocd.

Patrick Cassell (31:43)

I like that. And then I can hear in that how a person would over time start developing more self trust because they, they trust the ability to like, okay, am I relying on my perceptions here? Though one area I could imagine could be tough would be like. So one thing I talk a bit about is how a lot of us have kind of extra sensitivity to the emotional tone of the room, but it doesn't always match. Especially when we're around holistic people. The emotional tone doesn't always match their nonverbal communication. So like I, I've been in conversations where like, I can tell they're sad or maybe that they're mad. And I'll ask like, oh, are you sad or are you mad? And no, no, I'm not. And then there's, there is a perception disconnect because of what I'm perceiving and what they are telling me is at a disconnect. So I could imagine there would be some senses where it's, it's a little bit trickier to work through. Like when an autistic person or a hypersensitive adhder is like, picking up the emotional tone or picking up a perception that's maybe not as concrete as sight, smell, some of the other senses.

Brittany Goff (32:54)

Well, you bring up a really good point. And I think that is one of the flaws of icbt because I think that ICBT focuses on the five senses, but there's actually more than five senses. Like, it really doesn't take into consideration interoception, proprioception, which are very common things that a lot of autistic people struggle with. Which is why I've kind of been working on like, making the treatment a little bit more like affirming for neurodivergent people. Because, you know, interoception can very easily cause, you know, a person to develop like, health anxiety. They're not aware of.

Patrick Cassell (33:35)

Absolutely. Yeah.

Brittany Goff (33:36)

Sensations that they're having. Or I've even seen it, like with pharmacy, somebody might be confusing anxiety with like an urge and then they'll use that urge to justify their story as to why they should.

Patrick Cassell (33:51)

Yes. So you almost, to do like, neurodivergent affirming icbt, you almost need to start with like maybe a sensory based OT approach or like a sensory based approach of first working on refining our senses and like learning how to differentiate. So like with interoceptive challenges, a lot of us struggle with differentiating, like, is this anxiety or is this hunger or is this thirst? So you'd almost need to start with building that trust of senses and then be able to build on ICBT on top of that. Because I would imagine this would be a hard therapy approach if like a person's perceptions, their sensory perceptions are difficult to trust because it kind of, it sounds like it relies a little bit on the ability to put some trust in your senses. I'm not sure if I'm capturing that right or not.

Brittany Goff (34:52)

Yeah, no, I mean, you hit it spot on. Is, you know, sometimes people need like interoceptive exercises before they even get into icp. I really, really like Kelly Maller. She's an.

Patrick Cassell (35:05)

Her work is amazing.

Brittany Goff (35:06)

Yes. Oh, you know her? Yeah, sure. Yeah, she's.

Patrick Cassell (35:09)

Yeah. I have learned so much from her. She's. I, I had no idea what interoception was. And then like, her work has been so helpful for the community. Sorry I cut you off. Go ahead and talk.

Brittany Goff (35:21)

I'm obsessed with Kelly's work, too. So she's an occupational therapist for anyone listening. She has, like, an interoceptive curriculum. She has, like, different flashcards that you can use. I mean, her stuff is just brilliant. And I use a lot of her interoceptive stuff to help people get more back in tune with their senses, you know, because, you know, when you're late diagnosed autistic or autistic, you know, you. You start to, you know, only doubt yourself, but, like, you lose your ability to interpret different sensations. And I think some of that probably comes from masking. Right. When you're disassociating from your body for multiple hours a day, it's like, no wonder we develop difficulties around, like, understanding different sensations in our body and different emotions.

Patrick Cassell (36:14)

Yeah, yeah, absolutely. Yeah. Kind of related to that. Definitely related to masking. I would also think, like, one obsessive story I see a lot I see in myself, I see in most autistic people I know is if there's. If anyone's at all upset in the room around us, we assume it's us. And again, that. That I would think that would. There'd be a lot of, like, healing of our. Like, healing our relationship to our perception to be able to address that story of, like. No, it's not always. It's not always my fault. I'm not always the one making people angry, because I know that's a really common narrative for us. Yeah.

Brittany Goff (36:56)

And where the inferential confusion comes in, there is like the, well, you know, what if this is my fault? Like, what if I did something and then we start to ask for reassurance or whatever the compulsion might be to follow it.

Patrick Cassell (37:10)

Yeah, yeah. Because so often we have experienced ruptures without understanding why. And so again, that obsessive story is protective because it's like, well, I will tell you why, versus you living in that confusion.

Brittany Goff (37:25)

Another, you know, aspect of that kind of flows into what we're talking about with ICBT is, you know, one of the. The last modules is called the Real Self. And I love it because it's helping. It helped me figure out who I was as opposed to, like, who I. Who I was trying to be. Like, I was trying to be a neurotypical person for a long time because I didn't know I was autistic. So kind of like redefining yourself at the very end and, like, looking at yourself from, like, a different position from a more, like, neurodivergent lens rather than, like, the lens of, like, trying to be neurotypical. Yeah, just another cool aspect of icbt at the end, you kind of get to like redefine yourself and look at yourself in a really different way, which I feel like is, you know, really helpful for people that have masked for so long and lose sense of who they are.

Patrick Cassell (38:16)

Absolutely.

Brittany Goff (38:16)

Yeah.

Patrick Cassell (38:17)

I would think that would be so powerful. Patrick, you look like you had a thought a second ago, but I had.

Megan (38:26)

So many thoughts during this conversation and then they just are fleeting. And then I'm just sitting here, like I'm thinking about how powerful that would be, especially with how much confusion there is, how much disconnect from the sense of self that there is, how much. How many people try to like, learn who they are post unmasking experience process. And like, Megan and I have joked about this before, but even the concept of like, what do you do for fun? Becomes really complicated. So there's so much confusion in this process. So when you can't trust your brain or your thoughts or you can't trust your senses or your body, it's. It makes a lot of sense why a lot of these inferences are, are becoming more and more present in your life and how to manage them. It's, it's. This is a really fascinating conversation. I've honestly never heard anything about ICDT before in my life. And this is really just educational for me.

Brittany Goff (39:22)

So, I mean, I want to add, it's fairly new to the United States. I. So I remember I knew nothing about icbt and I knew that it was some areas that like ERP really didn't like, hit on for me very well. And so I was always kind of like looking for another. Another therapy. And I saw on Facebook, like, somebody was talking about OCD and described it in the form of like, dissociation. And that resonated with me so much because, I mean, for me, like, when I'm stuck in an OCD story, like, I'm disassociated, like, I'm in another world. And so when I started looking up icbt, there was, there was nothing. There was no resources. The only thing that I could find was a clinician's manual that was translated from French. And so it was really hard to like, understand and digest. But once I did, it's like, oh my God, like, where, like, how do people not know about this treatment? It's evidence based and it's a modality that they use in other countries in Europe, but for some reason in the United States, it just wasn't really heard of yet. So when I read the book I. I mean, my ocd, like, drastically changed. It changed the way that I looked at ocd. It changed the way that I treated ocd. And I started to kind of like, introduce it to some of my clients, told them a little bit about it, and then they all started getting better from it and they were asking me like, the same question, like, where was this therapy before? Like, why don't we do this first? So then I started introducing it to my clinician. So I have like 15 therapists that I. That I work with, so. And a lot of us all have lived experience. So I started introducing it to them and they were like, oh, my gosh, like, where. Why did we learn this therapy sooner? Like, where was this? So then I started to put together, like, some trainings to train other clinicians. And then I published the workbook, like I was telling you, kind of like, accidentally. I never meant to publish it. It was just me, like, learning ICBT and doing some handouts for my own clients to help them kind of learn it, and was convinced by some colleagues that I should publish it, which is why there's, you know, so many typos in it. But I actually didn't know that I was autistic when I published that. So a lot of. So it doesn't have any, like, the neuro firming aspect to it. I'm working on another one that. That does. And then eventually Cognitive Behavioral Institute hired me on as an instructor to. To teach icbt because, yeah, I mean, it just kind of blew up. I never really expected it to, but yeah, the resources are very limited. It's still upcoming and emerging. So, yeah, it was really hard for me to find resources too, because there was like, no therapist trained in it, no books, no nothing. But I think the narrative is starting to shift a little bit around ocd and it's starting to get a lot of traction and there's a lot more people that are getting trained in it. I've trained like hundreds of therapists at this point. The Facebook group started out with like five people. Now it's like 2,000, just within like a year or so. So it's. It's definitely up and coming.

Patrick Cassell (42:44)

My gosh, that's so incredible. And like, first of all, just think, like, thank you. Thank you for your work, because I've actually, I feel personally grateful for, in the sense that I've. I've been looking to try and find ICBT therapists and I can't. And so I'm so thankful that you are out there training therapists to Learn how to do this so that there will be more therapists who do this work. And I am hearing it talked about most in neurodivergent affirming therapy circles, which I think is probably no accident that a lot of neurodivergent affirming therapists or looking for more affirming ways of working with ocd. And this just makes so much sense for autistic and ADHD folks.

Brittany Goff (43:26)

Oh, when I figured out that I was autistic, that, like, really changed the way that I saw, like, OCD and putting a lot of, like, OCD terms to. Or putting a lot of autistic terms to what I was experiencing. So, yeah, it's. There's. There's as. There's nothing available about autism, ADHD, and icbt, unfortunately. But I've been working to kind of like, adapt some of those terms and, you know, incorporating things like interoception, proprioception. And so a part of ICBT is the person has like a vulnerable self theme, or they have different vulnerable self themes, which is why their OCD stories are created the way that they're created. So kind of going back to the logic of OCD I mentioned, like, there's different reasoning categories. So those reasoning categories are different facts that the person has acquired throughout life. The second one is different rules that they follow, and this is especially, like, prevalent for social norms. The third one is hearsay stories that they've heard. So it could be something that they saw on the news, something that they read about 20 years ago, or like a story from a friend of a friend, personal experiences that they've been through, and just the mere possibility of it happening. So since everybody has, you know, different facts that they've acquired, different experiences that they've acquired, that's going to dictate, like, what kind of obsessional story they have, plus their vulnerable self theme. And when I learned that I was autistic, all of the vulnerable self themes that I had, like, I've witnessed a lot of other clients have, were autistic features, like heightened sense of social justice, rejection, sensitivity, dysphoria, masking.

Patrick Cassell (45:18)

That's so interesting. And that makes so much sense. I kind of want to see, like a diagram, like a map where you kind of lay one on top of the other, like vulnerable themes and then neurodivergent traits. I feel like. Yeah, it just makes so much sense that there'd be so much common touch points there.

Brittany Goff (45:33)

Yeah, yeah, absolutely. I haven't.

Megan (45:38)

How.

Brittany Goff (45:39)

How long does it take you guys to edit these? Until they're aired.

Patrick Cassell (45:44)

This will come out end of October or early November. This is the last episode in our OCD series. Oh, perfect.

Brittany Goff (45:51)

Okay. So my training will. Will actually be out by then. So in my training, I actually list out, like, all the neurodivergent traits, vulnerable self themes from, like, an autistic perspective. So I'm happy to share any of that with you guys.

Patrick Cassell (46:07)

That sounds incredible.

Megan (46:10)

Great. Yeah. Whatever you want us to include in the show notes and as downloads or as links or whatever you need us to put into that. We will.

Patrick Cassell (46:21)

Brittany, do you have any itchy thoughts? I refer to itchy thoughts when it's like, I know sometimes I come into an invited podcast or conversation and there's like, oh, I know. I want to say this thing as. As we're kind of maybe coming to the end of our conversation. Do you have any itchy thoughts of things that you wanted to make sure and mention about ICBT or autism and OCD or ADHD and earthy?

Brittany Goff (46:46)

With icbt, when you have an obsessive doubt where you can't use the senses, the theory behind it is to rely on common sense, which is neurotypical. Right? Right.

Patrick Cassell (47:02)

There's common sense.

Brittany Goff (47:04)

But if you, instead of looking at common sense, like, looking at things like interoception and proprioception, those can go on to create obsessional stories rather than kind of just saying, oh, compare yourself to a neurotypical person and. And go off of that. But, you know, I have a lot of faith in icbt, and I think that this is just the beginning of where it's going to go in the United States. And it has a lot of room for change and a lot of room for implementation. So just something for people to be aware of, like when they do explore ICBT as it's not created for autistic or ADHD individuals.

Patrick Cassell (47:45)

I just had a runaway thought when you were talking. Is it okay if I chase the association? So there's some really interesting research around kind of abnormal perceptions in autistic people. And that can be hallucination, like experiences. There's also been. There's an article I read that was really interesting that looked at paranoia thought, and it was comparing autism to. I think it was schizophreniform or maybe it was. I don't think it was schizophrenia, but it was on the schizophrenia spectrum. You mentioned proprioception and interoception. People with very sensitive proprioception, for example, might have this sense of someone just pushed me or someone just touched me when someone walked by them. Right. Like, we're talking about very extreme proprioceptive sensitivity. I could imagine that the experience of having either abnormal perceptions or just, again, proprioceptive input that's not matching environment. I could imagine that could create some obsessive stories around psychosis. Is that something you see?

Brittany Goff (48:54)

Oh, yeah. Fear of developing psychosis is a pretty common obsessive doubt. But it's interesting, I never really linked it to proprioception like you just mentioned, but that. That makes a lot of sense. I always kind of assumed this is what just my theory behind it is. A lot of people with OCD get like, kind of visual superimposed over their vision. It's not like a hallucination. It's more of, like, you know, they can see things that aren't actually there, but they know that it's. It's not there. And that's why like, these OCD stories can be, like, just. Just wrap you in because the person can, like, actually visualize that scary story happening. So I always kind of just figured that some of that, like, psychosis or like, fear of psychosis was wrapped around that. But that's a really interesting point that you bring up about, like, proprioception.

Patrick Cassell (49:53)

Yeah. Yeah. Okay. Well, thank you for indulging my association, but I. I've had more and more questions come up around both, like, the experience of psychosis, but also, like, the fear of psychosis or obsessive stories around psychosis. And so I just. I thought I'd ask because I. I was suspecting that that might be the case. Yeah.

Brittany Goff (50:14)

And sometimes.

Patrick Cassell (50:16)

Oh, sorry, go ahead.

Brittany Goff (50:17)

No, go ahead. I was also gonna just mention that sometimes I've seen that, like, being related to autistic meltdowns, like, if a person is, like, losing control, it's not uncommon for them to start to like, okay, well, I'm losing my mind. Am I losing control of my mind? And then go into this, you know, obsessive story about, you know, could I develop psychosis? Could I have schizophrenia? So it's.

Patrick Cassell (50:45)

Yeah, yeah. We should someday do an episode on the, like, messy, messy history of, like, schizophrenia and autism and how, like, autism, you know, used to be classified as, like, childhood onset schizophrenia. But yeah, the overlap of these are fascinating. And I just think the whole experience around having abnormal perceptions. Years ago, I put an infographic out on kind of abnormal perceptions, hallucinations, and I had so many people reach out being like, oh, my goodness, thank you. I thought, like, I thought it meant.

Brittany Goff (51:16)

X, Y, Z that I was having.

Patrick Cassell (51:18)

This experience and having a name for it, like, abnormal Perception that, that just understand again, why, like, why do our brains work the way they do? Like neurons sometimes randomly fire and you might have an abnormal like perception that feels really scary and understanding that why can just be so powerful.

Brittany Goff (51:40)

Yeah.

Patrick Cassell (51:43)

I interrupted you in middle of. You were sharing resources and any itchy thoughts you had. So you've mentioned the Facebook group and you provided that nice disclaimer that for people getting trained, this isn't, not in and of itself a neurodivergent affirming modality. So there'll be some ableism language. Were there other things that you wanted to share in regards to either itchy thoughts or resources you wanted to mention?

Brittany Goff (52:13)

I don't think so. I think that, I mean, I think that we covered pretty much everything. I mean, the main thing that I wanted to talk about was like, you know, how different neurodivergent trades kind of like take off obsessional narratives. But I think we think we covered pretty much everything.

Patrick Cassell (52:31)

Yeah. Well, I'm sure there'll be lots of people who A, like want you to meet their therapist and I'm sure you're sadly limited, but B, would love to like, like for therapists listening, get trained from you. Like, where can people find you? Where can they find your work? Your trainings.

Brittany Goff (52:48)

So my trainings you can find@icbtonlinelearning.com to contact me directly, you can visit Zen Psychological center, which is the group practice that I run. So I am not taking any new patients. I primarily do autism evaluations and teach now. But there is a directory on the official ICBT website with a list of therapists that are trained in icbt. So the name of the official like ICBT website is ICBT Online. So they have a ton of resources on there. We used to do something called ICPT Fridays, which we're actually going to start doing again, where we had like different presenters come and like teach each module for free. And they're recorded, they're on the website. So if you want to watch the videos, you're more than welcome to. There's tons of. There's also some like handouts on there, so there's a lot of really good resources there as well. Definitely recommend joining ICBT and Neurodivergence, which is my Facebook group where we talk more about more neurodivergent or looking at OCD from the lens of like autism and neurodivergency rather than looking at it from like a neurotypical lens. So if you're, if you're a therapist, that's interested in, in taking one of my trainings. You can visit the ICBT online or ICB icbtonline learning.com. oh, one more. Okay, so the last one that I wanted to mention, so the book that I published, not on purpose, so that's on Amazon, you can just type in, like, inference space, Cognitive Behavioral Therapy. And it's the only, like, workbook besides, like the actual clinician's manual that comes up. So you can find it on there.

Megan (54:55)

Great. And we will have all of that information in the show notes with links to everything. So you have easy access to find all of Brittany's information and everything she just talked about. Brittany, thank you so much for coming on and wrapping up our OCD series.

Brittany Goff (55:10)

Thank you guys so much for having me. It's been, it's been great getting to just teach more people about icbt.

Patrick Cassell (55:19)

Yeah, I think there'll be lots of people that have kind of light bulb moments listening to this conversation. So thank you so much for coming on. Absolutely.

Brittany Goff (55:27)

It's been fun.

Megan (55:29)

And to everyone listening to Divergent Conversations, we have new episodes out on Fridays on all major podcast platforms and YouTube. Make sure to look at the YouTube channel Divergent Conversations if you want to follow along, especially for video content, screen shares and all of the resources that Brittany shared today. Thanks and have a good day.

Brittany Goff (55:48)

Goodbye.

Dr. Neff (55:58)

Hey, it's Dr. Neff here. This season we are clearly talking about autistic burnout, a topic that neurodivergent Insights has covered extensively. So if you would like more resources to supplement your learning, we've put together a page where we've curated all of our autistic burnout resources freed and paid resources. We have lots of articles on autistic burnout. We have a upcoming free email course. It's going to be released soon. We have workbooks on autistic burnout. So if you'd like to check out our resources again, both free and paid, you can go to neurodivergentinsights.com burnout resources. It's linked below and in the show notes. I hope you don't need these resources, but if you do, they are there for you.