Get to Know OCD – Episode Summary

Episode Title: Committing To Overcome OCD Is The Hard Part
Host: Dr. Patrick McGrath (NOCD Chief Clinical Officer)
Guest: William Schultz, OCD Survivor and Therapist
Date: April 2, 2026

Overview

In this episode, Dr. Patrick McGrath welcomes back William Schultz for an in-depth exploration of the professional and clinical complexities of overcoming OCD. The discussion centers around the pivotal role of commitment in OCD treatment, drawing from William’s personal experience, clinical expertise, and research into OCD’s biogenetic factors and metacognitive approaches. Together, they break down why understanding OCD is not enough and why making a "committed decision" to face it is truly the toughest step. The hosts also illustrate these themes with memorable real-life examples and helpful analogies for listeners ranging from OCD veterans and clinicians to those just starting their journey.

Key Discussion Points & Insights

1. Living With OCD vs. Complete Remission

[02:08–03:48]

• William shares his journey, living with OCD from 2007 to 2017, and describes his current relationship with OCD as "a negligible part" of his life.
• He still occasionally has intrusive thoughts or mild anxiety, but it’s manageable:

  “It’s not 100% gone, but not a big part.” —William [03:37]

• He points out that the OCD community lacks consensus on defining true remission.

2. From Personal Experience to Professional Focus

[04:02–07:11]

• William explains his research into the biogenetic origins of OCD, partly motivated by his own experience and clients’ frequent questions: “Why am I experiencing this?”
• He highlights how understanding causality helps inform better treatment approaches.
• Discusses the importance of metacognitive therapy and, most centrally, the critical role of commitment in OCD treatment—the main focus of the episode.

3. The Challenge of Commitment in OCD Treatment

[07:11–15:45]

• Patrick sets the stage: Commitment—not knowledge of treatment techniques—is usually where people get stuck.
• William highlights that understanding ERP (Exposure and Response Prevention) isn't especially difficult, but truly committing to do scary exposures is the hard part:

  “If you haven't really committed to the decision to overcoming OCD, it's just going to be a lot rockier road...” —William [06:36]

• They discuss how clinicians support clients in developing this commitment and the reality that no one can guarantee outcomes—undertaking ERP is always a calculated risk.

Notable Quotes

• “OCD almost never goes away on its own...at some point, if you don't make the committed decision to really go for it...it’s probably going to be largely in control of your life until the end.” —William [09:50]
• Patrick’s Irish saying:

  “Only an Irishman can tell you to go to hell and make you look forward to the journey. And I think about ERP like that sometimes.” [07:33]

4. The Life You Want to Live vs. The Life OCD Dictates

[11:04–15:45]

• The importance of clarifying what OCD is “costing” the client.
• William discusses how his turning point came when his top priority shifted from avoiding unlikely disasters (e.g., dying of rabies) to seizing the opportunity to be brave—even at the risk of discomfort:

  “For me, the core fear was not actually dying of rabies. The core fear was missing my chance to be brave.” —William [14:08]

• This insight enabled him to do ERP and skip safety behaviors for the first time in years.

5. Metacognitive Approaches and the Nature of Safety Behaviors

[23:53–35:29]

• William clarifies the difference between “object-level concerns” (the feared event itself) and “process concerns” (fear of internal experiences spiraling out of control).
  • Example: A client afraid of being struck by a meteorite is also afraid of losing control of their internal world in public settings.
• They explain how safety behaviors temporarily relieve both the external fear (event) and internal discomfort, fueling the OCD cycle.
• Patrick adds that “control is an illusion,” referencing personal and familial examples of worry as a (dysfunctional) control strategy.

Notable Quotes

• “What most of us with OCD do to least momentarily reestablish control of our internal world is a safety behavior.” —William [29:26]
• “If I worry hard enough, I can somehow prevent things from happening…If I worry I'm prepared and buffer myself.” —Patrick [31:10]

6. Exposure Practice: Facing Fears and Internal Discomfort

[16:55–23:46]

• Patrick analogizes facing OCD fears to the children’s book “There’s a Monster at the End of This Book”:

  “You get to the end and then Grover says, 'Oh, I’m the monster.'” —Patrick [16:45]

• William shares a client’s experience with scrupulosity who, at the top of his exposure hierarchy, read from the Satanic Bible—ultimately finding it “anticlimactic” and achieving remission soon after [18:29–19:13].

7. Working With Emotions: Anxiety, Guilt, and Sadness

[22:23–23:47]

• The process of exposures involves not just tolerating anxiety, but accepting and making space for emotions like guilt and sadness—especially for scrupulosity themes.

  “Sadness is the emotion that arises when something that you care about has been harmed, damaged, or destroyed.” —William [23:36]

8. Living Your 'Second Best Life' With Unwanted Internal Experiences

[42:58–45:04]

• Inspired by Dr. Jonathan Grayson: Committing to overcome OCD is about learning to live your “second best life”—life with intrusive thoughts, discomfort, or symptoms, but not letting them rule your behavior.

  “My first best life is the fantasy where all my experiences are perfect...Second best is, 'Yeah, this sucks. But I can handle it and keep going.'” —William [43:01]

• Personal note: Patrick and John both live with tinnitus, which never goes away, but they choose to engage life fully regardless.

Memorable Moments & Analogies

• The Grover Analogy: Facing feared outcomes often reveals they’re not the disasters imagined—much like Grover’s discovery. [16:45]
• Baseball Game & Meteorite Example: Illustrates both fear of rare events and fear of relentless internal discomfort. [24:50–29:50]
• Scrupulosity Exposures: Holding a devil image and reading the Satanic Bible, then recognizing the “monster” is not as scary as feared. [16:55–19:13]

Notable Quotes (with Timestamps)

• “If overcoming OCD is not a top priority, you’re going to find reasons to continue participating in your safety behaviors.” —William [13:26]
• "In order to be brave, you first must be afraid, because it wouldn’t really be brave if someone didn’t fear doing it." —Patrick [15:45]
• “Living as if is a very painful, distracting way to live your life that makes regular activities extremely difficult.” —William [43:24]

Timestamps for Important Segments

• 02:08–03:48: William describes his OCD journey and remission.
• 07:11–15:45: Deep dive into the psychology of commitment in OCD treatment.
• 16:55–19:13: Client stories—scrupulosity and the “Grover moment” of ERP.
• 24:50–29:50: Metacognitive insight—fear of losing internal control in OCD.
• 31:10–35:29: “Control is an illusion,” worry as a (false) control strategy.
• 42:58–45:04: Embracing your “second best life” with persistent symptoms.

Conclusion

This episode powerfully reframes the hardest part of OCD recovery—not in learning techniques or acquiring insight, but in making a fully committed decision to face fear and discomfort for the sake of a freer life. Through research, client stories, and personal anecdotes, Dr. McGrath and William Schultz offer hope, realism, and practical wisdom for all at any point in their OCD journey.

For more resources and support, visit nocd.com.