Get to Know OCD: "How Mental Compulsions Helped Me Hide OCD for Decades"

Host: Dr. Patrick McGrath (NOCD’s Chief Clinical Officer)
Guest: Shala Nicely (OCD Therapist, Author)
Date: June 26, 2025

Episode Overview

This episode features an in-depth conversation between Dr. Patrick McGrath and therapist/author Shala Nicely about her decades-long lived experience with OCD, what it means to hide intrusive thoughts and compulsions—especially mental compulsions—and how she found recovery and purpose by embracing evidence-based treatment (ERP). The discussion is candid, sometimes humorous, and ultimately hopeful, offering insight for people struggling with OCD and the clinicians who work with them.

Main Discussion Points & Insights

1. Shala’s Early OCD Experience and Secrecy

• Shala shares the roots of her OCD: Since childhood, she experienced intrusive worries, such as believing she’d given herself 'head cancer' after hitting her head as a child.

  • "I spent a lot of second grade just paralyzed and terrified because I thought I wasn't going to make it to third grade." [03:20]

• The role of secrecy: Shala’s OCD operated under what she called “Rule number one: nobody can know.” Fear of disclosure led her to conceal symptoms, turning to mental compulsions rather than visible rituals.

  • "It was hard for me to meet what my OCD called rule number one, which is nobody can know about me—the OCD. Nobody can know because...you'll be locked up if they know." [00:34]
  • "I took a lot of my compulsions and made them mental...I just became such a consummate mental ritualizer to be able to do the rituals at night—as if you told me you could do without getting busted." [22:00]

2. Living with Untreated OCD: The Cat in the Refrigerator

• The “Fred in the Refrigerator” story: Shala explains a characteristic OCD scenario where she compulsively checked the refrigerator, fearing her cat Fred was trapped inside—a story that became the title of her memoir.
  • "One day, my partner at the time caught me doing this...and I said, 'It's Fred in the refrigerator.' And we both started laughing because it was so ridiculous, yet so quintessentially my OCD." [05:31]

3. Compulsions, Perfectionism, and Workaholism

• Shala describes perfectionistic and work-focused behaviors as maladaptive ways to cope:

  • "Workaholism, substance abuse, perfectionism as a way to get accolades...because if I could get accolades for what I did, then maybe who I was—this kid being that violent, horrific, awful thoughts—wouldn't be so bad." [07:36]

• Discusses the double-edge sword of positive feedback:

  • "Compliments and accolades had a very short shelf life. All it meant was that you had to work even harder to make sure you could get more of those in the future." [12:43]

4. The Power and Challenge of Memoir Writing

• Reflecting on suffering: Writing her story was both healing and painful.

  • "Living with untreated OCD is a bit like living in a suspense novel where you're being held hostage." [07:36]
  • "My OCD is a character in the book because it was a huge character in my life." [09:00]

• Loneliness and the hope of connection:

  • "All of us with OCD can lose so much hope and feel so much shame and isolation...I wanted people to be able to pick up [the book] and say, 'But I'm not alone.'" [10:32]

5. Subtlety in OCD and ERP Treatment

• Shala’s therapeutic approach focuses on subtle, often-missed compulsions:

  • "I'm really big on the subtleties of OCD and ERP because OCD is so sneaky and can be so subtle that sometimes you can miss small things that could create tremendous leverage to help somebody get better." [14:49]

• Example: Emotional states as compulsions:

  • She describes “depression as a compulsion”—living mutedly as if already doomed, which is a subtle avoidance/compulsion.
  • "Even if I'd been in therapy...if I'm doing the exposures with this mindset that wow, still, you know, I'm doomed and I'm doing things in a depressed, muted way...that affect is actually part of my compulsive behavior." [15:35]

6. The Reality of OCD Catastrophes

• Rarely coming true: Patrick asks how many dire OCD predictions ever occurred. Shala recounts only one close call—with a bat, leading to rabies shots—yet even then, the disaster did not materialize.

  • "Other than that, none. None of these [catastrophes] ever happened." [20:00]

• Still, OCD rationalizes after the fact:

  • "If I had just done some more compulsions, that bat wouldn't have hit me, right?" [20:19]

7. Mental Rituals and Hiding OCD

• Mental compulsions as an adaptation: Because visible checking or behaviors drew attention, Shala exchanged them for rumination and mental review.

  • "You wouldn't have known I had OCD at its most severe because it was like...somebody was holding a gun against my head all the time—nobody could see it but me." [22:00]

• Impact:

  • "It's life consuming. You can do other things, but you're not really there because you're up in your head trying to save yourself." [23:00]

8. The Turning Point: Discovering ERP

• ERP revelation at a conference: Shala describes attending her first IOCDF conference (2010), realizing Exposure and Response Prevention (ERP) was an evidence-based therapy she’d never been offered.

  • "At that point, I'd been in and out of therapy for almost 25 years and no one had ever told me about [ERP]...I was so blown away that there was treatment for this." [25:03]

• Her first impromptu exposure: On the National Mall after the conference, she challenged a core OCD fear by confronting triggering images, sitting with anxiety instead of avoiding or ritualizing.

  • "I did my very first exposure. I just stood and looked at all those posters and I did it for, I don't know, 15 plus minutes...my anxiety got super high, and then eventually it started coming down." [27:18]

9. The Role of Mindfulness in OCD Recovery

• Shala and co-author Jon Hershfield’s approach: Mindfulness is not about calm, but about present-moment, nonjudgmental awareness—integral to ERP.

  • "ERP is basically meditation or mindfulness on a trigger." [30:25]

• For mental compulsions, she used "may or may not" scripting out loud as a mindful exposure, until eventually intrusive thoughts passed like "a leaf on a stream."

  • "Mindfulness is meditation on a trigger—however you need to do that...It's about being with it without judging it, that means doing it non compulsively." [33:00]

10. Integrating Passions & Triggers

• How she kept animals and other joys in her life: Rather than avoiding potentially triggering activities or pets, she used mental rituals as “workarounds” until her ERP and mindfulness skills took hold.

  • "I could have these things in my life, and I could be in my head about whatever the problem was and still do them." [36:00]

• Ongoing journey of presence:

  • "After years of being not present, I'm still working on being present every day with what I care about, not what my OCD cares about." [36:56]

11. Therapist Challenges & Coping

• Therapists get triggered too: Shala admits even OCD specialists get triggered and must apply their own coping strategies.

  • "I don't think you can [avoid being triggered]. Sometimes you're going to get triggered and...you have to use your own skills in that moment to bring yourself back to what's important." [38:11]

• Modeling for clients: Even when therapists move on after sessions, it's important for sufferers to see that this is possible.

  • "I was happy to report that I wasn't going to be focusing on this as the main thing in my life...to hopefully model that we can hear anything and still be able to move past it." [40:00]

12. OCD, Trauma, and Recovery

• Specialization on OCD/PTSD intersection:
  • Shala works with clients with overlapping OCD and trauma, noting that trauma may prop up OCD and must be treated together for effective recovery.
  • "The compulsions are really about keeping the trauma from happening...it's a matter of doing evidence based therapy for both." [41:20]

13. Encouragement for Listeners

• Addressing hopelessness:

  • "OCD is going to tell you you can’t do it, you can't get better, you're not strong enough, it's too hard, it's too dangerous—all those are just ploys to keep you trapped because your OCD wants to stay in control." [43:50]

• Personify OCD to externalize it:

  • "It has diametrically opposed goals and values than you have...when you hear those words that you can't do it or it's too hard, recognize that's OCD." [44:45]

• Connection and hope:

  • "You're not alone...through ERP you have an amazing chance to be able to tame OCD. You can do this. You can get better. It’s not necessarily going to be easy, but it is worth it." [45:30]

Notable Quotes & Memorable Moments

• “Living with untreated OCD is a bit like living in a suspense novel where you're being held hostage.” (Shala, [07:36])

• "You wouldn't have known I had OCD at its most severe because...somebody was holding a gun against my head all the time. Nobody could see it but me." (Shala, [22:00])

• "ERP sounds really straightforward...but OCD is so sneaky and can be so subtle that sometimes you can miss small things that could create tremendous leverage." (Shala, [14:49])

• "I did my very first exposure...and as I stood there, my anxiety got super high, and then eventually it started coming down and I realized I was horrified, but I wasn't scared." (Shala, [27:18])

• "Mindfulness is meditation on a trigger—however you need to do that." (Shala, [33:00])

• "OCD is going to tell you you can't do it...all those are just ploys to keep you trapped because your OCD wants to stay in control." (Shala, [43:50])

• “If you're at the conference in Chicago this summer and we're on a staircase together, I will think about throwing you down the stairs, just so you know.” (Patrick, [46:23])

  • "Well, I will probably think about pushing you down at the same time, so we'll throw the gap." (Shala, [46:39])

Key Timestamps

• 00:34: Rule number one—nobody can know about my OCD
• 05:24: The origin of “Fred in the Refrigerator” and OCD storytelling
• 07:36: Impact of untreated OCD; memoir as a tool
• 12:43: The short-lived comfort of compliments and perfectionism
• 15:35: Depression as a compulsion, subtle forms of avoidance
• 20:00: Catastrophic predictions almost never occur
• 22:00: The adaptation of mental compulsions to stay hidden
• 25:03: Discovery of ERP and the pivotal conference experience
• 27:18: First real exposure—ERP on the National Mall
• 30:25: Mindfulness, scripting, and ERP in tandem
• 36:00: Using mental rituals as a workaround to keep living
• 38:11: Therapists also being triggered, modeling resilience
• 41:20: Addressing trauma and OCD together
• 43:50: Words of encouragement and exposing OCD's lies

Tone & Final Notes

Honest, accessible, and often sprinkled with humor, the episode is a candid illustration of the complexity of OCD—particularly how “hidden” compulsions can dominate life. Shala Nicely’s blend of personal experience and clinical insight provides actionable hope for those living with OCD and the professionals supporting them.

For more from Shala Nicely: Visit her website, sign up for her monthly "Shoulders Back" newsletter, or check out her books (“Fred in the Refrigerator” and the forthcoming novel “The Price You Paid”).

For OCD help: Visit nocd.com