How Mental Compulsions Helped Me Hide OCD for Decades

Summary

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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

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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.

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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]

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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])

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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

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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.

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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

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Transcript

[A]

I have had OCD since as long as I can remember.

[B]

One of the best titles of a book I've ever seen is Fred in the Refrigerator. And maybe you could share a little about Fred.

[A]

So Fred was my cat and I used to worry that he was stuck in the refrigerator, go back and, like, move all the groceries to see if he was back there freezing, shivering and lying. So I used to. Excess. I do a lot of compulsions around this bread in the refrigerator. And it's hard for people to understand really what it is because so much of it is up here in your mouth.

[B]

Right, right.

[A]

And I think what I learned to do over time is 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. Because you'll be locked up if they know. OECD is going to tell you you can't get better. It's going to tell you you can't get better. You're not strong enough. This is too hard. It's too dangerous. And what I would share with people is try recognize. That's ocd. That's it. Trying to stay in control.

[B]

Have you ever felt so overwhelmed by your mental health concerns that it's hard to even contemplate getting help? Let's be honest, when you're really struggling, finding help and getting yourself to a therapy session can be really difficult. But that's where virtual therapy offerings like ours really make a difference. As a licensed clinical psychologist with 25 years of OCD treatment, I've worked with people to help them get their life back on track. I've also trained a clinical team to do the same here at nocd. NOCD is an online platform offering specialized, accessible and convenient OCD treatment. Our therapists take insurance and we'll work with you every step of the way to help you get your life back from obsessive compulsive disorder. So head to nocd.com to book a call to start your treatment journey. And don't forget to subscribe to our YouTube channel so you can stay up to date on our latest podcasts and webinars. Now, onto today's episode. Hi, everyone. Today's get to Know OCD podcast brought to you by NOCD Features, a good friend of mine, Shala. Nicely, Shalla. It's been a while that we. Since we've had a chance to chat. We've. We message now and then, but it's. It's nice to talk again. How are you?

[A]

It's nice to talk and thanks so much for having me on. I am fine. And how are you?

[B]

I am doing very, very well. Things are good here and I hope that is the same for you.

[A]

Yes, it is. Nice.

[B]

Awesome. So I know you know very little about OCD and have never experienced it. No, wait, that's a different first. Never mind. Never. You, you come with a, a lineage of OCD into this experience of your own personal journey through it. You've written about it, you've spoken about it. And I always appreciate when people are so vocal and open about what it's been like to live with ocd. And I like that model of living with OCD because you've really shown that you can live with ocd. So I'm wondering, to start off, can you tell everybody a little bit about you, your OCD journey and we'll get into one of the best titles of a book I've ever seen is Fred in the Refrigerator and things of that Nature. So. So yeah.

[A]

All right. So again, thanks for having me on. It's a pleasure to be here. So, a little bit about me. So I have had OCD since as long as I can remember. I am currently an OCD therapist living in the metro area. Like you said, I've written pretty extensively about my experience. I've spoken about it, blogs about it, because I think it's really important, important to let people know that they're power and that they. So a little bit about me and my experience. I probably had it, gosh, since I was in elementary school was when my first symptoms came up. And you know, for somebody that young, it's pretty scary. I would, I would have these thoughts that I had head cancer. Where I bought that idea. Reminds me, Lucy to get the idea. But I had hit my head on in a swimming pool when I was five or six. And when I was in second grade, my mind fished that memory out of its recesses and put it up in front of me and said, hey, look at this. I think you can get yourself head cancer. And so I spent a lot of second year aid just paralyzed and terrified because I thought I wasn't going to make it to third grade. I thought I was just going to be a little goth and dead somewhere because, you know, I had this awful thing and it into the wax even waning course and you know, I've experienced it throughout my life until I got treatment. And I'll just stop there because I could spend hours talking about what's happened to me, but that's how I got started.

[B]

Who is Fred. Everyone wants to know who Fred is. I. I know who Fred is, but maybe, maybe you could share a little about Fred.

[A]

Well, you know, and gosh, should I just say you have to buy the book and to figure out who Fred is.

[B]

Oh, yeah. Too bad. Buy the book, everyone. There you go.

[A]

No. So Fred was my cat, my orange and white cat, whom I loved dearly. And I used to worry that he was stuck in the refrigerator. And again, don't know why that thought started, but it would just hit me and I'd be walking past the refrigerator, and I would have to open the refrigerator and look, and this one has a good freezer and book. And that's, of course, that wasn't enough. I could open again and go back and, like, move all the groceries to see if he was back there freezing, shivering, and lying. And so I used to excess and do a lot of compulsions around this bread in refrigerator. And one day, my partner at the time caught me doing this, you know, slightly embarrassing, and he's like, what are you doing? And I, you know, he knew all about ioc. I just sit there and I said, is credit the refrigerator. And we both started laughing because it was so ridiculous, yet so quintessentially my ocd. Right. And. And we both said, you know, that would be a great title for a book, is Spread in the Refrigerator, because that's the kind of things that OCD makes you worry about.

[B]

Yeah. I was going to have a band called the Spread in the Refrigerator, but your book came out first and took it, so it was. It was already copyrighted. I couldn't do it.

[A]

I think it'd be great that you, you know, I'm happy to share the title with you, Patrick. You know, maybe you'll let me have a singing gig in the band.

[B]

Of course, yes. Well, of course you're more than welcome. Yeah. You know, writing. Writing a memoir about your own ocd, I'm sure has its pros and its cons. I mean, on the one hand, it's got to be wonderful to be able to look back and think of all the things you're not doing anymore. Right. But on the other hand, there's probably some regret of time of your life lost to ocd. How. How did you kind of weigh those two things together as you were writing the book? And how do you feel about that today as you look back on your life after the book's been published?

[A]

Well, you know, it was challenging to revisit all that and revisit the suffering that I had experienced. Experienced I think, you know, in terms of having regret about the time lost. I mean, of course I have experienced that. I think I was. When I was working on writing the book, I was really interested in trying to put together pieces in the way. In a way that would make it a compelling story. And unfortunately, living with untreated OCD is a bit like living in a suspense novel where you're being held hostage. So it wasn't sometimes that hard to try to put these pieces together because I'd been hostage for so long in so many different ways. And it was, I think, challenging at times to see how sneaky and sly OCD had been and how many ways that I had tried to manage it before I learned about erp. I think that was tough to really look in the face. Workaholism, substance abuse, perfectionism as a way to get accolades. What I. What I was doing, because that made me feel bummer, 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. You know, pulling away from people because of ocd, probably amount of anxiety and anger I experienced over the years, it was hard to face what I had become at times trying to manage this thing in my head that I couldn't seem to get anybody to help me with. And it. So to write about that is challenging. And sometimes I would write about it in such a way that I was trying to get so into my monstrous head to be able to describe this, because, you know, as, you know, my OCD is a character in the book because I thought that was the greatest way to do this because it was a huge character in my life, of course.

[B]

Yeah, yeah, so.

[A]

And my body. Dysmorphic disorder. My BDD is also a character in the books. You would like a side villain to my ocd. My OCD was always predominant. My BDD is secondary. It still could be quite bad at times. And I remember when writing the book, when I was working on the BDD and I was working so hard to get into its mind, which I called it a slick salesperson. Sell me these visions of what it could be like if I could just, you know, get this or that body, but perfect. And I remember writing that and. And starting to forget that that's not what I did anymore. Almost getting lost in those. Those BTV thoughts and wanting to do emulsions in because I was trying so hard to get in the mind of it so that I could find that. But I think ultimately I was really glad that I did, because my story is unfortunately quite like many people historians, that it took a very long time for me to get the right treatment. And it was a very long and winding journey and it wasn't, you know, straightforward in any way. And I think that's important for people to be able to see and also see that you can get better. Get better not meaning that I don't have OCD or bpd. I mean, I do. But that you can learn to tame it and live as high quality of life as anyone else who doesn't have these things. And so I'm really glad I wrote it. Those reasons that I went through the challenge and reliving some of the suffering to be able to put that out there, because all of us with OCD can lose so much hope and feel so much shame and isolation. I knew what that was like. I wanted people to be able to pick and say, but I'm not alone. Somebody else has struggled too, and has. Has gotten through it to the other side, where they're more in charge of their life than in a CP is.

[B]

One thing that you said that I really. I. I've always been interested in, and I'm glad you brought it up. And. And it's a topic that I've discovered first when I was traveling where I was in Australia, and I was asked, why don't Americans like compliments? Which I thought was kind of humorous, but they said no. Every time you compliment an American, they say, oh, no, no, no. And then you have to say it again. They go, oh, no, no, no, no. And then they say it again, they say, okay, thank you. And. And. And so a. I thought that was pretty funny, but it's all. It also then started me thinking about what I had seen in working with people who had both social anxiety, BDD and ocd, in that a compliment sets a standard that you now must achieve. And now if I ever fall below that, I'm a failure. So there's a lot of fear of compliments. And yet you just described how much you wanted to have that compliment. And yet you get it and now you must always achieve it or else you're a failure. Am I right? I'd love to hear your take on that of what you think.

[A]

Yeah, that's such an excellent point because to me, and I wrote about this in Frank, compliments and accolades had a very short shelf life so you could get them, but all it meant was that you had to work even harder to make sure you could get more of those in the future. And for Me, I just was so lost in perfectionism and workaholism to try to prove to myself I was okay. And when somebody else would tell me I was okay, I was gonna be okay. Well, am I? You have to keep going and going and going. And so you get in this never ending cycle. Not unlike the OCD cycle, obsessions and emulsions, the workaholic, perfectionistic cycle is the one where you're just trying to get these positive accolades and they're never gonna be enough. And you get lost in that because it also can keep the OCD at bay because you're so busy trying to get these accolades. It's hard sometimes for OCD to word edgewise other than to tell you it's not. So, yeah, it's. It's a really tough cycle. And, you know, I see a fair number of clients who've done the same thing in their lives. And then once you put the OCD under control, then you've got to sometimes get the workaholism under control. That's become its own monster, especially in our culture, which can sometimes make that seem like a good thing to get that under control so that you have time to live this life that you've opened. Because your OCD is much better.

[B]

When I have therapists on, it's fun to ask so many different things that are unique to them. What is your take on treating OCD that you think is kind of unique to you and that may come from your own lived experience or just the years that you've been doing this, but is there, is there a go to Charlotte nicely, you know, kind of kind of thing?

[A]

Yes, I think there is. I'm. I'm really big on the subtleties of, of OCD and of ERP because ERP sounds really straightforward. Let's face our heroes without. But OCD is so sneaky and can be so subtle that sometimes you can miss small things that if you would identify, that could create tremendous leverage to help somebody get better. And so I'm always thinking about, what are these subtleties? What are these small things that people are doing, maybe that I didn't done in my past that are keeping them stuck. So I'll give you an example. So one of the things that, that I realized eventually, years into my recovery, that I was doing is something I call depression as a compulsion of emotions, as a compulsion. Super subtle in that what I was doing is this is when I had this long standing obsession as my 20s that I give him myself HIV. And I was in my head all the time about this. And I. Everything that I did, I was doing is sort of like sentence hanging over me. Like I had been to court and I'd been sentenced and I was going to be going to jail anytime now. And so you could live your life sort of muted because, you know, oh, this is gonna be the last time I do this because I'm going to be in jail. That's how it felt to me. And so I would do things and it might look on the outside, you know, I'm smiling like I'm having women on the inside. I'm like, well, no, I can't really enjoy this because I've given myself this fatal disease because I was stupid and I. These terrible mistakes. And. And so even if I, at the time I wasn't in therapy, I don't think at this time I knew yet I had ocd. Even if I'd been in therapy and I had been doing exposures for that. If I'm doing the exposure exposures with this mindset that wow, still, you know, I'm. I'm doomed and I'm doing things in a depressed, muted way. That affect is actually part of my compulsive behavior. And what I learned for myself is it was really finding joy, even if it's a tiny, tiny little bit, remembering what would things be like if I didn't have this obsession? Okay, I'm going to act like. Like that. I'm gonna act happy. I'm gonna act like I'm really excited, even if I don't totally feel that as a way to stop acting like the OCD content is true. And that was a subtlety. That was huge for me when I finally figured that out. And I see it in a lot of my clients too, who have longstanding obsessions about which they've lost insight. They really believe it. We're trying to get it spooze, but in their core, they're believing it and acting. So I would say for me as a therapist, I really try to look at those Celtics because I think that they make a huge difference. If you can find them and there are lots of them and you be able to help somebody who's been stuck for a long time figure this out. Do ERP in a different way so they can.

[B]

How many of those worst case scenario, OCD doomsday things actually happened to you in your life?

[A]

You know, the only thing that actually happened, but the actual doomsday part of it didn't happen, the only thing that actually happened to me is that I, a bat ran into me at one point. And I had. And rabies is, like, way up on the list of my ocd even to this day. It was not very thrilled about. And I only knew that that was a problem because somebody in my grad school class had had a bat that was in their house.

[B]

Sure.

[A]

And they had told me and my OCP that in your house that they make you go get radio shots because bat bites are undetectable. And so if it was in the bedroom with you, you don't know, didn't have to go get radio shots. And this bat, my, like, you know, well, dancing wrapped itself around my arm and was like, doing this. I'm like, that's a problem. And so. So I had to actually go get rabies, a series of rabies shots with that. And also, you know, that was its own, like, pedal of fish. Because, sure, you know, I'm like, am I doing a compulsion? Am I not doing a compulsion?

[B]

Right.

[A]

And then I get there and they're like, well, how do you know? I'm like, well, I don't, but this is what I've been told. And, you know, back and forth, back and forth. And finally they're like, yeah, and refund scratches all over my arm.

[B]

Yes. But.

[A]

But anyway, so that. That was as close as ever forgotten to a doomsday scenario happening. But it didn't really happen. I didn't get babies, so.

[B]

Right.

[A]

And so I would say, other than that, none. None of these sure happened.

[B]

And. And this will be a weird question, but was there a point in your. In that experience where you thought to yourself, man, if I had just done some more compulsions, that bat wouldn't have hit me. Right?

[A]

Yeah, absolutely. Yeah.

[B]

Yeah. There you go.

[A]

Sat in the hospital. I just checked my bat radar better before I went. Bats were much, much better. Yes, definitely. Yeah.

[B]

I interviewed someone recently on here who convinced her doctor to start her on HIV medication even though she did not have hiv.

[A]

Wow.

[B]

So that's why I was asking. Just because obviously people see what OCD is in the media, but to be able to truly show what it's like to live with ocd, that's why it's fascinating to have you on and people with OCD on to describe all of the extents that you've gone to in your life to try to prevent things from happening, and yet the vast majority of them were preposterous. But OCD doesn't really care about that whatsoever. Right.

[A]

Yeah. And I think, to your point about. It's hard for people to understand, really. What is it is because so much of it is up here in your house.

[B]

Right, right.

[A]

And I think what I learned to do over time is 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 narrow because. Because you'll be locked up if they know. And also, you can't say anything about this because you'll make this stuff happen if you were to admit this to anybody. And so with rule number one, you know, guiding what I was doing, I couldn't do a lot of physical compulsions because people would see them when I had to explain them. So I took a lot of my compulsions and made them mental. You know, if I think I'm running over people, which I think I did, and I can't turn around and drive whack because people want to ask why, I can certainly review it in my head. And so I just became such a consummate mental ritualizer to. To be able to do the rituals night. As if you told me you could do without getting busted with doing that. And so for me, you. You wouldn't have known. Except if you were really, really close to me or looked at me. You wouldn't have known I had ocd. It was at my most severe because it was like the way I described it in Fred. It's like somebody was holding a gun against my head all the time. Nobody could see it but me. I just had to do these things. And it's. It's all these mental gymnastics and it's. It's. It's life consuming. I mean, you can do other things, but you're not really there because you're up in your head trying to save yourself.

[B]

Right. And a TV show of mental compulsions would be kind of boring because it would just look like this.

[A]

Yeah. Unless they could do something like inside out, you know, and do cartoons of what happened. It would be a. It would be a horror show cartoon.

[B]

Yes, it would. It would be a terrible horror show cartoon. Yes. But otherwise, yeah, not so fun. But it is so important for people to realize a mental compulsions happen and be that that is a part of ocd. Because I'm always afraid that people are going to see things on television and think that's the only way OCD is. Right. And so to get the message out, especially for the things you've described. Right. How much time you spent thinking about things and having to figure things out and the research that you can do online, but then the reviewing of the research that then you have to do in your head, post all of that. Just the amount of time spent in service of OCD is overwhelming.

[A]

It becomes your entire life, your entire existence. From the time you wake up to the time you're bad. You're in your nin, trying to keep that done that you feel is beside your not right.

[B]

And as much as real as it felt to you, I'm also betting you were not giving others advice to do the same thing.

[A]

No, because the rules only applied to me. Rule number one was my. My special.

[B]

My favorite word. Your specialness. Yes. The rules apply to me differently than any.

[A]

Yeah, that's right. Would you written about extensive.

[B]

I've done a. Done a little bit on that one. Yeah, that's very true. In the end though, you. You go to graduate school, you study this, you. You now do this for a living. What was the motivation for that?

[A]

So the motivation for that was actually going back to. Is by the refrigerator. So I had decided, I was in my late grades, that I was going to write a book about how to manage ocd, because even though it was still a problem, I was getting by. And I thought, well, Bosch, if I shared the things I was doing to get by, that would be maybe helpful for people. And people call it a splendid evaporator. And I thought, well, maybe I need to go meet some other people who have OCD and learn something about this. And so I looked up OCD online, which is crazy that I really hadn't so much envy before. And I found the Air National OCD foundation had a conference in just a couple weeks. You want to. This is in 2010. And so I went to the conference and the first session that I went to was by Dr. Reed Wilson to a friend of ours, and he was giving a talk called the Art of Persuasion Changing the OCP Mind. And I went to that talk, and he started out by saying, well, we all know that a gold standard treatment for OCD is erp. And I'm like, what? Because at that point, I'd been in and out of therapy for almost 25 years, and no one had ever told me about therapy. And so I'm like. And I was in the technology industry at the time. I'm like, enterprise Resource Planning software. Is that. Is that what he's saying? I don't understand. And I was so blown away that there was treatment for this. And so the whole conference was just one. Like, I walked around just my jaw dropping all over the place. There was this thing that you could do that actually. And so after a whole day of this, and it was in Washington B.C. that night, I went to the National Mall. And I have one of my big obsessions, always has been I just get these violent images of animals in for sure. And I was. Went up the escalator onto the National Mall from the Metro and right in front of me was this huge PETA exhibit, People for the Ethical Treatment. And of course, they. The pictures were horrific.

[B]

Yeah.

[A]

And I just looked away because that's what I always did.

[B]

Right.

[A]

And then I thought, now wait a minute, they've been saying this conference that I need to face my fears. And so basically I had a showdown with my OCD on the National Mall because I'm like, we're doing this. And my ocd, you know, pulled out. It's done. It's only a bit to my head. It's like, you can't look at this because if you let these images be there, an animal is going to die. It's going to be all because of you. I had this. I did my very first expenditure. I just stood and looked at all those boosters and I did it for, I don't know, 15 plus minutes. And I was shaking. Sometimes I was crying. But I like, I'm not looking away. I have learned I need to want my anxiety, I need to stay here. I need to just continue to be with the fear without doing any compulsions. And as I stood there, my anxiety got super high. And then eventually it started coming down and I realized I was so horrified by what I was seeing, but I wasn't scared.

[B]

Yeah.

[A]

And that was such a profound experience for me that I'm like, well, clearly, if it's taken me 25 years and no one has ever affirmation, disparity and it's so effective, then there aren't enough people doing OCD work. And so I went home from the conference that weekend and signed up for grad school.

[B]

Well, sounds like the discovery of no CD as well. Not, not, you know, lots of bad therapy until you find the right one. And then realizing the therapy isn't the problem, it's finding the therapy that's the problem and getting the therapy that's the problem.

[A]

Exactly, yes.

[B]

Why we here, why we do what we do. Yeah. Yeah. The conference is so fun because you have people. It's the only conference I go to where people with the condition are actually at and get to interact with each other. You also, I'm sure, have attended the therapist support group for therapists who have OCD and play a role in that. And I just think what a great experience for people to be in a place where everyone else around you gets it and understands it and isn't looking at you like you do. What now it's just like, oh yeah, I had that. One of those types of things. So it's really good.

[A]

I highly recommend it to anybody in the OCD world. People who have a condition, their family members, researchers, therapists, because it's a unique environment because of what you're mentioning, because there people work at this world, there everybody gets it and everybody's so compassionate and dreaming of their time. You learn so much. I felt like I got years of therapy at that first conference, just yelling to all the sessions. So highly recommended.

[B]

And then there's another book you wrote with our mutual buddy John Hirschfeld about mindfulness and ERP and ocd. And I think sometimes people get maybe a bit of a wrong idea about mindfulness. Wondering if you could maybe tell our listeners a little bit about it in your approach from a mindfulness point of view into the treatment world.

[A]

Yeah, because I think that mindfulness can be thought of as you need to be calm, which for some of ACV is I can't do that. And for John and me, what we did is we said said in the book, mindfulness is erp and the B is my choice because if you look at mindfulness, it's really non judgmental awareness of the present permanent. And so ERP is basically meditation or mindfulness on a Twitter. And I think about it in a couple of different ways. So for instance, because I was such a big mental witcher, for me to sit down at the beginning of my therapy journey and try to meditate and not have my head be swimming with intrusive thoughts and compulsive thoughts and rumination would have been virtually impossible. So instead what I did is I came up with a way that I could meditate on my obsessions out loud. Bikery. But I call these Mary, not stick statements or slipping. Well, I may or may not have been somebody over there may or may not be somebody lying back there. They've been lying and I may not have ruined their life and my life too. And I would say this over and over to allow myself to be pleasant with that obsession in a non compulsive way. To me, that's mindfulness. It's. It's like concentrated meditation. It's like meditating on a mantra where you're just trying to stay focused on something. I was trying to stay focused on these things that I was great at. And so that's one type of mindfulness over the years and it has taken me years. So if anybody's out there listening to this, you know, give yourself time. It took me years of doing what I considered a competing response to the mental rituals. Doing those sweeps out loud. Often I do them in a power coach. Try to make myself feel more empowered. Years of doing that for me to be able to. Able to be in the presence of. Of an accession and you know, put my shoulders back and just go on with my day to the point where I am now where I can have an obsession. Am I, am I hear it and it sort of goes right on through and I just turn that attention back to. And that might be more of a classic definition of mindfulness. You would think there was some intrusive thought or a thought of anything and it's just like a leaf on a stream and you just let it go. That is I think the strongest response to ocd because then you're acting like the obsession is completely irrelevant. Gives your brain nothing to go on as to why it should bring it up again. But it, it was very challenging for me to get there. But I think it's important for people to realize because I don't think I'm alone and that is that mindfulness is meditation on a trigger. However you need to do that. We don't want to get into this process. Perfection definition. Well, I'm not sitting on the cushion and my brain is p. No, it's not about that. It's about being with it without judging it. That means doing it non compulsively so that your brain can get used to it and stop being. To say scary.

[B]

Not easy to do though.

[A]

Not. Not easy, not easy to do but. And again that's why I relied so heavily on. On. On scripting and may or may not statements because that's what I could do and that's what I could be successful with.

[B]

And I love that. Yeah.

[A]

And. And again, for those of us just not very nice to ourselves and giving ourselves a break about what you know, it's okay for me to be. Just be good at this and not be good at this other thing. We're not always great at doing that. So it's really important for people that wherever stage of mindfulness they're in, get yourself a pat on the back for that.

[B]

And I think the not easy really is in the sense that don't just start doing this and think you're just going to be doing it. And if it doesn't work out the first time, think you're a failure at it. This is. This is like learning any skill, golf, whatever. You know, it takes time and practice, and you're going to goof up and you're going to be disappointed, but once in a while, you're going to get it. And then all. Hopefully that gets more and more often that the getting it is the more common experience than the not getting it. Right. And then you've come the other way. You know, you've gone from this person and even maybe during it. But who had these fears of harming animals. But you are an animal lover. You've had a horse, you have dogs, you know, just. And what. How did you work living with OCD and these things? Because there are, of course, people who have OCD who remove all sorts of things from their lives to make sure that they could never harm an animal, harm a child, harm someone with a knife or something like that. You know, what was it like to integrate these things back into your world again?

[A]

Well, that's a great question and in fact, a good segue from talking about mindfulness, because I. I actually did not deprive myself of a lot of things that my OCD was scared of because I figured out I could do them while mentally visualizing.

[B]

Ah, okay. Okay. So the horse was alive due to the mental rituals. Okay, I understand. Yeah.

[A]

So I. I could have these things in my life, and I could be in my head about whatever the problem was and still do them. So for me, the integration was really. Once I started doing erp, the integration was, how can I truly be present with, you know, these preachers, these activities, these people in my life that are really meaningful to me because I spent so much of my life not present. I was physically there, but I was up in here doing all sorts of gymnastics. And so the integration was, how can I be here and be present with triggers and with intrusive thoughts and turn my attention back to what I'm doing? And that has been a journey of, you know, I've been in recovery for 15 years now. I still work on that, to make sure that I'm trying to be present in every moment with what I care about, not with my ocd, what my OCD cares about, because those are two diagnostically opposed things.

[B]

Things.

[A]

And so that's been the integration that. That I've been working on. And I think for everybody who works on meditation and mindfulness, it's a lifelong journey. You never sure there.

[B]

Yeah.

[A]

And so I just continue to work on that. Day by day. In fact, today I was hiking and I was trying some meditations from the meditation app about walking and hiking because I was noticing I was up in my head when I was hiking, not obsessing with just like, planning and thinking about this. I want to do that. I'm like, I'm in the woods. Let's be in the woods.

[B]

Hello, tree. Yeah. Yeah, right? Yeah. That's really cool. And now that you are in the field and. And you are working with people who probably have a lot of similar things to what you've had to deal with, one of the questions that, again, I don't think it's talked enough about, and I'm excited to have you here to chat about this, is how do you prevent yourself as a therapist from being triggered by the things that you talk about with people who have ocd?

[A]

Well, I don't think you can.

[B]

There we go. Thank you. Thank you. There we go. See, this is important to talking about.

[A]

I mean, sometimes you're going to get triggered and, you know, your client may be doing exposure in the air to 4, and you're at 8, and that's the way it goes. And you know, that does not happen very often. The longer I've been doing this, the less it happens. But it happens sometimes. And it's just a matter of using your own skills in that moment to bring yourself back to. To what's important, which is the client in front of you and helping them manage their exposure and the subtleties and making sure they're catching everything that gets effective as possible. So it's really just using your own skills on steroids to make sure you're in the pleasant moment, but also know you're not going to be perfect about that and not beating yourself up because it happened because you're a person too. And, you know, obviously we wouldn't share that was happening with the client.

[B]

Sure.

[A]

But. But, you know, probably if clients thought about it just to know their own therapist, sometimes stories with these things, too, is a form of common humanity that makes them feel like, oh, well, you know, yeah, it's okay that these things happen sometimes. Use our skills and you do the best.

[B]

Right. Because. Because people with ocd, I mean, they know I don't have OCD when I'm treating them, because many times they ask, and I'm very honest about that, but they will still apologize. Oh, that might have been triggering for you. And I just say no. Or my favorite one was someone once said, I'm really sorry. I know that was a lot Today you're probably going to be going home and thinking about that for the rest of the night. And I said, nope, I'm going to get in the car and put some music on and think about what I'm going to make for dinner. And they were shocked, right? They were just, they were shocked that I was not going to now focus on this as the main thing of my life for them. And. But I was, I was also happy to report that I wasn't going to be doing that and to hopefully model that we can hear anything and still be able to move past it if that's the case.

[A]

Yeah, I love that because that's what they're working for, to be able to do the same thing. Right?

[B]

Yeah. And tell us a little bit about your practice and you've got a lot of media stuff that you do, so give us the skinny on what's going on there. Perfect.

[A]

So one of the areas that I have learned a lot about over the past five to six years that I really focus on in my practice is the dynamic intersection between OCD and PTSD or trust trauma, because it's such an interesting area that I think gets overlooked a lot and keeps up with the stuff when you have PTSD or trauma and then OCD steps in really as a help mate to the trauma and the compulsions are really about keeping the trauma from happening.

[B]

Yeah. Oh, hey, I can stop that from ever happening again. Just do this.

[A]

Yeah, exactly. And then if, if when somebody's getting erp, the therapist doesn't realize there's underlying trauma behind it. The ERP often isn't very effective because the trauma is propping it up. And so it's a matter of doing evidence based therapy for both getting started on one off in this trauma first, but then having to do them simultaneously so that you're trying to help with the OCD and the PTSD at the same time. I really find that fascinating and it's so helpful. This combined evidence based treatment for you too can help people who've been stuck for a long time do a better job at became realized. So that's, that's an area of specialty and interest that I'm focusing on. You know, I've also been working and recently finished a novel where it's called the price you paid and one of the protagonists has ocd. And it was important to me, as my next writing role to write something novel form about OCD that would be an entertaining story, but that also would teach people about OCD who might just be interested in reading the novel. But then they would also learn something about ocd. And that has been a really fun journey to put that together to hopefully get that up. I continue to write my. My gloves. I have a newsletter, Shoulders Back Tips and Resources for Canyon ocd that I send up once a month with new blog posts for our podcasts like this, helping people with free resources for how do they manage this? And a lot of times my newsletter is focused on the subtleties, these little points that can make a big difference in your recovery if you can figure out if they are.

[B]

Yeah, I like Shoulders Back and thank you. You know, a couple years ago when Susan was sick and when she passed away and you were very kind on there and featured some of the writing that I had done about the experience and everything. So I did appreciate that very much. There are people out there who will watch this who, like, I still don't know what is your motivational speech to have someone take that first step to try out this ERP that you so bravely tried out on the Washington Mall.

[A]

What's really important if you have OCD is that your OCD is going to tell you you can't do it. It's going to tell you you can't get better, you're not strong enough. This is too hard, it's too dangerous. And all those are just poised to keep you strapped because your OCD wants to stay in control. And if it can keep you feeling victimized, OCD is its own form of trauma. That's something I've written about too. Is oftentimes we feel like we have this abuser in our heads. We tend not to stay. And if it beats down on you enough, you almost get a sense of learned helplessness. I can't do this. I can't ever escape this. And what I would share with people is, is try recognize that's ocd. Like, that's it trying to stay in control and that it is going to fight you every step of the way at times to do this therapy because it knows that if you do it, that it's not going to be in charge anymore. And. And I, I think one of the most helpful strategies to me has been personification of my OCD and seeing it as this character in my life. And it, for me, it has all sorts of different ways it manifests in terms of its personification that my show and Fred, but recognizing that it's not you, it has different diametrically opposed goals and values than you have. And so when you hear those, those words that you can't do and it's too hard. Recognize that's OCD and, and try there, you know, especially with nocd. I think what you guys offer is amazing because you offer therapy in places now that people weren't able to get access to effective care.

[B]

Right.

[A]

And that's something that we didn't have, you know, 10 years ago, 15 years ago, for the bat. And so reach out, talk to an ERP therapist, find out how they might be able to help you. Give yourself a chance and, and know that you're not alone, that there are a lot of people out here who are also suffering because very similar things to what you're suffering from. But that through erp, you have an amazing chance to be able to tame ocd. And you can do this. You can get better. It's not necessarily going to be easy or a straight path forward. Mine certainly wasn't, but it is worth it. There is a different life awaiting you where you can have intrusive thoughts and be able to be in the pleasant it goes and focus on what you care about. So give yourself that chance.

[B]

I always tell people I've absorbed pretty much every thought, image and urge of anyone I've ever treated. And Shala, 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.

[A]

Well, I will probably think about pushing you down at the same time, so we'll throw the gap.

[B]

So if you're at the conference and suddenly you see these two strangers tumbling down flights of stairs, you know who they are. It's Shala and Patrick who for the first time finally decided, what the hell, let's actually do it. Instead of just think of, yeah, let's just. Well, thank you for being a shining light of what life is like with ocd, what you can do as a career and have OCD and for sharing your life and your books and, and your blog and everything. So really appreciate it.

[A]

Well, thank you so much for having me again. And thank you so much for all you and Missy Gable as well to help people leave fighting their lives. Mixing beach tickets.

[B]

Awesome. And hey everyone, if you liked what we were talking about today, subscribe to the NOCD YouTube channel where you can get more of the get to know OCD podcast as well as watch our Wednesday night webinars that we do. And if you're looking for help for OCD, check us [e-mail], that's N O c D com. We do work with ocd, body focused, repetitive behaviors, tics hoarding, trauma, anxiety, issues with mood. We're happy to help any way that we possibly can and we even have our NOCD 411 sessions where we help people in a one on one question and answer session for friends, families. If you have some areas that you want to talk about like that too. Otherwise, we hope to see you again soon. Take care of yourselves and be good to each other. Thanks.