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- [00:00]
A
Hi, everyone, and welcome once again to another episode of the get to Know OCD podcast. If you are interested in watching other episodes, please feel free to subscribe to our NOCD YouTube channel. And if you're looking for help for OCD or related conditions, check us out@nocd.com that's nocd.com we'd be happy to set you up with a therapist who's licensed in your area who knows how to treat OCD and other related conditions like body focused, repetitive behaviors, tics, hoarding, work with mood conditions, trauma, anxiety disorders, all sorts of stuff. So check us out again nocd.com today, my frenemy, Lauren Rose. Lauren Rosen.
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B
Oh, what an introduction.
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A
Wow. That's an intro, isn't it?
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B
Yeah.
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A
Hi, Lauren. How are you?
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B
Hello. Excited to be your friend of me today.
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A
Oh, you are. You are definitely my friend. And have a book out recently which is so, so very exciting. So we're going to chat about that and your work in the OCD field, but why don't you take a moment just to introduce yourself and let everybody know who you are and why you're here on this podcast.
- [01:06]
B
Okay, that. Well, thank you for the. The initial introduction. I am Lauren Rosen. I am a licensed psychotherapist practicing out of the state of California, though have accrued a long list of different states in which I'm now licensed. And I specialize in treating OCD and anxiety disorders and have a practice, the center for the Obsessive Mind, that specializes in working with folks with these conditions. And I have a special interest in working with mental compulsions, which is why I recently wrote a book called the Mental compulsions workbook for OCD. And I have a podcast which actually Dr. McGrath has been on purely OCD. It's been a bit.
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A
You should come back anytime. Anytime.
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B
Right on. And what else? I think that. That, I mean, sums up most of it.
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A
We've done some talks together at conferences.
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B
Oh, my gosh.
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A
And things.
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B
Yeah, yeah, we. I was trying to think back to when you and I first met. I think it was through the OCD and substance use disorder sig.
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A
I believe so. Yeah.
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B
Yeah. Yep. So awesome. Yeah.
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A
Well, thanks for being here. Of course, you come into the field through your own experience of ocd, which you've been very open about. And I was wondering if first you might want to share a little bit with our audience about what that experience of having OCD was. Life and like, and. And getting. Finally getting diagnosed and figuring out the right treatment and what led you into the field of now actually treating OCD and leading to writing this book.
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B
Yeah, I'm absolutely happy to dive into all of that. And yeah, I like to say I come by this career honestly. I, I do have ocd and I, you know, I think this is often the case that folks with OCD will have when they were diagnosed and then going back in time, the seeing moments in their lives where they can recognize the symptoms well before they were diagnosed. Yeah. And totally tracks with the delay between symptom onset and appropriate treatment and diagnosis that we're aware of. That's talked about a lot in the literature. But yeah, I. So when I look back at my life, probably around age 7, I. I started to experience intrusive thoughts at that point morphed and changed in wild and wonderful ways over the years. But at that time it was really focused on death and what happened after death and whether or not I would be okay. And it was terrifying. And in spite of my parents best efforts, I. I did not get a diagnosis then I, I did get some support that, you know, was. Was helpful to some degree. But it would be 17 years between then and, and when I was diagnosed and received proper treatment. ERP with a, you know, mindfulness based. A lot of acceptance and commitment therapy in there for good measure, separate from my own experiences of ocd. I had long been interested in this field. I, I actually got my undergrad in psychology from ucla, but I didn't have any sense of what kind of therapy I would want to practice. And I think part of that was truthfully informed by the fact that I still found myself struggling a lot and I didn't really have a name. And then, then I had another experience of. Of obsessive thoughts that took me out for a couple of years that we've talked a lot about in the context of substance use disorder as well. I was several years into recovery from an alcohol use disorder, and I found myself obsessing about my sobriety and whether or not my sobriety was legitimate based on a piece of tiramisu that I had eaten. And it was, you know, damn, that tiramisu, you know? I know, man.
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A
Destroyer of life. The terror.
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B
It is a destroyer. Oh my gosh. There was, there was a good, I think, five years in my family where nobody could really talk about tiramisu without, like, like wincing.
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A
Yeah, sure, you know, like, oh, oh,
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B
gosh, is everything gonna be okay? Because it came up so much. Right. And I. And the amount of reassurance that I say assault about whether or not that constituted a relapse. I mean, I. The hours upon hours of my life that I will never. Yeah. But I, I, you know, as much as at the time, I was like, this is. I. It was torturous, right? Like, spending all of that time trying to figure out whether or not that. That I was being honest. It's just that I'm grateful for it now because it ultimately led me to treatment. Like somebody finally identified. Like, oh, that sounds really obsessive. And I was like, yeah, yeah. I'm like, but I'm not doing any compulsions. Right. And that. And I think, well, and then, lo and behold, come to find out, at the time, I didn't realize that reassurance seeking as a compulsion, that mental activities could be compulsive. But I was fortunate to find somebody who was able to teach me about all of that and to support me in. In facing my anxiety and accepting uncertainty, which ultimately that paired with my. My. My interest in the human mind far predated that. I was like, this is what I want to do. So that's how I ended up in this particular niche within the field. I went back to graduate school knowing it was very funny. Like, a lot of people are very broad when they. When they go back into, like, a master's program for psychology and not sure what they want to work with. I was like, I know I want to do erp. To work with ocd and. And that's. And the rest is history, I suppose.
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A
Yeah.
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B
Yeah. And then we became frenemies.
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A
That's how that happened. Frenemies.
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B
Yeah. Yeah, yeah.
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A
You know, the. The tiramisu is not to bring. This is a tough time. I know.
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B
I think it's a. My family laughs about it now. Yeah. Yeah. I've.
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A
I've had debates about soy sauce as well, because it's fermented. And then is. Does that mean that if I eat soy sauce that I've lost my sobriety or I could get a DUI or something like that too?
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B
Yeah, totally. I mean, there's so. So many areas where. When you. When you dig into that, like vanilla. Vanilla extract. And one of my favorite things in the world is cookie dough. And you know what? I'm proud to say today that I eat cookie dough with a bandit. And in spite of the vanilla extract content and, you know, and I don't know what that means. Right. That's. That's really the work of our work,
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A
and we live with that. Right? Yes, that's it. Absolutely. It wasn't an easy journey, though. I Mean, no,
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B
no, no, it wasn't. I. But, I mean, life is not an easy journey, I don't think so. I guess I. I'm at a point in my. My journey where I don't think I'm unique in that. In that way. I. I just think that we all have our. Our struggles and. Yeah, it wasn't easy. I. And I did a lot of things to try to navigate my thoughts and feelings that were really unhelpful, compulsive, like compulsions, performing compulsions, drinking, you know, like, it's just. Was hard. And I'm really, really grateful now for, you know, for the fact that I found treatment and especially given the most recent white paper that came out with all the staggering statistics in terms of, like, how many people struggle and don't have proper diagnosis and treatment. It's sobering.
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A
Yeah. And that you. You hit like, the stat. Right. You were 17 years. We talk about that 14 to 17 year. You. You are the high end of the stat, which is.
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B
I. I am.
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A
Yeah.
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B
It's not the end of the stat you want to be on, as it turns out.
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A
No, it's really not.
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B
Yeah, no, I. Actually, it's funny because I. That's in the introduction to the book. I. I talk about that and remembering reading that statistic and being so struck by it because of the fact that when I looked back, it had been 17 years and. Yeah, it was a long 17 years. And I think. And on the other side of it, it's like the going through treatment has made my life so much bigger than I think it would have been otherwise. And I've been able to be so much more present to the world because of the tools that I've gained through this process. And obviously, like, I wouldn't. I don't know that I'd be in this particular career, would it, Were it not just because I, you know, never would have. Would have experienced ERP and wouldn't have known what I wanted to do, so.
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A
Right. Which would have been a shame because then how could we love. Hate each other so much?
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B
Yeah, exactly. What would whatever become of our. From Fermented? I don't know if that's.
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A
Yeah, that's what I loved right away when we met. I mean, we clicked, like, instantaneously. Just. I think you have a similar look. If we're not making fun of you, we don't like you. And so, yeah, that's why that was so good. And I appreciated your openness. On a topic that doesn't get enough chat is the Combination of OCD and substance use too. And how people turn to substances as a way to negate some of the thoughts and images and urges. And, you know, you and I are friends with Margaret Sisson. She's talked about Riley and his experiences. We've. We've done the great series that Margaret does down in Georgia there. There's just so many, so many good things that unfortunately, out of such tragedy, you know, we, we continue to push that, that idea that. Don't forget about the fact that there are people who are suffering and no one knows it because they assume it's just a drug or an alcohol problem and they don't know that there's an OCD underlying the experience.
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B
Yeah, absolutely. And I think you make, yeah, you. I think I certainly Margaret being a great example of this, but you make what you can out of the challenges and, you know, obviously, what a, what a loss. Right. And, and I think that, you know, you have two options at that point, which is to either proceed and, and try to, you know, carry on. Was Riley's wish was that, you know, there was more understanding and treatment available for folks. And so. Yeah, but it's, it's a, it's a hell of a combo right there. And there's such a obvious bedfellows. Right?
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A
Yeah.
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B
OC and substance use disorder. It's. It's still surprising to me. I just spoke at Shepherd Pratt back in December on the topic and, and that there's not a concurrent treatment that is established for these two is alarming to me and especially given that there are evidence based treatments for both that overlap. But there you go. So working on that. We'll keep on keeping on. Right?
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A
It's an area I'm always interested in.
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B
Yeah, yeah, totally.
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A
So your experience leads to this book that you've written and boy, there's. I mean, my favorite part is a blurb that I wrote. I thought that was really great.
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B
It's just the most excellent blurb I've ever written. It must have taken you hours.
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A
I spent so much time perfecting that. That blurb.
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B
It was a lovely. But truthfully, like, what a lovely blur. Thank you for your amazing words and support.
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A
No, I was so excited to do it too. It really. It was an honor. So thank you for thinking of me and having me be a part, a little part of that experience. But, you know, your own experience with mental compulsions and the idea that people don't really know what they are, I think is really important.
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B
Important.
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A
So can you kind of walk people through, you know, what, besides the obvious, the difference between mental and physical compulsions? But what should we really be looking for? And how do we even know or find out that somebody has mental compulsions?
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B
It's a great question. I think it. So one of the. It depends on who we're asking. Right. And who's on the lookout for mental compulsions. And if. If it's a loved one, a family member, even a clinician. Right. So often it's like, has the room gone silent all of a sudden? Right? Like, is there a faraway look in somebody's eyes? Do they. They seem sort of lost in thought? Because the likelihood is that they are. And in terms of the individual, really what we're looking at is are you reviewing information in your mind over and over and over, over again? Are you trying to. To do something to neutralize what, like, you know, whatever discomfort that you're feeling or whatever bad thing you think might happen in your mind and that, I guess it can look so vastly different from one individual to the next. But are you thinking a lot? And I think that. Well, I was actually just having this conversation. It's such. The experience of living in an obsessive compulsive mind is so disorienting if you don't have any, like, awareness of the fact that, like, there are these automatic thoughts and then there's emotions and then there's active thinking that it's really hard without having any of that basic education to even identify what's going on at first. It just. People often will say, like, I'm just obsessing constantly. It's like, okay, well, yeah, you're having a lot of obsessions, but are you then responding to those initial thoughts? Are you trying to figure out something with absolute certainty in your mind, or are you trying to apply rigid rules in terms of, you know, counting to certain numbers or praying in a certain way that are intended to. To address the. The discomfort that you feel. But, yeah, I. It's such a good question of, like, how can you know, like, when you don't know yet? I think it's. Yeah. So much. So much of it is in awareness and in spreading awareness. And frankly, my personal. One of many personal pet peeves, grievances that I'm going to get out when Festivus next comes around, is that. Are you ready for it, for the airing feats of strength? Oh, my gosh, that's pathetic. My feats of strength are pathetic. Physical ones anyway. But I think it is that there's no discovery discussion in our world, really. About mental behaviors. Like, no. Never before OCD treatment did I have a sense that there were these active behaviors that I would be doing in my mind. And it's not just ocd, it's everyone, right. Like, people. I was talking about this recently with a friend. Like, if you're angry with somebody and then you're having this, like, argument in your mind, like, you're like, yeah, well, you did this and you're, like, figuring out all the ways in which you're going to win the argument. Right? Like, that's thinking. And guess what? That causes a lot of suffering for people, too, in that it tends to increase anger and keep it at this heightened level and. And takes away from their lives when they probably have better things to do than be. To be engaging in fake arguments in their heads. Right. So I. I really wish that as a. Like, that there was more discussion of that concept more globally, because maybe that too, would help people who are experiencing mental compulsions to see those behaviors in the same way that they see excessive hand washing and door checking.
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A
I've likened that to sports. Sometimes if your team loses the. The amount of depression, anxiety, overthinking, you'll do for the next week about the fact that you're not even on the team and you're. You're spending this much time and energy.
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B
Right.
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A
You know, like, a lot.
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B
Yeah. Why?
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A
You know, but yeah, when something is that important to you. Right. And ocd, of course, sends a message that says, this is really important.
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B
Right.
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A
Then you get caught up in these types of things.
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B
Absolutely. And in. Not only do most people not realize that thinking is a behavior that they have any sort of agency around, but the. It's not even clear that it's. Well, I mean, I guess I was going to say the same thing in different phrasing. It's like, it's. There's a sense of being out of control, like, that this is just what happens in my mind. There's nothing I can do about it. And, like, the beauty is there's so much that we can do about it. Yeah, let's talk about that.
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A
Let's talk about what we can do. I mean, we have the Mental compulsions workbook for ocd, which is going to tell us all sorts of amazing things. And you talk a lot about mindfulness, too. Maybe we can clear up some ideas on mindfulness, because sometimes people mean think. That means sitting down and you're, you know, you know, that kind of thing. But what is mindfulness? Yeah, Yeah. I keep trying to levitate.
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B
I Haven't Me either. I'm so disappointed, frankly. I mean, I watched Empire Strikes Back and. And seemed like Yoda had it, but whatever. Yes, life is full of disappointments.
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A
Yes, exactly.
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B
No, but I think that there is. There are so many misconceptions about mindfulness and what it is and what it is not. You know, it's the idea, oftentimes people have the idea that, like, practicing mindfulness a requires meditation or that if you engage in mindfulness meditation, it's about clearing your mind, which good luck with that. I mean, if somebody's figured out a way to clear their mind that does not involve drugs or alcohol, I would. I would ask that they please contact me directly, because that sounds delightful, but it's not reasonable. Right. Like, minds are very busy places, especially the minds of people with anxiety and ocd. Ocd, yeah. So. So, yeah, I think, you know, there's a lot. I talk a lot about mindfulness in the book, and I think it boils down to really. And there are several chapters dedicated to mindfulness because there, it's about response prevention for mental compulsions. And that's the tricky thing with mental compulsions is people don't know how to disengage from thinking, from active thinking without engaging in thought suppression. Right. Or trying to push away. Like, there's this, like, weird middle ground where it's like, I'm not trying to push the thought away, but I'm also not trying to tango with it, so to speak. And that's what I think mindfulness is so wonderful for, is that it helps us find that space of existing and allowing without actively engaging. So in terms of. I mean, I could talk big picture about mindfulness and so many misconceptions, but I think if we are really looking at what can it do for folks who are living or grappling with mental compulsions, one, it promotes a very specific form of awareness. Right. So if anyone's listening who hasn't has very little understanding or knowledge of mindfulness, John Kabat Zin's definition is nonjudgmental awareness of the present moment, essentially. Right. So it's just. It's a type of awareness. And you, you know, you can be mindful of all sorts of things, of thoughts, of feelings. Right? So it's not like you have to feel Zen all the time, whatever that means. Right. Like, you don't have to be calm all the time in order to practice mindfulness. It's really about how I'm approaching what I'm experiencing. Right. Internally and sometimes externally. Depending on what you're talking about being mindful of. But in our case we're really talking about these internal experiences like thoughts and feelings. And when it comes to mental compulsions, mindfulness helps one with this that, well, I'd say that this is good for all compulsions actually. It's like if you're able to approach your thoughts and feelings with a sense of objectivity and curiosity, which is what mindfulness trains, it keeps us from immediately resisting an experience, which is in effect the problem. Right. Because when we start to resist it, then we're going to do compulsions to try and get rid of it. And now we've lost the thread and we're stuck.
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A
Yeah.
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B
So a, it's wonderful for acceptance. It provides sort of a roadmap for like, okay, if I can just non judgmentally be like, oh, I'm having this thought that I'm going to murder my family and I'm having this feeling of anxiety and a very different experience to oh my gosh, what if I, what if I want to murder my family and I, I, I can't murder my family? And how am I going to make sure that. Well, I did, I did. I feel like I wanted to murder my family. Right. Like all of the chatter that then ensues. So that's the, the first piece. The second piece is that mindfulness has this focus on present moment experience. And when it comes to mental compulsions, people spend most of, who mentally compulse all the time, spend most of their time outside of what's actually happening in the here and now. Right. Like, which unfortunately also happens to be where all of life is happening. So if you're not here at now, you're like missing life, right?
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A
Yeah, you're, you're looking everywhere else but right in front of you where everything's happening.
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B
Yeah, totally. So like you're, you're in the past about some piece of tiramisu or you're, you know, years into the future about what's going to happen after you die. If you take my examples of, you know, different obsessions I experienced.
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A
And what if you eat the tiramisu and then you die?
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B
I mean, that is, I mean, what if I eat lethal tiramisu and then I go to hell because I lied about it.
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A
There you go, you know, about your sobriety. There it is about my. So that's, that's that we got it all. There it is. There is, there is the grand exposure and response prevention there.
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B
Oh, there it is. Good times. But I Think understanding that like we. A lot of what we're trying to do when people are prone to mentally compulsing and whether that's ruminating, active worry analysis, mental debate, reviewing things, rehearsing situations. Like, there's so many different ways that we see this occur in somebody's mind that we're trying to be like, okay, well wait, can we just get out of trying to figure out how that's all going to go or how it went and just make contact with what's actually happening right now. So if we're trying to get somebody to disengage from mental compulsions, we're actually in effect trying to get them to re engage with something that is happening right now. And oftentimes, like when. And there's a lot of acceptance and commitment therapy stuff in the book, but like a lot of focus on values and like being the kind of person that you want to be in this present moment becomes the focus of attention rather than how do I ensure that nothing bad happens or that I'm not a bad person or whatever the concern is.
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A
There's a lot to unpack there. So, I mean, I love this conversation and I like it. You know, I'm glad that we're there. The values piece, so important, getting people to live the values they want to live and not the quote unquote values that OCD says you should be living, which of doing compulsions basically, which is that. And I think the big piece on the idea of acceptance. And I've been having some conversations recently with people who have more on the taboo side of ocd that that is potentially a very hard decision for them to accept the fact that they are a person who has these taboo thoughts, images or urges versus having to fight them all the time because they. They fear that if they accept them that it means that they are that thing. Right?
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B
Yes, completely. As in some ways I liken it to sort of an internal contamination like cleanliness. Right. Running to tidy up and make sure that like, you wipe the slate clean. Like I need to clear my headspace so that I'm not contaminated by these thoughts that mean this thing about me or could mean this thing about me. And yeah, I. And I think that there are a lot of misgivings around acceptance when it comes to that. And I think one important, important nuance there is that accepting the presence of a thought is not the same as accepting the content of a thought. So understanding that, you know, if. If you're having thoughts that are taboo in nature that are really upsetting to you that if you acknowledge that it is a thought happening in your mind, that you're not saying that it's. It. It inherently means something about you.
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A
Yeah. Because then we'd have to say, like, you know, Stephen King really does love murdering people like that.
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B
Right?
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A
You know?
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B
Yeah. Did you see that? What's his most recent movie? I saw it and I can't remember what it's. Man, this guy, he comes up with
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A
some stuff, doesn't he?
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B
Yeah, yeah, he sure does.
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A
Yeah.
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B
Yeah. And he would. He'd be in jail if. If. If thoughts meant. Were inherently meaningful. Um, but of course, this is where I think OCD is such a tricky disorder. Oftentimes, even with that education, people will go, but what if. What if it does mean something? And I don't want to accept the. Any of the. Right.
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A
Yeah, I. I've said OCD is the. Yeah, but what if disorder. It doesn't matter what answer I give you, because you're going to have a. Yeah, but what?
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B
True. Yeah, it's so true.
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A
Whatever I say, so true.
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B
But I do.
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A
What if the alcohol in the tiramisu was 0.07 instead of 0.08? Does that mean that it's under the legal limit and there.
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B
And therefore it doesn't really count, and therefore I'm safe. But what if it's actually in that particular piece of tiramisu? It was 0.09 completely. It's so true. Like, well, there's always another degree of questioning to be had around anything. But I do think that, like, it's important to educate people about the fact that thoughts don't have intrinsic meaning. And obviously, like, we can. We can do experiments with people in session. Like, okay, I want you to imagine that you have now won the lottery and sort of see what happens, which I haven't yet won the lottery.
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A
You don't realize, Lauren. I don't. I'm shocked you don't know this. Having ocd. But OCD doesn't work for good. It only works for bad.
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B
Come on.
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A
Come on, Lauren. It's basic stuff here. I don't. I do. I do say in talks, not one person has ever come in and said, I'm afraid everyone loves me and thinks I'm awesome. You know, that's just. It's never been a therapy session ever.
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B
I'm terrified that I'm too good. Everything's great.
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A
Yeah, yeah, no, no, it's true.
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B
Can confirm also my experience here. No, and obviously, again, yeah, but what if. And. And, yeah, but, yeah, but it doesn't. But what if, like, it only applies when we're talking about negative thoughts or bad things. Right. Like, and then you get, you know, people who are concerned about accidentally manifesting something and. Right. Like, of course, there's so much rhetoric in the world at large. I want to. At the upcoming conference, I think I'm going to put in something for, like, the issues with common sense or like common wisdom, conventional wisdom in the context of people who are living with us, because it's like, trust your gut or, you know, like those sorts of things, they just, they are lost, I think, on a person who.
- [30:54]
A
George Carlin did a amazing comedy skit on that. I don't know if you've ever seen it. You know, he talked about.
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B
I know, I love him. But what's this.
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A
There's one where he says, you know, the early bird catches the worm, but haste makes waste. So, you know, and he just, he takes these absolutely contradicting sayings that we say probably all the time. And in this context it's one, in this context it's the other. And. Oh, yeah, sure, sure. So, yeah, OCD will always pick and choose what can lead to the worst case scenario, never to the best case scenario.
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B
Yeah, well, and it makes sense. Right. Like the, the adaptive function of that sort of thinking is quite clear. Right. And we want to be on the lookout for the potential threats in our environment. It kept our ancestors alive. Sure. But it's not necessarily as helpful in the context that we find people struggling.
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A
One of the things I wanted to ask you about, the mental compulsions, something that I've noted, but you've done such extensive research here, is the idea that if I don't keep reminding myself about something, then I'm doomed to repeat it. And so there serves a purpose in constantly searching for something else about this. So that it's always top of mind. And just in case you seen that at all or.
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B
Well, I mean, certainly in a clinical setting that happens. There are also so many fears that people have that will, like, come to pass if, if they drop something and, and that. That is certainly among them. That. Yeah, that's not top of mind, then I will make the mistake. I think that the trouble is, and, and just again, like looking at. Yeah, that's a possibility, but it's also a possibility that keeping it top of mind all the time might make you, like, more pro. So it's like, like, who knows?
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A
Yeah. Then I'll manifest it. If it's top of mind.
- [32:48]
B
Yeah, it's like, it will. Exactly. So there's no winning. There's no winning. And I think that, you know, up a big part of our jobs is making people heavily skeptical of whatever's happening between their ears. Right. It's just. It's not reliable information. Yeah. Yeah.
- [33:07]
A
So difficult for people who have trusted their brains for so long have this part where we say to them, that one not so much. Right?
- [33:18]
B
Yeah, yeah, it is. It's. And it's. It's scary. I think, you know, people are like, well, what am I supposed to trust then? And it's like, well, you. You know, there are. There are things that you can, you know, rely upon not with absolute certainty, but, you know, like, there are ways. And that was one of the things I found interesting in. In writing the book. I. I don't know how familiar you are with rumination focused. CBT Watkins wrote a book about this. Gosh, I can't even remember the year. But it's. It's a treatment specifically for depression. Okay. And he talks about differentiating between types of thinking and helpful and unhelpful types of thinking. And, you know, how to go from. One of the, the pieces that he speaks to is like, going from abstract into concrete thinking is. Is so crucial because we get into these, what he calls Y type questions and see this tons in ocd, and it just. It could go on forever. There's no clear answer. There's, you know, like, endless possibilities. Disabilities versus, like, okay, well, what do I want to do right now about this situation? Which is so much more helpful.
- [34:36]
A
So what are great response prevention tips for those out there who have mental compulsions going on? What. What would be some things that we would want them to really be doing instead of the compulsions?
- [34:48]
B
That's a great question. And I, I think that's. Values based exposures are, from my vantage point, the most powerful here. Or I'm sorry, based answers to the response prevention piece. I mean, yes, for exposures as well, but I, I think being like, okay, what. What's important to you? And let's talk about reorienting in a direction that is meaningful. Right? Like, because so when we're trying to get people dropping mental compulsions leaves a vacuum, and we're trying to, like, find a meaningful place to land attention flexibly, right? So that, that we're not just sort of pivoting toward another way of trying to push out thoughts or to. To resolve them. So response prevention with mental compulsions, it's. It. It's. It's tough because it's Kind of in some ways, like passive. Right. Like it's dropping something kind of like, I'm going to turn off a faucet. Right. And I'm going to walk away from the faucet. So in the context of, of washing compulsion. So I think it's really about what are you going to do instead? If that makes sense. And it, and that's such an individualized thing when, when you're dropping a mental compulsion. So let's say throw out an example that, like a subtype. If somebody uses scrupulosity. So scrupulosity. And somebody wants to continually pray. Yeah. And, and, and pray over and over again, trying to make it feel just right so they can continue on with their day. That what, what they, what we might consider with them is like, okay, well, where do you want your attention to be? What, what matters to you? Who do you want to be in this moment? It's like, well, I, it's really important to me to be, you know, they're, they have scrupulosity. Let's say that they're Christian, that they might, you know, want to be Christ. Like, like, that's like something that is as meaningful to them and like embodying the qualities of Christ. So we might like, go, okay, well, what, what qualities are those? And how can you embody those qualities in a moment so that when, when you do drop out of the prayer, you can go like, okay, well, I'm gonna, I'm in this conversation with somebody. I want to be an active and caring and kind listener here. Like, kind and caring are values for me. I'm going to let those inform my actions now instead of trying to resolve this thing that I'm never going to resolve.
- [37:38]
A
Yeah.
- [37:39]
B
It seems like a bit of a roundabout answer, but it's. I think it's important. It, it is so individualized because what's. If I give. If I were like, this is the way, like, you want to do this instead of. Not, not that you're suggesting that, but, you know, for people to understand that, like, anything that's prescribed and rigid is just going to turn compulsive.
- [38:02]
A
Sure. I mean, the standards always apply too, of what we do physically. You can delay a mental compulsion if you have the ability, if it automatically occurs, you can undo it with a little bit of doubt statement at the end of it.
- [38:15]
B
Absolutely. Like, yeah, but maybe, you know, or,
- [38:18]
A
or that prayer didn't count, you know, or something like that. Or. And we can, we can reduce the amount of time or the numbers of time so all of those still apply to the mental compulsions in addition to the physical.
- [38:30]
B
100%. And I will say one of the things with mental compulsions as well is that it really is oftentimes you don't even know that you're engaged in them until you've been engaged in them for a while. Yeah. Right. And hopefully over time you develop more awareness. Especially like there are certain topics. Right. We know that that OCD tends to land on for people and so that you're like, I'm trying to think, I'm thinking about that thing again. I want to like go into this very cautiously or just abandon ship altogether. But I think that it's with recovery when it comes to mental compulsions, having the expectation that I'm never going to engage in unhelpful thinking ever again. It's just not reasonable. And that degree of, of fixation and hyper awareness would in it could very easily in itself become compulsive. Like if you're just like, I need to make absolutely sure I never engage in a mental compulsion, how do I, how do I make absolutely sure you don't?
- [39:34]
A
That becomes a compulsion. Try to never have a compulsion.
- [39:37]
B
Right? Yeah, yeah. Or you end up beating up on yourself. I see this so often with people. It's like, oh, well, I was engaging that mental compulsion and what's wrong with me? And I should know better by now. And now they're berating themselves and yeah, it's not a mental compulsion necessarily, could be, but like it's a really unhelpful mental behavior that's going to make you feel really, really badly in addition to feeling anxious. So probably not helpful.
- [40:02]
A
Right. The self flagellation of ocd.
- [40:04]
B
Right, right, totally. And then, and now. And you're also then like not giving yourself credit for catching yourself, which is so necessary. Right. Like just like the person who is like, okay, I really have this strong urge to go back another time to check the door lock. I'm not going to do that. But there has to be some, some element of celebration in that moment of recognition versus like, oh, why do I have that urge? What's wrong with me? Again, same, same sort of concept in
- [40:37]
A
your own evolution of your going from active OCD to now a passenger, hopefully in the trunk underneath the spare tire, you know, and also as a clinician who's now got years under your belt, what when you look back at younger OCD self and younger clinician self versus today, you know what, what would be something you go back and say to those, those two younger yous to really keep an eye on that you've learned in this process of, you know, doing the book and everything like that.
- [41:15]
B
Yeah, those are great questions. And I think I would say something slightly different maybe to both of those versions. I think I, I think to my, my much younger self, like to the seven year old who was so terrified about, you know, what was going to happen and whether or not I'd be okay, um, I, I think I would really want her, I want to tell her, like, you can just take it one step at a time. Like one moment at a time. Like you don't, you don't have to figure out the future. You can't figure out the future. In fact, it's, it's a total trap. Right. Um, so you can really just take it, like, what's the next thing? What's the next thing? So that. Yeah, because I spent so much time really like trying to figure out things that were. Yeah. Unfigure outable. That's a clinical term.
- [42:05]
A
I love that term. I say it all the time. Unfigure outable. I love that term.
- [42:10]
B
Yeah, exactly. And then I, I think from the, the clinician side of things and of course informed by the fact that I've, I've struggled myself is like there's, there's sometimes a great deal of pressure. I guess, unsurprisingly, like I get perfectionistic about trying to show up perfectly as a therapist and I, I think what I've learned over the course of my work is that there's. If you're trying to support somebody in, in responding to things with greater flexibility. Flexibility. One of, one of the greatest things that you can do is be flexible in, like in your interactions with them. If that makes sense. Like approaching it from a, like. Well, I don't know. Right. Like, and, and having like the, like not being like, okay, well, we have to do this absolutely perfectly because that's not. I often say that it's like you can't. Solving a rigidity problem with rigidity is not going to, not going to work. And so sort of focusing on being, being willing to do like a good enough job not just for my welfare, but also for the welfare of those that I worked with. I think a lot, like as I've grown as a clinician, it's, it's more like there's a, a curiosity that comes into the room and a recognition that I don't know, I don't have the answers and nobody does that. I have a lot of, of skills that I can share with people that support them in navigating this very uncertain world more effectively and with less distress.
- [44:00]
A
Yeah, I think about that too, for myself, of. Your job is not to give an answer. It's to help people learn to live with a question.
- [44:07]
B
Yeah, that's absolutely right.
- [44:10]
A
Right.
- [44:11]
B
Or all the questions. Yeah. Or.
- [44:13]
A
Yeah, or all the questions. Exactly, exactly.
- [44:15]
B
So many of them. Yeah.
- [44:17]
A
Because just get two people in a room and you're gonna have two different answers to the same question.
- [44:22]
B
That's it. Absolutely.
- [44:23]
A
That's what it is.
- [44:24]
B
Yeah. Yeah.
- [44:26]
A
Final advice to people out there listening who might be suffering with mental compulsions. Besides, of course, buy the book, everybody. I mean, you know, the Mental Compulsions Workbook for OCD on sale. Thank you.
- [44:40]
B
Yeah, yeah, There's a lot of. There's a lot of stuff. I. I talk for a while in there, so. Yeah. If you're looking for information. So. Yeah, one or two. But I think in terms of, like, last advice, I. We humans are so trapped by our unwillingness to have certain feelings.
- [45:05]
A
Yeah.
- [45:07]
B
And we spend again inside the context of OCD and outside, we spend so much time trying to manage and control our feelings. Things so that we can, like, move on or. And I. I think one of the benefits of having to go through OCD is that you learn that, like, you can feel anxious and do anything and, like, you can still prioritize who you want to be and how you want to show up, regardless of what you're feeling. And that, from my vantage point, is freedom. So it's. Reminds me there's a. A quote by Rainier Marie Rilke, who wrote letters to a young poet, and the quote is, let everything happen to you. Beauty and terror. Just keep going. No feeling is final.
- [45:58]
A
Love it.
- [45:58]
B
And, yeah, it's like. It's a beautiful quote, and I think it really speaks to the fact that it's like, just have the experiences like this is you don't have to manage and control all of them. Like, even if you don't like them. Right. Even if they're scary, even, like, you can have all of them and still live your life. And what that has translated into, for me is living, like, a really big and beautiful life in spite of a lot of anxiety about uncertainty. That, like, I'm. I'm not at a point in my life where I don't feel anxious about uncertainty. Right. It's just I deal with it so differently now.
- [46:36]
A
Right.
- [46:37]
B
So for whatever that's worth, be willing to feel all the feelings, and then you get your life back, and then you get to do life on your terms. You know, feel the feels.
- [46:46]
A
Yeah. Awesome. Well, Lauren, thank you so much for being here. This was a blast.
- [46:52]
B
Thank you for having me. It's always a blast talking with my favorite frenemy. And thanks again, truly, for having me on. I really appreciate it.
- [47:02]
A
Awesome. And if you again, you're looking for help with Mental Compulsions, the Mental Compulsions Workbook for OCD by Lauren. So thank you, Lauren, and thank all of you for watching. If you like the get to Know OCD podcast and what you saw today, subscribe to our NOCD YouTube channel for more episodes. And you can even watch reruns of webinars and Things We've Done Too, and some other great educational content. And if you're looking for help for OCD or related conditions, check us out@nocd.com that's n o c d.com com. We even do something that I like, our NOCD. 411 sessions. If you're not quite ready for therapy but you want to talk to an expert, we're there to chat with you. And remember this, be better to yourself than your OCD ever will be. We'll see you again soon.
- [47:42]
B
Thank you.