Podcast Summary: Get to Know OCD

Episode: The Overlap Between OCD and Anxiety Explained

Host: Dr. Patrick McGrath (NOCD Chief Clinical Officer)
Guest: Shauna Pachette, LPC (NOCD Clinical Operational Manager and Clinical Lead for Anxiety Disorder Treatment)
Date: November 13, 2025

Main Theme & Purpose

This episode focuses on the significant overlap between Obsessive Compulsive Disorder (OCD) and anxiety disorders. Dr. Patrick McGrath and Shauna Pachette explore how anxiety sensitivity plays into both conditions, discuss various anxiety disorders commonly co-occurring with OCD, and delve into treatment strategies—especially the use of interoceptive exposures. The conversation aims to demystify why tackling anxiety head-on (rather than avoiding it) is essential for progress, offering practical examples and addressing therapeutic misconceptions.

Key Discussion Points & Insights

1. Comorbidity of OCD and Anxiety Disorders

• OCD often co-occurs with other conditions, especially anxiety and mood disorders.
• Common comorbid anxiety disorders:
  • Generalized Anxiety Disorder (GAD): Persistent, widespread worry. ("Lots of worries about lots of things, lots of the time." – Shauna, 07:03)
  • Social Anxiety Disorder: Fear of being judged or criticized.
  • Illness Anxiety Disorder: Worry about having (or getting) a serious illness; often overlaps with health OCD.
  • Specific Phobias & Agoraphobia: Focused fears (e.g., elevators, crowded spaces).
  • Panic Disorder: Focus on fear of panic attacks and their sensations.

2. Understanding Anxiety Sensitivity

• Definition: Anxiety sensitivity is the tendency to misinterpret physical symptoms of anxiety as dangerous or catastrophic.
• This misattribution leads to a feedback loop: noticing bodily sensations → assigning negative meaning → increased anxiety → intensified sensations.
• Examples include “my heart is racing; therefore, I must be having a heart attack,” fueling more anxiety.

“It’s this misattribution or mislabeling of a physical sensation as being dangerous, as being something unwanted or scary or, you know, a sign of catastrophe. And so then I must get out of that feeling or do something about it.”
— Shauna Pachette [10:24]

3. Interoceptive Exposures: Treatment Approach

• Interoceptive exposures are exercises designed to induce the physical sensations associated with anxiety in a controlled, safe way to help reduce fear of those sensations.

  Examples (11:39 – 12:49):

  • Jumping jacks or running to increase heart rate
  • Breathing through a straw or holding breath
  • Spinning in a chair to induce dizziness
  • Purposeful hyperventilation

• Goal: Build confidence that one can handle uncomfortable sensations without escaping or using “safety behaviors” (like deep breathing or medication) to make them go away.

“The goal...is to break this down one symptom at a time and to really learn that I can handle that symptom, that I don’t need to be afraid of that.” — Patrick McGrath [13:04]

4. Shifting from Avoidance to Acceptance

• Both clinicians and clients must shift from avoidance/distraction strategies to “leaning in” and accepting discomfort.
• Many therapy modalities wrongly teach escape as the solution; the real progress comes from allowing discomfort and realizing it’s tolerable.

“We can’t get rid of uncomfortable feelings in our life. That’s just the way of it. There’s always gonna be uncomfortable physical sensations. There’s always gonna be uncomfortable emotions. Fighting it makes it worse.”
— Shauna Pachette [16:12]

5. Therapist and Client Challenges

• Many therapists (and clients) initially find it counterintuitive to invite discomfort.
• Therapists must trust clients’ resilience and avoid “rescuing” them from unpleasant feelings (17:27).
• Clients often hold out hope that anxiety can be eradicated—acceptance comes when they see that all emotions are part of life, not just the ones they label as “good.”

6. Somatic OCD: When the Body Becomes the Focus

• OCD can latch onto normal bodily functions (e.g., blinking, breathing), turning them into obsessive concerns.
• Interoceptive and behavioral exposures help clients break the link between attention to these sensations and catastrophic interpretations.

“[With somatic OCD] if I were to have us right now focus on our blinking...suddenly I’m very aware of my eyelids and my contacts in my eyes, and I’m like, wait, do I blink too much? How am I blinking? What does it mean?”
— Shauna Pachette [26:21]

7. Common Pitfalls & Motivating Change

• People often get “stuck” hoping anxiety will disappear rather than accepting it as normal.
• Safety behaviors and constant searching for the “why” behind obsessions keep people trapped.
• Education and gradual exposure are crucial; reassurance that discomfort is safe and manageable helps motivate clients.

Notable Quotes & Memorable Moments

• “Uncomfortable doesn’t mean dangerous.” — Patrick McGrath [33:33]
• “OCD is so creative. Right. It can find anything to be a trigger. Somatic OCD is this worry about the physical, like the workings of your body and the different sensations within your body.” — Shauna Pachette [25:24]
• “Life’s uncomfortable and so we are learning to get comfortable with the discomfort. And your world becomes a whole lot bigger once you do that.” — Shauna Pachette [33:51]
• “Fighting it makes it worse.” — Shauna Pachette [16:15]
• “OCD has an amazing capacity to be convincing to people that just around the corner is the answer...But in all our years, I have never once met a person who satisfied OCD.” — Patrick McGrath [35:21]
• “Sensations and emotions are just that…They can all be here. I think that’s part of what makes life life.” — Shauna Pachette [40:26]

Timestamps for Key Segments

• [05:08] Comorbidity: Intro to anxiety disorders comorbid with OCD
• [06:53] Breakdown of Anxiety Disorders: GAD, Social Anxiety, Health Anxiety, Specific Phobias, Agoraphobia, Panic
• [09:31] Defining Anxiety Sensitivity
• [11:23] Introduction to Interoceptive Exposures
• [13:04] Purpose and Impact of Interoceptives
• [15:21] Distinguishing Learning to Cope vs. Avoidance
• [16:47] Therapist Adaptation to Exposure-Based Models
• [18:39] Shifting from Fighting to Accepting Emotions
• [25:24] Somatic OCD Explained
• [28:01] Customizing ERP for Somatic Symptoms
• [31:59] Overcoming Hesitation to Exposure Work
• [33:33] Key Insight: Discomfort ≠ Danger
• [34:00] Common Traps: Hoping for Anxiety-Free Life
• [36:12] OCD’s Endless Cycle
• [38:35] The “Scooby Doo” Metaphor for OCD’s Tricks
• [40:26] Closing Wisdom: Embracing All Feelings

Closing Thoughts

The episode delivers a hopeful, practical message: While OCD and anxiety are challenging, meaningful change happens by facing—not fleeing—uncomfortable sensations and emotions. Interoceptive exposure is a powerful tool for building confidence, reducing fear, and reclaiming life. Acceptance, rather than avoidance or constant analysis, opens the door to long-term relief.

Final Advice:

“Sensations and emotions are just that... They can all be here. I think that’s part of what makes life life.”
— Shauna Pachette [40:26]