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Get to know OCD
The Science Behind Hair Pulling, Skin Picking, and Other Repetitive Behaviors
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Foreign.
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Hi, everyone, and welcome to another episode of the get to Know OCD podcast. I'm Dr. Patrick McGrath, the Chief Clinical Officer for no CD. If you're looking for help for OCD or related conditions, check us out@nocd.com that's n o c d dot com. We do lots of great work with OCD, but we also work with something called body focused repetitive behaviors or BFRBs. And that's what we're going to be talking about today. And I'm really excited to have two guests here who helped us at NOCD author a paper that is so, I think, just amazing to show the results that you can get for people who have body focused repetitive behaviors doing great therapy through a teletherapy service and not just what lots of people might have thought that you have to do this in person. So today we have Claire Beatty and Dr. Jamie Fiesner with us. Hi, Claire. And. Hi, Jamie. Welcome. I'm going to give the two of you a chance to introduce yourselves and tell us a little bit about you. And then we're going to break down some technical terms because, well, it's probably best just to break those down right at the beginning before we get into some things and start slipping in words that people might not know. And then we'll talk about the study. So, Claire, tell us about yourself.
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Hi, I'm Claire. Thanks for having us. Dr. McGrath. I'm a research associate at NOCD and I also am a clinician for people with OCD and BFRBS.
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Awesome. And Jamie.
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Yeah. So I'm very glad to be here. And I'm Dr. Jamie Fusner. I'm a psychiatrist by training. I'm the chief medical officer at NOCD and I'm also a professor of psychiatry at the University of Toronto and work as a senior scientist at the center for Addiction and Mental Health. Awesome.
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So we hear the term bfrbs, Body focused Repetitive behaviors. And they also have some pretty big names like trichotillomania and excoriation. So could you break those down? What are, what are these terms and what do they mean so that we can kind of set the stage going
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forward in our discussions? Great. Yeah, I can tackle that one. So, so body focus repetitive behaviors mean that these are behaviors and this is, these are disorders that we're talking about where they're. People have a problem generally with doing something to their body over and over again and in a way that's very hard for them to control and that often does some damage to their body. And so the most common Ones are what Patrick. Dr. McGrath had mentioned, which is.
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Patrick's fine today. That's all. It's all good. Yes.
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Trichotillomania. And so trichotillomania is. Is really pulling hairs. And trichotomia is a disorder where people pull hairs and they pull. Generally pull out hairs, really. It could be from any part of their body, but it's most often on. On their head. But it could be body hairs. And the reason people do it is it can be varied person to person. But for some people, it seems to be related to when they're in a very stressful state. But it could also be when they're bored, for example, or have some other kind of uncomfortable emotional state, like feeling depressed. It really could be almost anything. And pulling the hairs for a lot of people then may offer some kind of stress relief.
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And.
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And that. That's kind of one part of it. But it could be quite varied. And other reasons why people may do it is because it. It may become something that's kind of like a habit. And they find that they get to a point where almost without even thinking about it, their hands just kind of go to their head or go to other parts of their body. Their beard, sometimes eyelashes, eyebrows. And they just kind of start searching and eventually start pulling different hairs in. In a way that's really kind of like, unfocused. So we talk about kind of focused pulling, where people are doing it and thinking about it and maybe doing it sometimes in front of the mirror and then other times where they just may be sitting on a couch and then happen to be pulling. But it's probably serving some function, maybe of somehow reducing the stress. But it gets. It gets into a loop where it's very difficult for them to resist doing it. And that's where people often need help, because the problem can result in people feeling a lot of shame about doing it. So they might feel shame because they've created bald spots, for example. It can get that bad, or it's. Or they might have shame because they're doing it and they feel like, why can't I just stop doing it? What is. What is the. Like, why is it. I just can't stop doing it. I'm so locked into doing this. And they feel bad that they can't control it themselves. But this is the way that. That it seems to be that people have this disorder. It's probably rooted in some parts of the way the brain is functioning and then habits that developed over time related to it, too. So that's trichotillomania and, and the other ones are kind of similar in terms of what drives it and the behaviors, but they may just be focused on different kind of body parts. And so another very common one actually is. Seems to be even a little bit more common than trichotillomania is excoriation disorder. And so excoriation disorder is just a kind of a fancier name for skin picking. It's also called alternatively skin picking disorder. And. And that is where people are picking their skin and kind of doing it the same way. Sometimes in an unfocused way, sometimes in a focused way.
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We can also see things like nail biting and lip picking and cheek biting and some of these other areas which might not have the popularity in the diagnostic manual of. Of these large names, but still are things that people will engage in and do correct?
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Exactly. Yeah. And those are all common. All the ones that Dr. McGrath mentioned are common ones too.
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So Claire, tell us a little bit about the study and what was involved and like the demographics, the prevalence of BFRBs in the population that we serve here at NOCD and what some of our results started to look like.
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Yeah, so another term this to. To put out there before we introduce this study is habit reversal training.
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Oh yes, thank you.
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Excellent. Yes.
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Yeah. Why not talk about the therapy for it? Yeah, that's a great idea. Yeah. Good job, host. Just skip that over. Yeah, wonderful. Go, go.
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There's BRB and then there's something called hrt which is habit reversal training, which is the evidence based treatment and considered the first line treatment for BFRBs. And so that is what we are looking at here in this study. So in the study we looked at habit reversal training in a sample of people with hair picking, hair pulling and skin picking. Um, and we look at the outcomes of people who got HRT at no C. D. And what's really important about this study is it's a real world sample. So it wasn't a controlled research trial where we selected patients or who met certain criteria. These are all people who came into NOCD for treatment for their BFRBs. And the study took place between I think about like 2021 to 2025. So what you're seeing in the results is, is what happens in the real world when people get this treatment. And it's also important to note that it's a virtual treatment, which is something that's very unique about this study. It's actually the first, the largest virtual treatment study for BFRBs. So we had 1,071 patients. So almost, you know, cleanly split down the middle with trichotillomania and excoriation disorder. And a lot of the majority were adults, but we actually looked across the lifespan, so we had a pretty meaningful number of kids and teenagers too, which is very cool because these disorders typically start in adolescence. So we're, you know, intervening right when it starts for those people. In terms of what we saw in the outcomes is that the outcomes looked very similar to what in person treatment looked like. So there was a median 33% reduction in symptoms and over half of the people reached 35% or greater symptom reduction, which is in the treatment literature. Just to break it down, that's what the consensus is of meaningful reduction, which is pretty, pretty cool. And we also looked at outcomes, you know, over the course of like a year later, and people actually increased even more. So their symptoms got better over time.
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Yeah.
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When we have these kinds of interventions in the lives of people, it isn't just that the hair pulling or the skin picking changes. There's changes in mood and anxiety and quality of life and things. What, what did we find outside of just the picking changes and how life improved for people when they intervened in this one area?
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Yeah, well, we saw. So yeah, we know that, that these conditions commonly co. Occur with depression, anxiety, stress, quality of life. And there were also secondary improvements in outcomes. We saw, you know, pretty moderate improvements in depression, anxiety, stress and quality of life. Which is great because it tells us that getting the BFRB under control seems to have broader benefits for how people are just generally feeling overall
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these conditions. Some people might say, well, first of all, just stop it. Which we know doesn't work and why we actually need a good therapy. But these conditions, Jamie, can really lead to problems. Right. When you're skin picking, you can have scarring, you can have entry points for infection. Some people who pull their hair will then eat it and then that can cause a trichobazar. Another fun word to say. Right. But is a really serious condition. It's like a hairball for humans. And humans can't eject a hairball the way other animals do and sometimes can result in surgeries to have to remove them from the stomach. So can you talk a little bit about, you know, the impact of these conditions and what life changing therapy can do to help people not have to suffer.
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Yeah, one thing, and before even launching into that, until the to help people understand too, is you might wonder, well, why are you treating BFRBs at NOCD? You know, no CD is. We primarily, we first started treating OCD. So BFRBs are considered an obsessive compulsive related disorder. And many people with OCD have a bfrb. So the proportion of people with OCD who have a BFRB is a bit higher than in the general population, but it's not the same thing. And so that's just something I want to take the opportunity of kind of clarifying because sometimes people have a perception that, that hair pulling or skin picking is a type of ocd, but it's actually not a type of ocd. It's, it's kind of, it seems to be its own related disorder, but it's not exactly the same. But these problems can be really severe and, and they can affect people in pretty profound ways.
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And like with, with a lot of
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psychiatric problems, it does span a range of severity. So there are people that have milder versions of it, people have kind of moderate versions, people have really severe versions of it. And the really severe versions of it could result. Like I mentioned, people with trichotillomania, they could have, you know, very large bald spots. And when you also, when you keep pulling from the same area over and over again, you, you might end up getting some essentially scarring of the hair follicles and the hair might not grow back very well in some areas too. So you may essentially be causing some permanent damage. Most of the cases not, that's not the case. And usually when people get better, the hair grows back and they feel really great about that too. But the skin picking also can be really problematic. And like you mentioned, people can do some serious damage to this, to the skin, causing scarring of the skin and sometimes causing infections. And there have been cases of people that have picked sometimes so deeply that they have even picked past the skin into blood vessels. And theoretically that could be a life threatening problem if you pick into say, the carotid artery. And so again, those are kind of extreme examples, but it can, can really get that bad in some people and, and, and then other ways that it affects people's lives are, are then having to do with, for example, the, you know, the shame they feel. They often feel depressed about it because they feel like they don't have a good handle on a way of getting better. And maybe they don't even feel comfortable talking to other people about it. So it's really good for people to know about these problems and that, hey, this is something that it's not that uncommon. You know, it seems that almost about 3, maybe up to about 2% of people in the population Anywhere between a half and 2% of the population have trichotillomania and somewhere between 2 or 3 and a half percent of the population have excoriation disorder. So that's actually a lot of people who have problems. And, and so sometimes people like, will not go outside because their skin ends up really bad and has red spots on it and might have, have, have some scarring on it. They've done damage. And so people can be socially isolated because of it. Likewise retrobital mania. Sometimes people do really bad damage to their cuticles where it causes bleeding and they feel very ashamed about it and they may want to cover it up. So it can affect people socially that way and affect their mood, cause self consciousness and so it affects people in many different roles.
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Claire, you talked about this being, you know, in terms of the reductions being very good, but also I think the timeframe that it took to achieve those reductions was really interesting to, to show that we can have some pretty quick impact in the lives of people. Could you talk about, you know, how long it took for people to get those results and why that's an important part of the study also?
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Yeah, so it's, it's so true. The treatment duration we saw was about 14 to 15 weeks and roughly seven to eight sessions. So it's right in line with what has been shown to work in the research literature. So we're really getting results in a pretty comparable timeframe. But the key difference is that we're doing it in a real world virtual setting, not, you know, in, in a carefully controlled research study, which I think think is also, you know, notable because we are seeing these patients in their real, real world setting where the BFRBs are happening. Like, you know, if someone was skin picking might, we might actually do some of the HRT habit reversal training components like when they're in their bathroom where they skin pick. So yeah, the results are themselves, they're comparable to, to what's been reported for in person treatment. And they're right in the same range, which is pretty remarkable when you consider that this is a real world sample with all the complexities that come with that in terms of comorbidities and different severity levels. Our initial sample was in the severe range on the scale that we used and decreased by the end to more of the moderate, low to moderate range.
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What do you two think are some unique components of the therapy we do through NOCD that allow people the opportunity to really face these conditions. Right. And, and get the help that they need? I, I can think of one Jamie, that you said that's important is for people who might not want to go outside or be embarrassed about that, that virtual therapy allows you to start getting treatment without having to leave the house. And we can then work on getting you to go out of the house as part of the treatment so that that one stands out right off the bat. But what else do the two of you think are important about the NOCD virtual therapy component of this?
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Yeah, I, I think having that part of being accessible for people. So accessible not only in the sense that people who may have a lot of difficulty in the beginning of, of getting out and getting to a therapist office because of, of shame or having other worry about other people seeing them, even worrying about like the therapist seeing parts of their hair for example, then that's a lot easier to start with. The other, the other kind of accessible thing is that if people live far from a therapist, then this makes it a lot easier for them to do it so they don't have to have to travel. I mean, for some people it's just like not feasible at all. They're so far away from any kind of trained therapist. And this is a particular issue. I mean it's an issue for all therapy potentially depending on where you live. But it's really an issue for therapists who, who are trained to know how to do effective evidence based treatment for BFRBs because there are very, very few of these therapists. Unfortunately, it's not part of a standard training that people go through in, in their training or licensure. So people often, they may learn about it and read about it, but unless they get kind of matched up with a supervisor who really knows how to do it and have a lot of experience, they often will not get any training doing it. So the majority of therapist don't know how to do this and would have to seek some specialty training if they didn't get it during their training or licensure, which is what we offer at nocd. So we, we have training for this and all our therapists get trained in doing the habit reversal training that we provide, which is a type of behavioral therapy. So accessibility that's, that's facilitated by our platform and the way that we do the therapy here. And another really important thing is that we have between session support. And so that's something that's built into all of our treatments. And that support is in the form of messaging or one of, one of the forums is messaging. And so all of the members who are getting treatment can message their therapist. And so for example, if they're having a difficult time where it's been really hard for them to maybe to get out of the house and maybe that especially they perhaps have something that they were going to work on is reducing avoidance and they want some quick tips and advice rather than having to wait to the next session. They could message a therapist and say hey, you know, what do you, what do you think? Could be something I could try here. Or maybe they're, they were assigned to do some homework assignments which is part of the hrt. Like with erp, homework assignments are very important. So they may be doing a homework assignment of say practicing one of the main components of habit reversal therapy, which is called competing response. And so that's where people are then practicing doing something. It's typically with their hands because most people do the, the picking or the pulling with their hands, occupying their hands with something else that's kind of incompatible with doing that pulling or, or, or picking and that sometimes that thing they're doing with their hand is also maybe dispelling some tension or stress itself. Maybe they were going to use say Silly Putty, that's one that people often use and maybe it's just like not working for them and they want to know some advice and so they can message a therapist and get some information. So, and it's also, you know, so it's supportive and it also kind of keeps people on track. And that could be why then the therapy that we deliver is pretty efficient because people don't have to necessarily wait like a whole session to get that feedback. There's other support too. And so there's peer support at, at NOCD that are called member advocates and these are people who work at nocd, but they've had these problems themselves and they've gone through treating themselves and that's really helpful for a lot of people to be able to, to talk to somebody who's gone through it themselves. Especially if they're maybe have some doubts about whether they can do the therapy. Maybe it's been very difficult for them or maybe there's some logistical issues about finding the time to do it or some financial challeng, whatever might come up. Then peer support is really helpful and there's also community online support. So it's another very, very helpful thing that people can go online, very large community of people all around the world and, and you can, people can post there either anonymously or non anonymously about struggles they're having and get support and advice that way too.
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And even support groups that, that NOCD
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has available to you and sport groups.
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Claire, what did you find? Were there any other things that really stood out for you?
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Yeah, I think, you know, as Jamie was saying, like, patients sent about 70 messages to their therapist and opened the app over 80 times during their treatment. So that just goes to show how helpful or like the whole e. No CD ecosystem is part of the reason that we're getting these outcomes. Right. People aren't just left on their own in between sessions. And yeah, the access to the support groups, the online community, the BFRB group itself, I think it's the whole ecosystem of support around the person. Also, as Jamie was saying, it's hard to find a therapist who specializes in HRT. It's a specialized treatment, and 80% over 80% of our patients in this study had their treatment covered by insurance, which is especially meaningful.
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There's also an importance of awareness training, too. Like for someone who might be pulling their hair to have them wear a glove on the hand that they usually do it in the spot they typically do it, because how many people who have these don't even know they're doing it until maybe an hour into the experience of actually doing these things? So, like, that glove, suddenly it's a different feeling and it's, oh, oh, wow, I just. I just went up again with my hand. Right. And so that awareness is also a key component of the treatment, just to help people recognize how many times they're doing it, since this is almost an automatic behavior by the time people come in for treatment.
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Yeah, that's absolutely. That's a big part of another big component, important component of the treatment, the HRT is awareness training. And, and another one. So, and I mentioned the competing response, and another one is what. What we call stimulus control. So, like, a glove can actually be help with stimulus control and awareness at the same time. Stimulus control being that it's being able to. To kind of, in a practical way, what can you do in your environment to change things so that it's less likely that you'll pull? And you're just kind of like setting yourself up for success by introducing some barriers or just changing things in your environment to make it less likely you'll do it? So wearing gloves is one way of doing it. And for people that do a lot of pulling or picking in front of the mirror, then that's another thing is covering mirrors or taking down mirrors or smearing something on the mirror so you can't really see things to pull or pick, like soap, for example. And sometimes you'll do some picking with. With tools, actually. So tools typically like tweezers, for example, for skin picking. And so putting. Getting those out of the home or freezing them in a block of ice or something like that. So really readily get at them. That's. Those are other ways. And then the awareness training is another important, important part, which in addition to those things we're talking about, but other things are figuring out what are. What are the different scenarios where picking is more likely to happen. And a scenario could be a physical location they're at. So, for example, sitting on a couch, watching tv, there might be one or another one might be an emotional state kind of scenario where they. It's. Maybe it's the weekend and they didn't have things planned and there's a lot of downtime, and they're feeling kind of bored and. And they're feeling kind of empty and bored and restless. For some people, that's a. That's like a risk time. And so typically the part of the therapy and part of the homework is part of the therapy would be for people to identify when the pulling happened and then what was the situation they were in and what were they feeling typically like what they're thinking as well. And then as people do that and go through that many, many times, then they become more and more conscious of what the situation is so that they can identify it earlier and earlier on rather than after they've already picked kind of identifying, oh, what just happened. Here's the situation. So that's a big part of it, and that helps a lot of people get. Get a. Get a handle on it. Yeah,
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I think that this treatment, and tell me what you think about this, also gives life back to people, not just going back out of the house, but the hours people might spend putting makeup on or putting their hair in a certain position so that it covers things up. I mean, there's. There's so many compensatory behaviors that people do to hide this. And I think most of the general public might not even recognize how much of a problem this actually is due to the level of behaviors that people go to. To hide these things from happening. So wondering if you talk a little bit about. About that and maybe just how it changes lives when people do treatment.
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Yeah, I think there's so many people with BFRBs who might not even know that this treatment exists, first off, and who feel so ashamed that they've never been told that there is a treatment to help what they're going through. And now we have this evidence that HRT delivered virtually can help. We know that, that only like 20% of people with excoriation disorder ever get treatment for it. And I think the same is. It's around the same, maybe a little bit more for trichotillomania. And I think one of the barriers, you know, in addition to maybe feeling shameful about. Shameful about the condition and finding a therapist, is just that, yeah, they don't know that we can treat these things. And the common problems that come up with skin picking and hair pulling are so interfering and take up so much time. Right. Like, that's one of the things that you'll get from this treatment is just like a reduction of how long it's going to take to leave the house in the morning or how much time it's going to take, you know, to. To get your hair ready for a party. These are all things that we see in treatment, which is also, you know, partially, probably why we also see reductions in depression and quality and improvements in quality of life.
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There's, I think that there's also the ability for people to start living their life again and reduce this embarrassment is just so important. And that goes back to what I said. And Claire, I wonder if you could even since you did so much of the stats on this, just talk about what were the changes in quality of life? Were they significant? Did depression go down significantly or anxiety or stress? Did we see those changes happen too?
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C
Yeah, so. So we saw improvements across the board in depression, anxiety and quality of life and also disability. So the improvements were in the moderate range. So, you know, the treatment itself, if you're familiar with erp, HRT is not erp, but it's similar in that, you know, it shares kind of the same sort of function, which is that we're helping you change your relationship with uncomfortable internal experiences. Right. So if you're doing HRT because. And you become aware that you're skin picking because you're stressed, right now, we're going to help you become aware of that and develop a competing response so that you're doing something else when you're stressed. Maybe if you are pulling out your eyebrow hairs instead, we might have you do a competing response where you're like making a fist and holding it at your side. And so I guess the point here is that now you're learning that to ride that wave and experience the urge to pick and then sit with the stress and not do that. And so I think this is why we see improvements across the board with, you know, depression and anxiety too, even though we're not specifically targeting that is that you're learning how to sit with the feeling without doing anything with it. So that's my hypothesis on why we see gains in other areas. In addition to just the fact that you're getting a lot of your life back in terms of time, in terms of social events that you can go to for our teens and kids going to school, you know, on time and having playdates and hanging out with their friends for adults, you know, being able to turn your camera on during a zoom meeting if you're working remotely. Like all of these are just, you know, some ways that, that the treatment might help across the board.
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A
And just to add to that too is that another thing that we did in the study is we looked at longer term follow up outcomes. And so we had data on many people up to 52 weeks after they'd started the treatment. It wasn't everybody that we had, but we had still a considerable number of people that were we where they were continuing to do the rating scales. And so we knew what their symptoms were like. And so we saw that not only were there maintenance of the gains that they had made for the BFRB at that time point, then we also saw that many of them had even made further gains at that point, even if they weren't necessarily in kind of a more active part of treatment. So that is part, part of this therapy and as well as exposure response prevention is people learning to be able to do things on their own and be able to in a way, in many ways kind of be their own therapist and manage things on their own. And so I think that the fact that they were able to maintain and even improve on the gains all the way up to 52 weeks probably demonstrates that. And the other things that you were mentioning about the quality of life and functioning and anxiety and depression and stress, those also seem to be maintained at that time point too.
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B
It's exciting to see when good therapy works right, when people get the evidence based treatments and it's really helpful. Before we wrap up, I think that there's one thing maybe just to chat a little bit about for those who this, this concept may be new this term or maybe there's a relative in your life, but you, you haven't really talked too much about it. I, I think a lot of people might be familiar with the idea that oh, I've got that hangnail and, and you know, we'll, we'll pull at it or something until it feels well or. But how many people spend a lot of Time just doing this and looking for that one hair that feels different than all the other ones. And then you start to get preoccupied with that and maybe get the tweezers out and pull it. And then it goes to this hair. And it could be body hair and pubic hair and underarm hair and. And everything like that. And these things can really just kind of start to creep in. And. And for some folks, there's even Jamie, I wonder if you could speak to this on the brain side of it. There's almost like this reward system then that happens like when they, when they find that hair and they get rid of it. Like there's a sense of success and accomplishment or something which can be part of the feedback loop of all of this. Right? To keep people doing this behavior.
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A
Yeah, yeah, exactly. There's. That's one. One of the theories about how the. The behavior develops and kind of maintains over time is that it. It may serve both a function to reduce negative emotions. That's kind of what I was talking about before about how when people pick, they often feel less stress or they're not like paying attention to the stress. Sometimes people report feel a sense of feeling kind of zoned out while they're doing it where they're really. It feels like they're not, or it seems like they're not thinking about anything. And, and that's. For a lot of people, that's kind of a relief. So, you know, behaviors that reduce negative feelings get reinforced. That's called negative reinforcement, which means that anything that you do that makes you feel less bad can. You're more likely to do that thing again. But then there can also be this other piece that you were mentioning that you brought up that can be important, at least in some people, is that there could be a sense of reward or even a brain mechanism related to reward that can happen with a pulling. And so one of them is a sense of satisfaction. A lot of people do describe a sense of satisfaction when they pull a hair that maybe is crinkly or it's a gray hair, or they. Or sometimes even they just pull a hair and then they feel. Feel the bulb at the end. For a lot of people, they say, like, for. For some reason, that feeling of feeling the bulb feels very rewarding.
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B
Squish it in your fingers or something
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A
in their mouth and feel it. Mouth hope. You know, sometimes they might swallow it, but. But that like, it can feel like a rewarding feeling. And then for people who are skin picking, similarly, when they pick something and something comes out like a Black, like a blackhead or a whitehead. And then they can feel a sense of. Of reward from that getting out. It's like a satisfying feeling. And probably everybody has had that at some point in their life. But. But it, but it can be reinforcing. And so for some people, there might be a double reinforcement of both that what we're calling positive reinforcement, which means you feel good from doing it, like a sense of reward. And there could be a negative reinforcement because you're not feeling bad from it. So in some people, it gets doubly reinforced. For other people, it might be more one or the other of types of reinforcements. And there's circuits in our brain that mediate these like, reward circuits that mediate that. And there's also potentially in many of these reward circuits, then are a lot of the function is mediated by a molecule called dopamine that, you know, this is again, theoretically might get released during some of these times, but also when something happens that might feel a little bit painful, you might even have some of what's called endogenous opiates released. And that's our own body's mechanism of reducing uncomfortable pain as we have our own opiate molecules that we make. And so those might get released and that might also contribute to some people feeling good. Again, kind of a theory about the things that are happening in your, in your brain and body that might reinforce these problems.
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B
As we wrap up, what are you two most proud of the study that we've done and think just it says about the work we do and what you look forward to doing next?
- [36:14]
C
Yeah, I'm, I'm proud that, you know about the therapists and our clinical team. You know, these results don't happen without having exceptional clinicians who are committed to doing this specialized work and even learning this specialized work. I think one thing we haven't talked about is the model of supervision that we give at noct, where there's consultations, there's a whole training and supervision and consultations and meetings, and there's a whole lot of dedication that goes into getting the results that we see in this paper. And I think that all adds up to show these outcomes. So I'm proud that we've built a system where therapists feel supported and equipped to deliver this care, because that's what allows us to get results like this, like what we're seeing in this paper.
- [37:11]
A
Awesome. Yeah, I agree with all of that and how much support the therapists really get from not only the training, but also from each other. And, you know, when you're, when you're part of a community of treatment providers, it makes you so much better. You know, you learn from other people and you feel supported and we, there's situations that come up that we don't always know and we can run it by other people and get help with that. So yeah, I'm very proud of what we built in terms of the training and these results. Kind of showing that then how, how well this works. Proud of also of all of the members who, who, you know, had the courage to do this and to go through it and do some difficult things and get better and, and also I'm proud that we've created something that, where we can treat so many people in so many different parts of the United States and outside the United States and reaching different people in remote locations where reaching children, reaching adolescents, reaching adults, older adults and people can do it. The majority of people that do it can have their insurance pay for it. So just how broadly we're able to help people is something that I'm very proud of and I'm glad to be a part of it at nocd and
- [38:33]
B
I'm glad to have both of you on the team to help us do all this work and to not only help guide the work we're doing, but to publish and showcase the work we do too. So I thank both of you for being here today very much. It meant a lot and continued success on future publications as well.
- [38:53]
A
Thanks Petra.
- [38:54]
C
Thanks for having us.
- [38:55]
A
Thanks Claire.
- [38:56]
B
If you enjoy the get to Know OCD podcast, well you can subscribe to our NOCD YouTube channel. If you're looking for help for OCD or body focused repetitive behaviors like hair pulling or skin picking, go to nocd.com that's n o c d com. We have our care team waiting to chat with you and they will set you up with a licensed and as Claire was talking about, well trained therapist who can assist you in all of the issues that you have that you come to NOCD for. We're happy to be here for you and to help you get the life that you want to live and not the life that BFRBS or OCD is influencing all of the time. As you go out today, take good care of yourself and be better to yourself than any mental health issues might
- [39:42]
A
want you to be. We'll talk to you soon.