The “What If” OCD Thought That Took Over My Life

Summary

Get to Know OCD: The “What If” OCD Thought That Took Over My Life

Podcast Host: Dr. Patrick McGrath (NOCD)
Guest: William Schultz, therapist and President of OCD Twin Cities
Release Date: February 26, 2026

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Episode Overview

In this compelling episode, Dr. Patrick McGrath welcomes William Schultz, a therapist whose personal journey with OCD not only shaped his professional life but also provides deep insights into the lived experience of obsessive-compulsive disorder. William discusses how a single “what if” thought in 2007 spiraled into an all-consuming battle with OCD, the challenges of receiving a proper diagnosis, his path to effective treatment, and how these experiences influence his clinical practice today. The conversation highlights the profound nature of OCD, the pitfalls in treatment, and the immense courage required to confront one’s deepest fears.

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Key Discussion Points & Insights

William’s OCD Origin Story

• The First Intrusive Thought ([02:41])

  • William describes the exact moment his OCD “stormed into” his life: a thought while eating lunch, “What if I have an STD and don’t know about it?”
  • The intrusive thought triggers a relentless loop of analysis, checking, and escalating fears about health risks and contamination.
  • Quote:

    “Out of nowhere, I noticed this thought, ‘oh, what if I have an STD and I just don’t know about it?’…Now I’m in this very detailed analytic process...I’m not even eating my lunch anymore.” – William ([03:17])

• Seeking Reassurance & Testing ([07:02]–[10:44])

  • William seeks medical reassurance, insisting on unnecessary tests for “peace of mind.”
  • Gets a fleeting moment of relief, only to be hijacked by new obsessive doubts (e.g., “what if the elastic band was contaminated?”).

• The Compulsion Escalation ([12:18]–[15:35])

  • Compulsions generalize: avoiding touching things, excessive checking, elaborate “safety” routines, memory doubt (“false memory OCD”).
  • Encounters friends and professionals who try, but largely fail, to understand the irrationality and intensity of his fears.

When OCD Expands: Rabies Fear & Beyond

• The Rabies Obsession ([17:46])

  • A chance conversation about bats and rabies triggers new obsessions, transforming everyday encounters into imagined threats:

    “So I say to my friend, why do they have to remove bats?...the thought that came up was, well, what if that bat bit me and I somehow didn’t notice it?” – William ([18:31])

• Medical & Therapeutic Runaround ([21:18]–[25:52])

  • Multiple medical consultations result in anxiety diagnoses, prescription medications (benzodiazepines), and temporary relief but not resolution.
  • Attempts with three therapists fail; they can’t recognize OCD or refer him appropriately.

Reaching a Turning Point: Diagnosis and True Treatment

• Discovery and Stagnation ([25:52]–[27:39])

  • Only in graduate school does William finally learn he has OCD and is introduced to Exposure and Response Prevention (ERP).
  • Realizes intellectual understanding isn’t enough—he is unwilling to commit to exposures out of fear, especially of the “one time” risk.

• Identifying the Core Fear ([27:39]–[31:26])

  • With a therapist’s help, William confronts his true core fear—not death, but the regret of never having the courage to face his OCD.

    “The thing that hit the hardest was I never took my chance to challenge my OCD. The words that actually went through my mind: I missed my chance to be brave.” – William ([30:08])

  • This realization becomes the catalyst for true behavioral change.

The Shift: Values-Based Motivation and Recovery

• Embracing Uncertainty, Choosing to Live ([31:26]–[34:35])

  • William reframes recovery: overcoming OCD—not “staying alive”—becomes his top priority, allowing him to finally engage deeply with ERP.

    “If in some kind of bizarre, tragic accident…this is the one time I needed to check, and I end up making a mistake by not checking…then I’m going to go down fighting my OCD. And I don’t like that, but I can live with it.” – William ([31:27])

  • Achieves robust remission in about two and a half months.

Therapy, Treatment Agreements, and Barriers

• The Role of True Treatment Commitment ([34:50]–[36:13])

  • Psychoeducation is crucial, but true agreement to treatment requires a willingness to “live life with uncertainty, with thoughts you don’t like, with feelings you don’t like.”

    “If you’re not willing to do that, you’re going to keep doing your safety behaviors.” – William ([35:43])

• Treatment-Interfering Behaviors ([36:13]–[38:23])

  • Many years are lost not to a lack of knowledge or diagnosis, but to avoidance—a lesson William brings to his clinical practice.

The “What If” Disorder: Living with Uncertainty

• The Heart of OCD: Uncertainty ([40:58]–[45:08])

  • OCD creates endlessly plausible, emotionally charged “what if” scenarios—no amount of logic resolves them.

    “The rule of OCD is: if you can imagine a picture of the event in your head, then it’s possible…It doesn’t mean it’s likely, but it could happen. And technically, that’s true.” – William ([41:00])

  • The emotional brain doesn’t distinguish between possible and probable—feelings of danger feel real, even when logic says otherwise.

    “The movie is being projected into the psyche, and psyche's responding as if it's real. In OCD, those scary stories get projected…even if a part of you knows it's unrealistic, you'll bump into: ‘yeah, but it feels real.’” ([44:42])

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Notable Quotes & Memorable Moments

• On seeking reassurance:

  “One test would tell me everything I need to know, right? Of course. 100%.” – Dr. McGrath ([08:44])

• On shame and alienation:

  “I recognized at some level that this was really off the rails. But to explain that to another person felt impossible and very embarrassing.” – William ([47:56])

• On fear driving behavior:

  “I was literally afraid of my own shadow.” – William ([47:55])

• On values shift:

  “Staying alive is no longer my top priority. Overcoming my OCD is my top priority.” – William ([31:26])

• On the reasoning trap:

  “You could rename OCD the Yeah, But What If Disorder.” – Dr. McGrath ([41:43])

• On treatment barriers:

  “Clients come in because they’re hurting…and they kind of want to feel better…but maybe I don’t actually want to feel that much better if that’s what it means.” – William ([37:12])

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Key Timestamps

• 02:41–06:59 – First intrusive thought; the “What If” spiral begins
• 08:38–11:47 – Medical reassurance, fleeting relief, new doubts
• 12:18–15:42 – Spread of compulsive behaviors, loss of trust in memory
• 17:46–21:18 – Rabies obsession emerges
• 25:18–27:39 – Accumulation of “safety” behaviors, failed therapy attempts
• 27:39–31:26 – Core fear identified: missing courage/opportunity
• 31:26–34:35 – Values shift, ERP engagement, remission
• 35:43–38:23 – Clinical reflections on treatment-agreement and barriers
• 40:58–45:08 – The impossibility of “certainty” in OCD (“Yeah, but what if…”)
• 47:36–47:56 – Afraid of own shadow; shame experienced

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Tone and Language

• Both William and Dr. McGrath blend humor (“Cheetos bat, yes.” ([23:31])), candor, and warmth, destigmatizing OCD while emphasizing the pain, courage, and work required to recover.
• The conversation offers compassion for sufferers (“It feels impossible and very embarrassing.” ([47:56])) and clarity for listeners unfamiliar with OCD's intensity.

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Conclusion

This episode of Get to Know OCD is a raw, insightful exploration of how one “what if” thought can consume a life—and how, with the right understanding and willingness, it is possible to reclaim it. William’s story demystifies OCD, highlighting the vital importance of true therapeutic commitment, the limits of reassurance, and the need to live aligned with values—rather than fear-driven compulsions. A must-listen (or summary to read) for sufferers, clinicians, and anyone seeking to understand OCD’s lived reality.

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Next time: Part two will dive deeper into clinical insights, practical treatment tips, and current research on OCD and ERP.

Transcript

[A]

Foreign.

[B]

Hi, everyone, and welcome once again to another episode of the get to Know OCD podcast. If you're looking for help for OCD or related conditions, check us [e-mail]. if you like the podcast, you can subscribe to the NOCD YouTube channel. Today, after 78,493 reschedules, William Schultz is here. Hello, William. How are you?

[A]

Hey, Patrick. I am. I am doing great. Glad that we have the record for the most we do. The schedule changes. It. It's great to be here. I'm really excited. I love Yalls podcast. I love what y' all are doing. It's. It's amazing work.

[B]

Well, and just you just said y' all a lot, so that's cool. You must be Southern if that's the case. We got a little grew.

[A]

Grew up in Texas. No, I'm. Now.

[B]

Yeah. Yeah. There you go. All right. Well, thank you for being here. And you've got, you know, we've chatted a few times, and we have some mutual friends in the OCD area, some good buddies and things, and so thought it would be fun to have you on today to talk about ocd, OCD treatment and your own personal experience with OCD and how it's kind of led you into the work you do and everything. So why don't you start just by, you know, introduce yourself and tell everybody a little bit about you and what's brought you here today?

[A]

Yeah. Well, I never thought that I was going to be a therapist. And the reason I am is because in 2007, I. I didn't know it at the time, nor did many of the therapists that I spoke with know it at the time. But I. That's when my OCD began.

[B]

Okay.

[A]

And so I. I went through that process, and during the process, I got interested in it and ended up going to graduate school. And what I. What I do now is. So I'm a therapist in Minnesota. I have a private practice in St. Paul, and I'm the president of OCD Twin Cities, which is the. The Minnesota state affiliate at the International OCD Foundation. And I. And I do a little bit of research, although primarily I'm a clinician.

[B]

So I'm going to go in depth on some of that, if that's okay. Yeah, 2007. How do you figure out it's OCD? Do you figure that out? Does someone else figure that out? Because we know that a lot of times people with ocd, through maybe compulsive research, sometimes do figure out that they have ocd. And it isn't the therapist that they've been seeing because they're not trained in it and aren't familiar with what to do with ocd.

[A]

Yeah. Yeah. Well, so I'll. Patrick, I'll walk you through little snippets of the story, because I remember very well the day that OCD really came storming into my life. It was in July of 2007. So I had just recently finished my undergraduate degree, and I was. Which I completed in Minnesota. I was back in Texas helping my parents move. And while I was back down in Texas, I had rekindled a. A romance from my high school. This. This woman that I had gone to the homecoming dance with. And I was really. I was really excited about it. I thought, this is. This. This is great. She's great. There could be a future here. I was just feeling really, really good, and I. I had been meeting with her and chatting back and forth with her after I had finished helping my parents move for the day, because that was a, you know, a longer process. And I was a. Maybe about a week into the move, and I was sitting down to eat lunch, and I was just feeling great. I was really looking forward to seeing her that night. And kind of out of nowhere, I. I noticed this thought, oh, what if. What if I have an std? And I. And I just don't know about it? And I was like, what? But then it kind of hung around. What if I have an se. I just don't know about it. And then I. I tried to figure out, like, well, do I, Am I. Am I. Am I at risk? What. What do I know? And before I know it, I'm in this very detailed analytic process where I'm trying to trace out my risk factors and trace out my checkup so. So I can try and figure out, like, well, am I. Am I at risk? I'm not even eating my lunch anymore because I'm here fully pulled into this process.

[B]

The ham sandwich is not so important at this point in time.

[A]

Right. The burrito was not quite at the burrito.

[B]

There you go. Yeah. Yeah, that makes sense. That makes sense.

[A]

And it got to a point where I, I, I kind of vaguely began to realize, like, I'm not really making any. Any progress in trying to figure this out. You know, what. Whatever. If I. If I. If I have an std, I'll go to the doctor, I'll get it treated, no problem. And then another thought comes in. I didn't ask for it to come in. It just showed up. It was, oh, yeah, but, but, but didn't, didn't you, didn't you read the hsv? You, you can't cure that. You're kind of, you're kind of stuck with that. You can maybe manage it, but you can't cure it. And that one really hurt because now my original plan, which was I'll just go to the doctor and get it treated now it was, oh, I'll kind of be trapped. I can manage it, but I can't, I can't cure it. And that didn't feel so good. I didn't like the idea of telling a potential partner, like, oh, by the way, this is a part.

[B]

Yeah. And what, 80% of people have HPV, right? Or something like that. Yeah.

[A]

So, yeah, so I'm kind of sitting with that for a little bit. And I don't like that feeling either. It's really making me uneasy. And then again, I didn't ask for this one either, but this is the one that really hit hard. It was, oh, well, what if you have hiv? Can't, can't cure that one either. Manage it, but can't cure it. And, and now I'm, I'm really starting to feel panicky because now it's like, oh, this, this has the potential to have some kind of impact on my lifespan. What, what would it mean for me and this woman I'm really interested in pursuing a relationship with, if part of what's going to be involved in that is saying, like, oh, by the way, like, I, I have hiv. And that's something that we need to consider if we're thinking about moving forward. Well, burrito's not in my hand now.

[B]

No, no, definitely not. Yes.

[A]

And so for the next few days, I never experienced anything like this. It was just on my mind all the time. I'm trying to figure out what is going on, what is my status, all the stuff that you would expect, lots of memory checks. And that process eventually gets to a point where I say, look, this is, this is, I'm like, this is driving me nuts. I've got to do something about this. And so I, I, I found a clinic nearby that I thought, I'm just gonna go and get a test and then I'll then be good to go. And so I, they were able to get me in the next day. I'm, it was interesting because when I was actually sitting in the waiting room to go and do my, my consultation with the provider, I wasn't even actually all that nervous. I felt like I'm doing something, you know, I'm like, I'm gonna. I'm gonna. We're gonna figure this out.

[B]

Proactive. Here we are.

[A]

Proactive. Taking. Taking steps. So the guy comes out, we go back into his office. He says, you know, what's going on? And I. And I tell him what's going on, and he. He looks at me and he's like, william, I. I don't recommend that we move forward with a test based on what you've told me. There's. There's no substantial chance that. That. That you're a risk. And I guess that kind of felt nice to hear. But I said to him, hey, listen, I. I get it, but please, let's. Let's. Let's get the test taken.

[B]

The old.

[A]

Because then I'll know for sure.

[B]

The old peace of mind, right? Yeah, of course.

[A]

The old. Then I'll be certain.

[B]

Of course. Yes, of course. One test would tell me everything I need to know, right? Of course. 100%.

[A]

I'll get the test done, and it is going to be clear sailing.

[B]

Boy, I have a feeling. I know. Going. But continue on. Please continue on.

[A]

Patrick, I know you know the direction, even though you might not know the specific side road that it took.

[B]

Yeah. Yeah. But I. I kind of.

[A]

So, you know, he's like, yep, no problem. We can do that. He takes a little elastic cord, wraps around my arm, draws my blood, tells me the results will probably be in in a few days. I'm like, I'm good. And, Patrick, when I walked out of the clinic, I. I felt like I was born again. I was like, this feels great. Sun is shining, clear blue sky. My head is clear. I don't feel anxious. I'm going to get the results. I. I'm. I'm feeling. I'm pretty confident, like, yeah. Yeah. I'm probably not at risk. Just like he said. Just like I kind of thought. But either way, I'm gonna know, and it's probably gonna be fine. So I walk to my car, get in. I'm. I'm now thinking about my date tonight with some renewed enthusiasm. I'm not gonna have to deal with this.

[B]

Yeah. I'm gonna write down a prediction. I'm gonna see if it's right. Where. Where you thinking? Hold up. All right. I just wrote down a prediction.

[A]

I'm thinking, patrick, I think you are gonna. So I put my key into the ignition, and I'm about to start my car, and then out of nowhere comes this thought, you know, when. When he removed the elastic band from my arm, it kind of Brushed by where the needle was put into my arm.

[B]

Yeah.

[A]

And you know, it. I think it kind of touched where the needle went into my arm. And remember, there was somebody in the office right before me. So what if that guy got his blood drawn, and when the elastic got taken off, the blood from the needle wound got onto the elastic, and then it was still there when he took it off from me. And in that moment that. That was so painful because what. What I said, Patrick, was, oh, no, please, no, please, no, please, no. Because I had just gotten this little moment where I felt like I was free, and I realized I'm not, because this is. I can't shake this. Yeah, it's coming. And right when I thought that, then the next one just kicked the door in and said, oh, what if he reused the needle?

[B]

Dirty needle. That's what I wrote down.

[A]

There it is.

[B]

Dirty needle. There it was.

[A]

And then the thought was, oh, I actually had been absolutely, probably totally fine with all reasonable certainty, but now maybe I've actually put myself at risk.

[B]

Yes, the very thing I did now because I would destroyed me. Yes. Yes.

[A]

I was trying to be safe, and I inadvertently put myself at risk.

[B]

Gosh, this is the tale of ages of OCD right here. I tell you, there it is.

[A]

And one thing led to another,

[B]

and

[A]

within six months, I'm not touching things, or if I am touching things, There's a whole host of behaviors designed to keep me safe when I do it. Many, many weeks were spent evaluating handshakes, casual contact that I had. I had some conversations with people who were close to me, but they had a hard time understanding. You know, I had. I had some friends tell me, like, dude, I don't. I don't really think the HIV gets spread like that. Or conversations like, well, we'll do. Just go get a test them. Not knowing that I'd already had several. I'm not doing blood draws anymore. Only can do gum swaps now. But now I'm worried that maybe the. The gum swap somehow might be activating it as well. You know, all the. All the stuff. And I did have some people be like, talk. Talk to a doctor. Well, yeah, I spent thousands of dollars talking with doctors over the four years that. That was my primary theme area. And they all told me the same thing. They all told me, william, HIV is not spread through environmental exposure. Look, if you. If you don't have unprotected sex and you don't share needles, you're never going to get hiv. And, you know, they. They maybe weren't Prepared for what I was going to throw their way. I mean, I debated on the debate team in. In high school. I was ready, and I said, all right, doctor, well, how about this? I'm driving down the highway, and I see a car accident. I stopped to render aid, someone stuck in the car. I want to get them out. While pulling them out, metal shreds, and it really gashes my arm, and I slip down. There's already a pool of blood on the ground from the passenger in the car. So now my fresh gash has come into contact with the poor pool on the ground, which ends up being HIV positive, verified through later tests. Are you telling me in that situation there is zero chance that I contract hiv? And the doctors typically said something to me, well, even in that situation, I think the chances of transmission are relatively low. But we. We couldn't rule it out. And so my mind said, aha, It's a good thing I've been covering my hangnails in tape, because doorknobs actually are dangerous.

[B]

There you go.

[A]

Yeah.

[B]

Yeah, there. There it is.

[A]

So that's the beginning. And it got to the point. And again, you could probably write this down on the notepad, Patrick, where I. You know, I'm not trusting what people are telling me. And it very quickly goes to, I don't trust what I remember. I don't trust what I'm seeing in front of my eyes. Example might be I'm walking through a restaurant and notice someone's glass of water have condensation. That's poop pooling on the table. It sure does look like clear water to me. But maybe it's actually a pool of blood. And I don't remember getting anywhere close to it, but maybe somehow I did, and maybe now I'm at risk. So it's gone from maybe some way, somehow I had some kind of exposure in the past to I. I can't move around in a public space.

[B]

Little false memory, real event, OCD going on.

[A]

Memory. There it is. Yep.

[B]

Yeah.

[A]

So I doubt my perception of my memory. And I. I felt ashamed about this because some. Some part of me sensed that something was off.

[B]

Yeah.

[A]

About what was going on. But I. I couldn't rule it out. And, you know, my undergraduate degree in college was in philosophy, and I kind of realized that I. I couldn't be certain. So it just kept kicking around, making me feel very anxious all the time. I didn't, because I felt ashamed, and I felt like this is something I should be able to deal with on my own. I. I didn't seek out help. I maybe threw a few feelers out there, but no. No sessions, no help. Four years later. This is after my dream job out of college. I had to quit because I couldn't. Couldn't really be present to work, move back in with my brother, then move back in with my parents. OCD is taking up more and more space still. I did not know that this was ocd. I just knew that something was going on. And I'm working a job at a university library, just managing the front desk, basically, and it's okay. And I was, I was trying to be, you know, careful about my physical health, doing what I could to feel better, like trying to get some exercise and trying to meditate. It wasn't doing anything for, for my OCD related experiences, but I was just doing what I can. And I'd have better days and worse days, but, you know, I'm still doing safety behaviors every day, all the time. And I'm on a walk with my friend, and we just happened to be talking about some work going on at the college football stadium nearby. And he was telling me, you know, they, they have to, to come in to remove the, the bats that are roosting there. This might be a notepad moment, Patrick.

[B]

Rabies coming here. Yeah.

[A]

So I, so I say to my friend, why do they have to remove bats? And he said, well, first, you know, they poop everywhere. And, you know, that's, that's a nuisance. But the other thing is the public health hazard. And I'm like, what's, what's the public health hazard? He said, well, you know, bat's going to get rabies. And then my mind went back to a week earlier when at the library, a bat got in the library and was flying around. And I remember I, I went up to the third floor where the bat was flying around, and I watched the animal control guy try and catch it with like a, like a net. Yeah. And he, he didn't succeed. And I, I kind of thought it was a little bit humorous. Like you have the bat kind of is that way. I had zero concerns when I watched it at the time.

[B]

Sure.

[A]

But now that I was aware that bats might have rabies, the thought that came up now was, well, what if that, what if that bat bit me and I somehow didn't notice it?

[B]

Yes.

[A]

And a part of me said, well, I think you'd probably notice if the bat bit you. And another part of me was like, maybe didn't. And by, by this time, I already had a very tentative relationship with my memory and perception. So now I'm replaying where I was standing when I watched the animal control guy trying to catch the bat and all that good stuff. And then I'm on Google and would I know if a bat bit? And now I'm finding the scenarios where if you wake up in a bat in your room, there's a bat in your room, well, then you actually need to go and get medical care because you, if you were sleeping, you might not have noticed that the bat that you, and in my mind, that means, well, maybe I wouldn't notice if I was awake.

[B]

Of course. Yeah, makes total OCD sense. Right?

[A]

And, and, and that's where, that's where it really, it really started hitting. Because before my primary obsessional content was focused on the threat of possibly having to live with a, with a chronic health condition that might interfere with relationships. But now the threat was if I don't get the appropriate vaccines in time, I'm going to die.

[B]

Yeah.

[A]

And I, I, I just broke down and I, I remember going to my parents crying, and, you know, I, I was explaining to them what's going on and they of course will like, did it bite you? And I, so I don't think so, but, but maybe. And I went to the doctor and the doctor's first question was, where'd the bat bite you? And I was trying to explain to him, well, I don't know if it bit me. And he said, well, if it bit you, you'd know. And I said, well, but are you sure I would know. He told me some story about the last time he worked with someone who got me. And he's like, yeah, he stuck his hand in the thing, you know, he got bit. But I was just like, maybe I wouldn't, maybe I wouldn't, maybe I wouldn't. And he said to me, the doctor said to me, well, listen, look, my recommendation is that you don't get the shot. You would know. It sounds like what happened is you saw it from a distance and you would know. And you need to be aware that, you know, if you, the vaccine can have some pretty bad side effects too, and it's really not pleasant. And so I said, okay, well, I, I, I, I, I guess I'm not, I guess I'm not going to go with the, with the vaccine. And then he said, but what I do want you to do is I want you to meet with one of our nurse practitioners because he got some anxiety going on.

[B]

Wow.

[A]

So, so you need to meet. And so I said, okay. Okay, I'll do that. And so I, I had an appointment with. With her just a few days later, and she didn't tell me it was ocd. She just said, like, it. Yeah, it sounds like you got a lot of anxiety, even though, like, you're. You're safe and, and, and that's okay. Like, we've got this med that you can take, and it's. And it's really going to help. And she gave me a couple prescriptions, one for a daily and one for an as needed. And, well, the first time I used one of the as needed, I. I thought to myself, this is awesome. I. I felt like I. If I can feel like this, I don't really have a problem anymore. I felt great.

[B]

Yes.

[A]

No problem.

[B]

The old benzodiazepine, right?

[A]

The old benzodiazepine, that's right. But, you know, by the time. By the time I got back from, you know, my, My shift, it. Everything was back again.

[B]

So half lives are short on those.

[A]

Yeah, half lives are short. And so now it quickly transitioned from I don't like touching things when I'm out to I don't like being out because if I go outside, maybe there's going to be a bat.

[B]

Yeah.

[A]

And then it very quickly transitioned from, well, I don't like being out to I don't like being in. Sort of a bad gift, right?

[B]

Yeah.

[A]

Yeah, maybe. So now I'm checking windows, now I'm checking doors. Now I'm checking underneath couches. Now I'm pulling off cushion cushions. And then it got to the point where I'm going through my responsibilities at work, which includes, you know, pushing in chairs, big pieces of trash taking off. But, you know, that looks like a. That looks like a bag of chips that's empty, but maybe it's actually a bat. And in my mind, I'm thinking, that's a bag of Cheetos. That's an empty bag of Cheetos. It looks like an empty bag of Cheetos. Maybe it's a bat.

[B]

The Cheetos are you sure? Is a very dangerous bat, you know? Yeah.

[A]

Cheetos bat.

[B]

Yes.

[A]

And I don't want to touch that bag.

[B]

Right.

[A]

It. It looks like a bag to me. My senses are telling me it's a bag, but I don't want to touch it.

[B]

Hey, there's only one letter difference. It's a bag or a bat, Right. I mean, there it is. Look how close they are to each other. And, And I say this somewhat funny, but I also say this seriously, too, right? That these are the places your mind will go to.

[A]

That's where it goes. And. And. And then I'm. I'm struck with the experience of, okay, what does a bat look like? And I'll bring up the image in my mind. Okay, what does the Cheeto bag look like? Well, that's right there. But then it's okay. Was I imagining the image of a bat, or did I actually see the bat? How can I know for sure? And I stumbled upon what seemed at the time to be an elegant solution, which is, well, I just won't throw the trash away. I'll save it. Because if I save it and I worry that I didn't see it. Right, no problem. I'll just go back and check.

[B]

Go back and check. There we go.

[A]

And so now all of a sudden, the pushing in the chairs and throwing away some bags is, yeah, I'm pushing in some chairs, and I'm bringing out my bag that I can bring back to save. And that went on for a while. Still no idea that it's ocd. And by this time, I realized that something was really, really going off in terms of my mental health. I didn't know what, but my plan was, you know, I'm gonna. I'm gonna go to graduate school because I'm gonna figure it out there. Like, they study anxiety in graduate school for clinical psychology. And when I. Patrick, when I moved back from Texas to Minnesota, which is where I go to graduate school, about two thirds of my car was, like, my belongings, and the other third was my trash.

[B]

I was gonna say, please. The Cheetos bag came with you, didn't it?

[A]

That's right. The Cheetos bag. The. The soda cans, all the stuff. And of course, if someone's like, what. Like, what's. What's with all the trash? I didn't want to tell them, like, oh, well, you know, I'm. I'm worried that this white styrofoam cup might be a bat, and I'm worried I'll worry about it later. So I just keep it around in case I want to go back and check. And I. I didn't actually check my bags too often, but I liked knowing they were there, there.

[B]

Security.

[A]

Yeah, security. And so it.

[B]

It.

[A]

At that point, when the rabies first came in. This is before I went back to Minnesota. I did go to some therapists. The first therapist I went to listened to me Talk for about 20 minutes and then said to me, I'm sorry, I don't know how to help you or what's wrong with you? And that was the end of the conversation. She didn't even provide me a referral. And same thing for, for the next two therapists. They, they said, I, I don't know what's wrong with you. We can tell that you're really anxious and I, we, we think you're going to be just fine. But here, what, what we should do is why don't we practice some breathing and that'll help you relax so you don't have to be so anxious about it. And it's like breathing. That's, that's not. I've tried that myself. No one going to do anything for me. It wasn't until I got into graduate school when, until I realized that, oh, this is ocd. This is ocd. And then some things started to piece together. But it also is where one of the problems popped up because by the time 2014 rolled around, so I'd already been with OCD for seven years.

[B]

Yeah, y.

[A]

Now I knew that it was OCD and I also knew that ERP was the most well researched intervention. And I'd even connected in with some ERP therapists, but I wasn't willing to do the exposures. I was just too scared to do the exposures. And it was the typical sort of thing that, that you'll see. Well, well, yeah, but, but what if I do an exposure one time and that's the one time I actually needed to be careful?

[B]

Yeah.

[A]

What if that's the one time that it actually was an itch on the ankle that actually was the bat bite, so on and so forth. And what, what was going on there? What I, I didn't know it at the time, but what eventually I realized was even though some of the people that I was working with kind of knew something about OCD and kind of knew something about erp, they, they weren't really helping me discover what my core fear was. They were just assuming that my core fear was Diana Rabies. And that's a reasonable, that was a reasonable guess because that's what most of my obsessional content was. Now, sure, by that by 2014, my theme areas had gone into all the mainstays. Contamination, harm, responsibility, hit and run. It. It was all shown up and I ended up going to a therapist who wasn't actually even an OCD therapist. And I told her what was going on and she's like, well, William, you have ocd. It sounds like, you know, you want erp. Let me help you get somebody. I don't do erp. And I said to her, listen, I've already done that. I need you to help me understand why I'm not doing my ERP Mm. And she somehow realized that she. She should guide me in exploring. Well, you know, what. What might happen if I. If I don't do my ERP or if I do do my ERP she was guiding me into exploration of my core fears, and it was very illuminating for me to realize she walked me through. Okay, so, William, the doctor is bringing you back the piece of paper that says positive. What's that going to be like? I'd never gone that far on my own. I just blanked out. I was like, I know where it's headed. I want to. I don't want to go down then, Patrick. But what I was so surprised to see was when I got the piece of paper saying that it's positive. It's over. The thing that hit hardest wasn't the fact that I was going to die. I mean, I didn't like it. I was going to die. Very scary. But the thing that hit the hardest was I never took my chance to challenge my ocd. I missed. Actually got to stick around my entire life. The words that actually went through my mind. I missed my chance to be brave. Because to actually stand up to ocd.

[B]

Yeah, because to be brave, first you have to be afraid.

[A]

You have to be afraid.

[B]

It's similar to a phrase I say to people a lot. Will you spend the rest of your life sitting next to your tombstone wondering when you're going to be six feet under it? Or will you live the rest of your life and on the day of your death, arrive at your tombstone going, well, that was fun.

[A]

It's exactly on point, because once I had the realization that. That, well, yeah, of course I don't want to die, but what I really don't want to do is never give myself a chance to live a life. And to live a life, I have. I have to bravely confront this thing. And what that allowed is I began to prepare for my reframe when I did my exposures. And the OCD said what it always says, which is, what if this is the one time you're making a mistake? And if it is, then you're going to die and, you know, never going to get a chance to see what it's like to live a life or live a life without ocd. And I was able to say, well, probably not, but maybe. But staying alive is no longer my top priority.

[B]

There you go.

[A]

Overcoming my OCD is my Top priority. And if in some kind of bizarre, tragic accident of the universe, this is the one time that I needed to be safe and check and I end up making a mistake by not checking, well, then I'm going to go down fighting my ocd. And I don't like that, but I can live with it.

[B]

And then you're in an Alanis Morissette song. Isn't it ironic or something like that?

[A]

Right.

[B]

If that's the case, I don't like

[A]

the idea of dying early.

[B]

Nobody does.

[A]

But I would be proud of myself, sure. For standing up to that force, that dynamic that had taken control. And in my particular case, Patrick, I, that is what enabled me to actually lean into the ERP process. Abstaining from the safety behaviors. Do my, do my erp. And I was in remission in about two and a half months.

[B]

And basically, to pull a southern phrase in, you stopped fixing to get ready to do something and you started doing something.

[A]

I stopped the fixin and started the doing. So it was my hang up, wasn't knowing I had ocd, which I knew for the last three years that I had it. And it wasn't not knowing what evidence based treatment was. I, I knew a lot about erp. I didn't feel ready to do it, but I didn't feel ready to do it because I was still thinking that my top priority was staying alive. But if that really is my top priority, not dying rabies, well, then maybe I should be doing my checks. If it's my top priority.

[B]

Right?

[A]

The shift is my top priority. Has to be overcoming my ocd.

[B]

This is where ocd. Such an ass, right? I mean, just because I'm going to bet you look back at that now and are like, duh. I mean, you know, of course, but how manipulative OCD is because it isn't a logical problem. You had no logical issues going on. Right. You had an emotionally based problem where you were being driven by the fight, flight or freeze response going, ah, but what if this? And that could kill me and I don't want to die, so it's best just to do what I can to stay alive. And oh, look, I'm still alive. This must work. Okay, I'll keep doing it. And that's it.

[A]

It's. It's not a pleasant way to live. But at least I'm here.

[B]

At least I'm living.

[A]

Yeah, at least I'm living.

[B]

You know, Shawshank Redemption comes to mind, right? Get busy living or get busy dying. And how many people get busy dying Every day because they're given to OCD and what OCD wants instead of get busy living and do what you did, which was finally decide, I'm gonna take my chance.

[A]

Yeah, it's the, it's the committed decision and it's, it, it's a lot easier said than done, like, oh, just make a committed decision. I mean, we can envision what a committed decision looks like, but it's the, the willingness to endure the thoughts and feelings and the so called risks, which are negligible, almost always, but not zero.

[B]

Yeah.

[A]

To. To do the skills, to do the process. And in my case, it worked exactly like the science suggests that it will.

[B]

Yep.

[A]

But the buildup was the willingness, the willingness to do it.

[B]

How do you bring that into your own clinical practice now in the work you do with people and the trainings you do and the teachings that you give to people? Because I know that's a big part of your work.

[A]

Yeah. So, of course, the psychoeducation around what OCD is, what it looks like, why, what they've been doing to momentarily feel better is maintaining the underlying problem is all very important. Psychoed around, you know, trying to stop your intrusive thoughts is not going to be particularly effective. All that good stuff. But, but the next step is not one I created, just one that, that I really reinforced after reading Jonathan Grayson, which is, well, has the client agreed to treatment? What do you mean? If I agree treatment, I'm coming into therapy all the time. Isn't that. Yeah, that's coming into the office. That's not agreeing to treatment. Well, but what is it to agree to treatment then, William? Well, it's a number of things, but one of the things it means is are you willing to make the committed decision to learn how to live life with uncertainty, with thoughts you don't like, with feelings you don't like? Because if you're not willing to do that, you're going to keep doing your safety behaviors, Right?

[B]

Yeah, I've had the opportunity. When I was doing my postdoc, I was with Alec Pollard when he was really developing the first concepts for Tibs treatment, interfering behaviors and that work and everything. So this has just been an interest of mine all along. Right. When people are not getting better, what are these interfering things that are getting in the way? And you know, thank you for being so eloquent about years of struggling with these treatment. Interfering behaviors. Right. That were. And, and you could say to people, hey, I am in therapy. But looking back, I don't think you could really say well, I'm doing therapy. Right, but, but you could say you were in therapy.

[A]

Yeah, yeah. And, and, and, and that's a thing that, that, that comes up so frequently in, in practice where clients come in because they're hurting.

[B]

Right.

[A]

And, and they, and they kind of want to feel better in a way. I mean, they don't want to hurt anymore. But then when I review with them some of the processes that will be involved in them feeling better in the long run. Well, maybe I don't actually want to feel that much better if that's what it means. And of course, like you were mentioning when, you know, when my fight or flight was activated, it, it's one thing for me and a client to review that. Hey, you know, everything you're telling me sure does look a lot like ocd. That's why I've provided you a diagnosis of oc, ocd. But they get hit with the possibility that maybe it's not and they have to grapple with the fear of uncertainty. And there's no logical book around that you could frame it that participating in erp, really leaning in and doing erp, identifying and abstaining from safety behaviors, participating in your graded hierarchy. It's a calculated risk. It's not a realistic risk. Right, but it's a calculated risk.

[B]

Speak more on that though, because it's a topic I've wanted to talk about more on here and I'm glad we will. And I know we've been recording for a while and I love. We're gonna have to do a part two because we have other things we want to talk about. So we're just know that we're okay on time. We're gonna do a part two on this because there are still other things to do. But that, that idea, I, I'd love you to speak on this. The fear of what if this isn't ocd Also keeps people away from therapy.

[A]

Yeah, yeah, yeah, exactly. And well, as you know. Well, Patrick, when. And you won't be surprised that my clients are asking me that question all the time. And I mean that those would be the tame versions. First example that comes to mind is years and years and years ago, I'm. I'm working with a client who's got some harm related ocd. And he comes in to our, our fourth or fifth session and something's different about how he's showing up. Like we had had like it felt like a good rapport building, but he's kind of closed off in withdrawal. And I pointed out like, hey, you Know, are you doing okay? Because something's feeling a little bit different here. And he. He kind of becomes sullen, kind of feels a little bit ashamed. And he says to me, william, this past week, I got stuck with this thought that maybe you're actually like a mad scientist and you want these terrible things to happen. And so you're telling me to do these exposures so that the terrible things can happen.

[B]

They figured you out, William. They. They finally figured me out, yes.

[A]

But what I had to. To let him know is. Well, you know, probably not, but maybe.

[B]

But maybe, right?

[A]

It. It could be. And I'm not really all that concerned about the specific content that people are grappling with when they confront the. Yeah, but how do I know for sure? I'm more focused on the process, which is. Yeah, that's exactly what OCD looks like. Is. Yeah, but how do I know for sure? Yeah, but what if this is an ocd? Yeah. Yeah, but what if this is the one time. And. And that's why it's so tough, because there's not a conclusive answer to that. If by conclusive, we mean we know 100% sure. How? I explain to my clients the. The rule of OCD is if you can imagine a picture of the event in your head, then it's possible.

[B]

Sure.

[A]

And so if you could imagine getting abducted by aliens, then it's possible. Doesn't mean it's likely, but it could happen. Now, contrast that with something you can't even imagine in your head. A square that's also a circle at the same time, you can't even make a picture of that.

[B]

No.

[A]

But you losing control and mowing down a group of pedestrians on the side of the sidewalk, even though you don't think you want to do that, can you imagine a picture of it in your head? Yeah, that's easy. Of course you can. And if you can imagine the picture, then what happens in an OCD dynamic is it says, like, well, it could happen. It. It could. And technically, that's true.

[B]

I often said you could rename OCD the. Yeah, but what if disorder.

[A]

Yeah, but what if?

[B]

Yeah, but what if?

[A]

And. And when OCD throws those what ifs your way, typically it'll be with words. And those words are going to generate some images. You might not be aware of the images, but they're down there in the exact same way that if I said to. If I said you. Patrick. Hey, Patrick, do you know what a. What a tree is? At some point, as you explained to me, a definition of A tree. You're going to have some kind of tree. I don't know what kind it is, but it's going to be some kind of tree. And if I'm working with someone who's afraid that they're going to stab their kids and they have a. Yeah, but what if this is an ocd? Somewhere deep down there, they're going to have an image of them stabbing their kids.

[B]

Sure.

[A]

And that's not going to feel so great.

[B]

You can even take a branch from the tree and sharpen it and stab your children with it. I mean, you know, you could, right?

[A]

No. The only limits. The human imagination.

[B]

Exactly. Exactly. And that's why to. The idea of. It feels so real. I talk to people a lot when they are so confused that I start talking about lice. And after about 30 seconds, people start to do this. You know, they start to scratch. I was like, why are you itching your head? Well, you're talking about lice, and I feel tingles. Oh, are you then saying to me that just an idea of something can lead to a feeling. Oh, interesting. Isn't. Isn't that. Isn't that fascinating? The thing you were just denying 30 seconds ago, you've now experienced so in.

[A]

In Patrick. Fascinating. And also, isn't it. Isn't it kind of scary?

[B]

Yeah.

[A]

That we can be so vulnerable to the thoughts that we're having that all of a sudden we're. We're feeling an itch. Or. My client, who is concerned that she just smelled absolutely awful, and despite all the checks and reassurance from the people that loved her, she comes into the session and says to me, I smell it, William. I smell it. Don't tell me I don't smell it. I do smell it. What. What am I to tell her? No, you don't.

[B]

Yeah, yeah, you. You may smell it. Right. But just because you do doesn't mean we do.

[A]

That's. That's right. And. And we see that all. All the time in OCD where, you know, if it's a fear of a dirty needle. Well, William, I. I thought I felt a little itch in my foot when I was walking down the sidewalk, and it kind of. Kind of felt like a little bit of a poke. There you go. What I. What I'm often describing to my. To my clients, Patrick, is. I'll use an example, like, hey, have you ever gone to a movie theater and seen a scary movie? I'll be like, yeah, yeah, sure. It's like, well, were you scared? It's like, yeah, yeah. I was kind of scared. It's like, oh, well, did you, like, not realize you were in a movie theater? No, I knew he was in a movie theater. Well, why were you scared that.

[B]

Why were you scared? Yeah.

[A]

Because the movie is being projected into the psyche.

[B]

Right.

[A]

And psyche's responding to some degree as if it's real. Yep.

[B]

Yep.

[A]

And what happens in OCD is those scary stories, whatever those scary stories happen to be, are getting projected into the psyche. And even if a part of you knows this is so unrealistic, this is so unlikely, we bump into what you're pointing out, which is. Yeah, but it feels real.

[B]

But it feels real. Yeah. All right. We are going to do a part two because there's still clinical insights and practice stuff. And I also want to talk about some of the research work that you've done, too, so we're gonna have you back. But I purposely wanted to let you tell that story as you were doing it because I think it's just such a detail that's so important for people to hear. And I think not only for people who have OCD to listen to the beginning and to hear your story, but for people who don't have OCD who think, why don't you just knock it off? Why don't you just stop it? Why don't you stop thinking that? And they can see that this was not like a rational problem that you were experiencing. And on one level, you knew that this was not a rational problem, but you were being driven by fear, by anxiety. And for people who haven't had an anxiety disorder, for people who haven't really had something that frightening happen in their life, it just doesn't seem to make sense to them that that's the way that the brain can work. So I hope they listen to that and they realize, oh, but it can. Right? That is.

[A]

Well, Patrick, let me put a little punctuation mark on, please, because I think. Great. To your point. Very well.

[B]

Yeah.

[A]

One of the. One of the safety behaviors that I ended up developing related to my fear of bats was if I was exiting a room and had to turn the light switch off, the. The light in the room would typically cast a shadow from my arm as I move to turn off the light switch.

[B]

Yeah.

[A]

And I see the shadow. I have the thought, maybe the shadow is a bat, and I'm just not realizing it some way somehow. And so the safety behavior was I would stand in front of the light switch, and I would move my arm up and down certain number of times, and I trace the Shadow. Because if I'm tracing the shadow as I move my arm. Oh, well, yeah, it's my shadow. It's tracking my arm. But I was doing this in a classroom once, and I didn't realize that there was somebody in there. And they said to me, what are you doing? And the tremendous shame that I felt because some part of me recognized that this is really quite wild.

[B]

Right.

[A]

What I'm doing. I didn't. I had very little interest in turning around and saying, oh, I'm just verifying that the shadow of my arm is not, in fact, a rabbit bat that bit me. Without knowing, of course.

[B]

Yeah.

[A]

But the. The punctuation point is I was literally afraid of my own shadow.

[B]

Yeah.

[A]

And I recognized at some level that this was really off the rails. But to explain that to another person felt impossible and very embarrassing.

[B]

Yeah. William, thank you for sharing that. And when we come back for part two, definitely, we want to talk about again how you've translated a lot of your own personal experience into clinical practice, what you've learned, how it informs it. And we also want to talk about some research around OCD treatment and ERP medications and the combination of those things, too. So we will definitely do that in a part two. But I really thank you for being so open and honest today with your. With your own personal story.

[A]

Oh, of course, Patrick. Thanks so much for having me. I'm really looking forward to part two.

[B]

Yeah, me too. And for all of you, stay tuned because it'll be coming soon. So what is this? This is the get to Know OCD podcast. If you really enjoy it, well, subscribe to our NOCD YouTube channel. And if you're looking for help for OCD or related conditions, check us [e-mail] that's nocd.com we work with OCD. We work with BDD. We do hoarding work. We do ticks, we do body focused repetitive behaviors, depression, we work with trauma. There's so many things. So we'd be happy to chat with you. We've got people standing by on our care team to set you up with a very expertly trained licensed therapist in your area to help you out. And before you go, remember this, be better to yourself than your OCD ever will be. We'll see you again soon. Thanks for watching.