Podcast Summary: Get to Know OCD

Episode: Why OCD Makes Getting Help So Hard
Host: Dr. Patrick McGrath (Chief Clinical Officer, NOCD)
Date: January 4, 2026

Overview

In this episode, Dr. Patrick McGrath explores why people with OCD delay or avoid seeking treatment, despite knowing that help could improve their lives. Mixing personal anecdotes, analogies, and gentle humor (with a dash of Rick Astley), Dr. McGrath deconstructs the psychological barriers to getting help, sheds light on the trap of OCD’s false promises, and encourages listeners to reclaim their lives from OCD.

Key Discussion Points & Insights

1. The Trap of “Thinking About” Treatment (01:45)

• Many people get stuck in a loop of thinking about thinking about getting treatment, rather than taking action.

  • Quote:

  “I’m thinking about thinking about treatment is really what that means … almost a way to tell yourself you’re doing something toward therapy even though you’re not actually doing anything potentially therapeutic.”
  — Dr. Patrick McGrath (02:30)

• Dr. McGrath stresses there’s no judgment here; avoidance stems from fear, not laziness.

2. OCD’s False Promises & Rick Astley Analogy (00:25)

• Dr. McGrath uses the Rick Astley song “Never Gonna Give You Up” as a lighthearted metaphor: OCD never “lets you down” (in a sarcastic sense) because it convinces you that compulsions keep you safe.
  • Quote:

  “How much of you says, ‘I’m never gonna give you up,’ and OCD says, ‘I’m never gonna let you down?’ … OCD says, I’m not gonna let you down. If you just follow along with the things I tell you to do, all will be well.”
  — Dr. Patrick McGrath (00:25-01:10)

3. The Grover/Sesame Street Analogy (03:28)

• He likens OCD to the children’s book There’s a Monster at the End of This Book: OCD warns of disaster if you move forward (“turn the page”), but when you do, nothing catastrophic happens—just like you discover Grover (harmless) is the “monster.”

  • Quote:

  “OCD sends this message that if you do these things, terrible, awful, horrible things will happen. And yet… you talk to people who’ve come out the other side of OCD through treatment… and you might say, ‘Yeah, but for me it might be different.’”
  — Dr. Patrick McGrath (05:20)

• The analogy highlights that OCD’s threats are rarely real, and facing fears—like turning the page—leads to freedom, not disaster.

4. Gradual Exposure and Facing Fears (07:15)

• Dr. McGrath explains how Exposure and Response Prevention (ERP) works, using learning to drive as an example:

  • No one starts directly on the highway; it’s a gradual process.

  • Similarly, ERP is about facing fears step-by-step, not all at once.

  • Quote:

  “We gradually do these things to learn how to handle them. OCD says… they’re going to overwhelm you. It’s going to be terrible. Don’t listen to them. They lie. I’m the only one who tells the truth. And I hope you’ll listen to me… It’s OCD that lies.”
  — Dr. Patrick McGrath (09:30-10:10)

5. Possibility vs. Probability in OCD (12:10)

• A common OCD thinking trap: equating possibility with probability—if something is possible, it’s treated as if it is certain or highly likely.
  • Quote:

  “People with OCD very often believe that if it’s possible, it’s 100% probable. And… another great reason to not do treatment. Because if I don’t do my compulsion, terrible things will happen. It’s guaranteed!”
  — Dr. Patrick McGrath (12:18)

6. Specialness & The “Rules Are Different for Me” Fallacy (13:00)

• Some believe OCD is different for them; what works for others won’t help them, or the risks are uniquely high for them.
  • Quote:

  “The rules of the world apply to me differently than they do to everybody else. It’s fine if other people face their fears, but it’s not okay if I do.”
  — Dr. Patrick McGrath (13:25)

7. “Can’t” vs. “Won’t” Mindset (14:00)

• Dr. McGrath differentiates between can’t and won’t: most people aren’t physically incapable of doing exposures; they avoid them because they’re scary.

  • ERP is about learning to do hard things, not liking them.

  • Quote:

  “I only ask people to do things they won’t do. And the reason they won’t do them is because they’re afraid of them. And so I want people to learn that you can do things that are difficult… You never have to really like them.”
  — Dr. Patrick McGrath (14:15-15:10)

8. Distinguishing Thoughts, Urges, and Behavior (16:00)

• Dr. McGrath shares how, from treating so many fear themes, he now has intrusive thoughts (e.g., pushing someone down the stairs) but doesn’t act on them—showing thoughts and urges are normal and not dangerous.
  • Quote:

  “If you or I were on a staircase together, I promise I’d think about throwing you down the stairs… Now do I actually go push people down the stairs? Well, no, I do not. … I do have a thought, image, or urge to do it… So there’s this hopeful recognition… you can think anything, and they just don’t really matter.”
  — Dr. Patrick McGrath (16:20-17:20)

9. The Real Goal: Living Your Life, Not OCD’s (18:00)

• The ultimate aim isn’t to eliminate anxiety, but to live life on your terms, not OCD’s.
  • Quote:

  “That’s my ultimate goal … How do I get you to really live your life and not trust the life that OCD is promising you? Because there’s a parentheses in the promised life of OCD, and the parentheses kind of goes like this: ‘That’s not really true. I just like to say that so you’ll do these things.’”
  — Dr. Patrick McGrath (18:20-19:00)

Memorable Quotes

• “Don’t let OCD Rickroll you, right? You can give OCD up. OCD is always going to let you down, and I want you to give it up.”
  — Dr. Patrick McGrath (20:10)
• “If you want something that has your best interest at heart, it’s going to be learning how to handle the things you fear and facing them and being with them and knowing that whatever that thought or that image or urge is, you can just live with it.”
  — Dr. Patrick McGrath (11:25)

Notable Segments with Timestamps

• Rick Astley/OCD Metaphor — 00:25-01:10
• “Thinking About Thinking” Trap — 01:45-02:30
• Sesame Street/Grover Analogy — 03:28-05:50
• Driving/Gradual Exposure Analogy — 07:15-10:30
• Possibility vs. Probability — 12:10-13:00
• Specialness & “Rules Don’t Apply” Trap — 13:00-13:40
• Can’t vs. Won’t Distinction — 14:00-15:10
• Staircase/Intrusive Thoughts Example — 16:00-17:20
• Living Your Life, Not OCD’s — 18:00-19:00
• Final Message/Rickroll Callback — 20:10

Tone & Style

Dr. McGrath’s approach is empathetic, reassuring, and laced with warm humor and pop culture references. He de-stigmatizes common OCD fears, encourages self-compassion, and speaks directly to the struggle of starting treatment.

Final Thought

Dr. McGrath urges listeners not to be “Rickrolled” by OCD’s false promises and to believe that recovery is possible—just as it’s been possible for many others.

For more stories and support, check out other episodes of “Get to Know OCD” or visit NOCD at nocd.com.