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The OCD Stories
Brad Hufford: Functioning well despite OCD distress is still a victory (#520)
00:38:33
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- [00:00]
A
You're listening to the OCD Stories podcast hosted by me, Stuart Ralph. The OCD Stories is a podcast dedicated to raising awareness and understanding around obsessive compulsive symptoms. I do this through interviewing inspired therapists, psychologists and people who have experienced OCD. Welcome to the OCD stories and welcome to episode 520 of the podcast. And in this one I got on Brad Hufford. Brad is a licensed clinical social worker who specializes in working with ocd. In this we discuss Brad's OCD story. Being a therapist over the last 30 years, exposure and response prevention therapy, the therapy relationship, the idea of functioning well despite the stress is still a victory, motivation and erp. Words of hope and much more. Now if you stay tuned. At the end Brad wanted me to add a couple minute addendum clarifying some of his points during the interview. So I bolted that on at the very end of the interview. If you're curious about, and thanks to our podcast partners, nocd. If OCD is interfering with your life, NOCD can help. They're licensed therapists, specialise in exposure and response prevention therapy. The most proven therapy For OCD with NOCD, effective treatment that is 100% virtual is available for children and adults with OCD and most members can get started within seven days on average. No hassle, just real science backed help and support between sessions. Begin your journey@nocd.com or I'll put the link in the episode description. So thank you so much to Brad for his time and expertise. It was great chatting with him and of course thank you to you guys for listening. As always, it means a lot and without further ado, here is Brad. Welcome to the podcast, Brad.
- [01:44]
B
Thank you.
- [01:45]
A
Yeah, it's good to have you on. So yeah, where do you want to start? Like your OCD story or therapy journey of what got you into being a therapist? What's the logical start you think?
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B
I think maybe my journey. How it started.
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A
Yeah, let's do it.
- [02:04]
B
How I got into the possibility of thinking about becoming a therapist. A therapist who works with people with OCD. So my OCD started for me at age 14. That was when I was diagnosed. I'm now 58. So at age 14 I had a lot of numbers coming into my mind and I felt like I had to count the number of times my, my bones cracked. So which is not classical ocd, but certainly maybe touretic ocd. And then that didn't last very long and I got hooked up with people at National Institutes of Health and Dr. Rapaport and they started Me on some Prozac. That seemed to help somewhat. I was in some of the clinical trials there for chloramipramine or anapronil. So, you know, with. With the suffering I went through in high school, in college, I think it just became apparent to me that I did not want anybody else to live with this. I did not want to live with it, and I did not want others to live with it. So I was in therapy myself. It seemed like a pretty cool job to have. You know, you get to sit and talk to people about their lives. I didn't have ERP back then. There may not have even been ERP or it was in its infancy in the early 80s. I was not hooked up with anybody for ERP back then. And so I had just supportive therapy. And it was. It was helpful, though. I got to talk to somebody who. Who understood a little bit about OCD and took me through some of my high school years, in my college years, and I. It just became apparent to me that. That this was going to be what I did, what I wanted to do. And I like psychology. I was fascinated with OCD in all of its forms, all of the different ways that it can manifest. And I just started taking courses in social work. I went to graduate school. I met. I. I started a group. I don't know if I started a group, but I led a group, a support group in Northern Virginia. And I did that for about five years. Got to meet some professionals, got to meet Dr. Charles Manueto, who I ended up working with. And at first I wasn't sure whether it was a good idea for me to work with people with ocd, because I had ocd, and back then I didn't know anybody else who was a therapist who had OCD. So I told Dr. Mansueto that. That I think that it's going to work here, but I'll just keep an eye on things. I'll keep an eye on things in the sense that if I start having symptoms or if I start. If something really bothers me about a case that I work with, then I'll let him know. Or if somebody's. If I identify too closely with somebody, that was the. The main thing. You know, if somebody had similar symptoms, but really over the years, and I've been working there for 30 years now, it really hasn't been a problem. And even if people do have similar symptoms, I see it as a benefit now, as something that. That I can really understand and really help people come to grips with. So I. I started working there in 1995 and I'm still working there. I'm still working mostly with people with ocd. I would say over half of the people that I see clinically there have ocd. So we, we are no CD specialty clinic. We work with other disorders also and related disorders and anxiety disorders. But OCD is our bread and butter and worked with a lot of kids over the years and I, I work with all age groups more now. I work with more adults now than I used to. I enjoy it a lot. Ocd. Never. You never are bored working with a case with ocd, with a person with ocd, you never. It's always interesting and fascinating and rich, but I know how, how you know much suffering people can go through. So I'm highly attuned to that and appreciate that. Appreciate just the suffering that people can, can experience with this disorder.
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A
Yeah, yeah, absolutely. And in your stories you said. Yeah, in the early 80s, ERP was probably in its infancy and wasn't widespread across the country or the globe. So did at some point did you go through ERP yourself or did something else help or did you just learn to deal with OCD sort of on your own or.
- [08:03]
B
I, I was in therapy eventually for ERP and I also did my own therapy. You know, I had hit and run ocd. So I would go back to a specific location and, and go back and forth and back and forth and re. Drive the same route over and over again until it was something that really didn't bother me so much. Sometimes I would drive up to an hour away from my house to do this. It depending on where my symptoms manifested. And I may have to drive a long ways to get to the point to get to the place where my OCD was worst. So I would go back there and just drive the same route over and over again for exposure therapy and, and not do the rituals. My rituals have mainly been mental, so. And they tend to be sub vocal in the sense that I'm not saying words to myself to neutralize the anxiety. It's more of a feeling, a sense that I get in my head that makes things all right, that resolves the issue in the moment. So you have to be kind of creative not, not to, to do that kind of thing in your head. So I would just go back and forth and go back and forth, driving and I. That's one of the symptom manifestations that I have is one of the themes, is the driving. Yeah. And that's been tough over the years.
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A
Absolutely. Do you feel, because you said There you've been at Dr. Mansueto's center for 30 years. If I got my math. Yeah, right.
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B
Yeah.
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A
And, and obviously you may have worked a bit before that, so in graduate study placements and stuff. But what am I trying to ask here? How has your view changed over the years in those 30 years of how you treat OCD? I'm sure you've obviously learned things along the way, but have there been any big shifts or do you feel it's been pretty consistent from when you first learned the work to what you do now?
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B
How to treat ocd?
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A
Yeah, yeah.
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B
It's always been erp. I think over the years there's been various things that professionals have learned. There's also you can use inhibitory learning and that model can be helpful also. I think through experience you learn various techniques, various strategies in order to help you more. I think in the past it used to be thought that you, you would go up slowly up a hierarchy. You would start it the, the least anxiety provoking things and you would go up a hierarchy little by little by little. Now it's, it's more believe that it's better to sort of jump over little bit here and there and maybe not go methodically up a hierarchy to go to, to jump a little bit because that's really how life, Life is not going to present you with these gradual slow movements up a hierarchy. Life is going to throw things at you and you're going to have to be prepared for it. So therapy. So that's how I, I look at therapy now. As, as more of a. You want to start slowly but after a while, if people are able to tolerate higher, higher level anxiety experiences, to jump a little bit on the hierarchy and go back and forth and up and down and, and that, that's a change. So there have been, there have been some changes but essentially it's, it's still erp. We're still presenting anxiety provoking stimuli to people and they're still habituating. Yeah, habituation we used to think was, was, was needed in order for treatment to work. Now it's now, you know, you with me at least I believe that you present people with experiences with stimuli and that they get that provoking anxiety and then if usually the, the anxiety does dissipate over time with repeated exposure. But, but if not, that's not the end of the world either. You know that you're still doing exposure, you're still normally normalizing your behavior. But. So there was more of an emphasis in the past on habituation and now it's believed that, you know, habituation is nice, but it's not necessarily needed for treatment to be successful. So that's another, Another thing that's changed sort of the way that people think about. About erp.
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A
Yeah.
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B
The ERP is, Is still erp, you know, it's still, it's, it's. And, and it, it's very beneficial for people. It, it definitely works. I think when I first started, I was surprised at how well it worked. Was really, you know, after having suffered, I wondered if anything could help. That's right. You know, because it seemed so awful to experience these symptoms. But yeah, it. ERP really does work. And I, I hope that people. There are a lot of people out there who are on the fence about treatment or about doing erp, but hopefully, even though it, it's difficult treatment and it can be daunting, people will take advantage of it because it's really. You're going to suffer a lot less in the long run if you do the erp. ERP is. Provokes anxiety, for sure, but in the long run, you're going to experience much less anxiety if you do the erp. Yeah. So I hope. And it can make a change for your entire life. If you get good treatment. It can really cut down the symptoms, not just for the next few weeks or months. It can make a difference for your entire life because there are changes in your brain that occur, that persist over time with the treatment. So especially if you continue to do exposures from time to time during your life, even when you're not entry, those changes in the brain are gonna stick. They're gonna stay.
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A
Absolutely. And I mean, I think it's, it's always kind of a philosophy for life of forgetting OCD for a second. You're gonna come across resistance in other areas of your life that ERP will be helpful. You're going to public speak or give a presentation. You can think in those ERP terms to get yourself to do those things and grow your life and your experiences. Or maybe you're in the dating time of your life and you want to approach that girl or guy or whoever, you can use that ERP philosophy to go up to them and say, hi, you know.
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B
Yeah, exactly.
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A
Yeah, it's. I mean, it's, it's a life skill really as well. Yeah, yeah. So you mentioned before you got ERP when you were mainly on medication at the end of high school, early years of college, but you had a therapist or a counselor that was supporting you and you found them quite supportive. During that time, even though you weren't doing erp, is there anything you learned from them that you now tie into your work using erp, like those more general counseling experiences and skills?
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B
That's a great question. And the answer is yes, because I know, I tell myself some things that he told me. This has been, you know, 40, 45 years ago. He would tell me certain things that helped. Nothing is, of course, nothing is coming to my head right now, but there are things that do come up from time to time that, that remind me of those times in the past and of that treatment in the past and. But I can't think. Yeah. Of anything right now.
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A
Yeah. And I'm also. Because I'm sure during that time. Was it he? Did you say he?
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B
It was a he. Yes, he. He.
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A
I guess also general thing in general counseling would have. They're been listening to you obviously being empathic, all of this. Do you carry some of that in into with your clients of like at times being with them, so to speak, in speech marks, as opposed to sometimes the cliche view of CBT is right, step one, step two, step three, step four. Of course, most CBT therapists don't work like that, but yeah.
- [18:48]
B
Yeah, you have to have a good relationship with, with the client. It. That's of utmost importance. If, if you are encouraging them to do ERP and you don't have a good relationship, a good trusting relationship, they're not going to probably do erp. You know, you're. You're asking them to do difficult things and only if they really trust you and you have a good relationship with them, are they more willing to do what they need to do for treatment.
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A
Yeah.
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B
So it's extremely important to have a good relationship with the person that you're working with. Yeah. Yeah.
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A
I absolutely agree. So in, in today's topic now we're talking about functioning well despite distress is still a victory. So you obviously came up with that topic. Why is that important? Do you think this idea of functioning well despite distress is still kind of winning or a victory?
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B
Yeah, to me that's really important. You know, even while working, I have flare ups. So to me it's really important to think that and to believe. And, and I do believe this, that that despite what OCD throws at you, despite what you're experiencing, and even if you are still experiencing symptoms from time to time and you're living life at the same time and you're functioning, you're living life, you're doing what needs to be done, you're Working, you're have hobbies, you have relationships, but that's still a victory. I think, I think it's so easy to feel for people that if they have symptoms, if they have not sort of conquered ocd, then maybe that's a failure. But because we do, because people like to talk about, they're conquering, they're defeating, they're sort of getting one over on ocd and that's great. If people have that story, I'm really happy for them. That's fantastic. But not everybody lives that and I'm a person who, who sort of lives through the, through the ocd, if you will, experiences OCD from time to time. And my, my challenge is to keep going, you know, despite any anxiety I might be feeling, any, any symptoms I may be experiencing, to continue on. So that, that's the, you know, it's still a victory even if you have symptoms. As long as the symptoms don't stop you. You know, they, the symptoms sometimes try to interfere with relationships, interfere with your job, hobbies, with, with all aspects of your life. But if you continue on, you know, that's a victory unto itself. Yeah, you're not allowing it to stop you, you're not allowing it to, to control what you're doing.
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A
Yeah, I like that. And I think, you know, so I, I'll ask you this question.
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B
So.
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A
OCD is there occasionally for you, although obviously it sounds like you're doing a lot better generally, but it might still come up here and there. So despite that, despite that, because some people might feel, and I see this with my clients sometimes this idea, if you say, look, there could be a chance in the future, you have flare ups or whatever it is. And I might say when that happens, you've got the skills to deal with it. Like it's not going to be as big of an issue, but in those early few sessions, that's still an overwhelming prospect to them. So if I ask you, like, have you quite enjoyed your life despite having this now, now that you've got it under control, would you say you've, all things considered lived a meaningful life or good life, however we want to slice it?
- [23:41]
B
Absolutely, yeah. And that's really important to me. I mean that that's why I do what I do. You know, I want to make a difference with people with ocd. I know what they live through. You know, I know what an obsession feels like, I know what a compulsion feels, feels like. And I know the struggle, the challenge that there is between the obsession and the, you know, something comes up pops up in your head and then the challenge to not react to it, that, that's fundamental to OCD and it's something that only lived, experienced people know. Really. No. Yeah, of course there are non, there are people without lived experience who have a tremendous amount of knowledge about the disorder. I'm not downplaying that, but I am saying that, that I know what it's like. So it's something that I'm well aware of and it's something that I appreciate the, the challenge that people have every day.
- [25:01]
A
Yeah, yeah, absolutely. So I guess a follow on question to that is obviously some people think that like complete recovery or whatever we want to call it is like being symptom free or, you know, a constant feeling of calm. Why is that maybe unrealistic or unhelpful as a kind of goal?
- [25:29]
B
I think it can be acquired by some people. I think some people report that that's what they experience. And I do believe that. And I do tell clients that, you know, you, you could go, you could go for years without symptoms. We really don't know. We don't know. But there is hope, especially if they're doing really well in treatment and aren't experiencing many symptoms there. It's possible that you could go quite a while without symptoms or with minimal symptoms, but you may have a flare up here and there. We just don't know a lot about the future and what may come for a certain person. But I think there's a, there's a sizable proportion of people of sufferers who are going to experience symptoms throughout their lives. And for those people, they need to live their life despite the symptoms and despite what OCD is trying to, to do to them, because OCD is insidious and it will try to take away, take away at least the symptoms. Do they try to take away certain aspects of life? So, yeah, you know, if, if. As long as you don't allow the OCD to, you know, tell you what, what to do for a job or who to be with for a relationship, who to get married to, what to do with your time, OCD can try to remove a lot of those things. But as long as you don't allow it, you're winning. You're winning. It's a victory.
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A
Yeah, I, I fully agree with that. That's. Yeah, that's why I really like acceptance and commitment therapy in combination with erp. They're obviously very focused on committed action and directional values. And, you know, it doesn't matter whether you've got certain thoughts and feelings Are you taking the steps to live the life how you want? And. And that. Yeah, that is success. Like you're saying, I think, are you.
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B
Doing what has value to you?
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A
Yeah, yeah, yeah, exactly. Like, you know, many of us given public talks or presentations, and we've done it scared. You know, we could say, is that a failure because we were scared? No. You know, we gave the talk. It doesn't matter whether we were scared or not.
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B
We.
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A
We gave the talk. That's. That's what's important. Yeah.
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B
Yeah. My symptoms definitely increase when I'm. When I'm talking. Now, I tend to be a reserved person, so it's. It's somewhat difficult to. To do this interview as I do over the years. And, you know, I was the quiet kid in class. I was the kid that didn't say anything. I'm still reserved. So, you know, I'm experiencing a good deal of anxiety right now. But you just. You just go on, you know, you just do it. You. You don't allow OCD to get in the way.
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A
Yeah, yeah, exactly. Yeah. Doing this podcast, I was anxious for years, you know, meeting new people like yourself, building a connection and interviewing them, and it always triggered anxiety, and now it's.
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B
It.
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A
It doesn't really. If I'm a guest on someone else's podcast, then, yeah, I. I get anxious and. But like, you're saying, you do it anyway, and most people can never tell if you're anxious anyway. I wouldn't have known that, you know, unless you told me there. So. Yeah. Okay, nice. So just looking at my questions. Yeah.
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B
How do you.
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A
How do you help clients stay motivated in ERP if treatment feels either uncomfortable or progress is slow? How do you keep them focused and motivated?
- [29:56]
B
That's a really good question. And that really gets to the root of, you know, of. Of being. Of what makes it difficult to be a therapist. Right. To.
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A
To.
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B
To keep people going and motivated and doing erp, even though it may not be going as smoothly as. As you and they would like. I think that that's maybe what. Definitely one of the most important questions there is for. For anybody. For any therapist or any client. You know, how do you keep moving on? I think you just have to remember that there's decades of research, there's decades of people saying this therapy works. You may feel like you have a case that's unusual, special, different, and maybe you do, but ERP will still help. ERP helps everyone with ocd. No matter what symptoms you have, no matter what your feelings are about the symptoms, you can get help with erp. So I think you just have to remind clients about that and that there is always hope.
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A
Yeah, yeah. And sometimes progress is slow. It's not always quick.
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B
Exactly.
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A
Yeah, yeah, I see that my clients. Sometimes it's quick, sometimes it's slow, sometimes it's super slow. And that's okay.
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B
It's.
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A
It's their journey. And yeah, everyone has various variables that complicate treatment or, you know, all that stuff.
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B
Yeah, yeah.
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A
So is there, you know, words of hope? Anyone listening? You've already given words of hope. But more specifically, if I asked this question, any words of hope for anyone listening?
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B
I think when. When. When things are at their worst, I think people can lose hope. And I think over the years I've experienced those dark times.
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A
You.
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B
If you keep yourself going, if you understand that the next day is going to be better, understand the next week is going to be better, it may not be better right away, but things will get better over time. Dark times are temporary. OCD is very treatable. There's a lot of hope. There are a lot of therapists out there who know what they're doing with ocd. Now, that didn't used to be the case. So there's a lot of hope just in that. Yeah, I think to keep yourself going is the most important thing.
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A
Yeah. Yeah, I like that. Slight change. If you. Sorry. If you had a billboard in, say, Washington, D.C. what would you have written on that billboard?
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B
Oh, wow.
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A
Could be anything. Doesn't have to be acd. You don't want.
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B
I would say. I. I would probably, because OCD is very important to me. Having. Having OCD and having been. Been sort of. That being a big part of my life in so many ways, whether it's what I do with my job. I've written the book in the past. I've been in research. I've led groups. It's been a big part of my life. So I would definitely have this being. I would have OCD on it. I would have something about ocd. I would probably have about got ocd. You know, like, got milk. Yeah. Got ocd. And then question mark. And then a phone number you could call. I mean, any. Anything that's going to make it easier for people to get treatment. Because there's good treatment out there. Yeah. Ocd. Yeah.
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A
Yeah, that's good. And you mentioned a book there. What's your book called?
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B
This is, you know, 15 to 20 years ago. It's not in print, so I'm. I'm not trying to sell books, but The Boy who Finally Stopped Washing.
- [35:05]
A
Yeah, okay, nice.
- [35:07]
B
I was in.
- [35:08]
A
Yeah, go for it.
- [35:09]
B
I was in the best selling book the Boy who Couldn't Stop Washing. So I named it the Boy who Finally Stopped Washing.
- [35:16]
A
Oh, nice, nice. But if I can dig out a link I'll put it in the show notes and then if people can. I know it's used to this, not in print, but they might be able to get a second hand copy on Amazon or something. But no, I really appreciate you giving up your time and hearing your story.
- [35:34]
B
Thank you. I really appreciate it. This has been great, a big honor.
- [35:40]
A
Thank you. It means a lot. So thank you to Brad there. And Brad wanted me to clarify a few points from the interview. So I asked him to record a couple minute snippet on him clarifying the points he wanted clarifying. So here is his clarifications.
- [35:55]
B
This is an addendum to the podcast. I wanted to add and clarify a few things. First thing I wanted to add was that running is not a treatment, but it is what helped me get through the pandemic and beyond. It has been like a treatment in the sense that I know I have gotten a lot of benefit from it. I wanted to add about the two changes in the ERP treatment that I have found over time and that when I talked about that in the podcast, I wanted to make sure that that is something that people know that I have found through experience and that these two changes for me have been effective in treating people. But. But maybe not everybody includes these in their treatment and doing treatment. The what my first therapist told me when I was a teenager, I wanted to add and he said that you are in charge. And that statement has been helpful to me over the years, especially when I feel like OCD is in charge or is trying to take charge. In the podcast I said a sizable number of people are with symptoms, which is true. But I also wanted to add that typically those people haven't had treatment. Treatment is very effective. Many do well with treatment. 70 to 80% of people obtain significant symptom reduction. Obsessions are not just thoughts. Obsessions, of course are urges, impulses, feelings of disgust, somatic discomfort.
- [37:40]
A
Thank you for listening to this week's podcast and thank you to our patrons who help make this episode possible. And if you would like to find out more about Patreon and the rewards and benefits, then there will be a link in the episode description. If you enjoy the OCD Stories podcast and would like to support us, please subscribe and rate the show. Wherever you listen to the podcast and thank you to NOCD for supporting our work. If you want to find out more about nocd, you can click the link in the episode description and quick disclaimer. Guys, this podcast is not therapy. It is not a replacement for therapy. Please seek treatment from a trained professional and until we speak, take care.