The OCD Stories, Episode #483
Guest: Dr. Jon Abramowitz
Host: Stuart Ralph
Title: Living well with OCD
Date: April 27, 2025
Overview
In this episode, Stuart Ralph welcomes back Dr. Jon Abramowitz, a prominent clinical psychologist and professor specializing in OCD. The conversation centers on Dr. Abramowitz’s latest book, "Living Well with OCD: Practical Strategies for Improving Your Daily Life," which targets those living with unresolved OCD symptoms, those not yet ready for therapy, and those seeking ways to integrate OCD management into daily life. Alongside the book discussion, Dr. Abramowitz shares new research on postpartum OCD, delves into various cognitive-behavioral and acceptance-based strategies, and offers words of hope for listeners at all stages of their journey.
Key Discussion Points & Insights
1. Postpartum OCD Research
[02:12]
- Dr. Abramowitz discusses a recent five-year longitudinal study (in collaboration with Johns Hopkins) following approximately 250 women from mid-pregnancy to six months postpartum.
- The study assessed OCD symptoms and various risk factors (cognitive, biological, socioeconomic, relationship, mood).
- Early findings: Women with tendencies to misinterpret intrusive thoughts as significant were more likely to develop postpartum OCD.
- Prior prevention programs found that cognitive-behavioral interventions aimed at correcting these thought misinterpretations reduced OCD symptoms post-childbirth.
“People who tend to believe that those thoughts are important, they're more likely to develop OCD symptoms. People who are able to see those thoughts for what they are... you're less likely to develop OCD.”
— Dr. Abramowitz [06:31]
- Intrusive thoughts in new parents (e.g., concerning accidental harm to the baby) are extremely common and not predictive of intent or action.
“[The nurse] said if you have intrusive thoughts about harming the baby, then you're in trouble... I stood up and I kind of shut her down. Like, no, that is not true at all... Everybody thinks that way.”
— Dr. Abramowitz [08:15]
2. Motivation Behind "Living Well with OCD"
[11:47]
- The book is aimed at people who:
- Aren’t ready for ERP (Exposure and Response Prevention),
- Have residual symptoms despite treatment, or
- Are seeking management strategies outside of traditional therapy.
- Focuses on practical advice for daily living with OCD, such as disclosing OCD at work/school, getting accommodations, and maintaining relationships.
- Not a treatment manual per se, but a "living guide" for life with OCD.
“This book is for folks in each of those three categories... It covers what can I do to manage my symptoms if I'm not ready to do actual treatment... How do I live despite this?”
— Dr. Abramowitz [12:38]
- Dr. Abramowitz reframes "treatment resistance" as therapies sometimes failing the individual, not vice versa.
“People aren't treatment resistant. The treatments can be, you know, can fail individuals with OCD.”
— Dr. Abramowitz [13:55]
3. Acceptance and Commitment Therapy & Other Strategies
[16:24]
- Integrates ACT (Acceptance and Commitment Therapy) techniques and concepts, cognitive therapy, and inference-based CBT, aiming to empower people regardless of their treatment status.
ACT: The Value of Living Well Despite Symptoms
[16:24]
“Even patients that I would say have done really well still from time to time have some OCD symptoms. So how do you manage that? There's no book out there until now about how to do that.”
Urge Surfing
[18:31]
- Technique from ACT, borrowed from addiction literature: Encourage clients to observe and ride out compulsive urges rather than acting on them.
- Describes using the "wave" metaphor—visualizing the urge peaking and then subsiding—to help clients endure the discomfort.
“If I just kind of hang in there and ride it out, for lack of a better term, kind of like you're surfing a wave... eventually it does crest and it does come down.”
— Dr. Abramowitz [18:48]
Competing Responses
[24:33]
- Do something behaviorally incompatible with the compulsion to block the ritual (e.g., put on gloves instead of washing hands, leave the location). Inspired by habit reversal therapies used for behaviors like skin picking and hair pulling.
Self-Monitoring
[23:14]
- Track rituals and behaviors to increase awareness and foster change.
- Supports the adage: “What gets measured, gets managed.”
“If you want to change your behavior, the best thing you can do is to self-monitor.”
— Dr. Abramowitz [22:30]
4. Diffusion & Changing Relationship to Thoughts
[29:43]
- Uses diffusion (from ACT) to help clients relate differently to obsessive thoughts—objectifying them, giving them a character, or repeating them aloud to reduce their emotional charge.
“If I can give it some sort of quirky characteristic or a funny accent, then I can see it differently. I'm objectifying it... and all of a sudden, the threatening qualities of it are gone, or at least less and less.”
— Dr. Abramowitz [32:05]
- Metaphors:
- “Passengers on the bus” — You drive the bus; intrusive thoughts are just backseat drivers you can choose not to obey.
- “OCD as a con artist” — Understanding the ‘tricks’ makes it less powerful.
5. Self-Compassion & Values
[35:25]
- Stresses self-compassion—OCD is not a person’s fault nor their identity.
- Encourages developing affirmations and clarifying core values.
- Builds resilience and reframes OCD as one facet of a complex self.
“It's one thing to have OCD and beat yourself up about it and lose compassion for yourself. It's another thing to have OCD and respect yourself despite it.”
— Dr. Abramowitz [36:44]
6. Inference-Based CBT (ICBT)
[38:10]
- Describes ICBT as cognitive therapy focused on challenging the flawed logic behind obsessions, comparing these beliefs with external evidence.
- Suggests integrating helpful ICBT elements for those not helped by ERP.
- Argues that all effective OCD therapies share more similarities than differences and should be synthesized for clients’ benefit.
“ACT, ERP, ICBT, cognitive therapy, all of these techniques have more in common than they have differences... we do best for our patients and clients when we take the best out of all the [therapies].”
— Dr. Abramowitz [39:21]
Quotes & Notable Moments
On the ubiquity of intrusive thoughts:
“Everyone does. Yeah, I'm a dad... What if I push? What if I did something wrong while I was changing her? What if I drown her in the bathtub?”
— Dr. Abramowitz [06:37]
On therapist responsibility:
“People aren't treatment-resistant. The treatments can fail individuals with OCD.”
— Dr. Abramowitz [13:55]
On urge surfing:
“If they're able to see that urge for what it is... and ride it out... it does crest and it does come down.”
— Dr. Abramowitz [18:31]
On diffusion:
“I love the idea of objectifying intrusive thoughts... If I can see those thoughts differently, instead of taking them at face value literally as threats, [they become] less scary.”
— Dr. Abramowitz [30:15]
On living with OCD:
“You can live well in spite of it.”
— Stuart Ralph [45:08]
Timestamps of Key Segments
- [02:12] – Postpartum OCD research findings and prevention implications
- [11:47] – Why write "Living Well with OCD"? Motivation and audience
- [16:24] – Integrating ACT, ICBT, and practical management approaches
- [18:31] – Urge surfing explanation
- [23:14] – Self-monitoring, behavior tracking, and competing responses
- [29:43] – Diffusion exercises and reimagining obsessive thoughts
- [35:25] – The importance of self-compassion and values clarification
- [38:10] – What is ICBT and how can it be integrated?
- [43:48] – Words of hope for listeners living with OCD
Words of Hope
“If you're struggling with OCD, there are things that you can do to manage obsessions, compulsions, and that big footprint that OCD leaves... Even if treatment hasn't gotten you to where you want. That's what my book is about.”
— Dr. Abramowitz [43:48]
Final Thoughts
Dr. Jon Abramowitz offers a compassionate, practical perspective on everyday living with OCD, regardless of one’s stage in treatment. Through anecdotes, actionable strategies, and destigmatizing perspectives, both he and Stuart Ralph assure listeners: intrusive thoughts are universal, management is possible, and living well is achievable—OCD or not.