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The OCD Stories
Dr Jon Hoffman: Rethinking Mental Rituals: A Philosophical Conversation (#529)
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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 for interviewing inspired therapists, psychologists and people who have experienced OCD. Welcome to the OCD stories and welcome to episode 529 of the podcast. And in this one I welcomed back Dr. Jonathan Hoffman. John is a licensed psychologist and board certified in cognitive and Behavioral Psychology. He co founded the MBI Ranch and the neurobehavioral Institute where he was Chief Clinical Officer, exiting these roles at the end of 2025 after many years of practice. So in this episode I got an update on John. This topic generally is a very philosophical one, quite scientific, so it's not necessarily like the usual podcast. So go into it with that thinking that John or I aren't stating anything here. It's much more of a let's discuss this, debate this and try and understand things. So we discuss what are mental rituals or mental compulsions, but from here on out I just call them mental rituals. The history of mental rituals. Are mental rituals behaviors we debate, what is good science, how do we study mental rituals and much more. So if you're looking for more of a philosophical heady talk, I think you will enjoy this one. If you're looking for a more practical one, this episode may not be for you. And thanks to our podcast partners. Nocd. If OCD is interfering with your life, NOCD can help their licensed therapists specialize 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 to John for his time and insight as always, pleasure talking with him and is interested to get his perspective on this. It was nice to have more of an open philosophical discussion and thank you to you guys as always for listening. It means a lot about further ado, here is John. Welcome back to the show John.
- [02:26]
B
Oh it's my pleasure always to speak with you.
- [02:29]
A
Yeah, it's good to see you again. It's been probably a little while, so yeah. Just before we get into today's topic, is there any sort of update on you or what have you been up to since we last spoke?
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B
Well, the big, the big thing in my Life is that every 40 years or so I, I take kind of, I make kind of a change, a little break. So as you know, I, I was the co founder of neurobehavioral Institute, NBI and NBI Ranch and you know, involved in a few other enterprises through, through that. But at this point I've stepped down from those roles and I'm just going to be, you know, I'm just taking kind of a break now. I'm still have, you know, various affiliations and things like that, but not technically working. And I'm not really that, you know, as far as the practice that I had for, you know, decades. Not, you know, just kind of winding that down at this, at this point. But I'll see how this year goes. I've been doing some writing and I have some projects and things like that. I'll be in, actually I'll be in San Diego with Dr. Katya Maritz, now my former partner, but still, you know, associated with our various things, speaking on a topic at a conference in San Diego. So some things continue and some things will, will change. But thanks for asking. Appreciate it.
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A
Yeah, well, well deserved, I'm sure. And hopefully this, this new chapter brings lots of excitement and passion projects and whatever else.
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B
That's exactly right. That's what I'm interested in doing.
- [03:59]
A
Nice. Okay, brilliant. So today we're going to talk about an article you wrote which I can, I can link in the show notes. So if anyone wants to go read that in detail. But it's titled Reflecting on Mental Acts, Rethinking Mental Rituals. So why, what's it about first of all? And why write it?
- [04:21]
B
Well, I'll take it in reverse order. One of the things that, as you mentioned, passion projects, one of the things that I'm really interested in is actually looking at the fundamental and underlying principles behind many of the things that we take for granted when we discuss of various clinical topics or theoretical ideas. And I just find it very interesting to do that in all sorts of fields. And that's why I really appreciate the opportunity to speak to you about the article. And I think it's interesting and important to just once in a while take a step back and review a lot of our assumptions and see, well, where they may make sense, where they may not make sense. And I think history is replete with examples of where people had ideas and even if those ideas led to some fruitful things, you know, I have read about various medical things. I don't think there was any proof for the theory that, you know, Health is based on these four humors in your body. But actually they did some things that were helpful. And the bad air theory of malaria wasn't accurate, but it led to people avoiding certain places where mosquitoes who really were transmitting disease weren't there. And I also, like, sometimes we do the right things for the wrong reasons. And I don't know if that's the case here, and I guess that's the subject of discussion. But when I started to think about mental rituals, and this is getting into the second part, it struck me that this topic is hotter than ever. There are so many things being written about it and podcasts that I think it was. It just made me think, well, what actually are mental rituals? Where did this, you know, this idea come from that thoughts could actually be like behaviors? That mental rituals were the same as overt rituals? Because I think we take that for granted. But should we? And how can we do? Because, you know, on the one hand you could say, well, it feels like that, but on the other hand, what is the evidence for it? And that's what the article is about.
- [06:16]
A
Okay, yeah, good point. Yeah. It's always worth looking back and redefining things or making sure we are still aligned with the original thoughts were on this. And just. Just for. For clarity, for anyone not familiar with the term ritual, you're referring to compulsion, right? Mental ritual, meaning.
- [06:36]
B
I'm referring to, as we discussed throughout the field, mental compulsions. And it's a very interesting history because I don't think anyone thought of thoughts as compulsions till the first. The earliest reference I could really find was around the 1970s when where it started being discussed by Jack Rackman, who was a pioneer in ocd. And I'm not here to refute or critique or anything like that, but I say it was just like an interesting idea to introduce the idea, just introduce this concept that thoughts could be seen as behaviors. But actually, even before that, the idea that thoughts could be mental acts like behaviors was proposed by B.F. skinner in the 1940s, I believe, which was kind of interesting because he also had a very interesting theory that what we experience as are thinking are really sub vocalizations. And this is my only self experiment, but you could do it with me now, along with me, have a thought and see if you feel or don't feel something in your throat or something. You feel some physical sensation, like have. Have any kind of thought. I'll just give you a second.
- [07:46]
A
Yeah, I mean, I'm becoming aware of my body as I thought.
- [07:49]
B
Yeah. Like the interoceptive process. And I thought that was kind of really, really fascinating. And then I was kind of like, interested, like, so why this other theory about that thoughts of mental acts. But if you look around the. And I don't have any insight into whether this is really true or not, but it seemed like around that time there was a lot of fear that behaviorism was kind of like in that Clockwork Orange sense, going to control people or could use to exploit people. And there's a lot of critique about that and that it was dehumanizing people to think of them as mechanisms. So it introduced kind of some humanity back into it, that we have some specialness to us because we have this. That our thoughts somehow are different. But I started to wonder if this was just not another instance and we could talk about that more of the. Sometimes they call it the Copernican Fallacy. That's this idea of specialness which began with Copernicus kind of saying, well, maybe the Earth isn't that special. Well, maybe we're not. This Earth is not the center of the universe. And we've kind of had to come to grips with that. And then Darwin, maybe we're kind of not different than animals. Maybe we're a kind of animal. And Freud, maybe we're not so wise. Maybe there are things happening that we're unaware. And now with neuroscience and GLPs and all of these things, kind of contesting and AI especially kind of contesting this view of the specialness of our cognitive activities. So I think it kind of is a really cool time to really take a view at this and the history of it, because I think we kind of. And, you know, I'd love to hear your thoughts of this, that we. We take for granted that there is such a thing as mental rituals and that we can treat them, but when you think about it, and that they're exactly the same as overt rituals and ocd. And moreover, I think it's expanding that ruminations are like mental rituals for self and worries for self reassurance for all these things take on a compulsive aspect. But it's all predicated on the idea that thoughts can be behaviors. And I think it was interesting. And as you've read the article, can we really show that that's true? And what are the implications if it's not true for cognitive therapy, for just this idea of building therapies, which I'm not saying they don't work or they're not helpful to people, but they may be built on a foundation that is ultimately not scientifically valid or is it depends on how you look at something like that. And moreover, as I wrote in the article, we don't really have a big agreement in our field or across fields what the term behavior means. I mean, botanists talk about the behavior of plants, all sorts of. Can you talk about the behavior of neurotransmitters and the way that we would think of a behavior? But to me, the notion of a behavior, is it something we can control? And people have said, well, we can control certain thoughts. Can we make an effortful thought? And that's different than a poppin thought. And I'm not quite sure about the evidence for that either. We've spoke before about some of my views on intrusive thoughts. I'm not sure there's a whole lot of evidence that thoughts could be intrusive, even though it's very valid that people have that subjective experience. But people's subjective experiences, as I also wrote in the article, are that they're sitting still on a rotating planet. Just because people believe in something doesn't mean it's true. I think at certain point in our history, people would have sworn the earth was flat or would have said a lot of things that we have since found out are just subjective experiences. And we know in the whole field of psychology, we know there are certain things, like cognitive illusions, that there are ways of juxtaposing pictures to make us think that lines that are the same length are for different lengths even though they're the same. They are optical illusions. There are all of those cool things we look at, like that picture, or you look at it one way and it turns into one thing. The classic one is the older woman and the young girl where just keep switching back. So I'm not so sure why we trust our, our thoughts so much. Another thing that strikes me is a lot of the techniques that are used for this rely a lot on, on, you know, they really talk a lot about kind of like Eastern sorts of philosophies. But what is in Eastern philosophy, kind of the core of it be that the self is an illusion. So how could, if it's a self is an illusion? Well, some of it would be that, you know, of Buddhist philosophy, that this is all illusory, that, that our sense of things, you know, and I think that's. Maybe I'm mistaken, but that's, I think that's kind of like one of the ideas. But if that's even true at all, then how could disillusion be behavioral at the same time. So it seems to be a little picky and choosy about which aspects of Eastern philosophy. And also would in part of Eastern philosophy be what you attach to makes you suffer. So why. So why would one attach to whether they're their thoughts or their thought process? I'm not saying it's easy not to do that. And it might even be unfair to people who are experiencing this. I could see how it would be thought of that way. And I was thinking about something the other night about this. If I could just go ramble on for a moment. That's okay.
- [13:15]
A
Yeah.
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B
So did you happen to watch Skyscraper with Alex Honnold climbing Taipei 101?
- [13:23]
A
I saw clips of it. I haven't seen the full show.
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B
It was to me, amazing. Because me, I don't particularly like hikes, although I was recently in the Grand Canyon, I think. I think I did some desensitization on myself, which was helpful. But just watching it, I was sweating as if I was there. But he wasn't. He seemed to be having a lot of fun. Now I'm not inside him, I don't know. But he didn't seem at all bothered by it. And in fact, he was a joyful. It was a joyful experience for him, but it was too many people watching. It was anything but when you didn't, you know, if you see it on a repeat, you know, he lived. But, you know, who knows? Yeah, but I was. I did. I did this kind of weird experiment myself as I was watching it. I was sitting on a couch watching it and I leaned over the couch the way he was leaning over the building, which was making people, including me, sick, you know, about it. And I didn't fall off it. He somehow had the capacity to do that as if he wasn't 1500ft down in the air leading off something. Now most people have a sense wouldn't be able to do that because they have a subjective sense from. From, you know, just kind of just the way things work from an evolutionary sense that that is not safe and they would have a panic attack and they might even fall or something like that, you know, so it's. But it's easy to say, like from his point of view, maybe, and maybe not even easy. Hey, it's. No, there's no difference if I'm. And he did say that if I'm, you know, 50ft up, 100ft up and thousands of feet up, practically speaking, there's no difference. But to most people there is. But the truth is maybe there shouldn't be. And now another interesting finding with him was that when they looked at his amygdala and his fear circuitry, it's very, very different. But was he born that way or was that a product of which he seems to think of just doing this for his whole life, that maybe he was prone that way, but. But somehow he mastered that. So I think people who experience mental rituals, I certainly understand they are suffering and I'm not here to minimize that. I realize that that's a very, very valid experience, but it actually speaks to the idea, like, of what we do a lot in ocd, more of challenging ourselves behaviorally and maybe not so much mentally. And yet a lot of the therapeutic tools to deal with mental rituals seem to be increasingly about changing one's thoughts and changing. I think changing philosophy is very important. I'm just not sure it has an active ingredient. Because what is the evidence that changing a thought can directly influence anything in your brain, but changing a behavior, there's good evidence it can.
- [15:56]
A
Yeah, yeah, yeah. Good, good points. And I remember seeing the Alex Honnold's sort of amygdala scans and it was from a documentary ages ago. I don't know if they reference it in this recent one.
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B
Yeah, Free Solo.
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A
I was in Free Solo.
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B
Or maybe it was something else.
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A
Yeah, it was. Yeah, I've seen Free Solo, so it's probably in that. Yeah. And I, I had that for. Yeah. Of. Was he born this way? Was it just through repetitive conditioning? Basically would be a great testimony for erp. Right. Because he's constantly exposing himself, probably not doing safety behaviors except for the ones sensible for climb. But yeah, a few things come to my mind. I'll say the first one's in my head and then I'll go on to more, you know, share maybe how I view mental rituals and how I work with them.
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B
I'm so curious. Yeah.
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A
But just before that, this is. I could be way off base and maybe I'm just reading too much into it. But more recently I've been thinking about the term ocd, forgetting the D for a second. Compulsive. Obviously compulsions and obviously mental compulsions should fall under the sea of ocd. But when we think of, oh, obsessive. When I think of someone who's being obsessive outside of ocd, they're. They're. They're obsessive. They're overthinking things. Which isn't really why intrusive thoughts are. Or worries. Intrusive thoughts come to you. You don't actually have control over them. You're not, sorry, being obsessive over them. The moment you are being obsessive in my mind, you're doing a mental ritual. So in some way it should almost be rebranded. Not so intrusive for. But it's like intrusive for. And compulsive disorder as opposed to. Because for me, the obsessive is the compulsive part as well. I don't know. I'm not saying it needs to change, but that's just been on my mind of. I think when we get trees, the thoughts, we're not being obsessive over them, except for when the moment we are, then we're compulsing. I don't know what.
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B
Well, well, I would. I would differ that based, you know, based on some of my thinking. And I say that's probably obviously the subjective experience. I mean, I would subjectively have the same experience. I just. I just wonder how we can actually explain. I guess I'll use that word scientifically. You know, I don't want to be Mr. Scientist here, and I'm certainly not obviously, you know. But I would say how could a thought actually intrude into your mind? Is your mind even a place that can. You can intrude to. It's not a room, is it? You know, it's not a thing. And I think this is something that I would. I would have wondered about whether that's a help helpful in any way to think of thoughts like attacking our mind or something, or making our mind like place. And maybe a lot of the stress comes from it. Like if you think something's a place, you think you should defend it in some way or you should have control over it. But if you don't think of a mind that way, if you think. If you don't think of it at all that way, then it becomes less so. And maybe that's helpful to do. And I've certainly worked with. With clients who have found it helpful to look at it that way, if they can. I'm not saying that's easy, but it sort of takes a lot of the complexity and. And, you know, it's just fascinating to me about. People are specifying all these different kinds of thoughts. If you look at the literature and philosophy and psychology and psychiatry, that is, you know, all of these thoughts, as if thoughts are like creatures on a biological species chart. Like this is the same as talking about biology or these are actually physical elements like on the periodic table. You know, I think that that's a Very questionable analogy in my mind. I mean, maybe it'll be proved to be true one day, but there's certainly. And tell me, you know where, where what you think. Is there any proof of that a thought can exist in a physical form such that it could take a behavior. I don't want to give you a headache or anything.
- [19:52]
A
No, no, no, no. I mean, is it the end of my work week? But so my. Yes. No, I don't think so. But how I view it is seeing thinking as a behavior. Like if I'm thinking intentionally, then that becomes a behavior in my mind how I view it.
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B
And I would view that thinking intentionally is an illusion.
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A
Okay. That.
- [20:19]
B
How would you actually have control over that thought to think that thought? Like I could intentionally raise my hand and demonstrate it, but I kind of. How can it be demonstrated that you're thinking something intentionally and having the thought. How do you know it's not taking place? And this is where, you know the brain mind identity theory and brain mind emergence theory that I wrote about in the article. This is really where they come into play a little more. You have to kind of like in my mind, have a theory of how brain relates to mind. Because how could your, your mind be operating? It's your brain that's operating. And does your mind really. Could we dissect the mind and find a thought? Can you say your brain speaks English or whatever language you speak? I could see how it speaks behavior because when you do behavior, there are actually links that you could demonstrate into neural networks and things like that. I'm just not sure you can demonstrate with neural network theory that a behavior like an ERP that's incompatible with expectation under neural network based expectation, not a mental one actually can. Can possibly promote neuroplastic changes. That at least makes some sense to me. But when you, when you substitute thought into that as opposed to just thought is an experience that occurs while all these other things you're unaware are happening. Like, maybe it's obvious, but I'm not thinking too much of what. What I'm saying to you. It's just kind of coming out. And I would just base that on. And if I. If I start to think of every word the way some of our clients assuredly do, it probably would bollocks things up, right? Yeah. In a movie I saw recently, there was an example of a Jackson Pollock, one of those drip paintings and things like that. And the point, one of the characters made is that if he had thought where he was going to do every drip, he would not have brushed us, you know, there would have been no brush strokes, which is an OCD position that, that when you stop living life organically or start to believe you can control things that you can't control. I mean even if you control every thought, there's no evidence that you could that actually has any direct connection to your behavior or to your neurology. And I guess that's what the article is about. Now. Do I really know? No, I, but I do think it's a fascinating thing to, to think about. Again going back to what is the principle here that underlies all of this is the idea of mental acts, that a thought can be behavior. Now if you believe that's true and that you could control a thought and that thoughts come in different varieties, just like you know, you're sorting eggs or something or you're sorting out different things, then I guess you could believe that. But I think the onus should be on people who believe that to show some evidence rather than I feel this way because I'm not sure that's we should build science on just a feeling.
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A
Yeah.
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B
You know, and even if you believe that the, the brain, that thoughts emerge from the brain, once they emerge, according to that theory, well, it doesn't have any further communication with the brain. It's just kind of the analogy that I gave in the article was that an instrument plays some music, but the music's there but you can't put it back in the instrument. It's a one way trip even if you believe stuff like that. So when you're doing a mental ritual, where does it really take place? I'm going to argue for somewhere in neural circuitry that's very complex and beyond our awareness. Just like most of the things happening in our bodies and brains are beyond our awareness, which I would say gratefully because do we want to be conscious of everything? I don't think so.
- [23:56]
A
No, no, absolutely. Yeah. No, I think I agree with you in the sense of. Yeah, it probably is. Is very much a mental non physical process. But in terms of treatment, I think where the physical aspect of getting past rumination mental rituals for me with clients is I'm very act heavy based in that area because I think ACT does very well of mental rituals more so than ERP. But I know ICBT also has aspects for mental rituals. I know Dr. Michael Greenberg's Create his version for rumination. So for me it's getting clients to notice, okay, my brain's going to that place again or I'm overthinking and then Can I come back to my senses, refocus back in on what I'm doing? So like sort of noticing and naming, refocusing on the here and now, taking action. So that is obviously a physical response because I'm moving my body. My.
- [24:51]
B
Well, I would say, I would say the physical response is the movement of the body that just like if you thought about working out, it wouldn't be very beneficial without that movement. Now this is a research dilemma. Dilemma. There are, there are very few studies, but studies of mental rituals, at least there's one I can think of that that showed it was beneficial. It was done a long time ago. Interestingly enough, there's not a lot of pure research on this kind of stuff because of an inherent problem in it. How can you, how can you ever parse apart what you're doing mentally from the behavioral change that accompanies it? Because you cannot. It's entirely subjective. You can't. You can feel like, hey, I noticed it and I did that. But I would say if we could do an experiment, the best one would be just if you just change the behavior, what does all that noticing do for you? And what is believing? How much does that make you more self conscious to have to slow it down and notice this and do this mindfully and make all these inferences. And to me, one of the interesting things about CBT is, and I'd love to hear your opinion on this at some point. Where does it approach kind of just, you know, thinking from dynamic psychology, just in new words. And I think that's been a very interesting change in CBT over the years for being, you know, starting with its very, very behavioral roots to now being kind of third wavy or even fourth wavy. Now, about that. The idea about this inner, special, inner life we as human beings have, and they've been very, very important to address that in all sorts of ways. How do we actually know that creates any difference that's independent of the behavior that accompanies it? That would be my challenge to that sort of research. Just like in the scan research that says, well, you do something and this part of your brain changes. Well, you don't know what the chicken and the egg there is. It's very, you know, we always have those inherent problems. And that doesn't mean we should stop thinking about it or stop doing research or stop having treatments that appear to help people. This is more of a fundamental question about what's going on. And the problem is if you do treatments and you say, well, my treatment proves my theory because people Feel better? Well, that's kind of the most. One of the most famous, I think, mistakes in science that could be made. I'm thinking of the Princess Bride when, say, like invading Russia in the wintertime. These are the big mistakes. Like there's some speech in that movie about these are the big classic mistakes. And does it matter pragmatically if you get better? We could argue no. But does it matter to the evolution of this clinical science we're all involved in to actually understand these things at a higher level or at least admit we don't understand? Number one, I don't think we understand what a thought is. I certainly don't. And does anyone know what consciousness is? No. Yet we build theories as if we understood that. So what are we building on scientifically? Maybe those answers will become apparent. Maybe down the road a few generations or AI will tell us, what are you talking about? This is the way it works. But at the present time, we just don't know these things. And I think when we're building theories and doing research projects, I think there should be some openness about, hey, this is one of the limitations. But I really don't see. And maybe some people do and I just haven't noticed, and maybe you can correct me on this, that people are saying, hey, we don't really know what a thought is, but we're going to make up this stuff. And we don't really know if any of this is true, but we think this technique is helpful to people. But let's bear in mind that the fundamental theory here may be off. We have this hubris and we construct these theories as if we know how these things are working. And I guess you said, you know about a passion project. I guess one of mine is, well, asking. There's a physicist, Richard Feynman, I famously said that it's not the questions that you ask, it's never a bad question kind of thing. It's the questions you don't ask. And I think that's kind of a problem for a field that prides itself on being rigorous and evidence based. And just to kind of riff on that just a moment, you know, a moment. Evidence based is not the same as being scientifically based. And I think that's become conflated. You can prove a lot of things statistically, empirically, that it very hard to make sense of scientifically. Would you want me to throw something controversial into that?
- [29:35]
A
Because I just read the article, you
- [29:37]
B
know, when people look at the history, someone just wrote a brilliant article. It's been Being widely posted about the origin story of EMDR being different than the one that's postulated and I don't know if you saw that yet to me after this I can send it to you. It's just an article about how people came to believe something which some people will swear to and some people will not like what I'm saying, but may well be very pseudo scientific when you really look at the background, the fundamental concepts of the ideas, regardless of empirical proof. Because you know, you can, you can show many throughout history. I think you probably could have demonstrated empirically the world was flat or how many angels were on the head of a pin and you know, could fit on the head of the pen in the middle Ages. I think you could have had some good empirical results. But does it make any sense? That's a bigger question. I mean, what do you, you know, I love talking to you because it's so much fun to have a dialogue dialogue about this. And since it's a short podcast, some people just like kind of go into the ozone when they're speaking to me understandably about this, but I nevertheless think it is kind of an important and interesting subject to just have on a. Just have on our radar.
- [30:54]
A
Oh, 100%. And no, I'm, I'm happy to. I love science and research, but I'm under no illusion. It's perfect. And it annoys me when people talk about evidence based like it's the be all and end all, you know, and it doesn't mean it's good science or it's. Yeah, it's. You could prove anything if you measure it the right way and you know, sure. So yeah, I'm happy to like take things down a peg or two. I don't say people, but because I think sometimes we do need a bit of. All of us, including me, need humbling a bit at times, especially around evidence based therapies because we know they're not panaceas.
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B
Yeah, I think that's the, you know, the hallmarks of good science, skepticism and humility. Because I'm not saying this as if, oh, this is 100% sure. I just think it's a, I just think it's an interesting question. And beyond navel gazing, you know, to look into this, it could seem very granular, but I think it's actually really, really fundamental. And I think the idea of equating to get back to OCD is equating overt rituals just unquestionably as the same as mental rituals. I mean, theory matters. What theory you ascribe to will tell you whether mental rituals make sense or not. No such thing exists for overt rituals because they're observable and measurable. Everything we know about mental rituals is really based on subjective self report. And that's, I don't see how we get be, you know, get beyond that in terms of just, you know, having that. I think we take a lot of hubris to get beyond that and we should have a lot of humility about it. And you know, you brought up act. One of the things that I really like about act is just getting on with life.
- [32:43]
A
Yeah.
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B
You know, isn't that a British thing? I don't want to be stereotypical here, but isn't that like,
- [32:51]
A
what's the phrase, stiff upper lips? Maybe the phrase I'm thinking of? Yeah, yeah.
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B
That's why they came to my mind. And I, I don't know, keep, keep
- [32:59]
A
calm and carry on was the World War II phrase.
- [33:02]
B
I want to have cultural humility too. And it's certainly not my new, you know, I live in Florida now. But my New Yorkie based culture was definitely not stiff off a lip. It was pretty much, you know, fetch a lot. So it's a, it's a very different philosophy. Yeah. But the important thing really is no matter what you did, as long as you engage in the behaviors that mattered in something, whether you were playing a sport or studying or whatever you wanted to do that really was related to the outcome, not what you thought. Great figures in history are not remembered for their thinking. They're remembered for their actions.
- [33:35]
A
Yeah, well, including the evil ones.
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B
Right, right. Or the ones right. An evil behavior rather than evil thought. Because presumably many of us go around and have an evil thought once in a while but don't engage in the behavior. So doesn't matter.
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A
Yeah.
- [33:53]
B
And I'm sure we could find the opposite. People do plenty of stuff who have wonderful thoughts and their actions are what we would call evil. So again, I think there's a, there's a separation here that's, that's really important. But this, this so, so again back, you know, to the idea that overt behavior, overt compulsions or are similar, which it pretty much says in DSM that they are met, that mental act should be thought of as similar and treated as similar. And I'm just kind of interested why that that hasn't been interesting. Apparently that interesting to people to just say, oh yeah, thoughts can make behaviors. You know, thoughts can actually do things. You know, one of my favorites is when people, you know, and again, this is a real experience. But. And I'm sure you've had clients like this too, who think they're rewinding their thoughts and they're going back in time. But are they really going back in time? As far as we know, time travel is not possible. What are they really doing? They're having a thought, a next thought about a past event. And I think that's very important in psychoeducation to not literally take when people think, say they're rewinding their thoughts or they're redoing things in their mind, or they're erasing images, past images. Again, I have humility about, about this, but I haven't heard a good explanation about how that possibly can be true.
- [35:18]
A
Yeah, I think, yeah, a lot of these, these skills, techniques, tools, therapies, I think can, can work and be very powerful for mental rituals. But I agree that we don't know why. And I, I think five. Well, I'm gonna say five. It might be more than five years ago. Yeah, probably like six, seven years ago. Based on my time in the podcast. I remember hearing a lot of people, you know, who maybe their, their mental rituals didn't get seen or it was never picked up by the therapist or even given any importance to. And then the last sort of five years, six years, you know, everyone talks about mental rituals and mental compulsions and rumination and it's, it's. And every therapist talks about it and thinks about it and treats it. So there's has been this shift of obviously for some therapists, obviously did think about it for decades, but I think it got missed by so many. This. Yeah, but I think also with. Correct if I'm wrong, I feel we won't really know. I'll be able to measure mental rituals, compulsions, rumination, anything like that, until neuroscience speeds up. And almost like. And when neuroscience speeds up, then therapy will be able to create more targeted interventions for rumination and stuff like that.
- [36:40]
B
Well, I think, yes, I agree there'll be better therapies for that. But if the whole thing is an experience rather than a mental ritual, because I guess what I'm proposing is that that is not actually. That's a subjective experience. Just like thoughts are subjective experiences or the experience of different thoughts are just their experiences. We have almost like sensory experiences. And it was just only one article I could find in the literature about that. If anyone knows any others, please let me know because I'm very interested in it. But that, you know, and maybe the brain is kind of like, like That a little bit in a way it's not an exact analogy, you know. And yes, you're right. We oftentimes we do the right things for the wrong reasons. But let me throw this out to you. That what if we said to people, just for argument's sake, that instead of saying they're having mental rituals, having an illusion of mental rituals, of having mental rituals. That's what I've. I do evidence based treatment when I was stalled back a month ago in clinical practice. But I would actually talk to people about this and I found a lot of people really related to it and it was very interesting to think, well, if it's not happening, then I have a very different perception on it, at least for some people, not everyone, at least a different perception on it. Then I actually literally think I'm doing these things with my mind as opposed to I'm having an illusion I'm doing that. Like I could have an illusion. I'm a good singer and I assure you I'm not. But I actually do think, I know people don't enjoy my singing, but I do like to do that and it's kind of an illusion. Maybe if my ears. By my ears off or something like that. You know, we don't sometimes hear our accents. I'm sure we've been. After decades of living in Florida, I still have that New York accent. Especially like now I speak pretty quickly. Right. And. But we can have all sorts of illusions. What's so bad about saying that? Is that an invalidating? See, I would never want to invalidate someone's experience, but I, I think as practice, as clinical scientists, what is wrong with invalidating actual understandings?
- [38:45]
A
Yeah. And. Well, I think it can go the other way because I, I have a vague feeling of when rumination and stuff started to get talked about on my podcast. The, the idea that people would. It was something they were doing and it was something they had control over was offensive as well. Not so much anymore. I think people have taken it on board, but I think when it first came out, at least on my show, obviously it was around a long time before that people, yeah, I think got a bit offended at times about that too because it's either way you go.
- [39:19]
B
So we say a lot a thought is just a thought. Do we believe it or not? If we believe that's true, then we don't believe thoughts come in different varieties. We don't believe we control thoughts. We don't believe that therapy can modify really thoughts per se instead of reactions to experiences. I mean, do we believe that or not? When we say a thought is a thought, I mean, have you ever. You've said that to clients, right? A thought is just thought. I mean, I have. Yeah, maybe.
- [39:47]
A
Yeah. Don't, don't believe everything you think.
- [39:50]
B
Yeah. Or the same, the same thing. Do we believe thoughts are voluntary or involuntary? Ultimately?
- [39:57]
A
Involuntary.
- [39:58]
B
Right. So how come some of them like, like, it reminds me of an animal farm a little bit like, you know, some animal. All animals are equal, but some more equal than others, you know, So I think we do a little bit of that stuff with thoughts, dividing them into these categories. Thoughts are just thoughts, but some are different than others. I mean, how can we have it every which way? There's, there's something to me, and it just does seems illogical to me and unhelpful to look at it, you know, to look at that way. And I think some people would find it interesting and I think that's really, really fascinating because I, I agree with you. That was my experience that people would have been offended if you told them that they could control their thoughts and they should be able to disengage or take space from their thinking or control their thinking or modifier. And now it's. They're offended if you, if you don't look at it that way. So people, I mean, it just seems again, something's off, someone's wrong, can't have it. All those things can't be simultaneously true. But I think it's. I think it's good to. It was good to examine this and to me, it's just in line of, you know, some of this previous conversations we had. And I know, you know, people could take it, kind of rub people the wrong way. Well, we actually wrote an article I co authored about, about that actually did rub people the wrong way about sensory processing and the. I know the eating disorder stuff about really fundamentally or intrusive thoughts. But it's really not to be offense. Someone asked me, am I just trying to like, throw some things out? I'm really not. I really want to. I think to the enterprise that we've devoted our lives to, I think it's important to be, to be truthful about what we know and we don't know. And if we keep constructing things that aren't really solidly grounded, well, we could say, hey, this seems to work. We don't know why. I mean, a lot of tech things in medicine people will say, truthfully this works, but we don't know why. We're not concocting theories to post hoc explain why they work based on some, some theory that's not really grounded in some scientific reality.
- [42:03]
A
Well, yeah, it's similar with like SSRIs. Right. We know they work for some people. We don't know why they work. It's not serotonin imbalance.
- [42:13]
B
Right.
- [42:14]
A
This is what thing he was on recently who's now he works with you guys. Dr. Kaskar. Yes, yes.
- [42:23]
B
If you read to the end of the article, you'll see he had to put up with my endless conversations about this topic and the new things that I'm working on. Yes, but close colleagues and share an interest in just the fundamental logic of things like that. But yes, and one thing that you may not know and different times because of our age difference, we both were mentored by the person who came up with the serotonin theory of OCD, pretty much Dr. Jose Tobias. And he would be the first person to say, well, we came up with that because we don't know how to measure anything else and we don't really understand it. And it was kind of like Freud in a way saying, yes, these are placeholders. It's not literally an idiot super ego. Which gets me to another point of the article is how do we know that mental rituals are just not reification fallacy? Talking about something that's real, that's in a way that makes it seem like we're talking about something real when it's not actually real or tangible. And this is a rampant problem in the field, in the mental health and any type of field that involves the human experience, that we start to talk about something like an ego and then all of a sudden it's kind of reified that a person has an ego and with boundaries on it, and it has these things as if it's a real thing. And we kind of lose sight that these are just metaphors, these are not scientific realities. As you said, they're placeholders. Until maybe at some point we understand this.
- [43:55]
A
Yeah, yeah, yeah. I mean, we have to come up with theories, right, to try and understand things. It's just then important we test those theories and don't disseminate like we did with the serotonin imbalance for 40 years or whatever it was.
- [44:11]
B
Yeah, like I said, infomercial for them. And we know when they showed a picture of the two cells with the synapses and. And we know it's like so much infinitely more complex than that. And we know we don't understand it or when people point to a certain region of the brain that's firing and say this is how that happens. Or we can now read it. One of my favorites was we, we can now kind of read what a dog is thinking, you know, because of the. We could see some change in some metabolism on a brain scan or something like that. That's not the same as seeing a thought. And I think conflating that is really not very, very helpful. Just confusing to people. And then people who are really suffering, I, I think that's an additional burden on them, you know, and is. And I don't think there's anything wrong with just saying, hey, we don't know.
- [45:03]
A
Yeah, we don't know. But for anyone listening that's in that place. The therapies do help, you know, and they're. They, they very useful. We just maybe don't know at times why they help.
- [45:16]
B
Yeah, this is, this is less of a discussion about what, what people should do. And a lot of the things that are done for that are, are very, very helpful. We're just really talking on a different aspect of this thing is what is the underlying theory of it and would it be. Would be helpful to bear that in mind. I, you know, thank you for pointing that out. And I would never want to be construed as saying, oh, you shouldn't do act for this or, or for, or these things, but maybe people could think about when they're presenting research findings being more clear about this or maybe ds. No, look, there's a lot of thought within the American Psychological association now to actually looking at the underlying principles a little more than just the kind of describing things and making lists and maybe hopefully in the dsm, you know, that. I think that's a kind, you know, sort of has to do with the DSM and you know, their contribution to that. And I hope that that's reflected because, you know, just naming something is not explaining. It's almost like very medieval that if you know something's name, you have a power over it. But that's like I was thinking about this earlier, is that early in our history as a species, we thought that people would have legends about people whose thoughts can start fires and things like that. It was thoughts becoming mental. Now we have the idea we progress, that the thoughts are the behaviors. It's like the mentalization of human psychology. That doesn't mean human psychology doesn't exist as a very important experience and that we can't suffer from our own psychology. It's just, you know, or there aren't very, very helpful things within the field like you were saying with ACT and cognitive psychology and maybe a whole host of other techniques that people really, really find beneficial. So we don't want to throw out the baby with the bathwater, but we want to actually take a look at the bathwater sometimes, you know, and see it for the murky thing. It really, really is. But I appreciate that clarification.
- [47:14]
A
Yeah, no, absolutely.
- [47:15]
B
Yeah.
- [47:16]
A
Well, we are. We want to understand why they work in the same way. It'd be great one day to know why antidepressants work when they work, you know, it'd be really nice to have that information. Yeah. Yeah, I guess for me. I know I've already said this, but I'm just thinking for anyone listening, it might be. I think for me, the issue still boils down to four. Is just a thought, especially within, quote, unquote intrusive thoughts or extrusive thoughts, if they're coming from. From within us as opposed to entering us. But with rumination, the thing that's still in my head is. And it would need to be proven like you're saying, but it feels like it's something I'm forcefully doing. Well, not. Not initially. Rumination, sometimes you just get pulled into and it happens. But then the moment you realize, I guess then you have a choice to. Then do I redirect live my life, you know, But I guess, yeah, I guess I'm answering my question then before I've realized that the rumination is still just a. For an automatic.
- [48:26]
B
And yeah. And I think the goal is as quickly as you can act in a way that's country. That's. That actually takes your thought process. Not yours particularly, but anyone, as soon as we can say, like, we have your thought process, I don't feel like studying and we study. I don't feel like working out. I had that early. I had that a little bit early today. But Florida is kind of cold and just to go and work out a bit, it seemed like kind of. That was a cold. That was a cold experience today. But as long as my behavior was to go do it, I, you know, look, I'm fond of saying I trust my thoughts about as far as I could throw them. And I don't think you can throw a thought or lift it or do anything. I don't take. I try not to take any thoughts that I have particularly seriously or unseriously. I try to take them just as experienced. Now, does that mean that I don't have thoughts that feel like they're intrusive and really bother me or I get stuck on. Of course not because it's part of the human experience. I just think it would be. The more I cannot attach to that, the more I can really. I can really practice what I preach, which is thoughts are just thoughts. The more I can realize that what's going to matter is my behaviors. Not. Not. I just. I'm not trying to make it like, well, lab rats going through the. Through life. I actually think that humanizes us more because we're biological creatures. So why are we. Again, we're going back to that idea. Why be in denial that a lot of our. The things with us are kind of mechanistic, that you do the right behavior. It's like act we. You know, it was called acting as if you do the behavior and you start to have the. If it's a positive behavior, hopefully you have the ideas that are congruent with that positive behavior secondarily. But I think sometimes now we're getting the cart before the horse and that's a little concerning to me. And I did. I think it's great to have things that work. But ultimately, what's the test of something like act? Do you actually move? Do you actually kind of take you. You know, I guess an act you'd say take. Take this all along with you and go to work. As long as you go to work. The going to the work is to me the active ingredient, not the necessarily diffusing from the thought. Or that's just my opinion. Or in dbt having a wise mind. I personally don't think our minds are. I don't. I think it could be very, very helpful. But I'm not sure how we operationalize a wise mind or tell a wise mind from anonymous mind or why would we expect our mind to have be wise? I think behaviors could be good judgments, poor judgments based on some results and chance factors. But why. Why put that pressure on a mind which we can't actually even define what it is? No, like something, you know, because when you act one you say, oh, I have an unwise mind. Well, refer to your wise mind. I'd rather refer to your wise behavior personally about could not be. May not be a popular thing. And of course I enjoy debates about this for anyone who wants to. But. But. But not just hey, I feel this way or this feels wrong to me that I don't like that. But what is the actual argument for that aside from like hey, people who do that, which I can understand who refer to a wise mind may have better outcomes. But is that because they Engaged in wise behaviors. You know, how do we parse those apart and. Yeah, I don't know how you do that.
- [51:43]
A
Yeah, no, it's a fair point. I mean, DBT is not in my wheelhouse, but. Yeah, I mean, I'll play devil's advocate and say diffusion is something I teach and something I feel has been very useful for myself. But I'm. I'm completely open to be like, yeah, absolutely, we need to define and prove that and all of that. So, yeah, yeah.
- [52:05]
B
Well, again, it could be right things, but based on a science. Just like, again, going back to the example I gave, it could be bad air versus mosquitoes really are doing this. Your brain's really doing this. It may not matter practically. And I wouldn't suggest not doing that, of course, if it's helpful. Because, look, people are suffering and we want them to feel. We feel better. It's just really more just to have an open mind, so to speak. That's an interesting turn of a phrase for our discussion. Or just kind of be willing to look at these things because it's kind of a hop. You know how like in ocd, sometimes it's a hop, skip and a jump from obsession to paranoia. Hey, this is contaminated. Someone's contaminating it or whatever. That can happen to some people. I think in science we have to be a little on guard that it's a hop, skip and a jump from saying, oh, this is practical, to this is reality, to. We're talking about a metaphor. All of a sudden the metaphor is a reality, and we then forget how it all came about. And one of the things that I'm hoping to. I'm actually writing another article on a. On one of these basic concepts as it applies to sports, you know, just to take a look at these ideas that we have and how we study things. And I just think it's an interesting area. I'm not, you know, most of my life I've been a clinician. This is just kind of rare for me to kind of make my little forays, such as they are into just thinking about these things and writing about it. And I'm sure, you know, I have humbleness about my own limitations in that way. But I do think it's. I just think it's something that we should always ask some. Well, always be a question like, well, how come we believe this? What's the, you know, not just the evidence, like, hey, a study. Because, again, could be well designed. Not well designed, but what's the theory behind us? Does this really. Does this really makes sense. Yeah, because we are very good as, as a field of coming up with ever more complex things. And I will say one of the things that I, early in my career I studied, one of my degrees came from an institution where they did a lot of stuff on object relations theory. Now I'm not here to say don't or whatever, but I would say by the time, as you probably did in your own education, by the time you got to object relations theory, they had broken down the ego into so many compartmentals parts. They had the anti liberty and this one and that one that it started to leave the realm of. It started to go so in my mind into something which was. You could look at it almost as an absurdity or someone was writing satire.
- [54:30]
A
Yeah.
- [54:31]
B
Because how could you ever show that? And like, almost like forgetting these things were metaphors. And now you're dissecting a metaphor
- [54:40]
A
which,
- [54:41]
B
as if it's an atom and you know, and you're looking for, you know, a neutron and a proton and it's, it's not the same thing, but it's very tempting to fall into this.
- [54:51]
A
Yeah, yeah, that's a good. Yeah, good. I mean I liked studying object relations as a top level concept. I think it's actually quite interesting. Yeah, it is fascinating the moment it got boiled down. I agree. I'm like, I don't know what I'm reading here. This makes no sense. It's confusing as hell and not going to be useful for anyone. Yeah, I agree. And that's psychodynamic therapy. A lot of the principles, I think they have some really good theories but then they just, they go way too deep and it's confusing.
- [55:23]
B
Well, one theory begets another theory begets another theory. One of the other things I'm fond of saying is in most things we try to get things simpler. You're building a spaceship. They try to have as few moving parts as possible. That's why we don't have the space shuttle anymore, because it was so complex. We know what happened. Right. But as a field in psychology, we tend to get more and more complex rather than looking. What are the key elements here? What are the key working ingredients here? What's active about this thing? That's why we have the term purple hat theory. It's the same theory as the other theory, but now we put, so to speak, a purple hat on it and came up with another aspect of it. And these are things which I think are very important as we're developing techniques to at least stay pretty, pretty in Touch with. So that the things we're doing are not just clinically sound, but scientifically sound. But then again, I agree with you. We can't. Maybe some of these things are beyond our ability to study right now, and we just kind of muddling through and finding like, I guess in the early days of mental health treatment. We're doing the best we can, and I think that's important. And we're not going to say to people who are suffering, well, wait around until we understand this, because that's impossible. But hopefully, if people are listening now, I'd like to say, well, this is great because things are always evolving and maybe we'll have better ideas. Or maybe there's something about this. If you think of what's happening as an illusion and you're not offended by, hey, how could what I'm thinking about being an illusion, because what I'm thinking about is very important in me. Well, I would say this is, you know, is it. I don't know. You know, we could get very attached to this me concept or centering ourselves or grounding ourselves. But how do you actually do that? How do you actually define when you're grounded? Isn't that just kind of arbitrary? More centering yourself? It's like it is when you say it is. It's not when you say it's not. Is there really like. Like, you know, what OCD people are looking for this. This magic click, you know, but does it ever. How do you know what happened? It's just you're making up what had happened or making. There's no real click. It's just kind of arbitrary. And I would like to, you know, one of my goals, you know, how to have an. If I have another career in this another 40 years from now. Hopefully probably not, but that would be something I would really like to, you know, because I think it does help alleviate suffering to actually help people to get out of those kind of traps.
- [57:46]
A
Yeah, yeah, yeah, I agree. I agree. Yeah, yeah. I think we're. We. We. Often some people in the psychotherapy field will look back at Freud. We've kind of judgment and like, oh, he was an idiot or whatever, which he obviously wasn't. Amazing. No, he's amazing.
- [58:06]
B
Yeah.
- [58:07]
A
But there is. I have seen a lot of snobbery in that. Oh, what would he. They would. They will quote one of his theories and, like, belittle it. And I'm thinking he did the best he could with what he had. In the same way, 200 years from now, people will look back at Us and be like they're idiots, you know, not idiot, but you know, I mean, they could have the same snobbery because we're just doing the best with what we have. But Freud's tools weren't there at the time in the same way our tools aren't there. You know, in 200 years from now. They might not be there either, but it's.
- [58:36]
B
Yeah, right. That's why we should take what we do seriously, but not ourselves seriously, you know, but sometimes there's a danger that each kind of school of psychology and there's hundreds of them, I guess, or more, that a branch of therapy all becomes like a brand or becomes like a silo or becomes kind of like what. I guess certain analytic schools of thought became kind of these monasteries, these, these walled off things unto themselves. And that's also not very helpful. I mean, I think it's important, you know, one of my, my close colleagues and I were talking and he's talking about, hey, why don't we just have a conference on agreeing to disagree? You know, it doesn't always have to be panels of agreement that, that there's, there's a lot of room for heated debate and discussion of I, of ideas. Not between people like who's right or wrong or good or this person, smart or not. It's not about that or right or wrong. It's about having kind of a marketplace of ideas, you know, and I think it's really important to do that. And again, that's kind of like at this point that's my, my, my passion for this.
- [59:40]
A
There you go. Maybe you could run that conference.
- [59:42]
B
That would be the disagreeable, the disagreement.
- [59:46]
A
Yeah, yeah, actually it will be. No, I think it's important. We all need to communicate better and hopefully this, this episode has spurred on some researchers or psychologists, therapists, psychiatrists to re examine things and. Yeah. So is there anything else you wanted to say today?
- [60:06]
B
No, I appreciate, I. Look, I always really enjoy talking to you and I appreciate everything you do for everyone with OCD and beyond and practitioners and giving a forum to air out ideas like this, you know, and that being open minded to things and we're all not going to agree on things. And you know, I think the point you made that nobody should take this to mean, oh, they shouldn't be doing this therapy or that therapy. It's not about that at all. It's just about having, you know, just, just a talk about things, which again I think is important.
- [60:35]
A
And I, Yeah, I agree with that, absolutely. Well, thank you again for coming on and sharing this. Always a pleasure to to hear your your thinking and yeah, discuss it. 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 until we speak. Take care.