Dr Ronald Nicholson: Sensory OCD (Somatic/Sensorimotor OCD) (#538)

Summary

The OCD Stories — Ep. 538

Guest: Dr. Ron Nicholson
Host: Stuart Ralph
Topic: Sensory OCD (Somatic/Sensorimotor OCD)
Date: May 17, 2026

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Episode Overview

In this episode, clinical psychologist Dr. Ron Nicholson joins host Stuart Ralph to explore what he refers to as "Sensory OCD," a term he prefers over the often-interchanged "somatic" or "sensorimotor OCD." The conversation dives into the specifics of this OCD subtype, focusing on the awareness of internal bodily processes (e.g., blinking, breathing, swallowing), the role of perfectionism, core fears, common compulsions, effective therapy techniques, and the nuances of treatment. Dr. Nicholson offers practical advice and vivid examples for both sufferers and clinicians, emphasizing reassurance that sensory OCD is highly treatable.

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Key Discussion Points & Insights

Defining Sensory OCD

• Why "Sensory OCD"?
  Dr. Nicholson distinguishes between "somatic," "sensorimotor," and "sensory OCD," emphasizing that the unique feature is the intrusive awareness of neutral internal bodily processes (02:04, 03:42).
  • "The more I look at this, it's about sensory." — Dr. Nicholson [03:41]
• How it manifests:
  People become distressingly aware of processes like breathing, blinking, swallowing, or more obscure sensations (e.g., heart rate, noticing the tip of your nose, ear ringing) and fear they won't stop noticing them (02:10–04:52).
• Neutral/’Just Right’ Obsessions:
  These are not about danger but about sensations that are otherwise neutral—what the OCD sufferer fears is the awareness itself.
• Core fear vs. content:
  Dr. Nicholson emphasizes the importance of distinguishing between the specific obsession (content) and the root fear (core fear) fueling the distress:
  • With Sensory OCD, the core fear is often being "aware of this sensation forever" or "being distracted and not living up to one's potential" (05:20–07:00).

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Memorable Quotes & Moments

• "The awareness itself is perceived as a problem... you try to fix those thoughts in some way... [but] all of those efforts only makes that more likely to pop into your awareness." — Dr. Ron Nicholson [02:26]

• "The core fear is that you’re going to be aware of this sensation forever... The idea that you might be noticing it constantly for the rest of your life—it can be frightening." — Dr. Ron Nicholson [05:30]

• "With this theme, you have to learn to take the B. You’re shooting for the A... but you are an imperfect biological mechanism—take the B." — Dr. Ron Nicholson [09:50]

• "These compulsions are trying to get rid of or neutralize that unwanted thought, which is the awareness." — Dr. Ron Nicholson [12:56]

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Common Compulsions & Patterns (10:34–13:02)

Types of compulsions:

• Checking: Monitoring sensations (e.g., checking if you're still aware of breathing)
• Fixing: Attempts to make sensations "just right," or to eradicate awareness
• Researching/Reassurance seeking: Looking for information about the sensation or why it happened, or seeking comfort from others
• Avoidance: Trying not to think about the sensation, engaging in thought suppression

Unique pattern:
Some sufferers "idealize" previous OCD themes, wishing for the days before their current sensory-focused obsession.

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Who Gets Sensory OCD? (13:02–13:53)

• Not limited by demographics or profession:
  This theme appears across all kinds of people; perfectionism or high self-expectation may make it more likely someone latches onto it.

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Exposure and Response Prevention (ERP) for Sensory OCD (14:20–20:58)

• Why it’s tricky:
  Unlike external fears (contamination, harm), the "threat" is always present because it’s internal and natural.
• Key focus:
  Addressing the core fear (e.g., lifelong distraction, never being your best self)—not just the content (blinking, breathing).
  • "The threat is not blinking or your heart rate or your breathing... The threat is, I’m going to be distracted by this forever. I’m never going to be the person I want to be." — Dr. Nicholson [14:55]
• Scripted exposures:
  Vivid, emotive scripts imagining the feared consequences as viscerally as possible, e.g., failing in life due to constant distraction.
  • "I love to throw in… yes, my life is absolutely probably going to suck. I will have all this unfulfilled potential." — Dr. Nicholson [19:02]
• Ten times a day:
  Dr. Nicholson encourages practicing these exposures up to ten times daily but notes it takes time to build up.
• Habituation beyond boredom:
  Continue exposures until excluded content is so boring it no longer provokes anxiety, then keep at it a bit longer to fully rewire threat associations.

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Nuances and Pitfalls for Sufferers and Clinicians (23:54–28:31)

• Sufferer Pitfall:
  Believing their case is "untreatable" because the trigger is an internal process (23:54, 28:31).
  • "They think that the fact that this is an internal, necessary thing makes therapy impossible. That’s a mistake." — Dr. Nicholson [24:44]
• Therapist Pitfall:
  Focusing exposures on the content (the specific sensation), which is actually a compulsion, rather than addressing the underlying core fear.
  • "The core fear is omnipresent; the content might be internal versus external." — Dr. Nicholson [23:57]
• Key strategy:
  "Leave the door open"—neither reassure with certainty nor catastrophize, but accept the "maybe." Avoid reactivity to OCD’s shifting themes.

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Practical Wisdom & Closing Thoughts

• Universal advice:
  "It does not matter what theme you have... You feel alone, [but] you are far from alone. I guarantee you the treatment is possible. You just gotta try." — Dr. Nicholson [36:30]
• Therapeutic overlap:
  No matter the approach, fundamentally therapy is about "going towards discomfort and expanding your distress tolerance." [31:28]
• Live with imperfection:
  Taking “the B” instead of striving for perfection is not just an acceptance but a form of resilience and progress.

Listener Takeaway

Sensory OCD can feel especially distressing due to its focus on perfectly normal, ever-present bodily sensations. This does not make it untreatable—in fact, with carefully applied ERP that targets core fears, it is highly amenable to progress. Sufferers are not alone, and the experience, while deeply distressing, is neither rare nor beyond help.

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Segment Timestamps

| Segment | Timestamp | |----------------------------------------------------|-------------| | Introduction to Sensory OCD | 01:46–05:20 | | Neutral obsessions & core fears | 04:42–07:44 | | Perfectionism and “taking the B” | 08:54–10:21 | | Common compulsions | 10:34–13:02 | | Who gets Sensory OCD? | 13:02–13:53 | | Treatment Approaches (ERP focus) | 14:20–20:58 | | Script writing and exposure frequency | 19:22–20:47 | | Pitfalls for sufferers and therapists | 23:54–28:31 | | Recap and reassurance | 28:31–29:57 | | What every therapist should know | 30:06–31:28 | | Billboard wisdom | 31:34–32:59 | | Final encouragement for listeners | 36:27–37:03 |

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Notable Quotes (Speaker • Timestamp)

• "When you consider the core fear, that’s when it makes a lot more sense why that would bother you: being distracted for the rest of your life—yeah, that does sound kind of bad." (Nicholson • 07:44)
• "You gotta take the B. Even if it’s the moment where you’re getting married, you might have this unwanted thought, but that doesn’t ruin it. That’s just life." (Nicholson • 09:57)
• "The threat is, I'm going to be distracted by this forever. And on a deeper level, I'm never going to be the person that I want to be or live the life that I want to live, because this thought is there." (Nicholson • 15:07)
• "If you've got OCD, it does not matter what theme you have… you are far from alone. And I guarantee you the treatment is possible. You just gotta try." (Nicholson • 36:27)
• "All these different ways of doing therapy—there's a lot more overlap than people want to admit. The core thing… is learning to live with the discomfort and the distress." (Nicholson • 31:15)

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Summary Flow & Tone

The episode is informative, encouraging, and deeply empathetic. Both Dr. Nicholson and Stuart Ralph maintain a tone that deeply validates the distress sensory OCD creates while firmly reiterating the hope and efficacy of treatment. Their conversation is rich in practical detail, peppered with patient anecdotes, humor (e.g., “taking the B”), and motivational wisdom, making the episode approachable for listeners at any stage in their OCD journey.

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For listeners: If you experience distressing awareness of bodily sensations, this episode is a reminder that what you're struggling with is common, well understood, and very treatable—there is a path forward, even if it looks different from other types of OCD.

Transcript

[Stuart Ralph]

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 538 of the podcast. And in this one I got back on Dr. Ron Nicholson. Ron is a clinical psychologist and in this episode we discuss why he doesn't use somatic and sensorimotor OCD labels interchangeably, why he likes the label of sensory ocd, core fear versus content, the idea of taking the B grade, the obsessions and compulsions around this theme, using exposure and response prevention therapy on this theme, exposure scripting and much more. And thanks to our podcast partners. Nocd. If OCD is interfering with your life, NOCD can help their 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 [e-mail] or I'll put the link in the episode description. So thank you so much to Ron for his time. As always, it means a lot. And of course, thank you to you guys for always listening. I deeply appreciate it. Whether it's your first time or 500th time, it means a lot. So without further ado, here is Ron. Welcome back to the podcast, Ron.

[Dr. Ron Nicholson]

All right, thanks so much. It's great to be here.

[Stuart Ralph]

Yeah, it's good to have you on. So we're not talking about AI this time today we're going to talk about somatic OCD or sensory motor ocd. So yeah, let's start there. You know, what, what is it? And do you use those terms interchangeably?

[Dr. Ron Nicholson]

All right, I'll start off with what it is. And actually in doing the research for this and going over the experiences I've had with my patients, I've stopped using those terms interchangeably. And you can let me know if this is something you've seen as well, either in your practice or with people that you've talked to. So the somatic and most people, when they talk about this, they use those terms. They do use those terms interchangeably. All right, now what it is, this is OCD with intrusive thoughts about somatic or sensory material. Pretty basic. Now your body's doing lots of things at any Given moment, your heart's beating, you're swallowing, occasionally, you're blinking, and you probably were not thinking about that before I mentioned it now, but now it might be coming into your consciousness. All of these things are happening all of the time. Somatic OCD is when you become aware of one or more of these processes and that bothers you. The awareness itself is perceived as a problem, either because those thoughts are inappropriate in a perfectionistic way, or it makes you less efficient. So you try to fix those thoughts in some way. You want to force them out of awareness, you want to make sure that you don't have them, you're ruminating about why you might be having. Having them, whatever. And ironically, all of those efforts to get those thoughts and that sensation out of your awareness only makes that more likely to pop into your awareness. And in this case, the unwanted thought are just the awareness of the internal process, the. Or the threat that that awareness may be there forever. And that's what. That is what I'm calling sensory OCD versus sensory, motor or somatic ocd. The more I look at this, it's about sensory.

[Stuart Ralph]

So you're viewing. Okay, so, yeah, you're viewing all of it under this label of sort of sensory ocd.

[Dr. Ron Nicholson]

Yeah, yeah. And I'll get into that for a second. Because other health, Other OCD themes might focus a little bit on other aspects of bodily awareness. But what's specific about this one is that it's the sensation of some of our internal processes that the mind has latched onto and that becomes the part of the threat. So you might have like sensory motor OCD that might be like a nervous twitch. They might be worried about what my hand might do if I get near a knife or. And the similar thing that really made me think about this was people with health ocd, they're going to worry about their temperature, they're going to worry about their heart rate. But the core threat is a little bit different there because that's an aspect of their health ocd. What's specific about this one is that it's this otherwise typically somewhat neutral stimulus that the awareness of it has become a big part of what their OCD wants to worry about.

[Stuart Ralph]

Interesting. Yeah, you mentioned neutral stimulus there. So, yeah, this. These sort of themes can be called neutral obsessions. Right, right, yeah. Rather than.

[Dr. Ron Nicholson]

So if you're somebody with. Yeah, yeah. If you got this particular theme and you're looking at material, you probably have seen that label before, or looking at that might help you find some other materials out there. Other Podcast episodes about this kind of thing. But when you're thinking about it, to help delineate. I like to use the idea of sensory OCD to really specify what's going on now with the obsessions for sensory ocd. And this is purely a me thing. No one else is making that particular distinction that I have found yet. So that's a purely Dr. Ron thing. Now, the big ones that most people think about are awareness of your breathing, your swallowing, or your blinking. Those are the big three that most people think about. But honestly, it can be anything that your senses can align on or anything that you can become aware of, your heart rate, seeing the tip of your nose, eye floaters, or having a song stuck in your head. All of these are sensations that are themselves not terribly threatening. And most of us just sort of notice it and then reaffirm our attention somewhere else. But the OCD brain kind of latches onto that as something that is problematic. I like to make a difference between the content and the core fear of the ocd. And I got into this a minute ago with. That's where I want to distinguish between the sensory OCD and the health ocd. The content between. If your sensory OCD is focused on the heart rate, the content's similar to a health OCD that's worried about maybe having a heart attack. But the core fear is going to be what's different. The core fear with the sensory OCD is that you're going to be aware of this sensation forever because, you know, your heart rate is not itself scary. You know, blinking is not scary. The idea that you might be aware of that forever and noticing it constantly for the rest of your life. Yeah, I can see why that would be a little bit frightening or disturbing or disheartening. Yeah, that's not fun. And the other big one is that these thoughts, if they get in your way, will leave you distracted. And that presence of that thought in the future will in some way negatively impact or ruin your life. You'll be less efficient than you could have been. You won't be able to live up to your potential. It might get in the way at key moments. It might. And I've had some patients say this in a way contaminate key moments, because when you perfectionistically want to be fully engaged in what you're doing. Oh, but I was noticing my breathing right then. Ah. It's not as good as it could have been. So that's the kind of core fear of that.

[Stuart Ralph]

Yeah, yeah, I like that. Yeah, yeah. I've Often heard this with this sort of theme of this. It's almost like a. It's not a fear of going crazy, so to speak, in the sense of, like, mental health. Health anxiety, but yeah. In some way of.

[Dr. Ron Nicholson]

Yeah.

[Stuart Ralph]

Not being able. The fear that you wouldn't be able to stop blinking or focus on your blinking for years and years and years would drive you a bit bonkers.

[Dr. Ron Nicholson]

Yeah. When you get at that core fear with a lot of OCD stuff on the content level, it's like, why would that be that scary? Thinking about blinking, like holding a knife, What, Touching a dirty doorknob. That on its own, it's a little bit harder for those of us who don't have that specific theme to necessarily get into. Why would that be scary? When you consider the core fear, that's one of the. When you get into the world of. That makes a lot more sense to someone on the outside of why that would bother you. Like, if I touch something, then people that I love could get sick, like seriously ill, and then it's my fault. Well, that makes some sense why that would get an emotional reaction from you or being distracted for the rest of your life. Yeah, that does sound kind of bad. That sounds like something that's kind of scary. And it's that emotional reaction that when you've got ocd, All OCD needs is the emotional reaction and then it's going to send you whatever that content was over and over and over again. And the content can be anything in the world.

[Stuart Ralph]

Yeah, exactly. Spot on. Yeah.

[Dr. Ron Nicholson]

Nice.

[Stuart Ralph]

Yeah. Sorry, go on.

[Dr. Ron Nicholson]

Oh, no. Well, I was going to say the other thing that comes into mind that kind of overlaps with this one a lot is that I mentioned this word a couple of times is the perfectionism and the idea that you want things to be just right in a very perfectionistic way. So that tends to come up a lot in that treatment where people want to police their own thoughts, like, I shouldn't be thinking about this, or it's not normal to be noticing this, or these things are not going to be good enough. And a core fear that I hear a lot is I'm not going to achieve. I'm not going to be as efficient as I want to be, or I'm not going to be as effective as I want to be. I won't be able to live up to my potential. And that's what really bugs a lot of people with that. So when you do this kind of treatment, it's not just the exposure work that comes into play. You have to Do a little bit more work than usual on addressing the perfectionism component, the thought policing of it, and accepting. This is when I end up telling my patients, especially, they have to learn to take the B. You're shooting for the A, and that's great that you want to get there. And sometimes you can wear that hat and be really good at what you want to do. But when it comes to your own self and accepting that you are an imperfect biological mechanism that's trying your best, you gotta take the B. Even if it's the moment where you're getting married, you might have this unwanted thought, but that doesn't ruin it. That's just life. It's not as perfect as you think it could be. In moments, you will be distracted. But that's okay. You can take the B. Yeah.

[Stuart Ralph]

Yeah, I like that. Yeah. B's good.

[Dr. Ron Nicholson]

Bees will get you there.

[Stuart Ralph]

Be. Will get you places. Yeah, exactly. So what are some of the compulsions around sensory ocd? What would we be seeing? Or what would someone be doing in their head or. Yeah.

[Dr. Ron Nicholson]

Mm, excellent. Coincidentally, the next note that I had in my notes, compulsions for this. In my experience, they're often checking, fixing, researching, or avoiding. And you could probably say that exact same list for just about every OCD theme. Now, checking the sensation to see if it is still there or if it is still wrong in some way. So if my. If I'm worried about my breathing being wrong or less efficient, I'm like, checking my breathing. I'm looking at my heart, I'm looking at the end of my nose. I'm noticing the thing that my brain is wanting to warn me about. Or you're fixing the sensation to try to be just right. And that's like you're trying to fix some aspect of it. You're trying to fix your thoughts. Even, like, nope, I don't want my thoughts to have this. I have to have the thoughts that I want to be having right now, which is focusing a hundred percent on whatever this task is at hand that matters to me. And the other classic one, researching, trying to get reassurance about the sensation itself, the disorder, strangely enough, my patients with ocd, across the board, people have ocd. You have a brain. When you have ocd, you have a brain with ocd. And with this specific theme of ocd, when it was on other things. My patients with sensory OCD tend to idealize the day when they had that other theme or even not notice that that other theme was ocd. And for some reason, they really light on, oh, but before I wasn't thinking about my blinking all the time. If only I could get back to that. I hear this like you hear similar things when people are like, oh, this other theme was so much easier when I had that. And then when that theme comes back, oh, no, I wish I still had that first theme that I had when you saw me. Whatever. The grass is always greener. But for some reason with sensory ocd, I hear a little bit more often, like, oh, I wish I could get back to the days before I was worrying about this so there'll be some kind of research about, like, what was I doing differently before this happened? Maybe I could do that. A thing that I've heard with this particular theme. And then avoiding trying to force your thoughts away from the unwanted stimulus, trying to desperately not see the elephant in the room. And the big thing that comes up, the opposite of all of this, is allowing the unwanted thought to be there. So all of these compulsions are trying to get rid of or neutralize that unwanted thought, which is the awareness. And naturally, when we do the exposures, we try to allow for the thoughts as a big part of it. Really take an act based approach as part of that.

[Stuart Ralph]

Yeah, yeah, yeah, I like that. Is there any particular types of people you notice that seem to get this theme more than others?

[Dr. Ron Nicholson]

No. Across the board, demographically speaking, or with regards to professions and whatnot, this theme shows up with people from all walks of life. The thing that comes up more that is that the perfectionism is a little bit more likely to be there as well. So if your brain, if you're born with a brain with ocd, it's just a matter of what gets an emotional reaction out of you. If you've got a little bit of perfectionism and for some reason you really want to be perfectionistic with your own thought processes and performance, then this might be one of the themes that you gets an emotional reaction and your brain latches onto. But other than that, it could be anything and anybody could get it.

[Stuart Ralph]

Yeah, yeah, okay. That's good. Yeah. Good. And it isn't.

[Dr. Ron Nicholson]

We have assessed the situation. It is far from good when you're experiencing it.

[Stuart Ralph]

True. Exactly. But good. It's not targeting one person. So just looking at my questions. Yeah. How. How are you addressing this theme from like an ERP standpoint? What, what would.

[Dr. Ron Nicholson]

I love this part? Yeah, yeah. Now this is part of what made me say when I reached out to you, like, hey, how about we talk about this one? Because one, this particular theme doesn't get talked About a whole lot. And two, it's a little bit tricky to do an exposure when part of what the threat is is this internal, natural, and necessary biological process. Now, one of the things is people will find themselves compulsively checking their blinking, their breathing and whatnot. They're thinking about it as part of the compulsion. So it's not like touching the dumpster where you're like, okay, well, let's go towards the thing your brain is worried about. Actually, that's part of the compulsion right now. But that's why I make such a big deal about focusing on what and identifying what is the core fear versus the content. Because the threat is not blinking or your heart rate or your breathing or you're swallowing. The threat is, I'm going to be distracted by this. I'm going to be thinking about this forever. And on a deeper level, I'm never going to be the person that I want to be or live the life that I want to live, because this thought is there. So it's a little bit less, unfortunately, external. Like, I love it when the exposures can be something like, let's just pick up the knife, let's just touch the dumpster, let's walk outside, walk around the block, and accept the fact that someone might hate you, whatever that might be. Yeah, but this was one where we got to rely a bit more on script work and accepting that internal prospect. Like, when I do my exposures, when it's time to. During the rest of the day, if those thoughts come up, they can be there. I don't care. The phrase that I use with my patients a lot is maybe, but this is more important to me right now. When you're not doing exposures, maybe. I don't know, maybe I will be distracted forever. But, you know, going to the ATM right now is more important to me. Maybe, but when you're doing your exposures, I love to throw in like a. Yeah, it act like a big yes. Now that it's exposure time, let me look at my script. Yes, my life is absolutely probably going to suck. I will have all of this unfulfilled potential that I'm never able to go there. What is the core fear there? Let me take. Let me crank that up as high as I can in my thoughts, in my imagination. Let me think about what my life will look like. I have a patient with this kind of perfectionism, and part of his exposure is we get really vivid, like they do. Prolonged exposure therapy is the technique you use for ptsd, and it's Very similar to the exposure work that we do for OCD and with prolonged exposure work, which I learned how to do before I ever learned how to treat ocd. Part of what makes it work is when you can get vivid and descriptive and visceral with the scariest moments of your life. And there's a lot of research showing, like when people relive these horrible moments, the more present tense words they use, the more descriptive words they use, the more they can viscerally get into it, the better the treatment goes. They're willing to go towards the fear in a more visceral, reactive kind of way. And the same is true for your exposures. It can sound a little bit ephemeral light if what you're exposing yourself to is a thought versus, like the hard and fast content of holding a knife. So you want to go there a little bit extra and not just embrace my life might not be bad. Let's go through why your life might not be bad. What is that going to look like? What are you missing out on? What are the reminders of the life that you're not going to live? I'm going to have this degree on my wall taunting me that I was never able to get a job based off of it because every time I went in for an interview, I was blinking excessively because I was thinking about my blinking and they thought it was OD and they just didn't bring, take. Bring me to the next round of the interviews. Whatever. Whatever that might be. One of my guys absolutely hates fast food and we always incorporate fast food. And this is what your life could look like if things go wrong. And like, yep, that's a greasy, visceral, evocative mental image right there that I kind of love.

[Stuart Ralph]

Okay, so, yeah. Really making the scripts vivid, emotive.

[Dr. Ron Nicholson]

Yeah.

[Stuart Ralph]

Bringing it to life.

[Dr. Ron Nicholson]

Yeah, yeah, yeah. And embracing what it is you want to go towards the fear. I always talk about using that fear like a divining rod. Like that's what we magnetically draw ourselves to and make that vivid. And it's not the blinking or the swallowing. It's. I'm going to be distracted forever. And that sucks. I'm never going to live the life that I want. And that's going to be horrible. Embrace that during your exposure time. That's. So that's what I tend to do.

[Stuart Ralph]

Yeah. So, yeah, and yeah, just as you said with the. The big. Yeah. And you know, everything else, it's. It's tongue in cheek. Right. It's going into showing your brain that I don't care. Really. Yeah. Yeah. And then with scripting, more practical and a general question on scripting.

[Dr. Ron Nicholson]

Yeah.

[Stuart Ralph]

When you said it as home practice, how often are you asking them to do it each day?

[Dr. Ron Nicholson]

The number that I always try to shoot for iS10. Now, it takes a little while to get up there for most people. It's not easy. And you're talking about sometimes, maybe even going there once during the therapy session might be take you up to a 10 out of 10 anxiety when we can do it together. But eventually you can do it on your own. And eventually you're doing it multiple times a day. And the magic number that I have found is 10 times a day of really going towards what that might be. And I want to keep in mind as I'm saying this and I say the big yeah, that might be the case. You always want to include the word might because you don't want to give certainty in either direction, but you want to have a clear view of what that fear might be. And you hold the door open. You don't close it completely and avoid it. You don't walk through it and say this is definitely going to happen. But you have a really clear view of what might happen with that big might. And the number of times we want to do this today that we go towards that is 10. And when my patients are able to get up to that point, that's when you know the therapy's working and they're eventually going to be saying goodbye and going off and living their life. When they can't quite get up to 10 yet, you know it's going to, we got some more work to do and that's okay.

[Stuart Ralph]

Yeah, I like that. And are you saying it for the week and then when they come back, if it's not bothering them anymore, move on. Or if it's still bothering them, like, keep reading it for the next week.

[Dr. Ron Nicholson]

Oh, you keep reading it. I here's the thing that I tell all of my patients at the beginning with what we do. As you go towards this thing, basic habituation comes in. It's like watching a scary movie over and over again. The first time it's terrifying. The next time less so and continually less so until you're bored with it. If you stop doing it when you're bored with it, your brain still has mostly, if you look at the numbers in association associating this movie with being scared, it's when you're not bored with it anymore that we keep going. Because then you want to override all of the associations that your brain has with this material and being anxious or scared. I always tell patients, like, that's when we keep going, because that's when the best learning happens, when you're bored with it. So I always say, we're going to beat the dead horse. And we do. So we keep going with that for even a couple weeks. Like, if this is not bothering you anymore, great. We keep going. And then after maybe two weeks or more, if something else is starting to pop up, which inevitably it does, we'll incorporate that into the exposure routine as well. But we still keep the first one. We still beat that dead horse for a little while longer so that the OCD doesn't recognize. I'm going to completely go away from that. No, no, no. I'm going to keep showing you that this first thing is still completely irrelevant to me. And changing tack, like choosing different themes or different content for the exposures, when you make those kinds of changes, that also gives the OCD some level of relevance. It teaches the OCD that whatever you're going to send to me, I'm going to react to by changing my exposure routine. And I found with some patients that when they change their stuff too quickly in response to that, that fuels the ocd. So it just keeps changing. In beating the dead horse, you're deciding. I'm going to do my exposures based off of what I think is necessary right now. And whatever the OCD chooses to send me is irrelevant.

[Stuart Ralph]

Yeah, yeah, yeah. I like that. Really. Sort of pushing and going in much longer. That's interesting. It reminds me of the Arnold Schwarzenegger quote. He said something like, I don't. What was it? I don't count from the beginning. I only start counting when it hurts because that's when it matters.

[Dr. Ron Nicholson]

Yes. I think Muhammad Ali said a similar thing about his setups. Yeah. They might have both said it. I mean, if you're both in the same. If you're in a similar business. Yeah. Good quotes to have around, like. Yeah, only start counting when it hurts. Cause those are the ones that actually matter.

[Stuart Ralph]

Yeah, exactly. Yeah. That's when the muscle's being ripped so it can repair. Yeah. Yeah. Okay, cool. And are there any sort of pitfalls or nuances to treating this theme that often get people stuck or the therapist stuck or.

[Dr. Ron Nicholson]

Yes. Okay. So this is part of why I'm a big. This theme in particular really makes me be a really harp on the content versus the core fear. The content is this internal process, and that's what's different between this theme and most other themes. The core fear is actually really similar to other themes. I'm not going to live the life that I want. I'm not the person that I want to be. The core fear is omnipresent. The content might be internal versus external. Now, my patients, when they have this particular theme, I've noticed that this particular theme, they're more likely to say, oh, no, Doc, you can't fix me. I'm going to be that case that you can't fix. Doc, I don't know. Okay, well, I have my guess, but I'm always more likely to hear this. If I hear that before I hear anything else. I have a good sense of what the theme is going to be because they're mistakenly thinking that their trigger is this thing that they can never get away from. Well, people with POCD will tell you that, like, hold on, I'm still triggered by my own brain. That thought's always there, too. So that's a little bit of a mistake. The core fear is the same and always present, so the content's a little bit different. And that tends to get patients tripped up because they think that the fact that this is this internal, necessary thing is going to make therapy impossible. That's one mistake I see my patients making. And part of the reason that, like, I ever had the idea to reach out to you about this, because I had a patient who came in who was distraught over this idea, and it was such a wild moment to say to this person, no, no, you could treat this. And they. I might as well have been saying that the sky can. I'm sorry, that the sun can rise on the other side of the sky. She's like, how can I ever get away from this horrible thing? Because it's always going to be there. Couldn't believe it. So even if your trigger, your ocd, has latched onto something that is an internal process, the treatment is the same and the treatment works. That is a thing that I've seen patients get tripped up on. And I will very happily say that on a larger platform so that people know treatment's possible. The other thing that I have seen is people not quite knowing how to. And I mean other therapists not quite knowing how to approach the ERP because it can be a mistake if the content is. If the thing I'm worried about is blinking. Like, okay, well, let's focus on your blinking. That's actually what their compulsion was for a while. And that's where you get into providing certainty one way or the other. Now the brain wants certainty. It doesn't want certainty in one particular direction. It doesn't care. It just wants certainty. And like I said a minute ago, we want to keep the door open. We don't want to close the door, meaning it's not going to happen and I can avoid it. And we don't want to go through the door, meaning I'm just going to get certainty in the opposite direction. This is definitely going to happen. This is. What's that? There we go. I can just accept that. Then I'll be able to move on. Your brain wants certainty in one other direction. We want the middle ground. We want to keep that door open and have a big might. Maybe, maybe that'll happen. I might do that later. I might have that horrible life later. So you don't want to approach just the blinking because that's a little bit more of a compulsion, and it kind of provides certainty in the other direction. You don't want to focus on the swallowing or you don't necessarily count the swallows. You want to do what the brain is worried about, be distracted in a key moment. That's. So focusing on the core fear versus the content is the area wherein I've seen other therapists get tripped up. And when I say that, I mean, I've had patients tell me this is what their other therapists ask them to do that may or may not have worked. And then if they're coming to me, that other therapy wasn't a hundred percent effective. So that is the thing that I have heard of through my patients and an area that I feel that is often tricky if you're not an OCD specialist.

[Stuart Ralph]

Yeah, yeah, yeah, good point. Good points. Yeah. I think it's an important message to hear that it's very treatable and workable. Okay. Is there anything else on sensory OCD that needs to be shared? Do you think.

[Dr. Ron Nicholson]

Sensory OCD can be. I mean, I'll just restate what I have said before. It is treatable because it is a. It is fixated on something that is internal. The people suffering from it will often think that that means that they cannot be treated or that their OCD is different. Now, I would say that the OCD is not different and it is entirely treatable. And for the sake of treatment. The only real difference is that you want to lean into not the sensation itself, because that's not really the threat you want to lean into. You want to play the tape forward on the life that you don't want and the person you don't want to Be go towards that core fear versus just this surface level material.

[Stuart Ralph]

Yeah, yeah, I like that. Yeah. And I suppose if you focus on the surface level, you get pulled into the content, which is the blinking king, the whatever breathing.

[Dr. Ron Nicholson]

Yeah, it's answering the question.

[Stuart Ralph]

Yeah, yeah. Whereas if you're going to the fear, you're already moving beyond the thing itself. Mm.

[Dr. Ron Nicholson]

The obsessions are often across the board with different OCD themes. The obsessions are usually a question, and the compulsion is a urge to answer the question one direction or the other. Focusing on the content, you're, like, answering the question, leaving the door open and having the question without answering it is very difficult. And that's usually where the treatment lies and what ends up being both very difficult to do, but helping treat the ocd.

[Stuart Ralph]

Yeah.

[Dr. Ron Nicholson]

Spot on.

[Stuart Ralph]

Spot on. Okay, so what's one thing you wish you could have known at the start of your career?

[Dr. Ron Nicholson]

Oh, my God. Only one thing. Okay. The answer is to the eppp. A word for word recounting of my dissertation. So I could just write that once and be done with it. Actually, one thing that someone said earlier on, and, like, I listened, but I wish that someone had said it even earlier. And I want to reinforce that this is the way to go, which is all these different ways of doing therapy. There's a lot more overlap than people want to admit. And a lot of the different things about therapy are using different terms to alight on the same concepts. The core thing that ends up coming about is learning to live with the discomfort and the distress. Any kind of therapy you can think of, any kind of problem someone comes into a therapy room with, there's a good chance that you could look at that and say, what makes the therapy work is going towards the thing that is uncomfortable and learning to be comfortable with that, expanding your distress tolerance or becoming habituated to the scary thing. I'm a little bit biased because I do exposure work a lot, but the more I talk to my therapist friends that do other things, that's a common theme that we keep coming back to, and I like that.

[Stuart Ralph]

Yeah, yeah, I agree. I agree. Okay, so you got another billboard. What do you want?

[Dr. Ron Nicholson]

Another one?

[Stuart Ralph]

Another one? What do you want written on this one?

[Dr. Ron Nicholson]

Oh, what would I want written on this one? The life that you want and the person that you want to be

[Stuart Ralph]

are

[Dr. Ron Nicholson]

on some level within your reach. And then it would be my website, so people can come to my therapy office and find ways to get closer to that. But honestly, like, yeah, any therapist can help you, but I think people underestimate how close that they can get to the stuff that matters. Like not everyone can go play professional sports or whatever. But if you look at why does that goal matter to you? Chances are you can get at least closer to what matters about that you can self actualize more than you think you can. And you can challenge yourself more than you think you can. People settle. As I old quote, most men lead lives of quiet desperation because they think that they can't take the step and do more or find a way, or they feel limited by who they are and who they have been. But you can get closer than you think to the life that would make you happy.

[Stuart Ralph]

Yeah. Yeah, I like that. I like that. Yeah, I agree. I agree. I think that'd be a very useful billboard. And we'll change the age this time. So.

[Dr. Ron Nicholson]

Okay.

[Stuart Ralph]

And call 10 year old you.

[Dr. Ron Nicholson]

10 year old me?

[Stuart Ralph]

Yeah.

[Dr. Ron Nicholson]

Oh God. I could pick up the phone and call 10 year old me. Yeah, okay. Jesus. First off, invest in Apple and put a for your birthday. Ask for shares of S&P 500 and just hold onto them for 20, 30 years. It's a little bit trite, but I'd also say consider a career in psychology because I was not at all on my radar until much, much later. And it had never occurred to me when I was that young how much this one career would encapsulate so many of the things that have always been a core goal of mine and that are so energizing. Like I was a kid and it's like, you know, I want to do work in the world that like, you know, makes people happy and brings people to, you know, makes people help, be their best selves. I had no idea what that would be, but I wanted to have that positive impact and I wanted to have a direct line so I wasn't like a cog in someone else's corporate machine. I clearly watched way too many James Cameron movies when I was a kid because he's always got like the man as part of the bad thing. The Waylon Yutani Corp or whatever. I watched way too much of that when I was a kid. But the idea that you can be this specific kind of doctor and what you do is you help people put down the stuff that's holding them back and you help get them to the point where like they're coming in. I had, coincidentally. I love that I'm recording with you on a week that I had three different patients graduate from treatment and we're recording this on a Friday. And so I had two people Yesterday and another one the day before were like, yeah, this is my life now. And I'm happy. It's not a perfect life, but I'm able to appreciate what I got. And it's like to have moments like that, that's part of my day to day, that it's like a tangible, noticeable, quantifiable impact on someone else's entire quality of life and ability to reach goals. That's awesome. So if I had a phone line to my 10 year old self, I would first off have a more abbreviated way of describing everything I just said to you because that was way too wordy for a 10 year old and let them know that, yeah, that's. There is this career that ticks all the boxes and you don't even know it. Nice.

[Stuart Ralph]

Yeah, I like it. I like it. And then.

[Dr. Ron Nicholson]

And Stu, if you were gonna. If you had a phone for your own 10 year old self, what would that be? My man,

[Stuart Ralph]

10 year old me. Oh, 10 year old me. I would think I would just give him space to talk. Oh, to be heard. I don't think I'd hang up until he did.

[Dr. Ron Nicholson]

Oh, that is such a good therapist response too. Oh, well done, man.

[Stuart Ralph]

Thank you. There are other ages. I'll definitely tell things to myself. 10 year old me just needed to be heard.

[Dr. Ron Nicholson]

He needed the space.

[Stuart Ralph]

Yeah, exactly. Exactly. Is there anything else you wish you could have said today?

[Dr. Ron Nicholson]

Anything else that I wish I could have said today? If you have ocd, it does not matter what theme you have, what combination of themes you have, or where you are coming from. You feel alone. You may feel like you cannot be treated, but you are far from alone. And I guarantee you the treatment is possible. You just gotta try. Yeah, yeah, absolutely. Keep trying. Cool.

[Stuart Ralph]

Thank you so much for coming on talking about this topic.

[Dr. Ron Nicholson]

Always happy to do it. Thank you so much.

[Stuart Ralph]

Thank you for listening to this week's podcast and thank you to our Patreons who helped 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.