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- [00:11]
A
Welcome to the Therapy for Black Girls Podcast, a weekly conversation about mental health, personal development, and all the small decisions we can make to become the best possible versions of ourselves. I'm your host, Dr. Joy Hardin Bradford, a licensed psychologist in Atlanta, Georgia. For more or to find a therapist in your area, visit our website@therapyforblackgirls.com while I hope you love listening to and learning from the podcast, it is not meant to be a substitute for a relationship with a licensed mental health professional. Hey y', all, thanks so much for joining ME for session 425 of the therapy for Black Girls Podcast. We'll get right into our conversation after a word from our sponsors. This is an iHeart podcast. These days, most things cost an arm and a leg, especially vacations, but not in Rhode Island. Between affordable luxury stays, succulent seafood right from the source, and spectacular shopping that won't break the bank, you get a real bang for your buck in the Ocean State. The memories will be priceless, but the cost will be a lot less. Rhode Island all that, plan your trip today at visit rhode island.com that's visit rhode island.com Many of us play lots of different roles in life partner, employee, caregiver. And many of us also think about another role that could take our life where we want it to be. Degree Holder that's where National University comes in. They've been busy since 1971 creating more ways for you to work earning a degree into your hectic life. NU confers more graduate degrees to diverse populations than any other institution in the country, with more than half being earned by women. With flexible online formats, NU makes higher education possible and achievable for busy working adults. Learn more today at nu.edu. living with a rare autoimmune condition comes with challenges but also incredible strength, especially for those living with conditions like myasthenia gravis or MG and chronic inflammatory demyelinating polyneuropathy, otherwise known as cidp. Finding empowerment in the community is critical. Untold Stories Life with a Severe Autoimmune Condition a Ruby Studio production in partnership with Argenics explores people discovering strength in the most unexpected places. Listen to Untold Stories on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. This episode of Therapy for Black Girls is brought to you by Chase Sapphire Reserve. Whether you are booking your next trip or a weekend escape, Chase Sapphire Reserve is your gateway to the world's most captivating destinations. When you use your Chase Sapphire Reserve card, you get eight times points on all purchases made through Chase Travel and even access to one of a kind experiences like music festivals and sports events. And that's not even mentioning how the card gets you into the Sapphire Lounge by the Club at select airports nationwide. Travel is more rewarding with Chase Sapphire Reserve. Trust me. Discover more@chase.com Sapphire Reserve cards issued by JP Morgan Chase Bank NA member FDIC subject to credit approval terms apply. Have you ever heard someone casually say I'm so OCD just because they like.
- [03:46]
B
Things neat and organized?
- [03:48]
A
That kind of language often oversimplifies a serious mental health condition and can make it harder for those living with OCD to be seen and understood. Today we're digging into what obsessive compulsive disorder actually is and how it uniquely impacts Black women. I'm so excited to welcome back Dr. Jameika Moore for this conversation. You may remember Dr. Moore from session 407 where she joined us to talk about driving anxiety. She's a licensed clinical psychologist who specializes in ocd, anxiety and trauma, and she's deeply committed to making mental health care more accessible and affirming for Black women and girls. During our conversation, we explore what OCD looks like beyond the stereotypes, the ways it often goes unrecognized or misdiagnosed in Black women, and how effective treatment can help. Dr. Moore also offers insights on supporting loved ones with OCD and and tips for finding culturally responsive care. If something resonates with you while enjoying our conversation, please share with us on social media using the hashtag tbginsession or join us over in our Patreon to talk more about the episode. You can join us at community.therapy for black girls.com here's our conversation.
- [05:05]
B
Well, thank you for Joining us again, Dr. Moore. It's a pleasure to see you again.
- [05:09]
C
Thank you. I'm so excited to be back. It's a pleasure to see you again as well.
- [05:13]
A
Yeah.
- [05:13]
B
So when we talked last, you were talking about your actual specialty is working with clients with ocd. And I was like, we haven't had a full episode on ocd, so we definitely got to bring you back to talk about that. Ocd, it feels like, is one of those terms even for clinicians, that is misused. People don't quite know, you know, I think what all of the symptoms are required to meet the diagnosis. So tell me a little bit about what OCD is and how you actually.
- [05:39]
A
Got started with this as your specialty.
- [05:41]
B
Okay.
- [05:42]
C
Yeah. That's one of the reasons why I was super excited to come back and talk about OCD because there is a lack of information and misinformation about what it actually is. And usually people will think about OCD in the context of contamination or order and symmetry, but it's so much more than that. And broadly speaking, OCD is this experience of having intrusive images, thoughts, or impulses. And as a result of that, it can trigger a lot of distress in clients. And in order to neutralize or get rid of that distress, people will perform what we call rituals or compulsions, which can also be thoughts, behaviors that people feel compelled to do in order to experience some relief. And compulsions do work sometimes. And because they work and bring down that distress, it increases the likelihood that the client will do that behavior again. And before you know it, OCD just takes hold, and it will make your life smaller and smaller and smaller.
- [06:41]
B
So when you say it makes your life smaller, what do you mean?
- [06:44]
C
People will start performing what we call safety behaviors. And that could be escape, avoidance, distraction, and the compulsions in and of themselves. And so that means that things that are important to you, the ways that you used to show up in your life, you may no longer be showing up in that way because you are operating from fear and because you could be spending more time doing the actual compulsions or, or having other people join you in doing those compulsions. And so it can just take things away from you, because OCD really operates on a value system. And so you'll typically find it in areas of your life that are really important. And if you develop, like, an anxious response to that, you can understand how people will initially think that avoidance is the best thing to do, or that the compulsions are the best thing to do in order to feel better. But OCD is a liar, for sure. And it'll have you doing things in the best interest of the OC and not in the best interest of your own life.
- [07:43]
B
So, Dr. Moore, I don't feel like that is something I've heard talked about, and I don't think we talk about most diagnoses like this, like that it operates on a value system. What do you mean by that?
- [07:52]
C
So with ocd, because it has a great imagination and it can actually attach to anything. And so what I'm talking about, the misinformation and lack of information about ocd, this is exactly what I'm talking about. When we see it in such a limited view as OCD is hand washing, OCD is straightening these pictures behind me, it totally disregards how wide reaching it can be. And so when I say it Attaches on a values level. Think about it. If I have an intrusive thought about something I don't care about, there's no reason for me to develop as much disgust or anxiety or shame or guilt around it. But if it's something that I genuinely care about, then it's like, whoa, wait a minute. And so an example would be, let's take a new parent. They really obviously love this beautiful bundle of joy that they have. But then an intrusive thought comes in that says, what if I just toss this baby across the room? That's going to generate a lot of anxiety. Because it's like, why did I have that thought? Do I actually want to do this? Am I losing it? What is this about? And so because it's intrusive and the person is paying attention to it, it also increases the likelihood that you're going to have that thought again and that it's not going to be like a passing or fleeting thought. And so now the person's going to develop some safety behaviors because they're responding to the thought and the anxiety discomfort that it generates. And so now it's like, maybe I won't do the breastfeeding, maybe I won't change the diapers, maybe I won't hold the baby as much. And they're doing that as a reaction because they ultimately want to keep the baby safe. And when I say OCD is a liar, what I mean is what you really want to do is protect the child. But when you avoid the child, there is no protection of the child in that because you're impacting the way you will bond with the child. And so the OCD is constantly looking for what's important to you, because if it hooks onto that, it increases the likelihood that it can get the compulsion. And it absolutely needs the compulsion in order to exist.
- [09:50]
B
So what do we know about how OCD actually develops? Because it feels like there's like general kind of garden variety, so to speak, anxiety. But this definitely feels much more severe, much more kind of personalized, at least.
- [10:03]
A
In the way that you're talking about it.
- [10:04]
B
So how do. How does OCD develop?
- [10:07]
C
It's that same thing we say about how anything develops. There's a component that's definitely, definitely structural in the brain, surrounding things like your serotonin and actual brain structures. But then there, alongside of that, there can be some modeling that can take shape. And I believe that you can be predisposed for ocd. But just because you have that predisposition, it doesn't always mean that it will present inside of itself. There can still be some sort of mitigating factor in the same way that you could carry a trait for like migraines, but it doesn't mean that that gene will actually be realized inside of you. So there's still a lot more. Seems like as much research as we do on etiology, we still are like, and, and actually specifically how does it start? But we have some understanding that we can speak about along those lines.
- [10:54]
B
And I know so much of your work is working with black patients specifically who struggle with ocd. What have you seen about how OCD shows up differently in black women specifically.
- [11:05]
C
And black women specifically? That's a very interesting question. And I do, I want to say that from research, what we can see is OCD will show up in people like equally across the board. But when we try to think about how it impacts black communities specifically, and I'm going to deviate from the specific woman conversation, one thing that we do notice is that there can be an increase in more contamination based fears. But when they actually looked at some of the limited research that's been completed on this, they found that to be also found in non clinical populations as well. And so what they're essentially saying is that, how do I say this? Culturally we may have some differences in our approach to cleanliness and what's important to us surrounding cleanliness. And I think that if we look through a historical lens, we can understand why that may be the case. Right. And so if you're a group of population who's been told that interacting with you causes harm to someone else and you have to try to find a way to survive in a society that has a lot of oppression against you, we can understand how safety behaviors towards cleanliness could have been conditioned over time. And so I think that's why contamination is one area of focus. And again, it could be plenty of other areas of focus. And that's one of the main points that I do want to make is that when we have such a limited view of OCD or we can delay treatment for people, and so we have to take it outside of that lens of contamination in order and symmetry. But that is something that's on the table and I think interesting to dissect when you look through that historical lens.
- [12:40]
B
Yeah, I mean, immediately I'm thinking about how many years we've been told our skin is not clean, or even recent conversations I feel like developing on social media where people are saying like, oh.
- [12:50]
A
Dermatologists suggest like you only need a.
- [12:52]
B
Shower, like Every other day or every three days. And like, black people are like, absolutely not. Like, that is not what we do kind of thing. Right. And so it definitely feels like there is clearly some ties to our history and our association with cleanliness and I.
- [13:07]
C
Think the social media impact of it all. Like, we get exposure to the things of, I don't wash my legs or I don't do this, and, like, black people are like, wait a minute, what were other behaviors that we may find to be a bit more disgusting based off of what we are not willing to do and putting that in the context of ocd. So if generally speaking, we have that condition and connected to cleanliness, you could imagine that if you have ocd, that's going to be the temperature around that is going to be turned up higher than it would be. But again, I don't think that's to say that black people will necessarily have a worse presentation of that. It is just something that you can be on the lookout for based off of some research that's been conducted.
- [13:49]
B
So you've already talked about the fact that, like, cleaning and checking are the most common ways, I think that we see OCD presented. What are some other presentations of OCD that may be a little less typical?
- [14:00]
C
Okay, I love that question. And so because I said OCD can attach to anything, I really mean anything. We have, like, relationship ocd, how it will attach to your romantic relationship. We have sexual orientation ocd. And I want to say these are subcategories. If we treat ocd, we don't think any of these hold more power over any other presentation because they all get the same treatment. But sometimes clients like to be like, oh, you know, I have rocd, which is a relationship ocd, or this pedophilia ocd, pocd. That's another way that it can show up. We have, like, religious OCD with the scrupulosity, which can also have the moral or ethical component to it. Am I being a good person? Am I going to cheat someone out of money? How do I know that I'm actually good? And there's this existential category as well where people will ask bigger life questions. Am I here or am I in the matrix? Matrix. What's the meaning of life? How do I know this is not a simulation? So it really can hit, Like, OCD is creative. I mean, it is very creative. And so when I'm saying, like, it can attach to anything, I really mean that the possibilities are endless.
- [15:10]
B
And so relationship ocd. I don't think I've heard Very much about what does that mean? Is that like a fear of cheating? Like what is the concern around relationship?
- [15:18]
C
It can be right. So the intrusions can center around is this the perfect partner for me? How do I know that I've made the right choice? How do I know that I'm actually really attracted to this person? Are they good enough for me, Are they smart enough for me, are they whatever enough for me? And now it's natural to have some questions about your relationship as you should, you know, as you're trying to progress anything we insight, questioning, reflection is important, but this is pervasive, is persistent, it's constant, and it's extremely, extremely distressing. Especially because oftentimes people are feeling the opposite of what the intrusive thoughts are telling them. So they really want the relationship. But these intrusions are coming in. That's creating a lot of doubt. OCD had a nickname called the doubting disease, which makes them believe that because they start to feel anxious around it. And now we have emotional reasoning, right? I have these thoughts, I'm anxious, I start to reason from my anxiety. I need to know, I have to have absolute certainty that this partner is right for me. And uncertainty is the core distortion of ocd. Essentially, people are struggling with intolerance of uncertainty. Will I, will it, will it won't. And they're just trying to answer those questions. Maybe a relationship OCD can present like that, or it can be, I looked at someone in the and I found them attractive. And as I looked at someone, I experienced like a groanl which is maybe there was a sensation somewhere in the body. Now what does this mean? Does this mean that I really don't love my partner, that I don't like my partner, that I want to be with someone else? And so again, the questions can be endless. But it's just this idea that the OCD has attached to and is coming for your perception of your relationship. And you're going to start to doing some compulsions around that. And so compulsions could be checking. I'm going to check my body to make sure I still feel attracted to this person. Or I'm going to ask reassurance or I'm going to confess. I looked at someone else the other day and I thought they were like really attractive. I just need to let you know that I found someone else attractive. Now imagine someone's constantly doing this. At first you might be like, okay, cool. But if someone's doing this and you're experiencing these confessions multiple, multiple times a day or a week, that's the thing that's going to actually tax your relationship. So when I says that OCD will have a tendency to do the opposite, this relationship is really important to you. You're engaging in behaviors that can definitely impact your relationship in a negative way, but the OCD is lying to you and telling you that you absolutely need to do these compulsions.
- [17:50]
B
So I want to talk about the religious OCD also, because I think that that feels like one that could be something that maybe. Well, maybe not in terms of, like, the actual stats and numbers, but because of the history of the black community with religion and spirituality, it feels like this could be something that it does attach to. Right. Can you say more about that?
- [18:08]
C
I think that the religious aspect of OCD becomes very difficult to treat, especially when some of the things that we learn in our association with whatever our religion is, it perpetuates. It can perpetuate some of the thoughts connected to the compulsions. And so, like, there is this idea that you are praying or whatever those expectations are. And sometimes people will blur the line between how do you show up as a faithful, like, participant of your religion versus showing up for the ocd? And those are two totally different things. And that's why I think it's important when you're working with someone who's presenting with scrupulosity, that you get that release of information signed, if it's okay with the client, to maybe talk with their spiritual leader, their pastor, preacher, whatever the case may be. Because we can understand that there's a difference between saying a prayer and there's a difference between praying for two hours because you're getting a word wrong or because an intrusive thought or image came into your mind that force you to have to start over again. That doesn't serve your relationship with God. That serves your relationship with ocd. Right?
- [19:20]
B
Yeah, this does feel like the. Well, I. Probably all of the OCD subtypes have some particular nuance that makes it difficult. But this, I think, in particular, does feel like it's difficult to tease out. Because, you know, how do you know? What is the line between, like, I'm being very faithful, I'm being obedient, so to speak, versus ocd. But the question you just asked feels like it's an important one, right? Like, does this actually serve my relationship to my higher power? Or does this serve the relationship to.
- [19:46]
C
OCD a thousand percent? Right? Who is actually being served by engaging in this compulsion? And it's always the OCD that's being served and the person might temporarily think they're being served if that compulsion still works for them. Because if you're still in that pattern of negative reinforcement where you are relieving, receiving some relief, it works. But oftentimes it starts to, to, you know, take up more time, create more agitation. And so people aren't experiencing as much relief, but it's worth it to do it, because in their mind, the alternative I, I've offended God. I'm not being a perfect Christian. That can get in the way of the treatment. And so now we're back on wanting to do the compulsion again.
- [20:31]
A
And so what do you feel like clinicians often miss?
- [20:34]
B
Maybe when diagnosing ocd?
- [20:38]
C
I think that because there's so much limitation around people's understanding of what OCD is, they miss it if it's not presenting in a way that media portrays it. And it's more nuanced, like in your relationship or in your religion, or you have that new mom coming in and saying, oh, my goodness, I'm afraid I might harm this baby. What clinicians will typically do if they don't have exposure to ERP training is, let's look at this. Why would this happen? Even if they're doing solid general CBT work, let's examine the evidence for this behavior. You've never hurt anyone before. You don't want to hurt the baby. Now, the issue with that is the client. Okay, that's reassurance. This feels great. And that's a reason why people will attend their sessions and feel better in the moment. But then they go home and that intrusive thought comes in again, and it's, this doesn't feel great because I'm still afraid of harming this trial. So I think just doing a more like doing. Using measures like the Y box can be helpful in making sure your assessment is on point. Because then they have all of these different obsessions and compulsions that people will in different categories. Aggressive counting, ordering, symmetry, just right, those sorts of things that will help pick up some of the more less known OCD subcategories. And then that'll be like, okay, this. And I've had clients all the time in sessions say, I never even considered that a part of my OCD category, like that category. I've never. I would have never considered that. And so that's why I think proper training is important. And inside of that, proper assessment is important. And just us having these conversations to just say, hi. OCD is more than just cleanliness checking. And perfectionism is helpful as well.
- [22:34]
B
You Mentioned the Y box. Can you tell us what that stands for and how might like, a client use it or even ask for it?
- [22:41]
C
But I think it's the Yale Obsessive Compulsive Scale. That's what it is. And that's just one of the measures. And now you can also do some general measures of generalized anxiety and social anxiety as well as part of your assessment, just to kind of see where your client is standing on those metrics and how I do it. I start with a general intake just so that I can get to learn more about the client. And then I do a more specific OCD based assessment. Once we have that initial check in, some therapists may just move straight into a Y box. But I don't do that because I think, you know, I want the client to warm up a little bit and then we can get to know your history. Because I want to also be assessing for traumatic experiences and how that's going to intersect with the ocd. I want to know who the members are, like with the social context, like, who does this person have on their team? Are they married? Are they not married? Do they have siblings? Are they close with their family? I want to understand some of those things because it can also matter when we get into the OCD treatment as well. And I'm saying it matters because is someone co compulsing with the client? Right. Like, how does the system support and maintain the ocd? And so in order for me to get that, I want to know who the support system is in the role that they play in the client's life.
- [24:04]
A
More from our conversation after the break.
- [24:11]
D
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- [25:22]
A
Many of us play lots of different roles in life partner, employee, caregiver. And many of us also think about another role that could take our life where we want it to be. Degree Holder that's where National University comes in. They've been busy since 1971 creating more ways for you to work earning a degree into your hectic life. NU confers more graduate degrees to diverse populations than any other institution in the country, with more than half being earned by women. With flexible online formats, NU makes higher education possible and achievable for busy working adults. Learn more today at nu.edu this episode of Therapy for Black Girls is brought to you by Chase Sapphire Reserve. Whether you're booking your next trip or a weekend escape, Chase Sapphire Reserve is your gateway to the world's most captivating destinations. When I travel somewhere, I'm typically determined to try the best local pizza and find the best spa experience. With Chase Sapphire Reserve you have access to everything from private dinners hosted by award winning chefs to VIP treatment at the most sought after events. Chase Sapphire Reserve allows you to take advantage of one of a kind experiences while earning three times points on dining worldwide. No matter your destination, travel is more rewarding with Chase Sapphire Reserve. Discover more with Chase sapphire reserve@chase.com Sapphire Reserve cards issued by JPMorgan Chase Bank NA member FDIC subject to credit approval terms apply.
- [26:55]
E
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- [27:59]
B
I want to go back to something about the Y box because I think that there are lots of, like, checklists or like, DIY kind of things that, like, clients can take online.
- [28:09]
A
Like a screener almost.
- [28:10]
B
Yes, the Y box. And like, some of the other things that you have mentioned and that even other clinicians use are not actually things meant for a client to do themselves. Right.
- [28:20]
C
You.
- [28:21]
B
You may be able to find a copy online.
- [28:23]
C
They're online.
- [28:24]
B
They are online.
- [28:24]
C
They're online.
- [28:25]
A
Okay.
- [28:26]
C
By time people get to me, some of my clients are. So they. They are experts in anxiety. Right. And not a lot. I won't say a great significant number have, but because my clients are experts in understanding anxiety. And part of the compulsion can be hitting the Googles and being like, they come in, they tell me about ocd, and I'm like, you got it. Okay, so what are we doing now? You took a Y box and like, that's great. How are we going to further this treatment? Because now I just know how powerful the compulsions can be in your life. Once you've already reached me and you've. You can teach me about ocd. So that's a very big compulsion that you'll see people do is research, research, research, research, research, and more research. But it is true that, like, clients who reach me, they have a lot, have also haven't taken the white box. So I'm being a little bit silly when I say that, but it is important to know that you get experts in anxiety by the time they reach you. Yeah. You have to know how to deal with that.
- [29:26]
A
Yeah.
- [29:26]
B
And I think that that is an.
- [29:27]
A
Important distinction to make.
- [29:28]
B
Right. Because there are instruments like this and others that may not be so easily findable online, although I don't even know. A lot of stuff probably is online just because of where we are in.
- [29:37]
A
The world right now.
- [29:38]
B
But just like you mentioned, like, you wouldn't necessarily start with a Y box, and you consider that as a part of an assessment.
- [29:45]
A
Not.
- [29:45]
B
The only thing I think that that's important for non clinicians to hear is that, okay, you take this Y box because you find it and you feel like, oh, I checked, like, all of these boxes. That doesn't necessarily mean that there is an OCD diagnosis, but it could be grounds for a larger conversation with your clinician to consider.
- [30:02]
C
Especially in this day and age where we use words casually. Right. Like people say, I'm so ocd or I'm so on the spectrum. And I think that with ocd. OCD is painful. It's not like, I wish I had a little bit of ocd. People are struggling. It can be a pretty disabling condition for people when they're in the thick of it. There's a severity level to this. And so that's why I like for us to be careful with our words. These are things that actually impact the quality of people's lives and it can derail your life. And so it's not a casual thing to be tossed around. It's very serious. And we wouldn't do that same thing with other medical conditions. Right. We wouldn't be like, oh my gosh, I wish I had a little cancer. I mean, it's not the same. And like that the OCD can be as impactful on people's lives and we just need to be more sensitive to that.
- [30:55]
A
Yeah. So you mentioned that a part of.
- [30:57]
B
What you're doing in the assessment is also thinking about like a history of trauma and like considering how that impacts how the compulsion is showing up. Can you talk about how trauma might.
- [31:06]
A
Inform an OCD diagnosis?
- [31:08]
C
I think that in how I work with trauma. Well, first of all, if it's like big trauma to the point where it's hard for us to get to OCD treatment, I will refer out. I can do cbt, informed trauma, but I believe in specialists. You know, if there's someone who can treat that, they're going to be more helpful than I can be. So I want to make that referral. But if it's, it's that, that they have some well managed trauma, it's in their history, it might like pop out and say, hi, I'm here, pay attention to me. I can work with that. And what we're doing is really looking at how the OCD wants to reinforce the trauma. And so think about behaviors. If you're talking about a fight or flight reaction, it can say, I need to keep myself safe above anything else. So if this compulsion is keeping me safe, then it makes sense for me to do this compulsion. If avoiding this is keeping me safe, it makes sense to have that avoidance. And I do think that that's a functional way of being when you have had some trauma. But even if you're doing trauma informed exposure work, at some point it is going to be about confronting those uncomfortable feelings and in finding safe ways to confront those situations that you have been avoiding. Because again, it's just another way to shrink your life and keep it smaller. If there are safe spaces and safe. And I'm not using this in a healthy way. It's like, this is a safety behavior. This is a safe space. And so I only go here. These are safe people, so I only talk to them. That puts limitations on your life. And so we really want to understand the trauma and have the utmost respect for it and acknowledge, like, you have values that you're dissonant in because we're allowing your trauma and your OCD to come together to be like, you can't. You can't do this. And I'm like, it. What feels like I can't is more of a willingness issue, is, will you do this? Because you can, right? If you want to, if you make that decision. But it's, are you willing to take the risk and sit with the uncertainty connected to whatever the OCD and trauma are telling you?
- [33:11]
B
You also mentioned who's in the support system and how might they be co compulsing, which is also a newer term. I've not heard that one. But it makes complete sense, right? Like, if I have a loved one and I'm trying to support them, I may unconsciously, maybe sometimes support them in ways that aren't actually helping them to be better. So talk to me more about co compulsing and how to be attentive to that.
- [33:33]
C
Okay. So, yeah, co compulsing is what it sounds like. It's when you pull someone into your pattern of compulsing, and a lot of people are willing to do it because they want you to feel better. Right. And so unfortunately, that serves as a safety to the OCD is if every time I ask you for reassurance, you give it. Instead of learning what happens when I don't get that reassurance, I'm just learning that this behavior makes my anxiety go down. And therefore I'm going to continue to do this behavior. I really like to take the same way. I like to take a team approach and working with ocd. And so I'm like, I'm going to be the Phil Jackson. You're mj. We have our Pippins and our Rodmans on the team, and we're all going to work together in that same system that can help progress your treatment. It's the same system that can derail the treatment. And that's why the conversations, the assessments are really important to make sure we aren't having the team not support the treatment around that. And when you're talking to people who are on the team, it can be a relief to know I don't have to do this. Like I don't have to carry this along with you because ultimately, at the end of the day, the person in the treatment is the person in the treatment, and they have to be accountable for their treatment. They cannot overly rely on the system. And so people can feel relief, but they can also feel distressed because now they have to watch someone go through the anxiety, disgust, or shame connected to whatever is involved in that OCD cycle. And that can be hard to watch. And so they also have to learn how to resist that urge to rescue and provide that compulsion.
- [35:11]
B
So you mentioned that CBT is not necessarily like the gold standard when we're talking about an OCD treatment plan. You mentioned erp. So what does ERP stand for? And can you say more about, like, what treatment for OCD actually looks like?
- [35:26]
C
Yes. So we have our umbrella of cbt, and under that we have exposure and response prevention. And exposure and response prevention is, like you said, the golden standard for treating ocd. Because you're not going to be able to talk your way out of ocd. You will in traditional talk therapy. And that's because the part of the brain where the OCD is in the, like the midbrain, that's where you're getting that firefly reaction. Language is in the cortex. And so OCD does not care about all of that. It's going to always provide you another what if or what if, what if, what if. Right. It's an endless what if maker. And so because of that, we have to have a treatment that allows people to get exposed to the things that are anxiety provoking for them. And that can be an actual situation or a feeling or thought. And then we want to teach them a strategy called response prevention, which essentially means you are not engaging in that compulsion anymore. And so big picture, we're trying to teach people that they can sit with whatever that emotion is in the absence of that compulsion. Because the OCD says you cannot sit with this. You need to do the compulsion in order to feel better or prevent a negative outcome from occurring. And if the compulsion is always completed, the person doesn't really get to learn what actually happens. And at the end of the day, ERP is a learning model. We want to teach people new behaviors and allow them opportunity to practice that so that as they're practicing this new behavior, they get those older behaviors can shift to the background and they learn that they're competent and they can do it.
- [36:59]
B
So in the example that you gave around, like, okay, I'm a new mom, and, you know, I feel like I might Just throw this baby. What would an ERP kind of treatment look like there?
- [37:08]
C
Okay. And so if we're doing exposure work around harm based ocd, we I would ask that client what I want to know what they're avoiding, first of all, because if I can figure out what you're avoiding, I could turn that into an exposure. And it's likely going to be things that are naturally occurring and repeating. So that's a helpful one. So what that means is, have you stopped holding the baby as much? We're going to hold the baby, we're going to change the diapers, we're going to do the breastfeeding, or also might write what we call an imaginal script, which is obviously we're not going to tell someone to throw a baby. Like that's, you know, whatever. But we can use our imagination to create a script that says, there's a possibility that I'm not a safe mom. There's a possibility that I may throw this baby when I am feeding the baby. And despite this, I'm willing to take the risk. I may never have 100% certainty that I will not throw this baby, but it's important for me to bond with my child. And so I'm going to work through these intrusive thoughts and sit with these uncomfortable feelings and hold my baby. Right. That could be an example of script work. And so when we're talking about exposure, I do want to say, like, there are different types of exposures we do. That example was an imaginal exposure. And we do imaginal exposures when it might be illegal, unethical to do in exposure. And so we use our imagination. In vivo exposures are things that we can actually do. Right? Like I can lick my finger and touch a doorknob and lick it again. I can totally. We can do that. We can get in a car and practice driving over bumps without practicing turning around to make sure we didn't hit someone. So when we can do in vivo, we do in vivo and in neural interoceptive exposures when people may have trouble sitting with the physiological sensations of the anxiety. And so I might have someone hold their breath, spin in a chair, do some jumping jacks in order to get their body really dysregulated and teach them how to sit with that. And then we combine all of them. So I might do an interoceptive with an imaginal script for more deepened extinction to facilitate that learning.
- [39:18]
A
And how would you work?
- [39:19]
B
Even if we stay with this example? Right. Like, we know babies fall like, they bump into stuff. And if you are somebody who is struggling with like OCD type symptoms related to like, can I actually keep this baby safe? And then something happens, like, what does that then look like now when I bring that back into treatment?
- [39:36]
C
Yes, I love when those things happen. Because what we do know is babies will fall and toddlers will scrape a knee. And so it's not. OCD is not about always did the outcome happen or not happen? Because sometimes when you get into that pool, it can unintentionally trigger a series of compulsions. It's also about, but could you tolerate it? The baby fell and then what happened? Did you explode or were you able to sit with that dysregulation? And how did that anxiety respond over time? How did that guilt, I can't believe I let my baby fall. How did that respond over time? And so when the worst case scenarios happen, it gives us an opportunity to see. And how did you handle it? Because we want clients to learn that your OCD is lying to you. You can handle more than it's telling you you can handle. Right. And so that would be a great example. And we know the baby's going to fall again, the toddler's going to scrape the knee again. And so the parent gets an opportunity to learn that they can actually sit with whatever emotions, like if that guilt is there, that the guilt doesn't stay at 100% for the rest of their life, that it is a thing that's going to ebb and flow.
- [40:46]
A
And what does the treatment look like.
- [40:48]
B
When you bring in like the support system? Like what kinds of things are you talking with family members and friends about around how to support them while they're going through erp.
- [40:56]
C
Yeah. So I want to understand where the co compulsions are happening so that we can have a plan to decrease and then stop those. I also want to talk about how you can support in a way that doesn't allow the OCD to score points or to feel better. And sometimes that might mean saying things like if the person says, well, what if I harm the baby? Are you sure you want me to do the feeding tonight? And you say, maybe you will, maybe you won't. We're just willing to take that risk. And what it does is now the person was seeking certainty and reassurance and now we're back in the gray. And so if that other person doesn't come and do that compulsion by taking the baby and doing the feeding, now this gives the client an opportunity to learn what actually happens in the absence of that compulsion and what they can actually tolerate.
- [41:46]
B
I would imagine that this could be something. And you talked about, like, it being a very disabling kind of condition, because I could also see, like, relationship concerns being a spin off of this. Right. Like, now I don't feel supported because, you know, you're not enabling me to kind of keep up with the compulsions. Right.
- [42:00]
A
So I would imagine there could be.
- [42:01]
B
A whole host of other concerns that pop up as a result of trying to manage ocd. Be.
- [42:07]
C
Yeah. And as you can imagine, when you're trying to do this work and you're used to receiving reassurance and you're not getting it, we all have our natural reactions to things, and so OCD anger is a thing. Like, people get upset, and we have to work through that and learn how to navigate that. But as. As we're having our team conversation, I try to remind people that it's us against the ocd. Right. Like, ultimately, at the end of the day, even if we have to do some things that feel uncomfortable, let's remember what we're in it for, like, who our actual opponent is. And it's not us against each other. It's us against the OCD.
- [42:45]
A
Something else you've talked about, Dr. Moore.
- [42:47]
B
Is how hoarding can be, like, a part of the OCD spectrum and how this might look, especially in black families.
- [42:54]
A
Can you talk about, like, hoarding and what that looks like?
- [42:57]
C
Yeah, I think hoarding is one of those interesting things. I'm not a hoarding specialist, but again, like, if it's hoarding connected to ocd, I work with that. And I just think about, like, generations of families where collecting things was big, like, not having access to things and then having access. You get these knickknacks, you get these plastic containers that just seem to be endless. And sometimes people have had to operate. Maybe we. If we looked at it, we can say, I don't know if that comes from, like, survival, but it definitely can be a thing where every space seems to be filled with something. Right. In ocd, what we're looking at is what's the function of that behavior? And the function of that behavior can be different from how traditional hoarding presents. And so if someone's holding on to an item because they're afraid that they'll never be able to find that perfect item again, and it has to be that way, even if they don't like it or use it, they want to hold on to it, or people who will just keep buying things, like new shirts in that they don't want to break the new shirt in, so they'll just leave it in the closet and then they'll get another shirt and they don't want to break it in. And so they just keep accumulating shirts because they don't want to ruin it by actually using it. That's a presentation that I could see in ocd. And so that's why, again, the assessment and understanding the function of the behavior is really important because both will present with distress, though. But I want to understand the function.
- [44:26]
A
Right More from our conversation after the break.
- [44:37]
D
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- [45:47]
A
Many of us play lots of different roles in life partner, employee, caregiver. And many of us also think about another role that could take our life where we want it to be. Degree holder. That's where National University comes in. They've been busy since 1971 creating more ways for you to work, earning a degree into your hectic life. NU confers more graduate degrees to diverse populations than any other institution in the country, with more than half being earned by women with flexible online formats. NU makes higher education possible and achievable for busy working adults. Learn more today at nu.edu. this episode of Therapy for Black Girls is brought to you by Chase Sapphire Reserve. Whether you're booking your next trip or a weekend escape, Chase Sapphire Reserve is your gateway to the world's most captivating destinations. When I travel somewhere, I'm typically determined to try the best local pizza and find the best spa experience. With Chase Sapphire Reserve you have access to everything from private dinners hosted by award winning chefs to VIP treatment at the most sought after events. Chase Sapphire Reserve allows you to take advantage of one of a kind experiences while earning three times points on dining worldwide. No matter your destination, travel is more rewarding with Chase Sapphire Reserve. Discover more with Chase sapphire reserve@chase.com Sapphire Reserve cards issued by JP Morgan Chase Bank NA member FDIC subject to credit approval terms apply.
- [47:20]
E
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Years.
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- [48:23]
B
Something I've learned more about recently is Pandas. So this is like an OCD type disorder that happens in kids as a result of them getting strep throat, correct?
- [48:33]
A
Yes.
- [48:33]
C
Yeah.
- [48:33]
B
And so that is a newer kind of thing. I feel like that's recently something that medical professionals have discovered. Is there an equivalent or something like that where people will develop an OCD like symptoms related to a medical condition in adults?
- [48:49]
C
So yeah, that's very specific. There's pants and pandas. I may treat an adult and what they may find is that they've had like they started having strep when they were younger in life that was unmanaged and so I will refer them to a medical provider and maybe they keep having like getting strep over and over again. There's that resurgence and so I may have them go see a medical provider so that they can get on some long term management for that because that could actually be activating and maintaining OCD symptoms. But typically I see that I don't really work with kids anymore. I used to, but even with, like younger teens, when I work with them, I would see that presentation and it would be interesting. And again, that's why proper assessment is important. Because if you're asking those questions, now that we know that that is a thing that can inform your treatment and your referrals. Right. Because we can see those symptom severity drop down a lot. If it is a PANDAS presentation, once they get that management for the strep or whatever else is underlying condition that's activating the ocd.
- [49:55]
A
Got it.
- [49:55]
C
I think that's super. That's interesting.
- [49:57]
B
Yeah, it is very interesting. And I feel like, again, that's probably something in the last 10 years or so that they are learning more about. So we're always learning, I think, as always, what this looks like. So what if somebody is enjoying our conversation and they are thinking, like, you.
- [50:11]
A
Know what, this sounds like a condition.
- [50:13]
B
That I might meet qualifications for.
- [50:15]
A
Or I think a loved one may.
- [50:17]
B
Actually have some OCD symptoms. Where should they start?
- [50:19]
C
The International OCD foundation is a really great resource. They have so many different things, articles, books that you can look into on. On ocd. They do a lot of trainings for professionals as well. So if you're a professional out there and you think you might want to do some OCD work, I think IOCDF is a great place to start. There's also a newer resource, it's called ERP Kaleidoscope, and it's actually founded by a group of black women. And I think they're just recently getting it off the ground. And again, it's meant to be a space for providers and people who may be struggling with ocd. And so I think that those like iocdf, erp, Kaleidoscope are great places if you're looking for some specific OCD resources.
- [51:07]
B
Something else I wanted to ask you, Dr. Moore, what is the connection? And I feel like you talked about this a little bit around the religiosity, but, you know, what is the connection between, like, OCD and things like superstitions?
- [51:19]
A
Right.
- [51:20]
B
Like, how can you tell the difference?
- [51:22]
C
Okay, that's also a great one. Like, I can say, my family, we have a lot of superstitions that we operate on. You know, like some cultural things. Don't put the purse on the floor, you do this thing with the broom. Or if someone sees your foot. Yes, like a whole bunch of things. Now the difference with that, someone splits the Pole. I'm like, wait a minute, turn around. If someone did not turn around, I'm probably not going to experience a lot of distress. I might be annoyed momentarily, like, why couldn't you just do that? You know how I feel about this. But it's not something that's going to stick with me and create the amount of distress that they have to turn around or else is going to derail my next hour or the rest of my day. That's how we can differentiate with superstition from ocd. OCD has a high level of distress around it and if that person is in that phase, the compulsion has to be completed or, or they're going to be very dysregulated. With us, it's probably just going to be more of a fleeting thing if it's just regular superstition.
- [52:23]
B
Thank you for that. So are there any affirmations, books or other resources that you would like to offer to people who would like to.
- [52:29]
A
Learn more about this or feel like.
- [52:31]
B
This is something they're struggling with?
- [52:33]
C
My affirmation is you must be willing to risk. Right. It's not the type of affirmations that people think about that are reassuring. My affirmation is if you want your life back, you have to go get your life back. That means you have to take actions and steps. I say things like, let's be in our value here and what is the value? Is it to kind of stay here and co compulse with your ocd or is it to be able to go out and connect with your friends in this space that might not be ideal for you? Right. So my affirmations are more things that are geared towards pushing people into more discomfort willingly than just our sort of like feel good affirmations. Like I said, ilcdf. There are great resources listed there. I just think it's a great place to start.
- [53:19]
B
You know, as you're talking, I definitely think the way you show up as an ERP therapist or a therapist who does ERP feels maybe a little different than what you would might see in terms of like a typical presentation. But it feels like it fits the condition. Right. Like, that is why every therapist is not going to be the right therapist for everybody. Because we all have different trainings and our presentations, I think can look very different. And so what you're talking about, like you said, is very different than like the touching feeling. Well, not touchy, but, you know, the more feeling. Yeah, the more feeling kind of like, let's support you as opposed to this really, it Sounds like there's a high level of challenge that is necessary for this disorder.
- [53:57]
C
There's a high level of challenge and I think that if you're going to do ERP work, you have to be willing to do the advice exposures that your clients do and you have to be really willing to sit with other people's discomfort. A lot of providers like the techniques like breathing exercises and things like that because it helps clients feel better and people struggle with watching people reacting to things. And here we're like, we don't really do breathing exercises when we're doing erp. We don't really try those interventions because we're willing to sit with our clients having that distress because it's an impression important part of the treatment. Right. Like those sorts of interventions become distractions when it's directed towards ocd. And that's why I think proper training for clinicians is really important because a lot of times we with love it inadvertently co compulse with our clients because we don't fully understand OCD and the mechanisms that kind of maintain it. And you could be now I will say outside of erp, if someone wants just as a life, they're like, I breathe like this, this is me and my self care, go for it. But it's just not in the context of doing ERP work. And so I think you bring up a very important point in that the treatments can look different. And pertaining to ocd, you want to be trained to implement ERP and you have to have some willingness to sit with discomfort. I mean all therapists sit with a lot of discomfort but a lot of anxiety. And you have to be willing to show up and do the things that your clients are doing.
- [55:29]
B
And is the IOCDF the place that.
- [55:31]
A
You get trained in ERP or where.
- [55:34]
B
Would clinicians go to get training for this?
- [55:36]
C
Yeah, that's one of the places they do some advanced training in OCD and so I did some training with them as well. Knowledge tree is a place that's popped up, that's doing some more specific training and you'll get some overlap of experts who in the field who work in those different spaces. So yeah, those are two places to look for training. But I just think at ERP it's great to watch people level up in their. They feel more confident, they learn how they can actually tolerate things that the OCD told them that they can't tolerate. It's great watching people like grab bits of their life back that they haven't been able to do things in years. And I just think that when we talk about a barrier to treatment, one thing I see is people feel away by the time they reach an ERP specialist. Because sometimes people have had treatment and they're like, why didn't I know this treatment was available to me seven years ago? Because I would have, like, I've had some great therapeutic experiences, but it just didn't move the needle on my ocd. Help with my trauma helped with some general coping strategies, but my OCD seemed to never quite benefit from that. And I think the reason why I wanted to do this podcast is the information out there that there is specific OCD treatment, that it is very effective. We just want to make sure we are pushing people in that direction so that we don't delay treatment and have people incurring extra things like cost time, a waste of resource when it comes to time.
- [57:04]
B
And I'm sure there's no kind of standard on like, how long you would be in erp, but is there kind.
- [57:11]
A
Of generally, like how long you would be in sessions?
- [57:14]
C
Yeah, I want to check in around 12 and 20 sessions. And so I just want to look like if we're doing treatment for three months, I want to kind of look and see where they are in part of that. Why BOT scale. There's a severity scale that goes along with it. And so it's two parts. We look at the severity scale and I'll reassess that just to see how that number is decreasing over time. And when I say that number is decreasing over time, that doesn't always mean, like, the client gets to be anxiety free. ERP is about learning how to live with anxiety versus pure symptom reduction. And so a lot of people will come in thinking like, OCD me work means I don't have intrusive thoughts anymore or I don't have anxiety anymore. And I'm not signing that treatment plan. This is really learning how to live with an all cap. So I say things like, when we talk about affirmations, be anxious and do it anyway. Be disgusted and do it anyway. And so, yeah, like we can look at a session limit. And I use that resource, the YBOX Severity Scale, in order to help us know if we're on track. And I think it's a great accountability for me and for the client so that we're holding ourselves accountable for the treatment.
- [58:22]
A
Perfect. So, Dr. Moore, where can we stay connected with you?
- [58:26]
B
What is your website as well as any social media channels you like to share there?
- [58:29]
C
Yes, My website is Dr. Jamore.com and I am on Instagram at jam sessions. That's J A M S E S S I O N Z and so you can connect with me there.
- [58:43]
A
Perfect.
- [58:43]
B
Thank you so much for Joining us again, Dr. Moore.
- [58:45]
C
Yeah, thank you. It was good to see you.
- [58:47]
B
Of course.
- [58:52]
A
I'm so glad Dr. Moore was able to join me for this conversation and helping us better understand OCD and its.
- [58:58]
B
Impact on Black women.
- [58:59]
A
If you want to learn more about her and her work, be sure to visit the show notes@theapyforblackgirls.com session 425 for more information. And don't forget to text this episode to two of your girls right now and tell them to check it out. Did you know that you could leave us a voicemail with your questions or suggestions for the podcast? Whether you have ideas for future topics, book or movie suggestions, or just something on your mind, we'd love to hear it. Head on over to Memo FM Therapy for Black Girls and leave us a voicemail. If you're looking for a therapist in your area, visit our therapist directory@therapyforblackgirls.com directory and don't forget to follow us over on Instagram. Therapy for Black Girls this episode was produced by Elise Ellis, Indechuvu and Tyree Rush. Editing was done by Dennison Bradford. Thank y' all so much for joining.
- [59:50]
B
Me again this week.
- [59:51]
A
I look forward to continuing this conversation with you all real soon. Take good care these days, most things cost an arm and a leg, especially vacations. But not in Rhode Island. Between affordable luxury stays, succulent seafood right from the source, and spectacular shopping that won't break the bank, you get a real bang for your buck in the Ocean State. The memories will be priceless, but the cost will be a lot less. Rhode island all that. Plan your trip today at visitroadisland.com that's visitorodeisland.com Many of us play lots of different roles in life partner, employee, caregiver. And many of us also think about another role that could take our life where we want it to be. Degree holder. That's where National University comes in. They've been busy since 1971 creating more ways for you to work, earning a degree into your hectic life. NU confers more graduate degrees to diverse populations than any other institution in the country, with more than half being earned by women. With flexible online formats, NU makes higher education possible and achievable for busy working adults. Learn more today at nu.edu. this episode of Therapy for Black Girls is brought to you by Chase Sapphire Reserve Whether you are booking your next trip or a weekend escape, Chase Sapphire Reserve is your gateway to the world's most captivating destinations. When you use your Chase Sapphire Reserve card, you get eight times points on all purchases made through Chase Travel and even access to one of a kind experiences like music festivals and sports events. And that's not even mentioning how the card gets you into the Sapphire Lounge by the club at select airports nationwide. Travel is more rewarding with Chase Sapphire Reserve. Trust me. Discover more@chase.com Sapphire Reserve cards issued by JP Morgan Chase Bank NA member FDIC subject to credit approval terms apply.
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C
Com. Add a little to your life.
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E
Offers are subject to change and certain restrictions may apply.
- [62:47]
A
This is an I Heart podcast.