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Your Anxiety Toolkit - Practical Skills for Anxiety, Panic & Depression
463 My OCD Subtype Keeps SHIFTING: 3 Steps to GENERALIZE Your ERP Skills
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Welcome to youo Anxiety Toolkit. I'm your host, Kimberly Quinlan. This podcast is fueled by three main goals. The first goal is to provide you with some extra tools to help you manage your anxiety. Second goal, to inspire you. Anxiety doesn't get to decide how you live your life. And number three, and I leave the best for last, is to provide you with one big fat virtual hug. Because experiencing anxiety ain't easy. If that sounds good to you, let's go help.
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My OCD subtype keeps changing. Today we're talking about three steps to generalize your ERP skills. Now, have you ever felt like just when you start to make progress with your OCD theme, another one pops out of nowhere? It feels like whack a mole. I don't know if you've ever played the game of whack a mole, but when you manage one, another one pops up over here and you manage that one and another one pops over here. That is so common we often call it whack a mole obsessions. And we're here to talk about it today. The majority of my clients have had this to some degree and here is one thing that one of my students said and I thought it was so validating, they said all OCD is the ultimate trickster. It can flip flop all over the place and make your recovery feel like you're constantly starting over. So ultimately what I'm here to tell you is you, you don't have to start from scratch each time. And what I'm going to give you today is an idea or an approach that you can use if you struggle with this sort of switching between subtypes. And I'm going to give you some specific tools, three in fact, that you can use anytime, anywhere and hopefully you'll use them with a lot of self compassion. So let's talk about the agenda today. In this episode we are going to cover why your OCD subtype keeps shifting. We are going to cover how to generalize your ERP skill skills so that no matter how tricky they are, you have a plan and we're going to use evidence based tools to do so. Right? So this is not something I've made up. This is something that has evidence based so that you can feel confident and prepared. So let's get to it. Welcome to your anxiety toolkit. This is a podcast where I teach you everything I know about anxiety so that you can go on to live your biggest, most beautiful life. My name is Kimberly Quinlan. I am an OCD specialist in the Southern California area and I have this mission to help people with anxiety suffer less. I've been there myself. I know what it feels like. And my mission is to help you suffer a lot less or even just a little bit less. So let me tell you a real story about an actual client that I had, and hopefully you feel very understood and seen in this. So I once started seeing a client when she was quite young. She had contamination ocd. She would wash her hands when she had the thought that she had dirt on her or that she would make her grandmother sick. When she was a teenager, her mom called me back and said, oh, the OCD is back, but this time it's targeting perfectionism. She feels like she has to reread things. She has to check things. What did we do? We did what we'd already seen, work. We practiced exposure and response prevention, and once again, she got better. I terminated and slowly reduced sessions with her, and away she went to live her best life. But what happened is, again, I got a call this same client was now getting married, and she was being targeted by relationship OCD this time. And it was really impacting her ability to plan her wedding and even commit to staying married. She was already planning the divorce before she'd even gotten married because she was so, so overwhelmed by this new subtype of ocd. Now we learn our lesson. This time, we had seen that, okay, this has shifted themes quite a few times. Even though your ERP has been very effective after some years, which is great, by the way. She went on and lived an amazing, Got all of her goals met and her values met, which is awesome. But we knew she started to do family planning, that we would need to prepare for her OCD to come back. And so what we did is when she got pregnant, we did, of course, notice this obsession. We had obsessions back about contamination. We had pedophilia obsessions. We had postpartum obsessions. We had harm obsessions. We had all of the obsessions. But the cool thing is we had a plan. We were already expecting this to happen, and we knew what we needed to do. If this sounds familiar to you, I'm hoping it does, because it's a really important part of OCD recovery. Now, what I'm here to tell you is that maybe your OCD used to focus on contamination, and now it's moral OCD or harm ocd. Maybe it switches every few months. Maybe it switches every few minutes. That's also very, very normal. It can feel really terrifying. I totally, totally understand. And it can actually convince you that you're Never going to get better. But that is not true. Again, we just have make a generalizing shift in your approach. So the truth is here, this is the main point I want you to take away. But we're going to talk about how to do this as we move forward. The truth is, no matter the content, the treatment always stays the same. And we can actually generalize the treatment so that no matter what shows up again, your ERP skills are going to be incredibly helpful. Now, again, we just need to generalize these skills and we're going to break that down now. So let's first look at the mechanisms of ocd. So if you're following me here, you know the OCD cycle, I talk about it in all of our courses, on all of our YouTube videos. I talk about it on social media all the time. This is what the OCD cycle looks like. It starts with an obsession, an intrusive thought, feeling, sensation, urge or image. And when you have that, you feel an intense degree of anxiety or uncertainty or some form of discomfort. Maybe it's disgust or just a not right feeling. When we have that, we always engage in these compulsions to reduce or remove them, which does give us temporary relief. But when we have that relief, we actually reinforce the obsession. And now we're stuck going round and round and we don't break out of that cycle. Now what you have to remember is that same exact cycle happens. No matter whether you have relationship ocd, you have postpartum obsessions, harm obsessions, whether you have sexual orientation obsessions or scrupulosity or contamination or health anxiety, whether you have panic disorder, it doesn't matter. It's the same exact strategy used by ocd. You have an intrusive thought, feeling or sensation or urge, you have discomfort, you have to engage in the same five types of compulsions to get relief. But that relief reinforces this cycle and now you are stuck. And what I want you to remember here is, regardless of the theme, all compulsions have the same goal. They all do the same mechanism. These are OCD tricks I want you to be memorizing. These are what we would call OCD's goals, OCD. If we were to sort of externalize. OCD is it wants you to do compulsions. It wants you to keep ruminating, checking, asking for reassurance, avoiding or, or beating yourself up. Those are the top five compulsions. And that's what it's going to urge you to do immediately. It's going to always try to keep you hyper vigilant and focused on just in case it's going to be like, just in case, you better do it. Just in case, you know, I know this is probably not going to happen, but just in case you should do this compulsion. That's the goal. And the trick of ocd, it also is always going to create more drama if you do not adhere to its demand. So if you're like, no, no, no, I'm not going to do these compul. It's going to get louder. And that's often when it does switch themes. And we'll talk about that more here in a little bit. And so, of course, in every episode of your anxiety toolkit, I want to give you an anxiety toolkit to use to take with you, and so you can practice this for homework. So let's talk about it. When you feel like your OCD subtype keeps shifting, you have to remember it's all just content. Go back to that OCD cycle. Every single subtype has the exact same cycle. The only thing that changes is the content of the obsession. Maybe you're having intrusive thoughts about harming, or maybe you're having intrusive thoughts about things being perfect or not praying right, or that what if you get sick? Or it doesn't feel right, like, the list goes on. The content of the obsession is the only thing that changes. We do the same discomfort, have the same uncertainty. We have the same anxiety, we have the same disgust. We do the same five compulsions, we get the same relief and then we reinforce the OCD exactly the same. The only thing that differs is the content. And the content is simply just words. One day it's what if you want that person to die? And the next time it's like, what if you purposely harmed them? The next time it's like, what if you prayed wrong? Next time it's like, what if you want to pray wrong? Right? Like, that's the nature of ocd. The content, those words, those simple words, is what is different. And it's all about that content. So what I want you to remember here as we move forward is I want you to be kind. This is tricky work. It requires you to become a trickster back. With ocd, you have to, like, think big picture. When we talk about generalizing, erp, we have to think wider and broader and more abstract when we're having these shifting OCD subtypes. And you're going to have to be really kind with yourself because this does not come natural to us OCD folks. And it's going to take some time. So let's talk about how you can be tricky too. Number one, your job is to simply catch the repetitive cycle, catch how it twists and turns the content. We're going to then work at not engaging in the content. I don't want you to touch that content with a 10 foot pole. I want you to get so good at observing when that content shows up and being like, ah, you almost tricked me there. You almost got me with the content. But I am not engaging with that. You're going to have to be willing to be really uncomfortable and to be really uncertain because again, it wants you to do a compulsion so you can remove that discomfort or remove that uncertainty. And you're going to have to recognize the urge to solve or figure it out as a part of that cycle. And remember that this is not a special case. This is OCD playing exactly the same tricks, but just with different content. So I always use this metaphor with clients and I hope it's helpful for you. I actually created this image with AI and I love it. I think he's exactly how I imagine him. So I always think about OCD when I'm talking with kids, but with adults too, and I want to think about on my own. I always think of ocd, this like little monster that sits on my shoulder. And he's green, he looks just like this. And he's really lazy and he's really mean and he's really like a trickster, right? He's mischievous, but he wants to be lazy. He doesn't want to expend a lot of energy sending, you know, getting you all flipped out and freaked out. He's going to use the lazy approach by using the fears that you already have or using the values that you have to get you to do compulsions. That's his job. He's like, I'm tired, I want to chill on the beach, I want to sip my margarita. And so I know Kimberly really cares about her children, so I'm going to throw her a fear about that because I know that's an easy win. She'll definitely do compulsions if I tell her that, you know, just in case, you better do right. And so he throws you a thought about your children. Okay, now your job is to catch this trick and be like, oh, I see you just pulled out the easiest, laziest approach to get me to move. I'm not falling for it this time. Ocd.
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Okay, so if you're looking for effective OCD or BFRB treatment that's covered by insurance, I'm thrilled to Announce to you this week's sponsor, nocd. NOCD provides live face to face video sessions with licensed therapists who specialise in OCD and related conditions through exposure and Response prevention therapy, a highly effective treatment designed specifically for OCD. Their therapist can tailor a plan just for you. NOCD's treatment approach is clinically proven to significantly reduce symptoms with an app that helps you stay connected to therapists and peer communities in between sessions so you'll always feel supported. NOCD is available in all 50 states and even internationally and accepts most insurance plans, making care affordable and accessible. If you think you might have OCD or are struggling to manage symptoms, there is hope. Book a free call@nocd. You don't have to struggle alone. Big hugs. And now let's get back to the show.
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Now when you do that, I always imagine he kind of like sits up in his chair a little bit and he looks left and right and he's like, what? Kimberly's not falling for it. This is odd. I can always switch it and if she doesn't care, this is fine. He'll be like, this is fine, this is fine. I know what's gonna happen. Maybe, maybe she didn't fall for that one. But I do know that she really, really loves her husband and I know she has got some anxiety about her marriage and so I'm just making this up. He'll be like, okay, I'm just going to throw a thought at her that maybe she doesn't love him enough. That'll get her going, okay, cool, I'll just switch the content. So he throws that out and of course I'm like, oh, yeah, that really does matter to me. I would be thinking, oh, it would be really irresponsible if I don't pay attention to that. So I better give this some an attention. But if I don't give it an attention, he's going to be like, wait a second, what's going on? She didn't fall for that one either. Right. And so what's he going to do? He's going to throw you the next obsession. That's what he does. Does. Now, there might be times where I'm really caught up in one obsession. Let's say it's health anxiety and I'm really doing a lot of compulsions and I'm fully in the cycle and I've fallen off the wagon with my erp. That happens for everybody. And he's like, yeah, like, okay. Like she seems to be doing okay. And this is, you know, I've Got to do it a little comfort. I'm just kind of bored. And he might throw you a new obsession. Anyway, so this is how it functions. You're gonna have to get really good at observing the lazy tricks of ocd. Now, if you don't like externalizing it and sort of telling this sort of story, that's fine. But find that visual really helpful to think about. Like, he's lazy. He wants to sit back and enjoy his margarita and just chill in the sun. And so he's going to throw the thing out that you value the most. Your job is to get really good at not buying into that content. Now, we talk a lot about this in Euro CD Toolkit, which is an online course that we have that step by step teaches you exactly how to practice ERP from the very beginning, all the way through, exactly how I teach my clients. If you're interested in that, head over to cbtschool.com your OCD toolkit. And if you're a clinician and you want to learn how to use ERP with your clients, you can head over to CBT school. We also have a course called the Clinicians OCD Toolkit where we have continuing education units. We are covered by NBCC to provide treatment trainings for clinicians. And we go way in depth. We talk about the this so in depth. So you will love that resource. But in the meantime, let's talk about skills. Let's talk about actual toolkit. Number one we've already talked about it is you're going to need to practice catching the cycle. This is going to make you zoom out. You're gonna have to pretend like you're a camera when you're really zoomed in on a thought that you're having urgency around and you're having a lot of anxiety and uncertainty around and you're feeling a strong urge to do compulsions, you're gonna have to pause and be like, wait, I think I'm stuck. And you're going to have to zoom back out and catch that. This is the same cycle OCD uses in every subtype I have for every person that has ocd. Right. You're not alone. There's a large percentage of people, thousands and thousands of people with OCD where this same exact cycle plays out. And your job is to catch the cycle. The next step here is to practice not engaging. I say do not touch it with a 10 foot pole if it comes up. And again, I will repeat this if there is an intrusive thought that comes with a lot of Urgency that is not in line with your values, that is repetitive, like really relentless. And you feel an urge to do any of those five compulsions, right? It's ocd, right? If it's making you check, if it's making you ask for reassurance or avoid, or it's making you ruminate over and over and try and solve something, if it's making you beat yourself up, it's going to be your ocd and we're going to practice not engaging with it. We want to avoid that grumpy old monster that we talked about so much that he like spins out and passes out because he's just so overwhelmed with the fact that you aren't playing with him anymore. Now, the last thing. Oh, wait, I've actually got something really important that I'm going to tell you here is let's first talk about mindset. Mindset is going to be key because this work is going to take make grit. You are going to have to be able to practice this over and over. The thing that I have found my clients get the most stuck on here is they do it once and they don't engage. Then they do it twice because another thought, remember that OCD monster is like, wait, wait, I better bring out the big guns. Is they maybe two, three, four times they're practicing it, and then on the fifth time they're like, this isn't working. I give up. I'm going to do the compulsion. You're going to have a mindset of being ready and prepared for your intrusive thoughts and obsessions and subtype to move. Remember my client I told you about? She worked really hard at being prepared for all. We knew the areas that OCD was going to trick her in. In fact, it tricked her in areas she didn't even know, but she was prepared and ready to do this on repeat. So now if we move on to the third science back strategy, it is going to be response prevention. Now, remember in that OCD cycle where we talked about compulsions, your job is going to be to practice not engaging in any of these compulsions, no matter how many of these subtype obsessions you have, no matter how many intrusive thoughts you have or intrusive urges you have or intrusive images you have. And you're going to practice not engaging with any compulsions either to try and reduce or remove those obsessions. So that might be getting back into the thing you were doing. So let's say you are doing the dishes. All of a sudden you start having contamination Fears, you stay doing the dishes. You let the thoughts be there. You are willing to be uncertain, and you get really firm on, I am not going to ruminate about this. I am not going to beat myself up about this. I am not going to ask for reassurance about this. I'm not going to check. I'm not going to do any physical compulsions. So we're really going to double down on that response prevention. Now, once again, I will say we go deep into this on our course. I don't mean to be, like, repetitive in that I don't want you to feel like this is a sales pitch, but it is important that you get really clear on what those compulsions are. So if you're not in treatment, I do encourage you to have a very good list of the compulsions you tend to get engaged in so that you can resist that compulsion. Now, of course, I've talked about this already, but please have patience. This work sucks. It's not easy, it's not fun. It is muscle in your brain that we are strengthening. And you do have to remember that you're going to need to practice this on repeat. I often say to my clients, if you're doing this on repeat and you're going, okay, I'm going through those three steps, and then I have to do those three steps again, and then I have to do those three steps again with the next subtype. That is proof that you are doing good work. That is proof. I'm going to say it again. It is proof that you are doing the most, most courageous, badass work that we could ask you to do, because you are not engaging. You're doing your response prevention. You're seeing how it's pulling you in, and you're changing your behavior. What do we do when we change our behavior? We change our brain. We change the neuropathways in our brain. And so we want to have a lot of patience with ourselves as we do this. And we want to also know you will suck at it and you will fail at it. And that is totally normal. We're not here to judge you. That is a normal part. You just keep, keep on practicing. So here is something I want you to watch out for. Is OCD is really tricky at telling you this one is different. What it's going to do. Imagine that. Go back to that little monster on your shoulder. If it's tried to get you back engaged, it's pulled out the things you care about the most, your biggest vulnerabilities. It knows what your weaknesses are. And so it's going to throw it at that. Yet if you still don't budge, he's going to have to sit up in his beach chair and put his margarita down and be like, whoa, I'm going to actually have to get to work here. And so what's the easiest thing it can do? It can say, this one is different. I know in the past, you know, maybe that was your ocd, but this one. No, no, no, no. This one is serious and different. And you really would be irresponsible if you do not engage with this one, because this one is really important. Very, very tricky. OCD loves to convince you that this. This fear is real and it's urgent. It really loves to tell you that you're being irresponsible if you don't do this, you're a bad person if you don't do this. You know, it knows again, where our weaknesses are. And it will always have you do what we call just in case compulsions, just in case, you'll be able to really enjoy the party. If you just do this one compulsion, then you can go off and live your very relaxed life. Just do this one compulsion is what it's going to say. Very, very tricky. Okay, so what we want to say to OCD is, yes, this feels new, but it's still ocd. I know what to do here. Right. It's you being able to identify the cycle. Now, we don't want to go into overusing, like, this is just my OCD and this is just my ocd, because that can become a compulsion. We don't want to get caught in that where you have to keep repeating to yourself, it's just ocd. It's just ocd. It's just ocd. What we want to do is we want to be able to use a language where we have this wisdom and this insight as to. I can see this pattern. When I feel uncertain and I have these intrusive thoughts, I always go into this pattern. And this pattern never works. The more compulsions I do, the more stuck I feel. The more lack of confidence I have, the more I feel completely hopeless about this situation. I know what to do. I'm going to do a 180U turn, and I'm going to change how I respond. This is the work that I want, as all to be doing. Now, there are some things I want you to remember before we move on. Number one, thoughts are not facts. Just because you have an obsession doesn't mean you have to give it your attention. We also want to remember, exposure and response prevention is the gold standard treatment for ocd. Again, if you have not got access to an ERP therapist, please go to your OCD toolkit and we will teach you what you need to do and you can do it in your own timeline. Number three, do not get caught in the content. Right? That is a trap. Number four, please be kind. This is hard work, this is challenging work and it does require you to practice that part of the muscle of the brain where you zoom out and you see this for what it is. And I want to remind you, you can recover even if your OCD switches from one subtype to the next. All day long there is still the same treatment that you're going to use use. You're just going to apply it and generalize it to all of those different thoughts and not treat one thought as if it's more important than the other. You're just going to treat them all the same, right? With the same response and the same degree of non importance and the same degree of non judgment and the same degree of compassion. And if you start to do that, you will start to see some shifts. Thank you so much. I know how important and valuable your time is. As always, it is a beautiful day to do hard things and I cannot wait to see you in the next episode. Have a great day everybody.
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Please note that this podcast or any other resources from CBTSchool.com should not replace.
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Professional mental health care.
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If you feel you would benefit, please reach out to a provider in your area. Have a wonderful day and thank you for supporting CBTSchool.com.