Are My Intrusive Thoughts "Normal" Or Do I Have OCD?

What this episode is about

This discussion focuses on the nature of intrusive thoughts and their relationship with Obsessive-Compulsive Disorder (OCD), clarifying common misconceptions about both. The conversation emphasizes the importance of understanding these experiences, reassuring individuals that even complex and isolating feelings related to OCD can be addressed in a therapeutic context.

Key takeaways

• OCD isn't just 'liking things tidy'; it's life dominated by intrusive, relentless thoughts.
• Therapists are like emotional plumbers: they've heard every mental clog and mess before.
• Don't thank Apple Podcasts; thank your eventual therapist for helping unpick this mess.
• Clinically, no two OCD patterns are identical—every mind's a unique playground with its own rules.
• Compulsions aren't hobbies! If checking emails 20 times steals your day, it's probably OCD.

What is discussed, and when

1. 0:00 – 10:00: Intrusive thoughts, Catherine Wood, Christy Plantinga, Felicia
2. 10:00 – 20:00: Impulsive thought, Intrusive thoughts, International OCD Foundation, Relationship OCD
3. 20:00 – 30:00: Intrusive thoughts, Felicia, Substance addiction, Therapeutic relationship
4. 30:00 – 40:00: Intrusive thoughts, Pure O, best therapist.com, Best Therapists
5. 40:00 – 50:00: Intrusive thoughts, ACT therapy, elite OCD subreddit, freemind 213
6. 50:00 – 1:00:00: Intrusive thoughts, fabulous OCD subreddit, Felicia, OCD subreddit
7. 1:00:00 – 1:10:00: Felicia, Intrusive thoughts, Andrew of Converse, emboldened theapy.com

Notable quotes from "Are My Intrusive Thoughts "Normal" Or Do I Have OCD?"

• Therapist Thinks. I am Christy Plantinga. I've been to a lot of therapy. And I'm Felicia Keller Bole.

  about Felicia · at 0:58

• Lot of misconceptions around both of these things and that is OCD and intrusive thoughts and how those two things interact. So, I'm excited to get some definitions down for…

  about Intrusive thoughts · at 1:43

• So you talked about things like it's called magical thinking OCD. If I do this thing a certain way, someone I love is going to die.

  about Magical thinking · at 6:26

• We know there's pedophilia OCD of am I a pedophile? Do I love children? And we also hear unfortunately for people things feel even more they see themselves as.

  about Pedophilia OCD · at 7:43

• Through a trusted resource. I would say for anyone who's even a little curious, start with the International OCD Foundation that is very sound research and information. It's…

  about International OCD Foundation · at 11:03

• There is a difference between intrusive thought and impulsive thought. Impulsive is random, unexpected and it fleets, right? You might have a thought Oh my god, what if I killed my grandma? And then you never.

  about Impulsive thought · at 14:40

• Let's get into it. This was posted in the OCD subreddit. I'm sure this is like a very active and actually fantastic subreddit to be on just for finding community. And again, like the comments are popping off.

  about OCD subreddit · at 33:39

• Someone is actually a compulsion. It can also be that you fall further on the pure O side which has very little physical compulsions.

  about Pure O · at 38:17

Who and what is mentioned in this episode?

People

• Felicia — Person · 6 mentions · first at 1:02
• Christy Plantinga — Person · 1 mention · first at 0:58
  Can find it easily. Thank you so much, Apple Podcasts. Welcome to What Your Therapist Thinks. I am Christy Plantinga. I've been to a lot of therapy. And I'm Felicia Keller Bole.
• Felicia Keller Bole — Person · 1 mention · first at 1:02
  Therapist Thinks. I am Christy Plantinga. I've been to a lot of therapy. And I'm Felicia Keller Bole.
• Catherine Wood — Person · 1 mention · first at 1:07
  I'm a licensed somatic therapist. We are joined today by Catherine Wood.
• Maria Bamford — Person · 1 mention · first at 8:02
  Maria Bamford talked about this in her book, Sure, I'll Join Your Cult. So, for folks who don't know, Maria Bamford is an incredible stand-up comedian who does a lot of her comedy.
• freemind 213 — Person · 1 mention · first at 40:56
  Also in the elite OCD subreddit, this is from freemind 213. Is it true that all intrusive or obsessive thoughts are lies? I've seen a lot of people say that every intrusive or obsessive thought you have with OCD is not true,.
• Trashvesty — Person · 1 mention · first at 55:22
  Also in the fabulous OCD subreddit, I don't know if I could even pronounce this user name. Trashvesty. Yeah, good job on a creative name. but how does one just let an intrusive…
• Marley Cyrus — Person · 1 mention · first at 1:01:22
  Absolutely. To quote the great Miley Cyrus, it's the climb.
• Andrew of Converse — Person · 1 mention · first at 1:01:58
  Andrew of Converse. To your point, like there's so much distance in practice.

Books & papers

• Sure, I'll Join Your Cult — Book · 1 mention · first at 8:04
  Maria Bamford talked about this in her book, Sure, I'll Join Your Cult. So, for folks who don't know, Maria Bamford is an incredible stand-up comedian who does a lot of her comedy around mental health issues. And she has.
• DSM — Book · 1 mention

Companies & orgs

• OCD subreddit — Company · 3 mentions · first at 33:43
• What Your Therapist Thinks (WYTT) — Company · 1 mention · first at 0:55
  And rate the show so that new listeners can find it easily. Thank you so much, Apple Podcasts. Welcome to What Your Therapist Thinks. I am Christy Plantinga. I've been to a lot of therapy. And I'm Felicia Keller Bole.
• International OCD Foundation — Company · 1 mention · first at 11:07
• best therapist.com — Company · 1 mention · first at 32:24
  Absolutely. and that's one of the reasons why at best therapist.com, like we do have a vetting process for a therapist because as much as again, I want to be so careful not to throw our fellow therapists under the bus cuz I.
• Best Therapists — Company · 1 mention · first at 33:08
  Because there is such a wide range out there, this is one of the reasons why at best therapists we have a vetting process right?
• elite OCD subreddit — Company · 1 mention · first at 40:51
  Also in the elite OCD subreddit, this is from freemind 213. Is it true that all intrusive or obsessive thoughts are lies? I've seen a lot of people say that every intrusive or obsessive.
• fabulous OCD subreddit — Company · 1 mention · first at 55:16
  Really, we know evidence-based treatment for this kind of stuff. So, also in the fabulous OCD subreddit, I don't know if I could even pronounce this user name. Trashvesty.…
• emboldened theapy.com — Company · 1 mention · first at 1:09:58
  Yeah, people can find you at your website. I believe it's emboldened theapy.com. We'll link it in the show notes. You're also a verified therapist on best therapist, so people can find your profile there as well. Awesome.
• treatmyocd.com — Company · 1 mention

Concepts & topics

• Intrusive thoughts — Concept · 19 mentions · first at 1:49
• Impulsive thought — Concept · 5 mentions · first at 14:41
• Therapeutic relationship — Concept · 3 mentions · first at 0:23
  Somatic, right? Like it's very body- based as well. This is the value of the therapeutic relationship. When you're I cannot tell this to anyone. your therapist has heard it…
• Exposure and response prevention (ERP) — Concept · 3 mentions
• Pure O — Concept · 2 mentions · first at 38:21
• Dermatillomania — Concept · 2 mentions
• Trichotillomania — Concept · 2 mentions
• Magical thinking — Concept · 1 mention · first at 6:28
• Pedophilia OCD — Concept · 1 mention · first at 7:43
• Relationship OCD — Concept · 1 mention · first at 15:12
  They're not willed to exist. No one's saying, I think relationship OCD is a really tricky one. So, I'm going to use that as an example of like I don't love my partner. I'm failing them. I'm going to cheat on them. I'm a terrible person.
• Substance addiction — Concept · 1 mention · first at 29:52
  Because, people do have bad experiences with therapists. And in my practice, I specialize in substance addiction and I am so protective over that, right? And I imagine you're…
• ACT therapy — Concept · 1 mention · first at 41:50
  The crux of axe therapy. ACT therapy.
• rehabilitation counselor — Concept · 1 mention · first at 1:09:38
  Hold national certifications as board certified music therapist and rehabilitation counselor. So I do have some portability and how I can treat people from a different land. I…
• music therapy — Concept · 1 mention · first at 1:09:47
  Be very conscientious around the boundaries and ethics with that, but I have used music therapy to help work with OC in the past. So that's a little great and it can be more creative. So yeah, that seems like really cool work.
• Attention deficit hyperactivity disorder (ADHD) — Concept · 1 mention
• ERP — Concept · 1 mention
• Hoarding disorder — Concept · 1 mention
• Panic disorder — Concept · 1 mention
• Phobia — Concept · 1 mention
• Y-BOCS — Concept · 1 mention

Full transcript with timestamps

0:00 even yourself when you've gone to therapy. No one wants to be doing this for a long time. You want to be better now and move on with your life. It sucks because life doesn't work that way. And it is hard and messy and complicated.

0:11 It's such an isolating disorder. You're so in your own head and in your own experience.

0:16 Very cerebral, but also like very somatic, right? Like it's very body- based as well. This is the value of the therapeutic relationship. When you're like, I cannot tell this to anyone. your therapist has heard it all. Reassurance is kind of one of the worst things people with OCD can receive from others.

0:35 Say more about that. So basically, we are so grateful to have been featured in Apple Podcast new trailers. Yes, it has been amazing and we're so glad that you're here, too. Make sure to review and rate the show so that new listeners can find it easily. Thank you so much, Apple Podcasts. Welcome to What Your Therapist Thinks. I am Christy Plantinga. I've been to a lot of therapy. And I'm Felicia Keller Bole. I'm a licensed somatic therapist. We are joined today by Catherine Wood. Katherine Wood is a multi-certified and licensed therapist with 14 plus years of experience helping teens and adults with anxiety, OCD, and PTSD.

1:21 Along with being a therapist, Katherine is also a musician. She can be found in Nashville and around the country performing her own music. Catherine, welcome to the show.

1:31 Hi, thanks for having me y'all. Yes, we are so excited for you to be here. This is such an important topic. Yeah, today we are really excited for this topic. We think that there are a lot of misconceptions around both of these things and that is OCD and intrusive thoughts and how those two things interact. So, I'm excited to get some definitions down for this stuff so we can have that understanding and then we're going to jump into some excellent questions that I found on Reddit. Sounds good.

2:06 Sounds great. I'm excited. Let's do it. Let's do it. Okay. So, first things first, what is OCD? Actually, it gets thrown around a lot. You know, people say, "Oh, I have to have, you know, a clean counter at the end of the night. I have OCD." that sort of thing. What actually is OCD?

2:26 Sure. And maybe what isn't? Because again, like this is something people say a lot and it fires me up to be honest because I understand that OCD

2:38 can be such a debilitating disorder and the fact that folks casually throw it around. And I know they're not trying to be like unkind, but it kind of hurts my heart a little bit cuz I'm like, there are people out there who genuinely have this and it makes life

2:53 pretty hard in some cases. So, what is OCD and what isn't it? Sure. Absolutely. Well, for your listeners who may not know, it stands for obsessivecompulsive disorder.

3:05 And OCD is absolutely a mental health condition that is quite serious. You might see more mild cases, but a lot of times internally it feels very severe. I want to start things it's not just cuz you know why not? And that's fun. But you often hear people say, "I'm so OCD." Like you said, I want to have a clean house. Things have to be a certain way. I'm so type A OCD. Like the way things are organized in my work. There's nothing inherently like dangerous, bad or distressing to be an organized person to have your preferences or your routines to like things to be clean, right? OCD itself is when those kind of habits, needs or preferences start to really affect how you live your life and the ways in which you show up. So, a great example since a lot of people like to say, "Oh, I'm clean, so I have OCD."

3:56 No, it's okay to be clean. The difference is if you cannot have a spot on the floor, you will not leave your house on time for an appointment. You might be in a call just like this and the whole time inside your intrusive thoughts are like there's spot on the floor. You're failing. You're screwing everything up. You're a dirty disgusting person. You're gross. You have no value.

4:19 Right? It escalates and those thoughts are so repetitive. There comes the intrusive thought piece

4:25 that you kind of hook into it. And so the compulsive part of OCD is those behaviors to try to shut those thoughts down. Now again, cleanliness is that most common theme people think of, but OCD can hit all kinds of themes in your life. You talked about perfectionism and things being just right. Nothing wrong to want to do your best job, right? To be your best contributor. However, if you were losing significant time, weight, stress, hours, think about emails. Proof read an email. Sure. Once or twice? Sure. not 20 times. People who show a little OCD will do that and more.

5:02 We'll spend hours checking other things, comparing information. Did I make a mistake here? I did. I'm a failure.

5:09 I have to do everything I can to fix it moving forward. If two people have clinical diagnoses of OCD, no two people's obsessive thoughts or compulsions are going to be exactly the same. So, what I'm hearing is you're that's an example, right? It's not that every person with OCD is going to display checking their email 20 times, but that is an example, right? And for some people, it is that

5:31 thorowness and shows up as perfectionism, but other compulsions are maybe not that at all. It could be something that's totally internal, like counting things as another way that can show up. And correct me if I'm wrong here, Katherine, but one of the other things that can happen with OCD, one of the other common things is sometimes thoughts are about um our self-worth and things like that, but also there can be intrusive thoughts about preventing,

5:58 you know, maybe scary or harmful or dangerous things from happening, which gets into the sometimes delusional nature

6:06 of obsessivecompulsive disorder. So can you talk a little bit about that? Mhm. Well to your point there's so many different themes of OCD. OCD is an umbrella and there's so many trickles and it is case by case. Ultimately OCD praise oftentimes the things you value the most or care about the most.

6:26 So you talked about things like it's called magical thinking OCD. If I do this thing a certain way, someone I love is going to die.

6:33 Right? M I've learned that if I don't do X, Y, and Z, there's going to be a car accident today.

6:40 Um, so there's that piece which can lean toward a bit of a feels like an illusion even though that person having that experience

6:47 feels very convicted, you know, and will go out of their way to do every compulsive act like I did this routine one day and nothing bad happened. So that has to happen in the same order every time.

6:57 And is it worth the risk, right? If like my loved one could die in a car crash, why would I not do this? Even if it's like in the back of my mind, I know

7:05 maybe it's not true, but is it even worth the risk of not doing it? Exactly. Exactly. Yeah. Exactly. And oftentimes it may not make logical sense on the outside world. Like to your point, my fear is a loved one will car die in a car accident. So today I have to make sure I wake up at exactly 6:05 as I've done for the last year when no one died in a car accident. And from there I have to go to the bathroom first. Then I can take a shower. Then from there, I only have to eat these three things because that's the same thing I've had every day.

7:34 If I don't log on to this call by this time, it could happen, right? So like very regimented into these are the steps. But OCD can run lots of things. We know there's pedophilia OCD of am I a pedophile? Do I love children? And we also hear

7:51 unfortunately for people things feel even more they see themselves as deranged and challenge their ability like am I a murderer? I thought about pushing my grandma down the steps. I want to kill I want to kill her.

8:02 You know, Maria Bamford talked about this in her book, Sure, I'll Join Your Cult. So, for folks who don't know, Maria Bamford is an incredible stand-up comedian who does a lot of her comedy around mental health issues. And she has a form of OCD in which she has a fear that she's going to harm people,

8:25 right? but she doesn't, right? But there's this there are these obsessive thoughts about fears of harming people. So, it's really interesting that you bring that up. And then the behaviors that sometimes show up is things to prevent them from acting on it. Right. What's interesting is often times it's not even they don't actually have the impulse to hurt people. They have the fear that they're going to have the impulse to hurt people or the fear that they're going to take action to hurt people. So, yeah. Yeah, I mean I feel like we're kind of going all over the place here with all these different forms of OCD, but like you said at the beginning, it is really kind of a bit of an umbrella term and then there are different ways that this can show up in terms of the types and the nature of the intrusive thoughts.

9:07 Um the different types of repetitive behaviors and then the severity. Right. Right. Right. Well, now in the diagnostic manual for clinicians, OC is an umbrella term for other things like hoarding,

9:20 phobias, panic disorders, trickilomania, dermatillamania, so hair pooling and skin picking excessively, which are very compulsive in their nature. And even if you think about things like hoarding, it is the fear that they're something bad is going to happen by not holding on to these things. Most of the times the people know there's some part of them has that wise voice that's like well probably not but almost always those other intrusive thoughts and fears outweigh right so there is so many different ways OCD manifest in that anxiety spectrum now

9:55 so if someone suspects that they might have OCD what should they do what should they do how do they find out if they if they have this disorder or not that's a Great question because one compulsion can be excessive research and I see it a lot in my clinical practice. In fact, a lot of times with clients, we have to set timers like you stop at five minutes, you stop at one article. It's not a bad thing to be informed.

10:26 So, I say this all I couch this because obviously the internet is a great tool and I recognize that it can be costly to invest in an assessment upfront. Clinically speaking, if you have a concern that it might be OCD, there are several free screeners. You know that if you a great resource is treatmyd.com. They have a whole bracket of drop down menus of free screening tests and that they're all clinically sound. There's a dimensional OCD exam. There's the Y box. There's I could go on

10:56 and we can make sure that these are listed in our show notes so that folks know how to find them.

11:00 Perfect. Great. Thank you. But really, you want to go through a trusted resource. I would say for anyone who's even a little curious, start with the International OCD Foundation that is very sound research and information. It's also a site that is not going to feed OCD

11:17 with catastrophes and scary things and what if it's this and that. But start there. And if you're concerned, you can also access free screeners there. There's quite a few articles that are very clinically sound. Um, support groups, things like that. I think curiosity is where it goes. Then as you read things or take some screeners and if the information is showing up, you're like, it's really feeling like OCD, then it's time for you to start working with a professional and and get a little deeper clarity there.

11:47 Great. Thank you for that. Mhm. Yeah, the OCD community on Reddit asked great questions probably because of the researchoriented nature of

11:57 Yeah, it's funny that you mentioned that because that is related to one of the things that we are going to bring up today.

12:03 Yeah, definitely. I'm all for it. And I I see that a lot in the comments is like

12:07 I could tell you're researching a lot. But interestingly, I feel like that comment gets into like a bit of the pop psychology thing where we're looking at one aspect of someone's behavior and then going, "Oh, that's so OCD." And I think it's so important for us to understand that that's not enough

12:24 to say it's OCD. And that's where like the sort of popularization of psychology and like mental health speak getting out into the world. It's part of what's led to this issue I think of, oh, this person's toxic or they're narcissistic or OCD or whatever without actually having a deeper understanding

12:45 of what the disorder is. So, I just want to say like comments that are just like, oh, this proves you had have OCD is like, no, it doesn't. like that that in and of itself does not prove you have OCD. So

12:58 Mhm. Yeah. Absolutely. And sometimes OCD can develop almost situationally. It's really common to see it postpartum and maybe last 6 to 12 months at most.

13:09 Like there's a lot of hormonal changes, especially first time parents. Hey Christie. Um developing those fears. Um and you naturally care about your child, but other things can happen. And then

13:22 Milo actually shared that she had symptoms when my sister and I were little that she felt compelled to count things and I never knew this about her but she was like I would I would be counting the tiles on the walls because I was worried if I didn't you guys would get hurt.

13:35 Oh yeah. And I was like whoa that's I had no idea that was happening and then eventually it went away.

13:42 Right. Right. So and that adds that point like it can be situational can be a biological shift. traits of OCD and symptoms develop after like a a specific trauma that really once you address the trauma, the OCD aspects kind of reduce or diminish. So there's also nuances in is this a chronic issue, is this a life debilitating issue, is this situationally specific, and how do we need to address that? Mhm. Before we get into the Reddit questions, I do want to clear up another common, you know, thing that's thrown around and that is intrusive thoughts. What actually is an intrusive thought? Let's clear the air so everyone knows what actually is an intrusive thought. Yes, I love this because it is so in the lexicon of pop psychology now and very frustrating as a provider and for a lot of clients. So a lot of people who live with it frustrating.

14:40 There is a difference between intrusive thought and impulsive thought. Impulsive is random, unexpected and it fleets, right? You might have a thought like, "Oh my god, what if I killed my grandma?" And then you never think about it again, right? It just came out of nowhere. We have zillions of thoughts racing in our brain all day long. That was a moment of attention, right? Intrusive thoughts are repetitive, excessive. They're not willed to exist. No one's saying, "I think relationship OCD is a really tricky one." So, I'm going to use that as an example of like I don't love my partner. I'm failing them. I'm going to cheat on them. I'm a terrible person.

15:26 Right? That could be an impulsive thought that's coming up if you're there's actually some marital discontent when we're looking at OCD and this is an example that would be there's nothing disconnected but here's this thought this person doesn't want it it's uncomfortable and it keeps coming back and coming back and disrupting your attention your focus your ability to be present in that scenario and then it might lead to internal compulsions like monitoring how you feel physically when you're around that person

15:54 monitoring how your responses are to that person, right? So, I'm using examples, but hopefully that kind of helps the listener understand what an impulsive thought cycle looks like versus or excuse me, intrusive thought cycle versus impulsive.

16:08 So, as an example, maybe maybe I'm like, maybe not everyone has had this and I'm about to come off as a total weirdo, but you're like standing, you know, on the edge of a high place. You're like, what if I just jumped?

16:22 Yeah, definitely have had that thought. Which one is It could, and that's a tricky, it could be one or the other. However, in your context, I'm understanding it as an impulsive thought. Like, it just came out of nowhere. You're on the edge of a precipice. Like, yeah. Haven't I've had the thought of like, what if my car crashes in the street

16:40 and then I move on with my life, right? And that was the moment. Like, if you're standing on this mountain, Christy,

16:48 I don't go in mountains to be clear and I live in Denver. So, let's let's say it's a it's a skyscraper. That's you on a sky. Okay. You were looking over sky. What if I jumped off the skyscraper? Okay.

17:01 Sure. Could be an impulsive thought. Just a casual musing. Your brain was like, "Oo, this is really high up. Kind of a novel experience. A little weird. There's some risk here." All right. Then, but the intrusive thought cycle would say, "What if I jumped off of this? Oh my god. Do I want to die? Do I want to kill myself? I need to get back. I need to get down now. I might be with other people, but they're just going to have to stay here without me. I'm never going up on a height again. I will not walk over a bridge. I'm not. And then it can escalate to anything that looks like risk. Cuz I thought about jumping off this skyscraper and causing harm.

17:35 Maybe I can't drive cars anymore because what if I accidentally get the impulse when I'm driving to drive the car into something?

17:42 Yeah. And this means I want to die. And if I do that, I'm going to cause my own life and and then harm for all these people around me. And it just snowballs. So, it's almost like a distrust of self.

17:53 OCD boils down to that 98% of the time. It's not trusting in oneself. Um, and kind of your inner compass of like

18:03 maybe it's true, maybe it's not. These are my values and this is what I want to live.

18:08 Yeah. It seems like another theme with OCD can be like really strong fears that like I'm a bad person at my core.

18:17 Like I'm a bad person. I'm not safe. Other people might be unsafe around me. Like

18:24 it can also be like really related to our loved ones, right? So it's like I've got to keep my loved ones safe. So I have to do this in order to keep them safe. And maybe like if we go down a bit deeper, it could be like a good person would do that. A bad person would not keep their loved ones safe. So there's there can be a lot of focus on that. And I'm assuming that's not all that's not the case for 100% of people who have OCD diagnoses, but I imagine that a lot of people that is a that is a core feature of it. Absolutely. There's a series of like pretty common core fears and beliefs that underly a lot of OCD. The work in therapy is understanding it first and softening peeling the layers.

19:01 A lot of times, you know, and I I would say I take a more eclectic approach than maybe some other oi therapists, but I believe that we have and have seen where you need to kind of treat that stuff first. And you don't need to know if you're definitely a good person or a bad person, but you're acting in the way that you, you know, feel is a value based life.

19:20 That's really important. So, can you can you say again what aspect do we need to treat first in your opinion when someone's coming into therapy for OCD? Almost always there's very few circumstances where I start right with the exposure work with folks who are struggling. It is peeling the layers of how the OCD is presenting. What does this feel like? What's the core drive? Like okay, so you feel let's use this example about jumping out the skyscraper. Okay, what scares you about that? Well, if I do that, I'll die.

19:51 Okay, well what's scary about that? Like obviously death, right? But maybe that person's like, "I'll hurt everyone I love and cause massive pain for everyone." And then also, I don't know what happens after death. And that's scary, right? And peel it back some more and peel back some more. And the ball rolls into I again, I'm going to hurt everyone I care about

20:13 and I there's so much unknown and I can't handle the unknown. There's too much uncertainty. I can't handle it.

20:20 Right. So, it sounds like I I think Yeah. One of our maybe commonly held misconceptions about the treatment of OCD is that it's all just exposure therapy or like it's almost similar to like phob phobias treat how we imagine phobias are treated as like let's just put you in front of a bunch of these things that scare the crap out of you

20:40 and you're saying it's maybe much more based in healing and you we haven't said this yet but like healing the underlying trauma

20:48 you know and and the thoughts that arose out of the trauma that we experiience Like we've talked about trauma on the show before, but trauma isn't necessarily just like one event that is really hard. It can be developmental trauma. It can be something that is more subtle right?

21:05 But kind of getting at those underlying core beliefs that are driving the absolutely

21:13 obsessive and thoughts and compulsive behaviors. Right. Well, and to your point, so I also don't want to ignore that there's a high level of OC that starts in early childhood, four, five, six years old, 10, 11, like those brackets.

21:28 And often times with that, there may not be like an explicit trauma. The trauma is, oo, I had a weird thought. I don't know much about the world. It's bad that I had that weird thought. Oh, that's scary. I'm weird. I'm not like these other people.

21:42 The OCD can sometimes be its own trauma. And it is one of those tricky things of like treating it the intrusive thoughts in a way of like that's a thought

21:50 just as much as I can think the sky is purple. Maybe it is, maybe it isn't. I mean we deep down know it's not but

21:58 it is what it is, right? But absolutely working from looking at the core fears, the core roots first and managing ways to practice a lot more compassion, understanding, softening towards it, including those forms of OCD that feel really taboo and scary to talk about. And I have certainly worked with those clients who are like, "My thing is so disgusting and gross that I can't tell you what it is. I have to write it down." M

22:25 I love that there are therapists who specialize in this and that folks can go and share those things. No one should have to keep these things to themselves or be in danger of

22:37 losing their well-being, their lives, the lives they've built just to be able to talk about this because when we keep these things like inside, there's no one we can share them with. Um

22:47 like really there's just so much more suffering. Yeah, it's such an it seems like it's such an isolating disorder.

22:54 You're so like in your own head and in your own experience. Very cerebral. Very cerebral, but also like very somatic, right? Like a lot of these things like it's very body- based as well. But to your point about like when it arises early in childhood, it's like

23:10 you know, you think you're like this little weirdo and you're like, I can't tell anybody about how I'm feeling. Like it just I sound kind of like crazy. if I said any of this out loud or I would imagine there are probably sometimes cases where kids do say something out loud and their parents don't realize what's going on and they're like, "Oh, that's not going to happen. It's not a big deal." Right? Like don't realize the gravity

23:29 of like what their child is experiencing and it's probably hard to tell initially. like is this just like oh funny thought my kid is having and I can just encourage them and say oh it's not a problem sweetie versus when a child is really going beginning to develop these symptoms that may be with them for you know a lot of their life until they get help.

23:49 Absolutely. And to your point it's interesting you bring that up because reassurance is kind of one of the worst things people with OCD can receive from others and themselves. Yeah.

23:59 Wait, say more about that. Yeah. So basically the way these intrusive thoughts function is even though like consciously you know it's uncomfortable, you hate it, it sucks living like you said isolating, feeling crazy, feeling deranged, feeling whatever, your brain gets dopamine chemicals, worrying. And so when it's like here's this intrusive thought, let's figure out a way to answer this question. That reassurance she seeking which is a compulsion is one way you get the dopamine boost of I briefly answer this question even if it was only for two minutes and now the thoughts back right

24:33 so a kid who's like oh my gosh I if I eat this piece of meat I'm going to choke and I'm going to die and my brothers and sisters will never know how to live their lives again right okay so a kid might say like I'm really afraid of eating this meat I might choke and the parent could be like, "Well, you've never choked before, so go ahead and eat the meat. You're going to be fine." That you're going to be fine as a reassurance and that might help in that moment, but then in the brain, the brain's going, "Well, yeah, but this could be the time that it isn't, and maybe it's the type of meat, and it's maybe the way I eat it."

25:10 You go down the rabbit hole even further. It's like, "Oh, if that's okay, then what else do I have to control about this situation?"

25:18 You get 30 seconds of dopamine. And the brain's like, "We want more dopamine, so how else can we make a problem here?"

25:23 So, it's creating the problem so that it can get the hit from fixing it. Exactly. Yeah. Exactly.

25:29 That makes me think of biting my nails. And I'm not here to be like, "Oh my god, I bite my nails. I have OCD." Like, that's not what I'm saying. But I have struggled with biting my nails my entire life. And what you what you just described there,

25:41 like that is the experience of biting your nails. You're like finding a rough spot. And so you bite it. You bite your nail only to create a rougher spot only to bite your nail again. And it is a neverending cycle.

25:55 Never with brief teenytiny moments of satisfaction immediately followed by the need to do it again.

26:01 Yeah. I mean that's an excellent example too because I mentioned earlier in that OCD umbrella,

26:06 you trick some pulling hair skin picking and it's like I got all this out but now there's more so I have to go here,

26:13 right? Or this like I got this thing relieved. I don't know, a blemish, whatever. Now it's another blemish. So, we need to dig deeper, you know, and it's kind of the most tangible way I think you can kind of illustrate that dopamine cycle. Like you said, it's a there is a hit. It's a fleeting hit, though.

26:28 And really, OCD is not unlike struggling with other types of addictions. I was just going to say that, right? Like, we can kind of zoom out and be like, oh, this what does this have in common with other things that humans struggle with? And what are the other ways that we can have compulsions to repeat behaviors even when they are harmful in other ways to us?

26:48 Mhm. Absolutely. And I want to, you know, make the disclaimer too for folks who are listening. It doesn't mean that you are an addict if you have OCD or something under that, right?

26:59 But your brain functions in the same way. And you're absolutely right, Felicia. It it's basically the same cycle.

27:06 And it's also similar to eating disorders. So they're all in that same wheelhouse of

27:11 right there's there's that pattern that need for a chemical boost inside you go to all lengths we know it's bad we know it's uncomfortable we know it sucks we do it anyway got the relief that's not enough go more

27:23 yeah a process addiction like in many ways this is similar to a process addiction or a chemical dependency it just shows up I I feel like oftentimes this is just like a pretty human

27:36 thing like so many humans have experienced some version of a cycle like this, whether it's been for many, many years or something that's temporary. But that experience of I I feel compelled to do a behavior repeatedly even though it's causing other problems in my life is something I think probably most people are going to experience even if it's on a very small scale. It's like it may be almost imperceptible or may be very very brief, but you can probably relate to that. And again, that doesn't mean that if you've ever had an experience like this, you absolutely have OCD or you absolutely have an addiction disorder, but there is something about that experience that I think is so fundamentally human, you know?

28:19 Absolutely. Well, and it goes back to that theme you brought earlier like impulsive versus intrusive thoughts. Like we all go through things we're like, am I a bad person?

28:27 Am I unworthy? Am I causing harm? Am I imperfect? Right? and what are these things? But it's really how we respond to those inner worlds that creates more of the aspect of a disorder.

28:42 Yeah. Yeah. Great distinction. Thank you for that. I'm glad that we have some standard definitions. And I want to say before we get into the Reddit stuff, too,

28:53 this is the value of the therapeutic relationship. When you're like, "This is so weird. I cannot tell this to anyone." your therapist has heard it all. You know, like my comparison in my mind is like when you get a pedicure and you're like, "My toes are so weird. Like they're so weird. This person's going to be like so grossed out by me. They've seen it all. They've seen all the toes, you know? They're not bothered by your toes because they've seen all the varieties. And I think that's the value of getting help from a therapist, especially for something like OCD, because it is a no judgment space where you can be

29:32 where it should be. It should be, right? And if you do show up in a room with a therapist where that is not what you're experiencing,

29:41 right? Fire them. Move on. Move on. Move on. I just want to say that because, you know, people do have bad experiences with therapists. And in my practice, I specialize in substance addiction and I am so protective over that, right? And I imagine you're very protective over OCD and that you really want your clients to have

30:02 work with therapists who get this experience because there is a lot of misunderstanding sometimes even among clinicians. And so finding someone who specializes in the thing that you've got going on can be hugely beneficial. Right. And I'm not trying to throw therapists under the bus. I mean, there's a lot for us to know, right? Like even though we have our degrees and we have our experience, like there's a lot of disorders and you can't actually specialize in every single one. It's

30:29 literally it wouldn't be a specialty if you did, right? So, so finding somebody who really gets your thing can be just so beneficial.

30:39 Yeah. Yeah. 100% agree. I think it's funny as much as like the pop culture and their use of terms frustrates me, the clinicians who say they treat OCD, but they're just like straight up doing CBT like checking facts with clients and like you're making it so much worse.

30:55 And that's the kind of stuff that fires me up. Like if they say, "Well, this is my lens." I'm like, "No, exposure and response prevention is

31:02 like a subtype of a CBT, but there is no yes or no, right or wrong. We're not gathering evidence. It is that is a compulsion. It reinforces a dopamine cycle. It is so clinically unethical to work from that fra framework. And I would say the clients who I see are the ones who've tried therapy before and left feeling worse and why isn't this working for me?

31:24 And in this demographic is really susceptible because if you're an anxious person, there's always doubt. Is it me? Am I doing something wrong? I must be screwing something up. So I think that

31:35 so if they're not getting the results in treatment, it's fault. There's like maybe an even stronger chance that they're blaming themselves for that and they just think, well, I just need to be a better be a better client. They might not think at first, oh, I need to find a different therapist actually.

31:50 Oh yeah. I've heard stories where they've done numerous sessions with a clinician to the point where, you know, they tell me things and I'm like, that clinician what? How? you know, like they spoke about themselves for 45 minutes, they fell asleep. Um, they had someone in the room. Like really stuff that like we know as clinicians should not occur. But people who don't know otherwise and they're like, I guess this is what it is and it's on me to pick

32:16 as a client. Right. Right. It's your time. It's your money. You are the customer. It should be working for you.

32:22 Absolutely. I mean, and that's one of the reasons why at best therapist.com, like we do have a vetting process for a therapist because as much as again, I want to be so careful not to throw our fellow therapists under the bus cuz I think just as much as like with OCD folks may

32:39 need to like be more likely to leave if it's not a good fit. I feel like there are other diagnoses where like there is a strong impulse to leave like with um borderline personality disorder, right? where like maybe the medicine for them is like actually you might want to lean more towards staying cuz you tend to want to leave, right? But OCD is almost like the opposite end of that spectrum where their medicine might be to leave until they really find someone who's good a fit. So want to be careful about that. But

33:05 because there is such a wide range out there, this is one of the reasons why at best therapists we have a vetting process right?

33:12 So we make sure it's not it's not enough that you're just licensed. you actually need to have uh evidence that that you're a good clinician. Other people are going to vouch for you, right?

33:22 Yeah. Thanks for saying that, Felicia. And you know, we check for um any disciplinary action and stuff like that. Um and it's pretty rare in our experience. I think if you are applying for the directory, you know, you probably don't want to have skeletons in your closet. Um but we catch them. So,

33:39 um let's get into it. This was posted in the OCD subreddit. I'm sure this is like a very active and actually fantastic subreddit to be on um just for finding community. And again, like the comments are popping off.

33:56 You can tell a lot of these people have been in therapy and getting professional advice about all of this. Um so

34:03 from the subreddit OCD from Pink Tree 5, everyone gets intrusive thoughts. How are OCD ones different? I was recently diagnosed with OCD and I'm still trying to understand it. I'm kind of doubting my own diagnosis because I don't have hardly any physical compulsions. I just had a quick question. Did people with OCD just have more frequent/intense intrusive thoughts than typical people? Or is it just the way we react to those thoughts that makes an OCD diagnosis? I just keep searching for the reassurance that I do have OCD, but even when I do, I can't get relief. I think hearing your opinions might help me.

34:47 I'm already hearing like some OCD behaviors. I'm sure you guys are That's what all the comments were saying. They're like whatever like the stuff that you're saying, you know, that is like a a really good signal that yeah, this is probably happening for you.

35:01 Yeah. In the clinical world, OCD is like the doubting disorder. and she legit was like or he they were like I have my doubts like uh-huh light bulb and I think it's totally justified to want to consider second diagnosis because to that point we do have folks who are maybe not well trained or well informed and there are misdiagnoses all the time and I see it all the time I get a lot of clients with you who have ADHD because neuro divergence is a precipitating factor often for OCPD but get misdiagnosed with bipolar so I'm going off the rabbit trail a little bit but it's It's fair to for that person to want to get a little bit more feedback, but already like they are absolutely re reassurance seeking. I'm definitely aligning of doubt and question. I want to assume the best of how they received that diagnosis. So hopefully they did go through a battery of screeners and went through like a substantial clinical exam

35:53 before receiving that. Their question about is it external or internal? I think we kind of talked about this earlier. OCD can be a very internal experience and it can all be about your mental testing and monitoring and mental checking. Does not have to be external behaviors in any way.

36:13 And really internal OCD is much more difficult when there is no externalized place because it's just you up here all the time. And trying to break that cycle is really hard. And if I think I recall her, you know, this person talking about like repetitive intrusive thoughts. Yeah. I mean, if it's frequent and there is distress, I want to emphasize like distress is a key component here. And this is happening a lot and you're like, "Yeah whatever." It's probably not turning into OCD. It is just on its way. But I'm hearing this person kind of get hung up already on what it could or could not be. And I think we're getting a lot of signs here for them, you know, and it's clearly causing them enough distress that they feel the need to post and get information.

37:02 Christie, what did some of the top comments say? I want to get your thoughts, Catherine, on like whether or not you agree because part of our goal on the podcast is to,

37:12 you know, be the experts in the room of the internet and kind of see like is the advice out there that folks are giving things that we agree with or do we have some, you know, some updates that we want to share? How

37:27 some notes? Yeah. Again, I'm really impressed by the users on this subreddit. You can tell they're very educated because these are the researchers, right? So, it makes sense that they have a lot of like info in their back pock back pocket. Um, but this is from Tommy 151. He says both really any given intrusive thought tends to be a lot stickier for lack of a better term. So, for someone with OCD, that thought tends to be stickier. Someone without OCD has the thought flashed and they move on, while someone with OCD has it stuck in their head for longer, often leading to compulsions to try to get rid of it. And on the note of compulsions, they're way subtler than you might think. I thought I didn't have any, and yet I realized I did when I learned stuff like moving a sharp object away when having intrusions of harming someone is actually a compulsion. It can also be that you fall further on the

38:21 pure O side which has very little physical compulsions. Oh my gosh. I don't know.

38:27 User 100% user. Wow. Nailed it. I mean, whoever that is, Jace repeated a lot of things we've already talked about.

38:36 Yeah, I know. He's a pro. Absolutely. And you know to to his point almost every person I've worked with in the OCD spectrum thinks they have like one or two versions of it and then as we go further they're like oh OCD is my entire life.

38:51 It comes out in ways you don't know. So I think this the original poster is probably

38:56 as they go through their daily life they're going to see other ways that it is manifesting instead of is this right or wrong. They're going to start to learn oh well that's an example of my

39:04 OP. and this is from unraveling nicely. The primary difference isn't the thoughts themselves but your relationship with them. OCD involves significant distress, time consumption, which you mentioned Catherine, on one plus hours daily, and efforts to neutralize thoughts that non-OCCD folks can dismiss. Pure O is common, and mental compulsions like reassurance seeking and rumination count just as much as visible rituals. Notice how you're seeking certainty/reassurance about your diagnosis. That pattern itself is quite telling. Constantly needing to verify your diagnosis, but never feeling satisfied is exactly the kind of mental compulsion that defines many OCD cases, including my own, early on. I love it. I have no criticism. And I do agree, Christy. Actually, Reddit is one of the resources I send clients to and they're like, I feel weird. I'm like, please go down this like

40:03 not as research just as like this is a virtual community. You're anonymous, but like

40:08 all these people are living in this world. There's very few instances I've seen in the time I've spent there where it's been like really harming and concerning. It is almost always people trying to be like,

40:19 you're not weird. This is part of life. We're all struggling. That user that's amazing.

40:25 Excellent response. Yeah. Yeah. I I agree. I think I mean I definitely noticed some things in that comment that seem directly taken from the DSM like there was some language and some criteria specifically

40:38 that they were referencing. Yeah. And they've referenced so many things that we've already talked about.

40:43 Mhm. Yeah. Well, let's get into our next question then. And I really really like this one. Also in the elite OCD subreddit, this is from freemind 213. Is it true that all intrusive or obsessive thoughts are lies? I've seen a lot of people say that every intrusive or obsessive thought you have with OCD is not true, that it's a lie, that it goes against who you really are, and so on. But honestly, I think that's a misconception. In my opinion, saying every intrusive thought is false just makes people seek reassurance more, which doesn't help at all. After living with OCD for a few years, I've discovered that some intrusive thoughts might have some truth in them, even if others are clearly not true. That doesn't mean the doubts or questions themselves are true, but it's not helpful to think of them as always lies either. We need to learn to be okay with uncertainty in order to live a more normal life

41:44 as humans. Yeah, we were both just like, "Yes." Yeah. The crux of axe therapy. ACT therapy.

41:53 It is or it is not. We don't know. I mean, it's interesting that post sounds like someone who posed a question but really was just giving their own experience in a personal statement.

42:03 And it brides back to that topic we talked about earlier about intrusive versus impulsive thoughts because there are without knowing the context. I would have loved to hear some examples. And this seems to be a thread sometimes with OCD like for that person struggling the deeper you get into it. Any thought that feels out of the ordinary can start to feel like an intrusive thought versus just being an out of the ordinary thought. So yes, I think it's fair to say some could be true, some could be not. Uh but it really I think it would so depend on the context and without having more information and example I I don't know that I like comfortably clinically can say a certain answer to that question. Yeah, it kind of seems to me like that is really couched in the reassurance seeking and the wanting to be like certain, finding finding the black or white answer like the truth

42:52 and the discomfort with sitting in the ambiguity and being able to not interrogate that question, not make interrogating that question or attempting to control the outcome

43:06 like your whole life, right? being able to say like I don't know like there could actually be some truth in this but I'm not going to live my life as if like it is my one mission to answer this question because when that becomes my one mission everything else suffers right absolutely yeah

43:26 I do appreciate how the poster ultimately comes to that final piece of like certainty is kind of a delusion anyway which is true like nothing is truly certain

43:37 you can wake up and your whole day planned out and then the roof falls in on your house, you know, we don't know.

43:42 So, I love that they came back to that at the end. Um, I would have loved to hear them lead with that maybe, but that's just me.

43:50 Yeah, Christy, what were the comments on this post? Yeah, so a lot of agreeing. This is a deleted user, but they said, "Totally agree. Calling all intrusive thoughts lies can just increase doubt and reassurance seeking. It's better to accept uncertainty and not fight every thought. Sitting with discomfort helps more than trying to prove or dismiss them.

44:14 And that to me, correct me if I'm wrong because I am no therapist. That almost sounds kind of like mini exposure response prevention therapy. So you're not, you know, doing the whole like I don't get on planes cuz I'm afraid they're going to crash type thing, but it's just like this mini moment of like,

44:32 what does it feel like to sit with this thought that doesn't feel good? I'm not going to get that resolution, that dopamine hit.

44:40 Is that true, accurate at all? Yeah, absolutely. And I love your examples. really I think a lot of the clinical work and you'll see this kind of bar none even with like pure ERP OCD therapist it's a lot of that internal building tolerance to the unknown and uncertainty first we do a lot of imaginal exposures scripts narratives

45:04 practicing we have a lot of like statements that lead um that are very neutral um and yeah like you can stop a compulsion before it starts if you learn how to not engage with the thought again A thought is a thought. That's all it has to be.

45:22 Right? Beginning to decouple like from I if I have this thought I have to behave in this particular way. But the kind of process of decoupling to break down

45:33 um the series of behavior and maybe eventually the thoughts start to loosen a bit. They start to become less sticky over time

45:41 because you're learning uh perhaps slowly because we're not just talking about like pure exposure therapy, right? Right. You start to learn slowly that like, oh, I didn't do this behavior and the scary thing I was worried about didn't happen.

45:54 Right. Right. Yeah. You're basically just breaking that chemical tie. The the way the neurons light up to respond.

46:00 Yeah. You're creating new pathways in your brain. Like this is something I would always say to my clients is like our brains are plastic. Like they are very very changeable. And all of these habits that we have are like

46:13 these deep deep grooves in our brain. It's like walking down a street with like, you know, freshly paved sidewalks and like lots of lights and, you know, there are no trees overgrown. It's just so easy to take that path. But when you're forming something new in your brain, it's like you're trudging through the jungle with a machete. Like there is not

46:29 an easy path through it. It's overgrown and it feels like there's a lot of effort and work that has to go into making that new connection and that new pathway. But the more you walk down it, you know, new trails are much harder to walk on than trails where they've been walked on many, many, many times. We do have the innate ability to change our brains, to change our nervous systems, um, to change our behaviors, and to change our thoughts throughout the course of our lifetime.

46:58 And with really good therapy, that can become even more possible. Absolutely. Catherine, I'm curious what you think about this, if you feel like this is relevant to the treatment of OCD. One of the ways that I think therapy can be really helpful to folks is the way that therapists can co-regulate with their clients.

47:19 So when someone is having like a hard experience, the fact that there's another nervous system in the room or sometimes even online

47:27 can actually create a larger capacity in my opinion in my experience of working with clients. So I'm curious when folks may be sitting in that discomfort of the ambiguity of holding this thought and they're they're testing out what happens when I don't try to resolve that or get reassurance but I just sit in the discomfort. Do you find that having yourself as a therapist in that relationship in that connection with the client can increase the capacity?

47:51 Absolutely. I mean, and you had brought this up earlier, how isolating, lonely living with this, you know, diagnosis, disorder, whatever you want to call it, can feel. Um, so just be able to have another space where it's in the room and it's being returned back to you and there's nothing attached to it. There's no meaning, there's no judgment, it just is. And I will say I um I love dark humor. I'm a bit grass in that way, but

48:19 same same. Good. Then we're in the room. This is a safe place for all your twisted dark humor.

48:27 Yes. And I'm telling you, like I let folks have a few sessions before I show that side, but I'm like you need so much of that in this work.

48:34 Yes. You know, and like turning things into like that's funny. Like your brain is a really good comedian. It's so creative. Like

48:42 you are going to do a thing and everyone you want is going to die. Wow. you know, and like

48:46 yeah, being able to echo that back and it sometimes it's just taking you can see posture shift, a effect shift, just like energy shift of like, oh

48:57 yeah, huh. You know, just kind of you're not freaked out by that like when you respond to a person where you're like and this has to be done really really skillfully, right? Because I know that you know when you can do that with a client and when it's not time, right? when you don't have the rapport, when the trust isn't totally there yet for you to

49:14 do that slightly edgy thing or maybe very edgy thing, you know how to sense that because you're paying attention. But when you have that experience with a therapist where you're saying the thing that you've for your whole life or maybe for many years you've thought is like the craziest, wildest thing, the grossest thing, and you say it out loud and someone's just like, "Oh yeah, totally. Yeah, like everyone's going to die." And they're like not being freaked out. Sometimes you're like, "Oh, wait a minute. Oh, maybe that's not true or maybe I'm not gross." Like I don't have right. So knowing depending on like what the person's makeup is like what is the right medicine for them. So like yeah absolutely for somebody who's dealing with OCD it's like no that's not reassurance seeking like we're not going to do that. That wouldn't actually be helpful for them long term. And like again working with a therapist

50:03 developing that relationship so that they really really know you well. They have that deep connection with you and they're an expert in the thing that you are there to get help for is such a powerful combination.

50:16 Absolutely. Yeah. Absolutely. I think if I were to emp or empathize with our friends who are getting therapy for OCD, I would just be so pissed that it's like we just have to sit in this uncertainty. I would be mad about it. I'd be like, I need something because like the treatment often is. You're not going to get that.

50:39 That just sounds like obviously very healing. But as the non-therapists in the room, I'd be like, are you kidding?

50:46 You're like, that's what I'm going to pay for. You're not going to tell me. I get it. I It's so annoying. especially when they're like I just have to like like a lot of our initial work is like really just be able to notice name lots of mindfulness practices and they're like

51:03 no I came here for you to tell me what's right and wrong you know and I've had my own therapy I had a therapist once who I know I love homework and worksheets and they were like I'm not giving you homework you know that is your homework and I was like no that sucks I fire you

51:19 no and I did and I was like I'm not I'm going to see a different therapist the difference is I don't have OCD, you know, and I knew that like that's how I wanted to work in that framework.

51:29 But if I was an OCD therapist and that was my thing, I'd be like, "Well, this sucks and it's annoying." But it is the counter to literally everything I ever do.

51:36 And that is hard. The homework is going to be whatever is hardest for you right now. Yeah.

51:40 So, it's really hard to sit in uncertainty. Yikes. Here we are. And again, the therapist lending their nervous system to that process

51:52 can be really powerful. Um, and developing that relationship with a therapist, which takes time. Like, it's not instant. Although, I will say you do occasionally get lucky and the first therapist you meet, you fill that bond and you're just like, "Wait, I think this is the person for me." But if you don't, I do recommend going on several like first dates with therapists in in quick succession. Like don't do a bunch of therapy with one person and then go try a bunch of therapy. Like go do a bunch of first sessions with different therapists and you're going to feel the difference.

52:24 And it's not the case that like if you find a therapist you like, you're never going to have an issue with them ever. Because here's the thing,

52:32 your a relationship with a therapist is a real relationship between two human beings,

52:37 right? And it is not the purpose of therapy that therapists only ever do things that are going to make their clients feel comfortable all the time.

52:48 Discomfort in relationships is normal. And I always say like therapists are not intentionally trying to like aggravate our clients and we are people, right? And things may happen. So, what I always said to my clients is like this is a relationship and if anything happens that is hard for you or is a disturbance like please do bring it up. And the cool thing about that happening in the context of a therapeutic relationship is I have a vested interest in your well-being and I'm not just some random person in your life. Like my duty is to care for you. Like that's the benefit of working with a therapist. And yes, I'm gonna be a whole human with my own boundaries and my own feelings, but my explicit purpose is to be here to support you. So all of that, like that feels just like therapy in general, like for folks to know.

53:39 But I just want to say in terms of like folks who are looking for support with OCD like

53:44 do go try to meet with different therapists. And yeah, there may be times when your therapist, especially if you're working with Catherine, might be like, yeah, we're going to try to sit in this discomfort together and you might be like, I [ __ ] hate that,

53:59 right? And you could probably tell her and then you'd have a talk about it and that would be part of the work as well, right?

54:05 It is a big Yeah, our minds are very complex. So, we need to look at it from more of a wide lens.

54:11 Yeah, 100%. It's not a quick fix situation, is it? I mean, very few mental health conditions are right on the level.

54:19 It took a while for for things to get this way, right? It's going to take a minute for us to engage in the healing process. And it isn't it's never as simple as a therapist handing you the answers and saying, "Oh, just do this."

54:31 Right. Absolutely. Yeah. Yeah. That's the beauty of that intimate relationship over time.

54:38 I agree. Okay. Last so great. Last one. therapy is so great for my non-therapist friends out there. It's like, hey,

54:50 that sucks kind of. It totally does. But it's the right thing, you know? It it definitely is the right thing. Um, okay,

54:59 last one. And I think this is definitely where we get more to the advice. And there's really good advice in the comments, but I think I want to hear more from you, Katherine, for the really, you know, we know evidence-based treatment for this kind of stuff. So,

55:16 also in the fabulous OCD subreddit, I don't know if I could even pronounce this user name. Trashvesty. Yeah, good job on a creative name. Uh, but how does one just let an intrusive thought be? The more I say maybe, maybe not to try and quell my disorder the way everyone says to, the more it just stays locked in my head. I've been two days resisting doing any compulsions. Yet, my anxiety is still here all the time. It just makes me want to give in.

55:52 Ah, I see. Okay. That's a such a real experience for people especially early or in the process and it is one of the hardest ones to get through. Sometimes you'll see people stop at this point in the work because it's so uncomfortable and it's I'd rather just keep living in the turmoil. I feel for that person a lot. Maybe, maybe not is like a very mantra phrase that is rampant in this community. However, it's not the only one. Um, and I think understanding how intrusive thoughts gain powers is the amount of attention we give to them. You know, even if we're trying to approach a neut neutral mindset, if the mindset is I'm telling you this thing so it finally stops bothering me, that's another issue we're running into. It's not I'm telling my brain this thing and it is what it is. I'm going to feel uncomfortable for weeks or months. That sucks. You will often see that the anxiety starts to

56:50 subside. When you start to accept that this is uncomfortable, this is difficult, this is maybe painful, right? What I'm hearing this user speak from is I'm doing this thing cuz it's what I'm told is right. Right? So, I'm not trusting anything. I'm trusting everything else. I'm doing this thing that I know is the prescription. These thoughts are still here and I'm just maybe maybe not has now become their compulsion. Like it's not fixing it. The thoughts are here. I'm still anxious. It's not fixing it. The thoughts are here. Am I screwing up?

57:23 I need feedback from people. How do I fix this? The point of this work with the intrusive thoughts is not to say, "I'm definitely not going to feel anxious anymore." And there's a reason that with that exposure piece, there is a ratchet up to more and more distress. You're not saying it's going to finally stop. You're teaching your brain and body that you can tolerate it. I think maybe what this user is getting latched on is like, well, okay, but it should be better now, right? Because I tolerated it for two days. You had mentioned this point Felicia earlier, like it can take weeks, months, years to undo some of these responses. So that user will be needing to tolerate that for a long time. And really, as much as it probably feels like they can't access that, I would advise them to like lean into like this is uncomfortable and this sucks and I hate it and I guess I'm just going to have to hate it. Like I hate it a lot.

58:15 I'm going to think how shitty my life is going to be. I don't know if I can curse or not. Oh well.

58:22 Like how shitty my life is going to be four weeks like or months or like maybe maybe not doesn't work for me and like this thought is never going away.

58:31 Yeah. Okay. The thoughts never going away. Okay. I'm always going to be anxious.

58:37 Yeah. Could be true. Might not be, but we don't know. Yeah. So, what are some ways then to, you know, I want to use the wording that they did. Let an intrusive thought be. And there are some suggestions in the comments. Maybe I just want to share one that was kind of interesting and I hadn't really heard of or or thought before. This user said, "This might not be helpful for everyone, but my personal motto is I don't care. If I tell myself I don't care enough, it gives the thought less power." Again, just something that works for me.

59:14 I like it. I'm about it. That too. I mean, and just that approach makes sense for that person. And ultimately, like dealing with intrusive bosses, they are distressing and painful and frustrating because we are making meaning with them. So that person is trying to do the opposite and be like, "Yeah, I'm a max murderer. Yeah, I'm a pedophile. I guess whatever. Guess I'm a pedto, right? Guess I'm going to kill everyone in this town.

59:41 Guess I'm going to jump off the skyscraper. I don't care, right? It's almost like posturing, playing a role.

59:49 Eventually, that role becomes real with the practice and you start to realize that you're not going to actually act on these thoughts,

59:58 right? It's a bit of a fake it till you make it is what I'm hearing. Like what would it be like if I were a person who didn't care about these thoughts? And it might feel again like carving those new pathways in the brain. At first it is going to feel disingenuine. Like I remember working with clients and we be trying out new things and they're like, "Well, it doesn't feel like me." I'm like, "Yeah, no [ __ ] You've never done this before. It would be weird if it did feel like you." Like it's not like you yet,

1:00:25 but that's like part of how you change is to do a thing that doesn't feel like you is to try something else on. And that's a version of this like

1:00:33 yeah, what would it be like if I were a person like my spent my whole life believing these thoughts? And what would it be like if for just for this moment I pretended like I was a person who didn't believe these thoughts?

1:00:46 And maybe you feel like, yeah, like I can really tell I'm acting right now. like that doesn't feel true to me at all. And then you're like,

1:00:54 "What if I was a person who didn't care if it felt true or not?" And you're like,

1:00:58 "Right, it's not about like getting there on day one or even like this person day two."

1:01:04 Um, it's about this like very slow incremental progress which can feel like no progress at times,

1:01:13 right? And I think I think what you're saying here, Catherine, too, is like we need to make the scale much bigger for change.

1:01:21 Mhm. Absolutely. To quote the great Miley Cyrus, it's the climb. Um stimulus response, you need a lot more of it in between, right? It's the climb.

1:01:36 Uh very Nashville of you, Katherine, to Yes. Thank you. Way to go. sponsor. This episode has been sponsored by Nashville.

1:01:48 It hasn't, but it could be. It definitely hasn't. It could be. They might not want to get behind that.

1:01:54 Reach out to us. Nashville. Yeah, Nashville. Natural city of Nashville. Who knows?

1:01:58 Andrew of Converse. To your point, like there's so much distance in practice. And I think those probably think about any person, even yourself when you've gone to therapy. No one wants to be doing this for a long time. You want to be better now. right now. You want that first session to give you all of your Eureka moments

1:02:16 and move on with your life. And it sucks because life doesn't work that way and it is hard and messy and complicated and

1:02:24 and there are ups and downs. It's not like steady progress. Like some of the progress is simply increasing your pain tolerance, which it sounds so shitty, but like

1:02:34 that's a big part of it is de is increasing pain tolerance. And as you were talking earlier, like that's what kept on going off in my mind of like, oh, what is the experience of pain? Like physical pain. There's both like the actual physical like ouch, but then there's like neurologically what happens how we perceive pain. And it seems like there are a lot of similarities here.

1:02:56 Yeah. I mean, I think Okay, let's be like a little dark here, but I was out with friends yesterday and

1:03:04 we're not even sessions in Catherine. I know. But we're feeling it. We're feeling it. We feel like you can get dark with us. Especially for people listening like to to give a frame of reference, right?

1:03:17 In the pandemic, I was working in hospital system. I got CO in Nashville. Um and I got CO not because I was being irresponsible because I was literally working in hospitals all the time. And the plasma banks here were asking for people in healthcare with co to come donate blood cuz it was part of like developing is this going to help with vaccine development and I was like yeah sure

1:03:41 I have probably done it 30 times you know and like I don't care it's fine chill whatever

1:03:47 but I was out with a friend the other day who was like oh my god you've done that isn't it like the worst pain you ever felt in your life and I was like it just goes in and you forget and it's over. It's like a beast sting. Yeah. See, Felicia, your response where I'm like,

1:03:58 I I faint. It doesn't hurt, but I will I will faint. It is not a choice. If there is blood, I am I'm out. I can't handle it.

1:04:07 Well, and even Okay, so I'm going to use my little lens here, but even saying like if there's blood, I can't handle it already as a precipitator to I'm not going to be able to do it. I can't do it.

1:04:16 Oh [ __ ] Right. You know what's so funny is like uh my partner is like he doesn't get it. And so he's like, "Couldn't you just like expose yourself to blood and then it would get better?" And I was like, "I don't want to like

1:04:31 like I'm okay with fainting at the side of blood. That works for me." Okay. And you're if that's fine with you, that's fine.

1:04:39 And it doesn't scare It doesn't scare me. I come out of it really quick. Other people are super freaked out, but I'm like, "It's fine. I've been doing this forever."

1:04:47 If that's your mo like your mo and that's your mindset, that's all good. Like my friend was like, "Oh my god, that's gross. I like every time I have ever had to have a needle on me, like

1:04:57 I just think about the pain is like never gonna stop." Like that's interesting because it is so mental. And there's just so many studies that show like the pain experience is so mental,

1:05:07 right? And it's the same of how we're approaching OCD. Like how distressing is this this person who's like I don't know how to deal with these intrusive thoughts is like part of the distress is because I don't know. I'm putting the onus on me to figure out how I have to deal with this. I have this is a problem to solve. It is the only thing I can f focus on right now. It is the issue instead of like okay well now that's your whole life and that's your lens. Like this fear of the blood or the needles or whatever. Like

1:05:33 I know I have a doctor appointment today and they're probably going to draw a lab so it's literally all I can think about even though this is going to take 20 minutes of my time and I'm awake for so many other minutes throughout the day and have things I need to do. But now I'm keed up about it. It's a problem. It's my problem for the day, right? instead of like you might

1:05:48 I would be calling you if that was my experience, right? But you probably don't you're probably like I have to go this doctor sucks. I know I'm going to get a lab draw.

1:05:56 I'm just going to let them know I need to lay down and I'll lay down and I'll look away and it'll be over in a minute and like if I faint I'll be I'll come out of it in 30 seconds and they'll they'll just be like it's fine. that that maybe it's the worst thing ever and it sucks and I hate it and I just faint and I never wake up or like maybe it is what it is and I go and I need to do this because I care about my health and my well-being and that matters more to me than avoiding this process.

1:06:22 Exactly. Yeah. Honestly, weird fact about me. I think fainting is super fascinating and I actually kind of enjoy it. These are the sorts of thoughts every time.

1:06:36 People are like, "Felicia, tell me tell me more about how you like fainting." Yeah. I mean, I don't think I ever have. So,

1:06:45 Oh, I just did it recently. That one was weird because I saw a movie and I actually This was so gross, you guys.

1:06:53 I'm the oldest of 10, so nothing freaks me out. Oh, I love that. And that's therapist. And that's especially Catherine. Nothing freaks her out. So

1:07:04 there you go. Go tell her all the things. Go tell her all the things. Everything.

1:07:08 Catherine, it was such a pleasure having you on the show. I learned so much. I hope everybody listening learns so much. And we like to ask at the end of the episode what you really think about this topic. So if you could just get out your really mini little TED TED talk on [ __ ] and intrusive thoughts.

1:07:29 What would that be? Okay, sure. Well, thank you for having me. Of course, this has been really enjoyable. I've been looking forward to it and it did not disappoint.

1:07:38 OCD is a serious and real uh illness that can gravely affect lives. It does encompass many themes. It's not just cleanliness or checking. It can also be things like panic attacks, hoarding, physical body repetitive behaviors, social anxiety, the whole name of it. But it is also very treatable. It is very accessible to live a lighter way of being, to feel more confident, to feel more calm. And I think there are fortunately numerous people in the Reddit sub threads who can speak to that. Who were those people posting originally and freaked out and then years later like these things happened to me but it's whatever I move with my life. So I just hope that folks know like no matter how gnarly gruesome whatever self judgment you're telling yourself how deranged you are whatever you know maybe that is true and maybe it's not and this is a time to like not perpetuate the self judgment cycles isolation and loneliness.

1:08:42 Please like start talking with someone. It is so possible to feel another way about yourself and the world and to reduce this anxiety.

1:08:51 It's almost not fair how reasonable and possible it is to get there with the work.

1:08:56 Um you are not doomed. I love it. Amazing. Great message to hear. I think that there's hope at the end of the tunnel cuz I imagine that it, you know, just reading some other things I didn't include in the episode, but

1:09:10 feels like it can be really hopeless for people at times. So, yeah, to hear from an expert that, hey, I've seen this done,

1:09:17 I've done it myself, there's hope, I think that's absolutely incredible. If people want to work with you, you are licensed in Tennessee. Any other states?

1:09:28 Actually, I just earned my stuff for California. So gosh, amazing. I'm licensed in Tennessee and California. I hold national certifications as board certified music therapist and rehabilitation counselor. So I do have some portability and how I can treat people from a different land. I have to be very conscientious around the boundaries and ethics with that, but I have used music therapy to help work with OC in the past. So that's a little

1:09:51 great and it can be more creative. So yeah, that seems like really really cool work.

1:09:56 Yeah, people can find you at your website. I believe it's emboldened theapy.com. We'll link it in the show notes. You're also a verified therapist on best therapist, so people can find your profile there as well. Awesome. Thank you so much, Catherine.

1:10:12 Thank you all for having Thank you for being our guest. This was such a fun conversation about such a like serious topic, but we are so grateful that we got to

1:10:22 I don't know bring some lightness to something that could that is so often so dark and heavy. So, thanks for having the conversation with us. Thanks for having me, y'all. I appreciate it.

Questions about this episode

What is "Are My Intrusive Thoughts "Normal" Or Do I Have OCD?" about?

This discussion focuses on the nature of intrusive thoughts and their relationship with Obsessive-Compulsive Disorder (OCD), clarifying common misconceptions about both. The conversation emphasizes the importance of understanding these experiences, reassuring individuals that even complex and isolating feelings related to OCD can be addressed in a therapeutic context.

What is mentioned in this What Your Therapist Thinks episode?

40 people, works and ideas are mentioned, including Intrusive thoughts, Felicia, Impulsive thought, Therapeutic relationship, OCD subreddit, Exposure and response prevention (ERP). Each one on this page links to its own page with every episode that mentions it.

How long is "Are My Intrusive Thoughts "Normal" Or Do I Have OCD?"?

The episode runs 1 h 11 min; the transcript is about 13,398 words in 258 timestamped sections.

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