Beyond Anxiety: Deeper Dive into OCD Diagnosis

In this enlightening episode of the Heal Your Roots Podcast, we dive deep into the world of Obsessive-Compulsive Disorder (OCD) with the esteemed Dr. Katie Manganello, a Licensed Psychologist renowned for her expertise in OCD treatment. With a blend of personal insights and professional acumen, Dr. Manganello and our host, Kira Yakubov Ploshansky, unravel the complexities of OCD, offering a beacon of understanding and hope for those grappling with this often misunderstood condition.

Key Highlights of the Episode:

1. Journey to Specialization in OCD Treatment: 
   Dr. Manganello shares her evolution as a psychologist, shaped by personal experiences and a heartfelt commitment to aid others. She reflects on her motivations in pursuing a doctoral degree, underlining the transformative power of advanced studies in psychology.
   
   
2. Demystifying OCD: 
   The discussion navigates through the intricacies of OCD, emphasizing the critical need to distinguish it from anxiety disorders for efficacious treatment. Dr. Manganello delineates the nuances of OCD symptoms, such as intrusive thoughts and compulsive behaviors, enhancing understanding for both therapists and those living with OCD.
   
   
3. Unpacking Misconceptions and Subtypes of OCD:
   The episode illuminates various OCD manifestations, including fears related to contamination, harm, and social perception. A poignant segment discusses the distressing nature of intrusive thoughts related to pedophilia, distinguishing between ego-dystonic and ego-syntonic thoughts.
   
   
4. Innovative Treatment Approaches:
   Focusing on Exposure and Response Prevention Therapy, Dr. Manganello and Kira explore this cutting-edge treatment, highlighting its efficacy in confronting and managing OCD symptoms. The conversation underscores the importance of therapist-client collaboration and the gradual escalation of exposure therapy.
   
   
5. Navigating OCD in Relationships: 
   An insightful discussion on how OCD can permeate relationships, with practical strategies for involving partners and family members in the therapeutic journey. The episode stresses the value of empathy and understanding in responding to compulsive behaviors within relationships.
   
   
6. Challenges in OCD Diagnosis and Treatment: 
   Dr. Manganello addresses the hurdles in accurately diagnosing and treating OCD, advocating for increased awareness and education among clinicians. The role of the International OCD Foundation as a vital resource is spotlighted, offering support and guidance for both individuals with OCD and therapists.

The episode wraps up with the exciting announcement of Dr. Katie Manganello joining Heal Your Roots Wellness, where she will be available for sessions. This episode is a must-listen for anyone seeking a deeper understanding of OCD and its impacts, or for those on their own journey of mental health exploration and healing.

Tune in to this episode: For an enlightening exploration of OCD, its treatment, and the personal journeys of those dedicated to making a difference in the field of mental health. This episode promises to be a valuable resource for both mental health professionals and those affected by OCD.

Transcript

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Welcome back to Heal Your Roots Podcast. On today's episode, we have Dr. Katie Mangan lol a licensed psychologist and expert in obsessive compulsive disorder. In this episode, Katie shares her insights and approaches and evidence based treatment plans for helping those struggling with OCD. Katie, thank you so much for joining us for today. Hi, thanks so much for having me. I'm so excited. Absolutely. So we usually just dive right into learn more about the therapist before we learn about your expertise and specialty. So can you share a little bit about your origin story of how you became a therapist? And kind of what inspired you to do that? Sure. Yeah. So you know, I always found psychology to be interesting, I think like most people typically do, you know, when you're in high school, and you're taking all the different classes, thinking about what you want to do in college. And so you know, I'm just somebody who's a natural problem solver, I like to be helpful and find solutions to things. And I too, can relate to some of the issues that my clients experience in several people in my life that are important to me, the struggle at some point in their life with a lot of things. So in having, you know, my own relations to some of these issues, as well as other people that are important to me. I was interested in, you know, pursuing a career where I could move forward with doing that for people. Yeah, I feel like therapists always have some kind of link or thread, whether it's personal within themselves or a family member, that makes us feel like, oh, I want to learn more about this or like, become someone who helps other people through the same issues, for sure. And so can you share a little bit about your journey of becoming a licensed psychologist? Yes. So it's been a long journey. So I went to I'm originally from the Harrisburg area in Pennsylvania. And then I moved to Redding, Pennsylvania, where I went to undergrad at Alvernia. University. So I studied psychology and my major and I minored in philosophy while I was there. Yeah. Which was really fun. Yes. Yeah, I know, I wish I had more time and the ability to dig into that stuff a little bit more. But with this journey, I only had so much time for that. So. So then I applied to grad school, and I got my masters first. And so then I moved to Philadelphia, I got my masters from the Philadelphia College of Osteopathic Medicine. And so I got that degree in mental health counseling. And then I also went to pee calm PCOS for my doctor of clinical psychology. So that's the short version. Journey was like, I've been all over Pennsylvania, getting a lot of education around psychology. So within that time, I've done a lot of different kinds of trainings. I mean, at some point, I've worked in pretty much every kind of mental health setting. I've had experience in partial hospitalization centers I've had experienced in intensive outpatient, residential, typical inpatient, veterans, hospitals, private practice. So I've seen kind of the spectrum of how mental health can show up in different settings. So yeah, wow. So that's a wide range. That's a lot of different settings and perspectives to get and how people get help, and they're treated. It's incredible. Yeah, what what made you want to be a licensed psychologist versus like a licensed therapist? Like, what was that kind of thought process to go the next step to become a doctor? Yeah. Well, and that's a good question, because that's something I definitely struggled with along this journey. Because, yeah, why? Why do you want to go for a lesson? So I think, another part of that too, is I'm just so curious. And I always feel like if I can go the extra mile, like, why not and just learn the next thing that I can. And I'm so glad that I did. I mean, there was a point where I was in my master's program, and I was like, this a lot, like, do I like to go the next, you know, next step up, and I applied to my school because I was like, you know, what, if I get in here, then it's just, it's meant to me and then I did. And I was like, Alright, we're gonna go with and I'm really, really so glad that I did. Because looking back at where I was, skill set wise, as well as just my age and where I was as a person. At that point, I think that I would have really done just myself a disservice if I stopped there. So I'm glad that I kept going because I have learned so much more and become just so much more confident and I'm more I think just who I am as my own professional self in going through the doctoral program. So, you know, there's been some weighing of the ups and downs and pros and cons of it. But yeah, that's kind of ultimately what, what led me there. That's awesome. I remember having the same thoughts. I'm like, When is this gonna be over? It's such a long process, but it is definitely worth it once you're on the other side and the other hump of it. It's like, all right, like, I guess it was worth it. Right, yeah. And I mean, if I can provide all of the skills that I can learn, I'd rather just have it all in my toolkit and be able to work with all of the things and for me, too, it was a matter of if I stop, I'm probably not going to ever go back. So I just kept pushing through and going, going going and didn't take any breaks. And now here we are, and it's over. And that's great self awareness, right to know that about yourself. Yeah, you definitely need the self awareness and going through this. Absolutely. And so since you've been through all these different settings, you've gone through that program. What is kind of like your focus and specialty now that you work with clients? Yes. So right now my specialty is working with obsessive compulsive disorder and other related anxiety disorders. That's the majority of the population that I work with, I initially came into the field thinking that I wanted to work with SMI, like serious mental illness, that would include things from, you know, like schizophrenia, bipolar disorder, certain personality disorders, actually, OCD can even be considered SMI, depending on the severity of it. But so that's kind of what I came in thinking I was going to do. And I had experience in working with that population. And actually, I do love working with that population. Like that's still important to me. I guess the reason that I kind of ended up going towards OCD was because I didn't really know anything about OCD. But I was in an smi class in grad school, and I was trying to figure out what one of my next training rotations was going to be. And one of my teachers suggested, well, have you ever thought about doing any kind of rotation with OCD? And I was like, Well, no, I haven't because I don't really know anything about it. Besides what we learned in the basic intro psychopathology class. So I was like, alright, well, let's just see what it's all about. And the reason she brought it up is because there can be so much overlap with OCD presentation, as well as psychotic related disorders. So that that kind of got me curious, I got into it. And that's also the OCD population. Unfortunately, clinicians don't know enough about it. But ultimately, they usually find themselves in a private practice setting because it is like a specialty area. Whereas working with schizophrenia, bipolar, you know, other versions of SMI, you don't necessarily see that as a presenting problem in a private practice setting. Now, that doesn't mean you aren't ever going to see anybody with those presenting issues. But usually, if they are presenting with those issues, they are in a higher level of care to start. And then if they want to work on things, after those types of things are managed, then they may end up coming to a private practice setting. And OCD can certainly present itself in a way like I said, that can you know, clinicians can be unsure what it is. And they might think that it's a psychotic related disorder or something more severe, and they are in the hospital or they are in a higher level of care. And then they end up getting kind of referred into these more specialty practice is so interesting. Okay. Yeah, I didn't know see, like I only also had the intro to pathology in grad school, and didn't know much past that. Like, I feel like I might be able to identify and then be able to refer out what I wouldn't be able to, like have that specialized treatment plan or knowledge to help somebody through that because it is very different than just, I don't want to say just anxiety to diminish that but an anxiety disorder outside of OCD. Mm hmm. For sure. And so for listeners who maybe have some misconceptions about OCD, would you be able to share a little bit about like, what that means and like how you would really diagnose somebody with that versus someone who might have some traits or tendencies or sometimes people use it kind of just throw it around when it's not actually what's going on. Yes, so this is something that I am super passionate about, not only just kind of explaining this to, you know, anybody who comes across OCD, but also really I find it to be so so Important for clinicians to understand this because even if we can get people to a point where they can at least recognize it and then refer out then that's great. But a lot of times people think that OCD is just regular anxiety. And then clinicians are responding to the OCD in a way that is actually majorly making the OCD a lot worse. So, some things to consider. So why don't I just kind of like ask you this, if you're comfortable? So when you think of OCD, what do you think of like, what kind of presentation are you envisioning? So I'm thinking of obsessions and compulsions? Right? Like there is a lot of thought process in like spiraling and then compulsions, like a behavior attached with it that is like continuously going on. And if they don't do this particular behavior, then that kind of creates more anxiety, and more stress within them. Mm hmm. Yes. And so that's, that's right. And when you think like, what are some of those behaviors? Like, what does it usually kind of look like when somebody has OCD? Like, what do you kind of think of? I mean, like, the stereotypical is kind of around like germs or having to check something multiple times in a row, right? Like a very obvious behavior. I know sometimes I've had clients who, and I wanted to talk to this about just pure Oh, or just like obsessions, or just compulsions, like one or the other, like, even having to search something a million times. Like there's a repetitive nature to it. But I think the stereotypically is like repeating something over and over to make themselves feel a little bit more at ease. Yes, exactly. So the Yes, usually people think it's hand washing, it's checking things over and over again, it's perfectionism being organized, that kind of thing, which is all true. Those all can fall under the OCD umbrella. However, that is about this much of it when there's like this much of it going on. So to give some background like let's get specific, so OCD is defined in our diagnostic manual. The DSM five is it's so it's broken up into two pieces. It's the obsessions, like you said, and then it's compulsions. So obsessions are defined as recurrent and persistent thoughts or urges or images that are experienced that sometime during the disturbance as intrusive and unwanted, which is really important, and that in most individuals cause marked anxiety or distress. Also, under the obsessive criteria, the individual attempts to ignore or suppress the thoughts, urges or images, or to neutralize them with some other thought or some other kind of action, which leads into the compulsive part. So compulsions are defined as repetitive behaviors or mental acts that the individual feels driven to perform in response to an obsession or according to the rules that must be applied rigidly. The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation. However, these behaviors or mental acts are not connected in a realistic way with what they're designed to neutralize or prevent or are clearly excessive. Now, those are, you know, that's our definition that we get from the DSM. The way that I like to kind of think of it is, and I draw this picture for pretty much everybody that I talked to about this. So we want to kind of think of it as here's our bell curve. And we're going to use a suds scale, which is Su D S, it stands for subjective unit of distress scale, you're probably familiar. So here's our zero. Here's our 100. Do you see that? Okay. Yeah. Okay. So, basically, an obsession is the fear that you're experiencing. So that's the, you know, the thing that you're trying to really get rid of. So usually something triggers the fear, which brings the anxiety up. So here's our trigger, the anxiety goes up. You're freaking out, right? You're really worrying and what do you so let's use an example. Okay. Now, a phobia is a little bit different from OCD, but this will be a good example to kind of use so let's say that you have a dog phobia, because I know you don't have one more time do you do Okay, sure. So, Toby, all right, and let's say envision yourself walking down the street down the sidewalk, and up comes somebody with a German Shepherd they're walking with okay. And you start to feel really nervous. What do you do? How do you want to handle that situation? I mean, me personally, I would probably freeze first. And then maybe cross the street, go to the other side and continue walking, like get as far away as possible and keep going. Exactly. So you are going to do something to try to make that anxiety go away, which could be that, you know, the flight, fright freeze kind of situation. So, in that situation, you kind of said like, the freeze first and then probably like, flight, runaway kind of thing. And that's what most people will say. So here's our interaction with the dog, the anxiety goes up, we start thinking, Oh, my gosh, what can I do to make this anxiety go down, I'm going to cross the street. And when I crossed the street, that was a little uneven, the anxiety goes down. And when it goes down, we're like, all right, I'm good. Keep walking, everything's fine. Except for what happens in that moment is you have now trained your brain to think that whatever this trigger was, is actually a dangerous situation. And there's always a level of uncertainty to it, it could have been a dangerous situation. But that's what OCD does, it clings to any level of uncertainty that it possibly can. So basically, you just taught your brain, Alright, that was bad, because as soon as I escaped it, I felt immediately better. And what happens with that is, the more we do those things, the more we avoid it, the more we engage in any kind of compulsion, that is what snowballs it and feeds it and it becomes bigger and bigger and bigger. So again, obsession is that fear, the compulsion is pretty much anything you are doing to make it go down. That could be avoidance, that could be reassurance seeking, that could be really anything, again, that's going to try to alleviate that fear associated with the obsession. So whereas you think maybe it's harmless, that you cross the street, but the more it's happening, now, maybe you're not going on your walks anymore in the morning, because you know, that person walks with their job. Or maybe you purposely are like, let's go 20 minutes later, instead of, you know, the same time, which could then make you late for work, and then it's impacting your life, right? And then it could turn into, Oh, my friend invited me over and they just got a new puppy. And I am not going to go to the party with my friends anymore, because I'm avoiding the dog. So you get the gist. I mean, it can start out small, but gradually, it really kind of grows and grows and grows. So now, I'm like, what was your initial question? Because we were talking about like misconceptions out there, right. Yeah, finding what OCD is. Yeah. So what, what some of the misconceptions are around this is that, like we said, it's usually like, around germs, or like having things lined up perfectly, which those themes certainly exist, but there's a lot of different subtypes that fall under the OCD umbrella. So, most commonly, there's the perfectionistic obsessions that people know about. contamination, contamination is one of the big OCD fears that everybody knows about. So the way that a contamination fear could kind of show up is the core fear might be something like, I'm afraid that I will die. And so the way that that's manifesting is that I am afraid to get sick, meaning there's the contamination, if I get sick, I could potentially die. So what I'm going to do to try to control that or alleviate that is, anytime I touch something with germs on it, I need to go wash my hands. Now, that's also just one example. contamination can manifest in a lot of different ways. But that's just, you know, a kind of a broad example for people to understand. So those are the obvious ones, but less obvious ones are obsession, they can be kind of taboo. So some of them can be related to harm, danger, loss, embarrassment, sexual obsessions, sexual obsessions, around children, religious obsessions, the superstitious or magical obsessions. I think sometimes people hear of that, like the, you know, can't step on a crack break your mom's back in the day. And like helping body focused obsessions so that can look like a lot of different things. I think the most important thing in in being able to assess for OCD and for people to understand differences between just being like hand washing or you know, whatever it might be, is that OCD is ego distant onic which means it's not in line with your values. If it If something is ego syntonic, that means it is in line with your values. So let's say that somebody loves children and like, they really want to be a mom, or they, you know, they really enjoy being a nanny or any of those kinds of things, right? Like they, they really value being able to spend time with kids and nurturing and that kind of thing. Yeah. Now what's really unfortunate is this could manifest in, you know, having fears around, like, how to feel like OCD. So that could be something where it's like, okay, I go to the park, and I'm hanging out, I see kids running around, and an intrusive thought pops in my head. Now, everybody has intrusive thoughts. Pretty much everybody has intrusive thoughts, right? The difference between somebody who has an intrusive thought with OCD is that they cling to it, and then it starts to spiral. Whereas typically, somebody might have the thought, Oh, look at that kid, like, they're really cute, and then be like, That was weird. Like, that'd be weird for me to like, take that thought any farther. And then they just kind of shake it off and move with it. But somebody with OCD might be like, Oh my gosh, that was weird of me. Why did I even have that thought? Like, am I a pervert, maybe I should stay away from kids. And then it can kind of spiral right then maybe they're avoiding going to parks, maybe they lose their job nannying, because they're avoiding going to work, you know, any of these kinds of things, because they are afraid of that happening. So the big difference between this and being an actual person who's diagnosed with a pedophilic disorder is that ego disenchanted versus ego syntonic. So somebody who is diagnosed with a pedophilic disorder is like, actually aroused by children, and they will act on that kind of urge. Whereas the OCD is, I'm having the thoughts and I'm scared in the last thing I want is for this to happen, but they're so afraid that it could potentially happen that they might lose control and do something so unthinkable to that. So I'm hearing the difference is not that they're fully going through it, but they're scared if they allowed themselves to that that might be something and that they're like, scared Oh, could develop into that. So now they're obsessed around having a thought that they could become that versus actually having that, that yeah, rather than actually engaging in behaviors of like catching children or doing anything that's actually like inappropriate and leading to legal ramifications, or an actual diagnosis of a pedophilic disorder. Okay, so for example, right? Like, I'm just thinking, like, sometimes when I'm driving, right, like a random thought in my head might pop up, like, Oh, my God, like, what if I like rammed into the car in front of me. And something horrible would happen? What would be like, a version of like, that threshold of OCD then versus like, Oh, that's horrible. I don't want to think about this. And then just like change the station on the radio, and just try to like, move on with my life. Right. So that would be probably related to a harm subtype. And I actually have worked with people to the point where this has gotten so bad that we call it actually hit and run OCD, where people are afraid that they either are going to like, wrecked their car wreck into somebody, or that they might hit a pedestrian or something like that. So I've met people where instead of just like, oh, that's uncomfortable to think about, let me distract myself and carry on. It could manifest in a way where they are constantly checking their rearview mirrors, you know, making sure that they have specific like safety behaviors, whereas it's like, well, I need to make sure that I have the music on loud enough that I am always distracted. Whereas like, when somebody has an insurance on, they're like, Oh, that's weird, shake it off, listen to some music, and then your brain starts thinking of other things. That's a more typical kind of way that people think about things when random, intrusive thoughts come up. If somebody also has OCD around this, they might avoid driving in general, they might just not drive any more. I know with some people that they it OCD really likes to claim to control right, that's all about those compulsions trying to control situations. So sometimes it might be well, I don't want to be in a car as a passenger because I don't have control over the driving. Or maybe they would rather only be a passenger because they don't want that control of being the person who hid it. So again, that's why we really always have to do a thorough assessment because we want to really understand the function of the behavior. We always want to really understand that core underlying fear that it's related to. So what would be different because you know, I've have have a lot of clients who come in for anxiety around like attachment like anxious attachments, and they might Do kind of repetitive behaviors around dating, right? Like, let's say if they broke up with somebody they get obsessed with, like looking at their Instagram stories or like looking at certain things. And it always like confuses me in a way where it's like almost like torturing themselves. Like, if they want to feel better, they would stop looking at it, but instead they obsess, knowing that it's going to create more distress for them. How would that be like considered towards that? Or is that more of just like, anxious thoughts and like anxiety? So there is a fine line, I would say between sometimes there being because really, pretty much. I'm hesitant to I'm hesitant to say that all anxiety disorders engage in some form of compulsions, but most of them are doing something to try to alleviate it. compulsions just tend to kind of like manifest more intensely and show up more. Which brings me to your question about like the pure Oh, that's like a whole other topic. But compulsions can even be mental like as explaining, like mental acts, that could be reviewing memories, like, you know, going back and thinking of, you know, did I do this? Did I do that? These kinds of things, the difference is that the compulsions should take around, and more often do take more than like an hour each day and causing significant distress, impairing their functioning. So what you're explaining, with the example with relationships, that in the end, that anxious attachment, that can certainly be caused as a part of the issues with attachment. Right? OCD doesn't just appear out of nowhere, something that is related to it. And that can kind of like, bring them to that being their obsession or that core fear. But yeah, I mean, the thing is, is, they probably know that is going to cause more distress. But when you're having that part of your brain activated, you're no longer thinking logically, you can not out logic, OCD, which is why we have to do exposures in exposure and response prevention is treatment versus just like, a typical cognitive restructuring of like, you know, that doesn't make sense, right? Because people will be like, yeah, no, I get it. But it doesn't matter. Because when I'm in that headspace, that's what I need to do. And the reason they're doing is because they are getting some sense of like relief in the compulsion, because remember our picture here, right? It is bringing it down a little bit, because maybe if they're checking in, they're seeing, okay, that person didn't go on a date this week. Okay, sounds like that's good. But then they're like, but I need to keep making sure that that's, you know, yeah, yeah, it can be really, really painful for people. It's really it can be very distressing. Yeah. No, I appreciate you going through these like very specific examples, I think this will be really helpful for listeners to like differentiate as well. And so since you mentioned some of the approaches or treatments, can you elaborate a little bit more of like, what does help like, what does work with clients who are struggling with OCD versus like cognitive behavioral therapy for strictly anxiety? And like different approaches that you use when you work with people? Yes. So the, you know, our gold standard evidence based treatment for OCD is exposure and response prevention. So we call it ERP. So the reason that we are doing ERP versus a more basic version of CBT, is essentially, it has more of a behavioral approach to it, not to say that there's no cognitive interventions, but it's mostly behavioral. And some of that is because with the cognitive interventions with OCD, your brain can just, you know, like, talk yourself out of anything. It doesn't you're, you know, it can even get to a point where if you're doing cognitive restructuring, and in looking for evidence for and against, like, even that can turn it into a ritual or a compulsion. So, it's better to just allow those thoughts to exist and carry on and do our exposures. But so the reason I say a more basic kind of CBT is because exposure and response prevention is still cognitive behavior therapy. It's just the cognitive behavior therapy is so broad, it's another one of these umbrellas and then under that we have like sub therapies or third wave treatments. So, so ERP kind of falls under the cognitive behavioral umbrella. So the way that ERP is set up is exposure targets, the obsessions, and the compulsions are targeted with the response prevention. So essentially what we would do in treatment is As we do, again, a thorough assessment of what are the subtypes? How are they showing up? What's the function of the behavior? What are the core fears. And then with that, we make our treatment plan, which is essentially our hierarchy, which is going to list several exposure ideas, things that we would do to kind of target the fears. And then we would also have Response Prevention items as well. So what that might look like is, let's bring it back to our dog phobia. Okay. So the reason we do exposures is not necessarily to torture people. But what it is meant to do is that we want to purposely bring that anxiety up and sit with it without engaging in any kind of compulsions or safety behaviors, because what's going to happen is we will eventually habituate to it. That is how we're kind of re programming your brain. So if you allow it to exist, and not fight and not do anything, it will eventually come down. But it can be really distressing. Yes, yes, on its own. And that's what's hard for people to sit with. Because when you're in that feeling, it feels like it's not ever going to go go away, and you need to do anything you can to escape it. But once you kind of learn that, it's a feeling I'm working through, and I'm gonna allow it to just kind of exist, it'll kind of go down on its own. And that's a double process. Because as that's happening, you are building your distress tolerance skills. You're learning to sit with things that are uncomfortable. So that's the point of the exposures are response prevention. So an exposure for our dog situation could be, I'm going to watch videos of dogs, I'm going to watch videos of people getting bit by dogs, or I'm going to then go pet my dog or my friends puppy at their house. It can even just be like listening to a dog barking, it all depends. And it's all very individualized on the person's, again, our suds scale. So I might say, how sudsy does it feel for you to go pet your friend's puppy? And they might say on a zero to 100 scale? Well, that's about a 50. Okay, well, how much would it be if you were watching a video of dogs running around in a field? Oh, that's like only a 20. Okay, so we might start out lower, and then kind of build our ourselves up to it, we don't ever want to just immediately throw them into it. I mean, it's a, it exists, it's called flooding, right? But that is not necessarily the approach that we're using. I always take the approach of being collaborative, like, the client is the expert on them, and I am the expert on the treatment, we have to work together. And I'm never going to force somebody to do something they don't want to do. It's your goals, we're going to do what you're willing to do. And we want the exposures to be a stress not a strain. So it should be hard, should be difficult, but not to the point where you cannot handle it, because then you're never gonna go back and do it again. Yeah, we don't want to go into a panic state, it's more of just like, a safe discomfort. Well, you know, what in the thing is, is that they can panic. I think that's another thing is people are like, I can't let that happen. We can because we know that a panic attack is incredibly uncomfortable. Okay. My goal is never to be like, let's send you into a panic attack, unless we are maybe doing panic treatment, which is a whole different story. But the goal is to just kind of like, bring up the discomfort and teach them like, whatever is going to show up like I can handle it, I can sit with it. So where it is, it's not necessarily my goal to have a panic attack, we have to remember that there's uncertainty. And if it happens, like okay, we sit with it, we deal with it, you know. So, so yeah, so that's our exposure example, a response prevention example could be. So again, that's taking away our compulsions. So if you are avoiding by walking on the other side of the sidewalk, the example could be okay, I'm then going to take that away. And I'm going to still just go to work the same time, as I usually would. So with the response prevention example. Basically, you're going to want to cut out any of the kind of compulsions that you're doing. So with the dog thing you would want to leave for work the same time as you normally would, instead of being like, let me wait 20 minutes kind of thing. Or if it's a hand washing, let's say somebody feels like they need to wash their hands five times. Or they need to use five pumps of soap, we would say, All right, let's cut it back to two pumps of soap or like two times we wash our hands and then gradually kind of bring it down from there. And so how do you find clients? Are they receptive to this or does it ever like make them feel uncomfortable hearing that Part of the treatment is going to be the exposure or the response to things that obviously make them very uncomfortable. Yes, I mean, people definitely can be very afraid to do this kind of treatment. This is a treatment that requires a certain level of motivation. I mean, we, we really, there's some things we do to kind of prepare people for it. So part of it is assessing for motivation. Where are you at? Like, what are you willing to do? And really building up your reasons for why, why do you want to do this. And let's remember that when we're doing these exposures, when they're uncomfortable, Oh, you want to do it, because you no longer are going to work, you got fired, your relationship with your partner is, you know, really going downhill, you no longer are spending time with your family, you're secluding yourself to your house 24/7 You're depressed, you know, like, these are the reasons we want to do this kind of treatment. So motivation is important. But another thing I tried to do is kind of explain to them what I had just told you is that I try to meet people where they're at, I'm never going to force them to do something they don't want to do. I might like, you know, push a little and be like, oh, let's like kind of do this right. But like, ultimately, like, Yeah, I'm not going to force anybody to do anything that they don't want to do. We start out lower, we're always agreeing on the exposures that we're doing. And again, it's not like throwing you in the deep end, it's like, let's stick our foot in the cold water. And we kind of build ourself up from there. So I always try to make that really apparent, and really reinforced that it is a collaborative process. Sure. So there's comfort in knowing that they still have that level of control. Right, knowing that like, this is something that both of you are agreeing on. If this feels too extreme, we can go down to a lower level work through that until we can feel ready to go to the next level and continue on because because it's so negatively impacting their life. This is it's worth it right, like putting in the work so that they can have a higher quality of life as they work through these levels. Yes. And so I know, at least when we talked separately, you mentioned like bringing in other people into session sometimes whether that's a partner or a family member to kind of help support that process. Can you share, like what that kind of looks like in the in the treatment? Yes, so it totally depends on again, this is so individualized, it depends on who we're bringing in and why a lot of times we're bringing in, well, this is more so with children, but with children, we're bringing in their parents, because they're almost always accommodating their behaviors. So we are doing a lot of family work if it's with a child who has OCD. Let's say I liked your example you gave of like the anxious attachment and in like looking through Instagram, let's say somebody's coming in, and they actually have like a relationship OCD kind of thing. That could look like Oh, I'm afraid I'm gonna cheat on them, or oh, I'm afraid they're gonna cheat on me. I think a lot of times, I mean, it can be either. Usually, if it's the one where it's like, Oh, I'm gonna cheat on them. It might be more related to scrupulosity like I'm a bad person kind of thing. Whereas I think that other relationship OCD, right? How it can kind of manifest and I'm afraid they're gonna cheat on me kind of thing. Or they'll do something wrong in the relationship, or Oh, my gosh, I just committed my whole life to being with this person. What if it doesn't work out? Right, that uncertainty, so that would really impact your relationship with your partner? If you're constantly like, oh, my gosh, I went to work, what if they hooked up with their co worker or something like that? So it might show up of them texting their partner all the time checking their location on their phone? You know, asking for reassurance like what you do at work? Did you hook up with that person? Did you talk to them? Give me a list of all your co workers. And now I'm gonna stalk them on Facebook, like any of these guys, when I say stock, not necessarily actually stalk them. But look them up, learn information about them, whatever. So really, if that's the case, it's probably impacting their relationship, we would bring the partner in and explain to them how the treatment works, and explain to them that they're actually engaging in the compulsion with that person, if they are consistently like, here's my location, no, I'm not doing this. No, I'm not doing that, you know. So we might have them say, okay, instead of giving them like 20, different forms of reassurance. And again, we wouldn't be buying from the actual client on this. They need to be willing to do it as well. But if if everybody is understanding of what we're doing and why it's likely going to be okay, partner, instead of sharing your location, let's remove that. And if they say, oh my gosh, will you give it back to me? Like I only agreed that because that was the partner might say something, we want them to kind of respond with empathy because this is a huge struggle. And you we always want to keep empathy in mind because sometimes this treatment really can come across as like, torturous if it's not done in a compassionate way. So they say something along the lines of I understand you're really struggling with this right now. Like, I'm sorry, we agreed that I'm not going to give you my location. That's it. I'm not giving it to you. Whereas they might be tempted to do it. Otherwise, to kind of show them okay. Yeah, like, this is what I'm doing. Or they might say, you know, did you get lunch with that coworker today? You they could respond with, again, like some empathy, but also, depending on the person, even some humor and like some uncertainty statements, like, I guess you'll just have to guess and think about if I did or not like, I don't know, maybe they did. Maybe I did it. Oh, gosh. And again, these things can that could be a more sudsy type of response. Yeah. Yeah, totally just depends on where the person is at with things. But yeah, that's an example of how it can show up with them, you know, in a relationship kind of setting. Wow. So that's tough. So I think there's a lot of, it's almost like stern love, right? Like, because you're doing it, because you love them, and you want them to work through and you want to help this treatment, knowing in like, the short term, it is kind of emotionally painful to work through that. But for the greater good, right. So like, it's a team effort. And both people have to like clearly be on board. And I think emphasizing how you're seeing that empathy and like compassion, peace, because without it, it could feel kind of cruel. It can. Yes. And that's a really good summary of it. And yeah, people, we really do need to get other people on board, depending on how in mesh, these compulsions are other ways that it might show up. If you know, aside from that relation type relationship type of example could be a lot of times, you know, I think this is a more common example to have people like, I need to check the stove, that kind of thing. So sometimes people might be like, I'm not going to check the stove, right? Like, I'm not doing my compulsion, but like, Hey, babe, can you go check? Things like that, where they'll be like, Yeah, okay, you go in and check to make sure the candles are blown out, or whatever it might be. So like, even those are examples of, okay, like, Nope, we're just going to shut the door and give it our best guests that I think I blew him out. And that's it. We're leaving, whatever that that could look like. So yes, this can be a huge impact on family members and other kinds of relationships, which is why I had sent you beforehand, those book recommendations because there are support groups. There are lots of book recommendations, they can come in to individual therapy. I also sent you the international OCD Foundation website. So the international OCD foundation is an incredible resource for individuals who have OCD, as well as their, you know, partners, family members, etc. And so I go to this conference, I've gone the last two years, and I plan to continue going. And last year, I actually presented on it which at the conference, which was really fun. Yeah. But it's a really cool Foundation, because it's not one of these things where you just go to a conference, and therapists are there to learn about their continuing education credit. It also it's for therapists, it's for therapists who might have OCD. It's for family members, parents, partners, friends, in people with OCD, and they have different kinds of like, lectures, activities, different resources for all the different people that come to it. It's really, really cool. Yes, so that's always an option too, for people who want to either support someone with OCD or somebody who has OCD to look into those kinds of resources. Wow, that's incredible. I've never heard of a conference where it's that inclusive of not just separate for like the professionals treating or someone struggling with it, but like everybody, so it must be like lots of different like, whether it's seminars or resources or just like ways that they express this to help everybody across the board. Yeah, it's really cool. And I think that it's so inclusive because the OCD community is so I think like tight knit and in almost like protective of each other because there it's so misunderstood. Like it really people don't get it. So once they finally get that diagnosis, like on average, it takes way I wrote my thing down here It can take 14 to 17 years for someone to receive the appropriate OCD diagnosis. Wow. Like think about that 14 to 17 years of going to treatment providers trying millions of psychiatrists, psychologists, other kinds of therapists, different kinds of therapies, different kinds of medications, and you're suffering all that time without actually knowing what your problem is. And then once you get the the correct diagnosis, and you go through treatments, like, this makes so much sense. But for a lot of people, it takes a very long time. And so once they get that, it's like, okay, I found my people, right. So I think that that's, that's a really big reason why iocdf is so inclusive of everybody, and really, they do their best to help everyone out. Wow, that's incredible. Do you have an idea or know why it takes that long for someone to get the proper, like diagnosis and treatment for that? Yeah, because clinicians don't know how to assess for it. They don't understand that, you know, people like you, you just gave an example. And like you said, the person who you're explaining with anxious attachment might not even have OCD, it might look similar, but it might not meet criteria, but it could just come across as they have an anxious attachment. And that's it. And it's just anxiety. Right? It doesn't people don't necessarily always think like, oh, that's actually OCD. I think a really big example that I feel is really important to talk about is so when we're assessing for homicide, ality or suicidality, a lot of times people with harm or suicidal type obsessions can completely be mislabeled and get in, you know, get themselves hospitalized, when really their fear might be. Okay. Yes, I'm having these thoughts of, of dying by suicide or doing something very harmful to myself. But that doesn't mean I want to do it. You know, it means that I'm afraid that I would lose control and do it. Versus if somebody just says, Do you have thoughts of suicide? They could say, yes. And it's because I'm so depressed that I want to find a way out of this, which would be actual ideation versus an obsession, which it's like, Yes, I'm having these thoughts all the time. I'm distressed by them, like, I'm so afraid that I would do something to myself, that's different. You know, so people can end up in the wrong treatment setting, they can end up being hospitalized for something that's completely not related to what they're experiencing, which in itself can be. Now you have a trauma related to this, and you experienced this really horrible situation. I mean, I can't tell you how many people I've heard, say these things. I mean, people come in all the time. And they're like, Wow, I've been in therapy for years talking about these things, and got to the point where I am on leave of absence for work. And then I come in here, and I like completely turn it around. Wow. So I'm just hearing a huge gap in knowledge for even mental health clinicians to be able to properly assess, diagnose and treat this, that's causing, unfortunately, a lot of harm for clients who are struggling for years and years and decades, even until they meet someone like you, who has all this proper knowledge and expertise to help people find relief. Wow. Yes, and that's why I'm so passionate about this, and why I really find it into disseminate practice, because, at my very least, like one of my missions is to just have everybody know how to spot it, not everyone is going to treat it, that's fine to be able to know how to spot it so that you can refer them to the appropriate providers. Wow, this has been so informative. I mean, we're definitely gonna have to have you back on to even just like, be able to help people identify this as clinicians or, um, like, if you have seminars or workshops that you're doing, I mean, this is definitely going to be really important information for people to get and especially for clinicians to help people and their clients work through this. For sure, that's why I sent you those measures to which we didn't even get into but that's fine. They're just things that are helpful tools for clinicians to have an even just look at so they can understand it to an extent, you know, so I would be happy to I love talking about this stuff. So it would be it would be great. Absolutely. And so some exciting things can you share if there's anything new coming up for you or for listeners to hear how they can reach out to you to work with you? Yes, so I speaking of the International OCD foundation, so I am planning I don't have concrete plans yet. So We'll stay tuned. But I'm planning to potentially present at that conference again this year, it's going to be in Orlando, Florida in July. So that's something Yeah, that's really exciting. I definitely encourage anybody who's interested in this to just kind of play around with their website, there's so much out there. And so I'm also going to be coming on board with heal your roots. And so if you would like to work with me, I have some limited availability for people to come on board and I can work with you. And I also work at the anxiety and OCD Treatment Center, which is in Wilmington, Delaware. So if you really struggle with telehealth, and you want to come in person, I also am working there so I can be reached. Either way. Awesome. Yeah, I'm so excited. This is like a little surprise at the end of the episode. And maybe we'll let this let everybody know in the beginning, but we're super excited and thankful to have you join Heal Your Roots Wellness, I think you're going to be a tremendous asset to our team and be able to help so many people who may be struggling with this. So I'm excited. Thank you so much for being on and joining our team and I'm excited for this episode to air me to I can't wait to see it. And I'm really excited to share it and to join, Heal Your Roots Wellness. And it'll be a really fun experience for us to be able to collaborate more on this. Absolutely. So if anyone is interested in working with Katie, you can head over to our website, heal your roots wellness.com and schedule a consultation and we can kind of go from there. So thanks so much for being on with us, Katie. Yes, thank you so much for having me.