Heal Your Roots Podcast

Faith, Doubt, and Healing: Conquering OCD and Religious Trauma Together

• Heal Your Roots Wellness • Season 3 • Episode 9

Share episode

Welcome to a profound episode of the Heal Your Roots Podcast, Season 3, Episode 9, where we explore the intersections of Obsessive-Compulsive Disorder (OCD), religious trauma, and pathways to healing. Join us as we sit down with Dr. Katie Manganello, a clinical psychologist specializing in OCD, and Caitlin Harrison, a marriage and family therapist with expertise in trauma, to unravel these complex topics.

This episode dives deep into:

  • The essence of OCD and how it manifests through doubts and compulsions.
  • Understanding religious trauma: its sources, impacts, and the journey towards healing.
  • The concept of scrupulosity: navigating fears around moral and religious purity.
  • Approaches to treating religious trauma and OCD, including cognitive therapy, ERP (Exposure Response Prevention), EMDR (Eye Movement Desensitization and Reprocessing), and Internal Family Systems (IFS).

Dr. Manganello and Caitlin Harrison provide insightful discussions on how religious beliefs and obligations can intertwine with OCD, leading to a challenging mental health landscape. They offer hope and actionable advice for those struggling with these issues, emphasizing the importance of understanding, acceptance, and professional guidance.

Whether you're grappling with these issues personally, know someone who is, or are simply interested in the subject, this episode offers valuable perspectives, expert advice, and a message of hope.

Join us on this enlightening journey to better understand the complexities of mental health, faith, and the road to recovery.

Support the show

Check out the rest of the Heal Your Roots Podcast episodes at our website.

Learn more about Heal Your Roots Wellness

Kira Yakubov Ploshansky:

Welcome back to Heal Your Roots Podcast. In today's episode, we have returning guests, Dr. Katie Manganello and Caitlin Harrison, marriage and family therapist, we dive deep into how OCD overlaps with trauma, specifically religious trauma. We go into more insight into scrupulosity and real event OCD, you're not going to want to miss today's episode. So it really takes that past event and warps it until the person really views themselves as like the worst person in the world who can never be excused or forgiven for it. Do you can kind of see how OCD and religious influences could lead someone down a path that might make them really overwhelmed with this idea that I have to be perfect. Ladies, thank you so much for joining us for another episode today.

Dr. Katie Manganello:

I'm excited to be here. Yeah, thank you so much. I'm so excited. This is one of my favorite topics, so I'm ready to get into it. I've been looking forward to it. Awesome.

Kira Yakubov Ploshansky:

So both of these therapists work at Heal Your Roots Wellness. Dr. Katie Manganello specializes in obsessive compulsive disorder anxiety disorders PTSD. Caitlin Harrison Marriage and Family Therapist specializes in couples therapy, trauma, and specifically religious trauma. So I'm really excited for today we're going to talk about the intersection between OCD and religious trauma. So Katie, can you kind of start with a little bit of background about who you are and what you do? For some of the listeners that may have not heard your episode before?

Dr. Katie Manganello:

Yes, so like you say, Kira, I'm, I'm a clinical psychologist, I work at Heal Your Roots Wellness. I also work in a private practice the anxiety and OCD treatment center that is physically located in Wilmington, Delaware, mostly what I do is individual therapy, focusing on treating OCD. Sometimes that comes along with other things. There's a lot of comorbidities. So I also work a lot with ADHD, autism spectrum, body focus, repetitive behaviors, anxiety, PTSD, depression, a bunch of different stuff. And I work with people of all ages, a lot of times we bring couples in or family members and to assist in treating the OCD or whatever else the presenting problem is, me as a clinician in general, I really, I operate mostly under a cognitive behavior model. I also really, within that model, really enjoy Acceptance and Commitment Therapy. And of course, with OCD, I do a lot of exposure and response prevention.

Kira Yakubov Ploshansky:

Awesome. Thank you so much for sharing that. Healing. Can you share a little bit about yourself for the guests or for the listeners?

Caitlin Harrison:

Yeah, yeah. I think Kira, you summed it up? Well, I do a lot of work with couples. So systemic therapy doing it, whether that's like couples or even families, parent and child, like grown up, adults working on their parent and child relationship. And then I also do work with trauma. So I do EMDR therapy. And I focus a lot on religious trauma, which is also one of my favorite topics. And just like Katie pointed out with trauma, there's a lot of comorbidities a lot of things that can come up so that could look like anxiety, depression, PTSD, even OCD like we're talking about today. Self esteem, attachment wounds, things like that. So that's what the work that I do looks like here at Heal Your Roots Wellness.

Kira Yakubov Ploshansky:

So I think we can kind of lay down the foundation for listeners to know what is obsessive compulsive disorder, some background and what religious trauma is. And then we're going to talk about like some really nitty gritty stuff that I think is super fascinating that I haven't actually ever learned about before or heard of some of these words even so I'm really pumped to learn more about this so I'm going to have questions like as an audience member to see like to learn more about this. So if either of you can kind of start with what the specialty is that you have,

Caitlin Harrison:

So all I guess I can kind of define religious trauma but Katie just chime in whenever you feel like I'm missing something but um, so religious trauma is just like any trauma when you experience harm or abuse from something outside of you. So when it comes to religious trauma, it's you're receiving like religious or emotional or spiritual, I'm sorry, abuse from whether it be leadership. It could be your parents, an outside system, even just your the culture that you live in. You're receiving hateful messages about who you are as a person. And that leaves you with emotional mental, physical symptoms. So that's kind of how I define it. Anything you'd add?

Dr. Katie Manganello:

Yeah. And so I think that's something I like to tell people too, when we're talking about trauma is that you can experience trauma without becoming full blown PTSD, like post traumatic stress disorder. I'm thinking, usually when I work with trauma, I mean, there's a lot of people who've experienced trauma, right. And so, just kind of teasing trauma apart, like as a whole, apart from like, post traumatic stress disorder that in particular, is a disorder in which you know, someone has witnessed a traumatic event, such as like war, or sexual assault, or you know, any of the things that you had mentioned as well, and includes these recurring symptoms such as intrusive memories, flashbacks, nightmares, negative changes in thoughts and beliefs, and a lot of avoidance around any kind of cues that remind them of the trauma. So when I'm talking about OCD related things, I think I'm comparing a little bit more to a diagnosis of PTSD as opposed to kind of like a general sense of trauma.

Caitlin Harrison:

Yes, yeah. And the way that I think about trauma is sort of on a spectrum, because he talked about these big, and then slet are causing flashbacks, very marked memories of specific events. But then there's also this complex trauma that where you receive messages over and over again, that like, you can't trust your emotions, you can't trust your thoughts. So you might not have these specific memories that come up for you when you know, your pastor told you that. But there's something in you that questions like, Wait, am I allowed to trust myself? Am I allowed to trust my emotions, so there can be not so specific events when it comes to trauma as well, which I think is important to just know.

Kira Yakubov Ploshansky:

Sounds like constant messages being told instead of like an event. It's just messages that kind of seep in that create a narrative and a belief system within you.

Dr. Katie Manganello:

Right, several little events that can kind of like pile up. Yep.

Kira Yakubov Ploshansky:

And what about OCD? Can you share, kind of like what obsessive compulsive disorder is for the listeners?

Dr. Katie Manganello:

Yes, well, for me, this is such a difficult thing for me to make a small explanation for. So if you want an expanded definition, go listen to the episode that Kara and I recorded before I go in way more detail, but to try to keep it simple. OCD is a doubting disorder. It's fueled by uncertainty. And it's a disorder in which people experience repetitive and intrusive thoughts, images, urges or feelings called obsessions. And these fears are ego dystonic, which means that they do not align with the person's values. And everyone has intrusive thoughts here and there, but most move on from them realizing that these thoughts aren't really threatening or they don't mean anything about them as a person. But for people with OCD, these thoughts feel really significant and can cause intense negative feelings. So as a result of that they engage in compulsions, which are mental or physical acts performed to relieve the distress or to keep an unwanted event from happening.

Kira Yakubov Ploshansky:

Thank you for keeping it short and concise. I know that was tough. So it sounds like even just sharing that there's a lot of overlap. I feel like between trauma and OCD and how it presents and I know later on, we'll talk about how to differentiate between the two. But I did want to dive into Scrupulosity. I've never heard of this. I think this is super fascinating. If we can kind of just dive into what is that? And how does that show up for OCD versus trauma versus the intersection between the two?

Caitlin Harrison:

Yeah, so Scrupulosity that is basically this obsession or this need or this drive to achieve moral perfection, or like moral purity. And so even as I just say, that sentence, you can kind of see how OCD and religious influences could lead someone down a path that might make them really overwhelmed with this idea that I have to be perfect. And so that's what scrupulosity can look like, I mean, we can go into detail of what that could look like for you know, someone who did have a religious upbringing or was influenced even in their adulthood, maybe that's safe for a little later.

Kira Yakubov Ploshansky:

We can dive in now if you If you both want to I think like this is like I like that this episode is now the work. We have each episode with both of you kind of going through your background. Now we can get to like the specifics and the details of things because I've never heard of this. But thinking about this, I'm sure this is super common for a lot of folks. So hearing this, I think was going to be super helpful and beneficial.

Dr. Katie Manganello:

Yep, for sure. I think you did a really good job explaining that that's really very much. So how I would explain it to you know, it's that you know, this really all or nothing like rigidity around achieving that like perfection around being a perfectly religious person or moral person, even it doesn't even have to just be a religion, which I was. I'm just going to talk a little bit about bad person OCD, which is kind of the same thing. I mean, it's very similar in the sense of like, the morality aspect in wanting to just like, even if you're not following a specific religion, it's more so that moral compass of doing things perfectly moral type of thing. scrupulosity OCD, I actually see this a lot. I see this a lot within the practice. And so some common obsessions around scrupulosity OCD could be fears of committing a sin. Excessively striving for that purity, fears of going to hell or being punished by God, being possessed fear of death, fear of a loss of impulse control, doubting what you truly believe or feel in needing to have that certainty around religious beliefs. And then of course, there's lots of compulsions that can come along with that that could be if it is something like you said, Caitlin around like sex before marriage kind of thing. Maybe it's, I'm going to avoid dating in general, because I don't want to even tempt myself. It could be excessive praying, it could be I liked the example you gave to of donating money. So I can show up in a lot of different ways.

Kira Yakubov Ploshansky:

That's so fascinating. And I'm curious of since it's kind of connected to this belief of something higher kind of punishing us in some way, or like judging us or watching us? Do either of you see this ever come up with anyone who might be atheist or agnostic? Or is it very specific, like, they're kind of connected to a religion that's shared this message?

Caitlin Harrison:

Something that I see a lot and maybe it's not so much connected to religion. For them, it's this idea that I could make a wrong choice, when actually the choice the two choices before them are say, Should I take this job or this job? Both align well, with my schedule, both are good salary, you know, they they're kind of equal. There's no right or wrong, good or bad. It's just what which one do I want? And sometimes it can be difficult even outside of a religious context. To to tease that out, like, Am I really being good or bad by choosing one of these? It's that fear of the future or fear of like I could choose something wrong that would turment me in the future

Dr. Katie Manganello:

Yeah that sounds like the perfectionism to me right? Like am I making the perfect choice? The one that's best for me kind of thing, which is so much in the same like, yeah, the realm of that yeah, Kira. I feel like the bad person or like just moral aspect of this group philosophy shows up more so in like people who don't fall under a specific religion, like they, they could be a theist, because it's it that doesn't mean you subscribe to a specific god or gods or whatever, it could just be. I'm here, and I still feel like I shouldn't be nice to people or I should be, you know, a certain you know, certain behaviors or whatever. Yeah, that was just interesting and made me think about if that had a connection to it, but I guess just I mean, And even people who are atheist agnostic, right? Like there's still a moral compass and values that we follow. So it's more about that all or nothing kind of thinking around it versus it being something specific, like a religion. So it could just be the future, how we view ourselves is kind of what's in control of it. Yeah. And actually, I mean, considering OCD, like I said, is a it's a very doubting type of disorder. If it is a sense, where you're doubting what you truly believe or feel, anybody can experience that atheists could they could be like, maybe I am deep down a Catholic who and I think that I'm an atheist, right? Like,who knows,

Caitlin Harrison:

That's part of what makes religion so comforting, actually, is, I don't have to fear fear of the future anymore. I don't have to be afraid of what's going to happen to me. All I have to do is, you know, pray this many times, or live this good of life or trust in this certain thing. And then I have a sense of control again, over my future. And when you start to question that, when that's sort of what you paid, placed all of your security in, and that's sort of what made all of your anxiety subside. before. It's such a disorienting feeling, because then what can I trust? What can I rely on? What can help me predict my future? How can I control my future? And you're kind of like reckoning with that, like, maybe I can't anymore, but I used to feel like I could. It's so confusing.

Kira Yakubov Ploshansky:

It sounds that you have this certainty that you trusted in outside of you. And now that kind of caught like, it was crashed. And now it's just, I mean, it sounds super disorienting. Now, it's like all uncertainty, instability, and trying to like kind of grasp for an anchor. That does sound pretty traumatic, like internally.

Dr. Katie Manganello:

Yeah, I would say a little bit of a nuance to that with the OCD is that if people come in with scrupulosity, it's not necessarily that it's usually not that the person is so focused on. Will religion is my certainty. It's, it's more so of like, well, did I do this good enough? Am I being a good person? This or That? opposed to the latter?

Caitlin Harrison:

Yeah, yeah, I guess I'm I, speaking from a place of someone who's like if a client has walked away from a certain religion, and recognize that Reckoning and like, Okay, I used to have something that gave me so much comfort. And now where can I find comfort because it used to be that I did things perfectly. It used to be that I was the good Christian girl. It used to be that all I had to do is not sleep with my partner. And now who am I? Am I good? Am I you know

Dr. Katie Manganello:

yes. And I think that that's a really big difference and something for people to when they're evaluating for it to kind of keep an eye on because for people who have like scrupulosity OCD, like one of the main points I like to tell them is that my goal is not to take away your religion, because again, OCD targets your values. So if somebody's experiencing scrupulosity or bad person, it's targeting something that they find to be really important in their life. So the I always tell them, the goal is to bring you closer to your faith rather than to kind of like stray away from it if it is indeed that value for you. So that part is really important. And I also like to bring up with people to that, with that fear. And that uncertainty showing up with OCD. The whole point of religion is to have faith, right. And by definition, faith is that you are believing something that you don't actually really know, right? You don't have that concrete evidence for so kind of like leaning into that and with OCD work with scrupulosity. It is like really utilizing their their faith if that is something that's important to them as it relates to the obsessions.

Caitlin Harrison:

Absolutely. Yeah, I do a lot of work with people who are questioning their beliefs or change their belief systems or things like that. So speaking from that place, that can be a very disorienting like earth shattering. I used to feel like I had more certainty than I actually had. But when we're working with a client that does want to maintain that value system, but wants to have it in a healthier way, in a way that helps them feel more regulated and more like just success, like I can navigate life without having to worry so much about this being caring so much about every little thing that I do or think even I mean, that's another another thing that religion regulates even your thoughts, like if I think something bad, then I'm a bad person. If I think about having sex, then I'm a bad person. You know that but it's a lot of plaguing thoughts. And so if you can give yourself a little bit of freedom and grace, just like most of our higher beings give us that can bring a lot of freedom to.

Dr. Katie Manganello:

Totally I love that you brought up the that like some, some religions will say that like even thinking about it is a sin. Because you actually we can't control thoughts that pop up in our head like you cannot control an intrusive thought. We can control how we respond to the thought, but you can't control it popping up into your head. So a lot of things I like to say with people with the scrupulosity to is like, if we have faith in God, and we think that God is loving, or whatever this person's belief system is, then we can, we can probably use our best guests to say that I'm going to believe and have faith that God would forgive me and understand that I have OCD or understand that these thoughts are popping into my head, and I can't really control that.

Caitlin Harrison:

Yeah. And it's that practice of mindfulness, like you can notice those thoughts. And you can notice what prompted those thoughts, but you can't, you can't make them go away. You can only control what you do with them, and how aware you are of them. That's really the goal of any any real any religion, any God wants you to just be aware and connected to yourself, to your mind to your heart. It's the whole goal is to just be raising that mindfulness about who you are and how you're doing and what you're thinking not constantly fearing what could happen if you make a misstep?

Dr. Katie Manganello:

Yes, exactly. So I think that we can both probably agree that what we're saying here is like, it's not one religion, or any religion that we are considering to be like, that are problematic. It's kind of more so the way that people can hold on too tightly. of those things that are taught, or how they kind of interpret how to behave as a response of that.

Kira Yakubov Ploshansky:

This isn't really deep and powerful. This is like very existential, I can't imagine. Like on a very, man, I'm like getting chills thinking about this, like thinking about how I was raised in different ways of just even the thoughts, like I work with clients for sex therapy. And if they have an arose, talking to a client, like I feel guilty, fantasizing about somebody else, or having a thought that someone else is attractive. And like working through like, your mind is your playground you're allowed to have whatever thoughts you have, it's just what you do with them. And how you act upon them, is the difference. But what kind of goes on in your mind is yours. And it's private, and you don't have to share that with anybody. And I have so many thoughts in my head. So I can't imagine, like having to filter and like, Nate, like labeling this is bad. This is sinful. This is okay. That sounds exhausting. And like a job within itself.

Caitlin Harrison:

That goes, yeah, right along with what you're saying. It can show up a lot of times too, with that confession, like you feel this obsession or this compulsion to confess any sinful thing you did, or any bad thing that you did. Even thoughts, any bad thoughts that you had you feel this obsession, whether it's with with a pastor, a priest, mentor, your spouse, like, Hey, I was attracted to this person, like I need to tell you or you know, the privacy and that self trust can oftentimes just be broken and you feel so guilty and full of shame that you could be so evil as to have a thought that disgusting.

Kira Yakubov Ploshansky:

It makes me think about so in like Eastern European cultures, or even like Mediterranean cultures, they have like this thing called the evil eye. And if either of you have heard about it before, and so especially like growing up in my culture all the time, if you say like a compliment, or you admire something, or you're jealous of something in Russian, you would always say is Glaus it to like, you would say like, I don't want to curse it, I don't want to put a curse. I don't want to jinx it. And like, even my mom, like, I have a baby now and I'm telling her how beautiful she is, and all these wonderful things. And she was like nice guy that Don't say too many good things, something bad will happen. And I'm like, Mom, that's crazy. Like, I want to I want to see these good things and build up her self esteem. She's like, but you can't say too many because then something bad will happen. I'm like, this explains my child. A lot like you're holding back sharing positive things because you're scared that it will jinx it. And like even that superstition, I think is so strong. It makes me think about this, like our thoughts can be that powerful to cause something bad to happen.

Caitlin Harrison:

It kind of causes this in authenticity to like it's disingenuous, like I can't be honest about my thoughts. To other people around me, or because it's going to damn Me To Hell, if I'm honest with about who I am or what I'm feeling, and when I'm thinking

Kira Yakubov Ploshansky:

talking about shame, that's like,

Dr. Katie Manganello:

there's a lot of shame and guilt tied in with this specific subtype in the real event subtype that we can kind of get into whenever we're ready.

Caitlin Harrison:

Yeah, I mean, you can share what that means the real event.

Dr. Katie Manganello:

Yeah. So the real event, I think, there, there's definitely some overlap. So I really wanted to talk about the real event, because I think that it can be hard to tease real event OCD, apart from trauma and PTSD, because there is something that happened, like a lot of times people think, okay, OCD is like, I'm gonna flip the light switch up and down to make sure that my mom doesn't die on her trip to work today, or something like that. So it's more so or I'm going to, like, clean incessantly, so that I make sure that I don't get sick. But it's like, oh, well, what if something actually happens? Right? So real event, OCD is rooted in memories of events, which have already happened. So it could be that someone feels uncertain about what they've done. So an example could be like, maybe a person goes to happy hour with their co workers, and has one drink more than they typically would. And then they start to wonder, ooh, like, Did I say something offensive to my coworker? Did I hit on my boss, like, what if they fire me for how I've acted. So in this case, the real event is that someone did indeed get intoxicated with their co workers. However, they're more concerned around the uncertainty of the result of what their behavior could have led to, or how that impacted the others that were with them. And, as you can probably imagine, this theme specifically happens a lot with drinking because it like alters your memory, and the more you go back, and mentally review memories, that also messes with your memory. So there's a lot of a lot of that happening. Another thing with a real event, OCD is like a person could feel consumed with that guilt, that self doubt about something that did actually happen. And that could in turn result in doubting who the person is like, as a person. So an example of that, that could be more so like, okay, let's say, you steal something from a store, like candy or something when you were younger. And it's not like it's something you do anymore. It's not something you've done more than one or two times, right. But then you start to think, well, I did steal though, and that means that I'm a thief, and I'm a terrible person because of that. And, you know, if I have kids, like I shouldn't, because I could transfer that characteristic to my child, and it'll be my fault that there's more thieves in the world. I mean, it can really like spiral right? So the fear of wrong or potentially wrong past behavior drives people with this type of OCD to engage in compulsions aimed towards gaining certainty about what exactly they've done. And what this means about who they are as a person. And so some of the major real event compulsions include that mental reviewing the confessions, like halen was saying, and reassurance seeking like, Oh, I did this, like, do you think it's okay kind of thing. So this subject can be incredibly painful for people and confusing, because pretty much everybody experiences regret or doubt about things that have happened in the past. But people without OCD can usually kind of look back at it and say, like, oh, yikes, I shouldn't have done that. But reflect on it and move on. Whereas someone with real event OCD can have guilt over this, and feel it in such an overwhelming way that it could be equivalent to the feeling as if they like committed a murder or something. So it really takes that past event and warps it until the person really views themselves as like the worst person in the world who can never be excused or forgiven for it.

Caitlin Harrison:

Yeah, one of the examples that shows the intersection of this real event OCD, and religious trauma. I knew someone it wasn't an a client or anything that felt as though because they slept with their husband when it was just their boyfriend. So they weren't married yet. They slept together. And they felt that because they did that their marriage after they got married was just ruined. And that's why she was being mistreated by her husband is because she gave herself away before you know before that she should have and so it's sort of this like fear of I don't think that my marriage will ever be able to recover. She wasn't like being abused or anything. It was just bad conflict styles. And it was sort of this like what's the word fulfilled prophecy? Prophecy of like, we can't make it through this because of past things that happen to me. And that creates this vicious cycle of kind of proving to yourself that see I am bad. See, I did something wrong. Does that align well with what you're explaining?

Dr. Katie Manganello:

Yeah. And I think that there's things that could also just like continue to fuel those types of compulsions or whatnot. I feel bad for this person, especially because, you know, in the context of it being a marriage, like, you can't get divorced, or at least I'm assuming that's part of the religion that or that religious belief of like, once you're together, like, That's it, you don't divorce or if you do, like, that's bad. So it's like, oh, I messed up before my marriage, we got married, and now I'm stuck and it's ruined. And I'm, you know, in this unending sense of doom, basically.

Caitlin Harrison:

Yeah, this is I gotta pay my penance now, because, right, I'm being I did this for myself. Yeah. Yeah.

Kira Yakubov Ploshansky:

And so I can see this showing up just in any trauma, right? Like, especially a lot of this over section with OCD is like these intrusive thoughts, these flashbacks, like having this negative belief of yourself, the self fulfilling prophecy, right? Especially in like, in terms of interpersonal relationships, like, I'm a bad person, I did this or something bad happened to me. And now I'm scarred. Like, I know, a lot of you know, victims of sexual assault might feel that way that they're damaged in some way. And so they may push other people away, having this belief like so there's so much overlap that I think that maybe a lot of people may not have recognized between the two. And so I'm curious of how either of you kind of tease apart when you see somebody presenting a lot of the symptoms or issues? How it could be either? Is this PTSD? Is this OCD? Is this both? Is this the comorbidity that we're looking at right now? And helping them through that?

Dr. Katie Manganello:

Yeah, it will, it could indeed be both it could. It also could not, it could, so you should try to tease it apart. First, if that is the case, the difference is that like, while there are repetitive behaviors of OCD that are performed to like prevent an imagined threat from occurring, or from that perceived all or nothing thought from being true about themselves, that the repetitive behaviors are showing up with PTSD are done to avoid re experiencing traumatic memories. So it's more so well, if it's, if it's PTSD, where it's one specific event, at least, that's kind of the case. Even if it's a collection of memories, it's those memories or those specific, like themes that they are trying to avoid. That's how I would explain the difference. I think there's like a lot of overlap, though, and especially in what we are saying, like, I think in particular with religious trauma, some of the specific OCD themes discussed, like, there's this level of uncertainty around somebody's identity and around questioning their values and in learning how to trust themselves. Like I think that those are some really common themes that show up amongst both of them that you're going to still be doing some of that work.

Caitlin Harrison:

Absolutely. I think you summed it up well, and I think that they can exist together, they can exist separately. And the important part is just understanding the difference so that you can understand yourself better, so that you can understand your therapists can understand how to help you better. But if you're having these themes, they can show up in many, many different diagnosis could show up in anxiety and not OCD, it can show up as depression, simply like self esteem issues. So and

Kira Yakubov Ploshansky:

So how would each of you kind of go about helping someone who is experiencing religious trauma? Or the Scrupulosity or the overlap of the two what are some of your approaches that both of you kind of go through that might help the listeners kind of think about this if they resonate with this episode?

Caitlin Harrison:

Yeah, so like I said, I work a lot with individuals who are sort of changing their belief system or questioning their belief system and wondering if they want to change it. significant portions of it or the whole thing entirely. So like, for example, I'm, I'm questioning my sexuality, and I've always kind of suppressed that part of myself. I didn't want to confront it because I've just been shown that I need to be straight. And I need to have a nuclear family. I need to want to have kids you know, all that those kinds of things like maybe my sexuality and my true expression of not fitting the heteronormative mold Maybe I my belief system can coexist with that. And so I just need to question a part of my belief system or hey, I'm actually wondering if there's even enough evidence to support me believing this belief system that I once believed in. And so when I approach that kind of work, it's very slow. And it's a lot of grace for yourself. When we talk about scrupulosity, it's a lot of slowing down reminding yourself like, Hey, I know what voice This is that's talking. Whether that you name that voice, the OCD Scrupulosity, maybe you name that, that was just my youth pastor that was making me feel that maybe there really is somebody that's tied to that voice or that compulsion or that obsession. But just starting to recognize and separate yourself from that voice, can be really powerful, so that you can notice it as separate from yourself. rather than you being this evil person that can't manage to live a good life, or can't manage to be free from obsessive thoughts. If we're talking about real event, OCD, it's kind of where I start some initial thoughts that came to mind.

Kira Yakubov Ploshansky:

Sounds like being really gentle with themselves and you with them to going through that.

Dr. Katie Manganello:

I guess what I would start doing is just what we already just talked about in terms of is this both is it one or is it the other, and then I would kind of, I would probably go different directions if depending on what it is. So if it's OCD, I'm going to be doing exposure and response prevention treatment, in combination with Acceptance and Commitment Therapy that brings a lot more of that like, acceptance, gentleness, focus on their values, what they want that kind of thing. If I'm doing it with PTSD, I'm, I always, I look like a very collaborative therapist. So I really throw out what I can offer, and then what the person tells me that they think suits best for them. That's kind of what we go with. So if it's if they do want to work on their PTSD, I explained to them, Hey, I'm trained in cognitive processing therapy, I know how to do prolonged exposure. This is what each of these look like, these are evidence based track, you know, practices that we use, which basically just shows that like, you know, there's been a lot of research on these treatments, they help people. And I just give them more information around each and then they can tell me like, Hey, this is this one seems like a good fit for me or this one the other, or if they're like, not even at a place where that's something that they are like super ready to, like, hit the ground running with, I'll just kind of start out with whatever they say that they want to work on and kind of take it from there.

Kira Yakubov Ploshansky:

Can you share a little bit more about ERP and the cognitive processing for some of the listeners that don't know? I know, I keep making you explain things and concise ways.

Dr. Katie Manganello:

I like it, this could be a whole episode. So they're, they're both exposure therapies to an extent. So cognitive processing, therapy is a treatment for PTSD. A lot of it is what mostly what we're doing is we are looking at your thoughts and beliefs, and how they relate to the event or events that have happened, and looking at how they are not really helping you in your life right now. And talking about like what had happened and restructuring some of those beliefs with exposure and response prevention, that's like the OCD treatment. That is so the exposure part and exposure and response prevention is targeted towards the obsessions. So the exposure is we need to expose people to the fears so that they can, their brain can actually habituate to that anxiety and they can learn to tolerate it, building that distress tolerance. The response prevention piece of ERP is targeted towards the compulsions which is basically either eliminating the compulsions altogether or cutting them back with the goal to really have them be pretty minimal or gone. So if you want more information on that, you can go back and listen to the other podcasts when he's talked about that a lot. I think the biggest thing I'd like to just say in response to that is I think that all of these treatments sound really scary because they hear the word exposure and they're like that's what I'm trying to avoid. I'm I'm doing that. But again, like we're Working together, it's collaborative. I'm often doing exposures with people. And I'm, I'm never going to force anybody to do something that they're unwilling to do like we will find like little tiny exposures and then gradually build up like we are putting our toes in the water are not just, you know, Cannon going into that freezing cold ice water, we're like, gradually kind of dipping in. So don't be you know, it should be challenging. It should be a stress but not a strain.

Kira Yakubov Ploshansky:

Thank you. I appreciate both of you sharing that approach and how you would kind of go about that game. And I know that you also do EMDR. Is this something that you would do with clients who are struggling with scrupulosity?

Caitlin Harrison:

Yeah, so I without using the technical terms, what I was talking about before was internal family systems. So ifs is sort of this idea of understanding all the parts of you that show up and understanding why they're there, what they came to do to help you with. So what's scrupulosity, oftentimes it shows up to protect you from going to hell for to protect you from being socially rejected, to protect your parent from being disappointed in you, things like that. So it's kind of taking it and putting yourself your true, like authentic self in charge of all of these parts of you, but also appreciating like, Hey, you showed up for a reason you showed up to protect me, you showed up. And you helped me once upon a time. And now I think I want to be in charge. And so that's a long process. And it sounds really simple. And it's not. But that's sort of the basic theory behind how I would often approach scrupulosity. And there are times when it's trauma related that you could use EMDR. So if especially with the relevant or reprocessing, like a specific memory, or it could be a negative thought, a negative cognition that you attach to many different memories that you could use EMDR for. So if you notice compulsions or obsessions that come up, or memories that come up often with trauma related things, then we would use the MDR, if that makes sense.

Kira Yakubov Ploshansky:

And same thing, if you could share a little bit I know we talked a lot about EMDR in episodes together, but for the listeners a little bit of like, what that is and like the like the acronym that it's for. So they have an idea, kind of what that means.

Dr. Katie Manganello:

After this

Caitlin Harrison:

things, these are things we like talking about. Yeah. All right. So it's Eye Movement Desensitization and Reprocessing. So it's a mouthful, that's why we just say EMDR. Um, but basically, it uses the theory behind bilateral stimulation. So if you imagine kind of taking your body and dividing it into two halves, the right side and the left side, if you stimulate the right side and the left side, in a rhythmic motion, it could be fast or slow, just depending on where we're at in the process. It can help your mind your body and your feelings consolidate a traumatic memory that they couldn't process that it couldn't process previously. And so I think EMDR is a really good fit for people that haven't had good success with talk therapy. I think it's also a good fit for people that are tend to be like more emotional and creative creatures. I think it I noticed that it can tend to be a good fit for those people who like to do like visualizations and things like that. So yeah, it's it that what that looks like in a session is we do a lot of skill building at the beginning of treatment. So learning how to regulate your nervous system, learning how to calm yourself down. When a traumatic memory is brought up, or even a stressful event at work is brought up. We do a lot of skill building at the beginning. It's just like what Katie said, we don't just dive into the deep end and bring up you know, the worst thing that ever happened to you. Then we start to reprocess the memories once your whole nervous system is ready for that and you feel like you're able to regulate yourself and you have those skills that you need. need in order to do that, one benefit, I think of EMDR is that you don't actually have to say your memory out loud. Sometimes that can be powerful for people. And it's that avoidance that Katie's talking about, sometimes, it's actually really good for you to be able to say it out loud and have somebody else know what's happening. But it's kind of cool that in EMDR, you don't have to. And so you can start slow. And we reprocess the memories with bilateral stimulation. So sometimes you're looking left to right, left to right, that's the eye movement piece. But what research has also found is that any type of bilateral stimulation works, so tapping on left knee, right knee, left knee, right knee, or your shoulders or even sound in your left ear, then right your left ear than right here. So we kind of do what works for the client and also the environment that they're in. And some clients have relief in one session, some clients, it's eight sessions, some clients, it's many more than that. But that's kind of EMDR. In a nutshell.

Kira Yakubov Ploshansky:

I appreciate both of you really sharing that explain, I think he did a phenomenal job. And I think this is going to be a really powerful episode for a lot of people who could be struggling with this. Or even folks who know somebody in their life they love they could be struggling with this and understanding it a little bit more and having more empathy. I would say before we close out, is there any, any last bits of whether it's like giving hope or any other thoughts for listeners around something like this?

Dr. Katie Manganello:

I think that there is a lot of shame in some of these, especially when there is a real event because you essentially have to go and tell somebody, something that you think the worst thing about yourself. So I can understand that this is really, really difficult to see help in. But also like just to know that you're probably judging yourself for it a lot more than anybody else would, which is sort of giving reassurance right now, but I mean, you should you know, you, I would hope that somebody would feel comfortable coming and talking to me about some of those things. And just that having them know that I get how it operates. I know how it works. And like, we can put the judgment aside to like, get through it. So I think that that is a really important thing with with PTSD. And with OCD, I think there's often a lot of shame and guilt tied in.

Caitlin Harrison:

Yeah, I think just that there is a path ahead, that doesn't feel so disorienting. I think that's what I see a lot with the clients that I see anyway, you know, that really disoriented feeling of a foundation I once had is not here anymore, and I'm kind of grasping for anything that can make me feel comfortable again. Um, there is a path ahead where you don't feel so disoriented and so confused about who you are, what you're that like maybe listening to this and talking about values you're like, that's the last thing that I want to talk about because I don't even know when I think or believe or feel about anything anymore. And so yeah, I think just you can learn to trust yourself again, you can learn to be reconnected to all of you know, your emotions and your mind and your body and it not feel so overwhelming.

Kira Yakubov Ploshansky:

So for listeners, Katie and Caitlin at this time are both accepting new clients. So if you're interested in working with either of them, please reach out. You can head over to our website, heal your roots. wellness.com Katie, and Caitlin, thank you so much for being on with us again today. This was

People on this episode

Head Shot

Kira Yakubov, LMFT

Host