The Things Everyone Needs to Know About OCD

Summary

This script discusses OCD, explaining how intrusive thoughts lead to compulsive behaviors that temporarily alleviate stress but reinforce the cycle. It differentiates OCD from OCPD, emphasizing the ego-dystonic nature of OCD thoughts and the importance of psychotherapy in teaching patients to tolerate negative emotions without succumbing to compulsions. The speaker highlights the broader relevance of OCD treatment techniques for general mental well-being.

Takeaways

• 🔄 OCD involves a cycle where intrusive thoughts lead to compulsive actions that temporarily relieve stress but ultimately reinforce the cycle.
• 🤔 The more individuals with OCD give in to their compulsions, the stronger these compulsions become, making it harder to break the cycle.
• 👨‍⚕️ A psychiatrist's perspective is shared, highlighting the importance of understanding OCD to receive appropriate treatment.
• 🧠 OCD is linked to a specific part of the brain, the corticostriatal thalamic circuit, which governs the connection between thoughts and actions.
• 🚿 Common compulsions include excessive hand washing, repeating actions, or mental rituals to alleviate the distress caused by obsessions.
• 🤷‍♂️ People with OCD recognize their thoughts as irrational and unwanted, distinguishing it from OCPD where individuals find comfort in their compulsions.
• 🏥 The treatment goal for OCD is to teach individuals to not be controlled by their thoughts and to separate thoughts from actions.
• 🧘‍♀️ Psychotherapy for OCD focuses on teaching the skill of tolerating negative emotions without succumbing to compulsions, a skill valuable for everyone.
• 🚫 OCD can lead to avoidance behaviors, limiting an individual's life and opportunities due to fear of triggering obsessions.
• 💔 The shame associated with intrusive thoughts can result in depression, suicidal thoughts, and other mood disorders in individuals with OCD.

Q & A

What is the main issue with OCD that is being discussed in the script?

The main issue discussed is the cycle of reinforcement where engaging in compulsions to relieve the stress caused by obsessive thoughts actually strengthens those compulsions, making it difficult for individuals to break free from this cycle.

How does the script describe the relationship between thoughts and actions in OCD?

The script explains that in OCD, intrusive thoughts lead to compulsive actions as a way to relieve mental stress. Over time, this behavior is reinforced, creating a cycle that is hard to break.

What is the role of the corticostriatal thalamic circuit in OCD as mentioned in the script?

The corticostriatal thalamic circuit is described as a part of the brain that governs the connection between thoughts and actions. In OCD, this circuit becomes hyperactive, leading to a loss of control over actions in response to obsessive thoughts.

Why is it crucial to differentiate between OCD and OCPD according to the script?

The script emphasizes that OCD involves intrusive thoughts that the individual recognizes as irrational (ego-dystonic), while OCPD involves a desire for control and organization that the individual sees as rational and desirable (ego-syntonic). This differentiation is crucial for proper diagnosis and treatment.

What are the key features of obsessions in OCD as described in the script?

Obsessions in OCD are characterized as intrusive, unwanted thoughts that are ego-dystonic, meaning the individual does not want these thoughts and recognizes them as irrational.

How does the script suggest treating OCD through psychotherapy?

The script suggests that psychotherapy for OCD should focus on teaching individuals to tolerate negative emotions and resist engaging in compulsions, rather than trying to understand the content of their thoughts.

What is the significance of compulsions reducing mental stress in the context of OCD as discussed in the script?

The script explains that compulsions provide temporary relief from the distress caused by obsessions, which reinforces the cycle of OCD by making the compulsions stronger.

Why does the script argue that the skills learned in OCD psychotherapy are beneficial for everyone?

The skills learned in OCD psychotherapy, such as separating thoughts from actions and tolerating negative emotions, are beneficial for everyone because they help individuals avoid developing unhealthy coping mechanisms and improve overall mental well-being.

How does the script connect OCD treatment to broader life skills?

The script connects OCD treatment to broader life skills by highlighting how learning to manage internal discomfort without resorting to external actions can help individuals lead more fulfilling lives and avoid developing other mental health issues.

What are some of the common misconceptions about OCD mentioned in the script?

The script mentions that common misconceptions about OCD include confusing it with OCPD, thinking that it's just about being a perfectionist or control freak, and believing that it's an anxiety disorder rather than a separate condition characterized by obsessions and compulsions.

Outlines

00:00

🔄 OCD Cycle and Its Impact

The paragraph discusses the cyclical nature of Obsessive-Compulsive Disorder (OCD), where intrusive thoughts lead to compulsive actions that temporarily relieve stress but ultimately reinforce the cycle. It highlights the difficulty in treating OCD due to the common misconceptions about the disorder and the unique approach required for effective psychotherapy. The speaker emphasizes the importance of understanding OCD to break free from this cycle and mentions a transformative, helpful, and fun solution might be found in the link provided. The focus is on the distinction between OCD and general anxiety or perfectionism, and the unique brain circuitry involved in OCD that connects thoughts, actions, and compulsions.

05:01

🧠 Understanding OCD: Obsessions and Compulsions

This section delves into the specific characteristics of OCD, differentiating it from Obsessive-Compulsive Personality Disorder (OCPD) and explaining the nature of obsessions and compulsions. Obsessions are unwanted, intrusive thoughts that can be about contamination, danger, symmetry, or immorality. Compulsions are repetitive behaviors or mental acts performed to alleviate the stress caused by these thoughts. The speaker clarifies that individuals with OCD recognize their thoughts as irrational and unwanted, in contrast to those with OCPD, who view their compulsive behaviors as reasonable and correct. The importance of this distinction is emphasized in understanding and treating OCD effectively.

10:03

🌀 The OCD Vicious Cycle

The paragraph explains how compulsions in OCD are driven by a perceived need to perform certain actions to reduce mental stress caused by obsessions. It illustrates the 'magical' or illogical nature of these compulsions and how they can be both physical, like excessive hand washing, or mental, like repeating a phrase. The speaker discusses the neurological basis of OCD in the corticostriatal thalamic circuit and how engaging in compulsions reinforces the cycle, making it increasingly difficult to break free. The paragraph also touches on the emotional impact of OCD, including feelings of shame and the potential for suicidal thoughts due to the distress caused by intrusive thoughts.

15:05

🧘‍♂️ Psychotherapy for OCD: Focus on Tolerance

This section discusses the approach to psychotherapy for OCD, which is distinct from other forms of therapy due to its focus on teaching patients to tolerate negative emotions and resist compulsions. The speaker argues that the content of the thoughts in OCD is less important than the ability to manage the emotional response to these thoughts. The goal is to help individuals with OCD learn to act independently of their thoughts and feelings, which is a valuable skill for everyone. The paragraph also addresses the common misconceptions about OCD and the negative consequences of untreated OCD, such as avoidance behaviors and shame.

20:06

🛑 Treating OCD: Beyond the Symptoms

The final paragraph emphasizes the broader implications of OCD treatment, suggesting that the skills learned in psychotherapy for OCD are applicable to everyone. It discusses how people often develop maladaptive strategies to cope with OCD, leading to more significant problems than the disorder itself. The speaker also addresses the shame and depression that can result from OCD and how these are often misdiagnosed. The paragraph concludes by reiterating the importance of the psychotherapy approach for OCD in teaching individuals to manage internal distress through actions and behaviors that do not reinforce the OCD cycle.

Keywords

💡OCD

OCD stands for Obsessive-Compulsive Disorder, a mental health condition characterized by intrusive, unwanted thoughts (obsessions) and repetitive behaviors (compulsions). In the video, OCD is discussed as a disorder that is often misunderstood and mislabeled. The script emphasizes the distinction between OCD and being a perfectionist or control freak, highlighting that OCD sufferers recognize their thoughts as irrational and unwanted, unlike those with obsessive-compulsive personality disorder (OCPD).

💡Compulsions

Compulsions refer to repetitive behaviors that a person with OCD feels driven to perform in response to an obsession. The video script explains that these behaviors can temporarily reduce the anxiety caused by obsessions. For example, someone with intrusive thoughts about germs might develop a compulsion to wash their hands excessively to alleviate their anxiety.

💡Obsessions

Obsessions are persistent, unwanted thoughts or images that cause anxiety in individuals with OCD. The script describes them as intrusive and often related to themes like contamination, danger, or forbidden thoughts. These thoughts are ego-dystonic, meaning they are distressing to the individual and are a key feature of OCD.

💡Corticostriatal Thalamic Circuit

The corticostriatal thalamic circuit is a part of the brain involved in OCD. The script explains that this circuit is hyperactive in individuals with OCD and is responsible for the connection between thoughts and actions. It is the neurological basis for the cycle of obsessions and compulsions.

💡Ego-Dystonic

Ego-dystonic refers to thoughts or behaviors that are inconsistent with a person's self-image or identity. In the context of the video, individuals with OCD have obsessions that are ego-dystonic, meaning they conflict with their self-perception and they wish to be rid of them, as opposed to ego-syntonic thoughts that are consistent with one's self-image.

💡Psychotherapy

Psychotherapy, as discussed in the script, is a crucial part of treating OCD. It involves teaching individuals how to separate their thoughts from their actions and to tolerate negative emotions without resorting to compulsions. The video emphasizes that the skills learned in psychotherapy for OCD are beneficial for everyone, not just those with the disorder.

💡Avoidance Behaviors

Avoidance behaviors are actions taken to prevent the onset of obsessional thoughts and the subsequent need to perform compulsions. The script mentions that people with OCD may avoid certain situations or triggers to prevent the cycle of obsessions and compulsions, which can lead to a restricted life.

💡Mental Stress

Mental stress is a state of mental or emotional strain resulting from adverse or demanding circumstances. In the video, it is associated with the experience of obsessions in OCD. Compulsions are behaviors that provide temporary relief from this mental stress, but they reinforce the cycle of OCD.

💡Neuroscience

Neuroscience is the study of the nervous system and brain functions. The script touches on the neuroscience of OCD, explaining how it is linked to a specific part of the brain and how understanding these brain mechanisms can inform treatment approaches.

💡Intrusive Thoughts

Intrusive thoughts are unwanted thoughts that enter the mind unexpectedly and can cause distress. The video script describes how these thoughts are a key feature of OCD and can be related to a variety of themes, such as contamination or harm coming to oneself or others.

💡Shame

Shame is a painful feeling of humiliation or distress caused by the consciousness of wrongs or foolish acts. In the context of the video, shame is a consequence of OCD where individuals feel a deep sense of guilt or embarrassment about their intrusive thoughts, which can lead to depression or even suicidal thoughts.

Highlights

OCD is a cycle where actions taken to relieve mental stress reinforce compulsive behaviors.

Mislabeling OCD can make it difficult to receive appropriate treatment.

OCD is often misunderstood and confused with perfectionism or anxiety disorders.

Psychotherapy for OCD is distinct from treatments for other disorders.

OCD involves obsessions, which are intrusive and unwanted thoughts, and compulsions, which are actions taken in response to those thoughts.

Neuroscience of OCD is linked to a specific brain circuitry involving attention and actions.

Excessive hand washing is a common compulsion in OCD due to fear of germs.

The goal of OCD treatment is to teach individuals to not be controlled by their thoughts.

OCD treatment aims to sever the link between thoughts and actions.

OCD has been associated with some of the most unusual psychotherapy methods.

OCD is ego-dystonic, meaning individuals recognize their thoughts as irrational and unwanted.

OCD is different from OCPD (obsessive-compulsive personality disorder), which is ego-syntonic and related to control.

Compulsions in OCD can be physical or mental acts performed to reduce anxiety caused by obsessions.

The corticostriatal thalamic circuit in the brain is hyperactive in OCD, leading to a cycle of obsessions and compulsions.

Psychotherapy for OCD focuses on teaching the ability to tolerate negative emotions without giving in to compulsions.

OCD often leads to avoidance behaviors that limit an individual's life.

Shame is a common consequence of OCD, as individuals feel bad for having intrusive thoughts.

Psychotherapy for OCD can be beneficial for everyone to learn how to separate thoughts from actions.

Transcripts

and essentially what's going on here is

that I have a thought it leads to a

particular action and since the action

relieves my mental stress that behavior

actually gets reinforced so the tricky

thing about OCD is that the more that we

give in to our compulsions the stronger

the compulsions become and this is

actually what's so devastating about it

is we get stuck in the cycle because the

only way that we know how to fix this

thing is actually by giving into it I am

seeing in your future something that is

transformative helpful and fun

I don't know what it is but maybe it is

down in the link in the description now

so I want to talk to you all today a

little bit about OCD or obsessive

compulsive disorder and I think that

this is really important because one of

the things I've noticed is that people

sort of increasingly have anxiety and

people are also like somewhat

perfectionistic so a lot of times people

ask me questions about you know I'm

anxious all the time or I'm very

perfectionistic like how do I deal with

those kinds of things and one of the

things that I found as a psychiatrist is

that people don't really know what

obsessive-compulsive disorder is and

oftentimes what we'll kind of do is

mislabel it and by mislabeling it what

we end up doing is sort of making it

difficult for us to like get the

appropriate treatment or help for it so

I'd love to talk to you all a little bit

today about OCD and the other reason

that this is important is because I

think OCD has some of the most unusual

Psychotherapy

um involved with it so in my experience

sort of treating people with OCD the

angle I take in Psychotherapy is I

actually quite different from how I do

Psychotherapy for basically everyone

else and the reason that I think this is

important is because I think that

Psychotherapy for OCD gives us an

insight into a fundamental skill that is

probably the most important thing for

for all people so if I had to take one

skill that I teach people in

Psychotherapy and I had to if I had to

teach or if I could teach that to every

human being on the planet what I'd

actually do is draw that skill from

Psychotherapy for OCD and the reason for

that is because OCD is this this disease

which we'll dive into in a second which

is all about obsessions so we have

particular thoughts that are kind of

intrusive unwanted or don't sit well

with us and compulsions so compulsions

are actions that we take in response to

thought so even if you look at the

Neuroscience of OCD what we sort of know

about the Neuroscience of OCD is it's

caused by this particular part of the

brain that starts with sort of where our

attention goes so it's a disorder of a

tension so certain thoughts will

dominate our mind and then furthermore

those thoughts once they once they start

to dominate our mind will lead to

behavior and these are what we call

compulsions and these compulsions are so

severe that they'll sometimes end up

hurting us so for example like a really

classic thing that people are familiar

with is excessive hand washing so I'm so

concerned about having germs I have this

thought in my head oh my God my hands

are dirty my hands are dirty my hands

are dirty and even if I know it's

irrational I can't control that thought

and the only way I can get rid of that

thought is to wash my hands with

blistering hot water and soap seven

times in a row to the point where my

hands are peeling they're cracked

sometimes people will even get

infections from excessive hand washing

which then launches the OCD into a whole

different cycle so if we really look at

OCD we what we sort of know is that in

the brain it's kind of involved in this

this set of circuitry that sort of

dictates the connection in between

thoughts and actions and specifically

what happens in OCD is people have

thoughts that are so strong that they

lose control of their actions and so the

most important thing about treatment for

OCD is that we want to teach people how

to not be controlled by their thoughts

how to sever the link between thoughts

and actions and the reason this is

important for everyone is if there's one

core skill that I could teach every

human being on the planet it would be

how to separate your thoughts from your

actions how to act independent of the

way that you're thinking or feeling and

also how to have particular thoughts and

feelings which make you feel bad and not

be kind of beholden to them enforce

yourself into action so really good

example of this is uh you know unhealthy

Copic mechanisms so if I have particular

thoughts or particular feelings let's

say I'm feeling lonely let's say I'm

feeling unlovable in order to get rid of

those thoughts and feelings I may do

something like call an ex who's always

down to you know hang out or whatever

even though they're really toxic for me

so what we sort of see is that a lot of

what we struggle with in life like I

want to play video games today I feel

bored I don't feel like working so we

have all of these internal impulses and

then we give in to those internal

impulses so oddly enough I think if you

had to summarize the goal of OCD

treatment it's almost to like make

people disciplined and so what that sort

of means is that this is a

scientifically verified technique that

helps about 83 percent of people

separate their thoughts from their

actions and keep in mind these are

thoughts that are so powerful and so

overwhelming that they will lead to

major problems in these persons in these

people's lives so we're gonna kind of

that's part of the reason that I want to

teach about OCD and let's kind of dive

into a little bit more detail so the

first question is what is OCD so like I

mentioned earlier OCD is characterized

by thoughts or obsessions and

compulsions so obsessions are basically

thoughts that have a couple of key

features the first is generally speaking

they're intrusive I.E you don't want to

think about them right so you're going

about your day and you kind of like or

enjoy yourself and then suddenly certain

kinds of thoughts will crop up so good

examples like the most common forms of

OCD intrusive thoughts are things

related to contamination and hygiene so

sometimes people will kind of feel dirty

other times it'll be something related

to Danger so you'll have intrusive

thoughts about people kind of getting

hurt or having accidents or things like

that one way and part of the reason that

I think this is important to discuss is

because a lot of times people come in

and will say I'm anxious about you know

my kids getting hurt or I'm always

worried about bad things happening to

other people that's not really an

anxiety disorder for a lot of those

people what that really is is OCD so a

preoccupation with particular people

getting hurt yourself getting hurt bad

things happening things like that

another really important part of OCD is

that oftentimes the obsessional thoughts

the intrusive thoughts are very like

immoral in nature so you'll have

thoughts about hurting other people

sometimes they're sexual in nature so

you sort of have these thoughts that we

would kind of associate with being very

immoral or being a degenerate in some

way so those are some of the really

common ways in which obsessions will

actually manifest so we're concerned

about danger we're concerned about

hurting other people we're concerned

about kind of uh you know forbidden

thoughts thoughts of contamination

things like that

um so the uh the other aspect that's

important to talk about actually is that

the other way that people with OCD will

kind of manifest is with thoughts around

symmetry or organization and this is

where we have to draw a really big

distinction between OCD and ocpd so OCD

is obsessive-compulsive disorder and

ocpd is basically what we call being a

control freak so people with ocpd which

is obsessive-compulsive personality

disorder is actually completely

different from OCD a lot of times

nowadays especially on social media

people will use statements like oh my

God I'm so OCD if anyone rearranges the

shoes in my house I get completely bent

out of shape or I need my bathroom

organized a certain way or I need the

kitchen organized a certain way and

people who are essentially Control

Freaks and need to have something done

in a particular way those people are

ocpd OCD once again is a little bit

different they may be not obsessed they

may be sort of very focused on symmetry

or organization but there's a big

difference which is that usually OCD

people know or people with OCD know that

what they're asking is irrational they

kind of recognize that these thoughts

are intrusive and I don't want it I wish

I could be okay with some of this stuff

whereas ocp ocpd people are are

completely fine with their ocpd they

actually want everyone to conform to

their way of thinking their thoughts are

not intrusive they're not trying to get

rid of their thoughts they genuinely

think that this is the way that things

should be and everyone should listen to

me so this is a key a feature which in

Psychiatry we call ego syntonic or ego

dystonic which means is it okay with you

do you think that this is actually good

or do you actually want to get rid of it

in the case of OCD this is ego disc

tonic which means that people with OCD

usually don't like the thoughts they

don't like having the thoughts they try

to actually make the thoughts go away

and people who are ocpd are ego syntonic

which means that they actually they

don't they don't think that anything's

wrong with them they actually think that

everything is wrong with other people

the shoes need to be arranged this way

and it's the fact that other people are

so disorganized and barbaric that they

don't want shoes arranged this way but

this is the right way to do it and so

that's a key differentiating feature so

going back to OCD so we know that we've

got kind of obsessions that have four

particular types right so contamination

symmetry thoughts of danger and

sometimes kind of like like forbidden or

Blasphemous or kind of scandalous

thoughts the other things about these

thoughts are that they tend to be as we

mentioned intrusive which means that

you're kind of going about your day and

you don't want to have those thoughts

the thoughts can also be so severe that

they're like they impair your focus so

once a once an obsession actually crops

into your mind like you're not able to

focus on other things and this is what

really makes OCD like a bad disorder is

that along with the obsessions there

tend to be compulsions so compulsions

are behaviors that we engage in which we

may recognize are irrational so we know

like logically that washing my hands

seven times washing my hands once should

be enough like logically I know that if

I use soap and water like that should be

sufficient but a key thing about all

these compulsions is that they're sort

of like even though they're illogical or

sometimes they'll even be sort of

magical in nature so I'll give you all

an example so I had a a patient who

anytime their family was taking some

kind of long distance Journey like a car

ride that was over about an hour and a

half or any kind of plane or something

like that they had to repeat some kind

of like mental magical spell in their

mind and if they said a particular

statement to themselves seven times in a

row that would mean that whatever kind

of dangers their family was like exposed

to would be staved off and if they

didn't repeat this prayer seven times in

a row for each person that's traveling

by the way then something bad was going

to happen and even if you ask this

person like hey what do you think about

that they'd say you know I know it makes

no sense like there's no way that the

thoughts that I have in my head are

going to determine whether a plane

crashes or not but I really have to do

it because if I don't their plane will

crash so there's some amount of

understanding that the compulsions don't

actually like relate to what people are

doing or it's some sort of weird magical

or mystical connection so compulsions

are repetitive behaviors that we use

that may be a little bit illogical but

we feel sort of out of control with them

right we have a compulsion to do them

and the key feature here is that the

compulsions actually reduce our mental

stress so if we look at the purpose of

compulsions if you talk to someone who

has OCD they have particular thoughts

and then the only way they can get

relief from those thoughts the only way

they can calm down the thoughts the only

way they can go back to studying the

only way they can enjoy a movie is if

they go through the compulsions so

engaging in the compulsion whether it's

a physical compulsion of like you know

turning on and off the stove seven times

that's a really classic thing or

arranging things in a particular way or

sometimes we forget that compulsions can

be mental in nature too so they don't

even have to be outward acts that we

have to engage in the compulsion and

then what happens is once we engage in

the compulsion then the obsession kind

of calms down relaxes or goes away and

so this is sort of in a nutshell what

OCD is and we're going to Tunnel down

kind of a little bit further into

understanding why this is such a problem

and kind of what's going on here okay so

the first thing that I kind of want to

touch on is that we sort of know that

OCD comes from this part of the brain

called the

corticostriatal thalamic circuit so

there's a particular part of our brain

which is it's a circuit that's involves

three or four regions and this thing

forms a circuit that basically governs

attention with action and reward so what

we're thinking about what we do and what

we end up the benefit that we get from

it and the tricky thing about OCD is

that once I have these obsessional

thoughts once I have all these negative

thoughts let's say they're like kind of

forbidden sexual thoughts or something

like that I don't want them they're

intrusive they're distracting me from

studying and I feel bad about myself for

having them so that's is another thing

that happens with OCD is that people

will start to make judgments about

themselves for having the thought so if

I'm having like kind of forbidden sexual

thoughts I think of myself as a

degenerate or a pervert that in in turn

can induce things like shame and can

even lead to some amount of things like

suicidality so if I'm sort of having

these thoughts that I can't control then

what I sort of discover is that I feel

so bad for having these thoughts whereas

if I take a shower if I'm having a

obsessive intrusive sexual thoughts if I

shower three times that'll wash away the

impurity or wash away the sin and then

what happens is I'm sitting there

studying and I have to go into the

shower and I have to wash three times

and I leave I come back and then I end

up like studying for a little while and

then the thoughts come back and then I

have to go back and I have to shower so

if we kind of look at what's going on in

the brain here we have a particular

amount of mental distress and our brain

learns that in order to relieve the

mental distress what I have to do is

engage in the compulsion and so this is

why this corticostriot thalamic Circuit

of our brain kind of gets bent out of

shape we know that this circuit in our

brain becomes hyperactive in people with

OCD and essentially what's going on here

is that I have a thought it leads to a

particular action and since the action

relieves my mental stress that behavior

actually gets reinforced so the tricky

thing about OCD is that the more that we

give in to our compulsions the stronger

the compulsions become and this is

actually what's so devastating about it

is we get stuck in the cycle because the

only way that we know how to fix this

thing is actually by giving into it so

this is what makes Psychotherapy for OCD

actually a little bit different when I

look at most of my patients that I do

Psychotherapy for part of what I I sort

of think about is I want them to

understand themselves right we want to

understand okay what is the origin of

your feelings how did you come to feel

this way you know what do you believe

about yourself there's all kinds of

stuff offer around identity in the past

and sort of like understanding like how

your mind developed in this way but with

OCD it's actually a little bit different

because in Psychotherapy for OCD we

actually don't care about the content so

we don't care that you have let's say an

obsession around

um cleanliness or you have these

intrusive thoughts that are harmful in

nature or sexual in nature there are

some areas of of psychotherapy that will

do that kind of work like so psychonalic

a psychoanalytic perspectives will kind

of focus on that kind of perspective on

OCD but generally speaking what what I

found to work the best is not to dig

into the content of your thoughts so

whatever the thought is like we don't

really care in a sense right so whether

you're worried about cleanliness or

whether you're worried about hurting

other people or whether you're afraid

that other people are gonna like their

planes are gonna crash the content of

your OCD the content of your obsessions

is not actually the important thing the

important thing that we try to teach in

Psychotherapy for OCD is actually the

ability to tolerate your negative

emotions and not give in to the

compulsions and the reason that I think

that's incredibly important is because

that fundamental skill is actually the

skill that the Buddha yogis and monks

try to entrain in India so for thousands

of years we've had the spiritual

tradition that is trying to separate out

our actions from our our be our thoughts

and so what we try to do in

Psychotherapy for OCD is as these

thoughts start to arise within you you

start to feel particular things right so

if I let's say I have a forbidden sexual

thought so as this thought arises I make

certain judgments about myself I feel

bad I have difficulty focusing I start

to think of myself as a bad person and

my brain has kind of figured out that

there's one thing I can do to make these

thoughts go away which is let's say

shower three times the tricky thing is

that if I shower three times it works

right so if I go into the shower soap up

everything wash everything off and then

go through that two two more times I may

start to get raw skin my skin may start

to dry out but the thoughts get relieved

and this is the problem with OCD is that

essentially what we end up doing is

harming ourselves through relieving our

obsessions the only way we know how to

calm down our mental struggle or our

mental anguish is by going through these

behaviors and so essentially what we

want to teach is the ability to tolerate

that negative emotion and not give into

the behavior and the reason that I think

this is important even if you don't have

OCD is because this is a fundamental

skill that everyone needs to learn right

if we really think about it what causes

US problems in life it's essentially a

lot of mental anguish right so if I

don't want to go to a party because I

feel embarrassed if I don't want to go

to a party because there's someone there

that I asked out a week ago and it's

going to feel awkward so what do I end

up doing I end up not going to the party

I end up using an avoidance strategy to

avoid triggering that negative emotion

and so then and people with OCD do this

the same thing one of the key Hallmarks

of the actual diagnosis is the

development of avoidance behaviors right

so if certain things will trigger

obsessional thoughts and then I have to

go shower three times then I can't watch

any TV or anything like that that could

trigger even a remotely sexual thought

and so then what happens with people

with OCD is they start to build walls

around their life and they're not able

to actually like live a full life

because they're so terrified of

triggering the OCD that they start to

avoid particular aspects and we see that

in in normal people as well that when I

start to avoid negative thoughts when I

start to avoid particular situations

when I start to avoid putting myself in

an uncomfortable State I start to close

off the doors of opportunity in my life

at the end of the day OCD I think is

something that's that's horribly

horribly misunderstood you know at the

top of the list the the most important

thing that's kind of like um relevant to

OCD is that it's not ocpd so one of the

the biggest misnomers is that being a

control freak is not really what OCD is

OCD is characterized by having intrusive

persistent thoughts that are

ego-distonic I.E I don't want to have

the thoughts I don't think they're good

thoughts I don't think they're logical

thoughts I wish they would just go away

and the second consequence of OCD or the

second piece of it is some kind of

compulsion that our brain figures out

that we can either go through a mental

process or a physical process some kind

of action even if the action is mental

like repeating something to myself over

and over and over again in my head I can

engage in some kind of action that will

relieve the obsession the reason that I

think this is really important is

because if you actually ask someone who

has OCD what do you feel they'll

describe anxiety so they'll describe oh

I feel really worried I'm terrified

they'll describe a lot of anxiety and

fear so a lot of times what they think

is that they've got an anxiety disorder

or their anxiety is really bad well

truly what it is is OCD the other

problem with OCD is that as human beings

tend to do we develop our own intuitive

adaptations to the OCD and the problem

with those adaptations is that those

adaptations actually cause oftentimes

more damage than the OCD itself if I'm

you know if I'm kind of like triggered

by particular things in my surroundings

that triggers kind of the obsessional

thoughts and then the only way I can get

rid of them is the compulsions the best

strategy for me is to avoid big parts of

life in general because then I don't

have to if the thoughts don't get

triggered then I don't have to worry

about the compulsions and it's the only

way that I can feel safe the other big

problem with OCD is that oftentimes this

whole cycle leads to a lot of Shame so

this is where people with OCD will come

into my office and they'll describe to

me oh I'm depressed I'm suicidal but the

more that I do a diagnostic evaluation

in them the more I discover oh this is

not a mood disorder this is actually a

consequence of untreated OCD which is

intense shame for these intrusive

thoughts that we never asked for but

since I'm having these thoughts all the

time it must make me a bad person right

I must be a degenerate and the only

thing that I can think of is to take my

own life to provide relief and protect

the world from how awful I am so OCD

oftentimes masquerades as lots of other

things the last thing to consider is

that in terms of psychotherapy for OCD I

think it's really important because the

skills that we teach in Psychotherapy

for OCD I think are the most

generalizable to the rest of the

population and what we really kind of

Target or focus on is this idea that if

you feel mentally unwell within your

being that there are always actions in

the outside world that you can take and

those actions that you take in the

outside world can actually relieve the

mental distress within right so if I'm

feeling mentally unwell or if I'm

bothered by the asymmetry of my

workplace I can spend 15 minutes

organizing everything and that makes me

feel better the problem is that every

time I do that what I'm essentially

training my mind to do is to solve

internal discomfort with external

actions right I'm training my mind that

the only way to get rid of this internal

feeling is to act in a particular way

and we see this a lot in our community

let's say like I'm procrastinating right

I feel bad about myself I feel bad that

I'm not studying and I should be

studying and I want an A and the only

way I can manage these emotions is to

engage in some kind of unhealthy

Behavior so I'm going to spend the day

gaming I'm going to procrastinate and

binge watch some anime I'm gonna do

something I'm gonna spend some time on

Twitter or social media I'm gonna do

some anything but what I the work that I

need to do and so if you look at like

this fundamental idea of okay if you do

this what is your brain what is your

corticostrito thalamic portion of your

brain what does that circuit learn about

the solution to feeling fat on the

inside what it learns is that oh the

next time we feel bad we should actually

just start playing a video game because

that's what fixes our problems right

that's what leads to a relief if you

think about if there's a reward

circuitry involved here I'm feeling bad

and if I engage in a behavior that

behavior gets reinforced because the

reward is really good I don't feel bad

about myself if I start playing a video

game and so what we actually end up

doing is reinforcing the negative

behavior and that circuit seems to be

what's hyperactive in OCD so this has

been a kind of a really quick overview

of OCD there's a lot more that we could

talk about in terms of the the details

of like what Psychotherapy for OCD is

like the Neuroscience of OCD is really

fascinating even psychoanalytic

perspectives on OCD are really

fascinating but this is kind of a quick

overview that I really wanted to share

with you all to really help you

understand a little bit about what OCD

is why it's so devastating and a little

bit about even how treatment for OCD can

be useful for every human being on the

planet I saw that uh