The Things Everyone Needs to Know About OCD
Summary
TLDRThis 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
- đ OCD involves a cycle where intrusive thoughts lead to compulsive actions that temporarily relieve stress but ultimately reinforce the cycle.
- đ€ The more individuals with OCD give in to their compulsions, the stronger these compulsions become, making it harder to break the cycle.
- đšââïž A psychiatrist's perspective is shared, highlighting the importance of understanding OCD to receive appropriate treatment.
- đ§ OCD is linked to a specific part of the brain, the corticostriatal thalamic circuit, which governs the connection between thoughts and actions.
- đż Common compulsions include excessive hand washing, repeating actions, or mental rituals to alleviate the distress caused by obsessions.
- đ€·ââïž People with OCD recognize their thoughts as irrational and unwanted, distinguishing it from OCPD where individuals find comfort in their compulsions.
- đ„ The treatment goal for OCD is to teach individuals to not be controlled by their thoughts and to separate thoughts from actions.
- đ§ââïž Psychotherapy for OCD focuses on teaching the skill of tolerating negative emotions without succumbing to compulsions, a skill valuable for everyone.
- đ« OCD can lead to avoidance behaviors, limiting an individual's life and opportunities due to fear of triggering obsessions.
- đ 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
đ 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.
đ§ 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.
đ 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.
đ§ââïž 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.
đ 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.
Mindmap
Keywords
đĄOCD
đĄCompulsions
đĄObsessions
đĄCorticostriatal Thalamic Circuit
đĄEgo-Dystonic
đĄPsychotherapy
đĄAvoidance Behaviors
đĄMental Stress
đĄNeuroscience
đĄIntrusive Thoughts
đĄShame
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
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