Hey, Psych bytes with CCS is a weekly podcast hosted by Student Life Counseling and Consultation Service. This show is dedicated to discussing a wide range of topics pertaining to mental health commonly experienced in the college setting. It is important to note that this podcast is not a substitute for therapy. All of the topics on this show, while discussed by professionals are strictly psycho educational, and meant to inform listeners on available resources, skills and support. Topics on this show can be sensitive in nature. And should you find yourself needing additional support or resources, please visit ccs.osu.edu or call us at 614-292-5766. With that in mind, enjoy the show What is up everybody and welcome to Psych Bytes. My name is Josh and today we are joined by Courtney Arbogast a licensed independent social worker with a supervisory designation, who is a senior staff therapist with us here at Counseling and Consultation Service. Welcome Courtney.
Courtney Arbogast:Hello. Thank you.
Josh Bailey:So today you and I are going to be talking about OCD or obsessive compulsive disorder. Yes, I am so excited to talk about this because it seems like everybody's talking about it. Right now on Tiktok. Everybody's talking about the OCD.
Courtney Arbogast:That's true. Yeah, I'm excited too. I love working with people with OCD. So I'm excited to talk about it.
Josh Bailey:So let's start at the beginning. Yeah. What is OCD?
Courtney Arbogast:Yeah. So OCD, there's kind of two pieces to think about. Number one is patterns of obsessive thoughts. And so these will show up as sort of intrusive thoughts, they often sound repetitive. And the key is that they're distressing or upsetting. And the second piece is compulsive behaviors. So these are any kind of behaviors that we might engage in, to try and decrease the distress from the obsessive thought. So they can be behavioral. I think when we talk about OCD, a lot of people think about, you know, cleaning or organizing things, it can be other behavioral rituals as well. As well as on the mental side. Sometimes folks will do a mental review or kind of mental checking, walking themselves back through situations over and over again, trying to find like some certainty. And it's normal to have some random intrusive thoughts, right. I always like to highlight this with OCD, because having a random intrusive thought is not abnormal. But ultimately, the hallmark is with OCD is that they cause a lot of distress, they tend to repeat, and then we try and engage in those behaviors to decrease them.
Josh Bailey:Okay. So when you say distress, what do you mean? Or what could be an example of me being in distress? Because yeah, I definitely have a lot of thoughts that pop on my head, and I feel a way about them. But is there a feeling away about something and being distressed by something that maybe I could distinguish?
Courtney Arbogast:Yeah, I think, and with the random intrusive thoughts, we might feel some kind of way or say,"Oh, that was weird." Or, you know, "Why did I think that? I didn't like that." But when they start to cause significant distress, where it's looking like higher anxiety, maybe your heart is racing, feeling kind of warm, sweaty, trouble breathing, and feeling really, you know, emotionally impacted, upset by the thought is what I would think of as distressing.
Josh Bailey:And as you talk about that, you were kind of listing some symptoms. And I started thinking, Well, that just sounds like anxiety. Yeah, that's my thought is like, well, that sounds like anxiety, not a crippling, you know, psychiatric diagnosis. So what's the difference?
Courtney Arbogast:Yeah, OCD and anxiety can tend to overlap a lot. They tend to look a lot like each other. And so sometimes it takes some time, with a therapist with a professional to kind of talk about your experiences and really kind of parse out, okay, what's going on for me? When I think about anxiety, they tend to circle around like your thoughts will circle around more realistic concerns. And it can be across many domains. So there's a lot of that kind of general nervousness about lots of different things going on. This also kind of follows a train of thought, right? So you might have the anxious ruminations that just sort of go and go and go, and all of a sudden, you're at a different, you know, place when you started thinking wise. And again, that's going to include some of those physical symptoms that we talked about, you know, maybe the heart racing and trouble breathing pieces, but also things like a sense of restlessness, muscle tension and having those on an ongoing basis is more common with generalized anxiety than it is with OCD. So So to differentiate those, when we think about OCD, the thoughts are more repetitive. Sometimes we describe them as sticky thoughts that kind of stick in your mind and just play over and over again. They're often unrealistic, too. So things that aren't necessarily a realistic worry or have concern,
Josh Bailey:What might be a good example there? Because as I think about maybe just the day to day thing on campus, midterms are coming up finals are coming up something along those lines, I'm like, repetitively thinking, I got to study, I need to pass this, if I don't pass this, I'm going to fail out of school. There's, is that normal? Is that abnormal, when we're getting into there?
Courtney Arbogast:So someone with anxiety might have those worries about a test. But then when you get into the exam, I often hear folks with OCD say, I have to stay in my exam the entire time, even when I'm done with the test. If I feel okay, I have to check and recheck over and over again, and I'm sitting there for the full three hours, even when I know I can turn it in. When I don't think I'm going to catch an error. I feel like I have to keep checking it over and over and it wastes that time. I see.
Josh Bailey:Would another example maybe even fall in line with someone who is taking an exam? And I cannot go on to the next question unless I have fully and satisfactorily answered the first question in front of it. Meaning I might not even get my exam done in the allotted time, because I got stuck on question number two. And I couldn't get myself to a satisfactory place with that response. So I just forsook or forsaken everything else that was there.
Courtney Arbogast:Absolutely. Yeah, the reading questions over and over again, reading responses over and over again, to make sure we haven't missed something or feeling like the answer has to be perfect. It has to be just right can absolutely show up with OCD.
Josh Bailey:Something else that you were talking about before, as we were discussing the differences between anxiety and OCD, I think you mentioned this is the attempt to neutralize thoughts with rituals. Can we go into that a little bit more?
Courtney Arbogast:Yeah. So sometimes with OCD, the So something else that I would like to maybe look at then is distressing thoughts that we have can be really upsetting. Things like sometimes we have intrusive thoughts about wanting to hurt ourselves wanting to hurt other people, things that this idea of OCD and perfectionism. Sure, how are can feel really scary for folks, and wanting to engage in rituals to neutralize those or take away the distress as much as possible. So this might be something where someone has an intrusive thought, you know, maybe about wanting to hurt themselves. And they think they have to, or feel like they have to, engage in a behavior to neutralize that thought. And that's the only thing that they find in the moment that works. those two connected? How do they interact? What do we do with that? Yeah, so if we're thinking of, you know, going back to the example that we just talked about with tests, and needing to feeling a need to read those answers over and over again, looking for perfectionism, it's the idea that something has to be just right. And obsessive thoughts around, "This thing isn't just right, what if I turn this in, or I do this activity, and it's not perfect? What's going to happen?" And it's really connected to a need for certainty. And that's kind of one of the three lines that I see most when working with folks with OCD is we want a kind of certainty that's just not always attainable, or realistic. And so it's the idea of, I want to be certain that this thing is right. I want to be certain that I do this thing perfectly. And it ultimately can lead to a lot of compulsions, especially the checking compulsions, wanting to identify and fix something that maybe isn't perfect about, you know, our assignment or test whatever it is we're doing, when ultimately, OCD maybe is telling us something is there when it's not, there's nothing to be fixed. And we just keep checking, wanting that certainty that we're not going to get from the behavior.
Josh Bailey:I see. So making sure I have the absolute right decision. Like I know the way it's going to pan out, beginning, middle and end. Might this tie into some of the kind of classic paralysis by analysis? Like I think about this when I work with some individuals who maybe have an opportunity to make a decision between what med school they are going to attend, and they get hung up on the idea of which one's the right one which one's the best one which one is the perfect one for me and ultimately don't make a decision because I can't pick the absolute perfect right one. Is that in the same wheelhouse, or is this something a little bit
Courtney Arbogast:I think they're in similar wheel houses, different? you know? It certainly sounds like a stressful decision, right? And if you're already prone to anxiety, of course, you're going to spend some time ruminating on that. When I think about how someone with OCD might experience that is, when they do make the decision, there might be that obsessive thought about what if this wasn't right? What if this wasn't right? What if I should have made a different decision? What if I should have gone to this place instead? And having that thought, sort of stick with you?
Josh Bailey:So I'm curious, then if I'm going to have this type of rumination on that particular thought or that particular concern? What might we then notice as far as a compulsion coming from that?
Courtney Arbogast:Yeah, I think this is where we might see some of those mental compulsions that we've talked about coming in where maybe we reassure ourselves why we chose that program, or run through our decision making process again. This might even be we look up that Programs website and reread about it to make sure it's what we want, or we check to see if certain faculty or doctors are still working there to give ourselves that reassurance about having made the right decision.
Josh Bailey:And I think what I'm seeing as the major theme
here is:this is very intrusive, this is very time consuming. This is very distressing, where I am constantly battling the thought of "what if I did the wrong thing?" and then having to engage in reassuring practices of getting back on the website, maybe going as far as like calling the school reassuring that I'm still in, reassuring that I'm going to be going to the same classes, reassuring to me there. It just becomes very time consuming. And then maybe I start falling behind and other engagements or responsibilities, things of that nature.
Courtney Arbogast:Yeah, OCD takes up a lot of time, it engaging in those patterns over and over again, is a really time consuming piece of it. And it takes up a lot of brain space too. Those thoughts on repeat can get really, really noisy and it can impact concentration, it can impact how we engage with other activities, how we engage with our friends, it makes that really difficult.
Josh Bailey:Another thing that I want to talk about, and stop me if you've heard this one before, but the comment, "I am so OCD."
Courtney Arbogast:Yes.
Josh Bailey:It's become a thorn in a lot of clinicians sides, I presume, because it comes up a lot because it is popular in the current narrative, right? There's a lot of good stuff out there talking about and raising awareness around mental health and the various diagnoses. But I think there's also a lot of generalization and non experts providing expert clinical opinions or diagnoses on things that can cause a lot of worry and rumination and concern of"What if I have OCD?" or just normalizing the context of "I'm so OCD," so maybe taking away from what could be a more significant concern.
Courtney Arbogast:Absolutely. This is one of my this is like my personal soap box as a clinician because I'm so OCD. OCD is often used colloquially to talk about folks who maybe are prone toward cleanliness or organization like things a certain way we have certain quirks. Folks might say, "Oh, I'm so OCD, I need to have the TV volume on an even number. I don't like it when it's on an odd number, or I have to have certain things sorted by color color coded," right? That's fine. Like we all have quirks and preferences, those things are okay. They aren't distressing, right? The idea of this is something I like, there's something I want to have my space organized in this way. Or I, you know, I'm a clean person, I want to make sure things are very clean. That's all fine. If it becomes that distressing and time consuming piece that we've been talking about, that's when we become concerned for OCD. People with OCD have those really intrusive and upsetting thoughts that lead to some of those behaviors, the cleaning the organizing all that good stuff, right? This probably isn't maybe isn't happening for folks, when that's their preference, right? If they're having those upsetting thoughts, it's probably something to talk to someone about. If it's just a quirk of "this is how I like things. This is how I want things to be," live your life. That's fabulous. That's also not OCD.
Josh Bailey:So learning how to distinguish between habits and preferences, and obsessions and compulsions can be a pretty critical component here. And if you just so happen to like to alphabetize your blu ray collection, it doesn't necessarily mean hey, you have a clinical diagnosis here, right? You just have a preference.
Courtney Arbogast:And using it colloquially and that way, you know, can detract from the really difficult experiences that folks with unmanaged OCD have with their disorder.
Josh Bailey:So kind of getting back on track with diagnosable OCD, I'm curious, how do we address it? How do we treat it? How do we help people manage?
Courtney Arbogast:So the primary treatment that I use in working with folks with OCD is called exposure and response prevention. This is a very effective treatment, it's often recognized as like the gold standard for treating OCD. But there are a lot of ways that you can do that, of course. Exposure and Response Prevention at its face value, seems a little counterintuitive, can seem a little messed up. So I want to just preface it with that. It's the idea of exposing yourself to anxiety provoking triggers, in a gradual unstructured way to over time take power away from those obsessions. So we're purposefully putting yourself in an anxiety provoking situation, something that's going to trigger some of those obsessive thoughts. Because what happens when we're in that situation is Yeah, so of course, like, we start to feel some anxiety, right. But as we continue to practice that, it shows us, okay, this feeling of distress, like I can actually tolerate more than I thought. I can sit with this uncertainty, and that's okay. And it takes the power away from that obsessive thought, when we don't engage in the compulsion, we're not reinforcing that pattern in our brain.
Josh Bailey:So let's maybe look behind the curtain a little bit about the approach. So if we had someone who, let's say, was exhibiting symptoms of OCD in regards to washing their hands, right? Like a, an obsession with cleanliness, if I don't wash my hands, then I'm going to catch a life ending disease as a result of the bacteria that accumulate there. So I need to wash my hands after every point of contact with any object that isn't directly touching my body at that moment in time. How might we tear that? How might we start with that?
Courtney Arbogast:Yeah. Yeah, and this is something I do see with a lot of folks is the concerns around cleanliness, right, which I think is where some of that stereotype comes from. But it is a really good example. So with that person, I would want to know what to ask about different triggers for those obsessive thoughts. And we'll kind of structure them out, almost thinking of it like a ladder that you're working up. So we might identify some triggers that feel less distressing than others. If we're thinking like zero to 100, I want to start with, you know, maybe level 20, Level 30 sort of anxiety, something that is going to cause a little discomfort, but ultimately be relatively easy to engage with. So this might look like touching something in our room that we don't necessarily think is clean, but because it's in our space, it feels safer than others and practicing not washing your hands, okay, then we might work up to things that are a little more anxiety provoking, like touching, doorknobs, touching things in public places, right? And then the highest of that, you know, whatever that really, like 100% strongest trigger would be, is what we're working toward. So with folks with contamination, folks with contamination obsessions, this often looks like something in a public place that's known to be really dirty. Things like public bathrooms. It might be touching a door handle in a public bathroom and not washing your hands or flushing a public toilet and not washing your hands. And that would be you know, the ultimate goal. We're not going to start someone there because that sounds really distressing. And that's why it's important to go through that ladder.
Josh Bailey:I find myself feeling a little bit of anxiety thinking that.
Courtney Arbogast:Absolutely.
Josh Bailey:Alright. So it really is just experiencing the distress, sitting with it. Learning that the worst case scenario is not happening, and allowing it to subside, almost like the tide comes in. The tide goes out.
Courtney Arbogast:Exactly.
Josh Bailey:Courtney, this has been fantastic. I've really, really enjoyed getting your expertise and your thoughts on this. So I just wanted to say again, thank you so much for joining us today. And to all of our listeners: Thank you for taking the time and listening in. Keep your eyes peeled for our next episode. Take care of yourselves. And until then, my name is Josh and this has been Psych Bytes with CCS.