Restoration Beyond the Couch
'Restoration Beyond The Couch' with Dr. Lee Long: Insights for Mental Wellness: Join Dr. Lee Long on 'Beyond The Couch,' a transformative podcast blending professional psychological insights with real-life experiences, offering practical strategies for mental wellness that bridge the gap between therapy and everyday life.
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Restoration Beyond the Couch
Pure O OCD Explained: Living with Intrusive Thoughts
In this episode of Restoration Beyond the Couch, Dr. Lee Long sits down with counselor Brandon Stewart to talk about “Pure O,” or primarily obsessional OCD. Together, they explore what Pure O looks like beyond the stereotypes, how intrusive thoughts impact daily life, and strategies for finding clarity and hope in the midst of it.
I'm especially excited to introduce today's topic because chances are you know someone who struggles with it. It's called pure O OCD, and it's often misunderstood, but it impacts many more people than you might realize. To help us unpack this topic, I'm joined by Brandon Stewart, licensed professional counselor. He's a therapist here atoration and the head of our OCD program. Brandon leads both our support group and our Breaking Free program and he brings years of experience helping people navigate OCD in all of its forms Together. We'll talk about what Pure O really is, the misconceptions around it and the practical ways to break free and show up more fully in life. Your path to mental wellness starts here.
Speaker 2:Early on in my career I had a client who had OCD, you know, bought a book on it and then just found it really interesting. Um, I thought it was uh, oddly it was fun what do you love about it?
Speaker 1:What made it fun to you?
Speaker 2:I thought it was cool of the therapy is actually fairly straightforward.
Speaker 1:Yeah.
Speaker 2:And it just made sense to me. It clicked for straightforward, yeah, and it just made sense to me. It clicked for me, yeah, and so that was cool. And then when I was implementing the treatment, it worked and people got better and that's so rewarding, yeah.
Speaker 1:People like. If people come to our house for dinner, you know I like to do the dishes and people are like you do, like, yes, most of what we do we don't get to see a direct resolution.
Speaker 2:It gets better.
Speaker 1:Yeah, it's like doing the dishes or cutting the grass or like doing something that has a very, very defined beginning and end and you can see the result is kind of a nice. That's satisfying.
Speaker 2:Yeah, yeah.
Speaker 2:So I'm wondering if it's, if, if working with OCD was sort of like that for you where you felt like there was a defined yeah Process, there was a defined process of, like you're saying, of also like working with a client who maybe had a traumatic childhood and they want to work through that and figure out new ways to relate to people. Or they're you know, they're married and it's coming out and that's a. I really enjoy that. But that's, you know, it's a little bit more nebulous, Isn't quite the right word, but it's a little obscure, it's gradual, it's obscure.
Speaker 1:Yeah, people ask me from time to time do you believe people can change? And I'm like, well, yes, right, we wouldn't be in this field, right, but they. But I also believe that I always draw a scale on my whiteboard and I say there's at the zero, is in the middle, there's a negative number out here and then there's an equivalent positive number on the other side. That if you have somebody that's like, say, at a negative 75, if they move 25 spaces to the negative 50, like that's huge, right. But the reason why people feel like nobody changes is because there's still a negative in front of that number. Yeah, our perception is is that a person's going to go from negative 75 all the way to the positive 75. Yeah, and that'd be a miracle from God.
Speaker 2:Right, it doesn't always work that way, right, yeah, and that'd be a miracle from God, right, it doesn't always work that way, right, usually doesn't, yeah. And so, watching people change, where you can graph it, yeah, they were also just feeling less anxious, less triggered, yeah, and again, you could graph that and then they could see that and right, you know, uh, that's fun.
Speaker 1:And so OCD, obsessive compulsive disorder and a lot of people and we've talked about this before you and I that a lot of people say like colloquially oh, I have OCD because they like things a certain way. Right, and we know that it's not a clinical OCD, right, they may have the little bit of the O maybe a little bit of the C, but they don't have the D Right, and so you, you, you're.
Speaker 1:You're bringing up today that whole idea of the the pure O OCD. Can you kind of give us a little background of what that is or what that means?
Speaker 2:Yeah. So the funny thing is it's a bit of a misnomer in that they used to think someone who had OCD this subtype was purely obsessional, meaning they only had obsessions and no compulsions.
Speaker 1:So break that down for us.
Speaker 2:I'll break that down of how I think of it is the obsession, is the fear. It is the obsession is the fear, um, and then the compulsion is the behavior, the thing that I do to reduce the fear or prevent the feared outcome. Okay, so, um, I'm going to move this back a little bit. Um, the classic example, the easiest one to think of, is germs, right, so I have an obsession with germs. I have a fear that, um, I'll get germs on my hand and I'll become sick, maybe get a stomach bug. So that's my obsession the fear is getting a stomach bug.
Speaker 2:The compulsion is washing my hands, and so I wash my hands, or I avoid touching things, I avoid going to public places, avoid people who look like they're sick, you name it. And those are all compulsions, it and those are all compulsions. So, for the pure O folks, they used to think they don't have any compulsions, they're just thinking. It's just all in their head and so visually you'll never see an external compulsion. But that actually is not true. Um, and that's kind of the tricky thing about Puro that I thought would be good to talk about.
Speaker 1:Yeah, so the, the so, just so that I'm making sure that I'm hearing you, right? Yeah, there's like, let's say, if I'm obsessed with germs but I don't have something that, or or the obsessed like have this, this desire not to get sick but, I, don't have a hand washing ritual or I don't necessarily avoid places where people are sick. I just sit in that rumination of I might get sicker, I might get sicker, I might get sicker Right, is that what you're describing?
Speaker 2:Yes, though the only thing I would change is typically a person. If we're talking about a person who is worried about germs or contamination, I would say they always have the compulsion with it. The compulsion, the overt one, that you're going to see. So there's the pure O. People have more specific obsessions that are not contamination related, right, usually. So what example?
Speaker 1:would you use Like what? What do you see? Because, I'm assuming that these are folks that you see, yes, and so what do you see Like? What are the themes that you?
Speaker 2:see the big themes are and this is a little bit PG-13, if you will, but the big themes are usually violence, sexual, religious and then sometimes neutral, which we could get into as well. That one can be kind of confusing, but the big themes are usually violent, sexual, religious.
Speaker 1:So could you give me an example of those three is a person.
Speaker 2:their obsession, their fear is what if one day I snap and I go crazy and kill my kids or kill somebody or just run amok and just do wild, crazy, embarrassing things?
Speaker 1:Yeah.
Speaker 2:So that would be the obsession, okay.
Speaker 1:Um so, like that movie with Kurt Douglas, where he just has enough and he walks around with guns and starts acting like he's going to, or threatening to, shoot everything. Yes, that's that thought. They carry that.
Speaker 2:Yeah, they would. I haven't seen that movie, but a person with that obsession, would hate that movie.
Speaker 1:They would not want to see I'm date stamping myself because it's an old movie, but yeah, it's out there yeah, so that that whole, the whole kurt douglas movie, that part of it would be um an example of maybe, what's going on inside their head.
Speaker 2:Yes, Freaked out that they might do that Right.
Speaker 1:Yeah.
Speaker 2:And become violent. Right Be it again. Kill somebody, attack somebody, hurt somebody, grope somebody.
Speaker 1:Okay, so now we're moving to the sexual piece.
Speaker 2:Yeah, that kind of moves into the sexual piece, but it's. You know, am I a violent person? Am I capable of violence? Would I do something like that?
Speaker 1:and, to be clear, it's not that there is, it's not that there's the desire to do that it's the fear exactly, yeah, they have no desire to do that.
Speaker 2:Um, they're the nicest people, you know. They're the safest people, Right? So they're not. You know, if you were assessing this person or diagnosing them, you wouldn't be diagnosing them of? Oh?
Speaker 1:they're a threat to others.
Speaker 2:And they've got this personality disorder. We need to watch out for them.
Speaker 1:It's almost like they're trying to protect the world from themselves. Yes, and they're trying to protect the world from their thought. Yeah, yeah, that fearful themselves.
Speaker 2:Yes.
Speaker 1:And they're trying to protect the world's the world from their thought.
Speaker 2:Yeah, yeah that that fearful thought. Yes, not that.
Speaker 1:I want to do this. I want to protect the world against it. I don't want to do it, but there's some outside force that I'm afraid that is going to push. I'm going to be compelled to do it. Yeah. And that's the fear.
Speaker 2:Yeah, Usually it starts with I mean, when you think about it, all of us have dark thoughts.
Speaker 2:Everybody has weird out of pocket thoughts that they don't know why they just thought of it, but they do, um, and one example I've heard before is um, this, this becomes dark, but that's just the nature of it, of a person holds a little baby and they're like, oh my gosh, they're just like so tiny, they're so fragile, and partly what they're not saying is like if I dropped the baby, the baby would get really hurt, right, um, and a person without OCD could have that thought and not think much of that thought. It's just the overall idea that a baby is fragile, right, and I, you know it's life is in my hands right now. A person with OCD who is struggling with pure O or this could maybe be the start of it is they have that same thought that everybody else has, but that thought they then latch on to and become very fearful of oh my gosh, why did I have that thought?
Speaker 1:That's right. It's the rabbit trailing of chasing down the why. Yeah, yeah.
Speaker 2:Yeah, yeah. What does this mean about me? Right that I'm thinking about this, or I had that image in my head. What does that mean about me? Do I want to do that? And the rabbit?
Speaker 1:hole right and assigning meaning to a thought. And I always tell people you cannot control who knocks on your door, but you can certainly control who comes into your home. Yeah, and we have, like you said. I'm so glad you said that we have thoughts that fly around and they don't make sense, Right, and if you start trying to make sense of it, it might drive you crazy. Yes, Not not literally, but it might, yeah, yeah. And it's when we step back and and and say that's a thought, I'm not letting it in, but anyway.
Speaker 2:I don't want to get into too much of that.
Speaker 1:Yeah, but so that's the violent, so it's, but so that's the violent, so it's. My fear is the, the, the Puro, being pure obsession, right, and so it's that thought of like, oh my gosh, I don't want to end up doing something negative. I need to protect the world from my thoughts. Yeah, my thoughts are I may end up running amok. I love that, and so I don't want to run amok.
Speaker 2:And so that's where the loop happens, for them, yeah, and a person could be thinking about that and you would never know, right, and that's where the Puro, where they first called it that, because it was I don't see you washing your hands. I don't see you checking the lock. I don't see you checking the lock. I don't visually see anything, but yet they are in their head being tortured by that fear and by that thought, right, um, and they are still doing compulsions. It's just sneaky.
Speaker 1:Yeah, they're internal.
Speaker 2:Yeah, potentially they're internal, but they actually can also be external, right Too. Yeah, nice, okay, and so then the yeah, potentially they're internal, but they actually can also be external right too.
Speaker 1:Yeah, nice, okay, and so then the a sexual example of that would be, like you said. I'm afraid I'm gonna grope someone.
Speaker 2:Yeah, it's very similar to the violent, just you know like, am I a predator? Am I a pedophile? Do I want to commit bestiality? Or it can be kind of on a lower level. Those would be. Those are some more. That's violent also in nature Right Violent with a sexual twist yeah.
Speaker 2:But they can also be, um, like, a spouse is worried. Do I want to cheat on my wife, Um, or am I attracted to her? Am I more attracted to this person? What does this mean? That I'm attracted to this other person? Um, and there's also one where a person starts doubting their sexuality of, uh, you know a person who very much is straight, very much is attracted to the opposite sex, but then starts to worry am I gay?
Speaker 1:Um, so those are kind of usually the big themes within the sexual obsessions I could see that being a real struggle, because let's go back to the one where you're a married person and you're you're obsessing over. Am I going to be faithful? Yeah, and the shame associated with that and the fear associated with that and the oh my gosh.
Speaker 1:What does this mean about me as a? Oh my gosh. What does this mean about me as a like, characterologically? What does this mean about me as a human being? Yeah, what does this mean about our marriage? And I can see that ballooning or mushrooming into something that's really catastrophic in their mind yes, yeah. Yeah, absolutely. And the other one was, you said, religious, that's the third.
Speaker 2:Religious, yeah, yeah. And the other one was you said religious, that's the third Religious, yeah. Some people have maybe heard this as scrupulosity, all sorts of doubts or fears about their faith. Do I love God, do I really love God? Or do I truly believe in this? Do I truly have faith? Um, or you know, there's that one verse about, uh, blaspheming the Holy spirit. Like, have I done that? Do I want to do that? Would I do that? Um, a lot of doubting about sin, being perfectionistic, my motivations or having kind of ritualized prayers or ritualized.
Speaker 1:Like practices.
Speaker 2:Yeah, yeah, reading the Bible and then again the sexual piece can sneak in here too, of seeing God or Jesus in a sexual way that they don't want to. But those images pop in their head and oh my gosh, why am I having this thought? So it can also become like intrusive images, where they intrude, Like you're saying. This thought knocks on their door and maybe they don't let them in, but they go outside and start wrestling with that thought is kind of how I think about it.
Speaker 1:Well, in the theme that I see here, as you're describing it, it's like how do you prove a negative? Yeah Right. It's like how do you prove a negative? Yeah Right. It's like how do I prove to you, to myself, or whatever, that I'm not going to do something because it's and I will get into the neutral here. But it's like how do I prove that I didn't lie, that I didn't think that or that that thought right?
Speaker 2:yes, so it becomes real heady and really confusing, sure quickly super entrenched.
Speaker 1:Yeah, I've seen people who have experienced especially the scrupulosity part and it is it's so, and it is it's so. It's so intense for them because they believe that it's a life or death sort of thing. Yeah, and it is so weighty for them to walk through.
Speaker 2:Like I'm going to hell. Right, I'm about to face eternal damnation, right.
Speaker 1:And it's in, in walking, with the weight of that and then what it does, like as it ripples out into their, to their family, their spouse, their family, their community, and it's like that heavy weight is fully there, right, and so it's. You think about how just the toll it takes on them. Yeah, yeah.
Speaker 2:But there's hope, there is hope, there is hope. And what you were saying just right then, um, is we lead a free support group or offer a free? Can sometimes be characterized as like cute, funny quirky, but like, as far as mental illness goes, like you know it's cute, it's funny and it's a little invalidating.
Speaker 1:I'm guessing to them yes, very, it's cute, it's funny and it's a little invalidating. I'm guessing to them yes.
Speaker 2:Very much so. Yeah, very much so. Um, because, like you were pointing out, um, if someone, if someone was scared that they were going to be a pedophile or like, would do something like that, and really were wrestling with that and getting confused by that thought, that's terrifying.
Speaker 1:Yeah, and where? Where could you go in society and and to an untrained person and say I'm worried I'm going to be a pedophile? It's like I don't want to end up in prison, but do I belong there? Should I say something like like all of the working out of that thought as well, that could. That creates weight and pain and torment. Yes, yes.
Speaker 1:It's unreal, yeah, like I could imagine, you know, when people say, oh yeah, that's just my OCD, and, like you said, it's cute and it's it's yeah, that's just what I do, right, and it's like you're orderly and maybe you're type a, but that's not OCD. No, yeah.
Speaker 2:No, it's not, yeah, a yeah, but that's not ocd. No, yeah, no, it's not, yeah. And, like you said, it can be very lonely and isolating of hey, how was your week? Oh, it was pretty stressful, oh, yeah, yeah. Oh well, my, you know, money's a little tight. Oh, okay, cool. Yeah, I'm scared that I'm going to hurt my kid like whoa. That's different and and the untrained person is not always going to know what to do with that. So it's right, and they hold on to it, dialing cps like I think my co-worker right and it's like no, that's not it at all.
Speaker 1:And then, and then to the untrained person, it's like okay, but then there are people who you do have to be on on guard, or like you have to listen, like, hey, I'm, I'm afraid I'm going to hurt my kid, I kind of cause I just did and that's a whole different conversation. A whole different conversation, yeah, and there's that as I, as I've seen it, as I, you and I've talked before, it's like that's their fear. Right, that's a part of their fear.
Speaker 2:Yeah, yeah, and and that you brought up a good point too as far as, like history goes, like you said, of I'm worried I'm going to hurt my kid and cause last week I got really angry and I did right. These it's. They have no history of that, they have no desire for that. It's the scariest, most awful thing that they could think of, and so, based on that, that helps diagnose and yeah, and it helps us be like all of us in the community.
Speaker 1:Be aware, right, right, because I will say from my perspective, the people that I see in life, either in my practice or in life, who have this, the pure, that pure obsession, they are some of the most gentle, kind, loving, like you want them to be your best friend, because they are genuinely like the greatest people and you look at them and you're like, oh my gosh, you're lovely, you would not hurt a fly. And then you find that they're, you know, struggling with that obsession, right, yeah, right.
Speaker 2:Yeah, so tough, but there's hope.
Speaker 1:There is hope. I want to keep drilling, yeah, and it's like yeah this is big, it's, it's overwhelming for them, heavy, and yet there's hope. Yes, yeah, there. What's the hope?
Speaker 2:Well, the hope is is that um, cognitive behavioral therapy, slash exposure response prevention works? I mean, there's a lot of research behind that, decades worth of it, right? And while the germ OCD is for a person, maybe untrained is easier to conceptualize of like oh yeah, okay, I could see how. I mean, even I can see it, it's tangible. So I could see maybe, how we could work on that, right. And so some people might think, well, it's all in my head, how do I work?
Speaker 1:on that Right, because I can't stop washing my hands. Yeah, I can't expose myself to saying, okay, I just touched something and now I'm going to go a period of time without, without cleansing myself. So yeah, yeah, yeah yeah, you can.
Speaker 2:You can do that, you can see that Um, but the the big point is CBbt and exposure response prevention still works on puro. It's actually no different and it works on both. Um, it maybe is just not immediately as understandable, but it does. It does the same thing. So I should probably say what exposure and response prevention is. Um, so people have an idea. Um, it's funny. I went to a uh a training recently put on by the international OCD foundation and the guy who led it, super smart guy, um, psychologist Eric Storch. He's done a lot of research on OCD and works out of the Baylor College of Medicine in Houston. But he said several times he was like remember the acronym KISS, keep it simple, stupid.
Speaker 2:He was like yeah it's, don't overcomplicate it, which I appreciated. So, yeah it's, it's not overly complicated, and I think when I say it, people are like oh yeah that makes sense.
Speaker 1:Okay, I'm going to just pause you there for a second because I think that that whole I've always heard the keep it simple, sweetheart.
Speaker 2:I've heard the stupid and I like that but.
Speaker 1:But I love the keep it simple because I think all too often, like, what we're talking about is complex and the way that the mind grabs it and what it does with it, it feels complex for the partners or the spouses or the family members that are dealing with it or that live amongst that. Right, I've spoken with so many people who have a family member, a partner, a loved one that deal with this and it feels overwhelming and complex. So keeping it simple, I think, is a really big, huge part of this. So, yeah, keeping it simple, yes, I think is a really big, like huge part of this.
Speaker 2:Yeah, yeah, that's excellent.
Speaker 1:Let's not get too lost in it, and we'll just break it down and make it very clear so again, I'll use germs, because that's the easiest place to start.
Speaker 2:I'm going to expose myself to a thing I fear. So a bathroom door handle. I'm going to expose myself, I'm going to touch the door handle. And then response prevention, the RP. I'm going to prevent my typical response. My typical response is to then go wash my hands. So I'm not going to do that. So I'm going to touch the doorknob, touch the door handle, have my hand dirty and I'm not going to wash my hands and even, maybe, to make it a touch harder but more immersive, I'm going to take that dirty hand and touch my other hand and touch my clothes and touch my face and lick it. Maybe you know that would be harder, but we would start slow and we work our way up. That's kind of how you do it. You start with something easy, you feel good with that and then you work your way up, Kind of like when you ride a bike you don't start on a huge hill right, you start in a parking lot.
Speaker 1:Um, so, simplifying it, that's what ERP is, I have to tell you this, the first. One of the first times in early in my career. One of the first times early in my career, I had a, a, a young kid that was afraid of bugs so much so it turned into agoraphobia. Wow, and I was like, okay, I'm going to give this a shot and we're going to figure this out.
Speaker 2:Yeah.
Speaker 1:And, um, I was very clear with the family that this is where we're going to try this. Yeah, and we started off by just talking about bugs. We moved to looking at pictures of bugs, then we moved to watching videos about bugs. Then we moved to I brought in some fake bugs, some plastic bugs, and then we mixed in some bugs that were fake, that wiggled, and on the last day I thought my landlord was going to kill me. But on the last day I brought a bag of crickets, yeah, and we went outside, because we don't do this inside. We went outside and the that kid held the bag with the live crickets in it Awesome. And then he was so like he just wanted to flex at this point and his dad was there. It was the sweetest thing. That's awesome. He rips open the bags and like starts letting the crickets jump around on his hands Wow.
Speaker 1:Yeah, and it's like that's, that's exposure. Right, yeah, that's exposure, yeah.
Speaker 2:And exactly how they do it with OCD of start slow or start small, work your way up. And what's neat is like you're saying, people start learning, hang on, I can do this Like I'm stronger than I realized. And so that's really again to your earlier question of why did I, you know, get into this? I love seeing that it's so cool.
Speaker 1:I mean the dad who was like I don't know. I felt like he was like seven feet tall. He's probably like truly like six, seven, six, eight. He was enormous. I mean he just sat there. He just sat there, wept and held his kid and like he came and grabbed me like right, jumped up and down and shook me around, right. It was like high fives all around, yeah and then that little dude was no longer afraid to go outside, got his life back yeah, got his life and I I learned later that dad was like now he's obsessed with bugs.
Speaker 2:He was like you did it too well yeah.
Speaker 1:But I'm not saying that's the case for everybody. That people who get through the their their contamination fear is that they're going to go around then licking bathroom floors, so yeah. Or that they go into waste management per se Right, but there is that sense of being able to be freed from that fear and just kind of move about the world.
Speaker 2:Yeah, um right, normally, yeah, yeah.
Speaker 1:So, so walk us through then how that looks for the pure obsession.
Speaker 2:Yeah. Um where I would, where I would start? Um, two questions that I've learned that are super helpful, and even if a person's listening to this right now who does have Puro, I would start with these two questions. One, what can I not do because of my obsession? Yeah, I love that. And then what are my triggers? Because of my obsession, when where is the obsession?
Speaker 2:Where does the fear get triggered? You're probably going to get similar answers between those two questions, but you might get slightly different, so that's helpful. You get kind of some layers there.
Speaker 1:So an example might be when I walk into a religious establishment of my choosing, let's just say it's a Christian faith. And they walk into a religious establishment of my choosing, let's just say it's a christian faith. And they walk into a church.
Speaker 2:Yeah, walking into the church is where that gets triggered yeah, that would be the answer to one of it gets triggered when I go to church. Um and um, the, so the obsession gets triggered when they walk in church. The compulsion so it's not actually Puro Right. The compulsion maybe for one person is I now have to pray this special prayer to make sure that God forgives me of all my sins before I sit down for the service or take communion. I got to be sure that I'm not angry with my brother, and so the compulsive prayer might be I say God forgive me seven times. Seven is kind of a complete number. I've made up this kind of magical thinking that I have to say it seven times and I say God, please forgive me, god, please forgive me, god, please forgive me Seven times in my head. So that would be the compulsion based on the obsession. So do you want me to tell you then how you would do exposure on that? Yeah, so one the question what can I not do?
Speaker 2:It may be like for some people I can't go to church anymore or I can't. Maybe there's some sort of special rule, like I can't sit near the front or I have to watch it online, but I can't, I can't attend and I can't take communion, okay. So what erp would be? Exposure response prevention is, um, I think of it as okay. You've got OCD, as this like external force has come up with all these rules and you now have to follow these rules.
Speaker 2:So ERP is I'm going to fight back, I'm going to say, no, I'm not doing these rules and I'm going to do it wrong. So for one person it may be you know, I'm going to go to church, maybe dress a little bit more casual, that might hit on it a little bit. And then I'm not going to say God forgive me seven times. And not only would I not say God forgive me seven times, I would think with the person how could we do that wrong? And it may be something like God, if I have a sin that I forgot, that you haven't forgiven me of, hopefully you don't strike me down right now, kind of being sarcastic, a little bit playful with it, and that touches on something we may get into is about uncertainty, yes, but so ERP again to summarize is not saying the seven God forgive me rule and then figuring out a way how could I do that wrong? I do that wrong.
Speaker 1:So let's go through then the that's in the scrupulosity or the religious area, because we're not going to say to somebody go ahead, be a pedophile, Like because again we're not saying in the in the religious piece, we'll just go ahead and you know, behave how you want. So how then?
Speaker 2:what's a walk us through what it looks like in the the, the, the violence, and then the sexual, so the violent one could be again. Ask yourself these questions what can I not do? Or where is this obsession triggered? I can't cook anymore. Or when I cook it gets triggered. Okay, because when I cook I have to cut vegetables, and if I'm cutting vegetables I'm holding a knife and I'm scared that I'm going to take that knife and stab the person next to me.
Speaker 2:So exposure would be cook and get a big knife and cut those vegetables, and so I'm exposing myself by holding a knife and the response prevention is essentially the typical response would just be don't cook. So you're kind of getting them both right there, um, but that would be the, that would be the exposure. Cook, or if that, that might be a little bit harder because you're holding a sharp knife. So you could maybe start with um, carry around like a little pocket knife in your pocket and have a pocket knife Because the fear is I might go crazy and stab somebody, or am I a violent person and so I can't? Like you're the kid who had the fear of bugs, he starts closing himself in, right. So the same thing with violence. I start closing myself in cause, I'm, I'm dangerous. So exposure is? I'm going to start opening myself up and start taking some risk and being around things or situations that I typically couldn't do. Um, and I oftentimes see it around knives, um, and so it'd be gradually exposing to that.
Speaker 1:Have you ever, have you personally ever used like a fake knife, like a rubber knife, like a toy knife? Just so that there's that? Okay, it, it's there, yeah, and you're having where it's that. That is there, but it's not um, it's more gradual, right.
Speaker 2:Yeah, yeah, I haven't, but I love the idea.
Speaker 1:Yeah.
Speaker 2:And someone totally could, that would work the thing that I have seen.
Speaker 1:I saw one time in my career where a kid had a fear and there was a therapist that they were working with that did the, that did exposure, the ERP, and it was almost like it was almost like a person who hasn't seen the sun in a while, Like they've been indoors maybe work the night shift and they just aren't exposed to the sun, and like they were encouraged to go sit in the sun without sunscreen for two hours.
Speaker 1:Yeah, it's like, of course they came back at crispy critter, right, right, of course they got a sunburn, figuratively speaking, but it was almost like they were overexposed and they didn't have the, the, the, yeah, the. What am I trying to? Say I keep wanting to say they didn't have the, the, the, yeah, bound, the. What am I trying to say? I keep wanting to say they didn't have a yeah they weren't.
Speaker 1:They weren't tooled up, yeah To to deal with that exposure, yeah, yeah, and I, I just I want to put that out there. I know you have known you for many years. I think you are clinically like exceptional, excellent, and I know you don't do that because you, you tool the person up, you, you give them all the resources that they need to to be exposed to these things. I just want to put that out there that, like, watch out for that, because you know whoever's treating you for these types of things needs that. You need to be aware, like, you have to go at a pace now. Yes, you have to push yourself, but you have to go at a pace that you know is sustainable for you, that you have the resources to cope with.
Speaker 2:Yeah, yeah, exactly. Again, I think of riding a bike. Again I think of riding a bike. If you took a person on a huge, big hill in a busy neighborhood with tons of cross streets, that's going to freak them out, though they won't want to ride a bike again, and so, um, very not ideal for an exposure to start out way too hard, because again, the goal is I can do this, I'm stronger than I thought, and even start learning. Uh, I'm probably not going to do that Right, and if you start too hard, too fast, it can turn a person off and they're like I am never doing that again. So you do have to start slow and small, and sometimes you have to get creative of what is slow and small like you said, a rubber knife but if you're with someone who's trained in it, they should be able to know what's something smaller.
Speaker 1:That's something that I've always appreciated about you, brandon, clinically is is that, at the end of the day, the person that you're treating is really at the core of what you're doing? Yeah, like we're never going to overlook you.
Speaker 2:Yeah.
Speaker 1:We don't want to be like we have this and we're going to put this on you and you're a lab rat. I'm going to just do this thing on you, right?
Speaker 2:Yeah, yeah, yeah. No, I don't want to do that. No, I know you don't. And then can you give uh, this is like you said. This is a. This is maybe PG, but it's something we got to. I want to talk about 13. Yeah, 13. Um, maybe NC 17 kidding, I'm kidding, it can be that whole space of the sexual part of it, because you want to talk about shame. You know, like I've, I've worked with folks who struggle with this kind of a thing and with that sexual piece, and it's shame on top of shame, on top of pain, on top of fear. It's tender, very, yeah, yeah.
Speaker 2:Ask yourself the question what can I not do? Where am I triggered? So the pedophile one and I'm going to step out of this for just one second of two when I meet with people and they've got that obsession, because that one is, it really can undo somebody and this regulates somebody. Is education is also important, of like, hey, a lot of people deal with this, mm-hmm. Look, here's a book and there's a whole book on it, or there's a whole chapter on this. You are not the only one. You are not crazy. You may not believe me right now, but I promise you there are other people who are dealing with this. So I think that's an important place to start, kind of like you said that would be a resource is just starting to realize.
Speaker 2:Okay, this has a name. It's called OCD. Ocd isn't always just germs. There are some people who have these types of obsessions that you can't see I'm not the only one like that's important, um, but then the actual exposure may be, um, uh, one that would probably be a little bit harder.
Speaker 2:But is, what can I not do? Well, I can't be around kids, right? So then it's figuring out okay, walk past a preschool or go to a park and be by some kids or play with your niece or nephew or play with your son, um, wrestle with him. That might be a little bit harder, but it's, it's not cruel things that exposure would be. It's like let's get you back to your life so that you can enjoy your kids or enjoy this. Maybe you know I used to volunteer at Sunday school and now I can't do it anymore. Like, right, let's get you back to that, back to those values, and, and so it will be exposing, pushing into that, but again at a gradual level. So that would be an example, or even um, as we've talked about thoughts, so getting used to the thoughts, um, because we're talking about this right now and we don't have OCD, we can hear it and we're not getting dysregulated, but a person with OCD, if they even just heard the word pedophile- that's a trigger, that would be a trigger like that question.
Speaker 2:Where is it triggered? So it may be writing that word down a hundred times, or writing it on a note card and carrying it around while you're at home, or even putting up some like post-it notes around your house. That's just to trigger that word and so it's getting used to that word.
Speaker 1:Right, it's again. It's that exposure to the thing that I am fearful of. Yeah, yeah.
Speaker 2:Yeah, and getting starting to habituate to it, starting to get used to it, and for it to feel like a thought, like any other thought, right? And again, what I let them know is all of us have these thoughts. We all have some weird thoughts, Right? Not everyone's talking about it, but we do. Your OCD is latching onto it, and so we've got to figure out how to more. So let it be there.
Speaker 1:And so these exposures help do that they do, and it's somebody gave me the analogy a long time ago that it's like the, like the gatekeeper of your, of your brain. Let's say, like in the old days, you know, the the president of the company had a secretary that always sat out at his, you know, sat out in front of his office and and gate kept who got to come into the CEO's office.
Speaker 2:Yeah.
Speaker 1:And what? For whatever reason that secretary, that gatekeeper for OCD is, is gone, either gone to lunch was fired, left the job whatever.
Speaker 1:And so all the thoughts come to the CEO. Well, all the everything comes to the CEO and it's like I can't manage all of this and I have to run it all down because my job is to manage everything when, in reality, the gatekeeper of the thoughts walked away and I liken it to your front door was taken off, so everything comes in and you have to deal with everything that comes in. Yeah, and what you're talking about is putting the front door back on, rehiring the gatekeeper to keep those thoughts from making permanent residence in your brain as opposed to saying, oh, I'm sorry, the CEO is busy, they can't entertain this thought.
Speaker 2:Right, right, yeah, I um another analogy I use um someone uh I worked with showed me and I love it, so I use it as the really old school Disney cartoon with briar rabbit.
Speaker 2:Oh yeah, um, and there's a scene, and with briar rabbit, where there's the tar baby and the the briar rabbit walks by the tar baby and then punches it and then gets, you know, he's got one fist stuck in it. And then he gets his other fist stuck in it, and then his foot is in it, and then the other one, and before he knows he's all tangled up in it. Yeah, covered in tar, covered it, covered in tar. And that's when, when we try to not have a thought or make a thought go away right.
Speaker 2:That's when we start getting stuck in the thought. So the exposures help support that new attitude of dealing with thoughts, of let them be there, cause you have a million thoughts a day, um, and just let them come and go burst that.
Speaker 1:I love that analogy. Yeah, it's a good one, I like it. I often use that with people who don't have OCD but who are avoiding their emotions and they don't. They won't feel things Uh-huh, and why can't it stop?
Speaker 2:Exactly, yeah, it carries over, right For sure it's an overall principle, I would say Right, and the keeping it simple is it's a principle of approach Keep approaching, don't avoid, because the big compulsion with pure o is avoidance and and that is a behavior. So it's approach, approach, approach, um, and and then now you, now it feels a little bit more manageable yeah, okay, I just need to approach slowly but surely approach.
Speaker 1:That, yeah, and the idea feels simple, right, but it's certainly not easy, no, and so definitely not I.
Speaker 1:You know, brandon, one of the things again that I really appreciate about who you are as a clinician is that you always keep people at the core of what you're doing. Yeah, you always keep the person that you're treating at the core of how you see them, and I think that that is that's so key. It's like walking through this with somebody approaching something may take time, but it's like you're not going anywhere. Yeah, yeah, yeah, we have time. Go at your pace, and I think it's important for us to impress upon people listening, like if this is you and you're not in the Dallas Fort Worth area and you can't come see Brandon, then it's finding somebody who is willing and able to go at your pace, to not expose you to the sun in a way that is just too much yeah, going to leave you red and crispy.
Speaker 2:Right, yeah, cause it's really hard. So you want someone you can feel comfortable and trust with to walk alongside you as you do it.
Speaker 1:Yeah, yeah, yeah. Well, brandon, thanks for coming in this today and for us to lay this stuff out there and I hope that people walk away with the fact that there is hope. Yes, there absolutely is not a thought death sentence. No where you have to pull back from your whole life, and I love your messages approach so that you get your full life back, yep, so that you have the opportunity to celebrate that restored freedom.
Speaker 2:Yep, yep, so that's it.
Speaker 1:I love it Cool. Thanks, man.
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