Ryan Judd on What Causes OCD, ERP Therapy & Why Recovery Is Possible

In this episode of The OCD Confessional, we’re joined by Ryan Judd, Clinical Director of the OCD Institute Texas, a residential treatment program specializing in OCD and anxiety disorders.

Ryan brings both clinical expertise and lived experience to the conversation, giving him a unique perspective on what it actually takes to recover from OCD.

We start with his OCD confession and his personal experience before diving into his work treating people with some of the most severe forms of OCD.

In this episode, we explore:
 • What OCD actually is (beyond the stereotypes)
 • What science says about what causes OCD
 • Claims around gut health, inflammation, and OCD
 • Why Cognitive Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP) are so effective
• Why OCD is not something you just have to “live with forever”

Ryan also shares why he’s passionate about challenging the idea that OCD is “incurable” — and what real recovery can look like.

This episode is both educational and empowering, and a must-listen for anyone trying to better understand OCD or find a path forward.

Transcript

SPEAKER_02 0:00

I'm Alicia. And I'm Liam. We both have OCD. And instead of spiraling alone, we decided to turn our symptoms into a podcast. You're welcome.

SPEAKER_01 0:10

Here, we overshare real stories, laugh through the anxiety, and talk to actual experts who can explain why your brain keeps asking, What if I accidentally marry my cousin?

SPEAKER_02 0:20

Whether your thing is hand washing, mental rituals, or just silently panicking during normal conversations, congrats. You have found your people.

SPEAKER_01 0:28

This is a safe place. And let's turn interest of thought. In which case, get in line, buddy. We're both.

SPEAKER_02 0:34

So grab a weighted blanket, cancel your plans for the fifth time, and let's dive in. This is the OCD Confessional.

SPEAKER_01 0:42

And yes, we did check this recording four times before uploading it.

SPEAKER_02 0:49

Today on the OCD Confessional, we are joined by Ryan Judd, Clinical Director of the OCD Institute, Texas, a residential treatment program specializing in OCD and anxiety disorders. Ryan is a clinician who works with people at some of the most severe points in their OCD. And he's also lived through OCD and anxiety himself. That combination of lived experience and clinical expertise gives him a unique perspective on what actually helps people recover. He is especially passionate about cognitive behavioral therapy and exposure and response prevention, and about challenging the idea that OCD is something that people just have to live with forever. So, Ryan, welcome to the OCD confessional. Thank you very much. I'm very happy to be here.

SPEAKER_01 1:41

We're so excited to chat with you, Ryan. We start every episode off with a confession. Is there anything you would like to confess today?

SPEAKER_04 1:48

Uh an OCD confession.

SPEAKER_01 1:50

Yeah.

SPEAKER_04 1:51

Yeah. Well, uh something kind of kind of silly and funny. Uh I guess when my looking back now, recognizing that I actually probably had OCD a lot earlier than I definitely a lot earlier than I than I knew before I knew what it was. But when I was in school, I used to, I would get very distracted very easily. Um, but I wanted to pay attention, especially when it was something that wasn't interesting. Um, but I would have these thoughts like, oh, if I bumped my uh knee against the desk, I needed to bump it on the other side. Otherwise, I wouldn't be able to stop thinking about it. And my fear was like, oh, I'm I'm not gonna be able to pay attention if I don't, you know, figure this out, make this thought go away, make this feeling go away. Um, but then I would get so wrapped up in like, well, maybe I have to bump it two two times because that's a better number, or four times because that's a better number. And then of course, you guys know what happens next, right? I'm like totally not paying attention and actually making the thing I was worried about happen, happen through the ritual process. Yeah. And it was like took me a long time before I figured out, like, oh yeah, this is actually making it way worse. But yeah.

SPEAKER_02 2:52

Did you have any special numbers that you were using when you would do that? Like, oh, I had to be two and then two, or what was your what was your three, five, and seven were like good numbers.

SPEAKER_04 3:03

They felt complete, but then again, it was always like most of the time they felt complete, but then what if they didn't feel complete? Then I had to figure out another number, and it was yeah, I'm just gonna be honest.

SPEAKER_02 3:13

I hate three, five, and seven because they're not even. They're not even line. You need symmetry.

SPEAKER_04 3:21

Yeah, and that's so interesting because I was what I was looking for was like a symmetrical feel, but three, five, and seven felt that way to me. Isn't that weird, right? OCD.

SPEAKER_01 3:30

Yeah. Is that is that one of the first things you noticed show up? And and what are some other subtypes of things?

SPEAKER_04 3:37

It's like yeah. Uh the first, if I think back to the earliest like true OCD moment I had, I was really young, and I remember this is so bizarre, it's so weird, but that's how OCD works obviously.

SPEAKER_00 3:47

It's also weird. Yeah.

SPEAKER_04 3:49

I remember like some adult, maybe an uncle or something, talking about having chapped lips, and he was like, Oh, my lips are so chapped, I could I could die, or something like dramatic like that, like a mention of death. And then I started thinking, like, what if I lick my lips and then someone dies? Uh, it makes no sense. But yeah, it was a bit magical. And then I was so afraid, I was like watching myself, don't lick your lips. Because what if you do that and know that that could happen and that somebody could die? And I was terrified of this. And I think I was really young because I I eventually I went and told my mom, and she was like, you know, that's ridiculous, right? And I was like, Yeah, but what if? And she was like, Ryan, lick your lips, like you're fine. And I was like, no. But yeah, that was probably the earliest I remember of being terrified that something like that was gonna happen and um not knowing how to make it stop. Did she get you to lick your lips? I think she did, yeah. I think I think that's what probably put it to bed was she was like, lick your lips, do it, and I did, and then was like, okay.

SPEAKER_01 4:48

Yeah, she she was doing ERP and didn't even know it.

SPEAKER_04 4:51

Way, way, way ahead of her time with that, yeah.

SPEAKER_01 4:53

Right.

SPEAKER_02 4:54

And how did things go from there for you? That was your first sign that it might be there where there are other subtypes that emerged. How did your hero CD go from there?

SPEAKER_04 5:05

Yeah, it would kind of come up and uh up and down. I think there were periods where it didn't really bother me, and then or I'd have these kind of things about numbers and then tapping, but you know, I was kind of always able to uh get distracted with something more important, like school or extra, you know, activities or friends or stuff. Um, but I really had more of a social anxiety problem growing up. Like that was even maybe bigger. The thing that bothered me more, I was always kind of anxious about other people and their perception of me and feeling awkward and worried and replaying conversations and um avoiding things uh throughout like a lot of high school middle school and high school. Um and so OCD maybe just was like in the background, not super uh super there, which is probably why I never really realized that I'd had it until my mid-20s, and that's when it got uh really, really awful and really, really bad.

SPEAKER_01 5:55

Do you think people suffer with anxiety because of their OCD?

SPEAKER_04 6:01

It's a good question. You know, I so I'm actually the the DSM, you guys have probably heard of the DSM, the Diagnostic Statistics Cystrical Manual, which is where we get all these disorders from. It's kind of like the Bible in the world of mental health and treatment. Um and actually in the previous version of the DSM and DSM or OCD was listed under the anxiety disorders category. Um, and I think there are a lot of good reasons for that. And then they kind of uh took it out in the newest version, it's now its own thing. It's got its own chapter, it's its own classification of disorders. And there's some there's some rationale for that too. But um, yeah, I think OCD and anxiety kind of play on some of the same, you know, brain circuitry, and they can kind of like you know collude with one another to make your life miserable. And and and we often do see people with OCD, we know that they're more likely to have an another additional anxiety disorder, and vice versa, kind of the we know there's probably something around an anxious temperament. Like you guys have kids, I think, right?

SPEAKER_01 6:58

Yeah. Yeah. We both have two.

SPEAKER_04 7:00

There you go. And and and which one is of the two, you could probably very easily say which one has a more anxious temperament than the other.

SPEAKER_01 7:06

We each have one.

SPEAKER_04 7:07

There you go, right? And and most families do. It's interesting. And even if they don't, if they're not truly clinically anxious, there's always one that's going to be further on the anxious spectrum than the other, right? Um it's just kind of interesting how, you know, same genetics or mostly same genetics, same environment, but you have some people that are some children that are just born with a more anxious temperament and predisposition um than others. Some are some are risk takers by nature. They're very, you know, nothing feels dangerous to them. Other kids are very cautious in their walking around and looking at everything and afraid of everything. Kind of interesting. You said things got really bad in your 20s. What did that look like? Yeah, this is when uh this is when it got really, really severe really quick. So I had a bad night's sleep one night, um, like just randomly, you know, had trouble falling asleep or something, and then the next day felt, as one does, pretty fatigued and just groggy. And I started to think, oh man, I I better make sure that I get a good night's sleep tonight because this was awful. And then I started thinking, well, what if I like am so in my head thinking about falling asleep that I can't actually fall asleep? Because, like, what you know, you can't fall asleep if you're paying attention to yourself falling asleep. Kind of like it basically was a version of sensory motor or somatic OCD where the person's you know hyperfixated on blinking or swallowing or breathing. How do I know I'm breathing correctly? And you start to start your breathing, and you can't stop. And I I was doing that with sleep. And uh you can imagine what happened if you're doing that and you're worried about that and you start doing rituals around that. Um, you don't stop. So yeah, I started getting very little sleep every night consistently, and it became the only thing I thought about all the time. It's just a constant 24-7 obsession. And I was doing both like rational things to try to fix it, like, oh, this supplement or this treatment or this you know holistic approach or this mindfulness approach or this and and seeking out things that kind of made sense of like, oh, I have a sleeping problem. But I was also doing a lot of ritualistic things that made no sense. Like uh the drawer is slightly open, I need to close it because it this could be at like 2 p.m. But it's like, well, if I don't close it the right way, I I won't be able to stop thinking about it, it'll mess with me, it'll make it'll make something battle happen. So just go ahead and close it. So I'm doing my whole day, you know, is just totally consumed by this and my night because I wasn't sleeping very much at all. Um, and that happened for a long time. It went on for a very long time because I didn't know that it was OCD. Um I didn't realize I was like, I have a I have a real problem. I have a I can't sleep and I can't stop thinking about not sleeping. I had no idea that what I was dealing with was OCD. You probably thought it was just insomnia. Thought it was really bad insomnia and that this was it Yeah.

SPEAKER_01 9:56

At some point you dedicated your entire career to studying and treating OCD. Why and when?

SPEAKER_04 10:03

Actually, it's it's very accidental in a way. It's very pro like it's kind of uh like providence because like I said with the sleeping OCD, I actually still at this time didn't know it was OCD, and I went to several therapists trying to get help, and none of them clocked it as OCD actually. Now, whether that was because they didn't know about OCD, which I think that was probably the case, but also because um I was very convincing that like, no, this is a real problem and I could talk about it very rationally. Um but again, I think it was just a matter of like these people weren't trained, which is so often the case, and why people suffer so much for so long unnecessarily. Um, and so I at the time I was also training to be a therapist, um, but not thinking I wanted to work with OCD because I didn't even think I had OCD at the time, right? I thought I had a sleeping problem and just anxiety. Um, and so I got no help with that. I was actually working my first job as a therapist, I was working at a college counseling center. So I was working with college kids and you know, just helping them with kind of general problems and some some real mental health diagnoses. But um then my partner and I were gonna move to Houston for some reasons, and I had actually taken a training class in CBT and was like, oh wow, I really like CBT. I think this is what I want to do. This is the kind of uh intervention I want to use. It makes sense to me. And it's I can also see how a lot of my issues could be resolved with CBT. Um, and so I wanted to go that route. So I happened to ask a colleague of mine, hey, I'm moving to Houston. Where's a place I could go that is primarily CBT focused? Because I want to get more into that world. And she said, Oh, the that actually there's the best place for that. The OCD Institute in Texas. Um, Dr. Macingvale's there, that's their whole thing. And I was like, oh, but OCD, I don't, I don't really want to do that. You know, I want to do CBT, but OCD is like, what I'm gonna talk to people about organized.

SPEAKER_01 11:52

Meanwhile, you're struggling with it.

SPEAKER_04 11:54

Yes, yes, and wild. I had the same, even though I had been through a graduate program, of course, there was no specific training on OCD. So I'm still thinking OCD is like people wanting things a certain way, you know, wanting to be clean and just totally ignorant. Um, but I was like, well, I'm gonna take the job because I'll get the CBT training and then I can figure out what I really, you know. And when I got here and I started to do the training and learned about OCD, and I and then I was like, oh my God, this is me. Like I this is what I've been struggling with my whole life. And it was, and then I became just like on fire with passion as much as I could. And I wanted, I was like, my Liz was like, you need to slow down on your case. So I was like, no, I want to see as many cases as I can. I want to help people, like so. Yeah, it's it's actually kind of a really providential accident, you know, of fate that I ended up doing this work.

SPEAKER_01 12:46

Yeah, you became obsessed with those that moment though, when you find out that that's what it is, is it's a really good feeling mixed with a lot of like holy crap, I wish I knew this sooner. Right? There's a there's so many emotions that wrap up into that. I remember when I found out and I would tell Liam, I'm like, I don't want to believe that this is true. But it makes too much sense for it not to. And I'm relieved that I have answers now and I can, you know, work on it. But it there is uh it's an interesting feeling. Do you remember how you felt when you found out?

SPEAKER_04 13:21

Uh yeah. I mean, it everything clicked for me. Um luckily I was kind I kind of already started to I mean, I mostly recovered from that sleeping thing. It took many years, but I fully recovered once I figured out what it was. But um yeah, no, totally. And it it it it changed everything and it made so much sense to me. Um and I tell patients when I work with them, getting the diagnosis is actually the most reassuring thing in a good way. Like we talk about good reassuring. It's actually the because it's like, hey, I'm telling you this is OCD, which should then help you be able to accept the treatment for it. Otherwise, it would be so hard if you didn't actually know you had OCD, you would just go, I have a pedophilia problem, I have a harm problem, I have a sleep problem, I'd have a, you know, uh all kinds of things problem, right? Um you'll just go down that rabbit hole forever without ever getting relief.

SPEAKER_01 14:15

Which is what Liam and I both have done for many years.

SPEAKER_02 14:19

So many people, yeah. I uh to go back one step, because you mentioned that you and your partner were thinking of moving. So when you were going through the sleep issues, did you have a partner at the time? Were you living together? And what was the experience for the partner?

SPEAKER_04 14:34

Not good. That's actually how I got over it because it got so bad that as a lot of uh severe OCD when it's untreated and it just gets worse and worse, right? Well, I always tell patients with OCD, it's either getting better or it's getting worse. You know, I almost never see someone who's able to just kind of stand still in their OCD and kind of contain it. It's like, nope, you're either feeding it or you're it. You know, which one is it? Um, and mine was just getting worse and worse and worse to the point where I was thinking all the time about I think I just probably need to end my life because this is just uh interminable suffering and there's there's no way out of this. Um, or that I was gonna lose my mind or like have a or actually physically die because at some point I had just totally stopped sleeping for a very long period of time. Um and so I I stopped working. I took off, I took a leave from work because I was so like disabled in this. Um and that was actually what happened. My partner, he was a teacher at the time, and it was like during COVID kind of. So he was doing an uh a class online. I could hear, I could hear him. He was at home. I was at home, you know, disabled basically. And one of his students asked him, Mr. So-and-so, you seem so sad. Are you okay? Is everything okay? And then I heard him respond, and he kind of got choked up, and he was like, No, like yeah, I'm just going through something, but it's okay. Like, don't worry about me, you know. And it hit me so hard in that moment. I was like, I am ruining, like, not just my life is ruined by this, but I'm the people that I love and care about the most, my parents, my close friends who were so worried about me, all my colleagues who were like texting me everything, when are you coming back? Are you okay? And I was like, you know what? Maybe I'll never sleep again, but I don't care. This isn't the way I want to go out. Like, I am just gonna live my life and let go of all of this. Like, I'm gonna stop trying to figure this out. I'm gonna stop like maybe I never sleep again. I don't care, but I'm not gonna do this to the people around me. And that was what turned me around. Like from that moment, I went, I called my boss, I was like, I'm coming back to work. She's like, You you're not okay. I was like, it doesn't matter. Like, I'm gonna be okay, I'm gonna do it, I'm gonna work. And I went back to work, I just started doing everything, acting like I was normal, even though internally I was like, everything is not okay, but I did it, and then guess what happened? I started sleeping again. Isn't that amazing? Like when I stopped all of the bulls, all the you know, the BS rituals and research and everything. I whoa look what happened, you know. So fake it till you make it. Fake it till you make it. Yeah, I I tell people that, and that really is like that really is an important thing to do.

SPEAKER_01 17:18

Uh, is there something that clinicians without lived experience often miss with their patients?

SPEAKER_04 17:24

I think that the lived experience thing with clinicians is a little bit overblown, controversial take, right? Being a clinician with lived experience. And I'll tell you why, because I see like if two things. Number one, if you asked me if one of your kids had OCD and you said, who would you, who's the best person, right? I want my kid to see the best clinician for OCD. And I think of the, you know, the four or five people in my mind, half of them are clinicians that don't have lived experience, right? And half of them do, you know, so it's not it's not a requirement to get really good treatment. Um, and then the second thing is I think sometimes it can actually be an impediment. And what I mean by that is I've seen patients before who are like, well, I have OCD and I only want to go see someone who has OCD, a clinician who has OCD. But there are also bad therapists out there, bad OCD therapists who have OCD. So it's like just to have a lived experience doesn't necessarily mean you're gonna be a good clinician. And too often I've seen people stick with a clinician who's not helping them, but they're like, well, but they get it. They understand they must be good because they'd had OCD or they have OCD. And I'm like, no, they're good if they're good, you know.

SPEAKER_01 18:31

So right, right, right. You can empathize. That doesn't mean that you're you're good at explaining how to get the help.

SPEAKER_04 18:36

Exactly. And I totally get from a patient perspective, like you it is very comforting and and nice and you can connect on that level for sure. But um, I also, you know, for what it's worth, I don't disclose to my patients if I'm not I'm open about if they if they somehow know, you know, because they watch a podcast like this or something and they ask me, of course I'll be honest and say, yeah, you know, I'll answer any question you have, but I don't lead with that. And the reason why is because I want patients to trust what I say because they try it out and see that it works, not because they're like, oh, you right.

SPEAKER_01 19:06

Are you mixing your own personal experience with it and being biased? Right, right, right. That's exactly right. That makes sense.

SPEAKER_02 19:13

You said something interesting there, Ryan, just now, which was you said they have OCD or they had OCD or past tests. And I wonder how you define yourself right now. Would you say you have OCD or you had OCD? And this will get into that question of whether or not it's curable, which we've had a few times on this show. Liz and I, Dr. Liz MacIndale, the director of the OCD Institute and I actually had a debate about this during our episode. And I'm curious how you feel about that.

SPEAKER_04 19:44

Yeah, I I also uh Liz and I are kind of on the same page about this. And there we have a few other clinicians on our team who also had their own experiences with OCD who feel similarly. Um yeah, I mean, it's a past tense thing for me. I don't have it anymore, I don't meet criteria, I don't think of myself as having OCD anymore. Um and yeah, we you know, our message is freedom. You can get freedom from this. Uh it doesn't have to be a lifelong thing that you deal with. And, you know, that's that's I'm so happy about that for me personally, but that's also what I want for all my patients and what I shoot for with them. Um and I, you know, I have lots and lots of patients who um similarly will would would say, yeah, this is that was a thing of the past. It doesn't, it's not a part of my life anymore. It's not a part of my daily inner experience anymore.

SPEAKER_02 20:30

Help me define that a bit better. For you, you know, you had, of course, your obsession with whether or not you're gonna sleep. I'm sure some other subtypes popped up at some point. Do those thoughts never occur to you anymore? You don't have a bad day with them like ever? Or is it more that by freedom you mean no, they pop up and I have a bad day or whatever it might be, a bad phase, but I'm able to continue with my day, continue with my life, and it doesn't debilitate me the way it used to?

SPEAKER_04 21:03

Uh so that's a great question. I would say that in the kind of middle stage of my recovery from OCD, it looked like what you're explaining, which is like I still have these scary thoughts that pop up pretty frequently, and I'm I'm trying really hard to not let them affect me or to not respond to them, to not ritualize, to not avoid, to not go down the rabbit hole with them. Um, but as I kept going, as I kept getting better and better at ignoring those thoughts, at doing the opposite of what they were telling me and urging me, they became less and less frequent to the point where now they really don't show up any more than I would say, like a person who's never had OC has, you know, intrusive thought. Like, you know, you go to hold a baby and you're like, oh my God, what if I drop the baby? You know, like I that's pretty normal. Um, and most people have it and they might even feel a little bit of fear, but they're like, whatever, I'm gonna hold the baby. And then after 30 seconds, they're not thinking that anymore.

SPEAKER_01 21:58

Quick break, we'll be right back. First, a word from our sponsor.

SPEAKER_02 22:01

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SPEAKER_01 24:08

There's so many theories out there about what causes OCD. I'm sure you guys have both seen them online. There are a lot of doctors who would say that it's due to gut health and inflammation. Um we we trauma, brain chemistry, genetics. What do you think?

SPEAKER_04 24:30

Great question. Yeah. Um the million, the billion-dollar question. Um, I think that we're unfortunately, I think we're just way too uh not there yet. And you're being able to conclude with any kind of conclusive certainty, say this is what's going on. You know, all of the, even the brain studies, you know, we we've got some inkling of what's going on, what could be going on. But whenever those studies are replicated or they're kind of more information is put into them, or they look at, they compare with, they increase the sample size or the comparison studies, there are always flaws that come up and there are always limitations and questions. And so from a like a neurobiological stance, like of course it's a brain disorder. Of course there's something going on in your brain, but what is actually happening and is it consistent within and between individuals, we really can't say.

SPEAKER_01 25:18

Yeah, because there is a gut brain axis, right? And so you can argue that it maybe stems in your gut and then it affects your brain. But I guess my my question is for people who believe it's due to inflammation. Um, if you're only doing ERP and you're not addressing your gut health and you're getting better, you know what I mean? So like you didn't address your gut health, you would say that you don't have OCD anymore. You only did ERP. So how do you explain that? You know? Like how would someone arguing that that it comes from inflammation when you didn't target your gut health at all? That wasn't even part of your plan.

SPEAKER_04 25:54

Yeah. Well, I I mean, you know, it's it would be impossible to say for sure, but my my suspicion would be if you believe that your OCD is caused by your gut health and then it improves, it's almost like the placebo effect, and which is also kind of consistent with CBT. Like believe CBT is very big on what you believe really affects your interpretation of reality, uh how what you're paying attention to, how you're understanding things. So there are potential ways to explain it. Um, I think, and by the way, like I'm very naturalistic. I love like I do all of that. Liz will tell you, Liz makes fun of me because I'm so kind of like naturopathic. I I want people to have the best gut health possible because good gut health is good for you, right? Right. The I think where the pro where I see the problem happen is that if somebody is chasing gut health as a way to get rid of their OCD, it can really actually make it worse. Um, because it that kind of goes contrary to what CBT would be asking you to do, the way we would want you to approach your OCD from a CD.

SPEAKER_01 26:54

Well, that's what ha that's what happened with me. I became so obsessed with the fact that the reason I was performing these compulsions and having all these intrusive thoughts was because of my health, my gut health. So I I blamed mold and I and and sure, those things probably were happening, and I got tested and positive for toxins and all the thing, but I became so obsessed with fixing that. This is before I even knew I had OCD. So, so now that I know, you know, I've been diagnosed with OCD, I am on this hunt still, and that's probably my OCD of trying to figure out what is the cause. Where did it come from? And I should probably just let that go and accept the fact and still work on my health in a healthy way. But it's interesting to me because if you can choose, remember you said that you um you decided to just sleep better and that changed everything for you, changed your perspective. You went to work, you were like, I'm not gonna give in to this anymore, right? And you were in the thick of it. You were, you were pretty, it's pretty severe for you. And you go to work, you change that perspective, you fought through it, right? Is there something to be said about not giving in when our cortisol is high and you're stuck in that fight and flight and you're anxious and you're stuck in that loop and you're like, no, I'm gonna break it. I'm gonna break the loop. I'm gonna go do the hard thing. I'm gonna go to work and I'm gonna show up. You now have lowered that fight or flight response, that cortisol level, and then your gut is gonna get better because you're not producing that hormone. So it's like you are lowering that inflammation. And I mean, there's so many w ways to look at it. And for me, it's like just be healthy.

SPEAKER_04 28:31

It's like when people, and by the way, you and I are similar because I try, I mean, I can't, I could l I could send you a list, probably many things you've done. I went through, I had air filters in every room.

SPEAKER_01 28:40

I was Oh, I have one right here.

SPEAKER_04 28:42

Yeah, it was insane. I I've seen every type of naturopathic, holistic alternative medicine. Yeah. Because I was convinced of the same thing. There's something going on parasites. Yeah, I went down that rap. I've been down many, many of them. I can totally relate. And and again, I think all of like healthy practices are good. It's like when people come in and they say, Well, is yoga and mindfulness going to cure my OCD? I say, No, it's not. But I'm not telling you don't do yoga. Do yoga because yoga is good. Yoga's good because it's good for you. It's not a treatment for OC. The reason the thing about the cortisol, the where I see people go down this rabbit hole, and is cortisol's not really bad. It's a normal response. We have stress response.

SPEAKER_01 29:20

There are people out there. But when it's chronic, and I feel like OCD people, we experience But like people are in that all the time.

SPEAKER_04 29:27

Wall Street, like people on Wall Street, people who work in investment banking, people who work in a real estate. I mean, you guys are in where in LA? I used to live in LA. Yeah. You ever met a realtor in LA? Their cortisol is through the roof all the time. They don't have OCD, right?

SPEAKER_02 29:41

Alicia's looking for a house in LA right now and she's a lot of people.

SPEAKER_01 29:44

I mean, my cortisol is through the roof right now. I'm an actor in LA and it's intense.

SPEAKER_04 29:49

This is what I want you to hear. I want you to not have OCD, right? If you're if you're tying not having OCD to you being able to completely eliminate your cortisol ever being spiked, you're fighting against biology. It'll never happen. Yeah. Your body is designed to spike cortisol to help you. It doesn't feel good, but it's also not dangerous. It's not what's causing your OCD. You know, from my point.

SPEAKER_01 30:10

No, I think the OCD is first and then all that other stuff adds to it and makes it worse. I don't, I personally don't think it's a gut-related. My gut's the best it's ever been.

SPEAKER_00 30:20

I have no issues related, you know, and I still have OCD.

SPEAKER_04 30:24

Yes. Yes. Now you're super healthy with OCD, which is better than being not healthy and having OCD, right?

SPEAKER_01 30:30

100%. 100%. I guess, you know, it for a lot of us out there, we're just for me, actually, I'll speak for myself. I'm just trying to get to the root cause of it because at some point, you know, whether it's a decision or it's a mental shift of perspective, we would like to be free from it as well. And I know.

SPEAKER_04 30:46

Yeah. Well, I mean, maybe that that's actually a great segue into like what how CBT uh kind of consists of the case. Yeah, let's talk about that. Yeah. So you mentioned like I want to get to the root cause of this. So CBT, you know, cognitive behavioral therapy, which is really um, we have a lot of different interventions in the world of, you know, psychiatric medicine and and clinical practice, psychology. Um, CBT's been around for a long time, and it has a excuse me, a ton of evidence and literature that it is effective for all kinds of disorders. The good uh CBT for OCD is actually has one of the highest rates of efficaciousness, of effectiveness, right? Which is like good news for people with OCD. If we can actually identify you, if you can find a therapist who knows what's going on, which is hard, but if we can do that, we actually have this treatment that works really well. And the reason it works well is because it says we don't need to know the root or the cause of your OCD. We know how it's being maintained. The fundamental, uh the foundational principle of CBT is when we're treating a disorder, we're not looking for cause, we're looking for the main what are called maintaining factors. What are the things you're doing or the ways you're thinking or the things you believe? There's all kinds of elements that go into this. But basically, what is the pattern you're stuck in, the things you're doing that are keeping this going? We know what's keeping it going, right? It's like if you're driving a car, making this is a kind of a rough analogy, but if you're driving a car and you're like, I want the car to stop. Do you need to know where the car came from, how it was made, how it got there, or do you just need to know I need to take my foot off the accelerator?

SPEAKER_00 32:20

I do because I need all the unnecessary details of every situation.

SPEAKER_01 32:28

How many, I don't need to know the drivers, um, past drive. Yeah, no, I get I get that. That makes sense. So you don't need to know that maybe the OCD is what's driving the desire to know the root cause.

SPEAKER_04 32:41

Probably, yeah. Probably for me. Probably, yeah. And also just wanting relief, right? And and there's also this, there is a a belief, uh a misconception that it's gonna take a long time to squash, right? Which is, and it comes from psychoanalysis that if someone's experiencing anxiety or OCD, there must be some unresolved thing that is causing this, or a health-related thing, right? But it's if only it were that simple, right? That would be really nice if we could just figure out what was the one thing that triggered this all and then just talk about it and would go away. But the reality is, you know, no, there's things that you're doing, not you, but in general, right? Maybe you, but that people are doing with OCD that are keeping them stuck. And if we can identify those things, change those things, give them new ways to respond, the OCD will stop.

SPEAKER_02 33:28

I want to get into the CBT and how ERP falls within that, but I just want to touch quickly on what Alicia has been saying about uh trying to find the root cause is that OCD wants certainty, right? And this is where one of the Alicia hates one of my responses to some of the intrusive thoughts she has. My response often will be maybe. Maybe maybe not. And she's like, no, I can't accept maybe when when the when the outcome would be catastrophic, like maybe this horrible thing will happen to me, maybe not. But the point of the maybe, maybe not, is to tell your OCD, I'm not going to solve this. There is no certainty of anything in life. And the sooner I accept that and learn to live with the discomfort of that, the better off I'll be. The maybe isn't like diminishing the significance of the thing that is causing you fear. Like for you, Ryan, the thought that you might never sleep again, like that's pretty bad. You would die. You would literally die from that. Um, but the maybe, maybe not is again, it's challenging your mind to be like, you can't have certainty on this, and you need to learn to live with the distress.

SPEAKER_04 34:43

I think that's very well said. Um a lot of people theorize kind of OCD is a is a difficulty with accepting uncertainty, any amount of it around one particular thing. Um, which is interesting to think about how people with OCD they accept a lot of uncertainty around a lot of other things in life, but not certain things. They they they won't. But um, but yeah, you know, if you can accept, yeah, I I can't know the answer to this. I'm it's an unsolvable uh problem or it's an unanswerable question, and I'm gonna let it go. I'm not gonna attempt to do that, that helps you move forward for sure.

SPEAKER_02 35:17

Alicia, can you tell us why that triggers you so much?

SPEAKER_01 35:20

When you say maybe Yeah. I'm always one step ahead. I I think about uh scenarios and I try to predict outcomes. So if I don't have like a response to something to lead me in one direction and I'm in that like gray area, it's very unsettling to me. I don't know if that makes sense, but it's like a I I don't know. I've always needed to know. I need to know the plan, I need to know where we're going, I need to know how much time you're expected to spend on something. Like I think it's because I crave safety. I need to feel a certain way and feel like I'm prepared for whatever scenario may come up. And if you give me a direction, then I can plan accordingly. Otherwise, it's too unpredictable and feels too unsafe. So um I would rather a definitive, I would rather a response, even if it were negative and not in my favor, than nothing at all.

SPEAKER_02 36:20

Yeah.

SPEAKER_01 36:21

Because I need to know so I can prepare.

SPEAKER_02 36:24

I had this experience recently, Brian, where I became convinced that I had colorectal cancer. And um health OCD has been it comes and goes. It's not my main subtype, but I've had a little bit of it. And Alicia has been privy to some of it. Um but I had this fear that I had colorectal cancer, and so I was texting Alicia about it. Like, I'm and the way I would put it is it you put it in certain terms. So I'd be like, no, I am I am dying of colorectal cancer, and I want you to know that I'm dying of it. And and then Alicia was like, You don't really have colorectal cancer. And I was like, maybe, maybe not. And she was like, No, you can't say maybe you have colorectal cancer.

SPEAKER_00 37:05

Like you, you don't go find out. Yeah, that's yeah, I don't know.

SPEAKER_04 37:16

Sometimes when we say it definitively, like you like I have a colorectal cancel, people will laugh. You'll see them laugh, and you're like, why are you and you're like, well, I guess it is kind of silly, because there's no I'm guessing there's no evidence of that, right?

SPEAKER_01 37:27

Because if there were no. No, he's just decided that morning he woke up and had cancer.

SPEAKER_02 37:33

I my stomach didn't feel great.

SPEAKER_00 37:35

Yeah, you had to fart, Liam. Like, what do you mean? You go from feeling gassy to I have cancer.

SPEAKER_04 37:42

That's there you go, right? So so when you you we're able to laugh about it because OCD is so extreme and bizarre and kind of ridiculous, right? So sometimes if you can get someone like, okay, you're yeah, you're a pet you're worried you're a pedophile, why do you say I'm a pedophile? And then they say, like, oh, that's silly, right? They can see then if you're laugh at it, they can move on. The thing, your point, Alicia, about you know, the maybe, maybe not, I actually shy away from that. Um, you know, sometimes I use that with patients. I shy away because exactly what you said, which is that for some people, like if they go, well, maybe I'm a horrible person and maybe I did something so awful, it really doesn't matter what the fear is. But and you say, Well, can we just say maybe, maybe not? And they go, Well, how could you ask me? Like, even if there's some possibility that this is true, you want me to be okay with that. Well, that would mean I am a monster or something. That would I exactly for people what I found is easier for people to accept is to say, can can we say, yeah, this is your this is probably your OCD. We can't know for sure, you know, maybe it's not, but like you have OCD, you're here to work on OCD. Can we say this is probably your OCD? And will that help you then be able to let it go and move on? And I find that people are much that's much more accepted, I love that much more palatable to be like, yeah, I do have a long track record of having really extreme, bizarre thoughts that never end up being true. I guess I'll treat this one that way too, right?

SPEAKER_01 39:02

Yes, I love that. That's so helpful for me.

SPEAKER_02 39:06

There you go. I love that approach. Maybe, maybe not. I wanted to get back to the CBT question. So cognitive behavioral therapy. Where does ERP fall in that? It's kind of under the umbrella of CBT, right?

SPEAKER_04 39:21

Yes, exactly. And this this is this is great. You're kind of prompting a few important questions here. So ERP is practiced in a lot of ways as a standalone therapy, although I would argue it shouldn't be. It because it is a part of CBT, it was developed as part as part of the CBT uh you know theoretical foundation, theoretical framework, and as a clinical intervention, right? It was developed for OCD, but really as a variation of exposure therapy for other types of disorders, like phobias. Someone comes in, I'm I'm terrified of dogs, I don't want to leave my house or my kids terrified of dogs. She won't go to school because she's worried she's gonna be attacked by a dog. I have panic attacks. So exposure therapy is a behavioral approach that CBT developed a long time ago that works very well for lots of different types of anxiety and phobic disorders. Um, ERP is this kind of special one developed for like a tweak of that variation of that for OCD. But we should still be delivering ERP within this greater CBT framework. Um otherwise, you're gonna miss some, you could, not always, but you could miss some important things that like uh tools that we're leaving on the table, for example. You know, other other elements of CBT that can help people with OCD, that if we're just kind of hammering this ERP without taking it into a broader context of like what are the maintaining factors? Not all of them are necessarily avoidance and therefore need exposure. There may be some other things that we can we can look at that could really help you.

SPEAKER_02 40:52

Could you give an example of what that would look like? So I'll I'll um give you an example of what I'm working on right now in ERP, which is we've taken some of my main subtypes, developed exposures for them, I learned to sip of the distress, I do the response prevention messages, you know, your typical ERP framework. And what we've determined over time, my therapist and I, is that really the root kind of core thing at the center of all of this is this fear that I'm just not a good person and that I'm not worthy, and that I'm not attractive, not smart enough, all the stuff that you don't think comes with low self-esteem. And so now we've moved to working on that core thing, right? We've we've kind of attacked the subtypes. I've made good progress on those, not free of them, but good progress. And now we're kind of working at that thing. Is that kind of where you're coming back to that CBT framework of helping you rethink not just your individual thought patterns, but kind of how you think of yourself more broadly?

SPEAKER_04 42:01

Um, a little bit, yeah, a little bit. I mean, I think what you're getting at is or what your therapist is getting at is more of this core fear approach of like, let's go for the thing that really is um, you know, common to all of the different OCD triggers you've had. And if we go after that, if that's really the thing that shows up across the board, that will give us the most bang for our buck. And I agree with that approach. What I'm talking about is there are other things in CBT. So for example, um, you know, you there's something called like an attention bias. You've probably heard of this, you know. So um, I don't know what you guys do for work, but like for example, you know, if you're an architect, when an architect walks into a building, what do they naturally probably pay attention to? They notice the design and they notice, you know, different ornamentations and different things and you know, uh the way it's laid out and whatnot. Am I noticing that when I walk into a building? Probably not. I'm not I'm not an architect, right? I don't have that attention bias. If I have OCD, if I have contamination OCD and I walk into the building, what's the first thing I'm paying attention to? Where there might be contamination. If I have pedophilia OCD, what's the first thing I'm gonna pay attention to? Probably if there are children, right? So that's an example of like, and by the way, everyone has attention biases. You don't have to have OCD or a disorder. We all have attention biases. CB part of CBT is helping people identify what are you kind of unnecessarily or you know excessively paying attention to that's actually making this worse, right? You know, if I told you, you know, when you get in the car to go to work, if you are able to write down, note, every time you see a red truck, I'll give you a million dollars, you better believe your brain is gonna be paying attention to trucks, whereas it wasn't a minute ago, right? So something like that. Another example I'll give you would be, you know, Alicia, earlier you were talking about why you feel like you can't accept maybe. And you said something like, Well, I'm someone who I need to know in advance what's gonna happen so I can properly prepare. I can't really be okay with, you know, uh something not knowing what's gonna happen, right? That's belief you have. It's a very it's probably been around for a long time, right? Is that the truth? It's CBT would say it's not, you really believe it, and it's kind of almost become a self-fulfilling prophecy. Can we change that about you? I think we can. Is that also probable? I would argue that's actually not your OCD. It's something that feeds your OCD, though. It makes it harder for your OCD to go away. Oh, interesting. An alarm goes off. You go, oh wow. I I see one more thing that's contributing to her staying stuck in OCD. She has this lily fixed belief that she needs all the information ahead of time, or else she's not going to be okay. We can talk about that. We can target that. We can challenge that. We can create experiments to right in that.

SPEAKER_01 44:39

Isn't that getting to the root cause of it? In some sense, because you were going, you know, like let's let's let's dive into that a little bit. So my need for safety comes probably from my trauma of growing up in a really traumatic household with abusive parents who were dependent, whatever. I lacked that safety. I didn't have anyone to comfort me. And so for me, fear surrounds me in every aspect of my life, right? Like I'm gonna die, my kids are gonna die. Because I live a really beautiful life now. I fear that something is gonna come take it away. Because isn't that getting to the root cause of why I search for those things to root to I seek comfort? And then that creates the OCD.

SPEAKER_04 45:26

I would say you're really close. I would say it's not a it's not the root cause. It's one of the causes. It's one of the maintaining factors, right? It's definitely a big part of the of the process here. And it's absolutely something that I would want to talk to you about and hear more about it and explore and figure out all the ways it shows up right now. Not so much expecting what we would talk a little bit about what it was like growing up and and and how that played out, but really we'd be focusing on how is that showing up now for you? All the different ways. Some of them OCD, some of them I bet not. And I would want to target all of that. And you would see it translate into you better being able to resist compulsions, to trust yourself, to put yourself in situations where you're going to challenge that. So I'm a big, I'm really, really big on like, hey, ERP is the treatment for OCD, if it's delivered within its proper greater framework, which is a cognitive behavioral uh lens and and and theoretical foundation.

SPEAKER_01 46:23

Right. Because we're just rewiring that that thing, whatever it is in ERP, that you can do it and you are still safe. Yes. Right. And it's just because yeah. Okay.

SPEAKER_04 46:32

And and you and you you can do things that your mind tells you you can't, you know. Um you're actually, and and and both of you guys are evidence is you're successful, have families, healthy, right? Like you are way more capable than your mind tells you you are. Um and we and and and I want to I want you to prove that to yourself explicitly, intentionally ongoing.

SPEAKER_03 46:52

Yeah.

SPEAKER_02 46:52

What do you do with the idea that even self-affirmation? So at the end of my sessions, I'm supposed to say some words of affirmation about myself, you know, I am worthy of this, uh that that sort of thing. Um those actually feel like exposures themselves to me. Um because I when I say them, I'm like, I don't really believe that. So this is just an exposure. Um where do you stand on that? You know, do you like to end a session with, you know, listen gratitude and saying some nice things about yourself? I'm just not totally sure how I feel about that.

SPEAKER_04 47:31

Yeah, I mean, not as a rule for sure. Um, I mean, definitely I think people with a kind of moral scrupulosity or like I'm a bad person being their core fear, saying those things is a good exposure. I would say more importantly, though, is like, how are you treating yourself throughout the day, though? Like as you go through the day, are you are you behaving like you're a good person or are you behaving like you're maybe a bad person, right? Um and I see that all the time. And behaviors really are what uh what affects change. Um, and so I'd want you to say those affirmations, but I'd want you to live as if that were true. It is true. Alicia and I know that just talking to you, it's like, oh, this is a good person, giving you some reassurance, right? But but no, but you need we know that you'll never believe it until you start.

SPEAKER_01 48:12

We find out he has a whole nother family and a marriage going on in another country.

SPEAKER_00 48:19

He's been lying to everyone about who he is. You guys, I've had that thought. I'm like, what if I don't actually have OCD and this podcast is just a big I'm just a big actress.

SPEAKER_04 48:30

Such an OCD thought, right?

SPEAKER_00 48:33

Yeah, sorry, I interrupt so much. That's the ADHD.

SPEAKER_04 48:36

To doubt the diagnosis. No, that that was that's how that's when I know someone really has OCDs. They're like, but what if I what if I don't have OCD? I'm like, all right, great. Mauri know it's confirmed.

SPEAKER_00 48:47

Yeah. I text League of M that all the time. I'm like, are you sure? He's like, I yes, period.

SPEAKER_02 48:54

Well, sometimes I will say to Lucia, yes, we do have it. And then other times I've said, maybe, maybe not. Maybe, maybe not.

SPEAKER_00 49:05

And then I'm like, no, I definitely do. I don't, I didn't need to ask you for that. I definitely do.

unknown 49:10

Yeah.

SPEAKER_02 49:11

Mine, if if someone listening right now uh feels stuck, you have felt stuck. So Alicia and I have certainly felt stuck in our lives. What would you recommend? In addition to just reaching out to the OCD Institute.

SPEAKER_04 49:23

Yeah, yeah. Um no, I mean, this is what drives me the knowing that there are still so many people out there who are very stuck and feeling hopeless. But what I want people to know is that uh you can get better. This doesn't have to dispon you. Life can be better. Um there are people out there who are perfectly what you're going, and there are people that know what I can get out of it.

SPEAKER_01 49:45

Ryan, that was such a pleasure having you. Thank you so much for being here. Where can people find you on uh Instagram or any other outlets that you have?

SPEAKER_04 49:53

Um you can find me at the the OCD Institutes Texas, our website and um Instagram, OCDI Texas. Um I'm on there with clips of me and uh please reach out and being chat list.

SPEAKER_01 50:04

Thank you so much.

SPEAKER_04 50:05

Thank you.

SPEAKER_02 50:09

Thanks for listening to another episode of the OCD Confessional. Be sure to follow this show so you get new episodes. You can subscribe to us on YouTube or find us on Instagram and TikTok at the OCD Confessional.