Just-Right OCD & Somatic Intrusive Feelings

Do you ever feel like something is wrong, even when nothing happened? Kristina talks with Heather, an OCD specialist who lives with just right OCD herself, about the feelings you notice in the body that can come with it, which are often missed because they are not always tied to a specific fear. They also explain magical thinking, how to tell an obsession from an ordinary worry, and why giving in to compulsions keeps the OCD cycle going. Listen if you live with OCD or support someone who does. This content is educational and is not a substitute for one to one professional care.

Transcript

Today with me, I have an awesome guest. Her name is Heather, And she will introduce herself shortly. And we are going to cover something I think that's pretty near and dear, At least for me, To my heart. We're going to be talking about aspects of kind of the feeling component and OCD. So before we dive in there, Heather, Why don't you tell us a little bit about yourself? Hi, Yeah, I'm Heather Brown. I'm an LCSW. I specialize in OCD, Trauma, And anxiety, And I have a small group practice that's based out of Sacramento, California. Welcome to the show. Thank you. Yeah. So let's, So you and I connected and we talked a little bit about this one way OCD can show up. Is kind of a little different, I think, Than some of the other ways and can be often missed. And I know you also were kind enough to share some experiences for yourself. So if it's all right, I'd love to just jump right on in and hear a little bit about that from you. Sure. So I have something called Just Write OCD, Which is a subtype of OCD, As I'm sure you know. Where there's not always this specific thing that I can identify that is like off or there's not always a specific session other than just kind of this feeling of something is not done correctly. So it can be, If I go to put something away in a cupboard, I'll know right away if that was the right place to put it or not. And it's not, Is it even? Is it perfectly placed? Did it go in in the correct order? It's just, Was it put right on the shelf or not? So it's definitely a lot more of just kind of the somatic experience. That shows up, You know, Some places that I can kind of expect it to and some places that I'll just be going about my day and randomly I'll get that feeling. And I'll think, Great, Here it is again. But yeah, That's kind of how it presents for me. Yeah, So like when I think about it too, I think about a time like I, Like nothing was going on. Everything was, All intents and purposes, Totally fine. And I was taking a shower and I remember washing my hair and out of nowhere, It's like this hit, Right? Like something just hit in my gut and I'm like, Ugh. I'm like, Wait, What's going on? And I remember pausing with the shower. I was washing my hair, And I paused. And mentally, I started to scan, Like, OK, What happened? Did something happen? Did I say anything? Did anything go on? OK, What about yesterday? OK, What about the day before? OK, Wait a minute. And then I paused. I'm like, Wait, What are you doing? And I had to literally slow down and say, OK, Hold on, Girl. Nothing happened. What's going on? I think this is more of that feeling again. OK, You don't need to. There's nothing to figure out. Let it be. And it was one of those moments very early on when I was just learning even about that this is yet another way OCD can manifest that I was like, Oh my god, This is how that feels and I mean, I just think you could totally miss the mark here because People talk a lot about like core fears and you know, Figuring that out, But I think with this subtype like that, That's not really always there. It's not always based on a core fear. What are your thoughts? Definitely, Definitely. There are a lot of times where I'll be working with a client for months and even as an OCD specialist, It gets missed sometimes because a client doesn't think to report something. And I think with a lot of subtypes of OCD, This can happen where somebody is just so used to it, It becomes such a normal part of their everyday life. If it's more on the mild side, Especially, You know, If it's something really extreme, Often that's what's bringing people in. They're very aware of those obsessions and the compulsions that's taking up their whole day. But for, You know, Some of the more mild cases or some of the more discreet, Like internal cases where it's a lot more just what's going on in their body, What they're feeling, What they're thinking. We can be, You know, Doing months worth of work. And then finally, They mentioned something of, Oh, You know, I get this feeling sometimes, And I just can't quite shake it. And I'll be like, Okay, Interesting, Tell me more. And then we'll uncover that there's actually OCD underneath this layer that they thought was just generalized anxiety or trauma or something else. Interesting, Right? Yeah, I think that's actually an interesting point like with generalized anxiety and even some trauma stuff where You can miss it right and I also I'm thinking about some folks too that I've worked with where They might say like I find myself in my head a lot trying to figure stuff out and kind of not recognizing that even that in itself like how that can be compulsive because If you're typically thinking about things usually you arrive at some conclusion you usually form some some sort of there's some sort of an outcome There's some end result that happens. You don't just sit there endlessly dwelling on stuff, Right? But when you have a compulsive feature. Well, That's where that's happening. It's like there's no answer. There's no resolution. It's just on and on. And I find that, You know, When it comes to feelings, Especially, It's like one of the hardest, I think, Things to wrap your mind around that kind of how OCD brain affects that. Yeah, Kind of like what's your experience with that with the whole feeling emotions, Not even just right, But just even in general, Right, When you get a big feeling that You know, You think of that pain of anxiety or you get that like something, Your stomach is twirling and turning and something feels like, Oh, Like, I don't know what's going on, But just there's this dread. I remember really distinctly this one time I was driving and I was driving in the carpool lane. And, You know, In California, There's those those diamonds that indicate that it's the carpool lane. And I just all of a sudden got this urge that I needed my two left wheels to be going through the diamonds. And you can't do that because now you're not driving in the lanes and that's illegal and all the stuff that comes along with that. So that was really hard for me to just sit with that and know that I can't do this thing. Like there's this compulsion that my body is just out of nowhere telling me that I need to do. I can't do it because there's something bigger than that that's dictating this feeling even like the law and people's safety and my own safety and everything else. So yeah, Again, Sometimes it just shows up at the most random times and in the weirdest ways. And then for me as well, There's there can be a kind of like this magical thinking aspect to that kind of gets tied with just right OCD where sometimes I'll get this flash of, If you don't do this thing now the world's going to explode as a common one like I picture the world and it exploding. You know, The world's not going to explode. That doesn't even make any logical sense whatsoever, But it's just like this sudden feeling. And then this image and this idea that if I don't do this thing, Something bad is going to happen. So even if I can get rid of that idea of, OK, The world's not going to explode, Of course, The OCD is not satisfied with that. So it goes, OK, Well, Maybe something else bad is going to happen. Maybe you're going to have a bad day. Maybe somebody is going to get sick. Maybe some other kind of catastrophe is going to be attached to you not completing this compulsion. Yeah. So you threw the word magical thinking. So, I mean, I know what that means. I know you know what that means. But can you kind of break it down a little bit more for anybody listening right now who might not know exactly what we're talking about. Sure. So magical thinking in OCD is kind of where we skip over logic and go just from point A to point Z. So instead of saying, You know, A logical array of kind of what would happen like this would cause this would cause this and then we get this outcome and it makes a lot of sense and we can kind of break down all the individual pieces and say yes realistically this could potentially cause this. In magical thinking it's just what if these two things were randomly connected that don't make any sense and that sometimes even defy like the rules of science and of the world that we know. So you know me not driving correctly in the lane is not going to lead to the world exploding. There's no way that that connection makes any sense unless we're really doing a ton of mental gymnastics to get there. But the OCD just goes, Well, Now they're tied. Now they're right next to each other, Even though that's, Doesn't make any logical sense. Got it. Yeah. So it's like a distortion, Right? It's like a way that, That the brain is like, We're not seeing something clearly. And so, But because it could be, And it might be, And it comes with a strong feeling, It's like, Oh my gosh, The association is now there. There's a strong link. And then now you're getting stuck on that Okay, It's so okay because you run a practice and because you also happen to have OCD and we're talking about you know Some trauma stuff. I do want to ask because I know that this is a big conversation and a lot of times I've seen it. I've seen this on the internet as well people talking about how OCD can cause them trauma What's your opinion on that? Definitely OCD can cause trauma. Trauma can cause OCD. They can co-occur together very often. And that's actually what I specialize in. Is when somebody has trauma and their OCD is linked to that in some way. So I consider myself a trauma therapist and an OCD therapist, But I also treat that intersection between the two where they're showing up together and we need to do some work on one or the other to be able to do the work on the opposite as well. So how, How does that work then I guess like if like, Like pretend I'm I don't know like I'm fifth grader, And I just don't understand how exactly then what would this happen because, You know, I definitely know and I've heard like okay if you've had a trauma in your life, It can and if you have, You know, Already kind of can lean towards the OCD or have OCD, It can definitely, OCD can basically come out as a result of that. Not always, But it can. What about if you let's say didn't have per se trauma, But you do have OCD and you know We're talking about, You know, Probably more severe or taboo thoughts, You know where it just feels like this incessant intense Non-stop kind of internal badgering experience because your brain is just you know misfiring in all cylinders would that qualify as Trauma like to the point of PTSD diagnosis or would that be more like just traumatizing because it's just really intense to live with that kind of experience Thank you. It can definitely be traumatizing. So depending on the type of trauma therapy that a trauma therapist provides, They're going to give you a different explanation on what trauma is and how PTSD or PTSD-like symptoms arise. But one of the lenses that I operate through is From this idea that trauma, Like we get a trauma response, We develop PTSD or those types of similar symptoms. When we have a life event that shakes up our core belief system. So we're raised under this idea, Most of us are raised under this idea that good things happen to good people, Bad things happen to bad people. If you do good, Then you will get a good outcome. If you work really hard, Then you'll have a good life and you'll make lots of money. If you do bad things, You're going to end up in jail and society is going to shun you. And sometimes when we experience a traumatic event, That shakes up our whole understanding of how the world works and what the rules are. So if somebody develops OCD, And especially if they're having those intrusive thoughts or those obsessions that are a lot more taboo, That maybe somebody is wondering, You know, Maybe I'm secretly gay and I am misleading my partner, Or maybe I am going to abuse children and I'm actually, You know, A child abuser. Any of these more taboo ones, That can really shake up somebody's understanding of themselves, It can make them doubt themselves, Make them wonder if they're a good person. And then there's kind of this meta layer of even once they have an understanding that this is OCD, That these thoughts don't define them, There can still be this idea that why did this happen to me, This was a horrible experience, And I'm going to be dealing with it for a long time, Even if it's well managed. Why did this happen to me? I thought I was a good person. And so that in and of itself, Like that changing of one's worldview, That can be what the trauma is. Fascinating. And so from your experience then, How do you work with that? What would be an example of how you would treat both, I guess, Or treat that? Yeah, It really depends on kind of where somebody is getting stuck that determines where we start. So sometimes the OCD is the bigger presenting problem, And we really have to get a good handle on managing those compulsions. So the cycle of OCD isn't continuing. And we'll kind of triage that first. And then other times we have to work on the trauma or the PTSD first because those symptoms are so debilitating. And so it really just depends on the client where we start. But often if somebody's OCD resulted from a traumatic experience or that led to the onset of OCD, That we're really looking at what are those experiences that led you to believe that these compulsions are going to keep you safe. So we're not, You know, Doing any evidence gathering, We're not challenging, We're not engaging with the thoughts. So we're still coming from that framework of what we know scientifically works for the OCD, But we're looking at as well, Like what are the, What are the events that are underneath that, That led to this belief that you need to be so in control, That you need this as a, A method of control to keep yourself safe. So what kind of therapies do you use? Would you say then you're doing like exposure response prevention, Acceptance of movement therapy, ICBT? Are we doing like prolonged exposure for PTSD type or EMDR? Kind of what would be the blend? Yeah, So I use ERP and ACT for the OCD. I use ACT, Acceptance and commitment therapy, Just in all aspects of treatment. I love it so much. It's so applicable to everything. And then for the trauma, I use either brain spotting or cognitive processing therapy. Okay, Well tell us a little bit about that. What's brain spotting? Brain spotting is, It's kind of like the distant cousin of EMDR. It's kind of hard to explain. The way I explain it to clients is I take a magic wand and we find a spot in your visual field that connects to this belief, This feeling, This memory, Whatever it may be, And then we just let your brain do the work. And it's a little bit more complicated than that, But I like it because compared to EMDR, It's just so, Like free, I guess, Unstructured is maybe a better word. It's just, We kind of go with feelings. We use a lot of mindfulness. We use a lot of tuning into one's intuition, Which has a whole other slew of benefits, Which I really love about it. But yeah, That's kind of how I would sum it up. Interesting. And so with cognitive processing, Then what do you do with that? What is that about? If you give us a little snippet. Yeah, That by contrast is very structured. It's basically cognitive behavioral therapy, But specifically for PTSD. So that is, We have homework every week, We have worksheets that we're doing. We're looking at how somebody, This is where I get that theory of like how we develop trauma or PTSD. So we're looking at how somebody's worldview or their view of themselves is shaped by the trauma and we're breaking down those beliefs one by one. Wow, So it's very kind of comprehensive and integrated if somebody really has both going on. And then if somebody feels more like terrorized by their own OCD, Would you do any of the other kind of trauma-based work or would you still do more ERP and ACT? It's kind of hard to tell without somebody right in front of me, You know, As specific client comes in, It's easy for me to say, Okay, I know this about you and and how your issues are presenting and here's the plan for you in particular. But one thing I really like to do with clients is. Educate them on how to differentiate between an obsession and just a normal anxious thought. So we're going to treat both of those differently and both are totally valid and how they show up and how we respond to them. Being able to teach that client on how to respond to one type of thought versus the other, I find is very helpful in them becoming their own agent of change and then being able to carry on the work even after treatment has ended. So it just really kind of depends on what's coming up in that moment. I do always come from the lens of Here are obsessions. Here's what we do not want to do with them. So that takes precedence. And once we're very aware of what obsessions are, What, Whether, Or how you know that they're coming up versus another type of thought, Then we can kind of do some more work on, Okay, Maybe we're challenging these cognitive distortions over here. Cause those are not obsessions. Okay. So I know anybody listening right now, Because I know if I was listening, I would definitely want to say, Okay, Tell me, How do you know the difference between an obsessive thought versus a worry thought? So give us one tip. The biggest thing, And this is kind of a semi-long-term thing, Way to pay attention to it, But the biggest thing is that an obsession doesn't have an answer. It will keep coming back again and again and again. It doesn't matter what you give it. It doesn't matter how much reassurance you get. It doesn't matter how much logic you introduce to it. That obsession is going to keep returning in the same way and maybe worse versus a regular anxious thought, A doubt, A worry that is going to maybe have some relief depending on what information you give it or how you interact. Oh, I see. So you were saying that one of the clarifications is that a more worry-anxious thought really responds actually to some logic and some maybe further information or knowledge, And that an obsession really doesn't respond to any of that. So that would be one way to distinguish between the two. Yes, Definitely. Awesome. I love it. I hope people are taking notes on this. So let's get back for a minute about you and your own experience. What did you do for yourself that you're able to be here, Run your practice, Show up? I mean, I don't know, You tell me in terms of like, Where would you say your OCD is at this point? Do you feel like you're managing it pretty well? Or, You know, Does it does it really kind of flare up a lot? Because these are the kind of things people also typically want to know, Right? Like, OK, If I do some sort of therapy for this, Like, Do I stand a chance? Is it going to get better? For myself personally, I've done a lot of ERP on myself. I definitely do a lot of exposures in real time. I can kind of feel it building where if I haven't, If I've been giving it to compulsions, Maybe the more subtle ones, The ones that are a little bit less inconvenient that I can just kind of skate by with doing really quickly. If I do that for too long, It'll start to build up and then I'll have this bigger problem. As we know, That's how the cycle of OCD works. So when it gets to that point, I will do some really intentional exposures to kind of help me get back down to that baseline of, It just kind of feels like noise in the background most of the time. I'm really thankful that my OCD is well managed for the most part. Of course, If something big in my life happens, If there's a big change, Even a good change, It'll pop back up just because something's different and it wants the control. But I found that ongoing exposures for myself have been really helpful. So, When you when you're talking about OCD, And you're talking about it kind of coming back in the cycle of OCD, Can you I just I'm very curious to hear from your perspective. You know, If you were going to give us, You know, Kind of a quick little snapshot or explanation of what is OCD? How does it work? What would you say? Yeah, So I talk a lot about the OCD cycles I have today, And that's basically how I think of it. How I explain it to clients kind of depends on their age and their developmental level. But I like using the analogy of the OCD monster with pretty much everybody, Because it's just such a good way to explain it. We have this monster, Which is OCD, And it spits out these obsessions, These things that we feel like we have to listen to, That have a lot of weight, That have a lot of importance. And we feed it compulsions. So it spits out these obsessions, And it tells us, You have to give me compulsions in return. And so we feed this monster with the compulsions, And we think that that's helping, But actually it's just making it bigger and stronger. So what we want to do, At least through ERP, Is learn how to starve that monster so that we're not feeding it anymore, So that it gets weaker, And so that it learns that it's not important, And that it doesn't have any authority over us, And that it doesn't own our time, It doesn't own our energy, Our emotional resources, Any of that. So it's really just about breaking up that cycle by stopping the compulsions, Which If anybody hasn't done treatment yet, I get that that feels impossible right now, But with some help with good care from a qualified professional. That can definitely feel possible. That's really what we want to do. We want to be breaking up that cycle by ending the compulsion so we're not feeding that monster anymore. Totally. And I'm glad you said that because that's actually exactly what people get stuck on. And when you said the monster, I kind of internally smiled a little because very early on in when I was starting to specialize in this, I remember working with some kids and we named it the cookie monster because it wants cookies and more, More, Bigger, Bigger cookies and a lot more cookies. So yeah, Like you got to start to create a plan of how to. You know, Skip the amount of times you give cookies, Or make the cookies, Start to make them a little smaller and smaller, And kind of from there, Which goes to the point you just said exactly right. When folks hear this stuff, It's like, Yes, I get the concept of, Yes, I have to not give it compulsions, And then everything gets better, But like, How on earth is it that you can ask me to do that, Right, When I feel so scared, When I feel, You know, So much dread, Or disgust, Or maybe even anger at times, Sadness, Right? Thing that's kind of looming over me. And I know you just said, You know, Of course, Working with a provider, But if anybody's listening now, You know, Is there maybe just 1 thing if you're going to give them what could be 1 thing that they could. Kind of think or take with them to at least start that journey. I think just deciding that you are. Worth. Investing in is really big. A lot of people with OCD, They have that. They're so tied to their thoughts. They're so tied even to how their OCD impacts the people they love that oftentimes they don't even feel like It's worth working on either because that mountain feels insurmountable or because they feel like, Well, This is my problem and I just have to bottle it down and cope with it day to day. But there are lots of resources out there. There are a lot of self-guided resources as well that can at least get you started in learning about what OCD is and what the treatments are to intervene with it.