Obsessive and Compulsive? (Episode 85)

SPEAKER_02 0:01

All anxiety disorders are obsessive and compulsive in at least some way. We could rename panic disorder panic attack OCD.

SPEAKER_03 0:09

Or even the obsession is I'm having panic attacks, I must be broken. The obsession becomes I need to fix myself.

SPEAKER_02 0:14

What if I insert your health fear here? And then the compulsion becomes all the things you do in response to that thought to try and bring down the fear that the thought creates.

SPEAKER_03 0:23

Googling, reassurance seeking, scanning, body checking, poking, prodding, threat monitoring. There's a big list of compulsions there. The obsession is how am I performing in front of this person and am I pleasing them or not? Or whatever. What if people see who I really am? The compulsions are rumination, planning, rehearsing what to say, phoning people pleasing, critically analyze our social performance.

SPEAKER_02 0:52

Welcome to Disordered. This is episode 85 of the podcast entitled Am I Obsessive and Compulsive? It's a good question we're going to answer today. I am Drew Linsalata, one of the co-hosts of Disordered. I'm a therapist practicing under supervision in New York, specializing in anxiety and anxiety disorders. I'm a former sufferer of anxiety and OCD and depression for many years of my life on and off, but better now. Three-time author, social media dude, advocate, educator, you know, general like mental health guy. And happy to be here.

SPEAKER_03 1:23

I'm Joshua Fletcher, also known as Anxiety Josh, psychotherapist based in Manchester in the UK, who specializes in anxiety and anxiety disorders. Like Drew, I'm a previous sufferer. Like to combine personal experience with my professional experience. Author, podcaster, Instagram prancer around. And my star sign is cancer.

SPEAKER_02 1:45

Oh, I'm a Pisces. I don't think we've ever revealed that on Disordered. See, now you guys now you really know us. Now you really, we have that really parasocial relationship going on now. Now you know us, so you can trust us and buy stuff from us. Anyway, before I get on a rant. Am I obsessive or compulsive? Yes. Am I? Am I? Am I? This is a good topic. Josh came up with this one, and the premise here is the assertion that all anxiety disorders are obsessive and compulsive in at least some way. Fight us. Absolutely.

SPEAKER_03 2:23

Yeah. Should we go through them? Panic disorder, what's the obsessive compulsive nature of panic disorder?

SPEAKER_02 2:28

I would you I think that we could rename panic disorder panic attack OCD, and and we it would be valid. So like the obsessive the obsession is what if I have a panic attack? And the compulsions are all the things that people do to alleviate the fear that when they have that thought, what if I have a panic attack? I know where the argument's going to come right away, but panic attacks are real, and OCD generally latches onto things that are not based in reality. But if you look at the mechanism of how obsessions and compulsive work, obsessions and compulsions work, we could call panic disorder panic attack OCD if you want to. The obsession is what if I have a panic attack? Compulsion is all the things you do in response to that thought or worry.

SPEAKER_03 3:11

Yeah. Or even the obsession is I'm having panic attacks, I must be broken. The obsession becomes I need to fix myself. Yeah. That's a and so the compulsion the compulsions aren't just avoidance or they're not, you know, or things to stop a panic attack. They're like, what's wrong with me? I need to resource gather, I need to do this, I need to fix myself, I need to do wellness things. Yep. Endless compulsions of panic disorder. Yeah. Uh moving on, what about health anxiety? What's obsessive and compulsive about health anxiety?

SPEAKER_02 3:38

Oh, well, I mean, that's the what if insert your health fear here, and then the compulsion becomes all the things you do in response to that thought to try and bring down the fear that the thought creates. So, what if I get cancer? What if my dog gets sick? What if my kids are sick? Like whatever the health fear happens to be.

SPEAKER_03 3:53

So yeah, and the compulsions would be Googling, reassurance seeking, scanning, body checking, poking, prodding, threat monitoring. There, there's a big list of compulsions there. Um are you enjoying this quiz? Do you want the next one?

SPEAKER_02 4:07

Um, how about I give you one?

SPEAKER_03 4:09

Okay.

SPEAKER_02 4:10

This is gonna be a tricky one. Social anxiety. Oh what's the compulsion? What's the obsession in social anxiety?

SPEAKER_03 4:17

So the obsession is maybe the the fear of being judged or pushed away or get not getting things right in a social situation. Um, or things like fear of offending. Basically, yeah, the obsession is how am I performing in front of this person and am I pleasing them or not, or or whatever, or fear of embarrassment. The compulsions are rumination, planning, rehearsing what to say, constantly scanning the self during a social interaction for performance. Am I doing the right facial expression? Uh compulsions are fawning, compulsions like people pleasing, laughing at jokes that aren't funny, doing things like that, and then afterwards, main compulsion with social anxiety is usually to ruminate and critically analyze our social performance and worry if people like us, they don't like us, they're angry, they're not angry, etc. So that would uh yeah, that would fall under obsessive compulsive.

SPEAKER_02 5:19

Yeah, I think you nailed that one. The other thing that would add for maybe social anxiety is what if people see who I really am? Might be another compulsion, another obsession there. What if they really see my brokenness? Because I already think I'm broken, and what if they see that? And then the compulsions are going to be the same that you just talked about anyway.

SPEAKER_03 5:35

But I think some people And that and that yeah, that kind of brings in imposter syndrome, isn't it? Because that's basically imposter syndrome, isn't it? Uh here's an easy one. Is obsessive compulsive disorder, obsessive and compulsive.

SPEAKER_02 5:46

It's a trick question, isn't it? Yeah, clearly it is. Uh, is what defines that. But okay, here's one selective mutism. That's in the DSM. That's in that's the first one in anxiety disorders. Selective mutism.

SPEAKER_03 6:00

I have no idea. Yeah, I'm joking.

SPEAKER_02 6:02

I don't think there's a single person listening to this that has selective mutism, but it's in the DSM under anxiety disorders, and I always look at it and I'm like, eh, poor selective mutism, it doesn't get talked about.

SPEAKER_03 6:12

There's two people in my family with that with mutism, uh, often associated with autism and things. But I don't know. I really don't. It's not my field at field, so I'm not gonna not gonna talk about it.

SPEAKER_02 6:24

Selective mutism is what happens when you get ridiculous and I just refuse to answer you. That's that's on purpose.

SPEAKER_03 6:31

Yeah, I'm joking. Not leaving not leaving uh OCD alone, so like puro OCD, intrusive thoughts come the obsession. What if I'm a bad person? What if this catastrophe happens? What if I can't solve this unsolvable thing, or I can't feel better until I've solved this unsolvable thing? What if I don't feel sated and I don't feel that feeling of satiation, i.e., not cleaning, locking doors, checking, tapping, decontaminating, washing, etc., depending on how your OCD uh manifests, infinite themes. Uh, and the compulsions would be anything to either sate, get rid of discomfort, seek reassurance, try and find relief, uh, and not feel the way we do. So, yeah, that yeah, for sure. If you didn't know, obsessive compulsive disorder requires you to be obsessive and compulsive. Don't tell, don't tell us we don't teach you stuff here.

SPEAKER_02 7:28

Yeah, right. That was worth the price of admission right there. How about GAD? I I for my money, GAD is the one that's closest. Well, health anxiety too, but I don't I see almost no difference between GAD and OCD. The topics people will say it's the topics that are different. Yeah, well, again, OCD can be a little bit like anything can be an OCD theme, and no matter how unrealistic it is. And GAD people tend to be a little bit more focused on real things, like what if I, you know, what if I never get a good job, and what if I'm not a good mom? And like, you know, but they're very similar, except the the mechanisms I think are almost identical. Like GAD is the obsession there is uh I have to solve every problem. What if I don't figure it out? What if I'm not taking care of everybody properly? What if I'm not creating a loving home? What if I'm not it's always I have to meet this demand, and since I can't find certainty in my head about that demand, I just keep thinking and worrying and ruminating actively to try to bring down my discomfort that I might be not getting this right or not solving a problem or not knowing or not doing enough, whatever it is.

SPEAKER_03 8:32

And they all fall under S, A, R, shock, attention, resistance. That's it. We got to make that t-shirt for sure. Yeah, yeah. It sounds like we can go around to schools doing like an interactive school assembly. We're like we're dressed as superheroes, like S A R, and then we do into like a little song about metacognitive. No, I don't think that is a good we would do one school and then never asked to another.

SPEAKER_02 8:58

I think that that's my prediction for that business plan.

SPEAKER_03 9:01

You're you're frightening the children with the amygdala.

SPEAKER_02 9:04

Yeah, Gat Gad is the closest one, I think, but health anxiety is probably pretty close too. But like, yeah, the there's an obsession there. What are you looking your identity to me? Oh, I'm the problem solver, I'm the one that I'm the multitasker, I'm the fast one, I'm the one that gets it right. Oh, really? So then the what if the the obsession is what if I'm not? What if I don't do that? What if I don't figure out that?

SPEAKER_03 9:25

What if you're a what if you're a low self-esteem perfectionist? That could be obsessive and compulsive without you even realizing it.

SPEAKER_02 9:33

Yeah, and I think there's a lot of like perfectionism obsessions underneath GAD for a lot of people, you know, whatever their definition of perfectionism, I gotta get this right. I can't afford to get this wrong. No matter how small it may be, people feel like, no, no, I gotta get it right. Like the family's going on vacation. I gotta make those reservations a year and a half in advance. Like I gotta do it, it has to be done right now, and then I'm just keyed up all day long. Like, yeah, that's part of it. All right.

SPEAKER_03 9:58

So what what kind of airport dad are you? Do you get there like three years in advance before the gate opens?

SPEAKER_02 10:04

Or are you are you the guy that's I'm I'm Kramer skidding into the door, like I've hopefully paid for the like fast security thing because I'm gonna be late. No, I I cannot relate to airport dad. You're sitting around an airport terminal for like four hours just to be like in the right boarding group. No, ain't nobody got time for that.

SPEAKER_03 10:23

Yeah, I never got that with planes. You sat there and like you have a pre-booked seat, and like everyone sat around the gate and then they announced the gate and everyone's running to the plane. I'm like, you're just gonna be sat there for longer watching everyone else sit down. Never get that.

SPEAKER_02 10:39

It's the get up the minute the plane stops, too. Like you land, it stops. Everybody gets up, like you're in a tube, dude. You can't you're in the 4860 rows, and ain't right. You just sit down, just chill, like relax. Um, yeah, that's why that's my important idea.

SPEAKER_03 10:54

And compulsive um fixators, shock, attention, resistance, yeah. You know, lots of these themes which link us all together. Um, and yeah, we want to talk about you know, the obsessive, compulsive nature of whatever it is that your anxiety does. I think we invite you to be like, what's my current obsession or fixation? And what am I doing to mitigate the feelings around that? And you'll find that, yeah, a lot of anxiety disorders follow the same formula. Yeah.

SPEAKER_02 11:26

Look for I can't get off this topic, and then the corresponding thing you want to look for is, and it I feel like I really have to do this thing. Even within like the confines of any particular anxiety disorder, somebody's trying to get better, they're trying to do the recovery thing. You can develop those like mini microobsessions that come in there. Like, oh, I read that gut health is is the key. Gut health is it, and then you become obsessed with gut health, and you're constantly reading about it, and you're all the articles, and now you're trying to make sure you eat the right thing and carefully monitoring. And that could go on for a few weeks until that's not the answer, and then you move on to the next one. So it's that sense that I have to do this. This is it, this is the thing, I must do this, or it's urgent. That's a good clue.

SPEAKER_03 12:07

I remember casting our mind back to like I think it was the last episode with um when we answered questions and stuff, and it's something I've been bringing up in my practice recently, and when I've been doing talks, it's uh you know, that formula that I spoke about about you know, if I give attention and effort to something, it usually fixes it. And I'm gonna bring it up again because I'm really into this at the moment. Yep. Attention plus effort equals issue quick fixed quickly. But with anything that's obsessive and compulsive, no. You you you slam in the foot on the reverse.

SPEAKER_02 12:42

Yeah, you can almost never fix an obsession. I I'm not sure that you care ever could. I might I want to say never, but I'll say almost never because I'm not 100% sure. Because I no matter what, it's never enough. It's never gonna be enough.

SPEAKER_03 12:55

So you're tricked into thinking you can, you're almost there. Yeah, you're almost on the tip of the epiphany.

SPEAKER_02 13:01

Yeah, so close, so close. If I could just get, and you know what? Sometimes that well, that that's not really an obsession, but like when people who are afraid to start to actually do recovery work with exposure, face and the fear, willful tolerance, whatever you want to call it, if I could just what I just need that one thing to make it click so I can start. So I can start. No, no, no, no, no, no, no. That's the whole like no, no, you say I you think you're gonna think your way into not being afraid, so then you could do things that you're supposed to be afraid of. So that's a little off topic, but no, it's true.

SPEAKER_03 13:38

And and if you're if you're a fixator as well, take breaks. Nothing wrong with being a fixator, it just depends on what you're fixating on, but also take breaks because you need to learn that your attention muscle shouldn't be left alone, it gets weaker, it gets whatever. You know, you taking breaks is really good, even when you're not anxious. So if you're having a great week and you're enveloped in something that you're passionate about, project, work thing, whatever, take breaks and learn to not even fixate on that because you want your attention flexibility to be good. In fact, Drew and I are becoming fixated right now on this topic, so we should break it up with a community did it anyway.

SPEAKER_02 14:19

We totally should do that. And you know what I try to tell some of my clients? Sometimes we actually start with don't recover today. Don't. If they're so caught up in that, yeah, it's like, hey, guess what? Your your homework is to not recover today. And what? So good point. Let's get a let's do it. And we have two international dinner anyway, so let's start with a friend from Norway. Here we go.

SPEAKER_01 14:42

Hi, Drew and Josh. My name is Jesper, 22-year-old student from Norway. As Drew knows Norwegian, I will take this in Norwegian and he can translate. Just kidding. Uh couple of months ago, I had a panic attack with while playing Paddle with my friends. It was horrible, didn't know anything about this, uh, and got in a hole for a couple of months. Started having an anywhere, listened to your podcast, started helping me out, and I uh finally found the courage to play with my dad. Um I had a big panic attack while playing with him, ran to the toilet, uh heart pounding, feeling dizzy, but I remembered willful tolerance and remembered it was not dangerous, so I got back to playing quickly. Uh it was horrible, I probably sucked, but it ended and I got to spend some good time with my dad.

SPEAKER_04 15:44

But I'm not sure.

SPEAKER_01 15:45

But I wanted to challenge myself even more. So a couple of weeks later I booked with my friends for today. Uh, and an hour before, Craig the Critics was screaming at me, saying, You can't do this, you will have a panic attack, you will embarrass yourself. So I called up a friend asking if he can take my spot. So I won't disappoint my friends, and he said yes. Um I still showed up, so we were five, one extra than you need, and we just rotated it instead, and I had no panic attacks. I said, Darn you, Craig the Critic, and I proved him wrong, it was amazing. I felt free again, and I will continue testing myself. Thank you. I will say this in Norwegian, yeah you would have that. Thank you, bye bye.

SPEAKER_03 16:41

Yes, Jasper, that was amazing, but he's not done yet, he just kept going.

SPEAKER_02 16:45

I love it.

SPEAKER_03 16:46

Yeah, he's got the momentum going there. It was brilliant. Um, yeah, well done, and thanks for sending that in. I think thanks for the kind words in Norwegian, which I'm assuming were kind. He might have just been insulting our families.

SPEAKER_02 16:57

Uh he said you look like an elderberry bush. That's what he what was that flat yob what set medette. Like, great job, keep it up. I probably got that wrong for all my Norwegian friends, but like I'm trying, you know.

SPEAKER_03 17:10

Yeah, yeah. Fair enough. I like this little kind of subcommunity of Norwegians.

SPEAKER_02 17:16

Well, well done, Jasper. That was excellent. Very good, very good. Um all right, so what are we talking about? We have a couple more of these, but we'll sprinkle them throughout the episode.

SPEAKER_03 17:25

Yeah, being obsessive and compulsive, uh, also acknowledging that that fixation part of your brain, even when you're not being anxious. Actually, I think, and again, the older I get, the more metacognitive theory I get on this. I think sometimes I think it's a thinking style that leads us to anxiety disorders in the sense that we rely on the formula of attention and effort on something fixes something, and it's great. But when that's the only tool in our tool belt when it comes to thinking, it's really annoying when you've had a panic attack or you're trying to fix DPDR, or you're obsessing about ectopic heartbeats, or you're feeling a bit dizzy and tired, or you're afraid of sleep, or you don't like this intrusive thought because it means something horrendous or whatever, that's when it starts to backfire, and we end up in the obsessive compulsive loop.

SPEAKER_02 18:17

Yeah, that's a good point. I I might say the same for almost I don't I want to be careful what I say here, but like emotional style. There's the whole like I I rely so heavily on my emotions to tell me if everything is okay that now I start to try to uh compulsively get the right emotional feeling so that I know I'm okay in any given situation. And that could vary very widely, but I I always consult my emotions to see if this is correct. Does my gut telling me the right thing? Is my intuition right? Do I have the right feeling? Did oh did you see the way he looked at me? I think he's he's probably mad at me. Like I and now I have a bad feeling, so I'm gonna consult my emotions, and then when you can't get resolution, you can wind up on a hamster real real quick. Trying even harder and harder and harder to make the right emotion.

SPEAKER_03 19:02

So not what what can you remember being obsessed about and subsequently danced with compulsions?

SPEAKER_02 19:14

I became obsessed. This is funny because I use it in my life now and I talk about it all the time with the concept of meditation. It became an obsession. Uh meditation was what you used to calm down. Like I and I was never throughout my life, I had no interest in that whatsoever. Uh, you know, it just didn't resonate with me. I was never a meditator, I gave it no mind, I did not care. But then when I was in the thick of panic disorder and like freaking out and just trying not to panic all the time, it's like, oh, meditation, that's good for anxiety, that calms you down. And I would compulsively meditate. There was no doubt in my mind that I got stuck in that. So anytime I had to do anything that was going to be in the least bit challenging, you would find me sitting like cross-legged, listening to like binaural beats or some sort of like new age music, and trying so hard to meditate myself into calmness. It was not pretty. And then I would get more frantic because it wouldn't work.

SPEAKER_03 20:11

And and and looking back, we know that was just resistance.

SPEAKER_02 20:13

What a huge mistake that was. I was a compulsive meditator. I would build in time before anything for meditation. So I have a doctor's appointment. I got to build in 20 minutes of meditation before I'm gonna. I was airport dad at my doctor's office because I would get there early. I would start the day early to meditate before I went to the doctor's office, and I would get there 20 or 30 minutes early so I could meditate in the waiting room so that I'd be calm when I went in.

SPEAKER_03 20:38

So it's interesting though, because meditation is is great. It's awesome. And I like meditation, but when you use it as a safety behavior, it went off the rails. Yeah, and and it gets all the credit as well. Like this thing, you were techniqueifying meditation. It got ugly.

SPEAKER_02 20:57

It it really drove me into some tough spots too, because it became kind of frantic. I was then I remember the day when I realized like I I'm frantically meditating. Talk about an oxymoron, like yeah.

SPEAKER_03 21:09

I was gonna say you weren't at the irony is you weren't actually meditating.

SPEAKER_02 21:13

No, no, I was literally just trying to like because it's observing without judgment, etc.

SPEAKER_03 21:17

And you were like, No, everything I'm observing is with severe judgment. And I guess I hope this isn't anxiety.

SPEAKER_02 21:22

Most severe judgment that I could bring upon myself, yes, that is true. And it was just like, wait, I am frantically meditating, that is not right, that's not supposed to look that way.

SPEAKER_03 21:31

So, yeah, yeah. My big one obsessive, I mean, it was a theme of OCD for me. Yeah, I think I've said it in the past, but like just and a lot of people maybe listen to this podcast or relate to it. The idea of just fixing myself, and bear in mind like I realized I was absolutely fine. I was just on the hamster wheel, but I misinterpreted this and obsessed over the fact that well, if I'm getting disordered anxiety or if my threat response is misfiring, there must be something fundamentally wrong with me in the gym. Genetic makeup or in my brain, or something's happened, and using all the information that I've had growing up, maybe like you know, watching media and TV and stuff like that, pops like I thought, although something must be really wrong in my brain or my body, so I have to fix it somehow. And and then when you've got other trainee therapists doing it, and I've done this and I'm processing this, and I'm like, actually, I was just fine. And it became a thing because I behaved like it was a thing. And when you behave like something's a thing, the amygdala's like, I'll help.

SPEAKER_02 22:32

Yeah, yeah. And starts giving you adrenaline and cortisol, I'll help. Amygdala. Yeah, that's so good. Um, what else did I get? I I was obsessed with when I was going through the antidepressant withdrawal stuff. I did three episodes of The Anxious Truth on that. Go search for antidepressant on my website. That's all I'm gonna say about it. So do not ask me to talk more about it. But when I was going through the withdrawal experience, I was absolutely obsessed with what if I missed the thing that fixes this. And so there were a couple of websites that I was on, and I would sit and refresh the page compulsively, go through all the subforms and then go through them again, and I would spend hours just waiting to see if somebody had posted something new because that might go.

SPEAKER_03 23:14

You sound you sound boring.

SPEAKER_02 23:16

I was a I was a barrel of last in those days. It was very, very difficult. And you know what a paradox there though is the obsession and then the corresponding compulsions with what if I missed the the one thing that's going to get posted today when somebody tells me I figured out how to fix this, and I was so desperate to feel better. I mean, I can't blame myself, but that I was doing nothing to actually support myself. I was ignoring all the things that I could do to support myself just by like refreshing or just sit at that screen and look all day. It was not good.

SPEAKER_03 23:46

Yeah, something external from me must hold the key to fixing me. And that applies to panic, OCD, GAD. Something external is the key to stopping these feelings, whether it's in the depths of rumination, resource gathering, um, that's a very OCD thing as well, isn't it, Drew? I I miss the one the last piece of the puzzle. There ain't no last piece of the puzzle. Yeah, because it's uncertainty. So actually, yeah, you're gonna have to make a thousand-piece puzzle. And guess what? Taking out eight of the pieces, you know, do the best you can. Oh well you recover.

SPEAKER_02 24:25

Yeah, that's exactly right. Oh well. And then experience will fill in those missing eight pieces. Like that's the way that's gonna have to be.

SPEAKER_03 24:31

Yeah, yeah. And also rumination is like completing the puzzle and then going back to the box to try and find the pieces, or dismantling the puzzle, putting them back in the box and starting again, just trying to find the missing pieces. They ain't there. You fill them in yourself, it's okay. Yeah, you can imagine the pieces being there. I you can fill in the picture yourself. I'm sorry, I'm really getting into this analogy now.

SPEAKER_02 24:56

It's a good one. I could add to it by saying I finished the puzzle, but I don't feel right about how I finished it. So I'm gonna take it apart and do it again because I don't feel right about how I finished the puzzle. It just doesn't I don't think I did it right. Let me just let me do it again, just to be sure.

SPEAKER_03 25:11

And that's obsessive and compulsive. Yeah, yeah, yeah.

SPEAKER_02 25:14

If you feel like you have to do it or it would be irresponsible, or you'd be shortchanging yourself to not do that thing, that's that's when you've got to look at like, wait a minute, I'm am I being productive here or not?

SPEAKER_03 25:23

Yeah, let's let's talk a bit about the role of intrusive thoughts. So maybe you have an inappropriate sexual thought, maybe about someone you shouldn't, family member, whatever, a tree, I don't know. Yeah, and you immediately get that shock that has your attention, and then resistance, which comes in the form of compulsion. So they might be that's not me. Surely that's not me. Is it me? Let me ruminate a bit, reflect on my life. Have I ever done anything like that? Would I? Maybe I should scan my body and see if how it's reacting when I do think about that. Yeah. What's going on there? Maybe I should avoid compulsively just in case that horrendous thing happens. Or if I just simply am scared of the thought. You know, it becomes obsessive when you build your life around intrusive thoughts just in case that the content might happen or make you feel rubbish.

SPEAKER_02 26:20

I it make you feel rubbish, I think, is the key for a lot because this thought just makes me uncomfortable. What if I am? Like sometimes in you know, there is no necessarily like real-world outcome, especially with people with pure. What if? What if I am this type of person? There's no outcome necessarily, just I feel so uncomfortable when I have this particular type of thought that now I have to engage in mental compulsions to combat the thought and prove it wrong. And sometimes it's behavioral compulsions and it's not pure, but like it, you know, it really gets tricky because it can sometimes it's not even the feared outcome. It's just I feel bad. It makes me feel horrible, and then I'm doomed to feel horrible for the rest of the week. So now I have to do my compulsions to make sure I don't feel horrible. That can be the feared outcome sometimes. And then the argument would be, well, then it's not really OCD, but like these things blur together. The reason why we're doing this episode is it all blurs together so often that it's okay if you can't tell like what anxiety is.

SPEAKER_03 27:13

What you can say is I know I I can be obsessive and compulsive.

SPEAKER_02 27:17

Right, right, exactly. Like, is this the way I want to be living my life? No, well, then okay, uh, it doesn't matter what I call it. Clearly, I have some I have some work to do here.

SPEAKER_03 27:25

Okay. All right. And if you're an obsessive, compulsive person who's insecure, this could affect your relationships. Oh, I'm worried about my relationship. Okay, well, if I think about it and obsess about it more and compulsively seek reassurance, do things, act in a way that isn't my congruent, authentic self because I'm just trying to mitigate this feeling of uncertainty. Yes, you may have had a history of panic disorder and social anxiety or whatever, but note that you have an obsessive compulsive mechanism in your brain that you must challenge when it attaches to problems outside of the realms of panic disorder, OCD GAD, because that's what can happen too. That can become the point of fixation on obsession. And these are the people that can't sleep at night because they're obsessed about, I don't know, a work meeting or a relationship or a falling out or something, and know that it's the same mechanism that applies there. Maybe the hamster wheel isn't going as fast because it's not, it doesn't feel as severe or as urgent as maybe some of the themes of of of other of other anxiety disorders. But knowing that now, yeah, I've got that mechanism in my brain that I can change and I can rewire, but thanks to habit and things from the past, I I'm gonna be smart here and I'm gonna observe it metacognitively. Ah, I'm trying that key is trying to fit into that lock, but it's not the right key. So I need to step back and approach it differently.

SPEAKER_02 28:53

Oh, it's not the right key. That's really good. Like, no, no, that's the key I use for everything, though.

SPEAKER_03 28:58

Yeah, but but it fits in and and I and it's turning a bit. Yeah, but uh not really though, right? Maybe if I keep trying it, maybe it's the maybe the locks bust and you're there for an hour. Or if you're me coming home from the pum on a Friday night, it is the right key. I'm just purely incompetent. It's the right key, it's the wrong door. My neighbor's like, go home, jump. Go home, jump the third time this week.

SPEAKER_02 29:28

But that's a thing. We mentioned that in the round table we just did. And by the way, if you want to be involved in disordered roundtables, just pop on our mailing list at disorder.fm. These are little small group discussions we do on a regular basis. Like how I slid that in. Well, we were we were uh the round table was so fun. It was fun. We have it's us and 20 people, maximum 20 people, and that came up. We were talking about it was a health anxiety, we're doing another one next week. It's sold out, but get on our mailing list, we're gonna do more. But when that came up, it's like you're trying to you're you're seeing this as a problem that you solve using your big brain problem solving methods, and it's not working. And 20 heads on Zoom are bobbing up and down, like, yes, yes, that's right. So, like, yeah, that's that obsessive compulsive part of it. Like, yeah, I'm I'm uh compulsively trying to use my problem solving skills because they work for me, but here they don't. I cannot seem to get the right no matter how I jiggle the key, I can't get the right feeling. Really hard, man. It'll drive you into bad places sometimes.

SPEAKER_03 30:20

So yeah, yeah, your obsessive compulsive key. Yeah, unlock some doors, not all, you know, like oh, my roof's leaking. Yeah, if I pour obsession, effort, and fixation onto that problem. Yeah, my roof will be fixed quicker. Yeah, I've dropped everything and I've given it all my attention, and yes, my roof is now fixed, and it stopped the leak. Brilliant part of our brains, brilliant part of my brain that helped me. But if I use that key for something, it was like the door ain't even locked, mate. Why are you bothering using it? Yeah, the key doesn't unlock a problem.

SPEAKER_02 30:54

It doesn't unlock every door. And guess what? Not every door has a key and can be unlocked, which is really hard for people in our community to accept sometimes.

SPEAKER_03 31:04

We sound like a Paolo Cuejo.

SPEAKER_02 31:06

Suddenly metaphors of like, wait, let me put on some new age music and like start drop mic dropping uh the truth bombs, you know.

SPEAKER_03 31:16

Here's a story from my childhood. It's not as bad as the hot sauce one the other day. It's worse. Um, I was not the best behaved in school, and I stole one of the teachers' master keys to the school, and then I went to Timson's in town and got it. And it wasn't Timson's actually, not having any defamation, it was a market stall, an unnamed key cutter to protecting their confidentiality. And I said, Can you cut eight of these keys for me? And then I started selling master keys around to my friends, and then we used to just basically unlock all the doors in school, it was really fun. And I'm just like, until I got caught one day trying to uh steal some magnesium tape, you know that magnesium tape because it fired to it bright. Yeah, I was like, I want to play with that. Um, yeah, you're getting an insight into my childhood here. Uh yeah, and it just reminded me that yeah, I maybe think that my brain has the master key for everything. No, sometimes some doors just don't have a lock that you just need to leave it alone. So the moral of the story here is I did nothing wrong, and I still to this day shouldn't have got a month's worth of detention.

SPEAKER_02 32:26

That's my story, and I'm sticking to it. Your brain had eight master keys in that situation.

SPEAKER_03 32:32

I was still with this magnesium tape, they're like, What are you doing with that? I was like, I'm just really into science. And they're like, No, you're not.

SPEAKER_02 32:39

I'm not really into science. Yeah, but you know what's funny about that? Like, we could literally draw a line back to this topic on that. In when you have that obsessive compulsive thing going on, the the rationalization that happens inside your own head will even do stuff like that. I'm just into science, does young Josh, like to the school administrators like, no, you're not. In that situation, like, I'm just the kind of how many people listening to the podcast by show of hands, well, wait for you to raise your hand. How many people listening to this episode will say things like, Well, I'm just the kind of person that does better if I have answers to justify the compulsive resource gathering, reading, listening, videos, and like research. So you'll that justification or rationalization will come through loud and clear. But if everybody else kind of gives you the side eye on that, like you got when you said you were into science, it's a clue that, like, oh, this is that, yeah, the compulsion, the obsessive and compulsive nature of it is justifying itself. It's telling me why it's okay to keep doing this. I'm just the kind of person that does better if I know. Oh, well, tell me what you don't know. You already know all the things, yeah. So interesting. That makes sense. I want to talk for a second before we get to our last community stuff about very briefly, if all anxiety disorders have an element of obsession and compulsion, then does that mean that every anxiety disorder is treated with ERP? Because I know people are gonna ask that.

SPEAKER_03 33:56

There is an element of response prevention in yeah, in all anxiety disorders. Yeah. Some of them is yeah, I I would stand on a lectern in a at a conference um behind the riot shields uh and and tell the room or every therapist that yeah, yeah, every anxiety disorder has to have some some element of response prevention. Because as we know, the amygdala can only be rewired when it's activated.

SPEAKER_02 34:24

Yep.

SPEAKER_03 34:25

So so yeah, I I would I would definitely say that. And then when the in incoming missiles come in and I'm escorted off by my entourage that doesn't exist. Um but yeah, I yeah, I very strongly believe that.

SPEAKER_02 34:39

Yeah, me too. And I but it doesn't mean the only thing I'll throw in and then we'll get onto the rest of the stuff and wrap up the episode, but like it doesn't mean that no matter what anxiety disorder you have, you might do the manualized ERP that gets used in OCD treatment. But if you are doing exposure willfully tolerating, you are also doing some sort of RP. The willful tolerance, I will stop fighting and resisting is the RP part, no matter what you're doing.

SPEAKER_03 35:03

Well, that's a that's epitomized in here. I mean, uh when I in this practice, when someone comes in, like, I'm having a panic attack, what do I do? And I sit there and go, Nothing, nothing, right? They're like, What's the RP? Is there not breathing techniques, box breathing, five things, grounding, regulating? Yeah, no, because we need you you can tolerate this. You've probably had hundreds of these before, yeah, nothing bad's happened. So why don't we try not doing something, which is the response prevention, and it teaches the brain oh yeah, we tolerated that, and also nothing bad happened. So, I mean, you've killed two birds with one stone there. You're not looking for safety behaviors, you're not looking for things to give the credit to for why you were calm. You did that. That's ERP for panic disorder in a nutshell. But with any uncertainty, really, that's what it applies to.

SPEAKER_02 35:53

I came up on Tuesday. Like, well, if I'm out with my friends, I'm getting better at handling my anxiety, but like sometimes I feel like I have to run to the bathroom because my tummy gets upset, and then I'm embarrassed. And the answer was like, well, sometimes we get embarrassed, and you might have to get better at being embarrassed. And it was like a it was a light bulb moment for that person who was like, I never thought about that. Like, I just assume if I get embarrassed, I have to fix that, right? Well, not always. Yeah. So good. Anyway, uh, we got another audio did it anyway. We got it written, and do we have a question?

SPEAKER_03 36:19

Yeah, cool. Yeah, let's let's hear it anyway.

SPEAKER_02 36:22

The audio, how's that? We will do let me get rid of this one so I know I'm playing the right one, and let's listen to this one.

SPEAKER_00 36:29

Uh hi guys, hi Drone Josh. My name is Martha. You can use my name. I'm a sufferer of OCD and anxiety from Greece. Uh, wanted to share a win with you. So I was talking to a guy for quite some time, and it turned out that he was really attracted to me, but I was not. And it might seem like a very simple thing, like, okay, you're not attracted, what's the big deal? But my first instinct was, oh my god, I have to run away. I cannot do this. This is so terrifying. Like me telling him that I don't like him. I I thought of ghosting him, of avoiding the situation completely, but I knew that it would be good of me to actually you know have the difficult conversation. And the entire day I was I was terrified, my MCD was going batshit crazy. I wanted, I felt like I was about to faint, and uh, it was just uh very bad overall, but the experience itself turned out to be alright, actually. Um, but I did it anyways, even though I was terrified of the entire thing, and I feel pretty great with myself right now. Uh so guys, if you're listening to this, you can do it too. Do it terrified, do it anxious, just do it anyways, you know.

SPEAKER_02 38:01

That was really great. That was really great.

SPEAKER_03 38:04

I love that. I love that at the end as well. Just do it terrified, do it great. And I feel great now. Yeah, and it doesn't matter what the threat response it picks up on for this for for Martha and pre-existing OCD. It was no, you can't let this person down, you can't tell them no, and and and she did it anyway, and well done. And also you've respected a boundary. I mean, there's just so many good things about that.

SPEAKER_02 38:26

Yeah, it goes way even beyond just anxiety disorders. There's a life lesson in that one. Sometimes it's uncomfortable, and but we can handle it, and the other person probably did too. So good job, Martha. Very good, thank you.

SPEAKER_03 38:36

Um that's really, really good. Yeah, we're gonna get we're going global, Drew.

SPEAKER_02 38:40

We really are. I will do a we'll end with a question, so I'll read a did it anyway, and then we'll answer our question at the end, ready?

SPEAKER_03 38:46

So we've had Norway, we've had Greece. Where are you from?

SPEAKER_02 38:50

This is the UK.

SPEAKER_03 38:52

And where are you from?

SPEAKER_02 38:53

Oh, I'm from the US of A. Come on. The red tail hawk, aka the Eagle. Somebody else pointed that out to us just recently, I believe, in an email or something. Or it might have been in an Instagram comment, I can't remember. But it's an eagle to us, leave us alone. All right, here's a did it.

SPEAKER_03 39:10

No, it's a red-tailed hawk called Eagle.

SPEAKER_02 39:12

That's the name of the red tailed hawk is parental.

SPEAKER_03 39:14

The name of the hawk is Eagle.

SPEAKER_02 39:15

Yeah, they were American aphiles, U.S. aphiles. Is there such a thing? Um, so Kurt from the UK sends it a did anyway, gives us permission to use his name, and he says, Hi, Josh. And in air quotes, how do I put my phone on silent? aka Drew. Kurt has taken a swipe of my my okay cupid notifications. Good job, Kurt. You can use my name. Been listening and following you both for a while, and your content has definitely steered my recovery in a better direction. I wanted to share a Did It Anyway with you. Been at a setback recently after hiding handling my anxiety, the best I've done in years. I was going to a concert with my friend, and on the train, the anxiety decided to rise until I was in near panic while waiting for them. Craig the critic was telling me that I couldn't do it and that I should just cut my losses and go home because I had failed. We planned to have posh burgers before too, which has now seemed impossible due to the nausea. Posh burgers, love it. But I decided that I was gonna do it all anyway and stick to the original plan with no safety behaviors, spelled with a U. I went to the restaurant and ordered the burger, ate it all despite fears of having to run out and panic and throw up. I got lost in conversation with my friend and I felt the anxiety ease. I then went to the concert and enjoyed it. The anxiety decreased over the evening and I was able to relax. P. S. says, Kurt, why is Barry from EastEnders not the theme for the do-it anyways? Thanks again, Kurt. Oh, good job, Kurt. I think that was really great. Oh, wait, I'm playing the wrong thing, but I give you some applause. Is that the applause? Yeah, there you go.

SPEAKER_03 40:42

Well done, Kurt. That's brilliant. And again, showing the principles of things, doing it scared, you know, ordering the burger despite feeling, well, what if I'm sick and I don't really feel it? But just doing it, simulating it even, teaching the brain, oh, this is what I want to do. Well done. Hope you enjoyed the gig. Uh, yeah, we might get the clip from the Barry from Eastendis. You may have to use it. That's they're gonna do it anyway.

SPEAKER_02 41:04

Hey, that's that guy. I didn't know what that was until it was.

SPEAKER_03 41:06

Telling Drew, fun fact, I've had Barry from Eastendis in a headlock with my friend Francis when we were at um university. Not in an assault way. We asked, Can we put you in a double headlock? And he was like, Yeah, sure. It was pretty fun guy.

SPEAKER_02 41:19

All right, very cool. Uh, mushroom walks into a bar and says, I'll have a beer, and the bartender says, Get out of here. We don't serve your kind. The guy sitting at the end of the bar says, Oh, he looks like a fun guy.

SPEAKER_03 41:28

Uh, he's not an airport, dad, but he's uh dad. Dead jokes.

SPEAKER_02 41:34

By the way, Kurt did an SAR thing here when he got lost in conversation with his friend. You know what changed? His attention.

unknown 41:41

Right?

SPEAKER_02 41:41

Yeah, and then suddenly he felt better. Anyway, thank you, Kurt. All right, what do we got? We got a question to end it up. We got time for a question? Sure, we can answer it quickly.

unknown 41:48

What the hell?

SPEAKER_03 41:49

Hi, Josh and Drew. Feel free to use my name. Okay, hi Kennedy. I hope you're doing well. I was wondering if you could answer a question about food and eating. Um ask Kurt, you know. He just ate a posh burger. Yeah. Uh a posh burger. I have health anxiety where I worry about cross-contamination with food and foodborne illnesses and allergic reactions, and subsequently stopped eating certain foods and only eating at certain times and not eating for extended periods of time. Recently I've been eating food and then wondering if it has been cross-contaminated with something toxic, which is insane because I would never do something like that. This has also led to health problems like nutrient deficiencies, which only serves to exacerbate health anxiety symptoms. Um, I mean, before I even finish this, this sounds like OCD, contamination OCD, as opposed to health anxiety. Uh, my question is this how would y'all recommend I do exposures for this phobia problem without ruining my relationship with food? Like I want to be able to enjoy food and eat food in social settings like a normal person, and I worry that doing conventional exposures would make it hard for me to do that. Anyway, thanks for your time and all that you do. Good question, Kennedy. Where would you start? That is a good question.

SPEAKER_02 43:04

The first thing I would throw in is this is a situation where there's going to be medical care involved because that there's nutrient deficiencies and maybe you're underweight, that sort of stuff. We got to have a medical team involved, so I always got to throw that out there. But I think that the difficult thing there is how do I do exposures without ruining my relationship with food? It doesn't sound like you you're trying to do anything but eat normally again, right? Like I don't hear the demand to do anything special or to not feel bad. It's just I don't want to do these restrictions anymore. So honestly, it's maybe a little bit overcomplicated in Kennedy's mind right now. It's just, yeah, you're gonna feel bad when you eat things, right?

SPEAKER_03 43:39

I'd also argue that your relationship with food is already ruined, so you've got nothing to lose. That's exactly right. If you're nutrient deficient and you're avoiding foods, then I wouldn't say that's great. Uh this sounds a lot like contamination OCD, um, which is what if I contaminate myself? What if I've made something toxic, even though and when you said that it sounds insane because I knew I wouldn't. That usually sounds like an OCD style thing where OCD will use guilt as well as catastrophe to to take your attention. Uh your exposures, I mean, advice, do it with an ERP therapist, you know, and start out a little bit at a time, maybe eat a food you've not eaten for a long time, do things like that, and you build up and you build up. Um, I know one therapist who, you know, didn't they'll do an exposure like don't wash your hands and eat a sandwich. Yeah. But there's literally germs on my hands. Yeah. See what happens.

SPEAKER_02 44:33

Yeah. And I think you have to accept going in that like the exposure means, yeah, I'm gonna probably have those thoughts and those worries after I eat that thing. But that's make sure you expect it going in. And I would agree, the help of a professional here would be a big deal. I think that how to make sure I don't develop a bad relationship with food is a little bit of a meta thing, too, going on. Like, yeah, yeah, I need to do this right. Yeah, because I hear about you know ruining my relationship with I see that on online, so I don't want to do that. Uh, don't really, it's already ruined, so you gotta fix it.

SPEAKER_03 45:02

Get it, get get get an RP therapist with you and and stuff like that. Yep. Um, but yeah, challenging the uncertainty as well is always good. And yeah, get make sure you get food on you. Um, thank you, Drew. Really enjoyed that episode. Always do. And um, yeah, thank you for listening at home every Friday.

SPEAKER_02 45:21

Yeah, if you're uh really digging this podcast, maybe leave us a review on Spotify or Apple, because you know, we're ready, or maybe not.

SPEAKER_03 45:28

Yeah, and get on the mailing list if you want to join us on for Disordered Round Table. Um, we'll get new dates dropping very soon.

SPEAKER_02 45:35

Yeah, absolutely. Thanks for listening, guys. We'll see you next week.