OCD, Intrusive Thoughts, and Religious Anxiety: How Exposure Therapy (ERP) Helps Break the Fear Cycle

Hello.

Hello there fearfully and wonderfully made human, and welcome back to another episode of the Holistic Counselor podcast. It's me, Diana Rice from Through the Valley Therapy and Transform Mind Consulting and Coaching. Today, we're opening up a conversation around something that so many people quietly struggle with but don't always have the language for.

We'll be exploring intrusive thoughts, OCD, anxiety, phobias, and that feeling of being stuck in your own mind, like you just can't turn it off. Maybe you've had a thought that scared you. Maybe you found yourself going over the same thing again and again.

Maybe you've wondered, "Why can't I stop thinking about this?" or even, "What does this say about me?" If you've ever asked yourself, "Do I have OCD? Why can't I stop these thoughts? Or is this anxiety or something more?" this conversation is for you.

And here's something important to hold on to as we begin. You are not alone, and you are not your thoughts. Today is really just a conversation. We're going to explore, we're going to learn, and we're going to get curious together about what may be happening in the brain when it comes to fear, anxiety, and obsessive thinking patterns.

We may also touch on something called exposure and response prevention, or ERP, which is one of the main approaches used to treat OCD and anxiety. If you've ever felt trapped in cycles of fear, avoidance, or rumination, parts of this conversation may really resonate with you.

So, whether you're someone who struggles with intrusive thoughts, health anxiety, phobias, or even just feeling stuck, I want you to lean in and just listen. Take what is helpful and leave the rest. Today, I am joined by Megan Crow me, a licensed mental health counselor, anxiety specialist, and the founder of Still Mind Psychology in Fort Lauderdale, Florida.

Megan specializes in treating OCD, anxiety disorders, phobias, and trauma using evidence-based approaches, especially exposure and response prevention. She has over 6 years of experience working specifically with OCD and has helped teens and adults move beyond cycles of fear and intrusive thoughts into lasting recovery and confidence.

Megan earned her bachelor's degree in psychology with honors from New College of Florida and her master's degree in marriage and family therapy from the University of Central Florida. She is licensed in multiple states and works both in person and virtually. Megan, thanks for being here.

Absolutely, Diana. I'm excited to be on and I'm excited to have this conversation with you.

Yeah, well, well, before we even start, what uh states are you licensed in besides Florida?

Yes, yeah, I'm in Florida, Texas, Vermont, Idaho, and South Carolina.

Wow. Wow, good for you. I mean, I'm I'm still trying to figure out if this counseling compact is ever going to happen.

Yeah, no, no comment on that. I got so excited this year cuz there were one or two more states I had wanted to get licensed in, but I'm like, I'm just going to wait for the compact and here I am waiting.

Yeah, I think we all are.

clue

[clears throat]

when that's going to hit for us here in Florida, but hopefully soon cuz I would do more states actually, but I think I'm going to put a pause cuz it is a lot. Yeah.

Well, and anyone listening that's an intern or in our field and and is curious, I'll put uh if you don't know what I'm talking about the counseling compact, I'll put a link in the show notes so you guys can figure that out for yourselves too as we're all trying to figure it out.

Anyway,

[clears throat]

what led you to treating OCD, you know, intrusive thoughts and anxiety? And what were the some of the things in your life or training that made you really passionate? Because sometimes we as professional therapists, you know, we we start off general generalize of course and then all of a sudden we niche down because uh for a reason.

So, what's your story?

Yeah, so you know, like many therapists, it started a little bit with what I had gone through although it's a little unique in how I actually kind of it ended up more in the OCD realm. So, growing up I actually was someone who even just from a really young age consistently struggled with really intense social anxiety.

And as I got older, um it actually kind of got worse almost in my teenage years as does for many. Just, you know, you're expected to kind of be going out on your own socially a lot more. And for me, it kind of developed then from anxiety into, you know, really this idea of like getting panicked and eventually more agoraphobia.

So, I was always fairly functioning with it in that I could always leave the house, go to work or school, but it just got to the point for me where anything that wasn't kind of in that necessary routine would just trigger immense panic, panic attacks, fear, you know, I'd be crying at the idea of like going to go like pick up take out for my family by myself.

So, it was something I had dealt with and really had to work to overcome very significantly especially as I kind of like left home and went out to college and all of the safety behaviors that um I had as a teenager were really no longer possible.

So, I had to slowly but surely really get out of my shell and work through that with kind of self-guided exposure therapy at the time because I didn't necessarily have access to therapy at that age. Um and so, going into my practice, it was something that, you know, as I had really started overcoming it, it was just so passionate to me.

And so, I really, especially once I was able to start working more for like a group practice after, well, it was still during my internship, but I really wanted to actually work with panic disorder and agoraphobia because it was so special to me.

Um and it, of course, it really still is. However, what I actually noticed was that so many people, because I was saying that and like wanting to help people with agoraphobia, I realized about 75% of the people who were coming to me for agoraphobia actually had OCD.

And so, it was something at first I kind of stumbled into. I didn't kind of understand at first because I was, you know, a lot more familiar with the anxiety and panic realm. Um And so, when people were coming in for more of these concerns of, "Yes, I also can't leave the house, but for me it's because of this intense fear of contamination or getting sick or what if I harm someone or what if I make mistakes while I'm out?"

And so, I realized because a lot of times information on OCD was so limited, so especially back then, that these were people coming in completely unaware a lot of times they truly had OCD or even if they did, for them they understood it as agoraphobia.

So, as part of that, I actually really had to kind of figure it out and start learning about it because it was such a big part of the clients who were actually coming into me. Luckily, of course, right?

Like, I was already trained in exposure therapy, so I already had a lot of the tools and luckily at the time the group practice owner I was uh working with, she actually was an OCD specialist, so she was really helpful in guiding me kind of towards learning more about it and getting additional training and kind of figuring out how to conceptualize these cases and kind of grow more.

So, it became something I just started almost taking on on accident, um especially when I had really started in private practice. It was basically right after the pandemic had ended, you know, COVID.

Yeah, for real. And that can that social anxiety I see it in some of my clients. Well, before we even continue, I want if somebody that has no idea what the word of agoraphobia means, can you explain that a little more, please?

Yeah, so the the full name for the diagnosis is panic disorder with agoraphobia. So, it is primarily a panic disorder presentation, which means you get incredibly nervous and fearful about the idea of potentially getting panicked or having a panic attack in public. It's usually tied to this idea of intense embarrassment that could happen from having these panic attacks while you're out and about.

Um but it could also be tied into the idea of danger that could happen. So, for example, a lot of times it's really bad in like in closed spaces or especially while driving because it becomes this fear of what if I have a panic attack while I'm driving my car?

What if I have a panic attack while I'm out with my kids and now I can't take care of them? So, it can spawn into a lot of different flavors, but the core of it is essentially a fear of getting panicked.

And that eventually, like most anxiety disorders of this type and very similar to OCD, over time if left untreated and if we continue to kind of really fall down that rabbit hole, tends to lead to people's lives becoming smaller and smaller because you avoid these things that bring you panic.

And so, with agoraphobia, because being out in public is the trigger, right, of well, if I get panicked, people will see me and that's going to lead to all these issues, it can eventually become this part where we actually try to be out of house as little as possible.

So, usually we are, you know, staying home. You may be leaving the house only for absolutely required things like to go to work and go home, go to church and go back. Um, you know, so you may go out with like a safety person or things like that, but it becomes this really scary idea of at any point, you know, the only place I'm really safe is at home, and any kind of like public activity or place where I could get panicked becomes a trigger.

So, that's kind of what agoraphobia looks like. So, it's not necessarily a symptom as in fear of leaving the house, although I do think that's how people commonly understand it to be, but it is a specific category, like sub-diagnosis of panic disorder. So, it would it's not just I don't feel comfortable leaving the house.

Traditionally, it is defined as I have a fear of developing panic attacks, which leads me to this intense avoidance. But, like I said, because it is so commonly more associated with just generally people who have anxiety when they're any that's not home, a lot of times people can really relate to it and relate to those feelings and limitations even if the core of the fear is more OCD-related or trauma-related or something else.

Yeah, I mean it's like how do you disentangle what is just a person a shy personality? You know what I mean? Because that's the thing to and I and I realize like working with adolescents a lot for most of my career and just where I come from and what I've seen and what and stuff like that.

It's just like how do you teach someone or like if you're working with a teenager and the parents are like, "Oh, they're just shy. We got to push them."

Yeah.

But but you also want to not enable it either and then all of a sudden, you know, the child's stuck and they're can't go to school or they can't talk. I mean, you know, at all and they have a a lot of issues that end up showing up even more.

How do you disentangle that?

Yeah, so I think it's a great question and it's a fine line both with this with OCD you'll see it as well, which is how does a parent kind of balance being supportive without being enabling? Because you're absolutely right. A lot of times it comes out of this loving desire to help a child or a partner avoid anxiety that in the long run it creates this sort of dependence that actually makes the anxiety worse.

So, I don't know if there's any one perfect way. Um it kind of depends on the severity of things, right? So, if you have a child or a partner who's maybe like they definitely have some mild anxiety, encouraging them even just you know, like, "Hey, I believe in you.

You should get out of your comfort zone, you know, give it a try." Things like that often times are just great ways we can still be supportive, which I understand it is anxiety producing, but maybe reminding them of why it's so important to them, right?

Like, "But, you know, you really want to start college, so it's important to kind of be going to class, right? Cuz this is part of your value system." Um you know, "Let's try doing it. And of course, if it's really difficult, maybe we slow it down.

Maybe we can try inching you back into it. We don't have to do it all at once." So, I think there's a lot of ways of like gently encouraging people and just reminding them of, you know, why it's so important and maybe normalizing how hard these things can be and normalizing that it is anxiety producing to do a lot of these things, right?

To make new friends, to be in a new place, to go to a new school that everyone can relate even if they don't have that intensity of it, you know, with that diagnosis. All of us have had to overcome that fear to some extent.

Right.

So, I think normalizing it cuz a lot of times with agoraphobia or with OCD, it feels like, "Oh, I'm the only one who feels this way." And it's easy for everyone else. So, kind of breaking that down and breaking that idea into like, "No, of course maybe sometimes it wasn't as hard for me cuz I don't have this disorder, but at its core, these are really human anxieties and elements."

Um I will say what clinically often times can help is if it's very severe, what we often do is kind of a exposure hierarchy that is mirrored between support giver and person. So, for example, if I'm working through my social anxiety or agoraphobia and the thing I'm working on is something like, "Oh, I'm going to be going on walks by myself and then I'm going to try to leave the house for 30 minutes.

Then I'm going to try to go to these places by myself. Then I'm going to do this." Clinically, especially for children, um what we'll also do is come up with a separate hierarchy for the caregiver that we collaborate all together with, which includes steps that support that.

Um so, for example, that might be things like um usually mom would walk the dog because daughter's too afraid to be outside by herself in the evenings cuz she's worried she's going to bump into people and she could get nervous about that. Um so, usually mom walks the dog every evening.

Maybe as daughter's working on the exposure of like, "I'm walking by myself. I'm getting out of the house for longer periods of time." and she's getting really good at that. The exposure hierarchy that we do for mom would be, "I'm going to only walk the dog 3 days a week." so, the daughter now has to do it a few days a week by herself.

So, we can together because sometimes that's really useful for pretty more like severe presentations and it is the same with OCD where it's the goal is kind of whatever you're working on.

Mhm.

The parent step would be then to kind of remove whatever accommodation or compulsion that they're engaging in to help you kind of like do that on your own step by step by step. That's really useful when it is severe cuz there's so many triggers.

Mhm.

just generally being like, "Oh, like you got it.

You go do it all 100% by yourself." is not always actually doable. Um but it's designed to still do the same idea, right? Which is ultimately, we want to be supportive and empathetic. But we want to foster that independence.

Okay. So, so before we even go to exposure therapy, I think we should touch on OCD because with Tik Tok people, I mean, and you know, in every everybody on social media and assuming you know, it's it's it when you're on social media I've come to find out and realize this is why I take big breaks.

Like right now I I'm on a social media break, but it's you know, you have too much information to the brain and I can imagine now with things you know, anxiety, depression, OCD, narcissism through the roof, right? And but everybody has it and everybody's diagnosing everybody with all these things.

You know, I I mean, I've heard it and I've been guilty of saying I'm so OCD and I've literally do have not gone to a psychologist who actually you have to be diagnosed to really have the disorder, right? Because there's this OCD disorder, obsessive-compulsive disorder.

I want people that are listening that really have no idea because sometimes you you gather information and you're like, "Oh, I have this. I have I have You know how many people I know have died and I go, "Where'd you get your diagnosis from?"

They're like, "Oh, I just watched a video."

Yep.

And I'm like, "Oh, okay then." And then we have to take a dive into that because honestly, it might not even be OCD at all. It could be something totally different.

Yes, absolutely.

So, can we talk about

to see a professional cuz I think a lot of times we get so caught up in the the presentation of symptoms when the reality is so many mental health disorders and just so many parts of being human overlap. So, you really have to dig deeper.

It's not going to be this obvious thing on the surface that immediately you can be like, "Yep, I click that box. I do that thing which means I have OCD." It's obviously not that simple, but I am glad I guess overall there is more information out there compared to before.

Yes, it's still important because there's so much and we we don't always know. So, OCD I would say diagnostically is relatively simple in that there's really only two criteria. You have to have obsessions and compulsions. But I will break that down because

Please.

theoretically simple, not simple in reality in terms of diagnostically assessing. And probably I there's not enough research on this, but I would say in my own clinical opinion, one of the most commonly missed diagnoses out there because it is much more common than we currently know because it's constantly just said as anxiety.

So, two components, obsessions and compulsions. Obsessions would be repeated intrusive thoughts. Essentially, sticky thoughts that you simply can't stop thinking about. These are thoughts that are unintended, so that we're not trying to necessarily think of something, but it keeps popping up in our mind.

So, an intrusive thought is just any thought you are not purposely really bringing up that intrudes into your mind, so it shows up there usually in a distressing way. Those thoughts can be and often are um basically out of line with our personal values.

So, what we call ego-dystonic. They do not have to be um but the majority of them are. So, these are often times images, thoughts, or sensations that we don't want to be there that cause immense panic and distress um and often times violate our own personal morals and values.

Um for example, there are sexual intrusive thoughts, there are thoughts related to harm, there are intrusive thoughts related to pedophilia, there are intrusive thoughts related to so many taboo topics

Yeah.

and things that obviously, if they kind of just show up in your mind, they become very scary and very distressing. Um there are still intrusive thoughts that just bad things could happen that aren't necessarily always completely a you know, not our values. So, for example, contamination is considered one of those themes where the thoughts are often um ego-syntonic, which simply means they don't really violate our personal values, but they still cause a lot of distress.

So, the idea, oh, this thing could have some sort of like bacteria or virus on family sick and because I'm someone who cares about that so much, that causes me so much fear and distress. So, they can really be either way, but essentially it's any set of intrusive thoughts that reoccur.

So, it's not a one-time thought. You don't have OCD if you just get the occasional random intrusive that pops up and for most of us, they fade, right? We might get an intrusive thought, but we quickly realize, "Oh, that's just a silly thought.

I don't feel that way." and we move on, right? A normal person, they'd get an intrusive thought, "Oh, having a terrible day at work. My boss really dug into me on this project. I'm so upset about this. Oh my god, like I wish this place would just disappear and like blow up and I wouldn't have to go back to work tomorrow, right?"

An extreme thought that

99.99% of us would be like, "You're just upset at your boss. You don't want this whole place to disappear. You just are having a rough day. We need to go home and take a nap and relax and hope tomorrow's a little better, right?"

So, typically these intrusive thoughts are pretty rare. They come and go. We don't read much into them. They fade, but with someone with OCD, the issue is when an intrusive thought pops up, they are a lot more likely to read meaning into it.

So, they go, "Oh my god, I can't have that thought be in my head. What does that mean about me? What's wrong with me?" And so, it becomes something that really freaks them out. The attention we give to those thoughts is actually what causes them to turn into obsessions, which is recurrent intrusive thought.

So, instead of it being a one-time thing that really bugged me and scared me, it becomes the first thing I think of when I wake up, the thought that just can't go away. So, that's the first main piece. These [clears throat] thoughts can be on any subject.

So, there is no set number of themes or obsessions for it to qualify as OCD. It simply has to be any thought or sensation that causes you immense distress and keeps recurring.

Mhm.

The second criteria is compulsions. Now, I really like talking to people about this. It's something I'm very passionate about and I try to inform people on TikTok because one of the biggest misconceptions is that compulsions are only these physical acts that you feel like you have to do to make something better.

Um a compulsion is any physical or mental act, and a lot of them are mental, um that allows us to escape this distress in some way. Usually, it's something we're doing that we feel like neutralizes this thought or prevents a fear from happening.

Um so, for the most simple and commonly seen and diagnosed one would be something like contamination, where I have this fear that something actually is dirty or contaminated and could cause me or my loved ones to get sick,

Mhm.

the compulsion I'm going to do is make I need to sanitize. I use need to use bleach. I need to wipe it multiple times.

Yeah.

So, that is the compulsion that pairs with it. The cleaning is designed to neutralize that fear from happening. But, for every single obsession, there is no form of OCD that doesn't have compulsions, but what people often miss is that a lot of times they're doing mental compulsions.

So, these are invisible because they happen in your head, but these might be things like needing to reassure yourself that fear won't happen repeatedly.

Mhm.

Ruminating on the fear. So, that might be trying to like logically solve it um or come up with all these ways where like here's why it won't happen. Um researching it or replaying all of our memories to be more sure of something. Um and again, these are repeated, not just one time, cuz most do these things occasionally, but OCD is doing it all throughout the day.

Right.

Mentally strategizing. So, they're coming up with these plans on like if this happened, how would I you know, would I take my kids to the hospital if they got sick? What medicine would they give them? What What would happen if they died? What would happen at the funeral?

Would people judge me? Coming up with all of these kind of hypotheticals and plans for what they would have to do if it occurred.

A lot of what ifs.

Yes. OCD is kind of commonly called the doubting disorder. So it is

Wow.

tons of what if thoughts. It's almost always more concerned with these hypotheticals than it is like real in front of me life issues, right? It's more about you doubt. In fact, a lot of people with OCD have insight, which is they're aware this is not super likely to happen.

But the fact that it's possible feels so intense that it still feels like I have to do these compulsions to prevent even the possibility of this happening.

Yeah, and I want to explain to the audience that if if it's disturbing your play, your love, your relationship, you know what I mean? Like normal living, then that is a issue that needs to be addressed because it will just keep getting worse and worse until you you know what I mean?

Your whole body and system will finally be like, all right, this is enough and I'm in pain or I can't function or somebody's telling you like, okay, do you see this happening? And so I want people to understand like, yeah, we have normal, like you said, like sometimes I think, I know it sounds crazy, but it does where I'm like on the road I'm like, I wonder what happened if I just go over the bridge, you

Yeah, exactly.

But it's creativity, too. Like in the mind and you have to to disentangle. I want ask you about something cuz you know that I'm a counselor who works with a lot of faith-based um and and what I have seen a lot now that I've had my private practice is those that come in and they don't even know what the word scrupulosity is, right?

And that is a form of OCD where um I want people to understand like healthy spiritual conviction and then you have that anxiety-driven scrupulosity. And to me that's just real real religious OCD. Can you explain that a little bit for my listeners cuz I have a lot of listeners who are um Christians?

Yes, absolutely. So, you know, religious OCD is just kind of a theme. It's not technically a different diagnosis of OCD, but it's just a common obsession people will get because you know, OCD attacks what we value most and religion is one of those things that people tend to have a lot of value with.

Now, I will say you can actually get religious-themed OCD even if you do not personally identify as religious. So, these types of thoughts can still come up cuz a lot of times people, even if they don't identify with it, there's still big fears, you know, and kind of worries someone might have about what happens next and, you know, am I doing the right thing?

But generally religious OCD kind of involves repeated obsessions and intrusive thoughts about making some sort of religious mistake, error, not being um kind of like morally and religiously correct in some way. A lot of the common presentations you'll see are things like needing to kind of repeatedly pray or make uh like perform religious rituals.

So, commonly that might be things like I have to be doing the sign of the cross anytime I get a bad thought. Um if I have any thought in my head that I feel is sinful or wrong, I need to do something about it to instantly make it go away or else um a lot of perfectionism there.

So, a lot of times it's not just oh, I have a prayer routine I like, but it's I have to say this prayer perfectly. And if I say even one word wrong or if I have even a second where I have the wrong intention or thought as I pray, it's wrong, it's sinful, I need to stop.

What if it makes something bad happen? I need to repeat.

Right? It's the health thing. Like I I I'm just going to be frank because it's like I've heard it. It's like, "Oh my goodness, if I don't do A, B, and C, I'm going to hell."

Yes, that's a lot of times that's one of the big core fears is I'm either I'm going to hell or I'm disappointing God in some way. I will be rebuked by my religious community for not being religious enough or in the right way.

So, it definitely tends to correlate around those general core themes or like I'm not sure enough about what happens, which means instead of hell, maybe it's this idea of like what if I what if I'm in the wrong faith and then because I did the wrong thing, I'm kind of stuck in this void of devoid of meaning in the afterlife.

So, a lot of religious OCD tends to correlate around those specific core fears and it does tend to have a lot of similar compulsions across people. So, you'll definitely see general things like um repetition of prayer, the need to perform repeated religious kind of uh like acts and rituals, um repeatedly seeking reassurance often from their community, pastor, priest, etc. and people in their life, the need to kind of be like ruminating constantly and asking themselves, "Am I religious enough?

Was that wrong? Am I a good person?" Usually hyper avoidance. So, a lot of times anything they perceive as sinful or wrong becomes this area where they need to pull themselves back from extremely to prevent even the uh the wrong thought from entering their mind.

Um so, those are a lot of the common compulsions. Of course, the presentation of it can vary a little bit cuz each person's religious practice is going to vary and you know, varies by community even. So, you may see different versions of these types of compulsions across cultures, across different religious backgrounds, but a lot of times it just looks like these very like repeated mental and physical acts.

Um basically where there's any concern, any fear pops up that I'm kind of being sinful, wrong, not religious enough in some way and that caused so much distress, so much fear that they are you know, they're feeling like they are pushed, they're almost forced into doing these compulsions to correct it.

So, there's a a huge preoccupation with kind of needing to achieve this almost like perfect level of spirituality, of religious practice that if they fail to live up to makes them this terrible sinful person who's going to hell, who's going to be rebuked, kind of all of these really intense negative fears.

Of course, granted if you ask them that, they may not put it in that language, right? They're like, "No, this is just how it should be." And if I'm not doing that, it's you know, that's what everyone's doing, right? But, that's that's typically that presentation.

So, it's not just having routine or general spiritual practices, which I think many people have, right? Of like, "Oh, I like to say my prayer routine in the evening."

And we are routine I mean, it it helps to have routine. It helps to And so, that's what I'm trying to get at is is for people to understand like there is healthy conviction. There is healthy uh religion followings and healthy churches and synagogues and and and places to go, right?

It's just it becomes unhealthy when you can't function in society in a way that is you know, helpful for you and for the other people in your life.

Yes. And I would say what I often times use to help people understand that cuz a lot of times again, it's something people care about a lot. So, the idea often times people struggle with when they start treatment is I don't want to not do any of these things cuz they feel like part of my authentic spiritual practice and experience.

And so, part of what my job as a therapist is to help them disentangle that a little bit and understand the difference between it. Cuz while we all do have routines, we have practices, there's cultural practices a part of different churches, different religious practice, different ethnic groups, right?

Like how we want to practice has ritual as a part of it. And so, to disentangle the ritual of compulsion from the ritual of culture and religion is important. What I often highlight for people is that it's a one way I like to help them reflect it is, do you feel like you kind of have control over it?

Because again, it's one thing to make a personal choice of something that feels authentic to you that helps you feel closer to, you know, your higher power, your God. Versus if it feels like you have to do this, or else you cannot possibly move on.

You can't move on in the day, right? Because no matter what the religion is, right? Like Christianity especially, right? It's not about this idea of perfection. So, much of it is centered in this idea of empathy and forgiveness and maybe like striving, right?

For, you know, our general morals and principles. It's really what these people struggle with is much farther from that, right? It's this extreme version in which they actually lose a sense of control. So, it becomes, are you actually praying because you truly feel this connection right now and you would like to kind of experience that and do it, or do you feel like you have to right now?

Do you feel like if you don't do it, something bad's going to happen?

Right. The The axe is going to fall down.

Yeah, right? Like this is it. The axe is going to fall

testament God. The cosmic abuser is going to come get you.

Yes. That's like a way to help people differentiate. Yeah, that it's the

You know, it's not about this like, oh, I just I'm just choosing this. It's, you know, but if you made a small mistake or some of these just normal human things, if there's an immense amount of fear and distress around that and a feeling of like, I have to fix it or else, it's a great point to kind of reflect it.

It's like, hey, you're actually losing the point of this, which is connection to your spirituality.

And peace.

Peace.

You know, like really actually being authentic in the way you pray.

Right.

Versus now you're performing this ritual in a specific way that isn't even usually mandated by your religion. You know, like no one's telling you you have to say every single word perfectly or else like you're a terrible person. But it becomes this I've lost almost control in it, right?

That I almost feel compelled to do it.

Mhm.

Active choice is no longer feeling like a a big component. So that that definitely helps people disentangle it. And of course too, you can kind of just look at it as many mental health conditions in the DSM. If it varies significantly, right?

So if most [clears throat] people in your church will be like, yes, we're praying, we're performing these rites, we're doing these things, but you feel like your routines are in excess of that and to the point where you're panicked all the time, you're struggling to maintain relationships, you're struggling to get to work even because you're doing all these rituals in the morning.

You're no longer functioning and you're doing these rituals in excess of what any kind of person even within your faith and culture would probably really even recommend you to do. A lot of times these people they're talking with their their priest, their pastor who's even saying like, hey, you really don't need to do all of this.

Mhm.

You can tone it down. You're you know, your faith is not in jeopardy if you don't do these things. Even that level of reassurance is often times not enough.

Mhm.

Still becomes but but what if?

But yeah.

If that that what if?

This one prayer, making this one mistake, doing this one thing, letting this one thought be here is enough. And so that's the difficult part is it's often far in excess of what is kind of considered standard even in that particular faith.

Yeah. So I want to I want to know what you think about what's happening in the brain. Because I think a lot of people, especially if they don't know, right? Like we know these things because we studied them, we go and get educated, we have continuing education units.

These are, you know, I'm not a niche OCD person, but I know anxiety, I mean, and I know depression. These are signals. To me, they're signaling something in your body and you better pay attention.

But could it be a physical thing that's happening like you haven't gotten a nutrient or is it because there was, you know, childhood abuse that you disassociated from and it's in your subconscious and then all of a sudden, oh, now I remember back when I was 8 years old, I got caught masturbating and then my mom said I'm going to hell and we were raised in a very religious and so now I'm constantly like, oh my gosh, but now I have sexual thoughts cuz I'm a teenager.

You know, it could go I'm sorry, I'm going into a rabbit hole. I'm just I I I I literally just put like five clients in one statement that I had back when I worked with teenagers. But you know what I mean, right, maybe?

Yeah, yeah, that's I I would say I think unfortunately we don't fully know exactly what causes this to develop. Like um so many mental health disorders, there's a clearly complicated web of factors that can have a play. So there is a genetic component to OCD.

It's not 100% genetic, but there's a component there. Um these behaviors and rituals can certainly be reinforced by a caregiver. So if you have someone growing up who uh like a parent really instills perfectionism, a need on state control, difficulties with managing and accepting uncertainty.

These things can definitely be a lot more likely to develop. Um in fact, some parents often have undiagnosed OCD and bring those same exact fears into play with their children, right? They're like, oh, but no, this isn't clean enough. You know, you have to kind of follow these specific steps, which are likely to then be repeated.

Um I will say trauma, of course, like anything, it's just such a It's one of those factors that makes you more likely to, of course, struggle with any sort of mental health condition, but it's not particularly tied to OCD. Um Many people with OCD, of course, have trauma.

Some of it is related to the theme they struggle with. A lot of times, it's not necessarily related. So, it's one of those things where you don't have to have any sort of sexual trauma to have a sexually themed OCD. You don't have to have religious trauma or have any you know, church hurt to have any sort of moral scrupulosity OCD.

So, yes, can you have it? Absolutely. And I think it can play into the fear, right? Where not only is it at the specific fear of Oh, I could do this and go to hell, but it also can involve a lot of like personal guilt or shame that might have been involved in a previous trauma, which then can even make that harder to overcome the specific fear, but there isn't a one-to-one necessarily.

So, that is a misconception I think a lot of people have even is I get a lot of clients who come to me saying, you know, like, "Oh, I have a you know, like a very specific sexual trauma or this particular thing happened.

Is this what gave me OCD? And if I get rid of the trauma or if I treat it, will I not have this theme?" And, you know, the answer often is, it can certainly play into it, you know, without a doubt. Even if it's something you feel very activated in where you're getting consistent symptoms, sure, it's probably playing a role in how you feel towards it, but it's unlikely to be the exact cause.

Right.

Which is What happens is OCD just goes towards things you care about.

Yeah.

Now, if you had a trauma, if you had a sexual trauma, you probably really care about justice. You probably really care about bodily autonomy, and you really care about not causing that same type of harm to another person because of how important it was for you and how hard it might have been to recover.

Right.

That might make OCD care about it more and give you those types of thoughts, but it's not necessarily related to because I experienced this, now my OCD theme is there. It's usually more tied into things I put a lot of personal meaning to or things OCD is likely to attack because OCD's whole goal is kind of to get a response.

Right? It wants you to perform a compulsion. A compulsion is kind of the food, the fuel that keeps the OCD fire going. Without compulsions, OCD actually falls apart as a disorder. So, it's very cyclical. If you can break that cycle,

Right.

all apart. The obsessions, the intrusive thoughts fade on their own

Mhm.

if we don't feed them in this exact loop. So, OCD's job is almost uh an a A metaphor I like is, you know, like those clickbait news articles?

Oh gosh, yes.

There's a cure for cure for liver cancer. You know, big medicine doesn't want you to know.

Yes.

Terrible thing happened in your town. That's kind of OCD's job. It is a clickbait news article generator.

Right.

It needs you to click on it, which is to do a compulsion, to give it attention. And so, to do that, it's in your brain. It has access to everything you've been through and everything you value.

Mhm.

It is not going to pick something you barely care about because you won't do anything about it.

Mhm.

Right? If you know you don't care or like that doesn't feel true to me, that doesn't feel fake, that's not something I'm concerned about, you're unlikely to do a compulsion and so that thought fades. Now, when it picks on something that you have a lot of emotional response towards, we are much more likely to engage in a compulsion, right?

And so, I do think that to me is how I often see trauma does impact OCD because things that you went through are a big part of your story and often really care about it, right? You really It affects our morals deeply, which is we've been through that, we have so much empathy for other people and not wanting to repeat those cycles of harm.

So, OCD is going to gravitate towards that because you care so much, you will have a stronger response to it. You have a stronger response, you probably feel like you're going to have to do more compulsions. And so, it definitely [clears throat] targets your values.

Yeah.

Trauma just happens to be one of those things that, of course, it can have an impact on our values because it's part of our personal narrative and story. But, treating a trauma does not necessarily cause the OCD theme to go away. It can make it less intense because, obviously, you have less activation, less guilt, less shame.

Right.

But, it doesn't, on its own, cause the intrusive thoughts to actually fade. You still have to take that additional step of OCD treatment, whether formal or informal, which is to stop engaging in compulsions towards the thought.

And that's hard because, like, whatever uh fires together, wires together in the brain. So, this is what's happening in the brain. We got to get people to understand like oh, okay, like, it it is something that, you know, has gave you comfort, you know, and I think of like back in the day before I knew all this.

You know, I had a lot of superstitions. Like, and that was part of like, oh, I got to do A, B, and C in order to make sure I don't go to hell. Let's give you an example or something like that, right? And it's like this you know, and so, having to face the the fear, the false evidence appearing real.

I want to know about exposure and response prevention therapy. I really have not done a deep dive, and that's why you're here. So, I Can you explain that a little more and how it does help OCD?

Yeah, yeah, absolutely. So, exposure response prevention is basically just a form of exposure therapy specifically for OCD. So, it's really not that dissimilar from typical exposure therapy you would see for phobias, for social anxiety, for all sorts of other stuff. The big difference is that not only are you doing exposures, which is just any any act that is going to elicit some distress.

In OCD, that distress is tied to intrusive thoughts. So, more than likely, it's an act that is eliciting intrusive thoughts. And the big part is that you are doing response prevention, which is just a fancy way of saying, "Don't do compulsions."

So, the goal

But but I can't help it.

Yeah, I know.

I can't I can't help it. What do I do?

Yeah. So, the goal of it is every ERP exercise is trying to elicit some amount of distress and then practice resisting engaging in the compulsion. So, what that actually looks like is usually we build a hierarchy. We don't start with super intense fears and big things that you're terrified of.

We take your theme, we break down your triggers, and we figure out what are some different ways we could elicit some of this fear, usually starting very mildly, so that we can practice resisting fixing it with the compulsion, and that way you're actually able to see what happens as a result.

So, you get new learning. Now, that's the same principle of traditional exposure therapy, which is, "Hey, I'm doing something." And in an OCD mind, the compulsion fixes it, right? So, to someone with OCD, the reason you are constantly exposed to intrusive thoughts but don't improve is the fact that to the brain, in OCD logic, the fact that this thought came up,

Mhm.

but nothing happened, and of course they were still safe, doesn't feel safe because in their mind they interpret it as the only reason I was safe was because I did the compulsion, right?

So, I had the thought of like, I don't know, just, you know, a a random sexual thought, but because I did the sign of the cross three times, that's showing to God that I actually like disagree with that, and that that's not my morals, which means that's why I'm not going to go to hell, and that's why it's okay.

Mhm, right? So, even though, of course, we know from someone outside of it that whether you did the sign of the cross or not, that thought probably would have faded, and the same thing's going to happen to you. To someone with OCD, the compulsion is read as the reason these bad things aren't happening.

And so it's very important with exposure response prevention, we are trying to do some of these things and either reducing, delaying, or not doing the compulsion, and then allowing them to get the naturalistic learning of what actually occurs, right? So let's say instead it's okay, we're going to let that thought pop up, but this time let's practice, let's do the sign of the cross once instead of three, right?

Like three feels extra safe, let's just do it once and see what actually happens.

Right.

Because clearly

there with the client with the Okay, I was I'm just trying to to picture this too. Like with, you know, you know how you were talking about the social phobia that you had and you said you went through exposure and uh response prevention, right?

Yes.

So my thinking is like did someone go and say, "Okay, now you're going to go outside and talk to one person?" Or how did that work? I want I want to I want to do the religious you know, the scrupulosity kind of like challenging that too, but I also want that have no idea about, you know, they're not Christian or whatever that they're feeling that so cuz that's the thing that I see a lot, the social anxiety because of COVID like that.

Yes.

That has been intense now for a long time for, you know, 6 years and that developed in the brain of like, "Oh my gosh, I I'm I'm sure because you're probably cuz I don't, you know, I will refer people to you, but I'm sure you're probably seeing the like the cleanliness one and then the social one like full force nowadays more than ever because of what happened.

Yeah, after after COVID, that's what I said, it caught me into OCD because it was so much agoraphobia again cuz people like I'm so used to not having to go out or see

So how do you help someone that has that? Like that.

Um so for like agoraphobia specifically, it is the same concept. We're doing the same thing of building a hierarchy and personally I do it together. I will say that varies clinician by clinician. Some people prefer to do it in this way where it's like I'm just telling you what the exposure should be.

We're coming up with the plan. You're doing it on your own and then you come back and tell me.

Okay.

I prefer to do it at least the first time you practice it, whatever the new exercise we're doing is. So, let's say exposure is and again, this sounds small, but it's often one of the first exposures for agoraphobia, we're walking to the mailbox and back.

By yourself. Don't You know, you're not You're not bringing a friend. You're not bringing any safety things with you. Don't bring your, you know, your um like anxiety medication. We're just kind of going for the walk, staying there, going back slowly.

So, and then you talk about what happened, the feelings and the emotions that came up for you the person or like, you know, I'm just curious about like how like, all right, that's that first step. Now, they come back. Are you going, okay, what's going on in your body?

Are they breathing heavy? Are they thinking like, oh my gosh, I'm going to die now because I didn't do A, B, and C? Like, how else

Yes, the whole the whole time we're kind of like just allowing them to almost think out loud.

Okay.

I will say the role of a therapist in that type of exercise is a lot of just kind of a little bit of encouragement before we get started.

Mhm.

Allowing them to be aware of these are thoughts or sensations that come up as I do it,

Mhm.

kind of reminding them like my role is almost to help remind them of the process which is just because it's there doesn't mean we need to read meaning into it. Right, which is I feel anxious. My brain wants to say that means I'm going to have a panic attack which means all my neighbors are going to see me which means I'm going to be an embarrassment in my community.

Uh-huh.

Let's just try to stick with the actual sensation, right? Which is you're noticing shortness of breath, tightness in your chest, and nervousness.

Mhm.

Instead of ruminating about it, which is to assign all this meaning and think about what's going to happen, let's practice just staying present. Staying present in your body, not fixing it. So, a lot of exposure therapy is a little counter to what a lot of people traditionally learn for more typical anxiety, which is like deep breathing, do your progressive muscle relaxation, do all these cool thing techniques.

Um but the issue with this is well, you can't do those 24/7. You know, it's not really healthy and at its core, these are things you're going to learn to get used to and really don't need to cope with.

Mhm. And then those become compulsions.

Yes. They become a compulsion. They become in agoraphobia, we call them safety behaviors, but they are essentially also compulsions. They are incredibly similar, so you'll see a lot of similarities between OCD, phobias, and things like that. So, yeah, the goal is I don't need to reassure myself.

It's all going to be okay. Nothing bad will happen. Just stay present. Notice what's there, but we're practicing kind of avoiding the habit or compulsion or safety behavior of reading into it and trying to fix it right away because typically someone with OCD or any kind of social phobia is really mentally trying to do all of these big things to feel safer.

And again, it sounds simple cuz it's to the mailbox and back, but to them they might be going into their head needing to come up with a strategy of like, "If I had a panic attack right now, what would I do?"

Yeah. What if this happened? What if that happened? Yeah.

Yeah, they're doing the what if dance, I like to call it. My goal is to help them be aware of that and kind of continually reconnect back to the body. Nope, we're not. Let's try not to do that. We don't know if it'll work, right?

Like, you don't know if that strategy would work. Let's more focus on what's actually in front of you. Stay present. Stay focused on you're walking. You're seeing your neighbor. You're getting the mail. You're coming back. And once the exposure's done, we're processing that new learning.

So, really kind of showing them Hey, yes, you have these anxiety sensations. Were they actually dangerous? Cuz that's the big fear of both

It's a challenging of the thoughts and rewiring the brain.

Rewiring the brain because my brain screams, "You can't feel this way and be okay. The reality of course is you can do things anxious. It's not dangerous. It's uncomfortable, yes, but not dangerous. So even if I did get panicky, even if I had a mini panic attack while I was getting the mail, the new learning is to kind of process through, but you were still able to do it.

Yeah.

Just do it.

And you had the accountability and the encouragement of of another human telling you and and witnessing cuz that's what I'm hearing is that you witness the new wiring and make them understand that they can do it because so many people get so stuck and feel so alone that they think this is the only way or there's no hope for them and I have to tell you there's always hope.

There is always hope. So on that note, I want to know is there any practical tools, books, or resources that could help anyone that's listening right now that's like, "Hey, that sounds like me and I I need help and you know, I don't live in any of the states Megan Megan is practicing."

Absolutely. So if you need a resource, I would say for anyone who's kind of struggling with this type of thing is you can find an OCD specialist. You know, if you're not in one of the states I'm in, the International OCD Foundation has a website and they have a great locator tool.

So you can plug in your zip code and it's international and you can find people who basically are part a member of the International OCD Foundation. They are going to list their specialties as well as the way they treat OCD. Um, so they're going to kind of list all that information there and it's a great resource to be able to help you find the specialist.

Of course, you can use traditional methods like Psychology Today and you know, search and plug in, I'm looking for someone who does OCD and ERP and XYZ and do it that way, but I find that that's a great website. I'm on it but many many OCD specialists are members of this organization and are listed on there.

It's also a great way to find support groups. So, especially if therapy is just financially or time-wise or there's no one near you who can offer it, it also helps connect you with support groups, many which are peer-led and free, and that you're able to join and get access to.

So, that's a great resource for finding a provider. Um in terms of information, I will say exposure therapy actually has a lot of free information out there, which is the great part is because it's so well known it's been around for decades, and it's actually very commonly used because it's used for every phobia.

There's a lot of basic resources out there that are free and can kind of guide you through the basic process of things like creating a hierarchy, testing things out, and seeing what happens. I will say it definitely helps to work with a specialist because the treatment is simple in theory, very hard in application.

Yeah.

Um so, actually like brainstorming your exposures, being able to have someone be there to support you through them, but then also really help you process through, you know, your new learning or to be able to help troubleshoot with like why didn't this one work,

Right.

right?

Cuz a lot of times people are not aware of just the amount of safety behaviors or compulsions they're doing, and so that creates a big issue is if you're doing these exposures, but doing a bunch of compulsions, they're not nearly as effective, and people can stay stuck for a while.

So, I do think it's still really useful to work with someone through it, um whether they're a mental health professional or even like a coach who does ERP. Like having second sets of eyes sometimes on what's going on can be really useful, and we all need a bit of encouragement sometimes.

There's also a lot of pretty low-cost because again, a lot of this information has been around for so long, right? Like this is not a brand new manual. There's no one who really has the copyright on the treatment manual. Um there's a lot of resources out there, so even things like um workbooks are pretty accessible and low-cost, and tend to contain the at least the basic principles of ERP if you're trying to do it in a self-guided way.

So, one that I will refer clients to, although I do have my own workbook, too, that sometimes I'll say

do?

different one. Yes.

But, I mean, do you have a workbook for sale?

Yes, yeah, I have a I came out with it this year.

On your website?

OCD workbook. Yes, it's on my website. I think that's all we need to plug in.

Okay. Yes, recommend mine, but I will say there's so many out there, and again, it's not necessarily um you know, it's not brand new. It's not unheard of.

Mhm.

ERP is pretty out there, although like again, I think there's not enough clinicians, and all of us kind of know about that diagnosing and putting it out there.

I I This is why you're here. Like, I'm like I

Yeah, so that's the

another modality. Here's the And And it's beautiful though, because listen, this is the thing. Like, human beings are so We're so alike, but we're so complex, too. We're so different, but alike. I don't even know how to explain that. Like, you know, we all have blood and bones and nerves and head and brains and stuff like that.

But, then we're all very uniquely made. That's why we have thumb prints. And so, it's for you to not give up and and find the help that you actually need, and understand like, you know, you are basically responsible for yourself. So, it's like it you know, the witnessing of a therapist, this is what I like to call it, because some people come in thinking like, I'm giving them advice.

I'm telling them what to do. No, I have modalities. You're with yourself 24/7. You really know who you are. Sometimes people like, "No, I don't know." And I'm like, "That's because you've been listening to this world too much, and now we got to get you to a point of like understanding what is happening so you can function.

We are all meant to function in a healthy manner in this world. We are, Megan. So, where can someone find you?

Um so, probably my website is going to be the best bet. Um I am in the Fort Lauderdale area, so if anyone's around, you know, they can

they can find me that way. Um, but my website is stillmindpsychology.com. I I'm also on the IOCDF website. You can also kind of search my name. Um, luckily, I guess there's not that many Making Chromies out there, so I'm pretty up there on the search results.

Okay.

Uh, but yeah, you can reach out to me that way. Um, I provide

And and what's the age group that you work with?

So, I I typically work with teenagers and up. Um, it's it's in person usually I'm able to work with a little younger who benefit from it, and then virtually usually I work with like 15 up.

Okay. That's good to know. So, I'll have all that in the show notes. Is there anything you want to say to the audience before we say goodbye?

Um, I just hope if this is something you relate to, one of the biggest things, which I can't stress enough, is that OCD and phobias are highly treatable conditions. While yes, we cannot eliminate intrusive thoughts cuz they're part of the human condition, the actual act of obsessing about it, so really struggling with them and needing to perform compulsions, is really treatable.

So, a lot of people are able to essentially make full recoveries from OCD. It's not something that people have to live with fully in that way forever, but lack of kind of like getting treatment and taking those first steps keeps people stuck often times for years.

So, if some of these things we mentioned, hopefully if you feel like you relate to it in some way, I really recommend taking those steps to get help in some way cuz a lot of times what people maybe assume is anxiety that they're just going to have to live with for the rest of their life, ends up being this incredibly treatable condition, and a lot of people are able to get their life pretty much fully back.

Yes, you may still always have to deal with the occasional rare intrusive thought every week or two, but actually struggling and living with OCD and just the absolute horror it can be because it can be so debilitating.

Mhm.

It is very treatable for the majority of people.

Mhm. Love that.

That's one thing I would just instill hope and really say if you feel like any of these compulsions or things or are pieces you're struggling with, really worth going out and like seeing someone, getting assessed, you know, seeing if that's something that's happening and looking into what treatment options you do have because ERP does work tremendously well.

Of course, we can't guarantee anything as mental health therapists, you know, but a lot of people are able to make pretty much full recoveries, but to be honest, one of the saddest things I have seen is that so many people have been living with this for decades before

Yeah.

they talk to me, before they get help, before they actually realize, "Wow, I have these other tools and I don't have to like do this compulsive response. I can actually just let these thoughts be here and get my freedom back." Like that's one of the more heartbreaking things is a lot of times they've

suffered for a long time.

They've suffered for so long or they've

Well, that's because of the stigma on mental health. The second you try to And then this is why this show exists cuz I'm trying to break stigma in churches and in the in the in my people's community, the the black indigenous people of color community, you know?

And and and for everybody, honestly, but but you know what I mean? There's so much stigma going on the second you're like, "I have this thought." Oh, you're crazy. Oh, you're crazy. I mean, I don't know how many times I heard that and now I just like go, "Okay, yeah, I'm crazy.

What you going to do about it?"

Yes, I think it's so important to break the stigma

Yeah.

Especially culturally, there's a lot of negative stigma with intrusive thoughts and

Yes. It's scary. It's scary when you have like really like of hurting yourself of of religious going to hell of like trying to like sexually doing something like and you're stuck in that and then you feel like you're alone and then people think the only way out is to hurt themselves and then that And we didn't even get to the other stuff that I was going to ask you, but but listen, I will leave all the information resources we talked about in the show notes.

If you're listening to this and you need help, please reach out to what you see you know, the links in the show notes and stuff and then can you name the states again that you practice in?

Yes, yeah, Florida, Texas, Vermont, Idaho, and South Carolina.

All right, you heard that. So, any of you in in those states, please reach out to Megan and if not to the International OCD Foundation Is that what you said? The foundation, that'll be in the show notes, too. And I just want you to understand like there is help out there.

So, please go get it. And if you don't have this, please have some compassion and understanding because you never know what another human being is going through. Okay? And do not forget to trust in the Lord, guard your heart, and renew your mind.

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