Kristen

Welcome to the Close the Chapter podcast. I am Kristen Boice a licenced Marriage and Family Therapist with a private practice Pathways to Healing counselling. Through conversations, education, strategies and shared stories. We will be closing the chapter on all the thoughts, feelings, people and circumstances that don't serve you anymore. And open the door to possibilities and the real you. You won't want to miss an episode, so be sure to subscribe Welcome to the close the chapter podcast I am so grateful you are here with me and my special guest today. If you've ever struggled with anxiety, OCD, which is obsessive-compulsive disorder of any kind, you're gonna want to tune into this episode or maybe you have a loved one that's struggling a friend, a co worker, a family member, a colleague, the list is endless. We all have some form of anxiety. I'm going to be talking about what makes it turn into OCD. How does it develop? What are the signs, how do we work through it? How do we manage it, all that good stuff. So I know your time is valuable. And the fact that you're here with us speaks volumes and I am so grateful that you're on a growth journey of self-discovery and wanting to really discover who you authentically really are. I'm so glad you're here with us. So without further ado, let me introduce you to my amazing guest today that I'm so grateful is on the podcast. Medina alum licenced mental health counsellor and you are the Clinical Operations Director for the mid region of NOCD. Her current work includes treating individuals with OCD, obsessive compulsive disorder. And she's also provides a manages the operations and clinical competency for the organisation. Previously, she has contributed to the training and onboarding of therapists who are new to OCD, and ERP what is ERP for those that might not know,

Madina
exposure response prevention, which I'm sure will talk a lot more about today. Yes,

Kristen
we will dive deep into that. And she is a lover of all things fitness and well being and you're also a yoga instructor or yoga teacher.

Madina
I am certified to teach yoga, but I'm currently not formally teaching.

Unknown Speaker
Well, welcome to the close the chapter podcast.

Madina
Thank you. I'm so excited to be here.

Kristen
I am thrilled you're here. This is a subject I have not covered a lot about anxiety. But we've never talked about OCD. So let's first define what is OCD? And really how does it develop. So if you want to add anything about your background, feel free to jump in with that too.

Madina
You did my background perfectly. So thank you. OCD stands for obsessive compulsive disorder. So really the presentation of it is what we call obsessions. So these are intrusive or unwanted. That can be thoughts, images, urges that are typically followed with what we call compulsions. So these are behaviours that can be mental or physical, that a person will do to essentially reduce their discomfort or distress in the moment. And so because there's that cyclical cycle of each time someone does that behaviour or that compulsion, it strengthens the fear, so the fear is stronger, so they want to do the behaviour more. So it goes back and forth, and it becomes impairing to their life. So it'll impact different areas, which is what makes it clinical. As far as how it develops, there is a nature and nurture like most disorders that play in conjunction. So if you do have a first relative with OCD, you are more likely to develop it genetically, but also is probably things that maybe you observed growing up in childhood. The world is a scary place is something that is often taught to people with OCD, unconsciously right through the caregivers behaviours,

Kristen
how much trauma? Does trauma play into the development of OCD? Like if someone has any type of abuse, neglect, whether it's sexual, physical, emotional, unprocessed, grief, traumatic loss? How much does that play into developing OCD?

Madina
I don't know that I would say it's like one of the main factors as far as developing OCD in particular, but we know that people who've experienced upsetting things might have a predisposition to developing anything, right, because they're, they just experienced that upsetting memory. So their tolerance might be a little bit lower. And this might be a little off topic, but I'm going to say because I think it's important. Trauma and OCD have a lot of symptoms that are very similar. And so it can often be treated in a very similar way as well.

Kristen
That's what I found with EMDR eye movement, desensitisation and reprocessing, there's many modalities there's brainspotting, somatic experiencing, there's a lot of modalities that treat OCD. What are the symptoms that you first see with someone that comes in with OCD?

Madina
The first some noteworthy thing I'll notice is usually someone's been struggling for a very long time with OCD and didn't know. And so usually by the time they're seeing me, it's been years and years. onset is typically pretty early in childhood. And part of the reason we have no CD is because there is such a misperception on what OCD is. And so that is why people struggle for such a long time. But typically, what people will present with is there's some sort of like chaos or disruption in their life because of the obsessions and the compulsions. And so, yeah, to answer your question,

Kristen
yes. And I'm wondering, like you said, early onset, do you have an age typically, that you've researched, says it develops, often within this age range?

Madina
Don't quote me, but I believe it's 10. It's something around that, like seven to 12. I feel like I should know that off the top of my head, and I don't know, it's like pretty early. And typically, that's a good way to understand too, if someone is currently presenting with OCD. If you go back into their history, there's typically something kind of peculiar around like the way they thought maybe when I was seven, I worried that I was going to get AIDS, something a little bit above and beyond then, like a general anxiety of like, oh, no, like, hopefully, I handed in my schoolwork. Although OCD can present that way, too. It might just be a little bit more out there.

Kristen
Some people think it's like I count and they think, Well, I don't have the counting thing. But I have rituals, like I need to touch the doorknob. And then I need to go back and check the lock. And then I have to go back and check the doorknob like is that patterns and rituals a part of OCD from your experience?

Madina
Yeah, I'm so glad you said that. Because there is such a like, linear way that people see OCD. So it's like counting or like cleaning or like organisation which OCD can manifest that way. But there are a lot of other So there's four main types of OCD. One that many people might not know about is called harm OCD. So maybe this fear that I could harm myself, this fear that I could harm someone else. And it's followed by oftentimes a lot of actual, like mental rituals. So rumination on like, do I actually feel like I would harm that person? Do I want to do something like that? Do I want to live and it's very distinct from actual suicidal or homicidal ideation. And so just kind of understanding the different ways OCD can present is really important. And again, such a big part of why this organisation exists, is to get the word out because people with harm OCD for a lot of times are struggling with it and don't even know what's going on, or providers have, unfortunately, so sad, but providers don't fully understand OCD. And so I have clients I've seen who have literally been sent to the emergency room or like, put impatient because their provider thought that they were homicidal or suicidal when they really had OCD, or have OCD.

Kristen
Yeah, that's a good distinction. What are the other three? You mentioned? Four.

Madina
Yeah, so contamination, which is another really common one. So like germs, harm, unacceptable thoughts? So These might be things like, what if I'm not the sexual orientation? I think I am, or what if I'm a paedophile and then symmetry or just right. So that's like, kind of the organisation? Yeah, let me say this too, because it's interesting, sorry, I guess. So I'm talking about love it. So just write your symmetry can manifest that way. So like maybe organising or putting things in a particular way. But it can also manifest very somatically. So I don't feel quite right. So these are people who oftentimes might have an overestimation of like, their body sensations. And so the people who chronically go to the doctor, like there's something wrong with me, or what does that sensation mean? Or I don't feel quite right. What does that mean? So it can manifest in that way as well.

Kristen
That's really helpful to break it down in those four ways. Because people think the movie with Jack Nicholson as good as it gets, what you just took a breath. Tell me about,

Madina
Max, you're really bad with movie, so I have no idea what you're talking about. I haven't watched that movie.

Kristen
That's okay. It's old. It's an old movie. But basically Jack Nicholson is mean whether it's leaving the house, he has a germ phobia. So he has to bring plastic silverware with him to eat, he has to have the waitress act a certain way towards him. So he's kind of controlling, I mean, it comes across this controlling but underneath it's driven by fear. So the whole movie is centred around his anxiety and his fear and how he works through it through exposure, and building this relationship with the waitress. So let's talk a little bit about exposure therapy.

Madina
So exposure response prevention is ERP is actually the number one treatment used for OCD. And actually there's a lot of research that it's the number one treatment for a lot of anxiety disorders. I have a small private practice We're all treat, not just OCD, but just general anxiety. And I use exposure there as well. So basically, what you're doing is you're physically exposing the individual to whatever it is that they're fearing. And you're teaching them to essentially respond differently. So the whole crux of this treatment is that we're not necessarily getting rid of uncomfortable thoughts, images, urges, sensations, or uncomfortable situations, because we can't, right we if we could prevent bad things from happening, life would be a lot different for all of us. But we're teaching people that they can respond differently to what they're experiencing. So the big difference between someone who has OCD or another anxiety disorder that's clinical and versus someone who doesn't, is the person with the anxiety disorder has a thought that pops in, for example, so I might be driving and think, Oh, what if I veer off the road and run over this baby carriage? This mom is pushing? What if I do that, right? So person without OCD might be like, Oh, that was kind of weird and move on with their day. Someone with OCD or anxiety might stop their car, they might park it and get out and decide not to drive anymore? And then maybe they spend the whole day ruminating on what if I actually hit the baby? And I don't remember. And now I'm googling on internet to see if there was some sort of news article, right? Maybe I'm calling the cops to see if someone reported this right. And so it wasn't that the thought itself was different. Because everyone, I'm sure yourself included. We've had peculiar thoughts like that. It wasn't the thought that was the issue. It was everything that we did in response to the thought,

Kristen
and the thought controlled, it became almost like it really happened in the mind, or could happen.

Madina
Well, the interesting thing with that is, the way we can either strengthen or kill a fear is the behaviour. So the person who's not driving, Googling, calling the cops, those behaviours actually made the fear feel more real than the person who said, Well, that was weird and moved on. So this I love sharing this deck, I'm going to share it with you. So the plate and you might know this, but for the listeners, the place in your brain where anxiety and fear lives doesn't understand language. And so I could sit here and say, Well, you know, I didn't ever run over a baby carriage. I would remember that. But then if I did all those other behaviours, right, I stopped driving I Google, maybe I call my mom and say, Do you think that I would run over a baby and hit it and run right? All those behaviours, strengthen the fear, because that's all fear could hear, hear right in quotations, because it was paying attention to how you behaved. And so I love talking about what to do. But I also think all these skills are so relevant for anyone like I use these skills every day. Think of something you've been scared of everyone listening? Think of something you've been scared of? How did you get over it? Right? Can you think of something you were scared of? And how you got over it? A spider? So can you think of something that you've done to maybe get less scared of spiders?

Kristen
I think it's my thinking around spiders like, Okay, I'm bigger than the spider. It's okay. They're not going to hurt me. Even though they could bite me. I don't think it's my thought. If I'm processing it right now, it's my thought over the spider hurting me. I feel like I don't feel it doesn't have that body response like it used to because I got bit by a spider had to have my leg cut open. It was a big thing. So there's a reason. So it makes I was smaller when that happened. So that made sense to me. But now it's like, I'm okay. I can handle this to my thought around it. Yeah, I like how you said the behaviour can strengthen depending the fear. That's huge. What you just said,

Madina
Yes. And so every I think, again, OCD or not anything you do in your life, is your behaviour aligning with your values, or is it aligning with your fears?

Kristen
Is the behaviour aligning with your values, or aligning with your fears. So if someone has a compulsion, and they're like, I just feel compelled to get out of the car, stop driving, to use your example, like that compulsion takes over. And that's where their behaviour goes. Talk to me about that.

Madina
Well, that's when you teach people that discomfort is important, because really, what they're saying is it feels too uncomfortable. So I need to leave. And so the interesting part about being an ERP therapist is we're actually doing the opposite of what we're taught in school, right in school, we're set we're like, make them feel better, you know, reassure them tell them it's gonna be okay. I actually do the opposite. And you said something that was really important. You said, Well, I could get hurt by this spider. That's exactly what I'm looking for. Because you can you can get hurt by the spider, there is a chance you run someone over when you drive. Maybe you choke on your food later today. Maybe we could all die at any moment, right? And I'm not saying this to sound morbid. It's the reality of the situation. And so when I accept that there's uncertainty embedded in literally everything I can get At least live my life because what's happening with OCD and anxiety is that it's telling you falsely that you can avoid discomfort. But why does everyone come see me, they're uncomfortable. So really, you didn't avoid anything. And now you're spending a lot of time and energy trying to avoid, and you're still feeling uncomfortable. So I don't want to get rid of the discomfort for you. Because it's valuable for so many reasons. I know that might sound weird. But if I could, I can't avoid just comfort for you. I don't have that skill, I can only teach you again, how to respond to it differently.

Kristen
So the first skill you kind of had us try on was asking, what were you afraid of? And how did you get through it? Yeah. So what are some of the other skills when you're talking about you can teach these skills so people can get through it? I think one thing you said is accepting uncertainty like we, I don't know what's gonna happen one second for now, right? We have no idea. And getting that's the goal of the therapy is to help people just accept discomfort and uncertainty and be able to tolerate it and manage it.

Madina
Yes. So that is a good, like place to start is to acknowledge, like, Yeah, anything is possible. And then another thing I like to teach people is or to show people is to physically do whatever they're scared of. So I could sit here all day and tell you all the reasons why I'm sure you would be fine if a spider came in. But again, anxiety doesn't hear that. So I could be logical with you for the next 60 minutes. And you're still going to leave feeling? Ah, I don't know. Right? The best way would be to experience the spider right. And I think it's interesting, because it sounds like your worst case scenario did happen. And I'm sure you would prefer it didn't happen and obviously impacts you. But you also figured it out. You managed right. And that's the big thing with anxiety is that doubts, our ability to be resilient. And so sometimes which this might seven people might be like, Medina as a therapist, what, but I want some of my members, and we call our clients that no city members, by the way, so if you hear me say that, that's why, but I want individuals to experience sometimes those worst case scenarios to show them that they can handle it, it doesn't mean that they liked it, or they want to happen again, it just means that they figured it out. And they couldn't prevent it from happening, because that's what so much of anxiety is driven towards is this false perception that we can prevent bad things from happening. Oh,

Kristen
isn't that true? Don't we want like, we don't want bad things to happen? Yeah, we don't want someone to get hurt, including ourselves or other people, our kids or family, whatever, we don't want to go through loss and grief and trauma and those emotions,

Madina
right, which is valid, right? Those are not like they're not fun feelings. And I also like to point out, oftentimes, that desire to avoid those things actually winds up being a self fulfilling prophecy. So the very thing I'll use contamination, OCD is a very clear example, the very thing a person with contamination, OCD is trying to avoid getting sick, they're actually behaving in a way that increases their chances of getting sick by, for example, washing their hands so much that now their hands are crap. And now it's a breeding ground for getting sick versus if your hands were not cracked. So again, the very thing that person is trying to avoid, they've actually increased the chances of that happening.

Kristen
That's like their worst nightmare. But they believe in their mind that they're preventing. So how do you break through that, like that belief that they're really feel like they're protecting and preventing something bad happening? It's like that compulsion to say, No, I am actually, I believe that I'm protecting myself, how do you break through that,

Madina
the only way you can break through is to stop the behaviour. So you would typically you would like, slowly titrate off the compulsion. So say, like, someone's washing their hands 10 times after touching something dirty, I might have them touch something dirty. And let's wash it eight times. Instead, wash your hands eight times. And let's just sit with that discomfort with the chance that maybe your hands are dirty, maybe you'll get contaminated. And then maybe next time we do six and then slowly go down and down. And let's see what happens. And then I always like to point out the fallacies, right? Because you wash your hands so much, you must never get sick, almost always work. No, I've been sick. I'm sick all the time, actually. So are you telling me the very thing that anxiety said to do? So you don't feel this? Or get this or become sick? Actually didn't work. And now you're spending three hours Washington the day when you could be hanging out with your child or going for a bike ride or living our life. And the emphasis of there's always uncertainty whether we act out of our values, or we act out of our fear, there's always uncertainty, so we might as well act out of our values and still have that uncertainty.

Kristen
Yeah, that's the end result, right to get someone to that point, or they can live that way. Because anxiety doesn't disappear. Totally. I mean, you're gonna say something around that. Yeah.

Madina
No, I was just gonna say I'm sorry. I'm glad you brought that up. Because that is the last piece I think, and I'm sure you probably experienced this too is sometimes they actually think people are over pathologizing things that really are just ways of responding that are, I don't want to say normal, because I don't know if I love that word. But our ways that makes sense, right? We respond in ways that makes sense. And so I think the last piece of treatment is always teaching the person that yeah, sometimes you're going to feel anxious. Because sometimes what I notice are a lot of times what I noticed is Mateen. I feel anxious. And I don't know why. And I don't know where it's coming from. And it's like, well, maybe. So now we're going to worry about why we're worrying, or I feel a little anxious today, but I'm going to still go out and ride my bike. And I'm still going to cook dinner for myself. And I'm still going to call my friend on the phone. Even though I have that anxiety. They're kind of like background music. Because the last thing you want to do is to stop and halt our lives to try to figure out why we feel anxious. Because

Kristen
people want to know why. Like, why had someone just and I won't give away a details. They had a phobia of straw wrappers, wet straw wrappers, and I was trying to get underneath like, where is this coming from? Well, she had a procedure when she was younger. Yeah, I was like, well, maybe the rapper that the when they had to do the procedure, she has an unconscious memory of a rapper rap next to her like we could not get in, does that matter to figure out the root of it?

Madina
I don't think so. And this is gonna be again, the difference between talk therapy and ERP, a lot of times I'll actually gently interrupt and say, We don't need to know why we just know that this is upsetting for you. And how can we get over? Oh, we can get over it by let's get some rappers right now. Because that's the trick that anxiety plays these individuals to get back on top. It's like, Let's spend, I have sometimes and I giggle at this. And sometimes I can get my members to giggle at this too. Let's figure out why I don't feel anxious today. What's we're gonna sit and ruminate on why you don't feel anxious? Or can we go out and live life like a rock star because I feel amazing. Almost this rumination on constantly checking how you feel. And like determining if that's the way you should quote unquote, or not feel should or shouldn't feel. Versus just like accepting, like, Yeah, I'm human. So sometimes I feel anxious. Sometimes I feel sad. Sometimes I feel really great. Sometimes I feel even. And accepting that.

Kristen
Accepting that it's okay, whatever you're feeling in that moment, whether it's you feeling even you don't feel anxious you feel. And that's scary for a lot of people with OCD, because they're waiting for the next bad thing to happen. And so they want to prevent it.

Madina
Again, that false like believes that I can prevent bad things from happening and the way I know so that's already I'm gonna say it again, because they think it's valuable is we can truly believe that we can't prevent bad things from happening is to make sure our behaviours align with that. Because most people listening whether you have OCD or not know, we can't prevent bad things from happening, right? We logically can. But is your behaviour matching up with that logic? Is your

Kristen
behaviour matching up with the logic of that you cannot prevent bad things from happening? So you're looking at your behaviour, as a cue to say, am I trying to behave in a way that protects me? And I'm spending all my time trying to behave in a way to protect me? Or am I behaving in a way that just is living out my values? Is that the question?

Madina
Yeah, that's exactly what like the end goal would be. I always say the best ERP is that you live your life, despite what you're scared of.

Kristen
You live your life, despite I'm repeating these because they're so important for people to hear again, living your life, despite what you're afraid of. Because you're living with fear, you're befriending the fear in a sense.

Madina
I love using this analogy because I think it makes sense. So if I go to the grocery store, and my task at hand is to get my groceries, but I get to the store and there's like a really annoying like song playing on the background. I don't know I don't I'm not a huge fan of country. So for me, it'd be a country song that I don't really like, right? And so I wouldn't necessarily stop getting my groceries to go to the front desk and ask them to change the song. I would still get my groceries even though that song was playing on in the background. So it's like either that anxiety or that thought right and might have those unwanted thoughts in the background. I might have that unwanted feeling in the background, but I still live my life and do the thing that I need to do. And you can think of this even with depression, right behaviour activation, you're getting up and you're doing the dishes even though you don't feel like doing it. I'm going over to my mom's house even though I might have a fear that I could kill her cooking for my friends even though I'm scared I could contaminate their food and they could get sick because I value hanging out with my friends and I value hanging out with my mom

Unknown Speaker
to take care of yourself groceries.

Madina
Yes. I value having food in my place, right? I use the example of every time I go to eat, I could show but I value not feeling hungry. Like that's really important to me. I could get into a car accident today, but I value my independence. Yeah. So

Kristen
this whole idea of not knowing the Y, there are some clients where we do EMDR what I just explained, that's a form of trauma therapy. I don't do you do EMDR at all, but I know what it is. Okay. And so we might target the straw wrapper, right? And just see. And that's how we can discover, Oh, I did have a surgery, and then the client, and that doesn't mean we're going to fixate on, we're going to reprocess what might have gotten stuck in the nervous system to body sensations, right, that fear that they feel, if so afraid, reprocess that, and let that come up and out of the body. And so it sounds like with ERP, because I don't do exposure therapy, or exposure prevention work in that way. It's different in the sense that you are actually does it have to actually be the thing like, or can you imagine it happening? Yeah, that's

Madina
a really good question. Yeah. So there's two different types of exposures you can do. So you can do the what we call in vivo. So that's real life where you recreate it, but we can't always recreate it. So we can do imaginal exposures. So I might have someone write a worst case scenario script of what would happen if they got their friends sick. And the cool thing about this is, a lot of times you can get to what's called the core fear. So the underneath fear of why they're so scared of getting their friends sick. And it might be eventually that I'm scared that my friends would hate me, and they would leave me and I'd be left all alone. And so you would essentially have them reread that script over and over to get them. Essentially, we call it habituation, right, you get used to something when you read it over and over again. And you teach yourself that just because I say or think something doesn't mean it will happen. And something that people with OCD are notorious for is what we call thought, action fusion. So this idea that if I think feel or say something that means it's true. And so when you have them say something and test out that hypothesis, like so if you say you're a paedophile that now means you're all of a sudden a paedophile. Let's test it out, because someone with OCD will say, Well, like I know, logically I know, but I'm never gonna say the word. So again, the behaviour is not matching up. And so you would expose them, I know I'm getting a little off the original question, but you would expose them to saying these things out loud, to show them. A they can get used to it, and they can handle the discomfort but also that because they say something doesn't mean it's true.

Kristen
So how does somebody that has, let's say, they really struggle with these ruminating thoughts and compulsions, they just walk me through some additional skills that you would help them with to really interrupt that from taking action, like their behaviour, right, the thought to the behaviour, what are some other things that people can do?

Madina
I think with rumination particular, because a lot of times people will say like, well, maybe I don't even know that I'm doing it right. I think it's really, really important to help inform the individual the difference between thoughts and thinking, because they are right, we cannot control thoughts. So thought is what popped in. So the thought of Oh, what if I run over this baby carriage that itself I cannot control? Because that's where people get tripped up? I think they think they can control that thought they cannot we all have intrusive, thoughts like that. Now everything after that thought, all the stuff, I'm conjuring up the effort, that is what you can control. So I think the first and foremost thing is to understand there's a difference between thought and thinking. So you're not trying to control the wrong thing. And then it's just progression, right? As soon as you do catch yourself thinking or conjuring up that information. You respond with what we call a response prevention message. Well, this is what I do. At least I know some therapists do it differently. But I'll have them once they do acknowledge that they are ruminating, I'll have them read a message that acknowledges the uncertainty. So maybe I did run over that baby. And I would have them say that on repeat sometimes, right? Maybe that is possible. I could have done that. Right. I'm acknowledging that uncertainty. And I'm almost approaching the fear in the sense of, there's so much stuff I could talk about. I feel like I keep going a little off topic. No, you're great. This is good. It's similar to like, if you were to tickle yourself, right? Are you ticklish by chance? Depends on were not real ticklish? Okay, go with that because a lot of people are okay. Yeah. So think of if you're ticklish I know for myself, I'm extremely ticklish. If someone else tickles me. It's so funny, right? I can't stop laughing. If I took on myself, it is not I'm not laughing. Right. And so ERP is kind of like that when you willingly do something, right? Because I'm willingly tickling myself. It's not funny, but if someone else does it, right, it's not something that's in my control. It's all of a sudden funny. So exposure is like that, if I will. When we do something scary, then it's no longer scary, typically. So when I willingly say like, yeah, maybe I didn't do that, or I willingly keep driving, or I willingly acknowledge all that uncertainty. The fear kind of dies. Because again, the behaviour doesn't match up. If I really ran over someone, why would I keep driving? So fear dwindles after that. Well, I mean, she was so dangerous, you want to keep driving. So

Kristen
Xavier keeps going, you're not changing your behaviour because of the thinking.

Madina
Because the thinking is not all too accurate. It's a little backwards to a lot of like talk therapy. Like I'll say things that are provoking, right, like, yeah, maybe you did do that. That is possible.

Unknown Speaker
And they're like, how did they respond with you say, maybe you did?

Madina
Well, I think I would like to think I give enough psychoeducation. So they understand. So a lot of times, they actually laugh, because you think they understand where I'm going with and the realness of the situation is anything anyone is coming to me with? I don't know. So that is like the truest answer I can give, telling them, it's okay. Or they're going to be okay, as false. I don't know. I don't know if you or I are going to be okay, today. That's the realness of the situation. And so back to your original question, skills, the first one is to decipher between thought and thinking. And then when you do notice thinking to insert it with a message that acknowledges and accepts uncertainty, and then moving on with your day, because really, what you'll notice with anxiety disorders is anxiety wants you to stop, and just like ruminate all day.

Kristen
Yes, they would love it for you to camp out right there.

Madina
But you'll share it all the time. I'm sure you do, too, is in the morning. I'm a dean, I just wake up and I'm anxious. 99% of the time, I'll ask them, Are you laying in bed when you wake up? And 99% of the time, they say yes, it's like, stop laying in bed. And when you wake up in the morning, I want you to get right up and start moving on with your day. Because the reason you're waking, you're not really waking up anxious, what you're telling me is you're waking up and you're laying in bed and you're thinking and now you feel anxious.

Kristen
That's such a good point for people to not get up and move your body. Yeah, if you feel anxious in the morning, that's so counterintuitive. They don't feel like it. Like a lot of people think anxiety don't feel like it, they don't feel motivated, they feel scared. So you're like you've got to change the behaviour, then the thinking will change sort of,

Madina
in a way. So what I think happens is, you don't have any less intrusive thoughts or uncomfortable sensations. But because you've given them less attention, they don't bug you as much. So a lot of times, like towards the end of treatment, people will tell me the guy that really had any intrusive thoughts. I know that's a lie you have, but you just didn't notice them as much. And so that's back to my original point is that it's not the thought that's the issue. It's the way we're responding. This is glad you said the thing about motivation. Because with anything anxiety, depression, the issue lies in trying to wait to feel motivated, you don't feel motivated, and then behave you behave and then you feel motivated. And we have it backwards. So if I am only waiting, and think of like working out, right, that's probably like the number one thing that people like, I wish I had more motivation to do. I don't think people really feel motivated a workout you work out and then you usually feel motivated after and so just switching that for yourself to know that it's not that I need to wait for that feeling. Really what they're saying is I don't feel quite right to do the behaviour. Exactly.

Kristen
Okay, so that's a great tip. That's a great skill, what other skills

Madina
along the lines of values and fears, I love having people create a list of values and a list of fears and kind of carry it around with them in any moment, just randomly throughout the day looked at am I acting out of my values? Or am I acting out of my fears? Because again, that distrust that anxiety instils and people like well, I don't know. I don't know. Am I sick? Look at the list. What do you think? So that says that's tip. My other really good tip. I think I'm like over here like my tips are so I love

Unknown Speaker
your tips. These are great.

Madina
Thank you. Another tip would be to check in on reassurance seeking so people with anxiety disorders often ask for so much reassurance. And the research shows the more you ask for someone to reassure you about something the more unsure you feel.

Kristen
That is boom, drop the mic right there. I call it survey says. Yeah. When you think do you think it says it and they're surveying everybody. And the research shows the more you survey, the more you seek reassurance, the less reassured you're going to feel.

Madina
In the moment, you will be like Well, no, I feel better if someone tells me I'm going to be okay. Yes, that's that temporary sense of relief and that's what hooks you in. I want to validate. That's why we do compulsive like behaviour. It feels good. Same thing with drinking or maybe unhealthy eating habits or poor decisions in the moment. They feel good, but long term they just hook you in. And so yeah, the more reassurance I'm gonna say it again, because I think it's important, the more reassurance you ask for the less reassured you feel.

Kristen
And that temporary hit, I call it like a shot in the arm, like you're like, Oh, I feel a little better, but then it comes right back.

Madina
And it teaches that you can't handle discomfort. Yes, I'm so quick to try to get rid of that. Again, that behaviour anxiety is like she can't handle he or she can't handle that. Yes.

Kristen
Okay, so I'm gonna give you an example. Let's do this. Because this is just, I'm in the deep end of this, and I love it. So I have two teenage daughters. And one wants to ask me all the time, what do you think of this outfit? And like, what do you think of the outfit? And she will keep going until she gets an answer that feels because she's anxious whether how she looks? And does this look. Okay? How do you disrupt that? Like that needing reassurance of the outfit? I'm giving you a benign example. But let's just play this out. How would you handle that? skill wise?

Madina
Yeah, I would probably give some psychoeducation on what she's doing right? Asking reassurance and how you really care about helping her feel more secure and what she's wearing, right. So that's what she's looking for is that security should feel that. And so because that's important for you to help her with, I would tell her, I would say like, I actually will not be reassuring you. So I've done things like if someone in session asks me for reassurance, and I've already gone through my spiel if I'm not giving you any reassurance, because I care about you. And that's an OCD symptom, I might just stare at you until you realise what you're doing. And then they're like, Oh, interesting, because it's that modelling to the point where a lot of my clients literally can catch it before they say they start talking. They're like, Oh, no, I know, you're not going to answer that. They'll say that. And I'm like, Yes, I love that, because they realised they weren't going to get what they needed. So that's how I would approach that situation.

Kristen
That's so good. I mean, just I like this psychoeducation piece, meaning you're teaching people that the more you ask for reassurance less assured, you're going to feel like it, you're not going to feel more confident, you're not going to feel more reassured long term, that's not going to be the solution to what you're looking for relief, you're looking for certainty. Yeah, you're looking for security. And it's not going to offer you that.

Madina
Right. The reason that that's so important is because this, this type of therapy can easily feel like you're being in a hole elsewhere on here, but like, I'm like, sometimes I'm like, Oh, my gosh, you come across that way, right? And so I even say that to my individuals, like in the beginning of treatment, like you are going to experience me very differently than maybe a talk therapist you've been to, and here's why. If I'm ever coming off like an aihole, it's probably because OCD or anxiety is trying to run the session. And my hope again, that's right, the therapeutic model is the hope that they model how you have been with them, right? So if I'm really stern, and strict and direct with their OCD, the hope and goal is that they're that way, when I'm not around that they're like, actually, no, I'm not going to do that. Because fear says it, I'm going to do what I want out of my values, not what fear says I need to do.

Kristen
How do you integrate self compassion into it? Or compassion in general?

Madina
I love the go to statements have you got this? You can handle this? Because it's not telling them are going to be okay. Because again, I don't know. But I know that you can handle hard things. And so I like to implement those kinds of statements.

Kristen
This is so good. This is such a good conversation around I feel like the time flew by I was like it, did it fly by how did you get into this work? Now you've got to be curious, specifically with OCD.

Madina
So it's interesting, I was recruited by no CD over two years ago, but I was ironically practising ERP, but didn't know it. So I, as you said, In the beginning, I'm going to guide you know, I'm a yoga instructor. So a lot of the guests philosophies of yoga and like Buddhism and things like that are very similar to this idea of leaning into discomfort. And I was literally reading a book comfortable with uncertainty before I even discovered this, which is literally the crux of ERP. And so that's really what has kept me in the field was I just truly love the concepts of it. I practice it in my everyday life. I see it work, because I think that's the other thing is a lot of therapy. And anyone who has OCD or thinks they might have OCD, find a specialist because talk therapy is actually counterintuitive, and can worsen the symptoms. But in any just so cool to see at work and people literally get their lives back.

Kristen
That's amazing. What books or resources would you recommend maybe one or two that you think are the best like you find the most helpful if someone wants to dive a little deeper.

Madina
The book I just mentioned, comfortable with uncertainty. It's not like an OCD book per se, but it's very applicable to the concepts. That's by Thomas Trojan. I love it. I know. I've like literally read all your books, she's amazing. And then if it's okay with you, I have like a link to an article that I think is phenomenal, but Maybe you can link in your bio for this. That'd be

Kristen
awesome. Can you? You'll send it to me and we'll link it in the show notes.

Madina
Yeah, it's a pretty brief article on different ways we can respond to unwanted thoughts.

Kristen
That'd be fantastic. Yeah. So if people are learning want to know more about you, where can they find you?

Madina
My Instagram handle is mental health. Underscore Medina. Underscore, which I'm sure you'll probably link so I won't spell it. And yeah, you guys can find me there. If you follow me say hi. I tried to post recently learned how to do some reels. I feel like sometimes I'm like a 90 year old stuck in a

Kristen
32. I am just I'm like, what is what are we doing now? Oh, oh, no.

Madina
And then there's like levels to the reels to, like we're and I'm like, I'm not.

Kristen
Oh, I can't and then we can mix in things. No, no, no, I can't do that. Yeah, I'm with you. So Instagram is the best way to kind of find you. Awesome.

Madina
Yeah. So I do have my small practice. If you are interested, you can, you know, message me through there. And then I'll give you like further details on how to communicate. I'm not unfortunately accepting any people at no CD right now. But if you are feeling like you're struggling with OCD, please call us we have a lot of therapists in all the states. So wherever you're located, we can find you the help you need. Fantastic.

Kristen
Thank you, Bettina. It's been such a great conversation. I am so grateful for your heart and what you're doing in the world. This is such a good topic. And you gave so many helpful strategies on how to start really leaning into the discomfort, facing those fears, watching the behaviour because that seems to be one of the keys and coming up with a new embraced way of life. Instead of letting it control you, you're kind of embracing the uncertainty.

Madina
Well, thank you. That was a really thoughtful thing to say. And hopefully it was helpful and I really had so much fun talking to you to do it's fantastic.

Kristen
Thank you. Thank you so much for listening to the close the chapter podcast. My hope is that you took home some actionable steps, along with motivation, inspiration