Dr Steven Phillipson and Sarah: Metaphysical OCD and Sarah's story (#512)

You're listening to the OCD Stories podcast hosted by me Stuart Ralph. The OCD Stories is a podcast dedicated to raising awareness and understanding around obsessive-compulsive symptoms. I do this for interviewing inspired therapists, psychologists, and people who have experienced OCD. Welcome to the OCD Stories. And welcome to episode 512 of the OCD Stories podcast. And in this one, I chow with Dr. Stephen Phillipson and Sarah. Stephen is a licensed clinical psychologist who specialises in CBT for OCD and is clinical director at the center of a cognitive behavioral psychotherapy in New York and he is joined by one of his patients, Sarah. In this, we discuss what is metaphysical-femed OCD, what is metaphysical contamination OCD, trauma, Sarah's OCD story around this theme of metaphysical OCD, her sticking points in recovery, getting the wrong diagnosis, how her husband supported her, and her therapy with Steve. Really great conversation. Thanks to Steve for his expertise. And of course, thank you so much to Sarah for giving her time and her story. I really appreciate it and it was very inspiring. And thanks to our podcast partners, no CD. If OCD is interfering with your life, no CD can help. Their licensed therapists specialize in exposure and response prevention therapy, the most proven therapy for OCD. With no CD, effective treatment that is 100% virtual is available for children and adults with OCD. And most members can get started within seven days on average. No hassle, just real science-backed help and support between sessions. Begin your journey at nocd.com or I'll put the link in the episode description. So thank you to you guys, as always, for listening. I deeply appreciate it. It means a lot to me. And thank you to Stephen and also thank you to Sarah. I appreciate her time and Stephen's time. So without further ado, here is Stephen and Sarah. Welcome to the podcast Stephen and Sarah. Always good to be here, Sue. Yeah, it's good to have you on. And good to have you on Sarah. Hello, good to be here. Thank you for the invitation. No worries, no worries. So today we're going to talk about metaphysical contamination and getting loved ones involved in the process. So where should we start with this? Maybe what is metaphysical contamination, Steve? Well, I thought we would discuss sort of metaphysical OCD, which has a number of different branches to it. Metaphysical contamination is just one of a number of the branches. It's probably one of the most common of the branches. But so we'll talk about metaphysical OCD as a more general theme within the metaphysical community. Hey, so the first thing is I wanted to look up the term metaphysical because I don't think it's necessarily a widely comprehended topic or theme. And I found a definition on, of course, Google that I really thought described the phenomena very well. So metaphysical describes concepts or subjects that are abstract and beyond the scope of physical science concerning the fundamental nature of reality, existence, and being. The term is derived from a branch of philosophy called metaphysics, which explores questions and existence, causality, time, and relationship between mind and matter. It can also refer to something highly abstract, subtle, or fanciful. And I think that in all the many different manifestations of metaphysical OCD, this does a really good job of giving a very comprehensive description of the many facets and sub-sets of the metaphysical theme within OCD. I think that of all of the themes of OCD, the only one that comes close to metaphysical in terms of being confusing to both patient and practitioner is probably relationship OCD, which has its own reasons for being extremely confusing. But for the sake of metaphysical OCD, I think that it can be very, very confusing and convoluted. I want to say that the themes of metaphysical OCD are so convoluted that for many, many years, many psychiatrists, many mental medical professionals have mistaken this subset of OCD for psychosis. And we will unfortunately discuss that exact topic in a few minutes down the road. I first want to start off with the subset that you mentioned too, which is metaphysical contamination. This particular subset involves the idea that a historical event, which usually has some type of a traumatic nature, takes on a sense of emotional fragility in the current association with often objects that in some way are tangentially related to that historical traumatic event. Unfortunately, many people with metaphysical contamination have had some type of significant trauma often involving another person, where there's been some form of abuse. And so often with this particular spike theme, you have both a potential post-traumatic stress disorder diagnosis in addition to OCD. And in this situation, often I recommend that both of these diagnoses be treated separately, sometimes concurrently, meaning at the same time, and sometimes sequentially. If it's going to be treated sequentially, I recommend that the trauma be treated initially, so that the remaining subset of the OCD elements can be differentiated and treated in that kind of unique OCD way. Trauma and treatment for stress, post-traumatic stress, and trauma has a significant amount of cognitive elements to it. And that's why it's sort of important to keep them separate, because as we know, it's not really productive to use a cognitive strategy for an anxiety disorder. But in terms of trauma, a cognitive strategy can be very, very productive. Trauma is defined, and I make this point very clear to patients, more in terms of the impact of the trauma than the actual circumstance that occurred. And so, when humans might go through the same historical event that has a potentially traumatic nature to it, people will take that history and relate to it and manage it in very, very unique and individual ways. So for someone to have a very upsetting or traumatic negative historical event, we look at the way that that event reshapes a person's sense of how they see their own existence or own identity, how they see others around them, often in terms of trust and safety, and often in terms of how they see the world around them, and how they see their future in terms of their ability to function in their lives in a way where they have a realistic and optimistic sense of what they're capable of toward their future. So in dealing with metaphysical OCD, if we assume that a person has gone through successful treatment for PTSD, we often use very similar paradigm in terms of doing ERP with exposure. So a case that I worked with in Switzerland many, many years ago was a woman who had been unfortunately abused by her psychiatrist when she was a teenager. And so years later, her mind had created a tremendous sense of fragility around all things associated with that history, and so objects from her parents' home contained almost like a nuclear radioactive contamination sense. So in this regard, a person doesn't have a concern about getting sick from contamination, but they're more concerned about being enveloped by the energy of that history or wanting to preserve things around them from being associated more conceptually with that traumatic history. And so the contamination is more of a sense of the existence of the essence of that history imbuing itself into certain objects and sometimes even certain words that have the associated kind of emotional distress related to it. So treatment involves developing a hierarchy, in which we expose the patient in a systematic and gradual way to the objects from their history. And in that regard, the good news is that contamination OCD when performed in a very structured and very disciplined way can be a very time efficient and powerful and very often very successful treatment, but I've found most often when the person's relationship with the actual trauma has been navigated in a successful way. So in that regard, do you have any questions or any comments or any continuation on that topic? Yeah, now that sub-feme, well a couple of things metaphysical, just the term itself or metaphysical ICT, we could also call it existential ICT, right? Would we. Oh, existential OCD is, I would say very closely related, although I do see them as being somewhat differentiated with the existential OCD, a person is more disturbed by questions around philosophy and questions around kind of existence, whereas with metaphysical OCD, rather than it being a desperate need to solve the mysteries of the universe, there's more of a threatening component involving a person's thoughts that might have some type of deleterious effect on the future in some way, or that there is some concern about their relationship with kind of reality. So there's more of a threatening component where it's with existential OCD, it's kind of more of a, you know, I actually, when I speak to patients with existential OCD, I really wish I could just say, hey, time out talking about OCD, let's really get into a question like, you know, what's the meaning of life, you know, or, you know, is there a purpose to being on the planet? Or, you know, questions that have a crossover with metaphysical examination might be, you know, am I living in reality? So a metaphysical OCD topic might involve the idea, I've had patients say that their brain tells them that they may be God and that they may have created sort of all things around them. And therefore, nothing in their world is actually real beyond what they've created. So that theme also involves questions like, am I having a dream, which once again might be metaphysical examination, and that might sort of spill over a little bit into existential OCD. So I do see sort of a divide there, but I think in terms of the treatment, there's a lot of similarity in that regard. Whereas with metaphysical OCD, you can do a lot more, I think, tangential, concrete exposure work. Whereas with existential OCD, it's more about voluntarily conjuring up the questions and being resolved to leaving them in their sort of unresolved mystery state. Yeah, good, good definition. And then metaphysical contamination, the time I see reused a lot is emotional contamination. Same similar, different, yeah, where would you see it? I understand that idea, the idea that a perhaps an object might evoke a certain emotion, but generally I don't find that the person sees the emotions as being contaminated. It's more the associations to some historical event that they want to in a way not have come up on their mental radar. So it's sort of a sense of a concept being contaminated, but in a way that can, you know, imbue itself in an object. So, you know, if this pen were associated with some history with trauma, then this pen would almost emotionally glow with the sense of that reminder. I worked with another person who had metaphysical OCD in terms of contamination, but in this regard, his brain would conjure up a thought like, oh, maybe my friend will get cancer. And when his brain conjured up that thought, it would then say that the next object that you purchased or even the last object that you've purchased is now imbued and imprinted with this negative association. And so this person would literally throw out hundreds and hundreds of dollars worth of merchandise that he had recently purchased because while purchasing it or shortly after purchasing it, his brain would conjure up these very negative associations of ways in which loved ones of his might be put into some type of, you know, kind of metaphysical danger. And so the brain said, well, if you can discard the object, then it sort of undoes that danger because he's removing himself from the object. And he and I fortunately did very successful, very aggressive work, where he would actually purchase items and it actually started out with the pen. He actually wrote a very very well written success story on my website called the Poison Pen because the first object he used in his exposure and response prevention treatment was to buy a pen and to conjure up a thought such as, oh, I hope my wife catches a cold. And we built on both the topic of her and her, his friend's various diseases leading toward more lethal ones. And we also built up from buying an object like a pen to appear sneakers and and more and more expensive and valuable items with, conjoining those items with these voluntarily evoked negative associations. Yeah, that's interesting. And I'll link to that success story case study wherever it is on your website. I'll link to it in the show notes. So there are other sub themes you want to get into, which we bring in Sarah. I told Sarah, we'd start at about the half of our mark. I wanted to mention some of the other subsets, not related to contamination, OCD. I'm working with a woman in Sweden. And she has sort of an interesting subset of metaphysical OCD in which, once again, there are these protected loved ones. And her brain says, if you don't close the door in a repeated way or get into bed in a specific way with a clear mind, then these people will be at some type of risk that might involve disease or might involve some type of an accident. And so in this regard, once again, it's the idea that the thoughts, as I say, can bend the universe and a person tries to engage in ritualizing often in terms of undoing the thoughts that can be done through prayer, sometimes confession, and once again, sometimes through googling what's the chance that my thoughts might have an impact on loved ones in the universe. Historically, before OCD's themes have really been given a significant amount of attention, these types of OCD themes were referred to as magical thinking. And in this regard, that's why so many mistakes were made in terms of the diagnosis, because people who have psychosis often endorse magical thinking. The idea that their thoughts can produce some negative impact on the universe. And so for those who might be panicking right now, I'll say that it's not a very difficult distinction between a person with psychosis, because when their brain tells them that they can kind of project their energy and will onto the universe, it's a seamless belief that there is a realistic non-questioned component to this, whereas people with OCD are more frightened by this prospect. And that's why they engage in ritual, such as avoidance or undoing. Whereas the person with psychosis who engages in magical thinking, there is no temptation to ritualize, because their faith in the reality of their mind's power is sort of unshakable. So metaphysical OCD often involves a sense of a threat in terms of possibly actually had one person who his brain came up with the idea that his dead grandma might go to hell. And that regard, he would then pray to God, often and regular, that he didn't mean it. And so for people with metaphysical contamination, their brain is conjuring up, like any pure O, these very negative threatening associations. And then there is this kind of desperate effort to undo and subdue their brain's creativity. Sometimes with metaphysical OCD, there can be a bit of a blurring of the lines in terms of a person actually having faith that their thoughts might actually produce these negative events. And often you might see that kind of a blurring of the lines for people who are actually very religious, because obviously it's not uncommon. And I think most western religions to think that our prayers can impact certain outcomes. And so with that in mind, people grow up within a religious community in which they're educated that prayer and thought therefore has the potential to alter God's will. And by praying to God and then God intervening, it even supports the idea. It's like a concept where metaphysical concerns are substantiated by the foundation of the religious beliefs. And so it's often important to when working with a religious person, keep them separated from the religious component in terms of their authentic faith in contrast with an anxious driven or guilt driven component. Yeah. And I think in more, I guess agnostic or spiritual circles, or not everyone, obviously, with some people like the secret. Have you come across the secret? Unfortunately, I've heard of it on a number of occasions, and I'm not a big fan of its concept, but yes, it reminds me of that as well for those non religious might have read the secret. Yeah, no, the term that drives me crazy is the word manifest. The idea, you know, in the secret, it's the idea that we can manifest as in create our future through our thinking process. So, you know, the secret, I think it was in the 90s created a lot of people with OCD substantiating their themes, because here it is written in this very popular book, the idea that our thoughts can manifest our future interests. And so I did engage in a lot of debating because of that book. So, right, so you've got people manifesting their future by thinking, and the religion says you can manifest, you know, the causality of other people's situation by prayer. So, in the world, there is a lot of concepts that can substantiate this. So, at this point, Sarah, I really appreciate your being here. If I can make a quick introduction, I've been working with Sarah. Is it three months? Three months, yeah. Three months, I got to write this stuff. And I always thought it was more because Sarah has made such tremendous progress on two different fields of OCD, simultaneously, one of them being metaphysical OCD, not contamination. And I'm just so happy and proud of the work Sarah is doing. And I think Sarah can do the OCD community and the metaphysical community a great deal of favor and service by sharing her story, which, said for me, is sort of almost coming to the end of her treatment room. But Sarah, if you could give a background, including, unfortunately, well, I guess you'll start with the fire that started everything and then mentioning your unfortunate meeting with a psychiatrist. Yes. And I also want to mention that I also, the word "manifest", also, I don't like it at all because it created a lot of anxiety for me a few years ago. Yeah. Okay. But now I'm not afraid of the word anymore. So we can manifest anything. Okay. So yeah, my issue started quite some years ago. And it was around the fire. When I started to have this, so my brain just produced this weird thought that what if the person who was responsible for the fire got this idea from me. And at the time, I got really scared about this thought, which was just a random thought, but because there was a big tragedy at the time, I got really scared of this thought. And I started to have a really long period of anxiety. And I was desperate to prove that I have no connection with that fire, and that the thought that my brain produced is not true. So Sarah, I remember you mentioning that you had something to do with fireworks at a corporate event. Yeah. Maybe a little more detail about that. Yeah, I can give some more detail. So a few months before that tragic event, I was at one event where we had some fireworks. And then when the big tragedy happened in my town, my brain produced this idea, what if the person who was in charge of the fireworks at the tragic event had the idea that to bring fireworks because they saw the fireworks at my event, which was a really, I don't know, stretched connection that my brain produced. But for me, that created a really big anxiety. And it lasted for a few weeks. And I remember that starting at that point, my brain started to test what in some situations when there were big tragedies, my brain started to produce these thoughts like what if I'm responsible for a certain event. And my brain started to make sure that I have no connection with tragic events. But these were like more isolated events like every three months or every few months where there were like tragic events that involve more people. And after one year or two years, this event, this habit of my brain started to occur more and more often. So daily, let's say, or even multiple times per day, in a way that after a few years, whenever I would hear about an accident or about a tragic event, my brain would immediately create this connection. And I would immediately feel an anxiety feeling in my stomach that okay, what if this is because of me. And I was in this lead to, for example, that I would avoid any kind of news. So I was not able to listen to any news. So when I was in the car, I would turn the volume down whenever there was news on the radio, whenever I would be, for example, in my parents' house, I would just go in another room or I would have to cover my ears, but to not listen to any tragic event because I was so afraid that this would create some connection that my brain would create some connections and that I would enter in a state of fear and guilt. And my biggest fear was that I would enter in a state of fear and I would never be able to get out of it. Can you mention when you first saw treatment, when you realized that these concerns of yours were getting out of hand and becoming problematic? Yeah, so it was a time when it was about one year after the tragic event I first mentioned, the big fire. And it was a time when I would be triggered by a lot of small things. So for example, I would start to, I would be, for example, I would see some spots on the ground and my brain would produce these thoughts that if I would step on this spots on the ground, I might be guilty for doing something wrong or, for example, if I would be late somewhere, then maybe somebody would die because of me. All sorts of, my brain would produce all sorts of weird connections and I was in, in almost a permanent state of guilt and sometimes terror. And I went to the psychiatrist and she told me that I have a generalized anxiety with psychotic elements. This was written on my diagnosis. And then I started medication. And remember what medication she started you on? Yeah, it was a set of sat and ketia pin. So ketia pin was for the, let's say weird thoughts or this weird connection that I had that my brain produced and I know that in large doses, they are given for psychosis. Right. Right. So how did you react to being diagnosed with psychosis? Yeah, it's terrifying when you, for me, it was very terrifying to not have to lose control. And I was very afraid that I'm going crazy. So that was actually my biggest fear that, yeah, I will just go crazy and I have no control over my life. And also when you take medication, it's not. So in a way, it was good. And I'm really, really fortunate that I was able to take medication over the years because there were some points where where it was really hard to sleep and I was in a constant state of fear. So medication can help and especially anxiety medication in my case. It helped me in the past, in the past years. But some of the medication that I took, it also made me like really, really sleepy. It was really hard to concentrate. Sometimes it worked. It was really difficult to follow discussions. And I was sometimes I would just have to sleep during the day because I was not able to stay awake. Yeah, I think this is sort of an example of the common tragedy of being misdiagnosed. Obviously, this psychiatrist wasn't able to put the pieces together and recognize that this was just a subset of OCD and that you weren't having a lapse of reality testing. But your comment reminds me stew. Not only so, do we have religion that promotes metaphysical thinking and manifesting, but then there's also the superstitious element of it. You know, like step on a crack, break your mother's back and hear, you know, if Brandon is telling her if she steps on a spot, you know, that these negative reactions can happen. So, you know, it goes, it goes in, you know, that society promotes kind of metaphysical, metaphysical substantiation, you know, through a variety of these kind of thinking processes. Are you for interrupting Sarah? Yeah, so also about the superstitions, I also want to mention that when I was a kid, my mother would have all kind of interesting story with metaphysical components attached to them. And even now or a few years ago, my mother would tell me like, yeah, it's not your fault. You're not causing any of these tragedies. Maybe you just have premonitions. And this would not make things better at all for me because, yeah, if premonition exists, then maybe I'm also able to influence things with my mind. So, there are a lot of, especially in my country, there are a lot of superstitions that, yeah, that makes these kind of things easier to imagine that they can be possible. It definitely, there are many influences. Often with OCD, the brain kind of arbitrarily picks themes, but sometimes there can be a historical conditioning that kind of promotes the idea. In addition to medication, had you had any prior therapeutic attempts? Yes. So, I did have some OCD related to contamination. So, I had some CBT treatment for contamination OCD. So, I was supposed to write down what I did and what were my reactions and to imagine some more healthier way to respond to the triggers. But it didn't, that thing didn't quite work for me because I was always focused on the 1% possibility that maybe, but what if that 1% is true and that created a lot of anxiety for me? And I also had years and years of talking therapy. So, in the past 10 years, I had a lot of talking therapy. I also had EMDR therapy and neurofeedback. I think this is it, yeah. Yeah, it's, you know, I've been a shrink for 30 years and it never gets less frustrating to hear about the multiple ways in which clinicians believe that they're doing patients to favor by offering, you know, ineffective treatment strategies. So, you know, it's upsetting, you know, to think that you, you know, were misled, you know, out of your own sort of desperate seeking of remediation, you know, by people who didn't fully understand it. And I think that's one of the great things that Stu provides this community is, you know, a lot of much more informed opportunities for people. Can you, can you start to describe the work that we've engaged in kind of from the beginning? Yes. So, I will start with maybe after, it was kind of fast, I think, and I found our session moving really, yeah, at the, at the high speed, in a way that we didn't, we didn't, we didn't go through our, through my past. And I just want to mention this because sometimes I hear people like, yeah, I don't want to go again to start again with a new therapies, because then I will have to tell again the story of my life, my life to the therapist and it will take months, maybe, before we get to a point. And that was not the case when we started. So, it was just like we had like a 45 minute conversation about why I joined the session. And then I also had these questions like, okay, is this OCD? I wanted to make sure, like, do I have psychosis or what is it that is wrong with me? And then we started to identify like what are my triggers. And the bigger, the biggest trigger for me was hearing about tragic events, because this would create my brain would immediately make this connection that I might be guilty for, for these events. So, my first task was to just watch the news. And I would have to do this, let's say 10 times per day. And if I would be triggered by any of this event, then I would have to first wait for 30 minutes. And if the anxiety feeling would still persist after 30 minutes, I would always have, ready, I still have it now, close to me. I have like a small book, a small notebook. And I would write down on index cards, which are just piece of paper where I put down, like, what was my brain saying about the triggering event. And I would also have to put down what is my, how much resentment do I have for the way I feel about the event and how much the anxiety level is for me. And also how much I ruminate about the event. And it's funny that I'm now, it takes a lot of time to think about this, because I didn't, I wasn't triggered now in more than three weeks. And I was like, okay, what did I write the last time when I was triggered about? Yeah, because at first I got triggered quite often. And it was quite intense at the beginning. And every hour I would have to read again the paper I wrote until the anxiety feeling went below a two on a scale from one to ten. Right, so if I could just interrupt Sarah and say, so what Sarah's talking about is whatever it was index card therapy, in which Sarah writes down her brain's challenging theme, writes down the intensity of distress, the amount of ritualizing, which involved asking your husband for reassurance or some type of research, and the degree to which Sarah would be upset or frustrated or angry at her own brain for producing these types of creative thoughts. So Sarah, I just want to mention what I recall some of my favorite topics that your brain came up with. One of them I think involved this famous skydiver. Was it that you had thought of the term like hang gliding or you had talked about the term hang gliding? Yeah, so a few days before a tragic event where a famous person died, I think paragliding, I was talking with some friends that paragliding is kind of boring. And then when I heard about an event, my brain immediately produced this thought like what were the chances that this person died immediately or a few days after I discussed about this event? What if this is my fault? Was it a death related to paragliding or was it hang gliding? I don't even know exactly now if it was hand gliding or paragliding, yeah. Yeah, but there was that connection and then another time you talked about the horse was it? Yeah, so the next step in our therapy was to also to think on purpose about some events because that was also one of my fears that I was afraid of any negative events or any negative thoughts that my brain would produce. So for example, if I would think of the collapse of a bridge, then I would be immediately scared of this thought that my brain produced and then my brain would produce more negative thoughts. Yeah, and then I would be scared of that thought and so on and so on. So then one of the things that Stephen encouraged me was to just think on purpose of some negative events. And at one point, I thought about an accident with a horse. And then after a few days or something like this, there were multiple that's involving horses that were, I don't know how to say it in English, where you have a carriage in the horse that is used for transportation. And there was a tragic event one day and then after a few days there was another one where a car hit a horse and the carriage. And the driver also died, right? Yeah, the driver or one of the passengers, I don't remember exactly. And one of the topics that started to give me question as to whether you actually do have magical power in the universe was the stampede, which in this country, not many people die and stampede, but apparently you created that in Europe. Yes, so after the tragic event with the horse, there was, yeah, I had this thought that why did I thought of a horse? Maybe I should have thought of a cow. And then after a few days, I saw in the news that there was a stampede, where a cow hit a person in that person died. So as you're expressing your brains, and by the way, I really appreciate one point out, one of the pivotal things that you're doing, whether anyone's recognizing it, you keep saying, you know, my brain is saying. And so many people with OCD, they take ownership of their brains associations as if it's them who creates the thoughts that they're responsible for it. And so it really bears, you know, pointing out how you're engaging this very skilled relationship with your brain's activity and not taking ownership of it and in separating you and the choices that you make from your brain's activity, you know, it gives you a much better opportunity to exercise the discipline in being able to and willing to manage your brain's activity rather than just being a victim of it, which so many people with OCD are. So I wouldn't applaud you on on that discipline. And so as you're talking about the stampede and the hang lighting, and by the way, I don't think that's boring. I was on a paraglide. I found it exciting. So different strokes. And I didn't die. Thank God I did it before you brought up the topic. Otherwise, I would have been a goner in talking about now, you know, us sort of joking about your brain's ability to bend the universe. And here you are with a great smile and a good laugh. What is your perspective now about your brain's ability to affect changes in the universe and harm innocent others? Yeah. So my brain or you, I think in general, the brain produces a lot of thoughts. And unfortunately, I remember and we I think we remember only the things that trigger us in some way. So even what I mentioned earlier, because some of the listeners might be triggered like, okay, she thought of a horse and then somebody died. Even in that case, I thought of a different accident. Yeah. I thought of a horse's horseback riding. But the brain only picked the horse in my story and then connected to a tragic event. And then when the anxiety is very strong, I don't have the capacity to judge things. And even so how to say that what I've learned is that it doesn't matter that my brain produces these thoughts. And it doesn't matter that sometimes it's hard to so a lot of times I just wish that I could know for sure that it's not my fault. And that was let's say something that I hoped for for a very long time. So I just hope that one day I will be able to tell for sure that it's not my fault. And since we've been working together, I understood that this should not be the goal. But the goal should be that I'm able to accept that, okay, I might be guilty for tragic events. And in a paradoxical way, thinking like this, it just, it just turns things around and it makes it harder to believe that I might be responsible for tragic events. Even recently, a lot, there's a lot of paradoxes in the world of OCD and even in the treatment of OCD. So by saying to your brain, yep, maybe it was me. And I also want to comment that you've done also a very positive step. You included your husband in your treatment process and turned the ways in which you can bend the universe and destroy people into a joke between the two of you where your husband will present you with opportunities in the world for you to have destructive influence. And you guys have made a really good team and you know, accepting those offerings. And I think that's an important thing to mention also. Yeah. But just by accepting that, okay, it might be my fault. It takes a lot of pressure and a lot of struggle to, yeah, it's very tense. Like, okay, I must make sure that I'm not guilty. But then when you say, yeah, I might be guilty, then it's also, it's like you see things a bit clearer or I don't know, something changes. And I recently had an event like two or three weeks ago where I was afraid that I got COVID and I was because I have this responsibility, OCD, where I'm afraid that I will cause because of I'm responsible also for other people's health. I had at first I had this guilty reaction, guilty reaction and anxiety reaction. But then immediately when I had this shift in perspective, like, okay, yeah, I might be, I might have COVID and I might kill a lot of people. It just changes the way I relate to the to the thoughts that my brain produces and to the anxiety feeling that I that I have. Yeah, I mean, I can explain that when a person engages in an escape response to the brain's creativity, it sort of substantiates the idea that the threat may be legitimate and that you should take caution. But when you flip it around 180 degrees and you look into the anxiety, look into the fear and you look into the threat and you say, yeah, maybe it's me, maybe I'm guilty. The brain doesn't know how to manage that because you're not complying with its warning signal. And that's why the brain tends to shut down because once you choose to comply with the possibility that you may be responsible and you're not going to offer any resistance or escape, the brain just kind of disengages and that's why you get a pretty time effective relief from that type of response. I just also want to ask you, you mentioned that you haven't really even had a challenge in about three weeks or so. And a very important question is, is your relationship with your brain silence? One of like, oh, I hope it stays that way or one in which you're able to say, hey, brain, you've been silent for three weeks, I'm ready for the next one. Bring it on. Yeah, sometimes I have to remind myself that, okay, I'm ready for the next one. Even in this morning, because I'm still looking at news every day at tragic events specifically, I just hope somebody or nobody will check my phone history because I'm always looking like tragic events. Yeah, and every hour, I'm looking for tragic events like I'm some kind of weird person. And even this morning when I searched for tragic events, I had this, I started with this thought. Let's see what or who did I kill today. So sometimes I do remind myself that, okay, I'm ready for the next killing. Yeah, and I think just to mention that, as I tell people at your stage of recovery, the most important exposure right now is your blank index card, because carrying the blank index card and being ready to take on the next challenge, not with a sense of fear and fragility and trepidation, but with an aggressive welcoming of that possibility is such an important part of sustained recovery. And I just want to, you know, kind of mention, you know, for you and for anyone listening, you know, you can get to this place where Sarah has achieved the success. And I just also want to mention quickly, Sarah has also had responsibility OCD with actual contamination and has done an A plus job, not surprisingly, in spreading around all kinds of germy things to the unsuspecting public co-workers, family members, occasionally her poor husband, and not surprisingly, that Sarah has been so successful with metaphysical OCD, treating actual contamination OCD, even though it has a responsible responsibility component to it, which tends to complicate things. Sarah has also done a terrific job with and, you know, I'm not surprised because she's an incredibly disciplined person and very, very aggressive entreatment. Yeah, with contamination OCD, it was a bit easier in the end than with metaphysical OCD, because I just anticipated that it would be harder to do it than actually doing it. And every time I would like, okay, I'm just waiting for anxiety to rise because I did this, I did this, I don't know, this thing that I shouldn't have done with contaminating things around my house, but the anxiety would just not come. Yeah, it's just like, okay, am I doing something wrong, but now I can attach the button of my shoe and I can spread it around on my silverware and wears the anxiety because I would, yeah, I would, so one of more of the paradoxes is when you anticipate anxiety, it often will not emerge just when people dread the potential for anxiety that the brain would tend to visit. So, your readiness for it, your willingness for it has been a huge component and it's not showing up. So I know we're getting extremely close to being beyond time. Anything you want to ask contribute or say? Yeah, no, it's been good seeing here and listening to this because, I'm sorry, you know, it sounds like you've done a great job in therapy and you can clearly articulate what's helped you the process. That's usually a sign for me that someone has taken it on board and really embedded it and that gives me lots of hope for the future for you because you have the skills, you know, they're there now. I guess it's just a question on your husband, like how he got involved in treatment, how he helped you, anything like that. Yeah, so my husband joined one of the sessions with Stephen and he because of my reactions over the time and because he saw me during my worst times when I would wake up during the night with a burning sensation in my body and he would see me during the day with a constant state of fear in the past years. He would be very cautious about what he would say and a lot of time I would just tell him, like, please don't tell me anything, any bad news just because I don't want to go back into those states and he would be very scared, like he wouldn't know how to deal with me and I think it was also really for him when after he joined the session with Stephen that he could actually say a lot of a lot of things and we started to make a lot of jokes like, okay, so you killed those poor babies that we heard in the news that died or have you heard the news today that I don't know something bad happened in America or even in Europe and so his job was to mention the bad news and to say that it's my fault and yeah that was helpful because a lot of times these kind of feelings are really they make you they seem like really serious like the thoughts that the brain produce they look like really important signals that something terrible is happening and being able to make fun of it and being able to say, okay, yeah, I just I can take more and just yeah I'm ready for more bad news I'm ready for more killings so I'm not actually killing anyone just to make it clear we don't know there was an impede you know I think that that had your name on it no I always say that if something happens it's Stephen so if it's not my fault it's Stephen's fault so I'm yeah I think more responsibility Sarah list of names that I want her to put curses on just it's true and they didn't die yet so yeah I'm not sure anymore about my but I just want to mention something about your questions Stephen earlier that you you say how do I if I'm afraid of future events actually I just remember that this morning there was this thought that what if I would be I will be triggered now by something and it was more the brain produces this thought like in like this would be something bad and then my reaction my next reaction was because this happened this morning when I saw the index cards and my next reaction was yeah I do hope that something will happen because I haven't write anything in a long time and even if I write something it doesn't matter because it will just go away so sometimes there is a like this dance or I don't know how to say that I don't want to to give the impression to the listeners that everything just goes smoothly and there is no more anxiety feelings and no more thoughts and but it's just that this is not the point anymore that there are some anxiety feelings or there are some thoughts the focus is on the practice and as a result also the anxiety and the thoughts diminish but it's not the goal yeah good words good words yeah it's been really really great to hear how you've just taken to it like a doctor water and obviously as Steven said you're incredibly disciplined and hardworking and I'm sure that's just because you've you've lived with it long enough that you were sick of it and just ready to do the work and and and make improvements so it's been great to hear that so I guess lastly just to open up to both of you is there anything e-review want to say to finish the podcast the words I hope could be just anything else you wanted to say today I do want to say that at least for me the first reaction sometimes when Steven would suggest some things to try is yeah it's like sometimes I'm just afraid to okay should I do this should I look at the news should I but just actually trying it made it yeah much less scary than I thought of but I also think that it's important it's very important to have the right person supporting you so I know because I've been also in this situation on my own and I'm I don't know if I could have done it on my own because sometimes my thoughts would reduce a lot of anxiety and they would be very triggering so I think it's important to have a the right person to guide you in this process I would say yeah you know I'll just say occasionally more than I like to recall I hear people say you know OCD is a lifelong disorder and when people like Sarah engage in this treatment in a very aggressive way and are ready to face the next challenge not with you know fragilness but with aggressive acceptance this can this disorder can go dormant I look at it like once again a volcano that's no longer erupting and it can go dormant for for years and sometimes decades and so just as a real information of hope that you know people those who are not born with a lifelong affliction but a very treatable condition when as Sarah said in the right dance and more importantly when when the patient you know engages with the treatment and the kind of aggressiveness that the Sarah has taken on yeah good good words well thank you both for this important topic Sarah for you sharing your stories it's amazing to hear it and Steve your expertise is always so yeah thank you both thank you too it's always a pleasure thank you for the invitation thank you thank you share for sharing your your wonderful journey thank you for listening to this week's podcast and thank you to our patrons who help make this episode possible and if you would like to find out more about patreon and the rewards and benefits then there will be a link in the episode description if you enjoy the OCD stories podcast and would like to support us please subscribe and rate the show wherever you listen to the podcast and thank you to no CD for supporting our work if you want to find out more about no CD you can click the link in the episode description and quick to claim a guys this podcast is not therapy is not a replacement for therapy please seek treatment from a trained professional until we speak take care