Dr Steven Phillipson: Two of the most common spike themes of OCD (#290)

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. Welcome to episode 290 and in this one I interviewed Dr. Stephen Phillipson. Stephen is a licensed clinical psychologist and he's been on the show many times before. So I'm sure you're familiar with his work. But in this one we discuss two of the most common spike themes of OCD which are what if this never goes away and how do I know this is OCD and not an authentic concern. He normalises the process of OCD and the emotions that fuel it. The mistake some people make in their recovery mindset. When OCD pops up in your mind when you wake we discuss the idea of a relevance. The recovery mindset. He shares plenty of examples and illustrations and much more. So really interesting topic. I think this has got something for everyone in it. So I hope it helps. And thanks always to OCD for supporting the show. I deeply appreciate it. If you want to find out more about OCD and their therapy services, head to go.treatmyocd.com/theocdstories or click the link in the episode description. And as always thank you to you guys for listening. And without further ado, here's Dr. Stephen Phillipson. Welcome back to the show Steve. Always always a pleasure to be here Steve. Yeah it's good to have you on again. So yeah so today we're going to talk about a couple themes or worries. You know one is how do I know this is even OCD? And another one is you know will this ever go away or what if it never goes away and I'll be stuck worrying about this forever? Yeah so anything you want to share on those initially? Sure thing. I'd like to start actually with the second one that you've mentioned to kind of get the ball rolling. Obviously the condition of OCD is a very disturbing experience to go through and oftentimes it's a very disturbing content thematically just to kind of remind all of our listeners that without the malfunctioning experience of OCD without the intense distress signal or as all my patients call it the authentic crisis because OCD obviously produces an experience of alarm that is 100% authentic to any actual crisis that any person might be going through. I say it's kind of like if a cobra snake is about to bite you that's as real as OCD matches these themes with that experience. So the desire for this condition to go away obviously is immense and the seeking of relief from the condition is understandably very very high. Also just kind of reiterate at this point the idea that the only difference between a person's brain with OCD and a person's brain who does not have OCD is this distress signal. People place so much emphasis with OCD on the content of the thoughts as if they're the problem and in fact research shows clearly that persons who don't have OCD pervasively experience the exact same mental associations as in the themes of people with OCD the only difference is the emotional component. So people make two very common errors in their recovery mindset. Number one they want the thoughts to stop and that's a mistake because why would one want one's own brain to function in a way that's not natural to the human brain. It's very natural to all human brains to conjure up these associations that are often one might describe as dark or inappropriate but also you know it's just important that we remember in managing OCD to never really judge the theme of our brain's creativity but you know to get back to the idea that looking for the thoughts to go away as a measure of the finish line or success is a mistake and inappropriate. Now the goal really of OCD treatment is to bring the brain back into its natural state of function in which means that there is not going to be this profound alarm system going off because that's really the foundation and nature of the condition that people with anxiety experience this anxiety in a very pervasive and very disturbing and distracting way. So that's that's a really important component to focus on in terms of this number one topic where's the finish line and roll this OCD last forever. When patients ask you know when when can I expect to have relief that suggests naturally and understandably that there's a focus on reaching the finish line and what's really important is that in a OCD treatment mindset that looking for relief is actually counterintuitive to the actual therapeutic agenda. The entire basis of treatment for any anxiety disorder particularly OCD is the conveyance of irrelevance the the ability for the human to show his or her own brain that the activity the malfunctioning activity of the brain is irrelevant meaningless and consequential and when the brain is responded to in that way its natural tendency is to start healing itself. Looking for relief or even ritualizing to find and escape is tandem out to kind of peeling off a scab on a wound. You really don't let the body heal itself when you do that it actually reopens the wound and re-stimulates bleeding and that's kind of how relief seeking acts on the brain which really is not invested in producing these signals. People often look at their brain in its malfunctioning as it's sort of an adversarial tormenting enemy and it's really important to understand that OCD is a it's a warning signal that's gone awry that that's malfunctioning in this firing and it's creating an emotional warning of a crisis where there is no crisis. What's interesting is you know people focus on relief and the termination of their brain's malfunctioning in a way places a focus on not having the challenges. It's interesting because if I said to a patient oh I have this crystal ball that perfectly predicts your future and I can see that exactly one year from today your brain will stop malfunctioning. I would guarantee that the vast majority of people in receiving that information if they believed it would probably have their symptomology discontinue after about two to four weeks because there's such an emphasis on when am I going to get better, when is this going to go away that it actually creates and in the moment distress and resentment when the brain sends a signal that reminds the person hey I'm still here you haven't gotten relief yet. So also keeping in mind that relief seeking is not only the focus on you know waking up one day and not being reminded of OCD's presence but it also involves a lot of ritualizing with the desperation the idea that if I sufficiently ritualize if I come up with answers if I find closure on the topic that this will go away and obviously we're very very clear at this point in confident that you cannot shut down OCD through ritualizing. It's interesting because many patients indicate that when they wake up the first thing that occurs to them is their OCD theme reactivates and reminds the person that the condition is still here and that often sets off a very demoralized reaction to oh boy another day of suffering another day of being tormented in a recovery mindset where one is allowing the brain to heal itself the person the the patient would wake up their brain would prompt them about the topic and they would say okay another day where I have an opportunity to demonstrate to my brain that this continued prompt is meaningless and irrelevant and so a patient who's in a recovery mindset actually looks at challenges as an opportunity to demonstrate their relevance rather than a reminder that the condition is still present when when when when looks at someone who has a fear of flying what you often hear from a person with fear of flying as soon as the plane takes off they start looking for when the plane is going to land so they look at their distress during the flight as something that they try to achieve a sense of being tolerable by the reminder that it's going to come to an end and that focus on the end as if that is the goal once again it really sustains the idea that being challenged is the problem and so one of the ways that we can convey a relevance to the persistent brain activity is to be able to look at where you are in the moment and if you're engaged in a recovery mindset and a recovery life path one would notice that you're engaged in your life process in a way that has not been altered by the presence of anxiety and so to achieve relief in the idea about the persistence of the brain's challenges by by focusing on the idea of what I refer to as the the unaltered life path to be able to say yes I am experiencing these associations yes I am experiencing this emotional distress but look at me the choices that I've actually made as the gatekeeper have put me exactly where I would be with or without the challenges and in my mind the conveyance of a relevance has no greater mechanism of demonstration than to be able to say whether I'm challenged or whether I'm not challenged my life path remains completely unaltered on both sides of the fence and when a person achieves that degree of acceptance to be able to say hey brain it doesn't matter whether you challenge me or not because I'm able to live my life completely as I've designed it rather than being manipulated by belief seeking or avoidance of things that might provoke the thought that is the profound demonstration and allows for incredible healing so on the note of when will this ever go away for now at least those are some of the the critical ideas you know a patient you know can really be distressed because not seeing the finish line it's kind of like managing COVID I remember in May of 2020 in New York being shut down the world being shut down and them saying oh we need to flatten the curve and I remember when the curve got flat around May and then June they said oh no it's not flattening the curve that we need to look for it's that it not continue to spread and I realized that the government wasn't offering a finish line and I thought how profoundly demoralizing that's going to be to the population to be able to say when will normal CB return because they keep moving the finish line and I think that created tremendous emotional distress to the world and society at large and and the same thing has to be said about persons who suffer from OCD is that the absence of a finish line is a profound demoralizer for a person to be able to avoid the secondary features of OCD which are depression and depression is often a byproduct of a person feeling victimized and fermented and not seeing any potential to find an escape and I think that's one of the most tremendously emotionally disturbing aspects of OCD is it doesn't provide any definitive finish line nor can the therapist provide a definitive finish line although I can say to patients that if you adhere to the therapeutic guidelines if you're very compliant to the exposure the aggressive exposure paradigm and very compliant not only to exposure but the mindset of irrelevant and the elimination of the resentment for the brain being so persistent then it can really hasten the production of the the therapeutic goal one of the analogies that I often use with patients is I talk about two people who are starting a company and they're going to make any product and so in business the concept of the any product is called a widget and focusing on one of two things our partner a focuses on how much money is in the bank account which is the analogy to symptom relief and partner b focuses on the quality of the widgets that are being produced with the idea and faith that if we make really good widgets the profits going to show up as a secondary dividend of focusing on the process and so OCD treatment is almost exactly like that whereas many many people engage in the therapy but they keep checking their bank account to see whether or not they're still being challenged or how much they're being challenged and they become great demoralized because they think hey I'm doing the therapy why am I still being challenged like this whereas the skilled patient is businessman b who focuses on the quality of the widget or who focuses on the quality of their adherence to the the treatment process one of my patients in the Tuesday group said some thing that I think was one of the most profoundly brilliant things a patient has ever said about exactly this topic and when we were talking in the Tuesday group about the finish line he said the finish line is the right now in the moment awareness that you're engaged in the therapy in a skillful way if right now you can check the box I'm doing the things that the therapy requires to to find recovery and my mindset is one of acceptance and the conveyance of irrelevance rather than resentment then you've achieved the finished line because the brain will then heal itself but on its own time so there were two things in my life that I experienced something similar with as a parallel I've never had a day of OCD although some of my patients claim that I must be lying about that because I understand the conditions so well they seem to say but I can tell you that I'm not lying about that but I've had two things in my life that have been very persistent and undesired and one of those has been gastric reflux and one of those was a sciatic pain in my right leg I've only had gastric reflux once it took me seven months while suffering from the condition to figure out that it wasn't going to go away on its own and that I needed to kind of reformat my relationship with this gastric reflux and so here I am coughing with patients coughing up vomit having cramps in my stomach and engaging in a lot of burping and you know the funny thing about my gastric reflux was that it would start on Tuesday mornings and it would completely go away Friday afternoon and that just happens to be my work week so when patients were telling me to take medication I would say no I don't think this is a medical problem I think this is very stress-related because I don't think the body has the same calendar as my work week so for the start on Tuesdays and end on Fridays it suggests to me that I was mismanaging some stress in my in my practice so after seven months of suffering from this gastric reflux I decided to apply the exact same principles as I offer patients in managing OCD that being the conveyance of irrelevance the lack of resentment for my body malfunctioning particularly in front of patients and giving my mind permission to kind of heal itself rather than me desperately looking for relief and much to my shock it took eight months after I started managing my gastric reflux in a very very effective way for my brain to kind of get the hint that it's production of these symptoms was not really a necessary part of my life the good news is during those eight months it was a very kind of scalloped decrease meaning some days would be more intense than others I would notice like 10 minutes would go by and I wouldn't have any symptoms and rather than being like hooray it seems like it's going the way I would say to my brain at hey you know what whether the symptoms are here or not it doesn't make any difference because I wouldn't be doing anything differently anyway and so as my reflux decreased in its severity my acceptance of its presence maintained very very persistent and then I remember after it sort of had gone away when I would start talking to patients about this mechanism of recovery I would start burping and my brain would be like oh well maybe I can come back and my response to those burps would be okay be here or not it's equally irrelevant so there is tremendous parallels in the treatment of OCD and also that permission giving of not having to finish line not needing to see a finish line but knowing that you're engaged in the therapy in a skilled way from around that's very very important and I'm happy to say that the last time I actually had any symptoms of reflux was about 15 years ago I've maintained that that welcome to have it come back and it hasn't and my sciatic was sort of very similar only my sciatic would kind of flare up which is a very stress related condition of cramping in my right leg I would once again give my mind permission to send me these symptoms and gently after about two to four months the symptoms would go away and you know I would experience relief the funny thing about my sciatic is it's come back four times but you know right now it's been away probably for a year but once again in saying that I welcome its re re emergence and I just would say hey whether you're here or not life's going to be lived the same so those are sort of the main points in regard to the never ending nature or the never ending fear regarding people's relationship of those CD so before we go to the next topic did you have any questions or comments regarding that yeah I think the bit at the end that around you so physical ailments that that I would call them I would call them stress related symptomology okay I would follow physical ailments because that might suggest that medicine yeah yeah yeah yeah good point so yeah but you kind of you've got that air of acceptance or irrelevance whichever term we can use of will a bit comes up it comes up it doesn't necessarily change anything I'm still heading towards where I want to be heading or doing what I want to be doing which I think yeah thinking about OCD a that's a powerful perspective to have and be obviously when when people start to make progress and then it suddenly hits them oh shit I'm actually making progress here then that fear comes in of what happens if suddenly the spike comes back and then that obviously is indication it will come back because you're you're egging it on now you're bringing it back yeah yeah yeah that statement what if the spike comes back yeah shows right away if a person said that to me which I do here quite a bit that the person hasn't understood the nature of the therapy because spikes returning is just the rain acting like a human but a spike returning paired with the emotional distress can be you know alarming you can be unsettling it certainly is uncomfortable but once again it's really important that a person engages in the discipline to be able to say hey whether you're here or not here whether I'm facing challenges emotionally or not facing challenges emotionally I'm going to live my life the same now patients will argue with me they'll say well you know it isn't the same Steve because number one when it's here I feel uncomfortable versus not feel uncomfortable so there's a difference and number two it can really impact my performance you know it can it can have a deleterious effect on concentration and therefore in real world our life is somewhat impaired by it and to both of those I couldn't agree more you know yes uncomfortable or comfortable but you know to me life isn't a matter of like it being rainbows and roses so it is natural for all humans to go through periods of discomfort and it's really important that we accept that that is an unavoidable part of living as a human and number two that yes our concentration is distracted you know we can't really control that you know when I've had reflex or even occasionally if I have a panic attack I'm clearly aware that my mental faculties are diminished to some degree and that's an independent system and I've got no control over all I can say is I'm going to take cookie crumbs from the cookie jar and live on those whatever little parts of me are still available and not look desperately to reacquire that greater level of functioning that I'm capable of so in that regard you know we just have to kind of make space for that variability and allow for these actual kind of detrimental symptoms to exist without struggling with them or being desperate to reacquire who we are as a person so I'm sorry for interrupting you step. No no no it was absolutely fine and yeah I'm trying to have any more questions on that no not the minute let's go on to the next one so what is if it's not ACD? I don't think the question is what happens if it's not ACD I have more of a question that patients ask which is maybe this isn't actually OCD so you know the most common spike theme that I get with that question is people who have HOCD people who are afraid that they may be gay number two most common spike theme is you know people who have ROCD people who have questions about whether they're in the right relationship or not and then the big one that everyone thinks is the worst spike theme although in my opinion every spike theme is the worst spike theme which is the pedophile spike theme what if I'm capable of we're interested in being sexually attracted to or sexually engaged with children so so in this note you know it's interesting because unfortunately I think the greatest amount of wasted time in therapy is certainly around this question how can I be sure that I'm dealing with OCD and not an authentic crisis in my life unfortunately the answer is you can't and you know OCD is a condition as I've said many times is predicated on the emotional component the bad news is that this emotional malfunctioning component absolutely has zero ability to respond to words or cognitions so we can't speak mostly to the amygdala although there are a variety of systems involved physiologically in the malfunctioning of the brain but the amygdala is a very basic part of the lower brain stem that sole responsibility is to prepare us for an emergency so if you and I as cavemen walk into a cave and in this perfect darkness we hear a twig snap we don't know whether that's a bear about to attack us or maybe it's a delicious deer and we're about to eat well but our whole body is going to respond physiologically to prepare us for that classic term the fight or flight response and so with that in mind we can't speak to that part of the brain and say oh we're very confident it's just a little bunny rabbit we can only manage that signal through the conveyance of irrelevance we can't put out that emotional fire by me spending hours and hours and hours convincing the person you know this is OCD and not in actual prices it's funny because many patients who come in to see me for the first time who have spike themes related to harm OCD or pedophile OCD or in many forms of what I refer to as character indictments themes where it sort of makes them look like a bad person which is a very very common also kind of universal theme you know thoughts about doing harm thoughts about inappropriate thoughts that conveys this idea that their character is now being diminished so many patients come in for the first appointment and they're terrified that I'm going to say to them oh wow you clearly don't have OCD you actually are an ex right a violent person sex offender um and and so you know patients I can tell you my entire career not once have I said to a patient oh yeah I don't think this is OCD you actually have you know this actual problem in your life uh nor do I think it's ever going to occur in my career because people reach out to me typically after they've done a tremendous amount of research and logically speaking they've come to a pretty strong piece of confidence that they're dealing exactly with the condition because the factors that exist under the umbrella of the condition are so exactly identical to what they're going through but once again they can't lock in the answer the conclusion that this is OCD and not something that they should actually be concerned about because as I hear patients say over and over again and it a bit drives me crazy they say it feels so real it feels so authentic and there's no one who is more aware who has greater faith than the authenticity that these feelings that people are having are a hundred percent authentic and no different once again to being you know about to be bitten by a cobra snake because there's no way for a person to differentiate a anxiety malfunctioning signal and an anxiety authentic signal because the signal is exactly the same as it would be if you were about to do something very very dangerous so saying something like well you know silly a pedophile looks forward to molesting children they're not terrified of the idea that they might want to do it so that sounds very reasonable and very logical and it sounds like any intelligent person would be like of course not a pedophile the idea of molesting children is terrifying to me and hear many patients say I'd rather kill myself than ever be a risk to a child that's not how pedophile speak but unfortunately all this great wisdom has zero impact and even if a person gets 10 minutes of relief because they see the logic of it and their conviction through that logic walks in a sense of confidence the amygdala is going to malfunction again the amygdala is going to send them the emotional distress signal and once again it's going to feel like they're in terrible authentic danger that they may be a harm to a child or a harm to other people or that there's spike theme might be authentic so once again the topic for this theme you know in terms of recovery is not to speak about these topics as if we can ever convince someone that their theme is irrelevant but they have to be the ones to demonstrate that their theme is irrelevant and so it's really important that people not give into that emotional that emotional impulse yeah yeah I always tell patients talking to OCD is like talking to a two-year-old having a tantrum two-year-olds you know want that candy and they think of they scream loud enough that mom and that are going to give it to them so saying you know hey Johnny you can have candy after supper you just have to be a little bit patient probably isn't going to produce much of an impact but when we show Johnny that no matter how loudly he tantrums there's not going to be an effective response to him getting his way that can have much more of a biochemical change mechanism and one of the things that I always tell parents and I would tell you know when OCD suffer is when Johnny's in the middle of a tantrum you can say to him hey scream louder I can't really hear you of that well so that message conveys the relevance and Johnny will often be very disoriented by that message and even saying to the brain you know yep you know hey maybe I'm getting a little tingles seeing that same sex person in my groin hey you know what brain give me a full orgasm that would really be great right now so taking the the slight hints about there being a problem and voluntarily bringing up by call it turning up the volume can be a very very powerful mechanism that demonstrates irrelevance rather than you know seeking relief through reassurance so I just want to reiterate that you know patient patients with OCD tend to be very intelligent they tend to be very rational very logical and so therapists can easily be seduced into thinking well since this is such an intelligent rational person let me just actually explain to them why this is OCD and why they're at actual zero risk of catching AIDS from Adorno or zero risk from being harmed other people unfortunately that is completely not going to have any lasting impact that you know in the in the world of managing OCD I tell patients you know you're dealing with a condition where there are absolutely no answers so engaging in any answer seeking under the umbrella of the thematic umbrella of OCD is never going to produce any long lasting therapeutic benefit so but it's so amazing because no matter how many times I tell patients that the instinct to find relief through information gathering is just a very difficult one to kind of put out because you know a patient is about to be bitten by a snake they want to hear definitively that snake's not poisonous you're not going to die and unfortunately no matter how desperate a person is to get that reassurance it just really feeds as you're aware the condition reassurance seeking actually exacerbates OCD and it and it gives a signal to the the medical brain the biochemical brain there must be a real crisis happening look how much effort and energy you're putting into escaping it if there weren't a crisis you wouldn't be exerting all of this effort to find relief so in that regard there's that really terrible paradox that the most basic human instinct for survival giving into the most basic and compelling human instinct we have as an organism unfortunately exacerbates the condition and so treatment obviously requires tremendous emotional discipline you know to override the most basic compelling instinct we have as humans and not give into that desperate desire to seek relief and to make sure beyond the rash you know any any doubt that the nature of the threats are completely irrelevant do I want that on that note did you have any questions or input yeah not on this civic worry but like going back to the previous one of you know will this ever end that yeah something that just came to me is around you know you said you know if your exam your personal example it took eight months or whatever it was to kind of your brain to learn re-learn or learn and in the case of OCD let's say it's eight months obviously it's going to massively depend and fluctuate depending on person but let's just say it's eight months when you get those moments those the clouds part even momentarily you feel that sense of relief and maybe oh okay I'm getting it now this I'm feeling better this makes sense um yeah I guess it just comes back to your picking the scab example or as soon as that anxiety kicks back in but what if except for all these other worries it's too easy to pick that scab do the compulsions whatever it is that just undoes and I guess you're not starting back at week one but you are delaying that eight month if it is eight months eight month process you know I don't mind that just came to me and I just wanted to share it yeah now that that is correct um you know a person engaging in desperate ritualized and going online asking people for reassurance um unfortunately that resets the brain's healing capacity because you know the brain is designed the body and brain are designed to be self healing in many many aspects of life but sort of when left alone one of my most common parallels is really with sleep and it's interesting one of my future articles will be entitled sleep the hostage of anxiety because sleep requires that we give our brain the opportunity and environment where it activates itself we we don't choose sleep we set the stage for sleep and then the brain puts us to sleep but the more that we pressure the brain or even if we if we ask ourselves every minute it might sleep yet uh that distances us from the goal of falling asleep and anxiety and sleep are almost exact parallels in that regard uh people engage in all kinds of uh mechanisms because of their desperation to get sleep and um you know they they take medication that unfortunately puts them to sleep but it turns off REM sleep so that they wake up as if they you know have a hangover and they they wake up more tired than when they went sleep in the first place um they change their mattress they change their pillow uh they do all they they do nothing in bed other than sleep uh to me all of these are attempts at sort of tricking the brain but really there's no trick it's just a matter of dialing back desperation um and and just saying you know as I say when I'm challenged to go to sleep I just say hey you know what my goal laying in bed right now isn't to get to sleep it's just to relax and to be in a comfy cozy environment if sleep visits me great if it doesn't okay I guess I'll lose another night's sleep and tomorrow might be a bit more challenging but I've been there done that got the t-shirt and you know it's survivable so my entire focus in terms of sleep is the dialing back of desperation and it's sort of the same thing in terms of managing OCD because a way of distancing yourself from the finished line of OCD is to make sure that you're not desperate to achieve that finished line and desperation and resentment are our mechanisms within our our perspective and approaching and managing OCD that can push us back from allowing very wonderful ERP techniques to take their natural effect of producing a situation yeah it's kind of the term sort of getting out our own way is kind of what comes to me and that almost feels a bit harsh shame that but it's like just allowing our our body and our mind to do what it was built to do um and not interfering with that process um and then on across both of them we've talked a lot about a relevance and that's obviously come up before in past episodes um I guess initially the idea of showing one's brain irrelevance or even dialing it up and showing it irrelevance that way is a more extreme version of irrelevance extreme not the right word but um I guess some people are going to be like that's that's too much I can't even imagine to show my brain irrelevance because before it's so scary you know of being this bad person or so how do you work with someone who's really resistant to irrelevance uh I mean the answer that I have is not a very sophisticated one I would call it time and persistence uh you know in um really you know turning it over to the patient to finding within themselves to to finally get on board with the recovery path which is both a behavioral path I'm very happy to say as a behavioral scientist but it's also a perspective path and that's a little bit where some of the cognitive work comes in and just to reiterate you know it's not cognitive work as in pointing out the irrational nature of the themes because that would never have any impact on a thinkingless amygdala it's really the cognitive part in managing one's perspective desperation um and and and it a bit sort of an immunity uh you know I live in a world where there are no such things as good or bad people uh you know if we believe in people being good or bad the brain is going to continuously scrutinize within our own world whether we qualify to being a good or bad person I can assure you that the human brain is designed to place a lot more weight and bias honor deficiencies and moments of weakness and therefore people who believe in good or bad people are most likely to suffer a sense of inadequacy because the brain just naturally designed to to focus on their deficiencies I always you know using analogy you know why why would our brain do that why would our brain be conditioned to focus on our deficiencies and I can only guess I'm not a PhD in anthropology but my guess is when once again we were cavemen if you were really good at picking up cave chicks and not so good at spearing the deer I think your brain would say you know sure you can find a cave chick but you're not going to be able to feed your family so you better get better at throwing that spear rather than aren't you a great guy for picking up cave chicks and have on the really good spear thrower but I'm not really that effective at picking up cave chick cave chicks my brain would be like yeah you can feed yourself fat but you're going to not have any offspring or mate to kind of hang out with so your life's going to suck and so I do think that there is a survival mechanism to the brain being conditioned to place much more weight on our deficiencies you know rather than our assets and you know people with OCD are certainly not immune to that yeah it's interesting yeah because evolutionary speaking it will be our deficiencies a good get us killed yes our weakness here absolutely absolutely and the funny thing about your example it's the spear frower is probably the one that would have got the cave chicks because the spear frower that was able to feed and therefore that's that evolutionary sexy I guess pretty out that perhaps that would be the case being a little bit too technical for me I wanted to circle back on the best spike theme okay from interesting is that just a sort of an interesting demonstration about how meaningless the actual themes are I worked with this one patient who had four different spike themes they never co-occurred but his brain like a roulette wheel every week or every month would switch to the next theme so his four spike themes were number one that he might have run someone over when he was a new driver and 15 years later his brain still hadn't come to a conclusion whether he ran someone over and he always felt like working on figuring that out number two was that when he would be on a balcony his brain would tell him to jump number three he had thoughts that he might have cheated on his wife and number four he had thoughts that he might at work yell out racially inappropriate comments and when his brain would be on let's say the jump off the balcony topic the other three topics were completely irrelevant to him if his brain even reminded him maybe he ran over that kid when you were 17 he'd be like yeah whatever I don't think so because there was no energy in the other three topics he would respond like any other nano cd suffer to those topics and then a month later his brain would light up the you're going to yell out racially inappropriate things and he then wouldn't care about you know cheating on his wife he wouldn't care about jumping off balconies he wouldn't care about running over a person when he was 17 and he would beg his brain to go on to the other topics you know rather than being tormented by the one he had even though a month ago it was the other topic his brain was focused on and he couldn't wait for that topic to come to an end so it really just speaks to the idea that focusing on the topics in any way is a complete waste of time because this condition is just an energy that seeks out a face and that's what OCD is it's the it's the broken amygdala the neocortex the thinking brain can't handle feeling like I'm in a crisis for no reason whatsoever so it artificially links these very random often associations of these themes to the the emotional distress energy and most of the time OCD themes are completely unrelated to any element of a person's character or nature as a human being in any which way there are some exceptions like I've discussed I think in prior episodes where certain OCD themes have some tendencies toward some personality styles but that's a whole different presentation I think I already gave that one yeah now is a really really good descriptor description yeah I always think it's kind of the same beast it's just different masks yes right and today this mask isn't gonna scare us so let's put on this one and it's it's the yeah it's the fuel you remove the fuel you're not gonna care if you have those faults you know yeah it's interesting because in the in the groups that I run almost every patient in the group says oh I wish I had that theme that would be easy to manage the one that I have is the worst and and so that's a very very pervasive kind of you know sense about the uniqueness of what everyone's own suffering when actually I tell patients you know I've worked with people who they're in their entire OCD spike theme is a song stuck in their head doesn't even matter what the song is you know versus someone who might think that they're a pedophile not one is worse than the other to the actual sufferer it might seem to a lay person that oh poor person he thinks he's a pedophile what a horrible thing to think but the actual sufferers internal experience is equal suffering from oh my god I can't get this song out of my head and he would say well I wish I had pedophile OCD because all I need to do is avoid being around children then life would be a bowl of cherries when obviously it sort of just doesn't work that way yeah yeah interesting I just wanted to add it just to yeah while you were speaking what does treatment success look like I was talking to someone earlier today and this person asked me can you cure OCD you know is it is the finish line of cure and I'm asked this question quite a bit and I like the the perspective that I share and that is that OCD in its treatment success is like a volcano that goes dormant there's still volcano it's still capable of erupting some volcanoes go a hundred years without erupting some volcanoes were up every six months the idea that it's capable of erupting is like the amygdala still has this tendency to potentially start to malfunction again and be thrown off by some biochemical imbalances life stressors can certainly produce that but to say you know I've had patients reach out to me three four years after you know we have of course successful treatment where they you know achieve their treatment goals in no way being handicapped by the condition and they say oh it's kind of come back and that's very much not uncommon we call that booster sessions they usually last four times reconstitute the exact same principles that got them into recovery in the first place and the good news is most often their brain reacts in a similar way and it doesn't take nearly the same amount of time to recreate that dormant state so we don't use the word cure we we use the word remission I use the word dormancy and it's just like my my sciatic which has come back four times I would say I haven't cured my sciatic I would say that it's currently dormant for a year and if it comes back tomorrow it comes back tomorrow if it comes back ten years from now that's up to my brain it's not my department and that's to me one of the most dismissive mechanisms that I have in regarding sleep regarding gastric reflux regarding sciatic regarding any OCD this isn't your department you have no conscious control over these independent mechanisms therefore best thing to do is to say hey brain I'm gonna let you make these decisions about their your presence or absence and I'm not gonna metal in it and I'm certainly not gonna try to control it because as I said in my choice article trying to control independent systems does nothing but mark it up yeah yeah yeah I like that yeah good way to end now it's been a useful topic I think both of these concerns worries obsessions we've talked about today I've heard many many times over the years I probably had them myself I definitely have um yeah so I think I think it's gonna be helpful for a lot of people so thank you for sharing I hope so thank you for listening to this week's podcast if you enjoy the OCD stories podcast and would like to support us over one time tips slash donation please go to the OCD stories dot com forward slash support all tips no matter how large or small or greatly appreciated 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 visit go dot treat my OCD dot com forward slash the OCD stories and quit this claimer guys this podcast is not therapy it is not a replacement for therapy please seek treatment from a trained professional and to always speak take care