(soft music) - Hi and welcome to another
episode of Let's Talk About It. I'm Dr. Whitley Lassen, and I'm so excited to be joined today by Dr. Elizabeth McMahon. Dr. McMahon is a licensed
clinical psychologist, she's an expert in anxiety and she has a private
practice in San Francisco where she treats clients who are dealing with anxiety problems. She's also the author of "Overcoming Anxiety and
Panic" interactive guide. Welcome back Dr. McMahon. - Thank you Dr. Lassen. - Today we're gonna talk
about how to overcome OCD. Dr. McMahon and I have already
talked about what OCD is and what it's like to live with OCD. To learn more about those topics, check the links to those
videos in our description box. So Dr. McMahon, we've
talked before about how OCD is a mental health disorder. Can you talk a little bit
about the importance of recognizing it as such? - Sometimes people think
of OCD is kind of a quirk and they'll say things
like, oh, I'm so OCD, just because they like things neater than perhaps their roommate. But actual OCD is a serious problem. The thoughts that come to your mind are unwanted and distressing and the actions that they
make you feel you have to take the compulsions can take
up hours out of your day and can interfere with relationships. And those actions are response to fear. They're not a choice. It's interesting. If you saw the first video, you may remember that
scan of brain activity that showed that there are
areas of the brain that are over active. And this can start early in
childhood and adolescence. In fact, 80% of people with
OCD have their first symptoms as a child or a teenager. So OCD is not a choice or a preference. It's not the same thing as
wanting to dust once a week when your roommate wants
to dust once a year. It's not something that
you have freely chosen. But recognizing OCD is the first step toward getting effective treatment. - What kind of treatments
are effective for OCD? - The most effective treatment is a form of cognitive
behavioral therapy called exposure and response prevention. For people who carry out this treatment, who fully comply with it,
75 to 85% of these people get up to 50% to a 100% of symptom relief. This is more than can be
achieved by medication alone, although medication can help you carry out the exposure and response
prevention treatment. There are years of research
supporting its effectiveness. And even if it's not completely cured, OCD can get so much better. - Can you explain a little bit more about exposure and response prevention? - Absolutely. The exposure piece means
not avoiding situations that trigger your obsessive thoughts, that trigger your distress. And the response prevention means, not acting on the thoughts,
not acting on the discomfort, not carrying out your compulsions. This can be hard if
you're gonna understand. So you wanna know that OCD
is a misfiring in the brain and remind yourself
that your brain is stuck sending you a false alarm so that your job is to accept that false alarm like listening to a car
alarm that's stuck outside, at the same time ignore it. It's a stuck false alarm. The good news is, exposure
and response prevention, not avoiding and not
carrying out the compulsions, helps reset the brain levels
back to normal levels. The bad news is, you have to stop acting and
doing your compulsive actions while the obsessions are
still present and distressing. And it takes some time for the brain activity to
resume its normal level. - What does that actually look like? Can you give us an example of exposure and response prevention? - I'd be happy to.
That's a great question. So for example someone who's
been washing their hands 10 or 15 or 20 times before dinner, would wash their hands once and then stop. Even if they feel like
their hands are dirty or have germs on them. Someone who has OCD where
everything has to be perfectly put in a rigid order would be to allow objects to be put away without being perfectly ordered, without being perfectly lined up. You'd have to understand that the thoughts and the images that come into your mind although distressing are
not actually dangerous and do not mean that you will act on them. So for example, someone with OCD where they have thoughts and
images of harming loved ones, say thri, picking a knife
and stabbing someone would have to understand
that they're not violent, they're not gonna act on these thoughts and they'd have to continue
to use knives appropriately. Checking locks once and
then not going back, checking the oven once
or the garage door once, and then not going back, not
calling someone else to check, not mentally going over in your mind and reassuring yourself
that you have checked. Other therapy approaches
may also be helpful. Some of these may include
acceptance and commitment therapy, family therapy and
mindfulness-based cognitive therapy. In addition to exposure
and response prevention. I mentioned medication earlier and the medication that's most
commonly used in treating OCD is the family of medicines known as selective serotonin re-uptake
inhibitors or SSRIs. These are often well tolerated and helpful especially when combined with exposure and response prevention. Medication can make it
possible for someone to engage in the treatment, but medication alone tends to
provide less symptom relief to fewer people and
leaves a chance of relapse when medications are stopped. You may have also heard about forms of brain stimulation for OCD. And the research there is in
the relatively early stages with some inconclusive studies. But what's exciting is
that when OCD is treated either with exposure
and response prevention or with medication or with a combination, you can see in this brain scan that areas that used to be overly bright have now come back down to
normal levels of activity. - Dr. McMahon, thank you for explaining how exposure and response
prevention works. Can any therapist treat OCD? - Well, not all therapists are
equal when it comes to OCD. If you have OCD and you're
looking for a therapist, my recommendation would be to
find someone with experience both diagnosing and treating it. The research shows that
even with therapists who are providing exposure and
response prevention treatment, that therapists who have
experienced treating OCD have the best results, particularly therapists who are very good at creating what's called
a therapeutic alliance who are both empathic but
also willing to push you because the treatment can be hard. Successful therapists are respectful, they're understanding, they're interested and they're challenging. The research shows that
people with OCD and treatment don't get as good results
with therapists who are just neutral or permissive or
with therapists who are cold or unemphatic, which makes sense. - What doesn't work for OCD? - Just trying to relax. General anxiety and stress
reduction is always helpful but not an effective treatment
specifically for OCD. And another thing that doesn't work is trying to stop the obsessions. We don't control these
thoughts coming into our minds. The one use for what's
called thought stopping is to stop if you have mental compulsions in response to the obsessions. Stopping those because
remember the best treatment is exposure to the obsession,
but response prevention, preventing the compulsive action. So stopping a mental
compulsion, that's useful. - Some people might find
it tough or scary to share about their experience with OCD, but we know that social support
is helpful in coping with any kind of mental illness. How can someone talk about OCD in a way that will help them get support? - You might wanna to tell
people that you trust that certain things make you very anxious, and that as a result, you
feel the need to do things repeatedly or in a certain way or things that don't make logical sense. If you're seeing a therapist and engaging in exposure and
response prevention treatment, I would encourage you to
explain that treatment to the people around you and ask friends and family for support in carrying out the treatment because it's hard when you get anxious. Tell others what they can say that might help you when you're anxious. For example, some people with
OCD have found it helpful if their friends or family members say, "You're looking very anxious right now, is this your OCD, what is your OCD saying, and what are you supposed
to do to make OCD better or how can I help you
not do your compulsion, but to do something else?" Offering kindness and encouragement, supportive encouragement, can also help. Friends and family may
wanna say something like, "I'm sorry this is hard, I care for you and I
want you to feel better. I believe you can conquer OCD. What can I do to help you?" - Thank you Dr. McMahon. I'm so glad to hear that there are evidence-based treatments
that work in treating OCD. For more resources on OCD, visit the International OCD
Foundation find help website, or check out these books. "Overcoming Unwanted Intrusive Thoughts", "Stop Obsessing!" And "The OCD Workbook." For more resources from Dr.
McMahon on anxiety disorders, visit her website. Be sure to subscribe,
follow us on social media and visit our website for more information about our Mental Health
Ally Certification, in our CBT courses for
mental health providers. Leave us comments and questions, and suggestions on what you'd
like to learn more about. Thank you Dr. McMahon for
joining us again today and teaching us about treatment for OCD. - Thank you Dr. Lassen for having me. It's so important to know
about anxiety disorders because there is effective treatment. There is hope. (soft music)
