27:59

then a lot of aspects of recovery so

28:02

for me i started exposure response

28:04

prevention and twenty twenty one and

28:06

it is now twenty twenty three as of this

28:08

episode so i

28:11

as actually became mentioned i had com

28:13

morbid obesity ptsd uses that has

28:15

complicated treat in a little bit but overall my

28:18

trajectory of treatment is pre com

28:20

and which is that there is a

28:22

lot of games as soon as one

28:24

starts doing here p and they get under the understand

28:26

how it works near enough like it was teaching to buy

28:28

into a few well your p but

28:31

then from there i mean we the

28:33

only d the chronic condition and back and sounds scary

28:35

and it is but with the proper

28:37

tools

28:38

as he just talked about i for

28:41

i'm still at european doing it right after this episode

28:43

for to be downloaded from this episode also

28:46

it is a it's a practice for me because

28:48

i have come down from that

28:50

from scoring extreme on the why box

28:52

the yale brown obsessive compulsive scale that assesses

28:55

the severity the city a diagnosis it sometimes

28:57

on i've gone from mixed extreme to

28:59

severe sometimes i moderate to severe so

29:01

for me my oath it is very strong

29:04

it is i have recovered enough to see

29:06

my life i would you say

29:08

back because they didn't really have my life honestly

29:10

before treatments and it was very

29:13

limited life but with that being said

29:15

i still struggle deeply and

29:17

there are lots as on themes

29:19

and compulsion such i'm still working

29:21

through myself right now so i struggle with

29:23

be i talked about before mental compulsions

29:25

and they feel more difficult to deal

29:28

with because it's kind of feels like thinking that

29:30

they're us it's just a lot of compulsive thinking

29:32

he hands on themes that are more deeply

29:35

rooted so i think for me on your

29:37

p has been extremely helpful very quickly

29:39

with an almost more

29:41

surface level of sessions and i don't see surface

29:44

in a way to diminish the happiness

29:46

of how much impact of a life that it

29:48

really just feels more like this is oh

29:50

cd i understand this is oh cd so i

29:52

will do the rp at it works much

29:54

more easily is also a physical compulsion

29:57

but for things much more related to

29:58

you honestly i do team but

30:01

harm with the fear of hurting

30:03

other people with my thought coming through because

30:05

when i want to say is on adding

30:07

onto intrusive thoughts and harm people

30:09

with lcd or i guess everybody

30:11

hadn't true thought i would have a random thought

30:13

as like is

30:15

abhorrent things as things happening the people

30:17

like what if i stop my dog like what

30:19

if you know i'm driving under the bridge and it falls

30:21

on me and she'll most people without

30:23

oh seedier able to be like that's a weird thought

30:25

okay like moving on my brain just like

30:27

did something people with lcd have

30:30

such a hyper responsible response

30:32

to that bad it's like well what if that's all true like

30:34

what if i actually want dot what is and

30:36

be don't see don't want it at all the heat

30:38

that thought speedy not resonate i thought his ego

30:41

dystonic all that to same does

30:43

your what harm thoughts are to can extend to literally anything

30:45

ever and are very scary i'm so there's

30:47

some of the harder themes for me that i'm still working during recovery

30:50

so yes it can work in the short term of like you

30:52

do your sessions and you learn he rpt vomiting

30:54

life also and be advocacy and community

30:57

based ferocity we talk about your keeping a lifestyle

30:59

like because i was a d can kind of latch

31:02

onto anything that scary in our lives especially

31:04

when we the more be care about it the more too much

31:06

on until we have to keep doing the rp and

31:08

keep an understanding that

31:10

we could tolerate the obsession and not

31:12

you compulsive to some very simple but is extremely

31:15

difficult

31:15

you know if if i get into check for a second

31:18

and and maybe this is a helpful way

31:20

for listeners to understand

31:22

a philosophy that guides treatment

31:25

for oh city and to this point about

31:27

this be a chronic condition would that

31:29

mean said is one as

31:32

take care of themselves in a very specific

31:34

way and comparisons that i

31:36

use for clients had sometimes reassuring

31:39

i use it dentistry comparison so

31:41

when you go to the dentist you go regularly

31:44

because you know that that's good for your teeth

31:46

you also every now and then

31:48

when you go the dentist a dentist as are you need to filling

31:51

or you need root canal

31:52

and that means you going to go a little bit more frequently

31:55

but you still have every single day

31:58

a certain minimum level of care

31:59

maintenance that you to give your teeth your

32:02

the brush your teeth and

32:03

sometimes like brushing your teeth has not a great like

32:05

sometimes

32:05

people get section of guns or

32:08

you get like a piece of popcorn stuck

32:10

between your teeth and yeah to deal with that rises

32:12

like it a nuisance when people

32:15

get well enough with

32:17

oh c d that it's really better managed

32:20

they still need to do this regularly

32:22

and there will still be days where they go

32:25

oh wow you know same as a top her day

32:27

i had this intrusive thought of harming

32:29

someone it was lot stronger kind of reminded

32:31

me of what it was like six months ago and

32:34

that's kind of like a brief filling

32:37

that needs to be dealt with right like and

32:39

every now and that actually might be even worse we'll

32:41

at while you know i'm really stuck on

32:44

this formed saw an and i'm really

32:46

concerned again about

32:48

a whole with of things with germs

32:50

and contamination one that's like now

32:52

the root canal so we really

32:54

have to view it more through this lens

32:57

of regular maintenance and and

32:59

how to achieve wellness by integrating

33:03

with component of treatment a to your life beginning

33:05

with a period of time where it might eat up

33:07

a lot of time and then moving to

33:09

a period of time in your life where it might be

33:11

a regular daily of hurts

33:13

and i also want to add on few that analogy

33:15

really quickly because i know i said it with chronic

33:17

adds that kid at face value be taken

33:20

as oh well that's is so unfortunately

33:22

quiet and do treatment when i have to live with that my whole

33:24

life while kind of with the analogy

33:26

as a hobby media cavity that

33:28

you didn't get treated for like ten years

33:31

i haven't for two years so i know what that feels

33:33

like as if the amount of pain in it taking over

33:35

your mouth all day every

33:37

day like once you get your cavity

33:39

filled and then he brush your teeth and you might

33:42

get a cavity again like for the most

33:44

part wait until you get that next have the you're still

33:46

living in far less pain and in

33:48

far more freedom so it's still worst

33:50

team in the cavity felt and still worth of

33:52

at it there's still some his freedom so yes there's a

33:54

lot of hope it lcd even once it

33:57

it's chronic

33:57

exactly right back

33:59

i love that that's great thanks rebuilding

34:02

on it so and another

34:04

question occurs to me going back to something

34:06

that obama said earlier which is that she thinks that

34:08

she was born with a c d and i want

34:10

to ask you doctors say are people

34:12

born with it is it acquired when this

34:15

is first manifest how would you know if you

34:17

stewing in a child for example

34:19

yeah so i'm so we

34:22

usually think of oh cd is having two

34:24

distinct ages of or and said

34:27

i'm dizzy

34:28

young child version and

34:30

so children who did l a bit

34:33

where it's really evident to everyone

34:35

around them usually around ages six or seven

34:38

on what makes it a little more complicated

34:40

is that

34:41

this a developmental stage where children

34:44

exhibit compulsive behavior

34:47

of where it's expected in normal

34:49

ah and so when we think

34:51

about the birth of a child

34:54

who may have a future with a

34:56

c d c probably temperamentally

34:58

do

34:59

exhibit it early on we don't know definitively

35:02

how someone arrives with oh cd

35:04

but we do know that there are certain disposition

35:07

sat increase the odds on

35:10

and

35:10

those kids usually

35:12

develop an early dinner

35:14

a little

35:15

a little more than later on set which is in

35:17

the teen years and by the way

35:20

up for listeners his podcast if

35:22

you've had other people talk about other kind of

35:25

psychiatric conditions most conditions

35:28

have an age one at the teen years the teen

35:30

years or period of intense

35:33

social stress that

35:35

is a arm conduct

35:37

or a way in which a lot easier for an anxiety

35:40

disorders depression and other psychiatric

35:42

conditions show up so it's not surprising

35:45

that obe c d would have this other

35:47

second major age of onset so

35:50

kids you develop an early they probably

35:52

temperamentally are more anxious

35:54

more prone to developing this because

35:56

of circumstances in their environment

35:58

that naturally would a leather

35:59

there's a what i like to tell people is that you

36:02

probably would have developed it no matter

36:05

what

36:06

right to spend time in more

36:08

traditional psychotherapies where you might try

36:10

to break down behave yourself once parents

36:12

to look for conditions that

36:14

gave rise to it

36:16

is usually kind of a fruitless endeavor and and

36:18

frankly it doesn't promote any kind of wellness

36:20

anyway arm but we do know

36:22

that there are at temperament

36:24

says they call it condition he of

36:26

ways that you respond emotionally to the world

36:29

that you path when you arrive that

36:31

may set the stage with us and will my

36:33

you've talked about having some

36:35

com morbidities some some other

36:38

issues in addition to are

36:40

having a c d how how has

36:42

that affected your overall

36:44

wellbeing and is that really com and as

36:46

you're dealing as as and advocates

36:49

you see that a lot and people

36:50

yeah so there's

36:52

actually in terms of the research died and for

36:54

lcd it especially for therapeutics namely

36:57

right now and there's a lot of research speed

36:59

down with candidate in psychedelic for a city for example

37:02

a huge problem that researchers are facing

37:04

is that they have a quote unquote dirty population

37:06

meaning that people don't just have a cd

37:08

they also have many other com or but disorders and cells

37:11

were not really sure like if we're working specifically

37:13

those who did i think all that to say that

37:15

it's very common for has com where did it eat

37:17

especially i think them of the highest one third

37:20

major depressive disorder generalized anxiety

37:22

disorder one of than that i'm very particularly

37:24

interested in his post traumatic stress disorder

37:27

and i think with super important to note

37:29

down because i see this question a lot

37:31

in my research and advocacy

37:33

is while is a with these huge ltd

37:35

just a form of these disorders down or if it's

37:38

just a coping mechanism for these other disorders

37:40

it's only d while it does a lot have

37:42

a lot of overlap it's also a distinct disorder

37:44

with distinct functionality that requires distinct

37:46

treatment but to your question

37:48

of my overall wellness i think

37:51

just on surface level having these com or bit

37:53

at ease in the fact that it was far easier

37:55

to find my other disorders

37:57

before oath edu just delayed the

37:59

treatment that it could have received for so long which

38:01

really and rak me for some

38:03

as you my life and i'm working through the greece

38:06

has how much life i lost due

38:08

to undiagnosed untreated lcd

38:10

i mean like the amount i had gained

38:12

in my life in the last two to three years

38:14

from proper treatment like it's

38:17

just mind blowing what life would help

38:19

how much as possible for my life with proper

38:21

treatment so i think on surface level just as

38:23

com or did it he kind of mafiosi but

38:25

also in general like dealing with so

38:28

many conditions at once and the

38:30

severity of it all it's it's

38:32

really taxing and i think

38:35

it's hard to you and as parson

38:37

entirely apart as to what's the most

38:39

debilitating but i will say because

38:41

of be added burden of oath

38:44

edu being so under diagnosed

38:46

and also because who city has

38:48

this way of causing and casting doubt on

38:51

top of everything in my life and stuff

38:53

causing this level of on sci fi that the

38:55

other disorders don't really do as much

38:57

as some certainly didn't make things very

38:59

fun

39:01

i if i could add for a second as i described

39:03

exposure therapy exposure with response

39:05

or benson and mentioned it also

39:07

and she i think is a great

39:09

living example of someone who has benefited

39:12

from it and gotten freedom from

39:14

her oh city symptoms that if

39:16

you look on line so listeners to this podcast

39:19

may now go further and lookout exposure

39:22

with response from mention and the descriptions

39:24

that are out there vary widely some

39:27

of them fail to do it justice

39:29

so i want to say out loud and

39:31

with the strongest voice i possibly can that

39:34

conducting exposure with response renshon

39:36

for someone who suffers from most hideous probably

39:39

the most compassionate thing you can do

39:41

if it's done properly they're

39:43

all kinds of descriptions out there that characterize

39:46

it based upon the exposure part

39:49

and they also sometimes capture

39:51

elements that are gleaned

39:53

from execution by therapists

39:55

who may be understand what they're supposed to do

39:57

but do with in elegantly and

39:59

so that in error of miss

40:02

of blaming the treatment when actually

40:04

it was due to and in artful

40:06

or unskilled therapy execution

40:08

so i can't am i can't stress it or not it is really

40:10

the most compassionate thing you could do it provides

40:13

the fastest relief of any

40:15

treatment we know when done properly

40:18

and so i really feel like it's so important to really

40:20

highlight that for anybody listening

40:23

what about drug therapy though

40:25

i'm wondering since sumer brought that up our

40:27

our their drug therapies that are effective

40:29

for our city

40:31

sit there been a lot of drugs tested

40:33

for o c d and are on the market

40:35

for o c d that also has

40:38

a bout of forty five or fifty year

40:40

history and the

40:43

op medical research literature

40:45

on the one drug that got the started

40:48

is called clomipramine our

40:50

trade the trade name is enough for know i'm

40:53

the challenge with that rog as i understand i'm

40:55

not a medical doctor but i know enough about medication

40:57

that i could talk about it might with mile

41:00

competency ah is that

41:02

on

41:03

their side effects that people find

41:05

to be unpleasant ah the

41:07

new or

41:08

or anti depressants and the

41:10

class a drugs by the way that are most likely

41:13

to be used for oh cd or anti depressant so

41:15

clomipramine was the first that

41:17

really showed benefit our the

41:19

side effects people find to be difficult

41:21

to tolerate though and so the

41:23

newer ones and when i see new or it's

41:25

like as of prozac and on

41:28

so it's still like a thirty five year history

41:30

are better tolerated medication

41:32

so most prescribers who

41:35

treat oh cd regularly start

41:37

with new serotonin

41:38

reuptake inhibitors so

41:40

the neurotransmitter that's been implicated

41:42

in oh cd is near a is

41:45

serotonin ah prozac

41:47

as one drug that so often prescribed blue

41:49

box or aka both

41:51

both these you can get generics of lox

41:53

a teen for prozac flu vaccine

41:56

mean for blue box or sertraline

41:58

aka so long

41:59

he is also widely prescribed

42:02

newer medications than that

42:04

are things like on lexapro

42:07

ah which is commonly prescribed

42:10

and as you get to newer and newer medications

42:12

the what they call selectivity

42:15

ah the degree that they target only

42:17

serotonin and don't end

42:19

up targeting other neurotransmitters which is

42:21

where the side effects come into play is

42:24

what is the benefit for the new or once a less

42:26

a lexapro really

42:28

only target serotonin there aren't too many

42:31

other ah neurotransmitters

42:33

at a target so people don't have as many side

42:35

effects the downside is that the

42:37

research suggests that they may not necessarily

42:40

provide as much benefit and

42:42

the bottom line with all of this is that

42:44

most of the research has suggested that

42:46

medication alone is generally

42:49

not sufficient some most

42:51

sufferers at some point probably

42:53

will need to meet with a mental health professional

42:56

who does not prescribe in order

42:58

to help alleviate their symptoms but

43:00

medication can take the edge off and some people

43:02

find real meaningful and

43:04

lasting benefit from it so we should

43:06

really pay attention to that it's important facet

43:09

of how treatment can be done properly and comprehensively

43:12

the neuroscientists in the wants to this out

43:14

a few more things that

43:15

upset that again we're a line of her third

43:17

skill

43:17

it's odd it at buddha meet modulators

43:20

to glutamate as and excited to a neurotransmitter

43:22

that also that implicated or to the it's

43:24

while for that's being looked at as well as well as

43:26

psychedelic treatment for the purposes

43:28

of modulating many other type this neurons

43:31

and neurotransmitters additionally i

43:33

think when people hear the word anti depressant they

43:35

think that oh so it's just a form

43:38

of depression it's not at antidepressants

43:40

you help with depression but also they help with many

43:43

other things because they're asking us they're sinners ignorance

43:45

also specifically for oh cd patient

43:48

pants need a far higher dose of an attack

43:50

at an anti depressant or accessorize

43:52

than people and just for depression

43:55

and

43:55

the last thing i want to say is just exactly

43:58

on highlighting dr mckay said

44:00

about the research showing such yeah

44:03

of course like medication can make an impact

44:05

with a typically need exposure to spot prevention orders

44:07

far higher and more positive

44:09

outcomes with a closer to spot prevention especially

44:12

comparing if one just it your p

44:14

vs medication if they had to pick one or the

44:16

other which is not the case that if they had you york

44:19

he is more efficacious the medication alone and

44:21

medication can be adjusted and helpful as well

44:23

but your p is the cornerstone of treatment

44:27

so just to tie

44:29

up loose ends here let me ask

44:31

an overarching question to to you both since

44:33

you're both doing work in these areas out

44:36

what do you consider the big on answered questions

44:38

and what are you working on now where

44:40

you really hoping to maybe breakthrough

44:42

huma you want to take that first

44:45

i eyes a

44:47

narrow psycho pharmacologists

44:49

once you understand why

44:51

on earth both edi brains exists

44:53

white or it's the neural circuitry what exactly

44:56

is going on so hopefully we can develop novel

44:58

therapeutics a novel intervention i

45:00

also think that with the resources already been

45:02

done is already pretty evident that

45:05

there is a narrow developmental components in

45:07

that's above all it is a

45:09

brain disorder it is not a choice is not a quirk

45:11

it's not an adjective and that there are

45:13

a book or a unique brain circuits features

45:16

that are getting rice these horrific

45:18

experiences and people i also

45:20

once you understand if there

45:22

are differences in physical versus mental compulsive

45:25

in the way that it isn't force in the

45:27

brain because it seems to be like

45:29

there's sometimes a divergence in the way people recovery

45:31

not way at least in my experience and others

45:33

is while and i think dr mckay is

45:35

also doing amazing works you've heard of the field

45:37

just accessibility and understanding of disorders

45:40

i'll let him take it away as well

45:42

well that's exciting what you're working on una and

45:45

i'm i'm so glad that you're joining the field

45:47

in this area so it's great own will

45:50

and and to what you're asking about him so

45:52

my my focus of late as been

45:54

as as uma said accessibility i really

45:57

i feel it's so important that

45:59

more people first of all be able to identify

46:01

it right place the fact that people

46:03

go undiagnosed and then when they get

46:05

diagnosed don't get proper treatment to me is

46:07

really a tragedy are particularly

46:10

when the treatment has

46:12

been available and known for as long

46:14

as it has been ah so

46:16

what i entered the psychology workforce

46:19

in nineteen ninety three and

46:22

at that time exposure would response mention

46:24

was known it's not like when i

46:26

entered the workforce people like are and what to do

46:29

about oh cd we knew what to do

46:31

then and here it is now

46:33

all these years later and is still

46:36

a poverty of availability of treatment

46:38

to me that's that's like if he said we

46:40

know penicillin works but we can't get

46:43

it to everybody so that him

46:45

to me is really just horrible and

46:47

we need to do better ah in that

46:49

front at the same

46:51

time there are these giant areas

46:53

that we don't really fully understand

46:55

yet so we really haven't talked about or it's

46:57

probably a topic for a different podcast frankly

46:59

is what what is the role

47:02

of some other emotional states or

47:04

the focus of our discussion was anxiety

47:07

right most people with o c d immediately

47:09

report i'm anxious this

47:12

is terrifying byte

47:14

about fifty percent of all suffers

47:16

whether it's their main symptom or

47:19

it's a secondary symptom of a cd struggle

47:21

with contamination concerns and

47:24

that brings into the focus things are right

47:26

right at like alma are and

47:28

what suddenly gets wrapped up in this or thinks about

47:30

discussed and so

47:32

i only talk about briefly solas i guess

47:34

we'll be a teaser people who are listening email

47:36

me or invite me to another podcast ah

47:40

discussed his design added

47:42

score to prevent dot help prevent

47:44

us from getting poisoned by stuff or

47:47

whether it be through our skin or through our mouths

47:50

ah and so this is and

47:52

animating focus for a big portion

47:55

of people though cd not to mention other ot

47:57

other psychological conditions and we don't

48:00

we know what to do that yet i mean we have kind

48:02

of a sense but really good at it yet

48:04

ah so that i think is one of

48:06

a number of important frontiers

48:09

that we need a deal with and and obama will

48:11

appreciate as we know for discuss

48:13

whole different neural circuitry is involved

48:15

the one the brain areas involved in fear

48:18

or not the same ones for discussed so

48:20

that means we really have to deal with it differently

48:23

when it comes to psychological treatments or any

48:25

other kinds of medical interventions

48:28

and i want to come full circle to where

48:30

we started the beginning about the misconceptions

48:32

that lcd because that as dr mckay mentioned

48:35

treatment is available resources are available

48:38

why are people going so long misdiagnosed

48:40

and untreated largely that's because

48:42

oh cdc has a unique barrier that other

48:45

psychological disorders don't which is to complete

48:48

misunderstanding and misrepresentation of what it is

48:50

until i think bridging the gap really

48:52

started episodes like this on mars platforms

48:55

we get to raise awareness for what real o

48:57

c d s and making sure that

48:59

people are more aware early are that oh cd

49:01

is not a choice is not something people like

49:03

in that repetitive thoughts intrusive thoughts

49:06

and repetitive physical and mental behavior

49:08

can be a disorder that they can be treated

49:11

for so that full

49:13

circle this is why we need to raise awareness is his wife's

49:15

advocacy existence as a large scale

49:17

for ot specifically and why people like

49:19

you dedicate their lives to talking about it's not

49:21

it's good we want to talk about how hard are like

49:23

is it's because we're trying to make sure other people don't

49:25

suffer as long as we did unnecessarily while

49:28

more thank you both for joining me to there's

49:31

been a fascinating conversation i'm sure we

49:33

could go on longer and er doctor mckay me

49:35

to get back to disgust at some point that is

49:37

us a topic that i would like to talk about

49:39

side i'm sure i think we should join us for that

49:41

i'll hook as a nice yeah we we

49:44

we may all meet again then the word

49:47

for it even says are snacks

49:51

while that thanks about this been really great was

49:53

a pleasure thank

49:54

you so much

49:56

you can find previous episodes of speaking of

49:58

psychology on our website as speaking

50:00

of psychology dot org or an apple spot

50:02

of you tube or wherever you get your podcasts

50:05

and if you like what you've heard please leave a review

50:09

if you have com and sir ideas for future podcasts

50:11

you can email us at speaking of psychology

50:13

at a p a dot org speaking

50:17

of psychology is produced by me why numbing

50:19

ourselves editor ask

50:22

the american psychological association

50:25

on him mills