In this post, Emma asks Nathan Peterson, a licensed clinician and OCD specialist, 10 questions about OCD.
Emma: Hi, everyone! Today we have a special guest. It’s Nathan Peterson. He’s a licensed clinician and OCD specialist and he is also the guy behind the channel OCD and Anxiety on YouTube. So, I’m really excited to have him. Really excited to hear what he has to say. I’m going to ask him 10 quickfire questions about OCD and its treatment and I’m excited to learn more about it. So, let’s jump in and see what Nathan has to say. Okay. Awesome. Thank you, Nathan, so much for being here. Really excited to talk OCD with you.
Nathan: Yay! Thank you so much for having me here. I love talking about OCD and anxiety and hope we can get some good information out.
Emma: Okay. Awesome! Okay, we’re gonna do quick answers to 10 questions about OCD.
How is the brain of someone with OCD different from neurotypical brain?
Emma: So, number one how is the brain of someone with OCD different from neurotypical brain?
Nathan: Yeah, someone with OCD, their brain work just a little bit different. If we want to get in kind of the technical term, a lot of times, we look at the the front frontal lobe and it sends signals back to the basal ganglia, which all these different terms and sometimes people say it’s really overactive and it wants to problem solve and what’s really happening, yeah, they’ve seen brain scans and they can see almost like an overactivity of the brain just really recycling through a thought and almost literally being stuck in a loop because there’s no real answer a lot of the times to what they’re seeking. Someone explained this this to me once, it’s like it’s almost like this filter in the brain that is is almost open and information that normally we would want to problem solve it, it says, hey let’s problem solve everything, listing that you’ve already problem solved, listing through it again and think through it again. If we take it down to the simple measure, genetics plays a big part in it as well. They’ve done different twin studies and looked at that you’re almost predisposed to have OCD and it depends on when it’s going to come out, whether it’s 5 years old or 18 years old, if this filter is open, we’re going to get a lot more information through here that we don’t need and so the brain doesn’t know what to do with it. It’s going to process it however it wants and try to come up with ideas to relieve anxiety when there’s no danger right now in the moment.
Emma: So someone with a more neurotypical brain that filter might stop those thoughts from cycling and someone with a more OCD-type brain, they aren’t able to filter out those thoughts.
Nathan: Two people could have the same thought, someone with OCD someone without and the brain, if we use that filter example, it goes to that and says, hey, you know I’m not that important. We don’t need to think about that. Where OCD is like let’s actually like dive into it a little bit deeper and see if it’s important and it’s a lot of those what-ifs or you could do this or yeah and yeah sometimes different life experiences make that come out because it tends to attack our value system and our values change throughout our life.
Emma: Yeah that’s really interesting and it does seem like the things that we care about the very most are the things that OCD is going to start cycling on, right?
Nathan: And just through different periods of life, like, I’m a father and so it’s wow that is a big new value in my life. I wonder if [inaudible] thoughts can go crazy with whatever what if it wants to come up with and yeah yeah it can be scary and interesting. I can give a specific example. Yeah, I went to the water park with my kids and I’m up the very top and I have this thought. I could totally just grab my kid and throw him off the edge.
Emma: Classic intrusive thought!
Nathan: That’s a scary thought. But for me, that’s a weird thought and then it moves on because I don’t experience OCD. But for someone else, it’s oh that has meaning. That must really mean something if I had that thought and I feel the anxiety, maybe I even felt an urge to do it, must mean something. So, I better step away and because they stepped away their brain just learned something from that moment and said, you must have actually been in danger here. So, good job for stepping back and next time I give you a thought like this, you know what to do and then that’s where that loop starts and so yeah using that filter idea it’s like that thought went right through it and says, this is way more important than you think.
Is everyone a little OCD?
Emma: Okay, question number two: Is everyone a little OCD?
Nathan: No! So, working as an OCD therapist, I tell people, hey, this is what I do. Most of the time they’re like, we all have OCD, like my closet this or I love arranging things and it’s really like, no, no! OCD is not what we see on TV and we can have preferences, things that we really like, I like organization but if I weren’t able to organize this right now, like, I’d still be able to move on and be okay. Whereas somebody with OCD, they’re thinking about it until they fix that problem, maybe are late for work or they’re feeling lots of anxiety and the only way to relieve that is to organize for example or do whatever compulsion their brain says to do and usually if someone says everyone has OCD, you already know they don’t have OCD.
Emma: Yeah, because the experience is so different. I had a friend tell me, oh my grandma has OCD and I’m kind of like, maybe your grandma likes neatness maybe your grandma, like, has to have things done a certain way and then she said, yeah, my Grandma will vacuum the front living room and then she’ll do it again and then she’ll vacuum it again and then she’ll vacuum it again until she’s vacuumed it 50 times and it’ll take her about two hours, the one room, the single room. I said, oh, actually perhaps she does have OCD. There’s a difference. There’s a clear difference between someone who like, vacuums it very carefully and needs everything to be just as someone who says, I have to do it but then my brain maybe that wasn’t good enough and then I have to do it again and that loop ….
Nathan: And a good question to ask is if I’m not sure if it’s OCD or not, like, can I step away from this thing and still feel somewhat okay about it. I want to vacuum 50 times but I’m going to do it two times and see what happens. If I feel a lot of distress and anxiety and maybe threats come to my brain and they like, wait a second, something else is happening here.
Emma: Oh, I like that! I like that! That’s great. Okay.
What's the difference between an intrusive thought and a thought you just don't like?
Emma: Number three, what’s the difference between an intrusive thought and a thought you just don’t like?
Nathan: Yeah. So, most people have intrusive thoughts, they say almost probably everyone I would assume. Like my example of being up high with my kids, that was an intrusive thought, somebody with OCD that’s going to put a lot of value to it and meaning to it and really just a thought that anyone has. Everyone can have the exact same thought as someone with OCD. The difference is the value that the brain wants to put on it and that’s what I have made videos before where I tell people you’re not special with your thought. You’re special as a person but your thought is not special. Most everyone has had this thought at some point or or another but your brain somehow wants to just put a lot of meaning to it and so intrusive thought is just a thought we don’t want but it just keeps coming back anyway and maybe someone with OCD, it’s coming back day after day for weeks or months or even years I’ve seen. Whereas in another person it’s like a fleeting thought. It’s just for the moment and then it goes away. Maybe they’re thinking about it for a day like, I can’t believe I had that thought but it doesn’t want to stick around because their brains already worked through it.
Emma: Yeah and this is when someone’s intrusive thoughts become less helpful or more sticky, it’s usually because your brain is like, oh, my gosh! That thought means something about you or that thought, like, you’re walking to the kitchen with a a knife, you’ve been cutting vegetables and you think what if I stabbed my husband and someone with a more difficulty with sticky intrusive thoughts might be like, that must mean I’m gonna hurt someone. I have to avoid the kitchen. I have to avoid knives and they have to engage in all these behaviors to avoid that.
Nathan: Yeah, whereas somebody maybe without OCD would be like, ah, I don’t like that thought but I guess I’m going to keep cutting those vegetables. Yeah, because somewhere in their brain they’ve already known. This is not …. I guess for both they’re ego distonic, they’re not something that is actually part of us and it usually goes against our value system, which is the weirdest thing. We’re not having intrusive thoughts about we’re gonna have such a happy day today walking outside and playing with all the butterflies. Yeah! It’s not intrusive thoughts about that. It’s about the things we don’t want to happen.
Emma: Interesting. Yeah, if I had a really, like a thought that popped into my brain, man, what If today was great? I wouldn’t have any kind of like fear response around that thought.
Nathan: Unless someone said, oh, I just jinxed it!
Emma: Actually, yeah, you might think, oh, if I let myself think that, then bad things will happen! That’s true! That’s a good point.
If you get an OCD diagnosis, can you ever get to the point where OCD doesn't impact you as much or much where you're functioning?
Emma: Okay, number four, if you get an OCD diagnosis, can you ever get to the point where, I’m not going to use the word cured, but I’m going to say, can you get to the point where OCD doesn’t impact you as much or much, where you’re functioning?
Nathan: Everyone’s a little bit different. I’ve been working with OCD for about 14, 15 years and I’ve seen people where they have little to no symptoms with their OCD and this could be for weeks, months, even years, with the treatment, which I’m sure we’ll talk about. We’re retraining the brain to think differently about this. They might have the same thoughts they had before but it doesn’t impact them the way that it used to. So, I think the definition of recovery might be a little different than what people think. Yeah Let me have the same thoughts but my brain doesn’t want to stick to it, where other people might say I’m just not getting better because I’m having the same thought about stabbing my spouse and no, I have the thought but if your brain doesn’t want to stick to it then it’s not that big of a deal, just have the thought.
Emma: So recovery might not look like having, like you might still have poping thoughts because actually the vast majority of the population does have these poping intrusive thoughts but you get to the point where you’re like, oh, I don’t respond to those in a way that makes them super loud and super sticky.
Nathan: And realistically, when someone’s just living their life the way they want to live their life like, that’s managing OCD. We often use that word like …. Yeah. I think of it just like someone with diabetes like they’re managing their diabetes and they might have to do that the rest of their life, take insulin but they’re not doing that every second of the day. They got to take care of it. They’re functioning and some people hear that and they’re like I’ll just never get better. I guess, I’m stuck. No, you actually get a live the life like exactly how you want to live it and there there’s hope in that.
Emma: Yeah and it doesn’t necessarily mean that every single day is like white knuckling struggle like, it gets better. Right?
Nathan: Yep, it’s good to always have that the treatment skills that I learned. I can use those anytime OCD might pop up in the future. That maintains the progress that they made.
What feeds OCD? What makes it worse? What contributes to the cycle of OCD?
Emma: Cool! Great! Great! Okay, what feeds OCD? What makes it worse? What contributes to the cycle of OCD?
Nathan: Yeah reacting to it. Every time they react, every time they do a compulsion, it reinforces to their brain that like, you did a good job by keeping yourself safe. You got rid of the knife that you thought you were going to do something or you got away from your kids or you went back and check to make sure you didn’t hit someone with your car or you said five prayers and that took away that thought that you had because the brain doesn’t know any different. When we react to anxiety, when there isn’t immediate threat, then it said you did a good job! Do that again! But anxiety doesn’t need to come unless we actually are in danger. We have to see it. There has to be a car coming at us or a flood or all this stuff. But if we don’t see it then we’re like, I just want this feeling to go away. So, I’m going to do an action and the brain likes that because you feel better. Yeah. And so it just reinforces that and keeps it going.
Emma: So the cycle of OCD is reinforced by taking any kind of compulsive action that feels good in the short term.
Nathan: Yeah! Yeah!
Emma: It tries to make that short-term relief but then it perpetuates in your brain that cycle.
Nathan: Yeah.
What are the best treatments for OCD?
Emma: Okay, so what are the best treatments for OCD?
Nathan: Best treatments, we use exposure and response prevention is like that gold standard. Ultimately what we’re doing is we’re facing the fear and we’re using a response. The response is as if I really just don’t care about this anymore. I have to act like I don’t care even if it’s it’s a total act but maybe, I use my example up there with my kids that if I had the thought I’m going to throw you over the edge, an exposure would look like actually maybe I just take one step closer to you and I let the thoughts happen. And instead of saying, no, I’ll never do that. I would never do that. I’m a good dad. I’m a good person because that actually just causes more doubt.
Emma: Yeah, it’s like arguing with OCD makes OCD argue louder, right?
Nathan: Yeah, that’s a great line. We use a lot, for me I use a lot of maybe not statements …. Yeah, it hates certainty. It does not like it. It wants you to know for sure that you would never do that thing that your brain says you’re going to do. So if we can give it an answer that says, I don’t know. Maybe I’d throw my kid over, maybe I wouldn’t, maybe I hit someone with my car, maybe I didn’t, maybe God’s mad at me, maybe He’s not …. I don’t know! And we have to be okay with that uncertainty and then not do the compulsion. So I can’t say, maybe I’ll throw my kid over but just in case I’m going to fold my arm because I’m showing that there’s actually still a problem, which I know it seems really risky because everyone says what if I really did do it? And it’s like then we actually have a problem to solve and we have to assume that it’s OCD because we just know the nature of OCD and we practice this over and over again where I might maybe I’m watching videos of people walking up the stairs at a water park and that brings that anxiety and I’m saying, “You know what? Hey, I remember that feeling. I love that. Maybe it’ll happen, maybe it won’t. I don’t know!” You know, anything we can do to engage with that feeling and then not correct it, not fix it, almost act like we don’t care. Be a little bully to the brain, it literally is retraining it to say, “Let me only react to real dangers not ones you’ve just made up in my head!”
Emma: Yeah. So if someone’s got like OCD about germs therapy would be like, let’s not wash your hands.
Nathan: Yeah. Play the opposite game and if it says don’t touch that, I’m sure I’m going to touch that now. Go wash your hands like cool! Then now, I’m going to go like this, put it all over me and say, maybe I’ll get sick, maybe I won’t, maybe I’ll spread to someone else, maybe I won’t. It’s sitting with a discomfort. I think that’s the hard part.
Eamma: Right!
Nathan: It’s not going to feel comfortable at all but eventually that actually goes down and then the brain learns I lied to you. I told you the only way to feel better was to wash your hands but you already proved me wrong. So, I need to stop warning you that you’re in danger because I lied! I’m sorry!
Emma: That’s so interesting because really what ERP does, Exposure Response Prevention does is you show your brain that you can handle not engaging in that compulsion so the O in OCD is Obsession like an intrusive thought says, oh my gosh! What if my hands are filthy? What if I spread germs? What if I give someone HIV? Whatever and your brain’s like, this is terrible! The only way to avoid this is washing your hands and then you don’t wash your hands and then you don’t die. No one else dies and you show your brain, oh, actually I didn’t die. It must not be that dangerous. But I think what a lot of people get stuck in is they want to change how they think first. Okay, if I can just make myself not anxious about this first, if I can just change how I think and convince my brain that I’m not dangerous, then I won’t wash my hands. And like brain just doesn’t work like that, right?
Nathan: Yeah, that’s typically the thing that we do is let’s try to logic through it. You’re not this kind of person and I think that’s the interesting part about OCD is most people I talk to, they know the thing that they’re scared of. They’re like, I know I’d never do that. I know that goes against my value system. Yeah! But it doesn’t matter. I still do the compulsion because I want to feel better and unfortunately logic doesn’t work because we can talk about that all day long. Yes, you’re a good person. Let’s challenge those thoughts. But it ends up just causing more doubt and they call OCD the doubting disorder for a reason. And so that’s why we’re saying let’s give it a whole different response that it’s not expecting and to say I don’t need to know the answer because I don’t have a time machine. I don’t know what’s going to happen in the future. But I’m willing to risk it right now so I can live life.
So, what if someone can't afford therapy? Can they do ERP to themselves?
Emma: Yeah, I’m choosing to live life instead of seek certainty endlessly. Okay. so ERP is one of the good, like, one of the best treatments for OCD. What if someone can’t access therapy? They can’t find a therapist who knows how do ERP or there like because OCD does require specific type of treatment like it’s not the same as general anxiety treatment. So, what if someone can’t afford therapy? Can they do ERP to themselves?
Nathan: Yeah, absolutely! It seems scary but it’s not as hard as we think. There are plenty of resources online for that. I’ve got videos on my channel. Great! For teaching ERP and it’s you know, basic stuff. I have online courses as well that teach it like step by step. But really, the simple thing is like, can I …. I don’t usually have people write things down …. Can I write down all the obsessions that I’m having, all the compulsions that I’m doing, and maybe I rank them from easiest to hardest to face and then I just come up with creative waves to face it. So if it’s as simple as I’m picking up my ChapStick and this thing’s contaminated, then I’m just going to keep playing with this until I’m bored of it and maybe it takes a day or two or three I don’t know. But I’m going to keep doing it maybe multiple times a day and not wash my hands and then once I’m bored of it, I’m going to maybe find the next step I can do. What’s the next thing on my list and yeah, often, I just say if you’re living your life without doing the compulsions like you’re doing exposures. But we need to have the response with it too, instead of just like white knuckling it, where like, hey any threat that comes to our brain, we already know the answer. Yeah, sure, I guess it could happen. Maybe not. Some people even agree with it, which is a different approach. Yeah, I totally will get sick. I hope I do. Yeah, I hope I throw up over everybody. That’d be so cool! Embarrass myself. And it tells the brain, wait a second. Like, you’re really in danger. Why are you acting this way? So, people pick which one works best for them and I like the agreeing with it because it really is just takes all that power away. Oh, really? Cool! Let me touch that. I hope I get sick then.
Do medications help?
Emma: I like that. That’s cool! Yeah. Okay, makes sense to me. Do medications help?
Nathan: Yeah, but before I worked with OCD I was more like, no, let’s not do the medication thing. But with OCD, after seeing it over the years, people who maybe resist it and all of a sudden they’re like fine, I’ll do it and then they kick themselves for not doing it earlier because they’re like, dang it! This thing actually works and not obviously doesn’t work for everybody but typically that we use SSRIs and the thing that most people don’t know is there’s actually, before it even touches the OCD, it often has to be a higher dose than what we think. And so a lot of people say, I tried it it never worked for me. That’s because you were on 50 milligrams of Zoloft when kind of the target dose is around 150 to 200 and it’s like, let’s try again. But what I see is if I’m touching this and it causes a 10 out of 10 of anxiety 10 being the worst …. And I just can’t do it anymore. It’s so overwhelming, that medication might bring that down to a three. Sometimes I’ve created all these steps for people to face their fears. They started a medication. Then we look at the list and they’re like, none of that really bothers me. So, I think that part is so cool for people. I know for myself and I’ve told my spouse if ever our kids have OCD, that is like the first thing that we’re doing and obviously everyone’s got to make their own decisions but it works so well. Just do what I’ve seen.
Emma: Cool. Yeah, that’s really helpful it’s always nice to have as many resources and tools in our tool belts as we can. So, yep, yep.
Nathan: To find an actual specialist, for me I go to IOCDF.org, International OCD Foundation. People there they’re really passionate about OCD and they either have done a training or they’re on there for a reason. Yeah, that’s where I would look. Know that it’s maybe not a great therapist if they haven’t talked about exposures within the first, maybe two sessions.
Emma: Yep or if they’re doing a lot of cognitive work. They’re trying to get you to change how you think and argue with your thoughts. Like CBT is the number one treatment for like, general anxiety disorder and depression. Let’s look at your irrational thoughts and let’s challenge those thoughts. If you do that with OCD that could backfire, right?
Nathan: Yeah and that’s the typical thing we’ve been taught to do our whole life. Let’s think through it and why did this happen is because when I was five years old, I went to the swimming pool. But if we start going through …. that doesn’t change anything now and yeah, that doesn’t fix anything for OCD. That’s the hard part. It’s like, we’re living in the present, so what can we do to retrain the brain to think differently about this thing?
How can a family member help someone with OCD?
Emma: Yeah. Yeah. Okay, so the last question number 10 is a big one and I think you have an entire course on this but like, how can a family member help someone with OCD?
Nathan: So, it’s so hard because kids are, they’re just going to do what they want to do. So, family, one of the things I teach them to do is learn all the ways that maybe you’re accommodating or doing compulsions for them, which I get it. As a parent, that’s just what we do. We want our kids to feel better so we’re going to get them the soap that they want or we’re going to get them, they’re going to say I don’t want to sit there until it’s wiped down, I’m going to wipe it for them because I want them to feel good. Or I’m going to keep telling them they’re a good person, they’re a good person three times cuz that’s what they asked me to do. I want parents to learn like, these are all the things I’m doing and it doesn’t mean I have to get rid of all of them right off the bat. But it might be talking to their child and saying is there maybe one of these that we can work on reducing? Maybe instead of asking me this question 10 times a day, you ask it five times and if you do ask me more than five times my answer is going to be maybe not to whatever you asked me and or some parents depending on the person, I have seen that they just have to set those really strong boundaries and say, “I’m not doing any of these for you anymore. If you’re not willing to receive treatment for yourself, work through it, I’m not going to make this worse for you.” That is the hardest thing for a parent to do but to me it shows how much love they have for them because they want them to get better. I just want the person suffering with OCD to know what to do when they can’t do the compulsion. That’s the hard part.
Emma: Yeah. Okay. Yeah. so letting go of some of those kind of enabling behaviors are helping them. As parents, we do want to help our kids feel better and there’s often crying if we don’t and the hard part is like being like I’m not going to engage in that compulsion with you. Is that what you’re saying?
Nathan: Yep.
Emma: Or choosing when and how much to do that.
Nathan. We know it’s a compulsion if it’s a conversation that you’ve had multiple times with the person and so sometimes parents just don’t know and I think it’s being really aware of, okay, we’ve talked about this, maybe three times. So, I’m not, you know, if they come to me, we start talking about the same thing, I got to change my response to that or we need to talk about how this is maybe not helpful and let’s do an exposure instead of talk about it because talking’s not going to get anyone not anyway, talking is not going to do as much as doing an exposure for somebody.
Are there subtypes of OCD?
Emma: Right. Yeah. Okay. Awesome. As a bonus, can we talk about just a little bit about some subtype OCD. So, are there subtypes of OCD? Are there kind of general classifications? Can you tell us about them and just give us like a one- or two-sentence description of different types of OCD.
Nathan: Yeah, that’s the thing that we don’t see on TV and movies, are all these different subtypes. So, there are so many from harm OCD, like, I might harm somebody else to religious scrupulosity. I’m worried that maybe I’m sinning in some way. God’s disappointed in me or I took two samples instead of one sample at Costco and I think maybe I’m a thief now and the relationship OCD, questioning my relationship [inaudible] OCD I’m having thoughts about OCD and wondering if it’s actually OCD and that’s the OCD.
Emma: Oh, no! I hadn’t heard of that one.
Nathan: Yeah. It really can be all over the place and as we talked about at the beginning, it attacks people’s values and so you can count on whatever you’re worried about, that’s the thing you really care about the most. Like, I care about my kids. I care about religion. I care about making sure that my family is safe. So, I want to make sure they don’t get sick by the thing I have.
Emma: Yeah, like health OCD like I’m worried about whether I have a health condition. I know that’s now called. Oh my gosh! My brain just fell. What’s it called?
Nathan: Yeah, health anxiety.
Emma: Health anxiety! That’s what I’m talking about! Yeah! that’s connected closely to OCD. Worrying about having health condition and then worried about germs and getting sick, things like that.
Nathan: Well, there’s others that they’re actually coming out with some TV shows I think they already came out actually but like, Pure. Just all of it is in their head.
Emma: Not doing physical compulsions.
Nathan: Yeah, not physical compulsions but they’re doing mental compulsions, whether it’s pushing the thought away or trying to make sense of it or counting five times because that always makes that thought go away. But the important thing to know is when someone’s trying to find a therapist, sometimes they’re like, I need to find someone that does harm OCD or religious scrupulosity and it’s no, it’s actually you need to find someone that works with OCD.
Emma: That’s the same.
Nathan: All, you know, you take all the themes and they all are the same. They all funnel down to uncertainty in some way or another. So, we just got to help the person tolerate not knowing even if they think they’re going to do the worst thing in the whole world, I don’t know, it hasn’t happened so I’m willing to risk it and just do it. Just live life and yeah, so many subtypes but we just want to say, nope you got OCD.
Emma: Yeah cool. Thank you so much for being here. Can you tell us where people can find you and about your courses or membership.
Nathan: I’ve got a YouTube channel, it’s called OCD and Anxiety. Super unique name and I love just teaching everything about it. Great. Every subtypes on there. Got an online course since not everybody can access a therapist. It’s just step-by-step what I would teach somebody in my office. How to do exposures. There’s worksheets, videos, and I’ve got a Patreon as well or people are in there chatting about OCD trying to work on their own treatment in different ways and just supporting each other.
Emma: Awesome. Okay. I’ll make sure to link all those below. Thank you, Nathan, so much for being here. Really appreciate your time.
Nathan: Yeah, thank you so much. I really appreciate it.
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