Join Sarah Noll Wilson and guests Dr. Sally Winston and Dr. Martin Seif as they explore the often-misunderstood mental health challenge of unwanted intrusive thoughts.
About Our Guests
Dr. Sally Winston is the founder and executive director of the Anxiety and Stress Disorders Institute in Baltimore, MD. She is a master clinician who has given sought-after national workshops for therapists for decades. She is a frequent guest on podcasts and webinars. She received the prestigious Jerilyn Ross Award of the Anxiety and Depression Association of America (ADAA) in 2011. Her blog, Living with a Sticky Mind, can be found at PsychologyToday.com. Born in Montreal, Canada, she has three adult daughters, two granddaughters and a Senegalese parrot.
Dr. Martin Seif is is a master clinician who has spent the last thirty-five years developing innovative and highly successful treatment methods for anxiety disorders including: Panic Disorder, Agoraphobia, Specific Phobias, Social Anxiety Disorder, and Obsessive-Compulsive Disorder. He is on the faculty of New York-Presbyterian Hospital, Former Associate Director of the Anxiety and Phobia Treatment Center at White Plains Hospital, a founder of the Anxiety and Depression Association of America, and in private practice in Greenwich, Connecticut. Together, Dr. Winston and Dr. Seif have co-authored four books: What Every Therapist Needs to Know About Anxiety Disorders, Overcoming Unwanted Intrusive Thoughts, Needing to Know For Sure, and Overcoming Anticipatory Anxiety.
Resources mentioned
Website: http://www.anxietyandstress.com
Website: http://www.drmartinseif.com
VIDEO
TRANSCRIPT
Sarah Noll Wilson
Hello and welcome to this week’s episode of Conversations on Conversations where each week we explore a topic to help us have more powerful conversations with ourselves and others. I’m your host, Sarah Noll Wilson. And joining me today are two people who don’t know yet how they’ve changed my life, Dr. Sally Winston and Dr. Martin Seif. And we’re going to be talking about the topic of OCD. How it’s misunderstood, how we can support ourselves if we’re navigating it, how we can support others. And if you’ve been following me on social media, I shared a post recently about my own journey with OCD. So this is a particularly special episode. So let’s get into and let me share their bios and then we’ll bring them on. So Dr. Sally Winston is the founder and executive director of the Anxiety and Stress Disorder Institute in Baltimore, Maryland. She is a master clinician who has given sought after national workshops for therapists for decades. She is a frequent guest on podcast and webinars. She received the prestigious Geralyn Ross award of the Anxiety and Depression Association of America in 2011. Her blog Living With A Sticky Mind, which I love that title, can be found at psychologytoday.com. Born in Montreal, Canada, she has three adult daughters, two granddaughters, and I don’t know how to pronounce the parrot. How do you pronounce?
Dr. Sally Winston
A Senegalese parrot.
Sarah Noll Wilson
Senegalese parrot. Okay, I have so many questions, but I know we have a tight time so that might have to come afterwards. All right, and Dr. Martin Seif is a master clinician who has spent the last 35 years developing innovative and highly successful treatment methods for anxiety disorders, including panic disorder, agoraphobia, specific phobia, social anxiety disorder and obsessive compulsive disorder. He is on the faculty of New York Presbyterian Hospital, former Associate Director of the Anxiety and Phobia Treatment Center at White Plains Hospital, a founder of Anxiety and Depression Association of America and in private practice at Greenwich, Connecticut. Together, they have co authored four books, which I highly recommend if you’re interested. Check them out by them. Two of them for sure that I’ve read have changed, really changed my life. What Every Therapist Needs To Know About Anxiety Disorder, Overcoming Unwanted Intrusive Thoughts, Needing To Know For Sure and Overcoming Anticipatory Anxiety. Welcome to the show, both with you.
Dr. Sally Winston
Nice to be here.
Dr. Martin Seif
Thank you. It’s a pleasure to be here.
Sarah Noll Wilson
What else – we can start with you Dr. Winston, what else would you want our audience to know about you?
Dr. Sally Winston
That’s plenty. (laughter)
Sarah Noll Wilson
And what about you Dr. Seif?
Dr. Martin Seif
Know about me? I am an avid bicyclist. I spend most of my, I spend a lot of time cycling. I cycle 1000s of miles a year. And I’ve cycled all over the year, all over the world rather, and yes, and climbed mountains and done things that I shouldn’t have done. And the second thing about me is that I have, within the last year or two, got into woodturning on a lathe and making bowls and boxes and things like that. So those are two kind of interesting passions that I have.
Sarah Noll Wilson
I love it. Have you have you ridden Ragbrai? The you know, the great right across the state of Iowa?
Dr. Martin Seif
No, but I know a lot of people who have done that. I mean, basically it’s summer. It’s hot. It’s, I know the story has. It sounds like either you’ve done it or you know, people who’ve done it in some way.
Sarah Noll Wilson
I mean, I live in Iowa. No, I don’t do it. I think they’re crazy, like, but more power to them.
Dr. Martin Seif
Well, I know people who’ve done it when the temperatures were 100 degrees sometimes – anyway, so.
Sarah Noll Wilson
Awesome. Well, I’m so excited to to have you both on the show for us to talk about this. And so let’s just start with – help help us understand what is OCD and how, because that was one thing, I’ll just start with this. I never saw that as an option for what I was struggling with. Because I feel like my understanding of OCD was very limited to thinking about people who just wanted things to be very particular. Or that the compulsions were about, you know, not wanting to step on cracks or wanting to – and not realizing the depth of how it can show up, the depth of how compulsions can be very internal. And once, once my therapist and I kind of made this aha of, oh, this is more than just panic disorder. There’s something else going on here. And the more I started to learn about it, it really opened my eyes to not only understanding myself better, but also just being more tuned into the amount of suffering that people with OCD experience. Because it’s not just that it’s – I think a lot of people they go, Oh, I like to be clean. I have OCD. I’m like no you don’t. Do you have a lot of distress? Do you have intrusive thoughts? Do you? So so yeah, so why don’t you start us off Dr. Winston?
Dr. Sally Winston
Well, first of all, kudos to your therapist, because an awful lot of therapists would not have picked that up. It isn’t just the general public that have misconceptions about OCD. It’s also general therapists.
Sarah Noll Wilson
Yeah.
Dr. Sally Winston
Which is one of the reasons why we started writing is that we wanted to make a dent in the world, and also why we didn’t use the term OCD in the titles of our books. Because we thought that, you know, people would pick them up who didn’t know they had OCD, and then learn through reading that they in fact, do. Then it you know, for a long time, people did think that OCD was repetitive thoughts, those were the obsessions. And compulsions were defined as behavioral things that you do, like checking and washing and avoiding contamination and things like that. And, and there was also this idea of a personality trait of being very neat and organized, and so on. And I think what you’re saying is so important, because first of all, compulsions are not only behavioral, they’re also mental, and covert and things that are not obvious, either to the person who’s having them, or to people around them. And so it’s much more subtle.
Sarah Noll Wilson
I have to – it’s, it’s interesting to hear your intentionality behind the title, because I didn’t come to your work by looking for OCD. I came to your work, because I started to experience incredibly intrusive thoughts in a way I never had before. And that is actually what brought me and it was your work that made me realize, I think this is actually what’s going on.
Dr. Martin Seif
Well people get frightened because they think that when they have unwanted intrusive thoughts, they think that they’re somehow either fighting impulses, or they’re fighting an intentionality in some way. And so there’s no real recognition that this is an a, an anxiety disorder or a form of OCD in some way. So that’s another, that’s another reason why we really didn’t use the term obsessive OCD in the book. Another thing I just wanted to say is that therapists, you know, therapists still do not, there are many, many therapists who still do not understand obsessive compulsive disorder. And Sally and I, I think we sort of stopped when COVID came, but we gave really well received lectures at large things, essentially, to therapists, which were entitled Busting The Myth, Everything you earned about obsessive compulsive disorder in graduate school is probably wrong. And people were fascinated by that and interested in some way. But still, there are a lot of people who have difficulty with that. And I think that’s one of the reasons that we appreciate you getting the word out to people and why we enjoy the fact that people are willing to spread the word around our books.
Sarah Noll Wilson
What, you know, what do you feel like? Why does the misunderstanding or myths about it, do you feel like it’s so pervasive? Because that was something that even my therapist and I talked about. I think she had a moment of, I missed this. I, I, you know, I had I had little signs of it, but then it was like, it wasn’t honestly, it wasn’t until I started to connect the dots, that she started to connect the dots differently. And then it was like, oh, shoot, like, I totally missed this. What is it about OCD in particular, that feels, that is so misunderstood, compared to say, like anxiety, or you have a panic attack or depression. You know, what? I just I’m curious to hear your thoughts on why that’s so pervasively misunderstood?
Dr. Sally Winston
Some of it is just that, that it’s the the understanding of OCD, the way we understand it now, is just in the last maybe 30 years. Before that, really, the understanding of panic disorder didn’t even show up in the manual, the DSM until 1980. And obsessive compulsive disorder was understood through psychodynamic lens or a Freudian or, or a different way of looking at it, as if thoughts that one might have all are meaningful and worthwhile and should be explored and are insights into your deep unconscious and that, that, you know, the notion that we all have junk in our minds that’s not worth paying attention to, was not really, you know, available for the training of most people who are therapists. And we’re gradually making inroads into, you know, into the therapy community. But there are many people who train according to some school or sort of way of understanding the mind, or or a particular theoretical orientation or a bunch of technical interventions, and they just don’t run across the need to understand OCD, even though it’s actually more prevalent than it, then we thought.
Sarah Noll Wilson
Yeah
Dr. Martin Seif
Well, you know, and let me add to that, to some extent, there is really a, a, a well established long term, analytic conception, which goes somewhere to the sense that the wish is father to the fear. And so essentially, if a person fears something, there’s an analytic assumption that there’s some, that’s some response to a wish. And I think there’s some validity to that in certain cases, the fact is that there are things that that need to be explored. But if we also include the fact that what, if we go in what Sally saying, that the mind does create these junk thoughts, and that there are certain thoughts that we, that we need to take seriously and other thoughts that we need to say, no, that’s just junky, you know, pass, let it pass by. Just like, when you get a creative idea, sometimes you get a creative idea and say, Wow, that’s really great. And other times you say, that sucks, leave that alone in some way.
Sarah Noll Wilson
(laughs)
Dr. Martin Seif
That’s just the way our mind works and understanding of our mind. So the fact is that there are a lot of people, a lot of therapists still who go along with this old general, I’m giving a very general term, analytic assumption in some way. And I don’t know, I’m sure Sally has the same thing. I have people coming up to me who are in therapy, who liked their therapist who have intrusive thoughts, tell me their intrusive thoughts and say, Is it all right, do you think for me to tell my therapist that I have these intrusive thoughts in some way? You say, of course, of course, you got to do that in some way. I’m sure you’ve had that experience, Sally, haven’t you?
Dr. Sally Winston
Yeah, of course, all the time. And I think that the main misconception that that generates the shame and the misery and the secrecy around these thoughts, is that everybody has passing intrusive thoughts, certainly, but certain of those thoughts, if you have a sticky mind, or OCD, certain of those thoughts, get stuck and repeat. And the reason that those thoughts get stuck and repeat, is not random. It’s the most awful thoughts that you can come up with. It’s the things that are the opposite of you. It’s the anathema. The, Oh, my God, what’s that doing in my mind kinds of thoughts. And as soon as you seize on one of those passing thoughts, it’s no longer random. It’s because you hate it so much, that it gets stuck, it gets stuck by the effort to get rid of it. And by the –
Dr. Martin Seif
And so, as a result of that –
Dr. Sally Winston
Yeah, go ahead.
Dr. Martin Seif
I just wanted to add, I’m just completing what you’re saying. As a result of that the content of unwanted intrusive thoughts is usually pretty awful, pretty terrible. So that, so when person says, Wait a second, if I’m thinking about some awful thing. If I’m thinking about hurting people, or abusing people, or yelling out some blasphemy while I’ve been, while I’m in church, or if that’s what I’m thinking about, and it frightens me so much like it feels like an impulse, what sort of person am I? So there’s a desire to hide it, to keep it inside yourself because Oh, my God, what’s, what’s it gonna find? It’s sort of like, let’s, let’s keep the the box closed, let’s not open the, let’s not open it up in some way. So you see the dilemma that the these people are in. So so the first thing you have to think of is, how courageous people are to be able to talk about it. And I think a lot of this started coming out because there was the opportunity to do things online, to do things with some sort of – I have it. As a matter of fact, I have a personal website. This this is sort of the background to the book that we wrote Overcoming Unwanted Intrusive Thoughts. I have a personal website, which, you know, years ago, you know, maybe in, you know, 10-12 years ago, people were, you know, websites were getting 30, 40, 50 hits a day, in some way. And I had one little page associated that that described very briefly, I think I called them obsessive intrusive thoughts or something like that. And, you know, Google Analytics, all of a sudden, I was getting 100, 200, 300, 500, 1000 hits a day, you know, and so is this, I couldn’t understand it. And I realized eventually, that at that count, either there was – they were all landing on one page, most of them are landing on one page.
Sarah Noll Wilson
Got it.
Dr. Martin Seif
So, so either this was something that was really common out there and people were finding it, or else there were one or two people who were just spending their whole day clicking. (taps table repeatedly)
Sarah Noll Wilson
I mean, like, could be because we’re looking for reassurance. And we’re just like, let me read it again. And is that what I really have? (laughs)
Dr. Sally Winston
That’s why we wrote the book, because that was a huge gap in general information. Is that.
Dr. Martin Seif
And as we were writing the book, we learned more and more about it. And as we get questions from people, and for a while, – actually, I had a little newsletter that I tried to go up each month and people would, people would read it and subscribe. And I think we had, I don’t remember maybe five or six or 7000 people. This is in 2014. Subscribing to this intrusive thoughts newsletter in some way, and that a lot of that information went into the into the book that we wrote.
Sarah Noll Wilson
Yeah, it’s, I think, I think that was something that was so profound for me. I mean, there were so many major ahas, but I, I have experienced intrusive thoughts before, all humans do. And I’ve actually I realized that I’ve had times when what maybe was diagnosed with like, as panic disorder. Actually, when I look back, I’m like, oh, no, that was actually, like, repetitive intrusive thinking. And I was trying to explain it to somebody, I was like, this isn’t like one or two thoughts a day. When my brain is really, really sticky, because I’m under stress, because I’m tired, because I’m not right, like practicing my ability to sit with the uncertainty and float and fly above it. It can be hundreds, 1000s a day, of that coming through and imagine you’re trying to exist in the world. And to your point about those subtypes, I think that like that, again, that was another piece that was really insightful for me, because imagine that your intrusive thoughts wasn’t about cleanliness, but was about pedophilia? What if your intrusive thoughts were about harming children? What if your intrusive thoughts were about sexual orientation? And how so many of those, one, would feel very scary to share out loud, and two, could be misinterpreted by somebody who isn’t familiar with OCD as like, ooh, you might actually have a real problem. Or you might actually really need to be rethinking or you really need to explore this. That was so profound. And I will say that, in my own journey, I can’t imagine how many people are walking around, not realizing that this is what they’re suffering with. And not having the support and not having the space, right, like to be able to speak up, which is why I think it’s so easy for it to be silent, because there’s so much shame around these thoughts.
Dr. Sally Winston
Right.
Dr. Martin Seif
Exactly.
Dr. Sally Winston
And then the, what we say all the time is that OCD masquerades as issues. Right? So that if somebody if you if even if you are a mental health clinician, if you ask somebody, do you have suicidal thoughts? Somebody could, could could say, yes, they do. And there’s two different kinds of suicidal thoughts. One of them is, I want to die. My life sucks. Nobody cares about me. They’ll all be better off without me kind of suicidality. That’s real suicidality. But OCD also does something else. If we remember that the opposite of you is what gets stuck. People who love life can be tortured by the thoughts that what if, against my will, I suddenly lost control and jumped off a balcony or knifed by myself or hung myself because these thoughts are in my mind, that’s not being suicidal, it’s not being depressed. And yet, if, if you just answer yes to that question, you can end up hospitalized or you can end up very scared to ever say those thoughts to anybody because of the consequences. Your family’s gonna get all upset about you and all these other things. So those details about the thoughts are very, very important. And they can be so easily misunderstood.
Sarah Noll Wilson
Yeah.
Dr. Martin Seif
Another way of saying that is that obsessive compulsive disorder, OCD, can masquerade as many, many different factors. Sally was giving an example where it can masquerade as depression in some way. And it and, and we make a distinction between, between something like depression where a person is depressed, and obsessive compulsive disorder where the content of the obsessions are depressing in some way. So, –
Sarah Noll Wilson
Sure, sure.
Dr. Martin Seif
That’s another thing that we say. You know, an intrusive thought – you, I think – you made a really good point. We made a special effort to start the book with very specific examples of different types of intrusive thoughts, because we wanted people to see the nitty gritty of that, by the way, some people find that too triggering and they can’t continue on the book. But I think that it’s still (laughs) – you found it triggering at first.
Sarah Noll Wilson
In the beginning. In the beginning, I found it really triggering.
Dr. Martin Seif
Yeah, okay, so –
Sarah Noll Wilson
Yeah. And now I’m in a very different place, for sure.
Dr. Martin Seif
But in a sense, but, you know, it’s, again, let’s talk about the courage that people need in order to overcome this. I mean, it really means taking a chance, you know, it’s a leap of faith in some way that somehow the approach that’s being presented by people who wrote this book is going to be helpful, when in fact, it’s completely opposite to the way that I’ve been trying to deal with it in the past in some way.
Sarah Noll Wilson
Right, right. (laughs)
Dr. Martin Seif
But we did want people to know the nitty gritty, where really good people can have terrible, terrible, terrible thoughts in some way. And, and to understand that, that sense, but but to go to take just one step further. An unwanted intrusive thought is not defined by its content, okay. And that’s an essential thing. It’s really defined by how it feels. It feels terrible. And how it acts. It repeats, it repeats, it gets stuck. It’s it’s a, so that’s the way we define an unwanted intrusive thought.
Dr. Sally Winston
Another thing about how it acts is that what is maintaining, and the repetition of the thought, is the struggle against the thought.
Sarah Noll Wilson
Yep. (laughs)
Dr. Sally Winston
The thought has a relationship with whatever you’re trying to do to make it go away. And that can be something like a behavioral compulsion, tap three times and turn around, maybe the thought will go away. Or it can be a mental compulsion, maybe you’ll say a certain word several times, or you’ll try to reassure yourself that it’s not true, or some other kind of effort that you’re making to try to get rid of the thought or, and get rid of the feelings that come with the thought. And that relationship between the thought, which is called an obsession, and the thing you’re doing to try and make it go away. That’s called a compulsion. And for many people obsess, they just call it obsessing, or worrying. But if you’re going to get better, you got to parse that out and figure out some of it makes you feel anxious. Some of it temporarily makes you feel better. And it goes round and round and round.
Sarah Noll Wilson
Yeah. Okay. So that’s such a beautiful introduction to the concept of the three minds that you talk about in your book. Which, I laughed so hard when I was learning about the false comfort mind. I’m like, I have a very strong false comfort mindset. Dr. Seif, would you start us off by talking about that the way that you talk about it in your books of the Worried Mind, the False Comfort Mind, and then the Wise Mind? Because, for me, even I was like, I think everyone should just be familiar with that, regardless of what they might be challenged with or struggling with. Because it was such a it was just such a powerful visualization, but the false comfort mind was like, Yep, yeah, I see what she’s doing.
Dr. Martin Seif
Well, actually, we had a lot of fun with that when we were trying to write it and try to figure out what to call the names. But the real it started with the fact that we wanted to find a very explicit way of illustrating the conversations, the dialogue, the narrative that goes on in people’s minds in some way. It really followed from the idea when we realize that really, most of obsessive compulsive disorder is purely mental and purely cognitive and goes on within people’s mind. And that’s why we consider it to be, why people start to realize that it’s far more common than professionals had assumed prior to that. So we wanted to make this internal conversation very, very explicit and we decided we would just sort of take various characters and have them play out the interplay that goes on between people’s minds. Now the one of them is worried voice which we originally wanted to call it – that’s the that’s the obsession. That’s the that’s the part that triggers anxiety. Originally, we wanted it to be called something within O. I remember – remember that?
Dr. Sally Winston
Oscar, it was Oscar.
Sarah Noll Wilson
Kind of like Oscar the Grouch?
Dr. Martin Seif
Well, no but – And then and then. And then there’s something that answered that, which is false comfort, which is – and people can recognize this in some way, and we wanted to use the term false comfort because the comfort it provides is temporary, and essentially reinforces the next worried voice question. And the style, it goes on and on. And then we wanted to introduce the fact that people, if they pay attention to themselves, and center themselves, we all have some sort of common sense. We called it Wise Mind that says, Wait a second, this is being ridiculous, you know. We’re looking for absolute certainty, where we’re asking questions that whatever it is, in some way, and some way of grounding in some way. And we spend a good time going through these conversations that we hope people – internal conversations that we hope people could connect with. Apparently you did. Apparently, it made sense to you.
Sarah Noll Wilson
Yeah, yeah. It. No, it, literally, I mean, I felt so seen. (laughs) And not crazy, because I was like, what is – you know, because the other component of it is that, what do they call it? Ego dystonic. Of like, for my experience there, I have lived with this my whole life, right? And it has manifested in lots of different ways, whether it’s about health. Up until recently, it was about pregnancy, fear of pregnancy, even when it was irrational. And the ways that I realized that I was like, trying to reassure my compulsions, like, thinking about like, with my health was, I need to figure out where I got this from. I need to figure out like – or if I was really tired, and the joke in our house was always like, why do you, gosh, why do you think I’m so tired? And I was, so it was –
Dr. Sally Winston
Why? Why? Why?
Sarah Noll Wilson
Why, why, why? And like, and my husband so beautifully would be like, I mean, you’re just tired. Like, you don’t need a reason. I was like, no, but I like, am I getting sick? Am I? And then that would become the obsession. And you know, there’s been some other manifestations that I’m not quite ready to, you know, talk about and share yet, but like that, but that false comfort was like, seeing it, it played out. I was just like, I was laughing at one point. I was like, holy shit, this is my brain, like they see directly into my brain of the conversations that I’m having.
Dr. Martin Seif
We’re actually talking about you when we wrote this. I’m sorry.
Sarah Noll Wilson
Yeah, yeah. I figured. I was like, they’re like, she doesn’t even know that she has this yet. Okay, so one concept that I think is so that was so powerful, was this idea of thought-action fusion. And there’s, I want to just read, I want to read if I may, like a section from Needing To Know For Sure. And you, you wrote that there are four main perceptual changes, changes characteristics of anxious thinking. One, that no risk feels reasonable, the thought and action feel fused together, that’s the one I want to talk about. Worry, thoughts become sticky in the world is viewed as dangerous. And then you go on to say, anxious thinking makes the consequences of something you fear feel so significant, that the probability of that happening feels irrelevant. And it’s so powerful. And that idea of thought fusion was such a gift. Because what I’ve experienced and I know, other people experience, is that there’s some part of your brain and I know logically it’s not real. But there’s some part of your brain that’s like, because I’ve had this thought it feels as if I’m acting out on it. Which is, so, you know, if one of you wouldn’t mind talking about thought-action fusion, because that was a brand new concept for me. And it really opened my eyes to a lot.
Dr. Sally Winston
It’s really an an altered state of consciousness. When you’re sticky and you’re anxious. Your mind works a little differently. And one of the things that we’ve always said, I guess everybody’s always known that anxious people have great imaginations.
Sarah Noll Wilson
(laughs)
Dr. Sally Winston
Right? And what happens when you’re anxious and you have this sort of imaginary catastrophic story that you build in your head. That is anticipatory of some terrible thing that’s going to happen, that because you’re, you are anxious it becomes incredibly vivid. And it’s accompanied by body sensations of fear. And then it feels, somehow you make the mistake of treating that as if it’s a fact, as if it’s true, as if it’s something you have to now respond to, or do something about. It’s like going to a horror movie, you know, the Chainsaw Massacre movie, and sitting in the movie theater, and then forgetting that it’s a movie.
Sarah Noll Wilson
Sure, yeah. Yeah, no, that completely resonates for me.
Dr. Martin Seif
I think that there were, as you were talking, Sally, there were actually a number of things that were going through our mind. I think part of it is the fact that we, actually Sally and I have been talking about trying to expand this concept of anxious thinking, because it’s so it’s so profoundly different from the way we feel when we’re feeling comfortable. And when you’re really caught up in it, you really are in an alternate state of reality. So we were, we were playing around with the idea of I don’t think we anxious consciousness and nothing really – the world feels different at that at that point. And I’m not sure really what causes it. But it’s it’s profound, it feels real. And it’s an act of faith, to say, Wait a second, at some point, I’m not going to be feeling this way. It’s a leap of faith to do that in some way.
Dr. Sally Winston
It’s another thing also to remember that there was a time before that thought occurred to you, in which this entire issue was completely irrelevant and not urgent and not doing anything. And what’s the matter? Were you being reckless? And and ridiculous, then that you didn’t know about it? Or was that really you’re operating the way everybody else does with a certain amount of uncertainty that you don’t care about?
Dr. Martin Seif
I use the term I just want to get back to it stuck in my in my own mind, you said, I have these irrational fears, don’t like to use the term irrational in a sense.
Sarah Noll Wilson
Okay. Yeah, yeah.
Dr. Martin Seif
When you’re in this altered state of consciousness they seem perfectly rational.
Sarah Noll Wilson
Oh, yeah they do. Yeah.
Dr. Martin Seif
If you can follow the internal dialogue that you’re having, or as a therapist, if you can kind of communicate with the person that you’re seeing and sort of point out the internal dialogue, it makes sense based on that in some way. The problem is, the original assumption is wrong in terms of that, but it follows that entirely in some way. And since no risk feels reasonable, and you have to avoid all risks, and you’re looking for absolute certainty. You’re sort of doomed from the start in some way. That’s, that’s one of the things.
Sarah Noll Wilson
No, I appreciate. Yeah, I appreciate you pushing back on that, you know, because it is sometimes it’s like a wrestle, I feel like within my brain of it, and part of why I’m sharing this is not necessarily to get therapy, but like, but to educate people on what it can feel like. I mean, there are times when you go, I’m, there’s some part of my brain that’s like, I know, I know what this is.
Dr. Sally Winston
Right.
Sarah Noll Wilson
And I know that I don’t need to worry about it. And then some days, the other part of my brain is like, but maybe you do.
Dr. Martin Seif
Yeah. Well, I think, I think part of the thing is people have to realize, number one, that our brain is not quite as smart as we think it is, in some ways, you know.
Sarah Noll Wilson
(laughs)
Dr. Martin Seif
We have this, we have this, this sort of limbic, this amygdala in the back, which is very primitive, primitive animals have an alarm system in some way, which is binary, yes or no. And then we have all this ability to think in the in the prefrontal cortex in some way. And they don’t play together all that, well. They don’t communicate together all that well. And I think part of what we what we go through when we’re feeling this intense anxiety, and I’ve had a lot of anxiety in my life (laughs) I can tell you that. I’m speaking from experience, both, on both sides, as I tell both sides of the, of the office. On the couch, and and, and on the therapy chair. But but the fact that I’m part of it is that we’re trying to make sense of signals that are coming in that essentially don’t make sense to another part of the brain. And I don’t know that much about the neurology. We tried to give some explanations, some some very basic explanations in the book about that works, about how that works,
Sarah Noll Wilson
I actually, I really appreciate that. You know, my, my relationship with my amygdala started (laughs) 10 years ago, which is what started this shirt, is, yeah, because I think everyone needs to understand about their amygdala and because we’re often working with people in positions of power and authority, I’m like, No, you need to understand that person’s not being difficult. They’re having a stress reaction.
Dr. Martin Seif
Yeah.
Sarah Noll Wilson
And so like, we’re very passionate and you know, and some people will joke like, who’s Amy G Dala? She’s some singer.
Dr. Martin Seif
(laughs)
Dr. Sally Winston
(laughs)
Sarah Noll Wilson
So, but I loved I loved how you you in your books you talk about like, there’s the first fear, you know and use the example of like when somebody jumps out at you and scares you. And you have that initial whoosh, which whew, that that description of whoosh felt very accurate. Like, there’s like, I can’t describe it. I was like, oh, yeah, that is a very accurate description. And then there’s the, like, the second fear or not, right, and like part of the OCD brain is it just gets looped into it. Whereas other times, you go, Oh, it’s just a movie. Oh, it was just my friend who jumped out at me. And I want to come, I want to make sure that we give some space to that. You know, that that idea of certainty, right, of just wanting, like that, that is definitely something that was so profound. And I cannot say that I’m my muscle around that is built up as much as like – well, no, I know, it’s not built up as much as I want it to be. Right? Like, I’m still having to be very conscious of it. But there’s something –
Dr. Sally Winston
It’s very important concept.
Sarah Noll Wilson
Yeah.
Dr. Sally Winston
But the first thing to understand is that certainty isn’t about facts.
Sarah Noll Wilson
(quietly) Yeah.
Dr. Sally Winston
That it’s, it’s a feeling. You know, the, the truth is, we can’t be absolutely certain about anything. But there’s some times when we are fine, you know, as as Marty likes to say, when he says I’ll meet you at Starbucks for a cup of coffee, he doesn’t say, provided I don’t have an aneurysm and die before I get there. Just doesn’t think about it. And most of the time, we don’t think about it, we accept the fact that we can’t know for sure, that 100% certainty isn’t possible. And we just carry on, because we have this feeling of certain enough or okay, or, you know, that kind of a feeling. So, but when you have serious obsessional doubting, what happens is you start craving that feeling of certainty, and you think that it’s going to be established with facts.
Sarah Noll Wilson
Yeah! I just want to be done with it! Like, just what do I need to decide? What do I need to know? What do I need to read to just be done with this? And then that just perpetuates it.
Dr. Sally Winston
And the OCD loves to find itself located in anything that’s invisible, right. So that could be germs. It could be stuff in the future that hasn’t happened yet. It could be what somebody else might be thinking. But that’s where you have where you can’t prove something factually, that’s particularly, OCD loves that kind of territory. Because if there’s no facts, then what you have is your imagination.
Sarah Noll Wilson
Yeah.
Dr. Sally Winston
And then what you do is you rely on your imagination instead of the reality, which is that you don’t know anything. There’s a, there’s a wonderful little story that I stole from someone and I’m very sorry to say don’t know who I stole it from. But, but OCD takes facts and moves you along into a place where you can be sure. And it all feels very logical. So there is such a thing as termites. That’s a fact. termites eat wood. That’s a fact too. Sometimes when termites are eating wood, you you don’t know about it, you can’t hear them or see them, they’re, they’re far away. That’s a fact too. It is conceivably possible that there are termites eating the wood under the floor of your living room. That’s conceivably possible. So, you better not go in the living room, because you could sit down on a chair, go through the floor and get and die. So that is how it traps you. And then you find yourself wanting to learn about termites –
Sarah Noll Wilson
(laughs) Yes.
Dr. Sally Winston
And wanting to be sure you don’t have termites and calling the termite company, when all that happened was a story in your head about conceivable possibilities, built on completely irrelevant facts about imaginary things. But that’s how it works. And at the end it seems like well, at least, you know, call pest control and find out, why shouldn’t you and that’s how you get stuck.
Sarah Noll Wilson
Yeah, and then –
Dr. Sally Winston
Unless for sure that, for sure there are no termites. When last week, we never thought about termites and wouldn’t have cared less.
Sarah Noll Wilson
Oh man, and then you see where like, for people listening, you can see how that false comfort comes in like, oh, okay, like well, they said but it’s like oh, but they could come anytime. And then you just right back in that that loop again. I I’m having a moment of – I can’t wait to talk to Nick when this is over. And he’s like listening to you talk. I have no –
Dr. Martin Seif
He’s not listening to this.
Sarah Noll Wilson
Oh, no, he is, and I’m sure he’s like, yep, this feels about right.
Dr. Martin Seif
Let me go back in time a little bit. And we, you know, Sally and I have been around for a long time and our evolution, our understanding of some of the things has changed. If I go back to maybe before the year 2000, which is when we were probably just in our 70s or 80s. I don’t remember that year. (laughter) Anyway, if I go, if I go back to a long time ago, and we include some of this in our textbook, we wrote a little textbook, What Every Therapist Needs To Know About Anxiety Disorders, talking about obsessive compulsive disorder. That when we would find someone who had anxiety that seemed weird or strange to us in some way, and we, we talk about it to some, to another therapist, you know, say I saw this person who had this this, they would often laugh. It often brought up laughter and suddenly started, I started realizing a lot of these weird phobias were really obsessive compulsive disorder. And that we had to understand in some ways, people who were afraid of wind chimes, or the letter S or Estee Lauder in some way. If you begin to understand what it triggers in their mind, and the conversations in their mind and the the, you know, the worried voice and the false comfort, and the back and forth, then all of a sudden, these seemingly bizarre symptoms tend to make perfect sense in some way. And, and the issue is, and, and the issue is to get a person to be able to, to pay attention to be aware of their own internal conversations, their own internal dialogue, and to be able to stop doing the things that maintain it in some way. To stop doing the things that reinforce it. And, and in our terminology, we would say an obsession raises anxiety, compulsion lowers it. So your job is to allow the obsession, because you try, you’ve been trying to stop it for a long time, and not give yourself any false comfort in some way. And that allows you to, your body to begin to get better, I mean, to recover in some way. There’s a whole bunch of theories about what it does, which is less important than the fact that the notion is, the best thing to do when that happens, is to do nothing, which is very difficult to do. It’s really difficult to do.
Sarah Noll Wilson
It’s very hard. And sometimes, and what I’ve learned about like my experiences, my brain is doing compulsions, and I don’t even realize it’s doing.
Dr. Martin Seif
Oh sure.
Sarah Noll Wilson
Right? Like it is, you know, and so being able to catch it and, and I know that there are people who are listening, who are tuning in, because they don’t have it, and they want to understand it. So imagine the exhaustion of navigating intrusive thoughts, imagine the exhaustion of navigating shame. And now, literally, the exposure therapy response to it is to sit with that discomfort, and just how exhausting that is. Because that was one of the things that was – it made a ton of sense. And I forget what it is. But I know that like OCD is one of the top 10 most debilitating kind of diseases, disorders, period, not just mental health, but period. And so understanding that, which is also part of why I get a little frustrated when people are like, Oh, I have OCD. And they say it like it’s this cute thing. And I’m like, you don’t understand how much distress I have to navigate to just be functional, to just show up?
Dr. Martin Seif
Well, they’re saying I’m OCDish and that I’m, you know, the old version of I’m anal, I’m neat, I need everything to be neat in some way, which is very different than what we’re talking about.
Sarah Noll Wilson
Yeah, yeah, exactly.
Dr. Sally Winston
Yeah. Or it helped me get through grad school, you know.
Sarah Noll Wilson
Right. Right.
Dr. Sally Winston
That’s not it at all. But the other piece is that the that it’s, it’s important to understand that dealing with OCD is not about applying a technique to make the OCD go away. That it is about changing your relationship with your thoughts. So that your perspective on the thoughts changes. And if you do understand thought-action fusion and not every thought is important. And all of the details that we talk about in terms of over valuing or over explaining or analyzing thoughts, then you can have a thought and not do anything about it pretty safely.
Sarah Noll Wilson
Yeah.
Dr. Sally Winston
If you still think there’s something important about that thought, it’s much harder to do exposure and sit with your maybe I’m really a pedophile. That’s not helpful. But what you have to do is get to the place where it doesn’t really matter whether or not you have the thought because it’s, it’s not an important experience. And then you don’t have to put in effort to apply a technique of support. That it’s very important to make a distinction between doing something while you’re having the thought because the thought doesn’t matter, and you can’t make it go away, and who cares. Or doing something in order to deal with or get rid of or make that thought different. So it can be exactly the same thing. It’s your attitude towards the thought that makes the difference.
Dr. Martin Seif
Your attitude towards your thought, your attitude towards your thought, and I’m just going to sort of round out a bit Sally. Your attitude towards your thought, and the effort that you use, or not use to try to get rid of that thought. If we go with a very basic assumption that effort works backwards when dealing with anxiety. It certainly works backwards when dealing with OCD, then and the term we use, I don’t think – I think we use a book called It’s Paradoxical Effort, it it actually, the effort you use to try to push the thought away goes right into making the thoughts stuck in some way. So the concept there is that any effortful attempt to banish the thought, to get rid of the thought, to get the anxiety tends to backfire. Backfire pretty – And that’s, I just wanted to finish – yeah.
Sarah Noll Wilson
Yeah. And it is. Yeah, no, thank you for clarifying that. Because I mean, that’s, that’s the, that’s the muscle I’m building. Right?
Dr. Martin Seif
That’s the subtlety.
Sarah Noll Wilson
Yeah, it’s, and it is and you don’t even realize. You know, we had a guest, Dr. Tina Opie, on the show a couple of weeks ago, and, and we were we were talking about bias, but she used this analogy that when she said it, I was like, that actually is a gift for my OCD brain. She said, You know, we all have bias thoughts. Just think of them as a bird, let them fly by, but just don’t let them nest. And it was kind of just this, like, observe it, just observe it going by. And so sometimes that is what helps me is like, Oh, yep, there. Yep. I see you. Like, oh, you’re cute. Okay, there you are, right. And, and some days are easier than others. And I know from my previous experience, that there there can come a point where it becomes even easier. You know, I remember when I was, when I was dealing with my panic disorder. I had somebody come up to me and he said, I’m pretty sure I struggled with this, how did you cure it? And I was like, Oh, sweetheart. (laughter) I said, I just have a different relationship with it now. Like, I’ve just learned how to do it. And to that point, I want to, I want to just read a part of your book, kind of like as we’re wrapping up. But this idea of certainty that it was so powerful and, and even just reading it again, I sent it to my husband, I was like, Oh, I I needed to hear this again this morning. Like the timing of this and, and that was where you talked about, recovery does not mean being certain. You can and will be uncertain when you notice the realities of life. There’s no guarantees, no perfection, no foreknowledge, a lot of things we can’t control. But recovery does mean no longer struggling with trying to control the uncontrollable, predict the future, or avoid all risk. Recovery means flexibility, curiosity, excitement, growth. It means no longer being trapped in loops of reassurance. It’s stepping into the uncertain world of maybe and good enough and learning how to thrive there. I just like that just sums it up so beautifully. And there are days that that feels good, and their days are like dammit, I want to be in that space. (laughter) How do I get there? Um, one, I guess one final question, I’m curious. You know, I feel incredibly fortunate to have an amazing partner in this. I, you know, Nick has been learning alongside me. He is really great at holding space for it. He’s learning how to make sure like, is this a productive reassurance? Or is this, right, like, and and being able to talk very openly and courageously with him. What advice do you have for somebody who might have a family member, a friend, a spouse, a partner, a co-worker even, what are the best ways that somebody who doesn’t experience OCD could support somebody who’s navigating this?
Dr. Sally Winston
I think what you just said about being open to learning is the is the bottom line. That you, whatever the person who is working with their own OCD is, is doing, reading, watching. You know, there are YouTube’s, there are ways to absorb information that’s accurate, alongside the person who has OCD until you really, until you really grasp what’s going on. And then if you are at the point where you both agree that you’re not going to be giving reassurance, empathy reassurance, then it has to be done kindly. It’s so easy to say that’s your OCD. Just stop doint that.
Sarah Noll Wilson
Yeah. Yeah.
Dr. Sally Winston
Because, but it has to be done kindly, like, I can see you’re suffering with that thought, is it that one of those thoughts? Instead of either saying or withholding reassurance, just pointing out the process is the most helpful thing you can do. And understanding at a basic level, that it’s just OCD, you know that you have a sane and loving and normal person who was struggling with, with OCD. Which is actually, once you get the diagnosis, that’s really good news. There’s a way out. It’s not some kind of serious, awful thing that is going to be with them forever. And you’re all going to suffer forever. You have to be optimistic, because there really is a way to stop suffering.
Sarah Noll Wilson
Yeah. That’s beautiful. Well, I can’t thank you both enough. I just, I want to say thank you, to you both. You know, in your decades of this work, how much suffering those of us with OCD experience, and your work gave me the light to start moving towards. It helped me understand myself, it helped me understand others, I’m still learning. I’m still working on building that muscle. But I just want you to know how incredibly valuable your work has been to me, has been to people I’ve recommended it to, how important it’s been to our relationship. And so it’s been such a gift to have you both on the show and to continue to share your work. So thank you both so much.
Dr. Sally Winston
Thank you for having us. And I’m so glad that what we have written and talked about has been able to go all over the world. The books are actually available in what about a dozen languages now? And so the more people that we can reach and the more people like you who have the courage to share with the world, you know, what they’re going through, the better things will get for all those people with OCD.
Dr. Martin Seif
Yes.
Sarah Noll Wilson
Okay, well, we’ll be sure in the show notes, folks to share links to the books and, and again, thank you both so much for being on the show.
Dr. Martin Seif
And thank you. You take care. That was very, very heartfelt. Thank you.
Sarah Noll Wilson
Our guests this week have been Dr. Sally Winston and Dr. Martin Seif. And as you can hear from our conversation, and hopefully my voice, this was a really important show for me, and I hope it’s an important show for many of you. You know, there’s so much that I’ve taken away from these two but one of the things that particularly resonated was when Dr. Winston Sally talked about how the the OCD brain really likes things that are invisible. (laughs) That just hit me really hard. So now I need to stop looking for termites in my life. And we want to hear from you. I really do want to hear from you. If you are somebody who has struggled with intrusive thoughts, if you are somebody who knows and loves somebody who maybe has struggled with OCD and intrusive thoughts, or it just brought up something for you. Please feel free to reach out know that your stories are safe with us. You can send me an email at podcast @ Sarah Noll Wilson.com. Otherwise, you can send me a DM on social media. I’m particularly busy on LinkedIn. And if you haven’t already, please be sure to rate, review and subscribe to the show on your preferred podcast platform. This helps us get exposure, continue to do this great work and bring on awesome guests like Dr. Winston and Dr. Seif. And if you’re interested in supporting the show financially, consider becoming a patron. You can go to patreon.com/conversations on conversations where your support will go directly to the team that makes this show possible. And you’ll get some pretty great swag as well.
Speaking of the team, let’s give them some love! To our producer Nick Wilson, our sound editor Drew Noll, our transcriptionist Becky Reinert, and our marketing consultant Jessica Burdg and the rest of the SNoWCo. crew a huge thank you. I just want to thank again our guests Dr. Sally Winston and Dr. Martin Seif. It was an absolute honor to be able to have them on the show, to share their work and to be in conversation with them and with you. This has been Conversations on Conversations. Thank you all so much for listening, for being present. And remember, when we can change the conversations we have with ourselves and others we can change the world. So till next time, my friends, please be sure to rest, rehydrate and we’ll see you again soon.
Sarah Noll Wilson is on a mission to help leaders build and rebuild teams. She aims to empower leaders to understand and honor the beautiful complexity of the humans they serve. Through her work as an Executive Coach, an in-demand Keynote Speaker, Researcher, Contributor to Harvard Business Review, and Bestselling Author of “Don’t Feed the Elephants”, Sarah helps leaders close the gap between what they intend to do and the actual impact they make. She hosts the podcast “Conversations on Conversations”, is certified in Co-Active Coaching and Conversational Intelligence, and is a frequent guest lecturer at universities. In addition to her work with organizations, Sarah is a passionate advocate for mental health.