74. Exposure and Response Prevention (ERP) and NOCD with Stacy Quick, LPC
I’m privileged to be interviewing Stay Quick, a licensed professional counselor and therapist at NOCD. Stacy talks about how Exposure and Response Prevention Therapy (ERP) works for OCD and her own experience with OCD.
- Stacy’s personal journey with scrupulosity
- How does ERP help people who have OCD
- Can OCD be cured completely?
- More about NOCD
Links and Resources:
Episode 4: The Importance of Proper Diagnosis with Jessica Huddleston, LPC-MHSP
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Transcript
Carrie: Hope For Anxiety and OCD episode 74. Today’s episode is on exposure and response prevention, which is often used in treating OCD. I had wanted to devote an episode to this for a little while, because it’s something that’s talked about and has come up on our show before in personal experiences however, there’s a little bit of tension in the community between what I do. That’s a little bit different type of trauma informed approach and ERP as a result, some people have chosen not to appear on the podcast or have been very critical of some things that I have said or written regarding treatment methods, such as EMDR being used for OCD.
One person even actually accused me of spreading lies on my website before they even had a conversation with me about this. That was a little rough, but we recovered. And unfortunately, today’s guest contacted me to share her personal story and also the work that she does with exposure and response prevention. Today on the show, we have Stacy Quick, licensed professional counselor and therapist at N CD. Welcome to the show today.
Stacy: Thank you for having me on. I’m excited to be here.
Carrie: So I know that a lot of times we talk to professionals on our show who treat OCD and sometimes they have their own personal experience with OCD. And you had shared with me that you dealt with scrupulosity in the past. Can you just tell us a little bit about your journey of recognizing that you had OCD the symptoms being diagnosed with it?
Stacy: Sure. I’ve actually had OCD for my entire life. I don’t really remember a time not having it. Obviously, I wasn’t diagnosed with it for quite some time, because this was back in the eighties and kind of nineties. And so not as much was known about it.
Carrie: Sure.
Stacy: And some of my first, I guess memories, I would say is about age five or six and some of the very first ones that had started were more, what I would now know scrupulosity where I was having images of religious figures that were kind of inappropriate, that kind of things that would, or thoughts about that, that would pop into my head from a very young age.
And it would really, really bother me. And I can remember, I wasn’t really sure what was going on.
The interesting thing there is that at that time in my life, my dad was pretty much an atheist and we didn’t go to church. We didn’t really believe. So it’s interesting that it took on that form that young, I’ve always wondered about that, but it did. And I know my grandma had been religious and so I assume she had probably talked to me a little bit about stuff and she probably had pictures around her house. So I kind of knew the basics. I knew Mary, I knew Jesus. I knew that kind of thing. And then I think my brain just kind of went wild with that. And then it blossomed into lots and lots of things I joke and say, I think I’ve had every theme or form out there over the years.
Carrie: That’s important for people to know just about OCD in general, if they haven’t researched it, a ton is themes do shift. So sometimes they’ll think, there will be some kind of sense of relief when they’ve gotten through one theme, like, good that’s gone away now. And sometimes they can deal with a theme. The next theme is a little bit more manageable, so they don’t really feel like they have a problem. They’re like, well maybe that went away. That was super distressing. And then they’re able to manage or cope in their life with the next theme better. And then another theme hits that’s unmanageable. Have you gone through periods of like that because OCD has this tendency, you know, to like wax and wayne.
Stacy: Definitely. Almost all of the members I’ve seen throughout the years of doing therapy have said very similar things. They’ve said it comes and it goes, there are times in my life. Where it is really loud in times where it’s much quieter. And that seems to be reflective of many people’s experience, not just my own, but theirs as well. One of the things that I think research would support is that when you’re under more stressful times in your life or big life changes, that’s when OCD seems to be more prevalent. It kind of, I think of it in my own life as it kind of hangs out. And then it demands a little more attention during times of change or challenging times in my life. It tries to anyways.
Carrie: That’s a really good way of describing it. It’s like, it’s always there. And sometimes it’s a little bit more in the background and sometimes it’s more in the foreground, like knocking on your brain, demanding attention, like, Hey, pay attention to me.
Stacy: Yes. That’s definitely how I think of it. And I know what I always tell people, people always kind of ask, is it curable? Right? And what I say to that is. It’s very, very manageable. Right? You can live in recovery because of my beliefs. Do I believe that yes, it could be cured. Absolutely. And at the same time, my experience says that’s a very rare thing to happen. I believe God could do it for sure. And sometimes He doesn’t usually, He doesn’t for whatever reason, He knows a lot more than me. So I’m just gonna address that.
Carrie: I think that’s a great perspective to have on it that regardless of what people are dealing with, whether it’s anxiety or OCD or depression, sometimes we have battles in our life or trials that we go
through that are long term that are ongoing and we do struggle with why won’t God take this away from me? I don’t understand it. Why I’m having to go through this. Did you experience some of that in your own spiritual wrestlings with God?
Stacy: Absolutely. I really struggled with that throughout the years. I’m in my forties now. And so having had this for 36 years, at least. I started my relationship with God when I was probably around 11. And so since about that time, I struggled. And what has really helped me is when you look at Peter and what Peter says about how I have this thorn in my side, and I often go back to that where he basically says, I ask God three times to take this from me. And he didn’t. And he said, my grace is sufficient for you. And so for me, that’s what I go back to when people ask why, I don’t know why. And it is something that’s my thorn and it’s something I’ve carried doesn’t mean he won’t someday heal it.
But what it has brought into my life has been this calling, right? I would not be doing the work I do had I not had these experiences. And so I am a big believer that the things we go through or the trials or battles we face are meant to do something right. We’re supposed to do something with them. At least that’s my thoughts. And so I do think that definitely led me down the path. I would not be doing this if it wasn’t for that.
Carrie: There’s a really great verse in second Corinthians towards the beginning that I like that talks about how we comfort other people with the comfort that we’ve received from God. And I feel in a lot of ways, that’s like my life first, the sufferings and the trials that I’ve been through and have experienced with God. It’s like I’m able to pass the Baton and help other people through some of those similar trials and situations.
Stacy: Absolutely. I agree a hundred percent. I think the majority of the people I have worked with, who I’ve shared parts of my story with when it’s appropriate, have been so grateful just to find out I’m not alone. There’s someone else who has been down this road because I think OCD in particular has this. Certain peculiar missed about it, that people do feel very alone in it and feel like nobody understands it, because it can take on some really bizarre themes and it jumps so much. Right? So I think people find comfort in that, that, my goodness. Here’s somebody who has been through this and has in a sense, come out on the other side.
Carrie: So I wanna shift a little bit and get into talking about exposure and response prevention, because that’s the therapeutic tool that you use probably most often on NO CD. I’ve had a little bit of struggles over the years with ERP and I shared some of those with you before we started recording.I don’t dislike ERP I’m completely open to it. I know that it helps some people. I also know that from my background of dealing with trauma, that if someone tries to just use a straight ERP model with someone who’s experienced trauma, sometimes that can make their trauma experiences, PTSD symptoms and worse. And so there’s this balance of having to make sure that we’re helping people who have been diagnosed with multiple things. And a lot of times people will say, well It’s been research that ERP works well with OCD, and we know that people are people they’re complex. And I’ve tried to get someone to talk about ERP on the show and was basically told that I was spreading lies on my website because I talk about treatments that are not just ERP. And we’ve talked about all kinds of things on the show.
We were very open to whatever helps people like get the help that you need. And we had someone say they got help through brain spotting with their OCD and that’s awesome. Some people are helped by EMDR and by other methods. And so whatever you can get around you that is gonna help. I want people to be helped, but I’d love to have more of this conversation about how does exposure and response prevention help people who have OCD.
Stacy: I think you bring up a really great point. I think that’s why it’s so important that if you have been diagnosed with OCD or you suspect that you have OCD that you see somebody who specializes in it’s, somebody who is very familiar with it, because it is often misdiagnosed. And there are many, many people who get misdiagnosed and it can be harmful. Right?
Carrie: Yes absolutely.
Stacy: We’ve had people who have been diagnosed with psychosis and things like that when it wasn’t, but you really have to know it very well to see the differences. And you want somebody who’s trained enough, who also knows other forms of therapy so that they can tell what else you might need in conjunction. Right? Because you’re right. People often don’t come to you with just straight depression or straight anxiety or straight OCD, right? It is often a combination. And so one of the things we do really well, I think at OCD, is that we are careful to make sure that we’re also giving people resources and referrals for treatment providers that would deal with say complex trauma or major depression and things like that.
We know that when people do ERP for obsessive compulsive disorder, when it’s comorbid with depression and anxiety, it often does help relieve some of those symptoms. And there are times when they also need to be addressed separately and regular cognitive behavioral therapy or talk therapy can be very helpful for depression and for anxiety and for many other things.
And so I do think it is often a combination because it’s not often that you see somebody who just has OCD. And at the same time, we do know that exposure in response prevention is the gold standard treatment for OCD, but you’re right. You also have to have somebody who takes into account.
There might be some other things going on, and I’m very careful to do a trauma screening with everyone I see, because I do think you have to go about that in a very cautious way. Right? And often people can be doing trauma work separately while they’re working with me on street ERP. And so I find that to be very useful. And then we coordinate things.
Carrie: I appreciate your openness on that, because I know that there are some providers that are very rigid surrounding only using the ERP model. It’s a little bit frustrating, because there’s a level of rigidity with OCD that I feel like almost gets, there’s a parallel between that almost in the professionals that treat it, that I don’t feel like is helpful for the clients, just in general. Exposure and response prevention. There’s a lot of different things that go into that, but can you just give us kind of a brief overview.
Stacy: Sure. It’s basically gradually exposing you to triggers that typically would cause intrusive, unwanted, either thoughts, feelings, or urges, and then it works with you to prevent the compulsive response. So typically in order to be diagnosed with OCD you have to have obsessions or intrusive thoughts, images.
That are unwanted or urges and then compulsion something you’re doing that reduces those feelings of anxiety and discomfort or in a way neutralizes it. Right? And those can be internal or external. Right?
They can be things you see such as the most common ones, I guess, that you hear about are checking things repeatedly, or it might be saying prayers out loud, repeatedly, but it can also be internal. It can be mental compulsions, like trying to solve problems by replaying them over and over and over again. Did this really happen like this, or trying to reason sort of with the OCD? That’s the other reason it’s really important to work side by side with a trained therapist, because you might miss those mental compulsions. Right?
Carrie: Right.
Stacy: Sometimes it’s something as simple as I have to say this in my head or count this number in my head. Right? People don’t always recognize that as a compulsion, but it is.
Carrie: Because it becomes so automatic and just part of their process. I know that reassurance seeking is a really big compulsion that a lot of people have, like that need to talk to somebody else about it, or sometimes make confess certain things to another person.
Stacy: For sure. I know those are ones that often people don’t even realize they’re doing or they realize it, but then they get sneaky. Right? They don’t try to get reassurance without straight out asking for. Right? I know one big one for me when I was a kid was confessing. And I see that a lot with kids, especially really young kids.
That’s one of the first things I’m looking for when I’m talking to parents, are they coming to you a lot and telling you things that maybe. Another kiddo would not do. Right?
Carrie: Right.
Stacy: Cause I just remember that a lot with my mom and that really is reassurance seeking because then that person typically says, no, you’re fine.
That’s just a thought or that’s not something you’re really wanting to do, something to that effect.
Carrie: So there’s a exposure hierarchy where you’re kind of trying to start with maybe some things that would be easier for people to expose themselves to, and then gradually work up to harder and harder things.
Stacy: I always call it. I have this latter hierarchy that I always use with people. We’re taking it step by step. We’re not throwing you in the deep end and saying, “good luck I hope you swim at your worst level 10 fear”. We wanna baby step it. And some people can go in bigger chunks and some people, it takes smaller chunks. And so we really are working. Alongside with our client to make sure that it’s not too much and we’re monitoring it, we’re asking them, you know, what’s your anxiety level before this exposure? What is it during? What is it after we’re having them monitor that regularly? And we’re also doing it with them in session, as much as we can, because we know that in order to create habituation, which is why this treatment works so well for OCD.
We’re trying to really, in a sensory wire, your brain, you have this whole, your alarm system that’s going on and it’s telling you you’re in danger because of these thoughts. Images are urges when you’re not. And so you’ve developed this process of trying to rid yourself of those feelings, but it’s all based on this faulty alarm. So our job in ERP is to get that alarm when it goes off to recognize that it’s a false alarm, you’re not in any real danger. And that’s what ERP really is working towards.
Carrie: I’d like to tell people about this analogy. It’s almost like we have these pathways in our brain and there’s a saying that “The neurons that fire together, wire together”. Your brain has gone through this pathway of obsession, compulsion, obsession, compulsion, over and over.
And the more that you do, the compulsions and you, the more that you start to have the obsessions and you’re trying to get relief, but you’re stuck in this negative loop. It’s almost like a path through the woods. That’s really well worn. It’s been walked a lot. The sticks have been moved. It’s very easy to get through. And then when we’re trying to create behavioral change and new patterns, it’s like creating a new path in the woods.
There’s maybe some limbs down on it. It hasn’t really been walked through that time. So of course, it’s going to be uncomfortable when we do these new things. And we expose our brain to new experiences. It’s not always going to feel good, just like walking through the tall grass. There might be some bugs or things that you might encounter, but the more that you walk down that path, the more well worn it is. Just like you were talking about with habituation, the more that you’re able to expose yourself to something and reduce that anxiety, or learn to sit with that anxiety and know that it’s not gonna kill you. It’s going to be okay. You’re going to be able to work through it. The easier that path is gonna be able to take the next time. And it’s a process for sure.
Stacy: I love that. Actually, I love that metaphor. I think that’s a perfect explanation for what we’re trying to do is to get you to a place where you recognize.
That, yes, this is uncomfortable. And I’ll get through it and it won’t always feel like this. That’s the one thing over the years I’ve learned. Yes. Let me go back just a little bit. Everybody has the same thoughts that people with OCD have. They probably don’t have them as often, right? Because they don’t get stuck it’s they filter their filter works properly so they can take these thoughts that maybe aren’t very important and disregard them.
They have enough confidence, not certainty, but confidence that this is probably just a bad thought or just something that popped into my mind that I wouldn’t act down. The person with OCD though, for whatever reason, there’s a lot of mechanics in the brain. They get stuck on it and they say, why did I have this?
There must be a reason. What does it mean about me? And they internalize it. And then they start to think I’m bad or I’ve done. And that starts this whole, once you’ve latched on and gotten stuck on a thought, then it’s gonna be there more often. It’s like trying not to think about something. You’re gonna think about it. And so people with OCD it’s not that their thoughts are different from other people, but it’s that they get stuck on these thoughts and want to give them meaning. Why were they there?
Carrie: Stacy, I think that’s absolutely true and makes a lot of sense is that people do research about the general population. How many people have ever had a thought about driving their car off the road. There’s actually, I think about half of the people have had that type of thought and just even different thoughts about robbing a bank was one of them that I saw surprising sometimes how many people just have these thoughts go through their head. I have a fear of heights and so I will get certain places. And I shared with a friend who also has a fear of heights. I said, “do you like picture yourself falling from places because I do that”. And I thought to myself that was weird.
I didn’t realize that other people also have some of those thoughts too. And he was like, I also have that I struggle with. So it’s things like that, that if you allow yourself to get really attached to it and you can’t help it, because sometimes it’s, there are genetic influence. That happen with OCD and sometimes you just can’t help having these thoughts. You just pop in there. You don’t choose. I don’t think every time I go to a high place, let me visualize myself falling off of here. It just comes in. It just comes outta nowhere. What if I fell off of this thing and I died, you know, or I was permanently injured in some way, shape or form. And then it makes me want to not get close to any edge of any high thing.
Stacy: People often say, well, why does it latch on to some thoughts and not the others? The other thing we know is that it tends to latch on to things you value things you care about. One of the things that OCD seems to really attack is anything taboo, anything that would set you apart from someone else, anything that would make you bad or make you seem different. And so it really latches on and try to convince you in a sense, or have you doubt who you are as a person and the things that are most important to you. And I think that’s what makes it such a tormenting disorder. It goes after the things you care the most about.
Carrie: And that’s where we get to talking about. We’ve had people show in the past who have had children thoughts about either their children being hurt or thoughts about harming their children, that those can come in after they have children. They never had before they had children. Oftentimes people of faith will have scrupulosity, obsessions and compulsions because their faith is really important to them. People who are concerned about getting things done the right way are going may have obsessions compulsions about the, just so warm of OCD. That makes a lot of sense. I’m curious about, because I don’t know a ton about it, your work on NO CD. Tell me a little bit about that platform website.
Stacy: Sure. My work at NO CD is, you know, we are a very fast growing company.
And there’s a need out there for treatment. There’s a need for the right kind of treatment for OCD. OCD had, had an app for quite some time as my understanding. And then right around the time of the pandemic, there became a real need for therapy and it just has exploded. We’re helping so many people get this treatment that can be lifesaving. It really can be. We have a free app that you can download at treatmyocd.com. The cool thing about that is there’s like a little community in there. It’s sort of like a social media community where you can talk with people who also have OCD, and it’s very friendly community. That one of the most important things we’ve found is just knowing that there are other people out there who have this, who experience these things can be healing in itself, right?
Carrie: Sure.
Stacy: This not alone. And so the work that we’re doing is really trying to reach as many people as we can with affordable therapy. We know that many, many people can go upwards of 10 years before they get treatment and a proper diagnosis. And I can definitely vouch for that. I mean, I was 15 when I found out that this had a name. And the only reason I found out was 2020, this show kind of like a dateline show, aired an episode about OCD. And that’s how we found out that’s what I had. And then it would take me about seven years before I found somebody who could actually treat it, in a way that was manageable. And unfortunately back then we didn’t have the resources we have now where you can Google and you can type in and you can get just tons of information and, and misinformation. Right? That would’ve been a lifesaver back then. And, and we’re even seeing kids as young as five who are coming through for assessments and who have OCD. And so we’re catching it much sooner, which I really believe in. And I believe that that will be life-changing for them.
Carrie: Absolutely. That’s huge. Just the ability to have early intervention. One of the things that I really like about NO CD is that you take insurance. That’s so huge. I know in the Nashville area, most of the providers, and there’s a large treatment center, most of them don’t take insurance. And so people can spend hundreds, thousands of dollars trying to get the help that they need. And some people just aren’t able to do that with their financial situation.
Stacy: They are constantly adding more and more providers and trying to get more and more insurances to cover our services because it is such important work. And we see so many benefits. There are so many people who are getting better and it’s hard.
It’s hard to see the stories of people who can’t get the help they need, because. Insurance doesn’t cover it or, you know, it’s too expensive. And so it is, I think in general can be expensive depending on a lot of factors, but ERP in particular, but NO CD really does offer affordable payment plans for people who can’t afford. And so that’s been really great to see as well, people who wouldn’t normally get in treatment.
That’s what we’re all about. We want everybody who’s suffering from this disorder to at least have access to that because a lot of rural communities, I know where I live, there was no specialists. And the people that I see as members often will say, well, there’s one specialist that’s, you know, within an hour range, but they have a six-month or a year wait list. That’s, what’s so amazing about NO CD is you can get in within a week.
Carrie: Are these video session that you’re doing with people. I mean, it’s all Telehealth, right? Either through the app or the website.
Stacy: It’s all Telehealth. There’s actually was just a study that came out about it and about how effective it is. It really is. I mean, I honestly, as somebody who has done face-to-face therapy for many, many years prior to this, I can honestly say I don’t notice a difference because in some ways it’s actually more helpful because I’m in the home with them. And I can walk with them like they’ll device throughout the house and do exposures. And so in some ways it’s actually more beneficial because I’m there with them.
Carrie: I would agree with that. People being able to do those exposures in their own environment is really helpful and powerful. You’re able to do things that you wouldn’t be able to do in the office we have Telehealth. That’s something that people don’t realize. A lot of times they may look at Telehealth as, it’s a deficit or that’s not as good. But one thing that we learned through the pandemic when everyone was seeing their therapist online was how effective Telehealth can be.
Stacy: Sometimes I feel like people are even more open. In this setting, then they are face to face. There’s almost like a safety net there or something, but people are more open and seem to be able to express themselves more quickly than maybe in a face-to-face setting for whatever reason.
Carrie: Awesome. I like to ask people a question as we get towards the end of the podcast. And since some of this was about your personal story and experience with OCD, I just am curious what is something that you wish you could go back and tell your younger self who is struggling?
Stacy: I love this question. I get this question a lot, actually, cause I have had it for my entire life. I wish I could go back and say, you know, the things you’re worrying about, they don’t ever happen.
And when they do, you will get through it. You will because there’s no other choice. I wish I could get back time. I wish that I hadn’t spent so much time on this. That’s what I would tell myself.
I know it’s not a choice, obviously, as a kid, you don’t choose to have OCD and at the same time, I wish there had been someone to intervene to say, “Hey, this is a real thing, this is a disorder, this is how you treat it”. And then I would’ve been able to do that a lot sooner, but you can’t go back in time. You can’t undo the past. And so if it’s moving forward each day, I take it and I say, you know what? I’m not gonna waste any more time. Right? It’s already had a ton of time. That’s all it’s getting. And that doesn’t mean it’s perfect. It doesn’t mean it doesn’t creep up because it does. I’d be lying if I said otherwise, there are times when it’s hard, but it’s so much easier than it ever was. And I can truly say I’m 90% better and, and life is good. I wish I could just tell my little self, like, stop, stop being in your head. Just go have fun.
Carrie: I think that’s so relevant to people with, with any mental health issue is sometimes we can get so laser focused in trying to fix something that we miss, that we’re a whole person with social relationships, hobbies, dreams, goals, desires, that this is not who you are as a person, your diagnosis. You’re a whole person who struggles in this area. And yes, it does affect some of those other domains. And I’m not making light of that, but it’s much better if we’re able to say, “Hey, I’m a person who struggles with this rather than I have this”.
Thank you so much, Stacy, for taking the time to share with us your story and the work that you’re doing as a therapist on NOCD. We’re gonna put links in the show notes so that people who are looking for help or want to find out more information about you or NOCD. They can do that through the show notes.
Stacy: Thank you for having me on this show. I appreciate it so much. And I hope that there are listeners out there who recognize some of these symptoms and can get some help a lot sooner. And I appreciate you doing the work you do to get the word out there about this.
Carrie: Thank you. I enjoy this episode with Stacy and I hope that you do too. We may invite her back to enter some more specific questions about scrupulosity. If you have and already please be sure to join our Facebook group. We’re really trying to create a positive and supportive environment for people with anxiety and OCD. But then a little neglect full time about giving in near and hosting things but I really want to work on. Growing back online community this year. You find the link in the show notes.
Hope for Anxiety and OCD is a production of By The Well Counseling. Our show is hosted by me, Carrie Bock, a licensed professional counselor in Tennessee. Opinions given by our guests are their own and do not necessarily reflect the use of myself or By the Well Counseling. Our original music is by Brandon Mangrum. Until next time may you be comforted by God’s great love for you.
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