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133. Looking for an Alternative to ERP? Find out if ICBT is Right for You

Carrie discusses Inference-Based Cognitive Behavioral Therapy (ICBT) as a helpful option, explaining how it differs from ERP in addressing OCD symptoms and integrating faith perspectives. 

Join her as she explores ways to find peace and faith while managing OCD through these therapeutic approaches.

Episode Highlights:

  • The principles of ICBT and its approach to mental compulsions.
  • The importance of respecting someone’s faith in OCD treatment.
  • Common misconceptions about OCD treatment options and their effectiveness.
  • Practical tips for considering ICBT over traditional ERP methods.

Episode Summary:

In this episode of Christian Faith and OCD, I discuss an alternative to Exposure and Response Prevention (ERP) called Inference-based Cognitive Behavioral Therapy (ICBT). While ERP is the gold standard for treating OCD, it’s not always the right fit for everyone. Some find ERP too overwhelming or not trauma-informed, especially those dealing with co-occurring conditions like PTSD. ICBT offers a different approach, focusing on challenging the obsessional doubt at its core rather than just managing the anxiety it produces.

ICBT helps you recognize that OCD weaves facts with imagination, creating a story that feels all too real. By identifying the crossover point where you shift from the present moment into this imagined scenario, you can begin to break free from the cycle of obsessions and compulsions. What I love most about ICBT is its focus on the “feared self” versus the “real self.” The feared self is who OCD tries to convince you that you are or will become, but it’s a false identity. ICBT helps you reconnect with who God says you are—loved, valued, and free.

If you’re wondering which therapy is right for you, it’s essential to choose the path that aligns with your needs and challenges. Both ERP and ICBT require dedication and hard work, but the reward is a life of greater freedom and peace. Remember, you are stronger than you know, and you can overcome the struggles of OCD with the right support.

Thank you for joining me today. If you found this episode helpful, I’d appreciate it if you could leave a review on iTunes or Apple Podcasts. Your feedback helps others find our show and begin their healing journey. Until next time, may you be comforted by God’s great love for you.

Explore related episodes:

Hello and welcome to Christian Faith and OCD with Carrie Bock. I’m a Christ follower, wife and mother licensed professional counselor who helps Christians struggling with OCD get to a deeper level of healing. When I couldn’t find resources for my clients with OCD, God called me to bring this podcast to you.

with practical tools for developing greater peace. We’re here to bust through the shame and stigma surrounding struggling with OCD as a Christian, sharing hopeful stories of healing and helping you replace uncertainty with faith. I’m here to help you let go of the past and future to walk in the present abundant life God has for you.

Let’s dive right into today’s episode. If you haven’t heard, we are running a freedom from mental compulsions challenge on August the 5th at noon central time. You can sign up at www.hopeforanxietyandocd. com/challenge and we’re going to be giving away some cool stuff like free coaching with Keri, and maybe some coffee gift cards thrown in there.

You’re not going to want to miss it, so I will see you there. Welcome to episode 133. Have you been looking for an alternative to exposure and response prevention, ERP? I know that this is an important thing that many individuals with OCD are looking for. Maybe you’ve had a bad experience with ERP. Maybe it just feels too big or too overwhelming or too scary to do.

Maybe you’ve heard stories from other people and don’t feel as comfortable with the therapy. Well, today we’re going to talk a little bit about exposure and response prevention and then talk about ICBT as a potential alternative. I don’t want you to get stuck on black-or-white thinking, like one of these therapies is right, one is wrong, one is better, one is not better. Both of these therapies have been researched and are evidence-based treatments for obsessive-compulsive disorder. Both therapies have helped people heal, so we’re not in the interest of putting one above the other. We’re just letting you know that there are options out there that some people in the OCD community don’t know about.

What is exposure response prevention? This is a behaviorally based therapy. that focuses on developing a treatment hierarchy, things that you are avoiding due to OCD, things that you fear engaging with, and then you develop exposures, gradually exposing yourself to the things that are scaring you in order to overall reduce the anxiety, decrease the compulsions because you’re engaging in the activity.

You’re feeling the anxiety and you’re not engaging in the compulsion. It’s a way to retrain your brain so that when you encounter those things in the future, the triggers, you know, okay, this is OCD. I’m fully aware of what it is. It’s very uncomfortable, but I can sit with this and not engage in the compulsive activity.

Exposure and response prevention is referred to by the International OCD Foundation, among others, as the gold standard for OCD treatment. We’ve talked more in depth about ERP on the show. You can go back and listen to episode number 74. with Stacey Quick and episode 111 with Judy Lair, who both talk more in depth about what exposure and response prevention is and how it can be helpful for OCD. Both of these individuals work for NoCD, which is a online therapy group, and NoCD specifically hires therapists and focuses on using strict ERP as their main focus of treatment. Like any large online therapy practice, it really depends on the therapist that you get connected with and whether or not you have a good connection or relationship as far as what your success may or may not be.

If you’re going to be doing hard things, obviously feeling comfortable with the person you are doing those hard things with is really important. This is true for any type of therapy, not just ERP. I have a much older episode about ERP not being the only treatment for OCD where I talk about utilizing EMDR to really get down to the core fear and the inadequacies that people feel about themselves to create a sense of healing and that as we treat the trauma and those core fears that a lot of times the OCD symptoms would go down. I definitely need to update that episode now that I am engaged with doing more inference-based cognitive behavioral therapy, or ICBT, as we’re going to call that. This episode has been pretty popular. People have searched and found it on Google because they’re looking for alternatives to ERP. If this is the gold standard, then we have to ask ourselves, why are people looking for alternatives?

There’s several different reasons for that. ERP is effective, but it’s not perfect. I’m a therapist. I can tell you that no therapy is perfect. EMDR is not perfect. ERP is not perfect. ICBT is not perfect. This is why therapists often use multiple modalities of therapies with their clients in order to help them find the greatest level of healing. That would make you a somewhat eclectic therapist if you’re using multiple therapy modalities. When you get too stuck on one and try to pigeonhole everyone into the same type of therapy, I’ve probably done it myself, admittedly, then you run into all sorts of problems because people are complex beings and they come in with complex presentations.

One quarter of individuals who meet criteria for an OCD diagnosis also meet criteria for a PTSD diagnosis. There are times where ERP is not always trauma informed. It may exacerbate PTSD symptoms. I’ve had this happen with clients who saw a prior therapist to myself, and they were really just kind of encouraged by the ERP therapist of like, hey, well, this is a treatment for OCD.

We’ve got to keep doing this. We’ve got to keep going down this road, and unfortunately, they may have failed to look at the entire clinical presentation of that individual. Another reason people are looking for alternatives to ERP is that it’s hard. The reality of sitting with all of these uncomfortable anxieties, emotions, fear, body sensations that come up connected with that, it’s hard, and a lot of people end up dropping out of the process.

Just as ERP is at times not trauma-informed, it can be depending on the therapist. At times, it’s not religiously sensitive. I’ve also seen cases of this and that’s highly unfortunate because the International OCD Foundation has a great page on their website about religiously sensitive exposures.

They’re also very open and focused on working with clergy of a variety of different faith communities to help people who are dealing with scrupulosity or religious obsessions be able to get the best care and treatment possible. Let’s say that you’re doing ERP and maybe you cannot find a Christian therapist in your area who does that.

You may want to ask if that therapist would be willing to connect with your pastor to help you create appropriately religiously sensitive exposures so that you’re not feeling like you’re going against your faith by engaging in treatment. That is not what any ERP therapist would want you to do.

Another potential issue with ERP is that it can be harder to target mental compulsions. This is where I feel like ICBT has an edge over ERP. If you are targeting mental, like, worst-case scenarios, a lot of that’s imaginal exposure, where you’re having to write imaginal scripts and read those over and over.

A lot of times you’re writing down things that are not true about yourself, things that are not true about God. Some Christians struggle sitting with those things, to be quite honest, and I would be as well if I was the one having to engage in that type of therapy. The goal of that imaginal script is to retrain your brain to recognize that it doesn’t have to have a hold on you, and it doesn’t have to continue to create anxiety. You are sitting with the anxiety and essentially making it boring. I find that sometimes people end up playing whack-a-mole with their symptoms, doing a lot of different exposures over a variety of different themes, but they’re not really getting at the core fear. This is something that I feel ICBT does a little bit better job of.

Before I really knew about ICBT, like I said, I was using a lot of EMDR to really help people drill down what is it that you are really, really afraid of. Not just, I’m afraid of getting sick or I’m afraid of getting somebody else sick if I touch this doorknob. But. Like this deeper level of that, that deeper layer might be something like, I’m going to get so sick that I won’t be able to take care of my children and my family and other people will suffer.

At its core, exposure and response prevention is focused On feeling the anxiety, not engaging in the compulsion. So they’re focused on that piece of the equation. ICBT is different. It focuses on recognizing that the obsession is really irrelevant to the present moment right now. So if you resolve the obsessional doubt than you resolve the need to engage in the compulsion.

There are 12 modules to ICBT, so obviously it would take a long time to go through each of those modules. That’s another plug to join us in the workshop on August 5th where we’ll be able to talk about this more in depth. ICBT is based on the idea of inferential confusion. People with OCD overestimate possibility. They make irrelevant associations. They disregard sensory information, not just your five senses, but also your sense of self, who you are as a person. ICBT requires you to really slow down and focus on your thought process in a different way. It’s validating to a lot of my clients because it lets them know the obsession isn’t just coming out of nowhere.

There are reasons that you’re thinking these things that you’re thinking. It’s based on information that you know to be true that’s just a plain fact. Like germs are real. As a Christian, we have certain facts that we believe about forgiveness, repentance, salvation. Obsessional doubt may come from your own personal experience as well as hearing about the experiences of others, whether that’s people you know or whether it’s just another YouTube video you watched or something you read on Reddit.

What ICBT does is it helps you recognize that OCD is taking those facts and weaving them in with imagination to create a story. And this is not just any story, it is like a lifetime movie based on a true story that really sucks you in. and causes you to feel intense emotions, intense level of fear, even though nothing bad is happening right now.

ICBT helps you identify that when you get triggered, there is this crossover point from the present moment experience over into the imagination. And learning that crossover point helps you not to continue on with the obsessional story. But here’s my favorite part about ICBT. It causes you to look at identifying the feared self versus the real self.

The feared self is who you believe that OCD is telling you either that you are right now or that you’re going to become if you don’t engage in these compulsions. For example, someone may believe that if they don’t read their Bible enough, that means they are not a good Christian. Of course, reading your Bible enough is very relative.

I only read one chapter today, does that mean that I don’t really love God or don’t really care about Him? This belief system about self Whether it’s that I’m unworthy, not enough, that I’m going to harm other people, that somehow I have these, like, deep-seated desires to do things that are inappropriate.

That is a feared self, and it’s a false self. It’s not who you really are. Who you really are is who God says that you are. You are loved. You are valued. God wants you to have abundant life. God wants you to have joy. God wants you to have joy, even in the midst of difficult circumstances. You are a child of God. You are forgiven. You are free.

There are so many different things that I could say here about who you are in Christ. I encourage you to search the scriptures for those yourself. So let’s talk for a moment about, well, which therapy is best for me? How do I know? Here’s what I know. OCD recovery is no joke, okay? It’s hard either way. So whether you do ERP or whether you do ICBT, it’s going to be difficult. It’s going to require time. It’s going to require dedication. So choose your hard. You know what’s even harder? Living with unmanaged OCD symptoms that sucks the joy out of your life when God is calling you toward an abundant life with Him where there is joy and peace and freedom on the other side. I want you to know that whatever you choose to do to engage in, in your recovery of OCD, that you are strong. Stronger than you know. You can do hard things and I pray that you find the help that you need and the support that you need to be able to walk through these challenging times as you’re struggling as you know,

We’re in the process of of rebranding a bit and getting our website fixed. So until then, we are still at hopeforanxietyandocd.com or you can find me at my counseling practice, bythewellcounseling.com. Thanks so much for listening. Until next time, may you be comforted by God’s great love for you.

Were you blessed by today’s episode? If so, I’d really appreciate it if you would go over to your iTunes account or Apple Podcasts app on your computer if you’re an Android person and leave us a review. This really helps other Christians who are struggling with OCD be able to find our show. Christian Faith and OCD is a production of By The Well Counseling. This podcast is for informational purposes only and should not be a substitute for seeking mental health treatment in your area.

111. Using Humor with ERP with Judy Lair, LPCC

This week, Carrie is joined by Judy Lair, a licensed professional clinical counselor specializing in OCD therapy, to explore how to use humor in ERP therapy and how laughter and creativity can be powerful tools in overcoming challenges on the journey to healing from OCD.

Episode Highlights:

The use of humor and creativity as powerful tools in overcoming anxiety and intrusive thoughts.

Customizing ERP techniques based on individual interests and strengths.

Strategies for incorporating creativity to confront OCD challenges.

Insights into the sanctification process and the choice between living in faith or seeking constant certainty in managing OCD.

Episode Summary:

Welcome to episode 111 of Christian Faith and OCD! Today, I’m thrilled to have Judy Lair, a licensed professional clinical counselor, with us to delve into the use of humor in ERP (Exposure and Response Prevention) therapy.

Judy’s journey into specializing in OCD began from her own experiences with anxiety and a background as a litigation paralegal. After a transformative period working with a psychiatrist and discovering her passion for counseling, she transitioned to working in OCD therapy. Judy’s approach incorporates humor as a tool to help clients navigate the challenges of ERP therapy.

In this episode, Judy shares how she uses analogies, like the haunted house, to help clients understand and manage their OCD. By embracing humor and creativity, she empowers clients to face their fears in a more light-hearted and less intimidating way.

Judy also discusses the importance of recognizing OCD’s inaccurate threat levels, likening it to a malware virus that skews our perception of danger. Her innovative methods, including using personal interests and humorous visualizations, make ERP more accessible and less daunting for those struggling with OCD.

Tune in to gain valuable insights into integrating humor into ERP and how it can make a significant difference in the therapy process. Don’t forget to subscribe and leave a review!

Related Links and Resources

www.treatmyocd.com/therapists/76492/judy.lair
Jusy Lair’s Books on Amazon

Explore related episodes:

Welcome to Christian Faith and OCD, episode 111. Today on the show, I have with me Judy Lair, who is a licensed professional clinical counselor, here to talk with us about using humor in ERP therapy. We had a previous episode on ERP that you can go back and listen to; we’ll link that episode in the show notes for you, where we did just a brief overview of what it was. It was also a personal story from Stacy Quick, sharing some of her experiences with OCD and how she became an ERP therapist. Stacy was a therapist we met through NoCD, and we talked about that on that episode. Judy also works with NoCD. 

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Carrie: I’m  happy to have you here today on the show.

Judy: Hi, Carrie. I’m glad to be here. Even with this not being my real voice, I think I can still talk.

Carrie: Yes, she is recovering from a cold here, so thank you for bearing with us on that one. I heard you speak at the AACC conference. That was how we met, and it was exciting to see how many Christian therapists were there interested in a presentation on OCD. That’s not something often covered or has been covered, I guess, at that conference.

How did you specialize in OCD? How did you get that to be a specialty?

Judy: I’ve had a lot of different types of jobs in my life, but one of the things was when I was on the other side of the couch, working through my anxiety and such for about a year, talking to me like, “You can do this, you can be on the other side of the couch.” I’m like, “No, here’s a whole bunch of reasons why, no, it’s not going to be me.” I was never one of those people that everybody came to for advice and stuff; that’s not me. Much more cognitive, I’m much more thinking about thinking, planning, strategic types of things. It’s my forte and stuff. So I’ve worked in a number of areas in different things, especially I was a litigation paralegal in a law firm for a bunch of years.

That was really my background. Then I started working in a doc psychiatrist’s office, and that’s when I kind of got that message from God about, “You really could do this.” So I went back to grad school quite late in life to do that. I found that was my niche, that was the thing I was doing all along; I just didn’t know it. Being a paralegal, educating, and helping people through, I did when people got injured and hurt and helped them through that. That was the start of me counseling. I just didn’t know it at the time.

Carrie: Yes, there’s so many overlaps, I think, between counseling and education and problem-solving. I’m sure that there were things that problem-solving that you had encountered, so I could see how all of the skills would be beneficial.

Judy: Right. I had finished grad school, and I was disappointed because I wanted to work in a Christian counseling agency. Once you spend the time and the money to get your degree, you have to spend extra hours to be able to get your independent licensure. That’s where, at least where I was living, they all wanted independent licensure, and I’m like, “How do I get that if I can’t get that?” It was a quandary. I still worked at the law firm that I was looking at for a bunch of years, and I opened this out of my house. I did evening counseling out of my house. Shortly after I started, there was this woman who came to me and said, “Well, I know I have OCD. I was diagnosed with it years ago. I’ve had treatment at some of the well-known facilities. I now live in my area. So do you think you can help me?” She explained her obsessions and compulsions, and I’m like, “Fascinating. Okay, so when you do this and you do this, then it ends up like this. If you do this instead of this, does it go like this?” She’s like, “Oh my gosh, I have never heard anybody get it who did not have OCD themselves.” I could just get it. It was definitely a gifting from God too. I understand the logic of OCD, which has a lot of logic in and of itself if you understand the root part of it. Once she recommended that, and I started working with her, then I read Jonathan Grayson’s Freedom from Obsessive-Compulsive Disorder. I’m doing everything in the book; I already organically knew what to do and how to walk people through that, which was really exciting. I found my path away. So I eventually took the International OCD Foundation’s Behavioral B2BI training. I spoke at one of their Annual conventions, gave continuing education conferences in Columbus where I was at the time. It just really happened from my niche in my area. Now, 22 years in January, that has been my specialty.

Carrie: That’s awesome. I always used to tell counselors that I was supervising, your specialty kind of finds you; you don’t really find it. I didn’t necessarily think that I was going to be working in the areas that I’m working in now, but I’m happy that God has brought me along this path. Mine kind of branched out of working with anxiety, and once you see enough people with anxiety, you’re going to eventually run into some people with OCD, and it looks a little different.  You have to kind of readjust the toolbox and reexamine some of the things that you’re doing. We talked on that previous episode about creating hierarchies in ERP, the idea behind it that you’re exposing yourself to some things that are uncomfortable, starting with some smaller things and then gradually building up to the scarier stuff. You use a helpful analogy with your clients about a haunted house. Will you go through that with us? Just kind of like you would tell a client.

Judy: ERP, exposure response prevention, seems like anybody who’s heard about it has horror stories that it’s going to be so hard, so scary. But using the framework, thinking about a haunted house, if you’ve ever been to an actual haunted house, there are two things that you know to begin with. 

Number one, you know that nothing in the haunted house is designed to physically harm you. You walk in with that kind of knowledge. Second, the reason why people go to haunted houses is they like the uncertainty. They like the thrill that you get when somebody bumps out, and you don’t know or a noise, and you don’t know when it’s going to happen. You get this feeling, this anxiety. I call it anxiety because it would make me have anxiety, but other people are like, “That’s a thrill.” They get this thrill going on. The first time you walk through a haunted house, it’s full of uncertainty. You don’t know what’s going to happen, but that doesn’t mean that you can’t continue to walk all the way through and get out the back door. 

The good news for us is that God created a program in our brains called the habituation program. I like to call it Pac-Man. I just like the visual. So you’ve got OCD going, “Scary!” and then we’ve got a big old Pac-Man coming up, and we want to close scary down organically by inside, not us internally doing compulsions or something, but letting Pac-Man do that. The way that happens is if you walk through a haunted house the first time, it’s the scariest because you don’t know what to expect. You walk out the back door, come around the front, you walk through the same haunted house three times; you’re not going to be as scared by the 10th time. Pac-Man’s closing it down, closing down the anxiety to the accurate threat level, which generally is zero. But it closes it down so by the 10th time; it’ll be pretty funny. You walk through it; “Oh, the guy with the fair is going to show up. Yeah, then they’re going to dangle these things and go, ‘Boo!'” You can make fun of it, even if there’s still some level of nervousness in there. If we use humor in that way, like, “Oh, this is going to be silly, funny, scary,” it allows your brain to have that Pac-Man to start readjusting what is true about the threat level and close down the feeling, that adrenaline surge that you get, that feeling of anxiety.

Carrie: Talk about that a little bit more, just the inaccurate threat level related to OCD. Like OCD is telling you that something is going to be super scary, horrible, awful, but like your brain is malfunctioning there.

Judy: Yes, and that is key to OCD versus generalized anxiety disorder. With GAD and other anxieties, there’s still a thought where, “Oh, what if?” kind of thing to it, but your brain is able to quickly, if you use some logic, use some cognitive behavioral stuff, kind of, “Is it really true? Is that really that scary? Has that happened before in the past?” If you use some of those CBT kinds of things, generalized anxiety, your brain is like, “Oh yeah, that’s not really true. Calm down,” but when it’s OCD, it’s like, “No, maybe not that one, but another one and another one and another, and they pop up all over the place like that.” So the key, in terms of understanding if you have OCD, is the inaccurate thread. I call it a malware virus program in your brain. 

If you think of your brain like a supercomputer that God made that always has this underlying operating system running, just like your technology, you’ve always got an operating system running underneath in our brain; that operating system is currently using our senses. What we see, taste, touch, hear, smell. It’s looking for data. Internally, the data it’s looking for are thoughts, feelings, body sensations, and observations. The way it was designed is that if we get one of those pieces of data that pops up, it’s a neutral piece of data initially that brings it to the first program in your brain in the frontal cortex. That program’s design is to say, “Is this piece of data a threat or not a threat?” Definition of threat is jumping out of a plane without a parachute. That is the only definition. There is no other definition that goes with threat. Anything less than that is on a continuum scale of something that don’t really like, gross, that’s really terrible, but none of those are threats. That’s where the malware virus program of OCD gets in there and cherry-picks and hijacks the things that matter to us and skyrockets the threat and says, “Oh, there’s definitely going to be a threat here.” Then it starts pushing those buttons with adrenaline and neurotransmitters, makes you feel like there’s something going on. 

The urgency of now, we have to do it now, we have to figure it out now, know it now. All of that works together to combine to keep the threat being imminent, urgent, right now. That’s the part that with OCD there is no factual evidence that is what is actually true right now. You just think it and feel it, and therefore you feel like you must. Do something to fix it right now, going over and over because you do, you respond to it as if it actually is a threat. Then you create those neural pathways saying this is always a threat.

Carrie: That’s a really great explanation. Originally when I went to a two-day training in ERP with some people from Rogers and I got. Nothing against Rogers, by the way, it was just the training specifically really turned me off to ERP because there were a lot of extremes just we’re going to ban this behavior. You’re not going to be allowed to wash your hands at all, or you’re not going to be allowed to pray because you’re confessing too much to God.  I walked away just feeling not only was this very rigid, but I felt like I was being asked to torture people. And I’m curious, what you’ve done is kind of taken some of these principles and used the scientific evidence of what you’ve learned and yet added humor and made it more fun or let’s laugh at OCD or make fun of it. Tell me about some of those things that you incorporate with your clients.

Judy: I feel like that ERP, if you understand from a faith-based perspective, you know, how God made us and the interaction, learning how to do ERP is very much the same sanctification journey that we want to do in life anyway. We’re always those concepts, the broader concepts of struggling with our fleshly nature. Paul was talking about doing the things he doesn’t want to do and can’t do the things that he wants to do. That sounds very much like doing ERP to me, always has. That’s why I view it in that way. I’m looking at what is the root issue here. And the root issue is that the malware virus is scaring me. That’s something that matters to me is really big and scary. It tells me I should take care of it. I should do it on my own, which is the opposite of what we want to do in a faith-based journey. Yes. In a faith-based journey, we always want to bring God into things. We want to wait on God. We want to hear the truth that God gives us rather than us going ahead and trying to fix things or do it all on our own. So to me, that always made sense in terms of how I do ERP. 

I honestly don’t ever care if somebody who’s afraid of germs is able to reach out, grab a doorknob, and open the door. I really don’t care if they do it with their hand or paper towel. What I do care about is actually finding the courage to get through the door to find out. That really was their brain just scaring them about something and then they’re like, Well, I’m gonna let you do that to my life. I don’t need a paper towel. I’m just gonna keep on moving through. So attitude, that’s the attitude is one of the things that I feel like helps move us through things when we’re nervous and anxious and scared, kind of thing. That way of, let’s go, Jesus, the Rodney staff is with me, let’s go, let’s move it on, get to the banqueting table on the other side. That’s what I’m looking for, is the ability to have somebody be empowered to walk it out. 

Humor and creativity is one of the things I see in the Bible so much. Think about, there’s some amazing, interesting things that, how God does things in the Bible. The biggest one to me is Jericho. Seeing how they won Jericho. That worship band is out front, and all the people are behind singing and worshiping God, and then the walls fall down, like, oh my gosh. 

There’s other things, and I see other stories about how God used different people or situations. We’re very creative that we’re not the norm of how you do that. And that’s what works because God is showing that there’s all of these interesting creative ways of doing things. What I found is humor is really helpful if we can look at OCD. I have people come up with separating OCD as a separate entity and making a Fred Flintstone or one of the funny cartoon characters so that you can like, Fred, I don’t know anything about this thing, germs, or my relationship thing here, Fred Flintstone, what now? Um, and even though inside they’re going to feel like all of this, if you can make fun of OCD in that way and get your family member to say, you leave my wife alone, and then they’re both laughing and the laughter brings that level of urgency and oh no, and oh, it brings it down because you’re like laughing at it. Like you are ridiculous. You just think and think, or “Honey, I think you do,” Yes, you’re the worst thing in the world, being dramatic or silly or whatever. Doing it in these creative, silly ways really helps us as people to move towards something scary long enough for our brain to figure out, like, close it down. It’s not really actually that scary.

Carrie: Yes, I think of the two guys in the Muppets that are up in the balcony, and they’re just yapping around or somebody that’s heckling a comedian, you have that internal heckler, and sometimes it’s helpful to, like you said, create that separation, because it all feels like reality when you’re in what they call the OCD spiral, it just feels like everything’s so real now, but if you’re able to step back and even say, OCD is telling me that I’m going to get sick and die if I don’t do this, or if I go out in public and do these things, Then that helps you kind of create some of that mental separation. I think mindfulness and other activities that we teach clients thought diffusion helps with those things as well.

Judy: It’s really important how God made us and that’s one of the things that I always look for is something that’s sort of organic to how God made us rather than something so rigid and like you said extreme that they’re not, we actually have OCD or not we’re like, that sounds way too far. I would never do that kind of thing. I just feel like that people lost. That’s a little bit too much of the traditional ERP and that makes me sad in terms of understanding that if you work with somebody and with the way we were designed, that it actually helps us to go with the flow. One of the things that when I customize ERP for each client, I always want to find out about their background, things they’re interested in, who they are, if somebody is competitive, say in sports or something. 

I had a teenage client that was like a volleyball player. I’m having her visualize and practice spiking the ball into OCD’s face when it’s trying to give her a hard time because that’s a natural thing that she does and she can use it quickly to say I still feel all of this but I’m going to picture OCD standing there and I’m going to slam this ball in his face. If you’re a sports fan like me and you have your rival teams and you’re like, Oh, that rival team is not going to beat me. No, come on, buddy. You can’t beat me at all. I become animated and silly on purpose so that I can show my client that they can be animated and silly in terms of that. 

We use whatever types of things in that person’s life that they can use as a strength and empowerment strength to stand firm and be able to give some sass and give some, like, you are not the boss of me, give that one to kids a lot. You’re not the boss of me, which they love because they can’t tell that to their parents. They can tell that to OCD.

Carrie: Yes, I love it. I could see my daughter getting in on that if she had all those words right now. She would probably say that. “You’re not the boss of me.”

As far as like traditional ERP versus using humor and creativity, a lot of times I’ll have people just kind of sit and wait it out, right? Like, let’s wait for this anxiety where you’re trying to make the anxiety board, I guess, traditionally kind of wait it out. So you’re using some visualizations with people or. Some other, like, creative techniques where they can visualize and imagine themselves overcoming OCD in that process.

Judy: When you’re just waiting in the midst of it, you’re white knuckling. I hope it goes away soon. I hope it goes away. How long is it going to be? Is it done yet? Is it still here? When is it going to go away? That does not facilitate habituation, that doesn’t give the room for Pac-Man to go and close things down. We have to approach it, even kind of fake it till you make it, in a more empowered kind of stance. So that’s where, come up with a bunch of different ways that somebody can be active, but active exposing themselves and going towards OCD, and active while you’re waiting for that Pac-Man to do its job, rather than just sitting there and white knuckling. and stuff. 

One of the ways that you can do it is that you can say, “Oh OCD, I’m so glad you showed up. You’re such a good guy. I’m glad you’re showing up today. Let’s watch some TV. Do you want some popcorn? I’m not going to talk about what you want to talk about. Talk about TV. Let’s just look here. Oh yeah. You want to talk about this? Eh, don’t really want to talk about that. You can hang around all day you want, but not going to talk about that. Let’s talk about making sandwiches. What kind of meat do you like on your sandwich? What kind of pizza toppings do you like? No, I’m not going to talk about what you want me to talk about. Let’s talk about ice cream flavors or something.”  That is a more just calm, peaceful way for folks that like to be just kind of chill, calm, peaceful. 

You’re accepting that OCD is there. You’re just refusing to talk about what it wants to talk about. You can move it on to being something like I said before, kind of dramatic, real dramatic. This is such an important thing. “Oh my gosh, you are so helpful, OCD. Tell me every little thing. I don’t quite understand how you know. Do you have a question? It’s a hotline to find. Are you on the psychic hotline? Maybe you’re on the psychic hotline. Maybe I didn’t know that you knew all of those things.”

 Some of this like making fun of it, talking about what you’re not gonna take me on, you’re the opposite team. Any of these kinds of ways where you’re active, you’re active in doing ERP, which means you’re keeping your focus on OCD is there, um, looking at your OCD, I’m talking to you, but I am not talking about the topic that you want me to talk about because that thick is your inaccurate threat level on something, I’m not going to go there, you don’t have a driver’s license. You don’t have legs, and you don’t have arms, and you don’t have a face, and you don’t know how to drive. And kind of make it sort of funny that way. You’re being active while you’re waiting for the habituation to happen.

Carrie: You had talked about in your training singing silly songs like Old MacDonald or just other goofy songs.

Judy: I always have to make sure the clients understand there is, any school can be used as a compulsion, so anything you say or do can be a compulsion. Of course, the definition of a compulsion is doing something to make you feel better to avoid and get away from the anxiety, but anything can be an ERP tool as well. 

There are some people that are very behavioral that say you can never sing a silly song or you can never talk about pizza to things. Because it’s always a compulsion, and I disagree, you can use anything to say, “I’m going to look you in the eye, and I’m going to talk about that instead, because I get to talk about what I’m going to talk about.  This is my brain, this is my body, I’m going to talk about what I want to talk about”, and such. You’re using it to expose yourself, where OCD is trying to pull you to its topic, and you’re like, no, not going there. I feel it, not going there. That’s the key, the habituation. It’s not to have your hand on the doorknob for 24 hours without washing your hands. I guess maybe that eventually gets there. But it’s this struggle, this fleshly nature struggle, that where we choose to live by faith in that way, I’m not giving in to our feelings and our thoughts and our worries. As we do that, and we’re an intentional participant, that’s what makes that work better.

Carrie: Yes, I love that verse that talks about working out your salvation with fear and trembling because it’s God that works within you because we have a part and God has a part. One of the things that you and I run into in working with Christian clients is we’ll have people ask us or say things like, I’m praying, I’m waiting for God to take this away, and we’ve talked a lot about healing on the show. We’ve talked about various theologies and prayer and different aspects, but I love what you talk about with this being part of the sanctification process, because whether you have OCD or not, we’re in a struggle with our own minds on a day to day basis regarding are we going to be focused on the things of God and what God wants us to do? Are we going to be focused on sin and self and what other things that are negative? It really kind of fits in line with that sanctification process. What would you say to someone who says, “I just don’t understand. I’ve prayed and why hasn’t God just healed me from this yet? Or Why isn’t he helping me more through this process?”

Judy: What I’d say is that has to go back to our understanding of our role in God’s role and who he is. We have to broaden that picture too.  The Bible is very clear. Our thoughts are not God’s thoughts. We do not have the understanding, whether it’s about something in our personal life, or why God allows terrible things in the world, and such. It has to go back to, we always make the choice of, are we going to be the ones trying to figure it out and try to get God to answer to us about things that we don’t understand and figure out or if we understand the parental way of doing things. 

If you’re a parent, you understand that there are things that you say you can do with your child that they won’t get. They don’t understand because their age, their developmental age, or they haven’t walked through something yet. We know why we’re asking them to do or not do something, and they just think we’re being mean and they don’t get it and they don’t understand. To me, that’s parallel. “I don’t understand why you don’t take this away from me. I don’t understand why you allow things in the world. That causes me in my immaturity, that’s where I think that comes into our immaturity, back to sort of childishness of like, “I want to understand, I’m going to demand that I have to understand. I demand that you explain it to me”, whatever that might be, which includes that, “why haven’t you healed me” kind of thing, then our immaturity comes out and that’s what I think some of that’s a design to show that coming to the surface again, our fleshly nature is coming to the surface rather than saying, I choose to believe God is my heavenly father, who’s created me and loves me unconditionally therefore, everything he does is for my good. Even though it doesn’t feel like that and they don’t see it that way, I choose in faith to trust that and just walk out. I need to walk out day by day because that’s how I get to a healthier place that God wants me to be. That’s now how we get maturity is choosing to walk it out in faith even when we don’t see that may or may not change at any point in time.

Carrie: How do you work with clients dealing with scrupulosity, who are having some of these difficulties with trusting God, with the uncertainties of our faith and life?

Judy: I have a lot of folks who are like, what if, what I’m thinking or feeling, or even the thoughts that I have are sinful and if I’m not pushing them away, talking about not pushing away the scary thoughts or I’m not reacting to them, then that means, in their mind, that means I’m not faithful, I’m sinning because I’m not trying to push things away.

I go back to the broader concept. We talk about what is their view of God. How do they see God as in a punitive way, as their Heavenly Father? If they’re parents, well, if your child thought this about you, would that be accurate? That kind of thing. Have them understand that this one area that they are worried about doesn’t overshadow all the other things that they actually believe about who God is and how God loves and cares for them.

It’s just out of their fear and anxiety that they want to go out that they want to get certainty and know for sure but nobody has that nobody has that we’re humans and so we don’t have 100 percent certainty of anything honestly about God this side of heaven we really don’t we would like to say we do and folks with especially scrupulosity but let’s see they feel like but my friends or my family say they know what’s Certainty that God loves them or they’re going to have it or whatever they are so certain, well, yes, but no. Nobody has actual sexual certainty and our feelings about anything. If you ask that family member and you track their feeling of certainty from our, to our day to day, year to year, that would change too. It’s just a, a way of speaking at any given time about where we are. feelings but feelings do not equal truth. I broaden it back to how do they want to live out their faith? Do they want to live it out as a faith based journey where they’re walking you know and taking risks in faith or do they want to be the one that trusts in chariots and their own manpower and their own knowledge and their own understanding?

I always bring people back to which one of those two do you want to live out? Well, right now you’re trying to live out your own understanding and getting answer knowing for certain and such and nobody has that, so you can keep doing that if you want your life to keep feeling like this versus choosing to take this risk.

Carrie: I think that normalization of doubts and normalization of uncertainty is huge because in certain faith circles, there are things said like, do you know that you know that you know that you know that you’re a Christian and do you know, you know, you know you’re saved and that’s probably like the worst thing that you could say to someone with OCD because we all have to live with a certain level of uncertainty and unanswered prayers and not knowing. We’re not going to know everything, like you said, and we have to accept that, that we’re in the child space in our relationship with God, and we may not know all the ins and outs and the whys and so forth.

I think this episode is going to be really great and helpful for people who are dealing with all different kinds of OCD and maybe some people that are even in ERP therapy that can utilize some of these strategies that you’ve talked about to help them create a little bit more lightheartedness about it and not have to engage with it in such a serious, like you said, scared manner.

People are scared to engage with this type of therapy sometime. I think your presentation and dealing with other mentors that I’ve had have kind of helped me soften a little bit towards my ERP initial standoff ed ness that I had at the beginning of learning about it, I thought, this maybe, I don’t know that I can really do this, but it just kind of opens a doorway for me to be able to integrate some of these things with the clients that I’m working with.

Judy: Yes, at the beginning, the first couple of years, I had somebody, again, not to nullify Rogers, but who was in the Rogers program, and they contacted me for follow up care, and what they wanted me to do was come to their house, time them taking a shower, make sure they got out of the shower on time, and then time them when they were washing their hands to make sure that they got out of it because that’s what they did at Rogers. I did that for a couple weeks and I’m like, this, I can’t, no, I don’t believe in this. I don’t think this is going to help you long term. Have a babysitter stand there and watch you do these things. That’s not how you’re going to learn. You need to learn how to underline. I don’t want this for my life.  I’m not going to let you OCD do this for my life. So I’m going to find some way to give you some sassiness. And some silliness because I don’t want to live this way. That’s what I can provide to people and that has made such a difference. I am so blessed. I feel so blessed and thankful to God that every day I help people get out of these terrible places, these prisons, these torment place because I can help show them the pathway is that God designed this already that there is a way to get there and that you can do it. There is hope. That’s what we bring to folks is the hope that life can change, things can change and God already has it in your head. Let’s go use what God gave you to be able to get you out of this terrible place.

Carrie: Awesome. Well, we’ll put a link to your NoCD profile in the show notes. And I know you’re licensed in several states so people can. Look you up and see you as a option if they’re in one of those states, so that would be awesome too.

Judy: Not bragging, but I have written some books, so if you want to go on Amazon and my name is Judy Lair. I have a series called “Freedom from Fear.” There’s a specific book on OCD. There’s also one in Generalized Anxiety Disorder and one on stress and worry because men do not have anxiety, they might have stress and worry and then have a big one that talks about my journey with anxiety. It also talks about OCD and, and how I’ve come through all of that in the background I came through, how I got here. That talks about my faith and looking at faith in terms of that. You can go on Amazon and find those things if those are helpful resources.

Carrie: Yes, that’s awesome too. I forgot you were an author, so it’s good to put that in at the end. All right, thanks for your time today. 

Judy: All right, Carrie.Thanks!

__________________

Carrie: I wanted to let you all know that we have a new freebie on our website called How to Handle Difficult Thoughts. You can find this at www.hopeforanxietyandocd/free. We have several different free downloads that you can benefit from there, but this download specifically is to help give you a little bit of a taste of our mindfulness course coming up.

This is to give you a little taste of “Reclaiming the Mind: Learning to be Present.” One issue that a lot of clients talk to me about is having racing thoughts, not being able to know how to slow their mind down. Mindfulness is a great way to do that, so this course will be launching soon, and if you get our emails, you’ll be finding out all about it. I Can’t wait to share it with you. 

Christian Faith and OCD is a production of By the Well Counseling. Our show is hosted by me, Carrie Bock, licensed professional counselor in Tennessee. Opinions given by our guests are their own and do not necessarily reflect the views of myself or By the Well Counseling. Until next time, may you be comforted. by God’s great love for you.

101. A Secret Life (OCD) with Jim Juliana

Join Carrie as she sits down with Jim Juliana, an author, former high school teacher and an athletic coach, who opens up about his journey of enduring and overcoming OCD. He candidly reveals the obstacles, triumphs, and the profound impact of combining faith and therapy in his recovery.

Episode Highlights:

  • The intensity of Jim’s OCD episodes and how they affected his daily life.
  • The impact of OCD on Jim’s academic and professional pursuits.
  • The familial nature of OCD and its genetic implication
  • Jim’s struggle to reconcile treatment approaches with religious beliefs.
  • Jim’s book, “A Secret Life: Enduring and Triumphing Over OCD

Carrie also offers her insights on Jim’s treatment, providing additional context and highlighting the importance of individualized therapy plans for OCD.

Episode Summary:

Welcome to Episode 101 of Christian Faith and OCD. I’m Carrie Bock, your host. In today’s episode, I’m thrilled to introduce Jim Juliana, author of “A Secret Life.” Jim shares his deeply personal journey with OCD, detailing his experiences and treatment.

Jim first noticed something was wrong during elementary school in the 1950s. He recalls an incident where he fixated on an inappropriate image, leading him to fear eternal damnation. Despite being a top student and devout altar boy, he struggled with feelings of guilt and scrupulosity, intensified by his religious upbringing.

As a teenager in the 1960s, Jim faced increasing OCD symptoms, including tics and obsessive thoughts. He recalls an event where he ran away before returning to high school, seeking refuge in a tree house. This marked the beginning of his journey toward professional help, although he did not receive an official OCD diagnosis until 1980.

Jim emphasizes the importance of recognizing OCD in children, noting how it can affect well-behaved students who may internalize their struggles. He shares insights from his own experiences and from conversations with educators and parents about the prevalence of OCD in younger populations.

Join us as Jim delves into his past, the challenges he faced, and how he ultimately found healing. Tune in to hear his full story and gain valuable insights into living with and overcoming OCD.

Related Links and Resources:

Jim Juliana

Jim Juliana’s Book: A Secret Life: Enduring and Triumphing Over OCD: Obsessive Compulsive Disorder

International OCD Foundation

More Episodes to Listen to:

Welcome to Christian Faith and OCD episode 101. I am your host, Carrie Bock. On today’s episode, we have a personal story of someone who’s dealt with OCD and has gone through treatment and has written a book about it. So I’m very excited to have Jim Juliana on the show talking about his book, “A Secret Life.”

Welcome to the show.

Jim: Thank you, Carrie, for having me.

Carrie: When did you really first start to show signs of OCD and like, what were those? Even if you didn’t have a diagnosis or you didn’t know that that’s what it was.

Jim: I first knew something was wrong when I was in elementary school, we’re going back now to the mid 1950s, I’m showing my age, and I can remember and relate in the book, an incident where we had a plumber or electrician at the house working.

For my mom and I was snooping around the truck outside and there was a picture in the truck of a partially naked woman and of course I fixated on it. And then after the gentleman left, I started having very serious feelings that I had done something wrong. I was the oldest of eight children. I don’t think we had eight at this time, but went to Catholic school through 12th grade.

Was very religious. I was an altar boy. I was at the top of my class academically, and I thought I was a pretty good person. And then this event occurred and it took my mother and me. The rest of the afternoon for me to realize or come to the conclusion that I wasn’t going to go to hell for having looked at this picture.

Wow. And I remember it very, very vividly. My mother was my best friend all through my teenage years, and I worshipped her and loved her very much, and it was, uh, mutual. And she sat me down, I remember, in the kitchen and tried to explain to me what had transpired, and it wasn’t a mortal sin, and I wasn’t going to hell, and eventually I felt better about it later in the afternoon, and we’re talking several hours where she consoled me and talked to me, and so that was the very first incident where I knew there was something unusual going on.

Back then, the word scrupulosity came into play because of my religious background and upbringing. The other event that took place, which was really probably the most important event in my adolescent years, I had completed the first semester of Catholic high school. In an all boys Jesuit high school, it was Christmas vacation and I was scheduled to go back to school the next day to start the second semester in January.

Now we’re talking 1964 and as I had mentioned, I was a straight A student did very, very well. I like school, enjoyed school, but I had been having a lot of problems. My first semester at PrEP, Georgetown PrEP, was headaches, and I had developed some facial and bodily tics. And it was all trying to get rid of thoughts or ideas that I thought were sexually wrong or inappropriate.

And my grades had reflected this interruption, so to speak. And I was just afraid to go back to school, so the night before I was supposed to return, I ran away. And basically what I did was I went into the park. We lived near Rock Creek park and my friends had a tree for tree house. So I spent the night there freezing my butt off and got back to the house about eight or eight 30 in the morning.

And of course my folks were beside themselves. And that was the first time that I ever received any professional medical help for what was going on. I had just turned 15 years old then.

Carrie: Did they know that you were struggling with this thought process? Was there a lot of confessing that was going on to them?

Jim: No.

Carrie: Or assurance seeking? Okay.

Jim: It was my secret only at that point. And I was very timid. Even though I was a good athlete and a good student, I was behind the eight ball a little bit socially. I was very quiet and introverted. Even with my parents, they would have to pull things out of me, so to speak. You can imagine having a house full of children, all ages, all in school.

We had a nice middle class family and I was pretty happy most of the time, but this was an offshoot of what had happened in grade school and it just kept getting worse and worse and more invasive in everything that I did to the point where. I knew I needed help. I didn’t quite know how to ask for help.

So this was my way of speaking up and getting my parents involved.

I think it’s important to note for parents and others that sometimes like the kid that’s well behaved, that doesn’t mean that they don’t have the internal struggles going on. Because a lot of times we see situations where. A child can be very well behaved and they’re good in school, but then they’re holding on to this anxiety inside and unless it manifests in some way externally, a lot of times people don’t know.

Yeah, and I think I’ve mentioned to you, we have 4 children and 3 of our girls are school teachers. It’s amazing today just how many youngsters suffer from obsessive compulsive disorder. It would shock a lot of parents and… Through discussions with my girls and in the last few years I taught, it was just startling how many children are affected adversely in school and in their activities and at how young it happens.

My wife and I spoke to a lady who was a secretary work for our financial planner and Betsy started talking one day to her and she had twins, seven years old, and one of the twins was having nightmares. and all kinds of problems, and had been diagnosed with OCD. And this was just a couple years ago.

Carrie: Yeah, fortunately, like, they’re catching it a lot earlier, so that there can be earlier intervention.

Yes. Whereas, you know, many years ago, they did not catch these types of things earlier. When you got help at 15, did you get a diagnosis of OCD then, or no?

Jim: I’m laughing at remembering. We went to a doctor, psychiatrist that was a good friend of the family, Dr. Fitzgerald. He had a couple of sons attending prep with me.

He was a good friend of the family. And my parents and I never received or heard the word OCD until 1980, if you can believe that. I was married, had four children and into my career as a teacher and coach. Before OCD was ever mentioned.

Did you label yourself with something random, like I’m weird or quirky, or I feel crazy inside because I think a lot of times people with OCD do feel internally crazy until they get a diagnosis.

Yeah, you’re right about that. A lot of people I’ve met, they don’t want to talk about it. They’re embarrassed. Yeah. I think would be the word I would use, or they feel they’re lesser human beings.

Carrie: How did you explain this to yourself?

Jim: To this day, I think of what happened to me freshman year in high school, for lack of better words, is I had a nervous breakdown of some sort.

I had an emotional… breakdown. I had a mental disorder of some nature that I had no idea what was going on. In fact, just within the last couple of years, when I was meeting with my present Dr. Jim Gallagher, who inspired me to write my book, he talked about the fact that I was a 15 year old, going through puberty, going through all kinds of Emotional, physical changes at that time.

And a lot of that was part of what produced the headaches. The headaches were real. A lot of my teachers thought that I was faking it. I remember that. It was much, much more complicated than anyone thought back in 1964. And it encompassed everything I did, every day, every minute, something was going on and I knew it.

I knew I was different. In fact, later on in my adolescence, when I dropped out of college, I was drafted. It was during Vietnam and our pediatrician was able to write a letter and explain what was going on with me. And I really wasn’t trying to dodge the draft. In fact, I was thinking about going into the service.

They wouldn’t take me because I was, I think the phrase they used was mentally unstable or mentally incompetent. I was four F and didn’t have to worry about going to Vietnam.

Carrie: Wow. Well, you said it took until 1980 for you to get a diagnosis and hear the words O c D. While you were going through this in high school and beyond, was it always mainly themes of scrupulosity, like worried about offending God or going to hell or other things?

Jim: Yes, my wife and I were high school sweethearts and started dating. Oh, I first met her when I was 14. So right around, so she knows all about this and lived with this more than anybody else now that my parents are gone. And it was always a scrupulosity problem. It always, because of my deep religious Christian faith, my Catholicism, my love of God, but it always was, had sexual overtones.

And it was never talked about that. I had something going wrong with the chemicals in my brain. There were pathways that I had developed forcing me to go sideways in different areas. Even when the O C D was used in 80, I was seeing a doctor here in Denver and he actually was trying drugs, prescription drugs to use some of the effects of the OCD.

They hadn’t been accepted yet by the FDA, so my doctor had to get him from Canada. That’s the point where I was in the 70s and 80s where I’m trying every different prescription drug for anxiety, for depression, for whatever they thought it might work. And I probably went through half a dozen to a dozen different types of drugs.

And drugs have never really been a great assistance to my problem. Never. In fact, Dr. Gallagher says it’s normally about only 30% of people that have OCD find any kind of relief from prescription. Antidepressants, those kind of things.

Do you remember what some of the things you were on? Were you on like, because this was before the standard treatment now is SSRIs.

Were you on like a tricyclic antidepressants? Or do you remember? I was

on Prozac at one time. I know my brother. I can’t remember the drug that he used because he’s OCD as well. And I mentioned it to my doctor and we tried and it did have some side effects, but it helped a little bit, but it was never more than just mellowing me out.

Carrie: Okay.

Jim: Kind of controlling my temper and frustration and anger and anxiety in my case anyway.

Carrie: But it never helped like lessen the intrusions for you?

Jim: No, never.

Carrie: That’s hard to deal with. So I imagine that it was probably hard trying to navigate a sense of like healthy sexuality. It’s normal for teenagers to think about sex or be curious about sex or have questions about them.

But those things weren’t talked about. People weren’t having open conversations. Was that hard for you to navigate? Try to figure out like, I don’t know what’s normal versus like what’s OCD related.

Jim: Yeah, what was normal for me was what I had been taught in 12 years of Catholic school, nuns for eight years, Sisters of Charity, which I loved them, they were great teachers, but they were strict, and it was all by the book, the Catholic Church, the doctrines of the church, so I, being the person I was, That was kind of how I acted and reacted.

And if I thought it was a mortal sin to look at a girl walking away from me who had nice legs and a nice butt and swayed. And if that was a mortal sin, then that was a mortal sin. I had to go and confess that, go to church for that. I think like a lot of kids in the fifties and sixties, there wasn’t a lot of, uh, sex education or discourse on sex.

It’s what I learned in school, and it seemed like, as I look back now, just about everything was bad, was wrong. That was my approach, gotta be careful, and I never dated much. I never kissed a girl until my wife to be kissed me when I was probably 16. I was way behind the curve. A lot of it had to do with the OCD and worrying about sin and having to go back to church, confess my sins, talk to the priest, that kind of thing.

Carrie: Did that cause you to engage in confession maybe more than the average Catholic? I don’t know exactly how that works, but did you find yourself going back a lot and confessing impulsively?

Jim: Yes, absolutely. It’s like hitting your head on the brick wall, like, okay, this is going to help. And then you walk out of the confession. Confession works where you can go anytime you want. Okay. It’s up to the individual and it’s a sacrament, just like receiving the Eucharist or marriage. So it’s supposed to receive help from God and grace from God by going to confession, supposed to be helpful. And I turned it upside down on its head and it became drudgery and something that I avoided more than took advantage of.

Carrie: Okay. Did you have a lot of compulsive praying during this time? Like you’d have a certain thought and say a certain prayer or feel like you were repeating certain prayers over and over?

Jim: Yeah, that’s a good point. I’ve thought about that. Yes, most definitely. I used to, in grade school, during Easter, during Lent, Advent, Christmas time, I tried to go to church every day before school. And then in high school, we had mass, daily mass. Optional. And I went a lot. In fact, half of the kids that went to prep were boarding students. So about 200 day, we were called day hops and then 200 boarding students from all over the United States. And we would go back in early August for football camp to start practice.

And I was one of the captains my senior year. And the tradition had always been go to church, go to mass every morning before we start practicing the day. And a lot of kids were rebelling against that. And I remember along with the other co captain, we had a team meeting and I was the one that said, Hey, we’re going to go to church every morning.

We’re going to keep this tradition. And a lot of guys were upset with me. As I recall, that was an example of how. Impulsive I was about the religious. I even carried it into my responsibility as captain of the football team, making the rest of the guys go to church every morning, just because I thought that’s what I wanted to do.

It wasn’t anything I was hurting him, but I’m sure there’s some guys to this day that are still resentful why Juliana made us go to church on, uh, every single day during camp.

Carrie: I think that’s a good point though, where sometimes when people struggle with OCD, they can rope other people into their compulsive behaviors. And this especially happens for spouses, children, others that are closest to you. I’m curious, what was the impact on your wife and children? Because you had told me when we met a little bit before that they actually wrote parts of your book, right? Or you included parts from them in the book.

Jim: Each of the four children, they’re all adults now in their 40s. And then my wife, Betsy, wrote probably half a chapter. And what I wanted people to see is how my OCD affected them. I knew as a father with them growing up and trying to be a good dad, but I knew a lot of times they had no idea what was going on and what my actions, why I was doing what I was doing. I wanted them to have an opportunity to relate people who read the book, what it was like for them , especially for my son, he spent a lot of time with me in the fall. He was always the manager of the football team, and he was around me a lot during football practices and that kind of thing. Both my youngest daughter and Jimmy, our son, I taught both of them at the Catholic school they attended for, I taught them two years, which they talk about a lot of it was fun and it was a good experience, but there were some tough times for them. And then of course, Betsy’s perspective is probably the most intuitive and the most real because she knew me as the boy next door. Literally, her family moved next door to my grandparents at the beach.

She told her father the first summer that we knew each other that she was going to marry me. Now, how she knew that, I still don’t know. She said, Dad, I’m going to marry that guy. But she had an awful lot of insights and I give her a lot of credit because I wouldn’t be here if it wasn’t for her. She got me through a lot of tough times, especially in college.

When things got really bad, the thoughts got really bad, I called them episodes or sessions in the book, I think, where I would have a thought and it would kind of take control of my brain. When I went to see Gallagher in 2015. Those sessions amounted to 60, 70 times a day. I was interrupted in my mind related to something having to do with OCD and oftentimes sexual nature, 65 to 70 times.

Carrie: That’s a lot.

Jim: It’s terrible. In graduate school, I got my master’s because of my OCD. I couldn’t read my textbooks because I was interrupted so often. And I loved to read. There were times before that where, and I said, I think I mentioned I developed tics, shaking my head and trying to get rid of these thoughts and the children and Betsy offered, I think, excellent perspective to the book.

The other point that people should realize is OCD is familial. It’s genetic. Everybody, all my children have some form of OCD. My dad had it. My uncle had it. In fact, in 15 or 20 years ago, the National Institutes of Health in Bethesda, Maryland was doing a study trying to isolate the familial gene that causes OCD.

And about eight people in our family, my family, participated in the study to isolate that gene. Now that I’m better, and we can joke about it, but back then it wasn’t, like my dad was super OCD and perfectionist, and, but he would never admit that he had OCD or suffered from any kind of, It’s actually, I think, technically referred to as a phobia, OCD.

And yesterday, for the first time in several years, I went to see my doctor, just to kind of, he calls it a tune up. We talked for an hour and just got caught up, and he mentioned that I’m losing my train of thought, he, I can’t remember what the point I was trying to make, but anyway.

Carrie: What was that process of treatment like for you? So when you went in 2015, you feel like that was when you got some really good therapeutic help.

Jim: Yeah, it’s capital E, capital R, capital P, Exposure and Response Prevention Therapy. And I could spend 20 minutes describing it exactly. I’m not a doctor. I don’t want to do that, but it’s very controversial. My doctor, Dr. Gallagher, is the expert in the western part of the United States. People come from all over. In fact, the waiting list in 2015 to see him was a couple of years when he found out my age and what I had been through, I was getting close to 70 then, and it had to do with sex and religion. He knew he could treat me and help me.

So he saw me right away and within weeks and then months of seeing him, I experienced a change. Basically what he does is, for example, he went to my daughter Stephanie’s house. Stephanie has a mild case of O C D and it’s the cleanliness O C D. Okay? You wash your hands and organizational, everything has to be perfect, that kind of thing.

And some of those attributes are good, especially if you are a teacher. She teaches the little one second, third grade. So he went over to her house and he’s walking around our house and he would see a picture and he’d make the picture crooked and he’d move the furniture and play games with her head. We have fun talking about that.

And my uncle Charles, he had all his clothes organized. He showed me one time later in life. Perfectly white shirts, colored shirts, striped shirts, Hawaiian shirts. It’s amazing the way people will react to the OCD, and I was in the process of writing the book in the 2018, I guess, and there were two sisters that happened to live in Colorado, and they were in their 20s.

And they had suffered their entire life from clemennitis OCD to the point where they hardly ever left their home.

Carrie: Yeah, it can get really severe with the avoidance.

Jim: Yeah, and at one point, I mean, they were taking showers five and six times. Anyway. They moved out of their home and were living together, and during the course of my writing the book, they committed suicide. And Dr. Gallagher had never treated them, but he had been in a seminar where they were present, and he talked about some of the things that he might have done to treat them, but that was a really sad story. There are a lot of people that attempt suicide or commit suicide because of OCD.

Carrie: Tell us about, do you remember some of the exposures that you had to do that were really hard, like, I don’t know if I can do that, and not, like, give into a compulsion, because essentially that’s what they’re asking you to do, is kind of expose yourself to certain things and then, or have an intrusion and not give into the compulsive, whether it’s the tick or the prayer or the thing that you usually do, to kind of resolve that angst.

Jim: I had a doctor, a psychiatrist, MD, treated me for over 20 years, and he was the one that recommended Gallagher. We had talked about Gallagher before, but he knew of my strict Catholic faith and my religious background and everything, and he never thought I was ready for the exposure and response therapy because of what it asks you to do sometime.

Betsy and I saw Gallagher first time. He said, I’m never going to ask you to do anything that’s illegal or hurtful or harmful or against the law or anything like that. What I ask you to do may go against what you’ve been taught in your religious background. And I was to the point Betsy didn’t think I was going to do.

He said, if you do what I tell you to do, I can cure you. That’s how confident he was. And I was all in. I was surprised Betsy thought I was going to get up and walk out. Which a lot of people do. He told me that. And to answer your question directly, what did he have me do? He had me stop going to church.

Stop praying. I had never purchased any kind of a pornographic book or a Playboy or any of that kind of stuff. Second visit, we went on a field trip. He took me to a Barnes and Noble and told me to, and bought me three or four Playboy magazines, told me to look at the pictures, read the articles, that kind of thing. Gave me a couple websites on the internet, pornographic websites. The idea is to totally overwhelm you with what you don’t want to do. Like I said, within weeks and then months, Betsy could tell immediately that just by doing what he told me to do. And then initially I was seeing him a couple times a week. And then it was once a week, and then it was once a month, but it was pretty intensive.

Carrie: So you went weekly at first, or did you go more than?

Jim: I went weekly at first, yes. In fact, I think the first month I went twice a week. And then I went once a week for maybe another month or two, and then we got to the point where I went once a month and for an hour.

Oh, I know what else he did. He made tapes that I had to listen to. Anti prayer tapes. You don’t need to go to church. There is no hell. And a lot of people look at it as being very controversial, but I do too. I mean, pornography and those kinds of things are sickening to me, but it works.

Carrie: So that cut down after engaging in those activities, that cut down on the intrusive thoughts that you were having?

Jim: Absolutely. So what it did was, the pathways in my brain were destroyed by my having done those activities.

Carrie: Hey, Carrie, interrupting this interview just for a moment. Wanted to say that it sounds like what our guest went through was flooding. There’s a difference between in behavioral exposure therapy.

There’s a difference between flooding and gradual exposure. Flooding is kind of what it sounds like where you’re immersed in something very quickly. Gradual exposure is where you bite things off into smaller steps and you have a hierarchy and you move through that exposure hierarchy starting with things that are lower on the exposure level and then moving upward.

It’s quite possible that flooding was chosen in this situation for treatment due to the severity of the level of the issues, but I’m not familiar with many therapists today who are still using flooding techniques. There may certainly be some. I also want to point out that the International OCD Foundation, which is not a faith based organization, has principles of effective and religiously sensitive exposures for ERP.

We will copy that website and put it in the show notes for you so you can read those. They talk about not asking a client to do something that they knowingly would violate their safety or supported beliefs and being able to do the activities that other people from their faith community can do as a part of normal practice and identifying working with the faith community and the therapist.

We talk a lot on the show about various types of treatment, and so just to know that I just want people who are listening to this for the first time or maybe this is their first exposure to exposure and response prevention. I don’t want anyone to get scared or overwhelmed or think that this is going to be the absolute way Treatment plan for them.

Your own therapist has to assess what’s going to be best for you and your situation. So just keep that in mind.

Jim: Like I said, I went from 65 to 70 sessions a day to the peak of where I was feeling my best, maybe one.

Carrie: Okay. Wow. That’s a huge difference.

Jim: I was to the point where suicide was always in the back of my mind. The only thing that kept me from committing suicide was my family and crazy as it sounds, my religion. Because of course it’s suicide is mortal sin is a grievous act. I would assume most Christian churches. And yeah, it was startling revelation. I was a totally different person.

Carrie: How did you reconcile this concept of almost like, I have to sin in order to get better for my OCD. Like, I have to stop doing things that God wants me to do and start doing things that are against my faith system in order to, like, I think that’s a piece that a lot of people would really, like, wrestle with. liike, how can I be asked to do these things in order to get better?

Jim: That’s why the first doctor didn’t recommend Gallagher all those years, because he knew how religious I was. And to answer your question, and the way Gallagher explains it, he’s not Catholic, but he’s Christian. He was raised Christian. I think he’s married to a Catholic woman.

Anyway, I came to the conclusion that no loving God wants any human being to live the way I was living. To suffer at that level. Anxiety, depression, suicidal thoughts. If you’re a good teacher, it makes you tired because you put a lot of effort into it. My girls were always telling me how tired they are, and I said, I can relate.

So if you put on top of that, all this other, these thoughts and gyrations that I was going through to not sin, and I would come home at night, totally exhausted. That makes sense. Would sometimes lash out and get negative and be angry. Especially to my children when they were smaller, and to Betsy, because that wasn’t me, that’s not the kind of person I was, but this overwhelming guilt and anxiety and depression was just like a pall that surrounded my whole life.

So when Gallagher and I talked, and it was like, This is not what God wants. God’s a loving God, a forgiving God. If you make a mistake and you’re sorry, it’s over, done with. You don’t have to carry it for the next 25 years. So that’s the way I looked at the pornography and stuff. It was not sinning. It was allowing me to live the life that Christ really wants everyone to live, a happy life.

I have a God given talent to work with kids. And I always knew that, always considered myself, this is not a profession, it’s my vocation. I was meant to be a school teacher and I could motivate kids and help kids. And why would God allow me to lose that attribute because of OCD? That’s not what he wanted.

He wants me to be a good teacher, good father, good person, so in a perverted way, it’s not perverted, it’s not the right word, but in a strange way, doing what would be normally wrong was really making me a much better person, much better individual, able to live the life that I’m supposed to live. That’s why I’m talking to you today.

I feel this is my responsibility. I’m not teaching anymore. Dr. Gallagher told me yesterday, by the way, he said, I gotta tell you, there are three people that have read your book, and they’ve all been my patients, and they’ve all been kids. He said, and I’ve cured them all. That’s positive. And I couldn’t have done that had I not listened to him and done what he told me to do.

Carrie: Why did you decide to write the book? I know he encouraged you to write about your experience, but obviously, like, some of these things are personal, you know, that you’re opening up about. Why did you decide to kind of put yourself out there like that?

Jim: Because I thought it was my responsibility, my worst enemy, to have to live with OCD the way I did, and others do, like those two sisters that the only way out for them was suicide.

That’s not the way life’s supposed to be. The children were a little hesitant when I asked them to write something for the book, and I said, Hey, you could be helping some other people. You could be doing some good. Sure. And Betsy’s always been supportive. That’s her M. O. She’s a good, caring, empathetic individual.

It was kind of a team effort, and when I hear stories like Gallagher told me yesterday, makes it all worthwhile.

Carrie: So can people find your book on Amazon and other places?

Jim: Amazon is the best place, Jim Juiliana, author, is my Facebook, and it has a lot of pictures of the children and a lot of reviews from people who have read the book.

If they think they have it, they need to find out, determine if it is OCD. Especially with children, because so much going on with little children. I remember middle school children getting up out of their desk and falling down for whatever reason. They’re just all over the place, and you never know what they’re thinking and doing, and I hate the thought of teenagers and young children having to suffer OCD and not have any help from parents professionally.

Carrie: Well, thank you so much for sharing your story.

Jim: It’s been great. And I appreciate your putting the word out. Pay it forward.

Carrie: I’m really glad that we had Jim Juliana on the show to share with us about his experience with exposure and response prevention. It was tough for him, but it worked. We are very much about increasing hope on the show and wanting people to know that wherever you are on your OCD or anxiety journey, you can get better.

Never give up. And as always, thank you for listening. May God be with you on your next step towards treatment and greater mental health. Christian Faith and OCD is a production of By the Well Counseling. Our show is hosted by me, Carrie Bock, 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 wealth counseling.

Until next time, may you be comforted by God’s great love for you.

Is ERP the Only Option for OCD?

Individuals who are diagnosed with Obsessive Compulsive Disorder (OCD) are often told that they need to receive Exposure and Response Prevention (ERP) in order to treat their OCD. While ERP has been widely researched and works for some individuals, ERP is not the only treatment option for OCD. Eye Movement Desensitization and Reprocessing (EMDR) can be effective for treating OCD, especially with individuals who have a history of childhood trauma.     

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