👉🏼👉🏼👉🏼SELF ASSESSMENT for OCD: www.paigepradko.com/ocdquiz 👉🏼👉🏼👉🏼 This is a really helpful PDF: The Top 10 Things to Know to Practice ERP for OCD, Phobias & Anxiety: www.paigepradko.com/erp 👉🏼👉🏼👉🏼 Learn how to do ERP the right way: OCD course www.paigepradko.com/ocd 👉🏼👉🏼👉🏼 Coupon Code for 10% Savings on Course for my RUclips Subscribers YTTENOFF 👉🏼👉🏼👉🏼 Contact Paige at www.paigepradko.com
I needed this. As a person who experience chronic anxiety and thought that just changing my mindset will help, I now realize that I missed the part of exposing myself to new challenges.
You are such a precious human being, I have never met you yet I feel so loved by you and your videos provide me with much guidance and comfort. You are such a gift to us all
Hello Paige, I want to thank you from the bottom of my heart for answering all my questions the last time. I was the one that asked all those questions. I have refrained from doing a specific compulsion because I'm just exhausted and OCD recovery needs to start somewhere, right? I am able to carry on with life, I don't feel a horrible fear. But I have a very stressful and annoying problem. When I try to fully live, I feel like I am still holding on to the problem very tightly. When I focus on this problem, I enter this horrible cycle of rumination where I feel a lot stress more than fear. I desperately want to be free from this chain but feel chained still. In fact, I start to think that it's better to suffer trying to get the "just right" compulsion than to endure the rumination cycle. I'm able to stop rumination at times and I feel normal again. But in the back of mind I think: Are you sure you can really carry on normally? You can enjoy this moment but you know damn well you have a big problem. Then I focus back on the problem. When in this thought process, I don't feel the fear of doing exposure. I feel stress and anxiety due to rumination, I feel stuck. I do exposure but then I have to deal with rumination. I have noticed that these OCD feelings are very powerful. Is this where cognitive restructuring comes in? Could I be going through this because of so many years of feeding the cognitive distortion and now it's a habit? While researching psychodynamics, I self analyzed and realized that I have a certain natural desire that I try to satisfy. But with OCD, my core fear is a specific type of emotional suffering. My OCD case involves not being able to satisfy this desire because intrusive thoughts enter and according to my cognitive distortion, will cause emotional suffering right when I want to satisfy my desire. So it's two opposites that mix and I get triggered. I have hope. I firmly believe that recovery is possible and that I can be the boss of my life and not OCD. I really want my brain to learn that I don't need compulsion or protection to feel safe. Any advice is much appreciated! Thank you in advance Ms. Pradko.
Hi Isaac. It is difficult for me to answer your specific questions on this forum. It sounds like much of your compulsions are mental compulsions like rumination. And, you get caught in a cycle of trying to get a “just right” feeling through the rumination. The answer is of course to stop the rumination and allow yourself to feel “not” right on purpose. I realize that this is much more difficult that it sounds. I recommend using my I. A.M. method when you notice the rumination. Identify the ruminating, allow the obsessive thought or not just right feeling to be there, slowly shift your attention to what you were doing before you noticed the thoughts.
Here is a gift for you. A FREE PDF to download to help you with your Exposures and ERP: The Top 10 Things you Need to Know to Practice ERP: Exposure and Response Prevention for OCD, Phobias and Anxiety www.paigepradko.com/erp
Madam, rewatched the video once more just now, Nice to see that you are recalibrating your methods and fine tuning them for good.. In my recovery now, I somehow feel that the last part of healing and consolidation is not happening in me completely despite myself being focused & putting efforts.. Your new model will help me SURELY.. In SAVVY Surprise Yourself - is very true, The more surprised I become with the exposure and do the right necessary things later on, the better & more comprehensively I heal (Exactly like in Bodybuilding, the more we stimulate the muscle from different angles, the more the muscle goes in shock & to cope up with the shock it the muscle grows in size & strength (grows new muscle cells HYPERTROPHY) and this is how we get bigger better and stronger overall (varying the angle of stimulation of the muscle(S)) .. Brain is also a muscle after all....All the remaining aspects discussed in the above video are great as well.. A V V Y 👌👍... Dear Ollie looks away from the camera all the time, but that's OK whatever he does is Cute.. He is in the frame that's very important, he has great screen presence.. He is a Big Star, whatever he does on screen, he can get away with it, like a Big Movie Star! (We Love You OLLIE)
Arjun, I love your comparison to body building. You have inspired me to do some lifting today and shock my muscles. I always appreciate your comments and perspective. Stay well in India. I saw on the news that many countries including the US have sent medical supplies. Hoping that this virus will be under control in India soon. 🙏❤️
I feel very blessed to have found your channel! I love your serenity, humility, and sweet way of explaining! Thank you for providing the most recent research also! And I love the video editing! I decided to start my "Pure O" OCD recovery and your content is very useful. I believe in inhibitory learning, in fact I'm proud to say that ERP has helped to inhibit most of the fear conditioning in my OCD. My goal is complete inhibitory learning of the fear associations in my OCD. Paige, I would appreciate it if you answered these questions please! 1.) What is cognitive restructuring and why shouldn't I do it when I do ERP? 2.) Since fear associations remain, it makes sense to get quick rushes of fear. I get this when I ruminate a bit or sometimes randomly. It feels horrible. If I continue ERP correctly, can I eliminate these rushes of fear or will I need to deal with them always when they show up? 3.) Do you have any tips on ocd recovery? Would it be a good idea to track rumination. For example taking it day by day. While carrying out ERP. This is the only way I think I can eliminate rumination. 4.) Are there medications that help so that inhibitory learning sticks and also decrease rumination? 5.) Many say inflammation plays in a role in anxiety. What is your opinion and what lifestyle choices help in OCD recovery? Thank you Paige!
What great questions. I love how curious you are and your questions really show how motivated you are. Success in ERP is dependent on high motivation and determination, because it is indeed difficult. Cognitive restructuring is a technique used in Cognitive Therapy that points out how our thinking is distorted and helps us to change or restructure our thinking. A common distortion is called “All or Nothing” or “Black and White” thinking. I did a video on Cognitive Restructuring that you can watch here: ruclips.net/video/d68j2zvITfs/видео.html. Using Cognitive Restructuring before doing ERP or Exposure Therapy can reduce our anxiety and somehow lowers our expectancy of our worst feared outcome from happening. According to the research on Inhibitory Learning, our best exposures happen when we expect our worst case scenario, and then it doesn’t happen. We are surprised and our brains learn the best when this happens. Using Cognitive Restructuring reduces this mismatch or surprise. Also, there is something called Implicit learning (learn by experiencing, like driving a car) and Explicit learning (learn by reading, or someone telling you something like reading a book about how to drive a car). These 2 types of learning can interfere with each other if they happen at the same time. If they happen at the same time, they reduce the effectiveness of each type of learning. Exposures and ERP create implicit learning in the brain, Cognitive Restructuring is explicit learning. They should not happen together, or they make each process weaker. This is based on Joseph LeDoux’s book, Anxious, and Michelle Craske’s research as well as others. 2. Your quick rushes of fear is your anxious arousal in your body. This happens in ERP as well. This is treated through ERP exposures having these thoughts on purpose, multiple times a day and allowing your brain to learn. Allow the rush of fear to happen and do nothing to reduce the feeling. Your brain will learn on it’s own. The more you allow yourself to have the fear, the faster your brain will learn. Then, carry out the exposures in as many situations as possible. Vary every thing you can think of when having these thoughts on purpose. Do nothing to ease your anxiety. Yes, this will go away. However, we do not use the word “cure” with ocd. But, ocd is treatable if it does pop up again. It is common for ocd to try to scare you in a new area. You just do the same ERP treatment and take the power away. 3. I have lots of tips for ocd recovery. Here is a playlist for Pure O: ruclips.net/p/PL1lUhuKpYUYqKvEwlGXoRPDu_8blhbaq-. Keep in mind that when I started making videos I followed the older method of Habituation using SUDS scores. I do have my clients track their ERP exposures when they are “planned” exposures. I may do a future video on tracking. Basically, identify what your exposure is going to be. Decide how long and at what interval you want to track. I have people rate their belief that their worst case scenario is going to happen (0-100%). I also have people track their trust in themselves that they will complete the exposure (0-100%). I have them track anywhere from every 5-15 minutes during exposures that last 30-90 minutes. Then, I have them write about what they learned in the exposure and how they can change up the exposure next time. 4) SSRI’s have been shown to help with ERP and exposures by perhaps making them easier to tolerate. Some use them, some do not. 5) OCD is genetic and can wax and wane in life. I have seen that stress and change exacerbates, but, quiet time also seems to do that. I am sure there must be a connection with lifestyle and diet and gut health, but, I have never read any evidence one way or another. As you say, I do believe that inflammation makes everything worse. Whew...I hope I answered your questions. 😊
Thank you for another great video Paige! Would this work on depression? For example on depressed thoughts that tell you " you shouldn't" "what for" "no point" etc.
Even though ERP and Exposures are designed for ocd and anxiety, I do believe that having new experiences and activities daily where you challenged yourself would be wonderful for depression. I have not researched that piece, but, it makes sense. Thanks for your comment. 🙏😊
Hi Paige, Thank you so much for your wonderful work. I really appreciate your willingness to reassess your theory and practice as you become aware of better approaches to address anxiety. Could you clarify the information on the ILT slide at 2:13? It seems it should read: “but is replaced by new learning”. Kevin
Thank you for catching that Kevin. I am editing my reply, because I kept thinking about the wording of that slide. Although, it is a very narrow definition, it is correct. In Habituation or Emotional Processing Model, we used to believe that the original fear association to the trigger was replaced or erased by new learning through the habituation process during exposures or ERP. In the Inhibitory Learning Model, we now know that the original fear association wiring remains, even if habituation happens. During exposures and ERP we lay down new neuropathways that hopefully we can make stronger than the old, fearful association pathway. This is why it is common to have an anxious reaction out of the blue when someone has been having great success for weeks and months. Their brain just jumped onto the old neuropathway in that one situation. This is also why we want to vary our exposure contexts and environments and situations as much as possible during exposures, because we want to make it more likely that the brain will jump to a new neuropathway without the fear association. This is also why we want to tolerate anxiety, because occasionally we will jump to the fearful association in our brains and want to be able to tolerate that, even expect it when it happens. Inhibitory Learning Theory assumes that the old, fearful pathway remains...even after new learning has occurred.
Wonderful video Paige! I have missed your videos, I noticed you haven't posted in a month. I hope you are doing well, and hope we will see a video from you pretty soon. 💗
Thank you for noticing that. I have been diligently working on developing online therapy courses. They are an incredible amount of work. My first course is on help for people with Health Anxiety. I have been receiving so many requests for help in this area. I challenged myself to complete this course before putting out another RUclips video. I cannot wait to get back to RUclips.
@@PaigePradkoTherapy I'm so excited for you and for all the people who are gonna be helped by your course! Glad to know your absence from RUclips has been for a great reason!
Hello there Paige. Thanks so much for all the amazing videos. I am still in my Pure OCD recovery and I am fascinated with what I learn about my brain. I’m convinced that with the right knowledge and the effort, I can recover to the point that this disorder doesn’t control me. I still have some questions and would greatly appreciate your views. I agree with Dr. Greenberg who says that in Pure OCD, rumination IS the disorder. I can’t control my thoughts and have no intention in doing so. But, why do I have this urge to solve the problem, to protect myself from the perceived danger even though I know that I am safe. Is it because I have followed this harmful thought pattern for so many years? If I continue to not solve the problem, will this urge to ruminate eventually disappear? As if I’m creating a new neuro path for my thoughts to go on. I imagine that fully accepting thoughts will discourage rumination. Because why try to solve something that you’ve already accepted. Could it be that I have 2 paths in my brain. The one I’ve followed for many years which is rumination and what ifs. And another one that accepts the thoughts and recognizes that I simply can’t control thoughts. It’s like a violent war between these two paths. Hope to hear what you think of this. :)
Yes…that is exactly what is happening in your brain. You have your old neuropathways where your fear reaction is associated with those thoughts. Then, you have your new safety learning neuropathways that continues to strengthen when you do not ruminate or try to figure it out, and your brain learns that you are safe. This battle between what pathway will be used will depend on your response to your thoughts. The more you do not respond…the more safety learning and strengthening of the new neuropathways. I agree that you are on a good path and the desire to ruminate will fade as you continue to not respond to the thoughts. Keep up the good work!
I have recently started seeing a therepist through the phone, hoping to work on agoraphobia. She focuses on dreams and art therepy. I don't know what to expect so far. It hasn't been long enough to decide what I think. I'll still watch your videos for agoraphobia help. I'm doing about the same as always with that.
I am glad you are working with a therapist. I will continue to try to help you with Exposures. I am working on an online class right now for health anxiety and panic disorder. So much of the class relates to people with agoraphobia. I am going to post on this RUclips channel when the class is available. I think it will help you and it will be priced in an affordable price. After I finish that class, I will work on one entirely focused on helping people with agoraphobia. Exposures are the way out of agoraphobia. But, having the guidance along the way is also helpful. Keep working on your exposures even while doing your other therapy. If you do decide to change therapists, make sure you find one that is trained in ERP and exposures.
Thank you for this video! I do have a doubt though. If you're unable to go for therapy and try ERP at home, how do you know which exposures are appropriate? I've had some people say that their therapist wouldn't ever make them do something they wouldn't, while some others have said we should go beyond what people usually feel uncomfortable doing as well. (I read a few other comments saying they deal with the feeling of disgust (contamination OCD), I too deal with the same issue. ) What do you recommend, and how do we choose the exposures? Do we do anything differently when it comes to disgust, or does everything in ERP and otherwise remain the same?
Hi Jayson. Those are great questions. I discuss this ERP treatment for contamination OCD when the issue is disgust instead of fear in my new OCD course available on demand beginning April 4. ERP works for disgust, as it does for fear, but because of the brain structures involved with the experience of disgust, the ERP treatment is more gradual and takes longer. Response prevention becomes even more important. If you would like more help with this, you can sign up for a waitlist for the course here: www.paigepradko.com/ocd. To further answer your question, I do not ask my clients to do anything that I would not be willing to do myself. And, yes, we do have to push beyond what a person without ocd might do sometimes in ERP to target one’s core fear. Yet, you are in control of the pace and intensity of the treatment. Tolerating disgust in ERP is what your goal will be versus tolerating anxiety. Here is a pdf that may be helpful: www.paigepradko.com/erp
I have this thought like " i will go awkward now " and worry about my face emotions and then i go awakward. This thought never go away since 12 years ago. Is this ocd or trauma? Please help me anyone my life is destroyed 😢 i can't handle it anymore its runnied all my life i swear to god 😢
Hi , your videos are really awesome and helpful for all humanity . Thanks a lot for these beautiful efforts . I also want to ask u something . In any future videos plz try to tell more about contamination OCD exposures . I dont feel anxious while imagining contamination ocd exposures but feel anxious while try to do in real . To be specific , I have ocd for toxic and unknown chemicals , radiations and those particles stick from one thing to next and next , them comes the harm ocd that i may become spreader . My reaction was aggravated from the time my father was diagnosed with a tumour , He is fine now , but I feel really anxious from last 7-8 years . Your reply will be highly appreciated , but even if u dont , you still are doing really great job . Thanks .
Thank you for your comment and your suggestion. First, I am sorry that you are dealing with this. I will do a detailed video on contamination ocd in the future. You are not alone. Most people have difficulty getting anxious during imaginal ERP. I have experience treating people that have the same kind of ocd that you have. It is a process and it does take time and determination. Eventually, I have my clients work up to contaminating themselves and contaminating their entire home and vehicles and loved ones. I am working on developing online therapy courses that can help people with more detailed sessions. This may be a great option for you when I do a class on ocd.
@@PaigePradkoTherapy Thankyou so much for ur kind words . Ur such efforts show us the real beauty of being human --solidarity for unknown people beyond boundaries of nation , time zones , races .
Hi dear professor Thank you so much for your help and advice. I really appreciate your job. I wish you peace and happiness under the sky of prosperity. All the best. Take care and have a good time. Your follower from Algeria
Hello. This is a great video and i have to say that it seems a little bit strange to me because i have used the habituation model. The model that you suggested seems to me less goal - oriented because, if im not mistaken, i suppose that you dont do an hierarchy of the exposures. So, if there is no hierarchy, how exactly are you planning the exposures? I definetely want to give this model a try because as you said theres a lot of research behind. Ans something more? In which disorders are you using erp and exposure therapy, except OCD? You are doing great work with your channel!
Thank you for your comments as they are wonderful questions and concerns. It does feel a little different at first not using a hierarchy. But, the order or how much or how little you challenge yourself is still under your control. I do still have my clients make a list of fear triggers and core fear and make sure they are targeting those fears in exposures. But, SUDS scores are no longer used because we want to take the emphasis off of anxiety levels. We all have anxiety in life and we want to learn to tolerate all levels of anxiety versus looking at anxiety as something bad that we don’t want to have. We also use ERP and exposures therapy for phobias and social anxiety and agoraphobia…basically any area where we are avoiding activities, people, places and things. If you ever need more help with ERP, I have a new course that walks you through every step and gives you all of the tools and worksheets to plan your exposures and response prevention. You can find out more here: www.paigepradko.com/ocd
Hi Mrs. Pradko, beginning to learn more as I attempt a new direction in recovery and am trying to gain clarity on an aspect that I did not understand as I try to figure out how the Exposure process should be conducted. In your previous videos you discuss that the proper use of the ERP model is to expose until the SUDS score drops by about 50%, or after about 90 minutes. I recall you mentioning that if you stop prematurely you are in essence avoiding or fleeing the exposure thereby reinforcing the anxiety pathway and losing out on the efficacy of the exposure. However, in this video and in your 10 tips to maximize ERP effectiveness video, as I understood I believe that you suggest that it is okay if the Exposure remains at its peak throughout the exposure and never stops, as it decensitizes the amygdala and concerting SNS systems to the anxiety? From this, my question is, does that mean that your opinion has changed regarding when an ERP exposure should be stopped? Is it still best to wait for a 50% suds drop? Should one wait at least 90 minutes and if no drop, begin to move on from the exposure? If one leaves the exposure event before experiencing any drop in anxiety level, will that in essence indicate that the event was avoided to escape the anxiety and thereby reinforce the "flight" neural pathways? In another video, I believe I recall you suggesting that a newer and promising method was to switch back and forth between exposure doing 10 minutes of exposure, 10 of rest, then 10 of exposure. As I understood, this method was to be combined with other new empirically backed methods such as switching back and forth between exposure, overlapping simultaneous exposures, switching back and forth between exposures at different degrees of SUDS intensity, leaving one exposure behind and returning in a later 10 minutes SUDS block? Moreover, I'm just confused and I'm trying to get a clear picture of how you suggest that we know when we should stop an exposure, and if leaving before SUDS has increased by 50% deprives potential effectiveness of the exposure, or perhaps even reinforces the OCD patterns altogether? Apologies for my long winded question, and grateful for your help and incredibly insightful videos. Thank you!
Hi Brody. Thank you for asking such a wonderful detailed question as it shows that you are listening and really wanting to understand the research and recommendations on ERP and exposures. The research in the neuroscience community is evolving. What we have done in the field for the past 20 years is changing due to a theory shift from a habituation model to a model called Inhibitory Learning Model. We have discovered several important things about how neuropathways are formed and how to make the exposures more effective. Therefore, you will see my older videos explaining the habituation model and my newer videos explaining the inhibitory learning model. Both models work, and most people in the field still use SUDS scores and hierarchies and want you to stay in the exposures until the anxiety comes down by 50%. I have shifted to Inhibitory Learning…but sometimes use a hybrid of the 2 models if it is more effective with a client. I concentrate on having people create constant variations of exposures. Sometimes they have longer exposures and sometimes shorter, and we vary them in some way every time. Even more important than the exposures is doing the Response Prevention at all times. Exposures do not generalize very well, so we have to constantly do something different to try to generalize the exposures. Exposures still work, even if you have a bad exposure experience. I still try to have my clients not leave an exposure at the height of their anxiety because I do not want to create an avoidance situation. But, I no longer use hierarchies and SUDS, and instead have my clients stay in an exposure until they feel like their brains have learned something. This in itself is freeing to clients. The SUDS ratings do seem to imply that anxiety is bad. Part of the process is learning that you can tolerate anxiety and anxiety should not be thought of as bad…and something to avoid. The more willing a client is to accepting anxiety and at least tolerating it, the better they do at sustaining recovery.
@@PaigePradkoTherapy That makes so much sense! I can certainly understand evolving practices and understandings from research, as my background before being sidelined with my condition was an undergrad psychology degree with emphasis on cognitive psychology and learning. Nonetheless, however, clinical psych was something I never touched on and have very little understanding of & experience with, and I wanted to make sure I was doing things correctly in line with modern understandings from research. Cannot thank you enough for taking the time with such a clear and insightful response! This clears things up perfectly and will help me immensely as I begin trying to put these methods into practice! Thank you!!
I had an ocd relapse after 15yrs. I moved, my brother passed away and the pandemic hit. I haven’t had it this bad in a long time so I had to relearn everything. I’m doing better now after 2 months but still having instrusive thoughts( seems anxiety has gone down a lot) I’m doing exposures and I don’t seem to be bothered by them it’s kind of a relief after I do them I don’t get anxiety like most people. Is this normal? I have pure o
It sounds like you are on the right road with treatment and results. OCD can be episodic and flare up at stressful times. I do not mean to give reassurance, but, you are doing the right treatment. What you are experiencing is very common in people that have had previous treatment and experience a flare up.
Beautiful Video Madam.. Thank You.. S A V V Y.. Great Explanation by you.. .. Consolidation at the end.. OLLIE looking SWEET & CUTE as usual.. I will write my detailed comment on the above video later in the day.. ..
i love what you do but I have some concerns There is a lot of talk about ERP, typically the exposure part of ERP. No one really discusses good methods for Response Prevention of ERP I have seen your videos on compulsions and they are quite informative but there isn't a definitive guide on how we respond to anxiety triggers, for ERP. We're taught not to "follow up", as I like to say it, or don't compulsions once the anxiety is triggered, right? What are the best methods for dealing with a triggered emotion in ERP? I get it, don't do compulsions but how do we do it the right way. Do we tell ourselves "not to think about it"? Do we let the thought hang around and use your I.A.M method? Do we totally ignore the urges and pretend the sensations aren't there? I don't know! You see I am not very clear on how we should handle response prevention for ERP. I can't be the only one
I am on it, Mark. Thank you for your comment. You are right. I will do a video all about response prevention because it is actually more important than the exposure piece. Yes, the idea is to resist the urge to compulse and just tolerate the urge. But, not everyone can just quit cold turkey. So, I will go into the details of what to do. I have a few videos in the works before you will see it. But, if I work on it this week, you will see it in about 3 weeks. Thanks for pointing this out.
@@PaigePradkoTherapy I hope I didn't sound disrespectful. I am passionate about my mental health and it seems I have some progress by following your methods. Thank you for the response
ERP or exposure therapy is very effective overcome anxiety.. I do exposure therapy own my own of course by the help of your videos doc thanks again, I learned how to handle this anxiety.. after the exposure therapy I fell relief my brain is learning that this is not dengerous, like you Said doc, and I think I have to surprise my self, and do different exposure therapy.. To overcome this Anxiety.. Thanks for the video doc.
I am so proud of you Rommel. You are really making great progress. Keep challenging yourself and do not let fear stop you from living the life you want to live. Thank you for sharing how you are doing with me. 🙏❤️
Dear Dr. Pradko, a question. In retroactive jealousy ocd how can I surprise my brain and copy with anxiety? I explain myself better: My disturb can be considered as a PURE O, but, could be snooping on socials media be considered a form of exposure? When I see my gf past pictures arguing and asking to myself "was in this period that THAT happened?" or "I wanna ask her with whom she was". If I look at social media exposing myself and generating anxiety, am I not falling in a compulsion even without asking my girlfriend things?
Great question. Sometimes it gets confusing between what is an exposure and what is a compulsion. It would be an exposure if you looked at images on social media or listened to scripts or watched movies about people that cheated on their boyfriends, and then…did not analyze or ruminate or do any other compulsions. I tend to prefer an incidental ERP approach in this case that keeps you in response prevention like the I. A.M. method. When a thought pops up, you (I) Identify it as OCD, (A) allow it to just float in the background, shift your focus and attention to something you are doing in the (M) moment, and move on. You may feel anxious while doing the I. A.M. method until your brain learns that you are not going to attend to or examine those thoughts.
I think I have got OCD, last week I had a sudden thought in my head and then a panic attack. I was depersonalized for three, four days but I got over it and now I am left with this existential OCD. It's really confusing and scary. Can you please tell what's the first thing I should do? And does distracting myself will be helpful?
Hi Shruti. Sometimes we can get these scary thoughts out of the blue. Our brains can overreact to thoughts, and our job is to not alarm our brain. It sounds like your body is calming down on its own. I like my incidental I. A.M technique here ruclips.net/video/9nEC8yIgFKg/видео.html. Our brains can just get these crazy thoughts some time. They aren’t true and you don’t want to ruminate about it…they are just thoughts. Distraction should be more like a shift in focus, where the thought is still in the background…you know it’s there, but you shift your attention to what you are doing in the moment.
Hi, Ms. Paige. I think I have some kind of a meta Pure O. There is this urge or its own awareness that kinds of replaces my awareness, and makes me worrysome of keeping and separating the thoughts away. The ability to disregard the thoughts become the obsession itself. I have a hard time understanding my sense of self and I think I'm going crazy. My parents said that I'm okay and just stressful, but I believe I have been living with OCD low^key for 8 years till now it hits hard. I'm having lots of doubts and want to do a diagnosis. I'm scared to get help whether people will think I'm crazy or say I'm fine right out the bat, and I don't know if there are qualified therapists in my country. Help me find help. 🥺 love from Cambodia
Hello in Cambodia. I am hoping that you can find help for treatment for Pure O OCD, but, this may be very difficult for you to find in Cambodia. It is common for people with Pure O to obsessively “check” to see if they are having the obsessive thought, separating it like you are describing and even checking on their emotions as well. The inward, mental checking becomes the compulsion. It sounds like you are doing inward mental activity when you notice an obsessive thought and this mental activity of checking, analysis and separation is the compulsion that is feeding the ocd. You have to stop that compulsion. I know it may feel automatic, but, you are actually doing it. When you catch yourself either before, during or after the mental activity, tell yourself that it is ocd and you need to stop the mental compulsion. Eventually, you will catch the urge before it happens and you will be able to “not” do it. Most clinicians call this process “mental checking”, but, I understand that your process has a bit more mental activity added to the checking. You will need to stop doing all of it the best that you can. This will be your version of Response Prevention.
I have lots a job that for 8 years was my distraction from problems and gave me feeling of safety and all my social life was there and now when o am off I don’t know what to do with myself and I have very distressing thought that I am obsessed about this job 😞 I also suffer from agoraphobia
I am so sorry that you lost your job. It does seem that intrusive, obsessive thoughts bother us more when we are not occupied and surrounded by people. My first thought would be to find another job. You will probably do better if you are around people. Because you were able to push through the agoraphobia in the past, you will be able to do it again.
Thank you noticing, Mike. I have been creating a few online courses for people with health anxiety, panic and agoraphobia and soon, derealization/depersonalization and ocd. But, I hope to get back to RUclips later this month. It makes me feel good that you noticed 🙏❤️
Hi Paige , Here a question again. I think I suffer from arythmomania Ocd. I have intrusive thoughts about multiplying and also so much fear to do it all Day long, what doesn't Happen. There ist no really trigger, Just the thoughts. So I try to prevent it and Control my Thoughts. So ist multiplying already a Response although I am afraid of doing it? How should I do ERP? Really multiplying (in mind) or only thinking about it to rise the fear?
Hi Susanne. It sounds like your fear is that you won’t be able to stop multiplying or will think about it forever and this will cause you to suffer and possibly just go insane. Is that close to your core fear? And your compulsion is thinking about multiplying, actually multiplying and probably mentally checking if you are or want to multiply. You can do ERP by bringing it to your attention. You could paste little equations on stickers all over your home, computer, phone, etc. Make the equations difficult so that you can have an exposure of wanting to multiply, but you can resist doing it. You can also listen to scripts about never being able to stop multiplying and you can use the I. A.M. method when it comes up in the moment.
I have no interest in acting on my obsessions but what about aggressive ones? The thing is that my boyfriend has aggressive obsessions and I am scared he will act on it one day. We wanted to have a family, but I don't want to live in fear that he might act out aggressively. I love him but because of this I am considering leaving him.
Hi Celeste. It sounds like your boyfriend may have harm ocd. Of course I cannot diagnose on RUclips and do not know his history. However, if he does have harm ocd, he is possibly the last person that would actually harm someone or want to harm someone. I have worked with many people with this ocd theme, as it is very common, and I feel completely safe with them. It is also very treatable. If you or your boyfriend are interested in more help, please send me a message on PaigePradko.com. I have more treatment opportunities coming up in the next few months.
Also I had many other changes , stresses and loses in a short period of time and I don’t know should I continue ERP or start relaxation techniques. For last three weeks I am having nearly constant anxiety, not much eating and sleeping. I am all confused about what to do.
People do need balance in their life. ERP is something that someone with ocd remains using anytime their ocd acts up. I do not recommend relaxation or breathing techniques as a response to obsessive thoughts. But, there is nothing wrong with doing meditation and practicing breathing techniques and exercising daily as a part of healthy living.
Hi Paige - would you be interested in creating a video to help tackle relationship anxiety. The needy feeling that my partner is too busy for me, that I’m always hunting for scraps of attention / love.
What is the role of therapist DURING the exposure? It is my understanding that we should not coach the client through the experience, but allow them to feel the distress and manage. So do I just sit there while the client panics? Any insight is appreciated!
You are absolutely correct. And thanks for asking such a great question. I do not stay completely silent during their entire exposure. I will say little things every now and then, depending on the client. I might say something like, “stay with it” or I might ask them to describe what they are experiencing. Sometimes, I might ask them if they can add a fearful thought to their exposure. Afterwards, I really try to have them consolidate their learning by describing how they felt before during and after the exposure and describe what they learned and how they might change it up next time. Sometimes, if I have a sense that the client is not that anxious, I may say something alarming to them to bring up their anxiety. It is so difficult, but, I try very hard to not reassure the client during the exposure. They do understand that, but, it is still difficult to not reassure them. Great question.
Hi Geri. It sounds like you are experiencing panic and ocd. If you go to my playlist page on my channel you will find a lot of help for anxiety, panic, ocd and how to do ERP. My main advice is to practice response prevention. That means no compulsions or avoidances or safety behaviors as you go through your day. When you brain gets highly anxious, you want to give your brain every opportunity during the day to learn that you are safe. When you avoid something or do a compulsion, your brain believes that those behaviors are the reasons you are safe…which makes it more difficult the next time. Start out small…do easier exposures that you know you can do, and build your confidence up slowly. Don’t worry about making a hierarchy, just do what you can do. Some days we can challenge ourselves much more, other days we just do the best we can do. Panic, as uncomfortable as it can be, is not dangerous and this will quiet down when you begin to practice your exposures daily. I am working on some online classes to help people with treatment that will be available soon. 😊
@GJM Yes, you have a good strategy. OCD wants to keep you in that loop of worry and panic about your thoughts. The more opportunities you have to simply not respond to them the better. I would recommend staying with the I. A.M. method, where you identify it as an ocd thought, you allow it to just be there without alarm or concern…as if it means nothing at all…and then move on to what ever you were doing before you had the thought. Don’t be concerned with habituation, just keep repeating the strategy of I. A.M. 😊
Hi Larry. That’s a great question. Many people fear thinking about their pure O theme on purpose during ERP because they fear it will make it worse and cause them to have the thought spontaneously more often. The reason a thought becomes obsessive or gets “stuck” is because when you became aware of the thought, it made you uncomfortable or anxious, scared or even disgusted for some people. The purpose of ERP is to trigger your core fear associated with that thought, and rewire the thought in a new way that is not associated with fear, anxiety or disgust. We call this safety learning. The answer to your question is, “no”. We are not rewiring or creating new neuropathways to have the thought “more” often. We are triggering the core fear so that if the thought pops up, it will not be associated with a fear or anxiety response. I use an analogy of watching a scary scene in a movie over and over again, and it loses it’s ability to make us feel scared. When a thought losses it’s ability to make us uncomfortable, we no longer associate it with a fear response and the thought will pop up less and less because the brain no longer thinks it is significant.
Is it normal part of OCD recovery to eventually experience intrusive thoughts without anxiety? Since I've been doing recovery work, these thoughts no longer bother me nor do they make me distressed. Is this a sign of recovering? Secondly, should people without OCD examine every thought that pops into their head or Is it Always better to let intrusive thoughts be without paying attention to them, even when not having OCD?
Hi Andrea. Yes, it is normal to experience intrusive thoughts without anxiety. Some experience anxiety, others do not. No one, to be honest, should be examining every thought that pops into their head. Neuroscientists have estimated that we may have 60-80,000 thoughts a day. Some times people with ocd are anxious about what it means if they are not bothered by their thoughts. My advice to them is to accept the uncertainty and doubt about what it may or may not mean if we are not anxious about our intrusive thoughts. We have no way of getting to any evidence about what that means about us. The goal of ocd treatment is to tolerate not knowing the answer to those types of questions…and accepting the uncertainty of that.
@@PaigePradkoTherapy Thank you for guidance. I was just interested on the right way to respond to the thoughts. I've been told to examine them, but I find this very exhausting And unhelpful. In fact it was this 'examination' that caused my intrusive thoughts to become obsessions
I am so sorry you were given the advice to examine your thoughts. That would likely cause rumination and mental compulsions. I am glad that you learned that mental analysis is not helpful.
Hello dr paige just wanted to say ur videos have been so extremely helpful as i have just recently discovered im having ocd and is currently doing erp on my own on a daily basis. I was just wondering if you could do a video on how to transition from doing the old habituation model erp to the new inhibitory learning theory because i am having a hard time and when you said that habituation model is not as effective it made me feel that i have wasted time trying to do it and this gives me even more anxiety
Hi. I love your questions. No, you didn’t waste your time on the habituation model. There is a lot of cross over in the 2 models. Most therapists I know, including myself were trained in the emotional processing model (habituation) and have transitioned to the inhibitory learning model because it has increased effectiveness. But, I borrow from both models and try to meet my clients individual needs. You haven’t wasted anytime at all. I have a self help course on how to do ERP for OCD using the inhibitory learning model coming out in March. If you have an interest in learning more, I think you would really benefit from it. If you are interested you can send me a message on PaigePradko.com, or join my newsletter and I will send you more information. This may help as well. www.paigepradko.com/erp Thanks as always for the great questions and suggestions.
But it'll not work for someone with health anxiety, can't expose themselves to actual diseases and get comfortable, I don't understand how a person with fear of a certain diseases when logic also supports it - like I take finasteride for Alopecia and I read that it can cause PFS which is incurable - so my ocd kicked in and so did anxiety, how can I use ERP in this case? As I won't be exposing myself to the actual PFS and get comfortable with it. The more I read about it the more paranoid and anxious I get thinking I've already taken the dose, I can't undo it and logically it can happen. So its not a fear of something that is logically impossible; which makes it more real and threat.
There is often a confusion that happens in people with health anxiety that confuse possibility with probability. And then, like you are describing, the doubt and ocd are activated. Focusing on response prevention is helpful, making sure that you are not doing any behaviors to support the ocd.
I have a question, so I understand everyone has anxiety because let’s say someone is about to get hit with a ball they’re going to get scared of course. But since people with OCD have more severe anxiety is it possible to not have ocd come back if one is completely free from severe anxiety in general ?
This could be partly true. OCD does get worse if one reacts with fear to their thoughts. Although we cannot stop the initial whoosh of anxiety, we can stop the anxious, worried, what if thoughts and the compulsive behaviors that feed the ocd cycle.
@@PaigePradkoTherapy yea since ocd is mainly triggered by anxiety once someone with no anxiety at all they would be less likely to have it again correct
Hi Barb. I have been working for the past few months developing an online class for the treatment of health anxiety/ocd. The class will be available in less than a month. But, until then, here is a playlist to help you. It is not as complete as I would like it to be. ruclips.net/p/PL1lUhuKpYUYonn-zlZxzTRR8V4myEHgCY. If you are interested in being notified about the course when it is available, please send me your email through PaigePradko.com
Please let me know if you ever open a waiting list for zoom cash patient consultations, since have not heard anyone else explain things and help as much as your videos so it would be a true blessing to have a consultation with you! 🙏
Hello, My erp therapist has only given me one kind of exposure- reading off an index card. I have asked them several times if there will be different kinds of exposures and he says there is not. What else could I be doing?
Hi Johnny. I am sorry that you are going through that. It is common for OCD to switch themes. Here is a video where I talk about how to treat that: ruclips.net/video/_0-48NxOgjo/видео.html.
Should the same be be followed if there is no fear? I have contamination OCD, and I'm just scared of making everything "dirty" and it just feels disgusting.
Hi Arie. Instead of fear, you will be doing exposures to tolerate the feeling of disgust. It takes longer to make progress with disgust compared to fear. The same principles do apply. Sometimes people with difficulties tolerating disgust practice response prevention and look at stopping the compulsive behaviors and avoidances as a main focus of treatment.
@@PaigePradkoTherapy Thank you so much for the help!! So does ERP not work for such a case, or should I keep trying, and only start focusing on response prevention when I'm sure ERP fails? When and how do you think I should shift my treatment?
When I am working with a client with disgust, I still start with ERP and then monitor the progress. If the client is consistently doing exposures, but not seeing progress after several weeks of ERP, then we switch to a response prevention treatment where they work on tolerating the disgust feeling and still do what they have to do. But we make sure there is no avoidances or compulsions. Sometimes disgust is stubborn and ERP can work…but progress is just not as fast as fear. I wouldn’t recommend shifting treatment unless no progress is made after consistent exposures for several weeks.
@@PaigePradkoTherapy Thank you for the information, I will continue to work on ERP as I do see progress to some extent even if it's really slow. I'll definitely look into response prevention if I don't seem to improve further. Also you mentioned they still do what they have to but don't avoid or do compulsions, does it mean they do ERP anyway, but focus more on not doing the compulsions and responding rather than focussing on exposures?
If they transition treatment to response prevention…then they do what they have to do in their daily life…and focus on not avoiding or compulsing versus doing intentional exposures. But, it sounds like you are experiencing some progress. In your case, I suggest continuing as ERP works with disgust…just a slower progress rate. If you need more help, I have a course where I cover this in more detail in treating OCD. It will be offered in April. For more information: www.paigepradko.com/ocd
I have ocd of food allergies my diet is limited due to it I’m terrified of any of the major allergens even though I have never been allergic to anything
Hi Melissa. I am glad that you have recognized that your fears are triggering OCD. Sometimes people are mistakenly treated for eating disorders when OCD is actually the trigger. I do recommend working with an OCD specialist if at all possible for more help with ERP. I will have more treatment options available in the coming months for people with OCD that you may be interested in. Please sign up for my newsletter on PaigePradko.com if you would like more information.
Hi I have a question about OCD treatment. Basically, whenever I have an intrusive thought, I completely ignore it, I don't analyze, I don't try to correct it or convince myself wheter it Is or isnt true, I just move on And don't pay attention to it. Is this the right way of dealing with OCD And intrusive thoughts?
@@PaigePradkoTherapy thanks! And can some intrusive thoughts be about completely irrelevant things that arent important for me, such as doing something strange in the public etc?
@@PaigePradkoTherapy I'm asking because someone told me to replace OCD thoughts with pleasant thoughts, but I find this to be a mental compulsion that makes the intrusive thoughts become more frequent. I also think that replacing every single intrusive thought Is very exhausting And doesn't work to treat OCD at all. I'm not a therapist but I Always thought that OCD recovery is about accepting intrusive thoughts without asigning meaning to them And not about getting rid of them
Hi Paige, I was wondering if you were taking on new clients and whether you would take on clients from the UK. I have so many questions that I want to ask. The treatment seems very similar to the way Dr. Claire Weeks worked. She basically said that it is the "no longer mattering about the symptoms" that brings recovery and freedom. Am I correct? Is there any way in which the recent advice differs from Dr. Weekes and if so in what way? Is it alright to loosen your body whilst doing exposures as Dr. Weekes says or does this weaken the effects of the exposure? If I followed Dr Weekes would that also lead to long term recovery or is there something extra I need to do that the new research has found to be more effective? Thank you.
Hi Charlotte. Nice to hear from you. I read Claire Weeke’s book on Agoraphobia several years ago, and would have to review what she said. But, it is interesting on how much she did get right during a time before we had functional MRI scans to view brain activity. Yes, you can relax yourself naturally during the exposures, but, do not practice relaxation techniques during the exposures. Just do the exposure and let your brain learn. If you are doing a driving exposure, I do remind my clients to loosen their grip on the steering wheel. To answer your question, I do work with clients in other countries, but, am not adding names at the moment to my waitlist. I will be working on an online therapy class for people with Agoraphobia that I hope to make available this year.
Hi Paige, Thank you for your reply. I followed Dr.Weekes when I had my first panic attack and I was able to lead a semi normal life, however I do have a lot of safety behaviours. Should I stop all safety behaviours from now on when I go out or should I eliminate them one at a time? I am very interested in your online course do you think it would provide sufficient support for someone recovering without a therapist?
Hi Charlotte. I think reducing safety behaviors one at a time makes sense. You want to feel challenged, but still feel like you can complete the exposure. I am creating therapy courses with instruction, that is broken down into separate sessions. For many people, there are just no therapists available and I am trying to accommodate for this. However, a best case scenario is having your own therapist and using my course as additional education and support.
Thank you Paige that was very helpful. I would love to work with a therapist but I trust that what you are teaching is the most effective way to long lasting recovery and I don't know any therapists who would work in that way. Do you think if I found someone who practiced ERP, as you advised me to do previously, I could ask them to implement your methods or would they be offended? Thank you for your help.
Hi Danny. Yes. The research on this video applies to OCD and Pure O OCD or intrusive thoughts. If you need resources for more help, please feel free to contact me on paigepradko.com
I absolutely do recommend using the I. A.M. method. But, there are different kinds of ERP or exposures. The I. A.M. method is an Incidental “unplanned” or in the moment exposure. The suggestions I make in this video are for planned ERP or Exposures. I hope that clarifies it. Thank you for your question 🙏😊
Intrusive thoughts are distressing thoughts that are unwanted and are reoccurring. Other than that, thoughts are just thoughts. They are just mental activity. If you have ocd, the thoughts are distressing, unwanted and occur obsessively.
OCD can be so exhausting. I am sorry that you are going through this. I do have a video on Moral Scrupulosity. It is a similar theme, and the treatment is the same treatment. ruclips.net/video/fXzs4F0BNTo/видео.html. The feeling of guilt is very strong with all ocd themes. Part of the treatment is challenging yourself to tolerate the guilt without doing anything to avoid that feeling. I wish you the best.
Hi Arun. I understand. Health Anxiety can cause so much uncertainty about our health. But, people that were even skeptical about the vaccine, now seem to be getting the vaccine. When you break down the risk, it is clear that we have more risk not getting the vaccine, than getting it. It is ok if it makes you anxious thinking about it. You can tolerate that anxiety. I am working on a class for health anxiety that will be available soon. I will post on my channel when it is completed and available.
They are shocking numbers. My source is (Craske et al. 2008, 2014). Joseph LeDoux also addresses these poor results in his book, “Anxious: Using the Brain to Understand and Treat Fear and Anxiety”. Michelle Craske also has several talks on RUclips where she talks about these results and what led to her work that resulted in Inhibitory Learning Theory.
I am so sorry that you are struggling with those themes. All OCD themes are treated with ERP. You do exposures on your thoughts (scripts are a good option) and you do nothing to reduce your discomfort. Here is a playlist that may help you. Be sure to watch the videos on scripts, mental compulsions and moral Scrupulosity may help as well. ruclips.net/p/PL1lUhuKpYUYqKvEwlGXoRPDu_8blhbaq-
Thoughts are just neutral activity, Andrea. But, I realize that sometimes you are wanting reassurance and I want to try my best to not give you reassurance as it feeds the ocd and anxiety worry cycle.
@@PaigePradkoTherapy I still have setbacks in my recovery. I read online OCD thoughts Are dangerous. It sounds to me like nonsense, how could a mere thoughts be dangerous, only actions are. But it still kind of freaked me out.
Hi Algene. I am so sorry that you are struggling with these thoughts. Here is a video to help you. ruclips.net/video/c-HKZNh88dQ/видео.html I have an online course coming out to help you with this at the end of March. Send me a message on PaigePradko.com or join my newsletter there and I will send you more information. And here is a pdf that you may be interested in www.paigepradko.com/erp.
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That is really a nice thing to say. Thank you. I appreciate your support 🙏
I needed this. As a person who experience chronic anxiety and thought that just changing my mindset will help, I now realize that I missed the part of exposing myself to new challenges.
Yes, sometimes we have to let our brains do the learning through experience or exposures.
You are such a precious human being, I have never met you yet I feel so loved by you and your videos provide me with much guidance and comfort. You are such a gift to us all
Thank you Tam. You really touched my heart with your comment. 🙏❤️
Hello Paige,
I want to thank you from the bottom of my heart for answering all my questions the last time. I was the one that asked all those questions.
I have refrained from doing a specific compulsion because I'm just exhausted and OCD recovery needs to start somewhere, right? I am able to carry on with life, I don't feel a horrible fear. But I have a very stressful and annoying problem. When I try to fully live, I feel like I am still holding on to the problem very tightly. When I focus on this problem, I enter this horrible cycle of rumination where I feel a lot stress more than fear.
I desperately want to be free from this chain but feel chained still. In fact, I start to think that it's better to suffer trying to get the "just right" compulsion than to endure the rumination cycle. I'm able to stop rumination at times and I feel normal again. But in the back of mind I think: Are you sure you can really carry on normally? You can enjoy this moment but you know damn well you have a big problem. Then I focus back on the problem.
When in this thought process, I don't feel the fear of doing exposure. I feel stress and anxiety due to rumination, I feel stuck. I do exposure but then I have to deal with rumination. I have noticed that these OCD feelings are very powerful. Is this where cognitive restructuring comes in? Could I be going through this because of so many years of feeding the cognitive distortion and now it's a habit?
While researching psychodynamics, I self analyzed and realized that I have a certain natural desire that I try to satisfy. But with OCD, my core fear is a specific type of emotional suffering. My OCD case involves not being able to satisfy this desire because intrusive thoughts enter and according to my cognitive distortion, will cause emotional suffering right when I want to satisfy my desire. So it's two opposites that mix and I get triggered. I have hope. I firmly believe that recovery is possible and that I can be the boss of my life and not OCD. I really want my brain to learn that I don't need compulsion or protection to feel safe. Any advice is much appreciated!
Thank you in advance Ms. Pradko.
Hi Isaac. It is difficult for me to answer your specific questions on this forum. It sounds like much of your compulsions are mental compulsions like rumination. And, you get caught in a cycle of trying to get a “just right” feeling through the rumination. The answer is of course to stop the rumination and allow yourself to feel “not” right on purpose. I realize that this is much more difficult that it sounds. I recommend using my I. A.M. method when you notice the rumination. Identify the ruminating, allow the obsessive thought or not just right feeling to be there, slowly shift your attention to what you were doing before you noticed the thoughts.
Here is a gift for you. A FREE PDF to download to help you with your Exposures and ERP:
The Top 10 Things you Need to Know to Practice ERP: Exposure and Response Prevention for OCD, Phobias and Anxiety
www.paigepradko.com/erp
Thank you for sharing! Very kind of you Dr. Paige.
As always, great video Paige!
Thank you for watching 🙏❤️
Madam, rewatched the video once more just now, Nice to see that you are recalibrating your methods and fine tuning them for good.. In my recovery now, I somehow feel that the last part of healing and consolidation is not happening in me completely despite myself being focused & putting efforts.. Your new model will help me SURELY.. In SAVVY Surprise Yourself - is very true, The more surprised I become with the exposure and do the right necessary things later on, the better & more comprehensively I heal (Exactly like in Bodybuilding, the more we stimulate the muscle from different angles, the more the muscle goes in shock & to cope up with the shock it the muscle grows in size & strength (grows new muscle cells HYPERTROPHY) and this is how we get bigger better and stronger overall (varying the angle of stimulation of the muscle(S)) .. Brain is also a muscle after all....All the remaining aspects discussed in the above video are great as well.. A V V Y 👌👍... Dear Ollie looks away from the camera all the time, but that's OK whatever he does is Cute.. He is in the frame that's very important, he has great screen presence.. He is a Big Star, whatever he does on screen, he can get away with it, like a Big Movie Star! (We Love You OLLIE)
Arjun, I love your comparison to body building. You have inspired me to do some lifting today and shock my muscles. I always appreciate your comments and perspective. Stay well in India. I saw on the news that many countries including the US have sent medical supplies. Hoping that this virus will be under control in India soon. 🙏❤️
@@PaigePradkoTherapy Thank You Madam, Thank You Soo Much, Appreciate the fact that you read & reply to every single comment here.. 👍👌
I feel very blessed to have found your channel! I love your serenity, humility, and sweet way of explaining! Thank you for providing the most recent research also! And I love the video editing! I decided to start my "Pure O" OCD recovery and your content is very useful. I believe in inhibitory learning, in fact I'm proud to say that ERP has helped to inhibit most of the fear conditioning in my OCD. My goal is complete inhibitory learning of the fear associations in my OCD. Paige, I would appreciate it if you answered these questions please! 1.) What is cognitive restructuring and why shouldn't I do it when I do ERP? 2.) Since fear associations remain, it makes sense to get quick rushes of fear. I get this when I ruminate a bit or sometimes randomly. It feels horrible. If I continue ERP correctly, can I eliminate these rushes of fear or will I need to deal with them always when they show up? 3.) Do you have any tips on ocd recovery? Would it be a good idea to track rumination. For example taking it day by day. While carrying out ERP. This is the only way I think I can eliminate rumination. 4.) Are there medications that help so that inhibitory learning sticks and also decrease rumination? 5.) Many say inflammation plays in a role in anxiety. What is your opinion and what lifestyle choices help in OCD recovery? Thank you Paige!
What great questions. I love how curious you are and your questions really show how motivated you are. Success in ERP is dependent on high motivation and determination, because it is indeed difficult. Cognitive restructuring is a technique used in Cognitive Therapy that points out how our thinking is distorted and helps us to change or restructure our thinking. A common distortion is called “All or Nothing” or “Black and White” thinking. I did a video on Cognitive Restructuring that you can watch here: ruclips.net/video/d68j2zvITfs/видео.html.
Using Cognitive Restructuring before doing ERP or Exposure Therapy can reduce our anxiety and somehow lowers our expectancy of our worst feared outcome from happening. According to the research on Inhibitory Learning, our best exposures happen when we expect our worst case scenario, and then it doesn’t happen. We are surprised and our brains learn the best when this happens. Using Cognitive Restructuring reduces this mismatch or surprise. Also, there is something called Implicit learning (learn by experiencing, like driving a car) and Explicit learning (learn by reading, or someone telling you something like reading a book about how to drive a car). These 2 types of learning can interfere with each other if they happen at the same time. If they happen at the same time, they reduce the effectiveness of each type of learning. Exposures and ERP create implicit learning in the brain, Cognitive Restructuring is explicit learning. They should not happen together, or they make each process weaker. This is based on Joseph LeDoux’s book, Anxious, and Michelle Craske’s research as well as others.
2. Your quick rushes of fear is your anxious arousal in your body. This happens in ERP as well. This is treated through ERP exposures having these thoughts on purpose, multiple times a day and allowing your brain to learn. Allow the rush of fear to happen and do nothing to reduce the feeling. Your brain will learn on it’s own. The more you allow yourself to have the fear, the faster your brain will learn. Then, carry out the exposures in as many situations as possible. Vary every thing you can think of when having these thoughts on purpose. Do nothing to ease your anxiety. Yes, this will go away. However, we do not use the word “cure” with ocd. But, ocd is treatable if it does pop up again. It is common for ocd to try to scare you in a new area. You just do the same ERP treatment and take the power away.
3. I have lots of tips for ocd recovery. Here is a playlist for Pure O: ruclips.net/p/PL1lUhuKpYUYqKvEwlGXoRPDu_8blhbaq-. Keep in mind that when I started making videos I followed the older method of Habituation using SUDS scores. I do have my clients track their ERP exposures when they are “planned” exposures. I may do a future video on tracking. Basically, identify what your exposure is going to be. Decide how long and at what interval you want to track. I have people rate their belief that their worst case scenario is going to happen (0-100%). I also have people track their trust in themselves that they will complete the exposure (0-100%). I have them track anywhere from every 5-15 minutes during exposures that last 30-90 minutes. Then, I have them write about what they learned in the exposure and how they can change up the exposure next time.
4) SSRI’s have been shown to help with ERP and exposures by perhaps making them easier to tolerate. Some use them, some do not.
5) OCD is genetic and can wax and wane in life. I have seen that stress and change exacerbates, but, quiet time also seems to do that. I am sure there must be a connection with lifestyle and diet and gut health, but, I have never read any evidence one way or another. As you say, I do believe that inflammation makes everything worse.
Whew...I hope I answered your questions. 😊
Thank you for another great video Paige! Would this work on depression? For example on depressed thoughts that tell you " you shouldn't" "what for" "no point" etc.
Even though ERP and Exposures are designed for ocd and anxiety, I do believe that having new experiences and activities daily where you challenged yourself would be wonderful for depression. I have not researched that piece, but, it makes sense. Thanks for your comment. 🙏😊
@@PaigePradkoTherapy I believe so too Paige! Thank you so much for replying! 😊
Hi Paige,
Thank you so much for your wonderful work. I really appreciate your willingness to reassess your theory and practice as you become aware of better approaches to address anxiety. Could you clarify the information on the ILT slide at 2:13? It seems it should read: “but is replaced by new learning”.
Kevin
Thank you for catching that Kevin. I am editing my reply, because I kept thinking about the wording of that slide. Although, it is a very narrow definition, it is correct. In Habituation or Emotional Processing Model, we used to believe that the original fear association to the trigger was replaced or erased by new learning through the habituation process during exposures or ERP. In the Inhibitory Learning Model, we now know that the original fear association wiring remains, even if habituation happens. During exposures and ERP we lay down new neuropathways that hopefully we can make stronger than the old, fearful association pathway. This is why it is common to have an anxious reaction out of the blue when someone has been having great success for weeks and months. Their brain just jumped onto the old neuropathway in that one situation. This is also why we want to vary our exposure contexts and environments and situations as much as possible during exposures, because we want to make it more likely that the brain will jump to a new neuropathway without the fear association. This is also why we want to tolerate anxiety, because occasionally we will jump to the fearful association in our brains and want to be able to tolerate that, even expect it when it happens. Inhibitory Learning Theory assumes that the old, fearful pathway remains...even after new learning has occurred.
Wonderful video Paige! I have missed your videos, I noticed you haven't posted in a month. I hope you are doing well, and hope we will see a video from you pretty soon. 💗
Thank you for noticing that. I have been diligently working on developing online therapy courses. They are an incredible amount of work. My first course is on help for people with Health Anxiety. I have been receiving so many requests for help in this area. I challenged myself to complete this course before putting out another RUclips video. I cannot wait to get back to RUclips.
@@PaigePradkoTherapy I'm so excited for you and for all the people who are gonna be helped by your course! Glad to know your absence from RUclips has been for a great reason!
Hello there Paige. Thanks so much for all the amazing videos. I am still in my Pure OCD recovery and I am fascinated with what I learn about my brain. I’m convinced that with the right knowledge and the effort, I can recover to the point that this disorder doesn’t control me. I still have some questions and would greatly appreciate your views. I agree with Dr. Greenberg who says that in Pure OCD, rumination IS the disorder.
I can’t control my thoughts and have no intention in doing so. But, why do I have this urge to solve the problem, to protect myself from the perceived danger even though I know that I am safe. Is it because I have followed this harmful thought pattern for so many years? If I continue to not solve the problem, will this urge to ruminate eventually disappear? As if I’m creating a new neuro path for my thoughts to go on.
I imagine that fully accepting thoughts will discourage rumination. Because why try to solve something that you’ve already accepted.
Could it be that I have 2 paths in my brain. The one I’ve followed for many years which is rumination and what ifs. And another one that accepts the thoughts and recognizes that I simply can’t control thoughts. It’s like a violent war between these two paths. Hope to hear what you think of this. :)
Yes…that is exactly what is happening in your brain. You have your old neuropathways where your fear reaction is associated with those thoughts. Then, you have your new safety learning neuropathways that continues to strengthen when you do not ruminate or try to figure it out, and your brain learns that you are safe. This battle between what pathway will be used will depend on your response to your thoughts. The more you do not respond…the more safety learning and strengthening of the new neuropathways. I agree that you are on a good path and the desire to ruminate will fade as you continue to not respond to the thoughts. Keep up the good work!
@@PaigePradkoTherapy thank u and mam i wanted to ask is it really common that during ERP we may get more new urges which feel like real ?
As usual you always amaze
Thank you for watching 🙏❤️
I have recently started seeing a therepist through the phone, hoping to work on agoraphobia. She focuses on dreams and art therepy. I don't know what to expect so far. It hasn't been long enough to decide what I think. I'll still watch your videos for agoraphobia help. I'm doing about the same as always with that.
I am glad you are working with a therapist. I will continue to try to help you with Exposures. I am working on an online class right now for health anxiety and panic disorder. So much of the class relates to people with agoraphobia. I am going to post on this RUclips channel when the class is available. I think it will help you and it will be priced in an affordable price. After I finish that class, I will work on one entirely focused on helping people with agoraphobia. Exposures are the way out of agoraphobia. But, having the guidance along the way is also helpful. Keep working on your exposures even while doing your other therapy. If you do decide to change therapists, make sure you find one that is trained in ERP and exposures.
@@PaigePradkoTherapy I'm no longer seeing that therapist. I'm also recovered from my agoraphobia. Not because of her.
Thank you for this video! I do have a doubt though. If you're unable to go for therapy and try ERP at home, how do you know which exposures are appropriate? I've had some people say that their therapist wouldn't ever make them do something they wouldn't, while some others have said we should go beyond what people usually feel uncomfortable doing as well. (I read a few other comments saying they deal with the feeling of disgust (contamination OCD), I too deal with the same issue. ) What do you recommend, and how do we choose the exposures? Do we do anything differently when it comes to disgust, or does everything in ERP and otherwise remain the same?
Hi Jayson. Those are great questions. I discuss this ERP treatment for contamination OCD when the issue is disgust instead of fear in my new OCD course available on demand beginning April 4.
ERP works for disgust, as it does for fear, but because of the brain structures involved with the experience of disgust, the ERP treatment is more gradual and takes longer. Response prevention becomes even more important. If you would like more help with this, you can sign up for a waitlist for the course here:
www.paigepradko.com/ocd.
To further answer your question, I do not ask my clients to do anything that I would not be willing to do myself. And, yes, we do have to push beyond what a person without ocd might do sometimes in ERP to target one’s core fear. Yet, you are in control of the pace and intensity of the treatment. Tolerating disgust in ERP is what your goal will be versus tolerating anxiety. Here is a pdf that may be helpful: www.paigepradko.com/erp
I have this thought like " i will go awkward now " and worry about my face emotions and then i go awakward. This thought never go away since 12 years ago. Is this ocd or trauma? Please help me anyone my life is destroyed 😢 i can't handle it anymore its runnied all my life i swear to god 😢
Hi , your videos are really awesome and helpful for all humanity . Thanks a lot for these beautiful efforts . I also want to ask u something . In any future videos plz try to tell more about contamination OCD exposures . I dont feel anxious while imagining contamination ocd exposures but feel anxious while try to do in real . To be specific , I have ocd for toxic and unknown chemicals , radiations and those particles stick from one thing to next and next , them comes the harm ocd that i may become spreader . My reaction was aggravated from the time my father was diagnosed with a tumour , He is fine now , but I feel really anxious from last 7-8 years .
Your reply will be highly appreciated , but even if u dont , you still are doing really great job . Thanks .
Thank you for your comment and your suggestion. First, I am sorry that you are dealing with this. I will do a detailed video on contamination ocd in the future. You are not alone. Most people have difficulty getting anxious during imaginal ERP. I have experience treating people that have the same kind of ocd that you have. It is a process and it does take time and determination. Eventually, I have my clients work up to contaminating themselves and contaminating their entire home and vehicles and loved ones. I am working on developing online therapy courses that can help people with more detailed sessions. This may be a great option for you when I do a class on ocd.
@@PaigePradkoTherapy Thankyou so much for ur kind words . Ur such efforts show us the real beauty of being human --solidarity for unknown people beyond boundaries of nation , time zones , races .
Thank you. Talking to people like you is the best part of being on RUclips 🙏🏼❤️
@@PaigePradkoTherapy ❤️
Hi dear professor
Thank you so much for your help and advice.
I really appreciate your job. I wish you peace and happiness under the sky of prosperity.
All the best.
Take care and have a good time.
Your follower from Algeria
Hello friend in Algeria. Thank you so much for watching and commenting. 🙏❤️
Hello. This is a great video and i have to say that it seems a little bit strange to me because i have used the habituation model. The model that you suggested seems to me less goal - oriented because, if im not mistaken, i suppose that you dont do an hierarchy of the exposures. So, if there is no hierarchy, how exactly are you planning the exposures? I definetely want to give this model a try because as you said theres a lot of research behind. Ans something more? In which disorders are you using erp and exposure therapy, except OCD? You are doing great work with your channel!
Thank you for your comments as they are wonderful questions and concerns. It does feel a little different at first not using a hierarchy. But, the order or how much or how little you challenge yourself is still under your control. I do still have my clients make a list of fear triggers and core fear and make sure they are targeting those fears in exposures. But, SUDS scores are no longer used because we want to take the emphasis off of anxiety levels. We all have anxiety in life and we want to learn to tolerate all levels of anxiety versus looking at anxiety as something bad that we don’t want to have.
We also use ERP and exposures therapy for phobias and social anxiety and agoraphobia…basically any area where we are avoiding activities, people, places and things. If you ever need more help with ERP, I have a new course that walks you through every step and gives you all of the tools and worksheets to plan your exposures and response prevention. You can find out more here:
www.paigepradko.com/ocd
@@PaigePradkoTherapy Thank you very much for your answer!
The skin on my leg is actually burring from anxiety just listening to this.
If you have listened to me before, you might already know what I would say….allow that anxiety to be there. 😊
Hi Mrs. Pradko, beginning to learn more as I attempt a new direction in recovery and am trying to gain clarity on an aspect that I did not understand as I try to figure out how the Exposure process should be conducted. In your previous videos you discuss that the proper use of the ERP model is to expose until the SUDS score drops by about 50%, or after about 90 minutes. I recall you mentioning that if you stop prematurely you are in essence avoiding or fleeing the exposure thereby reinforcing the anxiety pathway and losing out on the efficacy of the exposure. However, in this video and in your 10 tips to maximize ERP effectiveness video, as I understood I believe that you suggest that it is okay if the Exposure remains at its peak throughout the exposure and never stops, as it decensitizes the amygdala and concerting SNS systems to the anxiety?
From this, my question is, does that mean that your opinion has changed regarding when an ERP exposure should be stopped? Is it still best to wait for a 50% suds drop? Should one wait at least 90 minutes and if no drop, begin to move on from the exposure? If one leaves the exposure event before experiencing any drop in anxiety level, will that in essence indicate that the event was avoided to escape the anxiety and thereby reinforce the "flight" neural pathways?
In another video, I believe I recall you suggesting that a newer and promising method was to switch back and forth between exposure doing 10 minutes of exposure, 10 of rest, then 10 of exposure. As I understood, this method was to be combined with other new empirically backed methods such as switching back and forth between exposure, overlapping simultaneous exposures, switching back and forth between exposures at different degrees of SUDS intensity, leaving one exposure behind and returning in a later 10 minutes SUDS block?
Moreover, I'm just confused and I'm trying to get a clear picture of how you suggest that we know when we should stop an exposure, and if leaving before SUDS has increased by 50% deprives potential effectiveness of the exposure, or perhaps even reinforces the OCD patterns altogether?
Apologies for my long winded question, and grateful for your help and incredibly insightful videos. Thank you!
Hi Brody.
Thank you for asking such a wonderful detailed question as it shows that you are listening and really wanting to understand the research and recommendations on ERP and exposures. The research in the neuroscience community is evolving. What we have done in the field for the past 20 years is changing due to a theory shift from a habituation model to a model called Inhibitory Learning Model. We have discovered several important things about how neuropathways are formed and how to make the exposures more effective. Therefore, you will see my older videos explaining the habituation model and my newer videos explaining the inhibitory learning model. Both models work, and most people in the field still use SUDS scores and hierarchies and want you to stay in the exposures until the anxiety comes down by 50%.
I have shifted to Inhibitory Learning…but sometimes use a hybrid of the 2 models if it is more effective with a client. I concentrate on having people create constant variations of exposures. Sometimes they have longer exposures and sometimes shorter, and we vary them in some way every time. Even more important than the exposures is doing the Response Prevention at all times. Exposures do not generalize very well, so we have to constantly do something different to try to generalize the exposures. Exposures still work, even if you have a bad exposure experience. I still try to have my clients not leave an exposure at the height of their anxiety because I do not want to create an avoidance situation. But, I no longer use hierarchies and SUDS, and instead have my clients stay in an exposure until they feel like their brains have learned something. This in itself is freeing to clients. The SUDS ratings do seem to imply that anxiety is bad. Part of the process is learning that you can tolerate anxiety and anxiety should not be thought of as bad…and something to avoid. The more willing a client is to accepting anxiety and at least tolerating it, the better they do at sustaining recovery.
@@PaigePradkoTherapy That makes so much sense! I can certainly understand evolving practices and understandings from research, as my background before being sidelined with my condition was an undergrad psychology degree with emphasis on cognitive psychology and learning. Nonetheless, however, clinical psych was something I never touched on and have very little understanding of & experience with, and I wanted to make sure I was doing things correctly in line with modern understandings from research. Cannot thank you enough for taking the time with such a clear and insightful response! This clears things up perfectly and will help me immensely as I begin trying to put these methods into practice! Thank you!!
I had an ocd relapse after 15yrs. I moved, my brother passed away and the pandemic hit. I haven’t had it this bad in a long time so I had to relearn everything. I’m doing better now after 2 months but still having instrusive thoughts( seems anxiety has gone down a lot) I’m doing exposures and I don’t seem to be bothered by them it’s kind of a relief after I do them I don’t get anxiety like most people. Is this normal? I have pure o
It sounds like you are on the right road with treatment and results. OCD can be episodic and flare up at stressful times. I do not mean to give reassurance, but, you are doing the right treatment. What you are experiencing is very common in people that have had previous treatment and experience a flare up.
@@PaigePradkoTherapy thank you
Beautiful Video Madam.. Thank You.. S A V V Y.. Great Explanation by you.. .. Consolidation at the end.. OLLIE looking SWEET & CUTE as usual.. I will write my detailed comment on the above video later in the day.. ..
Thank you, Arjun. I wish Ollie would look at the camera, but, he hides his head from the lights. I would do the same if I were him. 😊
i love what you do but I have some concerns
There is a lot of talk about ERP, typically the exposure part of ERP. No one really discusses good methods for Response Prevention of ERP
I have seen your videos on compulsions and they are quite informative but there isn't a definitive guide on how we respond to anxiety triggers, for ERP.
We're taught not to "follow up", as I like to say it, or don't compulsions once the anxiety is triggered, right?
What are the best methods for dealing with a triggered emotion in ERP? I get it, don't do compulsions but how do we do it the right way.
Do we tell ourselves "not to think about it"? Do we let the thought hang around and use your I.A.M method? Do we totally ignore the urges and pretend the sensations aren't there?
I don't know! You see I am not very clear on how we should handle response prevention for ERP. I can't be the only one
I am on it, Mark. Thank you for your comment. You are right. I will do a video all about response prevention because it is actually more important than the exposure piece. Yes, the idea is to resist the urge to compulse and just tolerate the urge. But, not everyone can just quit cold turkey. So, I will go into the details of what to do. I have a few videos in the works before you will see it. But, if I work on it this week, you will see it in about 3 weeks. Thanks for pointing this out.
@@PaigePradkoTherapy
I hope I didn't sound disrespectful. I am passionate about my mental health and it seems I have some progress by following your methods.
Thank you for the response
@@markj6681, no, you were not disrespectful at all. I actually love your suggestion and completely agree with you. 😊
ERP or exposure therapy is very effective overcome anxiety.. I do exposure therapy own my own of course by the help of your videos doc thanks again, I learned how to handle this anxiety.. after the exposure therapy I fell relief my brain is learning that this is not dengerous, like you Said doc, and I think I have to surprise my self, and do different exposure therapy..
To overcome this Anxiety..
Thanks for the video doc.
I am so proud of you Rommel. You are really making great progress. Keep challenging yourself and do not let fear stop you from living the life you want to live. Thank you for sharing how you are doing with me. 🙏❤️
Thankyou for video mam. Mam I have pcod and anxiety n panic disorder are they related to each other?
Yes, people with OCD often have anxiety disorders like you are experiencing.
Dear Dr. Pradko, a question. In retroactive jealousy ocd how can I surprise my brain and copy with anxiety? I explain myself better: My disturb can be considered as a PURE O, but, could be snooping on socials media be considered a form of exposure? When I see my gf past pictures arguing and asking to myself "was in this period that THAT happened?" or "I wanna ask her with whom she was".
If I look at social media exposing myself and generating anxiety, am I not falling in a compulsion even without asking my girlfriend things?
Great question. Sometimes it gets confusing between what is an exposure and what is a compulsion. It would be an exposure if you looked at images on social media or listened to scripts or watched movies about people that cheated on their boyfriends, and then…did not analyze or ruminate or do any other compulsions. I tend to prefer an incidental ERP approach in this case that keeps you in response prevention like the I. A.M. method. When a thought pops up, you (I) Identify it as OCD, (A) allow it to just float in the background, shift your focus and attention to something you are doing in the (M) moment, and move on. You may feel anxious while doing the I. A.M. method until your brain learns that you are not going to attend to or examine those thoughts.
I think I have got OCD, last week I had a sudden thought in my head and then a panic attack. I was depersonalized for three, four days but I got over it and now I am left with this existential OCD. It's really confusing and scary. Can you please tell what's the first thing I should do? And does distracting myself will be helpful?
Hi Shruti. Sometimes we can get these scary thoughts out of the blue. Our brains can overreact to thoughts, and our job is to not alarm our brain. It sounds like your body is calming down on its own. I like my incidental I. A.M technique here ruclips.net/video/9nEC8yIgFKg/видео.html. Our brains can just get these crazy thoughts some time. They aren’t true and you don’t want to ruminate about it…they are just thoughts. Distraction should be more like a shift in focus, where the thought is still in the background…you know it’s there, but you shift your attention to what you are doing in the moment.
@@PaigePradkoTherapy thank you for replying. I'll check the video you've mentioned here
Hi, Ms. Paige. I think I have some kind of a meta Pure O. There is this urge or its own awareness that kinds of replaces my awareness, and makes me worrysome of keeping and separating the thoughts away. The ability to disregard the thoughts become the obsession itself. I have a hard time understanding my sense of self and I think I'm going crazy. My parents said that I'm okay and just stressful, but I believe I have been living with OCD low^key for 8 years till now it hits hard. I'm having lots of doubts and want to do a diagnosis. I'm scared to get help whether people will think I'm crazy or say I'm fine right out the bat, and I don't know if there are qualified therapists in my country. Help me find help.
🥺 love from Cambodia
Hello in Cambodia. I am hoping that you can find help for treatment for Pure O OCD, but, this may be very difficult for you to find in Cambodia. It is common for people with Pure O to obsessively “check” to see if they are having the obsessive thought, separating it like you are describing and even checking on their emotions as well. The inward, mental checking becomes the compulsion. It sounds like you are doing inward mental activity when you notice an obsessive thought and this mental activity of checking, analysis and separation is the compulsion that is feeding the ocd. You have to stop that compulsion. I know it may feel automatic, but, you are actually doing it. When you catch yourself either before, during or after the mental activity, tell yourself that it is ocd and you need to stop the mental compulsion. Eventually, you will catch the urge before it happens and you will be able to “not” do it. Most clinicians call this process “mental checking”, but, I understand that your process has a bit more mental activity added to the checking. You will need to stop doing all of it the best that you can. This will be your version of Response Prevention.
I have lots a job that for 8 years was my distraction from problems and gave me feeling of safety and all my social life was there and now when o am off I don’t know what to do with myself and I have very distressing thought that I am obsessed about this job 😞 I also suffer from agoraphobia
I am so sorry that you lost your job. It does seem that intrusive, obsessive thoughts bother us more when we are not occupied and surrounded by people. My first thought would be to find another job. You will probably do better if you are around people. Because you were able to push through the agoraphobia in the past, you will be able to do it again.
Thank you very much
Hi, so long without new videos by you)
Thank you noticing, Mike. I have been creating a few online courses for people with health anxiety, panic and agoraphobia and soon, derealization/depersonalization and ocd. But, I hope to get back to RUclips later this month. It makes me feel good that you noticed 🙏❤️
Hi Paige ,
Here a question again.
I think I suffer from arythmomania
Ocd. I have intrusive thoughts
about multiplying and also
so much fear to do it all
Day long, what doesn't Happen.
There ist no really trigger, Just
the thoughts. So I try to
prevent it and Control my
Thoughts. So ist multiplying
already a Response although
I am afraid of doing it?
How should I do ERP?
Really multiplying (in mind)
or only thinking about it to
rise the fear?
Hi Susanne. It sounds like your fear is that you won’t be able to stop multiplying or will think about it forever and this will cause you to suffer and possibly just go insane. Is that close to your core fear? And your compulsion is thinking about multiplying, actually multiplying and probably mentally checking if you are or want to multiply.
You can do ERP by bringing it to your attention. You could paste little equations on stickers all over your home, computer, phone, etc. Make the equations difficult so that you can have an exposure of wanting to multiply, but you can resist doing it. You can also listen to scripts about never being able to stop multiplying and you can use the I. A.M. method when it comes up in the moment.
@@PaigePradkoTherapy Thank you!
I have no interest in acting on my obsessions but what about aggressive ones? The thing is that my boyfriend has aggressive obsessions and I am scared he will act on it one day. We wanted to have a family, but I don't want to live in fear that he might act out aggressively. I love him but because of this I am considering leaving him.
Hi Celeste. It sounds like your boyfriend may have harm ocd. Of course I cannot diagnose on RUclips and do not know his history. However, if he does have harm ocd, he is possibly the last person that would actually harm someone or want to harm someone. I have worked with many people with this ocd theme, as it is very common, and I feel completely safe with them. It is also very treatable. If you or your boyfriend are interested in more help, please send me a message on PaigePradko.com. I have more treatment opportunities coming up in the next few months.
Also I had many other changes , stresses and loses in a short period of time and I don’t know should I continue ERP or start relaxation techniques. For last three weeks I am having nearly constant anxiety, not much eating and sleeping. I am all confused about what to do.
People do need balance in their life. ERP is something that someone with ocd remains using anytime their ocd acts up. I do not recommend relaxation or breathing techniques as a response to obsessive thoughts. But, there is nothing wrong with doing meditation and practicing breathing techniques and exercising daily as a part of healthy living.
Hi Paige - would you be interested in creating a video to help tackle relationship anxiety. The needy feeling that my partner is too busy for me, that I’m always hunting for scraps of attention / love.
I have a great interest in relationship OCD, or ROCD. This affects so many people. I have this on my to do list. Thank you 🙏
What is the role of therapist DURING the exposure? It is my understanding that we should not coach the client through the experience, but allow them to feel the distress and manage. So do I just sit there while the client panics? Any insight is appreciated!
You are absolutely correct. And thanks for asking such a great question. I do not stay completely silent during their entire exposure. I will say little things every now and then, depending on the client. I might say something like, “stay with it” or I might ask them to describe what they are experiencing. Sometimes, I might ask them if they can add a fearful thought to their exposure. Afterwards, I really try to have them consolidate their learning by describing how they felt before during and after the exposure and describe what they learned and how they might change it up next time. Sometimes, if I have a sense that the client is not that anxious, I may say something alarming to them to bring up their anxiety. It is so difficult, but, I try very hard to not reassure the client during the exposure. They do understand that, but, it is still difficult to not reassure them. Great question.
Hi Geri. It sounds like you are experiencing panic and ocd. If you go to my playlist page on my channel you will find a lot of help for anxiety, panic, ocd and how to do ERP. My main advice is to practice response prevention. That means no compulsions or avoidances or safety behaviors as you go through your day. When you brain gets highly anxious, you want to give your brain every opportunity during the day to learn that you are safe. When you avoid something or do a compulsion, your brain believes that those behaviors are the reasons you are safe…which makes it more difficult the next time. Start out small…do easier exposures that you know you can do, and build your confidence up slowly. Don’t worry about making a hierarchy, just do what you can do. Some days we can challenge ourselves much more, other days we just do the best we can do. Panic, as uncomfortable as it can be, is not dangerous and this will quiet down when you begin to practice your exposures daily. I am working on some online classes to help people with treatment that will be available soon. 😊
@GJM Yes, you have a good strategy. OCD wants to keep you in that loop of worry and panic about your thoughts. The more opportunities you have to simply not respond to them the better. I would recommend staying with the I. A.M. method, where you identify it as an ocd thought, you allow it to just be there without alarm or concern…as if it means nothing at all…and then move on to what ever you were doing before you had the thought. Don’t be concerned with habituation, just keep repeating the strategy of I. A.M. 😊
Hi Page. If you try to do exposures and think about your O, are you rewiring your neuropath ways to think about it MORE often?
Hi Larry. That’s a great question. Many people fear thinking about their pure O theme on purpose during ERP because they fear it will make it worse and cause them to have the thought spontaneously more often. The reason a thought becomes obsessive or gets “stuck” is because when you became aware of the thought, it made you uncomfortable or anxious, scared or even disgusted for some people. The purpose of ERP is to trigger your core fear associated with that thought, and rewire the thought in a new way that is not associated with fear, anxiety or disgust. We call this safety learning. The answer to your question is, “no”. We are not rewiring or creating new neuropathways to have the thought “more” often. We are triggering the core fear so that if the thought pops up, it will not be associated with a fear or anxiety response. I use an analogy of watching a scary scene in a movie over and over again, and it loses it’s ability to make us feel scared. When a thought losses it’s ability to make us uncomfortable, we no longer associate it with a fear response and the thought will pop up less and less because the brain no longer thinks it is significant.
@@PaigePradkoTherapy Bless you… your answers are always clear and concise and makes great sense.
Is it normal part of OCD recovery to eventually experience intrusive thoughts without anxiety? Since I've been doing recovery work, these thoughts no longer bother me nor do they make me distressed. Is this a sign of recovering? Secondly, should people without OCD examine every thought that pops into their head or Is it Always better to let intrusive thoughts be without paying attention to them, even when not having OCD?
Hi Andrea. Yes, it is normal to experience intrusive thoughts without anxiety. Some experience anxiety, others do not. No one, to be honest, should be examining every thought that pops into their head. Neuroscientists have estimated that we may have 60-80,000 thoughts a day. Some times people with ocd are anxious about what it means if they are not bothered by their thoughts. My advice to them is to accept the uncertainty and doubt about what it may or may not mean if we are not anxious about our intrusive thoughts. We have no way of getting to any evidence about what that means about us. The goal of ocd treatment is to tolerate not knowing the answer to those types of questions…and accepting the uncertainty of that.
@@PaigePradkoTherapy Thank you for guidance. I was just interested on the right way to respond to the thoughts. I've been told to examine them, but I find this very exhausting And unhelpful. In fact it was this 'examination' that caused my intrusive thoughts to become obsessions
I am so sorry you were given the advice to examine your thoughts. That would likely cause rumination and mental compulsions. I am glad that you learned that mental analysis is not helpful.
@@PaigePradkoTherapy so if I get a random intrusive thought after I recover, I should just ignore it And not examine it in any way?
@@andreacervenkova9005 yes actually this is a process in which u have to learn to live without judging the thoughts❤have a good day
Hello dr paige just wanted to say ur videos have been so extremely helpful as i have just recently discovered im having ocd and is currently doing erp on my own on a daily basis. I was just wondering if you could do a video on how to transition from doing the old habituation model erp to the new inhibitory learning theory because i am having a hard time and when you said that habituation model is not as effective it made me feel that i have wasted time trying to do it and this gives me even more anxiety
Hi. I love your questions. No, you didn’t waste your time on the habituation model. There is a lot of cross over in the 2 models. Most therapists I know, including myself were trained in the emotional processing model (habituation) and have transitioned to the inhibitory learning model because it has increased effectiveness. But, I borrow from both models and try to meet my clients individual needs. You haven’t wasted anytime at all. I have a self help course on how to do ERP for OCD using the inhibitory learning model coming out in March. If you have an interest in learning more, I think you would really benefit from it. If you are interested you can send me a message on PaigePradko.com, or join my newsletter and I will send you more information. This may help as well. www.paigepradko.com/erp Thanks as always for the great questions and suggestions.
But it'll not work for someone with health anxiety, can't expose themselves to actual diseases and get comfortable, I don't understand how a person with fear of a certain diseases when logic also supports it - like I take finasteride for Alopecia and I read that it can cause PFS which is incurable - so my ocd kicked in and so did anxiety, how can I use ERP in this case? As I won't be exposing myself to the actual PFS and get comfortable with it. The more I read about it the more paranoid and anxious I get thinking I've already taken the dose, I can't undo it and logically it can happen. So its not a fear of something that is logically impossible; which makes it more real and threat.
There is often a confusion that happens in people with health anxiety that confuse possibility with probability. And then, like you are describing, the doubt and ocd are activated. Focusing on response prevention is helpful, making sure that you are not doing any behaviors to support the ocd.
I have a question, so I understand everyone has anxiety because let’s say someone is about to get hit with a ball they’re going to get scared of course. But since people with OCD have more severe anxiety is it possible to not have ocd come back if one is completely free from severe anxiety in general ?
This could be partly true. OCD does get worse if one reacts with fear to their thoughts. Although we cannot stop the initial whoosh of anxiety, we can stop the anxious, worried, what if thoughts and the compulsive behaviors that feed the ocd cycle.
@@PaigePradkoTherapy yea since ocd is mainly triggered by anxiety once someone with no anxiety at all they would be less likely to have it again correct
How do you treat health anxiety OCD with ERP for specifically cancer fear? Thank you!
Hi Barb. I have been working for the past few months developing an online class for the treatment of health anxiety/ocd. The class will be available in less than a month. But, until then, here is a playlist to help you. It is not as complete as I would like it to be. ruclips.net/p/PL1lUhuKpYUYonn-zlZxzTRR8V4myEHgCY. If you are interested in being notified about the course when it is available, please send me your email through PaigePradko.com
I have ocd and that's I went to a place to work 2 days so to fulfill 3 times I want to go there again
Doctor pls give me a solution for this
I am so sorry. Unfortunately, that is magical, superstitious thinking. To treat this, you do not give into your compulsion.
Please let me know if you ever open a waiting list for zoom cash patient consultations, since have not heard anyone else explain things and help as much as your videos so it would be a true blessing to have a consultation with you! 🙏
Hi Cecilia. Please feel free to contact me through PaigePradko.com 😊
Hello,
My erp therapist has only given me one kind of exposure- reading off an index card. I have asked them several times if there will be different kinds of exposures and he says there is not. What else could I be doing?
Unfortunately, I am not sure what you are going through. But there are many different options of exposures for OCD regardless of theme.
My ocd switches I got hocd but I was seeing a girl now she left me now I carnt get her out my head
Hi Johnny. I am sorry that you are going through that. It is common for OCD to switch themes. Here is a video where I talk about how to treat that:
ruclips.net/video/_0-48NxOgjo/видео.html.
Yes, I'm LOVING this content!!
I am so glad. I have been wanting to make this video for awhile now. Glad you like it.
Should the same be be followed if there is no fear? I have contamination OCD, and I'm just scared of making everything "dirty" and it just feels disgusting.
Hi Arie. Instead of fear, you will be doing exposures to tolerate the feeling of disgust. It takes longer to make progress with disgust compared to fear. The same principles do apply. Sometimes people with difficulties tolerating disgust practice response prevention and look at stopping the compulsive behaviors and avoidances as a main focus of treatment.
@@PaigePradkoTherapy Thank you so much for the help!! So does ERP not work for such a case, or should I keep trying, and only start focusing on response prevention when I'm sure ERP fails? When and how do you think I should shift my treatment?
When I am working with a client with disgust, I still start with ERP and then monitor the progress. If the client is consistently doing exposures, but not seeing progress after several weeks of ERP, then we switch to a response prevention treatment where they work on tolerating the disgust feeling and still do what they have to do. But we make sure there is no avoidances or compulsions. Sometimes disgust is stubborn and ERP can work…but progress is just not as fast as fear. I wouldn’t recommend shifting treatment unless no progress is made after consistent exposures for several weeks.
@@PaigePradkoTherapy Thank you for the information, I will continue to work on ERP as I do see progress to some extent even if it's really slow. I'll definitely look into response prevention if I don't seem to improve further. Also you mentioned they still do what they have to but don't avoid or do compulsions, does it mean they do ERP anyway, but focus more on not doing the compulsions and responding rather than focussing on exposures?
If they transition treatment to response prevention…then they do what they have to do in their daily life…and focus on not avoiding or compulsing versus doing intentional exposures. But, it sounds like you are experiencing some progress. In your case, I suggest continuing as ERP works with disgust…just a slower progress rate. If you need more help, I have a course where I cover this in more detail in treating OCD. It will be offered in April. For more information: www.paigepradko.com/ocd
Thank you!!!!
I have ocd of food allergies my diet is limited due to it I’m terrified of any of the major allergens even though I have never been allergic to anything
Hi Melissa. I am glad that you have recognized that your fears are triggering OCD. Sometimes people are mistakenly treated for eating disorders when OCD is actually the trigger. I do recommend working with an OCD specialist if at all possible for more help with ERP. I will have more treatment options available in the coming months for people with OCD that you may be interested in. Please sign up for my newsletter on PaigePradko.com if you would like more information.
Hi I have a question about OCD treatment. Basically, whenever I have an intrusive thought, I completely ignore it, I don't analyze, I don't try to correct it or convince myself wheter it Is or isnt true, I just move on And don't pay attention to it. Is this the right way of dealing with OCD And intrusive thoughts?
Yes. It is absolutely the right thing to do. Great job! Many people have such a hard time doing that. ❤️
@@PaigePradkoTherapy thanks! And can some intrusive thoughts be about completely irrelevant things that arent important for me, such as doing something strange in the public etc?
Yes…they can be about anything 😊
@@PaigePradkoTherapy I'm asking because someone told me to replace OCD thoughts with pleasant thoughts, but I find this to be a mental compulsion that makes the intrusive thoughts become more frequent. I also think that replacing every single intrusive thought Is very exhausting And doesn't work to treat OCD at all. I'm not a therapist but I Always thought that OCD recovery is about accepting intrusive thoughts without asigning meaning to them And not about getting rid of them
Can you please do a video on metaphysical contamination OCD
Thank you for the suggestion. I made a note to include this on an ocd themed video in the future. 😊
You r excellent......
Thanks for watching…hope it was helpful 🙏❤️
Hi Paige,
I was wondering if you were taking on new clients and whether you would take on clients from the UK.
I have so many questions that I want to ask.
The treatment seems very similar to the way Dr. Claire Weeks worked.
She basically said that it is the "no longer mattering about the symptoms" that brings recovery and freedom. Am I correct? Is there any way in which the recent advice differs from Dr. Weekes and if so in what way?
Is it alright to loosen your body whilst doing exposures as Dr. Weekes says or does this weaken the effects of the exposure?
If I followed Dr Weekes would that also lead to long term recovery or is there something extra I need to do that the new research has found to be more effective?
Thank you.
Hi Charlotte.
Nice to hear from you. I read Claire Weeke’s book on Agoraphobia several years ago, and would have to review what she said. But, it is interesting on how much she did get right during a time before we had functional MRI scans to view brain activity. Yes, you can relax yourself naturally during the exposures, but, do not practice relaxation techniques during the exposures. Just do the exposure and let your brain learn. If you are doing a driving exposure, I do remind my clients to loosen their grip on the steering wheel. To answer your question, I do work with clients in other countries, but, am not adding names at the moment to my waitlist. I will be working on an online therapy class for people with Agoraphobia that I hope to make available this year.
Hi Paige,
Thank you for your reply. I followed Dr.Weekes when I had my first panic attack and I was able to lead a semi normal life, however I do have a lot of safety behaviours. Should I stop all safety behaviours from now on when I go out or should I eliminate them one at a time? I am very interested in your online course do you think it would provide sufficient support for someone recovering without a therapist?
Hi Charlotte.
I think reducing safety behaviors one at a time makes sense. You want to feel challenged, but still feel like you can complete the exposure. I am creating therapy courses with instruction, that is broken down into separate sessions. For many people, there are just no therapists available and I am trying to accommodate for this. However, a best case scenario is having your own therapist and using my course as additional education and support.
Thank you Paige that was very helpful. I would love to work with a therapist but I trust that what you are teaching is the most effective way to long lasting recovery and I don't know any therapists who would work in that way. Do you think if I found someone who practiced ERP, as you advised me to do previously, I could ask them to implement your methods or would they be offended?
Thank you for your help.
Hi was just wondering if this met this works with intrusive thoughts ocd ? And can u litterly rewire your brain to get better ? Thanks :)
Hi Danny. Yes. The research on this video applies to OCD and Pure O OCD or intrusive thoughts. If you need resources for more help, please feel free to contact me on paigepradko.com
New Hope 🙏
🙏❤️
So do you not recommend I.A.M. method for Pure O OCD anymore?
I absolutely do recommend using the I. A.M. method. But, there are different kinds of ERP or exposures. The I. A.M. method is an Incidental “unplanned” or in the moment exposure. The suggestions I make in this video are for planned ERP or Exposures. I hope that clarifies it. Thank you for your question 🙏😊
@@PaigePradkoTherapy yes it does thank you! Do you have an email where I can contact you privately?
@@FamilyDinnerDelights . Yes, you can send me a message on PaigePradko.com and it comes to me privately.
Hello mem ..I want take full course of ERP therapy..can you help me
I am working on some online classes, but, do not yet have them available.
Is there any way to distinguish intrusive though from a real one?
Intrusive thoughts are distressing thoughts that are unwanted and are reoccurring. Other than that, thoughts are just thoughts. They are just mental activity. If you have ocd, the thoughts are distressing, unwanted and occur obsessively.
I have religious ocd I feel guilt over my ocd thoughts? How to overcome gulit mam? Please help me 🙏
OCD can be so exhausting. I am sorry that you are going through this. I do have a video on Moral Scrupulosity. It is a similar theme, and the treatment is the same treatment. ruclips.net/video/fXzs4F0BNTo/видео.html. The feeling of guilt is very strong with all ocd themes. Part of the treatment is challenging yourself to tolerate the guilt without doing anything to avoid that feeling. I wish you the best.
@@PaigePradkoTherapy Thank you mam for your reply I feel like its good thoughts and it's bad thoughts. How to stop judging the thoughts?
@@PaigePradkoTherapy mam how to do ERP for religious abusive thoughts?
How can I contact you?
Hi Vicky. You can leave me a message on PaigePradko.com
Mam i have health anxiety i was scare to vaccinate for covid. Can i vaccinate i was so negative about vaccination for covid.
Hi Arun. I understand. Health Anxiety can cause so much uncertainty about our health. But, people that were even skeptical about the vaccine, now seem to be getting the vaccine. When you break down the risk, it is clear that we have more risk not getting the vaccine, than getting it. It is ok if it makes you anxious thinking about it. You can tolerate that anxiety. I am working on a class for health anxiety that will be available soon. I will post on my channel when it is completed and available.
@@PaigePradkoTherapy thanks for your reply
40 to 50%? What is your source? Where did you get those numbers?
They are shocking numbers. My source is (Craske et al. 2008, 2014). Joseph LeDoux also addresses these poor results in his book, “Anxious: Using the Brain to Understand and Treat Fear and Anxiety”. Michelle Craske also has several talks on RUclips where she talks about these results and what led to her work that resulted in Inhibitory Learning Theory.
Mam i have Harm and RELEGIUS ocd every time i m very sad pls tell me how to cureable it permanently
I am so sorry that you are struggling with those themes. All OCD themes are treated with ERP. You do exposures on your thoughts (scripts are a good option) and you do nothing to reduce your discomfort. Here is a playlist that may help you. Be sure to watch the videos on scripts, mental compulsions and moral Scrupulosity may help as well. ruclips.net/p/PL1lUhuKpYUYqKvEwlGXoRPDu_8blhbaq-
@@PaigePradkoTherapy it is cureable or not
Are OCD thoughts dangerous?
Thoughts are just neutral activity, Andrea. But, I realize that sometimes you are wanting reassurance and I want to try my best to not give you reassurance as it feeds the ocd and anxiety worry cycle.
@@PaigePradkoTherapy I still have setbacks in my recovery. I read online OCD thoughts Are dangerous. It sounds to me like nonsense, how could a mere thoughts be dangerous, only actions are. But it still kind of freaked me out.
I learned a lot through this!
P.s. I am “jess_positivity” on Instagram where I’m always following your content there!
Hi Jess.
I love your music. You are a very talented artist. Thank you for watching. ❤️
surprise your brain
anxiety tolerance
violent your expectations
very context
you - tracking
Thank you 🙏
I have sexual intrusive thoughts and I dont know what to do to not think about it I need some tips what to do 🥺
Hi Algene. I am so sorry that you are struggling with these thoughts. Here is a video to help you. ruclips.net/video/c-HKZNh88dQ/видео.html
I have an online course coming out to help you with this at the end of March. Send me a message on PaigePradko.com or join my newsletter there and I will send you more information. And here is a pdf that you may be interested in www.paigepradko.com/erp.
I watched the ads!!!! hehehe
You’re the best! ❤️
my home should NOT have cctv
As an OCD sufferer I find your background very distracting. (I say in part jest and part seriousness)