Ep. 195 Depression as a compulsion (with Shala Nicely)

This is Your Anxiety Toolkit - Episode 195. Welcome to Your Anxiety Toolkit. I'm your host, Kimberley Quinlan. This podcast is fueled by three main goals. The first goal is to provide you with some extra tools to help you manage your anxiety. Second goal, to inspire you. Anxiety doesn't get to decide how you live your life. And number three, and I leave the best for last, is to provide you with one big, fat virtual hug, because experiencing anxiety ain't easy. If that sounds good to you, let's go. Kimberley: Hello there. I have with me a very special friend who is going to talk about something so important. So, so important. I am so excited to have with us Shala Nicely. Oh my goodness, thank you for coming back onto the show. Shala: Thank you so much for having me. I love being here. Kimberley: Oh my goodness. Okay. So, probably the reason that I have been so adamant about getting you onto this episode is this topic that we are going to talk about is probably one of the topics that comes up the most with my patients and clients that nobody is talking about. Shala: Yes. Kimberley: Nobody. And I am seeing it more and more and more and more and more, which is why I wanted to have you on. So, thank you. Shala: Yeah. Kimberley: Thank you. Okay. So, you wrote a blog about depression as a compulsion. Can you tell us what does that mean? Shala: Yes. I'll start off by saying that this is one of the many subtleties of OCD. Sometimes OCD takes a long time to figure out. I spent years becoming a therapist. I spent years thinking about my own experience and when I was writing my memoir Is Fred in the Refrigerator?. It wasn't until after Fred was published, that I figured out this particular compulsion that I had been doing. By identifying it, it's been able to help me make a huge difference in my recovery, and that's why I wanted to share it and write the blog. Kimberley: Right. It's so important. I mean, I can't tell you, I've been practicing for many, many years and I only came across this in the last year or two. But the more I get to know it and the more I understand it, I'm just like, I feel like I see it in almost all the cases in some way. So, go ahead. Tell us what it is. Tell us what it looks like. Shala: So, I'll give you an example that I used in Fred, which is, when I was in my twenties, I was convinced I'd given myself HIV aids because I had gotten cut with a broken beer bottle at a party and I had spent all this time in my head arguing with OCD about whether or not that you can transmit HIV aids through that. It went on for months and months and months. While I was doing all this ritualizing in my head, trying to figure this out and prove to myself I didn't have this disease, which this was years and years and years ago, the treatments for HIV aids are much better now, they weren't. This was 25 years ago. I know people with OCD are still frightened of it. I was really frightened of it back then because there weren't very many treatments for it. And so I would spend all day long thinking about how I had given myself a fatal disease and how I was going to die. And then I started acting as though I had a fatal disease that there weren't good treatments for and I was going to get it and die. So I would go into situations and put on a happy face and smile, but in my head, I was thinking, "Oh, this is the last time I'm going to be doing this. Oh, this is so sad. Just wait until people find out what is really going on with me." So I would focus in those situations on how awful this was and how depressed I was and how this was going to be the last time I was going to do it. So, I was actually acting as though what OCD was telling me, which is that I'd given myself fatal disease, was true. And the depression that came from that became the compulsion because I took that emotion and I acted on that emotion. So I started acting depressed, making depressed choices, living in a depressed lifestyle, having a depressed attitude as I went out into the world because I had given in completely to what OCD was saying. When I realized that, again, this was after I'd written the story, after it had been published, and I started seeing this in my clients. I started recognizing I still did some of this. I'm like, "Wait a minute, it's the depression itself, which was really propping all this up." It's really a very subtle form of compulsion that if you don't recognize it can sabotage your ERP work. Kimberley: Yeah. I would admit as a young intern of treating OCD, I think if I saw this, I would have stopped ERP and focused on depression and really worked on that, which is not a bad solution, but without really recognizing it under the lens of OCD, right? So, I would have seen it as separate. I love it. Let me explain how I've seen it a lot. Once I've shown them your article, patients and clients have said, "I recognize in the moment that I'm having uncertainty. I try doing a compulsion to make the uncertainty go away and that doesn't work. So, going into depression is our easy way to just exit out of uncertainty. It's the worst-case scenario. That's where I'm going to hang out." That has been so helpful for people to be able to recognize that. It's a response to not wanting to be uncertain. Shala: And I think it's important to differentiate between depression that comes secondary to having a diagnosis of OCD from this, because a majority of people with OCD will end up with some form of depression at some point, because it's just so debilitating. It's the 10th most debilitating condition in the world. So people will end up depressed just because of how exhausting it is to manage this monster in your head all day long. But that's very different than being depressed because you've decided to believe that the OCD is true because you cannot figure it out otherwise. And OCD just wants certainty. It doesn't care what kind of certainty it gets. If it can't get certainty, for instance, that I don't have HIV aids, it's just going to go the other way and say, "Well, I'm going to get certainty that she does have it," and then go from there and then becoming depressed as a result of that obsession. So, I think that's really important for people to understand. You can have both going on at the same time too, which makes this even more tricky. Kimberley: Yeah. Even more tricky, but even great to know that we can differentiate the two now, because we'll talk later about how to manage that. Now, this is where I want to look at insight because, in your blog, you talk about insight. I think that's an important piece of this, right? Because when you first have the onset of OCD, you might recognize that this is like ego, what we would call egodystonic, like this stuff. "I know it's not true, but I keep fearing it's true." Can you share how insight impacts this specific situation? Shala: Yes. In fact, it was Jon Hershfield who introduced the two of us years ago, who helped me put this insight about insight together, because I was talking with him about this depression is a compulsion. What he pointed out is that typically, when an OCD obsession starts, you're doing compulsions to try to prove that it's false. If you can't get that to work, which of course you can't because there's no way to prove all this stuff that I see he's worried about, then sometimes you can start going the opposite way and trying to prove that it's true. Really that's the difference between insight. When you're trying to prove that it's false, then you know that what OCD is saying in some part of you is nonsense. "I don't have HIV aids, come on." Not like in a reassuring way, just there's a part of you that still recognizes, "Yeah, this is super scary, but this is OCD reacting to an intrusive thought. This isn't actually a real problem." So, you've got that insight there. You're still stuck, but you got insight. When you start trying to prove it's right, that's when you've lost insight. When you really give in to everything that OCD is saying, really hook, line, and sinker, and you don't have any insight anymore. That's really when this depression as a compulsion becomes a big problem. The longer that a particular obsession is maintained by doing compulsions, the more likely you are to lose insight, the longer it's been going on. Kimberley: And this is where it's hard, isn't it? Because we know the whole story of when you stare at something for too long, it starts to look weird and distorted. I think that's very much true here. I think it's true of depression in general and in this subtle compulsion. When we look at things as negative, we notice more and more things that are negative. Is that what you feel to be true here? Or is it just the same story that you hear over and over? Share with me how that might sound in your head. Shala: I think it starts to sound like a soundtrack for my life because most of my rituals became internal. And the way I see mental rituals, it's physical rituals taken inside. So you can't do things physically because you don't want people to see or whatever. So you start pulling it inside. The more that I would do that, the more I would argue with OCD, of course, the more I'm strengthening in it. So the more I hear it and the more I argue, it just expands to fill every waking moment. It really becomes a soundtrack playing 24 hours a day because I was doing those mental rituals. And then the longer that that went on, the more likely I was to start becoming depressed because I was losing insight, which then also further reinforces this cycle. Kimberley: So interesting and so helpful. One thing that you talk about is emotions as a ritual. Can you share how this may play out with other emotions such as – you've written guilt and shame, regret and grief? Shala: Yes. So what I'm going to do to describe this is I'm going to take you through the OCD cycle in some anatomical details, so to speak, so we can piece together how this is all happening. So you have an intrusive thought. That is not OCD because everybody has intrusive thoughts. The OCD is the next stage where OCD reacts to the intrusive thought – "Why did I have this? What does this mean? Am I going to do it? Am I going to make it come true because I have the thought?" That reaction, that's the OCD. Of course, that makes you feel anxious. And then if you haven't had treatment, you typically do some form of compulsion, something to try to get certainty about what the OCD is bothering you about, because this is all based on an intolerance of uncertainty. And OCD just picks content that you care about and puts uncertainty about it in your mind and then gets you stuck in that cycle. When you do a compulsion, it tells your brain that this is a dangerous thought, "This intrusive thought I had is dangerous," and you need to keep doing something about it. These steps just repeat on an endless loop. And then what happens is that when it repeats on the loop long enough, the acceptance of the scary thoughts that OCD is presenting causes you to experience the emotions that you would feel if those stories were true. Those emotions tend to be things like depression, as we've talked about, guilt, regret, shame, grief, and others. And then in classic cognitive behavioral therapy perspective where our emotions and our thoughts and our actions all come together in this triangle, the emotions then dictate how we act, so we begin to act depressed or guilty or regretful or shamed or grief-stricken. Those emotions can then become compulsions because they're driven specifically by believing the content of the OCD, by acting like what OCD is saying is true. That's the definition of doing compulsions. So that's how emotions can become part of the compulsion cycle because you start acting as though they're true. Kimberley: Right. This is so true and this is where I see it play out a lot, is when people have an intrusive thought that they've done something wrong, and then they feel... Because they start to believe it, they go into regret and then they go into confessing, right? Then they'll go into like, "Well, I have to confess it because I've done something wrong," instead of that they had a thought that they did something wrong. Or that they feel such deep guilt that they're saying things like, "I'm a terrible person. I'm terrible. And I'm so guilty. What kind of human am I?" because of a thought like you've just described, how then that plays out and keeps playing out over and over again. Let's play out because we haven't really talked about this, but what would the action be as a result to regret? It would be reassurance seeking or confessing. What else would you say? Shala: Maybe going back in your mind and trying to undo it and, "Gosh, what would it be like if it had only gone like this?" Almost like a wishing compulsion that I think [14:22 inaudible] talks about in his book. All sorts of things like that. Kimberley: What about guilt? Similar, but what about guilt? Shala: I think with guilt, it's a lot of self-punishment as a ritual. "I'm bad. I did something bad." With guilt and shame, guilt is, "I did something bad," shame is, "I am bad." I think in this case, those can get conflated together and people just start punishing themselves. "Well, I don't deserve this because I did this bad thing," or "I am this bad person." They start being very uncompassionate with themselves and treating themselves like they're this horrible human being. Kimberley: Right. And that's a big part of how I see it play out is that the self-punishment is pleasure withholding, like you don't deserve the nice-- it could be as subtle as you can't have the nice brand of crushed tomatoes. You have to have the crappy brand because you don't deserve good things or you don't deserve the nice sheets or so forth. And that will make you feel-- when there's no pleasure in your life, you get depressed, right? I think that's a very subtle way that OCD plays out. I've heard lots of people will say, or the flip side is they'll say something like, "Oh, because I have harm thoughts about my child, I have to buy them the best diapers," which is treating yourself as if you've done something wrong. Shala: Yes. You're making up. Kimberley: You're making up for something that you had a thought about, right? Shala: Yeah. Kimberley: Right. It's so subtle. What about grief? Can you kind of give an example of that? Shala: I think with grief, it's pre-planning things. So, for instance, I'm not kidding you, I've pre-planned my funeral in my head – "Well, this is what it's going to be like. It's going to be so sad and I wonder if this will happen and that will happen," as though it's an event two weeks from now on my calendar, Shala's funeral. So I think it's almost like you act like the loss has occurred already and you begin to start going through the grieving process. People with OCD tend to be really empathic people, so it's really easy to go there. It's easy to put yourself in that, "Oh, so-and-so has died. This horrible thing has happened. Let me go ahead and get into that grief state," because we're just good at being able to put ourselves in other people's shoes to imagine what something would feel like, and to feel it as though it were happening. Kimberley: It's so good. All right. So-- Shala: Can I say one more thing? Kimberley: Of course. Shala: Sometimes I think of these as fake emotion. They're not, right? But they're OCD-induced emotions. Kimberley: They're manufactured. Shala: They're manufactured. They don't actually fit the truth of the situation. I'm not saying they're fake like, gosh, the shame you're feeling or the guilt you're feeling isn't real. Certainly it's a real emotion, but I think it is induced completely by the OCD, as opposed to being induced by a situation that has happened in life. Kimberley: I agree. And that's where that insight is really important, right? Is to be able to catch that. I fully agree with you. I'm so glad that you recognize that because people will say it feels real, right? It feels real. And then I'll always follow up with like, "But it's not a fact." But still, it's important to have that conversation. Now, I want to just jump in here. Before we talk about how to break this cycle, how might this play out with just Right OCD? Shala: I can give you an example from yesterday about this. Kimberley: All right. Shala: I decided I was going to get these floating shelves and hang them on the wall. It requires using a drill and all sorts of things, which I can do, but I'm not very good at it. I also, I guess, was sort of distracted and I'd had problems with one of them and with the drill, as I went downstairs to do the other one. I put the shelf a couple of inches too high because I used the wrong mark on the wall, probably because I was exhausted from having drilled drywall over the place and making a huge mess upstairs. Once I got the shelf installed, I'm like, "Oh, what's that little mark on the wall? Oh, that was where it was supposed to be, a couple of inches higher." I am not redoing it because it made a huge mess in the wall and it's going to have to stay there. My OCD put this little feeling in my stomach. "That's just too high. It's wrong. It's horrible." I could feel it. Like, I feel it right in my solar plexus, this little tightening, like, "Oh, we can't stand this." What I decided to do, because I am not moving that, I just say, "OCD, this is great. I am so glad that shelf is at that level. I'm glad, number one, because it's upsetting you. But number two, it actually probably is a good level because I have a big dog who likes to bounce around on the couch. This is above the couch. If it's actually too low, he's probably going to knock his head on it and knock it over. We're just going to live with it. There are some good things about it being at this level, just like there's some good things about it being at another level. I'm just going to smile and be happy every time I see that shelf." So, when I see the shelf now, I really try to have good, positive, happy emotions about the shelf being at that level and tell myself, "We're not changing it. OCD, if you don't like it, fabulous." Kimberley: Right. But originally, was it that you would slip into a depression as a compulsion? Shala: Yes. So, what happens with Just Right OCD that can have this same thing go on is we look at the shelf every day and go, "Oh, it's ruined the house. The house is not perfect because the shelf is in the wrong place. If we could just move the shelf down." And then you envision moving it down, but then you think, "Oh my gosh, it's going to open up more holes in the drywall, and then I'll have to fix that. I can't do that. If I'd only been paying more attention." Everybody can't see this because they're not watching the video of this, but if you can see my posture, it's like-- Kimberley: It is. You're getting low. Shala: Like, "I screwed up and now it's bad and I'm depressed." And then every time you look at it, you have those regretful thoughts and you think about, "Gosh, how I'd like to change that." And that causes more regret. And then that fuels the whole emotions as a compulsion cycle. Kimberley: Which is interesting. I think this is true for any subtype. And you may correct me on this. The thought that I hear the most is, "This is going to bother me forever." That's where I feel like the depression as the compulsion set seen as like, "You'll never have happiness again. This is going to be the worst." And then you go actually, like you sunk down into that. You sunk in and you stayed into that kind of mindset. Is that an example you would give as well? Shala: Yeah. I think with any Just Right OCD, it's this feeling that life is somehow ruined because this thing is wrong. Ruined means forever. It's all blurry, black and white like you were saying. So it feels not only unfixable, but unbearable, and then giving into that and then acting as though this unbearable thing has happened, then becomes the emotions as a compulsion. I think this is probably pretty common within the whole Just Right OCD thing, is having so much regret that it's not right, then act as though that regret were true. Kimberley: Right. Well, okay. So, that's the perfect segue, is how do we break this cycle? How do we intervene? Where do we intervene in the cycle? Shala: The way that we intervene in this cycle, through exposure and response prevention obviously, is doing the acting as though the content that OCD is threatening you about or bothering you about is irrelevant. Let me start out by first saying how people tend to make mistakes doing this because I think this is important. So, as we know with exposure and response prevention, we're exposing ourselves to the uncertainty of the obsession while not doing compulsions. If you have emotions as a compulsion, depression as a compulsion, you can do an exposure. Think you're not doing compulsions because you're using scripting to get out of your head. You're not asking for reassurance. You're not doing your physical compulsions. But you're still bummed out, regretful, ashamed. So you're doing it while in your head, really spending a lot of time in that emotion. So you're really doing exposure without response prevention. You're doing some response prevention, but you're not doing enough response prevention. So the exposures don't work very well. People can get stuck in this cycle where they're doing ERP over and over and over again and they think that they're getting rid of all these components and they're not getting better. It's probably because something like this is going on in the background where they're still, at some level, believing this and acting as though it were true. So, that's where people make mistakes. What we really need to do here is find that little bit of joy because it's there. It's probably been so covered up by the OCD, the depression, whatever other negative emotions you're experiencing, that you don't think it's there, but it is there. You can take yourself back to when you were really happy about whatever it is, like, say that you think you're going to harm your children. And you can remember times that you were with your kids where this wasn't bothering you. So, you take yourself back to that and you think, "How was I acting? What was I doing? How was I feeling?" You find that and you go do those activities and you focus on that joy. So, when the OCD says, "Oh no, we can't, we can't. You're irresponsible. We were going to kill them. We're going to harm them. We have to focus on how bad we are," you're like, "Nope, I'm going to focus on how much fun my kid is having in the pool. Isn't this great? It's a sunny day. Really enjoying it. It feels so nice to be out here. Look how happy my kids are." You just find all of the joy you can and you focus on the joy. What we're trying to do here is act as though the content is irrelevant. So, if you're acting like it's relevant, you're standing in the pool with your kids going, "Oh my gosh, this is terrible. I'm going to kill them. They're happy now. But just wait until I kill them and their mother finds out or whatever, that it was me." Or you can be in the pool like, "This is great. I love spending time with my kids. This is awesome. Look how much fun they're having. They're doing so well with their swimming. They're having a great time. They could probably stay in here until they turn blue. This is great." You're acting like all that stuff in your head about the fact that you might harm them doesn't matter. And that's the essence of good exposure. It really takes this finding joy because you want to do the opposite of what OCD is saying. OCD says you should act depressed, regretful, ashamed. So you say, "I'm going to do the opposite of that. I'm going to act happy, jubilant, carefree." And that's how we do these exposures. It's not easy, but if you get good at it, it can be really revolutionary in terms of your recovery. Kimberley: I love this. So, I'm thinking of one particular person right now, and it's a follower actually. What would you say, because I love everything you're saying. What would you say to the person who then may start to do that as a compulsion too? Shala: Yes. I think that OCD can turn anything into compulsion. Kimberley: It's so skilled. There's such skill. So Shala: Yeah. I think that that is a potentiality for anything that we do with ERP. We are not doing this to make your anxiety go away. In fact, you're going to be more anxious while you're trying to find this joy because you don't deserve to be joyful. It is not responsible to be joyful. It is tempting fate to be joyful. So you're going to be-- Kimberley: Irresponsible is the word. Shala: Yeah. You're going to be having maybe 5% joy and 95% anxiety if you're doing this right. If you make this compulsive, you're doing it to reduce anxiety. I'm so glad you brought that up. That is what we're looking for here, is this is going to make you more anxious. And the more that you do it and really find the joy and act like you're having fun anyway, eventually, the anxiety will subside. Who knows when? It may take hours, days, weeks, months, whatever. But that is not the goal. The goal is to be in the situation while being anxious. And the more anxiety, the better, right? Because that means you're giving your brain a good learning experience. That means that you're doing things that help you tame OCD and reclaim your life. Kimberley: Right. Thank you so much for sharing that because that's such a crucial piece – to be able to integrate joy and anxiety in the very same moment. If you could do that, you're winning, right? You've won, because OCD wants you to integrate anxiety and depression at the same time. So, I love that that is the way to give OCD birth ultimately, is to show that you can do that. I love it. So, let's talk about one more thing. I want to be respectful of your time. Someone has had OCD for a long time, obviously, because this has gotten so stuck. They're having a lot of this depression as a compulsion. We're asking them to find things that used to bring them joy or look back to a time where they could integrate anxiety and joy at the same time. What are your thoughts around "Fake it till you make it"? Is that an approach that you would consider? I know you've talked about other ways. Would you like to share your thoughts on it? Shala: Yeah. I mean, there's nothing inherently wrong with the "Fake it till you make it" stand, except for if you're saying you're faking it, you're saying that there is no happiness there. And that's almost giving in to the OCD once again. So, what I like is a different way of phrasing it, which comes from a woman named Heather Hansen who wrote a great book called The Elegant Warrior. We've both been on her podcast. What she says is, "Show it till you grow it." I love that because that acknowledges that the positive emotions are there. The OCD is sitting on them and squishing them and you can't feel them, but they are there. That also reinforces this notion that the OCD, this is a bunch of content it's making up. It doesn't feel like that, but these are things that it has imposed upon your life to make you worry about them. But you've got this great life that sort of smushed down underneath it. And you just need to find a little bit of what that great life used to be and find that and grow that. It's almost like if you think of a black canvas and then there's a little pinprick of light, sunlight and it comes through as like a ray. And then the ray comes through and it starts to makes the black cloth start to have the hole, get bigger and the sunlight gets bigger. And then the sunlight comes through and eliminates everything. That's what we're talking about here. It's just a pinprick. It's a tiny bit, but it's really there. If you say you fake it till you make it, you're not giving yourself the empowerment you deserve, that it is in you. It is there. You just don't feel it because of the OCD. Kimberley: Right. It is. It's like a muscle that you grow. I agree with that. I think that that is exactly perfect for it because, like anything, if you're trying to get 100% joy, you won't get any joy. But if you give yourself permission-- because we can get perfectionistic about this and be like, "Well, no, this used to bring me so much joy." So I think you're right. It's just little baby steps and little baby pinpricks is the way. Shala: I'm so glad you brought that up because like all of us with OCD can make things compulsive. We can also try to do our therapy perfectly and try to do these exercises and go out and be like, "But I wasn't totally happy. I did have some intrusive thoughts. I did feel some depression." Yes, of course. You're going to. So, I think recognizing this is a process and what we're trying to do is find the 1%, the 0.05%, the 3%, the 15%, whatever it is of joy and focus on that. Yeah, you're going to have those depressed feelings. They've been there for a while. By the time you have depression or other emotions as a compulsion, it's probably been there a while. So, this process of ERP is also going to take a while and it's challenging and it's hard. So, you're not going to go out and do this perfectly. You're not going to go have some awesome experience with your kid. You're going to be acting as though you're having an awesome time. You're going to be trying to focus on that in your head. But the vestiges of the OCD and those other emotions are going to be there. Let it be there. We're not with this trying to shove those away necessarily and not feel them. What we're trying to do is focus on the ones that actually match the ERP, which is, if I'm going to go focus on being with my kids and having fun, that's what I'm going to focus on. Not this other stuff that's going on over there. But give yourself permission to have this be a messy process because it is and do it imperfectly because you're going to, because everybody does. It's going to take a while, because it took a while for all of us with this to get there. It's going to take a while to unravel it. And then even after you unravel it, it can still come back. I still have to watch for this one. If I get triggered with something that is a really high-level item for my OCD, I have to work on this sometimes too, because it's easy for me to sink back down to this because I did it for so many years. Kimberley: Which I'm so grateful that you share that because I think that for those-- and I want to make sure I just did it before we finish up and I want to hear about what you're up to these days is, the treatment for this is actually similar to the treatment of just depression too. You're working double shifts here, but in a good way. You're working on two things using the same tool. So, do you have any feedback on that? Shala: Yeah, that's a really good point. I hadn't thought about it like that before, but it's very much a behavioral activation approach. Behavioral activation is used in the treatment of depression to help people start to put activities back in their lives that gave them pleasure and that gave them some feelings of mastery. And that's what we're trying to do with the added component of "And let's focus on that pleasure. Let's focus on that feeling of mastery. Those other feelings are going to be there, but let's focus on the way life used to be before the depression came in." So, yeah, it is a very behavioral activation type approach here. Kimberley: Oh my gosh. I love it so much. It's so good. I feel like everyone needs to be trained in this specific area because it's such an important area that gets missed and missed and missed and missed. So, you're like brilliant, brilliant in my mind, as you already know. Shala: Well, thank you very much. Kimberley: Okay. Is there anything you want to add before you tell us the way we can find out about you? Shala: I don't think so. I think we've covered everything. Kimberley: Okay. Tell us where people can hear about you, your blog, and all the amazing things you're doing. Shala: They can go to shalanicely.com. On that website, you can sign up for my newsletter, which is called Shoulders Back!: Tips and resources for taming OCD. I send it out every couple of weeks and it has some sort of new resource I've created or been a part of every time I send it out, free resources to help people learn how to effectively tame OCD and reclaim their lives. So, that is where you can go. If you want to read more about this, this particular blog is on my Psychology Today blog. It's called The Subtle OCD Compulsion that you might not know you're doing. Again, you can go on my website and it'll link back to all the Psychology Today blogs as well. Kimberley: What about your book? Shala: Yes. So, both books, Is Fred in the Refrigerator?: Taming OCD and Reclaiming My Life and Everyday Mindfulness for OCD: Tips, Tricks, and Skills for Living Joyfully, which I co-wrote with Jon Hershfield. You can learn more about those on my website or on Amazon or anywhere that you buy books. They're both available on audiobooks as well. Kimberley: Right. Let me do a plug for your book because I have had so many of my patients say it's the first time they wanted to hand their book to everybody because it was exactly how it felt for them. I have so many clients who bought a copy for themselves and a copy for their parents because their parents were like, "Oh, this is what it's like to be you. Now, I finally get it." So, I'm so grateful you did that beautiful book. Shala: Well, thank you. That's the whole reason I wrote Is Fred in the Refrigerator? because I wanted people to understand how it feels to have OCD. If you have OCD, I wanted you to understand that you're not alone and that there is hope that you can get better. You can tame OCD and you can reclaim your life. Kimberley: Right. Oh my God, thank you so much for being on today. Shala: Thank you so much for having me. It was fun. Kimberley: Such important information. I can't say it enough. So, so important that we're addressing this more. I think that this can open it up to everybody having a better understanding. Shala: Thank you again. Website: shalanicely.com Is Fred In the Refrigerator: https://www.amazon.com Everyday Mindfulness for OCD: https://www.amazon.com Psychology Today blog ----- Please note that this podcast or any other resources from cbtschool.com should not replace professional mental health care. If you feel you would benefit, please reach out to a provider in your area. Have a wonderful day, and thank you for supporting cbtschool.com .