Understanding and Treating Real OCD with Berkeley Runia Paulsen (Part 2)

Welcome to Finding Noble, a podcast where we climb into the world of young people's mental health and where we provide support for the adults who support them. I'm your host, Carly Redd.

Yeah, yeah. So I'll say this. They explain the OCD cycle. So you have whatever threat or trigger something. So maybe it's. I don't know. What's a good example? Maybe, like, I have some thought in my head that I feel is immoral or something. So then I. And then it causes. The next step in the cycle is anxiety. I have anxiety because I've attached my worth to that for whatever reason. And then what I would do next is a compulsion. Like, okay, my brain received that as a threat in my head, so I need to do something to drive that out, get rid of that threat. And then it reinforces the idea that that thought really was a threat. When you do that conclusion, you're telling your brain, oh, yeah, that was bad. That would be bad if I had actually thought that. Or that would be bad if I didn't wash my hands like that. So when you do that conclusion, you're reinforcing this. This idea in your head. Literally. Your brain is receiving things that are not threats, as threats, because you have these strange compulsions. So it was so helpful when they explained that to me. And then they said this exposure therapy is basically, you stop a cycle at. Okay, we are going to give you a trigger. You're gonna feel the anxiety, but you're not. We're not gonna. Obviously, you can work up to not doing any compulsions at all, but you're not gonna do the compulsion. And let's see what happens. And eventually your brain goes a different way where it's, oh, I didn't tell that person. I didn't wash my hands, and it was okay. Or I didn't wash my hands for 20 seconds, and I'm just gonna sit with that. And then the more you do it, your brain's like, oh, okay, that's not a throw anymore, and you don't have that anxiety with it.

Interesting.

Yeah. So the concept in neuroplasticity is neurons that fire together, wire together. It's we refer to as the Hebbian law. So if something fires, it wires together. And so when, with an obsessive thought, right, Then I've got to do the compulsive act, right? And so what it's doing in the treatment there is exposing yourself to, what if I don't do that? Which is a different. Literally, it's a different neural pathway to not do that behavior or go through that whole process, the ritual of the compulsion. So when you don't do that, you're literally creating a new neural pathway. And that new neural pathway, the more you do it, it's like, oh, I'm still alive and it's okay. And so it, it helps reduce the amount of anxiety by not going into the old pattern that has become a super highway with O C D. Does.

This happen over time? I mean, I'm imagining sort of like a wheat field or a cornfield, and that treading the same path creates a very clear, distinct path through the cornfield or the wheat field. And then if you were to switch to a different path, that might take some time because it's like you're basically macheting your way through it. Right?

Yeah. And it does take that because. Exactly. Because it hasn't become a super highway or because when you get into aggressive, compulsive thinking, you don't even question it. It's what you do to get through day to day.

Yes.

Survival.

And then you feel the shame and you still feel like, I'm embarrassed and I can't talk about this. That's typically what we see. That's why giving it a voice. And that's why you said earlier, Berkeley, just giving that a voice and talking about it, that's so courageous. Because there are professional treatments that are very effective in helping reduce the symptoms. Yeah. Good on you.

Okay, one more question. So if you are creating, macheting your way through to a new neural pathway, does the old one, like a corn or wheat field, eventually start to grow in and that it's not as much.

Of a super highway.

Historically, with neuroplasticity, we have a use it or use it or use a brain.

Okay.

It doesn't mean it's going to completely go away. It could be reignited with elevated stress or situations that remind me of. And that's why I have to lean into the solutions that I found to be effective. Because once you find an effective solution, that solution is a solution that can last for a lifetime.

Okay.

But under high levels of stress, it could be easy for me to come back to that space and start to feel those feelings again. And so learning how to respond, having those tools, having those strategies is really important for long term success. Because when we do that, we know I can respond to this like, Berkeley, you right now, you know that if something was to come up, you could respond with some of the tools you've learned.

Yeah, yeah. So explain what started to happen over time, as you would do these exposures. Maybe give us an example of some of the exposures that you did.

This. It was horrible. Especially towards the end. They'd be like, okay, you've mastered whatever stuff. So they would. They literally have a list. I should have brought it, but I kept one cuz I wanted to remember this. But they would write out every week. You would, you'd have a therapist help you write out your obsessions and the compulsions. And they'd be, okay, this is what we're gonna do to expose you to that threat. And then this is what you would normally do. And this is. You're gonna make a plan to not do that. And so you're gonna lean on certain skills. So for example, I. I wanted to ask if you knew this. I. In my psychology classes, I remember learning that I have body dysmorphic disorder. And I remember them saying it was historically in the D1 of the DSMS, it was a subcategory of OCD. And now I don't think it is, but from my understanding it's a similar cycle where it was obsession and I was doing so many compulsions related to your body. Yes.

Yeah, very much so. Again, I really believe we can obsess about many, many things and it is not limited to historically what we have thought. Gotta check the stove, gotta lock the door. Right. I think it can be related to our own body. It could also be related to our own sexuality. And so it can really morph into multiple areas of our lives.

Yes. Yeah. So I actually they our. I don't know if not all of you okay with this, but we have a brother that came out as gay when I was. How old was I? Eight? I don't know, probably, but. And then the OCD came a few years later, but I felt like, oh my gosh, what if I. How would I know if I am straight or gay? I don't know. So for a couple years it would come and go and I felt obsessions would be like somebody. A gay couple kiss on television. I can't, I have to look away. Cuz what if that I'm worried I would feel something so I need to not look. I saw especially in a more conservative area that was really hard for her brother. So I'm like that would be hard for me if I. I find felt that myself. So I was this massive fear. So then they would. At the OCD place I told them that. And then also if you wanted to say once I just looked up when I lived with that roommate she was like, oh, yeah, those are common OCD things. And I was like, what? Like these weird things that I think I didn't know. And I looked it up and it was, oh, sexual orientation is something. And I think people think about. And I was like, what? This is something that I thought was just odd with me because everybody else seems secure in what they. How they feel. I. I'm having these weird obsessions about it. So just knowing that was something that people with OCD feel was such relief. And then also they would do exposures for that where they'd be like, you're gonna. I would play this game called Hot or Not, where I would go through, look up celebrities on my phone and scroll through, and they'd be boys or girls. And no matter what who they were, I would say if they were hot or not, if I thought they were hot. And I have literally have to say, I think that girl's hot. And they'd be like, you probably feel uncomfortable because you're worried for whatever reason that's gonna change your sexual orientation or whatever and make you unsure about yourself, but you have to just sit through it. And that some of the exposures within just a few times of doing it, it was like, all right, I got this. I can say that now comfortably. And I can see that this is. I can get over that. But one was. That was really hard, was I was so concerned about weight, and I had such an attached. It felt like my weight was attached to my morality. And it was that obsessive compulsive cycle. I would literally. In the car, I remember driving home from the OCD center one of the days, and I had to move my hair a certain way and sit a certain way because I couldn't look at my legs. Cause I hated how they look. Cause they look too big. So I was. I didn't even realize I was. I didn't know those were compulsions, and they were reinforcing the cycle. And I was stuck in the trap. And that's also. When we were in California. I hated my body so bad. I could see everything. But I had these compulsions. I have to wear this shirt because that would be. Anything else is going to make me look bigger. And I had so many compulsions. And then also they would make me show pictures of when I weighed my heaviest in my life. And it felt like it was going to crush me. And it would take, like, a full hour for me to recover. Me having to show somebody that picture and not doing any compulsions, like, oh, this was A long time ago or I lost the weight or saying anything. I had to just show the picture of when I was at my heaviest. And then they wouldn't let me do any compulsions. They. I could choose if I needed to do some to cope a little bit, but I would see the recovery time go from almost two hours to two minutes. Like in 11 weeks or probably within six weeks, I started seeing that shift. And, I mean, I was only doing that a couple times a day, but it really, it was. I could see the change in my brain. Oh, that's not. I don't have anxiety. Attachment. Yes. Like, why? What would be so bad? And also the OCD place, their whole motto was live uncertain. So just. You just have to accept that you can't control it. So maybe it was when you show that picture, maybe my worst fear is that somebody will think I'm fat. I'm so obsessed about my weight. And so they would be like, just tell your brain maybe they will, maybe they won't. You don't know, and you can't control it and you never will be. And once you tell your brain that, it's like, oh, I can't really argue with a maybe that kind of cuts the conversation where it's, I won't know, and what am I gonna do with that? I don't know. And then your brain just lets it go.

So through all the. What you just described, which is what we typically refer to as exposure therapy.

Yeah.

Yes.

Right. And as we go through that process, you begin to realize it's not two hours, it's maybe a couple minutes. And. And as you work through those things, and that's one of the powerful things that we understand about the treatment now is like, you don't have to suffer in sile. There are solutions. And if you utilize those solutions, you're going to feel different, you're going to experience different, you're going to think different. And what becomes actually a part of your journey is you gain confidence because you don't feel the confidence when it's controlling you and you're spending two hours responding to something, but when you can respond in a couple of minutes now you feel more in charge or in control. And that is the healing process, because you understand it and you're not living in this place of what's happening to me like you were in the very beginning.

Yeah. Yes. So you're saying the more you accept that you're not in control of everything, the more in control you feel.

Yes. At least that's how I Feel like it's, I'm okay. That people, whatever obsession I have, it's. That could happen. I have at some point. I can only control up to this point and I have. That could happen. I don't know. And I can't. I'm not going to ruminate all day about it because I'm not. I can't expect anything from this outcome. I don't know what, I can't make it happen or not happen.

I found it really interesting. I went to her graduation after the 11 weeks and first of all, let me say when I went to that graduation and all the people that were in the room, a lot of the. Would you call them students that are still in there, clients, students that are participating, you're all in a big circle. And it was Berkeley's graduation day, so me and another, a brother of ours and my mom was there. Right?

Yeah, and death, I think.

Oh, and death. Anyways, so we were there and they were talking about Berkeley and they just said she worked so hard, she faced so many fears and you really did the work. So I think that's probably important to know is that if you really do want to start to heal your brain, it requires work and you have to be ready to do some hard work.

Right?

Yes. Yeah.

And then the other thing I was gonna say, well, it was fun too, cuz everybody had sweatshirts walking around that said maybe. Almost like got milk? But it just said maybe with a question mark. That was the motto of the place. I kind of love that. But it telled me as I well maybe, maybe. And there's nothing I can do about it. But the other thing that was fascinating was the demographic of humans in there. There was no one size fits all. So many different types of people. There were mothers who had six kids at home. There were younger boys, there were older men, there were Berkeley's a like every from all different walks of life struggling with this. Would you call it a disorder, this condition?

Call it ocd. At the end of the day it is used to be anxiety and then it was a subset of anxiety. And that's typically how it's been looked at, ocd.

So they were struggling with ocd. I thought that was really interesting. But some of the other. I remember you telling me that some of the other exposures that other people were doing, like one of was this you or was it someone else that had to go into a bathroom floor?

Oh, that was, that was horrible. Wait, tell us what that was. This was for my contamination ocd, but I still have A problem with the bathroom floor. And that is a sign that I should just do more exposures cuz then it will help me have less anxiety in the bathroom. But because I had such a hard time walking barefoot in the bathroom and just flat foot, I always am on the edges of my feet trying. Which doesn't even make sense. The germs are still. What? I don't even know.

You get less of them on your feet that way.

Yes. I thought about it this morning. I was like, this doesn't do anything. But I was, I told them that I have a hard time in the bathroom. My feet, the floors feel disgusting. I think about people going to the bathroom, it's never feel sanitary enough. So they had, they, they made me, didn't make me. I said I would do this, but we would play Bananagrams on the public bathroom floor at the OCD place and the poor staff, they had to do it too. They were really nice but they wouldn't let me. They let me wash my hands, but they would ask, how long can you wait? You touch the tiles, you try not to do compulsions of sitting funky or using your fingernails to pick up the things, things like that. It was weird, but it did, it helps. It trains your brain like, oh, I didn't die. I didn't die when I didn't wash my hands. Okay, I did it.

Although I would not want to do that.

Yeah, I don't think anybody really would sometimes.

No, I don't think any of us would sign up for it. However, when it's debilitating or it prevents you from living life to the fullest, you lean into that storm. You face the storm and it takes so much courage to do it. But it's a beautiful thing because now you're in control. I really. The concept that you talk about, build a brain, right? And what you're doing is you're building the brain that is most functional for you.

That's cool. Carly was saying earlier it was a really quick transition. Oh, I found out about this treatment center and I'm going because I was literally months before I was like, this is how I am. I don't know how I'm going to do this, but I'm going to try and I'm going to have to live with this for the rest of my life. So I was at a place where it was. If there is anything that can help me, I will absolutely do that. So that's why I also think not everybody needs to do an 11 week program three hours a day. But for me, this is. It's been 10 years with OCD and I cannot figure this out on my own. If somebody has the key to this door, if somebody can set you free, can set me free. And, and when I went to this place and the science was there, I was like, why did everybody keep this from me for nine years? How did I not. It's. It makes me sad and to see the people there. We, some of these people for 20 years have had the same problems and they can't get out of that loop. And all we needed was, oh, they actually have done research on this and people have spent their lives learning about this and they can help you. And I was willing to do anything at that point just to get to be a healthier person. And I also feel like OCD is not fun, but it is, it's a blessing to have a brain that can be helped in such a fast amount of time and it won't ever be cured. But in 11 weeks I felt better and it's obviously still, I have to maintain those exposures and whatever I need to do to stay healthy. But it's a blessing that like there, there is research out there and people can help you. It's beautiful.

Absolutely.

I'd like to ask what was that like coming out of the intensive and back into everyday life? Did it feel like whiplash a little bit or did you feel confident going into everyday life?

I think I felt pretty confident. I mean, it's harder obviously to do exposures every day. You go from focusing on treating OCD and then it's kind of up to you to be like, I could go right into my old pattern, so that would be really easy and that's automatic. Or I could really remember part of it is just remembering what they taught you. So I wouldn't say whiplash, but it definitely. I just felt lighter. And obviously it took time to continue to implement what I had learned and I continued to get better. This also was helpful when they, when we left, they were like, it's not a linear. Your happiness isn't going to go from here to here because you went here. Recovery takes. It's obviously going. Yes, exactly like it's going.

It's.

There's a trend, but it's not a straight line. So that was helpful to know I'm not back to where I was just because I have this bad day. But I also did ICBT inference based cognitive behavioral therapy. I went to a therapist, but that helped with my OC just because it was nice to do the exposure Therapy. Then also to have more time to talk to a specialized therapist explaining maybe where that those thoughts come from. And your brain is making these assumptions based off of things you've heard and things you've seen. And you've made this whole narrative about your wife and you're acting on that when that narrative is likely not reality. Especially when you're in an OCD state like that. I'm not a horrible person because I had that thought, but I really believe I am because I've made this really compelling story about myself. Especially after you've had OCD from so for so many years. It's like that, that icbt, I would say exposure therapy was the most helpful. And then that afterwards was nice to be like, oh yeah, I guess I'm now seeing in my family why I probably thought that and how I turned it into this obsessive thing. It's morphing because I have this tendency to get obsessive about whatever disrupting that.

Story and making your own and thinking.

Oh you know what? That's not my reality and I'm. That's not who I am and I don't have to believe that. And then also I recently I was on medication for. I think I tried something like 9 years after I was like diagnosed Dyson OCD. But I was on Prozac first. Now I'm on Luvoxamine, Luvox. But that, like honest, that has been. That with the knowledge of OCD and exposure therapy has been seriously life changing. And I remember on that trip in California when we had that talk, I. I told you this is in my head, it's miserable. And I remember thinking, I don't know if I could ever be on a trip like this and not feel this way. I just felt like so hopeless. Like, how could I. It's been so long and it's not gone away. How could I ever feel like that? And now it's so weird to be on the other side where I feel like that now know that it's my life isn't. I don't feel like that anymore. And also medication, I think also just helped. Every 30 seconds there was some obsession. I need to do this or I should have done this or this is bad or. But now this, that medication, I've had to test some things out and that might not be for everybody, but that has really helped. Just like I'm not in that constantly ruminating state anymore.

Are you saying you want to go leap on the beach right now?

Excuse me.

Yeah.

That's a Great idea. What's so interesting about this is you're not listing one thing. And that's a really important part of when we change in life. Rarely is it a single thing that creates the change. It's multiple things done over time. Awareness and knowledge, practicing. You went from the exposure therapy to the I, C, B T. You include or add onto that medication. You put all that together, you have multiple things that are benefiting you in the healing process. I think it's beautiful.

Yeah, that's really good. Okay. Are there any factors that exacerbate or make it feel like your OCD is.

Worse when I don't sleep? They also taught this at the place. It was helpful to know. Oh, maybe sometimes when I'm having a horrible day, I'm like, what's wrong with me? But it's okay. I didn't. I slept six hours last night. I need eight. I know that about myself. Or if. If I don't see anybody, if I'm home alone until 2pm I have a hard time. I can really get in my head. So being social. And then also if I'm not exercising, that's when I can get in a pretty hard place. So exercise really helps.

And also, I was going to ask this question because I'm really curious. Now that you're at this point in your life, does your OCD seem to attach itself with the same intensity and you just know how to cope with it? Or does there seem to be this diminution in its potency, like it's improving and maybe less of a threat overall, that it's not as big of a problem in your brain?

I think it's both. Where OC feels less threatening because I know what it is, but when I didn't know what it is, it's like this massive thing that feels like a barrier you can't overcome. So now it feels like, okay, I know what I'm up against. That lesson is the threat. And then also, I know I have the tools, like what you said earlier, Dr. Skinner, that obsession could happen and I could struggle with that. But now I know I've gone through all these other things. At some point, it may take some time, but I'm gonna get over that and I can handle it and manage it. That's really good.

Well. And I even know before you got married, you had some relationship ocd.

Yes.

That it resurfaced. And what was that like, working through that?

That's hard. It was really confusing. But it is now, like being on the other side of it. Got married. But it makes sense because that marriage is uncertainty. Like, I don't. I couldn't know what it's going to look like in four years. Of course, with this tendency to need to be certain about the future. That was such a scary thing. And it took some time, but the medication really helped. I was on medication for most of the time. Sometimes where I could think about all day where it was, oh, that still comes across my brain, but it's not nearly as strong and disruptive in my life. And then also I just saw a therapist during that and that was helpful and kind of explained, oh, yeah, relationship OCD is a thing. And people have that. There's an OCD book. It literally is called Relationship ocd. But it was helpful to read that and be, oh, that's exactly what I'm thinking. And these are some exposures I could do to help. And that was really awesome.

And it helped that you had a very patient boyfriend.

Fiance.

Spouse that also is reading the book and tries to understand Nice about it. Yes, he's very kind about it. Okay, the last thing I want to ask is, what can we do as parents now? What to say, what not to say, tools to learn, the environment we create as parents. I know there were a lot of things early on that you found were helpful and not helpful when you had O, C, D as a child, now into adulthood.

Yeah, I think we were talking about this earlier, but an OCD brain really is different. If your kid comes to you and says, I think I'm fat, I think I'm fat, you're probably gonna be like, yeah, you might be like, that's probably not what a parent will say.

But, like, hopefully not, right?

Yes. But after going to that OCD center, they talked about reassurance versus validation, where if you reassure your child like, no, you're not fat, then that's confirming to our brain, that would be really bad if I was fat. If they are like, no, you're not. That's telling myself, okay, that's a threat. I can't. I gotta make sure I'm okay today, but tomorrow I'm gonna have that same fear. But a parent can validate and be like, that is hard. And even if you are, even if you did gain 50 pounds, and that would be hard because obviously that's not what you were hoping would happen. Whatever. Maybe you were wanting to get in shape or something. That's hard. But not saying, like, that won't happen. I guess when it. Just to try and make the uncertain certain is not helpful. As the child, when that's kind of what parents want to do. That's like your natural. And it probably will look different. Like if my parents are talking to me at 12, verse 22, they can probably be more honest with me now and be like, maybe you do look different than you did. And that's okay. It's. We're gonna be okay.

I like that you call it neutralizing the threat that you're making it nail and that it doesn't hold power. I think that's really profound. Even the other day, my son might kill me for saying this, this was yesterday, but he's already starting to recede. His hairline starting to go back. And I got him some minoxidil to put on his head, and I don't even think we're using it right. And he was so fearful, what if this doesn't work?

What if.

What if I started to go bald? And I just said, what if. What if you start to go bald? What does that mean about you? And he was like, well, nothing. They said, luckily, you have a nice face. This is probably bad. This is reassuring. I said, you have a nice face. And I said, you have a nice head. So if you shave your head, you'll look good. I felt ill. Okay, that was probably the wrong thing to say, but it was this trigger that went off in my brain based off of conversations that we had of neutralizing the threat. So what if you go bald? What does that say about you? Well, nothing. And he has a bunch of friends that are already starting to recede more than he is. And maybe something's underwater, I don't know. But I just thought that was so interesting. Like, oh, yeah, that's probably not a normal response for a parent to be like, yeah, so what if you were. So what does that mean? And it really does suggest, oh, my value does not shift in any way, shape or form because of something that I perceive to be a threat.

And part of this. As a clinician, I would often ask a parent to say, what does that mean to you? You're trying to. You're trying to get their interpretation. What does it mean? Okay, what does it mean if your hair is receding? What does it mean if we go bald? What does it mean if I'm gaining weight? What does that mean to you? So that curiosity and their interpretation can help you can actually help them. Like the meaning of that. That's not how I would see that. You have a wonderful face and if you go bald, great. You got a great round head. You're gonna be just fine. Now you're helping, you say neutralize, you're helping them look at this in a different way. But first of all, if we can see how they're interpreting it, and that's where we can come in and say, that's an interesting interpretation, can we look at it possibly another way?

Right.

And that kind of curiosity with information can help them, like, oh, okay, that's cool, it's not fixed. And that means nobody's gonna love me or they're gonna make fun of me or whatever the interpretation is. We can help them have a different interpretation.

And like you said when you were going to this other therapist, helping you see the motivation or the impetus behind some of the thoughts you were having as a parent, it is nice to know, asking, so how did that make you feel? Understanding the value system that maybe we've unintentionally supplanted into our children's souls, into their minds, because maybe we didn't even know that they picked up on something that we said a long time ago or something that we didn't realize that we focused on heavily in our home. And then that's helpful information as a parent. Also humbling information.

Yeah. So let me add a couple things that I would add to this. The parent, if you're concerned, we've identified the symptoms, we've talked about it. You guys have done a great example of personal story, which is phenomenal. But if you're concerned that your child might have OCD or someone in your family has, because we can genetically pass this down and we have to be aware of it. But if we understand that knowledge is power, we can respond effectively, we can get the information, we can help our children understand, we can go through this intelligently rather than what is this? And what's wrong with me? And I think that's one of the core takeaways that I would have with your story, Berkeley, is you got more information and you sought help and you didn't settle like, okay, is this the rest of my life? No, this doesn't have to be the rest of my life. And that's there is always hope. And that's one of my key takeaways.

Oh, that's wonderful. I, like you said, there is a genetic component to it. And as Berkeley really committed herself into understanding and learning more about this, it was very eye opening for our whole family. She's the youngest of seven kids and she was born into a host of in laws and then immediately after grandkids. And so she's just been surrounded by a lot of people. But for all these people to really look up to her as the youngest, especially me and my siblings and even my parents, and recognize, oh, this may come from somewhere, we may carry these tendencies ourselves, we may have promulgated these tendencies as siblings and parents ourselves, and that we can really make some shifts there. But for one individual to have the courage to go get the help, it really shifted this concept in our family or this mental health dynamic. And recognizing this is very possible that some of us might be struggling with this. So thank you.

Oh, you're welcome.

Yeah. Thank you so much, Berkeley. I love personal stories like this. So really, really phenomenal, because I think as our. Hopefully our listeners will understand, hope there's opportunity for change and awareness and knowledge. And the more you get, the more in control you feel of an environment that has felt out of control. Interestingly, you're trying to take control with ocd. You realize I can't control, but then that gives you more control.

Yes, the great ironies of life. Okay, thank you so much for coming today, both of you. We'll put any resources that we've mentioned today in our show notes, so make sure to look at those and we'll catch you guys on another episode of Finding Novo. Thanks. You've been listening to Finding Noble. I'm Carly Red. Follow Finding Noble on all available podcast directories and find out more on our website, findingnobel.com that's finding noblen o b l e dot com and if you or anyone close to you are looking for further resources on young adult and adolescent mental health, Dr. Skinner and a host of other leading professionals working in the mental health world share courses and even answer your questions, all on parentguidance.org that is parentguidance.org brought to you by the Cook center for Human Connection.