Thanks so much for joining us this morning. So this is the latest in all Our Mental Wellness series,
which is brought to you by the Department of Experimental Psychology here at the University of Oxford.
My name's Cathy Creswell, and I'm really pleased to introduce you to Professor Paul Salkovskisoday.
He's Professor of Clinical Psychology in the Department of Experimental Psychology,
but also director of the Oxford Centre for Psychological Health and the Oxford Institute of Clinical Psychology,
Training and Research and Cognitive Therapy Centre,
and the school's director for the Clinical Psychology Doctorate Course here and
clinical director for the Oxford Health Specialist Psychological Interventions Clinic.
So as you can hear, he brings a wealth of research and clinical experience,
particularly in the understanding and treatment of anxiety disorders and more specifically, OCD, panic and agoraphobia and health anxiety.
So we're really looking forward to this talk today. `nefore we get started
just a reminder to have a look at our Department of Experimental Psychology website and our YouTube channel,
where you'll be able to find all the previous talks in this series.
We've had a number of really fantastic talks now on a range of topics, including coping with trauma,
bereavement, eating problems, depression and low mood, sleep problems, stress and anxiety.
And the next session will be on the 9 June with Dr. Hannah Murray.
We'll be talking about understanding and managing troubling mental images.
So please, um, keep following the YouTube channel or our website for all of that content and also will be on that after today as well.
If you want to look back or to share with anybody that you know,
just a reminder that we'll finish at ten forty five and we really encourage you to take a bit of a break after the session.
Sometimes these sessions do raise challenging thoughts and feelings for us,
so really important not to just rush into the next thing, but give yourself a moment and have a cup of tea.
Go for a walk, whatever works for you before you start the next part of your day.
And also, we will remind you later on,
but you'll receive a feedback form and we'd be really grateful if you could complete that just to help us really make the most of these sessions.
But so without further ado, though, are now pass over to Paul.
He's going to be talking to us about obsessive compulsive disorder, Too careful, too nice and trying too hard.
Thanks very much for joining us, Paul. Thank you, Cathy.
And having heard your introduction and I realise why nobody can ever accuse me of being a man with no direction.
OK, so my talk is about OCD.
I have a subtitle which is really just a variation on the same theme,
which is, why it can hurt when you're too nice, so that you try too hard to be too careful.
So I'll try to unfold that over the next half hour. I'll tell you what OCD is.
I'm going to tell you that it is a bit more than "I'm a little bit OCD."
A lot more than that. I'm going to talk about the sad fact that in OCD, typically it's too little, too late.
So there is this there's an important need for early recognition and early help for people with OCD.
I'm going to try and explain how being too nice works and how psychological theory helps us understand who it is,
who suffers from OCD, trying too hard and how the solution becomes the problem
and this is sort of good news because if it's about trying too hard and possibly
one of the ways forward for people with this problem is to not try as hard,
but that's difficult. I'm going to talk about the checking trap, which is why being too careful can cause problems.
Briefly touch on the psychological treatment
and my view that OCD is an unnecessary illness, that no one should suffer from it, but many do because of the unavailability of treatments.
And then very briefly, if CBT cognitive therapy is and so I'm going to try and tell you what's in the box.
So OCD, in terms of the diagnosis offered then, is intrusive thoughts, images and impulses.
It's obsessions and compulsions, it says or in the diagnostic criteria.
But it's always and compulsions are meaningfully related to the fears.
And this is very important because it says essentially that this is a culturally determined problem to
a degree, that the meaning that people attached to their fears relates to their background and values.
By definition, the person seeks to ignore or suppress intrusions.
And as I think many of you will know already, the attempt to get rid of a thought essentially has the effect of making it worse.
But the key to the diagnosis, I'm going to emphasise this again in a moment,
is not that these things occur, but it's the extent to which it produces severe distress that becomes disabling. Types of OCD include washing,
checking, rumination, dieting, scrupulousity, mental contamination and so on.
Not OCD and recently separated from it is hoarding.
I'm not going to talk about hoarding today, but it's not entirely unrelated problem.
So that's kind of the diagnostic version of what it really is in terms of phenomenology is obsessions unpacking OCD obsessions or recurrent thoughts,
image, impulse or doubt, which tells the person that there's a potential for some kind of harm.
But even more importantly than the idea of harm which would make you anxious is the idea that you can either cause or prevent it.
The idea of responsibility, which drives the compulsion so compulsive the compulsion refers to some sort of action reaction that's
intended to do two things to prevent the harm that you're worried about because of the obsession,
but also to diminish responsibility for its occurrence.
Both of those things should be familiar because everybody gets intrusions. So very, very long time ago.
Jack Rachmann. Sadly, we lost Jack last year, but Jack is one of the big movers and shakers in this field.
He and Padma de Silva, myself and Jim Harrison later demonstrated something about intrusions in people with and without OCD,
and in particular, pretty much everyone has intrusive thoughts, images, impulses.
So it turns out that it's not confined to OCD.
If you make a list of the intrusive thoughts that people experience and then ask experts to say, Well,
which of these are from people who have OCD, who've got the disorder, and which of these are from people who don't?
Well. they can't. There is absolutely no difference in terms of what people worry about.
Christine Purdon and David A Clark, this is from a list that they produced looking at people who don't have OCD and don't have any mental health problems.
These are the percentage of people who experience thoughts like so 64 percent of women have intrusive thoughts about running a car off the road,
56 percent of men jumping off a high place, 39 percent of women, 46 percent are men, and so on.
And you'll see that the pattern of intrusions that we see in OCD are pretty much across the piece.
Everyone is getting these. So that's a bit of a puzzle. Does this mean we're all a little bit OCD?
Well, as my friends and colleagues at OCD UK say, no this is a myth.
OCD is not an adjective. The D in OCD stands for disorder.
And this is about suffering. This is about people being damaged.
So the fact that somebody wants to arrange things in their fridge in a particular way
and that's a bit quirky, does not mean they have OCD,
and we should not be describing it that way, because it devalues essentially the terrible things that are happening to other people.
So let's go back to what it really is and be more complete.
OCD is a disorder, D is for disorder, and together obsessions and compulsions make the person feel awful,
scared, disgusted with themselves typically, and stop the person from doing things which matter to them.
OCD destroys lives and for many, is a living hell.
It's not a little quirk to boast about on your social media.
This is work like Sturby and I did and we looked at people who were currently affected by OCD very severely.
So this is a group of people who have really, really struggled to get help, and we just ask them to look back over time.
This the different colours adjust two different groups of people, either fifty-seven or one hundred and thirty nine, and the first signs of OCD for these people,
on average of carrying around 15 or 16 significant interference occurring at age of 20,
which means, of course, half of people are developing it before 20 and half of people later.
But here's the interesting thing from the point at which they essentially have the disorder to the point where they started to seek
help, six years go by, and then two more years go by before that correctly diagnosed and the treatment of any kind occurring later.
Why is that important? Well, that's important because if, if,
if I invite the people on this webinar to think about what they did between the age of 20 and 28
and if that wasn't able to happen because of some sort of mental health problem,
how would there life be different now? And much of what we see in severe OCD is not actually the direct effects of OCD.
It's like an experience of OCD, but is the thing that I sometimes call collateral damage
the destruction of relationships and education and just life in general.
And this is why we should be helping people detect OCD earlier and and then get it treated more quickly.
And we'll talk a little bit about why that doesn't happen in a moment. So let's talk about this thing about being too nice.
So is it really true that people with OCD are too nice?
Well, yes, I think it is. OCD happens to people who are too nice for their own good.
There are, in fact, lessons from history and evolution, the focus of OCD
What OCD is about changes over time and is typically OCD focuses on the invisible spiritual, moral or physical menace,
whether that's as it is at the moment COVID 19 or HIV, or in the 50s and 60s radiation, but going much further back.
You know, we're looking at people who experienced religious obsessions, blasphemous thoughts and so on.
And of course, very famously, a couple of peep figures from history.
There are many more. But Martin Luther, I'm talking about Martin Luther, the monk in Germany, a John Bunyan who wrote Pilgrim's Progress,
very famously describing essentially obsessional ruminations, and the fact that we don't see so much religious OCD at the moment in this country,
but we do in some other cultures is very informative, in my view.
So who gets what, what type of OCD?
And I'm just going to summarise that by saying, for example, that loving parents develop OCD around harming their children.
Clean people develop OCD about being contaminated or contaminating
others. Deeply religious people develop OCD around blasphemy.
Gentle people develop OCD around being violent,
you should be spotting the pattern because - we can see people who are risk averse develop OCD about being careless -
the pattern is this, but loving parents worry about harming their children. So hen they have these intrusive thoughts
it doesn't mean they're going to harm their children. That means that is the worst thing that could happen.
And so they worry about that as we all worry about the worst thing that would happen to us,
clean people worry about being contaminated and contaminating others deeply.
Religious people worry about blaspheming. Gentle people worry about being violent.
People who are risk averse worry about being careless. So essentially, OCD is the opposite of who you are.
Opposite of the values that you espouse. And that's really important.
That takes us to the cognitive theory of OCD.
And as its simplest, the cognitive theory says – unacceptable intrusive thoughts, images, impulses, doubts occur
in everybody. Intrusions that we notice are the ones that we think are important for us, interesting, positive or negative.
But we're focussing on OCD on the negatives.
Intrusions can include day-to-day stuff, good ideas and unpleasant and unacceptable ideas. When unacceptable intrusions occur
the person with OCD fears and believes they might be responsible for harm if they don't react to prevent or undo it,
and they respond by trying too hard. OCD is fundamentally a matter of the person who's beset by frightening thoughts,
trying to get rid of them and therefore experiencing them more. People trying to
prevent harm and becoming less and less certain that they are able to do that,
trying to be too sure and so on. And what happens is the solution becomes the problem.
So in OCD, the person who's worried about contamination and contamination OCD, if you want to call it,
contamination is not their problem, it's it's the washing and the attempts to avoid being contaminated.
And we'll talk about a more extreme version in a moment.
So trying too hard is not a solution in OCD, and I'm just going to summarise this by saying no one in the history
of time has ever got rid of OCD by giving in to it, by doing better rituals or more rituals, or getting better at avoidance.
No one ever. But OCD is a liar, and it falls people into thinking that if they could just get the perfect wash,
then they would be better off. Because it did like digging to get out of a hole.
And yeah, you could say, Well, I need a better spade to get out of this hole.
Well dig for longer, need to dig more efficiently. What happens if you constantly double your efforts?
So here's what happens. So here's how it starts. OK, so you know you've got a perfectly reasonable thing.
You wash your hands after, use the bathroom or you check the door before you leave, and it's all very functional.
But if you keep digging, yeah, then of course, that gets a lot worse.
And then if you really, really try to keep digging, then this is how it's going.
And this is unfortunately what happens if you try to get rid of OCD by giving into it.
So now that's it's not just a matter of not giving in to it, it's a really hard thing to do.
So too careful, let's just talk about being too careful and the cruel truth about OCD.
OCD is a con tha promises safety and comfort and steals the person's life.
I saw yesterday somebody said that OCD drives everything out your life until only it is there, and in most the most extreme cases
I think that's right. OCD wants you to be careful in a way which distracts you from the real risks.
So risk in OCD is often misunderstood. I sadly heard recently about somebody,
this is quite common, saying this is somebody who was working in a as a teacher and a mental health professional,
misunderstood their OCD and then essentially alerted the authorities to the fact that they had thoughts about harming children.
And as a result, that person essentially was barred from their job I hope temporarily.
And and essentially, that was seen as a risk. Now bottom line on this is that people with OCD who have
thoughts of harming people, they are the least harmful people in the entire universe.
So there's the question of risk in OCD is a complicated one.
But it also is very simple in the sense that I would say there is no primary risk,
If someone with OCD is afraid that they're going to harm somebody or something, then they're not going to do that.
But there is this thing called secondary risk. So let me explain secondary risks are in this way.
This is very sad news story. This is a man in Manchester.
And the coroner, basically after he died, basically said that he died of an overdose of Detol.
This is somebody who had it cleaned so much that he absorbed this disinfectant through his, through his skin.
And as a result had died. And that is secondary risk, the secondary risk in OCD is not that the things you're afraid of will happen,
but it's the way you try to prevent these things have the effect of prevent, of causing a different harm.
So the loving mother is afraid of harming her child, may not be able to cuddle the child in the way that the child and she needs.
And as a result, from not being able to put the child on the floor and potentially some damage can happen.
That damage is not happening because of the OCD. It is happening because of the lack of treatment.
Now in this piece on this poor man who died of Detol poisoning,
his sister said the bottom of the slide, he didn't want any help and was scared of receiving it.
And that's because he was afraid of doing so. And this, in my view, is the elephant in the room.
The elephant in the room in OCD is that it's so poorly understood that people
think that if someone has the thought of being a paedophile or of causing harm,
that that means that they are a risk, which of course they're not. And the elephant in the room is stigma.
What an elephant is. What this particular elephant is composed of is essentially avoidance,
Reluctance, denial, ignorance, diversion, silence, awkwardness, I don't quite know whether Trump fits in, but we'll leave that and so on.
So one of the things that my lifelong aim and the aim of the charities I work with, particularly OCD UK, is to try to remove the stigma.
So let's try and get a bit of a better understanding of what's going on in OCD.
Let's briefly talk about the checking trap.
Now, you would think, wouldn't you, that if you're struggling to remember something that, you know, if it was very, very important and of course,
by definition, people with OCD feel that checking their door is very important because they don't get burgled or whatever.
You think that checking would be helpful because if you check, you're going to be more sure.
But here's the thing. When you try by repeatedly checking to be completely and perfectly sure, as demonstrated by psychologists Marcel,
Fontenot, by Adam Rodonsky and others, what happens is that repeated checking removes your confidence in your memory.
Anybody, whether they have OCD or not, if you go past six or seven checks, as you've checked the door, is it locked, or checked
the iron is it still on and so on.
You become less and less confident in whether or not the kind of end point was safe or not, so repeated checking undermines confidence in memory.
You and I, if we don't have OCD, we typically are not checking or not checking more than a couple of times. People with OCD because they think it's so
important to be completely certain and perfectly sure, check loads of times that get further and further away from the idea that they're safe.
Their memory gets worse and worse. That country's memory deteriorates. So those who check don't have problems remembering, but they do try too hard.
They use problematic stop criteria. Another piece of research Karina Wallen and myself did,
and the repeated checking of the type prominence in OCD progressively undermines the confidence which makes you want to check more.
And there is one of several vicious circles which we've identified OCD. Just as a note,
there's a type of checking which isn't as obvious, but it's still checking and that's seeking reassurance.
Asking your loved one "are my hands clean, are you sure the door is locked and so on."
Now that's actually checking with an extra element. And what our research said in particular,
Osama Kaburi and I picked up that what's happening there is that when you seek reassurance, you're checking.
And you're also transferring responsibility, so the idea of responsibility so that you make the other person responsible for the harm.
And that seems to make it easier in the short term,
but has the effect of undermining your confidence both in that particular occasion and in general in your ability to be sure.
So, OK, that's broadly speaking the way we psychologically understand it.
So if what I'm saying is true, shouldn't we just just stop it?
So we should say a person with OCD, stop it. It's a bit like saying to a person anorexia to eat more, while the person is depressed
say cheer up. Lots of people, they can't just stop it. i
It's just not that easy. What's needed is appropriate support.
OCD is not an accident, and this is an important starting point.
It's about who you are. The values you have, but not typically in the way you think. That the person who is troubled by blasphemous thoughts is,
of course, the person who's got the collar on the wrong way around, the person, the minister of religion or the imam or whatever.
So what the person with OCD needs to understand is why is the problem so severe?
And again, in a psychological formulation helps us understand that. But even more importantly, why does it persist?
And as with almost all of the problems we deal with in mental health,
it's not necessarily a problem that people feel anxious or that they have intrusions.
But why are these severe, severe and persistent and how can we change the things which which actually are making it severe and persistent?
Sometimes it's helpful to know why it starts, but typically it's not actually where you would start in treatment.
So what treatment does, treatment cognitive behavioural therapy
it all falls roughly the same pattern of OCD and everywhere else, but it has unique features.
And in general, what we do in psychological treatments is help people see things differently so they can do things differently.
That's about perspective. But more importantly, also by using that perspective to experiment. What do I mean?
Well, I mean, the people suffer from anxiety problems such as OCD because they think the situation there is more dangerous than it really is,
and they get stuck in this way of seeing the world and they get caught in these loops.
I've given you the checking
trap as an example of that. Effective change needs the person to be able to be more flexible in the way they see things.
And that's a really crucial thing. It's about actually being more flexible.
This means finding and considering an alternative, less negative way of understanding their problem.
So the person who says to me. Paul, I think I'm a paedophile, I'm going to say, well, I understand why you're afraid of that,
but is it possible that you're actually a person who's terrified of being a paedophile?
It's not that you are a paedophile, it's that it's the fear of being a paedophile
that's the problem for a different way of thinking to be helpful.
It has to fit with the person's past experience. It has to make sense. And it's really, really important that people feel understood.
And as a therapist, it's very important that I don't just help them feel understood, but I do that by understanding.
It's also it's not enough just to get an understanding so-called insight, but it's also important that you can then test it out.
So good therapy is actually about, at least two people, myself and the person who is suffering, working together and that working together
is important to find out how the world really works. And good therapy is always about two experts working on the problem
in close collaboration. Me as somebody who knows a little bit about OCD, but not necessarily a great deal about the person's life.
And that person who knows everything is a super expert in their own life and, by the way, a bit of an expert in OCD, too.
So in terms of how people should approach CBT, it's important to understand that therapists, CBT therapists, people like myself, do not
change people. People choose to change themselves
so CBT in the end is self-help with someone helping you to understand and apply that understanding. You need to go to therapy
if that's where you're headed, and helped to understand the nature of the problem and help to choose to change.
You should go to therapy and really importantly, we're pretty useless therapists until you help us.
So you've got to go to therapy expecting that a therapist is going to need a lot of help from you.
So here's what I say is in the box when I open it
for CBT and and what you should expect to see, it's your user's this manual for a CBT,
some time to understand you as well as your problem. A good therapist first gets to know you before they get to know your problem.
Discussion of how best to deal with questions in therapy itself
and essentially, I would typically start therapy by saying, Well, I'm going to ask you a lot of questions, but before we do that,
do you have any questions for me and encouraging people to ask questions and to be participate actively in treatment as we go through.
And then it's about allowing the person to share the story, agreeing on what it is you're going to work on.
I would want to do a general assessment and find out what's happening to this person in general,
but then a specific assessment leading to the thing we call formulation,
which is a shared understanding, working through some combination of helping people to change the way they think.
But also the thing we tell behavioural experiments, which is don't trust me, but find out for yourself.
Helping the person confront their fears, helping them to generalise changes, and then really importantly, working on how to reclaim their life.
That is the only show in town as far as psychological treatment of OCD is concerned.
To find out more, I've already recommended OCD UK. OCD UK
also they make available other books I've been involved in.
All the books are available and I'm just going to mention at the end here that
we always need help with our research and that's that's our website at the bottom.
And if anybody wants to volunteer, if they've got problems or they haven't got problems,
We're always very keen to have that.
So hopefully I've helped you understand that OCD is not as weird as you think and that really this is a problem for people who are too nice,
too careful and trying too hard. Thank you very much. Thanks very much indeed, Paul.
I'm sure that was extremely useful information for people, and thanks very much for sharing those resources as well.
As you know, we had various questions submitted, so many of those you touched on already,
but we've got a chance to delve into them a bit further now. I mean, you've obviously spoken a lot about OCD, what it is,
what it isn't and the public perception of that, and the importance of overcoming the stigma and the barriers that people face in being able to access,
seek help and then access it. I mean, what do you think of the key things that need to be done to improve public understanding of OCD?
Because, as you said, it is often so misrepresented? Well, we can stop the representation, I mean,
I got into a bit of a battle with Channel Four when they they ran a programme called Obsessive Compulsive Cleaners,
which was horrible, which is horrific, which kind of paired up people who were struggling with cleanliness with people struggling
with hoarding and so on, with people who had very severe cleaning rituals.
Some of whom did, some of whom didn't.
And it very much kind of portrayed it as sort of, let's point and laugh at the the dirty people and then then marvel at people,
you know, pouring bleach over themselves and other people and so on.
And that that was at a time when Channel Four had signed the mental health pledge that they would destigmatise,
and they completely ignored the representations of multiple organisations and so on.
So our media needs to get its act together and it needs to stop misunderstanding this.
We need to stop being in the position. I mean, it is deeply frightening for I mean,
I mentioned the young man who's a teacher and who's been stopped from being a teacher because he
was honest enough to talk to mental health professional about the problems he was experiencing,
which did not increase his risk and he's facing this horrific battle.
And just so so we need to we need to get out there that it's not just a funny little quirk, that it's not all about washing hands,
although washing hands is a very serious problem for those who have it, and we need to
we need to be having more sessions like this and we need to have better understanding all around.
So yeah, it's being more open, making, making, giving people better access to treatment, not putting hurdles in the way, not giving them
as sometimes happens, meaningless treatments before they're able to get through to more specialist or focused treatments.
Mm-Hmm. Thanks very much.
I mean, within that you talk about hand washing, obviously the contamination fears of what of that, I guess probably one of the more well-known aspects of OCD.
To what extent did the stresses that you've described earlier apply to contamination fears?
And is there any sort of particular advice you'd give for that context?
Oh, entirely. I mean, and of course, it's very relevant at the moment because it I mean,
one of the things that happened early on with lockdown, people were using hand gel, self-isolating and so on.
And so some people with contamination OCD that that gave them a bit of a bit of a break, a bit of a holiday.
But that was kind of a false thing in the sense that it just meant that they were able to
avoid more, as opposed to having to deal with everyday things that no one can ask about.
Because it's worse because we've had sort of socially sanctioned sort of avoidance and checking.
So contamination is what a particularly easy to treat within OCD, with one exception, which I'll briefly mentioned in a moment.
And essentially, because this is a kind of physical, it's a physical thing that you can confront.
As with any other sort of more sort of phobic type pattern, people can confront this thing and can be supportive of that.
The self-help book, Break Free from OCD, talks great deal about what you can do with
that and other things and so on, so people can do a great deal themselves.
And yes, CBT works particularly well. With the exception I mentioned is this thing called mental contamination,
and this seems to relate to something that came out very recently again.
Jack Rathman was the person who generated this, this insight that some people don't feel contaminated about what they touch,
but contaminated by what's going on in their mind. And also that relates to traumatic events.
Bullying seems to be one.
And I know you got a previous one, to believe bullying seems to do this, that people feel dirty inside and try to deal with it by washing.
So it's probably sort of Lady Macbeth or Pontius Pilate style.
You know that you have these horrible feelings and washing as it is used as a way to get rid of.
Exposure to contaminants don't help there.
And so you actually did quite a different strategy that involves dealing with the memories that people have with these things.
Okay, thanks very much and be useful to know that the book that will be particularly useful in that situation.
I suppose one of the other things that people often linked with OCD is perfectionism.
So can you say a bit about the association between OCD and perfectionism, and how they may or may not be linked?
Perfectionism is an interesting thing, isn't it, because it's a double edged sword,
Cathy on with that, I accuse you of being a bit of a perfectionist in some areas.
And I don't think you can really deny it, except that it's in particular areas.
And that's the issue, isn't it?
So the problem in perfectionism is defined typically as having unrelentingly high standards, but really across the piece,
not just in terms of the research you do, but also in terms of how clean your shoes are and and how tidy your office is,
which I'm going to plead guilty to not being perfectionist, and so perfectly unrelenting high standars across
the piece and being really worried about mistakes in how tidy your room is in the same way as in your data.
And again, I'm going to accuse you of being a perfectionist to make sure your data is correct and correctly dealt with.
So persistence is helpful. Clinical perfectionism is not.
There's an interesting wrinkle that the piece of research that Clare Lomax and myself and others did where where
Essentially we looked at people with what's called obsessive compulsive personality disorder, which is not OCD.
And we looked at people who had both OCD and OCPD,
obsessive compulsive persons and the people who had both problems did better than the people on our OCD.
And we worked out. And we're pretty sure that this is because their perfectionism clicked on in that treatment.
And so they did the treatment very thoroughly. So perfectionism is an advantage, but not what it overgeneralises.
So it can impact on OCD, but it's a double edged sword, as I've already indicated.
Thank you. I mean it. We're very clear that obviously OCD, the D stands for disorder, so we're talking about
people who are experiencing high levels of distress and interference in their lives and how
Obviously, many of the symptoms you described are things that different people will experience to different degrees.
And obviously, as you said, many of the intrusive thoughts are things that are extremely common for us all.
So at what point should people be worried about these symptoms and at what point would you encourage people to seek help?
OK, you've sort of answered it in your question, haven't you?
I mean, it's when it is, when it interferes, or when it begins to interfere or when it starts to make you feel
Horrible. And and I think there's a really simple in a sense in terms of what we could do about this.
I think we need to be working in schools, are working in universities and so on.
Helping people to understand that if something happens and we start to find that being
disturbed by intrusions and then having to change their pattern of things to do,
then they need to confront these things. And I call that secondary prevention, that you're starting to get you some signs of this.
And so you guys, you're worried about washing your hands too much.
So you stop washing your hands for a day and sort of try and nip it in the bud.
So it's about when it starts to interfere, then fight back rather than digging to get out of the hole and ending up as the digger
in that basic picture. So so I kind of think it's it's beginning to interfere with you, with with the lives of your loved ones.
I mentioned not once, but OCD is something that suffered not just by the person,
but by their families as well by the people who love and care for them and so on.
And, you know, and it starts to interfere, then that's the time to fight back or seek help.
Thanks very much. A few things just to pick upfrom what you just said that first of all,
you mentioned schools and we did have some questions about this. Obviously, lots of examples you describe today are based on adults,
but obviously recent studies have suggest about half of all people who have OCD will first have it before the age of 19.
So can you say a bit more about treatment of children,
adolescents and what the prognosis is and and how we might approach treatment differently for young people versus adults?
OK? Yeah.
I mean, in a sense, the graphs that I showed would indicate that showed average of 20 about some folks, which means half of people developed it before.
Interestingly, the the epidemiology suggests something, though because of that,
because the number of children with OCD and the number of adults with OCD looks almost identical,
which means probably that half of those children had a remission of their problem,
and probably not necessarily just with treatment, but remission, the problem said.
So it's not a life sentence when children get it. Children, as you know, Cathy, are it, respond extremely well to treatment.
And of course, almost by definition, they don't have this big delay.
So there's a potential advantage to having, kind of having it occur relatively
early because your parents will take you along by the hand and get help and so on.
I understand there are difficulties in getting specific help and so on, but nevertheless it comes to light earlier.
So that's important. The treatments that we use with the adults generalise extremely well.
They need adapting. And again, you and your colleagues,
people like Polly White and and others have done a really good job of adapting the adult things so that they're developmentally appropriate.
But it looks the same. I mean, it's actually surprisingly similar in this kind of way.
And I think we don't necessarily have to wait as long. There's another encouraging thing.
Victoria Bream I did a piece of work on people who were as adults had OCD rather like the the the the stuff we showed onset.
So we looked at them as adults and we divided them into people whose OCD started before the age of 12 or after the age of 16.
So these were adults, but the start of their problem had been very early or relatively later.
And then we looked to see how well they did in treatment today and whether in the 40s and 50s and so on.
And what was very encouraging was, in fact, if anything, the people had started their problem earlier.
They they they they were more severe at the beginning of the treatment that we offered them,
but they improved more, and actually they ended up in the same place as the people that started the problem later.
So even even later in life. I think treatment of children is why is the way to go.
But if that doesn't happen, don't get upset because you started your OCD before the age of 12.
It turns out you will do very well under those circumstances, which is great news. That is.
Thanks so much.
And the other thing that you mentioned when you're speaking for what's about, you know, supporting a loved ones if they're experiencing OCD?
Can you say a bit more about that? You know, what can we do to support those around us who are struggling with OCD?
Well, let's start by not blaming them. And one is that, yeah, I've got a big b in my bonnet about
about people being blamed. Because the because the because their children or their loved ones got OCD because because they gave in to them,
you know, they checked the door for them or gave them reassurance and so on.
And and I'm afraid as professionals, we do a lot of damage by saying things like, Well,
it's only you'd not given your child the reassurance, only you're not adapted, if only you haven't done these things and so on. ,
The reality is this that if your child comes to you with some with you and wants reassurance and they're distressed and so on,
you could in principle say, I'm not going to make sure you are not going to look at your hands.
I'm not going to do these things for you and know those circumstances. There's going to be a meltdown and it's going to go on for hours.
And at the end of it all, you're going to end up giving in because you've got no other choice.
And so you know, what people do is the right thing. They do what their job is as a mother or a father or partner.
And they they offer love and support to the person by reassuring them by doing things for them.
And so that is not that is not a terrible thing they're doing.
That is the only way they can get through the day because they see if they respond by giving reassurance,
by by checking the door or checking the hands of the young person or the adult, then that helps this person get through the day.
Once they move into treatment, then that can shift. But it's not a matter of that person stopping giving reassurance or stopping accommodating.
It's about the person, the child agreeing to that and then shifting to shifting from, say, reassurance seeking to support.
So, so basically, mum can give the child a big cuddle and say, I'm so proud of you for not washing your hands.
I'm so proud of you for not asking me to check the door. Now let's let's do something nice instead and so on.
But the reality of this is very often the parents already feel guilty.
You already think, Well, what could possibly go wrong? Feel terrible about it.
And then they blame themselves. And sometimes we kind of add to that which we absolutely shouldn't.
Absolutely agree. And I could see exactly what you said
there applies equally, not just to parents and children, but to partners, to friends, to others as well.
They can take the same supportive approach. Thank you.
We are out of time.
There was one other question that we were keen to ask, which was about support that might be available for university staff and students.
But I think what we'll do is follow up with some information to attendees about that.
But thanks ever so much, Paul. That's been a really fantastic session. I hope that everyone who's joined us today found
it as useful and interesting as I have. Just a reminder of our next session, which will be on the 5th of May with Dr. Hannah Murray, a
talk about understanding and managing troublesome and troubling mental images,
which obviously is very much related to what we've been talking about here today as well.
And also just a reminder of our YouTube channel. Department of Experimental Psychology at the University of Oxford YouTube channel,
which has all of the talks on it and will have Paul's talk on it soon, too.
So please do look back at that and catch up on any of the sessions you might have missed.
Thanks ever so much again for joining us. Thank you very much, Paul.
Please do take a little bit of time now before you go on to the next part of your day.
And we hope you can join us again soon. Thanks very much.