1 00:00:03,340 --> 00:00:09,310 Thanks so much for joining us this morning. So this is the latest in all Our Mental Wellness series, 2 00:00:09,310 --> 00:00:14,800 which is brought to you by the Department of Experimental Psychology here at the University of Oxford. 3 00:00:14,800 --> 00:00:20,500 My name's Cathy Creswell, and I'm really pleased to introduce you to Professor Paul Salkovskisoday. 4 00:00:20,500 --> 00:00:24,520 He's Professor of Clinical Psychology in the Department of Experimental Psychology, 5 00:00:24,520 --> 00:00:31,120 but also director of the Oxford Centre for Psychological Health and the Oxford Institute of Clinical Psychology, 6 00:00:31,120 --> 00:00:35,140 Training and Research and Cognitive Therapy Centre, 7 00:00:35,140 --> 00:00:39,400 and the school's director for the Clinical Psychology Doctorate Course here and 8 00:00:39,400 --> 00:00:43,500 clinical director for the Oxford Health Specialist Psychological Interventions Clinic. 9 00:00:43,500 --> 00:00:48,100 So as you can hear, he brings a wealth of research and clinical experience, 10 00:00:48,100 --> 00:00:57,040 particularly in the understanding and treatment of anxiety disorders and more specifically, OCD, panic and agoraphobia and health anxiety. 11 00:00:57,040 --> 00:01:01,360 So we're really looking forward to this talk today. `nefore we get started 12 00:01:01,360 --> 00:01:07,570 just a reminder to have a look at our Department of Experimental Psychology website and our YouTube channel, 13 00:01:07,570 --> 00:01:11,260 where you'll be able to find all the previous talks in this series. 14 00:01:11,260 --> 00:01:18,130 We've had a number of really fantastic talks now on a range of topics, including coping with trauma, 15 00:01:18,130 --> 00:01:24,820 bereavement, eating problems, depression and low mood, sleep problems, stress and anxiety. 16 00:01:24,820 --> 00:01:28,930 And the next session will be on the 9 June with Dr. Hannah Murray. 17 00:01:28,930 --> 00:01:33,220 We'll be talking about understanding and managing troubling mental images. 18 00:01:33,220 --> 00:01:42,970 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. 19 00:01:42,970 --> 00:01:46,630 If you want to look back or to share with anybody that you know, 20 00:01:46,630 --> 00:01:52,900 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. 21 00:01:52,900 --> 00:01:58,510 Sometimes these sessions do raise challenging thoughts and feelings for us, 22 00:01:58,510 --> 00:02:04,030 so really important not to just rush into the next thing, but give yourself a moment and have a cup of tea. 23 00:02:04,030 --> 00:02:09,280 Go for a walk, whatever works for you before you start the next part of your day. 24 00:02:09,280 --> 00:02:10,990 And also, we will remind you later on, 25 00:02:10,990 --> 00:02:19,930 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. 26 00:02:19,930 --> 00:02:24,220 But so without further ado, though, are now pass over to Paul. 27 00:02:24,220 --> 00:02:29,770 He's going to be talking to us about obsessive compulsive disorder, Too careful, too nice and trying too hard. 28 00:02:29,770 --> 00:02:32,980 Thanks very much for joining us, Paul. Thank you, Cathy. 29 00:02:32,980 --> 00:02:39,970 And having heard your introduction and I realise why nobody can ever accuse me of being a man with no direction. 30 00:02:39,970 --> 00:02:45,130 OK, so my talk is about OCD. 31 00:02:45,130 --> 00:02:50,200 I have a subtitle which is really just a variation on the same theme, 32 00:02:50,200 --> 00:02:58,300 which is, why it can hurt when you're too nice, so that you try too hard to be too careful. 33 00:02:58,300 --> 00:03:04,210 So I'll try to unfold that over the next half hour. I'll tell you what OCD is. 34 00:03:04,210 --> 00:03:08,230 I'm going to tell you that it is a bit more than "I'm a little bit OCD." 35 00:03:08,230 --> 00:03:16,000 A lot more than that. I'm going to talk about the sad fact that in OCD, typically it's too little, too late. 36 00:03:16,000 --> 00:03:23,620 So there is this there's an important need for early recognition and early help for people with OCD. 37 00:03:23,620 --> 00:03:30,940 I'm going to try and explain how being too nice works and how psychological theory helps us understand who it is, 38 00:03:30,940 --> 00:03:36,550 who suffers from OCD, trying too hard and how the solution becomes the problem 39 00:03:36,550 --> 00:03:42,130 and this is sort of good news because if it's about trying too hard and possibly 40 00:03:42,130 --> 00:03:45,850 one of the ways forward for people with this problem is to not try as hard, 41 00:03:45,850 --> 00:03:54,010 but that's difficult. I'm going to talk about the checking trap, which is why being too careful can cause problems. 42 00:03:54,010 --> 00:03:57,280 Briefly touch on the psychological treatment 43 00:03:57,280 --> 00:04:07,030 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. 44 00:04:07,030 --> 00:04:13,750 And then very briefly, if CBT cognitive therapy is and so I'm going to try and tell you what's in the box. 45 00:04:13,750 --> 00:04:24,940 So OCD, in terms of the diagnosis offered then, is intrusive thoughts, images and impulses. 46 00:04:24,940 --> 00:04:29,890 It's obsessions and compulsions, it says or in the diagnostic criteria. 47 00:04:29,890 --> 00:04:33,880 But it's always and compulsions are meaningfully related to the fears. 48 00:04:33,880 --> 00:04:40,610 And this is very important because it says essentially that this is a culturally determined problem to 49 00:04:40,610 --> 00:04:47,650 a degree, that the meaning that people attached to their fears relates to their background and values. 50 00:04:47,650 --> 00:04:51,520 By definition, the person seeks to ignore or suppress intrusions. 51 00:04:51,520 --> 00:04:58,600 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. 52 00:04:58,600 --> 00:05:03,380 But the key to the diagnosis, I'm going to emphasise this again in a moment, 53 00:05:03,380 --> 00:05:13,100 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, 54 00:05:13,100 --> 00:05:19,190 checking, rumination, dieting, scrupulousity, mental contamination and so on. 55 00:05:19,190 --> 00:05:23,360 Not OCD and recently separated from it is hoarding. 56 00:05:23,360 --> 00:05:28,070 I'm not going to talk about hoarding today, but it's not entirely unrelated problem. 57 00:05:28,070 --> 00:05:40,040 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, 58 00:05:40,040 --> 00:05:46,700 image, impulse or doubt, which tells the person that there's a potential for some kind of harm. 59 00:05:46,700 --> 00:05:53,180 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. 60 00:05:53,180 --> 00:06:02,030 The idea of responsibility, which drives the compulsion so compulsive the compulsion refers to some sort of action reaction that's 61 00:06:02,030 --> 00:06:08,120 intended to do two things to prevent the harm that you're worried about because of the obsession, 62 00:06:08,120 --> 00:06:12,530 but also to diminish responsibility for its occurrence. 63 00:06:12,530 --> 00:06:23,420 Both of those things should be familiar because everybody gets intrusions. So very, very long time ago. 64 00:06:23,420 --> 00:06:31,580 Jack Rachmann. Sadly, we lost Jack last year, but Jack is one of the big movers and shakers in this field. 65 00:06:31,580 --> 00:06:42,290 He and Padma de Silva, myself and Jim Harrison later demonstrated something about intrusions in people with and without OCD, 66 00:06:42,290 --> 00:06:48,050 and in particular, pretty much everyone has intrusive thoughts, images, impulses. 67 00:06:48,050 --> 00:06:51,380 So it turns out that it's not confined to OCD. 68 00:06:51,380 --> 00:06:57,980 If you make a list of the intrusive thoughts that people experience and then ask experts to say, Well, 69 00:06:57,980 --> 00:07:03,980 which of these are from people who have OCD, who've got the disorder, and which of these are from people who don't? 70 00:07:03,980 --> 00:07:12,060 Well. they can't. There is absolutely no difference in terms of what people worry about. 71 00:07:12,060 --> 00:07:23,400 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. 72 00:07:23,400 --> 00:07:32,340 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, 73 00:07:32,340 --> 00:07:40,260 56 percent of men jumping off a high place, 39 percent of women, 46 percent are men, and so on. 74 00:07:40,260 --> 00:07:48,180 And you'll see that the pattern of intrusions that we see in OCD are pretty much across the piece. 75 00:07:48,180 --> 00:07:54,450 Everyone is getting these. So that's a bit of a puzzle. Does this mean we're all a little bit OCD? 76 00:07:54,450 --> 00:08:00,900 Well, as my friends and colleagues at OCD UK say, no this is a myth. 77 00:08:00,900 --> 00:08:07,080 OCD is not an adjective. The D in OCD stands for disorder. 78 00:08:07,080 --> 00:08:11,280 And this is about suffering. This is about people being damaged. 79 00:08:11,280 --> 00:08:16,380 So the fact that somebody wants to arrange things in their fridge in a particular way 80 00:08:16,380 --> 00:08:19,270 and that's a bit quirky, does not mean they have OCD, 81 00:08:19,270 --> 00:08:27,180 and we should not be describing it that way, because it devalues essentially the terrible things that are happening to other people. 82 00:08:27,180 --> 00:08:31,830 So let's go back to what it really is and be more complete. 83 00:08:31,830 --> 00:08:39,900 OCD is a disorder, D is for disorder, and together obsessions and compulsions make the person feel awful, 84 00:08:39,900 --> 00:08:46,860 scared, disgusted with themselves typically, and stop the person from doing things which matter to them. 85 00:08:46,860 --> 00:08:50,460 OCD destroys lives and for many, is a living hell. 86 00:08:50,460 --> 00:08:56,100 It's not a little quirk to boast about on your social media. 87 00:08:56,100 --> 00:09:03,940 This is work like Sturby and I did and we looked at people who were currently affected by OCD very severely. 88 00:09:03,940 --> 00:09:10,740 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. 89 00:09:10,740 --> 00:09:19,770 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, 90 00:09:19,770 --> 00:09:26,610 on average of carrying around 15 or 16 significant interference occurring at age of 20, 91 00:09:26,610 --> 00:09:31,920 which means, of course, half of people are developing it before 20 and half of people later. 92 00:09:31,920 --> 00:09:38,820 But here's the interesting thing from the point at which they essentially have the disorder to the point where they started to seek 93 00:09:38,820 --> 00:09:48,630 help, six years go by, and then two more years go by before that correctly diagnosed and the treatment of any kind occurring later. 94 00:09:48,630 --> 00:09:53,700 Why is that important? Well, that's important because if, if, 95 00:09:53,700 --> 00:10:01,440 if I invite the people on this webinar to think about what they did between the age of 20 and 28 96 00:10:01,440 --> 00:10:06,750 and if that wasn't able to happen because of some sort of mental health problem, 97 00:10:06,750 --> 00:10:16,080 how would there life be different now? And much of what we see in severe OCD is not actually the direct effects of OCD. 98 00:10:16,080 --> 00:10:20,550 It's like an experience of OCD, but is the thing that I sometimes call collateral damage 99 00:10:20,550 --> 00:10:25,980 the destruction of relationships and education and just life in general. 100 00:10:25,980 --> 00:10:34,620 And this is why we should be helping people detect OCD earlier and and then get it treated more quickly. 101 00:10:34,620 --> 00:10:43,290 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. 102 00:10:43,290 --> 00:10:47,050 So is it really true that people with OCD are too nice? 103 00:10:47,050 --> 00:10:52,110 Well, yes, I think it is. OCD happens to people who are too nice for their own good. 104 00:10:52,110 --> 00:10:57,000 There are, in fact, lessons from history and evolution, the focus of OCD 105 00:10:57,000 --> 00:11:06,000 What OCD is about changes over time and is typically OCD focuses on the invisible spiritual, moral or physical menace, 106 00:11:06,000 --> 00:11:14,860 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. 107 00:11:14,860 --> 00:11:22,080 You know, we're looking at people who experienced religious obsessions, blasphemous thoughts and so on. 108 00:11:22,080 --> 00:11:26,310 And of course, very famously, a couple of peep figures from history. 109 00:11:26,310 --> 00:11:34,990 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, 110 00:11:34,990 --> 00:11:46,680 very famously describing essentially obsessional ruminations, and the fact that we don't see so much religious OCD at the moment in this country, 111 00:11:46,680 --> 00:11:51,210 but we do in some other cultures is very informative, in my view. 112 00:11:51,210 --> 00:11:54,240 So who gets what, what type of OCD? 113 00:11:54,240 --> 00:12:01,980 And I'm just going to summarise that by saying, for example, that loving parents develop OCD around harming their children. 114 00:12:01,980 --> 00:12:06,100 Clean people develop OCD about being contaminated or contaminating 115 00:12:06,100 --> 00:12:12,560 others. Deeply religious people develop OCD around blasphemy. 116 00:12:12,560 --> 00:12:15,200 Gentle people develop OCD around being violent, 117 00:12:15,200 --> 00:12:22,400 you should be spotting the pattern because - we can see people who are risk averse develop OCD about being careless - 118 00:12:22,400 --> 00:12:29,390 the pattern is this, but loving parents worry about harming their children. So hen they have these intrusive thoughts 119 00:12:29,390 --> 00:12:33,530 it doesn't mean they're going to harm their children. That means that is the worst thing that could happen. 120 00:12:33,530 --> 00:12:39,550 And so they worry about that as we all worry about the worst thing that would happen to us, 121 00:12:39,550 --> 00:12:43,720 clean people worry about being contaminated and contaminating others deeply. 122 00:12:43,720 --> 00:12:47,830 Religious people worry about blaspheming. Gentle people worry about being violent. 123 00:12:47,830 --> 00:12:55,960 People who are risk averse worry about being careless. So essentially, OCD is the opposite of who you are. 124 00:12:55,960 --> 00:13:00,190 Opposite of the values that you espouse. And that's really important. 125 00:13:00,190 --> 00:13:04,360 That takes us to the cognitive theory of OCD. 126 00:13:04,360 --> 00:13:12,610 And as its simplest, the cognitive theory says – unacceptable intrusive thoughts, images, impulses, doubts occur 127 00:13:12,610 --> 00:13:19,930 in everybody. Intrusions that we notice are the ones that we think are important for us, interesting, positive or negative. 128 00:13:19,930 --> 00:13:24,190 But we're focussing on OCD on the negatives. 129 00:13:24,190 --> 00:13:32,740 Intrusions can include day-to-day stuff, good ideas and unpleasant and unacceptable ideas. When unacceptable intrusions occur 130 00:13:32,740 --> 00:13:40,420 the person with OCD fears and believes they might be responsible for harm if they don't react to prevent or undo it, 131 00:13:40,420 --> 00:13:48,730 and they respond by trying too hard. OCD is fundamentally a matter of the person who's beset by frightening thoughts, 132 00:13:48,730 --> 00:13:52,600 trying to get rid of them and therefore experiencing them more. People trying to 133 00:13:52,600 --> 00:13:57,010 prevent harm and becoming less and less certain that they are able to do that, 134 00:13:57,010 --> 00:14:02,950 trying to be too sure and so on. And what happens is the solution becomes the problem. 135 00:14:02,950 --> 00:14:09,610 So in OCD, the person who's worried about contamination and contamination OCD, if you want to call it, 136 00:14:09,610 --> 00:14:17,590 contamination is not their problem, it's it's the washing and the attempts to avoid being contaminated. 137 00:14:17,590 --> 00:14:21,310 And we'll talk about a more extreme version in a moment. 138 00:14:21,310 --> 00:14:30,820 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 139 00:14:30,820 --> 00:14:39,370 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. 140 00:14:39,370 --> 00:14:48,010 No one ever. But OCD is a liar, and it falls people into thinking that if they could just get the perfect wash, 141 00:14:48,010 --> 00:14:53,110 then they would be better off. Because it did like digging to get out of a hole. 142 00:14:53,110 --> 00:14:57,040 And yeah, you could say, Well, I need a better spade to get out of this hole. 143 00:14:57,040 --> 00:15:03,480 Well dig for longer, need to dig more efficiently. What happens if you constantly double your efforts? 144 00:15:03,480 --> 00:15:09,070 So here's what happens. So here's how it starts. OK, so you know you've got a perfectly reasonable thing. 145 00:15:09,070 --> 00:15:14,620 You wash your hands after, use the bathroom or you check the door before you leave, and it's all very functional. 146 00:15:14,620 --> 00:15:19,630 But if you keep digging, yeah, then of course, that gets a lot worse. 147 00:15:19,630 --> 00:15:25,660 And then if you really, really try to keep digging, then this is how it's going. 148 00:15:25,660 --> 00:15:33,100 And this is unfortunately what happens if you try to get rid of OCD by giving into it. 149 00:15:33,100 --> 00:15:39,130 So now that's it's not just a matter of not giving in to it, it's a really hard thing to do. 150 00:15:39,130 --> 00:15:44,890 So too careful, let's just talk about being too careful and the cruel truth about OCD. 151 00:15:44,890 --> 00:15:51,430 OCD is a con tha promises safety and comfort and steals the person's life. 152 00:15:51,430 --> 00:16:00,610 I saw yesterday somebody said that OCD drives everything out your life until only it is there, and in most the most extreme cases 153 00:16:00,610 --> 00:16:09,310 I think that's right. OCD wants you to be careful in a way which distracts you from the real risks. 154 00:16:09,310 --> 00:16:16,840 So risk in OCD is often misunderstood. I sadly heard recently about somebody, 155 00:16:16,840 --> 00:16:25,510 this is quite common, saying this is somebody who was working in a as a teacher and a mental health professional, 156 00:16:25,510 --> 00:16:32,620 misunderstood their OCD and then essentially alerted the authorities to the fact that they had thoughts about harming children. 157 00:16:32,620 --> 00:16:38,900 And as a result, that person essentially was barred from their job I hope temporarily. 158 00:16:38,900 --> 00:16:48,290 And and essentially, that was seen as a risk. Now bottom line on this is that people with OCD who have 159 00:16:48,290 --> 00:16:54,200 thoughts of harming people, they are the least harmful people in the entire universe. 160 00:16:54,200 --> 00:17:01,730 So there's the question of risk in OCD is a complicated one. 161 00:17:01,730 --> 00:17:06,930 But it also is very simple in the sense that I would say there is no primary risk, 162 00:17:06,930 --> 00:17:13,220 If someone with OCD is afraid that they're going to harm somebody or something, then they're not going to do that. 163 00:17:13,220 --> 00:17:20,210 But there is this thing called secondary risk. So let me explain secondary risks are in this way. 164 00:17:20,210 --> 00:17:26,750 This is very sad news story. This is a man in Manchester. 165 00:17:26,750 --> 00:17:33,260 And the coroner, basically after he died, basically said that he died of an overdose of Detol. 166 00:17:33,260 --> 00:17:43,130 This is somebody who had it cleaned so much that he absorbed this disinfectant through his, through his skin. 167 00:17:43,130 --> 00:17:52,130 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, 168 00:17:52,130 --> 00:17:59,510 but it's the way you try to prevent these things have the effect of prevent, of causing a different harm. 169 00:17:59,510 --> 00:18:08,000 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. 170 00:18:08,000 --> 00:18:14,120 And as a result, from not being able to put the child on the floor and potentially some damage can happen. 171 00:18:14,120 --> 00:18:19,280 That damage is not happening because of the OCD. It is happening because of the lack of treatment. 172 00:18:19,280 --> 00:18:25,040 Now in this piece on this poor man who died of Detol poisoning, 173 00:18:25,040 --> 00:18:30,530 his sister said the bottom of the slide, he didn't want any help and was scared of receiving it. 174 00:18:30,530 --> 00:18:37,100 And that's because he was afraid of doing so. And this, in my view, is the elephant in the room. 175 00:18:37,100 --> 00:18:44,240 The elephant in the room in OCD is that it's so poorly understood that people 176 00:18:44,240 --> 00:18:49,880 think that if someone has the thought of being a paedophile or of causing harm, 177 00:18:49,880 --> 00:18:55,370 that that means that they are a risk, which of course they're not. And the elephant in the room is stigma. 178 00:18:55,370 --> 00:19:04,750 What an elephant is. What this particular elephant is composed of is essentially avoidance, 179 00:19:04,750 --> 00:19:13,840 Reluctance, denial, ignorance, diversion, silence, awkwardness, I don't quite know whether Trump fits in, but we'll leave that and so on. 180 00:19:13,840 --> 00:19:24,280 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. 181 00:19:24,280 --> 00:19:28,270 So let's try and get a bit of a better understanding of what's going on in OCD. 182 00:19:28,270 --> 00:19:33,490 Let's briefly talk about the checking trap. 183 00:19:33,490 --> 00:19:40,690 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, 184 00:19:40,690 --> 00:19:46,690 by definition, people with OCD feel that checking their door is very important because they don't get burgled or whatever. 185 00:19:46,690 --> 00:19:51,400 You think that checking would be helpful because if you check, you're going to be more sure. 186 00:19:51,400 --> 00:20:03,190 But here's the thing. When you try by repeatedly checking to be completely and perfectly sure, as demonstrated by psychologists Marcel, 187 00:20:03,190 --> 00:20:14,710 Fontenot, by Adam Rodonsky and others, what happens is that repeated checking removes your confidence in your memory. 188 00:20:14,710 --> 00:20:21,670 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 189 00:20:21,670 --> 00:20:24,490 the iron is it still on and so on. 190 00:20:24,490 --> 00:20:37,560 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. 191 00:20:37,560 --> 00:20:45,600 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 192 00:20:45,600 --> 00:20:57,960 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. 193 00:20:57,960 --> 00:21:07,380 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. 194 00:21:07,380 --> 00:21:13,140 They use problematic stop criteria. Another piece of research Karina Wallen and myself did, 195 00:21:13,140 --> 00:21:20,760 and the repeated checking of the type prominence in OCD progressively undermines the confidence which makes you want to check more. 196 00:21:20,760 --> 00:21:27,390 And there is one of several vicious circles which we've identified OCD. Just as a note, 197 00:21:27,390 --> 00:21:33,690 there's a type of checking which isn't as obvious, but it's still checking and that's seeking reassurance. 198 00:21:33,690 --> 00:21:39,390 Asking your loved one "are my hands clean, are you sure the door is locked and so on." 199 00:21:39,390 --> 00:21:45,480 Now that's actually checking with an extra element. And what our research said in particular, 200 00:21:45,480 --> 00:21:53,580 Osama Kaburi and I picked up that what's happening there is that when you seek reassurance, you're checking. 201 00:21:53,580 --> 00:22:00,510 And you're also transferring responsibility, so the idea of responsibility so that you make the other person responsible for the harm. 202 00:22:00,510 --> 00:22:03,330 And that seems to make it easier in the short term, 203 00:22:03,330 --> 00:22:09,750 but has the effect of undermining your confidence both in that particular occasion and in general in your ability to be sure. 204 00:22:09,750 --> 00:22:15,160 So, OK, that's broadly speaking the way we psychologically understand it. 205 00:22:15,160 --> 00:22:20,370 So if what I'm saying is true, shouldn't we just just stop it? 206 00:22:20,370 --> 00:22:28,190 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 207 00:22:28,190 --> 00:22:32,160 say cheer up. Lots of people, they can't just stop it. i 208 00:22:32,160 --> 00:22:38,040 It's just not that easy. What's needed is appropriate support. 209 00:22:38,040 --> 00:22:42,630 OCD is not an accident, and this is an important starting point. 210 00:22:42,630 --> 00:22:52,230 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, 211 00:22:52,230 --> 00:23:00,960 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. 212 00:23:00,960 --> 00:23:06,720 So what the person with OCD needs to understand is why is the problem so severe? 213 00:23:06,720 --> 00:23:13,140 And again, in a psychological formulation helps us understand that. But even more importantly, why does it persist? 214 00:23:13,140 --> 00:23:16,590 And as with almost all of the problems we deal with in mental health, 215 00:23:16,590 --> 00:23:20,700 it's not necessarily a problem that people feel anxious or that they have intrusions. 216 00:23:20,700 --> 00:23:32,170 But why are these severe, severe and persistent and how can we change the things which which actually are making it severe and persistent? 217 00:23:32,170 --> 00:23:39,600 Sometimes it's helpful to know why it starts, but typically it's not actually where you would start in treatment. 218 00:23:39,600 --> 00:23:43,920 So what treatment does, treatment cognitive behavioural therapy 219 00:23:43,920 --> 00:23:49,470 it all falls roughly the same pattern of OCD and everywhere else, but it has unique features. 220 00:23:49,470 --> 00:23:56,500 And in general, what we do in psychological treatments is help people see things differently so they can do things differently. 221 00:23:56,500 --> 00:24:02,220 That's about perspective. But more importantly, also by using that perspective to experiment. What do I mean? 222 00:24:02,220 --> 00:24:11,580 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, 223 00:24:11,580 --> 00:24:15,480 and they get stuck in this way of seeing the world and they get caught in these loops. 224 00:24:15,480 --> 00:24:16,560 I've given you the checking 225 00:24:16,560 --> 00:24:25,920 trap as an example of that. Effective change needs the person to be able to be more flexible in the way they see things. 226 00:24:25,920 --> 00:24:30,600 And that's a really crucial thing. It's about actually being more flexible. 227 00:24:30,600 --> 00:24:36,070 This means finding and considering an alternative, less negative way of understanding their problem. 228 00:24:36,070 --> 00:24:44,210 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, 229 00:24:44,210 --> 00:24:49,580 but is it possible that you're actually a person who's terrified of being a paedophile? 230 00:24:49,580 --> 00:24:53,090 It's not that you are a paedophile, it's that it's the fear of being a paedophile 231 00:24:53,090 --> 00:24:58,970 that's the problem for a different way of thinking to be helpful. 232 00:24:58,970 --> 00:25:07,460 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. 233 00:25:07,460 --> 00:25:13,640 And as a therapist, it's very important that I don't just help them feel understood, but I do that by understanding. 234 00:25:13,640 --> 00:25:20,660 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. 235 00:25:20,660 --> 00:25:31,960 So good therapy is actually about, at least two people, myself and the person who is suffering, working together and that working together 236 00:25:31,960 --> 00:25:39,660 is important to find out how the world really works. And good therapy is always about two experts working on the problem 237 00:25:39,660 --> 00:25:46,320 in close collaboration. Me as somebody who knows a little bit about OCD, but not necessarily a great deal about the person's life. 238 00:25:46,320 --> 00:25:53,550 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. 239 00:25:53,550 --> 00:26:04,460 So in terms of how people should approach CBT, it's important to understand that therapists, CBT therapists, people like myself, do not 240 00:26:04,460 --> 00:26:08,270 change people. People choose to change themselves 241 00:26:08,270 --> 00:26:16,610 so CBT in the end is self-help with someone helping you to understand and apply that understanding. You need to go to therapy 242 00:26:16,610 --> 00:26:23,820 if that's where you're headed, and helped to understand the nature of the problem and help to choose to change. 243 00:26:23,820 --> 00:26:29,790 You should go to therapy and really importantly, we're pretty useless therapists until you help us. 244 00:26:29,790 --> 00:26:35,580 So you've got to go to therapy expecting that a therapist is going to need a lot of help from you. 245 00:26:35,580 --> 00:26:39,330 So here's what I say is in the box when I open it 246 00:26:39,330 --> 00:26:45,120 for CBT and and what you should expect to see, it's your user's this manual for a CBT, 247 00:26:45,120 --> 00:26:51,990 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. 248 00:26:51,990 --> 00:26:55,910 Discussion of how best to deal with questions in therapy itself 249 00:26:55,910 --> 00:27:01,980 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, 250 00:27:01,980 --> 00:27:10,110 do you have any questions for me and encouraging people to ask questions and to be participate actively in treatment as we go through. 251 00:27:10,110 --> 00:27:17,310 And then it's about allowing the person to share the story, agreeing on what it is you're going to work on. 252 00:27:17,310 --> 00:27:21,990 I would want to do a general assessment and find out what's happening to this person in general, 253 00:27:21,990 --> 00:27:25,620 but then a specific assessment leading to the thing we call formulation, 254 00:27:25,620 --> 00:27:32,640 which is a shared understanding, working through some combination of helping people to change the way they think. 255 00:27:32,640 --> 00:27:38,910 But also the thing we tell behavioural experiments, which is don't trust me, but find out for yourself. 256 00:27:38,910 --> 00:27:49,410 Helping the person confront their fears, helping them to generalise changes, and then really importantly, working on how to reclaim their life. 257 00:27:49,410 --> 00:27:54,570 That is the only show in town as far as psychological treatment of OCD is concerned. 258 00:27:54,570 --> 00:28:00,090 To find out more, I've already recommended OCD UK. OCD UK 259 00:28:00,090 --> 00:28:06,630 also they make available other books I've been involved in. 260 00:28:06,630 --> 00:28:11,040 All the books are available and I'm just going to mention at the end here that 261 00:28:11,040 --> 00:28:16,830 we always need help with our research and that's that's our website at the bottom. 262 00:28:16,830 --> 00:28:21,630 And if anybody wants to volunteer, if they've got problems or they haven't got problems, 263 00:28:21,630 --> 00:28:25,020 We're always very keen to have that. 264 00:28:25,020 --> 00:28:36,270 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, 265 00:28:36,270 --> 00:28:41,930 too careful and trying too hard. Thank you very much. Thanks very much indeed, Paul. 266 00:28:41,930 --> 00:28:48,500 I'm sure that was extremely useful information for people, and thanks very much for sharing those resources as well. 267 00:28:48,500 --> 00:28:54,380 As you know, we had various questions submitted, so many of those you touched on already, 268 00:28:54,380 --> 00:29:01,070 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, 269 00:29:01,070 --> 00:29:10,250 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, 270 00:29:10,250 --> 00:29:16,610 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? 271 00:29:16,610 --> 00:29:23,780 Because, as you said, it is often so misrepresented? Well, we can stop the representation, I mean, 272 00:29:23,780 --> 00:29:32,390 I got into a bit of a battle with Channel Four when they they ran a programme called Obsessive Compulsive Cleaners, 273 00:29:32,390 --> 00:29:38,660 which was horrible, which is horrific, which kind of paired up people who were struggling with cleanliness with people struggling 274 00:29:38,660 --> 00:29:43,280 with hoarding and so on, with people who had very severe cleaning rituals. 275 00:29:43,280 --> 00:29:45,020 Some of whom did, some of whom didn't. 276 00:29:45,020 --> 00:29:51,860 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, 277 00:29:51,860 --> 00:29:55,430 you know, pouring bleach over themselves and other people and so on. 278 00:29:55,430 --> 00:30:01,550 And that that was at a time when Channel Four had signed the mental health pledge that they would destigmatise, 279 00:30:01,550 --> 00:30:07,010 and they completely ignored the representations of multiple organisations and so on. 280 00:30:07,010 --> 00:30:11,780 So our media needs to get its act together and it needs to stop misunderstanding this. 281 00:30:11,780 --> 00:30:16,370 We need to stop being in the position. I mean, it is deeply frightening for I mean, 282 00:30:16,370 --> 00:30:21,860 I mentioned the young man who's a teacher and who's been stopped from being a teacher because he 283 00:30:21,860 --> 00:30:27,230 was honest enough to talk to mental health professional about the problems he was experiencing, 284 00:30:27,230 --> 00:30:32,630 which did not increase his risk and he's facing this horrific battle. 285 00:30:32,630 --> 00:30:41,330 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, 286 00:30:41,330 --> 00:30:45,230 although washing hands is a very serious problem for those who have it, and we need to 287 00:30:45,230 --> 00:30:52,140 we need to be having more sessions like this and we need to have better understanding all around. 288 00:30:52,140 --> 00:31:02,600 So yeah, it's being more open, making, making, giving people better access to treatment, not putting hurdles in the way, not giving them 289 00:31:02,600 --> 00:31:09,260 as sometimes happens, meaningless treatments before they're able to get through to more specialist or focused treatments. 290 00:31:09,260 --> 00:31:11,590 Mm-Hmm. Thanks very much. 291 00:31:11,590 --> 00:31:19,400 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. 292 00:31:19,400 --> 00:31:23,240 To what extent did the stresses that you've described earlier apply to contamination fears? 293 00:31:23,240 --> 00:31:27,680 And is there any sort of particular advice you'd give for that context? 294 00:31:27,680 --> 00:31:31,130 Oh, entirely. I mean, and of course, it's very relevant at the moment because it I mean, 295 00:31:31,130 --> 00:31:37,790 one of the things that happened early on with lockdown, people were using hand gel, self-isolating and so on. 296 00:31:37,790 --> 00:31:43,520 And so some people with contamination OCD that that gave them a bit of a bit of a break, a bit of a holiday. 297 00:31:43,520 --> 00:31:47,870 But that was kind of a false thing in the sense that it just meant that they were able to 298 00:31:47,870 --> 00:31:53,000 avoid more, as opposed to having to deal with everyday things that no one can ask about. 299 00:31:53,000 --> 00:31:58,760 Because it's worse because we've had sort of socially sanctioned sort of avoidance and checking. 300 00:31:58,760 --> 00:32:08,780 So contamination is what a particularly easy to treat within OCD, with one exception, which I'll briefly mentioned in a moment. 301 00:32:08,780 --> 00:32:15,140 And essentially, because this is a kind of physical, it's a physical thing that you can confront. 302 00:32:15,140 --> 00:32:23,960 As with any other sort of more sort of phobic type pattern, people can confront this thing and can be supportive of that. 303 00:32:23,960 --> 00:32:27,650 The self-help book, Break Free from OCD, talks great deal about what you can do with 304 00:32:27,650 --> 00:32:31,610 that and other things and so on, so people can do a great deal themselves. 305 00:32:31,610 --> 00:32:37,820 And yes, CBT works particularly well. With the exception I mentioned is this thing called mental contamination, 306 00:32:37,820 --> 00:32:42,110 and this seems to relate to something that came out very recently again. 307 00:32:42,110 --> 00:32:49,310 Jack Rathman was the person who generated this, this insight that some people don't feel contaminated about what they touch, 308 00:32:49,310 --> 00:32:54,080 but contaminated by what's going on in their mind. And also that relates to traumatic events. 309 00:32:54,080 --> 00:32:55,820 Bullying seems to be one. 310 00:32:55,820 --> 00:33:02,490 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. 311 00:33:02,490 --> 00:33:06,080 So it's probably sort of Lady Macbeth or Pontius Pilate style. 312 00:33:06,080 --> 00:33:11,970 You know that you have these horrible feelings and washing as it is used as a way to get rid of. 313 00:33:11,970 --> 00:33:14,990 Exposure to contaminants don't help there. 314 00:33:14,990 --> 00:33:21,870 And so you actually did quite a different strategy that involves dealing with the memories that people have with these things. 315 00:33:21,870 --> 00:33:27,860 Okay, thanks very much and be useful to know that the book that will be particularly useful in that situation. 316 00:33:27,860 --> 00:33:32,330 I suppose one of the other things that people often linked with OCD is perfectionism. 317 00:33:32,330 --> 00:33:41,390 So can you say a bit about the association between OCD and perfectionism, and how they may or may not be linked? 318 00:33:41,390 --> 00:33:44,960 Perfectionism is an interesting thing, isn't it, because it's a double edged sword, 319 00:33:44,960 --> 00:33:49,820 Cathy on with that, I accuse you of being a bit of a perfectionist in some areas. 320 00:33:49,820 --> 00:33:53,660 And I don't think you can really deny it, except that it's in particular areas. 321 00:33:53,660 --> 00:33:55,070 And that's the issue, isn't it? 322 00:33:55,070 --> 00:34:02,630 So the problem in perfectionism is defined typically as having unrelentingly high standards, but really across the piece, 323 00:34:02,630 --> 00:34:08,840 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, 324 00:34:08,840 --> 00:34:14,000 which I'm going to plead guilty to not being perfectionist, and so perfectly unrelenting high standars across 325 00:34:14,000 --> 00:34:21,020 the piece and being really worried about mistakes in how tidy your room is in the same way as in your data. 326 00:34:21,020 --> 00:34:27,740 And again, I'm going to accuse you of being a perfectionist to make sure your data is correct and correctly dealt with. 327 00:34:27,740 --> 00:34:33,020 So persistence is helpful. Clinical perfectionism is not. 328 00:34:33,020 --> 00:34:42,590 There's an interesting wrinkle that the piece of research that Clare Lomax and myself and others did where where 329 00:34:42,590 --> 00:34:50,420 Essentially we looked at people with what's called obsessive compulsive personality disorder, which is not OCD. 330 00:34:50,420 --> 00:34:53,120 And we looked at people who had both OCD and OCPD, 331 00:34:53,120 --> 00:35:00,050 obsessive compulsive persons and the people who had both problems did better than the people on our OCD. 332 00:35:00,050 --> 00:35:06,320 And we worked out. And we're pretty sure that this is because their perfectionism clicked on in that treatment. 333 00:35:06,320 --> 00:35:14,270 And so they did the treatment very thoroughly. So perfectionism is an advantage, but not what it overgeneralises. 334 00:35:14,270 --> 00:35:20,930 So it can impact on OCD, but it's a double edged sword, as I've already indicated. 335 00:35:20,930 --> 00:35:27,260 Thank you. I mean it. We're very clear that obviously OCD, the D stands for disorder, so we're talking about 336 00:35:27,260 --> 00:35:32,460 people who are experiencing high levels of distress and interference in their lives and how 337 00:35:32,460 --> 00:35:38,600 Obviously, many of the symptoms you described are things that different people will experience to different degrees. 338 00:35:38,600 --> 00:35:43,340 And obviously, as you said, many of the intrusive thoughts are things that are extremely common for us all. 339 00:35:43,340 --> 00:35:51,050 So at what point should people be worried about these symptoms and at what point would you encourage people to seek help? 340 00:35:51,050 --> 00:35:56,020 OK, you've sort of answered it in your question, haven't you? 341 00:35:56,020 --> 00:36:01,950 I mean, it's when it is, when it interferes, or when it begins to interfere or when it starts to make you feel 342 00:36:01,950 --> 00:36:07,530 Horrible. And and I think there's a really simple in a sense in terms of what we could do about this. 343 00:36:07,530 --> 00:36:13,590 I think we need to be working in schools, are working in universities and so on. 344 00:36:13,590 --> 00:36:17,550 Helping people to understand that if something happens and we start to find that being 345 00:36:17,550 --> 00:36:21,960 disturbed by intrusions and then having to change their pattern of things to do, 346 00:36:21,960 --> 00:36:29,610 then they need to confront these things. And I call that secondary prevention, that you're starting to get you some signs of this. 347 00:36:29,610 --> 00:36:33,060 And so you guys, you're worried about washing your hands too much. 348 00:36:33,060 --> 00:36:40,500 So you stop washing your hands for a day and sort of try and nip it in the bud. 349 00:36:40,500 --> 00:36:50,250 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 350 00:36:50,250 --> 00:36:58,290 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. 351 00:36:58,290 --> 00:37:02,760 I mentioned not once, but OCD is something that suffered not just by the person, 352 00:37:02,760 --> 00:37:08,100 but by their families as well by the people who love and care for them and so on. 353 00:37:08,100 --> 00:37:13,890 And, you know, and it starts to interfere, then that's the time to fight back or seek help. 354 00:37:13,890 --> 00:37:18,930 Thanks very much. A few things just to pick upfrom what you just said that first of all, 355 00:37:18,930 --> 00:37:25,260 you mentioned schools and we did have some questions about this. Obviously, lots of examples you describe today are based on adults, 356 00:37:25,260 --> 00:37:31,560 but obviously recent studies have suggest about half of all people who have OCD will first have it before the age of 19. 357 00:37:31,560 --> 00:37:34,380 So can you say a bit more about treatment of children, 358 00:37:34,380 --> 00:37:44,040 adolescents and what the prognosis is and and how we might approach treatment differently for young people versus adults? 359 00:37:44,040 --> 00:37:45,000 OK? Yeah. 360 00:37:45,000 --> 00:37:53,250 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. 361 00:37:53,250 --> 00:37:58,110 Interestingly, the the epidemiology suggests something, though because of that, 362 00:37:58,110 --> 00:38:04,290 because the number of children with OCD and the number of adults with OCD looks almost identical, 363 00:38:04,290 --> 00:38:09,140 which means probably that half of those children had a remission of their problem, 364 00:38:09,140 --> 00:38:12,660 and probably not necessarily just with treatment, but remission, the problem said. 365 00:38:12,660 --> 00:38:20,250 So it's not a life sentence when children get it. Children, as you know, Cathy, are it, respond extremely well to treatment. 366 00:38:20,250 --> 00:38:24,360 And of course, almost by definition, they don't have this big delay. 367 00:38:24,360 --> 00:38:31,020 So there's a potential advantage to having, kind of having it occur relatively 368 00:38:31,020 --> 00:38:35,610 early because your parents will take you along by the hand and get help and so on. 369 00:38:35,610 --> 00:38:41,760 I understand there are difficulties in getting specific help and so on, but nevertheless it comes to light earlier. 370 00:38:41,760 --> 00:38:46,380 So that's important. The treatments that we use with the adults generalise extremely well. 371 00:38:46,380 --> 00:38:49,860 They need adapting. And again, you and your colleagues, 372 00:38:49,860 --> 00:39:01,080 people like Polly White and and others have done a really good job of adapting the adult things so that they're developmentally appropriate. 373 00:39:01,080 --> 00:39:06,510 But it looks the same. I mean, it's actually surprisingly similar in this kind of way. 374 00:39:06,510 --> 00:39:11,580 And I think we don't necessarily have to wait as long. There's another encouraging thing. 375 00:39:11,580 --> 00:39:22,470 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. 376 00:39:22,470 --> 00:39:30,780 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. 377 00:39:30,780 --> 00:39:37,620 So these were adults, but the start of their problem had been very early or relatively later. 378 00:39:37,620 --> 00:39:42,690 And then we looked to see how well they did in treatment today and whether in the 40s and 50s and so on. 379 00:39:42,690 --> 00:39:48,480 And what was very encouraging was, in fact, if anything, the people had started their problem earlier. 380 00:39:48,480 --> 00:39:53,880 They they they they were more severe at the beginning of the treatment that we offered them, 381 00:39:53,880 --> 00:40:00,120 but they improved more, and actually they ended up in the same place as the people that started the problem later. 382 00:40:00,120 --> 00:40:05,520 So even even later in life. I think treatment of children is why is the way to go. 383 00:40:05,520 --> 00:40:11,070 But if that doesn't happen, don't get upset because you started your OCD before the age of 12. 384 00:40:11,070 --> 00:40:16,170 It turns out you will do very well under those circumstances, which is great news. That is. 385 00:40:16,170 --> 00:40:17,100 Thanks so much. 386 00:40:17,100 --> 00:40:23,670 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? 387 00:40:23,670 --> 00:40:28,830 Can you say a bit more about that? You know, what can we do to support those around us who are struggling with OCD? 388 00:40:28,830 --> 00:40:34,500 Well, let's start by not blaming them. And one is that, yeah, I've got a big b in my bonnet about 389 00:40:34,500 --> 00:40:43,680 about people being blamed. Because the because the because their children or their loved ones got OCD because because they gave in to them, 390 00:40:43,680 --> 00:40:47,460 you know, they checked the door for them or gave them reassurance and so on. 391 00:40:47,460 --> 00:40:52,800 And and I'm afraid as professionals, we do a lot of damage by saying things like, Well, 392 00:40:52,800 --> 00:41:00,120 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. , 393 00:41:00,120 --> 00:41:10,350 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, 394 00:41:10,350 --> 00:41:14,580 you could in principle say, I'm not going to make sure you are not going to look at your hands. 395 00:41:14,580 --> 00:41:20,880 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. 396 00:41:20,880 --> 00:41:25,500 And at the end of it all, you're going to end up giving in because you've got no other choice. 397 00:41:25,500 --> 00:41:32,760 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. 398 00:41:32,760 --> 00:41:38,220 And they they offer love and support to the person by reassuring them by doing things for them. 399 00:41:38,220 --> 00:41:41,860 And so that is not that is not a terrible thing they're doing. 400 00:41:41,860 --> 00:41:46,050 That is the only way they can get through the day because they see if they respond by giving reassurance, 401 00:41:46,050 --> 00:41:53,520 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. 402 00:41:53,520 --> 00:42:01,920 Once they move into treatment, then that can shift. But it's not a matter of that person stopping giving reassurance or stopping accommodating. 403 00:42:01,920 --> 00:42:11,160 It's about the person, the child agreeing to that and then shifting to shifting from, say, reassurance seeking to support. 404 00:42:11,160 --> 00:42:20,310 So, so basically, mum can give the child a big cuddle and say, I'm so proud of you for not washing your hands. 405 00:42:20,310 --> 00:42:26,900 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. 406 00:42:26,900 --> 00:42:31,410 But the reality of this is very often the parents already feel guilty. 407 00:42:31,410 --> 00:42:35,100 You already think, Well, what could possibly go wrong? Feel terrible about it. 408 00:42:35,100 --> 00:42:41,340 And then they blame themselves. And sometimes we kind of add to that which we absolutely shouldn't. 409 00:42:41,340 --> 00:42:43,650 Absolutely agree. And I could see exactly what you said 410 00:42:43,650 --> 00:42:49,050 there applies equally, not just to parents and children, but to partners, to friends, to others as well. 411 00:42:49,050 --> 00:42:52,500 They can take the same supportive approach. Thank you. 412 00:42:52,500 --> 00:42:53,580 We are out of time. 413 00:42:53,580 --> 00:43:01,080 There was one other question that we were keen to ask, which was about support that might be available for university staff and students. 414 00:43:01,080 --> 00:43:06,060 But I think what we'll do is follow up with some information to attendees about that. 415 00:43:06,060 --> 00:43:11,820 But thanks ever so much, Paul. That's been a really fantastic session. I hope that everyone who's joined us today found 416 00:43:11,820 --> 00:43:18,870 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 417 00:43:18,870 --> 00:43:22,200 talk about understanding and managing troublesome and troubling mental images, 418 00:43:22,200 --> 00:43:28,210 which obviously is very much related to what we've been talking about here today as well. 419 00:43:28,210 --> 00:43:34,650 And also just a reminder of our YouTube channel. Department of Experimental Psychology at the University of Oxford YouTube channel, 420 00:43:34,650 --> 00:43:39,390 which has all of the talks on it and will have Paul's talk on it soon, too. 421 00:43:39,390 --> 00:43:44,700 So please do look back at that and catch up on any of the sessions you might have missed. 422 00:43:44,700 --> 00:43:47,760 Thanks ever so much again for joining us. Thank you very much, Paul. 423 00:43:47,760 --> 00:43:51,450 Please do take a little bit of time now before you go on to the next part of your day. 424 00:43:51,450 --> 00:44:00,016 And we hope you can join us again soon. Thanks very much.