The term OCD gets thrown around a lot these days, so let’s get clear on what it is and how to treat it.
Do you want to learn more about Obsessive Compulsive Disorder (OCD)?
Then stick around, because in this episode of the Mental Health Toolbox, we are talking with OCD and Anxiety specialist, Andrew Cohen LMFT on Obsessive Compulsive Disorder (OCD) -What it is and how to treat it.
*Some of the links found here are affiliate links: As an Associate I earn from qualifying purchases by way of commission at no additional cost to you. See full disclaimer here:
Table of Contents
BIO: Andrew Cohen, LMFT, OCD and Anxiety Specialist.
Are you experiencing debilitating intrusive thoughts and obsessions that will not get out of your head? Do you have to engage in time-consuming rituals to get through the day? You may be suffering from OCD or another anxiety disorder. These symptoms do not have to control your life, and it is possible to break free from your vicious anxiety cycle! In my practice, I utilize Evidence-Based Practice to treat OCD and Anxiety, including CBT, ERP, ACT, and Cognitive Based Mindfulness. Additionally, I have experience working with Depression, Interpersonal Conflicts, and Families.
I received my Master of Science degree in Counseling Psychology, with an emphasis in Marriage and Family Therapy, from California Lutheran University (CLU) in 2018. I received my training in CBT; specifically, Exposure and Response Prevention, ACT, and Mindfulness, to treat OCD and Anxiety disorders by Dr. Jenny C. Yip at Renewed Freedom Center. By exposing yourself to your obsessions and fears, while refraining from engaging in compulsions, you rewire your brain and fight-or-flight system for long-term anxiety relief. Additionally, I serve on the Board of Directors for OCD SoCal, an affiliate of IOCDF and completed Supportive Parenting for Anxious Childhood Emotions (SPACE) training in April of 2021.
Everyone experiences their OCD and anxiety differently. This is why I aim to understand each patient’s specific concerns to help set up the best treatment course. From utilizing my own personal and professional experiences of having and treating OCD, let me help you overcome your battle with it.
https://www.cohenocdtherapy.com/#about
Learn More About Andrew Cohen, LMFT, OCD and Anxiety Specialist:
SOCIAL:
-Website: https://www.cohenocdtherapy.com/
-Instagram: https://www.instagram.com/andrewcohenocdtherapist/?hl=en
-Facebook: https://www.facebook.com/andrewcohenLMFT
-Lin: https://www.linkedin.com/in/andrew-cohen-ms-lmft-27110374/
-Twitter: https://twitter.com/LmftCohen
OCD Awareness Week:
At the time of this post, next week is OCD awareness week.
A special thanks to Andrew Cohen MS LMFT for sharing the below on this great learning opportunity.
Save the date: 10/15/22 @ 11:00am PST
In honor of raising mental health awareness, there is a free virtual event/summit being held by expert speakers in the field of OCD, on evidence based practice ERP basics, psychopharmacology for OCD, strategies for staying motivated in OCD treatment, navigating family dynamics, and latest information on treating kids with OCD.
You can get your link to join the online event by emailing info@ocdsocal.org.
Flyer: https://lnkd.in/gutyBCcN
OCD Resources
- International OCD Foundation: https://iocdf.org/
- OCD Southern California: https://ocdsocal.org/
Watch The Interview
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Want to learn more? Check out my top picks for books on self-improvement and recovery HERE!
NEED CRISIS HELP? If you need immediate crisis help with your depression, you can call the National Suicide Prevention Lifeline at 1-800-273-8255 or text “START” to 741-741
OUTSIDE THE UNITED STATES: See International Suicide Hotlines
WHERE TO FIND MENTAL HEALTH HELP:
-NAMI Referral Helpline: 1-800-950-6264
-California’s Statewide Mental Health Helpline: 1-855-845-7415
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Interview Transcript:
00:00:00 Patrick Martin LCSW
The term OCD gets thrown around a lot these days, and if you find yourself wondering what exactly OCD is, then you’re in the right place.
00:00:09 Patrick Martin LCSW
Because in this episode of the mental Health Toolbox, we’re talking all about obsessive compulsive disorder, with special guest Andrew Cohen, OCD, and anxiety specialist Andrew has a thriving.
00:00:20 Patrick Martin LCSW
Private practice in Westlake Village, CA.
00:00:23 Patrick Martin LCSW
And in case you didn’t know, this is OCD Awareness Week.
00:00:27
OK.
00:00:28 Andrew Cohen LMFT
So for the listeners based.
00:00:29 Andrew Cohen LMFT
Basically what ego dystonic means is these are thoughts that are not in line with your morals and values and who you.
00:00:36 Andrew Cohen LMFT
Are as a person.
00:00:37 Andrew Cohen LMFT
And OCD thoughts are ego dystonic and that’s what makes them so, so, so scary and an ego syntonic.
00:00:46 Andrew Cohen LMFT
Our thoughts and things like that that are in line with.
00:00:48 Andrew Cohen LMFT
Our values what we’d like so.
00:00:49 Andrew Cohen LMFT
An example I.
00:00:50 Andrew Cohen LMFT
Like to use?
00:00:50 Andrew Cohen LMFT
Is, you know, I like.
00:00:54 Andrew Cohen LMFT
I have two dogs that I absolutely love and a wife that I love and.
00:00:59 Andrew Cohen LMFT
You know, I don’t have harm OCD, but somebody you know with harm OCD would potentially experience thoughts of, you know, stabbing their dog or strangling their dog and but what OCD does and why is it you’re bullying such a just a really, really difficult thing to deal with is it attacks.
00:01:18 Andrew Cohen LMFT
The things you love and it knows it’s going to get under your skin.
00:01:21 Patrick Martin LCSW
Our guest this week, Andrew Cohen, has brought to my attention that there is a special 2 hour online virtual event in honor of OCD Awareness Week that’s being held on October 15th, Saturday.
00:01:34 Patrick Martin LCSW
If you’d like to sign up for this virtual event, you can send an e-mail to.
00:01:38 Patrick Martin LCSW
Info@oakcal.org that’s info@oakcal.org where you can sign up to get the link for this online free virtual event. You’ll learn about exposure and response prevention 101 for OCD, medications for OCD.
00:01:59 Patrick Martin LCSW
Maintaining motivation and OCD treatment.
00:02:02 Patrick Martin LCSW
Navigating the family accommodation trap with compassion and conf.
00:02:07 Patrick Martin LCSW
As well as treatment for kids with OCD and what is upcoming in this specialized field.
00:02:14 Patrick Martin LCSW
Alright, I’ll make sure to put that link up in the show notes and description so you can jump in and get your registration set up for this special online event.
00:02:23 Patrick Martin LCSW
But without further ado, let’s jump in.
00:02:26 Patrick Martin LCSW
And chat with Andrew Cohen, OCD specialist and anxiety specialist.
00:02:31 Patrick Martin LCSW
Let’s go.
00:02:39 Patrick Martin LCSW
Hello Andrew, and thank you so much for making time today to be on the mental health Toolbox Video podcast.
00:02:45 Patrick Martin LCSW
I really appreciate you jumping on here to share your words of wisdom around OCD and anxiety treatment, so thank you so much.
00:02:53 Andrew Cohen LMFT
Yeah, absolutely.
00:02:54 Andrew Cohen LMFT
I’m really, really happy to be here and spread awareness and hopefully help some people.
00:03:00 Patrick Martin LCSW
Yes, that’s the whole goal.
00:03:01 Patrick Martin LCSW
I appreciate it.
00:03:02 Patrick Martin LCSW
Raise mental health awareness, psychoeducation, actionable tips and information right ’cause we all want to live our best lives and.
00:03:11 Patrick Martin LCSW
Right.
00:03:11 Patrick Martin LCSW
And any ammunition we can gain around what moves the needle?
00:03:16 Patrick Martin LCSW
Sure. It’s.
00:03:17 Patrick Martin LCSW
Awesome, right?
00:03:18 Patrick Martin LCSW
So that’s the goal.
00:03:19 Andrew Cohen LMFT
Absolutely, absolutely.
00:03:21 Patrick Martin LCSW
So I invited you on.
00:03:23 Patrick Martin LCSW
I sought you out actually.
00:03:25 Patrick Martin LCSW
I vetted you.
00:03:26 Patrick Martin LCSW
On LinkedIn, and I really appreciate you responding because I have a particular passion around anxiety treatment and whether that’s social anxiety or general anxiety or in this case OCD.
00:03:41 Patrick Martin LCSW
Not something I’m specialized in.
00:03:43 Patrick Martin LCSW
So I invited you on to share your words of wisdom, your knowledge around this subject, because I do believe it gets rather convoluted sometimes.
00:03:52 Patrick Martin LCSW
The terms we throw around people say, oh, I have OCD and or they don’t really know what that means or anything, right?
00:03:59 Patrick Martin LCSW
But anxiety is just kind of like a bucket that contains a lot of different.
00:04:04 Patrick Martin LCSW
And so I I hope to really kind of UN muddy the waters a little bit here for our listeners or viewers around how we talk about anxiety and maybe when we’re educating our friends and family on what kind of anxiety we struggle with.
00:04:19 Patrick Martin LCSW
Uh, maybe learning that the terminology to to communicate clarification around those things or short if we’re looking for treatment, maybe what to gun for and that.
00:04:29 Patrick Martin LCSW
Kind of thing.
00:04:30 Andrew Cohen LMFT
Absolutely, absolutely.
00:04:31 Patrick Martin LCSW
Before we jump in, if you could maybe share a little bit about who you are, where you come from and what you do.
00:04:38 Patrick Martin LCSW
We greatly appreciate it.
00:04:40 Andrew Cohen LMFT
So obviously Andrew, Andrew count.
00:04:43 Patrick Martin LCSW
Yes. Yeah.
00:04:45 Andrew Cohen LMFT
So let’s see.
00:04:47 Andrew Cohen LMFT
I mean, I grew up in Southern California.
00:04:49 Andrew Cohen LMFT
I was born in the East Coast.
00:04:50 Andrew Cohen LMFT
We moved out here at a young age.
00:04:52 Andrew Cohen LMFT
So, uh, you know, and and growing up I.
00:04:56 Andrew Cohen LMFT
Definitely exhibited or showed symptoms of anxiety disorders mainly I think like separation anxiety, never really got officially diagnosed with anything like that.
00:05:09 Andrew Cohen LMFT
And then looking back now to definitely kind of OCD things going on as well.
00:05:16 Andrew Cohen LMFT
Uhm, personally, you know, growing up.
00:05:19 Andrew Cohen LMFT
I I wouldn’t say it was like insanely, insanely debilitating, but there were it.
00:05:24 Andrew Cohen LMFT
It definitely impacted me as a kid.
00:05:27 Andrew Cohen LMFT
I actually had a really difficult time, like sleepovers, staying away from home, those kinds of things.
00:05:33 Andrew Cohen LMFT
And then growing up.
00:05:35 Andrew Cohen LMFT
Let’s see, in round, round high school, I actually started going to my own.
00:05:40 Andrew Cohen LMFT
For the first time.
00:05:41 Andrew Cohen LMFT
And that actually is kind of what sparked my interest in psychology wanting to potentially become a therapist.
00:05:48 Andrew Cohen LMFT
Uhm, you know, in addition to that, like another one of my huge passions is music.
00:05:55 Andrew Cohen LMFT
I’ve been playing guitar since I was like 8 years old.
00:05:58 Andrew Cohen LMFT
And, you know, and bands and things like that and.
00:06:02 Andrew Cohen LMFT
Wanted to potentially try and pursue a career down that path.
00:06:05 Andrew Cohen LMFT
And then the more I, you know, kind of looked into that, I I felt being a therapist was was a better fit for myself and kind of keeping the music as a hobby and just kind of playing for fun.
00:06:17 Andrew Cohen LMFT
Uhm, and then let’s.
00:06:20 Andrew Cohen LMFT
See, so you know when I, when I was going to therapy, it was kind of traditional talk therapy for a long time.
00:06:27 Andrew Cohen LMFT
It was helpful for.
00:06:29 Andrew Cohen LMFT
Certain things, you know, just kind of like family issues or friend related issues, interpersonal things like that.
00:06:35 Andrew Cohen LMFT
But you know, I never really saw.
00:06:37 Andrew Cohen LMFT
Much of an improvement in the anxiety symptoms, which is common when it comes to talk therapy, and I’ll talk about that later on on.
00:06:46 Andrew Cohen LMFT
And you know, I, I went to Moorpark college.
00:06:51 Andrew Cohen LMFT
I was kind of like in and out of therapy with the same person, just like here and there.
00:06:55 Andrew Cohen LMFT
And then I went to UCLA and when I was my last quarter there, things got really, really, really hard and bad for me.
00:07:04 Andrew Cohen LMFT
That’s when like a lot of the OCD.
00:07:07 Andrew Cohen LMFT
Anxiety symptoms like totally spiked.
00:07:09 Andrew Cohen LMFT
And this was just, let me just explain.
00:07:12 Andrew Cohen LMFT
Like I was definitely dealing with it and somehow managing with it, but then once it got to.
00:07:18 Andrew Cohen LMFT
Like that last quarter?
00:07:20 Andrew Cohen LMFT
It it it it got very, very debilitating and, and uh, you know, I I graduated, which was, you know, good.
00:07:29 Andrew Cohen LMFT
Uhm, but after.
00:07:30 Patrick Martin LCSW
This was undergrad or Graduate School.
00:07:32 Andrew Cohen LMFT
Undergrad, undergrad, yes. I graduated UCLA in 2015.
00:07:37 Andrew Cohen LMFT
Uh, for undergrad in psychology, and you know.
00:07:42 Andrew Cohen LMFT
I I I always.
00:07:44 Andrew Cohen LMFT
Working as a ABA therapist or for you know, a a bit and you know, it was just very, very difficult balancing that with kind of the OCD and the intense anxiety of experiencing, you know, I kind of I started going to like psychiatrists to try medications.
00:08:04 Andrew Cohen LMFT
And things really kind of helping, but not so much.
00:08:07 Andrew Cohen LMFT
And then finally I went to this therapist who recognized, you know, I think you’re actually dealing with like OCD and she’s like, I don’t specialize in this, but like, let’s.
00:08:17 Andrew Cohen LMFT
Get you to someone.
00:08:21 Andrew Cohen LMFT
Who you know, knows how to treat this.
00:08:24 Andrew Cohen LMFT
And so luckily I, you know, started.
00:08:27 Andrew Cohen LMFT
I went to it’s called the city center of Los Angeles.
00:08:30 Andrew Cohen LMFT
My therapist there was wonderful.
00:08:33 Andrew Cohen LMFT
Her name is Laura Yocum.
00:08:35 Andrew Cohen LMFT
And, you know, I just remember the intake session, we we we did the the Y box, which is the Yale Brown Obsessive Compulsive survey to assess for OCD.
00:08:44 Andrew Cohen LMFT
And I was like, Oh my God.
00:08:46 Andrew Cohen LMFT
Like, everything on here basically just was like screaming like at me.
00:08:50 Andrew Cohen LMFT
Like, wow, this makes so much.
00:08:55 Andrew Cohen LMFT
And so I I you know, I would, I would go I think like 3 * a week, you know, 90 like no, three times a week, like 2 hour sessions at a time for a very long you.
00:09:04 Andrew Cohen LMFT
Know probably a.
00:09:06 Andrew Cohen LMFT
Couple months of that intensive then we titrate that out a bit, but through that.
00:09:11 Andrew Cohen LMFT
Is where I really found my passion.
00:09:13 Andrew Cohen LMFT
You know, I I knew I wanted to be a therapist, but then I really, really found my passion for treating OCD and.
00:09:18 Andrew Cohen LMFT
Anxiety disorders?
00:09:19 Andrew Cohen LMFT
I didn’t really realize.
00:09:20 Andrew Cohen LMFT
That’s what I was going through all this time and you know luckily I was introduced to it’s called ERP exposure and response prevention and we’ll, I’ll explain that in a bit but basically you know it’s the evidence based treatment for OCD and anxiety disorders at the moment.
00:09:37 Andrew Cohen LMFT
It was uh, I mean.
00:09:39 Andrew Cohen LMFT
It definitely saved my life and that’s not me being like overly dramatic, but that was it was it was at that point or it’s just I I was miserable.
00:09:46 Andrew Cohen LMFT
So, you know, I’m just really grateful to finally get to a therapist who recognized what was going on.
00:09:54 Andrew Cohen LMFT
On and this is no like disrespect to my therapist growing up, because he’s awesome, a great therapist.
00:10:02 Andrew Cohen LMFT
It’s just I think with OCD and anxiety, the reason I’d like to do things like this is because it’s so misunderstood and misrepresented.
00:10:09 Andrew Cohen LMFT
You know, I wasn’t the, you know, Oh my God, the germaphobe or the neat freak or whatever all those terms are.
00:10:15 Patrick Martin LCSW
You didn’t show up this session with your latex.
00:10:15 Andrew Cohen LMFT
Know my wife.
00:10:16 Patrick Martin LCSW
Gloves on and.
00:10:17 Andrew Cohen LMFT
Exactly, exactly.
00:10:19 Andrew Cohen LMFT
I mean, my wife can definitely attest to me not being a neat freak and things like that, so it it just didn’t show up in that.
00:10:28 Andrew Cohen LMFT
My my main compulsions were a lot of mental compulsions that no one even saw.
00:10:34 Andrew Cohen LMFT
No one even realized what was going on up here.
00:10:36 Andrew Cohen LMFT
It was like I was running a marathon in my head every single day and you know, I was.
00:10:40 Andrew Cohen LMFT
Exhausted all the time.
00:10:41 Andrew Cohen LMFT
And just it was.
00:10:42 Andrew Cohen LMFT
It it was really hard and.
00:10:44 Andrew Cohen LMFT
That’s not to say I.
00:10:44 Andrew Cohen LMFT
Still don’t struggle with.
00:10:46 Andrew Cohen LMFT
It because, you know, we’ll talk about.
00:10:48 Andrew Cohen LMFT
Like OCD is is a it’s not curable at the moment, there’s no known cure for it.
00:10:53 Andrew Cohen LMFT
It’s just highly treatable.
00:10:54 Andrew Cohen LMFT
So you can get to a place where you’re kind of like what we call like subclinical levels where you don’t necessarily fully meet criteria for it, but there’s ebbs and flows and definitely deal with little lapses here and there.
00:11:07 Andrew Cohen LMFT
Which is very common.
00:11:09 Andrew Cohen LMFT
With those Indian anxiety.
00:11:11 Andrew Cohen LMFT
But yeah, so that’s.
00:11:13 Andrew Cohen LMFT
Trying to think.
00:11:13 Andrew Cohen LMFT
Oh, and then.
00:11:14 Andrew Cohen LMFT
Probably should talk about how.
00:11:16 Andrew Cohen LMFT
I actually became a therapist.
00:11:19 Andrew Cohen LMFT
Staff care.
00:11:19 Patrick Martin LCSW
I’m loving this idea.
00:11:20 Patrick Martin LCSW
I really appreciate you sharing your your Baxter.
00:11:22 Andrew Cohen LMFT
Yeah, absolutely. So after graduating.
00:11:26 Andrew Cohen LMFT
From UCLA and doing the OCD treatment.
00:11:30 Andrew Cohen LMFT
I went to.
00:11:31 Andrew Cohen LMFT
It’s called Cal Lutheran University CLU in Thousand Oaks for my masters in marriage and healing therapy and.
00:11:39 Andrew Cohen LMFT
Uhm, you know, I I went into that knowing I wanted to specialize in OCD and anxiety.
00:11:45 Andrew Cohen LMFT
And you know, it’s it’s funny.
00:11:48 Andrew Cohen LMFT
Like, I don’t know about your experience in grad school, about what you learned about OCD, or if it was probably just a half of 1/2 of a psychopathology class and maybe hearing.
00:11:58
The term CBT.
00:12:00 Andrew Cohen LMFT
Would probably never really exposure and response prevention or.
00:12:02 Andrew Cohen LMFT
Anything like that?
00:12:03 Andrew Cohen LMFT
Maybe a tidbit?
00:12:05 Andrew Cohen LMFT
So I had to seek out.
00:12:06 Andrew Cohen LMFT
You know, specialized training.
00:12:08 Andrew Cohen LMFT
And everything.
00:12:09 Andrew Cohen LMFT
Yes, I had my own personal experience with it, but that’s not, you know, that’s not enough to become an actual you.
00:12:15 Andrew Cohen LMFT
Know therapist for it.
00:12:16 Andrew Cohen LMFT
So, so working a lot of different treatment centers and treatment programs and things.
00:12:22 Andrew Cohen LMFT
Like that trying.
00:12:23 Andrew Cohen LMFT
To find a place that actually does, you know, OCD specialty treatment currently.
00:12:28 Andrew Cohen LMFT
I did this place called renewed Freedom Center for over 2 years in the West Los Angeles doctor Jenny.
00:12:34 Andrew Cohen LMFT
Yep, there.
00:12:35 Andrew Cohen LMFT
She’s excellent.
00:12:36 Andrew Cohen LMFT
Great training.
00:12:38 Andrew Cohen LMFT
And you know it, they have like personalized PHP and IOP programs individualized where you know you get a lot of great experience working with some very intense cases along with just outpatient level of care too.
00:12:51 Andrew Cohen LMFT
So you know your weekly to true twice a week kind of sessions and now.
00:12:58 Andrew Cohen LMFT
Since I want to say.
00:13:01 Andrew Cohen LMFT
Over 2. Little over 2.
00:13:03 Andrew Cohen LMFT
Years now, yeah, I’ve been in my own private practice as well in Westlake Village.
00:13:09 Andrew Cohen LMFT
So that’s where I’m at now.
00:13:10 Andrew Cohen LMFT
Full time and.
00:13:11 Andrew Cohen LMFT
I’m also.
00:13:12 Andrew Cohen LMFT
On the board of the treasurer of what’s called OCD Southern California, which is an affiliate of the the International OCD Foundation and there it’s, it’s a wonderful nonprofit organization.
00:13:26 Andrew Cohen LMFT
We we’ve spread awareness.
00:13:28 Andrew Cohen LMFT
Our main location is Southern California had a little OCD, so callous.
00:13:32 Patrick Martin LCSW
Yeah, cool.
00:13:35 Andrew Cohen LMFT
And yeah and we put on you know awareness events like a virtual conference every year and and OCD awareness walk and actually this coming, I don’t actually know when this is going to be released, but October 15th we’re doing.
00:13:50 Andrew Cohen LMFT
A virtual awareness event for our city.
00:13:53 Andrew Cohen LMFT
Awareness Week where there’s some presentations and talks on it.
00:13:54 Patrick Martin LCSW
Wow, that’s gracious.
00:13:56 Andrew Cohen LMFT
So yeah, I I try to do, you know.
00:14:00 Andrew Cohen LMFT
As much as I can to spread awareness and.
00:14:03 Patrick Martin LCSW
Is that a free event you guys are hosting?
00:14:05 Andrew Cohen LMFT
Yes, yes. So it’s October 15th I I want to say it starts like 1111 to two I could send you over the.
00:14:13 Andrew Cohen LMFT
Information after that discussion.
00:14:14 Patrick Martin LCSW
Yeah, I’ll put it up on the blog show notes for anybody who wants to sign up for that register.
00:14:17 Andrew Cohen LMFT
Yeah, yeah.
00:14:17 Patrick Martin LCSW
That is great.
00:14:19 Andrew Cohen LMFT
It’s a, it’s a really special then I think.
00:14:22 Andrew Cohen LMFT
So that’s that’s kind of where I’m at now.
00:14:24 Andrew Cohen LMFT
I mean, I know I’ve.
00:14:25 Andrew Cohen LMFT
Been talking for probably.
00:14:27 Andrew Cohen LMFT
10 minutes but.
00:14:28 Patrick Martin LCSW
No, it’s fantastic.
00:14:30 Patrick Martin LCSW
I mean, it makes great sense.
00:14:30 Patrick Martin LCSW
When I invited you on, I did not know that you had personal experience.
00:14:34 Patrick Martin LCSW
And and dealing with this type of anxiety.
00:14:37 Patrick Martin LCSW
And that makes sense.
00:14:38 Patrick Martin LCSW
A lot of therapists, I think, gravitate toward their own pain points right, where they’ve had overcome lived experience, right.
00:14:45 Patrick Martin LCSW
Uhm, mine being like social anxiety to some extent.
00:14:48 Patrick Martin LCSW
And and yeah.
00:14:50 Andrew Cohen LMFT
And now look at you. You’re hosting A blog on YouTube.
00:14:53 Patrick Martin LCSW
I know right about then.
00:14:54 Patrick Martin LCSW
I was always a behind the scenes guy, you know, and and put me in front of an.
00:14:58 Patrick Martin LCSW
Audience ’cause I would.
00:14:59 Patrick Martin LCSW
I would freeze.
00:14:59 Patrick Martin LCSW
But yeah, I think the reason I’ve sought out this kind of thing is because I have had to work very hard at the things like public speaking, you know, being having the spotlight on me to some extent.
00:15:14 Patrick Martin LCSW
So this is kind of like my own therapy to some extent, even as even as a 40 year old man.
00:15:17 Andrew Cohen LMFT
I mean this is this is.
00:15:19 Andrew Cohen LMFT
Exposure therapy right here now.
00:15:19 Patrick Martin LCSW
It’s yeah, yeah, I think it, it keeps me in that mindset, you know, to not not that, you know, shy away to some extent.
00:15:29 Patrick Martin LCSW
Uhm, so yeah, I mean, so you started off even interning ABA, right?
00:15:36 Patrick Martin LCSW
Is applied behavioral analysis, so we’re talking about working with.
00:15:38 Andrew Cohen LMFT
Correct, yes.
00:15:39 Patrick Martin LCSW
Kids, I imagine.
00:15:40 Andrew Cohen LMFT
Yeah, kids on the spectrum, along with some.
00:15:43 Andrew Cohen LMFT
Other, you know, the governmental.
00:15:44 Andrew Cohen LMFT
Disabilities and with, you know, with autism comes a high comorbidity with OCD and.
00:15:51 Patrick Martin LCSW
That’s what I was thinking.
00:15:53 Andrew Cohen LMFT
And and you know, it’s interesting because it wasn’t really.
00:15:57 Andrew Cohen LMFT
Talked about much?
00:15:59 Andrew Cohen LMFT
Uh, but you know a lot of the ABA principles of, you know, it’s very behavioral and as exposure and response prevention therapy, so.
00:16:09 Andrew Cohen LMFT
Uhm, it was.
00:16:10 Andrew Cohen LMFT
It was a.
00:16:11 Andrew Cohen LMFT
Really good foundation.
00:16:13 Andrew Cohen LMFT
You know, learning all those kind of concepts.
00:16:16 Patrick Martin LCSW
Now that was happenstance or you sought that out?
00:16:20 Andrew Cohen LMFT
I’m sorry.
00:16:21 Patrick Martin LCSW
Was that internship happenstance, like just the first one you’re able to snag, or is that?
00:16:25 Patrick Martin LCSW
Something you sought out.
00:16:27 Andrew Cohen LMFT
So that’s actually something I did seek out growing up too.
00:16:31 Andrew Cohen LMFT
I I like would in in my own state intern.
00:16:35 Andrew Cohen LMFT
Not like intern in the sense of like accruing hours, but like just like when I was in undergrad.
00:16:41 Andrew Cohen LMFT
Uhm, I I would like number summers, do little internships or like work at these camps for kids on the spectrum or.
00:16:49 Andrew Cohen LMFT
Who have disabilities?
00:16:52 Andrew Cohen LMFT
You know, I knew that.
00:16:54 Andrew Cohen LMFT
Uh, ABA is one of the only.
00:16:57 Andrew Cohen LMFT
Jobs you can get.
00:16:58 Andrew Cohen LMFT
To be in the psychology field as an undergrad, at least right off the bat.
00:17:02 Andrew Cohen LMFT
I mean you can work in like residential center, treatment centers and things like that as like clinical assistance, but I actually didn’t even know about that part and so now, but yeah they so I I did actively seek it out.
00:17:14 Andrew Cohen LMFT
Work for this this place called Stair steps for kids.
00:17:18 Andrew Cohen LMFT
You know and.
00:17:19 Andrew Cohen LMFT
It was. It was.
00:17:20 Andrew Cohen LMFT
Really, it was.
00:17:21 Andrew Cohen LMFT
It’s really hard.
00:17:22 Andrew Cohen LMFT
Probably the hardest job I’ve ever actually had.
00:17:27 Patrick Martin LCSW
Dimensions, but it takes a lot.
00:17:27 Andrew Cohen LMFT
Yeah, you know.
00:17:28 Patrick Martin LCSW
Of energy, you know.
00:17:29 Patrick Martin LCSW
Present at that level, right?
00:17:32 Andrew Cohen LMFT
And the sessions are.
00:17:33 Andrew Cohen LMFT
You know like usually 3 hours plus, you know and it’s it’s a intense it’s really rewarding when you see like it pay off but.
00:17:43 Andrew Cohen LMFT
Uh, yeah.
00:17:44 Andrew Cohen LMFT
So I did seek it out though.
00:17:46 Patrick Martin LCSW
Wow, good for you.
00:17:47 Andrew Cohen LMFT
I worked. I worked.
00:17:49 Andrew Cohen LMFT
There for a little bit when I was.
00:17:50 Andrew Cohen LMFT
In grad school, but then.
00:17:53 Andrew Cohen LMFT
It was just I I needed it more.
00:17:55 Andrew Cohen LMFT
So focus on ground school.
00:17:56 Andrew Cohen LMFT
And then I just drove Uber and Lyft on the side just to make.
00:17:59 Andrew Cohen LMFT
Some cash was a little less.
00:18:05 Patrick Martin LCSW
But it sounds like even from your clinical?
00:18:08 Patrick Martin LCSW
Experience right out of grad school.
00:18:10 Patrick Martin LCSW
I mean, it was very targeted.
00:18:12 Andrew Cohen LMFT
Well, grads looking for OCD.
00:18:15 Patrick Martin LCSW
Yeah, yeah.
00:18:16
Yeah, yeah.
00:18:16 Patrick Martin LCSW
Like experience.
00:18:17 Patrick Martin LCSW
Yeah, yeah.
00:18:19 Andrew Cohen LMFT
Definitely no.
00:18:20 Andrew Cohen LMFT
I I knew, you know.
00:18:23 Andrew Cohen LMFT
I I basically a lot of the places I worked at for my associate ship post grad getting my hours.
00:18:29 Andrew Cohen LMFT
Most of it was OK.
00:18:31 Andrew Cohen LMFT
I need to find a place that I can actually learn.
00:18:34 Andrew Cohen LMFT
Mostly anxiety, you know?
00:18:36 Patrick Martin LCSW
What was the name of that again?
00:18:37 Patrick Martin LCSW
And just for anyone who’s listening.
00:18:39 Andrew Cohen LMFT
With a place like.
00:18:39 Patrick Martin LCSW
Were you where you worked prior to your private practice?
00:18:42 Andrew Cohen LMFT
Yeah, it’s called.
00:18:43 Andrew Cohen LMFT
A renewed freedom center.
00:18:44 Andrew Cohen LMFT
So they’re in West Los Angeles.
00:18:47 Andrew Cohen LMFT
And uh, yeah, they they they have.
00:18:49 Andrew Cohen LMFT
A big specialty in in.
00:18:50 Andrew Cohen LMFT
Kids that work with all agents as well.
00:18:53 Patrick Martin LCSW
Good to know.
00:18:54 Patrick Martin LCSW
Yeah, yeah.
00:18:54 Patrick Martin LCSW
I’m trying to make mental notes of that because a lot of times I’m working with clients who probably would meet criteria for OCD, but it’s not always clear where to.
00:19:01 Patrick Martin LCSW
Send them so.
00:19:05 Andrew Cohen LMFT
Another reason I like to, you know, do this and all that and then.
00:19:11 Andrew Cohen LMFT
I’m gonna say another really good resource is going to the International OCD Foundation IO website because they have you can find clinicians who do specialize in it and have training.
00:19:24 Patrick Martin LCSW
Good to know.
00:19:24 Andrew Cohen LMFT
So yes, we should.
00:19:25 Patrick Martin LCSW
Thank you.
00:19:26 Patrick Martin LCSW
It’s international OCD foundation.
00:19:28 Andrew Cohen LMFT
Yes, I ocd.org.
00:19:31 Patrick Martin LCSW
Thanks, man.
00:19:32 Patrick Martin LCSW
Thank you for that.
00:19:33 Patrick Martin LCSW
Appreciate so.
00:19:35
That’s why I.
00:19:35 Patrick Martin LCSW
Asked you on your now your wealth of information.
00:19:38 Andrew Cohen LMFT
No, I know, I know.
00:19:39 Andrew Cohen LMFT
You want actionable.
00:19:41 Patrick Martin LCSW
Yes, I’m all about.
00:19:41 Andrew Cohen LMFT
Things and whatnot for your listeners, yes.
00:19:45 Patrick Martin LCSW
You don’t know what you don’t know.
00:19:47 Patrick Martin LCSW
I mean, even therapists like, like you were just talking about myself.
00:19:49 Patrick Martin LCSW
Like, you get into this field and it’s very, you know, it’s very specific.
00:19:55 Patrick Martin LCSW
You know, you work a particular job, clinic dis.
00:19:57 Patrick Martin LCSW
The plan.
00:19:58 Patrick Martin LCSW
But there’s all of these other avenues and roads that we don’t know about.
00:20:02 Patrick Martin LCSW
I’m constantly learning about how things work even with insurance and how every person with medical versus private insurance and what type of therapist or what type of clinic or you know what’s available or even career wise.
00:20:14 Patrick Martin LCSW
You know, as a therapist, what are your options?
00:20:16 Patrick Martin LCSW
What what can you do?
00:20:17 Patrick Martin LCSW
You know, outside of the typical box that we understand, so.
00:20:22 Andrew Cohen LMFT
Yeah, no, it’s a, it’s.
00:20:23 Andrew Cohen LMFT
It’s constantly growing, constantly learning.
00:20:26 Andrew Cohen LMFT
I mean, you kind of telling me all the places that you currently work and, you know, doing those assessments for inmates are in mental health and all of that kind of stuff too.
00:20:35 Andrew Cohen LMFT
There’s so many different avenues that you can take.
00:20:38 Patrick Martin LCSW
That’s the reason, yeah. Yeah.
00:20:38 Andrew Cohen LMFT
And then things like this, you know?
00:20:42 Patrick Martin LCSW
Right, absolutely.
00:20:43 Patrick Martin LCSW
Something more altruistic and yeah, giving back.
00:20:46 Patrick Martin LCSW
Yeah, absolutely.
00:20:47 Andrew Cohen LMFT
Totally. Only.
00:20:50 Patrick Martin LCSW
So good catch by your therapist, by the way, who’s you know referred you and to be to be assessed.
00:20:56 Patrick Martin LCSW
I know it’s not always clear and that’s why you know.
00:20:59 Patrick Martin LCSW
What I I.
00:20:59 Patrick Martin LCSW
Hope to dive into is, you know, it’s not always clear when you’re treating somebody with anxiety how to diagnose for or look for OCD versus something.
00:21:10 Patrick Martin LCSW
OCD, general anxiety, panic, disorders of agoraphobia, trauma, PTSD, OCPD, there’s a lot of overlap, you know, measurement sometimes in symptoms, symptomology that.
00:21:24 Patrick Martin LCSW
You know we’re trying to do a differential diagnosis or get an idea clinical impression of what’s going on.
00:21:29 Patrick Martin LCSW
It’s not always clear, you know what the what to to hone in on and refer out for so.
00:21:37 Andrew Cohen LMFT
Absolutely, absolutely.
00:21:39 Andrew Cohen LMFT
I mean the the assessment process doing a thorough intake and really ask, knowing the questions to ask and you know, gathering all the necessary information is is crucial.
00:21:50 Andrew Cohen LMFT
You know, you don’t want to be I I always like to refer it back to like.
00:21:56 Andrew Cohen LMFT
Actual like physical medical treatment, you know, you want to actually figure out like OK is the person dealing with a tumor, is the person dealing with diabetes, you know, because the treatment is going to be very different regard.
00:22:08 Andrew Cohen LMFT
You know what what it’s going to be.
00:22:10 Andrew Cohen LMFT
Uhm, now I will say caveat of.
00:22:13 Andrew Cohen LMFT
That, though, is.
00:22:14 Andrew Cohen LMFT
With the good news here, I guess is.
00:22:18 Andrew Cohen LMFT
With the diagnosis of OCD versus anxiety, generalized anxiety disorder, or separation anxiety or agoraphobia, the treatment is going to look relatively similar.
00:22:30 Andrew Cohen LMFT
And the fact that exposure in response prevention, you’re going to be actively facing these fears, while the response prevention part is, you know, working, you’re doing your best not to engage in those.
00:22:42 Andrew Cohen LMFT
We call them compulsions in OCD or safety behaviors and anxiety, things that you know, give you short term relief.
00:22:49 Andrew Cohen LMFT
Just kind of.
00:22:50 Andrew Cohen LMFT
Fuel the anxiety, so there’s going to be an ERP component now.
00:22:55 Andrew Cohen LMFT
When you’re doing a differential, you know, I I start all my patients out with a 90 minute intake session where I send over a lot.
00:23:02 Andrew Cohen LMFT
Of different assessments.
00:23:04 Andrew Cohen LMFT
To, you know, the Y box included along with like what’s the back anxiety inventory?
00:23:11 Andrew Cohen LMFT
Uhm, there’s one called this, this acronym is scared.
00:23:15 Andrew Cohen LMFT
I think it’s like screened for childhood anxiety and related.
00:23:16 Patrick Martin LCSW
Oh yes, yes, that one I want.
00:23:18 Andrew Cohen LMFT
Yeah, yeah, those those kinds of different things that that screen for all these different types of anxiety disorder.
00:23:25 Andrew Cohen LMFT
And what helps me is kind of figuring out.
00:23:29 Andrew Cohen LMFT
What are the?
00:23:30 Andrew Cohen LMFT
The the actual like content of the things that they’re worried about. So for example, in generalized anxiety disorder, you might see someone excessively worried about. There’s a reason it’s called generalized because it’s typically your day-to-day.
00:23:46 Andrew Cohen LMFT
Things so work, school, family, finances, those kind of stressors that fall underneath generalized anxiety disorder.
00:23:57 Andrew Cohen LMFT
And with generalized anxiety disorder too, you’re not necessarily seeing somebody with OCD is going to be doing more.
00:24:06 Andrew Cohen LMFT
Like, not necessarily, but you will see more, I guess ritualized behavior or like concrete responses to specific fears.
00:24:15 Andrew Cohen LMFT
So I’ll give an example like.
00:24:17 Andrew Cohen LMFT
Say someone with OCD has, you know, an.
00:24:21 Andrew Cohen LMFT
Intrusive thought that they’re. They’re.
00:24:23 Andrew Cohen LMFT
Really scared that you know they’ll they’re going to lose control and and hurt someone so.
00:24:29 Andrew Cohen LMFT
So, you know, a response that might be OK you know, I have to.
00:24:34 Andrew Cohen LMFT
To, uh, seek reassurance from my parents that I’m.
00:24:39 Andrew Cohen LMFT
A good person and.
00:24:40 Andrew Cohen LMFT
Not a bad person.
00:24:41 Andrew Cohen LMFT
There’s like a direct, like a direct correlation to that specific fear.
00:24:46 Andrew Cohen LMFT
With generalized anxiety disorder.
00:24:49 Andrew Cohen LMFT
A lot of times there’s just kind of a.
00:24:51 Andrew Cohen LMFT
Lot of worry or rumination going on, kind of.
00:24:54 Andrew Cohen LMFT
I like to think of rumination basically as this mental process where you are putting on a detective cap and trying to figure out everything.
00:25:04 Andrew Cohen LMFT
Uhm, anxiety and and OCD are fueled by uncertainty. We want to be 100% certain that whatever it is, we’re scared about.
00:25:14 Andrew Cohen LMFT
Uhm, isn’t going to happen.
00:25:15 Andrew Cohen LMFT
So say, you know, generalized anxiety.
00:25:18 Andrew Cohen LMFT
Maybe you’re really scared that you know, uh, you know, you’re not very financially secure.
00:25:23 Andrew Cohen LMFT
So you’re constantly worrying trying to figure.
00:25:25 Andrew Cohen LMFT
Out OK if I budget like this if I budget like this, if I.
00:25:28 Andrew Cohen LMFT
Do this if I save here.
00:25:29 Andrew Cohen LMFT
Yeah all.
00:25:30 Andrew Cohen LMFT
That kind of stuff.
00:25:30 Andrew Cohen LMFT
And it’s constant.
00:25:31 Andrew Cohen LMFT
Excessive right ’cause?
00:25:34 Andrew Cohen LMFT
Another important you know factor in this is not you can’t really diagnose something unless it’s causing actual impairment, like somewhere you know in the excessive nature.
00:25:44 Patrick Martin LCSW
Right.
00:25:45 Andrew Cohen LMFT
’cause, like anxiety, is a totally normal and healthy emotion.
00:25:49 Patrick Martin LCSW
It’s a prime emotion.
00:25:50 Patrick Martin LCSW
We all have it.
00:25:50 Andrew Cohen LMFT
Yeah, it’s keeps us alive.
00:25:51 Patrick Martin LCSW
It’s healthy for large extent, yes.
00:25:53 Andrew Cohen LMFT
It keeps us alive.
00:25:54 Andrew Cohen LMFT
It keeps us safe.
00:25:56 Andrew Cohen LMFT
All those kinds of things.
00:25:57 Andrew Cohen LMFT
And motivated.
00:25:58 Andrew Cohen LMFT
Exactly, exactly.
00:26:01 Andrew Cohen LMFT
And on top of that.
00:26:02 Andrew Cohen LMFT
Come, you know, it’s normal to a certain extent to kind of plan.
00:26:08 Andrew Cohen LMFT
Planning problem solve.
00:26:10 Andrew Cohen LMFT
Right.
00:26:10 Andrew Cohen LMFT
And make concrete plans for things and that’s fine.
00:26:14 Andrew Cohen LMFT
The issue though is when you have that plan and then you start doubting it or starting to re figure it out and kind of continue to go down that mental rabbit hole.
00:26:23 Andrew Cohen LMFT
But I got a little off topic, my apologies so.
00:26:25 Patrick Martin LCSW
No, it’s perfectly on top exactly what I.
00:26:27 Patrick Martin LCSW
Was looking for, yeah.
00:26:29 Andrew Cohen LMFT
With generalized anxiety, you might see like those worries as work, school, family, friends.
00:26:34 Andrew Cohen LMFT
If you’re looking at social anxiety, like you said, there’s typically 2 main fears I’m looking for.
00:26:39 Andrew Cohen LMFT
It’s this, you know, excessive worry that you were being negatively perceived.
00:26:45 Andrew Cohen LMFT
And then two, it feels as if there’s constantly.
00:26:48 Andrew Cohen LMFT
Eyes on you and they’re negatively appraising you, right?
00:26:52 Andrew Cohen LMFT
It kind of.
00:26:53 Andrew Cohen LMFT
Just constantly worried about how you’re coming off.
00:26:56 Andrew Cohen LMFT
What if I embarrass myself?
00:26:57 Andrew Cohen LMFT
What if I don’t perform up to a certain standard?
00:27:00 Andrew Cohen LMFT
If I say.
00:27:00 Andrew Cohen LMFT
Something stupid.
00:27:02 Andrew Cohen LMFT
All those kinds of things.
00:27:03 Andrew Cohen LMFT
And the behaviors you’ll typically see in social anxiety in response is a lot of avoidance of social situations.
00:27:12 Andrew Cohen LMFT
And then if you do have to go to social situations, you know very much in your head.
00:27:17 Andrew Cohen LMFT
How does my voice sound?
00:27:18 Andrew Cohen LMFT
Am I standing weird?
00:27:19 Andrew Cohen LMFT
And my you know what?
00:27:20 Andrew Cohen LMFT
What’s going on?
00:27:22 Andrew Cohen LMFT
There’s my facial expressions.
00:27:23 Andrew Cohen LMFT
Match am I interesting enough?
00:27:25 Andrew Cohen LMFT
All these kinds of things you’re trying to figure out.
00:27:27 Andrew Cohen LMFT
So a lot of ruminating going on there too.
00:27:30 Andrew Cohen LMFT
So when it comes to OCD specifically like the content, you know.
00:27:36 Andrew Cohen LMFT
Basically, let me define OCD real quick, just for the listeners.
00:27:39 Patrick Martin LCSW
Now proceed.
00:27:40 Andrew Cohen LMFT
Stands for.
00:27:40 Andrew Cohen LMFT
Yeah, it stands for.
00:27:41 Andrew Cohen LMFT
Obsessive compulsive disorder.
00:27:43 Andrew Cohen LMFT
So there’s two components to it.
00:27:44 Andrew Cohen LMFT
You have obsessions and compulsions.
00:27:47 Andrew Cohen LMFT
So obsessions you can think of as any sort of unwanted, intrusive thought, feeling, sensation, urge that pops into your head against your will.
00:27:56 Andrew Cohen LMFT
They can also be in the form of an image or like a.
00:27:58 Andrew Cohen LMFT
Video playing on loop.
00:28:00 Andrew Cohen LMFT
And it’s really just, yeah, it’s really, it’s really distressing, OK.
00:28:04 Andrew Cohen LMFT
These thoughts are thoughts that you do not.
00:28:06 Andrew Cohen LMFT
Want to be having.
00:28:08 Andrew Cohen LMFT
There are terms that I, you know, I teach my patients called ego dystonic and ego syntonic.
00:28:13 Andrew Cohen LMFT
I don’t know if you’re familiar with those.
00:28:15 Andrew Cohen LMFT
OK, so for the listeners, basically what ego dystonic means is these are.
00:28:19 Andrew Cohen LMFT
Thoughts that are not in line with your morals and values and who you are as a person and OCD thoughts are ego dystonic.
00:28:28 Andrew Cohen LMFT
And that’s what makes them so, so, so scary.
00:28:32 Andrew Cohen LMFT
OK.
00:28:32 Andrew Cohen LMFT
And and ego syntonic, our thoughts and things like that that are in line with our values, what we like so.
00:28:36 Andrew Cohen LMFT
An example I like to use is.
00:28:38 Andrew Cohen LMFT
You know, I like.
00:28:41 Andrew Cohen LMFT
I have two dogs that I absolutely love and a wife that I love, and you know, I don’t have harm OCD.
00:28:49 Andrew Cohen LMFT
But somebody you know with harm OCD would potentially experience thoughts of, you know, stabbing their dog or strangling their dog and.
00:28:59 Andrew Cohen LMFT
But what else?
00:29:01 Andrew Cohen LMFT
And why is that your bullying such a just a really, really difficult thing?
00:29:05 Andrew Cohen LMFT
To deal with.
00:29:05 Andrew Cohen LMFT
Isn’t attacks of things you love and it knows it’s going.
00:29:07 Andrew Cohen LMFT
To get under your skin, so.
00:29:10 Andrew Cohen LMFT
A little, I mean little self disclosure here.
00:29:13 Andrew Cohen LMFT
Like I have what’s called also relationship OCD to determine, call it that.
00:29:18 Andrew Cohen LMFT
There’s not, these aren’t actual diagnosis, there’s just like OCD, OCD.
00:29:22 Patrick Martin LCSW
Right. Uh, frame it. Yeah.
00:29:22 Andrew Cohen LMFT
So we kind.
00:29:22 Andrew Cohen LMFT
Of we frame it in like what are the content of your obsessions about so you know relationship OCD like.
00:29:30 Andrew Cohen LMFT
Worrying about, you know, the goodness of 1 relationship, the the goodness of fed, it’s a healthy relationship.
00:29:36 Andrew Cohen LMFT
All these things which again.
00:29:38 Andrew Cohen LMFT
Totally normal to do.
00:29:39 Andrew Cohen LMFT
It’s the excessive nature of it though, you know, the constant, the constant worry.
00:29:43 Andrew Cohen LMFT
And and so like all, you know, intrusive thoughts about you know, how do you know you other like you know, how do you know this, you know are you attracted or all these kinds of thoughts that pop in and they are very distressing.
00:29:58 Andrew Cohen LMFT
That that they’re not in line with who I actually believe so obsessions.
00:30:03 Andrew Cohen LMFT
Can be about anything that’s going to get the sufferers attention.
00:30:09 Andrew Cohen LMFT
You know, if you’re a a new parent, you love your child and you have OCD, there’s a good chance you’re going to maybe have some harm thoughts of going out.
00:30:16 Andrew Cohen LMFT
What if I just?
00:30:16 Andrew Cohen LMFT
Drop them on their head.
00:30:18 Andrew Cohen LMFT
My God oh.
00:30:18 Andrew Cohen LMFT
My God, what if I go crazy and I and I stab them or something or drown them, and these people do not?
00:30:23 Andrew Cohen LMFT
Want this at all?
00:30:25 Andrew Cohen LMFT
The farthest from that?
00:30:27 Patrick Martin LCSW
Right, right.
00:30:29 Andrew Cohen LMFT
So naturally, these obsessions that cause so much distress lead us to engage in compulsions, compulsions or any sort of behavior that one does to get rid of the distress that are caused by the obsessions.
00:30:42 Andrew Cohen LMFT
And compulsions can be either physical, so things you can see, or mental so things up here and in my.
00:30:49 Andrew Cohen LMFT
My personal experience, I had more mental compulsions.
00:30:52 Andrew Cohen LMFT
Yeah, there were some physical but mainly mental.
00:30:55 Andrew Cohen LMFT
So concrete examples that, you know, we will use.
00:30:59 Andrew Cohen LMFT
Some of the.
00:31:00 Andrew Cohen LMFT
Uh, I guess what people probably know about OCD is like contamination fears germs.
00:31:06 Patrick Martin LCSW
Right.
00:31:07
’cause that is a.
00:31:08 Andrew Cohen LMFT
Real thing with those TV that happens this.
00:31:08 Patrick Martin LCSW
Oh yeah.
00:31:10 Patrick Martin LCSW
Nova didn’t help us.
00:31:13 Patrick Martin LCSW
The Cova didn’t help me.
00:31:14 Andrew Cohen LMFT
Oh no, no, definitely not.
00:31:16 Andrew Cohen LMFT
Uh, so, you know, what happens is, you know, say I touch my computer and I have an intrusive thought of like, Oh my God, you know, there can be some sort of contaminant on that that’s going to get you really sick.
00:31:30 Andrew Cohen LMFT
And you might spread it to someone so that obsession is going to create anxiety and that fight or flight response is me.
00:31:35 Andrew Cohen LMFT
And, you know, it’s very uncomfortable.
00:31:37 Andrew Cohen LMFT
So naturally, to make myself feel better, I would go either put some sanitizer on my hands or wash my hands.
00:31:45 Andrew Cohen LMFT
The problem with that, though is, you know, say I wash my hands and then I.
00:31:50 Andrew Cohen LMFT
Immediately turned the sink off and I had a thought of Oh my God, I could just touch the sink handle after washing my hands.
00:31:56 Andrew Cohen LMFT
That’s dirty.
00:31:56 Andrew Cohen LMFT
So I gotta, you know, re wash all that kind of stuff.
00:31:59 Andrew Cohen LMFT
OK, OK, I got a paper towel.
00:32:01 Andrew Cohen LMFT
I’m gonna turn it off like this.
00:32:02 Andrew Cohen LMFT
Alright, cool.
00:32:03 Andrew Cohen LMFT
Oh, wait, I just opened the bathroom door with, you know, and then you have to go wash again and you get into the vicious OCD cycle.
00:32:10 Andrew Cohen LMFT
These compulsions are basically you can think of them like behaviors that we do.
00:32:16 Andrew Cohen LMFT
To get 100% certainty that whatever we’re scared of isn’t going to happen. So with contamination fears I want to be 100.
00:32:23 Andrew Cohen LMFT
Percent certain that you know.
00:32:26 Andrew Cohen LMFT
I’m going to get sick with harm. OCD fears 100% certain that I’m not going to hurt someone with you know and there’s more quote UN quote taboo fares and there’s there’s something called POCD or pedophilia, OCD these intrusive thoughts of. Yeah absolutely. And it’s, it’s really common. I don’t say. I mean it’s it’s very common.
00:32:39 Patrick Martin LCSW
Mines like that.
00:32:46 Andrew Cohen LMFT
And these people are the.
00:32:48 Andrew Cohen LMFT
Artist from that you know.
00:32:50 Andrew Cohen LMFT
Uhm, so these are really, really scary, debilitating thoughts.
00:32:56 Andrew Cohen LMFT
I would say the contamination, the harm, the sexual intrusive thoughts.
00:33:01 Andrew Cohen LMFT
There’s also what we call just right OCD, or just so OCD things need to feel a certain way, or symmetrical, or be.
00:33:10 Andrew Cohen LMFT
You know, if if something feels off, you just can’t really go on.
00:33:15 Patrick Martin LCSW
It’s like when you.
00:33:15 Patrick Martin LCSW
See in the movies where they everything has to be aligned on the table and.
00:33:20 Patrick Martin LCSW
The pen, pencil, pen can’t be like cricket, right?
00:33:23 Patrick Martin LCSW
Everything has got to be.
00:33:24 Andrew Cohen LMFT
Through to certain extent, yeah, just right.
00:33:26 Andrew Cohen LMFT
Yeah, you know, like something that I dealt with as well was, you know, more of that just right.
00:33:33 Andrew Cohen LMFT
OCD was like sometimes I would get stuck like working out in the gym because I would be doing.
00:33:40 Andrew Cohen LMFT
Say like dumbbell bench press or something and you would be dumb, you know, say I did like 10 of them and then if I go up to that 10th one and like my left arm didn’t feel just as and I right, I would sit there and like kind of have to adjust and adjust it.
00:33:54 Andrew Cohen LMFT
Adjust until it felt right, and that would lead me in there for a lot longer than I really needed to be.
00:34:02 Andrew Cohen LMFT
That that’s just that.
00:34:03 Andrew Cohen LMFT
That wasn’t like a very, very severe one, but I I definitely experienced more severe.
00:34:09 Andrew Cohen LMFT
Just write things like with like bathroom routines, being in there for like hours doing.
00:34:14 Andrew Cohen LMFT
Things until it feel just right.
00:34:19 Andrew Cohen LMFT
Basically with the the the obsessions.
00:34:22 Andrew Cohen LMFT
Uh, anything under the sun really is grounds for an obsession as long as it’s going to get the sufferers attention and and get them trapped in this vicious OCD cycle of having an obsession becoming anxious.
00:34:36 Andrew Cohen LMFT
You do a compulsion, you get this temporary relief, but the obsession comes back and you just go around and around.
00:34:44 Patrick Martin LCSW
So it’s a great explanation that’s like, spot on, that’s great.
00:34:46
Thank you.
00:34:48 Patrick Martin LCSW
But you know, I’ve always thought of anxiety in general as being like the fear of pending issues or ambiguous issues that have no particular resolution or because they’re not immediately relevant.
00:35:01 Patrick Martin LCSW
Right, or fear based, right.
00:35:02 Andrew Cohen LMFT
That’s absolutely.
00:35:02 Patrick Martin LCSW
We all agree.
00:35:04 Patrick Martin LCSW
Anxiety is fear based.
00:35:05 Patrick Martin LCSW
So OCD then is like you said, it’s almost this vicious thing where it it becomes, it feeds on your desire to be.
00:35:13 Patrick Martin LCSW
Protective of yourself and others are the things we care about, and then it’s almost this overcompensation to make sure those things don’t happen.
00:35:21 Andrew Cohen LMFT
I think that’s really well put and I’m just gonna say.
00:35:25 Andrew Cohen LMFT
And.
00:35:27 Andrew Cohen LMFT
When I talked about earlier, you know, differential diagnosis, it’s important.
00:35:32 Andrew Cohen LMFT
However, it’s not like the end of the world in terms of.
00:35:36 Andrew Cohen LMFT
That treatment outcomes ’cause if you’re doing exposure and response prevention and this treatment and stuff, you’re going to be because anxiety, the anxiety vicious cycle and the OCD vicious cycle is the same thing.
00:35:48 Andrew Cohen LMFT
So social anxiety, for example.
00:35:50 Andrew Cohen LMFT
You know you have this.
00:35:51 Andrew Cohen LMFT
Fear of a social situation.
00:35:54 Andrew Cohen LMFT
So you have this emotional response.
00:35:57 Andrew Cohen LMFT
This anxiety and then to get rid of that anxiety.
00:36:00 Andrew Cohen LMFT
You’ll do something about it, right?
00:36:02 Andrew Cohen LMFT
Uh, safety, behavior or compulsion.
00:36:04 Andrew Cohen LMFT
They serve the same function.
00:36:06 Andrew Cohen LMFT
So you avoid the social situation and then you get this.
00:36:08 Andrew Cohen LMFT
Ha, it’s temporary relief.
00:36:10 Andrew Cohen LMFT
But what happens the next time you have to go to a social situation?
00:36:13 Andrew Cohen LMFT
It’s like this, this thought, this worry is going to come back.
00:36:16 Andrew Cohen LMFT
This emotion is going to happen and you’re just in this same.
00:36:20 Andrew Cohen LMFT
You’re having these uncomfortable thoughts that are triggering uncomfortable feelings.
00:36:24 Andrew Cohen LMFT
So you’re doing something about it to get this temporary relief, and then the fear comes back.
00:36:30 Andrew Cohen LMFT
Every single time.
00:36:32 Patrick Martin LCSW
And working with clients with panic disorder agoraphobia, I know something that I often lean on is the habituation hierarchy exposure therapy, right?
00:36:41 Andrew Cohen LMFT
Exactly, exactly.
00:36:43 Patrick Martin LCSW
Reduce the company story behavior, you know, protective behavior, the safe behavior, whatever we want to call it, is basically to reduce, to increase the distress tolerance, the threshold between the the trigger and the impulse, right to, to evade, to run away, to minimize.
00:37:01 Andrew Cohen LMFT
Absolutely, absolutely. Yeah. Do you?
00:37:01
It’s not.
00:37:03 Andrew Cohen LMFT
Want me to talk a little?
00:37:04 Andrew Cohen LMFT
Bit about that part of it, yeah.
00:37:05 Patrick Martin LCSW
Yes, that’ll be great.
00:37:06 Patrick Martin LCSW
Yeah, please.
00:37:06 Patrick Martin LCSW
Thank you.
00:37:09 Andrew Cohen LMFT
Basically, you know, before talking about exposure and response prevention, it’s really important to just understand anxiety and it’s the mechanisms and everything behind it because like we were saying earlier, anxiety is a totally normal, healthy emotion to have and it keeps us alive.
00:37:23 Andrew Cohen LMFT
I always talk with my patients about the idea.
00:37:26 Andrew Cohen LMFT
Of the. The.
00:37:27 Andrew Cohen LMFT
The caveman leaving a cave and seeing a.
00:37:29 Andrew Cohen LMFT
Saber toothed tiger.
00:37:31
You know.
00:37:31 Andrew Cohen LMFT
If if the case, all the good old days.
00:37:37 Andrew Cohen LMFT
Yeah, so, you know, walking out of The Cave, the caveman.
00:37:40 Andrew Cohen LMFT
Sees a Saber toothed.
00:37:41 Andrew Cohen LMFT
Tiger if we didn’t have any.
00:37:44 Andrew Cohen LMFT
Or fear that Caveman might be like, Oh my.
00:37:47 Andrew Cohen LMFT
God, that is so cute.
00:37:48 Andrew Cohen LMFT
I want to go pet that and what would happen to the caveman?
00:37:52 Patrick Martin LCSW
Wouldn’t be a caveman very much longer.
00:37:54 Andrew Cohen LMFT
No, he would be dinner or whatever, right?
00:37:54 Patrick Martin LCSW
Maybe dinner?
00:37:57 Andrew Cohen LMFT
And we would have never evolved to where we.
00:37:59 Andrew Cohen LMFT
Would have to say, you know, we didn’t have anxiety.
00:38:01 Andrew Cohen LMFT
So luckily, you know we.
00:38:02 Andrew Cohen LMFT
Do have anxiety and I.
00:38:04 Andrew Cohen LMFT
Love saying ’cause like I work.
00:38:05 Andrew Cohen LMFT
A lot, too, with like, kids sometimes.
00:38:07 Andrew Cohen LMFT
So I’ll say like, you know, even like your dog as anxiety, your cat as anxiety or Bunny, all these they they all have.
00:38:12 Patrick Martin LCSW
Right, right.
00:38:14 Andrew Cohen LMFT
It’s fight or flight response in them to keep them alive, you know so.
00:38:19 Andrew Cohen LMFT
What happens is you know.
00:38:21 Andrew Cohen LMFT
That caveman sees that that.
00:38:23 Andrew Cohen LMFT
Saber toothed tiger.
00:38:24 Andrew Cohen LMFT
He feels that emotion on anxiety and his body automatically goes into the fight or flight or freeze response.
00:38:30 Andrew Cohen LMFT
And I know there’s some more aspects to it, but just for simplicity purposes, the fight or flight response is basically.
00:38:37 Andrew Cohen LMFT
Our body, it’s.
00:38:38 Andrew Cohen LMFT
Automatic response to whatever we perceive danger.
00:38:41 Andrew Cohen LMFT
And the keyword here is perceived danger, OK?
00:38:44 Andrew Cohen LMFT
And this is actually where anxiety disorders and OCD come into play, because sometimes our body will be perceiving danger when they’re.
00:38:51 Andrew Cohen LMFT
Is not.
00:38:52 Andrew Cohen LMFT
Right.
00:38:52 Andrew Cohen LMFT
There’s no imminent threat, so.
00:38:55 Andrew Cohen LMFT
A whole bunch of things happen to our body when we go into this fight or flight response.
00:38:59 Andrew Cohen LMFT
You know our heart rate increases.
00:39:01 Andrew Cohen LMFT
We need to have more blood throughout our body to our arms, legs to fight or run away from the danger our beating will increase.
00:39:09 Andrew Cohen LMFT
A lot of times will feel this shortness of breath or like we need to hyperventilate.
00:39:12 Andrew Cohen LMFT
Because we need.
00:39:13 Andrew Cohen LMFT
More oxygen in our blood.
00:39:15 Andrew Cohen LMFT
To get us to fight or run away body fuel really a lot.
00:39:20 Andrew Cohen LMFT
Also times our digestion will shut down.
00:39:22 Andrew Cohen LMFT
You know, we don’t need to be digesting food in the presence of a.
00:39:26 Andrew Cohen LMFT
Saber toothed tiger.
00:39:26 Patrick Martin LCSW
Not top priority.
00:39:27
They not top.
00:39:28 Andrew Cohen LMFT
Priority right are the energy is basically diverted from our you know digestive tract to.
00:39:32 Andrew Cohen LMFT
Our arms and legs.
00:39:33 Andrew Cohen LMFT
To the fight or run away and.
00:39:35 Andrew Cohen LMFT
That’s great in those actual moments of danger, but when you’re.
00:39:39 Andrew Cohen LMFT
Dealing with anxiety.
00:39:40 Andrew Cohen LMFT
Disorder or OCD when you’re constantly going in and out of this fight or flight response, and your digestion is constantly turning on and off, on and off, this can wreak havoc on your GI track.
00:39:49 Andrew Cohen LMFT
So it’s so common for people with severe anxiety disorder, myself included, to deal with a lot of GI issues like Constipation, digestion.
00:39:58 Andrew Cohen LMFT
I mean sorry, indigestion, diarrhea, nauseous Ness.
00:40:03 Andrew Cohen LMFT
Acid reflux.
00:40:04 Andrew Cohen LMFT
All these kinds of things are really common with the fight or flight response.
00:40:08 Patrick Martin LCSW
Makes total sense, yeah.
00:40:09 Andrew Cohen LMFT
Yes. So and then one last take away to with this fight or flight response, basically our ability to think rationally or logically, that all happens in the top part of our brain, the prefrontal cortex and that uses by far the most energy out of any part of our body.
00:40:25 Andrew Cohen LMFT
We don’t necessarily need all that brainpower in the presence of an actual danger.
00:40:30 Andrew Cohen LMFT
So for an example, you know if a save it through Tiger or Patrick walked into your office right now, besides being like, whoa, I thought you were extinct.
00:40:42
What do you?
00:40:43 Andrew Cohen LMFT
What would happen if you know you sat there like that?
00:40:47 Andrew Cohen LMFT
What do you think the best tool to use right now would be?
00:40:50 Andrew Cohen LMFT
Would be or the, you know, best escape route?
00:40:52 Andrew Cohen LMFT
What do you think would?
00:40:52 Andrew Cohen LMFT
Happen in the time you actually decide that.
00:40:56 Patrick Martin LCSW
That would be gone, yeah.
00:40:57 Andrew Cohen LMFT
You would be gone.
00:40:57 Patrick Martin LCSW
Oh, yeah, yeah, yeah.
00:40:59 Andrew Cohen LMFT
So what do you?
00:40:59 Patrick Martin LCSW
My wife would be aware.
00:41:00 Andrew Cohen LMFT
What do you actually?
00:41:01 Andrew Cohen LMFT
Think should.
00:41:02 Andrew Cohen LMFT
Be a window?
00:41:02 Andrew Cohen LMFT
Yeah, exactly right.
00:41:05 Andrew Cohen LMFT
What do you think would actually?
00:41:07 Andrew Cohen LMFT
Happen, you know, would you freak out like.
00:41:08 Patrick Martin LCSW
I’ll go the window to my left.
00:41:11 Andrew Cohen LMFT
Exactly right.
00:41:13 Andrew Cohen LMFT
Like no thought happens.
00:41:14 Andrew Cohen LMFT
So what happens is when this fight or flight response is the top part.
00:41:19 Andrew Cohen LMFT
Of our brain.
00:41:20 Andrew Cohen LMFT
Basically owns it, shuts off.
00:41:21 Andrew Cohen LMFT
But the energy?
00:41:22 Andrew Cohen LMFT
Is directed to our caveman brain, the part of your brain where you hear a loud bang and you.
00:41:27 Andrew Cohen LMFT
All right.
00:41:28 Andrew Cohen LMFT
What that means is our ability to think rationally and logically while we’re actually in this fight or flight response is is greatly impaired.
00:41:37 Andrew Cohen LMFT
So you with your social and you know, issue social anxiety kind of related.
00:41:41 Andrew Cohen LMFT
Stuff how many times?
00:41:43 Andrew Cohen LMFT
You know, after the fact.
00:41:45 Andrew Cohen LMFT
Have you been like, Oh my God.
00:41:46 Andrew Cohen LMFT
Like, why was I anxious?
00:41:47
About that.
00:41:48 Andrew Cohen LMFT
That was just, there was really no.
00:41:50 Andrew Cohen LMFT
Reason to be.
00:41:51 Andrew Cohen LMFT
Right.
00:41:51 Andrew Cohen LMFT
But then in the moment.
00:41:53 Andrew Cohen LMFT
The next time a trigger comes around.
00:41:54 Andrew Cohen LMFT
Are you able?
00:41:55 Andrew Cohen LMFT
To like actually think your way out of that, or talk your way out of that, or does it feel so real?
00:42:00 Andrew Cohen LMFT
Looks very.
00:42:00 Patrick Martin LCSW
No, absolutely.
00:42:02 Andrew Cohen LMFT
Yeah, so exactly.
00:42:02 Patrick Martin LCSW
You learn living, you learn, yeah.
00:42:04 Andrew Cohen LMFT
But we we can’t think our way out of anxiety.
00:42:08 Andrew Cohen LMFT
We can’t logic our way out of anxiety when we’re in this because that part of the brain isn’t working.
00:42:12 Andrew Cohen LMFT
So we have to behave our.
00:42:13 Andrew Cohen LMFT
Way out of anxiety and.
00:42:15 Andrew Cohen LMFT
This is where exposure therapy comes into play because.
00:42:18 Andrew Cohen LMFT
Basically, what happens when we have an anxiety?
00:42:20 Andrew Cohen LMFT
Disorder or OCD is.
00:42:22 Andrew Cohen LMFT
This this fight or flight response, this body fire alarm is misfiring.
00:42:26 Andrew Cohen LMFT
It’s going off and there’s not actually danger, OK?
00:42:29 Andrew Cohen LMFT
And every single time you’re triggered and you do a compulsion or safety behavior, you’re just reinforcing in your brain that that thing is actually dangerous and that that is.
00:42:38 Andrew Cohen LMFT
Actually a bad thing. So let’s use an intrusive thought. For example with those 3DS, say you have an intrusive thought that you want to punch your best friend in the face, right?
00:42:52 Andrew Cohen LMFT
If you kind of just let that BOP either and let it pass, you’re not going to really, it’s not really going to bother you.
00:42:58 Andrew Cohen LMFT
However, if that thought pops up.
00:43:00 Andrew Cohen LMFT
And like Oh my.
00:43:00 Andrew Cohen LMFT
God do I.
00:43:01 Andrew Cohen LMFT
Really want to do that, hey?
00:43:02 Andrew Cohen LMFT
John, I just had a.
00:43:03 Andrew Cohen LMFT
Thought of punching you in the face?
00:43:04 Andrew Cohen LMFT
You think I’m actually going to do that?
00:43:05 Andrew Cohen LMFT
And I’m like, no, you’re not OK, I feel.
00:43:08 Andrew Cohen LMFT
OK, cool.
00:43:09 Andrew Cohen LMFT
That and that just kind of reinforces.
00:43:11 Andrew Cohen LMFT
That that’s actually dangerous and something should be scared of.
00:43:14 Andrew Cohen LMFT
So, and our bodies are, are what we are designed for survival.
00:43:19 Andrew Cohen LMFT
So we’re constantly looking out for threats in our and and if we, if we respond to certain things like there are threats, they’re going to keep popping up.
00:43:29 Andrew Cohen LMFT
Oh yeah, one one thing I want to know too is intrusive thoughts are totally normal.
00:43:36 Andrew Cohen LMFT
Every human experiences them, you know?
00:43:39 Patrick Martin LCSW
Thank you for saying that ’cause I was like.
00:43:42 Patrick Martin LCSW
Normalize that, yeah.
00:43:42
Well, every.
00:43:44
Yeah, no and.
00:43:45 Andrew Cohen LMFT
I I wish I said that earlier, honestly.
00:43:47 Andrew Cohen LMFT
Because intrusive thoughts are a human experience.
00:43:49 Andrew Cohen LMFT
Like, you know, I imagine you drive, right?
00:43:52 Andrew Cohen LMFT
And have you ever been driving down the road?
00:43:54 Andrew Cohen LMFT
There’s a group of bicyclists here, right?
00:43:56 Andrew Cohen LMFT
You’re just like, what if I just bone down?
00:43:58 Andrew Cohen LMFT
Or, you know, you’re not driving down a Canyon?
00:43:58 Patrick Martin LCSW
Right, right.
00:44:01 Andrew Cohen LMFT
You’re like, what if I just drove off?
00:44:03 Andrew Cohen LMFT
Now do you?
00:44:05 Andrew Cohen LMFT
I don’t think, I don’t know if you have hormones with.
00:44:06 Andrew Cohen LMFT
You or not.
00:44:07 Andrew Cohen LMFT
But you might.
00:44:07 Andrew Cohen LMFT
But do you when you have those thoughts?
00:44:10 Andrew Cohen LMFT
Are you like?
00:44:12 Andrew Cohen LMFT
What do you do?
00:44:13 Andrew Cohen LMFT
I guess, yeah, what?
00:44:13 Patrick Martin LCSW
Are you doing OK?
00:44:14 Patrick Martin LCSW
So, like, I’m driving on.
00:44:15 Patrick Martin LCSW
The 101 like going coasters.
00:44:17 Patrick Martin LCSW
Like, oh, wow, oceans.
00:44:19 Patrick Martin LCSW
Like, right over that Cliff.
00:44:20 Patrick Martin LCSW
Like, what if I accidentally jerked and, you know, drove on like, you said my first.
00:44:24 Patrick Martin LCSW
Impulse is like.
00:44:26 Patrick Martin LCSW
To move to the left.
00:44:28 Patrick Martin LCSW
To do something to remove myself from the possible danger I just identified, right?
00:44:32 Andrew Cohen LMFT
Sure, sure. And then do.
00:44:34 Patrick Martin LCSW
Yeah, try a little more carefully.
00:44:35 Andrew Cohen LMFT
You, oh, sorry, go ahead.
00:44:37 Patrick Martin LCSW
I’ll say just drive a little more carefully or I might think like, oh, I have really precious cargo, you know, especially after becoming a father.
00:44:42 Patrick Martin LCSW
It’s like all of a sudden, like, oh, I start driving more carefully because I’m I’m more aware of the risk around me or their level of responsibility on me to protect.
00:44:51 Andrew Cohen LMFT
Those I love.
00:44:53 Patrick Martin LCSW
Oh, absolutely.
00:44:55 Patrick Martin LCSW
I’m sorry that that can be its own form of anxiety, right?
00:44:59 Patrick Martin LCSW
Parental anxiety.
00:45:02 Andrew Cohen LMFT
I mean, we could do a whole other talk on that.
00:45:04 Andrew Cohen LMFT
I’m sure you know.
00:45:05 Andrew Cohen LMFT
Uh, another time, but.
00:45:07 Andrew Cohen LMFT
Uhm, so basically.
00:45:09
What? What?
00:45:10 Andrew Cohen LMFT
But then let me ask you this like after you have.
00:45:12 Andrew Cohen LMFT
That thought, are you constantly learning about that and thinking about all those things?
00:45:17 Andrew Cohen LMFT
You know, all different possible.
00:45:17 Patrick Martin LCSW
Lasts for like half a second.
00:45:19 Patrick Martin LCSW
It’s over.
00:45:19 Andrew Cohen LMFT
Right.
00:45:20 Andrew Cohen LMFT
Half a second it’s gone, right?
00:45:22 Andrew Cohen LMFT
That is your typical intrusive experience, OK, when someone has OCD?
00:45:27 Andrew Cohen LMFT
They’ll have that thought.
00:45:29 Andrew Cohen LMFT
Be like, Oh my God, why did I just have that thought?
00:45:31 Andrew Cohen LMFT
Like, do I actually want to die?
00:45:33 Andrew Cohen LMFT
Oh my God, do I want my kids to die?
00:45:34 Andrew Cohen LMFT
Am I a horrible parent?
00:45:35 Andrew Cohen LMFT
And then you start kind of going down this rabbit hole and that sucks you in.
00:45:41 Andrew Cohen LMFT
And you know, it’s really interesting about OCD is.
00:45:47 Andrew Cohen LMFT
People with those who have intrusive thoughts and respond to them completely normally to like, have someone, as long as it’s not something the OCD latches on to.
00:45:57 Andrew Cohen LMFT
So like for example I have OCD.
00:46:00
Right.
00:46:01 Andrew Cohen LMFT
But I’ve I’ve really rarely had the experience of when I’m driving down a Canyon like I I’ve had the intrusive thoughts at that, totally.
00:46:10 Andrew Cohen LMFT
But I’ve never gotten in that cycle.
00:46:11 Andrew Cohen LMFT
Of like, oh.
00:46:12 Andrew Cohen LMFT
My God, do I actually want to do this?
00:46:14 Andrew Cohen LMFT
Does that mean I’m?
00:46:15 Andrew Cohen LMFT
What does this mean?
00:46:15 Andrew Cohen LMFT
About me and.
00:46:16 Andrew Cohen LMFT
All that kind.
00:46:16 Andrew Cohen LMFT
Of stuff, so it really only latches on to.
00:46:19 Andrew Cohen LMFT
Whatever the sufferer brain will.
00:46:22 Andrew Cohen LMFT
Allow it to I guess.
00:46:23 Patrick Martin LCSW
If you want what we give meaning to, it sounds like.
00:46:27 Andrew Cohen LMFT
Yes, because it attacks the attacks.
00:46:28 Andrew Cohen LMFT
Things you care about most values.
00:46:30 Andrew Cohen LMFT
All that kind of stuff.
00:46:32 Andrew Cohen LMFT
So that being said.
00:46:33 Andrew Cohen LMFT
Uh, a fight or flight response?
00:46:36 Andrew Cohen LMFT
OK, it’s going off when it doesn’t need to be going off.
00:46:38 Andrew Cohen LMFT
We wire that.
00:46:40 Andrew Cohen LMFT
OK, now.
00:46:44 Andrew Cohen LMFT
The fight or flight response is fun little fact for the listeners.
00:46:48 Andrew Cohen LMFT
If we’re triggered and we do absolutely nothing, we kinda just sit there with the anxiety.
00:46:52 Andrew Cohen LMFT
The longest our fight or flight response can last is up to 60 to 90 minutes.
00:46:56 Andrew Cohen LMFT
After that, our parasympathetic nervous system.
00:46:58 Andrew Cohen LMFT
Kicks in and calms itself down naturally without doing anything.
00:47:02 Andrew Cohen LMFT
It’s pretty remarkable, actually, our bodies.
00:47:03 Patrick Martin LCSW
That’s fantastic.
00:47:04 Patrick Martin LCSW
That’s great news.
00:47:05 Patrick Martin LCSW
Great news, great news.
00:47:07 Andrew Cohen LMFT
Now, I could probably almost guarantee that people who suffer with OCD and anxiety disorder hasn’t really waited that long before performing their compulsions because.
00:47:17 Andrew Cohen LMFT
The distress feels so scary.
00:47:18 Andrew Cohen LMFT
So you’ve never gotten to experience that.
00:47:20 Andrew Cohen LMFT
We call it habituation, the anxiety naturally going down, right.
00:47:26 Andrew Cohen LMFT
So with treatment exposure and response prevention, this vicious cycle is happening with OCD, you know you’re having an intrusive thought.
00:47:34 Andrew Cohen LMFT
And you’re having this uncomfortable feeling.
00:47:37 Andrew Cohen LMFT
It’s a motion and you’re doing a compulsion that gives you short term relief, right?
00:47:43 Andrew Cohen LMFT
Problem with that relief is it’s very short term because it only lasts long until you have another obsession.
00:47:49 Andrew Cohen LMFT
And what we know is we actually can’t control.
00:47:52 Andrew Cohen LMFT
When I say we just humans in general can’t control.
00:47:55 Andrew Cohen LMFT
The thoughts that pop into our.
00:47:57 Andrew Cohen LMFT
Uhm, so you can’t.
00:47:59 Andrew Cohen LMFT
You know, I always, like, I always like to use the example of don’t think about a yellow duck.
00:48:04 Andrew Cohen LMFT
Are you immediately?
00:48:05 Andrew Cohen LMFT
Going to think about yellow duck, right?
00:48:07 Andrew Cohen LMFT
So don’t think about hurting someone.
00:48:09 Andrew Cohen LMFT
Don’t think about something bad happening.
00:48:11 Andrew Cohen LMFT
You’re going to keep thinking about it.
00:48:12 Andrew Cohen LMFT
Right.
00:48:13 Andrew Cohen LMFT
And then another piece of this is we actually can’t control the feelings of the experience either, right?
00:48:19 Andrew Cohen LMFT
So if I just, I always see my, my patients like, oh, stop feeling anxious, is it possible?
00:48:25 Andrew Cohen LMFT
If it was, we wouldn’t need therapy right there.
00:48:28 Andrew Cohen LMFT
If it really wouldn’t be anything.
00:48:31 Andrew Cohen LMFT
But we we can only the only thing we actually have direct control over is our behaviors, what we do, the compulsions in our response to those thoughts and feelings.
00:48:39 Andrew Cohen LMFT
And the good news is?
00:48:41 Andrew Cohen LMFT
Changing your behaviors indirectly changes your thoughts and feelings.
00:48:45 Andrew Cohen LMFT
It’s called this the the cognitive triangle in CBT, or thoughts, feelings, and behaviors.
00:48:51 Andrew Cohen LMFT
Right.
00:48:52 Andrew Cohen LMFT
So exposure and response prevention, what we’re going to do is we’re going to intentionally trigger those obsessions, those worries, those anxieties, those fears and instead of doing our normal responses, which is those compulsions.
00:49:05 Andrew Cohen LMFT
Up to get that quick relief.
00:49:08 Andrew Cohen LMFT
We’re going to wait it out.
00:49:09 Andrew Cohen LMFT
And like I said, that’s 60 to.
00:49:11 Andrew Cohen LMFT
90 minutes.
00:49:11 Andrew Cohen LMFT
A lot of times it’s less, just depending on the severity of the trigger will pass and what you’ll experience is the society will naturally go down.
00:49:19 Andrew Cohen LMFT
And you can’t just do it one time.
00:49:21 Andrew Cohen LMFT
You have to repeatedly.
00:49:22 Andrew Cohen LMFT
Do these exposures.
00:49:23 Andrew Cohen LMFT
It’s because ultimately this treatment is very behavioral.
00:49:26 Andrew Cohen LMFT
I like to compare it to like say you’re learning an instrument.
00:49:30 Andrew Cohen LMFT
If you practice one time a week, you’re really not going to get where.
00:49:33 Andrew Cohen LMFT
You need to.
00:49:33 Andrew Cohen LMFT
Be you have to practice every single day for a good amount of time for that.
00:49:38 Andrew Cohen LMFT
Learning to take place.
00:49:39 Andrew Cohen LMFT
Because when you do that exposure again.
00:49:41 Andrew Cohen LMFT
And again and again and you’re realizing, OK, I’m fine, I can handle this.
00:49:47 Andrew Cohen LMFT
That fight or flight response stops going off.
00:49:50 Andrew Cohen LMFT
Much and if.
00:49:51 Andrew Cohen LMFT
It does go off.
00:49:52 Andrew Cohen LMFT
You’re you.
00:49:53 Andrew Cohen LMFT
You inherently are like, Oh yeah, there’s that.
00:49:56
Let’s see.
00:49:57 Andrew Cohen LMFT
India again.
00:49:58
There’s that anxiety.
00:49:59 Andrew Cohen LMFT
Again and you actually start to learn and build insight more so too into that anxiety and OCD.
00:50:06 Andrew Cohen LMFT
So these, these exposing yourself to these triggers and then you know really working hard not to do the compulsions is ultimately what’s going to get you long term relief from OCD as well as anxiety disorders.
00:50:19 Andrew Cohen LMFT
And this is done in a very gradual process, you know, within treatment with my.
00:50:25 Andrew Cohen LMFT
You know we start.
00:50:26 Andrew Cohen LMFT
Out by basically naming this monster this OCP anxiety monster because it is a bully, right?
00:50:34 Andrew Cohen LMFT
It’s a bully that comes in and takes over your life and and makes you, you know, makes it shrinks your world, right?
00:50:39 Andrew Cohen LMFT
And we need to treat it as a bully.
00:50:42 Andrew Cohen LMFT
And so we then then after that we we create what’s called this monster rules list, which is a list of all of the compulsions or safety behaviors that one does to get that short term relief.
00:50:55 Andrew Cohen LMFT
And then we rank on a scale of 1 to 10.
00:50:58 Andrew Cohen LMFT
How anxious you would be.
00:51:00 Andrew Cohen LMFT
Be breaking those rules and not doing those certain compulsions.
00:51:04 Andrew Cohen LMFT
And that’s basically how we create what’s called an exposure hierarchy.
00:51:07 Andrew Cohen LMFT
We start by exposing you to semi triggering triggers you know so that you can learn what you said earlier to stress tolerance.
00:51:16 Andrew Cohen LMFT
Your ability to handle uncomfortable feelings and the.
00:51:20 Andrew Cohen LMFT
Better you get at that.
00:51:21 Andrew Cohen LMFT
The easier it is, also easier.
00:51:23 Andrew Cohen LMFT
Easier is not.
00:51:24 Andrew Cohen LMFT
The right word is this treatment.
00:51:26 Andrew Cohen LMFT
Definitely not.
00:51:27 Patrick Martin LCSW
Potentially just uncomfortable.
00:51:29 Andrew Cohen LMFT
Yeah, it’s not easy, but it.
00:51:31 Andrew Cohen LMFT
Is very effective.
00:51:34 Andrew Cohen LMFT
That being said, you know, you build more stress tolerance and then you also learn through, you know, because that’s what habituation means, is learning.
00:51:43 Andrew Cohen LMFT
You’re literally getting used to your learning.
00:51:45 Andrew Cohen LMFT
Uhm, that you can handle whatever uncomfortable feeling arises, whatever thought arises, and you basically learn that, OK, it really is just the thought.
00:51:54 Andrew Cohen LMFT
Or OK, it really is just a feeling.
00:51:56 Andrew Cohen LMFT
I don’t have to do anything.
00:51:59 Andrew Cohen LMFT
So that’s. That’s.
00:52:01 Andrew Cohen LMFT
That’s the majority of treatment is very behavioral.
00:52:04 Andrew Cohen LMFT
I also incorporate a lot of mindfulness components to treatment teaching along my post to be fully present.
00:52:09 Andrew Cohen LMFT
In the exposures.
00:52:11 Andrew Cohen LMFT
And an acceptance of, you know, all thoughts, feelings, physical sensations.
00:52:14 Andrew Cohen LMFT
Because I always like to say like if you resist it.
00:52:17 Andrew Cohen LMFT
It’s going to persist.
00:52:19 Andrew Cohen LMFT
So like especially with like a panic disorder or.
00:52:23 Patrick Martin LCSW
That’s a great, great point to make.
00:52:25 Patrick Martin LCSW
So we want to make sure that in in the process of doing this, let’s have that you habituation work that the individual is fully attached, they’re not are associated I should say.
00:52:38 Patrick Martin LCSW
It’s just they could be they.
00:52:39 Andrew Cohen LMFT
In the moment as much as possible.
00:52:39 Patrick Martin LCSW
Could be there, but not emotionally mentally present.
00:52:42 Patrick Martin LCSW
It could be.
00:52:43 Patrick Martin LCSW
Catching, right?
00:52:45 Andrew Cohen LMFT
And we don’t want that necessarily, right, because you know that that again that is an avoidance uncomfortable feelings and again going to reinforce that something bad can’t handle it.
00:52:57 Andrew Cohen LMFT
And I’m trying to think, I mean, there’s a lot more I could talk about with it, but I think that’s kind.
00:53:03 Andrew Cohen LMFT
Of the general gist.
00:53:04 Andrew Cohen LMFT
Of treatments.
00:53:05 Andrew Cohen LMFT
Do you have any questions like?
00:53:07 Patrick Martin LCSW
No, that’s, that’s uh, that’s fantastic.
00:53:10 Patrick Martin LCSW
Thank you so much for we’re talking around what OCD is, what it looks like, the life applications.
00:53:17 Patrick Martin LCSW
I really appreciate that.
00:53:18 Patrick Martin LCSW
I know everybody watching and listening does as well.
00:53:21 Patrick Martin LCSW
And then how that might walk and talk a little different from your general anxiety and other forms of anxiety, and what the course of action is for OCD in particular, and how that works.
00:53:34 Patrick Martin LCSW
And I really, really love the analogies of of the monster, the bully, right?
00:53:38 Patrick Martin LCSW
Because that makes a whole lot of sense and I think.
00:53:41 Patrick Martin LCSW
For anyone struggling with, uhm, that type of.
00:53:44 Patrick Martin LCSW
Anxiety disorder that it would be reassuring to understand that you know this is not obviously what you really want to happen.
00:53:52 Andrew Cohen LMFT
And this is treatable, very treatable.
00:53:54 Andrew Cohen LMFT
Yeah, it’s, it’s very treatable.
00:53:56 Andrew Cohen LMFT
And you know, another reason it’s a passion is because I think there’s such a misunderstanding of those who do it.
00:54:01 Andrew Cohen LMFT
It can take an average of 14 to 17 years to be correctly diagnosed.
00:54:04 Andrew Cohen LMFT
And treat it because it’s just so misunderstood.
00:54:07 Andrew Cohen LMFT
So, you know, anything we can do to lower that.
00:54:11 Andrew Cohen LMFT
Amount of time.
00:54:13 Andrew Cohen LMFT
Uhm, yeah.
00:54:15 Andrew Cohen LMFT
Uh, yeah, thanks.
00:54:17 Andrew Cohen LMFT
Thanks for that.
00:54:17 Andrew Cohen LMFT
We is there more or we are.
00:54:19 Patrick Martin LCSW
And no, I’m.
00:54:20 Patrick Martin LCSW
That’s perfect.
00:54:21 Patrick Martin LCSW
It’s perfect, yeah.
00:54:22 Patrick Martin LCSW
And and so the specific treatment you were talking about is uh.
00:54:29 Andrew Cohen LMFT
Exposure and response prevention CRPS.
00:54:31 Patrick Martin LCSW
Thank you.
00:54:31 Patrick Martin LCSW
Exposure and response prevention, the response being that compensatory behavior, we’re trying to prevent that.
00:54:37 Patrick Martin LCSW
Right with border based.
00:54:38 Andrew Cohen LMFT
You expose to the trigger, you prevent the compulsion so you can win.
00:54:43 Patrick Martin LCSW
Just trying to make sure we all understand that.
00:54:45 Patrick Martin LCSW
So if anyone is looking for treatment they know what to look for a therapist who is trained and that that type of model right or intervention.
00:54:53 Andrew Cohen LMFT
And don’t you?
00:54:54 Andrew Cohen LMFT
Know just for consumers, ask as many questions as you can about the therapist experience if.
00:55:00 Andrew Cohen LMFT
They’re giving you kind of broad, not.
00:55:04 Andrew Cohen LMFT
As specific as you’d like.
00:55:06 Andrew Cohen LMFT
Those kind of would be some red flags.
00:55:08 Andrew Cohen LMFT
Uhm, you want someone who you know you feel really comfortable with and feel really.
00:55:14 Andrew Cohen LMFT
I mean just that’s like any other therapy, just someone you feel who really understands you, gets you.
00:55:19 Andrew Cohen LMFT
But you know, I think too many people have been through.
00:55:24 Andrew Cohen LMFT
Not great experiences with ERP and things like that.
00:55:28 Andrew Cohen LMFT
Maybe a?
00:55:28 Andrew Cohen LMFT
Big part of it due to lack of.
00:55:31 Andrew Cohen LMFT
Competence on some certain clinicians and.
00:55:34 Andrew Cohen LMFT
You know, I think.
00:55:35 Andrew Cohen LMFT
Uhm, that’s just it’s.
00:55:37 Andrew Cohen LMFT
So be be a.
00:55:38 Andrew Cohen LMFT
What’s the word a aware consumer?
00:55:41 Andrew Cohen LMFT
I don’t know if that’s the right word.
00:55:41 Patrick Martin LCSW
Yeah, don’t be afraid to shop around, right?
00:55:43 Patrick Martin LCSW
Don’t just say that.
00:55:45 Patrick Martin LCSW
Yeah, yeah.
00:55:46 Patrick Martin LCSW
Advocate for yourself.
00:55:46 Andrew Cohen LMFT
So that’s the, that’s the word.
00:55:49 Andrew Cohen LMFT
I was looking for.
00:55:50 Andrew Cohen LMFT
Thank you.
00:55:51 Patrick Martin LCSW
Yeah, absolutely great.
00:55:54 Patrick Martin LCSW
Great advice.
00:55:56 Patrick Martin LCSW
So obviously I want to have you back on in the future if you don’t mind with your wealth of information.
00:55:59 Andrew Cohen LMFT
Yeah, of course.
00:56:01 Andrew Cohen LMFT
Yeah, there’s a.
00:56:02 Andrew Cohen LMFT
Lot more we can dive into.
00:56:04 Andrew Cohen LMFT
Like I can, you know.
00:56:05 Andrew Cohen LMFT
We can talk about specific exposures.
00:56:07 Andrew Cohen LMFT
We can talk about, you know, other anxiety disorders and how to treat those and you know.
00:56:13 Andrew Cohen LMFT
Interoceptive exposures or panic disorder.
00:56:15 Andrew Cohen LMFT
Something special.
00:56:16 Andrew Cohen LMFT
A lot.
00:56:17
Lot of things.
00:56:18 Patrick Martin LCSW
Yes, I know it’s a deep well.
00:56:20 Patrick Martin LCSW
Yeah, I know we just scratched the surface of it, but you did a great job explaining, you know, what the definition of OCD is and what it looks like, how it’s treated.
00:56:31 Patrick Martin LCSW
And I’m sure this is going to be very beneficial to our audience and I appreciate this.
00:56:36 Andrew Cohen LMFT
Thank you so much for.
00:56:37 Andrew Cohen LMFT
Having me?
00:56:37 Patrick Martin LCSW
Yeah, where where can we learn more about you and the work you’re doing?
00:56:41 Andrew Cohen LMFT
Yeah. So, uhm, you can, uh, my website is Cohen OCD therapy. So Cohen is Cohn.
00:56:49 Andrew Cohen LMFT
Dot com colon OCD therapy.com and you know my contact info is on there. If you were, you know, wanting to become a patient, reach out. I will get in contact with you.
00:57:03 Andrew Cohen LMFT
Uhm, relatively quickly.
00:57:06 Andrew Cohen LMFT
I don’t like to to leave people you know with messages for days and days, so I do my best to return calls as promptly as possible.
00:57:14 Andrew Cohen LMFT
And emails.
00:57:16 Andrew Cohen LMFT
Well, and you can e-mail me at andrew@colonocdtherapy.com I guess there’s my website.
00:57:23 Patrick Martin LCSW
This is your site, right?
00:57:24 Andrew Cohen LMFT
That is my site, correct?
00:57:26 Patrick Martin LCSW
Perfect. Thank you.
00:57:28 Andrew Cohen LMFT
Yeah, that phone number, no.
00:57:30 Andrew Cohen LMFT
And then then you could contact under my e-mail.
00:57:33 Patrick Martin LCSW
Contact up here.
00:57:35 Patrick Martin LCSW
Phone number.
00:57:37 Andrew Cohen LMFT
Yeah, and.
00:57:39 Patrick Martin LCSW
Now for travel.
00:57:39 Andrew Cohen LMFT
Uh, offers telehealth, Yes.
00:57:39 Patrick Martin LCSW
Health it’s good.
00:57:44 Andrew Cohen LMFT
And there’s me.
00:57:48 Andrew Cohen LMFT
Uh, yeah, and then I’m.
00:57:51 Andrew Cohen LMFT
Trying to think.
00:57:52 Andrew Cohen LMFT
Oh, and then just for, you know, really good at the OC D f.org as well as OCD.
00:57:57 Andrew Cohen LMFT
So Cal about or really good resources for people suffering with OCD, but I think you you can put those in.
00:58:03 Andrew Cohen LMFT
The use of.
00:58:04 Patrick Martin LCSW
Yeah, show notes and everything.
00:58:04 Andrew Cohen LMFT
Like a lot of these.
00:58:05 Patrick Martin LCSW
Yeah, absolutely.
00:58:07 Patrick Martin LCSW
These are all your socials down here, right?
00:58:09 Andrew Cohen LMFT
Correct, yes.
00:58:10 Andrew Cohen LMFT
Stop there.
00:58:11 Patrick Martin LCSW
I’ll be sharing.
00:58:11 Patrick Martin LCSW
Later today.
00:58:13
Perfect.
00:58:16 Patrick Martin LCSW
Hey, you’re using simple practice for your website, that’s fine.
00:58:18 Andrew Cohen LMFT
I am, I am.
00:58:19 Patrick Martin LCSW
Lots of good things about.
00:58:20 Andrew Cohen LMFT
Use simple.
00:58:21 Andrew Cohen LMFT
Yeah, no, there’s really good.
00:58:22 Patrick Martin LCSW
I don’t I bootstrapped off of WordPress but.
00:58:25
OK.
00:58:27 Patrick Martin LCSW
I was just up for.
00:58:28 Patrick Martin LCSW
The challenge I guess, but.
00:58:29 Andrew Cohen LMFT
Yeah. No, it’s fair, fair.
00:58:32 Patrick Martin LCSW
Yeah, that’s a good thing about Simple practice though with their websites.
00:58:36 Andrew Cohen LMFT
It it is really good.
00:58:38 Andrew Cohen LMFT
It’s it’s a good HR.
00:58:42 Patrick Martin LCSW
And all in one, right.
00:58:43 Patrick Martin LCSW
That’s great.
00:58:44 Andrew Cohen LMFT
All in one.
00:58:45 Patrick Martin LCSW
Now these therapy notes are mine, but they don’t.
00:58:48 Patrick Martin LCSW
Include a website.
00:58:49 Andrew Cohen LMFT
No, I don’t.
00:58:50 Andrew Cohen LMFT
Yeah the renewed Freedom Center when I was there at least was using therapy notes.
00:58:53 Andrew Cohen LMFT
It’s good to I I just, I think simple practices.
00:58:56 Andrew Cohen LMFT
Uh, a more friendly interface either from the interface.
00:59:01 Patrick Martin LCSW
Until now.
00:59:03 Patrick Martin LCSW
It’s I love the.
00:59:03 Andrew Cohen LMFT
I don’t work there simple practice by the way, so.
00:59:04 Patrick Martin LCSW
Work you’re doing.
00:59:06 Patrick Martin LCSW
Yeah, that’s no.
00:59:07 Andrew Cohen LMFT
I’m not just plugging simple graphic, but yeah.
00:59:10 Andrew Cohen LMFT
I don’t worry, I don’t like this.
00:59:11 Patrick Martin LCSW
Of course.
00:59:13 Patrick Martin LCSW
Excellent, excellent.
00:59:14 Patrick Martin LCSW
Well, I really, really appreciate you being on.
00:59:16 Patrick Martin LCSW
I love the work you’re doing.
00:59:18 Patrick Martin LCSW
It’s very, very much needed.
00:59:21 Patrick Martin LCSW
Uhm, perfect, you know, aspect of the profession.
00:59:24 Patrick Martin LCSW
So keep it up and I will be tapping on your shoulder to have you back on, if you don’t mind.
00:59:28 Andrew Cohen LMFT
Well, at least I would, you know, love to come back and.
00:59:31 Andrew Cohen LMFT
Uh, you know.
00:59:32 Andrew Cohen LMFT
Uh, talk about a lot of other things.
00:59:35 Patrick Martin LCSW
Excellent. I appreciate it. You enjoy this more mild Southern California day. It’s not 100 degrees right now.
00:59:43 Patrick Martin LCSW
Good day for a lunch.
00:59:44 Andrew Cohen LMFT
So much better.
00:59:45 Andrew Cohen LMFT
So much better.
00:59:46 Patrick Martin LCSW
Looking forward to the fall and now we share the same, the same weather here.
00:59:50 Patrick Martin LCSW
So Ali, yes, all right.
00:59:54 Patrick Martin LCSW
OK, Andrew, thank you so much and I hope you have a great week.
00:59:54
Right.
00:59:57 Patrick Martin LCSW
OK.
00:59:58 Andrew Cohen LMFT
You too. Thank you. Bye.
00:59:58 Patrick Martin LCSW
Alright, take care.
01:00:00 Patrick Martin LCSW
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01:00:10 Patrick Martin LCSW
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01:00:12 Patrick Martin LCSW
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01:00:20 Patrick Martin LCSW
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01:00:29 Patrick Martin LCSW
Thank you so much for your time.
01:00:30 Patrick Martin LCSW
I hope this was valuable and another tool for your toolbox.
01:00:34 Patrick Martin LCSW
So until next time, keep making good things happen.
01:00:38
Bye, bye now.
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