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Episode 45

OCD and “Urges”

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On today’s episode of the Purely OCD podcast, Kelley Franke, LMFT, and Lauren Rosen, LMFT, are joined by the wonderful Catherine Benfield to talk about OCD and urges.

The three discuss Catherine’s recent article (with an assist credit to Kelley) about urges in the context of OCD.

Some questions they cover include:

1. What is an obsessive urge?

2. How can we practice ERP in the face of obsessive urges?

3. What is the role of accepting uncertainty with urges?

There’s specific mention of Postpartum OCD, Harm OCD, Sexual Orientation OCD (aka HOCD), and Relationship OCD. The content of this episode could also be applied to POCD. We hope you find a little hope in this open conversation of what it’s like to live with and recover from this disorder.

2:09

Catherine takes a moment to introduce herself and the amazing work she is doing in OCD advocacy.  She is a VERY busy lady!

She:

• is a primary school teacher and football coach
• is a mental health advocate, particularly focused on OCD advocacy
• runs her website, Tamingolivia.com, which is all about inserting creativity and compassion into OCD recovery  

Side note – meet Olivia, Catherine’s illustrated version of OCD:

But, from Catherine’s amazing artwork back to all of her other amazing work. She is:

• working to create a version of Taming Olivia to help children work on things like resilience, failing forward and mental health.
• working with University of Bath and University of Oxford to develop an app for relapse prevention, and to investigate Perinatal OCD. 
• executive producer of a film called Waving, which is going to be one of the first big mainstream media films about intrusive thoughts. 

4:40

Lauren toots Kelley and Catherine’s horns by announcing that the two got to collaborate on an article Catherine wrote about Perinatal Postpartum OCD and urges in general.  

6:45

The crew delves into a discussion about people who support those with OCD.

Catherine talks about the brilliant support her husband gives her and how important it is.  since it can be really tricky being in a relationship with OCD.  

Lauren shows her enthusiasm for those who supporter people with OCD, saying:

“I’m really excited to give the keynote this year at the conference at Kennesaw State (as part of the Riley’s Wish lecture series) on OCD and Substance Use Disorder. It’s all about connections… We tend to put things in boxes like, here’s the supporter, and here’s the person who has OCD, and here’s this type of OCD, and here’s a Substance Use Disorder, and here’s eating disorders. And they’re so interrelated. Not only is it all of the disorders that come together, but it’s a family issue. Mental illness touches everyone on the planet.”

Lauren Rosen, LMFT

9:05 Catherine shares, 

“I spent a long time feeling really bad for my son when I was going through a particular recovery time. But actually now I can see that there’s no way he would have been as open minded and expressive, and as open to talk about mental health had he not watched me go through some of it. And then we talked about what was going on. So as hard as there are disadvantages for the family, there’s also some positives that come from watching that challenge, watching what you’ve been through.”

Catherine Benfield

9:46

Kelley notes how taken she was by the fact that she hasn’t seen the issue of OCD and Urges brought up more often. She asks Catherine what prompted her to write on that topic?”

10:06

“The whole idea of bodily sensations, for years I was in this world of thinking, oh, my goodness, doesn’t that mean I want to do it? When I had my son, I could just about handle the intrusive thoughts, the violent ones. Therapy kind of helped me to get a grasp on the fact that I wasn’t my thoughts, but I thought these urges indicated intent. I thought it meant that I wanted to do these things, and that was what was so terrifying about it. 

As we’ve gong through advocacy and after all these years of talking about Perinatal OCD, gradually people started to talk a little bit more. They were talking about Harm OCD. They were gradually starting to talk about sexual thoughts. So it was gradual. Every time someone did something, someone else built on it. Yet we never ever talked about this kind of bodily sensation to harm, and it was just this gaping hole in knowledge. The conversation is changing, and yet I always notice that when we get to this subject, no one talks about it. So you’re left with someone with OCD thinking, what on Earth does this mean?” 

Catherine Benfield

12:15

The ladies discuss the difference between urges and the experience of physical sensations that people interpret as urges with OCD.

Kelley notes the importance of the difference is between “a genuine urge versus that fear that I could have this urge.” Lauren notes that sometimes the trouble is in “the interpretation of the physical sensations of it. This must be an urge, because I’m having these thoughts.”

“The DSM defines obsessions as thoughts, images and urges, which I disagree with, but there are two parts. There’s the trigger, which can be an internal image, a physical sensation, a thought. And then there’s the interpretation of that as something that could be a threat, which is where the obsession comes into play.”Oh, my gosh, what does this mean about me? Maybe this means I actually do want to harm my baby. Or maybe this means that I am attracted to fill in the blank.” There are all of these different ways in which that can then impact people. But that initial thing, not only is it not an obsession, in my opinion, it’s a trigger, but then it’s this idea, that urge.  It’s like the precision of language is really not there.” 

Lauren Rosen, LMFT

13:37

Catherine talks about how scary it is for people to talk about these “urges” and also explains why she decided that she had to:

“No one can explain it…the description around it and the discussion around it just isn’t there. I wanted someone to be able to talk about it and just say how it was. And I thought, I’ve been working in this field for six years now. There’s not a person on the planet who can’t Google me and find out my deepest, darkest thoughts. I might as well be the one to do it. 

Kelly, there’s no way I would have written that without your help. There’s no way. I had to have someone that I trusted completely, because there was absolutely no way I was going to run the risk of getting that wrong for people.”

Catherine Benfield

16:09

Kelley talks about how thoughts that are consistent with momentary emotional experiences can be triggering:

“I think the urge and the feeling of having an emotion that’s in line with anger, for example, if I feel angry at my daughter because she is frustrating me. I do all the things in the effective way a parent should do them, and she’s still throwing a tantrum. And then I get an intrusive thought like, oh, you could just _____… That’s just as scary to me. It mirrors and parallels that urge feeling, because it feels like, “oh, I’m that much closer”. “I’m a little closer to doing that thing.” OCD is just difficult.”

Kelley Franke, LMFT

16:55 Catherine relates to Kelley’s story.  “I’ve done so much work around self compassion, and when I’m angry at my little one, it makes me realize, I’m allowed to be frustrated and angry because this is a frustrating and anger inducing moment I’m going through right now.” 

Lauren talks about how being triggered by thoughts that are consistent with momentary emotions can come up in ROCD: 

“It kind of reminds me of ROCD that way in that there’s not enough discussion about what it’s like to actually be a human, whether its a human relationship to a child or a relationship to a significant other. There’s this fairy tale of, well, you give birth and then you look at this thing and you’re immediately connected. The continuity of love does not necessitate constantly liking somebody or their behaviors. Having that nuance in terms of how we look at our relationships to other people is really important. Otherwise, when you have a thought like, “Oh, I just want to murder this person”, it’s like, “Whoa, what does that mean?” Well, of course you have that thought, because people are frustrating as well.”

Lauren Rosen, LMFT

19:04

Kelley brings everyone back to discussing what an “urge” in OCD is?”

Kelley encourages the listeners to check out Catherine’s website Tamingolivia.com for the full article. 

The way that we were talking about it is if you’ve ever stood at the edge of a train and going, “Oh, I could just push somebody or I could just jump right onto the tracks”. Or if you’re driving your car and you get this urge of like, “Oh, I could just swerve my car and go across all the lanes and slam into the center divider. 

That’s how we would define it.  The way that we’ve defined it is that this is not what we would actually define as an urge, because an urge is something that we are aligned with. Like, “Oh, yes, I have this urge to want to eat this ice cream, and it feels good and Yum, Yum, Yum.” But in OCD, it’s this feeling, this physical reaction or this trigger of uncomfortable distress and intrusive thoughts, and then going, “Oh, what if I did do that?” It’s not a true urge if it’s not aligned in that way.

Kelley Franke, LMFT

20:57 Lauren adds, 

I think what happens is when we call it an urge, that comes with all of the associations that we have with an urge. So if you say,”Oh, I’m having this urge”, that’s different from saying “I’m having this physical sensation that I’m interpreting as an urge”, and that’s likely to make you more anxious, because you’re associating all of what Kelly was just saying with what you’re experiencing. “Oh, well, that means that it’s something that I want.” Not that you’re actually thinking all of these things, but the human mind connects all these things.

Lauren Rosen, LMFT

21:58

Sean Shinnock of Draw Your Monster, comments “What if the urge isn’t necessarily associated with a validating emotion that sometimes goes along with it, like “slam” an urge out of nowhere?” 

Kelley agrees with Sean’s statement. “It doesn’t have to be because you’re angry. It could just be, I’m just driving along, having a ride back home from work and suddenly think I could just take the wheel and turn it. I could just kill 60 people with just a little turn.” 

23:01 Catherine shares her childhood memories of this experience: 

 When I was little, I wasn’t aware of any thought that was in it. It was just this sudden kind of urge feeling the bodily sensations. It’s like the pump of adrenaline. I could immediately feel the stress hit. I’d assume that those bodily sensations were representing me actually wanting to do it, because there’s a doubt, an uncertainty because of OCD. 

Catherine Benfield

23:37 Lauren adds, “You start to become very aware of the tingling sensation in your hands and, “Oh, my gosh. Does that indicate that I’m about to do it?”

Catherine notes that it affects her vision, and feels it’s the biological side of anxiety. 

24:28

Kelley asks Catherine, “In those moments of just terror, I’m wondering, how do you approach it? In the moment or earlier?”

25:14 Catherine answers,

“I think the way that I’ve dealt with it has evolved over the years. [At first] it was sheer terror. It was duck to the sofa terror. My husband was in between me and my son, because that’s where I directed that. In came all the compulsions and avoidance. It was sheer terror where I couldn’t move. 

You start small and you expand. It’s baby steps all the time. I would force myself to sit for three minutes, then four minutes, then five minutes before I address whatever I was doing, whether it was just getting up and going somewhere else, whether it was  putting on TV just to distract myself, just for five minutes. 

I’m at the point now where I’ve done so many exposures, I can’t get them to bother me at all. I keep working that muscle. I’ve done so much exposure work now that I’m indifferent to it. I just think, oh, here we go again. Shut up! 

It took a long time to get there, and it was self compassion. The whole thing with Olivia was about separating myself from the condition in the first place. It was that kind of little cartoon character that just helped me to draw on those kind of feelings of wanting to help the vulnerable and then apply that to me.  But it took a long time.  I was really ill about seven or eight years ago, and it’s only been the past couple of years that I’m actually at the point.”

Catherine Benfield

27:32

Lauren asks, “I’m curious if there were any techniques or tools that you found useful when it came to recognizing what was happening in the moment, because to your point earlier, that experience of the ‘urge’ is so overwhelming, and it’s so easy to get hooked in that. Is there anything particularly helpful.” 

Psychoeducation was massive. As I understood things, I would then kind of tell myself and educate myself about it in the moment.  They have to be short little snippets, and they have to be easily accessible. Things like books that I’d read, the odd little sentence, or I’d written myself compassionate letters, and I’d actually read them so many times, I could pretty much recite them word for word. But they all were for different reasons. 

I had one that was about the bodily sensations. There was one time we went see HMS Belfast, which is a big warship on the Thames, and I was standing very close to my son near the edge, this massive drop down. That was absolutely horrendous. But I do remember I knew what was happening. And so I knew what I wanted to do was to run away and to be away from him. I knew I wanted my husband to be in between us. And so I didn’t let myself do it, because I knew immediately, because I’d read so much about it. I just knew that it would make it worse if I gave in. So I forced myself to stay there. I’d learned about my breathing by that point and how to make sure that I was properly breathing… knowledge of the biology of the body. So I understood that the reason I felt like I was going to be sick was anxiety, not because I really was going to chuck my son over.

Trying little bits, even if it’s only one minute, is important.

Catherine Benfield

30:25

Lauren asks Catherine, “I’m curious about the idea of accepting uncertainty.” What happens when your brain goes, “yeah, but what if it is a genuine urge?”

I think you have to be a certain level in your recovery to be able to accept it. If someone came to me when I was really poorly and said, you just need to work on accepting this, I would just say, “What are you talking about?”

It’s educating people what acceptance actually means, and then knowing that you really have a bit of a safe unit inplace before you suggest it, because I do think that people are told to use acceptance very early on when they’re still very poorly. And I think that’s just utterly terrifying.

Catherine Benfield

31:58 Kelley agrees, “It’s just really scary. I usually try to slowly dip people’s toes into the idea of it.“

32:09

Lauren builds on ways to help people accept uncertainty.

“I think that’s where things like cognitive restructuring can be really helpful.  Say, okay, well, what’s likely here? Before we take the plunge, and we just accept that these thoughts are here, and really accept ultimately, (we can’t know for sure what they mean) let’s look at what’s most probable, and we’re going to assume that that’s right. While accepting that we don’t know. 

Kelley and I were just having a conversation about this last night. The idea of when you don’t know something, not assuming the worst. There’s this weird middle ground where you assume that everything’s going to work out, but you accept that you can’t know for sure.

Lauren Rosen, LMFT

32:56

Because we often get into this place when we’re doing exposures.  We go to negative default, “the bad things going to happen”, and then we lose sight of the fact that we can hold optimism and still move forward in exposures.

Kelley Franke, LMFT

In fact, behaving as though things are going to work out is an exposure.

34:11

The ladies take questions from viewers:

“Having urges makes me feel out of control. How sit with the fear that you might act on it?”

This is going back to what Catherine was saying when early on is knowing this is anxiety. This is what anxiety feels like. But then the piece we didn’t say is her willingness to say, “I’m going to sit through this feeling, and hold my son, and be here without doing the compulsion.” It’s very hard, and to have tons and tons of self compassion if it doesn’t go that way. But I think that’s the key is the willingness to just do nothing.

Kelley Franke, LMFT

35:10 Catherine agrees,

I think as well, before I even started doing exposures, I had such doubting who I was as a person. So sitting with that wasn’t an option for me then.  We stopped all the ERP just so that I can work on doing some stuff about me and try and build up my self esteem. Because it was once I actually started to believe that I was worth that recovery and not this hideous dangerous monster, that’s when I could start with the ERP and start sticking with certain stuff.

There were skills behind it as well, that I feel we need to learn first, because if you’re self esteem is at rock bottom, it’s going to be hard for you to sit there with those things sometimes. 

Catherine Benfield

35:58

Kelley discusses the inclusion of self-compassion: 

And I think that’s where the self-compassion comes in.  “This is hard. This is scary. That’s okay. If you didn’t do it, that’s okay.” 

And I think when I look at OCD recovery, I zoom out, and I look at it as the header of learning to trust ourselves again. Because it’s so much doubting.

Kelley Franke, LMFT

36:32

Lauren ties back to the listener’s question:

It’s about what you just said about trusting yourself. How do you sit with a fear that you might act? You make the choice behaviorally to trust yourself.  Even in the absence of whatever we might experience as the feeling of trust. What I have experienced myself is just taking the leap, seeing how it goes.

Lauren Rosen, LMFT

37:25 Lauren passionately cautions, 

It is a journey. I love what you said, Catherine, about taking it one step at a time. And for anyone who’s listening, I think that it can feel very daunting and perhaps unattainable if you’re hearing us talk about these things with sort of. “Oh, well, it’s just that thought”, which has not been the case always for any of us here. And sometimes still isn’t.

I have thoughts come in where I’m convinced, and I have the wherewithal now to be aware of my conviction being inherently suspect, but that doesn’t mean that I’m not still sometimes pulled in by the undertow, as Kelley said… of feelings. It’s hard.”

Lauren Rosen, LMFT

38:25

Another listener asks, “Can urges be very intense?”  

38:30 With lots of head nodding, Kelley says:

“Oh, yes. They will knock you on your ass. There’s no doubt about it. But that doesn’t mean that it’s more true. Or that you’re more likely to. It’s just a very uncomfortable experience. 

38:48 Lauren adds a side note about things “feeling real.”

Lauren: I’m actually pretty firm with my clients on this. Like”whoa, whoa whoa, wait a second. What are we talking about? Feeling real? But that’s not a feeling. I don’t know what that face on the Feeling Wheel Chart is.  

Kelley: Sad, Angry, Fear; not real.

Lauren: No, that’s not a feeling. It’s a narrative. It’s thoughts. I’m having an emotional experience and the interpretation of that is “this must mean it’s real”, because of the intensity. And if we then go and say, “Oh, it feels real”, that does the same validation that Kelly was talking about earlier with the urges. It essentially says, “Oh, well, then it’s likely to be real”. And that’s just not the case.”

Kelley and Lauren discuss the fact that “feeling real ” is a cognitive distortion. It’s called emotional reasoning.  Feelings aren’t facts.  

40:44

The ladies address a final question: Why do we get urges? 

40:55 Catherine begins,

Isn’t it just being a bit random?  I just think it’s part of being a human being. But the way I kind of think to myself about it is that it makes sense in the evolutionary sense for us to be slightly aware of different things. And that’s just one of the things that happens. I think that about thoughts [and] I think that about feelings…it’s just a bit random.

Catherine Benfield

41:30 Lauren adds a humorous example: 

I think that we think as humans that all of our internal experiences have some sort of meaning ascribed to them as opposed to like, we don’t think that about dogs. If a dog starts barking at the mailman, while looking out the window, we don’t think, “Well, stupid dog. It’s just the mailman.” We’re like, “Oh, of course the dog is barking at the Mailman again, right?”  

…If we are breaking down the urges as we have been talking about it, physical experiences are random, and they come up, and then our brains want to figure everything out. And to your point, Catherine, of course we do. That’s very evolutionarily beneficial. It’s trying to figure things out that keeps you safe, unless it then goes totally haywire, and then you end up with OCD or anxiety disorder… 

We call them urges because that’s the fear.  We started this conversation with the discussion of postpartum OCD. And can you think of anything scarier to a new parent then, “Oh, my gosh, but what if I…?” So that’s why you’re going to experience that as an urge, because that’s the scariest thing. And the thing that you want to protect yourself from.

Lauren Rosen, LMFT

43:47 Kelley loops back to Catherine’s Olivia:

“I think this where Olivia plays a great role in describing OCD. She’s part of our brain. All the other little Olivias running around.”

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