 John Green from the Vlogbrothers has been very open, honest, and vulnerable when talking about how he deals with his symptoms of obsessive-compulsive disorder. And I don't know much about OCD, so I brought along a very special guest. What is up everybody? This is Chris from the Rewired Soul, where we talk about the problem, but focus on the solution. And if you're new to my channel, my channel is all about mental health and what I like to do is pull different topics from the YouTube community to teach you how to improve your mental and emotional well-being. So if you're into that stuff, make sure you subscribe and ring that notification bell. So yeah, what I like to do is pull these topics from the YouTube community to teach you how to improve yourself mentally and emotionally, all that stuff. But John Green of the Vlogbrothers has talked about obsessive-compulsive disorder and I don't know much. I know some, but I don't know much about it. So the special guest I have today, and I'm super excited, is Dr. Ali Matu. Alright, he has a YouTube channel over here, so I will link his channel up in the info card down in the description. And in the pinned comment down below, you have to, have to, have to go check out his channel and subscribe. Because as all of you know, I'm not a credentialed, licensed professional, but Dr. Ali Matu is. So please go subscribe to him. And without further ado, I'm going to pass it along to Dr. Ali Matu. Hi, I'm Dr. Ali Matu, clinical psychologist, and I specialize in treating anxiety, OCD, hair pulling, nail biting, skin picking, and ticks and Tourette's. And I also have a YouTube channel called The Psych Show, where I make psychology fun and easy to understand. I celebrate mental health and I share my journey as a clinical psychologist. Chris and I were talking last week. We just sort of met each other. And he asked me if I would be interested in making a video about OCD. A lot of questions about OCD have been coming up in this community. And since it's an area of my expertise, I am happy to do this for you all. So I do want to do it in the way that Chris makes reaction videos. And I wanted to react to a YouTuber who is really explaining OCD well. And really doing it in a way that's right and honest and authentic. And when I thought about that, there was just one name that came to mind. And that's John Green of Vlogbrothers and Crash Course and Under Days and so many other YouTube channels. So there's four videos that John has made over the past few years where he talks about his OCD. So what I'm going to do is I'm going to play a few clips from them and walk you through how this relates, how his description relates to what OCD is. And then we'll wrap up at the end and talk about if someone like John came to me and shared these kind of things, what would I do? What would I recommend? Because we want to focus on the solution as well, on the rewired soul. So here we go. This video is about my mental health, but I want to say here at the outset that I am not a psychologist and that in general I think we should listen to experts when it comes to mental health and also when it comes to other things. I am a psychologist and an expert on OCD, but I also need to say something at the onset here. I'm talking about the symptoms of OCD and later on treatment as they relate to the kind of things that John is talking about. But I have never met John. I don't know John. I think he's awesome and I love all the work that he is doing as well as Hank. I love Hank and I really enjoyed his book that just came out last year. But I digress. Getting back to John here for a moment, John is not my patient. I've never met him. Without actually meeting someone face to face and hearing from their perspective about what's going on, I can't make a diagnosis. And then even in that scenario, if someone is a child or a teenager, I also need to hear from their parents and sometimes also their teachers to get a full picture of what's going on. Without that type of stuff and information and face to face contact, I can't make a diagnosis. And even if I had all of that, I wouldn't be able to talk about any of that sort of stuff without that person's explicit permission. So this is an exercise in public education. This is not me diagnosing John. This is us hearing John's description of what he goes through and me sharing what I know about OCD. It seems to me that the stuff happening way down inside of us is difficult to talk about partly because those experiences aren't really accessible by the senses. You can't usually see or hear psychic pain and it's difficult to describe without simile or metaphor. I love this description just for anxiety and many other forms of mental illness as well. I've been treating anxiety for a very long time and I still can't tell when someone is going through anxiety. Now in some situations I can, like for example with panic disorder, sometimes you can see the symptoms. But for things like OCD, social anxiety, generalize anxiety disorder, sometimes with separation anxiety, you can't quite see the person's distress because it's so much internal. So I love how he just kind of explains that and explains how the best he can do is explain what it's like. So I have obsessive compulsive disorder which is mostly seen in the popular imagination as being about excessive hand washing or neatness or whatever because those are things you can see, you know? They're not like the formless and sensate horrors of psychic pain. They're behaviors that you can portray in a movie. This is such a good point that I never thought about until I sat down to make this video for you. One of the reasons why the OCD that is represented in TV and film is probably the OCD that's about cleaning and repeating rituals is because it's the one that most easily translates to something you can see. There's so many forms of OCD that you can't really see. It might be all internal. It might be all things that someone does completely inside of their own head. So there's this rule in TV and film and for YouTube as well is show, don't tell. Whenever possible, show something. And that's probably why representations of OCD are so biased towards this one type of OCD. So I experienced these obsessive thought spirals in which intrusive thoughts that is like thoughts that I don't want to have that seem to come from outside of me sort of hijack my consciousness. John is doing a fantastic job of talking about how his obsessions spiral out of control. And we all experience obsessions. I made a video about what makes something an obsession versus an addiction. I'm going to play a clip for you right here. Obsessions become problems if you have a hard time controlling these thoughts. If your routines start to get in the way of your life, if you experience a lot of anxiety or if you lose a lot of time or money. If I spend all my free time thinking about Star Trek, avoid going to something really important because there's a new episode of Star Trek Discovery, get anxious because someone used my Netflix account and I lost track of where I was in my rewatch of Star Trek Voyager and I blew a ton of money buying Starships. Then I might have an obsession. So there's probably stuff that you get obsessed about too. It's a normal human condition. And this is the thing about mental illness is every aspect of mental illness is something we've all experienced regardless of whether we have it. So we all go through anxiety. We all experience some of the symptoms of depression in our lives. Even things like schizophrenia, there are times where sometimes we are not sure what we saw or what we heard. If it's a really scary night, it's raining and you hear a sound in your home. Maybe you imagine something is there. So we all experience these things. Mental illness is on a continuum from very common experiences to less common experiences. From something that doesn't get in the way of your life at all and it might actually be very helpful to something that is very much limiting causes a lot of distress really gets in the way of your life. So here John is explaining how we all get obsessions and I've got my obsessions about Star Trek. I've got my Star Trek combadge because I really like wearing it when I watch Star Trek Discovery and I just like collecting these and I've got my starships right over here. But those thoughts that I get about the things that I really get obsessed about, they don't necessarily get in the way of my life. They don't limit my life. What John is talking about with his thought spirals, they get out of control and they hijack his mind to use his own words. They make it very hard for him to do whatever he wants to do. That is one very classic symptom of OCD. That's the O in OCD is you might experience thoughts, images, urges that are very hard to get out of your head. And when that gets bad I can lose all control over my thoughts for an extended period of time to the extent that I can't follow what's happening in a TV show or read a book. Here John is talking about another criteria of OCD which is the impairment criteria. So individuals with OCD might experience these thoughts, they have a very difficult time getting rid of these thoughts and that in itself can make it very hard for them to live their life. It can make it hard for them to do the things that they need to do. This is what we call impairment. You can't quite do your daily activities and one of the ways in which OCD can be very impairing for people is it just takes up a lot of time. In the diagnostic criteria your obsessions or your compulsions need to take up about an hour of your time or more. Usually by the time people come to see me their OCD symptoms are taken up more than an hour of time. So again we all experience obsessions, we all experience compulsions, I'll get into that in a moment, but we might not get stuck with them and they might not get in the way of our life and they might not take up that much time. If those things aren't happening you don't have OCD. If they are happening you might be experiencing OCD. So the compulsive behaviors I use to cope with these obsessive thoughts by rules repeatedly checking my food for contamination for instance or spending hours googling what will happen to me if I eat moldy bread. Those are for me ways of trying to comfort and calm myself, like I'm not checking over and over again to be eccentric or whatever, I'm doing it because I cannot stop obsessing over the fear that I might have eaten living mold and I will do whatever I can not to be strangled by that thought. Here John is explaining the way in which he engages in compulsions. So what are compulsions? Compulsions are these repeated things that you do over and over again, often times they feel like rituals, like they need to be done a certain way. It might be stuff like John is talking about like a checking kind of ritual. It might be a repeating ritual. It could be a tapping ritual. Sometimes it's actually a mental ritual, so you might say something in your head. You might say a word or try to neutralize a bad thought with a good thought or a bad number with a good number, or it might be just trying to get evenness. So you might need to do something a certain number of times until you hit an even number or an odd number or a lucky number. Sometimes a compulsion might be just you need to feel just right. It's hard to describe, but you have to do something over and over again until it feels like you got it. And this is another way in which OCD can cause a lot of distress and it can take up so much time out of your life. It can really rob people of their time. What people often try to get when they're engaging in compulsions is they're trying to get more certainty. OCD is fueled by uncertainty. I don't know if I did that thing just right. I don't know if my stove is off. I don't know if I said something bad into my phone and now it's going to be shared with my whole contact list. I don't know if I might have become contaminated by this thing. I don't know if I blinked the right number of times or if I tapped the right number of times. All that uncertainty drives up anxiety and those obsessions become more and more intense. And so people often engage in rituals to try to get more certainty. I might check my phone a number of times to make sure I actually didn't send that audio file that I'm worried I might have sent or I might check the stove a number of times. I might tap a certain number of times. The thing about this is is you people who experience OCD never quite reach that point of certainty. You might do something until it feels right. And then there's a little temporary relief. But then soon after those obsessions can come up again and the whole cycle just repeats itself and people can get stuck in that OCD loop of obsession, uncertainty, compulsion, temporary relief, obsession. So in this video, John doesn't get too much into treatment, but he does mention in his comment section that medication and cognitive behavioral therapy have been helpful for him. And that is the treatment for people who have mild to moderate OCD symptoms. One or the other might be helpful going in and getting medication treatment or going in and getting cognitive behavioral therapy. The specific type of cognitive behavioral therapy is called exposure response prevention. So it is something that helps people to face the fear, face their the obsessions that they have, and to not engage in the compulsion. The whole goal of exposure therapy is to help people be able to tolerate that uncertainty. And it's it's not about getting more certainty, but it's about building up your ability to tolerate that uncertainty. The rewired soul, this whole channel, started about the idea of neuroplasticity, the brain's ability to rewire itself. And there's actually fMRI studies, functional magnetic resonance imaging, I think, studies that have looked at the brains of people before and after they engage in exposure response prevention therapy and notice changes in their ability to manage these emotions through what's being shown on the fMRI scans. Well, it doesn't show you changes in your ability, what it shows us changes in the activity of the brain. And so there's there's really good research around that. And on the medication front, there's really good medications that can help as well. So for mild to moderate, one or the other is the way to go. If you have moderate to severe, you probably need a combination of medication and psychotherapy, specifically exposure response prevention therapy. The way I describe that to people is if you're in the moderate to severe range, we probably need medication that brings your symptoms down to a place where you can actually take advantage of the therapy. OCD can rise and fall with stress. In fact, we're going to see that with one of John's videos in a moment. So usually people come in, they learn these skills, they get their symptoms under control and then they kind of go on with their lives. And then maybe in the future, if they're in a tough spot, maybe they need to come in again and get some more booster sessions or booster treatment so we might support them in that way. And then they're kind of go on with their life. OCD can go up and down with stress and with difficulties that come up. Speaking of that, I want to play a little clip from another video of John's where he talks about some of the recent struggles he's been experiencing. As you know, I have been very sick the last several weeks as I've tried to figure out a new medication regimen. Over the years of living with my illness, I've learned a lot about how to make it tolerable. I've learned to celebrate small successes. I've learned to encourage myself without being cruel. And most importantly, I've learned that there is hope and that when I feel like there isn't hope, my brain is lying to me. But still, it is awful. And after years of relatively good health, I have been reminded in the last several weeks just how painful and crushing this stuff can be. So big props to John for being so honest about his experience here. The more honest he is about his experience, I think it makes it easier for other people to share the difficulties they're going through and actually to get help as well. So thank you, John, for that. And here he's talking about the chronic nature of OCD. OCD can rise and fall. It can be better for a while and then maybe something happens and it's not so good. Medication can be helpful. And then maybe at some point in the future, you might need to change your medication. You might be doing well in therapy and you kind of got the stuff and you're doing it on your own. And then something changes and maybe you need extra help. So that is the nature of OCD. It can rise and fall. In this next video, John describes how there's a difference between what you see in his videos versus what he records. And he goes through this process that he shows some unedited footage. And I don't know if this is a compulsion that he experiences a ritual he feels like he needs to do, or this is just his process. But regardless of that, it does show what some people might experience when they could be experiencing a repeating OCD compulsion. So I want to play this for you. Like you hear me say, good morning, Hank. It's Tuesday. I'm going to try to do this without a script. But, like what you don't hear is this. Good morning, good morning. Good morning, Hank. It's Tuesday. So the other... Good morning, Hank. It's Tuesday. So the other day... Good morning, Hank, it's Tuesday. So the other day, I was talking to a YouTube friend of... Good morning. Good morning. Good morning. Good morning, Hank. It's Tuesday. So the other day I was talking to a YouTube friend of... Good Morning. Good Morning. That goes on for about two minutes and 40 seconds. This is another good example of how we all experience stuff like this. I probably recorded the beginning of this video five times or so. Now, I don't get stuck in it for the length of time that it seems like John is describing that he might get stuck in it, but it's that continuum of human behavior from very common to less common, from helpful to impairing, and it's something that he and I both share in common, but the degree to which we experience it is very different. The next video isn't from Vlogbrothers channel, it's from the 100 days channel, this project that John did to really embrace physical health and mental health and exercise. And this video goes into depth about his experience with OCD, so I want to play some of this for you. So okay, I want you to imagine that you're having one of those weird passing thoughts, but instead of being atop a cliff, you're eating dinner, like you're at Chipotle, which is your favorite. One of these weird intrusive thoughts passes across your consciousness, what if this food is poisoned? Now that's not totally irrational, years ago you worked at a restaurant and you once saw an angry employee spit in the food of a customer who complained about their salad not having enough dressing, I mean this stuff does happen. Or actually, maybe they didn't spit in it at all, maybe they cut their fingers and bled into it, in which case you'll very possibly get hep C or God knows what else, and what are you going to do? You can't complain to the manager, that only increases the chances of spit or blood in your burrito, and you can't tell for sure because you've got the red salsa, which you never should have ordered. This is a beautiful description of what the obsessive thoughts of someone experiences with OCD can be like. We see here that a lot of John's thoughts can get back to this idea of contamination and this fear that the thing he has might be contaminated. I should say for a lot of people who experience OCD, it's not just about this fear of bad things happening to themselves. It is so often a fear about causing harm to other people. So not just that they might get contaminated, but they might get contaminated and spread it to other people. It's not just that my apartment might burn down, but the whole building might burn down. It's not just I might say something bad into the phone and it gets out, but I might say something bad and it's going to destroy relationships for many people. So often OCD, it's about that uncertainty, that something bad might happen. I didn't do something. I wasn't vigilant enough or I just don't know if this thing happened. And then this fear that some harm might come to me or it might come to other people. And then you hit the pause button because this is not your first rodeo and you say I am having an intrusive thought spiral. There is almost certainly neither spit nor blood in my burrito, which was prepared for me by hardworking kind people. Which gives you a very brief break until you circle back to the words almost certainly. I mean, you can't be sure. It remains a real and undeniable possibility that within this burrito is the drop of human blood that will cause you to get a chronic disease or the drop of spit that will kill you. And then you're trying to calm yourself down by remembering what is happening, that this is not reasonable. But then you're saying, well, but because really it isn't totally unreasonable. And you try to comfort yourself and then you say, well, but and you try to comfort yourself and then you say, well, but and the spiral tightens and tightens for literal hours until you're a sweating, shaking mess completely out of control of the thoughts that are said to be yours. And also you never got to eat the burrito. So great description of that uncertainty that can fuel OCD. You just don't know. You'll never have that 100% certainty and a lot of people with OCD that uncertainty will drive them to try to do something over and over again. Or it might just make them stuck in that moment and they might not engage in any compulsion. They'll just be stuck. I should mention this. With OCD, there are some people for whom it's largely just obsessions. And just the obsessions are alone are what caused the distress and the impairment. And then there's some people who just engage in compulsions. They don't really have the obsession piece. But the compulsions, those rituals, that's what gets in the way. Oftentimes when we work with kids, we might just be experiencing or we might just be seeing the compulsions. They can't really talk about their obsessions. They might not even be aware of any obsessions. Their brain might not have developed to the point where they can really come up with that kind of stuff. And then sometimes I work with someone and they just can't talk about the obsessions. So we just work on the compulsion piece. So there's diversity in all of this. But getting back to the diagnostic criteria, people do experience either compulsions or obsessions or sometimes both. And they really get in the way of their life. They take up a lot of time in their life. They create a lot of distress to the point where they can't live their normal lives. For most of my adult life, I have lost hours every day to these obsessive thought spirals and the weird compulsive behaviors that I use to cope with them. That's the impairment piece right there. John is talking about all the time he's lost to OCD. And for some people, the impairment is the massive amount of time they've lost. For some people, the impairment is just how much distress they go through, how hard it is on themselves to be in a situation. Just something as simple as paying in cash for something, how much terror that can induce in a person. We have no idea the struggle that someone near you might be going, because so much of it can be invisible and can be all inside. We have just no idea how an everyday simple thing can be so challenging for someone. So if someone like John came to me, or if you are experiencing these things and you came to me and asked me for help, this is what I would say. The first thing I would mention to you is this is not your fault. OCD is a biologically based problem. For some reason, you're experiencing it. Maybe it's a genetic reason, maybe it's something else. We know when it comes to OCD, it's a biologically based problem. You didn't do anything to cause this. And it is your problem. So it's not, you didn't cause this, you didn't do anything, you're not responsible for the reason why you're experiencing this stuff. And it is your responsibility to learn how to treat it and manage it. The next thing we do is get a sense of how intense your symptoms are. There's these two standard measures that we administer. One is called the Y-box. The other is the child version of the Y-box. And it's an interview that we do that gives us an understanding of how intense your symptoms are and what types of obsessions you might be experiencing. I'll put the types right over here. And then also what types of compulsions you might be experiencing. And I'll put those types of compulsions right over here. Once we have an understanding of how severe the problem is, that's going to guide my treatment recommendations. If it's mild to moderate problems, I might recommend just exposure response prevention, that type of cognitive behavioral therapy. If it's more, or I might just recommend medication, kind of depending on you and we have discussion about it. Again, I'm a psychologist, I don't prescribe medication. I just do the therapy side of things. But I might refer you to a colleague of mine if you're interested in just pursuing medication. If you're more in the moderate to severe range, that's a situation where I'd recommend a combination of treatment, both medication as well as psychotherapy. People who might be cautious of medication, what I might recommend then is we're going to do a whole dose of CBT. We're going to give it a few months. Let's see how this goes. And if we don't make the type of progress that we both want to make, then let's revisit a medication consultation and see if that could be something that helps you to better take advantage of the therapy. Then I walk people through what exposure response prevention treatment is. And it's a collaboration. It's a partnership. I talk to people about how I'm like the coach and you're the athlete. We're going to work together. I know the skills. I know the drills. I know how to help you reach your goals. But you're the athlete. You're the one who's going on the field on game day. You're the one who's playing the game. I'm going to be helping you along, but I can't play the game for you. But it's a complete collaboration. I'm never going to force you to do anything, nothing like that. We're going to work together. I want the person to trust me and know that this is a complete partnership. I always tell my patients that I promise you 100% honesty and I expect 100% honesty as well. I know not at first because it takes a while to build up that trust, but I want to earn your trust so hopefully you can be honest with me. And as long as you're honest with me, I'm always going to be honest with you about this whole process and where we are and what I think is going to help us to get to that next level. And then what we do is we create a fear avoidance hierarchy. We make a complete list of all the kind of situations that are very difficult for you. The kind of thoughts that are difficult for you. The kind of things that trigger your OCD. And then we go through and we rate 0 to 100. How much are these things that you avoid? And how much are these things that cause you anxiety? And then we put it in order from easiest to hardest. Then I get a sense from the person, what are the things that you can tolerate right now? What are the kind of situations that you can get through and it's not that difficult for you? Then I want to find out how high can we go before your symptoms really start to get in the way? And once we have a sense of that, then we know where we might want to begin in the exposure response prevention treatment. And where we usually begin our exposures that are going to feel like a little bit of a stretch, but they're still tolerable. What questions do you have about OCD? Let me know in the comments below. I'll be hanging out to answer as many comments as I can. And if you want to learn more about mental health and psychology and my journey as a clinical psychologist, head on over to The Psych Show. I'd love to see you there. Let me know that you're coming over from Chris's channel and I'd be happy to keep this conversation going over there as well. And thank you to Chris for inviting me to do this episode on this channel. Chris and I just met a week ago and I think it's super cool that he invited me on. And I also think it's really innovative the kind of stuff he's doing on this channel. He's doing stuff that I could never do. And I think it's great to keep this conversation about mental health going in lots of different directions on YouTube. We need way more people talking about mental health than we have right now. So thank you, Chris, for being part of that discussion. All right, y'all requested longer videos. So there it was. So a huge thank you to Dr. Ali Mathew for making this video. I learned so much more about obsessive compulsive disorder. And I get a lot of questions from all of you about these different symptoms. And I've had people ask me like, what I was thinking about as I was learning more about OCD through his video. I was thinking about my own addiction because I've had other people ask me like, do people with an addiction have symptoms of OCD? And by the way, check out the description below because there's actually a video from the Psych Show channel where Dr. Ali Mathew talked about addiction and things like that. So check that out. But maybe we'll do another collab where I ask him some more questions about that. And I guess as I said it publicly, you're tied to doing another collab with me. Anyways, let me know down in the comments below what is your experience with dealing with any of the symptoms even if you're not diagnosed like Dr. Ali Mathew said. Many people deal with obsessive thoughts, anxiety and things like that. So let's have a conversation about our experiences down below, all right? But anyways, that's all I got for this video. If you liked this video, please give it a thumbs up. If you're new, make sure you subscribe and ring that notification bell and a huge, huge thank you to everybody supporting the channel over on Patreon. You're all amazing. And if you would like to subscribe to Dr. Ali Mathew which you should click or tap on that icon right there. So thank you once again for coming over and doing this guest video and educating us all. I appreciate it and I'll see you all next time.