Podcast: My Experiences With OCD—as Patient and Provider

Episode Transcript

Jenn: Welcome to Mindful Things.

The Mindful Things podcast is brought to you by the Deconstructing Stigma team at McLean Hospital. You can help us change attitudes about mental health by visiting deconstructingstigma.org. Now on to the show.

Hi folks, thank you for joining today, wherever you are, whatever time it is there, to talk about the lived experience of obsessive compulsive disorder, both from the patient and the provider point of view.

I’m Jenn Kearney. And I am a digital communications manager for McLean Hospital. And my guest today is Dr. Nathaniel Van Kirk.

So often when I have a guest join me, we talk about, air quote, lived experience that’s been shared by the provider where the person themselves has either, they either had experience with the condition that we’re talking about, or is really close to somebody that’s had the condition.

But we’ve never actually had a full session dedicated to the lived experience, I mean, until now. So I’m really glad that Nathaniel’s joining me to talk about his experiences with the diagnosis of OCD, how it’s shaped his career, and so much more.

Nathaniel: Thank you for having me.

Jenn: Before we do get started, sorry to jump the gun, I want everyone who is tuning in to keep in mind, every person with a health condition is different. Every person is different anyway. So no matter what, your experience with the condition is going to be unique.

So if you or somebody you know has OCD, it’s totally possible your experience is mirrored in Nathaniel’s, or it’s not like his at all. And no matter what, that’s totally okay. And that’s why we’re here to de-stigmatize and talk about mental health. So that way, we can all understand where we’re all coming from.

So one brief introduction for Nathaniel, and then I’m just going to start throwing questions his way. If you are unfamiliar with the wonderful Nathaniel Van Kirk, PhD, here’s my introduction of him.

He is the coordinator of inpatient group therapy and the coordinator of clinical assessment at the OCD Institute at McLean Hospital. He’s also a licensed clinical psychologist that specializes in severe anxiety disorders, OCD, and trauma/PTSD.

So thank you so much for joining me. And I just want to kick things off by both acknowledging and asking. You’ve been really open about your diagnosis with OCD. Very easy to Google it, find out what’s going on. Can you talk a little bit about your first memories of the condition starting to show itself in your life?

Nathaniel: Yeah, definitely. Well, thank you for having me to talk about this. I think that, I wanted to, before I jump into it, I wanted to reiterate a little bit of what you just said in terms of everybody is different.

I think that’s especially true in OCD, ‘cause really a lot of times what we’ll say is the only limit on how it can present is a person’s kind of creativity and imagination. And so this is just one story. I think there’s tons of wonderful stories out there about it. And so kind of getting back to your question, when I think back to when it first popped up, it definitely caught me off guard, to say the least.

Looking back, I can maybe see kind of pieces that, where I tend to be anxious at times or more anxious than that I might have been otherwise, but generally speaking, didn’t really have any indication of OCD being there until I actually went away to a tennis camp for a week.

That was right before eighth grade. And so I guess around 14-ish or whatever age there now, I feel like so long ago, somewhere around there. And I went there and I remember that was really when Purell wasn’t used a whole lot unlike today. And there was just a few small bottles, and they were kind of given out to be nice.

And throughout that week that I was there, what ended up happening is I started realize that I was using Purell more and more and more, and felt like this kind of growing urgency and need to continue to use it and to find more, which ultimately kind of led me to, at that time, trying to essentially sneak out of the dorm we were staying in as a kid to go to 7-Eleven to go find Purell to put on my hands and everything and racket.

And at that point, I wasn’t quite sure what was happening or why I felt like I needed to do it. I just had this urge that I had to kind of get this feeling of being not contaminated, and this seemed to help.

And so over those two weeks, or I think it was about two weeks while I was at camp, it went from never having used Purell really before, to by the end, I was kind of lathering my arms, my hands, my face at times, my tennis racket, my sneakers in Purell routinely, trying to kind of decontaminate or clean them all.

Needless to say, I didn’t do very well at the camp, ‘cause I couldn’t even hold on to my racket because every time I tried to play, I was throwing it across the court and sliding all over the place ‘cause everything was coated in Purell.

But there was a certain point I kind of knew something was off, but I didn’t know what, but at that moment, that kind of feeling of anxiety and fear and kind of urgency just kind of overwhelmed anything else.

Jenn: So you’re in eighth grade. You’re living with your parents at that point still. Was this something that like, when you got picked up from the camp, did you actually, did you talk to them about it after? Or in a typical 13-year-old fashion, were you like, nah, it was fine, and that was that?

Nathaniel: Yeah, definitely more of the latter. They kind of asked, and talking with my mom after this also, she would say something was off, but of course, as mentally most 14-year-olds, 13-year olds, I would just sit there and be like, “No, I’m fine, it was great.”

And then just kind of like lean back and pretend that nothing had happened. That went on for a little while. I tried to hide it as best I could. ‘Cause I wasn’t quite sure what was going on, so I tried pretty desperately to hide it. That didn’t last super long.

I actually got very lucky. At around that time, my mom was actually taking a psychology course and finishing her degree, and they were talking about OCD. And so she was kind of, there was something there in the back of her head that had been primed for it.

And they knew something was off. It really I think all came into focus one day when I remember I used to get up at probably around 3:00 a.m. trying to like, all of a sudden, Purell wasn’t enough, so I started washing my hands in the mornings.

I was trying to hide this. And so I’d get up really early. I remember I’d kind of lost track of time one morning, and she kind of pushed the door open and I was standing at the sink with this pyramid of bubbles that I created where I’d kind of like carved out the top and move them over ‘cause I ran out of space.

And keep doing it, and just kind of ask like, “Are you okay? What’s going on?” I was like, “I’m fine.” And just kick the door shut and kept on going. Needless to say, at that point, very quickly, my parents knew something was wrong.

And kind of from there, we started looking at treatment options, and just so happened that, because she was studying anxiety disorders at that point, had a little bit of an idea of what might be going on.

And so we kind of got the process started. Although at that age, I wasn’t super excited to go to treatment or go to therapy or even talk about this, especially with my parents.

Jenn: Yeah, I imagine it’s difficult for people to talk about this stuff. I know even starting dating, it’s really hard to disclose mental health conditions, let alone the people who’ve raised you, who know you better than you know yourself.

I feel like even if you’re not being open with them, they’re picking up on it, and you know, they’re filling it, they’re filling in the blanks for you.

Nathaniel: Definitely.

Jenn: So how old were you when you started going to therapy? And were there different types of therapies that you enrolled in?

‘Cause there are, ERP is considered one of the, it’s like the gold standard for OCD, but there’s other types of therapies that are also helpful. Did you have to try a bunch before settling on one that worked better for you?

Nathaniel: So I got into therapy pretty quickly, just kind of, my parents noticing something was off, but not knowing what it was with kind of certainty. I got in pretty quick. I would say, ERP, exposure response prevention, or cognitive behavioral therapy is the gold standard.

There’s acceptance and commitment therapy approach, it augmented ERP for OCD as well. And they really are the gold standard piece for OCD. And it took a little while to get there. And unfortunately at that time, there really weren’t a lot of ERP therapists.

It wasn’t as widely known as some of the other treatment approaches. At that time, I also didn’t know about intensive or residential treatment centers like McLean and the OCD Institute and the intensive programs that were around, and there wasn’t really any in my area. And so kind of what ended up happening is kind of hopping.

We started with a psychiatrist. We go in for medication. Unfortunately, I didn’t have a great reaction to a lot of medications and didn’t really get a lot of benefit from it during that time, so we were looking for other options as well.

And so I did try a number of different ones from kind of standard talk therapy, which we know tends not to be super effective for OCD, just because the rituals and the behaviors are happening in the world, and you had to kind of go out and practice them.

Talking about them or figuring out what caused it, that was another place where we started where people were trying to figure out, like what caused my OCD, what started it? And what I’ve learned over the years now as a clinician as well is that OCD really, it generally doesn’t matter a whole lot what started it.

There are a few caveats, like when it comes to like trauma, things like that and PTSD, there’s some emerging literature on that. But generally, figuring out what caused it doesn’t help get rid of it, because the behaviors are so learned at that point. They’re so ingrained.

And so we did that for a little while. Went to another therapist who, for general challenges would have been a great approach, therapist, but also wanted to kind of help build my motivation. And so they’re like, “Well, I’ll wait, and we’ll talk when you’re ready. And I’m just going to kind of follow your lead.”

I was also an only child, so I was really good at just not talking. And so we spent pretty much an hour each just kind of staring at each other. Him assuming that I will break at some point and want to talk about something. Me having quite an imagination, being used to sitting by myself.

So I was like, alright, well, I’m just going to go into my own little world, and so we’re done. So that went on for a little while. But eventually, I did find a wonderful therapist, Dr. Richard Bader down in Virginia, who had really kind of took a chance on me and really helped me kind of take those steps.

And what’s been fun is over my career, I’ve actually gotten to do some presentations with him where we talked about like what it was like kind of being my therapist. And some of the differences and perspectives that we had going through the process from me as a teenager and him as a therapist. And so there’s been some really, a lot of fun opportunities that have come from that.

Jenn: That’s really incredible too, because now as you’re, you’re a clinical psychologist, you can see it from the provider point of view, but also looking back on somebody who is clearly so influential and impactful. That’s, wow, that’s a really interesting point of view.

Nathaniel: Yeah, definitely. It definitely reinforced, I was a very stubborn child, so I did apologize for my stubbornness at one point in time, but-

Jenn: All good, I’m sure. I’m sure it’s nothing that he didn’t encounter in the armchair every so often.

Nathaniel: Very true.

Jenn: We had, we actually had somebody write in to ask about, can you talk a little bit about ERP for real event OCD? Do you have any knowledge or experience on this?

Nathaniel: Yeah, and I think this is kind of getting at a little bit of kind of what I was mentioning around some of the emerging literature around traumatic experiences or stressful life experiences, how they may relate to OCD.

And there has been for many years, there’s this idea that OCD fears are OCD by nature because they’re not possible. But what we know is that OCD doesn’t respect that same limitation that I think as a field that we’re trying to put on it. And OCD really does latch onto things that for, in some instances, people have experienced.

I think one of the things that’s most important is that even when the event is something that’s been experienced or is a trauma, treatment can still work. And when you’re going through ERP as a treatment provider, I never tell someone, what you’re experiencing won’t happen or isn’t possible. ‘Cause in all honesty, we don’t know that.

They keep redefining the laws of physics all the time every time that they learn more. So I always think about that, that we really don’t know whether or not something’s going to happen. And so the idea behind ERP is learning to tolerate the distress and anxiety that comes with the uncertainty of the unknown.

And learning how to do things that are important to us amidst that uncertainty. And so when it comes to the idea of like real event OCD as well, the premise is still the same. There’s that idea of knowing that all these things are possible. Life is full of challenging things, stressful life events, traumatic events.

ERP is about building the skills to be able to face them head on and do the things that are most important to you, be with the people that are most important to you, and not let the uncertainty and anxiety and fear of uncertainty kind of stop you in your tracks and keep you from living the life that’s important to you.

Jenn: I want to just loop back really quickly, because what you said about your mom taking a psychology course is really important, because obviously, I imagined that that was probably a couple decades ago when this is going on. Internet’s not really a thing.

There’s not as much information out there that we have now. But long and short of it is, your parents were more attuned to mental health conditions than others may be. Do you have any advice for how a parent can tell if their kid has something that requires attention that may be OCD, or if their kid is just quirky?

Nathaniel: Well, I think in general, like if it’s OCD, a lot of times, there’s going to be a pattern that’s going on, that’s going to grow and intensify. And a lot of times, it’s focused on how do we kind of keep others safe, or keep myself safe, or this fear that just won’t go away.

And so I think when it comes to, for parents, if there’s a question, I recommend going to, try to get an evaluation. Go talk to a therapist to do an evaluation. It’s better to have that at the beginning and then not know.

And I think the other piece is that, it kind of goes with the stigma component as well, is that a lot of times we think like, oh, you can only go to a therapist if there’s something terribly wrong. When as therapists, we actually have some ideas for good day to day life skills as well that are good for all of us to learn.

I always say like, ERP is really a great life skill for everyone, ‘cause if you can face the worst your mind can throw at you, then you can really face anything in life ‘cause you have that skillset.

And so I say, if there’s concern, go reach out, try to get an evaluation, learn more, talk with them about what’s going on and say, are there any, why don’t we see if we can go talk to somebody and kind of figure out what skills might be helpful.

And helping people know, it’s not that if you start going to therapy, you can never stop. And that you can only go to therapy if there’s a diagnosis. So I say, if there’s a question, go ask for help. ‘Cause if anything, there might just be some easy skills that can be helpful in day-to-day life.

Jenn: And there are also types of therapies that have a timeframe. Like, I believe, I think it’s dialectical behavior therapy is only, it’s recommended to be about six months, because that’s how long it takes you to develop the skills, right?

Nathaniel: Yeah, and there’s, so each one has a little bit different, depending on the intensity. If you’re doing like a skills training or a full DBT course, which sometimes could be a little longer, but also CBT generally speaking is a 12-week protocol.

Some of the protocolled ones are 12 weeks. There are brief interventions for primary care settings that are a few sessions just to learn basic kind of coping grounding skills that are effective.

So there’s a whole lot of time-limited, and I think, a number of cognitive behavioral therapy kind of treatments, the things, strategies that are under that umbrella, that include ACT, some elements of ACT and DBT and other aspects are usually time limited to start. And kind of working on that idea that the goal isn’t for you to be in therapy forever unless you want to. It’s to help give you the skills to go out and live your life.

Jenn: Exactly. One thing I want to acknowledge that in times of COVID, schooling is very different than what it was like even two years ago. But when you were dealing with OCD and you were in school, did you find that trying to navigate your condition was really challenging in school?

And if yes, did you find that the school was helpful in ensuring that you kept moving forward? Any advice for teachers, counselors, coaches that are tuning in about if there’s a kid with OCD that they’ve encountered, like how you can help them stay motivated?

Nathaniel: Yeah, that’s a great question. School was fascinating at times. My OCD was, while it started out with contamination, it also morphed a lot and changed a lot over the years. So it looked a little bit different each year.

And so early on, a lot of the contamination piece, I always carried around the giant purple L.L. Bean backpack, like that really big ones that you could get. And that was just kind of how I was known. And the reason behind it was actually ‘cause I couldn’t touch my locker, ‘cause it was contaminated.

And so I would stuff all my books and anything I could potentially need in that backpack and then carry it around with me. It was the only thing big enough I could find to carry everything with me.

And even to this day, my friends and I still kind of joke about that, that backpack and just what it was, but it was ‘cause I couldn’t quite, there are many times like I missed turning in assignments ‘cause I would put into my locker and then I felt like I couldn’t touch it.

And I couldn’t figure out how to get the assignments, so I just say I didn’t do it and it was stuck in the locker. Or times when the assignment got contaminated, I didn’t want to contaminate others, and so I would kind of pretend to lose it or something like that.

The other piece was trying to figure out how do I do my rituals at school without others noticing. I thought I was kind of sneaky. I was probably less sneaky than I thought I was. But I think even larger than that was just getting to school.

So at the worst, I was probably taking somewhere between three to four-hour showers a day and wash my hands each morning, about two and a half plus hours. So I was usually up at before the sun trying to get my rituals done, and then would do it when I got home as well. And throughout the day, I tried to wash my hands as much as possible at times before I was going through treatment.

So that got a little difficult, ‘cause I was always like walking in and out of the bathroom, pretending I was going to the bathroom and using it quote-unquote normally, which obviously meant I would just like walk out and say, oh, I forgot something, turn around, walk back in and just keep doing that for hours.

So at a certain point, I actually, I think held the record for the most missed days of school, between therapy and my OCD and being late to school. But I got incredibly lucky. The principal of my school was really understanding. And so was my guidance counselor. And so we were able to tell them what was going on.

They helped find a way to help me get through the year. My second year, my freshmen and sophomore year of high school, I was failing out. I remember the end of the year, I had 14 tests and quizzes to make up in four days or I would fail at high school.

And they found a way to essentially let me, give me the chance to catch up, and give me the chance to take those tests and see what happens.

And it was because they did give me that chance and they were willing to work with me and work with my therapist, and work with my parents and myself, that even though they didn’t really understand OCD all that well to start, they were the reason I was actually able to graduate from high school. And so I’m forever thankful for them.

So if there’s family members going through it, or coaches or clinicians, working closely with the school is really important. And also helping the school understand, what is the difference between support, what type of support does someone need based on their OCD, and then what’s accommodation that’s just going to make things worse.

And have like an ongoing dialogue with the individual who’s going through it, with the family member, with the school, and include the treatment team. ‘Cause it’s definitely helpful to have everybody on the same page.

Jenn: I can also imagine, not only, you know, we all get 24 hours in a day, you’re spending four plus hours going through your rituals. I can’t imagine, not only is that time consuming, but like my skin gets dry.

My skin gets dry when I go outside in November. I can’t imagine the pain that you must’ve been in. Just going, you must’ve been using really hot water and excessively scrubbing. I mean, that had to have impacted you, right?

Nathaniel: Yeah, there’s, I used to get some interesting questions from teachers ‘cause I kept handing in papers with blood on them, ‘cause my hands would bleed while I was holding pencils. And so that definitely did happen.

And I think for those contamination OCD or other OCD related to it, a lot of times we can do a lot of damage to our bodies because the fear is so powerful and feels so real. I’d say, at the worst, yeah, I was four plus hours in the shower, and then probably four to six hours washing my hands. And that was just those amidst a myriad of other repeating rituals.

And I had intrusive thoughts of harming people, hit and run, fears that I was killing people every time I was, when I learned to drive. But in the midst, it does suck up a good chunk of your day.

So, I think there is a lot of creativity that goes into trying to figure how to navigate your day and have rituals. And, so, sometimes in treatment, one of the things I try to focus on is, how do we use that creativity to kind of help switch it to where the creativity is about not doing the rituals or finding a way to overcome them, versus kind of making them work.

I always like to tell the story, ‘cause I think it kind of demonstrates this. There was a point where when I was going through treatment, I had to reduce my hand washing and my shower times and we’re stepping it down, and I was like, I hit a plateau. I was like, I just don’t know if I can take this next step.

So I was like, well, what can I do to try to make that next step and still protect, I feel like I’m protecting those around me. And if anyone knows what New-Skin is, so it’s the aerosol liquid bandage, I found that at a 7-Eleven or a CVS or something one day, and I was like, huh, well maybe this will work.

So I would actually coat my arms and my legs in New-Skin. And then when I got contaminated, I would scratch it all off and then reapply. So I didn’t have to wash my hands, but I was essentially putting a bubble around myself. It turns out that wasn’t a sustainable process, and it very quickly hit my parents, like, “What’s going on in your skin?”

So I was like peeling off large chunks of New-Skin liquid bandage. But looking back, I can kind of laugh at that was a pretty creative response, I felt like. It wasn’t necessarily in the spirit of treatment or the best thing for me. But I think it was that creativity that OCD tends to push you to use, to try to keep itself alive, that could also be used to help overcome it.

Jenn: When you were going through these rituals, did you have the awareness that something seemed like unusual or overly time-consuming or were, in your mind, was it basically like you were telling yourself, no, this is how it has to be, this is just the way it’s going to be?

Nathaniel: Initially, it felt like it sort of had to be, but I didn’t know why. But I knew something was off. But in the moment, that quickly would kind of fade away because of the intensity of the anxiety. But yeah, I would definitely say like, I knew something was off.

I knew they didn’t make sense. Unfortunately, when I became really overwhelmed in the moment, until I learned the skills to kind of challenge those thoughts and defuse from those obsessions a little bit, once I got in the moment and got overwhelmed, even though I knew it didn’t make sense, I knew it didn’t work that way, I knew these fears weren’t real, it very quickly, I kind of lost grasp of that to start.

But the more I practiced, the easier it got to hold on to that and be like, okay, I can see this is excessive. Time to stop no matter how it feels. But it definitely took a lot of time in practice.

Jenn: One thing I do want to talk about too is whether or not you talk to your friends about this. It’s hard enough for teenagers to just be teenagers. My heart goes out to them on a regular basis. But how open were you with your friends about OCD? And if you weren’t that open, in hindsight, do you think that you would have been more transparent about it than you were?

Nathaniel: Initially, I wasn’t very open about it. I tried everything I could to try to pretend it didn’t happen. In hindsight, yeah, I definitely wish I was open with people a little bit sooner.

What I think was interesting is, one experience that really stood out to me is, I remember the first time actually sitting on the bus in a school band trip where, the first time I had someone also mentioned they had OCD and I overheard them, and then we started talking about it.

I very distinctly remember that first kind of conversation with anyone. And so I started just, after that, I started to slowly open up a little bit more to people. However, I have a really good friend that used to, while I was washing my hands, would just sit downstairs and like eat ice cream, because I was never on time for anything before treatment.

So, stocked the freezer with ice cream, he would sit downstairs, eat ice cream for hours. And then when I was done and we could leave, he was like, “Alright, you’re ready? Cool, let’s go.” And just never said anything.

But I think what’s really nice is that over time, as I became more open about it, I realized that most people were kind of curious, but they really, they knew something was up, but didn’t really know what it was. But most people were just, were curious and supportive.

Then over time, I was much more open about it in college, especially, as treatment started to work. And through the end of high school, I became much more open about it. I wish I’d done it sooner.

What was interesting is, in some ways, they help hold me accountable. Because if they notice something, they’d be like, what are you doing? Let’s go. I’m like, oh, alright, good catch, yeah. And so they would kind of, I allowed them to joke with me about it.

And that was their way of keeping me accountable, and we found our own kind of style to keep each other accountable. And it ended up being really, really important in that recovery process.

Jenn: I think there is, the social aspect of that is enormous. And I know I was diagnosed with generalized anxiety when I was in my early 20s. And one of the first things I did was tell my family and some of my close friends, because I was like, hey guys, there’s a reason why I act the way that I do.

It was almost like a light bulb went off for everybody, because it made sense. They could ask questions. They could be supportive when they needed to. I don’t think I’d be where I am without them. So it’s the social aspect.

You can’t speak volumes enough about it. Did OCD impact your self-esteem? And if so, did you address it in treatment? Or was that something that you felt like you needed to tackle more on your own?

Nathaniel: It definitely did. And I was somewhat socially anxious to begin with. It actually took quite a while to honestly, teaching as a grad student, when I started teaching, that was the best thing ever for becoming more confident in doing public speaking, stuff like that, ‘cause there’s nothing more terrifying than 60 college students at 8:00 a.m. staring at you and being like, what do you have that’s interesting to say to me this morning that’s going to keep me awake?

And like, oh, okay. But I think before that, the other part was that I knew my OCD didn’t make sense, so it was hard for me to talk about it. So one of my main fears when I first started out was contamination from sexually transmitted diseases, bloodborne pathogens, or pretty much anything that I could pass along and harm someone else.

So I was worried that I was essentially killing people by contaminating them that then I would end up dying. I also had a fear of getting people pregnant by touching them, but I knew very, very clearly, that is not how that works.

It wasn’t that, I knew that, but then I had this fear that I couldn’t shake, and I knew it didn’t make sense. And so for a long time, it’s always interesting navigating high school when you’re afraid that every person you touch, you might accidentally make pregnant if they touch your locker. And then at the same time, you’re like, what am I thinking?

But then that fear is still there. And so that, I’d say self-esteem wise, I kind of isolated myself away from a lot of people to start. And that definitely tanked my self-esteem for a while, as isolation tends to do, but also knowing I couldn’t seem to even explain it to myself or trust myself. And that took a little while.

We didn’t necessarily address it specifically in treatment, but it was a, and I really think this is an important part of ERP is kind of from the research, we know that increases in self-efficacy and self-esteem are kind of a core component of how ERP kind of promotes recovery on a long-term basis. And I’ll say that was definitely true.

The more I went through, and especially as I went through high school and college, the more I went through treatment, the more I tried new experiences and practice pushing myself out of my comfort zone, the more confident I became. Because I kind of had those experiences to build on.

But early on, when I felt like my life was just in free fall, I really had none, just ‘cause I couldn’t even control my own behaviors. And so I didn’t feel like there’s anything else I could do. But as a by-product of treatment, it actually helped a lot.

Jenn: I think too, teenagers have a little bit of an invincibility complex. They feel like they can do anything. When you marry that with lower self-esteem, a lack of self-efficacy, the belief that you can actually do whatever you put your mind to, it’s really difficult to try to navigate that just all around.

Nathaniel: Yeah, and I think with that was the flip side too, of, you have that with OCD, the one thing I was really good at is I can tell you a hundred different ways that each situation was going to become catastrophic, as I think many kids with anxiety can.

So all of a sudden you’re like, alright, I feel so invincible, and then all of a sudden your brain kind of switches a little bit, and it’s like, yeah, but what about all of these ways in which you could die? And you’re like, oh, thanks.

I hadn’t thought about any of those yet. Wonderful, now I can pretty much tell you every way in which I’m going to die by going to the movies tonight. This is going to be a great time. And it was, what’s interesting is I actually think that process has helped me a little bit as a clinician, because you do understand all the different ways it can go awry, but it also helps normalize it.

I always try to tell people that I’m working with this too, that having fears and intrusive thoughts is a human thing, not just an OCD or a PTSD or an anxiety thing. It’s human. And when we take some of those scales, like I will come up with all sorts of intrusive thoughts, because I’m used to coming up with them. And now that I’m not afraid of them, I can have a little bit of fun with them.

Jenn: Have you, oh, I’m sorry, please.

Nathaniel: No, no, go for it.

Jenn: I was just going to ask about what you’ve found as you got older to be helpful therapeutically. So did you live away at college? Was that, okay, so you lived away at college. I imagine you started dating.

You went for your doctorate. You’ve, I’m sure you’ve traveled. Did you find that with a base of ERP and that self-efficacy built in, did you find all of these to be like air quote nature’s ERP? Or did you find that your anxiety turned itself into a cycle of paralysis?

Nathaniel: Different answers for different times. In high school, definitely. I’d say going to college was probably the best thing I ever did for my recovery. It was one of those things that probably transformed the way that I approached most of day-to-day life because, and moving, kind of moving around a little bit in high school towards the end too.

But I think one of the things that really stood out to me when I think about all those experiences together, it was how to, thinking about how to take the process of exposure and integrate it into your daily life.

So, I actually started to kind of make it more of a challenge, and think about, like how can I push myself? Like how far can I push myself? I also picked up kind of purposely tried to reengage with hobbies that maybe I’d done before.

I worked on farms for a while when we lived on farms. And there’s certain elements of that, like mucking a pig pen, whether you have contamination or not, it’s not the most pleasant thing to stand in like a flooded pig pen, but when you have to do it, you have to do it.

But then once you do it, you’re like, oh, alright, so I can tolerate that. And I picked up things like hiking and camping and rock climbing and found ways to kind of push my own boundaries in the same way that ERP asks you to push your boundaries with what you can tolerate. And so it became a little bit more of a challenge.

So I felt like I had a little bit more control over it in that sense. And I found ways to integrate my exposures into what I was doing day to day. So going places like rock climbing, there’s no way to, when you’re rock climbing outside, there’s no way to really use Purell or wash your hands when you’re hanging from a rock face. And it’s like, oh, there’s something squished when I put my hand in that hole.

Do I really want to take my hand out and look at it and try to get rid of it just in case it has a disease or a bacteria or something like that, and fall 20 feet? Or am I just going to kind of deal with that and keep going?

So I found ways to have activities that essentially pushed me out of my comfort zone for my OCD and challenged it as part of them. And I found that to be really helpful and kind of making it like an exposure lifestyle, if you will.

Jenn: This is going to be the lowest hanging fruit question, but what made you actually decide to become a psychologist? I know there are some folks who I have talked to, a mishmash of therapists and psychologists who have said, I wanted to better understand my own condition so I could help others with the same condition.

I like to think that you’re a little bit more selfless than that point of view, but again, curious, what made you want to become a psychologist?

Nathaniel: I appreciate the vote of confidence. I mentioned I was a stubborn child. I remember, at least this is how it worked in my recollection. What I’ve learned is, you know, our recollections as a 13, 14, 15-year-old are probably a little fuzzy at best at times.

But I was going through a treatment session, and I’d been labeled kind of treatment resistant, treatment refractory at one point. And they were talking about what to expect, and the idea that I could never, I’d probably never really fully hold down a job or career, that type of thing.

I think I got, I essentially got mad at someone, and told them that I can do, like I can do this better than you, and I’ll prove it. Sort of like what, that was more or less what first started it. ‘Cause I actually wanted to do entrepreneurship, go get an MBA and do that track. And then at that point, it kind of shifted.

Essentially, I went into the field ‘cause I was really pissed off at a therapist and wanted to prove a point. And then it turned out that I love what I do. And I started to realize that my story and my experience, it wasn’t that uncommon in terms of that trajectory.

So there was kind of a need for this, for more OCD treatment, more understanding, but also the stigma component and how lucky I got in a lot of ways in this process. And so how do we help others go through the process? And so it started out with being a stubborn teenager.

From there, I got lucky that I love what I do and I couldn’t imagine doing anything else. And so that was part of what, over time, my interest has kind of snowballed and grew, but yeah, at 14, I wasn’t necessarily thinking, I was thinking about proving a point and winning.

Jenn: I’d say you’re doing pretty well in terms of proving the point quite well. So you’re doing a great job.

Nathaniel: Good thing I love what I do.

Jenn: I know one of the things I’ve acknowledged previously, you’re well-known for disclosing your condition in talks. I distinctly remember when I joined McLean a couple of years ago, a couple folks on my team said, “You’re going to meet Nathaniel. He’s one of the nicest people you’ll ever meet. Ask him about eating a sandwich wiped on his shoe.”

I was like, that’s probably the weirdest thing I’ve heard about a colleague, but okay. Have you always been this open about disclosing your OCD in professional settings?

Nathaniel: It’s a good question. So I actually, when I first entered the field and decided to go to graduate school, I wanted to be open about it. And I wanted to share my story and not be part of the platform.

It was about that time that I actually got probably some of the hardest advice to hear, but also probably the best advice, which was one of my professors when I was applying for graduate school said, be careful.

For every six slots, they’re getting 600-700 applications. You can’t control the story when you write it down on a brief, in like a brief summary, and it’s possible that they could see it as a red flag. It doesn’t matter how far you’ve come.

Be careful, ‘cause, and at that point, that was hard to hear, ‘cause I thought, in psychology and mental health stream, of course, share your story. Everyone will see that as an asset. But that was kind of that wake up call that stigma still exists.

But also that there are kind of real practical implications of the stress of graduate school at times. And it’s hard to control your story in 250 words. And so what it did teach me was to be purposeful about how I think about self-disclosure, and how I learned to self-disclose.

I actually very luckily, I got into one graduate school, and it was at Virginia Tech where I was also an undergrad, and they took a chance on me. And I just stayed there for 10 years between undergrad and grad school.

What ended up happening was actually wonderful, ‘cause they taught me how to tell my story effectively, when to use it, how to use it. And to be thoughtful and purposeful about what is the goal of sharing my story. What message am I trying to get across to those that I’m talking to, to the field as a whole, and what things do I want to change?

So they taught me to kind of use it strategically. And so I kind of started with wanting to share it with everybody. And I shared to get into college ‘cause there was no way with my grades I was getting in college otherwise. I had to explain why I almost failed out.

Then from there, then I became a little more purposeful and started sharing, like during, as part of psychology club, or during classes, or when I started teaching, I would do a seminar on having OCD and what it’s like, what ERP is like.

Then I started sharing to the International OCD Foundation conference, kind of in these small contained areas as I grew my story and kind of my career grew.

Then when I came here to McLean as a post-doc, at the very end of my postdoc, the day that I actually, I passed my licensure, I was finishing my postdoc, I did a Schwartz Rounds talk on living with OCD and mental health stigma in the medical field, hammering home, like stigma, it’s usually not malicious in that sense.

It’s just these kinds of things that are held over that we don’t always think about. And so I did that talk. I always joke with my supervisors at the time who are at the OCDI who are incredibly supportive about it. I was like, well, no one can take it away. I’m licensed, so I’m going to do this. I’m just going to throw it all out there.

At that point I kind of told more of the story and the entire story more openly, and then did the Deconstructing Stigma piece, which again, my mentors at the time gave me great advice that there’s certain bells that once you ring it, you can’t unring it. And once it goes on Google, that is that bell.

The McLean algorithm’s really good. It’s the first thing that pops up every time that you Google my name is the Deconstructing Stigma, which is great, but it was also purposeful in the sense that I thought through what I was doing, what was the message I wanted to send, what part of my career I was in.

So it’s ebbed and flowed, but I’d say I’ve always been wanting to be really open, but I just, it took me a little bit of time at the beginning of grad school to learn how to do it effectively. And I’m really glad that I took that time.

Jenn: I think that’s really, that’s super important to consider, because there are so many people who want to be more open with folks they care about or in the workplace, really just about what they’re enduring, whether it’s a mental condition, a physical condition, difficulties at home.

It can be really difficult that you’re the one holding the pen for your own narrative. You can’t really, sometimes you can’t erase the ink. So you have to be careful about what you’re sharing and how much you’re sharing, right?

Nathaniel: Definitely. The thing that I always tell people is, before you share, think about what your line in the sand is. Because to be an advocate or to share and disclose it doesn’t mean you have to share every little detail, right?

What is the message that you want to get out there? What is your line in the sand? And think about that ahead of time.

‘Cause I think when people, the thing that I’ve seen the most as a challenge for self-disclosure is when we’re kind of making it up on the fly, ‘cause then we start kind of going down rabbit holes and saying things that we kind of wish we hadn’t, or we don’t have a planned response when someone asks a really personal question that isn’t something that you really want to talk about, and then you’re not sure how to get out of it.

So I always tell everybody, your story is your own. And so thinking about if, how, when, what message, all those questions are really important. So you can feel confident in sharing your story the way you want it to be shared and the message that you want to get across, and think about what that line in the sand is for you so that you’re ready.

Jenn: I imagine the next question I’m going to ask is going to nag at your anxiety a little bit, but have you ever had concerns that colleagues or patients view you differently since you’ve been so open and candid about your diagnosis?

Nathaniel: Yeah, it definitely comes up. I went through a little bit of a phase where, I guess a phase, I always feel like I had to sort of prove it a little bit to prove that I could do the exposure. So I was always someone that, as a true and front was willing to do pretty much anything.

If it meant sitting in a random dumpster with someone to hold a session, fine. And I probably push things, I definitely got sick once or twice. Where initially it was, I felt like I’d had to prove myself. And in some ways I did.

I had to also prove to myself that I’m not going to ask someone else to do an exposure that I’m not willing to do myself. And so I really had to be very honest with myself about where I was at, what did I need to work on, what would I need to prep for if I did need to.

I think that was a process of self-growth just from a professional standpoint, that actually was really important for me to do. And so, yeah, there were times where people, I felt, I kind of felt like people would be like, well, is he going to go through with it or not?

But I had to make sure that part of my job is that I need to be able to go through with it, ‘cause that’s what I need to do to help others if I’m going to ask them to do it. And so I made that kind of a commitment to that piece.

And over time, and I think everyone has, even, especially when you get right out of grad school, everyone has doubts like, alright, so where are your clinical skills? What are you capable of? I think that’s natural at the beginning of any job.

Sometimes, if you want to work with the thing that you’ve struggled with, you do have to go a little above and beyond at times in terms of, to prove that you’re ready for it. And you have to be honest with yourself.

I think the biggest challenge that we’ve tried to work on more now is that it isn’t something that’s usually discussed in supervision or things like that. I say this over and over again, I got incredibly lucky with some wonderful mentors that helped me learn how to refine it and how to balance the two, what to look out for that they don’t really teach you during classes.

So that’s one of the, that’s one of the areas that from stigma reduction I like to focus on is opening up the conversation about it, because there are some different challenges that anyone who has OCD and works with OCD may face, same as anyone who has any challenge, medical or mental health that works in that same area, there’s going to be pieces that come up that are unique for each person.

The hardest part is when you can’t feel like you can’t talk about them But just ‘cause you’ve experienced it doesn’t mean that you can’t be highly effective. And so that’s part of what we try to do with some of the stigma reduction efforts now, moving forward is talk about it as a training experience and as a growth experience for us as people.

Jenn: I know we have talked about your story is very easy to find. You are Google-able, as my mother would say. Is it, do you ever find that since people can so easily find you, is it hard to hold boundaries if clients are curious about your story? And if yes, do you have any strategies or guidelines that you would use when it comes to disclosing during a patient session?

Nathaniel: That’s a really great question. I’m going to answer with a little bit of a tangent to start, just in terms of, it’s probably not, I like tangents, but I think self-disclosure is something that as a field has really kind of gone to this all or nothing approach, partially ‘cause I think people didn’t know what to do with it.

There are some important reasons that you don’t disclose everything therapeutically, but that doesn’t mean that all self-disclosure is bad. I think one of the best articles I’ve ever read on it was this idea that as treatment providers, we self-disclose all the time and don’t realize it.

The clothes we wear, the pictures we have in our office, the art we hang on our walls. All of those are self-disclosures in some form or fashion. We don’t think about them, because they’re kind of smaller self-disclosures.

We don’t think of them as front and center, but technically, everyone we’re working with, just like as humans, when we meet someone, we’re taking in all that information as part of our evaluation and our understanding of someone.

So when I really think about that, when it comes to self-disclosure, I think the most important question sometimes to ask is, what is the purpose? Why? Is it disclosure for the sake of self-disclosure? Is it self-disclosure because there’s a therapeutic kind of challenge or issue that I think someone hearing one version of a personal story might be really beneficial?

So what is the why? What is the therapeutic rationale for why you’re disclosing this moment? And then the next is how. And so not just, you know, that means just being very purposeful about what you’re disclosing, what is the message, why, and rehearsing, how are you going to share it.

Now that, like you said, ‘cause I’m Google-able and it’s there, I think I’ve had to be more prepared. I know people may ask, and some do and some don’t, and I think that’s another important thing is that some people don’t care.

They don’t care if I’ve had experience with it, ‘cause our experiences aren’t necessarily the same. And I think that’s also a really important point of that side. And so when it comes to it, I think asking yourself why. What’s the therapeutic rationale? How am I going to do it?

Then what happens if it doesn’t work? ‘Cause sometimes, I think most times it’s appreciated, and sometimes it’s appreciated, but it’s not helpful. Other times it doesn’t work and it backfires. And so what are you going to do?

So treating it like any therapeutic skill that we use, I think is important. And because I have the advocacy component out there, I’ve learned I have to be prepared for that. I have my different aspects, my stories, and the main messages that I found therapeutically helpful ready and rehearsed so that I can share that in a thoughtful manner.

I’ve also practiced kind of how to shift focus if I don’t think it’s going to be helpful, and say like, we can talk about that at a later date, but right now, we need to focus on, I want to focus on this piece. I’m happy to talk about that, but not after we kind of deal with this therapeutic context here. Or let’s set that aside to talk about and plan a time to talk about it.

So I think that comes up. I’m always willing to share. And I think as part of doing like wide spread advocacy, kind of saying I’m willing to share. But as a clinician, your role is also a little bit different. And so you have to balance the advocacy and the clinical realms, and understand which one you’re in at that time, and how to use each slightly differently in each setting.

Jenn: Yeah, and absolutely understand what components of your own story are actually going to help the person in front of you, versus them just being curious, and even maybe playing a mental comparison game over who’s got it worse, or who’s dealing with what, or how to overcome it. So it’s a really fine line.

Nathaniel: It is, but I will say as a whole, I’d say self-disclosure as a whole, people have appreciated it, it’s been helpful, but it’s also not a cure all or a fix all. All of us, we still have to do the work.

So it can’t be the only tool that you use, but it can be a really, one that’s everyone appreciates. And I think 95% of the time it’s been positive. But as a clinician, our job’s also to think about, alright, what’s the 5%? And how are we going to help someone, ‘cause our job is to help them. And that’s what we’re here to do.

So I think self-disclosure is a tricky one. The field’s growing significantly with it. When we think about peer support specialists, we think about some of the new research going on around advocacy, around lived experience, normalizing mental health experiences are human experience.

Not, just ‘cause we’re a therapist, or ‘cause I have doctorate doesn’t mean that I’m immune to it. I think that that’s, as the field has grown, we’ve gotten a better understanding of what it means and how to use it effectively, and just what it means to be human.

Jenn: Exactly. And so I do not have a degree in psychology, but I studied communication theory as my master’s.

And one of the biggest components of successful health promotion campaigns is what they call narrative theory, which is sharing your story in which other people can either identify themselves or someone they know, because when it becomes something that’s personal, that’s when it’s most impactful. And yeah, that just, it 100% echoes what you’ve been saying.

Nathaniel: I think in some ways it’s a good reminder that it’s good for us to cross lines in the different fields and like with communication and other areas where this is telling your story is something that’s been refined in a way that, in mental health, we haven’t, because of this kind of holdover.

So as we kind of challenge that stigma, I think learning from other fields on how to do this effectively and what this means is a really important step.

Jenn: Could not agree more. I know I would be remiss if we did not talk about COVID, because it’s something that is still going on with us. And as somebody who had had anxieties around contamination, are you still facing triggers? And if so, what tips or strategies do you implement now if you encounter them?

Nathaniel: I’d say as a whole, it’s a good question. In all honesty, I’d say that there are times where I noticed like patterns of hyper-responsibility, primarily of responsibility for safety of others. And find it, while part of that is included in my job, part of it there’s also a fine line that I have to be aware of, and I can feel the urge at times to pull to that other side.

That’s actually probably one of the things that starting out I had to learn was, where is the line between, all OCD behavior kind of typically starts out as somewhat normative and functional. It’s kind of in that functional zone, but then just becomes so extreme and rigid that it’s no longer useful in that sense.

So that can also make it tricky for those with OCD, ‘cause you’re kind of like walking a tight rope sometimes. And then something like COVID happens where like the tight rope just disappears because there’s nothing we could’ve predicted in that sense.

Then you kind of have to figure it out on the fly. And there are definitely times where I feel that pull. I’d say my standard classic rituals haven’t really come back in that way, which is, but it was something I was also very aware of, like when we started having to use Purell a lot, I know that like, I’d never really used Purell.

I remember, I actually went through a very distinct phase in my training, I was working on a medical unit with MRSA and C.diff and we had to ground up, did neuropsych evaluations, and to Purell kind of in jail in and out.

That was the first time in years that I even used Purell, because I just said, alright, cold turkeyed it. And then, but I also noticed I had that feeling again of like, oh, well, if one squirt’s good, two’s probably better.

I had kind of learned to be aware of it, ‘cause that quickly goes to like, oh, two’s better, 75 is probably the best, until you get one more, then it’s like, you know what, just do four sets of 75, ‘cause you like number four, just keep on going.

Jenn: It’s the perpetual itch that you can never fully scratch.

Nathaniel: Exactly. And I will say COVID, I’ve noticed it. I think I would have been caught more off guard definitely if I hadn’t had that experience before where I really had to check myself. So I’m thankful for that experience. I’ll say with COVID, a lot of times the thought is that obviously those with OCD struggle significantly with COVID.

Some, the thing I always like to tell people is that it’s very individualized, just like with anything. Some did, some didn’t. We’ve talked to many people who did really well in ERP, and were able to take those same principles and sit with the uncertainty that surrounds us right now, ‘cause they had practiced it and they felt confident and able to do it.

Then for others, it really exacerbated the OCD symptom, made it really, really difficult, due to the symptoms overlap or isolation, lack of structure. So there isn’t one path to take.

I definitely feel the pull. I think when I first started too, I definitely felt like I felt the pull. And I had to be really kind of aware and honest with myself about like, alright, where’s that line? And am I allowing myself to get a little too close to that line? And sometimes I still do.

I think that’s where we get into the idea of recovery in OCD is that it’s not that you never have an obsession, or you never have the urge to ritualize. But it’s that you can notice it, or when it does happen, you can kind of check it and go back to the functional behavior, keep your life moving forward.

Because that’s just normal fluctuations of, anxiety is normal right now. Uncertainty is higher than it’s ever been before. A lot of people are learning what it’s like to live with OCD in a sense, because that perpetual uncertainty is very similar to what OCD is day in and day out. So it’s bringing us closer together. Sorry.

Jenn: No, that’s okay. I keep jumping the gun. I have too many questions to ask you.

Nathaniel: Oh, it’s good that you do, ‘cause I’ll just keep on going.

Jenn: In your clinical practice, how have you seen ERP change because of COVID? I know a lot of therapy has become tele-health. Is there a difference in efficacy because you’re not really face-to-face with somebody? How is it? Is it any different at all?

Nathaniel: I think honestly, the overall data is that telehealth is really effective. And that includes for OCD. We’re running a virtual partial program at the OCDI and all via telehealth, and it’s been incredibly effective. I think there are some individuals where in-person is more helpful or maybe necessary, but also might depend on what else is going on.

Then for others, tele-health has allowed access to ERP and care that they didn’t have before, ‘cause they had no providers around them. And so it’s really, I think it’s added a really important element. And the efficacy of it is continually demonstrated over and over again. And in terms of the purpose of ERP, I think the purpose still stays the same.

It’s all about learning to tolerate uncertainty and kind of do what you have to do with the midst of it. And so even with COVID, while it may change a little bit, ‘cause we can’t necessarily go out in the community in the same way.

We take certain precautions for COVID. We kind of, the tagline, I think, my colleagues and I have used a lot is, we follow the CDC guidelines, no more, no less. And then you sit with the uncertainty of that, ‘cause there’s always going to be some. And I think that’s been, that spirit is still there, and it’s allowed us to reach more people.

Jenn: Do you have any updates on research that you’ve done about technology to understand, assess OCD symptoms and treatment? Anything new that you’d like to share from your corner of the world?

Nathaniel: Well, actually, I think most of my research right now has focused on the overlap of PTSD and OCD. And we actually just did a symposium on that and collaborated with some colleagues at Rogers Behavioral Health as well. And a number of colleagues across country, we’re collaborating on this idea of understanding where, how does that co-morbidity play out, and realizing that there are multiple pathways.

Some we might need to do more kind of integrated treatments for both, especially if someone has OCD that kind of followed after a traumatic event or development of PTSD and kind of in some ways, it can almost serve as like a protective factor, almost like an umbrella shielding the person from having to re-experience the trauma-related beliefs.

In those cases where there’s a functional connection, we see that we kind of need to adjust treatment just a little bit. We have empirically-based treatments for both and we can make them work.

We just have to kind of be thoughtful and planful about it. But as a whole, the other great thing that’s come out of it is that for intensive or residential treatment, some of our data that we just presented on is that it still works.

So having a trauma history or having PTSD doesn’t mean that treatment for OCD or for PTSD can’t be effective. We actually see that it does work. I think that’s a really important thing to know is that having that co-morbidity doesn’t mean that you’re untreatable.

It’s going to be challenging, and it’ll be hard, but we have effective treatments for both. And the data’s showing that we, there are certain cases where we do need to be more individualized, but the mechanisms still work, which is really exciting.

Jenn: I have one more question for you, ‘cause I want to be cognizant of how valuable your time is. I know you have joined me before. We have talked about how much words matter in terms of recovery.

We’ve talked about recovery-oriented practices before. And how impactful language can be, whether it’s a provider’s choice of language or how people are addressing their conditions to themselves or their loved ones.

Do you have any advice for people who are having a tough time talking about their mental health conditions while remaining compassionate toward themselves?

Nathaniel: I think trying to default to the objective when you’re trying to describe your experiences is important. The other is, and this is one that I struggled with greatly, is the idea that self-compassion is like letting yourself off the hook and giving up.

To this day, I still, and now I joke with a lot of my clients about self-compassion is sometimes in OCD, and I think in anxiety as a whole it’s kind of like this, like a dirty word, and they’d be like, well, have you tried self-compassion? I don’t want to.

And like, I feel the same thing. And I was the same way for a long time. That’s actually one of the areas that clinically, as a clinician, I’ve had to really dive into to get better at.

‘Cause I think it’s important to remember that self-compassion is about understanding your own experience and where you’re at and the factors that got you there, but not saying, alright, that means I don’t have to try.

But understanding why trying is going to be hard, but that you still have to push through it in some ways. So I think that’s a really important one is that the idea of self-compassion has somewhat been distorted when we talk about it and OCD likes to distort it.

That’s not letting yourself off the hook, but it’s about understanding why it’s so hard and that’s okay that it’s hard and it’s okay to be overwhelmed. It’s really about what do you choose to do next.

I think the other, the other one that comes up a lot when I think about talking about it, I always encourage people to have a sense of humor about it. It’s really hard to do when you’re struggling with it, and you’re suffering with it.

But in some ways, the greatest thing I learned was to be able to laugh at myself a little bit, because it gave me a little bit of distance from the pain and the suffering and gave me a choice of things to do.

It also gave me a way to make meaning on the experiences I went through, ‘cause I can do things like this and share the experiences of some of my rituals that were way outside of what we’d even think about as rituals.

But they were kind of interesting. Funny stories kind of came out of them in hindsight. And so I think that’s one way is to be able to look at your own experience and also see some of the kind of interesting twists that your own experiences have brought you, the things that you’ve learned, the experiences you’ve had.

The only other thing that I would say is start small. So start small when you’re talking about disclosing, or when you’re trying to talk about your own experiences in a nonjudgmental way. It’s a skill like anything else, and it takes time to practice.

Just starting with one small thing, in an objective, non-judgmental way is a step in the right direction. Sometimes, and I feel this, and I know many do, there’s almost like a safety in ruminating and judging yourself.

At times, there’s probably times where it worked to motivate you to do stuff. It may work for short-term motivation, but the data shows that that kind of berating yourself doesn’t work for maintaining long-term change.

But it can feel safer, ‘cause it’s known. It’s what you’re used to. The uncertainty of what’s next is sometimes even more daunting, and what life could hold for you after, both positive and negative. So just take small steps. That’s a long-winded way of saying that.

Jenn: I don’t think that we could have ended this conversation on a much better note than that. So Nathaniel, from the bottom of my heart, thank you. This has been awesome. Your story is phenomenal. And the way that you talk about it with such candor and humor is very inspiring.

So thank you very much, and thank you to everybody who joined. This actually ends our session. So until next time, be nice to one another, but most importantly, be nice to yourself, just like Nathaniel suggested. Thank you again and take care.

Nathaniel: Thank you, everyone.

Jenn: Thanks for tuning in to Mindful Things! Please subscribe to us and rate us on iTunes, Spotify, or wherever you listen to podcasts.

Don’t forget, mental health is everyone’s responsibility. If you or a loved one are in crisis, the Samaritans are available 24 hours a day at 877.870.4673. Again, that’s 877.870.4673.

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The McLean Hospital podcast Mindful Things is intended to provide general information and to help listeners learn about mental health, educational opportunities, and research initiatives. This podcast is not an attempt to practice medicine or to provide specific medical advice.

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