40. Why Your Anxiety Isn't Getting Better with Morgan Slade, LCSW

If you’re an anxious person, you’re going to love learning from Morgan Slade, LCSW. We discuss perinatal anxiety and OCD, all kinds of intrusive thoughts, sneaky compulsions we do that intrusive thoughts feed on, and the treatment that has an 85% success rate.

Resources

• Serenity's Website 
• Connect with them on Instagram @serenityrecoverywellness. 
• Lyndsey Proctor’s episode (owner of Serenity)
• Jenna Overbaugh's episode
• If you want to learn more about OCD resources go to iocdf.org
• PSI's free virtual group for perinatal OCD

Follow along on The Sad Moms Club's Instagram: @the.sad.moms.club

Follow along on The Sad Moms Club's Instagram: @the.sad.moms.club

Transcript

Joni: 0:00

Hey, y'all welcome back to the sad moms club. It's been a minute since I've been able to put up an episode. Because we're pregnant, which is so exciting. It's funny that we, I say we are pregnant. I am pregnant. But we are going to have a child. So thanks for all the congratulations on our pregnancy announcement the other day. I truly don't know how people have babies again and again, and again. Because I've accomplished just the bare minimum. For several months, I haven't done laundry. I haven't done dishes. I've seen my clients and that is it. And I've slept.

Samson Q2U Microphone-3: 0:30

And I don't even have another child to take care of.

Joni: 0:32

It's just. Me. I feel like the more I venture into being. A woman, the more, I just appreciate all that women have to go through. Not really because you get a choice. I mean, you get a choice if you. I want to have a child or not, but you just get a period. For the most part and you just. Get to deal with your hormones fluctuating. So. I'm still throwing up sometimes and nauseous sometimes, but I have days where I feel better, which has been such a treat. Today, we're talking to Morgan Slade, who is an LCSW at serenity. Which is located in Riverton and Provo, Utah. And if you've been around here for a minute, I interviewed the owner of serenity, Lindsey.

Samson Q2U Microphone: 1:09

Proctor. Over a year ago. I think she's the second episode. So if you want to learn a little bit more about their office, you can go with some there. But today we talked to Morgan about intrusive thoughts, how OCD works, sneaky ways we feed the fire of our intrusive thoughts. We briefly touch on what exposure and response prevention or E R P is all about, which is the primary modality to treat anxiety and OCD. Specifically OCD, but it works for anxiety as well. And then just so you kind of know if you're looking for someone. For therapy, serenity offers an intensive outpatient program. Or I, Oop. IOP groups are just that they're intensive. So. And their case, you go into the office for group therapy a few days a week. And then you have that along with your individual therapy session. And one cool thing that serenity offers is childcare. So babies are welcome and group. And kids can go to a playroom where they'll be babysat during group therapy. While you get the help you need. They started a newer group recently that's focused on anxiety and OCD and perinatal women. And Morgan had the idea for this group and then the serenity owners and staff just jumped aboard. And I've already had patients who have done incredibly well by going through this program. Couldn't recommend it enough. I'll be sure to link serenity is contact information, as well as a previous episode, where we talked about OCD with Jenna overbought, we kind of referenced it a little bit. was released this time last year, and which is one of the most listened to episodes.

Joni: 2:31

Okay. I've talked enough. Let's talk to Morgan.

2:34

Welcome to the Sad Moms Club. Welcome to the Sad Moms Club. Welcome to the Sad Moms Club.

Joni: 2:44

So thanks for coming on today, Morgan. We have Morgan Slade, who's an LCSW at Serenity Recovery and Wellness. Is that still what it's called or did the name change?

Morgan: 2:54

Yeah. I mean, I think that's, you know, technically, but we just call ourselves Serenity Recovery Wellness or Serenity Wellness, whatever you want.

Joni: 3:04

Okay. Sounds good. So we're going to talk a lot about intrusive thoughts, OCD, within motherhood. So I was hoping at first you could just share a little bit about your own story and just start wherever you feel comfortable.

Morgan: 3:19

Totally. Thanks for thinking of me too, Joni. This is fun. And I, I know we're both passionate about this population and I, For everybody listening, Joni is just awesome. And such a beautiful person to work with, and I'm just glad to be here and have this conversation with her. So I, I did my undergrad, and knew that I wanted to end up in this field, but I didn't know with what population, so I, I did my undergrad graduated and I took quite a bit of time off. to raise my family. And in the middle of that time off is when I really discovered things about myself. And, what population I wanted to work with came after that, but my husband's in the military. Actually in the beginning, I thought that that's where I'd end up like kind of working with that population. Something I'm really passionate about. Something that I I do do a little bit on the side here and there now, but, he's in the military and raising a young family in that setting is pretty difficult. I got pregnant with my third baby and about, I don't know, a couple months before I was due to give birth to him, I started getting these really wild thoughts that something. Was just going to happen to him and that wasn't new to me. I had always been a pretty anxious person like I had some things early like in my adolescence that occurred within my family that just kind of made me a control freak right to

Joni: 4:50

hmm.

Morgan: 4:50

Try to prevent bad things from happening to the people I love and so it wasn't new to me. I think it was just The timing of everything that made this a little bit different and nuanced for me because I had already had two other kids and I had some experiences with them like general anxious things Transitioning, into parenthood from I was college athlete then, you know actually found out I was pregnant during my college career it was a difficult transition. So there was some difficult things for sure along the way, but about a couple of months before I was set to give birth to my third baby. I just had some interesting thoughts that something was going to happen to him. And it was usually focused around illness. And we were in cold and flu season. So, I mean, it, it all made sense, which I'm going to talk about this a little later. Like what are the nuances between generalized anxiety and OCD? And I know it's kind of a hot topic even within the profession a little bit, but it seemed like a, pretty valid concern. Like I was in the middle of cold and flu season and worried about this baby, getting sick potentially, and then something detrimental happening to him as a result, which would be, when it boils down to it, my fault that I didn't do what I needed to do to protect him. So I would actually call different family members in these months and just tell them like what was on my mind. And I would get so much reassurance. Just that everything would be okay. Like I was smart that we were going to take the proper precautions and that kids get sick and they, and they survive. Everyone would tell me that it would feel good for a minute. Right? It got less and less effective, but it would feel good for a minute. But that eventually, you know, like the anxiety was still there. I did give birth to him and. When I was in the hospital, I had discovered that someone who had come to visit us was exposed to whooping cough, and then had come to the hospital. They didn't have whooping cough, just like had close contact with someone that did. And it took me for a ride.

Joni: 6:58

hmm.

Morgan: 7:00

I wasn't necessarily co sleeping with my baby, but I would have to sleep with my hand. next to his mouth or on his chest to make sure it was going up and down or that I could feel his breath on my hand. I wasn't sleeping at all some nights and I really miss the sleep. So I would sleep during the day, when I could, but with two other kids, that was pretty impossible. But when he was two weeks old, My husband called me and I remember like exactly where I was, I was nursing him in our bed and he told me that he was going to have to rapidly deploy to Afghanistan. And so We didn't have long to prepare. This was a rapid deployment. So it was a matter of weeks before he was gone. So then not only am I worried about my baby, not breathing, but I'm worried about like all the things that come with sending someone you love into a war zone, right? Cause he was in a combat zone in Afghanistan and. I remember the day he left, vaguely, but I remember being so tired that I looked in the mirror and I couldn't even open my eyes all the way. It looked like I was basically a zombie. And I remember thinking that and how tired I was. I remember pepping myself up, which this is something we'll talk about later too. Like you've got this, you're, you're strong. You can push through this. You've done tons of hard stuff before. Like we can do this, which inherently of itself is. Not bad, but we'll talk about that in a minute. So I, I'm just so tired at this point. I did what you should never do. And I watched like a million sad movies and just crying my eyes out just to validate. Oh, I was feeling, but, I got so tired to the point where I like just couldn't handle it anymore. And my parents don't live necessarily super close. To where we live. They live about three hours away, but I just called my mom and said, Hey, like I'm going to come down there. I just need a nap. I did not feel comfortable, even though I loved my neighbors. I love them so much and they were the best people. I had so much guilt and shame around asking someone to just like come over and sit with my kids while I took a nap that I thought it was a better idea to just drive three hours to my parents house. That I trusted right to, to watch them. And they'd see me like pretty vulnerable. So I'm like, Oh, they still love me. So let's go down there and get to my parents house. And as soon as I go to lay my head, On the pillow, like this is poetic, right? I lay my head on the pillow and I hear this huge crash and I'm like, are you serious? You know, like I'm thinking, oh, of course, right? My kids have ruined something. I actually thought they pushed over her China cabinet, so I got up really slow just to savor, like what I knew was gonna be chaos, right? But as I was getting up really slow. I heard my mom yell that my little boy's finger was missing and so I was like, what, what is going on here? And my mom and I've done another podcast, Joni, where I shared this story and I feel like I throw my mom under the bus a little bit and my mom knows I love her, but she is not the most calm presence in a crisis. So I was like, what are you talking about? His finger is gone. So I'm thinking okay. Like somebody, they pushed over the China cabinet and he got a little, you know, a little blood or something, but nope, I walk upstairs and my three year old is holding up his hand with a finger, like halfway gone.

Joni: 10:48

Oh my

Morgan: 10:50

this is, this is so poetic. So long story short, like he had. I thought that I was so in control. I went somewhere that I thought for sure my kids are going to be safe. I'm going to be safe. And I'm going to get this nap. And he had been jumping on my parents bed. and got his finger entangled in a blind cord. And it, what they called, I think is they, it topped his finger. So it amputated from his first knuckle onward, just freak accident, right?

Joni: 11:20

Oh my word, and it's like, this is the safe place, this is the controlled environment, this is where you can sleep and you still can't. That's wild. I'm so sorry.

Morgan: 11:31

It's crazy. Yes, you're right I was like, nothing bad can happen to me here. Right. And so that happened. Long story short, my parents live in the middle, middle of nowhere, which is, I love it, but it's not close to any hospital. Well, there's a hospital 30 minutes away, but they just don't have, what we needed. So we ended up getting lifelighted to 20 minutes from my house where I really live. and we're there and we're, we're at the hospital. And I just remember thinking like, no one is safe. Like nothing is safe. And there's nothing that I can do to make the people in my life or myself have that sense of safety. And it was so encompassing. It was just so dark. we left the hospital. I had a ton of support, but obviously like not the support I wanted. My husband's deployed. And I remember just the days after that were so dark, just really dark. And, I remember, Checking the news. Like, I don't even want to say how many times a day. I don't even know if I could count. I had all the apps on my phone just to make sure that like my husband was still alive and I'm still doing like the things at night to make sure my baby was okay. And now I'm like, you bet your best. I cut off all the strings on my blind cords, right? Like I'm doing all these things. To try to make my environment and the people that I love safe while simultaneously knowing that it's outside of my control. And it drove me to a pretty dark and scary point. When I was just all alone. And I think the only reason why I got through that year where he was gone is because I knew that I just had to write at, at the expense of myself and. There were good moments too. It wasn't all darkness, but it definitely didn't resolve when he came home. We actually got word that we needed to move to a different military site in California when he came home. During that same time, I had a really good friend, which your audience might know, and her name was Emily. Her sister is my sister in law. And so I got to spend a lot of time with the Cook family. I jokingly say that I've adopted myself in just because they're just the best people. And if anyone knows Emily's story, she passed away from the effects of postpartum anxiety. During this period. right after my husband got home, just a couple of months later, I got a, I got a call from my brother in law saying that Emily had passed away. And it was really that moment because I had known Emily. I'd known that she was going through, not like intimately, but I knew it was really difficult. I had seen her just a week or two before she had passed. And I knew that. If it was serious enough for that to happen to her, cause she was untouchable in my mind, like the perfect mom. The most incredible wife, such a beautiful friend. I knew that if it, got to that point, it was scary for her. It kind of scared me into action for lack of a better term. And I got to California, which is where we were moving from the military and I got a really great therapist. It's actually a funny story. I didn't immediately seek him out. As we know, like OCD theme pops all over the place. So not my husband was home and he was helping me keep everyone safe. And it latched onto something new where I thought I had all these medical conditions and I went to the same doctor. I don't even know, maybe like 10 times. And on the 10th visit. She was like, so sweet about it. Every year at Thanksgiving, I'm grateful for her, but she, she said to me, she's like, Hey, I think you're dealing with something that isn't necessarily physical health related. And it was her nice way of saying like, girl, we need to get you in somewhere. And she referred me to this beautiful, awesome therapist. And he was exactly What I needed, he didn't do outright ERP with me, although it was very CBT, with behavioral activation based and it was just enough. I'm pretty like, once I knew what was wrong with me, like I'm going to do this like most people I'm going to do this hard and I'm going to do this all the way. Right. And I did see incredible improvement. Right. Barely quickly after I got on medication and started in that kind of therapy. And after that whole experience, I was just like, okay, I'm going to work with moms, I want to specialize in this area. And. that helped me get to where I am today, where I work at Serenity and we just started our OCD anxiety outpatient program, which is going so awesome and just get to work with the best people, my coworkers and the women in the population. Just incredible. I count myself so lucky.

Joni: 16:29

it's a really cool job. I was gonna ask about your story. So you were having this intense anxiety OCD for over a year, like maybe two years. It was a long time you're dealing with it. And so was it Emily's story that made you think Oh, there's something wrong. Or did you kind of know beforehand, like this might be something more serious. When did you like, other than the doctor, when did you start realizing there might be something more going on?

Morgan: 16:57

no, That's such a beautiful question for anyone that's not in the clinical field, and like, I know you know this, one of the major differentiations between OCD and in general anxiety disorder, really like it is written in the DSM, but also like just kind of inferred is that anxiety is about everyday worries. And OCD is more of this like outlandish out there worry,. Like I'm preoccupied with, and this does happen. So I don't want to make light of it, but just like the contamination stuff that I'm going to touch a doorknob and, spread a deadly illness to my entire family. For me, it made sense. All these things were coming in my life. And I'm like, of course, I'm anxious. My husband's deployed. I just had a baby. I'm all alone. So it felt like something I just needed to flex a little harder. If that makes sense through, it didn't feel like a chronic condition. When now I have that insight, I can look clear back and know that when I was a kid, I was doing weird things. Like not stepping on cracks on the sidewalk because I really thought I could hurt my mom, you know, seven, a crack. I remember avoiding cracks. I was scared of so many things and I would get these wild thoughts about, if I don't pick up that penny, It's going to be a terrible day. Like some of those like magical thinking type thoughts, I had those all the time. And I'm just over here picking up pennies and not stepping on cracks and thinking everything's great because it really didn't hinder my life in a way that I could see at that point.

Joni: 18:30

Yeah, yeah, I think that's a good point because I feel like when I see patients who I'm like, this has like an OCD flavor, lots of times their concerns make sense because something happened or some context in their lives or like COVID, like COVID was a perfect example of, like now contamination is a real concern, but are you dealing with it and more of like an OCD kind of way, or are you dealing with it in a more, you can still live your life in a functional way? Yeah, it's hard to tell.

Morgan: 19:00

It is hard. No, I think you nailed it with the COVID thing. I think that that's what changed the conversation to be quite frank in the clinical community as well about. Hey, general anxiety is just like these everyday worries, whereas OCD is like this outlandish, really just cliche, doing the light switch thing three times compulsions, or like you said, the contamination obsessions. It really changed the conversation on what is OCD and how do we see it in this population. I

Joni: 19:35

So let's talk about that. What is OCD first for someone who maybe isn't familiar with it? And then what are common ways, common obsessions women have? Or mothers, pregnant, postpartum women have.

Morgan: 19:50

love that. Okay. Just, you know, really short story kind of condensed version of what is OCD. OCD involves those obsessions and compulsions. And I'm going to have like a little bit, maybe not so much of a hot take. I think you've had a couple other guests on here that agree as well, but. I don't see a functional difference between OCD and anxiety. Like we treat them the same, but for our purposes, obsessions, which can be mental pictures, scary mental pictures. Like I was envisioning something terrible. We don't want to envision. Intrusive thoughts, thoughts that we don't want to have urges that we don't want to have in feelings that we don't want to have all encompass that obsession. So OCD involves those obsessions and really the intolerance of doubt and uncertainty, which is the huge component, and compulsions. Things we do in order to alleviate the distress caused by those obsessions. So if I have a scary thought, I'm immediately doing something to help alleviate that distress.

Joni: 20:58

going back to your personal example, you had the thought, my baby's going to be sick, and so then you would call your family. So that was, like, the obsession was, my baby's going to be sick. The compulsion was calling family members and seeking reassurance. And then it, escalated from there once you're, Baby was born and the person came that had been exposed to whooping cough. So it started being maybe more physical at that point where you're like touching, your baby, being near the mouth, making sure the chest is moving up and down, not sleeping. It became a lot more obvious maybe at that point. And more like you can actually see the compulsion, but sometimes I think like, like what you're saying is. It's not as obvious and it can all be in your, in your head. That doesn't sound good, but it can be all in your head.

Morgan: 21:39

true. It reminds me of that Dumbledore quote, right? Where Harry asked if it's all happening inside his head and Dumbledore says like, of course it is. And that doesn't make it any less real. It's, it's totally appropriate to just say like, these compulsions can 100 percent happen inside. your head. It doesn't necessarily have to be something that we see, which is very counter popular culture of what OCD is. We think that these compulsions, these things that we do to alleviate the distress caused by these obsessions needs to be outwardly noticed. And that's where we can do a lot of disservice to people who are struggling by not helping them get the treatment they need because we can't identify what's actually going on. But you're right. With the example in my own life, the reassurance became not enough. It did not have the same potency. To alleviate the distress once I engaged in it for a long period of time. So it escalated from there. And you know, something I didn't say, but also I would take him to the doctor and just, Every little sniffle, I remember I was there twice in one week and I could tell they wanted to ask me how I was feeling. Like they thought I was crazy. I started to feel like I was a little bit, outside of my normal functioning. I felt like everyone thought I was crazy, but I still felt this sense of like, no, this is a viable threat. It was a weird dissonance. It was almost like I could see what was happening and I was going to do the thing anyway, to get the relief.

Joni: 23:12

Yeah, that's a really interesting. I've heard this, like, I feel kind of crazy, but I also feel like I need to do it. I can't not do this or I can't be left alone or I can't go in the kitchen but they recognize it as like, this is different for me. Yeah.

Morgan: 23:30

yes, no, I hear that all the time too. It's actually probably one of the most frustrating parts of dealing with OCD is that you can see almost what's happening. but still feel this extreme pressure to do it anyway. It almost feels reckless and irresponsible not to do it, not to do those things like go to the doctor and call a family member. It feels irresponsible, which makes it so difficult if you don't know what you're dealing with. It just feels Sticky. And I hear a lot of times the word trapped and stuck. And that's exactly what it feels like.

Joni: 24:09

mm, that's good. So what are some common obsessions you're hearing and list as many as you want because I think this is very, very helpful for people.

Morgan: 24:19

Yes. Oh no. I love this too. just backtracking a little, diagnostic criteria, which for OCD is you have to have the presence of those obsessions and compulsions for one hour per day. And I always tell people that, and they laugh at me. They're like, okay, check common obsessions. Especially for parents. Um, I'm going to use the term what if, but it doesn't have to sound like this. This is just like a easy way to identify, but a lot of obsessions about what if something happens to the baby and that can be at the hands of ourselves or someone else. So these topics are actually getting a lot of traction. I'm so grateful for it too, but I do think they merit some recognition because they're taboo. So harm intrusive thoughts. 100 percent happen in the postpartum and pregnancy period. And it doesn't need to necessarily mean physical harm. So those could sound a lot like, what if I, what if I don't feel connected to my baby? And what if I neglect them emotionally and they turn out to have negative outcomes because I wasn't feeling that attachment to them. That's a big one when we hear. It also can escalate to that harm place. Like what if I get angry and I lose control and hurt my kids. Also, what if I get angry and lose control and hurt myself? That's another big one. I've actually had experiences with even different providers who call those experiences, different things. And I think we're seeing a really beautiful upward trend in recognizing that these are intrusive thoughts, not actual threats to anyone or anything. Other than it's just really distressing for the people having them. That's something that's been so great in our community, but also the other taboo, I wanted to mention, which I feel like it's getting a lot of traction maybe lately, but just in case someone hasn't heard these, lots of sexual intrusive thoughts. I've had like multiple, like countless encounters with people who misinterpret sensations that they have in the presence of children as meaning something meaning. Like say you're playing in a play area with your kids and you feel aroused, they misinterpret that to mean that they could possibly be pedophiles. And so then they become obsessed with, What if I'm a pedophile? What if I, will lose control of myself and harm a child? And it's it's so important to know that these are not thoughts people want to have. These thoughts scare these people. Right. And I was actually in a training. Once that the person giving the training actually told us that the safest person to babysit your kids is someone with POCD. He's like, there's no one I'd rather have change my baby's diaper than someone with POCD. That really just drove home to me. The distress these people have when they have these thoughts, because they're so against their value system. So as we talk about like harm, intrusive thoughts and sexual intrusive thoughts, it's really just thoughts. In these content areas that are completely against what you want, what you believe, and what you value. other thoughts though that aren't so noticeable that I feel like deserve a lot of conversation, is parents who think that they aren't doing a good enough job parenting their kids and then they'll go do a ton of research on parenting styles and parenting interventions because if they don't, they're then they're going to somehow cause their kids this great detriment and harm. I see that all the time. Also, I know people call it just health anxiety, but again, this merits the same. And I gave this in my own experience, but I see a ton of people in this population who are over concerned about their own health or the health of their children. And some of the things that they do is go to the doctor a million times, Google, right? Google symptoms, Google, things that could be wrong with their kids, not feel good enough with an answer a physician gives and go to a different physician, right? Those are some very common experiences that we have here. And then there's also, and I don't know if you want to talk about it here or not, Joni, but some really sneaky obsessions and compulsions in motherhood.

Joni: 28:31

Yeah, I just wanted to add one that I see that's common, that isn't always OCD, but it can be is the baby breathing and feeling like I'm being a good mom if I'm checking on the baby breathing. And I've been surprised how many like even people have been moms years ago, like, I didn't know that that's what that was. I thought I was being a good mom. And so it can be something, feeling like you're being a really good parent. Like as simple as that, like I want to make sure my baby's breathing, I think the hard thing is like, that does align with your values. Like I do want to make sure my baby's breathing. So sometimes they, like you said, they totally make sense. Or I want to make sure I don't mess up my kid. I want to be a good parent. Yeah. That's totally in line with your values but it can become something overtakes your life and really prevents you from being present with your.

Morgan: 29:19

beautiful point, Because what anxiety and OCD latch onto are the things they care about the most. So it all involves the fear of those things either being taken away, unappreciated in some way, or taken advantage of in some way, or us losing those things in some way, which like you said, keeps us from actually. Being present with those people and things we love and living a life where we can fill the utmost, peace in our relationships. We're always worried about like that relationship being taken away instead of us, being mindful and present in those moments because OCD latches onto the things we care about. That's how it gets our attention, right? OCD and anxiety. both do that, but that was a good point for sure.

Joni: 30:07

Well, I mean, you said it as well, but I just, just in case someone's listening, it's like, well, this aligns with my values and I've had this conversation with one of my patients recently, they're like, I'm being a good parent, like, yes, but you're over parenting, you're doing too much.

Morgan: 30:22

For sure. That's a good point because I think we have to examine the functionality behind what we're doing. Are we doing that thing? Are we like checking on our baby multiple times a night because it's a fear driven thing or a value driven thing? And what I mean by that is I always ask the question in reverse, what happens if you don't check on the baby and for someone not struggling with anxiety or OCD, they'll say like, Nothing. the baby sleeps. We're good. Right. But if for someone who's anxious or maybe has more of these OCD traits, the detriment of not checking on the baby most likely means the baby's going to die. Or the baby's going to die and it's going to be my fault. I could have prevented it for someone who's doing something in a value aligned way. Fear isn't involved. So that's one of the biggest differentiations between doing something that we want and love and think is good to do. Or are we doing something because we're scared that there will be this, catastrophic adverse consequence if we don't do that thing. That's a good metric. Yeah.

Joni: 31:31

Yeah. That's really helpful I can look at my own things and, and think about that too. That's, that's a good way to, Decide.

Morgan: 31:38

That's the beauty of this work,

Joni: 31:40

yeah, so tell me about more sneaky obsessions slash compulsions.

Morgan: 31:46

Totally. Okay. I think these are so difficult because they are framed and normalized. And listen, I love a good, funny TikTok, Instagram reel as much as the next person. But there's a lot of people out there giving advice or just like sharing their experience with intrusive thoughts and almost normalizing it to the extent where people think it's just normal to have and go through these things and experience distress. And that that's just how it is. And that's how it's going to be. And the reason why I love to talk about this is because I love the advocacy. I love the connection that like, Hey, you're definitely not alone. in experiencing these things, but it takes people on average, 10 to 17 years to be diagnosed correctly with OCD. it's a lot of times because it looks functional or it feels functional in the first place. And a lot of these things are mental. So the things that I'm going to talk about are mostly mental obsessions and compulsions or compulsions that wouldn't necessarily be deemed as ridiculous. They feel. Like just every day we all do this kind of things one of the big things that happens in motherhood is this idea of blame and shame and if we think about OCD and anxiety as an intolerance of doubt and uncertainty. I love this quote And I can't remember who said it, and I was going to look it up before we got in here, but I, I love this quote. It's from, I believe a British psychoanalyst, but the quote goes a little something like this. I would rather live in a world as a sinner ruled by God than in a world ruled by the devil. Because if I don't have anything to pin ambiguity on, right. If I don't have anything to attribute distress, pain, and suffering to, that makes me feel like I'm out of control. So one thing moms tend to do is if something is happening that fills outside of our control that intolerance of doubt and uncertainty. Remember is what we're talking about with OCD and anxiety. They love those things, right? We will make things certain by assuming blame, which then causes shame. So if something happens, like if you're in Target and Your kids having a full on meltdown cause you wouldn't buy them, you know, insert toy here. We will tend to blame and shame ourselves that we aren't doing the correct parenting approaches that we haven't taught them correctly. It's too much for us to think that, Hey, I don't have really any controller over this stressful situation. I can't control my kids. That's too ambiguous for us. That's too scary for us. So we'll result to shame and blame in order to fill some semblance of control. So shame and blame in this kind of scenario, are compulsive because they push away the distress of I don't have control. I'd rather blame myself than Then have zero control that gets really sneaky, right? That happens like if our kids get if you have OCD or anxiety, we'll often blame ourselves like I shouldn't have taken them to this outing that we went on. Or I've done something wrong or we think that if we avoid going to those outings that our kids are going to be fine and okay. Those things are really sneaky in parenthood because it's not something that's really out of the norm for us to do. And I'm not talking about situations like say your family member all has a stomach flu and You're like, I'm not going over there. That's great. But if we're having these thoughts of everywhere is this potential for harm to my kids, like either illness wise or whatever other potentials for harm. And we avoid those things. That looks pretty normal. Like no one would be able to tell that, Hey, we had an intrusive thought of something bad happening to our kids. And we avoid going those places just like the blame and shame often happens in that same context, like if my kid's having this tantrum in the store, no one can see me blaming myself. No one would know that's compulsive. Does that make sense?

Joni: 36:03

that totally makes sense. And I actually didn't know that that could be a compulsion. So that's really helpful for me. Something to kind of just notice and ask more about.

Morgan: 36:13

Yeah, I think one of the other, there's a few, but one big one. I really want to talk about is Comparison is a form of reassurance, right? And I want to talk about reassurance Because we frame reassurance a lot of times especially even in our field like even in the therapy world We give a ton of reassurance All the time, and this is not really anyone's fault unless we're like blindly disregarding, some opportunities to learn a little more, but we often give reassurance as a way to gain that certainty again, right? We need to know if. Something is true or not true. So we'll look for, we'll look to other people for that. We'll Google what that looks like in motherhood. I think one of the biggest things that we want reassurance about is if we're doing a good job or not. Cause our kids don't give us that, especially when they're babies. right? They don't smile or we can like put a whole lot of emphasis on what that smile means or the lack of that smile. It's really hard to know if you're doing an adequate job or not. There's really no way that we can objectively tell ourselves that 100 percent of the things I'm doing right now is great. So what we'll do is we'll try to get that certainty by comparing ourselves to other people. And that can be. Okay, I'm doing the same thing as this mom over here. That must mean it's okay. Or I'm not doing this. That must mean that. I'm not doing a good enough job. And we can do that quite compulsively, right? We can do that where we're like scrolling all the time and not even really know what we're doing, right? These thoughts are popping up and I would take a little audit, if this rings a little true to you next time you're scrolling Instagram, kind of catch yourself. Like, why are you looking at the content that you're looking at? Hey, this gives me some certainty that my house looks okay, that I'm wearing the right clothes, that I'm doing the right parenting skills, or even in the opposite direction of this means that I'm not doing those things. That's really, really sneaky. And I would say comparison is probably one of the biggest things that we deal with in the population that we both work in with moms. And that can be something that we do compulsively to try to gain certainty for sure.

Joni: 38:43

That's interesting. I've never heard it framed that way. I know it's certainly not helpful to do like the comparison game, but I never thought of it as like a way to reassure yourself one way or the other, like, Oh, I do suck or I am good. I'm doing okay.

Morgan: 38:58

And which makes it tricky, right? Cause like clients come in to see you or they come in to see me and we're like, okay, yeah, like that is a problem, but we don't necessarily pinpoint that. And I'm not saying everyone that does that has OCD, but that's definitely something that comes up with OCD, maybe the last thing I'll share is just the chronic people pleasing, So people pleasing is our attempt to alleviate someone else's distress or control a narrative about us. And that can be done pretty compulsively, meaning I have distress that someone may may not like me, or there's like a threat that they may not look like me. So maybe I wouldn't say no to that person or I'd go over the top. In trying to please that person in order to alleviate that distress and control that person's like for me, which in all reality., I always give this example of the time, like I've gotten feedback that I'm too happy, there's nothing that you can do to control another person's perception of you. But we like to think that there is, and sometimes we'll use people pleasing as a way to control that narrative. Right. for a lot of people, even with social anxiety that's something that we do in order to avoid the distress of rejection or the distress of loneliness, or even just not being able to sit with the distress of what do people think of me? that's a huge one that we see is that chronic people pleasing. And again, not to say that everyone who does that. Um, and it's, it's not necessarily meets the criteria for OCD and anxiety, but those things show up all the time when we are like working with our clients with OCD and anxiety.

Joni: 40:37

Yeah, that's helpful. can you, do you take a drink of water? I'm wondering if you could just, not that I can tell, list off a few other like mental compulsions. This was really helpful, but maybe some like more, um, I guess less sneaky ones, but ones that people still may not think of as compulsions, one I've noticed in. Some people is like repeating the same story or the same, like, what's going on in their life, what they're worried about. They repeat it over and over and over and over again. And it seems compulsive. It seems like a way to like decrease their anxiety a little bit. It's like, well now this person can give me some reassurance about this situation that I'm worried about. So I guess that's more reassurance seeking, but it's like repeating to get that reassurance.

Morgan: 41:21

Yeah. think too, that could fall within the, this mental compulsions called rumination. And it's basically any engagement with a thought. There's this saying of there's a difference between a thought and thinking. And sometimes we think we can think our way to a problem solution. The more we think about it, we'll come to the solution and everything will be okay and rumination is really just any engagement with an intrusive thought. Rumination is probably one of the most consistent mental compulsions that we deal with. If you notice a thought on repeat and you keep thinking about it over and over again, or trying to figure something out. Did I really say something stupid at that party? Like what exactly did I say? That can even fall under a realm of something called a mental review. And those two are pretty related. So trying to, like you were saying, think something through, but you're not actually coming to a solution. The story just comes back on repeat. We think that if we can find some grain of evidence either way. If something is true or isn't true when we're thinking that that will alleviate our stress that's called rumination. It's probably the most common one most common mental compulsion that we do but like you said closely related to that is mental review and that can be if you've just gone to Like a social event and you're replaying if you were awkward or not like kind of the experiences that you had at that party or even conversations with people. If you notice that you do that a lot, that's definitely a compulsion. We're trying to figure out if we really were awkward or if we did say something to offend someone, that's definitely a common mental compulsion. So is that self reassurance that we talked about, and that's a tricky one because that actually can be, Even framed as an affirmation. I got this, I can do this. It also can be like, I'm not sick. This is not a deadly disease. My baby's going to be fine. Right. All those things, those things are not inherently bad. None of these compulsions are inherently bad. The actual behavior themselves, it's just, we want to know when and why are we doing it. We call this like WTF. What's the function. So if the function is to alleviate distress and you're doing these things, then they're probably compulsive. if you wanted to wake up in the morning and tell yourself some affirmations. Great. probably not trying to push away distress in that moment, but if you're in a moment of distress and you're trying to push away that distress by, we call this thought swapping. So replacing bad thoughts with good thoughts of, like I'm going to totally go in here and make a fool of myself with, I got this. I'm awesome. I'm going to be the star of the party. That's actually compulsive. And sometimes that's what's really difficult in therapy is that if a therapist isn't, aware of what OCD and anxiety look like, those are some of the things that we can actually encourage. So knowing those things is helpful. And listen, we've all, had our growing pains, even in the therapy realm. And I know I have, but that's something to watch out for. If you do have a therapist and you notice a ton of that reassurance and anxiety is your primary. condition that you're working with, maybe having a conversation around what is a safety behavior? What is a compulsion, especially a mental one? the mental review, the self reassurance, rumination, those are all huge. Can you think of any others that you wanted to discuss?

Joni: 44:58

No, that, that covers them. That was great. So I guess if I was like listening to this and thinking like, Oh my gosh, I'm doing some of this, what, we kind of talked about in the episode with Jenna over ball, like what exposure and response prevention can. look like, but I guess I'm more curious about, you started this group at Serenity where people who have anxiety or an OCD can come, and how are you helping treat these moms and helping them deal with the intolerance of uncertainty or learn to tolerate uncertainty?

Morgan: 45:32

Ooh, I'd love that. first of all, like it, it's the best work. It's the best. So we started this group and as you just said, and I loved your interview with Jenna. ERP is primarily what we use in this group setting and it's the best treatment that we have. It has a nickname of the gold standard, but I believe it still holds the title of the most effective treatment for its associated disorder out of all the treatment modalities we have in their associated disorders. So it's super effective. And what's cool about our group is that We get to do exposure and, I know this was like briefly, this was briefly discussed before, but I feel like that word scares people and it's definitely not easy treatment, but it's probably not as backwards as everyone thinks it is. It involves a lot of us for lack of, a better summary, us facing our fears and doing nothing while in it. So the cool part about our group is that we get to do that as a group of women in similar circumstances, and it's really powerful. We utilize exposure and response prevention. 100 percent and we do it in a group, but we also do it individually with each. Individual in that group as well, but the group settings really cool because. It forms such a cool camaraderie when you do hard things with other people and really scary things with other people. It's such a cool bonding experience and to know like you're not alone in it is so powerful and gives us kind of the courage to go out and do those things on our own with the individual therapy aspect of it too. So we utilize a ton of exposure and response prevention. And I know you kind of briefly went over that with Jenna too. So I, I don't know, like, do you want me to

Joni: 47:23

It probably wasn't hard to go over it. Not everybody listens to every episode. Lots of people don't. So yeah, if you just want to like, I'm really interested in like examples, although I know that there's like not one exposure fits all, but does that look like in practice?

Morgan: 47:39

Totally. I'll give you 1 example and I'll, I'll kind of explain what exposure and response prevention is really quickly. And for everyone listening, you should go back and listen to that episode with Jenna over box. That was a really good episode. So, Exposure and response prevention has really three components. Like why we do it. So the first concept is this habituation model where, as like we previously discussed, we think that if we encounter distress in any way, but mostly in the form of doubt and uncertainty, that we are taught that we immediately need to do something about it. To alleviate that distress, we need to engage in a behavior and if you have OCD and chronic anxiety, that's where the problem starts, right? Is that we engage in these behaviors that have really told our minds that the intrusive thought or the experience that we just had is dangerous and we're doing something about it. That kind of solidifies that that is true. In our minds. Like, I want you to think about if you had a thought, I I'm going to use a funny one just because I can't at the moment think of a better one. But I've heard so many people have this thought, especially when it's dark and you go to use the bathroom in the middle of the night, like, what if there's a snake in there? And so you check to make sure there's no snake. And the reason why we keep having that thought and that urge to check is because we keep checking, So our goal is want to kind of have those thoughts and move on with life as normal. Without engaging in a behavior that solidifies that that thought is actually relevant and that we are indeed in danger. So the habituation model tells us that we can teach our minds and our bodies to encounter stress and distress. And not do anything about it. We don't need to do anything about it. Time takes the anxiety away, not something that we do takes the anxiety away. So when you do exposure with a therapist in a group or an individual setting, that's something that we're being really mindful of. we're putting you in a situation that causes you anxiety and then helping you basically not compulse or do nothing about it. Just sit with the distress. we talk a lot about how it's like going into a cold pool. If you have ever walked into a cold pool, it's not the most comfortable thing, but the more you go into the pool and eventually immerse your body in it, the more your body habituates to the temperature of the pool and it it's not as uncomfortable anymore after time, right? So I want you to think of like that habituation model is the same thing. I mean, that's one thing that exposure. does. The next thing is that it gives us this kind of sense of disconfirmation, which means the thing that anxiety and OCD says is going to happen, typically doesn't happen. And even if it does happen, it's not as bad as OCD and anxiety state is. So like, say like, you're really worried about your kids getting sick. And then they actually get sick and no one dies. That's just confirmation, right? If OCD said like, Hey, you've got to prevent your kids from getting sick at all costs because something terrible is going to happen to them. Disconfirmation and this idea that is encompassed in exposure. It's like, that wasn't necessarily as bad as I thought it was going to be. We don't want to love it. the idea is not to love it and like it, But that it gains sense of self efficacy and self trust back. And that's where the mastery comes in. When you do hard things repeatedly without engaging in safety behaviors or compulsions. You become confident, you grow this confidence into this ability to trust yourself so that you don't have to pre plan things. You don't have to do this like war game in your thoughts of if so and so says this, then I'm going to say this. Or if this happens, then I'll do this, or this is what I would do if a fire, engulf my whole house. don't need to premeditate those catastrophic events. Because we can just trust ourselves that if something happens, we're going to have the ability to deal with it because we've done these hard things and we keep doing hard things. So that's kind of like the three reasons why we engage in exposure, in response prevention. In that setting, it teaches our minds these beautiful concepts of we can handle distress and we can trust ourselves simultaneously. It's really quite powerful. And it's, I know I'm biased. It's the best work. It's the best, it's the best approach. and I, I love every second of it because I've seen what it does. For these women who engage in it.

Joni: 52:19

Yeah, I'm excited to, I'm doing the training in December. I'm really excited about it because I, I teach patients about this cycle all the time. Then I'm like, and now you have to go see somebody else because I don't know what I'm doing. But, I do think the group would be really cool to see other women. Who struggle with these same obsessions, facing their fears and seeing like, okay, things turned out okay for them. So maybe they'll turn out okay for me too. That seems like that would expedite growth a bit.

Morgan: 52:49

No, you're, you're so right. And that's one of the reasons why we don't do like a cohort group, meaning like people come in at the same time and then graduate at the same time. We have new people coming in with people who are about ready to graduate. It's kind of like a really cool concept of that disconfirmation. Process and for someone new starting, what this can look like when you get further along in the treatment.

Joni: 53:10

Probably feels pretty unbelievable. Like does it actually get better? But it's like, well, they got better, but they seem like they were already fine beforehand. So yeah, that would be really.

Morgan: 53:18

yep,

Joni: 53:19

That'd be interesting. Can you tell me a few exposures that you guys have done with your group

Morgan: 53:25

Yes. one, I love this one. It is probably one of the hardest ones we do. And I think people might be repulsed after we talk about it and be like, I'm never doing that, but it's really cool. We have actually what's called an unpopular opinion day where we get to say something that's completely in line with our values that we would never say face to face with someone for fear of like. Oh my gosh, that person thinks I'm a terrible person. That person's going to reject me. I'm going to be scorned off the face of the earth. Or maybe I offended someone with what I said. Those things are all again, sneaky compulsions that come up in motherhood and why a lot of women and mothers in particular have a difficult time forming opinions and actually standing up for what they believe in publicly. Or even not very publicly, but even like it's almost Thanksgiving when we're recording this. So like, it's a really hard thing for women to stand up for their values in the midst of their family or express like concern over those things. So one thing that we do is we have this day where we share on popular opinions, but it has to be a high stakes opinion. We've shared thoughts on abortion and like our thoughts on, different high stakes measures of like, when should you transition a kid out of a car seat? Should you send your kid to daycare or not? Remember, like this is a group full of such diverse women that they have diverse beliefs. And it's really hard to say these things in the midst of other people. And so something that we learned from this is that, I can maintain healthy relationships. And still stand up for what I believe in, even if someone disagrees with that belief or if someone, even is offended by what I said, I can have the skills to navigate, what that looks like. So that's one of the exposures we do and we also do. Some contamination type exposures as well. We have a day where we actually like put bad fortune cookies on the floor, meaning like these fortune cookies are like, I don't know. You're going to contract a serious illness or

Joni: 55:30

they're unfortunate cookies.

Morgan: 55:33

unfortunate. That's the best unfortunate cookies, you have to eat them, take them from the floor, but we also have this pretty fun where you wear thrift store clothing while you're eating it. And that's this contamination fear of eating this cookie off the floor. I'm also ingesting something like a bad fortune, Which typical people don't think as contamination. And That's kind of another sneaky one. It's not just about germs, but we can also think of contamination as bad ideas. If we're around people, we'll have bad ideas, or if we read something, we can ingest bad ideas and become bad ourselves. So we do that while we're wearing these clothing and then. We do this whole like ritual prevention where a lot of people like want to go home immediately and just like shower or not eat the cookie all the way, or, seek reassurance that this is not going to happen to them. Lots of different things come up. It really depends on the individual and what the individual fear is. But something cool about the group setting is we take whoever's in there and we get to know their fears really well. And we tailor these exposures to that person's, and a lot of times these are in the group setting, this is a cohort fear, right? And we get to do things that are really targeting what that group at that time is going with. So sometimes it'll even be us like watching a scary news story, like about someone getting kidnapped. That comes up a lot too. If you have constant fears that your kids are going to get kidnapped. We will approach that fear and learn to sit with the distress that fear causes so that when that fear comes up in the real world, when that cue comes up in the real world, it doesn't have to encompass our whole day. It can be something that, Hey, we heard it on the radio and then, well, I got to go do the laundry now. It doesn't stop our whole day, right? That's the whole goal of exposure and response prevention that we can have an intrusive thought, or we can meet up against a trigger and it doesn't have to hinder how we live our lives. We can still go out to the playground and enjoy our kids playing in a distance. Without these fears of, they're going to get kidnapped and some of these other, really prominent things that come up in our world. And we have access to all these news stories that happen that really trigger us and want to make us that we, never risk the safety of our kids. And that's what it feels like that we're being reckless when we take a break from them or let them play, in the backyard or at a friend's house. We don't want to avoid living life because we're scared of these things. We want to learn to live life with this uncertain factor to it. And I know that sounds so scary if you're listening and it doesn't even sound doable, but this treatment is so beautiful and it helps us gain the confidence that we can live in an uncertain world and we can be present and enjoy our relationships that we have now, instead of worrying about these detrimental things happening 24 seven. That really do keep us out of those things and away from those people we love.

Joni: 58:37

The hope that it offers is worth the I mean, it probably feels very painful to do ERP, maybe not painful, but I mean, certainly very uncomfortable. Your coping skills to deal with this anxiety have been kind of removed and you're learning how to just sit in it. I love that you're just reminding us, there is something amazing on the other side, whether you do it within like a group like yours or individually, there is hope on the other side. I was going to ask about the unpopular opinion one. How do you prevent someone from doing ruminations? Cause that's just like something they can do in their head. Oh, I saw that person make that look, I know that they're upset with me. How do you like, do you guys just call each other out? I'm like, stop ruminating. do you do that?

Morgan: 59:22

No, it's actually kind of cool. and obviously like 100%, that's on the person. When we have this part of our program, like what is rumination? What does it look like for me? That's all part of the program. And we examine those things and look at how that looks for you. So it's on the person doing it, but also people think that I enjoy torturing people, but I don't like, that's not the point of it, but I get to play the role of OCD sometimes. Just like asking like, Hey, what does OCD say right now? And it's kind of cool because like when it's that person's turn to share their own popular opinion, a lot of times they'll say like, OCD says that everyone in this room hates me and that they are deeply offended by what I said. And then we don't talk about, but there's an approach is a therapeutic approach of how do I help this person sit with this distress? Instead of going down this story line of rumination and trying to make it make sense or make it feel better in their minds, I want them to be stressed. I want them to sit with that stress in that moment because I know, and they know that if you can handle the immediate and short term stress, you can have longterm peace. And so in that group setting, we have trained therapists who know what rumination looks like. And know how to spoil it ourselves and how to teach the client to spoil it once they do it. Cause we all do it. We all ruminate. It's kind of cool In the program we teach you how to spoil the compulsions that you do because we're going to do them. We're all going to do them. we all do weird things. but it's kind of fun and really empowering to learn. Okay. Once I do that thing that I'm really used to doing, how do I spoil it? It does get tricky, but it's very, effective the way we do it in there. You're really good question because you can't catch 100 percent of those mental compulsions, but once you know what you're looking for, it gets a lot easier.

Joni: 1:01:17

Yeah. That makes sense. I have friends who like will tell me kind of what they're going through and they're sharing something with me and like, Oh, this kind of sounds compulsive. And I'll say like, apparently you're supposed to stop doing that, but I don't know how, I don't know how to stop thinking,

Morgan: 1:01:32

here's, a sneak peek. Maybe everyone does hate you, Joni, and maybe they don't. Can you sit with that distress? And we just say, you know, maybe, maybe not. I guess we don't know. Yes.

Joni: 1:01:44

helpful. And that's kind of what I thought is like, like, if your thought is like, my husband's going to die, then it's like, well, he might die. He, he could die. He could be dead. You haven't talked to him. really leaning into it.

Morgan: 1:01:55

yeah, I know. And I think people are sitting there like, what? I'm not giving permission for this to like, maybe, maybe not happen. And that's not the point, right? The point is to sit with the distress and not do anything about it in a controlled environment. It's funny cause after you go to school, you have the opportunity to get different certifications. I was in this ERP certification, program where I was getting certified for ERP and the doctor who was leading the consultation said, I want everyone that you guys treat to wake up in the morning and say, okay. Well, probably gonna get in a terrible accident today and ruin the rest of my life. What's for breakfast, right?

Joni: 1:02:39

Yeah,

Morgan: 1:02:41

to this place that's so powerful of these thoughts can come and the things that are stressing you so much out right now, and it feels so dangerous and scary right now can become. Annoying white noise that you don't have to do anything about and I know that for myself And if like the only thing people get from listening to this today is I want everyone to know that this is absolutely something that you can encounter and you can have, and you can have the most beautiful life with this disorder. You can have the most brilliant value aligned life in the midst of anxiety and OCD. There's help available. There's a really beautiful treatment for this. It's very effective. terrible what you're going through, but the outcome can be so hopeful. And I really just hope people grasp onto that concept after all the anxiety we've caused everyone by talking about what these exposures look like. I hope that that's the takeaway is that there's something so beautiful on the other end of this. And it really isn't that far out of reach.

Joni: 1:03:53

Yes, absolutely. I'd have nothing to add. If someone wanted to work with Serenity or go to this group that you guys are offering, what's the best way to contact you guys?

Morgan: 1:04:04

Yeah, that's, you can go to our website. It's just ww dot serenity rw.com. Um, you can also email me and my email isMorgan@serenityrw.com. You can also find us on Instagram at Serenity Recovery Wellness. Yeah, any of those platforms will do the job.

Joni: 1:04:27

Awesome. Thank you so much for your time, Morgan. I've learned so much and I can't wait to do this training and then. feel really stupid and eventually learn all this stuff. It's so awesome. It's so opposite of what you would think therapy would be. So I really, really love learning about it..

1:04:43

Welcome to the Sad Moms Club. Welcome to the Sad Moms Club. Welcome to the Sad Moms Club.