Ellen:
With me today is Dr. Celin Gelgec, a clinical psychologist based in Melbourne here in Australia, who specializes in anxiety, and all of the different ways in which it manifests and challenges us. Celin is a senior clinical psychologist and the director of the Melbourne Wellbeing Clinic. She works with children, adolescents, and adults who experience obsessive compulsive disorder and anxiety disorders, as well as secondary depression.

Ellen:
I've asked Celin to join us today to talk a little bit about phobias, but I suspect this conversation will divert into some of the other topics around anxiety, and particularly obsessive compulsive disorder, because I know that's one of your areas of specialty. Welcome Celin.

Celin:
Thank you so much. It's really exciting.

Ellen:
I'm excited to have you here. I do have lots and lots of question for you. But I might even just start out by asking what got you interested in OCD or obsessive compulsive disorder, firstly?

Celin:
Many, many years ago, probably about over 10 years ago now, when I was a student and I was on my final placement at the Melbourne Clinic, which is a private psychiatric hospital in Richmond, and I was on placement there in the OCD inpatient unit. While I was working there, I was there for about six months as a student, and then I was lucky enough to be offered a job, so I got to stay on and I was there for another three and half years.

Celin:
Over that time, I just really fell in love with working with the condition and the people as well, in terms of hearing their stories and being allowed into that journey, because people with OCD can be quite private, because of the nature of their intrusive thoughts, it can be quite confronting and scary, and so they're not always ready and willing to disclose that, because there's thoughts of, "What if I'm crazy? No one's going to understand this. What if I really am a pedophile or a murderer or what if I really do kill someone because I wasn't careful enough? Or what if I spread germs and people get hurt because of me? Or what if I stuff it up because I didn't do it right?" All those sorts of things.

Celin:
They can be really confronting things to talk about with people, so it's easy to hide, it's easy to not disclose any of that. It just felt very, I guess, privileged in being able to share those experiences with people, and seeing their recovery and that journey, I guess, of people coming in distressed, but then working through and really understanding OCD and knowing that there's something they can do to help manage and eventually overcome what their dealing with, yeah.

Ellen:
Can you tell us, because I think there's a lot of misunderstanding, and I was particularly interested to see, we always ask our guests for a list of resources and links and things that our audience might like to access after listening to an interview, and I noticed that you included a link to a YouTube video that's called You Probably Don't Have OCD and This is Why.

Ellen:
Because there is a lot of misunderstanding about OCD, it is one of those terms that we often use just in everyday parlance now to refer to someone likes things to be neat and tidy, or can be a little ritualistic about things. What is it actually?

Celin:
For me, everyone has a little bit of obsessive compulsive, but what people don't have is the disorder, in terms of the part that really impacts on life. The part that makes your world start to get smaller. The part that makes you start to feel scared about taking on challenges or taking risks, or even talking to people or interacting with people starts to become nerveracking and you become hypervigilant about your surroundings.

Celin:
It starts to take up a lot of your thinking process, that's when it starts to become a problem, when it's really interfering in your life and stopping you from being the person you want to be, stopping you from doing the things you want to do, taking those challenges and risks, that's when we really need to start going, "Okay, this is no longer okay. It's getting in the way. It's a hurdle. I'm going to need some support".

Ellen:
Okay, so it is actually an anxiety disorder, is it not?

Celin:
Well, it was. Anxiety is a part of it. The DSM, when it got upgraded in 2013 to the DSM–5, OCD came out of the anxiety disorders and was classified on its own. While anxiety is a large part of it, it's now got its own classification system under obsessive compulsive and related disorders, and then within that there's hoarding and loads of other things like trichotillomania and that sort of stuff.

Celin:
The research is showing that while anxiety is really large component of OCD, there's so much more to it. I think that's really helped inform treatment too, so the layers involved in treating OCD too is becoming much better understood I think, yeah, yeah.

Ellen:
We can all be a little obsessive compulsive, but we don't necessarily have obsessive compulsive disorder?

Celin:
Yeah. We all have our little quirks.

Ellen:
Which brings me, I guess, to phobias because I think certainly my understanding of phobias is that we do all have degrees of different phobias and sometimes they're very common things.

Ellen:
I think most of us have bit of a phobia about snakes and spiders, especially here in Australia where they tend to be fatal at times. But we'll have other specific fears that maybe we're okay with or maybe can be very problematic for us. What is a phobia from a psychological point of view?

Celin:
Yeah, from a psychological point of view, a phobia is something that causes excessive distress in response to anything. People can have phobias about literally anything. I once worked with someone who had a phobia of balloons.

Celin:
But you've got your common ones like you talked about, in terms of snakes, spiders, various different animals, dogs, cats, bugs, that sort of thing. And then, yeah, you've got your more uncommon ones, like balloons for example, or black dots.

Ellen:
Really? Black dots.

Celin:
Yeah. And so many other things, the list is endless. I guess the thing to think about again is while you might like something, if it's not impacting on your life, if you can live your life fairly functionally without being impacted, then do we technically call it a phobia or do we call it something that just causes a reaction, but it's not persistent? It's not just, is it distressing? But it's also the frequency and intensity and duration of that distress.

Celin:
For example if you were working as a zoo keeper, but you had a fear of monkeys, but you were fine with all the rest of it, then obviously that's going to impact on your functioning, so we would classify that as a phobia. But if you were scared of spiders and didn't really like them much, most of us live in houses and how often do we come across spiders anyway? Can you chuck it in the garden? Can you spray it with Mortein? Can you do whatever? It feels uncomfortable but we can tolerate it to a certain extent, and we don't like it, and you don't have to like, but it's, can you cope with it? Can you do what you need to do and then move on with your day? Or are you paralyzed and stuck to the point where it impacts on functioning? I guess it comes down to that, yeah.

Ellen:
It could be then the degree of impact that it has on you, so the degree of emotional distress that you might have if exposed to that thing? I know, I don't particularly love spiders, and we have big ones here like huntsman that run, which is a bit alarming. But I can tolerate them. That's fine. I'm very fortunate enough to have a 10-year-old son who takes great delight in catching them and releasing them into the garden, so that's helpful.

Ellen:
But I remember having a friend stay with me at my parents' farm when we were young, and she actually couldn't go in and out the front door because there was a spider nearby. It wasn't even close, it was nearby, and she actually just couldn't bring herself to walk past there, so that would obviously be a bit more disabling if it means you can't get in and out of your house.

Celin:
Exactly, exactly, absolutely, yeah. They're perfect examples of the differences of something being more disabling versus, "I don't like it but I can tolerate it, even though I don't like it". Yeah, yeah.

Ellen:
Why do we have them?

Celin:
Why do we have them? We can have them for different reasons. Largely they're learnt, in terms of growing up, you might have someone in the household who is afraid of some of these things, so you learn that reaction and you internalize that fear.

Celin:
Or sometimes there's massive traumatic experiences, or there's really unpleasant experiences that gets internalized and that fears sticks. We can have them for all sorts of different reasons.

Ellen:
Are some of them more innate? Because I think when we look at things like snakes or spiders, again particularly in Australia where they are quite dangerous, or can be quite dangerous, or a fear of flying makes some logical sense to me because it doesn't really makes sense that we should be up there in the air in a giant tin [crosstalk 00:10:30].

Ellen:
A fear of heights makes some sense because there is threat there. But a fear of balloons doesn't necessarily make sense [crosstalk 00:10:42].

Celin:
Or black dots.

Ellen:
Yeah, or black dots, or glitter. I do know people for whom glitter is a problem.

Celin:
Absolutely.

Ellen:
Are some of them just innate and they make sense, and then others not?

Celin:
I think from a perspective of some of the more stranger ones where there's no logical consequence of something, "I could actually die. Or I'm going to get harmed," or something like that, like glitter for example, I think it comes down to more of the feeling. For example it doesn't feel right, or it might be a disgust factor, or it might be a textural thing rather than an emotional thing. There are all these different reasons that might not have a harm consequence, that have more of either an emotional or textural or some other thing, that people then, the thought comes in, it gets stuck, and then the interpretation of that starts to become bigger and bigger, and then the brain starts catastrophizing that even more.

Celin:
And then before you know it, you've talked yourself up into this really big anxiety provoking situation. That becomes more of a learnt situation. When we pair, I guess, the stimulus or the trigger with emotions, that's a perfect recipe for our brain to really submit that into our longterm memory and be like, "Don't forget that because that caused a lot of distress, and we need to protect our person from that distress," and whatever is associated with that distress goes with it. It becomes a harm related thing, but it's misplaced, if that makes sense? A lot of the time people will be like, "I know logically this doesn't make sense, but it just feels too wrong".

Ellen:
Is that a little bit of what happens with OCD, where people might have ... because I do remember when, and I should see if I can look it up and find it, it was an amazing program that I watched years ago on TV and it was about, I think it might have been an English program, and they put-

Celin:
The House of OCD?

Ellen:
Yeah. The House of OCD. That's it. They put a number of people together who all had OCD but it manifested in different forms. There was a guy who didn't like sharp objects, and he was a teacher, and so he'd developed this fear.

Ellen:
My understanding was his fear that somewhere in his brain, or somewhere in his brain was telling him that if he was near sharp objects he could pick one up and stab someone. He didn't really believe he was going to, but that was the fear. Is that, what the brain does?

Celin:
Absolutely.

Ellen:
-coupled with some harmless information, and then spins [crosstalk 00:13:30] out of control.

Celin:
Absolutely, because what happens is just by way of the way the brain functions is the anxiety center of our brain, which is known as the amygdala, largely controls emotions. When that's active in terms of, it's always active, but when it's heightened, I guess, what it starts to do is it starts to shut down our frontal lobes from working. Our frontal lobes are responsible for higher order stuff, so problem solving, reasoning, logic, attention, concentration, decision making, all the stuff we need really, and that makes us different from the rest of the animal kingdom in inverted commas.

Celin:
If our ability to reason and logic is shutting down, we're then functioning purely from the emotional center of our mind, and that problem solves from an emotional perspective rather than a logical perspective, and it will talk to our longterm memory and be like, "Quick, what did Celin do last time she was in this situation that made this go away?" It doesn't have to make logical sense, it's just whatever got rid of the distress, that's the answer, and so there's immediate relief. But then when everything calms down, the amygdala is like, "Great, I've done the job. My person is safe. We're good," and then the frontal lobes come back online again and then you think back and you go, "What the hell was that about? Why am I doing that?" Because logic is kicking back in.

Celin:
A lot of people often say, "I know it doesn't make sense, but when I'm in the moment, I just can't help it". That then leads us to going, okay, well a lot of what we're doing here is really learning to regulate some of this anxiety, learning to sit with some of this discomfort, learning to build tolerance to this level of discomfort in terms of treatment, rather than focusing on content of thoughts, if that makes sense?

Ellen:
Okay, okay, so we're being hijacked, I guess-

Celin:
Yes, yeah.

Ellen:
-by a brain that [crosstalk 00:15:30] that logical part that said, "You don't actually have anything to fear here. Nothing really bad is going to happen," but for whatever reason, because the level of anxiety is heightened, that bit has shut down and we're being taken over.

Ellen:
Is that where some of, I suppose the behaviors that we often associate with OCD, for example like excessive hand washing or having to double check things, is that what's coming in, when you talk about, "What did Celin do last time? Well, she just washed her hands again," so it's almost like-

Celin:
Yeah, yeah, and then you build tolerance that, because the other thing that gets activated if the reward center, the reward pathways in our brain, so the message is we're doing the right thing.

Celin:
Then it becomes almost like a drug addition, where you feel like you need to do more to get the same effect because you're developing that tolerance to it. And then after a while, the more we do it, people can get stuck there for hours because it just never feels enough, yeah, yeah.

Ellen:
My mind is going, coming back to the phobia idea and almost beyond phobias, just some of the rituals and almost superstitions that we can have. I'm imaging the footballers who have to put their socks on in a certain way, one foot before the other, some of those little rituals that we have.

Ellen:
I've been watching the French Open and watch Rafa Nadal and the hair flick and a couple of other things, that we manifest these rituals because somewhere in there we think, "I did this once and we won. Or I did this once and I played a brilliant game". Somewhere do we believe that if we keep doing it, we're going to keep having the same outcome? Is that what's going on there?

Celin:
Yeah, in a sense. We do, we have this magical thinking idea of, in a sense innately sort of believing, I guess, becoming hopeful that this action led to this consequence, therefore if I do it again it might happen again. I'm guilty of that too. How many times have we knocked wood on something or done whatever else it might be.

Celin:
I remember as a kid wearing my lucky socks playing cricket in primary school and all that sort of stuff. The more meaningful things are to us, the more likely we are to engage in those behaviors. I guess it's because it just tells us that we want it to go well. But at the same time, the scientist in me says, "Well, then I would have won the lottery 10 times over by now," so yeah.

Ellen:
A lot of our behavior can defy logic and we do it for other reasons.

Celin:
That's right, yeah, and more emotional than logical.

Ellen:
Yeah, which has just reminded me, you were talking about being a kid, and I remember I was living in Melbourne, it's going to betray my age, but I was living in Melbourne, I was about 10 when we had the big Ash Wednesday bush fires, and although I wasn't anywhere near the affected areas, we did have ash fall and we had glowing orange sky. It was quite scary, my parents were out at the time, and I remember being quite upset because I didn't know what was going on. We had a young babysitter and she didn't know what was going on.

Ellen:
I remember going to bed and I could see all this stuff. There was a little gap in the curtain, I could see this orange sky, and I remember having to really close it tight so I couldn't see it, because it was distressing me. For years, literally almost decades in that house, I have had to do that same thing of having to close that. It took me a long time to be comfortable with not having that bit of curtain closed. Is that because that level of emotion that was going on for me at the time?

Celin:
Exactly, the higher the level of emotion at the time, the more the brain really struggles to let that go, because it becomes survival then. And then we enter into that fight, flight or freeze, where when we're in fight mode we might overcompensate by doing some of these safety behaviors. When we're in flight mode we might avoid, we don't want to think about it, we don't want to talk about it, we don't want to whatever. We might keep ourselves busy or something like that.

Celin:
Or if we freeze, we totally surrender and give into the demands. For someone with OCD that looks like giving into the demands of OCD and just doing what OCD wants them to do. For someone with phobias it's following through with all the checks and balances I might need to do, all that sort of stuff. And then the brain doesn't want to forget that, because it's like, "No, I can't risk my person being hurt. I need to look after ..." that really primal response takes precedence over anything else. Yeah, absolutely.

Ellen:
I love the way, that language you're using about my person, because it does really help you to see how your brain and the person running the brain don't always sync up if you know what I mean. The brain is there to protect the person.

Celin:
That's right, yeah, and they're not always on the same page. Certain parts of your brain might not always do what you want it to do.

Celin:
But there is that part of us that has that reflective capacity to, when things come back online and threat has passed, we are able to reflect and recognize and develop insight and grown and learn how our brains and thinks, and that's when change occurs.

Ellen:
Yeah. My understanding is that anxiety related issue, just understanding that can make a big difference to helping people overcome it, is that right?

Celin:
Absolutely, because the thing is we can't get rid of it. We can all just cut our amygdala out because-

Ellen:
We probably need it.

Celin:
Yeah. It's there for a reason. It stops us from driving too far, or it stops us from taking too many other risks, or it stops us from going, "Oh, I wonder what will happen if I opened the plane door while the plane's in the air?"

Ellen:
The things toddlers might do.

Celin:
Yeah, the things toddlers might do, absolutely, yeah, definitely.

Ellen:
Celin, coming back to phobias in particular, when it comes to treatment, so say, because I know there are people for whom some of these phobias become quite problematic.

Ellen:
I know parents who have children who have a real fear of dogs for example, that's hard. If you go for a walk down the street and you're confronted with a dog that's going to be distressing for everybody. What are some of the methods we use to help treat these [crosstalk 00:22:09]?

Celin:
The most common method that's used is called exposure therapy. In a sense it's a form of desensitization. You'll get to know the person, get to know what exactly about dogs, for argument's sake, is triggering, because it could be different for everybody. And then you work out and you brainstorm with the person different ways of gentling exposing the person to each of those things.

Celin:
For argument's sake it might be the sound of a bark might be uncomfortable but not too bad, so that will be the way to step into that. Then we might have a look at cartoon pictures of dogs, then real pictures of dogs, photographs of dogs, and then we might go for a walk down the street and be across the road from a dog or something like that. And eventually, gradually, slowly working up to holding a leash, touching one, patting one, letting one smell your hand, that sort of stuff. It's a way of just gently wading in. At our clinic, we're lucky enough to have virtual reality as a tool to-

Ellen:
Wow.

Celin:
-treat phobias, which is really cool, and dogs are on there, which is great, as well as a whole myriad of other things. The great thing about virtual reality is it's a really nice bridging gap between doing some of the in house stuff or using imagination as a form of exposure as well, as well as pictures and other things, you might bring in a dog leash or something, that sort of stuff, and actually going out and doing exposure work in real time.

Celin:
It's a really nice bridging gap and it's still safe. I know the one with the dog for example, again there's cartoon-y versions and then there's more real life, realistic looking versions, so you can mirror and mimic those things of walking across the street from a dog, one with a muzzle, one without a muzzle, one with a leash, one without a leash, so the different degree of difficulty comes into it too.

Ellen:
Not that easy always to organize that without the use of technology, you'd have to have these dogs [inaudible 00:24:29]. And for other things, I'm imagining things like spiders, if spiders are becoming a real problem, a fear of flying? I know that is one that they're traditionally used, I supposed they've actually had to have simulators and different things, but virtual reality gives you that in a much simpler, easier, more accessible way that you can actually do it inside your clinic.

Celin:
Yeah, absolutely. There are lots of flight schools and things, which is really great, but then they can also be really costly, so not everyone's always going to have access to that stuff. And not everyone is always going to be going on a holiday regularly enough to have that desensitization happen, because the most important thing is consistency and repetition, in terms of treatment.

Celin:
Doing exposure once isn't going to really achieve much. I think the best way of relating to that is expecting to build your fitness, if you're trying to increase your fitness, you can't just walk once and expect to be fine, you need to keep doing a little bit each day or a little bit every other day to really build on that, and the brain works the same way. If we want the brain to change, we need to treat it like a muscle and we need to exercise it, so absolutely, it gives people more of that flexibility, yeah.

Ellen:
Wonderful. Is the idea, as we gently expose people or expose ourselves, because I'm guessing this is the kind of thing that if we've just got a mild issue with spiders or bugs or something, that gradual exposure is just to get comfortable with that discomfort.

Celin:
Yes, absolutely. You don't have to like it, you just have to be comfortably uncomfortable with it.

Ellen:
Sit with it, as we say.

Celin:
Yeah, absolutely, yeah.

Ellen:
Fantastic. [inaudible 00:26:20] just some interesting things about phobias, because I know this is the kind of stuff that just fascinates people, I know it fascinates me, do we know or have any idea about the number of people or percentage of people who might have significant phobias, things that become really problematic?

Celin:
Yeah. Well, if we think about the stats for anxiety just generally, I think it's about one in four people at any one time has a diagnosed anxiety disorder, and phobias would fit into that. So if you think about it from that perspective it's pretty full on.

Celin:
A lot of the stats that are out there are American statistics, but in terms of the one in four, that also relates to Australian stats, so there's quite a number of people, yeah, that would have a full on phobia, yeah.

Ellen:
Yeah, absolutely. We've spoken a bit about some of the more common ones, and you mentioned some of the ones that you've come across that are less common, like balloons. But are there any other unusual ... could people literally be scared of anything?

Celin:
Pretty much, yeah. Anything that's caused ... for example if there was a tissue box on your desk, and you heard an explosion go off while grabbing a tissue, your mind could associate that loud noise and that fear with the tissues.

Celin:
So all of a sudden you might start feeling a little bit anxious when going near tissue boxes, for argument's sake. I think if there's a strong enough emotional reaction, it could literally be anything.

Ellen:
Okay, which when you think about it that way, it does make sense that a balloon for example, especially because if balloons pop in your face, that's quite a startling thing.

Celin:
Absolutely, especially when you're a toddler, and then all of a sudden it just bursts in your face, that's something that could provoke a strong enough emotional reaction to then stick with you, yeah.

Ellen:
And then I'm guessing that the more you avoid those things then, if that's your response, is to avoid being exposed to it because it makes you uncomfortable or fearful, the more you do that and the longer you do that for, in your mind the bigger the fear becomes?

Celin:
100%, yeah [crosstalk 00:28:36]. Sorry, I cut you off.

Ellen:
No, no, that's all right. I was going to say just thinking about in that context, it does make sense that people could develop a fear about anything.

Celin:
Absolutely, absolutely, yeah, definitely. The thing I guess in terms of that, of developing that fear, often we think what we need to do is to avoid and all that sort of stuff.

Celin:
But while that gives us immediate release, it just makes it worse in the long run, as you mentioned. The very thing we fear doing is the thing that we need to do gradually in order to overcome it, yeah.

Ellen:
Ans so that's the approach and the goal of treatment then is just to have that gradual exposure?

Celin:
Yeah, yeah.

Ellen:
What about [crosstalk 00:29:23], oh sorry. Keep going.

Celin:
No, I was going to say some people will choose the flooding approach of just going right to the top, but I always find there's a lot of prep work too that needs to go into that to prepare the person in terms of building a toolbox to help cope with the level of distress.

Ellen:
If that's spiders for example, it's just basically thrusting a big spider at someone and saying, "Hold it"?

Celin:
Pretty much, yeah, absolutely, which can be quite distressing. But that's effective too, I guess it's just a matter of figuring out what you feel comfortable with.

Celin:
As long as you're working with someone to help support through that process, I think that's probably the best approach, yeah.

Ellen:
Yeah, although I must admit, inadvertently that has helped for me because I always had a bit of thing about spiders ... I think as you say, it's interesting that you say about what's modeled for you because my mom has always been a bit, "Eek," with spiders, so it was, I suspect, a bit of a learned thing.

Ellen:
Please tune out for anybody who does have a particular fear of spiders, I've had two instances in which I've had hunstmen land on me. One was actually in the shower, it was up on the ceiling and I thought, "You're all right. You stay there. You stay there, I'm okay with you," but the steam from the shower must have made it slip, it fell on me. I realized what happened, I squealed and flicked across the room, managed to get rid of it. But to be honest, after that I was like, "You know what? A spider landed on me and I lived, so maybe it doesn't matter so much anymore".

Ellen:
And then the second one was actually not realizing at the time, but I was out, I don't know where I had collected it from but I was hanging washing in the garden, and I suddenly felt something and I looked and here's this huntsman on my shoulder. And again, flicked it away, but probably I don't think I had as an extreme response that time I just got rid of it. Now, I'm still not going to pick them up like my son does, but yeah, I think for me it was being able to then say to myself, "A spider walked on me and I'm still okay. It's not that bad."

Celin:
Yeah, definitely. I had a similar experience where I had learnt fear of cats and dogs because my mom, she got bitten when she was five by a dog, so she then learnt to fear dogs. And then I learnt that fear through her.

Celin:
But then as an adult, having a cat of my own because I always loved animals and thought they were, I still do obviously, I think they're adorable. I was like, "Aw, this cat is up for adoption. It's really cute. I'm scared, but at the same time I really want to try and overcome this fear," so bringing it home as a young kitten, now we're in each other's faces and have cuddles and all the rest of it and there's no fear. I guess over the first, I would say probably three or four months of getting used to it really helped my anxiety to get used to it, which is really cool.

Ellen:
So we can actually, with milder phobias or fears [crosstalk 00:32:36] made our own exposure therapy just consciously or unconsciously.

Celin:
Yes, absolutely.

Ellen:
Inadvertently in my case.

Celin:
Yeah, yeah, definitely.

Ellen:
Wonderful. I was going to come back to just a question about OCD and the treatment for OCD, obviously there's a bit of overlap here with the fears and behaviors and what have you.

Ellen:
More broadly, what are the approaches to treating obsessive compulsive disorder?

Celin:
It's similar in a sense where the treatment is exposure and response prevention. The exposure happens to triggers, intrusive thoughts, and the worry beliefs that are around the intrusive thoughts. We purposely bring them up gradually, we work out a bit of a hierarchy, least anxiety proving to most anxiety provoking. And then what happens is that then obviously generates discomfort and the person feels uncomfortable, whether it's guilt, uncertainty, anxiety, disgust, frustration, anger, whatever it might be. That then brings up distress and then there's a really strong urge to engage in an associated compulsion to alleviate that distress.

Celin:
But what we do is we teach tools to help sit with that discomfort, so that the person then can surf that urge and ride that wave, and not do the compulsion, which then gradually through lots of repetition, and I mean lots of repetition, the pathways of the brain slowly start to change, in a sense where, where a path would recently be activated going, "No, this is what I need to do to alleviate this distress," the brain is then like ...

Ellen:
Oh!

Celin:
Because I've now learnt, I've now unlearnt that response, if that makes sense?

Ellen:
Yeah, okay. I can understand OCD when it comes to say some of those obsessive behaviors, so having some intrusive thoughts and then wanting to wash your hands or check things.

Ellen:
What about some of the other intrusive thoughts or beliefs that people have? I've certainly heard, I know Osher Günsberg talks about struggling with OCD and a lot of his intrusive thoughts, which ended up manifesting as almost psychotic type hallucinations and things, were around fears like climate change.

Celin:
Yeah, some of the bigger life questions.

Ellen:
Yeah, yeah. What's going on there?

Celin:
There are lots, but underlying that is a sense of responsibility, underlying that is what we call scrupulosity type OCD where people are really fused with needing to be a good person, wanting to be responsible, wanting to do the right thing, which are wonderful qualities to have as a person. But what people feel distressed about is while it's important to worry about these things, I'm one person in the bigger world, and this is what becomes overwhelming, and I can't fix it on my own, and we need other people to also be involved with this, and the distress in needing to get messages out there and doing this and all this other stuff, it just becomes really distressing.

Celin:
People start to also feel depressed about that because it's like, "Well, what can I do? How significant am in this world?" Which can then lead to existential type OCD where people then worry about, and have this preoccupation with, "What's my purpose in life? What are we doing here?" And can search the internet incessantly and spend hours and hours and hours needing to find the answer, when perhaps really, is there an answer to any of this stuff? We're still trying to think about all of this, so that's where people get stuck.

Celin:
And while part of it is consistent with values, there's also a part that causes distress because it's like, okay, be involved in these causes, do all this amazing stuff. But then at the same time, we need to be comfortably uncomfortable with the fact that it's not going to be fixed overnight. We all have a role to play. And excuse my French, some people are a shit, some people do not realize that this is a problem, and are completely ignorant to it. All that sort of stuff.

Ellen:
But we can't control what other people do.

Celin:
We can't control what other people do. Absolutely not. Yeah.

Ellen:
Okay. There's more than just one type of OCD, I guess, is what I'm asking?

Celin:
Yeah, absolutely. It comes under that idea of scrupulosity in terms of morality, existential, there's thoughts about pedophilia, people get sexual intrusive thoughts, there's various germs and contamination obviously, there's order and symmetry, there's saving and loss, people get aggressive intrusive thoughts, people have thoughts of, "What if lose control?" There's suicidal as well, in terms of, "What if I lose control and kill myself?" In terms of people will often say, "I don't want to do this, but I'm worried that I might. What if it happens?"

Celin:
There's relationship type intrusive thoughts as well, where people worry about, "Am I attracted to my partner?" Or they might get jealous if their partner is talking to somebody else, that they might think, "What's going on there? Do I love my partner?" Yeah, all that sort of stuff.

Ellen:
So the obsessive compulsive part comes in where these thoughts and feelings, I'm guessing, become so overwhelming, so perhaps when it comes to things like climate change, "I'm so overwhelmed by what there is to do and how we're going to do it," and they become obsessive intrusive thoughts.

Ellen:
And they're compulsive and then perhaps there's associated behaviors that become compulsive.

Celin:
That's right, like, "I need to solve it, or I need to find the answer, or I need to be involved in every single thing possible, or I need to get my message there," all that sort of stuff.

Ellen:
Okay, so a fear and overwhelm and it just spiraling out of your control?

Celin:
Yeah, yeah, absolutely, yeah. And in terms of what you mentioned earlier of verging on that delusional, almost psychotic, I guess, presentation, for me that's when anxiety gets so high, when people's anxiety levels are through the roof.

Celin:
The brain then generates this idea of, "This is what's going on," and the person then starts to believe that that actually might be true, which then causes an even bigger level of distress, yeah.

Ellen:
Osher Günsberg, in his book, which is Back, After the Break, and he talks about actually seeing sea levels rising. It was like he could actually see, and so his brain and his body therefore were believing that that was what was occurring, and yet all the other signal around him, nobody seemed to be reacting to the fact that the sea levels were rising, and obviously left him and his brain in a complete quandary, and I think he does talk about the fact that that was the point at which he realized that he needed to do something.

Celin:
Yeah, for sure. That's what happens when we get so stuck on an idea, that the brain then starts to generate these intrusive images that, if it happens often enough, we then start to feel like it's true and we believe it. It's really just to keep pulling us back in and hooking us into that level of discomfort, to reinforce that pattern.

Ellen:
Okay, it's so interesting that obsessive compulsive disorder is so much broader, I suppose, than what most of us believe to be.

Ellen:
We've referred earlier to this YouTube video that I will encourage people to take a look at because my understanding is that we're not helping people when we talk about having OCD in a flippant way. Do you want talk about that just briefly?

Celin:
Yeah. It's definitely used as an adjective probably more often than not, I guess. Yeah, if you talk to anyone with clinical levels of OCD, they'll often say they feel so frustrated, if only people knew what it was like. It's not something that you wish you had. It's really not, it's exhausting, it's tiring. 14% of people with OCD, which is a high statistic, can't work.

Celin:
The World Health Organization listed it in the top 10 of all the world's physical and mental conditions, as the most debilitating condition. People don't realize it, but the way that it can really take someone's life away, in terms of what they want to be, who they want to be as a person, and the way it can also impact families and relationships, and the amount of relationships that become destroyed because of it, it's horrific.

Ellen:
So part of that, I'm guessing from the sounds of what you're saying, that your clients mention to you is that it would help them, it might help us all if we had a bit of a better understanding of what the disorder is, and just how disabling it is.

Ellen:
And perhaps not use those terms quite so flippantly because it doesn't help, it just doesn't [crosstalk 00:43:03].

Celin:
No, definitely not, [crosstalk 00:43:03]. Yeah, yeah, absolutely. Yeah, yeah.

Ellen:
I must admit, I've become a bit more sensitive, firstly with the term schizophrenia or schizophrenic, that used to be referred and sometimes still is as one thing or the other, or people can behave in different ways and people would refer to that as being schizophrenic.

Ellen:
Firstly, well that's not an accurate representation of what schizophrenia is. But also, that's not helping because this is actually a really distressing disorder for people.

Celin:
Absolutely, and even bipolar to describe two personalities, and it's like actually no. That's a totally different thing. [crosstalk 00:43:45] erratic, they're like, "Oh, they're so bipolar," and it's like no.

Ellen:
No, don't do it. And yeah, so the same with OCD. If you find yourself wanting to use the phrase, just pause for a minute and think, "Actually maybe I'll find a different way to describe this," because this could actually be quite distressing to somebody who really struggles with the disorder themselves or has a loved one or somebody they know who struggles with disorder.

Ellen:
I will put a link to that video too, so that people can watch that as well. I will also put a link, Celin, to, you gave such a wonderful long list of books and resources. I'm not going to go through them now because there's about 20 of them. But they're all there in the show notes for the episodes, so that you can if you're interested in following up. That covers specifically around OCD, so you had a number of different books and tips and resources for people. But also anxiety generally, which is fantastic, so lots of information there.

Ellen:
Is there one standout for you, in terms of if there's the first book you might go to?

Celin:
Not particularly, because I err on the side of everyone's different, everyone receives information differently, so I think you've got to just check out what's there and choose what feels right for you because that's the most important thing and that's what's going to work.

Ellen:
Perfect psychologist response.

Celin:
Yes.

Ellen:
Celin, thank you so much for today. It's been really interesting. I've learnt a lot and I hope our listeners have learnt something too, or given us even just pause to think about our own fears and phobias and our anxiety responses to very ordinary things, and when they're helpful or when they're perhaps not helpful, and a better understanding of what's going on in our brains when we're having those experiences.

Ellen:
I think the more we can understand about what's happening, the more power we get.

Celin:
Absolutely, yeah. Definitely.

Ellen:
I really appreciate all of your insights and wisdom and knowledge and-

Celin:
Thank you, it's been an absolute pleasure.

Ellen:
Where can people find you? I will put all the links in the show notes as well, but where can people find you if they want to find out more? Because I know you're on social media and you've got websites and all of that stuff.

Celin:
Yeah, yeah, so people can find me on my practice's website, which melbournewellbeinggroup.com.au. They can find me on Instagram, they can follow the clinic, under Melbourne Wellbeing Group, or they can follow Dr. Celin Gelgec as well, and it's the same handles for Facebook. Yeah.

Ellen:
Okay. You've got free resources on your website, you've also got blog posts on your website.

Celin:
Yes, yeah. We have downloadable tip sheets and resources and that sort of stuff. And we do, we have a list of resources. We also have a weekly blog which goes up.

Celin:
We also have a YouTube which we were doing really good at posting videos, little videos, but we haven't posted one up for a little while. But the aim is to get back onto that as soon as we can.

Ellen:
Maybe this will help trigger that.

Celin:
I hope so, yes.

Ellen:
Get you back on. I know what it's like to put a lot of pressure on yourself to produce a lot of content.

Celin:
Yes, definitely.

Ellen:
I know that experience. Celin, thanks again, I really do appreciate it, and I'd encourage everybody listening, if you've got an interest to check out Celin's social channels, any of those resources on our episode and show notes, and contact Celin yourself if you might like to know more.

Celin:
Thanks so much, Ellen.