In this second of a two part exploration of OCD, Dr. H and Dr. Amy Indermuehle, a Colorado-based OCD expert, deconstruct Erin's treatment. Dr. Amy is a big fan of in vivo exposures, whether that be watching stomach-churning Youtube videos, touching forbidden items at Target, or riding out the anxiety wave in a public bathroom. Dr. Amy highlights how OCD treatment is so different from typical psychotherapy for anxiety and why so many therapists default to the much more comfortable (but counterproductive) option of trying to help patients soothe their nervous systems.

OCD is arguably the most-missed psychiatric diagnosis, for reasons that Dr. H and Dr. Amy explore. OCD is often mistaken for generalized anxiety or for bipolar disorder, with the unceasing obsessions being mislabeled as racing thoughts, and the frantic compulsions as mania.

Dr. Amy Indermuehle
http://facemyanxiety.com

Exposure and response prevention
https://www.theatlantic.com/health/archive/2016/10/exposure-response-prevention-for-ocd/505538/

Meds for OCD
https://iocdf.org/about-ocd/ocd-treatment/meds/

Exposure therapy and OCD-related disorders
http://jonabram.web.unc.edu/files/2012/07/Abramowitz-Jacoby-2014-misuse-of-exposure.pdf

Dr. H and Back from the Abyss
https://www.craigheacockmd.com

On Twitter @bftapod

The postpartum period is by far the most psychiatrically vulnerable time in a woman's life. Erin had always some some mildly annoying obsessive-compulsive tendencies, but they were never a major factor in her life, until just after her daughter was born. Almost immediately she was flooded with horrific violent images and urges, these then morphed into a paralyzing dread of viral contamination.

This is the first of two parts. This episode is Erin's story of learning to lean directly into her fears, the next episode will be Dr. H and Dr. Amy Indermuehle, an OCD expert and Erin's therapist, deconstructing Erin's treatment and how exposure therapy helped her to reclaim her life.

Postpartum OCD
https://iocdf.org/expert-opinions/postpartum-ocd/

https://www.postpartumdepression.org/postpartum-depression/types/ocd/

Exposure and response prevention
https://iocdf.org/about-ocd/ocd-treatment/erp/

Dr. H
https://www.craigheacockmd.com

On Twitter @bftapod

Listeners ask: "Can I tell my story on Back from the Abyss?"
"Can you heal trauma that you cannot remember?

Dr. H then looks back at 3 years of 800+ ketamine sessions and further explores the question of intramuscular (IM) vs intravenous (IV) treatment, as well as whether reaching full dissociation is necessary for optimal efficacy.

Dissociation improves ketamine response
https://www.psychiatryadvisor.com/home/depression-advisor/ketamine-induced-dissociative-symptoms-predict-antidepressant-response/

Dr. H
https://www.craigheacockmd.com

On Twitter @bftapod

If only swimming or meditation were as good as vodka. Unfortunately, the most powerful and rapid-acting coping strategies also tend to be the most damaging and addictive.

Annie learned this the hard way. After her father's death when she just 9 years old, she eventually found two of the most alluring and effective coping strategies, and they made day to day life possible, even manageable. They worked fantastically well, until they didn't. Annie found healing through 12 step groups and also through DBT (Dialectical Behavior Therapy) and now works as a clinical psychologist, sharing her hard-earned wisdom and relentless hope with others.

Dialectical behavior therapy
https://www.psychologytoday.com/us/therapy-types/dialectical-behavior-therapy

Effectiveness of Alcoholics Anonymous vs other modalities
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012880.pub2/full

Dr. H
https://www.craigheacockmd.com

After a nightmarish sexual assault at age 15, Mitch's life felt over. Wracked by daily dread, panic, and a desperate longing to die, he eventually found his way 22 years later to the MAPS trial of MDMA-assisted psychotherapy for severe PTSD.

In this astonishing account, Mitch describes how MDMA was able to reactivate his innate healing intelligence to allow him to go directly into the hottest fires of his trauma with a powerful shield of openness, safety, self-compassion, and trust. Mitch describes the actual "how" behind MDMA-assisted therapy and why it shows such promise for the future of trauma treatment.


MAPS (Multidisciplinary Association for Psychedelic Studies)
https://maps.org

Dr. H interview on Therapy Chat podcast about working with MDMA
https://baltimoreannapolispsychotherapypodcast.libsyn.com/218-understanding-the-research-on-psychedelics-with-trauma-survivors-with-dr-craig-heacock

BFTA in the top psychedelic podcasts of 2020!!
https://blog.feedspot.com/psychedelic_podcasts/

MDMA and inner healing intelligence
https://maps.org/news/bulletin/articles/383-bulletin-winter-2014/5427-a-conversation-with-mdma-assisted-psychotherapy-researchers-winter-2014

https://maps.org/news/bulletin/articles/435-maps-bulletin-winter-2018-vol-28-no-3/7515-cultivating-inner-growth-the-inner-healing-intelligence-in-mdma-assisted-psychotherapy-winter-2018

Dr. H
https://www.craigheacockmd.com

The root system of a tree is its hidden protection against the harsh realities of wind and drought and disease.  For people, loving and healthy childhood  attachments are our central hidden protection against the inevitable losses and tragedies of life. But what happens when these early attachments aren't safe and secure?

Jami's childhood emotional neglect and abuse and profound loneliness left her attachment roots shallow and damaged, yet her inner fire and natural resilience helped her to grow up strong and healthy despite the childhood challenges. When the winds of loss and grief started to blow, she came toppling down, twice. This led to a long list of failed treatments, benzodiazepine dependence and its horrors, and even a brief course of ECT (electroconvulsive therapy) when seemingly all other options had failed.

And today, she again stands strong and tall, a testament to her refusal to give up and to relationships that have helped to scaffold her and compensate for those early traumas.


Adverse childhood experiences and effects on long-term resilience and risk of chronic illness
https://www.acesconnection.com/blog/got-your-ace-resilience-scores

Major depressive episode vs "nervous breakdown"
https://www.psychologytoday.com/us/blog/how-everyone-became-depressed/201309/bring-back-the-nervous-breakdown

Ketamine vs ECT
https://www.psychiatryadvisor.com/home/topics/mood-disorders/depressive-disorder/short-term-treatments-for-depression-ketamine-vs-ect/

Dr. H
https://www.craigheacockmd.com

Life is much better on Adderall, until it's not.

In this episode, Dr. H and Dan Ronken, a Boulder-based psychotherapist and addiction specialist, explore the double edged sword of stimulants.  Using Dan's ADHD and addiction story as a launching point, they explore questions including:  Do stimulants make us smarter and more productive? What is the saliency circuit and why is it so relevant here? Are some stimulants safer than others? Can they safely be used by people in active addiction or in recovery? What behavioral strategies are helpful with ADD? Can you ever get that same dopamine rush without drugs? They then transition to the question of whether ketamine therapy is safe for people in recovery.

Dan Ronken
https://www.inclusionrecovery.com

Dan's Youtube channel
https://www.youtube.com/user/danronken

Dr. H
https://www.craigheacockmd.com

In this mini-episode Dr. H explores the critical implications of thinking about Depression as a syndrome rather than as a meaningful clinical diagnosis.  The diagnosis of Depression is but the first tiny step in the journey of exploring biological, psychological, and interpersonal causes and factors which might then point toward effective treatment.


Dr. H
https://www.craigheacockmd.com

In this second installment of therapists in the abyss,  Dr. H sits down with Jungian analyst and master therapist Dr. Michael Daine to explore how facing death catalyzed an exploration of the unconscious and the eventual rebirth both of his career and sense of purpose in the world.  This then leads to a discussion of whether one can be a capable and resilient therapist without having successfully passed through periods of darkness and despair.


Dr. Michael Daine
http://www.dainepsychservices.com

Dr. H
https://www.craigheacockmd.com

This is the first of an intermittent series of therapists sharing their abyss stories.  Samantha was a newly minted therapist just out of her MSW program, full of hope and excitement for her new career, when she met a client whose horrific trauma story and rapid disappearance from therapy haunted her for years.  Dr. H and Samantha explore how she was able to eventually move from the grief and regret of this vicarious traumatization to a place of acceptance and self-compassion.

A heads up— this story contains a description of a sexual assault.

Dr. H / Back from the Abyss
https://www.craigheacockmd.com