A

You're listening to the OCD Stories podcast hosted by me, Stuart Ralph. The OCD Stories is a podcast dedicated to raising awareness and understanding around obsessive compulsive symptoms. I do this for interviewing inspired therapists, psychologists and people who have experienced OCD. Welcome to the OCD stories and welcome to episode 546 of the podcast. And in this one I chat with Dr. Peter Astonishment. Peter is a licensed clinical psychologist. He specializes in working with high performance athletes and professionals using cognitive behavioral therapy for anxiety disorders, substance use disorders, ocd, depression, stress and trauma. He's also a clinical assistant professor within the Department of Psychiatry and Behavioral Sciences at Stanford University, co founder and co director of California Psychology center, and the team psychologist for the San Jose Sharks in the National Hockey League or the NHL. And in this episode we discuss working with the San Jose Sharks, why he works with ocd, OCD and anxiety in athletes, Prevalence of OCD in athletes, Performance anxiety, exposure response prevention therapy, acceptance commitment therapy, how OCD can affect athletes and much more. So obviously it's very athlete specific and in particular professional athlete specific, but I think it's the usual help everyone. There's lots of stuff in there that Pete shares that will be relevant to everyone listening, I'm sure. So I think you'll enjoy this episode whether you consider yourself an athlete or not. And thanks to our podcast partners. Nocd. If OCD is interfering with your life, NOCD can help their licensed therapists specialise in exposure and response prevention therapy. The most proven therapy For OCD with NOCD, effective treatment that is 100% virtual is available for children and adults with OCD and most members can get started within seven days on average. No hassle, just real science backed help and support between sessions. Begin your journey@nocd.com or I'll put the link in the episode description. So thank you so much to Peter for his time. It was really great chatting with him and I love sports myself, so it was great to talk to him and a psychologist who works with a professional sports team, that's always been an interest of mine, so it was great to speak to him and of course, thank you to you guys for listening. As always, it means a lot. About further ado, here is Peter. Welcome to the podcast Pete.

B

Thank you so much for having me. I'm so excited.

A

Yeah, it's good to have you on. So it'll be good to start with your background and then why you eventually became a therapist and specifically ocd.

B

Yeah, definitely happy to talk about that. So I'll just Share specifically because we're going to be talking about athletes. I think there's so many different angles to take on this question, but I was a former professional athlete myself. I played professional hockey, and when I was playing, definitely had some struggles with anxiety, had certain traits that I now look back on in myself as being kind of ocd. Like, I'm sure at times, if I was quite stressed and met a psychologist at the right time, there could have been some questions there. But I definitely witnessed a lot of struggle in players at the time. There was probably even more stigma than there is now, thankfully. And I could see overuse of control anxiety themes, um, sometimes in teammates, alcohol use, substance use, and just 10 different ways of coping with the stresses of being an athlete. And so after I decided to end, just felt most drawn to psychology as a profession and wasn't necessarily thinking about working with athletes at the time. But really kind of my first love clinically was ocd. And I really just felt like it was relatable. And just the kind of human themes of just dealing with uncertainty, needing control, not being able to find it, just kind of resonated with me as kind of a very human dilemma. And then eventually I was lucky enough to start working with athletes again, where I got lucky and got a position with the San Jose Sharks. So I'm back in the sports world and back in the hockey world now.

A

Nice. Brilliant. Brilliant. And you also work at Stanford, is that correct?

B

That's right, yeah. So I work at Stanford and my main role there is treating OCD and health anxiety.

A

Okay, cool. Nice, nice. And then with this San Jose Sharks, is that more the sort of team psychologist type role?

B

Yeah. So there's kind of different buckets there. There's a mental health component, for sure. There's a performance component. And then I also help with personality assessments for the draft. Um, and so it's. It's definitely an interesting role, to say the least. Yeah.

A

Okay, nice. And if you don't mind me asking, who did you play for when you were playing?

B

Oh, I was in the hockey world. I was what we call a suitcase. So I was traded around a bit, but different leagues. I never played in the NHL. I was drafted to the NHL. I played in. There's something called the American Hockey League. And so that's kind of one step below the NHL where there's like, you're on a farm team for NHL clubs. But I never made that final jump, partly due to probably anxiety and, and, you know, maybe a deficit of talent.

A

Fair enough.

B

Yeah.

A

Okay. So you Never came over to Europe to play because a lot of them.

B

I played in Finland for half a season, but that was the closest.

A

Yeah, okay, fair enough. Yeah. Because our hockey league's quite good. It's not nowhere near the NHL, obviously, but it's quite high.

B

No, a lot of the best leagues are in Europe, so. Yeah, definitely.

A

Yeah. All right, nice. So, well, you got to the NHL eventually. It was just as a psychologist.

B

There you go. Yeah, exactly. Finally made it the hell.

A

Yeah. Yeah. Cool. No, interesting story. So. So with the ocd, it was more just when you were training, you somehow stumbled across that and thought, I like this. This is sort of my area.

B

Yeah, I just had a really great supervisor, and I just had one case with her. Her name is Faith Brozavec. She was amazing and really was the first supervisor who I felt really held me to a really high standard and asked me a lot of questions and forced me to kind of question and think about what I was doing at all times. And it was actually. I remember thinking of it like it was almost like supervision with her. Felt like going into a sports game with all the bodily functions happening. But she was very, um. But just that having someone to just hold me to a high standard and question kind of every decision I'm making clinically. Um, and so, because it was ocd, it was the first time I felt like, oh, I really understand how to treat this. Um, it felt very aligned with kind of my own experience, and. And I felt like I finally had a model to work from that was kind of hammered into me by my supervisor. Yeah.

A

Okay, nice. Okay, so we're starting off with, you know, athletes, professional athletes, because I'm sure it will be fairly similar among the different sports to a point, because the same sort of expectations are there. I guess what's initially upfront worth us knowing about, you know, OCD and anxiety in athletes, what sort of things are they? How does it differ, I guess from the general public?

B

Yeah, that's a good question. I think, like, whatever environment you're in is going to pull on certain themes with ocd. Of course, any type of OCD can show up in any arena or any kind of area. But I would say that types of OCD that are kind of more. Hold on. In the athlete world, I would say there's a lot of body focus, so kind of being really overly fixated on different aspects of your health or body or where your body is working. There can also be a component in, like, the more violent sports, like hockey, with knowledge of, you know, the Impacts of concussions, where people are kind of questioning, like, my memory. Is this working okay? Is there something wrong with me? Am I gonna, like, be okay? And that's actually not necessarily just, like, an intrusive thought that doesn't fit the facts. It can be something that is a real concern for people. But that's definitely an anxiety theme that comes up in the hockey world. But, yeah, just a lot of perfectionism around performance. And as an athlete, I think you're really exposed, especially at the highest levels, so there's a lot of eyes on you. So there's a lot of mind reading and guessing what people are thinking and not being able to live with the uncertainty about what coaches think or fans think or. Or whatever. And then I think sometimes athletes will really fixate on, like, concrete things, like, what are my stats? What are my contracts looking like? Am I secure? I think something that is true about being an athlete is it's almost like an exposure thing, where you're doing something that has an uncertain outcome. Most athletes, unless you're the best of the best, you're actually in a very insecure position, so you're only as good as your last game. So there's a lot of, like, anxiety that can come in. And, yeah, the stakes feel really high. As an athlete, your identity is kind of in it. And I think of it as, like, the. It's like a virtual reality of importance. Um, and that's kind of what OCD does to us, too, right? It creates this virtual reality of importance. So I think. Yeah, I think there's a reason why a lot of athletes do experience OCD symptoms and anxiety. It's partly because the environment and it pulls on different kind of fears for people.

A

Yeah, yeah, yeah, you're right. Because unless you're LeBron James or Cristiano Ronaldo, you are not really that safe at any moment. You know, Traded.

B

No.

A

Sold, or.

B

Yeah, demoted. Yeah, yeah, exactly.

A

Yeah, yeah. And that must be quite a really unstable way to live, especially when you suddenly might have to move across the country and sell your house or buy a new house or rent a new house and move your family from their schools and. Yeah, that must be really tough.

B

Yeah, it is really hard. I tell I sometimes when I'm working with players, and even though at one point my dream is to make the NHL, I work with them, and I'll tell them, like, I don't want your life, because I can have a bad session as a psychologist, and no one really knows. And, you know, people are generally nice when they have OCD and anxiety. So it's. There's a lot of forgiveness that doesn't happen in sports in the way it does in other professions. Yeah.

A

So maybe. I know this isn't quite ocd, but, like, how would you work with an athlete who is maybe struggling with this kind of. What's the word? Like, I don't have. Existential stability is the right word. But like this. I don't know whether I'm going to be here in two months. Not in terms about the team, not life. You know, how do you. Sort of. Because obviously, I guess thinking with my therapist hat on, if we can't. It's like Maslow's hierarchy of needs. Right. If we can't give them that kind of stability, love, belonging, food, shelter. That must be really hard to then work on, say, the ocd.

B

Yeah, definitely. I mean, I think it's a huge thing where I. I don't have any research on this, but I would imagine people's anxiety levels and OCD kind of. You saw a graph over time, like upon their contract expiring, like, there's more insecurity. They're invested in the game, likely, you know, anxiety. And I've seen this before. Anxiety and OCD will kind of ramp up for those folks. And I think a huge part of it is just validating. Like I just said, like, you're not secure. Like, this is a really unique job. Of course, like, there are other jobs that are very insecure as well, but the stakes are so high. And one of the things about sports is, like, your performance is just so on display. Right. And so concrete. So I think. I think kind of what I lean into is not trying to come up with some secure story, but to really validate what they're doing is really hard and try to kind of help support them. Embracing that part of the profession. And then obviously, from an ERP standpoint, really kind of scaling back any kind of overuse of control that might be coming in as a way of coping and kind of sticking to that, like, therapeutic attitude of acceptance of uncertainty and embracing the uncertainty. And. Yeah, again, just respecting what that person has to go through. It's very, very stressful.

A

Yeah. Yeah, that makes a lot of sense. And yeah, I guess maybe you can't give exact numbers, but, like, within your experience of working in the hockey league, how much do you see ocd? Specific.

B

Yeah, I mean, it's interesting. There is some research on this in OCD in college athletes, which I think is really great research. And there's a article by Kromer and colleagues, which looked at, yeah, Division 1 athletes in the United States and basically examining kind of obsessive and compulsive symptoms. 35% of those athletes kind of had obsessive compulsive symptoms. And then they kind of funneled down to around 5% would meet criteria suggestive of OCD, a clinical diagnosis which is like about double the general population. And so, yeah, it's definitely prevalent. I think like I said before, there's aspects of the environment that pull on anxiety because it's much more insecure. So I think that's a big piece of it. But when I'm working with athletes, I, I kind of, I see kind of different pathways to becoming elite. And you know, if we deconstruct so there's an elite athlete, how do they get to that place? Obviously there's the, the God given talent and all that stuff. You have to have some like natural born skill to kind of become to that elite status. And yet of course athletes are practicing. I can think of it as like organized behavior over time is practice. And what are the different pathways to organized behavior over time? One of them is the athlete who is highly conscientious, driven, focused, you know, that's part of the personality that they have, maybe has some positive emotion, generally emotionally stable. That's the most common presentation of an elite athlete. And then that organized behavior over time, which we call practice, happens naturally. It just kind of becomes a self reinforcing thing because of those personality factors and then they get really good. But there's another way to organize your behavior over time which is more fear based. So the athlete I'll often work with is someone who's certainly conscientious. Conscientiousness is really important for development and progression, but it's mediated emotionally not from positive emotion, but from fear. And so that's leading to this kind of behavioral organization and progression. And then they might become really good at their sport. But one of the cool things about this study, and probably the most important thing is they then looked at all conference athletes within the pool. And so these are the elite Division 1 athletes compared to the rest of the pool. And actually those athletes had less ocd, so more kind of aligned with the general population. And it kind of debunked this myth that OCD is like good for performance. And it's good insofar as it can help shape behavioral organization towards a goal, but it also holds people back from getting to the next level. So it's actually a bit of a myth. I think that somehow OCD is good for performance. It's much more nuanced than that. And I think of the way, for example, if someone's really anxious about performance, the way they practice will be different. They'll practice not so much for growth, but they'll practice for security. And so there's. I don't know. Have you heard of Macklin Celebrini?

A

No, I haven't.

B

Okay, maybe not in the hockey world. He's like the next superstar of hockey right now. And he plays for the San Jose Sharks. And I'll just share. I've never really even talked to him, so I've not worked with him or anything. But I've listened to him on podcasts, the way he talks about his practice. And he would. And this is like through his teenage years, as he was kind of improving. And he would go to, they call it Gretzky Hour, which is basically free ice to work on whatever you want. And he described in this podcast, I listened to how he would just think back to his last game and just focus on all the things he wishes he could have done better. Like. Like different moves and probably on a very micro scale. Cause he's kind of very focused and dialed in. But he's not training to feel secure. He's actually training from a place of opening up to anxiety and trying to get better. Whereas when I was a player, I would often practice the things that I was already good at, and it would make me feel really good about myself, but I wasn't necessarily moving the needle and progressing the way someone who wasn't, like, OCD focused would. And then there's other aspects where, yeah, OCD will definitely block the flow state. Obviously, athletes are trying to, you know, play freely. You don't want to overthink when you're playing because you want things to happen automatically. And then the other piece where I think people with anxiety and OCD are so held back is recovery. So. And when you're younger, when you're 15, 16, you know, 18, it's not as a parent, but as you become a pro and you get older, Right. Or if you have children, like, you need rest and recovery and OCD does, and anxiety blocks that, the stress is kind of preventing the body from recovering. So there's all these ways in which, even though, yes, fear can organize behavior in a practice way, that can make you better to an extent. To me, a lot of athletes reach a ceiling that's not their real ceiling because they're still operating from this OCD place. Or an anxiety place. And all those other factors that I just mentioned are kind of being held back. Um, so, yeah, it's, it's, it's one of, that's the type of athlete I love working with. It's like, okay, you've got the talent, you've gotten so far, you're very driven, but we need to turn your motivation from a stick to a carrot. Um, and you still need to kind of work on your craft, but a different way of being needs to come in.

A

Yeah. Yeah. That's really interesting. Yeah, I mean, I can relate a lot to that. I never played professionally or semi professionally, but you need this sort of amateur leagues. Even in skateboarding, when I was a kid and a teenager, my technical ability was way beyond what I was actually doing in terms of size of things because my head would just overthink, get in the way, amplify the worst case scenario. And then when I got into basketball later on and then played for my university and all of that, I did okay. But I knew what I could do in training was like three times as good as what I could do in a game. And, and it was just my head. I couldn't think. I was thinking too much. Sorry. And it wasn't until I got in my 20s and I was playing in the amateur leagues and, and I started to dominate and do really well because I worked on anxiety. I wasn't as bothered.

B

Yeah, yeah.

A

And, and I sort of. My ceiling grew, you know, too late, but it grew. Yeah, but I was really loving playing for once, you know, in my head.

B

And there's a joy that comes from playing free. Right?

A

Exactly.

B

It sounds like you went from the threat focused mindset to more of a free play and. Yeah, I was, we call that in hockey world, a practice player. I was. Oh, my God, Stu. I was a practice player. I was so good in practice. And then game would come and I'd be tight and I'd be overly controlled. And then things that would be automatic in practice would not work in games in the way that I wanted them to. And in the sports psych world, there's a curve called the Yerk Dodson law. And it's basically this principle of performance being optimal when stress is kind of in the middle. Like, you don't wanna be too low because then you're not gonna have the energy and focus that you need. But if, then you go too high, obviously you get tighter and you get more kind of, you know, in your head and, and then you kind of fall into these control things. That take you out of the flow state. And so, yeah, a lot of people with ocd, one of the telltale signs is, are you better in practice? Because as soon as the stakes are high, anxiety goes up and then, boom, they lose their game. Um, so, yeah, you're in good company here with me.

A

Okay, that's good. That's good. Could have done with you 20 years ago. Would have helped me a lot. Um, no. Yeah, that's. Yeah, it. Yeah, it must happen to so many athletes. Yeah. And it's sad because they. I mean, I was never, ever gonna go anywhere near professional, but for those that are on that cusp, it's really sad that ocd, you know, gets in the way like that, or anxiety generally.

B

Yeah, yeah, it feels. I mean, it feels out of control. Right? Like, and people with OCD in general know what it's like, where your body is not doing what you want it to do and what, you know, it can do. And. And, yeah, it's. It's so frustrating for people, and it can feel like. Yeah, very oppressive almost.

A

Yeah, yeah, yeah, absolutely. Okay, so how. Well, okay, maybe specifically to your work with the San Jose Sharks, how do they come to you? Do they volunteer for, like, mental health support? Or is it like the coach said, look, this player's struggling. Can you speak to them?

B

Yeah, no, it's definitely an interesting environment. The team is very supportive, and at the same time, I think people look a little sideways at the psychologist. So I try to find opportunities to present on a topic so people can have. Have some sort of reason to approach me or some sort of commonality versus me. I'm not a big schmoozer, so I can't just go and like, hey, you come here often? Like, it's just not my style. So I. I really try to kind of emphasize I need kind of some sort of facetime with the team, and that way people can have a reason to approach me. I do kind of presentations throughout the year, and then. And then sometimes the coach or a teammate will kind of say, hey, can you check in with this guy? And we'll kind of work together on zoom briefly. I also work with the staff and. And hockey is. I mean, hockey is a really intense world, as is, like, a lot of professional sports, so I'll share that. Like, when I was a player, I was stuck in the. The virtual reality of importance of sports to a point where I couldn't get out of it. I had to have a long time away from the sport where I could kind of see that this is actually kind of empty. And I think sports are both like, full of meaning and also empty of meaning. And to me, like, when I first interviewed with the Sharks, I was very nervous. And I remember walking into the arena and I was like, oh, I haven't been in one of these things for 15 years, but I feel exactly like I did as a player. And I could really feel what it was like to be in that environment. I felt watched, I felt high stakes, there's an anxiety. But then Luckily I've got 20, 20 years of experience and like years of clinical training. And it was an interesting experience to kind of feel myself like in that virtual reality and then seeing, wow, this is empty. And it was just kind of like back and forth consciousness that was happening. And as I was kind of untangling myself from like the really kind of sticky meaning of how high stakes this all is and how. And that. And the sports world will really enforce that. It's like all people care about, right, is winning and performance and, and it's just, it was helpful. I was like, I wish I could do that as a player. I wish, I wish back in the day I could see how it is meaningful and it is empty. And sometimes you need to kind of have that psychological flexibility to kind of zoom out. And actually I've worked with players before who said, and I find this kind of unbelievable because I'm like, how does anyone be a professional athlete and have children? Because, like, you're not sleeping, you have no time for yourself, right? That being an athlete is kind of a selfish profession. Your job is to feel good. But what happens is people become parents and then they exit that virtual reality of importance and they have a different view on the game. And even if they're not sleeping as well, amazingly, they feel better and they can play free. So I've encountered that and I think that that's something that athletes definitely struggle with. Where you don't think there's anything else, there's just this. This is the most important thing, your whole identity is in it. So anyway, it's just, it's just an interesting environment to be in. As a former player.

A

Yeah, absolutely. Well, I guess they've spent their whole life getting to this point that they haven't developed. Maybe the other areas of their life, other hobbies, relationships. Obviously that's not the case for everyone, but I imagine, yeah, those things have to become secondary to make it.

B

Yeah, there's a lot of behavioral shaping. Right. As a teen, as, as you advance in sport, your whole environment is defining Success as being related to performance. And I think parents can do a really good job hopefully of like helping kids zoom out from that versus kind of sometimes parents can actually reinforce that mindset, thinking it's going to help the kid play well and then they're going to feel better about themselves. So let's just help you be better. But parents, I think one point of advice for anyone who has an anxious athlete, and sometimes, by the way, athletes will start out loving a game and then when they're 13, 14, 15, it becomes higher stakes. There's an identity piece that comes in and then boom, they're kind of having an anxiety problem and the game loses that joy association. So yeah, just I always say to parents, like, help your kid reconnect with why they love the game and help them see the importance of it for growth on a more meta scale. It's not just about winning, but also how much there is outside of the game or the sport. So.

A

Yeah, yeah, yeah, absolutely. That's good, that's good advice. And you know, going back to the themes of OCD around professional athletes or even hockey, I mean, because I know there's the NHL, NHL, they do, they still allow sort of punch ups, misfits, punch ups, uppercuts.

B

Yeah, no, they, they fight. Oh, yeah, yeah. It's rough.

A

Sorry, not punch up as in an uppercut. In the uk we just call it a punch up, a fight.

B

Oh, yeah, okay, nice.

A

No, literally punching up. Okay. Maybe that's where that saying.

B

I kind of thought I was mistranslating there, but I went for it.

A

No, no, no, it might, that's where it might come from. But yeah, anyway, a fist fight, punch up, they still allow it, right?

B

Oh, yeah, yeah, you get, well, you get five minutes to sit down with yourself. So that's the punishment. You get to sit on a bench for five minutes.

A

Okay, cool.

B

Yeah, yeah.

A

Because they allow in the hockey league here in the UK as well, which it's. I know it's probably controversial still, but I kind of like it. I think it's fun. You don't get it in other sports except for MMA and boxing and. Yeah, yeah. Anyway, my point is, I imagine for someone who's like me, I imagine if I played hockey I would probably get in a fight, enjoy it, and then 20 minutes later be like, oh my God, I just ruined that guy's day. What happens if I've hurt him? Seriously? You know, I'd feel really like bad about it. I wonder if you see those sort of themes of harm coming into like you get caught up in the moment, let's have a fist fight, and then the ACD kicks in. And why did you do that? You know, is there any of that sort of?

B

Definitely, yeah. I think it's interesting where. I think. I wish that came up more. In a way, I think, you know, whatever is taboo becomes like a ripe area for ocd. And I would say that at least in the hockey world, harming someone is not necessarily like, being a dirty player is frowned upon kind of. But sometimes you want that dirty player on your team because then it helps you win. So it's kind of a mixed bag. There's a lot of, like, pretending we don't like dirty players or like, you know, I don't know, there's something about it where harm to others is not taboo in a way.

A

Okay.

B

And you just look at the, you know, fans going nuts for fights and all the reinforcement there. So in some ways, because of the culture of hockey, it's actually not likely to be as intrusive. And that doesn't mean that doesn't happen. I mean, hockey players are humans and they care about people. And that I think, definitely it probably does. I haven't encountered it a ton, though.

A

It's a good point. So maybe in other sports, like, I think, you know, my past, where I've been playing football is in soccer or basketball, and I've got carried away in the moment and shove someone. Or it's more when I was younger and hadn't worked on myself, but. And then. And then later on I'd be like, why did I do that? You know, like. And then it all kicks in. Because obviously shoving someone in basketball isn't socially acceptable. You know, aggressively slide tackling someone in football is kind of acceptable, but it's dirty and frowned upon. Not that I was doing it intentionally, but maybe I went in too hard or whatever.

B

Yeah, well, I mean, I'll just share a brief story. When I was a pro hockey player, I actually was in a brawl. We call it a brawl, not a punch up. I like punch up. That's good. And everyone on the team was squaring off with someone. And at the time, I was strong and I wasn't a fighter. I'm not really someone who could play aggressively in the way that probably would have supported my career. But I was tossling this guy and somehow his helmet fell off and I was on top of him and his bare head was on the ice, and I was just pinning him down with my knees on his shoulders and. And then I did Nothing. And I actually. It was kind of, I don't know, dissociative experience to go. When you get it called in the coach's office. It's never for good reasons in hockey. And so I was called into the coach's office the next day. And I walked in and the coach was really silent. He had me sit down. The assistant coach was there. They were playing the video of the fight. And he played it, rewinded it, played it, rewinded it. It was silent the whole time. Then he looked at me and said, what did you do wrong? Um. And I said. I mean, I. I tried to stick up from, you know, I. I don't know what I said. But he said, you have to finish him. And so that's just to say, like, I mean, this is 20 years ago.

A

Yeah.

B

And I think there's a bit of an awareness now that, like, the dressing room and the code of what happens is not as, like, secure lockdown. So some of those, like. I don't know if a coach would say that today to a player. Yeah. But I mean, you're. He was kind of saying, you know, you gotta, like, damage this person's brain. Like, there was no reason for it in. In my mind, and it was just not in my nature to do that. But it was definitely one of the more terrifying moments of my career just thinking about, what. What is this?

A

Yeah, it was.

B

So. Yeah. Certainly I was almost having the opposite experience of wanting to, like, wishing I could have thoughts of wanting to harm people, but they weren't coming.

A

No. Yeah. That does feel really extreme to hear. Yeah. Because it's one thing having a fist fight on your feet. As soon as someone's on the ground, then it's a whole different level. It's dangerous. It's dangerous on the feet, too, but you know what I mean? It's super dangerous. So, yeah, it's. But I guess that's the culture, right? As you said. But. Yeah. Odd, because I guess. Yeah. Maybe he's also thinking from a fan perspective. That's what they want to see, and we're here to sell tickets.

B

And I think he said, what would he do to you? That was his kind of argument. And I would hope he wouldn't, you

A

know, but you're not him. You have your own values, right?

B

Yeah.

A

Right.

B

No, exactly.

A

All individuals. Yeah.

B

Yeah. And it wasn't like I was on top of him thinking about my values, but I, like, just, like, I'm not there.

A

Were your values kicked in, didn't they, Automatically.

B

Yeah, yeah, exactly.

A

Yeah, okay. Well, yeah, you made the right decision, I'm sure. And yeah, you could have done the whole wrestling, pretended to hit him. You know, we just go really close and then don't.

B

That would have gotten me.

A

Yeah, just like just told him to act, Just move your head when I.

B

Yeah, yeah, yeah, exactly.

A

Yeah, yeah, no, that's tough. Yeah. Okay. So, yeah, maybe it's sports specific, because different sports you get in a fistfight is probably very taboo, like basketball and so what else? So with the. Obviously, ERP is going to be very similar. Right. It's the same therapy for any athlete with ocd. But is there anything you need to consider as a, as a psychologist when working with them and how you do it or. I don't know what I'm asking, but,

B

you know, it's a great question. Yeah, I think, yeah, there's definitely adaptations to be made with erp, I think. And by the way, when I'm working with someone who has anxiety and wants to improve their performance, ERP is the model I'm working from. So I'm trying to help the person's brain not produce such threat signals. And to me, that response prevention piece is the key to that, of course. But yeah, I think one thing we do with athletes, athletes are really good at suffering. So it's one thing that I think is an advantage to an athlete where they know how to deal with discomfort. It's not usually like anxiety necessarily, but you can translate that tolerance of discomfort to anxiety. Usually a lot of stigma gets in the way of that. But once you work through that and think of this as like a new challenge, that can be something that's strength that you draw on. But another thing that because they're so good at suffering, they don't care about it that much. They really care about winning and performance. There's a competitive element. So oftentimes when I'm framing treatment, I'm actually framing it in terms of performance versus for someone who, who isn't necessarily an athlete. I, I, I would, or like a high performer kind of mentality person. I would frame treatment around suffering, but sometimes there's not a lot of they don't care about suffering as much. Not to say that they don't, but they, you know, that that's a helpful frame for some players. I don't want to overgeneralize here. And then I think, I think because what you're trying to do is help people accept anxiety while they're playing and not engage in kind of control strategies that end up reinforcing anxiety. Um, but then they're also, while exposed, they're needing to perform. So there's a lot of integrating body movement into exposures. So kind of connecting with the body and kind of moving with the body, kind of accessing flow in the midst of anxious thoughts, anxious experiences. But I think that's another. Another piece. There's probably other adaptations. I mean, there's a lot of just control around routines and kind of helping athletes go from like, what's a healthy superstition versus, like, more of a compulsive superstition. Like, that's kind of something that is often a topic with athletes, which could be true for anyone, really. But. Yeah.

A

Yeah. Do you. Do you. I guess. Do you ever sort of mess with their superstitions? And I don't mean on purpose, but, like, ever use it as a way of challenging of, like, let's show that this is just, you know, tying your left shoelaces first isn't actually helping you play well. Or do you just kind of leave that?

B

That was my compulsion. How'd you know? I had to do my left skate first. So funny. Yeah, that was, like, one of my main ones. Yeah, absolutely. Yeah. So, I mean, and I think it's, like, helpful to really have a sense of what is helpful. Like superstitions or magical thinking is so ubiquitous, especially in the sports world. I think it's just because there's so much insecurity and uncertainty that you need to somehow outsource control to some behavior or thought. Sometimes people will, you know, point up to God. And that feels like almost like a helpful outsourcing of control for a lot of elite athletes. And you see them do that on the court or on the ice or whatever. But, yeah, so to me, it's all about, like, what is the outcome of this behavior. So I remember when I was a player, and it's funny, this was stemming from when I was a kid. I used to. When I was waiting for the bus, I'd rub my palms together, and there was this genuine belief that, like, this is influencing reality. And I knew that was, like, something I should hold private. But there's a magical thinking, like, there that. And I wait for the bus. And sometimes it would come, and I'd be like, yes, it worked. And sometimes it wouldn't come. I'd be like, well, it doesn't work all the time. It's not perfect. But then as a player, I remember when I was listening to the anthem before the game, I would do that in my gloves. I would kind of Rub my hands. No one would see it. And. But I was one and done. And maybe there was a grounding component to it. Helped me focus on something kind of more visceral versus my thoughts. And. And then also there was a belief that somehow even though I didn't believe this belief it was still present that like, this would make me play better in some ways or there was some sort of like, magical belief there that it's hard to even put my finger on. But yeah, that would be a superstition that has no negative consequence. Like it. It helped me feel more willing to approach the game and be open to uncertainty. But yeah, you have other players who. The rituals get more intense and it becomes more of a need for control and they're using it to kind of avoid the feeling of uncertainty and that's going to really kind of hinder performance. So. Yeah. Yeah, there's a whole. The whole range and yeah, messing up. Messing them up for sure. I mean, I remember yeah, telling just like around like kind of control behaviors. For example, with eating, like, athletes are overdoing, kind of like having the perfect diet before a game and just being like, okay, you're gonna go to McDonald's. Like, this is like you're gonna do something completely different from what you're doing. And.

A

Yeah.

B

And that, you know, that can kind of break the cycle a little bit. Take some of the power away if it's gone too far.

A

Yeah, yeah, yeah. Okay. I like that. I like that. Have you worked with any athlete clients who their OCD is kind of come in during a game and. Because I imagine a lot of it is. Yeah, let's do exposures, you know, as normal in the therapy room. Here's your homework. But is ever the homework is actually do this during a game for those athletes that the OCD is specifically targeting gameplay. Definitely.

B

Yeah. And that's where like practice players might not struggle with those thoughts and experiences when they're practicing because the stakes might be lower. It might come in a little bit. But really the game is often the exposure. And so it's the best arena for growth and change and transformation. So. Absolutely. And. And yeah, I'll just share Athletes, the best athletes are just highly conscientious people often and they need to solve problems. So sometimes I'll. I'll help athletes kind of make a deal with their mind. For example, like, okay, we want you to be kind of exposed to uncertainty when you're playing and open to uncertainty. Not engaging these control strategies that kind of like take your focus away or Take your energy away and become a distraction and block your flow. And yet maybe they make a mistake. And there's this automatic kind of rumination that comes in during a game. And that's kind of like obviously a control behavior. So what some athletes will do is they'll. They'll make a deal. Okay, this is a problem for one hour after the game. And that kind of deal of like, I will deal with this helps them in the moment kind of stay open and kind of reset in a way. So, yeah, definitely, there's a lot of stuff to be done there. And then there's also some routines that help people reset. Breathing routines, different kind of things that could, like almost ritualistic, but you're just working as a therapist to help build those routines in a way that won't backfire. And then, and then always looking at what is the function of this routine here. And usually the routines are happening on the bench between shifts. For example, in hockey versus kind of while they're playing. While they're playing. It's just. Yeah, allowing feelings is really important. Another thing that athletes with OCD really struggle with is because there's a lot of talk in the mental performance world of visualization that doesn't work if you're one of those athletes who is someone who's kind of more threat focused in terms of like the way you approach the game. Because then you start visualizing and guess what happens, you start having intrusive thoughts.

A

Right.

B

And this tool that feels like it works for other people and people talk about, it's like the main tool that people talk about in the sports world is exactly the opposite of what you want. If you have OCD or anxiety as an athlete, you have to accept thoughts and not try to, to neutralize them or have positive thoughts. So that's another helpful thing in the game. And then the other piece that I think is important in the game because things are happening so fast, you have to make quick decisions and just having people quickly decide, am I going to treat this like a real arm or a false alarm right now? Right. And treating it like a false alarm is usually the right choice when you're needing to perform.

A

Yeah, yeah, yeah. Okay. And so you've mentioned it already, I think, but like, do you use act?

B

Oh, yeah, yeah, definitely.

A

Yeah. So using that and I guess other things to also help them become more present in the, in the moment, as you say, get in the flow. Are there any particular skills within ACT or anything else that you like for helping people focus or come more present?

B

Yeah, I, I don't. I'm not a big metaphor person personally. And sometimes, you know, as a therapist, you kind of treat people the way you want to be treated. So there's a little bias there. For example, leads on a stream. I've never been able to connect with it. I'm not a big visualization person either. But yeah, I think the most, the most important thing that I do that feels act focused is just kind of coaching people towards acceptance. You know, I'll sometimes have open palms. I think self as context is a really important kind of facet of act that I think is really relevant for athletes because you're really wanting to. I think what happens with anxiety is we tend to start to fixate and if you start to fixate, you lose the global plot of your body working. So kind of being able to zoom out and observe your behavior as you perform almost like from this third person perspective is something that if people kind of can resonate with that, I can kind of latch onto that as being like a, a perspective shift that we can bolster. That definitely helps athletes in a big way. So self as context, to me it's like being open to everything inside and being open to everything outside as this kind of like observer. And if people have a sense of that building on it, it can be unlocking a lot of kind of performance resilience. Because yeah, I think, you know, what happens is when you get anxious, your attention contracts. And I know what it's like to play hockey with contracted attention. It's not fun, it's dangerous. It's really dangerous. So, yeah, that, that openness and I'm usually coaching, not necessarily in metaphor, but just with whatever words come. Yeah, coaching. The ERP model, basically with an acceptance lens.

A

Okay. Yeah, I like that. Yeah, you're right. When that anxiety kicks in, I guess just anyone with ocd, it's like, it's like a tunnel vision, isn't it? And you just lose situational awareness, which. Yeah, if you've got a load of big hockey players sprinting at you on ice, it's probably quite dangerous.

B

It's terrifying. Yeah, no, for sure.

A

Yeah. Cool. So is there anything else you wanted to say on working with athletes and ocd?

B

Yeah, I think, I think the main point, I think just to reiterate is just to debunk this idea that OCD is helpful because I think a lot of athletes who have had some success and recognize that there's a fearful control that comes in will attribute their success to the fear based control. But really what Hap. What leads to success is the practice and there's other ways of organizing that practice behavior that doesn't necessarily need to be fear based. And even if you have benefited to a point, you will be held back by ocd. You know, you, you won't get to the next level because as I said before, it's holding you back in the way you practice, it's holding you back in the way you can be resilient in games and flow. And then recovery is a huge piece too. So I think debunking that, I think continuing to drive a culture of help seeking, I think any coach out there should be aware that, you know, 35% of your athletes might be having kind of more of anxiety based approach to the sport. And you know, a good number of them might kind of either have OCD or kind of be on the cusp of such criteria. And the way you coach them is going to need to be very different from the way you coach that other athlete who's kind of more a standard story of an athlete, conscientious, you know, hardworking, positive emotion, emotionally stable. And so I don't know, I try to frame everything in sports as being kind of performance related. So just get buy in. And like, I think teams really need to pay attention to how to support players who are struggling with anxiety. Obviously for the humanistic angle that's the most important thing. But even, you know, for performance, you're not getting the best out of your players if you can't support them well. So I think hockey has a long way to go with like more of a help seeking mentality and support mentality with mental health and it's probably behind other sports to be honest. But yeah, just to, just to like deliver the message of. This is a common story for an athlete and therapy helps. Don't keep doing what you're doing, get help early because like, you know, I know what it's like to kind of burn out on that pathway and it's really not fun.

A

So.

B

And I've seen it many times with different players and so yeah, just kind of create a culture of help seeking and support in the sports world. Continue to drive that. I think things are getting better.

A

Yeah, I agree with that. And do you know, I got a feeling it's probably not just hockey. I imagine most professional sports, I mean you can see that. Like how many professional athletes have been on my podcast? Like two, I think. Braden Smith, recently from the NFL. So there's, there's obviously a ton of athletes that have it And. And none are talking about it. And I get it, because there's a lot of risks for them. You know, they worry a public opinion. Like, I get it. Would I talk about it? I don't know. So there's no judgment on. On them from me. But it's more just to say, any athletes listening and they want to come on, you're welcome. Because then that helps, that culture of asking for help, because you destigmatize it through sharing those stories.

B

Yeah, absolutely. And as a psychologist, like, when I. When I was. It's interesting. One of my first. Almost like I would even call it an awakening moment was I was a professional hockey player. My career was going down the drain. I was not feeling in control of my game. I wasn't playing well. I was sitting in a bar. We would often go to the bar after a game and feeling sorry for myself and kind of in my own virtual reality of failure. That's what it felt like. And then for some reason, I don't know if you've ever experienced this where, like, you know, when the refrigerator noise turns off and then all of a sudden you have clarity. It was just this moment where all of a sudden everything in the room went silent. And I could see all the players around the table, and no one was talking to me. I could see their faces. And it was like, the first moment, I'm like, oh, everyone here is suffering. Like, there's suffering. Even as they smile, I can see the suffering in their faces. And I can see. Not to be cynical, but, like, I could see that I wasn't alone. And now, as a psychologist, I go around the sports world and I see the struggles of players, and it's very hidden, as OCD often is or anxiety often is. Right. It's hidden through avoidance. And. Yeah, but, like, players are never as alone as I think they are with these issues. You would be amazed it's not the glamorous lifestyle that most athletes promote on Instagram. A lot of athletes do struggle with control and. And control behaviors and anxiety.

A

Yeah, good. Good point. And, yeah, even if it's not, I see anxiety, it's dealing with, like, pressure from social media. You've got all these fans calling you idiot or like, yeah, terribly, you lost the game for us. Or, you know, whatever they're saying. Yeah, that's gotta be horrible as an athlete to. To get all that criticism.

B

Yeah. Sorry, One more thing is just athletes. One thing is like, yeah, it's a hard life, and we're watching them for a reason, which is like, we like to see people deal with uncertainty, with composure. But I just want to say, like, fans want to see you succeed, but they also like to see people fail. And. Yeah, and it's just. There's a lot of eyes on you as an athlete. It's very intense.

A

Yeah, yeah, absolutely. Absolutely. Okay, so you pick up the phone and call the 20 year old you. What do you tell him? No, actually.

B

Oh, yeah, no, I know.

A

Were you. Sorry, were you good in college? Like as in were you like performing well or do you still have anxiety?

B

No, I mean, I think. I think around when I turned pro is when kind of things went south. So I was like 21. Yeah, 21.

A

Let's go 21 then.

B

Yeah, 21.

A

Oh, wow.

B

I mean, I think part partly, it's like, you don't have to do this. And I'm not someone who advocates for people to quit the game, but at that point I was holding on for all the wrong reasons. And the healthiest thing for me to do was actually to stop playing. But it's interesting that it never occurred to me that I could. And I remember the day I thought, oh my God, I can go to school, I can do something else is the day I decided to. It was interesting. I never had the thought. I was like stressed out about my next contract and kind of figuring out next moves and like, the identity investment was so deep that I never could see outside of it. So I think, I think what I would want to tell my younger self is like, if I could as an athlete, if I could have seen outside of that virtual reality of importance and also got help, I think I could have stayed in the game, actually. I think there was a version of my life that could have been reconnecting with the love of the game. I loved hockey, but, yeah, I couldn't. I couldn't see out of. Was just so all encompassing for me and so important. So, yeah, there's more. I guess there's more to it. There's more to life. There's more, more important things. It's all kind of empty, to be honest. And even though it's also kind of important.

A

Yeah, yeah, it's both. Okay, nice. And you got a billboard. What do you want written on that billboard?

B

I knew you'd ask this. Yeah, I think I would say be yourself and let other people be themselves. I just, I think had a lot of just humbling experiences where you think you know someone and then you realize you don't. And just to remind yourself to be humble, to be comfortable with who you are in your own skin. That's really helpful for athletes, by the way. But yeah, don't prejudge people and know that you don't know, I guess is really helpful.

A

Okay, Yeah, I like it. Lastly, anything else you wish you could have said or shared today?

B

No, I think it was a great conversation and I really just. Just felt thankful that it felt natural. So thank you for your leadership there. And, and yeah, I'll just say I benefited so much from this podcast. When I was asked to teach an anxiety course for grad school students, I was like, oh God, I need to learn this stuff more. And actually your podcast was a huge resource for me. I listened to it all the time and, and had so much learning that came from it. So I just, I'm so excited to have had. Had the chance to talk to you and all the great things you're doing in the OCD world is really, truly amazing and I'm grateful. And, and I know a lot of patients actually who your podcast is truly their safety blanket to kind of connect with other people and feel like a sense of community, even when they can't find that in their life. So thank you.

A

No, thank you. I appreciate that. And yeah, please thank your clients patience for me. So, yeah, thank you for coming on, sharing your story and obviously your expertise and working with professional athletes. Hopefully it's helped some athletes out there and just everyone generally.

B

Amazing. Awesome. Thanks so much too. I appreciate it.

A

Thank you for listening to this week's podcast and thank you to our patrons who help make this episode possible. And if you would like to find out more about Patreon and the rewards and benefits, then there will be a link in the episode description. If you enjoy the OCD Stories podcast and would like to support us, please subscribe and rate the show wherever you listen to the podcast. And thank you to NOCD for supporting our work. If you want to find out more about nocd, you can click the link in the episode description and quick disclaimer. Guys, this podcast is not therapy. It is not a replacement for therapy. Please seek treatment from a trained professional and until we speak, take care.