Understanding Cognitive Therapy for OCD with Dr. Maureen Whittal

Dr. Maureen Whittal: Yeah. So like many things in life, it was serendipity that brought me here. Back when I was a graduate student or undergraduate student actually, and I was looking for a summer job, I ended up working as a research assistant for a fellow by the name of Jack Rachman, and I didn’t really know who he was at the time, and I’d come to find that he was really the father of OCD treatment and has been and had been for decades. He wasn’t doing OCD work at the time, but when I came back to Vancouver after I did my studies that was opportunity to come back to Vancouver and work with Jack again, as well as Peter McLean, who also co-founded Anxiety Canada, in a project in OCD. And that’s how it started. And that was… Gosh, I want to say that was 1996.

Mark Antczak: ’96. Yeah. So it’s been a chunk of time now that you’ve navigated these circles and really having learned about so much of Jack’s work, just in my short career here, I really did do so much foundational work for where we are today. We have so much thanks to give to him.

Dr. Maureen Whittal: It did. Most people who do any sort of work in OCD will have read and followed many of Jack’s ideas.

Mark Antczak: Well, on the topic of Jack, one of the main kind of topics that we’re covering today is specifically talking about cognitive therapy for OCD because we know with OCD it’s always ERP, ERP, ERP, and it’s so important, it’s so integral to progress and being able to have some treatment. But can you give a little bit of explanation surrounding what cognitive treatment for OCD is?

Dr. Maureen Whittal: Yeah, sure. And I’m going to really start off by saying that I am also a fan of ERP. And ERP works, and it has been the gold standard for a really long time and hunDr.eds of thousands of people are helped by it. So, me talking about alternatives to ERP is not about me downplaying the importance of it, but rather providing people alternatives because it doesn’t help everybody, and no treatment is going to help everybody.

So, cognitive treatments really came into their own in the early mid-nineties, and it’s really based on this idea that everybody has thoughts that they don’t want to have. Everybody. Well, the research literature shows that it’s about 93, 94%, and I think that the other folks who would say no to that question either didn’t understand it or may not be telling the truth because it’s a universal phenomenon to have a thought that you don’t want to have, whether it be to jump in front of a moving vehicle or to push somebody or to say mean things to somebody or wonder if the door’s locked or, “Did I leave that on?”

So, everybody has thoughts that they don’t want to have. And so, it’s not the thought that is the problem, it is the meaning that you place on that thought. So, if I take an example of somebody who’s having a thought of doing something physically inappropriate to someone else, like pushing them into traffic, some people would be able to say, “Nah, that’s a weird thought,” and then let that go. But other people might give pause to that and say, “What does this say about me? Am I this terrible person? Could I be homicidal? What if I actually do it?”

So, it is the meaning that we place on these thoughts that then impacts how the emotions that we feel in response to them and what we do in response to them, which then sets up a subsequent pattern of either doing nothing if it’s just a, “That was a weird thought” and just let go of it, nothing happens. But if you say that, “This is something about me” or something about, “This is the real me bubbling to the surface,” then I might start a pattern of being very hyper-vigilant of my own self, which then sets up a cycle to make it more likely that it gets maintained.

Mark Antczak: Right. So just reiterating some of those pieces. So, cognitive therapy for OCD really focuses on how we make meaning from those intrusive thoughts, how we interpret them almost in a sense the same way when I walk across Burrard and oh, I always have the image of me letting go of my dog’s leash into traffic instead of me saying, “Oh, is there a reason I’m having that thought? Does that mean I’m a bad person? Does that mean I want my dog to die?” I could sway off and say, “Oh, that was weird, but I know it doesn’t mean anything” and keep moving on with my life. Versus people with OCD could have that same thought and because of the emotion that evokes, because of how contradictory it is to them, they will basically use compulsions for that.

Dr. Maureen Whittal: Yeah. So it really is… And cognitive therapy is focused on the meaning or the interpretation of the thought. And as I always say to people in the beginning, don’t believe it because I’ve said it. Treatment is about because you are the expert on you. I’m going to give you things to do to help you develop an alternative and much less threatening understanding of these thoughts, but one that is also based on the evidence that we will collect in our treatment.

Mark Antczak: Right. So related to how ERP fits into this equation, can you make a couple of distinctions between what cognitive therapy does that ERP necessarily wouldn’t hit?

Dr. Maureen Whittal: Yeah. So, and I will say this, that ERP is changing a little bit over time. When I first started, ERP was exclusively around staying in a situation until your anxiety Dr.ops or Dr.ops at least 50%, and doing that repeatedly and you get used to it. That’s old-school ERP. So, I think the contemporary forms of ERP are blended, I think, with a little bit of what we’ll be talking about. So it can be a little bit more challenging to distinguish cognitive therapy and flat out ERP because many people blend the two. I’ll give you an example of some of the core strategies, I suppose, used in cognitive therapy. behavioural experiments are example of one. And sometimes people who have strong behavioural ERP backgrounds say, “That’s exposure and that’s ERP.”

But there is a little bit of a difference between them, is that they are… You have a question, too, that you… I’ll give you an example of someone who is a checker, who checks the stove before they leave the house because of a fear of, if not, something will be left on and it will cause a fire. So a behavioural experiment. So, that person might have in their head the idea of all the things that would happen and they happen immediately to end in the worst case scenario. So, a behavioural experiment might test that.

So, for example, a burner that is left on for 5 minutes, 10 minutes, 20 minutes, 2 hours, does it ignite a fire on the stove if there’s nothing near it? That’s an example of a behavioural experiment. So you’re getting… Yes, you might be exposing that person to some anxiety and that person might feel some anxiety while doing it. It’s done in the service of answering a question. In this particular case, is it threatening or dangerous to leave the burner on a stove?

Mark Antczak: Right. Because that’s really highlighting that underlying belief. If I leave the stove on, then this outcome, aka my home will burn down. [inaudible 00:12:29] a certainty that leads that catastrophe. Versus if we use a behavioural experiment, we get to put on our scientific lab coats on and say, “All right, let’s see what happens if we leave a burner on” in an environment where it’s observed, where we don’t just leave it alone, but to be able to see, “Okay, does anything happen that one hour, two hours?” And I imagine for a lot of people, they’re quite surprised when they do a behavioural experiment like that.

Dr. Maureen Whittal: Like any good experiment, you make a prediction before you compare it to the actual, and then what was the takeaway? So, in debriefing it, that’s what we would do. We would compare and then say, “What was the learning there?” And of course, our jobs would be way easier if it was one and done. Do that once. You’re good. Of course, it doesn’t work like that because OCD has a really funny way of coming in and trying to negate successes. So, I do a lot of externalizing OCD. So OCD comes in and says, “Well, maybe you got lucky. If you keep doing it, it’s going to happen.” So sometimes there is a little bit of a repetition, but it’s really focused on the meaning. In this case, the overestimation of threat.

Mark Antczak: And really reiterating too that it’s not like you do this experiment once and that belief all of a sudden can be leaned into fully, it’s something that needs to be repeated in slightly different contexts to be able to really lean into and start to belief as well.

Dr. Maureen Whittal: Yeah.

Mark Antczak: Yeah. So belief, or behavioural experiments, that’s one of the big kind of pieces that we’re talking about here. Going off more of some of these tools or some of these phenomena that we learn about in cognitive therapy for OCD, can you speak a little bit about what the term egodystonic means? I feel like that could be particularly relevant.

Dr. Maureen Whittal: Yeah, so egodystonic is just a… It’s an overly fancy way of saying something doesn’t agree with who we are as people, so it’s foreign or alien to us. I’ll use myself as an example. Really important for me to be kind to people in terms of a value. That’s the thing that’s at the top for me. And if I had an intrusion of being unkind to somebody, that would be egodystonic. So something that runs against who I believe myself to be as a person. It also brings up some of the hook that grabs people or can grab people, is that even though they know it’s egodystonic, that it occurred or it occurred so frequently, it can make people start to doubt, “Is it really who I am?” In our language, we would say they’re starting to doubt if it’s egosyntonic. “Is this the real me this? Am I a wolf in sheep’s clothing? I’m pretty sure that being kind is important, but why are these thoughts of hurting other people coming around so much?”

Mark Antczak: Right. So using that example with the different ways that I can harm my dog. If it keeps happening often enough, it almost starts to make you doubt. And that’s why they call OCD the doubting disease. “What does this mean? Do I actually have to do something about this?” And would it be fair to say that that is also why OCD latches onto the things that matter most to you?

Dr. Maureen Whittal: Yeah, absolutely. Absolutely. There’s lots of very good research that says that it either lines up with our values, in opposition to our values, or can involve the people that are the most important to us. Very common prior to weddings or significant moments that someone might start to doubt their partner. Another really common time for a bump up in OCD is in the postpartum period for both mothers as well as fathers because that little bundle of joy now represents something that they couldn’t imagine loving anymore. And it’s immediate, but then the nasty little underbelly of that is, “What if I put it in the microwave or what if I smother it? Or what if I do something wrong and accidentally harm this thing that I love so much?”

Mark Antczak: Absolutely. I remember learning about that early in my career, just how little is known or how little that is taught to folks. Postpartum depression is commonplace. Everyone knows that it’s this very frequently occurring phenomenon. But postpartum OCD, something that is really not talked about nearly enough. I feel like I’ve been seeing more and more of that as the years have gone by, especially in the last half-decade.

Dr. Maureen Whittal: Yeah.

Mark Antczak: Yeah.

Dr. Maureen Whittal: And of course it’s very upsetting for people. It really goes without saying. And such a lot of shame that can come up, which is often… I don’t know if you were going to ask this, but I’m going to say it, that it’s often why it stays in the shadows for people. People can often take the content of the thoughts on face, we call it face value, and the content makes me seem, quote-unquote, “Crazy,” or, “I know that door’s locked, but my brain won’t stop telling me that it’s not. And if I tell someone else, they’re going to think about me the way that I’m thinking about me, and I don’t want that. And it’s really embarrassing and it’s shameful, so I’m just not going to tell anybody about it.”

Mark Antczak: Right. This actually prompts a question that I think is so important to adDr.ess in OCD because of that role that shame and guilt play. We know that a lot of people, especially from more of the taboo forms of OCD, anything involving self-harm, harming others, especially if they’re having thoughts involving a minor of whatever nature. What words of encouragement would you give to folks to be able to make a distinction of these are thoughts that are OCD and these aren’t thoughts you’re going to get in trouble for? Because we know, we’ve heard those horror stories where [inaudible 00:20:16] even [inaudible 00:20:16] able to make that distinction.

Dr. Maureen Whittal: What I often say to people, it’s not so much the content of the thought. And like I was saying earlier, it’s not the content of the thought, it’s the emotions that come up around it, the immediate… I just snapped my fingers there and it is that quick, the immediacy of those emotions. How does that content make you feel and what does that content make you do? So, for example, thoughts about sexually harming a child. Terrible content to have. Does that content make you excited and does that make you want to go near playgrounds? Does it make you feel revulsion and fear and shame? And does that make you want to stay away from chilDr.en? Does that make you say, “I’m not going to have a child, I can’t have a child”? It’s not always that easy to distinguish the two, but on the surface it is that how it makes you feel and what it makes you do.

Mark Antczak: Right. Such an important distinction because so often we hear the line, “But what if it means.” And I always have to point out that undertone of you notice what’s happening when you say that, that emotion underneath, is that desire, is that excitement or is that fear?

Dr. Maureen Whittal: Right.

Mark Antczak: Well, that’s fear. Whoa, okay. And that puts a bit of a blinker, a little bit of a light bulb moment.

Dr. Maureen Whittal: Right. Here’s an example of thinking back to your question earlier about some of the differences between ERP and cognitive therapy. And what I’m going to tell you is something quite different. Another behavioural experiment based on what we were just talking about is what will happen for folks is when they have content like that, like sexually harming a child, that the fear is that it reflects desire. So I will have people… we’ll do a little behavioural experiment around pulling those two things apart. So I’ll say it sounds silly on the surface, and I always think about Jack when I do this because Jack was a real fan of the silly, that, “Go and have your favorite meal. I’m not going to tell you why, but I want you to go have your favorite meal and I want you to be good and hungry. And then I want you to write a little bit for me about what it feels like to want that thing.”

So, when they come back, we debrief that. So what are some words that you would use to describe that? So, as that turns out, unless you have a problem with eating food when you’re really hungry and your favorite food when you’re really hungry, is a really good experiential representation of desire. So then we can compare and contrast that to how do these intrusions of sexually harming a child, how do those feel? Can we pull those… Do those circles overlap? They never overlap. So that people get to see that and feel that sexually harming a child doesn’t feel like fettuccine Alfredo or pizza or sushi, and one doesn’t become the other.

Mark Antczak: Right. I’ll make a bit of a comparable example, and I think I actually learned this one from you years ago where when you’re at a grocery store and you’re fighting the urge to get an item that you really, really want, like a snack food or that candy or that sugary cereal, it’s even just being able to acknowledge, “I want it, but I am trying not to” and how different that kind of experience is noting on something similar to what you’re sharing there. You mentioned the word face value a little bit ago, and that leads me to think a little bit about the concept of thought-action fusion. Would you feel comfortable sharing a little bit about that?

Dr. Maureen Whittal: Yeah, you bet. So thought-action fusion, it’s a belief that people with OCD often hold. Now, the research work came out of Jack Rachman’s lab in the mid-nineties, and it’s based on this idea that having a thought… There’s a couple different ways that it shows. Having a thought either makes it more likely to happen. So likelihood thought-action fusion. In the early days, we parsed it out a little bit further, that likelihood self. So if I have a thought about something bad happening to me, it increases the likelihood. Versus others, that if I have a thought about my loved one dying in a plane crash, it makes it more likely.

Now, those two, that distinction didn’t hold up. So now we talk about it as likelihood thought action [inaudible 00:26:31]. Actually, the thought either has power to start that thing happening or it now becomes a possibility because, I’ve just thought it. So that’s one aspect of thought-action fusion. And the other is we call it moral thought-action fusion. So thinking it is as bad as doing. So I might ask you, Mark, about your thought about letting the leash go. Is there moral thought-action fusion around that? So having the thought of that, is that equivalent to doing it? And often the two are related in that moral thought-action fusion is there because it seems that the likelihood is there.

Mark Antczak: Right. Can you give a more extreme example of someone with OCD and how they might be able to apply both of those kinds of logic? So, yeah, with likelihood and moral.

Dr. Maureen Whittal: Yeah. I’m doing this now with a couple of my people, is… So in both senses we’re testing the power of thought. So, thought, I’ll use a likelihood example. I’m often doing thought experiments with people, and this is another distinguishing between cognitive therapy and more ERP, is the… the experiment, if you will, is to how powerful are thoughts? Can thoughts start the chain reaction that results in the bad thing from happening? So I’ll give you an example. And when I put together a thought experiment, I ask… I’m often the initial, quote-unquote, “Target” of it. I’m someone that they’re seeing fairly regularly, but I’m not in their inner circle.

And so I want that person to be thinking about something bad happening to me, something that is uncommon but not rare. So if you’re thinking about me getting polio and I don’t get polio, that doesn’t really tell you anything about the power of thought. If you think about me getting the flu in the middle of winter, because the base rate of that is so high, that wouldn’t tell you anything either. So, you want something that’s uncommon, but not rare, and I don’t want you to tell me what it is. And I don’t want you to tell me what it is because I don’t want you then to say, “well, it didn’t happen because she knew I was thinking that and she was probably just more careful.” But I also want it to be observable. So the next time you see me, whether you see me online or you see me in person, you’ll know right away. It wouldn’t be something that I could hide. So it could be a black eye, it could be a chipped tooth, it could be a twisted ankle.

Mark Antczak: Okay. So they might be thinking…

Dr. Maureen Whittal: …And really think it. And for some people it’s writing it down. Sometimes I will have people put reminders in their phone to, “Oh yeah, I got to think about this terrible thing happening to Dr. Maureen.” And then we work into getting people that are closer and closer to their inner circle. And the goal of these is to be able to say, “These thoughts are just thoughts. That’s all they are.” The content is always going to be unpleasant, always because they are a reflection of our values. And cognitive therapy doesn’t change our values. Our values are our values. I hope, and I expect that kindness… Kindness has always been important to me. I hope and expect that kindness will be important to me in decades to come, because we don’t change that.

So, as a result of that, we’re going to have these thoughts, not in the frequency that we’ve been having them, but they’re going to come. But if you can say, “These are just thoughts and they don’t have the power to produce bad things,” then your emotional reaction to them is more muted. And the behavioural reaction, the things that you do, the compulsions, the avoidance is also hopefully non-existent.

Mark Antczak: Right. We’ve talked about a number of these different phenomena and interventions in the context of cognitive therapy. And what I’m really getting from this is as opposed to ERP, cognitive therapy seems to be a lot more multifaceted, or there seems to be a lot more angles that you can hit it from. There’s a lot of study under current themes, but there just seem to be a couple more distinctions to be made.

Dr. Maureen Whittal: I think that one of the differences is that I think the learning is the same, but cognitive therapy makes it more explicit, I think, than ERP. I think people are learning these things in ERP, but it’s not necessarily the target. Although, as the two are getting closer over time in contemporary forms of ERP, and in practice, frankly, there is a blend. Often there is a blend.

Mark Antczak: Yeah. So really just kind highlighting that blend is often happening quite automatically just because of where the training has gone to, where the more modern treatment for OCD looks like. But really just highlighting that when OCD sometimes get tricky or when it gets a little bit more nuanced, some of these cognitive approaches can really highlight some of these more explicit lessons that people need to learn.

Dr. Maureen Whittal: Potentially. And I think it might get things that ERP might not get or might, might make it a little bit easier for people to do what they need to do to get the learning that is going to help them see that these things aren’t dangerous or that they’re not a danger.

Mark Antczak: Right, right. Okay, so that’s so incredibly helpful. And I guess that can help us segue into this next piece, which is starting to figure out whether you’re already seeing a therapist or you’re looking for an OCD therapist, what are some things you could ask them to try to make sure that you have someone that is trained in cognitive therapy?

Dr. Maureen Whittal: It’s such an important question. Thanks, Mark. Because this treatment, whether it’s cognitive therapy or ERP, is highly specialized. OCD is a presentation… Part of some of the reason I like working with it so much is, and I am fond of saying, you get 10 people in the room with OCD and you’re going to get nine different presentations of it. There’s certainly some common themes, common presentations, but there’s such a variety. So it’s really important to have somebody who really knows the disorder, that will influence whether it’s the cognitive therapy, how the ERP is done, and having someone who knows the disorder is key, and the various ways in which it presents.

So some of the questions that I would ask if I was somebody coming in for treatment, I would want to know what their training is in OCD, how many people they’ve seen. It might be hard to get someone who has treated hunDr.eds of people, but you probably would want somebody that… If you are able, getting someone who’s seen a number of cases. And I would also ask a little bit about their treatment approach. “So can you tell me,” and I understand because I get these questions too, and my response back is, “I can’t tell you everything because it would take many sessions to do that, but I can tell you and give you the 30,000-foot overview of what we would do.” So I think it’s reasonable to ask generally, “What would your approach look like?” Appreciating that you can’t do specifics at that stage.

And with OCD, and really I would say probably with anything, but a good thorough assessment is really important. Sometimes people want to jump into treatment right away. “I want something right now that’s going to help me.” I try to really encourage the folks that I’m seeing, is, “Be patient with me while I gather some of these nuances, the devil is in the detail, because it will allow me to have a better conceptualization of what’s going on,” because sometimes OCD is not the only thing that’s going on. “And if I have a better conceptualization, I’m going to be able to design a better treatment. If I design a better treatment. It increases the probability that you’re going to receive some benefit from that treatment.”

Mark Antczak: Absolutely. Yeah. And I learned this from you, the more information you have, the more specific of a treatment plan you can conceptualize, the less wasted time there’s going to be for the patient. You just get to really hit the parts that are going to make the biggest amount of influence and impact.

Dr. Maureen Whittal: And of course, you’re not going to be able to know everything and conceptualization or formulation, it’s dynamic. It always changes as we get more information.

Mark Antczak: So respective of the main modalities and Dr.. Peggy Richter spoke to this a little bit, when you have someone asking what are the main ways that you approach OCD, I’m hearing they should have some medley of ERP training. Ideally, they’re saying something to the effect of, “I have cognitive training for OCD.” Is there any specific wording or phrasing that you would encourage folks to use, if there’s any models that you think would be helpful for folks to put down?

Dr. Maureen Whittal: Yeah, and I think it’s more about… Because sometimes people will throw out words like CBT, ACT, ERP. I would want to know if my provider knows what that means in the consulting room. So yeah, you can say… “I do ERP.” “What does ERP for you look like?” So, if I’m somebody who has contamination concerns, what might that look like? It’s just a little more specific to see if your provider has enough knowledge to be able to use words like, “If this is ERP, I would look at all the things that trigger a hand wash. We would order them. We would start with things that are relatively easy relative and work our way up.” That would be an ERP example.

And most people are not going to come in and say, “Hey, do you do cognitive therapy?” Because it is less common of an approach. And I will often say to people who… They’ll reach to me and say, “Do you do ERP?” And I say, “Yes, I do. It’s not necessarily my first go. I would do a really thorough assessment. And what I’m about to say, there’s no research data on. So I want to be super clear on that.” But from my own almost 30 year experience with OCD that after I do my really thorough assessment, I might choose to do ERP with somebody.

Say for example, if somebody is a straight-up contamination, fear of germs, fear of illness, I might start with ERP and then move into something that is more cognitively focused if they’re not progressing in ways that I would want them to. If somebody is coming in with egodystonic thoughts about harming themselves or someone around them, I might start with more cognitive therapy and vice versa, and then move into something more ERP-ish, if they’re plateauing and they’re not getting any better.

Mark Antczak: Gotcha. And that’s a perfect segue into I think one of our final questions here, which is surrounding the nature of plateauing and feeling like you’re stuck in therapy because we know even when you have the best of intentions, clinician, when you have someone that’s really trying their hardest, sometimes we can get stuck with OCD. So, at what point as a patient would you consider needing to either adDr.ess that stuckness in the session and what could you ask for more of, or what could you do at that point?

Dr. Maureen Whittal: Yeah. Yeah, that’s a good question. One of the things that I do as a clinician, I don’t do this with everybody. Well, that’s not true, I probably do. The frequency of it varies from person to person, is that I will give questionnaires that some of them are meant to be before and after, but there are some that I give pretty routinely throughout, sometimes every three sessions, sometimes every 10 sessions. But it allows me to track progress if belief is changing. And that’s also something to look for as a consumer, is someone using questionnaire type data? Not everyone will and I think that that’s a reasonable thing to expect however, that someone will. Someone whose well trained will use questionnaire data to augment what they’re hearing from the person.

So, I will say, “I just want to give this to you to make sure I’m barking up the right treat, that I think it’s this and this is how I think I would organize my treatment, but I just want you to do this to see if there’s convergence.” And so that’s one way of saying it. And ideally, that discussion about plateauing should come from the clinician because we as clinicians shouldn’t be continuing our treatment if we think it’s not going to help the person, or the person doesn’t seem to be getting better. So, in the absence of that, I do think it’s reasonable as a consumer to say something to the clinician, as hard as it is.

And hopefully, the clinician has set up a frame of we’re collaborating together against the OCD, it’s not you and them, but, “Let’s try to put this down.” And a clinician will hopefully also get to see that, “I can’t help everybody. I can’t. I’m not going to help the 100% of people who walk through my door.” And sometimes that’s the benefit of seeing someone else because they might use different words that resonate better. The ideas might be the same, but the words might be a little different.

Mark Antczak: Such a key piece. And this is something I actually reiterate in my intake, which is, this is not me in a white lab coat telling you what to do. This is you inviting me to walk alongside you. You tell me where you want to go, and I’m going to help you get there by pointing you in the right direction and giving you certain nudges. And if at any point you’re feeling stuck, if at any point you’re feeling disgruntled, please tell me because I’m in service to you. And that’s a really important reminder, I think in general in this entire field, is recognizing that clinicians are there to help, we have specific training. But at the end of the day, if something’s not working, voice it. We won’t be upset. We’re not going to be mad. We’re going to try and figure it out to either make our own adjustments or refer you to someone that could be a better fit.

Dr. Maureen Whittal: And there are many people who, and I have to say and be honest and say I’m not one of them, who routinely provide opportunities for people to give feedback on the session, “How do you think that went? What went well? What didn’t go well? What would you like to see more of?” And so making that a formal part of the treatment process might just very easily facilitate that.

Mark Antczak: Such important words to end on. Dr.. Maureen, any final thoughts that you’d like to share with any of our listeners around this process?

Dr. Maureen Whittal: Maybe just one thing is that it’s really important to have hope, that this is a treatable condition and you don’t have to be suffering in silence. Take the time to find a good person and do the work. There’s life on the other side of it.

Mark Antczak: Yeah, really reiterating if you are feeling stuck, figure out if you have a person that’s giving you competent care, that’s giving you the right care. And always just making sure that we hold onto that hope because we’ve seen some very, very powerful turnarounds in our work.

Dr. Maureen Whittal: Yeah.

Mark Antczak: Thank you for joining us, Maureen. It’s been such a delight.

Dr. Maureen Whittal: Thanks, everybody. Bye-bye.

Outro:  Thank you for listening to #OurAnxietyStories, the Anxiety Canada podcast. To share your own story or to find resources and support this podcast, visit us at anxietycanada.com.