The ACT Workbook For Teens With OCD by Dr. Patricia Zurita Ona Interview

Apr 14, 2020 | Podcast


Dr. Patricia Zurita Ona (“Dr. Z” for short) and I talk about the Coronavirus and her latest book, The ACT Workbook for Teens with OCD.  Listen to this episode to learn how to cope with heightened anxiety and worry that we all feel during this time of Stay at Home orders. 



Leann H 0:17
Welcome to the first virus edition of the shelf aware books podcast. Today I am delighted to have Dr. Patricia Rita owner. She is a licensed clinical psychologist in California and she has been working for 14 years with people who have struggled with obsessive compulsive disorder, post traumatic stress disorder, and different forms of anxiety. Welcome, Dr. z.

Dr Patricia Zurita Ona 1:12
Thank you so much for having me, Leanne. Super excited to have a chat with you. Thanks. Well, of course, she has written books. And so the two I have in front of me are the act workbook for teens with OCD. And I also have escaping the emotional rollercoaster act for the emotionally sensitive, which is my personal favorite of yours. Tell me a little bit about your practice right now. And now that we’re recording this in the beginning of April, how has your practice changed since we’re now all locked at home? Mm hmm. Where so much has changed in the last four weeks, right. And I feel very appreciative of my clients Air Force to continue our work together. And believe it or not, we have been running every single session virtually, we’re using all types of platforms. And we’re becoming technologically savvy by for one day to another day, and I seen a highlight of moving everything visually has really been my client’s commitment from that child that wants to overcome OCD to the person who is an adult, and in the mid 50s, really showing up to the sessions. So I think that has been really a highlight of all this process, seeing how people don’t want to stop doing the war over common anxiety and getting back into the lives. And I was honestly surprised. I feel very appreciative to see my clients commitment and courage. They have to continue facing their fears.

Leann 2:49
That is a lot of courage to continue working on facing those fears in the midst of fear.

Dr Patricia Zurita Ona 2:56
Yes, yes. Enough timing which there is the story collective experience of fear and panic about what’s happening with Coronavirus. I am really, really surprised to see how people are showing up to the work. And the other aspect of I think I witnesses that most of my clients who have been dealing with anxiety and they have been committed to the war on practice, in this case, they’re handling the situation very skillfully. And I think because they had had more practice to sit with discomfort to sit with uncertainty to sit with fear in general. So they have allowed your repertoire of skills to handle that right. I think versus people who haven’t been in treatment too long or they haven’t dealt with anxiety but degree my clients deal I think there is a larger reaction there. So surprisingly, I’ve seen that people who have been in treatment and present more exposure war, they do have a larger capacity to handle these uncertain times that we’re living.

Leann 4:02
Well, those sound like very useful skills to have, especially at a time like this. Tell me a little bit about your treatment. And I know we mentioned OCD. Tell me a little bit about what you help people with.

Dr Patricia Zurita Ona 4:15
Yeah, thank you for asking that question. And the last one, since since I was a school psychology, I was very interested in anxiety and depression. And in my country in Bolivia, I was working with children, teens and families. When I came to the States, I started working primarily with adults. So the last couple of years I have been working primarily with people struggling with all types of fear basis tribals, OCD, panic, generalized anxiety, chronic worry, social phobia, and the last 40 years. Because of my clients feedback, I decided to start an intensive treatment for clients with OCD. And anxiety, that has been such a amazing thing and amazing addition to the practice. So clients come from this intensive 15 hours a week, five days a week. And we as a minimum of three weeks of commitment. So primarily, that’s what we’re doing a lot. We’re doing these very compact interventions in which we help clients to approach and to lean towards the things that is scared off. And, and in addition to that, we do have the clients that calm on a weekly basis, but the practice is a specialized on all types of anxiety, and some emotional regulation skills training as well.

Leann 5:41
So how would I as a person know if I need something like yours?

Dr Patricia Zurita Ona 5:46
That’s a great question, Leanne. I think the difference is that the wise we’re doing that behavior, right. I seen any scene that we’re doing to reduce anxiety to minimize service conflict. Because we can all lever to go, that could be affecting our life, right? versus something that I want to embrace in my life. That’s different, right? So I think that why or, you know, academically speaking, we call the function of that behavior. But it’s basically looking What are my drivers?

Leann 6:20
So if someone feels like they may be having a hard time functioning because they’re so busy worrying, is that assigned for concern or is that normal in these times?

Dr Patricia Zurita Ona 6:33
I think it’s to the degree in which I want to behaviors are affecting our day to day functioning right? If I can no, go to watch a movie with my husband because I have to keep doing this. Whether this planning my mind what has been happening, whether Am I traveling on angry thoughts, I would say right, so that that’s a problem, right? Because I want to live freely is all about Connecting and doing the things that are important to us, right. But if I’m consumed by a particular behavior, and I cannot let it go, that’s a challenge for all of us. So that will be a good time to step back, right? And just check, look at what’s going on here. Right? Is this taking over how I want to live my life? Is this making it harder for me to be the person I wanted to be? And that will be one of the criterias to consider therapy as an option.

Leann 7:31
And what about the folks who feel like Well, some days they have issues and some days they don’t, so maybe they don’t meet clinical criteria? Have you helped them?

Dr Patricia Zurita Ona 7:41
Thank you so much for asking that question. I seem one of them. One of the areas that have become very interesting over the years is that on the one hand, in my practice, we work primarily with clients who have missed clinical criteria, whether it’s OCD, social anxiety, I do specific anxiety or specific phobias. But I at the same time, what I have witnessed is that there is a large number of people who don’t meet clinical criteria, and yet they are organizing their behaviors around playing it safe, or they are organizing their behaviors around fear, right? For example, how often a person may sustain a relationship because they’re afraid about being alone. And they know this part that is not for them, but they are so afraid about being alone, that they stay in a relationship, or how often people may not apply to a job that I really want to try because they’re afraid about failing. So I think the way in which feed affects our lives. It’s not only when people meet clean clinical criteria, I think it’s really before that people can be doing all types of things day by day and hour by hour, but They also could be doing a lot of things because of fear, like a fear based response. So I think that is another area that I’m super, super interested in how in day to day life, whether people have OCD or not panic or not, we do play it safe because of fear, fear about making mistakes, feel about not being a good enough person, feel about rejection, you name it, but I think fear is one of those emotions that can affect so many behaviors across many areas in our life.

Leann 9:36
And I think that’s a really good point to bring out more is that what is the function of it? Of course, we’re all going to be afraid right now, none of us want to be sick and sick enough that you need hospitalizations and one of those pressures ventilators. So just having fear isn’t abnormal. It’s the level of reaction and the level of checking in protecting yourself.

Dr Patricia Zurita Ona 10:01
Thank you so much for clarifying that. Yes, I think we are wired to experience all kinds of emotions, right? That comfort the old ones like love, coziness and comfortable ones like fear. The challenge is not having the emotion per se. It’s how we relate to it. How do I respond to the motion? How do I handle that? And we feel what we have is that people may tend to we all may tend to avoid any situation that can trigger fear. Right? And that makes sense, right? I don’t have any of my friends telling me Patricia I can wait to be a scare, I think right? I certainly don’t right. I certainly don’t like oh, this Jackie feeling right. And, but the challenge is that without realizing we may be doing things, avoiding blame save going to parties, when We only know people that you know, we feel comfortable with doing a job that we have familiarity with being in a relationship with a person that we have history with now, because it’s a good partner for us, right? So I think if we don’t pay attention, fear based responses, maybe shaping all of those areas.

Leann 11:21
And I think this is a really good segue into your act workbook for teens with OCD, I realized the title says, for teens, but I as a adult for a long time since it’s been since I was a teen really found it helpful, because they’re very easy to understand and very easy even if, again, you don’t need, quote, clinical criteria. For OCD. It’s really helpful to walk through and validate which of these emotions and feelings are quote unquote, normal, or appropriate, or maybe in this terms helpful. And how in your book you read We really focus on which of these thoughts are truly helpful. And which is fear based? What made you decide to write a book in debt teens with OCD?

Dr Patricia Zurita Ona 12:11
Thank you for asking that question a couple of years ago, maybe, I don’t know, four or five years ago. And I remember having a first meeting with a family in which the kid was very clear my client of a time say that z i have seen like three therapists and I hated that I hated because the therapist and my parents, they tell me cause them do what I need to be doing. I know it’s obvious to be but I’m so fed up of being told what to do. And I think for me that that hearing that from that teenager was very, very brilliant because we know that exposure based treatments, we know that exposure response prevention is the frontline treatment. It’s a gold standard treatment for the with OCD and anxiety, and while it has been extremely successful, we also have clients that don’t relate to it, or they’re scared of it. Or they feel that it’s not consistent with who they want to be in life. So in that case of teenagers, one of the things that happens is that because developmentally they are in a place in which they like to choose, and they’re going to be trying new things, and they don’t like to be told what to do or what to say what to think, harm in a place in which they can be in charge of the treatment. I think it’s fundamental, I think it’s actually key for them to respond and take ownership of the treatment and face all those scary things they are dealing with. So I think, to me was that session with these, these teenager that basically really say, I am tired of being told what to do. I know it’s a CB but I can’t take it any longer than being told what to do. So for years, I was thinking how we can make your PII more accessible to the teams in a way that they take ownership in a way that they are the main driver of the treatment. And that’s how I was on the time thinking how asked also how acceptance and Commitment Therapy. Cool are some of these skills to EMP, and I tried different ways. The choice point has different iterations that I had with my clients getting feedback from that. Were but when trying the choice font, it was such a powerful tool, because it really capitalizes that moment that a person has of a teen has to choose how to respond to the unknowing and pesky obsessions they are dealing with. Now because I tell them to do so because the parents tell them to do so. But because they are willing open and when intention, they do want to face that. So I seen, that was the biggest The biggest thing that I’ve tried to build on something that captures that capacity to choose and to try new things that our teens have naturally given where they are developmentally speaking.

Leann 15:19
And I think that’s what helps make your book very unique. For those who don’t know, can you explain what exposure and er D is and what that has to do with the choice point?

Dr Patricia Zurita Ona 15:31
Thank you. You know, sometimes psychologists, what do you think all this? Can you appreciate the question? And when we think about exposure response prevention, we’re thinking about behavioral intervention to approach while we have been avoiding, we can be avoiding a situation like given presenting at a conference, we come in avoiding an image right when I have these images about torturing my kids. For example, or we can be avoiding people who are triggering for us, or activities, right, like cooking, for example, right. And so I seen exposure is that intervention that help us to approach why we’re afraid of, and this affecting our life. And, and when we think about acceptance and Commitment Therapy, it’s a powerful therapy approach that is blending mindfulness with behavioral interventions, but really helps a person to step back and know this, all the internal experiences they are having the thoughts, they’re having emotions, we’re having sensations we’re having, and instead of getting rid of minimizing challenging, or trying to find the right way of looking at things or the right way of feeling about some things, it’s really about learning to have all that internal experience. figured out what matters in life, our values and do what matters. And so the choice point what it does, it’s a tool derived from acceptance and Commitment Therapy, but makes it so much more accessible. And what he does is basically a graphic that at the bomb has that equation that you are you are encountering or you are one to approach on top has the obsession that pops up. And on the left side, you basically list all the things that you do that keep you hooked on the obsession that keep you trapped with an obsession, like replaying counting, praying, asking for reassurance. And on that right side, you have all the unhooking skills, you’re going to be learning about all active skills to manage that obsession without letting it affecting your life. So If I can summarize a little bit right the choice point, a segue that simplifies act to a way that people can use it day to day and moment by moment. Because think about this ever then we’re choosing something, right. How we’re going to handle the field that we have about Coronavirus, how we’re going to handle the moments in which we’re watching the news, right? And people say the things are really hard for us to hear. I have to choose how to respond to that internal experience. So the choice point capitalizes that natural capacity that we do have to face and relieve that internal struggle, what hobby

Leann 18:42
I really like that. So to kind of use it in practical use, you know, let’s have to go to the grocery store, or I want to take my dogs for a walk. You know, my value is feeding myself or exercise, but I’m really afraid of running into other humans right now. How would I use the choice point to accomplish what I need to do?

Dr Patricia Zurita Ona 19:04
So at the bottom of the choice point, we will have the situation going to the groceries, right? And then on top of the choice point that is a thought bubble. And in the Thought Bubble I will ask you lean when you think about going to the groceries, what does your mind tell you? What is your mind coming up with?

Leann H 19:22
That people will be there and they’re breathing and they may breathe on me.

Dr Patricia Zurita Ona 19:27
Okay, so we’re going to write down the thoughts right people may breathe on me right? Now let’s think about that. When you have this thought, what are all the things you do? What is all the stuff that you do that you know we can see? And all the stuff you do also in your mind? Well, will you say

Leann 19:45
The things I would say or maybe I shouldn’t go to the store. Maybe I can make this jar of peanut butter last meal whole week? No, the things I would do would be stay on the couch, surf Facebook for a large amount of time. And try not to think about going to the grocery store.

Dr Patricia Zurita Ona 20:04
Okay, so we’re going to write on the left side of that choice point graphic. All the things you say, is staying in that in the house laying down in the couch, flipping the phone, ones on Facebook valving pride, one that you can do I do this, do I do that? Right? And linguine you do all this stuff, what happens to your life in the long term, what happens to your friendships, what happens to your health, what happens to how you want to be with yourself,

Leann 20:38
I am not staying a part of the community even virtually, I’m not making sure I have proper nutrition to keep my immune system up. And my mind is going over and over and over again, around all the fear based scenarios that pop into it.

Dr Patricia Zurita Ona 20:57
So one of the things that we try to do in the choice point and this is just a button this is from the exercise is to really know this how we do help a person to step back and watch what’s the impact of my behaviors. When I get hooked on this thought people may brief on me whether all the things I do and how does it affect my life? Right. So that is the first part of the choice point. And then what I will do is, I will say, Leanne, will you be open for me to teach your new skills to handle this stuff, the father says people may brief on me. So you can be the person you want to be for your community for yourself and take care of your health. So when we ask a person that and assuming you will say yes, right, then I teach two different active skills to relate to your thoughts to relate to your emotions. And one of the skills that we teach in the case of OCD and anxiety is exposure. Try just facing that. in the service of being the person you want to be, so I think and Dan says that’s what it’s a little bit different than within the act mobile. And I tried to convey that on the book. It’s doing exposure per se is not the goal, do an exposure in the service of my values, approaching my fears in the service of being the person I want to be. That is at the core of the workbook and the act model. Right. Right.

Leann 22:28
Right, perfect. And I think that’s a great way to point out that not everyone gets to check with Dr. Z, every single day. So her book does a great job of walking you through each step and walking you through the model. It’s filled with graphics by Louise Gardner – ACT Auntie. I was so tickled because she does the same artwork for the podcast here. And the book, you know, I’m really, really motivated to To talk about and encourage people to read books that are easy and accessible for anyone, you did not write this as a clinician, you wrote this as a another human being who’s trying to help their fellow man.

Dr Patricia Zurita Ona 23:13
Well, thank you so much for saying that I, I certainly I feel grateful I have a chance to collaborate with with gardener at ounty the illustrations definitely add a differing look at the book and they make it so much more friendlier. And, and they agree with you I did my best to to write a book that is not complicated or has a lot of academic terminology or statistics. This is really a workbook that people can use day by day. And while the title says that it’s 14 people have asked me to sit down, it can be extremely helpful for any adult as well. It’s not exclusively for teens. And so I think any person you know 20s, late 30s, mid 50s, they kind of still benefit from that book, because it’s full of the skills about how to handle our fears and our obsessions.

Leann 24:10
And it’s also I think, again, timely because right now I know a lot of folks are not able to focus as well is when we’re not in the middle of a pandemic. And so having a workbook that literally takes you step by step, page by page, through the skills that can actively help our lives during this time, I think it’s a really important book. And I hear you are creating a course. Can you tell us a little bit about this?

Dr Patricia Zurita Ona 24:38
Thank you so much. Yeah, one of the things that I’ve realized once again, because of my clients feedback is that there are not many resources accessible for people all over. And so theme books help us to make skills accessible to people, but also given the new technology. We do have But the fanciest man should think that it’s out there. I thought about creating something that could be easily accessed from whatever you are in the world. Online Education has been out there for so many years. I seem we know how to do it. And for the first time in my life, I’m embracing this new project, which I am super, super excited. That online class is called act to be on OCB. And it’s going to be one of the first online class focusing on ad for obsessive compulsive disorder. My first online class, it has eight different models. And while they have an each model is a bunch of active skills and exposure response prevention to face ocv. I also have some willingness workouts I have some awareness workouts. So we all come practice how to step back and watch our obsessions. Fish as they come on, we’ll learn to relate to them. And, and that class is also going to have a face to face component. And we’re still working on it, but I’m super, super ultra duper excited to put it out there.

Leann 26:16
That does sound great. And if anyone wants to check out and keep an eye on when that class is available, please check out www dot act beyond OCD calm. That’s a CT, b, e, y, o nd OCD calm. And check out. This is Dr. z calm. That’s where you’ll find Dr. Z’s website. And you’ll see her books and a little bit about the class mentioned in her background and you can also contact her she’s in California. If you’re in the state and you want to get some help directly from Dr. z. You can also see her list of the books and the other practice. At her center, is there anything that you want to leave us with during this time that you found to be particularly helpful for folks?

Dr Patricia Zurita Ona 27:09
Yeah, I think if it’s okay, maybe I may have to leave the messages. Sure. First one is to remember that we are all doing the best we can. This is a very challenging time and, and we’re doing the best we can to not lose our mind. So just want to remind everyone that just take a deep breath when feeling overwhelmed and remembering that we are really doing the best we can given what we are. And I think my second takeaway message is that there is so much there is all types of messages in the media about some people you know, being happy all the time, some people just not doing okay. And it’s a natural thing that our mind is going to compare for I’ll actually be happy. You know, is there something wrong with me because I’m not as happy as they are. I’m not finding anything positive in this Coronavirus moment, I think I will invite people to watch for those companies on thoughts. There is no need to judge our experience. We feel what we feel. We have the thoughts that we do have right. And otherwise, it’s going to be really hard if we’re just harshly judging while we’re filming. There is no right or wrong way to fill in this situation. There is no right or wrong way to just sense of in our body it is what it is. So we’ll invite people to have openness to their experience us in this. And if you find if people find themselves comparing to others, just watch out here comes the commentaries on thought, but we don’t have to get hooked on that.

Leann 28:44
Exactly. Thank you so much for your wisdom and your time and your books and all the help that you’re trying to offer your fellow humans during a once a century hopefully, event. Thank you very much. Take care.

Dr Patricia Zurita Ona 29:01
Thank you so much, Leanne. Thank you so much for having me. I appreciate that.

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