8 Things I Learned From Watching The OCD Doc

Happy week! If you are reading this, you are alive and breathing. Woohoo!

Congratulations to the Open Closed Doors organisation who is bringing the robust OCD treatment, The Bergen 4-Day protocol, to New Zealand. (They are currently collecting client and clinician expressions of interest here.)

The new documentary, Exposure, about young New Zealanders who took part in this OCD treatment, airs on TVNZ Monday 31 August (trailer here).

The doco is great, highly recommend.

As I left the screening, I wondered, "What learnings from this program may have transdiagnostic applicability for our own mahi (work)?"

To make the list below, I've briefly reviewed both

• the methods of the Bergen model
• and writing on primary change mechanisms of anxiety treatment, especially as the research and theory has shifted from a focus on habituation and extinction to an updated focus on the inhibitory learning model. (Full citations at end of post, example quote below.)

"Rather than solely relying on extinguishing the original fear-based system, this model suggests a central mechanism of strengthening the inhibitory learning system involves maximizing expectancy violations, generalizing exposure efforts to a wide variety of situations (increase retrievability of inhibitory learning), and increasing distress tolerance skills and acceptance of variability in habituation."] - Spencer et al 2023

My Takeaways After Watching "Exposure"

Many of the ideas I list below aren't in and of themselves new or revolutionary. Some have been described in different ways by different experts. I bet you do some / many / all of these ideas regularly.

Take what is helpful, discard the rest.

1. Begin with psychoeducation that creates a shared language which externalizes the disorder or disordered behaviour, such as The OCD/ addiction/ rumination is not you or part of your identity.
2. Suggest or co-create a catchy memorable metaphor that encapsulates the treatment mechanism. In the Bergen method, this is describing OCD as a hungry sick cat (or seagull). The obsessions are the cat meowing and the compulsions are the ways you feed the cat to make it quiet even though feeding it only makes it keep coming back.
3. Ask the client to self-identify meaningful and emotionally resonant goals. After safety is assured, what does the client most want to change in their life? What is worth engaging in this courageous and effortful work? For example, I think a health professional would recommend that my first treatment goals should be to reduce my sugar intake and do more weight training. But honestly, I just don't care about those things. The health goals that are worth it to me are more walks with my husband, weekly Krav Maga with my daughter, and working enough to afford regular massages to prevent migraines. That's what I'll show up for.
4. To me, one of the most exciting and inspiring parts of the Bergen model was how they redefine success and effort. Briefly, one of the core features of the approach is the “LEan into The anxiety” (LET-technique)*. Patients were educated about how regulation through avoidance or rituals maintains OCD. Thus anxiety in and of itself is critical for change and their job is to ACTIVELY APPROACH situations that elicit it.
   1. As the developers describe, "Throughout the treatment it is systematically underscored that it is essential to first learn to do exposures with the correct technique (without subtle avoidance or rituals), and then to apply this approach to the tasks that “the OCD dislikes the most.*”
5. Building a behavioural repertoire means practicing in lots of different places, situations, and ways.
6. As treatments ends, psychoeducation with family and partners (who may maintain old patterns) can be important and powerful.
7. Human life is a team sport. In the documentary Exposure, it was incredibly touching to watch participants talk together about the crippling weight of OCD. And then during the audience Q&A, to hear from a patient and a therapist about how powerful it was to do the intervention as a group.
   1. Although all my clients see me in one-on-one settings, involvement in peer support groups, gyms, churches, and other spaces where there is connection and collective action is powerful.
8. The Bergen method also masterfully addresses the reality that many obsessions are not amenable to disconfirmation and the compulsions function to create a false sense of certainty. And yes, life is at its core so deeply uncertain. In our own work, helping patients understand how they may limit their life to avoid or control fear or uncertainty is powerful. Can we instead live fully in the midst of uncertainty? How would we do that?
   1. I feel like my second job is just trying not to be an overcontrolled stressball at all times. Soothing helps. But I also love the Bergen inspired idea of diving straight into uncertainty-maxxing, as described in one of the research studies, "Loop tapes can be used in these situations to maximize uncertainty, e.g., using repeated statements such as “I cannot be certain whether or not I got contaminated by touching all these objects.”"
      
      Say it with me,
      
      I cannot be certain,
      
      I CANNOT be certain,
      
      I CANNOT BE CERTAIN.

Ok I've run out of steam and you need to get back to the rest of your life.

Things To Be Excited For

1. Exposure, the documentary about young New Zealanders who took part in a gold star Bergen intensive OCD treatment, airs on TVNZ Monday 31 August (trailer here).
2. Catherine Chidgey's new book out early 2027! (see pic below)
3. Emily St John Manuel's new book, Exit Party, coming out 15 Sept!
4. Madeline Miller, author of my very favourite The Song of Achilles, has a new short story coming out 29 Sept!
5. The peanut butter cookie recipe below (from Emelia Jackson's Some of My Best Friends Are Cookies) - y'all I am eating about 5 cookies a day.

Kerry Working

1. You can hear me on the Mindform podcast talking about burnout: found on YouTube, Apple, and Spotify. Notice how tight and pressured my voice sounds in the opener? I was really uncomfortable for the first chunk of this interview but settled into more normal Kerry mode midway through.
2. Please join me for a 90 minute webinar "ACT For Burnout" hosted by ACT Wellington. Let me copy paste from the advertising lol

What is different about Kerry’s approach to burnout?

She actively engages the tension between the very real system-level drivers of burnout and the reality that meaningful relief often begins with individual change.

She helps clinicians understand the connection between values and vulnerabilities—and why this matters for resilience and returning to work post-burnout.

This fully revised 2026 training includes two important additions:

integrated shame and moral injury interventions, essential for those working in high-risk and service-focused professions

a review of cognitive distortions common among helpers that fuel burnout (and what to do about them)

And finally, I'm sending you a lot of love. Let's keep showing up for ourselves with kindness, respect and dignity as we try to save our bit of the world one little electron at a time.

Big hug, Kerry

*Launes G, Hagen K, Sunde T, Öst LG, Klovning I, Laukvik IL, Himle JA, Solem S, Hystad SW, Hansen B, Kvale G. A Randomized Controlled Trial of Concentrated ERP, Self-Help and Waiting List for Obsessive- Compulsive Disorder: The Bergen 4-Day Treatment. Front Psychol. 2019 Nov 15;10:2500. doi: 10.3389/fpsyg.2019.02500. PMID: 31803089; PMCID: PMC6873786.

Spencer SD, Stiede JT, Wiese AD, Goodman WK, Guzick AG, Storch EA. Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder. Psychiatr Clin North Am. 2023 Mar;46(1):167-180. doi: 10.1016/j.psc.2022.10.004. Epub 2022 Dec 26. PMID: 36740350; PMCID: PMC11170287.

Van Woudenberg C, Voorendonk EM, Bongaerts H, Zoet HA, Verhagen M, Lee CW, van Minnen A, De Jongh A. Effectiveness of an intensive treatment programme combining prolonged exposure and eye movement desensitization and reprocessing for severe post-traumatic stress disorder. Eur J Psychotraumatol. 2018 Jul 10;9(1):1487225. doi: 10.1080/20008198.2018.1487225. PMID: 30013726; PMCID: PMC6041781.