Treatment Resistant OCD: Building The Ultimate 8

Episode 6 of OCD Insights with host Samantha Bray, LCSW, and guest Carl, OCD advocate and creator of The Ultimate Eight. Lightly edited for readability. Transcribed from the final published episode, including the recorded introduction and closing.

Introduction

Samantha Bray: Imagine three rounds of therapy and nine medications, and you're still up to your neck in OCD. What do you build when the standard path available to you hasn't been enough?

Samantha Bray: I'm Samantha Bray, licensed therapist with over a decade specializing in OCD.

Samantha Bray: Today, welcome Carl. He's calling in from a small village in the UK. And although he had symptoms from about age eight, he wasn't diagnosed until a severe flare-up in his thirties.

Samantha Bray: So what does a person do when the standard treatment protocol that's available to you in your country leaves you stranded? Well, he built his own. Carl created what he calls the Ultimate Eight, eight practical pillars designed to make OCD recovery possible.

Samantha Bray: Now some of these pillars are squarely evidence-based, and some Carl is experimenting on his own life, and he'll tell you about that himself.

Samantha Bray: Quick before we get started. If you find this podcast helpful, please follow, like or share the show. If you have ten seconds, leave a quick rating. It truly helps others find these podcasts.

Welcome

Samantha Bray: Hi, Carl, welcome to the OCD Insights podcast. How are you today?

Carl: I'm good, hi Sam. Thank you for having me.

Samantha Bray: My pleasure. Thank you so much for being willing to share a little about your OCD journey. I'm so interested in the path that has gotten you to what you describe as creating the Ultimate Eight. I'm just excited to hear about your journey to this point and what you've created. So where would you like to begin?

Childhood: Doors, Light Switches, And Counting In Sets Of One Two

Carl: Okay, I'll start with my OCD. I had OCD as a child. I wasn't diagnosed until later in life, actually about 13 years ago. But as a child I can remember doing things like I'd shut the bedroom door and then I'd open it, then shut it, then open it, then shut it. And it was in sort of sets of one two, one two. And if that didn't feel right, then I had to do one two, one two again. And checking the bedroom door, shut, shut, shut, shut. And even saying the word shut, shut in a one two, one two pattern.

Carl: As well as that was turning the lights off. Again, I'd have to turn the lights off, on, off, on, off, off, off. And it was always to prevent something bad from happening. So that was round about, I reckon, my earliest sort of memory, maybe about eight or nine years old.

Samantha Bray: Do you remember if anyone had a clue that was OCD, or what did they think was going on with you?

Carl: No, not really. I mean, it was back in the 80s. I think my parents just thought I was mucking about, just messing around or playing a game. Which in some ways, sometimes it did sort of gamify a little bit. It would be like, if I step on this crack, something bad will happen. So don't step on the crack, jump over it. Sometimes OCD would sort of almost gamify a little bit as a child.

Teen Years, The Twenties, And Drinking

Carl: And then moving on to teenage years, it was similar sort of stuff, but obviously the stove when cooking as well. I checked the stove quite a few times after cooking. And I'd have issues around going to the toilet and washing my hands. I'd have to wash my hands a certain way, a certain number of times. And then I find my OCD sort of comes and goes in waves. It eased off for a while in my 20s. Mind you, saying that it did ease off in my 20s, but I did sort of replace it with drinking quite heavily at the time.

Samantha Bray: Like self-medicating.

A Care Home Kitchen, And The Thought That Stopped Him Working

Carl: And then in my 30s, it came back quite fierce. At the time I was working as a chef in an elderly care home. And I just suddenly had the thought, I live in a very small village, what if I do something that makes somebody in this care home sick or makes them die? What if I don't cook something properly? What if something's not hygienic enough? And that thought just took hold and grew at a rapid rate. I had to stop work for a while, and that was when I was diagnosed with OCD. That was back in 2013.

Samantha Bray: So it took until you were in your 30s to get the proper diagnosis. I'm wondering, when you were a child and even in your teen years and you had the distressing thoughts that if you didn't do something in that game right, that something bad would happen, did you ever share that with any of your family or a therapist?

Carl: No, not really. I didn't really know what it was. I just thought it was a quirk of my mind. Just something that everybody did, or if not everybody did it, then just something that I did. I didn't really question it too much.

Two Hours In The Snow, And The Day He Was Diagnosed

Samantha Bray: So then when you were in your job and that theme popped up so strong, what was it that led you to get diagnosed?

Carl: I can remember one day I was in the kitchen working and I just had so many different thoughts bombarding my brain, and I just couldn't do it anymore. I told my manager that I had to go home, that I was sick. I didn't really say what it was, but I said I had to go home.

Carl: And I remember that day, it doesn't snow very often in the UK, but that day it was really, really snowing. I only lived around the corner from where I worked. I left work, went around the corner to home, and my wife wasn't in, she'd gone out to the shops in town, and I didn't have a key. So I stood outside in the garden for about two hours in the snow, not wanting to go back to work, not able to get into the house. Then I got so cold and so freezing that I had to go back to work because I had to go back inside. I needed to get warm. And then they sat me down and I spoke about what was going on inside my head. And that was the prompt to go and see the GP, the doctor. From there he diagnosed me with OCD.

Samantha Bray: Wow. So were they kind to you at work?

Carl: Yeah, they were. I don't think they really understood it much, but it was clear that I was in a level of distress.

Medication, And The First Round Of CBT With ERP

Samantha Bray: So after your GP appointment and they diagnosed you, what happened after that?

Carl: I began medication. I started on sertraline, an SSRI. And after a few weeks, I got an appointment to do some CBT and ERP. That was the first set of CBT and ERP that I did. To date I've done three sets of CBT with ERP, but that was the first one.

Samantha Bray: And what do you mean exactly by set?

Carl: I don't know how it is in the US, but here in the UK you go on the NHS, which is free at the point of entry. But the NHS is very stretched, very underfunded and busy, and waiting lists for things like CBT and ERP can take quite some time. So when I say sets, I just mean one treatment was a 12 week program. You go once a week and it was a 12 week program. So I've done three sets of 12 weeks between now and 2013.

Samantha Bray: All right, so once a week, and how long were your sessions?

Carl: About an hour. And the first one had longer ERP sessions. There was a period with the first set of CBT and ERP where you could go in and have an all day session doing ERP in a group.

Inside Group ERP

Samantha Bray: In a group. What was that like? How did they structure it?

Carl: It was actually all right. I remember I was very unsure at first, but in a group setting, one, it's nice to see that there are other people experiencing something similar to what you are. And I think as well, maybe it's a character flaw on my part, but there's also that thing of pushing yourself a little bit more doing the ERP because you don't want to be the one person in the room who isn't able to do the exposure. So it's a little extra push in a group setting.

Samantha Bray: So would you sit in a circle and take turns doing the next exposure in your hierarchy?

Carl: Yeah, I'm trying to remember because it was about 13 years ago. We'd sit in a circle, and depending on what the exposure was for different people, some people would do it in the room, some people would go out into another room and do it with one of the therapists. Meanwhile, the rest of us would be talking within the group about our triggers and our OCD.

The Whirlpool At The Edge Of The Drain

Samantha Bray: So in between the three times that you went through the program, how long did you go between those? And after your first set, what did you find helpful, and how long did you go without going back in?

Carl: I found it helpful, and in a strange way somewhat enjoyable. It was a controlled setting and I was facing some of the fears, and it felt very productive and proactive. But where I fell down a little bit was outside of that setting. I wouldn't push myself. I wouldn't continue. It didn't stick for too long.

Carl: The next time I went for more CBT and ERP was after 2013 and 2014. Again, it sort of comes in waves. It eased a little and I was at a manageable, functional level for quite a while. And then in 2024, the next big wave hit. That was when I went back to do another set. It was late 2024, early 2025 when I went back to do the second set of CBT and ERP. And set number two and set number three sort of ran one after the other, because I'd got a place on the NHS, but I'd also, through my own research, sourced a charity that was doing online therapy sessions via Zoom. So I signed up for that, and that began when the NHS one finished, which meant I had an extended period of treatment.

Samantha Bray: And how often did you meet via Zoom?

Carl: Zoom was a similar sort of format. Once a week for about an hour and a half. And again, it was a 12 week program.

Samantha Bray: In a group setting as well. That's really interesting. They have a lot of group work, it sounds like, in the UK. Maybe you have to do that because there's an extensive waiting list, and a lack of resources.

Samantha Bray: I'm curious about a couple of things. One, I'm wondering what you noticed was different about the way ERP was taught or approached between the first time you learned about it and the last. I'm also wondering, I know OCD can come in waves, but typically it can get sparked by changes in developmental stages in our life, setting new goals, major milestones. I'm wondering if you correlate any of these timeframes, like the second and third time, with something happening in your world.

Carl: If I answer that one first, I can't really. What I did feel both times though was, you know when you're in your bathroom and you fill the sink with water, and then when you pull out the plug and the water goes down the drain? It felt like I was on the edge of the whirlpool, but I could feel that I'm going to go in unless something changed. I felt that both times. But obviously nothing changed and I ended up going down the whirlpool. I can't pinpoint it to any developmental stage or any particular event, other than the fact that I had this seed, this thought in my head, that things are getting more difficult, things are worse, and I feel like I'm on the edge of the whirlpool.

Samantha Bray: So if I'm hearing you right, correct me if I'm wrong, you were on the edge of the OCD whirlpool. It never really went away, but it was well managed for all those years. You must have been doing some things right to manage it that long.

Paddling Or Up To Your Neck: The Ocean Analogy

Carl: I guess. I don't know. A quote I heard from one of the therapists was that OCD can be like paddling or bathing in the ocean. Sometimes you go in and the water, or OCD in this case, is just on your toes. Other times you go in and the water is up to your neck. I think that's sort of stuck with me. There have been times where I've just paddled with my OCD, and there have been times where it's at my neck.

Cured Or Managed?

Samantha Bray: That's a good analogy. What did you notice was different about the way therapists approached exposure and response prevention in that span of time? That was about 10 years from the first time to the third time?

Carl: Just over, yeah. I think actually the first time was the best time. The charity that I discovered, like I said, that was online via Zoom. I don't know what your opinion is on this, but one of the facilitators did say that they were cured from OCD. I know that in the OCD community, that's a very controversial issue. Can you be cured from OCD, or can you just manage OCD?

Samantha Bray: What do you think about that?

Carl: Myself, I'm open. I'd say that it would appear right now that the best you can hope for with OCD is to manage it and not have it manage you. But I am open, hopeful and optimistic that if one day there is a cure, then sign me up.

Carl: The treatment there fell into two categories. One, detached mindfulness, which is one of the pillars from the Ultimate Eight. And two was ERP. Now, obviously on Zoom, in a group, you can't really do ERP. So the onus was that you would go away and spend a certain amount of time that week doing ERP yourself. And also in a group setting, if you find you're struggling, or there's something you want to talk about, you don't always feel open enough to share within the group. So there were flaws.

Samantha Bray: How did you handle that? If you wanted to share, did you just keep it to yourself, or did you have a chance to speak to the therapist individually?

Carl: There was never a chance to speak individually, but there was a chance to speak in smaller groups. So for example, if there were say 20 of us in the cohort, we'd get broken down into groups of maybe four or five.

Samantha Bray: Did that feel safer?

Carl: Yeah, I think at times. But again, I suppose depending on what's on your mind, sometimes you might be a bit more inclined to hold it back, sometimes more inclined to speak up.

Samantha Bray: I'm curious, did they have any rhyme or reason to how they would split the group up? Was it by theme, or by gender, or was there any thought to how they did that?

Carl: No, just random.

Samantha Bray: Would it have been helpful, do you think?

Carl: Honestly, I don't know. Possibly, perhaps for some people. Maybe some of the women might have felt better talking in an all-women environment, and maybe similar with the guys. Or those with contamination OCD might have felt a bit more comfortable sharing in an environment where everybody has it, everybody's the same.

Samantha Bray: I can imagine that would be helpful for people that have different kinds of taboo thoughts or harm thoughts.

Samantha Bray: So in your charity Zoom sessions, if you weren't doing exposures in the session, what were you doing? Do you remember what kind of material, or how it was structured?

Carl: We had chapters of a book to read in between sessions, and the facilitator spoke a lot about detached mindfulness and about different aspects of OCD. There was one time where family and friends were invited to join, and we had to leave, the OCD sufferers had to leave the Zoom meeting early, so that he could talk to family and friends about enabling.

Samantha Bray: How did that go for you? I'm intrigued that they had you leave the group.

Carl: I'm smiling now as I say it, but my wife obviously was my significant other and she went to the meeting. We've been doing this OCD thing our entire married life and there was nothing really that she didn't already know. You're not supposed to give reassurance. If you give reassurance, it's only going to make it worse.

Carl: I think possibly the charity one was the one that had the most connection. We'd talk with each other, we set up a WhatsApp group afterwards, so we kept in touch via WhatsApp, and in that sense, not feeling like you're the only person. Obviously OCD can make your world very, very small. So to have 10, 12, 15 people who know exactly what you're talking about, I think that actually helped more in some ways than the actual sessions.

Samantha Bray: I love to hear that. I've hosted some groups in the past and I'm starting a beta group soon because of that exact reason. Instilling hope, normalizing it, and not feeling alone is so powerful, isn't it?

Severe And Treatment Resistant: Nine Medications, Six Classes

Samantha Bray: You had written me that it sounds like you were diagnosed with severe, treatment resistant contamination OCD. Why severe treatment resistant?

Carl: Well, I think the treatment resistant bit comes from me. But obviously I've done three rounds of CBT and ERP. I was writing a list earlier today, and since 2013 I've been on nine different medications across six different medication classes for OCD, and none of them have really had much of a positive effect.

Samantha Bray: Were there issues with side effects, and maybe you couldn't get to a high enough dose, or they just weren't working for you?

Carl: I think all of them bar one, it was just that they weren't working for me. I did last year have some quite troubling side effects with clomipramine. Constipation, slurred speech, muscle spasms.

Samantha Bray: That was not a good fit for you.

Carl: No, it wasn't.

Detached Mindfulness, And The Telephone You Let Ring

Samantha Bray: When you mentioned mindfulness that the program introduced, that's music to my ears. I think that needs to happen more here in the States, where it's paired with ERP. I'm curious, was that your first time being introduced to mindfulness, and how did you experience it?

Carl: I'd looked at certain meditations before online. But the actual topic of detached mindfulness, that was the first time that I'd really come across that.

Samantha Bray: Can you, for an audience that doesn't know what that means, put it in your own words?

Carl: It's basically observing the thought without reacting to it. So in OCD, you'd have a thought, and instead of engaging with it or reacting to it or arguing with it, you would say, there's that OCD thought, or I'm having that thought that blah, blah, blah. And you would just not engage with it. It's not about trying to push it down or bury it away. It's just like if a telephone rings and you don't answer it, it's still there going, ring, ring, ring, but you're just not engaging with it.

Samantha Bray: That's so effective, and it's a very good way to handle mental compulsions. It's not just physical things that you have to stop. You have to stop arguing and debating and analyzing and all those other things in your mind, by noting. I guess here in the States they don't call it detached mindfulness. I haven't heard that term here, but what you're describing, yes, that's mindfulness. Paying attention to the present moment on purpose, or what's going on in your mind on purpose, with intention and no judgment, and noticing. Therapists will say, name it to tame it. And you say, that's my OCD thought. And that gives you that little bit of distance to use your wiser mind. I'm glad that you were taught that.

Carl: It's definitely a practice that needs practice. I find that I've had a thought and I've argued with it, or done the compulsion, and then I was like, oh no, actually I was supposed to use detached mindfulness there. It's a practice that you have to practice.

Samantha Bray: It's like brushing your teeth. It's just something you have to do on a regular basis to see the results you want. What are your current mindfulness practices? How do you stay on top of it these days?

Carl: It's a pillar in the Ultimate Eight, detached mindfulness. At the moment I'm trying to be very aware of the moment and watch that my mind doesn't turn on the noise. Something else that I do that I find is a help at the end of the day is a body scan meditation. That's a good way of being in the present moment.

Samantha Bray: So your anchor in that meditation is to bring your mind back to doing the body scan. And then if it wanders, the practice is to come back.

Carl: Yeah, and obviously the mind will wander, but it's just the practice of bringing it back.

How The Ultimate Eight Came Together

Samantha Bray: I'm so curious how you came to develop your Ultimate Eight, the eight pillars. This is a great list. We could jump into going over each of the pillars a little bit. So where did you start? Are these in order of how they came to you?

Carl: No, they're just the order that I wrote them down, apart from pillar number one. Pillar number one is the cornerstone of everything else. I want to ask you a question actually, if it's okay. I can remember in your channel trailer, you mentioned noticing that ERP wasn't the right fit for everyone at every stage of their journey, and that people needed options, and you used a house metaphor. I was wondering if you could remind me what that was.

Samantha Bray: Yeah. The house metaphor is like when you're building a home. ERP to me is a tool. You need tools to build a home, but you also need to lay a foundation, and you need a variety of tools. You can't do everything with just a hammer. That's the analogy. ERP is one part of the toolbox.

Samantha Bray: But like we were talking about, how you handle the mental noise and using mindfulness, that's another tool. And I think a lot of folks need psychoeducation, which I would say is the foundation, to understand why they're doing the exposures and how to hit the bullseye. Because sometimes you can be told to go do something to be exposed, but if you're not counseled on how to do that intentionally and mindfully, how you move your body in such a way that you have your body tell your mind, hey, it seems like he's not running from a tiger, it must be a paper tiger, because he's walking up to that exposure at a normal pace, he's breathing, he didn't run from it, he actually went towards it and engaged with it.

Samantha Bray: If you do this with a willing spirit and move your body in a slow, controlled way, even if all the bells and whistles are going off inside you, your mind takes note that you overruled it and you moved in such a manner that you're not running from the tiger. And it'll start to dial back the alarm, the sensitivity, and start to increase your tolerance.

Samantha Bray: We don't need to flood you with anxiety. There's education, there's mindfulness, there are different tools in inference-based cognitive behavioral therapy around understanding where the mind's pulling logic from and being able to see your thoughts with distance and not be fused with them. So there are all kinds of ways to approach how you manage your OCD.

Samantha Bray: And on another note, there's the holistic buffering and getting yourself resourced. Having all the foundations under you that help your nervous system, help your outlook and your mindset. Your diet, your sleep, your relationships, having things in your life where you feel purpose. So you can kind of squeeze OCD out by having things to put your mind on that you value. Does that resonate with you?

Carl: Yeah, there's quite a bit of Ultimate Eight in there.

Carl: Well, first of all, how I came up with the Ultimate Eight. I felt like I needed something to take the edge off doing ERP at home while stuck in treatment limbo.

Samantha Bray: So you never had a therapist consistently this whole time.

Carl: Just during those periods, those 12 week periods. So I started searching online with purpose. And as I was looking, I came across a quote. Sometimes if you want something to exist, you have to create it yourself. And I love that idea. So using AI, I'm a big fan of artificial intelligence, and searching online, Facebook groups, Reddit forums, I put together this eight pillar system to help make ERP more doable in real life. So that's basically how I started with the Ultimate Eight.

Samantha Bray: Very resourceful. I love that. What was the first thing that you came across in your research?

Pillar One: ERP

Carl: Okay, so pillar one is ERP. It's the most important thing in the entire protocol. And if I'm being honest, it's also the hardest. The idea with ERP is straightforward. You face the thing that triggers your OCD. You resist doing the compulsion that follows. You face the trigger, anxiety spikes, and you sit with it without performing the ritual. It's quite simple to explain, but it's genuinely quite hard to do, which is why I came up with the following seven pillars.

Pillar Two: The Mediterranean Diet And The Gut Brain Axis

Carl: Pillar number two is the Mediterranean diet and supplementation. To be honest, I didn't really think that food, apart from the general advice to eat more fruit and veg, mattered too much in OCD. But then I learned about the gut brain axis, the direct two-way communication channel between the gut and the brain. An inflamed, undernourished gut sends a chronically dysregulated signal upward to the brain. A healthier gut means a calmer, more resilient brain.

Samantha Bray: What does the Mediterranean diet consist of? I think I have an idea, but for those that don't, maybe you could describe it.

Carl: Whole foods, healthy fats, lean protein, vegetables, legumes. My wife goes through stages with different cookery, different food from around the world that she wants to try. At the moment it married up perfectly, because she's got a thing for the Mediterranean diet and cooking Mediterranean. So that's quite a handy marriage of convenience.

What OCD Took: Cooking, And The Lightning Rod

Samantha Bray: So you're the chef and she's the cook at home.

Carl: Well, you see, OCD takes things away from you. And one of the things that it took away from me was cooking. I never returned back to work after I left my job that day. Cooking certain things is still a bit of an issue for me right now.

Samantha Bray: Is that something you're working towards? I don't want to say it took it from you.

Carl: Yeah, I am working towards it. Obviously, spending so long being a chef, there are times when I want to cook, or I have an idea for something that I'd like to make. But the amount of preparation and the amount of checking and washing, and the feelings of anxiety that come up, it just takes away the joy.

Samantha Bray: I hear that often. I tell my clients OCD is lightning, and it strikes the lightning rod in your life. And the lightning rods in people's lives are the things they enjoy, the things they love, their goals, their dreams. That's a lightning rod. And have you ever heard the idea that OCD sometimes can be like an inner protector that's really gone off the rails? It's way overprotective and it's really trying to keep you from losing the thing you love by being extra, extra safe. But in doing what it tells you to do, you ultimately lose the thing you love. So it says you'll win if you do what I say, but you do what it says and you actually don't win.

Carl: Well, that's literally how it manifested for me. In a work setting it was, what if something I do or don't do, or don't check, or don't do right, will make somebody ill or even kill them, and it will be my fault. At home it's, what if something I do or don't do makes my children sick or die? The bizarre thing is that my children are now 18 and 16, and it's worse now than when they were babies.

Samantha Bray: Interesting. Why do you think that is?

Carl: I really don't know. Obviously, logically, I look at my daughter who's 18 and my son who's 16, and I see the things that he does, and the state the kitchen's in after he's made himself a sandwich, and I think back to the things that I did and how I lived when I was 16. And I think, he's going to be okay. He's going to be fine. But there's no logic.

Samantha Bray: One thing that crossed my mind, because I have two sons that are grown up now, and then I have a daughter that's in middle school. I wonder if the idea that they're about to launch, you know, and be grown on their own feet, isn't that far. You're closer to that deadline than you were when they were a baby. I wonder if that might be part of it. Like, you're almost there, just keep them safe.

Carl: Yeah, I hadn't really thought of it like that, to be honest. It's possible.

Samantha Bray: Maybe when they were babies it was something else. But what's clear is it's a theme about wanting to keep people in your world safe.

Blame, Prison, And The Fear Of Being Cast Out

Carl: And almost equal to that is the fact that it would be my fault, and I would be in prison, or I would be to blame.

Samantha Bray: Absolutely. In the second podcast that I just released this week, I said almost that exact example, when I was explaining to my guest how rumination works. The topic we're talking about is that he started an app called WeCroak, that a client brought to me years ago and showed me, and I've been referring my clients to it for years. I interviewed him about it, and it's based on a Bhutanese saying, ancient wisdom, that says to be happy in life you need to contemplate death five times a day.

Samantha Bray: When people have a thought, and people without OCD don't understand this often, it's not just, my hands might be dirty, I need to wash them. It's, what if I touch something and I'm contaminated, and then I spread it to this person or that person or someone I don't even know, and something happens to them? What we do is that downward spiral technique.

Samantha Bray: And for almost everybody I've ever worked with in 15 years, it ends in one of two ways. What's the worst that could happen? Well, someone could get sick. And then what's the worst that could happen? Ultimately it gets down to, they could die. Or they don't die, but you get blamed in such a way for the thing happening that you're taken away from your people. You're put in isolation. People either say, I go to prison, or I'm alone under a bridge and no one will have anything to do with me.

Samantha Bray: So I think because primally we know if we're kicked out of a village, back in ancient times, if we were thrown out of the gate, we were going to get eaten by that tiger. We need people on so many levels as humans. That's the ultimate threat, I think. What do you think?

Carl: Yeah, that thought of being outcast, being alone. Obviously we're sociable creatures. And I think the very thing that you're trying to work against in OCD is actually being fueled even more.

Pillar Three: The Wim Hof Method And Cold Exposure

Samantha Bray: That's the conundrum. Well, let's get back to the pillars.

Carl: So pillar three is the Wim Hof method. Have you heard of Wim Hof?

Samantha Bray: I have, but I'm not very versed in it. Please tell me more.

Carl: Wim Hof is a Dutch extreme athlete, known for climbing mountains in his shorts and doing all sorts of silly things in the snow in the freezing cold. His method is a specific breathwork pattern followed by cold exposure, in the form of either a cold shower or an ice bath. I came across the Wim Hof method about six months ago. The breathwork is 30 deep breaths, then on your final exhale a breath retention for about 30 seconds or a minute, or as long as you can manage, and then a recovery breath, and then a 15 second retention. That's one round. It usually lasts for between three to four rounds. And the cold exposure is getting in a cold shower, or turning the shower to cold at the end for 30 seconds or a minute.

Samantha Bray: And this is meant to strengthen the nervous system.

Carl: Yeah, I believe the breathing conditions your stress response system and resets the nervous system.

Samantha Bray: And have you found it to be helpful in the past six months? Have you noticed any improvement or changes?

Carl: I will admit that my practice of the Wim Hof method has been very sporadic until recently. It's only been the last four or five weeks that I've actually really seriously done it daily. But yeah, I think so. The cold exposure is the biggest one for me. It's basically like doing physical ERP, in the sense that you're staying in the cold water when every instinct is screaming to get out. And you're staying in that moment.

Samantha Bray: You're doing what you put your mind to, despite what the body is saying. You're overriding it. So it's more like you're practicing that skill, but not with the exact trigger that your OCD is focused on. I get that. And I wonder if it also helps with inflammation. And I know it's a technique often used for emotional regulation too.

Pillars Four And Five: Detached Mindfulness, Exercise, And The ERP Triple Threat

Samantha Bray: And then the fourth pillar, we just chatted about the detached mindfulness.

Carl: Yeah. And like I say, one of the later pillars is body scan meditation, and again I use a lot of YouTube for that sort of thing. Workouts, guided meditation. In that sense YouTube is a great resource.

Samantha Bray: Great. Okay, pillar five, tell me about your exercise and resistance training.

Carl: When I was looking into exercise, I discovered that when you exercise, your brain creates a neuroplasticity window of one to two hours where new learning sticks more effectively and new neural patterns form more readily. So even 20 minutes of movement produces a measurable shift in your mental state and starts that neuroplasticity window opening. So practically, looking at this and pillar one, it would imply that ERP done within an hour of exercise is neurologically more effective than ERP done cold.

Samantha Bray: So when you're doing this hard work, you can get more bang for it. That's awesome.

Carl: I was looking into that a bit more because I was intrigued by it, and I came up with my ERP Triple Threat. Basically you have exercise, and then you have the ERP. And if you add a meaningful reward after ERP, something genuinely enjoyable, then the sequence becomes more powerful. The reward triggers a dopamine release that marks the entire experience as significant and worth repeating. The brain does not just record, survived that exposure. It records, survived that exposure and something wonderful followed. So basically, exercise primes the brain, ERP rewires it, and the reward reinforces the rewiring.

Samantha Bray: I love that. Can you give me a rundown of something you would do?

Carl: I would do an exercise session. A particular exercise I'll talk about in more detail in a moment is something called DDP Yoga. After a DDP Yoga session, I then look at one of my exposures from my hierarchy. At the moment, something on my list would be walking the dog and collecting the poop, then just carrying on with the walk and the rest of the day without over washing and without changing my clothes. And after the dog walk has been done successfully, in the past my wife and I have either gone to the local bar for a drink and a mini date, or I've spent some time playing computer games. Another one was, we lined it up so timing wise we were going out for the day as a family. So the exercise came in the morning, followed by the dog walk, followed by the family trip out.

Samantha Bray: I love that. So it sounds like you really value those quality time moments.

Carl: Yeah, I think OCD can take so much away from you if you're not careful. Like you said yourself, my children are getting to that age where they're looking at flying the nest. So any time you can spend that's quality time, that's not OCD time, because a lot of time ends up being OCD time.

Samantha Bray: That's part of what my philosophy is about, filling your life. Not that you have to be busy 24-7 doing something, never meaning that. But you carve out time for rest, and that's what you're doing, not OCD. You're resting. When you have clarity about what you value and what's important to you, and you decide to be living your life in line with your values, then you can design what you want to do. And when you're doing that, OCD gets the back seat. It doesn't get to be front and center running the show. I just love the examples you gave. Playing a game, fertilizing and growing your relationship with your wife, doing things as a family. That's your anchor, where you want your mind to be.

Carl: I think there can be a danger sometimes that your partner can become almost more of a carer to you than a partner, if OCD is that severe and every day is OCD, OCD, OCD. So to be able to carve out those times where you do things as a family and as a couple, date nights and so on, you're steering your relationship back in the way that it was meant to be.

DDP Yoga: Starting From Wherever Your Body Is

Samantha Bray: Well put. So we were talking about doing aerobic exercise, and you mentioned the yoga, and then the Triple Threat.

Carl: Oh yeah, I wanted to mention DDP Yoga.

Samantha Bray: Yes. What's that like?

Carl: The reason why I mention DDP Yoga is because I have to be careful what sort of exercise I do, because I have knee arthritis. DDP stands for Diamond Dallas Page. He's a former professional wrestler who developed this yoga system. With DDP Yoga, it combines traditional yoga postures with dynamic resistance and old school calisthenics. So you actively flex and engage your muscles throughout each position. It basically delivers the benefits of yoga, cardio and resistance training simultaneously.

Carl: And the good thing about DDP Yoga is that you can start at any fitness level. There are workouts that you can do from your chair, workouts that you can do from your bed. Online is full of stories about how DDP Yoga has helped participants lose weight, reduce anxiety, gain confidence, and helped physical rehabilitation. So in attempting to make the Ultimate Eight as easy and as accessible as possible, you can do DDP from your couch. You can do DDP from your living room.

Samantha Bray: Start where you're at. So no matter what your activity level has been, there's a starting point for everyone. That's cool.

Pillar Six: ACT Values And Valued Living

Carl: Pillar six is ACT, values and valued living. Would you mind explaining acceptance and commitment therapy? Because I'm sure you do it better than me.

Samantha Bray: Sure, just a brief intro. ACT stands for acceptance and commitment therapy. The acceptance piece, these are my words, is accepting that our mind will think thoughts, that our minds are predicting machines, that things out of our control happen, and allowing the thoughts around these things to come into our mind and to be there. It doesn't mean we agree with them. It doesn't mean that we want them. It doesn't mean anything. We actually are not going to assign meaning at all to those thoughts. They are simply thoughts.

Samantha Bray: And then the commitment is, when we have a thought or a trigger, the commitment is to bring our attention and our mind back to what we value. And typically that's the thing you were doing the second before you were hijacked by some thought or some trigger. So you accept that that thought's in your mind, and you pick up the needle on the record and you put it down on the song you want to listen to. You put your mind's focus back in the present moment on something you value. That's the simplest way I could put it. Is that how you understand it?

Carl: Yes, thank you. So I identified my core values, which for me were to be a present father to my two children, being a good husband to my wife, and helping other people with OCD. And like we've just spoken about, I decided to extend it out beyond pure ACT values to include passions, hobbies, social connection, intimacy. Because recovery isn't just about reducing symptoms, it's about rebuilding a full and rich life.

Carl: So for me that looks like martial arts. One of my passions in childhood was martial arts and I haven't done that for years, so I'm currently looking for a good school in my local area. Date nights with my wife. Working on my YouTube channel. And getting out more in nature, spending more time out and about with the family. So again, it's about building a life so full that OCD is pressed to the edges.

Samantha Bray: Yeah, you make your life big, it doesn't make your life small.

Carl: Yes, I think you can, without even noticing, find that your life has become quite small due to OCD. Sometimes it just happens. You don't realize it at the time.

Samantha Bray: I think that's one of the biggest game changers when I work with clients, when they have that attitude and start to put energy in, instead of trying to calm OCD down, they put their mind and their energy on building the things they want into their life. And that first step is all those domains that you noted, hobbies and passions and lifelong learning and your social connections, family, your health, all of those things. I see it like a pie, and those are different domains.

Samantha Bray: And there are more. For some people it's spirituality, there's community service, there are a lot of domains, and you pick the ones that you want depending on your time in life, the ones that are important to you. Pick a couple and just take one step in the direction. And that's one step OCD didn't get from you.

Pillar Seven: Body Scan Meditation, Or ERP Lying Down

Carl: And then pillar seven, again, is something that we've already spoken about. Body scan meditation. Most evenings I lie down and do a 15 to 20 minute guided body scan meditation from YouTube. The practice is simple. You slowly move your attention through your body, from your feet to the top of your head, noticing whatever sensations and feelings are present without trying to fix them, change them or judge them. Any tension, discomfort, warmth or heaviness, whatever is there, you just notice it. You're not trying to make anything happen. You're simply observing what the body is telling you without reacting to it.

Carl: Which might sound easy, but for someone with OCD, I think it's genuinely therapeutic. Every compulsion we perform is a reaction to discomfort. Something feels wrong and we immediately act to fix it. The body scan trains the alternative. Feel something uncomfortable and simply observe, without doing anything about it.

Samantha Bray: How long have you been practicing this?

Carl: I've been doing the body scan meditation now for about four or five weeks. And I think, for those reasons, I like to think of it as ERP lying down.

Samantha Bray: What a way to put it. I see it as the gym for the mind. It's like you're lifting the little weight. And then whenever you're out in the world and some spontaneous exposure crosses your path, you've built up that muscle to be able to skillfully deal with it. Have you ever heard of yoga nidra?

Carl: Yes.

Samantha Bray: That's another type of way, I think, that you can scan the body and practice that's soothing and restful.

Pillar Eight: Rewriting The Internal Narrative

Samantha Bray: So pillar eight, this one really caught my attention. I'm curious about your experience with it.

Carl: Yeah, I'm a big fan of pillar eight. Every night as I'm in bed, I listen to a passive hypnosis audio, again most likely from YouTube, focused on confidence, self-esteem, positivity. The thought behind it being that OCD is a condition that feeds on self-doubt, uncertainty, and a deeply negative relationship with your own mind. Deliberately and consistently inputting messages of confidence, self-worth, and positivity every single night is quietly powerful. You're consciously choosing to change the internal narrative. Every morning when you wake up, having spent the night being told you are capable, you are enough, you deserve a good life, over time, I believe the message starts to stick.

Samantha Bray: Because OCD erodes all of that. It can just really wear it down.

Carl: My OCD tells me a lot, and most of the time it's things I don't want to hear. It tells me I'm not capable, it tells me that I can't do this or I can't do that. So I think just changing that internal narrative, and in that relaxed state, inputting positivity, confidence, self-esteem building. It's probably one of the least evidence backed of the pillars. But I think that it's genuinely worthwhile.

Samantha Bray: I have had some experience with hypnosis myself and I found it to be really helpful. I don't quite understand how it works, but I imagine it's similar to taking vitamins for our body. It's feeding our mind some better thoughts, and it's pointing our mind in a trajectory we hope it goes in. And again, if you're listening to something around confidence and self-esteem and positivity, it's a competing response. It's competing with listening to something like true crime. You're choosing to put something a little more nourishing in your mind.

The OCD Practice, The Book, And What Comes Next

Samantha Bray: Well, this is a stellar list. I'm very thankful for you sharing it with us. And now you're an advocate and you're putting this on your YouTube channel. Do you want to speak some about what you're doing with your work?

Carl: At this stage, the Ultimate Eight is something that I'm experimenting on myself. The YouTube channel is The OCD Practice. I share, mostly shorts, parts of the Ultimate Eight and tips about OCD recovery. I think my latest video was about the Triple Threat ERP.

Samantha Bray: I'm going to take a listen to that.

Carl: And I'm working on a book to go alongside the Ultimate Eight.

Samantha Bray: What's your timeline on that?

Carl: Probably about a month or so. About four or five weeks. The working title is When Nothing Works.

Samantha Bray: Ooh, I like that.

How Carl's Wife Supports Him Without Feeding The OCD

Samantha Bray: Do you mind if I ask you a question? You mentioned your wife a couple of times, and how the group that you were a part of had a session where they spoke to the significant people in the group members' lives. A lot of people that might listen to this may not have OCD so much as be trying to figure it out for the sake of a loved one. So I'm curious, what do you find are the most helpful ways that your wife supports you that doesn't feed the OCD? Not reassurance to the content of the thoughts, but what ways does she support you or help you when you seem to get stuck or in a compulsion?

Carl: That's a really good question. This might sound a bit bizarre, but we sometimes laugh at the OCD. So if I come in with an OCD question, meaning basically I'm looking for reassurance, my wife will not laugh at me, but laugh at the topic. For me, a lot of the time it's around the kitchen or the toilet. So she might say something like, we're not talking about anything from the toilet today, nothing at all. It's a toilet free day.

Carl: And I think as well, she's really good, not in the reassuring sense, but really good at just listening, when I'm trying to explain how I feel. I think the main thing is communication. I know that I can talk to her about anything.

Samantha Bray: So somehow she's become skillful at being patient and listening, and offering humor, but not reassuring you or getting into the weeds of the content of the OCD. That's awesome.

Wrapping Up With Carl

Samantha Bray: Well, is there anything that I haven't asked you today that you would have liked to talk about?

Carl: I wondered about the idea of possibly, perhaps, months down the road, after I've spent a couple of months inside the Ultimate Eight, coming back on and sharing any results.

Samantha Bray: I would love that. That would be amazing, in about eight weeks or so. Let's do it. I think that would be great. See how it's evolved and what your takeaways are. And Carl, I really appreciate your time. Thank you for trusting me and coming on here. I really appreciate it.

Carl: Thank you. Sam, it was really lovely to meet you and to talk with you.

Samantha Bray: Thank you.

Closing Thoughts

Samantha Bray: If you take one thing from today, let it be the part where he talks about building a life so full that OCD gets pressed to the edges, rather than spending the day negotiating with it. I love how he chooses to get out there and live life.

Samantha Bray: This is an invitation to pick a valued domain and take one step this week. That's one step OCD does not get.

Samantha Bray: ERP, ACT and mindfulness are the evidence-based practices of the Ultimate Eight, and the rest is Carl's own scaffolding. And hopefully we'll get to hear from him in the near future and see how it's going. That would be amazing.

Samantha Bray: If this episode meant something to you, or you found it helpful, follow, like, subscribe. Someone else who feels like they have run out of options can find their way here.

Samantha Bray: Until next time. Thank you for listening.

This podcast is for informational and educational purposes only and is not a substitute for therapy, clinical diagnosis, or professional mental health treatment. If you are struggling, please seek support from a qualified mental health professional.

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