Episode 73 Transcript: Living Well with OCD

 

Welcome to the Mind Dive Podcast, brought to you by the Menninger Clinic, a national leader in mental health care. We're your hosts, Dr. Bob Boland.

 

And Dr. Kerry Horrell. Monthly, we explore intriguing topics from across the mental health field and dive into hidden realities of patient treatment.

 

We also discuss the latest research and perspectives from the minds of distinguished colleagues near and far.

 

So thanks for joining us.

 

Let's dive in. Very happy today to finally have on Dr. Abramowitz. I've been trying to get you on for a while. Dr. Abramowitz is an internationally recognized expert on OCD and anxiety disorders. He specializes in providing Cognitive Behavioral Therapy for individuals and families affected by these disorders. He has published over 350 research articles, chapters and books, and other related topics. He gives lots of research and other workshops for professionals, community agencies, consumer groups, and he provides up-to-date training on the use of effective treatment methods for OCD and anxiety disorders. Along with his prior practice, he's a professor of psychology and neuroscience at the University of North Carolina, Chapel Hill, leads the clinical psychology PhD training program there. He got his PhD in clinical psychology from the University of Memphis; his master’s in psychology from Bucknell University in Pennsylvania. He's been recognized with numerous awards for his contributions to the field of OCD, anxiety disorders, and clinical psychology. And he's been recognized. Well, you already said this twice here and here, Kerry, but numerous awards. We're clear away, lots of awards for his contributions to the field. Yes. Exactly. Anxiety Disorders Clinical Psychology. With nearly 30 years devoted to this field, Dr. Abramowitz joins us to discuss today's topic, Living Well with OCD. In fact, that is the title of his latest book.

 

Welcome, Dr. Abramowitz.

 

Thanks for coming on. Thank you. Thanks very much for having me. It's an honor to be talking about this important topic with you guys.

 

I feel excited about this for a few reasons. Number one is that I feel like between you, Dr. Eric Storch and Wayne Goodman, and Dr. Liz McInvale, we have like the OCD experts like have now been covered on the podcast.

 

That feels like it's an honor to be to be mentioned with those guys to have a lot of people.

 

And I think one of the things that we say when we're marketing our podcast where we talk about it is we talk about covering parts of treatment or parts of clinical experiences that are maybe not covered as much. And as we're going to get into, I feel like your book really covers a few of those things around OCD. That even though again, like we've had several episodes on OCD, like there's stuff around this, like, how does this impact relationships and families and how do people manage it throughout their lifetime? Like that's stuff that I don't actually think gets covered very much in training on OCD. So I'm very excited for this episode.

 

So we're going to start with what we usually do and just tell us a bit about your career, and you know, just how you got interested in working with OCD patients.

 

Yeah, you know, it was kind of fortuitous when I was an undergrad. I took a class in abnormal psychology. And the professor, I went to a small college, the professor literally walked around with a hat, and we picked, you know, out of a hat which disorder from the DSM we were going to do our term paper on and a presentation. And I had OCD. And this was the late 80s, and there wasn't a lot of stuff out there on OCD.

 

So just to clarify, there was so it was random. You're random. It was random.

 

I knew I was always  interested in psychology. And so I had taken a bunch of psychology classes, and I was interested in behavioral therapies because those are the most effective treatments. So I knew I was kind of interested in all of that, but I didn't realize that there was so little good empirical research on OCD. And so I read about it, dived in, exposure, therapy, behavioral approaches, work. And it just spoke to me because I'm a scientific guy. And so just the science behind that and condition extinction and all that. And then I got to graduate school. You mentioned my master's program. I got to Bucknell. It's nearly impossible to get into a good PhD clinical psychology program right out of college. Our program at UNC, we get over a thousand applicants, and we take about seven or eight students. So, like, yeah, right. So, no one's getting in right out of college. You have to have experience. So in those days, you could get a master's degree and then have a better chance to get in. So, I went to Bucknell, did a two-year, wonderful master's degree program there. And same thing. The first class, and it was like advanced or graduate level abnormal psychology, and the professor literally said, you know, ‘Abramowitz, you're going to do your paper on OCD.’ I'm like, ooh, I know a little something about that.

 

Maybe you're like fascinating. Already been here. Yeah. Exactly.

 

So, you know, again, I did a deeper dive, and I got to meet some people with OCD, and I fell in love. So, when I was in grad school, I kind of was like, you know, this is what I want to focus on. And I had the fates have spoken. I've pulled out of the hat OCD. This is my literally, yeah. So that's what I tried to, you know, do as far as my research and my clinical work. Yeah, I love what I do. I love the clinical aspect; I love the research. Uh, I love teaching and supervising, mentoring, and all that. Yeah, being a clinical psychologist rocks. It's an awesome gig.

 

Retweet. I completely agree with that as a clinical psychologist. But especially with OCD, I don't think that there's really any benefit or utility in like hierarchicalizing the suffering of certain disorders. So I just want to say that before I say this, but I do think that OCD is so uniquely hard. Like it's so like the people I meet who are who are going through OCD, especially like acute episodes of really intense symptomology, it is so horrifying. It's so painful. And so I feel like one of the things that I've really, I don't treat OCD in regard to like I don't, I don't specifically treat OCD, but when people are inpatient, you know, they were working with all sorts of stuff. But the people that I've met, I feel like one of the things that's gratifying about this population is that there's such good treatments and there's symptom remission and people feel better. And you can just see it so clearly happen. And so, I'm so grateful there's good treatment because it's such a, again, such a debilitating disease.

 

You're absolutely right. And of course, you know, there are levels of severity, but folks, there are a lot of people with OCD. And we know from research that OCD accounts for a large amount of missed days, within the mental health arena, OCD accounts for a lot of days of missed work and problems with relationships and school problems kind of general satisfaction with life. And so we can see folks that have just such terrible debilitation from this, and we have treatments that can be effective, most notably, of course, exposure and response prevention. And within a relatively brief amount of time, we're talking a few months, folks can really reclaim their life. And I saw that in grad school when I started learning about this and working with folks. And that was one of the things that made me want to gravitate towards it. It's not a panacea. Treatment's not a panacea. Unfortunately, there are plenty of folks who don't respond. And so, we need to continue to do research to improve our understanding of OCD, to improve the treatment. And I think to this particular book, improve not only reducing the symptoms of OCD, but also improving people's lives with OCD outside of just their symptoms. Because, you know, as you're mentioning, the symptoms of OCD have long tentacles. They get in the way of lots of stuff.

 

Yeah, I think you stress in there that this, you know, this is a lifetime disease for most people, which I'm not sure is always known. I mean, we know it.

 

Yeah, and it almost feels like a taboo thing to say, but like I don't know why with like bipolar, for example, it feels a lot more known and easy to say. Like you're going to have this for the rest of your life in regard to maintenance, and symptoms can get a lot better, but you're going to need to think about this for the rest of your life. I don't feel like that gets talked about in the same way with OCD. I don't know if that's your sense. And again, its kind of a dark question this is like, is OCD something people typically have to kind of work on or maintain treatment for the rest of their life, usually?

 

You know, it varies from person to person. We see folks who, yes, that's definitely the case. And then we see other folks who are able to put it in the rearview mirror. So it, you know, like lots of questions in the mental health field, the answer is it depends. But  yes, I mean, it generally look, the truth is that we all experience unwanted intrusive thoughts, whether you have OCD or not. So the seeds of obsessions are there for people who have had OCD. They're not going to get rid of their intrusive thoughts. What they're going to learn is how to have a healthier relationship to them so that those thoughts don't bully the person around anymore, and so that they're not having to do avoidance and compulsions. To that extent, you know, and anxiety also, you know, this is a normal emotion that we all need, that we all experience again, whether you have OCD or any other anxiety-related problem. And so we're not, it's not about getting rid of anxiety and distress. It's about having a healthier relationship with it, not getting pushed around by it so much.

 

Yeah. And you, I mean, this actually brings us back to the basics, but it's probably worth saying since we have, you know, a varied audience. But because I always think that OCD suffers from the same problem of certain other disorders like depression and stuff, of having kind of like a lay understanding as well. Like it's not unusual for someone to just glibly say, ‘Oh, yeah, that's my OCD acting up’ or something like that. By which they mean that, they're just being a bit compulsive or something.  So it probably is good to say a word or two about how this is different than just normal perfectionism and stuff that people consider to be a good trait sometimes.

 

Yeah, so important and OCD, I think, is one of those problems that does unfortunately have more of that. I don't know how we how we want to refer to that, but more just kind of folks almost make fun of it and discourage.

 

Well, yeah, I've had patients told they're lucky, you know, great. You know, I could keep on, you know, to have that much attention towards things.

 

Yeah. But no, I mean, OCD is not something that's helpful at all. And I know there've been TV shows about that. OCD is not --the person does not want to have OCD. There is nothing good about OCD whatsoever. It gets in the way of your life, it causes, you know, tremendous amounts of distress, avoidance, things like that. And I think you're and another point is that people often think of OCD as, oh, you know, just washing or checking or perfectionism. OCD can take many, many different forms. People can have intrusive thoughts about harm. They can have intrusive thoughts of a sexual nature; they can have intrusive thoughts of an existential nature. Really anything that's important to you, a person can develop OCD around. And maybe we'll talk about that later on.

 

Well, no, I think that's I you know, one of the things that I've had with my patients that I find to be incredibly helpful as even just like one of the first things is that they come in and, you know, they finally sort of admit or they share, they're like, I have these thoughts. And I they're often aggressive, sexual, like there's something, and they feel horrified to share that this is something that's happening in their mind. And they have no idea that this is the ballpark of OCD. And when I start to be like, that sounds like OCD, they're like, What?

 

Yeah.

 

They're like, it feels like what does that have to do with this idea, this caricature of OCD that they've heard about? And I've watched patients feel like they take a huge sigh of relief when I say something like, it's actually really common with OCD that the intrusive thoughts are sexual or aggressive in nature. They can be quite violent, quite scary, and they're really not wanted and they're not pleasant. Like it's not like you're fantasizing about it. They come into your mind intrusively. And when patients hear that and they've not had good psycho ed on OCD, you just watch them take a breath of like, oh, there's a name for this. I'm not just sick or like, you know, perverted or terrifying in my mind.

 

There's a lot about OCD that's not known as far as, you know, what is OCD and what isn't. So, to your point, people often have OCD and they don't realize they've had it. Then there's also the problem of a lot of people think they do have OCD and even get diagnosed with OCD when they don't have it. There's just a lot of drift with the boundaries of this problem. Some people think, well, I obsess about things, you know, I obsess about how terrible I am, which is really depression, right? I obsess about how things are hopeless. That's not OCD. Or I pull my hair all the time, or I pick my skin all the time. That's my OCD behavior, and that's not OCD either.

 

Yeah. Well, and so maybe one thing I can appreciate as I ask this question, that it's probably going to be ‘it depends’, but maybe just on like a broad level, are there things that tend to lead to people having more intense or acute OCD symptoms? So, are there life experiences or things that kind of correlate with increased symptomology for OCD or even like the onset of OCD?

 

Well, we don't know about the causes of OCD. We have some guesses. There's some guesses about biology or genetics. There's some guesses about learning history and environment. But at this point, there, these are guesses. And the truth is that it's probably multifactorial. Whatever leads to OCD is probably a hopelessly complex combination of factors.

 

Yes.

 

And, you know, for someone to say, well, OCD is caused by this, or OCD is caused by that, that's over, you know, serotonin or that's just way oversimplifying. So, we don't know. But you know what? We don't, I mean, it'd be nice to know, but at this point, we're better served by trying to put our energy into understanding the symptoms of how it works and what we can do to reduce it. Because even though we don't know the exact causes of OCD, we do have a pretty good handle on how to treat it effectively. And we certainly understand how the symptoms work. So, when you say what makes a more severe case of OCD, we know that the way that people respond to their unwanted thoughts has a lot to do with the severity of the problem. The more that someone tries to push back against unwanted thoughts, the more that someone tries to control their thoughts, control their feelings of anxiety and guilt, that's going to make the symptoms worse. And treatment, effective treatment is about reversing that process.

 

Yeah. And you mentioned already exposure and response prevention. It might be worth it to say a little bit about that. Uh, you know, a lot of times when people go for treatment right away, they hear about the medications and stuff. And I'm not even told that one of the most effective treatments is a psychotherapy.

 

That's exactly right. So exposure and response prevention, what it means really is helping people with OCD to approach and process their fear stimuli. And what that more specifically means is working with the therapist to come up with kind of a list of ‘here are the things that provoke unwanted thoughts,’  you know, like that we talked about before. It could be about contamination, it could be about harm or violence or sex, thoughts that are intrusive, the person doesn't want to think about them, and they spend a lot of their time trying to push these away. And what we're doing in therapy is we're helping the person to approach those thoughts, approach the stimuli, approach those unwanted feelings and lean into the situation, lean into that feeling and process, --what it's like to actually approach it rather than avoid it.  So that's exposure therapy. Response prevention means resisting that urge to escape, to do the washing rituals, to do the checking or the reassurance seeking, and to find out that, you know, I can get through this situation. It's not as dangerous as I thought. The feelings, the thoughts, these are more manageable than I thought, and they don't have to run my life. I can still do things that are really important to me, even though it might mean having to approach, rather than trying to figure out how to avoid, my fears. And that's really the nuts and bolts. The therapist is a coach, a cheerleader, not a taskmaster.  The therapist never forces people to do exposure, like unfortunately, some people think, or it's portrayed on TV shows sometimes. It's a very collaborative process.

 

You also talk about the importance of self-compassion. And I this particular thing to your work, you know, as being an important strategy for managing OCD. Can you say a little bit more about that?

 

Yeah, people with OCD, they struggle with a lot of shame and guilt because of their intrusive thoughts. Those thoughts can feel, you know, really personal, especially if they're about things that go against the person's values, like you know, harming others or acting immorally or something like that. And just having OCD, sometimes people can feel like they're a burden or feel guilty about that. Even though, you know, lots and lots of people have OCD and everyone has strange intrusive thoughts. And so that's where the self-compassion becomes really important, right? Recognizing that this is not, you know, no one wants to have OCD, no one is having OCD on purpose. Everyone has intrusive thoughts. That doesn't make you bad or dangerous. Having OCD doesn't make you bad, it makes you human. Having unwanted intrusive thoughts makes you human. And so, when we teach people how to respond to their own distress and their own kind of situation with more kindness and understanding, they're less likely to have shame and guilt and more likely to have self-compassion. And that helps just create more emotional space to do effective treatment and to get back to doing life more effectively.

 

Well,  if you Google “ treatment for OCD,” you're going to see stuff about medication, ERP, maybe even stuff like deep brain stimulation, but I actually feel like some of the stuff that you really cover in your new book is the stuff that's going on with most therapists who are doing OCD treatment. But maybe again, it's not as talked about, like doing interventions on self-compassion, giving that space to talk through the shame and the guilt and the pain. And so, the other thing you spend quite a bit of time in your book talking about… well, there's two pieces here. I sometimes do this. So, hold on, let me not get too complicated. I'm going to start with one piece, which is the relational piece, which is that OCD treatment can be understandably, this is how our field works, focused on the individual with the OCD. How do we treat them? And we don't often think about the impact that the illness has on the family, on the relationship, on the work, on the school. And that this is something I think you have 30 plus years of experience working with OCD people or folks with this disorder, that you've seen this, it gets in the way of their life in these ways that maybe goes beyond just their individual treatment. And I wonder if you can speak to this, how you see this disorder challenging the relational part of people's life.

 

Yeah, definitely. Well, first let me just say that one thing that we need to do better at when we're developing our treatment protocols is to incorporate exactly what you're talking about, is not just reducing the symptoms of OCD, but also helping to repair the person's life more generally. And one of the ways that's important is with relationships, as you're mentioning. OCD doesn't just affect the person who's experiencing OCD, it pulls in people around them-- partners, family members, teachers, coworkers, friends. They can all get drawn into like providing reassurance, accommodating rituals, helping the person do rituals, helping the person avoid OCD triggers. And these behaviors, they're almost always done out of love and concern. You want to help them. What the person who's helping, in quotes, “helping,” doesn't recognize is that those things inadvertently strengthen their OCD cycle. And over time, this can create tension and resentment in relationships, burnout in relationships, in marriages. And loved ones, they sometimes feel like they're walking on eggshells around the disorder, that the disorder is dictating everyone's behavior. And we have developed treatment protocols to teach loved ones about how this works and help them help their loved ones in more helpful ways; I guess. Again, we can talk about that in more detail if you want, but that's something we have to we have to do better at.

 

Well, my thought too is that, like you said, it's out of love that so often this is happening.  I work a lot with adolescents and young adults. I'm working with parents a lot. And a lot of times these parents are like, ‘no, you can't do that. They can't handle it.’ And in many ways, it's correct. We have to really work on developing their coping skills. But helping the family realize too that we all together as treatment team family, as a whole crew, er need to support this person in realizing and empowering them that they can do this. That's exactly what I'm saying. OCD to be obviously as an anxiety disorder, it falls into the similar category of trauma and phobia, in that the more you avoid, the smaller your world gets and the more terrified it seems. I always imagine it's the farther back you get into the dark cave. And the scarier and scarier it seems to come out of the cave. And it's to help families realize too, we are actually really helping them, even as scary as it seems to realize they can, they can approach this and it's not going to hurt them. Like they can get there and they're going to feel so much more freedom rather than keeping the training wheels on and the gloves on all the time. 100%, Carrie.

 

100%, Kerry. One of the things that I like to say is that family members sometimes think that their loved one with OCD is like a like a candle flickering in the wind, and that with a gust of wind, they're just going to go out if you know if they have too much anxiety. But that's not the case at all. What we want to do is we want to strengthen that person and those around them to see that your loved one with OCD is actually really strong. They know how to manage anxiety because unfortunately, they deal with it on a daily, if not hour-to- hour basis, but it's helping them in the right way rather than protecting them and screening them from the wind, it's actually giving them healthy support, which we want to teach them to do.

 

Can I go back to my other thought too, really quickly? My other part, and actually in your book, I'm going in the wrong direction. You end your book on relationships, and you start your book with identity. But this is this other piece I wanted to talk about. And you touched on it a bit with self-compassion, which is that perhaps folks with OCD are getting wound up in their identity in a way that then, again, like there's shame and there's guilt and there's a feeling of brokenness, and there's just a feeling of like, this is who I am. It can again continue to make the world feel small. And I wonder kind of if you could highlight some of your thoughts about that for people with OCD of how to kind of dissect this as this is a part of your life, it's an understandable part of your life, and it's not all of who you are.

 

Yeah. Well, and I think you just you hit you hit the nail on the head that this is, we know we can't ignore it. At the same time, yeah, we don't want to define ourselves. Often a mistake that that we make in our thinking, and again, this isn't just if you have OCD. I think we all do this, is that sometimes we we tend to blow up things about ourselves that we don't like, and we use these aspects of ourselves to label ourselves kind of over-generalizing. Well, I have this problem, therefore, you know, I am damaged goods. There's something wrong with me. And that's just an unhelpful and illogical, kind of untrue way to think. OCD is a part of you. If you have OCD, it's not who you are. People are much too complicated to just, you know, label with one adjective or one thing. We all have areas of strength; we all have areas of weakness. Even again, talking to people who might be affected by OCD, even or depression, even if it's hard to see those things, you do have strengths in your life. You do have things that you do well. And we don't want to just define you as a person based on one aspect of it. So sure.

 

In your book, I'm going to show your book as if they're going to be able to see this. We don't do videos. 

 

So nobody's going to see it. But I am hoping he knows, I'm guessing he knows, what his book looks like.

 

I'm holding Dr. Abramowitz's book, and it's a very good book. I think one thing that I like about it, again, I say this because I work with young adults and adolescents. And if I'm like, hey, here's a book, they're going to be like, thanks, Dr. Horrell, I will not be reading that. But I think one of the things that you really focus on in your book is making these strategies usable, like not making it so jargony and like here's 10,000 steps. It's like here are just some practical ways. And I wonder as we kind of start to wrap up for today, like, are there kind of major takeaways you'd be wanting, especially clinicians, because this is kind of who our podcast is geared towards, to be thinking about like working with people with OCD, helping them manage this as especially like more of a maintenance level lifelong, like how they relate to their own minds. Like, are there strategies and ideas you'd want to kind of point them towards?

 

Yeah, well, I mean first I think it's essential for clinicians to really understand what OCD is and how it works, kind of how we were talking about before. A lot of people have a very kind of rudimentary understanding of it. And it's not just what it says in the DSM. You have to really dive in. It's so heterogeneous. So, understanding what's happening with intrusive thoughts and intolerance of uncertainty and ways that people try to prevent discomfort that just ends up kind of backfiring on them. And then understanding evidence-based treatment. So, a lot of therapists would say ‘why would you have someone approach and lean into their fears?  That's only going to make them worse.’  But that's not the case at all when we do this therapeutically, like exposure and response prevention, acceptance and commitment therapy, which overlaps a lot with DRP. These are powerful tools that can help people to re-engage with their life, but they require that therapists know what they're doing, that the therapists convey confidence and warmth, respect for how hard the work is. And then the last thing is I would say is don't just treat the symptoms. Of course, treat the symptoms. That's really important but help people to build a life around what matters to them. The goal isn't just to eliminate anxiety and intrusive thoughts. I would say that that's actually not the goal. The goal is to help clients relate to their anxiety, relate to their thoughts in a way that can help them re-engage with their, with their values, I guess.

 

Yeah. I know we don’t have the time to go all into treatment methods, but I am curious, you know, having done it a few times, how do you engage people? Because that always seems a challenge to convince people to really do this. I mean, and not to cheat, and what to do if they do cheat, but even just how to get involved in the first place. Because as you said, it sometimes seems counterintuitive, the treatment when you first discuss it.

 

A good therapist will spend a lot of time on the front end helping the person to get on board with teaching them about how OCD works and about how the therapy works. So it becomes kind of like a no-brainer. Oh, of course I need to do that. So that's one important piece of it. And the other piece is having that trusting relationship with someone. You're a team where you're working together and you're working together to solve a problem and to do good together. Though that is so important. And we just don't do enough in our treatment protocols and our books and all of that to really convey that that's what happens in therapy. It's not just the therapist standing there saying, ‘now touch the floor,’  right? It's not like that at all. It's not like what you see on TV. So that's just so important. When I was a beginning therapist, I had to learn that. And I remember the first few folks that I worked with in OCD, I kind of jumped into because I knew this could work. And I kind of jumped into it so fast, and the people weren't responding, and they weren't even coming back. And my supervisors were like, Yeah, it's because you know, you’ve got to give them a rationale, you got to help them understand. You understand it's good for them to do it, but you’ve got to help them to understand. And I find a lot of therapists don't do enough on that end.

 

So, you just can't get past the importance of a therapeutic relationship.

 

Yeah, it's so important. And let's add the thing about CDT is that the therapeutic relationships sometimes get short shrift. And that's a shame. The therapeutic relationship is not the key ingredient in therapy from a cognitive behavioral perspective, but you need that relationship in order for the active ingredients to have their effects.

 

Yeah.

 

Well, and I was going to say, like the empathy of it all too, like as we're talking about the relationship, I'm thinking about again, I feel like my exposure work tends to surround trauma more in my day-to-day work. But you know, a lot of times I I'll tell my patients before, as we're first kind of getting into the work, I'll say, if I had a magic wand that I could make this go away without you having to go back to or to approach this thing that feels so awful, I would because I know how hard I just like being with them of like and appreciating with them. This is really hard. It is so hard to approach stuff that feels like if I don't do this compulsion. If I don't do this ritual, I might genuinely feel like something horrible could happen. And that I like I could die, someone else could die, something horrible could happen. Like that's really terrifying. And I think just that empathy of like, this is so challenging. And I believe in your capacity to do it. I believe that this will actually feel better. I think it can go so far to let them know that we see how hard it is. If I could make it so that this didn't have to be the way to get better, I would. I would. So, you don't have to do all this hard work. But this is the thing that's really going to help.

 

Yeah. A hundred percent. Yeah.

 

Thank you so much for joining us and giving us a bit of a taste. Again, I just want to remind our listeners, the book is called Living Well with OCD, Practical Strategies for Improving Your Daily Life. It is a book that is written specifically for clients and for patients.

 

I think it is useful for clinicians as well. Yes, yeah.

 

Well, I know clients and patients who either, you know, have a hard time, like we were talking about, have a hard time with the therapy, or they're not ready to try it, or they don't have access to it, or maybe they've gone through the therapy and it hasn't gotten them all the way home. So that's why I wrote this book because there are a lot of folks like that, unfortunately, arguably, there are more people like that out there than people who have had successful treatment. Yeah. Yeah.

 

And to normalize most people with OCD are going to need some of these strategies. Yeah. That there's going to be times of stress in their life where things going to, you know, some of the symptoms might come back, or that just might be something they live with chronically. And so I think it's incredibly helpful. So, thank you so much for coming and sharing with us. Again, you've been listening to Dr. Jon Abramowitz on the Mind Dive Podcast. I'm your host, Dr. Kerry Horrell.

 

I'm Dr. Bob Boland. And thank you for diving again.

 

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