Sensorimotor OCD (with Max Maisel) | Ep. 434

In this episode, OCD specialist Dr. Max Maisel joins Kimberley Quinlan to unpack the misunderstood experience of Sensorimotor OCD and offers empowering, evidence-based strategies to help listeners find relief and reclaim their lives.

What You’ll Learn in This Episode:

• Why Sensorimotor OCD often goes undiagnosed—and what it actually looks like
• How subtle compulsions like mental checking and self-monitoring keep the cycle alive
• Why typical ERP can backfire if it’s not applied carefully with this OCD subtype
• The power of radical acceptance and how it rewires your relationship with awareness
• How to use “reminders” as an unexpected but effective exposure strategy
• Max’s personal story of recovery—and the mindset shift that changed everything

Understanding and Treating Sensorimotor OCD: Strategies for Recovery and Radical Acceptance

Sensorimotor OCD—sometimes called somatic or hyperawareness OCD—is a lesser-known but deeply distressing subtype of OCD. In this episode of Your Anxiety Toolkit, OCD specialist Dr. Max Maisel joins Kimberley Quinlan to break down what Sensorimotor OCD looks like, why it’s so debilitating, and most importantly, what can help.

Let’s explore the key skills and strategies discussed in this hopeful and practical episode.

What Is Sensorimotor OCD?

Sensorimotor OCD involves an obsessive hyper-focus on automatic bodily processes like blinking, swallowing, breathing, or heartbeat. Most people aren’t even aware of these sensations—until they are. And for people with this form of OCD, that awareness becomes a source of intense anxiety.

Rather than accepting the sensation as temporary or benign, the brain sounds an alarm:
“What if I’m always aware of this? What if I can’t focus or enjoy my life anymore?”

This leads to compulsions that are often mental, subtle, and exhausting.

Common Triggers and Themes

Sensorimotor OCD can attach itself to virtually any physical sensation or internal awareness. Common examples include:

• Blinking
• Swallowing
• Breathing
• Heartbeat
• Eye floaters
• Pressure or sensations in the bladder or bowels
• Awareness of limbs or body parts

The common denominator? It often targets the things we care about most—like enjoying a movie, playing video games, or spending time with loved ones. OCD attacks what’s meaningful.

Mental Compulsions: The Invisible Cycle

Unlike some other OCD subtypes, the compulsions in Sensorimotor OCD are often internal and invisible. These might include:

• Monitoring: “Am I still noticing it?”
• Checking: “Is it getting better?”
• Distracting: Trying not to notice the sensation
• Reassuring: Telling yourself it will go away
• Ruminating: Worrying about how long it will last
• Resisting: Mentally pushing the awareness away

Ironically, these attempts to “fix” the awareness only lock it in further. The more you try not to notice blinking or breathing, the more aware you become.

Why the Usual ERP Approach Can Backfire

Exposure and Response Prevention (ERP) is the gold-standard treatment for OCD. But as Dr. Maisel points out, ERP must be applied carefully with Sensorimotor OCD.

Here’s why: If you do exposures like staring at a blinking light for 20 minutes, you may actually be reinforcing the compulsion of focusing on blinking.

Instead of focusing on the content, the goal is to shift the relationship to awareness itself.

The Key: Response Prevention + Radical Acceptance

Two core treatment strategies were emphasized throughout this episode:

1. Stop Fighting Awareness

You don’t have to like the sensation, but you must stop trying to push it away. That includes letting go of distractions, monitoring, and self-criticism.

💡 Practice: “I’m going to allow this awareness to be here. I’m not going to fight it.”

2. Embrace Radical Acceptance

This isn’t just passive tolerance. Radical acceptance means changing your attitude from “This has to go away,” to:

“I can live a full life, even if I’m aware of this forever.”

In fact, Max encourages going a step further:

“I hope I’m always aware of my blinking. Bring it on.”

Why? Because when you stop resisting, OCD loses its grip.

Mindful Shifting: Awareness vs. Attention

You can’t control what shows up in your awareness, but you can choose what you give your attention to. This is called mindfulness.

Try this:

• Gently return your attention to a task or conversation—not to drown out the sensation, but to reengage with your life.
• Don’t check if the sensation is still there. Let it be background noise.
  
  

Real-Life Strategy: Use Reminders as Exposure

One powerful tool Max Maisel uses is random reminders. These are small nudges throughout the day to bring the unwanted sensation into awareness, paired with practice accepting it.

Examples:

• A phone reminder that says: “You’re blinking.”
• A post-it note that reads: “Notice your heartbeat.”
  

The goal? To practice living life while being aware, without trying to change or suppress anything.

For Tough Cases: Start Small

Some people feel stuck in near-constant awareness. Max offers this advice:

• Start with micro-moments of acceptance.
• Be kind to yourself and practice self-compassion. Resistance is automatic at first.
• Notice resistance itself without trying to stop it.
• 1% shifts daily create long-term change.

As Kimberley says, “Even a small win is a massive win.”

The Trap of Needing to “Do ERP Right”

A common roadblock is obsessing over whether you’re doing treatment correctly.

Sound familiar?

• “Was that mindfulness or avoidance?”
• “Should I have done the exposure differently?”
• “What if that was a compulsion?”

This is just another trap. The key is to make a choice, allow for the possibility of doing it wrong, and move on. That’s a form of exposure, too.

What If the Sensation Keeps Changing?

Another frequent question: “What if my OCD keeps shifting from blinking to swallowing to breathing?”

Max’s response is clear:

It doesn’t matter what the sensation is. It’s all the same pattern.
The fear is: “Something is in my awareness, and I don’t want it to be.”
The treatment is the same: acceptance, non-resistance, and living your life anyway.

A Story of Hope: Max’s Personal Experience

Max Maisel shared his own story of a Sensorimotor OCD spike. One beautiful day at the park, he became hyper-aware of floaters in his vision. His mind spiraled: “What if I can never enjoy the sky again?”

But he used the very tools he teaches:

• He accepted the awareness.
• He welcomed the floaters.
• He said, “Good. Bring it on. Let them stay forever.”

Within 20 minutes, the floaters faded into the background. He wasn’t trying to make them go away—but they did. Because he let go.

Final Thoughts: You Can Recover

Sensorimotor OCD can feel endless. But with the right tools and consistent practice, you can reduce its grip on your life.

🛠 Here’s what to remember:

• Stop resisting the awareness.
• Practice radical acceptance.
• Use reminders to lean into fear, not escape it.
• Focus on your values, not the sensation.
• Let go of trying to “do it right.”

Your brain might offer blinking, breathing, or floating thoughts—but you get to decide what you do next.

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Transcription: Sensorimotor OCD (with Max Maisel)

Kimberley: Welcome back everybody. Today we have our guest again, so happy to have him back. Doctor, well, Max Maisel, PhD. I know you don’t like me to call you doctor, but thank you for being here. Max is an OCD specialist. We’re here to talk about sensorimotor OCD. I’m so thrilled to have you. Thank you for being on again.

Max: I’m so excited for this conversation. We’re gonna nerd out on this stuff and I cannot wait.

Kimberley: Yeah. It’s a topic that isn’t talked about much in the OCD community in my experience. Mm-hmm.

Max: Yeah, agreed. I mean, this is a topic where, um, I’ve worked with people that have had OCD for a very long time, and people that have treated OCD and they’ve never like heard of sensorimotor OCD or when it shows up, they don’t really understand that that kind of fits what we think of as OCD,

Kimberley: right?

So let’s go straight to it. What is sensorimotor OCD.

Max: Yeah, so sensorimotor OCD, so it has a couple different names. It all sort of gets at the same thing, like some people call it somatic, OCD or somatically focused OCD. Um, I’ll probably refer to it as sensorimotor OCD, kind of just like vibes if me more, but essentially.

Any given moment, there is a ton of different stuff happening within our bodies. There’s different sensations, there’s different bodily processes that most of the time we are totally unaware of, right? For example, Kimberly, right now, you and I are having this conversation, and in the background our hearts are beating, our eyes are blinking, we’re salivating and swallowing the saliva, we’re breathing all this stuff that probably before I said anything you weren’t even aware of.

Now we’re talking and I’m like, oh my gosh, I’m blinking a lot, aren’t I? Um, so essentially, essentially what sensorimotor OCD is, is when people become aware of, uh, one or more of these different sensory experiences or bodily processes, and they kind of freak out. They don’t wanna be aware of it, they don’t like being aware of it, and they do all this sort of stuff to try to get those sensations out of their awareness.

They try to distract themselves. They question, why am I aware? Um, they reassure themselves. They check, am I still aware? Is the awareness there yet? Is it gone? So they do all these things and unfortunately, and paradoxically that fight, that resistance to the awareness actually lodges those sensations into the awareness even more.

1. So it gets to the point where people can’t become unaware of these different things, and the anxiety piece, the core fear in this is that now that I’m aware of this thing that I don’t want to be aware of, whether it’s blinking breathing, heartbeat. Um, it’s going to ruin my life somehow. It’s going to take away from my ability to have conversations because I’m distracted or I’m not gonna be able to enjoy watching movies if every single time I blink, I’m aware of blinking.

So not only is it going to hurt my experience, but it’s going to last forever. Like, what if I never am able to get this thing out of my awareness? And you could. Just like reflect on how dreadful and scary that could be. And, um, and working with this, I’ve worked with people that, uh, range from like mildly annoyed to it all the way to like, just absolutely debilitated and paralyzed by this form of OCD.

Kimberley: Yeah, yeah. It, it, I, I have the same experience. That’s that hyper-awareness of those sensations. And I think the thing to remember is when we use the term hyper-awareness, it’s, it’s. Both involuntary and voluntary, like you’re not asking to be hyper aware, but as you said, then when you respond, it even adds to how much we are hyper aware of this sensation.

I’ve even had clients talk about where they’ll just say, I notice my left hand. So it’s not even a physical sensation so much as it is, like I just can’t stop noticing my left hand or something about, you know, their experience. And that’s a similar thing. So I think that absolutely, it can be so, so debilitating.

What are some of the core triggers? You’ve, you’ve already really done a great job of sharing the, the symptoms of sense somatic OCD and sensorimotor OCD. What are some of the common triggers for people with this condition?

Max: Yeah, like, I mean, like you were saying, Kimberly, it could, it could really be anything.

Um, it could be the, I mean, the common ones, right, would be like swallowing, blinking, breathing. Heart beating, but it could be. I’ve worked with people that have like been hyper aware of how they’re holding video game controllers or eye floaters, um, is a big one. Yeah. And as with anybody, the trigger. It’s really gonna be something that they care about, right?

If somebody cares about playing video games, um, their OCD can very easily attack that. ’cause they wanna be able to play video games in a way that’s fun and pleasant. And if they’re worried, oh, what if I never have this experience playing without this annoying awareness of how my hands is on the control?

Or I’ll never be able to enjoy my games again. So it really just like, I think like what all OC d targets our values and it targets what people care the most about, which is. I think why OCD is as vicious as it is. ’cause it really kind of finds ways to get under, um, what makes life worthwhile for people.

Kimberley: Yeah. Talking about triggers and you talked about like heart rate beating and breath. Do you think that. And I think there can be no right answer here is do you think that the trigger is anxiety? Meaning like they’re, they’re having anxiety, their heart’s racing, and therefore they notice it? Or could it be that they just notice the simple boom, boom, boom, boom, boom, boom of their heart rate?

Um, does there have to be a specific change in the body? For them to get triggered into having OCD in your experience, or could it be just like you said, one day they sat down at the office desk and all of a sudden they just started noticing.

Max: More of that one, right? Like, uh, the, the specific triggers.

Usually that happens more with like panic attacks. Like people, their body reacts really strongly and that freaks ’em out. But this, it could be anything. It could be a conversation somebody has and they realize that like, oh, am I looking at the person the right way? Like, oh my gosh, wait, what does it mean to look at somebody the right way?

I don’t know. So it really can attack people out of the blue, although I will say that. Just like with all OCD people are definitely more susceptible when they’re stressed, right? Yeah. When they’re stressed out or anxious, the resistances are low, and OCD has a lot more ground to be able to creep up and catch them.

But once somebody’s stuck on this and they start engaging in the compulsive behaviors and avoidances that we’ll talk about, um, it tends to last. And until people understand how to break the bonds, it has.

Kimberley: Yeah, I, um, I’ve also had cases or consulted on cases where they may notice like the feeling of pressure in their bowel or the feeling of needing to urinate and they’ve gone and had all of these tests, but they just can’t stop feeling this feeling and, and being aware of this feeling and maybe even feeling like they need to empty their bowel or their, their bladder to get rid of it.

Only to see that, um, there’s a sensorimotor component to this.

Max: Yes, yes. That’s so, that’s exactly right. Um, you can see how vicious that could be when there’s like a combination of pot, like physical needs, but then also it’s hyper awareness. And to be able to parse those out can be very nuanced stuff.

Kimberley: Yeah, yeah. And really, really painful. Really painful. Um, let’s talk about, you know. Often with OCD, we misunderstand it as only having physical compulsions. What might be some of other compulsions that people are doing specific to sensorimotor OCD? Like you’ve mentioned some, but I wonder if you can share more about like the mental internal compulsions that happen for people with somatic or sensorimotor OCD.

Max: Yeah, of course. Um, I mean, the biggest one. By far is resistance, right? Mm-hmm. So like the brain gives them something in their awareness. It’s like a gift from the brain. Like, here you go. Like, here’s awareness of your eye blinking. Um, and it’s our rejection of that. We don’t like it. We don’t want it. So it’s almost like an attitude shift of like, ugh, like I need this thing out of my awareness.

But that entails, um, paying attention to it, which can definitely be a compulsion, which we’ll talk a lot more about when we discuss like how to, um, treat sensorimotor oc. But people paying attention these things in their awareness, like they, they notice every single blink and I’m focusing my attention on it in order to figure it out or in order to try to, um, check to see if it’s still there.

Am I monitoring. Am I still aware my blinking, it’s still there, is it not there? So all these things mentally first involve paying attention to it and then involve trying to do something to like make it removed from their awareness, which again, as of all OCD, unfortunately, it’s a valiant effort, but it really just makes it latch its claw in even more firmly.

Kimberley: Yeah. That monitoring is the tricky one because even I, I’ve had so many clients say. I’m fine. I’m not noticing it, but I keep monitoring to see if I’m noticing it. Yeah. Which makes you notice, like all of a sudden now I’m talking to you, I’m thinking about my blinking, you know, I’m aware of it now. So I think that that monitoring is such a subtle compulsion and it can be hard.

I mean, what would you, would you even say a lot of my patients, but I’m curious to know your experience. Mm-hmm. Will say that self-monitoring, that self-check is almost automatic. That they sometimes can’t. Feel, they don’t feel like they can control that aspect of it.

Max: Yeah, I think that’s a huge piece of it, especially early on in treatment.

It is automatic and it is like our body’s natural reaction to something really scary and uncomfortable. And part of working with it is to slowly compassionately build the tools where we can begin to bring more, um, awareness to our kind of self-monitoring and checking behaviors to start chip away at it.

But yeah, it can be its own process that, um, it can feel absolutely involuntary for a lot of people.

Kimberley: Yeah. Yeah. Okay. So let’s talk about the evidence-based treatments for sensorimotor OCD. What, what can people do, uh, to help manage this condition or overcome this condition?

Max: Yeah. Um, and I, I love the differentiation here between managing and overcoming.

Um, and the reason is, like, for most OCD, um, I think we sort of have to accept that like our, our brains are gonna be wired towards OCD and we can live a full. Rich, meaningful life and still kinda have to navigate the stickiness of our minds. But with sensorimotor, OCD in particular, like people can very much get to a place of recovery sometimes.

Um, because the, the trick of it, the trap of it is pretty, pretty simple to circumvent once you understand how it works, which we’ll, we’ll talk about. Um, so I mean, to answer your question directly, ERP, exposure and response prevention, that’s what we use for this. And, um, we wanna be really nuanced with how to apply ERP because sensorimotor OCD is a little bit different.

It’s kind of its own beast in some ways. So, Kimberly, if, if you’re okay with it, I was thinking maybe first I can explain how I’ve seen ERP potentially misused for sensorimotor OCD and talk about how to use it in ways that might be more helpful for people.

Kimberley: Mm-hmm. Let’s do it!

Max: So, and when I’m like consulting with colleagues or working with clients that have been through ERP in the past without, um, the, the most effective benefits for their sensorimotor OCD, typically where what I see going wrong is people do exposures to like the sensory experiences themselves.

Um, for example, they’ll sit there and like, for 20 minutes, we’re just gonna pay attention to our blinking. Or for half an hour we’re gonna sit there and just notice our heart beating. And like sometimes that could be helpful for some people. But the problem with that. Is, as we talked about, one of the core compulsions in sensorimotor OCD is paying attention, right?

It’s like a hyper focus. And um, the problem with doing exposures like that is we’re doing more compulsions, potentially. We’re like having people focus more on something that they’re already focusing heck of a lot on. And as you know, good ERP, we wanna open up to the discomfort. We wanna allow the scary thoughts and feelings about doing anything to make it go away or to get rid of it.

So, um. ERP for this presentation of OCD, it really needs to emphasize two factors. Probably won’t be surprising to you, but the RRP response prevention is gonna be huge and so important. So essentially what we wanna do is allow whatever is in our awareness to be there. Right. Whether it’s eye blinking, swallowing, heartbeat, feeling of pressure when I’m sitting, allow it to be there without doing any of the stuff where OCD wants us to do, to make it go away without resisting, without suppressing, without ruminating.

Um, another big compulsion we get is sort of like this resentment almost like, oh my gosh, like, why am I struck with this? I, I wish I could go back in time before I was aware of my. Dang eye blink. So all that stuff we want to be able to like, let go of and just allow the experience to be. The second piece, which is just as important and plays a huge role in sensorimotor ERP, is what you could think of as radical acceptance.

So with this theme in particular, it’s all about people rejecting this thing in our awareness because there’s a sense that it’s taking away from our life. I’m, I’m gonna be more distracted. I’m not gonna be able to be present. And the radical acceptance piece is approaching it like, okay, I’m okay living my life, being more distracted.

I’m okay living my life in a way where maybe I’m never going to enjoy watching a show as much because I’m aware of every single time I blink. Note for listeners that have sensorimotor OCD, that might be a terrifying prospect to accept, but I, I can, I can promise you, I. Now if we can bring this sense of radical acceptance of openness to can it be okay living a life that’s less optimal?

Can it be okay living a life that’s more distracted? Like your OCD won’t be able to help but become bored. Right. And that awareness won’t be able to help but let go. But it does take some work to get to that place. Yeah. Of like fully opening up to it.

Kimberley: Yeah. Yeah. So how might that look? Let’s play out a case.

So let’s say somebody has, we talked about, uh, a hyper awareness or a hyper, you know, really noticing their blinking and they can’t, they’re, they’re both. Um, distressed by the awareness of it. Mm-hmm. And they’re distressed by the fear, like that kind of meta fear. Like, what if I never stop thinking about this?

Yes. What, how might you, um, use ERP in that case, in a day to day practice for them?

Max: Oh, I love, love that question. So first I would start. Um, with a little exercise, like I have a white noise machine in my office. Um, so I would, uh, say something to my client like, I want you to notice that there’s a white noise machine in the background right now.

Do you hear that? Yes. I, I do hear it. Max, did you, were you noticing it like two seconds before you said anything? No, I wasn’t. Um, so Kimberly, for you and maybe even your listeners, I just want you to take a moment and see if you notice any. Background noises right now happening outside, could be maybe music or air conditioning or traffic.

Just notice if there’s anything that comes up, right? So if there was, you probably weren’t paying attention to that before I directed your attention there, but now you are. So once we kind of noticed that there’s this background noise that wasn’t in my awareness a second ago, the question is like if you wanted to forget about it, if you wanted to not be aware, what would you have to do?

And a lot of people intuitively have a sense of like, oh, well I would need to like allow it to be there and like not worry about it and shift my attention to the conversation. Right. And I’m kind of gently focused on something I do have control over. Um. Since your motor OCD, that’s a lot harder than a white noise machine since we’re gonna be sitting the exposure, sitting with the anxiety and discomfort and the fear.

But mentally, it’s the exact same shift, right? It’s like, can I allow this background thing to be there without making a go away, without doing anything about it? And then gently easily shift my attention to things I can control. Not in a way that’s like trying to drown out. The background noise, but in a way that’s like taking control back.

Yeah. Um, so I think that’s a pretty cool way to do it. Um, and then usually for exposures, I’ll start off having a conversation with people and be like, okay, Kimberly saying you’re my client. Like, I wanna have a conversation with you about something really cool. Like whatever you want. It could be maybe a Hawaii vacation you’re gonna take or what you did for summer break or anything that feels fun.

But starting right now. Um, and throughout the conversation, I want you with every brain cell in your head to Will for OCD to give you awareness of your eye. Blinking. I, I want you to just sort of like, if you, if you’re religious, like pray to whatever de to you play, you pray to just will with your heart and soul, that not for a millisecond of this conversation, you’ll have no awareness.

I want it to be there every single millisecond. As we talk. Now that doesn’t mean pay attention to it, that doesn’t mean purposely focus on it. That just means like hope and an attitude shift where you’re really inviting OCD to give you its worst. And after five minutes of conversations like that, can you guess what typically happens?

Kimberley: You you’re having a hard , you’re not, that’s not happening.

Max: You forget. Yeah. And because os once we invite and allow, we stop fearing it.

Kimberley: Yeah.

Max: And. It just naturally falls back to the background.

Kimberley: Yeah.

Max: And then the homework I’ll give to clients usually with this form of OCD has to do with reminders, right?

Yeah. So like random app reminders?

Kimberley: Yes. I was just about to ask him about that.

Max: Oh, man, that’s, that’s my favorite thing, because the reminders, they’re not like having people intentionally focus on the sensation, but they’re purposely bringing up this unwanted thing in their awareness. For example, the reminder might be.

Remember, Kimberly, you’re blinking right now, right? Or blinking. And the goal, once you are aware of that reminder, which then brings the blinking into your awareness, will be to practice radical acceptance. Yes. Practice. Okay. I’m blinking. It’s distracting. I’m gonna live my life being distracted. Thank you.

OCD. If you wanna take it a step further, I hope I never get this blinking out of my awareness. I wanna live life full of always being aware of my blinking. Yes.

Kimberley: Yes. I love that you brought that up. I was just about to ask, ’cause that’s a huge piece of the work that I do with my patients. And then we even go one step further because just, just like any subtype of OCD, we we’re as distressed by the obsession as we are by the fact that it’s taking our US away from the meaningful life that we want.

So I’ll say, okay, now I want you to go back to doing the things that you love doing. That OCD took you away from.

Max: Yep.

Kimberley: Like if you love painting, I want you to go back and stop painting again. But I also want you to set a reminder while you’re painting. Yes. To remember to blink. Uh, and often clients will go, no, I don’t want blinking to like take away from my joy again.

It’s taken already enough from me and I totally get that. There’s so much grief involved, but like that reminder is sort of a, a metaphor for saying, I radically accept you in my life.

Max: Yeah. Yeah. I’m gonna paint and be aware of my blinking and it’s okay to. Feel grief, and it’s okay to feel lost that I’m not painting in the way that I want to or used to.

Yeah. And okay, can I accept that this is my new reality and I’m gonna paint with awareness? And if people can accept that the, the, this is the paradoxical thing is like they will not be aware of it, but you can’t try to get it aware. You have to fully accept that this is my experience. I’m gonna be okay for every single time I paint, I’m gonna notice my swallowing.

And. Cannot be my life.

Kimberley: Yeah. What about those, let’s talk about really tough cases. What about people who say, oh, like Max, there is not a minute of this day where I don’t notice my breathing, my blinking, my heart rate, my arm, my, you know, my ear, whatever it might be. My my, your, my, my urinary tract, whatever it might be.

What would you say to them? Who, where they’re saying there’s literally not a minute where it’s not 99% of what I’m aware of.

Max: Yeah. Um, I mean, first off, I would, I would give all the, like the validation and compassion in the world. ’cause that just sounds like torture. And it is, and I mean, I mean this form of OCD, like it is torturous, um, even more so than others.

I, I feel like, not, not to compare, but for like contamination, OCD people can avoid going to the bathroom. Mm-hmm. Um, or harmless people can avoid cutting vegetables with a knife. Those aren’t, it’s not good for the long-term health, but they can get like a reprieve from Yeah. Not so much with this stuff.

You can’t avoid blinking, you can’t avoid swallowing, you can’t avoid, uh, breathing. And so I think it’s like, yeah, it’s so, so vicious. But I would also really want to encourage them that, you know, like, uh, your OCD is giving you hell of a lot of opportunities to practice, right? It’s like, if, if it’s happening all the time, there’s a lot of inroads that OCS handing us.

And, and if we could start small. Start very gently, but use at least one or two of those opportunities as a way to practice radical acceptance as a way for ’em to really see that if you can lean in, if you can allow it to be in your awareness, change happens and to start building off of that. But yeah, will, some of those cases will take time.

And I think compassion for oneself and. Patience. Yes. Utmost importance.

Kimberley: Yeah. It’s a mindset game really. It’s like, I will always say to people like, it’s really just 1% shifts every day. So I know that, uh, all day. But even if you made a one or 3%, like, like you were talking about some of these skills, and I will also add you, you and I previously did an episode on attention control, which can be so helpful.

Even a 1% shift is a massive, massive, um, step in the right direction. Yes. Even if it’s taking up all of that time. So, um, absolutely.

Max: Yeah. Even, just like noticing that I’m resisting. Without, without having to stop bursting, but just noticing, oh, I’m engaged in this battle right now and that’s actually not helping me.

Kimberley: Yes,

Max: just that awareness is like a, such a awesome foundational place to start without having to do anything other than like notice it.

Kimberley: Right. So, so. We’re gonna talk now about some of the roadblocks with treatment for sensorimotor OCD and sensorimotor obsessions. One question that I have gotten quite a bit in our online course for OCD ’cause in our course there’s a sub sub module for this is sort of the trying to weed apart how to use exposure and response prevention in an effective way, not a compulsive way.

So. I’ll often talk about mindfulness. Right. Where you bring your attention back to the present, not the sensation. Yes. And they’ll say, yeah, but that’s what I’ve been doing as a compulsion.

Max: Ooh, I love this question. Yes. Right.

Kimberley: So, so I think that like, this is where I think it’s important. We do get, everyone has gonna have a different plan.

Can you sort of speak to. When we bring our attention to other sensations or what’s presently happening, what might, how might we mod modify that to be effective treatment?

Max: Oh, it’s so good. Um, so I. It reminds me of, uh, sort of like the two-tailed spike, right? So Steven Phillipson, he’s like a big OCD expert guy.

That’s awesome. And I, I love how he talks about two-tailed spike, especially with this theme in particular. And, uh, Kimberly, it’s pretty much exactly what, what you were saying. And so like. Okay. If I swallow, then I’m, I’m giving in to the compulsion.

Kimberley: Mm.

Max: But if I don’t swallow, I’m avoiding.

Kimberley: Yeah.

Max: Yeah. Or if I’m mindful of the present moment, so I be mindful of the present moment, but is that avoiding or do I like focus on the sensation and do some exposure with, like what do I do with that?

Right. How do I like focus about getting caught up in this bout of like, what am I doing? Am I running away, am I leaning in this, that, or the other? Um, so. I mean, like, the answer is simple, but also really tricky. And it, it does take that 1% shifts to do, but essentially it’s sort of like making a decision, like committing to doing something.

And honestly, it, it really doesn’t matter what you do, right? It doesn’t matter whether you swallow or you don’t swallow. It’s committing just because you’re a person, you have agency, you can choose to do something regardless of having a reason. And then being okay with the fact that you might have done the wrong thing.

Kimberley: Yes.

Max: Or even accepting that you did do the wrong thing and not ruminating about it. Not questioning it. Not focusing on it. And that’s exposure too. That’s sitting with the discomfort that I just did the wrong thing. Yeah. Mm-hmm. I focused on the present moment and, oh, that’s not the right move. Okay. Can I sit with uncertainty that I did it?

Quote unquote wrong. Yeah. And then get onto my life.

Kimberley: Mm-hmm. Mm-hmm. And that’s, that’s such a key point, and I’m so grateful for you, uh, slowing down and articulating that is we can get in the weeds on, we can almost do compulsions about whether we’re doing compulsions.

Max: Oh, yeah. A hundred percent!

Kimberley: And, and I think that you could even maybe just have a little bit of a, a sense of awareness of yourself if you’re spending time trying to figure out.

What, like, and you’re really anxious about whether you’re doing compulsions or not. You’re probably best just to like move forward and do that radical acceptance and let it be messy as an exposure. Um, and, and return to back to some value-based behavior. I. Right. Like what would I, I always ask myself like, what would I be doing if I didn’t have this anxiety or this fear or this uncertainty?

Okay, I’ll go and do that thing. Um, what are your thoughts?

Max: Yeah, I, I love, I love that so much and I think it really does get back into our last podcast episode where we talked about the difference between awareness and attention, right? Yeah. So we like all the thoughts about doing it wrong, messing up, doing the compulsions, like can we.

Let all that stuff be in our awareness, just sort of like noticing it, but then control what we can control, what we focus our attention on in terms of like, how do I wanna live life in this moment? Can I allow the thoughts and the feelings and the discomfort to be in the background and the control, what I can?

And it could be anything. It could be values-based action. It could be. Um, I don’t like watching tv. It doesn’t matter. Like you get to choose, you’re the one that has agency over your life.

Kimberley: Yeah. Yeah. Okay. Another roadblock. Um, and you can actually give other roadblocks if you like, but just another one that often gets asked in, um, in our online.

Program is what if my specific sensorimotor obsession flip flops, so I’m noticing my blinking, and then I use the skills, but then all of a sudden I’m noticing my swallowing and then I use the skills, but then all of a sudden I’m, I’m noticing my heart rate and so forth.

Max: Yeah. Yeah. And OCD is so good at that, right?

As, as soon as like, um, you feel like you’ve like, gotten a hand, like it, like throws out something else to get you. Yes. Um, and it, I mean it’s, it’s all the same thing, right? And I think what one of the, we talk about rising above the content, right? It’s not about. Certainly I get it feels like that, but at end day it’s not about blinking, it’s not about swallowing, it’s not about heartbeat.

It’s about like something, anything is in our awareness and our rejection of that which we can’t control, right? So whether it’s your eyes or a feeling or a thought or blinking, swallowing, whatever, it’s all the same thing. It’s can we accept that our brain just gave us this thing? We have no control over what our brain gives us.

And can we be okay with that? Yeah. Can we allow it to be in our awareness? And then like we said, like choose to do something that’s in line with the life that you wanna live.

Kimberley: Yeah. So you’re like, okay, now I’m thinking about this. That will be what I’m aware of and how can I, you know, that’s the, the. Like the soup de jour.

It’s the, it’s the noticing. Du jour.

Max: Yeah. Or even better, like good. Yeah. Yeah. Thank you. Keep it coming. Ocd like, this is awesome. I wanna be aware of every single thing, like bring it on. Right. Um, and yeah. And eventually OCD will, will get bored and I mean, I always like to use humor. Yes. Like, dang, OCD Wow.

That’s a new one. Like, I’m aware of my, the tip of my nose that I’m looking out in my face. Like, wow, you’re, you’re tricky. OCD Thanks for that. Yes. Really approaching, I think with humor, um, if that works for you, can be helpful. Yeah.

Kimberley: For sure. I’ve even had clients say they, like, if their brain gets stuck on a specific sensation, they just, for as an exposure, like imagine their blinking goes outta control so much that they like fly away or they just like playing with it.

Yes. Instead of treating it like so important, they just make like, they just imagine it being silly or, or however you know, you know. A joke or even making a song out of it or so forth. Okay. Yes. What advice would you give someone who is hopeless or stuck be, or feeling hopeless or stuck because of their sensorimotor?

OCD?

Max: Mm-hmm. I was wondering if I could answer that with like a personal story that I think could be helpful.

Kimberley: I’d love that.

Max: So, um, I haven’t like met criteria personally for OCD in a very long time. It’s like kind of teen, young adult, but I do get spikes occasionally, especially when I’m stressed. So my last spike happened a couple months ago and it happens to be a gnarly sensorimotor OCD spike.

And I was thinking about this podcast, I was like, oh, that could be potentially a, a helpful thing to, to share with people. So here’s what happened. I was at the park with my little three-year-old. Um, she was playing on the playground and it was like literally the perfect day in the South Bay of Los Angeles.

Blue sky, expansive, not a cloud in sight. It was so, so nice and it was just like sitting, hanging out, enjoying being with my daughter, looking at the sky. And all of a sudden I noticed a little floater in my vision. It was like a little kind of green squiggly. I was like, oh, okay. That’s okay. It’s a floater.

And then I noticed another floater and another floater, and after a couple minutes it was sort of like floaters everywhere. That was all I was seeing. And almost instantly I got that sort of guttural sense of dread. Like, Ooh, uhoh, oh my gosh, this isn’t good. What if I can never appreciate another beautiful sky without seeing these dang floaters in my vision?

Or what if there’s something, what if all the what if stories? Um, and I tried taking a breath, wiping off my sunglasses, looking at the sky again. Floaters, right? Uh, and it, I had a moment of panic. It’s like, oh no. Like this isn’t good. This would be horrible. I wanna enjoy time with my daughter. What if I’m with clients when I see floaters and they can’t concentrate?

The classic thing, but fortunately, right? Um, I don’t know much in life, but I do know OCD very well. Um, so I was able to step back and be like, oh, wait a minute. I know exactly what’s happening. Like I, I know exactly what to do here. So what I ended up doing, which, um, I, I would encourage anybody to do when they’re stuck in a cycle like this is to, the soft talk was like something like this.

Like, okay, good. You know what? Max, I hope I never am able to look at the sky without floaters again like that. What a cool experience to be able to see floaters in the sky every time you look. That’s not something that most humans get to experience. And yeah, it sort of sucks. You know? It’s a nice day and like I’ll, I’ll miss looking at the sky without floaters, but this is my life now and that’s okay.

And in fact, I hope every single time I look at the sky, there’s floaters, like OCD, gimme all the floaters you got. Like, I never, ever wanna be unaware of those floaters. Um, and after about 20 minutes, um, gone, nothing, right? Mm-hmm. ’cause I lost the fear and my OCD my brain got bored and I haven’t thought about floaters, um, until I was thinking about this podcast episode.

Mm-hmm. So my words of hope would be, if I can do it, you can certainly do it too. It, it really comes down to. Understanding that trap of like your brain giving you something in your awareness. And can we be okay with that, right? Yeah. Can we bring a sense of acceptance and openness to it? Um, and your brain will get bored.

It has to get bored. OCD thrives off of our fight and our resistance, and if we can like step outta that process, um, you’ll get to exactly where you want to go.

Kimberley: Hmm. I love that story. It made me think of, uh, Stephen Hayes we had on was talking about how he has tinnitus.

Max: Yes.

Kimberley: And, and how that’s sort of similar, right?

Like if you have tinnitus, it’s a constant ringing in your ear. If you foc like. You just have to accept it radically and then it bothers you less, even though for him it’s still ringing. Yeah. Um, but I’m so glad that you had, you know, you could get back to your daily life. Now, I also wanna recognize, because I love this story so much and it brings so much hope and clarity to what can be.

You also know OCD really, really well. You’re an OCD specialist. How long might it take someone who’s new to this to be able to implement that strategy and get some relief?

Max: Yeah, I mean, it, it’s, it’s such a good question and I, I would encourage an anybody working on this stuff too. Um, to really focus on the process and to let go of having to get to a certain place.

Like, like you said. Yeah. I’ve been doing this for a very long time. Yeah. Um, I mean, and it’s not just ERP, I didn’t like expose myself to the floaters. It’s, it’s really like this attitude shift Yes. Going from resistance to acceptance and that, I mean, that takes a lot of practice. Yes. And a lot of like, uh, attention and, um, patience.

So, I mean, some, some people. We’ll be, I think, be able to get there quicker than others. Others, it, it might take a very long time, but I think the most important thing for anybody to know is just like you said, it’s like 1% shifts. Yeah. Right. Like trusting the process, understanding how OCD works and applying it on a day to day.

And slowly over time things will get better. But that, that’s another kind of paradoxical piece too, is ’cause the last thing we wanna do is. Check. Am I better yet? Yes. Am I better? So, because that, that’s exactly like part of Ooc D So I really would encourage people to like, as scary as this may sound like, let go of needing to go anywhere.

Um, yes, work with a competent like OCD therapist, know that you’re doing the right work, but then sort of like just trusting the process. Trusting yourself, knowing that like when it’s ready it you’ll get back to where you wanna be.

Kimberley: Yes. And I love that you mentioned that because so often a big part of the first like psychoeducation that I do with clients is our goal isn’t to get rid of your, your.

Awareness of it. Meaning like, if your only goal is that I don’t have to notice this anymore, you will keep noticing it. Like the recovery is that you don’t, um, do those compulsions or you’re not, you know, getting really negative on yourself for having it or spending a lot of time. Like, yes, being hyper aware, like the removal of the obsession.

If that’s your only goal, that’s gonna probably trick you back into doing a lot of compulsions.

Max: That’s, yeah, I, yeah, that was very well said. And yeah, and, and to bring this acceptance, like, it’s okay having this in my awareness, it’s okay to not be optimal, right? It’s okay to be more distracted. It’s okay to, to not have as much enjoyment in life.

And as soon as people can get there, yeah, it does, it will melt away. But without checking or monitoring or doing the things that our OCD wants us to do.

Kimberley: Yeah. Yeah. I love that. Thank you. Yeah. Max Maisell. Please tell me where people will, tell us where people can hear more about you, get in touch with you, work with you.

I want to know all the things.

Max: Yes. Thank you so much Kimberly. So, um, our, our website is beachfront anxiety.com. Uh, it’s myself and a couple clinicians on our team and we all do this stuff like OC D and OC related concerns. And I also have an Instagram page @DrMaxOCD, so you can also follow me there, try to make videos post together, little kind of Canva things

Kimberley: It’s a great account

Max: yes, exactly. Um, so those would probably be the two big places to find out more and to reach out.

Kimberley: Wonderful. Thank you. I’m so grateful that we had this conversation. I think it gives a lot of hope to people with this specific condition, um, and some really applicable tools that they can use right in like immediately, which I always love to give.

So thank you so much for coming on again.

Max: Oh my gosh, my pleasure. Um, your podcast is my favorite one of all, so I’m just so honored to be here with you and you do such incredible work. So thank you so much for having me again.

Kimberley: Oh, thank you.

Max: Okay.

Kimberley: Yay.