Obsessive compulsive disorder, or OCD, is a mental disorder that consists of recurrent intrusive thoughts or images or urges which are extremely anxiety-provoking and distressing.

distressing.And that leads the individual to either avoid the situation or activities that provoke them, or to do various compulsions, things you have to do over and over again until you feel comfortable, till it feels right.

Hugh's type of OCD is of recurrent intrusive thoughts and especially images of tragic events happening to his family, which he feels he has to protect.

He has a wide range of rituals, order, and symmetry, and tidiness, which he feels that he has to do over and over again till he feels comfortable.

A lot of these rituals that he's been doing have functioned by avoiding, I think, a lot of the th- the thoughts and images that he has.

You know, whilst he does them, it stops him thinking about these images that he finds so terrifying.

And it's just the way it is.

OCD is certainly regarded by many people as a secret illness.

If

people without OCD get these sorts of thoughts, they don't really dwell on them.

They don't think much of them because they just pass in and out.

Usually the content of an obsession is linked to the things that you value most.

So the person who's worried about their dog, it's because that dog means a lot to them.

It usually attacks the things that you're most afraid of.

If you desperately love children or whatever, then it tends to attack the fear that you might be a paedophile.

So why don't we start as big picture as possible? If you could tell us what OCD is first.

So the challenge is, can you give us a brief explanation about how emetophobia develops and is maintained without repetition, hesitation, deviation, boxes, arrows or other visual aids?

Thank you.

Well, I think at the core of emetophobia is the uncertainty, not knowing whether you're going to vomit or not.

It's you're on your constant red alert, yeah? Not knowing whether you'll be sick, the anticipation of it.

And we have to now thank Mark Friesen and colleagues who very much focused this feeling of uncertainty with that visceral sensation, particularly in the stomach.

So classically, it's gonna be misinterpreted as evidence of being sick, making you more anxious, more uncertainty.

and going around in that vicious circle.

So given all those processes and those maintenance cycles, what are the key elements of CBT then for emetophobia and how do they link to those maintenance processes?