What Parents Need to Know About OCD

Episode Transcript

Dr. Nicole Beurkens:
Hi everyone, welcome to the show. I am Dr. Nicole and on today’s episode, we’re talking about obsessive compulsive disorder, also known as OCD. This is one of the more challenging disorders, I think, for children and families, as well as for professionals who provide treatment. OCD can significantly impact a child’s life and functioning, as well as that of the family. Many of the things that we intuitively think to say and do for kids with OCD, sometimes aren’t that helpful, and it’s really important for us to understand what’s at the root of OCD and how to best approach it. So to help us with that, I’ve invited Dr. Tamar Chansky on the show today.

I first found Dr. Chansky’s work on anxiety and OCD many years ago and have really found her approach is invaluable in my work with patients at my clinic, so let me tell you a little bit more about her.
She’s a licensed psychologist, and the Founder of the Children’s and Adult Center for OCD and Anxiety in Pennsylvania. She’s the author of numerous books on the treatment of anxiety, including the popular “Freeing Yourself from Anxiety Series: Freeing Your Child From Anxiety, Freeing Your Child from Negative Thinking”, and “Freeing Your Child From Obsessive Compulsive Disorder”, all of which, as a side note, I highly recommend. Dr. Chansky is the creator of the educational website: worrywisekids.org. Her most recent book, “Freeing Yourself from Anxiety: 4 Simple Steps to Overcome Worry and Create the Life You Want” is for anyone suffering from everyday worry, an anxiety disorder or depression. It’s such a pleasure to have you on the show today, thank you for joining us.

Dr. Tamar Chansky:
Oh, thank you so much Nicole. My pleasure.

Dr. Nicole Beurkens:
So, I always like to start by having guests talk just a little bit about how you came to be doing the work that you do today. So what has your career and life path been that has lead you to really specializing in anxiety, and particularly obsessive compulsive disorder?

Dr. Tamar Chansky:
Life is full of flukes that we do something with. That’s how I would shorthand my story. Yeah, I started in graduate school, back in the 80’s. It’s been a long time now and one of the opportunities in grad school, where you could actually work with patients, they don’t let you do that for a long time. But there was one group that was working on a protocol for treating kids with anxiety and you actually got to work with the kids, and so I kind of found my way into that program and I just loved it and it was a great fit, and the rest is history.

Dr. Nicole Beurkens:
That’s fantastic, yup, they don’t let us with the patients right away, and yet we learn the most when we actually get to work with people, right? At least that’s been true for me.

Dr. Tamar Chansky:
Absolutely.

Dr. Nicole Beurkens:
Yeah. So let’s dive in and talk specifically about OCD, obsessive-compulsive disorder. I’d love to have you just give an overview of what it is and then also a bit about how it differs from just garden-variety anxiety or worry.

Dr. Tamar Chansky:
Sure. So it’s become a colloquial term. “I’m so OCD about this, I’m so OCD about that” and what they mean is that usually they like things a certain way. That they’re going to wash their hands before they eat all the time, that’s just what they like to do or how they arrange their room, something like that. What is different about that from people who actually suffer from the disorder is that they suffer. So OCD is really about having intrusive thoughts that you don’t want to be there. You don’t want to be thinking about germs but your brain won’t let it go. You keep thinking that if you don’t wash your hands for a certain amount of time, something terrible is going to happen. Either something related to the content of that worry like you’re going to get sick or get someone else sick, or it can have a kind of more of a magical or symbolic consequence. Somebody in your family will get hurt or you’ll do poorly on a test or something like that.
So there are two components. There are the intrusive thoughts and then the compulsions are what a person does to try to quell that thought or get rid of that thought. And so you see people with a lot of repetition of things. You can watch somebody trying to lock their door and leave the house and it might be that they lock the door, they go to the car, they come back, they go back — and the reason why is not that they want to be doing this. It’s that their brain isn’t sending the signal that something is finished. And so with that doubt, they keep going back to fixing it. So you were saying, what’s different about that vs. other kinds of anxiety, part of it is that OCD is really about concerns that aren’t what’s expected from typical concerns.

A child might worry, am I going to do poorly on tests? Am I going to get homesick at a sleepover? We might prefer that our kids not worry about those things, but we’re not alarmed by that worry. If a child comes home and says, “I think I might have stolen something from school”, they’re so upset about it, a parent is really puzzled. They don’t steal things, they didn’t steal something, why are they talking about this? So part of what happens, the content can be about doing something wrong. An intrusive sexual thought that’s very alarming to parents that a little kid is talking about something sexual, and parents are thinking, did something happen to them? And it’s really the garden-variety of OCD includes that kind of thing. It’s that they’ve done something wrong. There are symmetry kind of intrusive thoughts and rituals kids will feel like if they touch — Somebody bumps into them on one side, they’re going around trying to bump the other side to even it out, because they have this strong feeling that either that feeling is never going to go away if they don’t do it, or again, something bad might happen. So when you hear those kinds of concerns, parents scratching their head like “What? This makes absolutely no sense.” And that’s the beginning really of the story of what OCD is about, that because the content doesn’t make sense, on the one hand, it’s very concerning and alarming to parents, on the other hand, it gives you permission: It’s clear that what’s happening with OCD doesn’t have a reality component to it, it’s okay to start playing with that content because it’s meaningless.

Dr. Nicole Beurkens:
And I think that’s important that you provided those examples because often times, people’s only frame of reference for OCD is maybe things they’ve seen in movies or whatever, which is more the compulsive behavior pieces, turning the light switch on and off a certain amount of times or washing hands, but what you’re saying is that it can also be these ruminating obsessive thoughts and ideas. It doesn’t always have to be those outward behaviors that we see, is that right?

Dr. Tamar Chansky:
Yeah, and a lot of times, again, that is so concerning to parents, is that the nature of those thoughts that just go around and around are just so counter to what they would expect from their child, from any child. I didn’t mention religion. Religious thoughts is another category of thoughts that kids are troubled by, that they might have a bad thought, that they said something bad about God or something along those lines. If you take that at face value, you might feel like you need to correct your child, especially if you’re religious, it would be completely understandable, but there is this cognitive dissonance because you’re on the one hand — parents are thinking that, on the other hand, they see their child so upset about it, so they know that it doesn’t really fit, that something is not quite right there and the issue is that this is not the will of the child. This is not what your child wants to be thinking about. These thoughts barge in and kids don’t know what to do with them, which is why I love talking about this because it’s really a very brave path that parents need to walk and think when they have a child dealing with these kinds of issues, and then kids will see that it’s safe to walk that brave path kind of playing with these thoughts that seem like they’re so serious and they’re about such serious content, that it’s not really about that.

Dr. Nicole Beurkens:
Well, I think it’s so important for parents to understand what’s really going on with this stuff, because when you don’t experience these kinds of obsessive thought patterns yourself, it’s hard to understand. You go, “Why are you thinking — stop thinking about that!”, or “That’s ridiculous!”, or “That doesn’t make any sense”, or “You need to think about something else,” like it’s easy to just dismiss it or to go like — what is the problem of why you can’t let this go? And yet it really is more than that. If the kid could let go of it and move on, they would.

Dr. Tamar Chansky:
Yeah, absolutely.

Dr. Nicole Beurkens:
So, this can really impact not only the life of the child in significant ways, but certainly also for parents and even families, I mean often when kids come in to see me and they’ve got — especially the longer this has been going on, it’s sort of like the entire entire family system sort of acclimates around these obsessions and compulsions and it can be a whole family systems issue, but I think it’s important for people to understand that this is treatable, right?

Dr. Tamar Chansky:
Absolutely, yeah. When you first said, Nicole, that it poses quite a challenge for families and professionals, this is the thing, it’s so treatable. Part of the process — it’s really a multilayer process that with these kinds of conversations, hopefully also therapists listening will know how to demystify this process and actually, in some ways, treating OCD is simpler than anything else. I’ll talk more about that in a second, but one layer is helping clinicians to know this is really treatable and so that they can be very reassuring to parents about that, and then parents can be very reassuring to kids. So from the outside, it’s so debilitating. I don’t want to minimize that by any means, it’s so debilitating when you don’t have a plan, when you don’t understand what’s going on. But once you start to work on things, kids do really well with the treatment, so it’s a very hopeful picture for families.

Dr. Nicole Beurkens:
Well, I agree with that. That’s why I really think your work was such a shift for me and finding that, because typically the information that parents, even professionals are exposed to is “Ugh, this is a very debilitating, very difficult thing to treat, these people spend years and years in treatment for this.”,and when I found your work and really started delving in, it’s like well, actually, when we understand what’s going on here and can start to have, as you said, a plan to work on it, it’s incredibly treatable, I find that that’s surprising information for a lot of parents who come in, they’re like “Ugh, my kid’s been in therapy for years, it’s not getting better, this is never going to go away.” and It’s like wait a minute! When you have a plan and you understand how to address this, it absolutely gets better.

Dr. Tamar Chansky:
I think one of the big factors really is to depersonalize the content. Part of when folks have been unfortunately in therapy for a long time and haven’t made headway, part of the issue, I think is that therapists are trying to understand why. Why is this person thinking that they need to redo things 50 times or what does this have to do with their childhood. So fortunately, we know that’s not how OCD is built. It’s really very impersonal, even though the content feels so personal, it’s really impersonal and the more that we treat it that way, the better. I say to kids, “I know that anybody would feel so afraid if they were hearing the things that are going through your mind, I totally get that. But we know that this is a brain hiccup. So the more that you can hear this as “Blah, blah, blah”, really what it’s worth, nothing has value but the value that we give it. So for kids to start thinking, “Ah, that’s — wait, it’s saying that something terrible is going to happen in my family if I don’t sharpen my pencil just right, yeah, that really makes sense.” So when kids can — this is part of why I love treating OCD, because I love sarcasm, and so many people too. so when kids can start to see that that’s a tool that they are allowed to use here, and it’s not being mouthy or snarky, it’s what they’re using on their OCD, it’s really helpful, that whatever OCD is saying, they might add kind of a suffix, something like “Because that really makes sense.” And as they do that, they’re able to separate more from the content and feel more empowered that this is not something they need to think about.

If I can just talk too about that idea of separating the [inaudible 0:15:33.4] or the content of the intrusive thoughts from the child, it’s really helpful for parents to do that too. Like you were saying, parents might say, “Why are you thinking that!” Understandably, if you don’t get what OCD is about, and why would you? Why would you, unless you read about it? Of course your common sense is going to say don’t think about that. Then kids feel alarmed that something is wrong with them or they really are bad kids or something like that and so the response that we go for is for parents to say, “Wait. What’s worry saying to you now?”, or “What’s your OCD saying to you?”, or “Oh my gosh what did it come up with now?” Again, that separation allows distance for the child to look at that thought and decide — I call it junk mail, does it really belong to them? Or is it some universal thing. It’s probably happening to other 1000s of people with OCD at that moment too and it really has nothing to do with them.

Dr. Nicole Beurkens:
I love that you talk about it as a brain hiccup and that depersonalizing, like this is just something that is happening right now, it has nothing to do with me being a good or a bad person or my child being a good or a bad person, let’s delve into a little more because you’ve started to talk some really important aspects of effective treatment. What are the best approaches for this in your opinion? What are some of the other things that you find are really helpful when treating this?

Dr. Tamar Chansky:
So the research if very strong and clear that what’s called exposure and ritual prevention is the treatment of choice and very highly effective for treating OCD. It’s a type of cognitive behavior therapy, and very simplified, what it means is putting yourself in the situation where normally, you would have OCD symptoms — touching the floor, touching your shoes when you would feel like you need to wash your hands and resisting the urge to do that. So that’s kind of the simplest unit of that work where it becomes more of an art to it, in a sense, it’s helping kids to understand that it’s okay to take those risks. So if we think of cognitive behavioral therapy, the behavioral part is going to be doing that, what we call ERP, the exposure. But the C, the cognitive part is really helping the kids to name, kind of relabel what’s going on, to give a name to this process, this thing that’s bothering them so that they can understand that again, that doesn’t have any authority that they need to heed, that they really didn’t need to do things in that very complex way of 50 steps to get out of bed in the morning to not have bad luck. Their parents would be telling them to do that, so we know that it doesn’t mean anything. So once they understand that, then creating a hierarchy, we call it, what would be the easiest kind of exposure to do to the hardest and then starting with the easiest.

Usually, we talk about a scale from 1 to 10, very few things are below a 5 when you really have OCD. So I’m looking with kids to find things — and this is a very collaborative process, by the way. Some people think, “Oh, I don’t want to go to behavior therapy, they’re going to make me put my hand on a trashcan!” That would not make sense for me to be yet another voice, in a sense, telling you what to do, that’s what we’re trying to undo, that the OCD is kind of telling you what you’re supposed to do — No. I’m going to help you, I’m going to coach you that you make decisions that make sense to you. So we look for the things that are about a 5, all the way up to 10 and then we start with something that’s about a 5 or a 6. And importantly — so if it is getting close to the trash can, a real clincher here is for families to understand that when you do an exposure, even though that’s the treatment that’s absolutely going to work, then you’re going to feel so much better. You can’t cure OCD but you’re really going to take charge of it, so you don’t need to cure it. It’s not going to feel better when you do it. So that’s something to make sure that you clarify. I say, “I have to tell you this, because if I don’t, when you go home and you do these exercises, you’re going to say ‘This feels so wrong! She gave me terrible advice because this feels awful!’ So we practice in the office to find something that’s like a 5 or a 6 and then ride out the bad feeling that naturally comes because your brain is saying “Wait! You’ve been doing it this way! You tied your shoes 4 times for all this time! It’s going to feel wrong to do it any other way!” But you just ride out that feeling and then your brain does reset because it was never important advice in the first place.

Dr. Nicole Beurkens:
Yeah, I think that’s so important for parents as well as kids to understand that progression, because often it can be distressing for parents when they see their child distressed, right? So for parents to understand that this is going to make your child uncomfortable to practice with this, but that’s the point, right? To realize that this discomfort can’t hurt me and I can make it through that and it will be okay on the other side of that.

Dr. Tamar Chansky:
Exactly, so we call it Planned Discomfort, and it is important that it is planned. Sometimes, again, parents care about kids but sometimes we have our own ideas about how things are going to improve the situation and they don’t always work that way. So it’s very important that your child is choosing what they’re ready to work on rather than kind of interpreting this exposure idea as, “Oh, we’ll just stop letting him go to the sink”, or something like that. That’s not going to work. You can’t do it overnight, but in terms of that exposure feeling and feeling bad, I use the analogy of a swimming pool, that we have a conversation, what does it feel like when you get into a pool? Wait, it feels really cold, it doesn’t feel good. And then what happens? After a couple of minutes, it feels fine. Did they warm up the water? No, you adjusted. The idea that each exposure really is a swimming pool. Some are going to be big, some are going to be small, some are going to be freezing, some are going to be okay, but it’s that same process that you kind of trust that you are going to adjust but know that it’s not going to feel good at first.

Dr. Nicole Beurkens:
A great way of thinking about it. I’d like you to comment on — you were just talking about that initially, this is hard, it gets easier over time. As parents and even as professionals, we wish we had a magic wand to just make our kids better right away. How do you talk with kids and with parents about what to expect as far as the progression of this and the amount of time that it may take to really work through this in an effective way.

Dr. Tamar Chansky:

That’s a really good question. They’re all good, Nicole, but I think expectations are so important and one is putting out the very positive expectation that improvement is absolutely in their reach, and also that it’s going to take some time. When you have been doing this work for a long time, as a therapist, as with any specialty, it’s easier to really accelerate the process in a sense because you’re not afraid of what you’re doing. I may be revealing a secret here, but therapists are human beings too. We’re talking about parents needing to be brave to do things. With therapists with less experience, they may be more cautious and kind of take more time with this, that’s okay. Then they’re going to be able to move faster as they go along. So what we find is that usually within the first month of treatment, that kids are making headway, they’re not done but they are getting a sense that they can do something different when these feelings come up, when these thoughts come up. So usually, and this sort of a rule of thumb within the field, but if a child is not showing improvement within three or four sessions, something like that, you might consider adding medication or talking about the possibility of adding medication to improve the child’s willingness to do these exposures. A lot of kids don’t — if they come into therapy not on medication, often they don’t go on medication.

So just having someone be very encouraging about what they need to do and they see after that first exposure, “Oh, that wasn’t as bad as I thought”, or “That was bad, but I’ll try another one”. So on average, treatment is usually about four to six months. I tend to see families every couple of weeks instead of every week because I really give them assignments of what they’re going to do at home, and I think that pretty much reflects the [inaudible 0:26:06.3] something like about 16 weeks of treatment, give or take.

Dr. Nicole Beurkens:
Yeah, and I think that it’s important to say that that assumes that it’s effective treatment being done, right? I mean as we touched on earlier, lots of kids and even adults have been in various kinds of therapies, I see this all the time and I’m sure you do too, they come in and they’re like, “I’ve been bringing my kid to this therapist for years”, or “My kid has been doing all these different things”, or “He’s been on medication all this time and nothing is getting better. So I think what you’re saying is that when we have the right strategies and the right understanding of the issues, aligned with it, kids can make progress quickly, but it requires really understanding and honing in on what actually needs to happen. And if your child hasn’t been in treatment that has been very effective at resolving the symptoms, that is maybe typically in my experience, is more a reflection of just things being done that aren’t really aligned with what needs to happen as opposed to something just terribly wrong with the kid that they can’t get better.

Dr. Tamar Chansky:
Very, very important point. Yes, when I was laying out that trajectory, I’m talking about doing cognitive behavior therapy. It’s the only treatment that has been [inaudible 0:27:28.8] shown to improve symptoms of OCD, so yes, absolutely.

Dr. Nicole Beurkens:
Because I think your point about retaining that hope, and really just that expectation that this will get better, that’s so important because often kids and parents come into the treatment process just feeling so demoralized and so much like there is something terribly wrong with me, I can’t get better from this and one of the things I hear really coming through in you talking about this is just the confidence that yes, this can get better and here’s how we do that.

Dr. Tamar Chansky:
Yes, for sure. For sure. And often, I’ll say when folks come in, I’ll say, “Look at my face. You’re telling me these things, these thoughts that you’re having, did you see me flinch? Did you see anything happen there? Am I surprised? No? Why? Why do you think I’m not surprised? Right, because I’ve heard this from so many people.” Again, not at all to diminish the suffering of what it’s been like to think that those thoughts were important, but on the other hand, that because they’re not. They’re not personal, this is garden-variety OCD and you can see it online, you can read about it in books, this is just what everybody experiences, so now we’re kind of cracking the code with people so they know — “Oh, okay, I don’t have to believe what I’m hearing, just because I have these thoughts, it doesn’t mean that I need to listen to them.”

Dr. Nicole Beurkens:
I think it’s such an important differentiator in how to think about that because many times, adults will respond to these kinds of things that kids are either communicating about what they’re thinking or the compulsive behaviors by trying to reassure them. “That’s not true, don’t worry about that, it’s going to be okay!” Can you talk a little bit about why it is that reassuring kids doesn’t really work?

Dr. Tamar Chansky:
Sure, yeah. That is usually understandably the treatment of choice that parents have gone to, it makes total sense. If that worked we wouldn’t have a disorder, we wouldn’t need treatment, and so what happens is when a child is saying, “I think I did something terrible. I lied to somebody at school.” And parents will say, “But you’re so — of course you didn’t do that!” and “You’re such a good kid!”, what happens is that the child comes in in distress, and then by the parents taking that content seriously, you reinforce this for the child that that is possible that they might have done that. So yeah, I have kind of an odd way of talking about a lot of things, Nicole, but this is no exception. So I say to parents “If your child came in and said, ‘Mom, dad, I think I’m a cantaloup!’ You wouldn’t say ‘Well, let’s see, is your head — how round is your head?’” It sounds absurd but that’s the thing is that when parents can immediately say, “Wait, who does that sound like? It sounds like Mr. Worry or it sounds like OCD”, then kids can immediately put it in a different category of things that they don’t have to take seriously and they change their relationship with those thoughts, they boss them back, they make jokes about them, they pretend they don’t hear them right, like, “I might have fried? What’s that, OCD?” Just taking that really puts them in a different position.

Dr. Nicole Beurkens:
Yeah, so that reassuring, that attempt to soothe actually can add fuel to the fire by teaching a kid or teaching their brain that oh, these are serious things that we should be paying a lot of attention to, and what you’re saying is, no — we actually want to do the opposite and help kids that these aren’t things that I need to pay attention to.

Dr. Tamar Chansky:
Right. So on a neurological level, that when you take seriously those thoughts by reassuring them, it just reinforces that circle that when you have a thought like that, get help, it is an emergency. Of course, the brain will prioritize anything that feels like an emergency and so it just reinforces that cycle but you can pivot and break that cycle.

Dr. Nicole Beurkens:
It occurs to me that it might be helpful to talk just for a moment about why kids develop this or what are some common things that you see with that, because I’m sure that that’s a question that a lot of parents have and ask all the time at the clinic, “Why is it that my kid has this?”

Dr. Tamar Chansky:
As much as we’re trying to get better answers for that, the answers are simply that there is a very small genetic component to this, a lot of kids — this is just something that happens. About 1%-3% depending on what study you look at, of kids have OCD, and it’s been around for hundreds of years. So it’s just the way that I think about it is more that it’s kind of a good idea to be careful about things, but this is the brain in overdrive. It’s a glitch that we have to fix that is not because of anything that parents have done wrong, the kids have done wrong, parents will feel so guilty. “I always said you have to wash your hands when you get home from the mall! This is my fault!” And I’ll say, “Well you have two kids and one of them has OCD and the other one doesn’t!” So it’s just more sort of the presets that that other child has that resonated with that, that heard that warning in a certain way, that your other child was just like, “Ah, there goes mom bothering me about washing my hands again.” So it’s a no-fault disorder, that’s the very short answer, not too long.

Dr. Nicole Beurkens:
Well, I think it is one of the frustrations of this, that there isn’t as much research that goes into this as compared to some other things, so we don’t have good answers for that, but I think understanding it, you talked about it as a glitch in the brain, I’ll often refer to with kids as a ‘stuck’ brain, you know, helping the brain get unstuck with that and I think it is really helpful for parents and kids to understand that this isn’t something that you did that cause that, because I think, especially for children, there’s a sense of that on their part, like “What did I do to cause my brain to do this?”
What about — just briefly, because this is something we’ve covered in some past episodes on the show, but more people are becoming familiar with it, the whole issue with PANS and PANDAS, as it relates to OCD — so these infectious issues as it’s connected to OCD, how often are you seeing that?

Dr. Tamar Chansky:
So that, in about one-third of kids who have OCD, the beginning was this autoimmune reaction to strep or a virus or lyme disease, some physiological, biological component where the immune system rather than just dealing with whatever it is that’s in the body, starts to attack the part of the brain where it’s understood that OCD happens. So, importantly, two things: One is that if your child does develop OCD or their OCD is suddenly extremely escalated, it’s important to go to the pediatrician first and say, “This happened.” Test for strep or whatever other test you need to do, because the difference between this PANS or PANDAS OCD and regular OCD is that when it is PANS, it’s almost — I call it ‘exact date disorder’ parents will say, “My child went to bed one way and they woke up in the morning a different child.” So certainly, if that’s the presentation, go seek medical treatment first, there may still be a place for cognitive behavior therapy for those children, but the medical piece has to be addressed.

Dr. Nicole Beurkens:
Yeah, just doing the cognitive behavioral piece alone won’t resolve it if there is some kind of medical component there. That’s interesting that you talked about that about a third of the kids that you see with OCD had that because it’s something that we’re seeing more and more in our clinic, studying too, just this onset subsequent to infectious kinds of issues and then there are multiple pieces that need to come together, there is the medical treatment for that, but then also often, there are things from a cognitive behavioral perspective that need to be done as well to support that, and certainly, that’s a really scary thing for parents too, you know, my child was completely typically functioning, completely fine, then all of a sudden they weren’t, and I think it’s just important for parents to know that that does happen and there
are underlying reasons for that and to look into that.

Dr. Tamar Chansky:
Exactly. And what’s, I think, really helpful is there seems to be a great word of mouth between parents letting other parents know of their experience because no parent wants to go through that. It’s treatable, but it’s so frightening, that overnight kind of phenomenon.

Dr. Nicole Beurkens:
You have provided such valuable insights and practical strategies for all of us today, I want to make sure that people know where they can find you online to get more information about your work, your clinic, what you’re doing.

Dr. Tamar Chansky:
Absolutely, it’s such a pleasure to talk about this any time, Nicole. So more information about this on my website, which is tamarchansky.com and also worrywisekids.org, and I’m on Facebook as well at Tamar Chansky.

Dr. Nicole Beurkens:
And we’ll make sure that the links to all of your wonderful books as well as the websites and your social media are in the show notes. For those of you listening, I can not encourage you enough if you and/or your child struggle with anxiety, struggle with OCD, check out the resources that she has, get the books, they are really, really powerful for professionals listening as well, if you’ve not been exposed to these resources, definitely check those out, really such a wealth of valuable information. Thank you so much for being with us today.

Dr. Tamar Chansky:
Thanks so much, my pleasure.

Dr. Nicole Beurkens:
And thanks to all of you for listening to this episode, we’ll see you back here next time.