Anxiety, OCD and Exposure in Popular Media

There are many examples of Anxiety, OCD, Exposure Therapy, and Exposure with Response Prevention (ERP) therapy that occur in popular media. Please note that these representations often have inaccuracies in them as they are written and performed for entertainment, rather than educational, purposes. I’ll update this list as I find more and please add more in the comments if you find them:

Parks and Recreation

In Season 2, Episode 4 “Practice Date,” Ann uses Exposure Therapy on Leslie to help her overcome her fear of first dates. Ann decides to expose Leslie to a series of horrible first dates so Leslie can learn that she’ll survive and can cope even if the worst happens. Although this exposure therapy is effective in the show, it is a bit problematic. First off, Leslie never consents to the exposure therapy, although she ultimately thanks Ann for it anyways. Secondly, Leslie is consuming alcohol throughout her exposures which interferes with effective exposure. But still, a great example of how you have to face your fears and see that you can handle them to improve.

Chris Traeger and Dr. Richard Nygard (Parks and Recreation)

Chris Traeger, played by Rob Lowe, has many of the fears and compulsive behaviors of an individual with Health OCD. He undergoes therapy on the show, though the diagnosis of OCD or health anxiety, is never explicitly discussed. In Season 5, Episode 13 “Emergency Response'“ Chris has to portray a person who ultimately dies in a simulated Bird Flu Epidemic. After his simulated death, he proudly proclaims that prior to his therapy he never would have been able to even pretend that he had a deadly illness prior to therapy. This is an example of “Imaginal Exposure” in which someone has to imagine something catastrophic is occurring because it would be problematic to do the exposure in real-life.

There is some evidence that Chris’ therapist, Dr. Richard Nygard, promotes exposure therapy. In Season 5, Episode 5 “Halloween Surprise” Chris announces that he was instructed by his therapist to confront his fears so he will dress as his greatest fear for Halloween. We later see Chris dressed as an old man (presumably closer to death).

There is another reference to Dr. Nygard’s use of exposure techniques in Season 5, Episode 18 when the team needs to find all new employees for the Animal Control Department. They interview a woman who explicitly says she doesn’t want the job. She then goes on to explain that she is terrified of animals and only applied at the urging of her therapist, Dr. Richard Nygard, who told her she needed to face her fears.

Stranger Things

Many of my clients have described living with OCD as quite similar to the Upside Down in Stranger Things. The upside-down maps perfectly onto our world with the same streets, trees, and buildings except there are also horrifying creatures and monsters lurking all over the place. Living with OCD is a lot like walking around in the Upside Down. In Stranger Things they need a massive concentration of energy to travel between the Upside Down and our world, fortunately, we can get back to our world with the use of Exposure with Response Prevention Therapy.

Obsessed

Obsessed was a documentary-style show on A&E that ran for two seasons. It focused on OCD and other anxiety disorders by introducing us to real-life sufferers and then watching them as they proceeded through exposure therapy. Obsessed is one of the most realistic shows I’ve ever seen in terms of showing what treatment for OCD and other anxiety issues looks like.

Turtles All the Way Down

Best-selling author John Green suffers from OCD and wanted to write a book about a character with OCD in which their symptoms of OCD would not be the main plot point. In his book, Azia is a teenage girl with OCD who is trying to solve a mystery surrounding the disappearance of a very wealthy man.

Maria Bamford

Maria Bamford is a comedian who lives with OCD and has undergone effective treatment for it. She often discusses both her symptoms and her therapy in her work. Note, Maria often calls OCD “unwanted thought syndrome” in her act.

The Aviator

The Aviator is a movie starring Leonardo DiCaprio as Howard Hughes who famously had symptoms of OCD focusing on contamination fears. This is briefly touched on in the movie.

As Good as it Gets

Jack Nicholson plays a surly man with OCD who develops a love interest in Helen Hunt. Jack’s symptoms appear to focus on contamination, although he also has specific rituals surrounding turning lights on and off a certain number of times and avoiding sidewalk cracks. The understanding of OCD in this movie appears a bit shallow from my perspective; my sense is that they took symptoms that most people associate with OCD and crammed them into one character. Nonetheless, at the time it was one of the only representations of OCD in film and I do appreciate the question he asks in the psychiatrist’s waiting room “What if this is as good as it gets?” Ultimately, I believe this is the question that motivates people to proceed with ERP. There is a deep hope that there has to be some way that life can be better than it is right now.

Jack’s character never undergoes Exposure therapy and instead treats his OCD exclusively using medication. The kind of response seen in the movie is atypical as medication rarely provides meaningful relief in isolation.

Chidi Anagoney (The Good Place)

In the TV show The Good Place, Chidi Anagonye, plays a moral philosophy professor who is plagued by overwhelming guilt and anxiety whenever he has to make a choice. In the show, it is never discussed that he has OCD, but he appears to display many of the classic behaviors and fears of individuals who have moral scrupulosity OCD. Furthermore, it’s an excellent illustration of how you cannot talk, or think, your way out of feeling anxious. It seems that Chidi’s profound knowledge in the fields of morality and ethics only serves to make him more confused about what the “right” thing to do is.

Raising Hope

In Season 1, Episode 13, “A Germ of a Story” the Chance family collectively becomes highly fearful of germs after a blacklight is shone on their home revealing that virtually every surface is covered in germs. No exposure therapy takes place, but the family does come to realize, after watching an old family video, that they were raised eating off the floor and have been living in germs for years without any major health problems. I like this resolution somewhat as it speaks to part of the rationale for ERP. People often object to the seemingly extreme exposures of touching the ground and licking your fingers, but they fail to realize that we ingest “ground germs” all the time. Kids sit on the floor and then eat, we move our shoes before eating, and we may even touch the bottom of our shoes at the gym when stretching, and then eat a protein bar. People often falsely believe that they are safe because they rarely encounter germs or because they use so much sanitizers and soaps; in point of fact, they are safe because many germs are harmless or are easily managed via our immune system.

Sheila Jackson (Shameless)

In Seasons 1 and 2 of Shameless, we meet Sheila Jackson who is terrified of leaving her house. We also get some brief glimpses of her treating her Agoraphobia with Exposure Therapy. In Season 1, Episode 6 “Killer Carl”, she uses virtual reality to simulate leaving her home. Eventually, Sheila works her way towards actually taking her first steps outside. We also see that her therapist gives her clear behavioral goals as we see her counting her steps outside and one day she mentions that she needs to take 100 steps away from the door today. In a touching triumph, Sheila eventually buys an RV and decides to travel the country. Her story is one of how a person can start with tiny steps (virtual reality within the confines of her own home) and eventually be free to travel wherever and whenever she pleases.

Raj Koothrappali (The Big Bang Theory )

Raj Koothrappali has Selective Mutism which appears in the very first episode of the show when he cannot speak to Penny. He is fearful to speak to women outside of his family and is seen repeatedly throughout the show whispering his comments to the men whenever a woman is around. He is also seen using alcohol to talk to women. Later in the show, he tries dating a deaf woman and using texts to work around his fear. The whispering, the alcohol, the texting, and dating a deaf woman are all excellent examples of “Safety Behaviors.” These are things people do to make themselves less fearful. While these techniques appear to be helpful in the moment, they are merely additional forms of avoidance and ultimately cause a person’s fear to get worse in the long term. In the show, Raj suddenly overcomes his selective mutism in Season 6. No explanation is provided and this type of miraculous and sudden recovery is quite atypical in real life, although it makes for a touching moment in the show. He experiences a partial relapse in Season 12.

Holden Ford (Mindhunter)

In the final episode of Season 1, Holden Ford has a “panic attack” after being embraced and threatened by Ed Kemper, a very large man who also happens to be a serial killer. The term “panic attack” here doesn’t quite seem appropriate here; while Holden was clearly panicking, this is different from a panic attack, and that term is not usually used if someone is in a life-threatening situation. Perhaps we are supposed to be getting a glimpse into the state of mental health at the time the show took place...

Somewhat tragically, he is told by a physician not to bother seeing a psychiatrist and instead to simply “watch out for Panic Disorder,” to which Holden responds “You mean this could happen again?” Panic Disorder is a recurring fear of panic attacks, which Holden didn’t have until this doctor told him to watch out for it. So it seems that his doctor may have induced his Panic Disorder by making him fearful of having another panic attack. Furthermore, instead of recommending exposure therapy (which is extremely effective for Panic Disorder), his doctor recommends benzodiazepine treatment as well as avoiding any situations that trigger the initial signs of a Panic Attack. Both of these interventions will provide short-term relief at the expense of a long-term worsening in his symptoms. Nonetheless, towards the end of Season 2, Holden seems to have somehow overcome his Panic Disorder.

Russian Doll

Russian Doll is a Netflix original about a woman who keeps waking up at the exact same time and place. It is somewhat similar in concept to Groundhog Day, although instead of reliving the exact same day repeatedly, she awakens in the same situation but can live for a second, an hour, or several days until she dies again and then wakes up back in the same place. The show is ultimately about recovering from trauma and there is a reference to EMDR (Eye Movement Desensitization and Reprocessing). EMDR is a controversial treatment due to mixed research findings. It seems to be effective in treating Post-Traumatic Stress Disorder (PTSD), although the benefits appear to be the result of the exposure components of the treatment, whereas the claims that eye movements, or bilateral body tapping, help to facilitate trauma processing have not been empirically validated.

The OCD & Anxiety Center of Cleveland does not utilize EMDR as the evidence for exposure therapy to treat PTSD is stronger and has been replicated repeatedly without such controversy. Nonetheless, Russian Doll is a great show that illustrates the concept of how individuals with PTSD can often become stuck living and reliving similar experiences, with a chronic sense of imminent death until they can ultimately confront, process, and overcome the fear associated with their past traumas.