Social Worker Elizabeth McIngvale on treating OCD & Anxiety with erp

An Interview with Clinical Social Worker Elizabeth McIngvale

Elizabeth McIngvale, Ph.D., LCSW is the Director of McLean OCD Institute in Houston, and a Lecturer at Harvard Medical School. She specializes in obsessive compulsive disorder as well as anxiety disorders.

Tori Steffen:  Hi everybody. Thank you for joining us for this installment of the Seattle Psychiatrist Interview series. I'm Tori Steffen, a research intern at Seattle Anxiety Specialists. We're a Seattle-based psychiatry, psychology, and psychotherapy practice specializing in anxiety disorders. I like to welcome with us today clinical social worker Elizabeth McIngvale. Dr. McIngvale is the director of McLean OCD Institute in Houston, and a lecturer at Harvard Medical School. Dr. McIngvale specializes in obsessive compulsive disorder as well as anxiety disorders. She founded the Peace of Mind Foundation and ocdchallenge.com, which is a free self-help website for OCD, which is live in six languages and serves nearly 4,000 individuals. So before we get started today, Dr. McIngvale, could you let us know a little bit more about yourself and what made you interested in studying OCD and anxiety disorders?

Elizabeth McIngvale:  Yeah, absolutely. So I'm actually a clinical social worker. I do have my PhD, but not a clinical psychologist. And I think for me, I really entered the field because of lived experience. I've lived with OCD since I was a young adolescent and went through intensive treatment that saved and changed my life. I then really led into advocacy and started doing a lot of advocacy work around talking and giving back in different ways, which led me into this field. So I ended up doing my undergrad master's and PhD in social work and really was just, and continue to be just really excited to be able to do for others what people did for me.

Tori Steffen:  Awesome. Yeah. Thank you for sharing that. Well, getting down to the basics around our topic, could you explain for us what exposure and response prevention, or ERP, is?

Elizabeth McIngvale:  Yeah. It's actually exactly how it sounds. So it's an exposure with response prevention. So what we mean by that is that from an OCD perspective, individuals with OCD have intrusive thoughts, triggers, things that scare them, and they engage in a lot of compulsive behaviors. And these compulsions or rituals are done to try to alleviate the distress caused from the obsessions. So when we talk about ERP, what we're encouraging patients to do is an exposure. So they face their fear, maybe they touch a doorknob that feels contaminated to them or they do some other exposure, but we're going to ask them to engage in response prevention. So we want them to prevent the response they usually do. So we want them to prevent rituals. So if you typically would wash your hands after you touch something contaminated, we want you to touch that doorknob and not wash your hands. So response prevention is that not ritualizing part. That's really important.

Tori Steffen:  Got you. Okay. That makes sense. Is exposure therapy similar to ERP in any way or how might they differ from one another?

Elizabeth McIngvale:  Yeah. It's a great question. Obviously there's a ton of overlap, and it's very similar in the sense that you are facing your fears, you're doing exposures. We see exposure therapy be really useful in trauma work, in social anxiety work, for phobias, you name it. But what we know is that individuals with OCD, if they're doing exposures, but they're also ritualizing, they're reinforcing their OCD. So for OCD, the big difference is that it's still exposure work, which is very similar, but we have to no longer do the ritual. If we follow the exposure with a ritual, we reinforce OCD versus being able to reinforce treatment and treatment outcomes.

Tori Steffen:  Okay. Awesome. Yeah, that definitely makes sense. And what are the main goals of ERP as a treatment? Are there any specific things that a clinician expects to see?

Elizabeth McIngvale:  Yeah. I mean, obviously we want to see a decrease in the anxiety in the disability and in the hold that someone's OCD has on their life. But across the board, the bigger pictures, we really want to start to change individual's relationship with anxiety and their relationship with their OCD. So we want to be able to teach them that anxiety and OCD isn't dangerous. It feels really dangerous because of how we respond to it, and that actually if we change the way we respond, we get to change the power that it has. So I think the bigger goal of ERP is that individuals understand how to change their relationship with anxiety, how to change their relationship or the way they feed their OCD so that this treatment can not just apply to any future OCD or anxiety triggers, but also to life as well.

When we think about fear in general, we either feed our fear or we fight our fear, and sometimes we think that what we're doing makes sense because it gives us short-term relief, but it actually just makes the fear bigger. If my daughter is afraid of a dinosaur in a room and I get rid of the dinosaur so I don't have to deal with her anxiety, I'm actually reinforcing that dinosaur's scary and that you aren't capable of being around it and being calm. Where instead, if I do exposures, I teach her to lean in and to not be afraid of it and to be with it, she can change her relationship with fear. She starts to realize that, "When I'm scared I don't have to run from it. I don't have to ritualize to make it go away. In fact, I can approach it," and that fear will go away.

Tori Steffen:  Okay. Awesome. Yeah. It sounds like almost a training of coping mechanisms in a way.

Elizabeth McIngvale:  It is a little bit. I think the thing we want to be careful about when we think about coping mechanisms is a coping mechanism often makes us think that we're going to give you a tool to make you feel better. Actually, what we're really doing is trying to allow you to change your relationship with distress. So when you have distress, we don't want to just get rid of it or make you feel better, we want you to learn that you can sit through it and you don't have to respond to it, and it doesn't have to be dangerous.

Tori Steffen:  Okay, great. Thank you for explaining that. So when might a clinician know that ERP is the right treatment option for a client?

Elizabeth McIngvale:  So ERP should always be the first line treatment for OCD, it is the most evidence-based and has the most research to support it. So we always want to start with exposure and response prevention. When we're treating a patient with OCD, of course, the most common treatment is a combination of ERP and medication, and that's often the route that most individuals will go, but we definitely always want to start there. We never want to start with other modalities that are not as proven because I mean, we want to start with what we know has the best chance of success and the best chance of helping our patients. What I will say is that it's really important if you're an outpatient clinician or a clinician who specializes in ERP, if a patient is not making progress, it's really important to sit back and understand why instead of to just keep trying the same thing we're doing.

So some of the reasons why, it could be that a patient... It appears they're trying to do ERP, but maybe they're actually holding on, maybe they are still ritualizing, maybe they're doing mental rituals or avoidance behaviors, and they're still feeding OCD or anxiety somehow. Maybe they need a higher level of care, maybe their OCD is so severe, so debilitating that they're not able to do ERP on an outpatient basis in the sense that if they just come and do it for 45 minutes with you every week, but they go home and they're ritualizing, we're not going to see progress there either. So they may need some support, maybe they need a more intensive treatment program. So lots of things to think about when we're doing ERP with our patients as well.

Tori Steffen:  Okay. Awesome. Could you provide an example for us of an ERP treatment for a client that has a specific phobia, maybe fear of dogs?

Elizabeth McIngvale:  I mean, I think that typically for phobias, we're going to do more exposure therapy than ERP, so it's really going to be getting them to approach that dog. So we might start with looking at pictures, watching videos, and eventually we want to get them working up to being able to hug their family dog, be with their dog, live by their values. I want them to tell me why being able to be close to dogs is important to them, or the reasons that if they don't do it will impact their life in a negative way. We want to really push on those values. I guess if it was an OCD fear, so for example, if the dog is contaminated, we want to do the exposure of getting them close to touching the dog and the response prevention of not washing their hands or not changing their clothes or not engaging in cleaning rituals that they may normally do.

Tori Steffen:  Got you. So it's important for them to understand that even if the dog is contaminated, it's not going to kill them or give them a disease. Would you say that that's true?

Elizabeth McIngvale:  Yeah. So it feels like that's what you'd want to tell the patient. You'd want to give them that reassurance, but actually we want to lean more into the fact that like, hey, people touch dogs all the time and there's value behind it. It's more important for us to focus on doing an exposure and touching our dog, but we don't want to reinforce that, I'm safe. It's okay. Nothing's going to happen. People don't get sick because the reality is that people could get sick. I can't guarantee if you touch a dog, you're not going to get sick. I also can't guarantee that if you touch a dog, you will get sick. So we want to focus less on confirming or denying our certain fears and more on living by our values and not responding to our fears, letting that fear be there that, well, what if I get sick? Being able to acknowledge that and not respond to it. So not try to make sure you don't.

Tori Steffen:  Okay. Awesome. Thank you for clarifying that. What does the process of habituation look like in therapy? How is it usually conducted?

Elizabeth McIngvale:  Yeah. So habituation is a term we don't really use as much anymore in ERP. Habituation traditionally is the thought process that when you face your fear, when you do something challenging, while it will be triggering, eventually your anxiety will subside, you will habituate. It's like you go into a locker room that smells, if you choose not to leave, eventually you'll get used to the smell. The smell doesn't go away, but you habituate to the smell that you were experiencing. And that's really the thought process behind habituation, especially for OCD, is that if you face your fear and don't do anything about it, eventually your anxiety will drop and you'll see that you didn't need to do that ritual to feel better.

We have transitioned in recent years to what we call inhibitory learning, and the point of inhibitory learning is for us to recognize two things. The number one thing is that not everybody habituates the same, and so we don't want to give you the thought process of like, you're going to just sit in habituate, because some people, it takes a couple of hours or their anxiety lingers, and I want them to be able to go do what they want to do and be able to live their life, not sit there and feel like I have to wait to habituate first. But the second, which is more important, is what is the message of habituation versus what we call inhibitory learning? Habituation is an old school model where you might sit and touch something that's contaminated if this is contaminated, and the thought process was you just sit there and you sit with the distress until it goes away.

The problem with that is that what we're teaching you is that you can't move on until you feel better, and we're putting a lot of emphasis on the anxiety and distress. On like okay, the success measure is if you start to feel better, that means that you can face this habituate. What inhibitory learning says and what we're learn, what we learn and really want to practice is that actually you can face challenging things. You can lean in all the way and you can still move on while you're experiencing some distress.

So we want the emphasis to be much less on the distress because again, we don't want you to believe the distress is dangerous, and we don't want to send that message that the distress is really important. It's actually not that important, and it will subside if you don't feed it. But what we don't want to do is sit and wait. We want to make sure that we're emphasizing the distress less, and we're more living by our values. So you're touching this contaminated thing. You're still slowing down to lean in to feel the distress, to think about the fear and choosing to move on and go do other things even if the distress is still lingering.

Tori Steffen:  Got you. Okay. That definitely makes sense. What can a client expect to experience when ERP is working correctly for them?

Elizabeth McIngvale:  I mean, alleviation across the board, they should start to see their intrusive thoughts come with less frequency and with less intensity, and they should start to feel like they're able to get back to their life and functioning the way they want to. They should be able to envision living by their values and OCD not having a grip. My biggest piece is that I want all my patients to be at a place where OCD no longer makes any decisions for them or their life, and instead they're making those decisions for themselves.

Tori Steffen:  Okay. Awesome. How can a clinician tailor ERP for a client? So for example, how might ERP differ for a client with OCD versus panic disorder?

Elizabeth McIngvale:  Yeah. So again, remember with panic disorder, you're going to be doing more exposure therapy because there's not going to necessarily be as many rituals. There will be avoidance. So we're going to get patients to avoid less, start living their life, and we're going to encourage them to engage in exposure therapy. We may also be doing some CBT skills with panic disorder because there may also be a lot of distorted thinking, or maybe there is some ruminating after certain events that we want to help break that cycle. But there's not as many outward rituals with panic disorder, and so the emphasis is much more on exposure compared to OCD. It's going to be much more focused on exposures and preventing those rituals or responses.

Tori Steffen:  Okay. Awesome. How can a clinician train a client to continue ERP or exposure therapy on their own, even outside of therapy?

Elizabeth McIngvale:  Yeah. This is a great question, and really this is about that bigger piece we talked about early on is what do you want patients to get out of ERP? What we don't want them to get is just that they succeeded because their symptoms went down. While that feels like that's successful, what's really successful is that their symptoms go down and they understand the why, and that learning actually took place. So the goal with ERP treatment is that patients understand across the board that they've truly changed their relationship, their responses to anxiety and to OCD.

And if they've done that, then they get to do what I call ERP as a lifestyle where all the time you're having opportunities to face anxiety, to feel it, to lean in, versus to respond to it in a way that you run from it, or you try to get rid of it with a ritual. So ERP should be something that it shouldn't have to feel like sometimes when you're first stepping down from treatment, you need to do more dedicated ERP, but eventually it should just come innate. It should be natural that I'm responding to my life, to my values, not to my OCD, which means I'm doing active ERP all the time. But it shouldn't have to feel like it's active ERP, if that makes sense.

Tori Steffen:  Okay. Yeah, that definitely makes sense. Is it ever possible for ERP not to be effective?

Elizabeth McIngvale:  Absolutely. I think that we definitely see ERP not to be effective if there's a lot of comorbid conditions. I think for me, one of the big things I want to know is if ERP isn't effective, why? We want to understand the why, and oftentimes it's because the patient's not ready or able to do ERP yet. So just because ERP is not effective right now, it doesn't mean it won't be in the future. For example, if a patient is dealing with a lot of distress intolerance difficulties, they're struggling to emotionally regulate, they may need DBT skills first so that they can do ERP. ERP probably wouldn't work right then for them. If their emotion regulation skills were really poor, their insights really poor, but it may be able to in the future.

Tori Steffen:  Okay. That's great to know. How might a clinician move forward? Let's say ERP isn't working for the client, and yeah, that definitely makes sense with DBT. Is there any other ways that you might move forward in that scenario?

Elizabeth McIngvale:  Yeah. I mean, I think the biggest thing when ERP isn't working is to make sure that your patient's ready for ERP. So we need to slow down. We need to think about motivational interviewing, we need to think about rapport building. We need to make sure that they understand why we're asking them to do this, that they're bought into it. No patient should be doing ERP because we're telling them to, they should be doing ERP because they see the value in it and they want to be doing it.

Tori Steffen:  Okay. Awesome. Well, do you have any final words of advice for us, Dr. McIngvale, or anything else you'd like to share with the listeners today?

Elizabeth McIngvale:  I think the biggest thing is just to remember that help and hope are always available, and what I want to make sure people know is that there is evidence-based treatment for any diagnosis you're going through. Make sure you figure out what that is and that you find somebody who has specialty training and background in that area.

Tori Steffen:  Awesome. Great advice.

Elizabeth McIngvale:  Okay. And for OCD resources, please always check out iocdf.org, which is an incredible nonprofit for OCD and host an annual conference, and is a great way to continue to get connected with the community.

Tori Steffen:  Awesome. Well, thanks so much for sharing your knowledge with us today, Dr. McIngvale. It was great speaking with you.

Elizabeth McIngvale:  You as well. Thank you.

Tori Steffen:  Thank you guys, and thanks everybody for tuning in.

Please note: The views expressed by the interviewee are for educational and informational purposes only, are not meant to diagnose or treat any condition, and do not necessarily reflect the views of Seattle Anxiety Specialists, PLLC.

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Editor: Jennifer (Ghahari) Smith, Ph.D.

Ecologist Lance Risley on Mitigating the Phobia of Bats

An Interview with Ecologist Lance Risley

Lance Risley, Ph.D. is Professor Emeritus of Biology at William Paterson University in Wayne, New Jersey. He is an expert on bats and has conducted field research on bat populations for 20 years for the Federal and State Governments to study their health and ecological significance.

(Click here to access the photos at the bottom of this transcript)

Jennifer Smith: Hey, thanks for joining us today for this installment of the Seattle Psychiatrist Interview series. I'm Jennifer Ghahari Smith, Research Director at Seattle Anxiety Specialists. We are a Seattle-based psychiatry, psychology, and psychotherapy practice specializing in anxiety disorders. Today I'd like to welcome with us ecologist Lance Risley. Dr. Risley is Professor Emeritus of Biology at William Paterson University in Wayne, New Jersey, and is an expert in bats. Before we get started today, could you tell our audience a little bit about yourself and let us know what got you interested in becoming an ecologist -- and I have to ask, why bats?

Lance Risley: Well, thanks for allowing me to talk about bats. I appreciate that. I was born in California, so I'm from the West Coast, traveled across the country, lived in different states growing up, and always loved the outdoors, wherever the family was and liked identifying things. And that led me to major in biology to graduate school, and then to get into the world of ecology, which is what I spent my professional career working in - in the world of ecology, mostly ecosystem ecology, studying forests. And then I got into insects somewhere along the line and worked in the treetops and did some canopy related work. And doing that work, that was now in New Jersey, I spoke to a fellow who was a state biologist, and he asked me if I'd seen bats when I was up climbing around in the treetops. And I had no idea why he would even ask such a question because I didn't know much about bats except I thought they were underground, only came out at night and that was the end of it.

And he said, "Well, there's more to it than that, and that they might actually be eating and somehow regulating the insects that I was studying." That got my interest. Now then I thought, "Well, what do we know about bats? "Asked questions. He knew a few answers because there weren't very many answers, and that got my interest. So I attended a workshop on bats from Bat Conservation International and got over my fear of being out in the middle of the night in the woods because I hadn't done that before and wound up studying bats for about 20 years, and definitely got past the business of being out at night because it turns out it's a great place to be at night. Much different than I thought it would be, but that's what got me into bats.

Jennifer Smith: Wow, that's great. And can you discuss some of the research that you've conducted on bats?

Lance Risley: Yeah. The research that I did in New Jersey was very fundamental because we didn't have a lot of information on bats. We had, at that time, an endangered species, later, another endangered species. And so in trying to find out about bats, it was very simple in a way. It was going to different locations in the state, catching bats with nets, identifying them, so figuring out where bats were in the state, what areas did they like, maybe more than others, what species were there. And that focus later developed into one looking at mostly female bats. They're very picky on where they go in the summertime. So this was summer work, and then using radio transmitters to follow these bats around, find out where the females actually spent their time raising young and that was valuable information for the people that I usually worked with, which was everything from state wildlife there in New Jersey to the US Fish and Wildlife Service Department of Interior.

Oh, well, the Department of Interior, but well, what was National Park Service and the actually Federal Aviation Administration for some of the work that I did, but fundamental stuff. And then later in the research, as you know, recording devices got to be pretty sophisticated and pretty good at allowing us to record bats when we weren't there. Just put a recorder in the woods and listen in to those recordings, identify the bats, and then deal with that kind of information. So it has become more sophisticated now with technology, which I guess is a good thing. We know more about bats now.

Jennifer Smith: Great. And for our audience, a little bit of fun here. I actually worked with Dr. Risley back in the day. He was my professor, so we know each other pretty well, and I helped assist with some batting projects. Sorry, mom. Yes, it's true. So I can provide a picture for people too in the transcript, which is pretty fun, I think.

So, it seems like bats have gotten a pretty bad rap over time, and I don't know if it has to do with Hollywood or folklore, and it causes some people to have pretty bad anxiety about them. Only about 0.5% of bats actually carry rabies, but people tend to associate them with being disease carriers and dangerous. So do you know what has caused the association with people fearing the mammal?

Lance Risley: There's no one thing you could point to. Maybe it's because bats come out at night and that's mysterious by itself. They're the only flying mammals - that makes them maybe more mysterious. Somewhere along the line, they got connected with Dracula and then linked to Halloween. And of course, people have seen Batman movies and bats are portrayed in maybe not the best light. So in this country, they've been the subject of some maybe negative stories would be putting it mildly, some superstition. There's much superstition in the world about bats. In some places, the folks in different countries really have placed bats on a pedestal in a way with high value. And in other countries, they're the subject of superstition. We don't know for sure. And by the way, in October, I think it's the last week of October, it's officially Bat Week in this country to celebrate bats.

And the disease business has become interesting because we've all experienced COVID, some literally. And COVID has changed all of us. And where COVID began has been of great interest. So there's been a great deal of scrutiny put on bats, and were bats somehow responsible? So I can say that there is no direct link to bats or between bats and COVID-19, that particular virus. Bats do carry viruses, but about the same amount as any other mammal. There is no direct evidence that bats have contributed to Ebola virus being caught by humans. That's another story. So in the end, bats are much less disease issues than what we've given them way too much credit for. Bats have never caused epidemics of disease in humans. They do not have epidemics within their own populations. We know that if you carry rabies, and we can address that in more detail, it's a very small percentage. So they're much less of an issue than we've given them credit for.

Jennifer Smith: Oh, wow. Okay. And I think it's probably akin to "Jaws," right? There's a story goes out there, a book, a movie, and then like you said, just one thing platforms onto another, unfortunately.

Lance Risley: And there are a lot of myths and misconceptions. And maybe later we'll have a chance just to talk about a few of those that may surprise some people if they don't know a lot about bats, that some of these that have been brought down through generations are just absolutely false.

Jennifer Smith: Great.

Lance Risley: If we have time.

Jennifer Smith: Sure. So how likely, you had mentioned rabies, how likely is it that someone can catch rabies from a bat? If they're outside at night and you see them flying around, should a person run inside and seek cover? Do bats tend to attack people?

Lance Risley: So bats don't attack people, and we do know that there is a small proportion of rabies within bat populations. It never causes epidemics in bats. We think rabies probably evolved in bats. So within this country, if there are any cases of rabies caused by bats in humans, then it's typically because a human handled a sick bat. They didn't know it had rabies. You can't tell it has rabies. It looks like any other sickness. So maybe they picked up a sick bat off the ground, handled it, they were bitten or scratched, they were not vaccinated.

The researchers in this country that handle thousands of bats a year, I know of no cases of rabies and any of them, and I'm one of them. All of us get vaccinated before we do the work, much like a vet technician would, and that helps protect us. So bats and then rabies, it's real. But bats giving rabies to humans, it's just so, so unlikely. Meanwhile, if you're outside and you see a bat flying around, it's a healthy bat, doesn't present a problem for you, enjoy it. They're incredible to watch. They're aerial acrobatics are just second to none. So it should be a pleasure and certainly not a fear.

Jennifer Smith: Great. Regarding mental health, if someone has a phobia or extreme fear of bats and gets anxiety thinking about them, one way that they can help lessen that anxiety is to participate in what's called Exposure and Response Therapy, or ERP. Exposure therapy helps by slowly exposing someone to the thing that they have a phobia of in helping them overcome their fear responses. So in addition to (if they have this phobia or anxiety of bats) in addition to working with a licensed mental health provider to do ERP, what are some ways that you could recommend that a person could potentially be exposed to bats in a safe manner?

Lance Risley: One way, and there are all kinds of different ways to do this, some more direct. Some are the real kinds of things where you might enjoy watching bats fly around in the evening, and there are a lot of places to do that, whether it's a city area like Seattle or out in the countryside, whether it's a grassy area, forested area, the bats are there. And they're, again, they're a pleasure to watch. It's not a danger. There are other ways though, to get exposed. One is the zoo. I mean, zoos have bats from different countries, and they're pretty incredible. The bats in other countries are sometimes quite large. They have all kinds of really interesting eating habits different than the bats in this country, which for the most part, eat insects except for a few along our southern border with Mexico that feed on flower pollen and nectar.

So for the most part, enjoying bats outside is a great way to get exposed to bats. Seeing them in the zoo, which is a very protected space, and maybe even attending bat talks. Bats Northwest is an organization, a nonprofit in the Seattle area that probably has programs that are offered, I would imagine, educational programs for school groups and for adults alike. If there are local nature centers, I used to give talks at local nature centers in New Jersey about bats, and it's a pleasure for me to do that. And I think people really appreciate when they hear more about bats. And if that talk at a nature center is followed, maybe it's in the summertime, followed by a little walk into the area around the nature center to actually see a bat. It gives you just a much greater feeling of, I guess, appreciation for those animals. And those might be ways. I'm not in the world of mental health working, so I can offer up those kinds of ways to be exposed to bats in one way or another.

Jennifer Smith: Yeah. No, that's great. Thank you. And I think also just people listening to talks like this, as you said, it's just more education. It's just a way to learn a little bit more about them and be exposed in various ways. So it's definitely helpful.

Lance Risley: Yeah.

Jennifer Smith: So ecologically speaking, what roles do bats have?

Lance Risley: In this country, bats are primarily insect eaters. And in that, they eat insects, including mosquitoes, which plague us all. And they eat a lot of other insects that are negative influences on crops and crop production. So the feeling is, even in this country that bats may represent several billion dollars worth of value in protecting crops from getting eaten by some kinds of insects. So if a caterpillar is feeding on, let's say cabbage in a field somewhere in maybe California, Oregon, Washington, then that caterpillar will develop later into a moth. And that could be the favorite food of bats that fly around those fields at night. So in that respect for this country.

The pollinating bats along our southern border with Mexico are incredibly important to Saguaro Cactus. Those really tall columnar cacti that grow in the desert southwest are pollinated mostly by bats. So they're presence is mostly because of bats. Agave, the cactus that is later used to make tequila a valuable beverage. And whether you care for it or not, it is valuable economically. Bats are the sole pollinator of that particular species of plants. So in the world, bats pollinate over 750 species of plants. They're incredibly important in pollination. Some plants owe their existence to the bats. A big literally example is a baobab tree that grows the national tree of Madagascar, owes its existence to bats. It's a habitat for a lot of other animals.

So in other places, bats eat fruit and disperse seeds much like birds do and can be really important as dispersers of seeds, especially in rainforests. So just offering those up as bats being really, really important ecologically.

Jennifer Smith: Wow. And it's kind of ironic, because you had mentioned that bats eat insects like mosquitoes. Mosquitoes are notorious for spreading disease.

Lance Risley: Yes.

Jennifer Smith: So it kind of proves the point that bats are even more helpful. They're not really the disease carriers, but they're helping prevent the spread of disease, ironically.

Lance Risley: In that sense. Yes.

Jennifer Smith: Great. Okay. So you had mentioned that if bats were to go extinct, it sounds like agave, for example, that would not be able to reproduce, right, because bats are the-

Lance Risley: Correct. And it's not unusual in the world for plants to have very, very specific pollinators that they depend on for reproduction.

Jennifer Smith: Okay.

Lance Risley: Some plants can reproduce in other ways just through roots and other structures, but if their sole means is through flowering, bats can be incredibly important to those.

Jennifer Smith: Sure. And I would imagine too, that just ecological balance would be thrown off too, in terms of the insects that the bats eat, for example, if the bats were to go extinct.

Lance Risley: Well, good point, good point, because if bats are eating and focusing on one particular thing, then if the bat isn't there, those organisms are going to maybe have other predators in the case of insects, but maybe not very many. So those particular species of prey in that case might do quite well, and that might be an issue for us.

Jennifer Smith: Wow. Okay. Bats in the US have been suffering from a disease called white nose syndrome, which was initially detected in New York in 2006. According to whitenosesyndrome.org, it's been unfortunately detected as far west as Washington since 2016. And can you explain for our listeners what this sickness is and how it affects bats? And also can it affect humans in any way?

Lance Risley: Well, first, it does not impact humans at all. Humans do not get the fungus, other animals don't either. So it seems to be very, very specific to bats and bats, not just in this country, but also Europe and Asia. This country's the worst. So it's a fungus that causes this thing called white nose syndrome. It's a fungal infection of exterior tissues, kind of like skin. And the problem is that it infects hibernating bats. So I'll give you that in a moment. The name "white nose" is from the fuzzy fungal growth that occurs on the noses of bats infected. And at that point is bad news for the bat, because at that point, if the bat has an obvious white nose, it's probably the death of that bat. So when bats hibernate, they do so because of fat reserves that they've built up in the summertime and in the fall, late fall, usually they go into hibernation, which is a very, very profound kind of sleep.

And they spend several months hibernating, waking up here and there during the winter. So white nose syndrome as an organism that infects them, causes their metabolic rate to pick up. And because that increases that causes more fat to be burned. So the bats infected with this fungus wake up instead of April when they should and go out and start feeding on insects, they wake up too soon because they're now starving to death. Their fat reserves are depleted, and they either die in place and there are piles of thousands of dead bats in areas where white nose has hit. It's really horrible. Or they fly outside, it's winter, and they die of starvation pretty quickly and freeze to death, also. It's a gruesome death for the bats, and it's caused the mortality of over well over 90% of some species in the Eastern United States where I live. And it's marching across the country.

It's hit Washington state in 2016 and continues to spread. It's almost in every state now. It's not every state of the lower 48, but about 37 states. And it continues to increase. There is no cure. There's treatment for it after a sort. Bats are stable now in some places in the Eastern United States, however, bats have such a low reproduction rate that it's going to take a long time, if ever, for bats to return to numbers that once existed. So this is the fear for the Western United States, for Washington, Oregon, California, to suffer these same decreases in numbers. So it's a fungal disease. It's only in bats. It's gone through the populations of bats in this country like wildfire. It's killed millions of bats. We don't know exactly how many. It's the biggest mammal or well, mammal die off in recent history on the planet. So this is huge. And the good news is it's not as bad in Europe and Asia, but it continues.

So we're fighting it as best we can as biologists. There's some bacteria that have been used to fight it, and there may be vaccine for the bats in the future. It's difficult to vaccinate bats. It's difficult to reach them and numbers enough to be helpful doing that. So I guess that answers most of what I wanted to say about white nose. It's just been incredibly important to bats. It doesn't hit all bat species equally. So some species are surviving as if there was no white nose syndrome because they don't get it. And that includes some here in the East.

So there'll be some species out in Washington. Washington has about 15 species of bats that reside in the state. Some of those do not go underground to hibernate, so they will not be impacted by the fungus, and they'll do just fine and that's good news. So bats won't disappear completely, but the ones that have disappeared a lot, you have one in Washington called the Little Brown Bat, which has been proposed as an endangered species by US Fish and Wildlife Service because of white nose because the numbers have fallen so much. We don't know if it will be. There are, I think this year in 2023, the Fish and Wildlife should let us know if it's going to be endangered.

Jennifer Smith: So what are some ways that people can help protect the species? Is there any way that a random person can help make a positive impact in any way?

Lance Risley: Well, I think being positive about bats in conversations and being better informed. It's that negativity that seems to be easy with bats because it's already there among us. And I've seen this in programs that I've done on bats at nature centers, that folks in general seem to be sitting on a fence about bats. They're not quite sure which side they want to lean toward, whether bats are bad and they should be afraid of them, or if bats are good and they should enjoy them flying around just the presence of bats. And it's interesting. So I think even in conversation being more positive about bats, seeing bats and talking about how great that was to watch bats fly around. I mean, I can say that more here in the East with maybe more emphasis because we have fewer bats now. And I've talked to folks who've said they used to enjoy watching bats, and now they rarely see one.

And that's sad. But just being, I think, better informed. I mean, bats have been killed off by the hundreds of thousands. I know of some specific cases because of misinformation and prejudice against the bats, because thinking that they're bad somehow and being afraid of them. So what better way to deal with bats than to kill them? So that's sad. And it's typically from misinformation. So just that alone is useful to think more positively and talk about them in a more positive way. There are other indirect ways. There are certain kinds of plants that you could actually grow in a garden that might be good for the bats, and that might be indirect because of plants that you put in there to attract certain insects that the bats eat.

Even a pool of water in the backyard might be useful if bats are roosting nearby. Female bats in the summertime get really thirsty during the day, and when they come out at dusk, the first thing they want to drink is water. So they may take a dip, literally kind of skim along the surface of water and get a drink at a local little pond or pool.

Building bat houses. People have done that. It's a more direct way of being a bat proponent. And those have been really good scout projects, by the way, for bat houses to be built and mounted. There are all kinds of ways to do it properly. So you do maybe even attract bats. Bats need to be in the area for a bat house to work, but there are many plans available online. Those are ways.

And bats cannot be kept as pets in this country unless you have a special permit. And usually those are only with pet dealers, people that own and run pet stores. And those kinds of bats are maybe fruit bats. So if you ever go to a pet store and you see a bat that's a fruit bat that's in the store, unless you had a really super duper kind of wildlife keeping permit, which are difficult to come by, you couldn't keep one as a pet.

So as a result, if you ever found a bat that was wild in Washington or wherever, here in the United States, it's illegal to keep them. You can't keep them as pets. I would not recommend it. They're wild animals. But we have had interesting cases where bats roost on or near houses, and these are typically females that roost in groups in the summertime, and people have put cameras on. So if you want to have a bat cam on a local group of bats, it turns out to be really entertaining.

New Jersey did this. Their state and wildlife folks did this to a group of bats that were roosting on screen in a window. The window wasn't open to the interior of the house. And the bats would... They'd groom, they'd groom each other, they'd stretch their legs out and do all kinds of things that mammals do. And they even had pups, which were the young that females give birth to, and it turned out to be a really, really popular website. So there are all kinds of interesting ways then to support bats if you want to. You could be part of the big tourist groups that go see groups of bats.

The Congress Avenue Bridge in Austin, Texas is famous for its colony of bats, thousands of them that roost under the bridge in the summer. And then at dusk, they all come out by the thousands, and it's a huge tourist attraction. And there's even, I think, a bat parade that celebrates those bats. So I guess there are all kinds of ways that you can participate and be a part of the bat advocacy crowd. You can visit these places, or you can simply go out and watch bats on your own and enjoy that and talk about.

Jennifer Smith: Wow. I have to say, one of the most amazing things I ever saw was in Lake Tahoe about two years ago, just walking around, and it was around dusk and just happened to look up, and the sky was swarming with bats, and it was beautiful.

Lance Risley: Really?

Jennifer Smith: Yeah, it was amazing. And just as you said, they're very acrobatic in the way that they were just moving all around. And I was cheering them on because that means less mosquitoes for me to have to deal with. But it was just really wonderful to see them in action like that and in such healthy numbers as well.

Lance Risley: It is. And whenever you mention bats in numbers, that's the thing that we see in the movies that's supposed to make us afraid. But it turns out those are really places people like to go, and they want to witness that for themselves. Keep in mind that if you ever hear about those places, you never hear about bats coming out of the sky attacking people. You never hear about those people that are there getting rabies. So it becomes a popular and safe thing to do. So I guess there's some proof in that that bats are safe to be around, even if there are thousands and thousands of them not very far from you.

Jennifer Smith: Right. You had mentioned about how bats can roost by people's houses. So if someone was to come home, or they go in their attic and they see there's a few bats there, or if a bat somehow flies into your house and they make a wrong turn, what should someone do if they do find a bat or encounter bats in their home?

Lance Risley: So I've talked to people that have bats in their house. Love it. I don't recommend that they love that, but they do in some cases. And in one case, they would sit out in lawn chairs in the evenings and watch the bats emerge from the attic of their house and get a real kick out of doing that while they were all around their barbecue. Meanwhile, if you don't want bats inside your attic and you have them, you can call animal control experts. Animal control companies usually do have training on how to handle bats, how to evict them. They can't kill them. They can't use chemicals against them. So it's all mechanical based, and there are only certain times of year's to do that. So if you have bats in your attic, it's probably a bunch of females.

In the summer, they probably are giving birth to pups. So if you evict the bats at the wrong time, it strands all the pups, they'll die. So there are ways to do it correctly to protect the bats, protect yourselves, and that's typically done through an animal control company of some kind. Meanwhile, if you have bats that are on the outside of the house and you're okay with that, fine. The guano that they produce, guano, that's the bat poop, so to speak, guano is harmless. You can actually buy it as fertilizer. It's expensive to buy. So it's safe for people, and it is good fertilizer for the garden. It's about 10% nitrogen, I think. And so it doesn't present a threat. But if people don't want bats on their house using their house as a roost, and bats are loyal, they'll come back to the house year after year after year. And that could be for 20 or 30 years.

So evicting them is a good way to do this. If you don't know how, call the animal patrol people. Some people put up bat houses near their house, and upon evicting the bats from their house, the bats will then be looking for a place nearby, find the bat house and use it. So that could be good for the bats. Good for you, if you're okay with having that bat house.

Meanwhile, it's a whole different ballgame if the bat is in the house, in the living quarters of the house. So I went to a church once in New Jersey, and it happened to have bats in it and had probably for 100 years. The church was old. And every once in a while, the bats would get down in the sanctuary and fly around. And people didn't like that very much, especially during a church service. So I came in and gave some advice on how to cure that particular issue. So bats do sometimes get into living spaces or even working spaces. The Centers for Disease Control have very specific guidelines on how to handle that.

And there are different means of handling that bat or bats. Typically, it's one. Typically it's in the middle of the summer. It's a juvenile bat that's exploring and gets itself in trouble by flying into a house. So one way to get a bat out of your house is to try to close that space off except for a door or a window to the outside. If it's a window, make sure the screen isn't on it. Open that and wait for dusk. The bat will most likely fly out, and they're very good at navigating inside closed spaces. I've seen one fly inside a car, fly around in the car, eating insects attracted by the dome light of the car and fly right back out again without hitting anything in the car. Bats are very good at what they do, and they can do it in pitch darkness.

So them flying out of a house will be easy for them. If you don't want to do that and you're uncomfortable, again, you can call animal control. They'll come in. They'll probably catch the bat using a bucket, heavy gloves, something like that. They'll catch the bat alive, take it outside and release it. If it's a healthy bat, it'll fly away and be just fine. If you find a bat right outside your house, a cat brought it in, a dog brought it home, maybe the bat's injured, you don't know if it's injured because of the animal. You don't know if it's injured because of the sickness it has, not rabies, maybe something else. And you don't know if it's dying of dehydration, which they do sometimes on really hot days in the summertime.

So treat it as if it could cause you harm and either don't handle it at all or handle it with gloves. Put it in a bag or a container of some kind. Call a local health official. And that could be, it depends. It could be a state agency, it could be a county agency, it could be a city agency. It depends on where you live in the United States, how they handle things like this. You can submit the bat for having test... You can have it tested for rabies if you're concerned at all about the bat. You can simply hand it over to someone who knows how to deal with that bat. And in many cases, bats fly into a house. People have experienced it before. If these are places where there are a lot of bats and they either calmly go catch it with gloves and a pillowcase or something similar. Take it outside, let it go, and hope it doesn't fly back in again.

So in other words, there are all kinds of ways of doing this, but there are official guidelines that the CDC has provided for homeowners in case the bat's flying in a room with a child like an infant or with someone that's mentally disabled and would otherwise not know what to do if there was a bat nearby. So does that person need to be immunized against rabies? Maybe. And that depends on the situation, but there are ways by you if you have that bat to call either the city, the county. They have a health person that you could talk to and get some advice.

Jennifer Smith: Fantastic. Thank you. Is there anything else that you'd like to share with our listeners today? Earlier you had mentioned some myths about bats, I believe. If you want to-

Lance Risley: Yes. If we have time, that'd be a pleasure.

Jennifer Smith: Absolutely. Yeah.

Lance Risley: Bats are so amazing. And one thing I mentioned earlier, they live long lives. So the longest recorded lifespan we have is about 41 years for a bat. And bats, they're small, say about this large in this country, have been in zoos documented at over 30 years old. They're not ecologically speaking, little animals, mammals, never live that long except bats. So they're incredibly long lived, which is kind of neat. The bats in this country, for the most part are pretty small in terms of their body. Their wings may be about like this. Depends on the species. And the sad part with this white nose syndrome is they usually produce maybe one pup a year, rarely two of young. So thus, it takes a long, long time for bat populations to come back in numbers if those numbers have been depleted by disease.

So that's an issue just to bring up they're long lived, but they reproduce in very, very small numbers. I guess for the females out there that might be listening to this, when the typical US bat gives birth, that one pup might weigh a third, the body weight of the mother at birth, they're huge. And it requires a tremendous amount of food for that mother to get, the mother bat, to produce enough milk to feed that young pup. So female bats that are taking care of young eat huge amounts. They almost eat nearly their body weight per night, which is a lot of insects if you're counting the insects they're eating. So those are cool things.

The next part gets to expressions like "blind as a bat," which all of us have heard, and who knows where that came from. Bats have eyes, and they may be small in some bats, but bats can see incredibly well.

They see so much better than we do at night. And they see in shades of gray, for the most part, just like most night active animals do, but they see quite well, so they're not blind. So that's completely incorrect. Other kinds of things like "bats are rodents." There's an expression in Europe called "flittermouse" or a word. "Flying mouse," that's a term they use for bats. Meanwhile, bats are more closely related to us as humans than they are to rodents like mice or rats. And a real simple way to tell is if you've ever seen a picture of a bat, bats don't have buck teeth like rodents do. Rodents like rats and mice are built more for chewing very hard things like seeds. And bats meanwhile have teeth that are very much like cats and dogs. So bats are predators. They look way, way different in terms of teeth.

So that's a quick way to tell that bats are not rodents. "Bats get caught in your hair." You used to hear that a lot. The fear that if you had hair, I guess, and a lot of it, and you had that distinct risk of going out at night and a bat would fly in and get caught in your hair-- it doesn't happen. I've never heard of it happening. So you don't have to be afraid of that. I've heard of "bats flying right at me," especially for those people that have had a bat in the house. "It came right at me. It was going to attack me." And a bit of a story there. Bats, when they take flight, they're usually up relatively high because they don't jump into flight as many birds do. Birds can kind of jump up and then take wing. Bats don't have calf muscles that are developed.

They can't jump. So instead of jumping, they don't. They're hanging upside down, which is a longer story to explain. They hang upside down, which is called roosting. And they literally let go when they want to fly, they drop a few feet until they get air under their wings, then they can fly and maneuver. So if you approach a bat in a house and it's roosting, the first thing it needs to do to get away from you is fly. And that means it has to drop down, probably glide toward you for just an instant until it has enough air under its wings to then flap its wings and maneuver.

So that's a different kind of perspective, I suppose, on bats and let's see. Are there any other things? Let's see. On my little list here, I suppose I should mention echolocation, just because bats make sounds at night. Unfortunately we don't hear most of those sounds. It's out of our range of hearing. And they use those sounds to listen for echoes, to catch insects or to just avoid objects in their path. But sometimes you can hear bats. There are some bats that emit little clicking sounds. So if bats fly over and you hear something, it's okay. They're making clicking sounds and that helps them navigate or hunt something to eat. Just that most of the time you don't hear those sounds.

 And I've heard this one too. I just thought of this that people used to kind of in a guilty way, tell me, "Well, as a kid, they used to throw rocks at bats because the bats would dive at the rocks or move out of the way to avoid the rocks." And I can tell you, I've never heard of any bat ever being hit by a thrown rock because they can detect the rock coming and will first explore it. So probably fly around it and then realize it's nothing of interest, and then just let it go. So if you wind up throwing a rock up in the air thinking you're going to hit a bat, don't worry, you won't. And meanwhile though, the bat may come down and explore the rock, because it may think it's something to eat at first until it realizes it's just a rock. So don't be worried about that.

Other than that, I mean, there are lots of stories about bats. There are a lot of interesting superstitions people have about them. But I think blind as a bat is probably one of the big ones. We've already talked about the disease issues and basically the non-issues about bats and not to be worried about that. Just don't handle a bat with bare hands. That would be something you'd never want to do.

Jennifer Smith: Right.

Lance Risley: Enjoy them. Yeah.

Jennifer Smith: That's wonderful. Thank you so much Dr. Risley. And for our listeners out there, if you are anxious about bats or have any type of phobia about them, hopefully this will help and lessen your anxiety. And we'll have some links attached in the transcript. You can learn more. And thank you again, Dr. Risley, for joining us today and wish you all the best.

Lance Risley: All right. Thank you.

*For more information about bat conservation, check out www.merlintuttle.org.

Please note: The views expressed by the interviewee are for educational and informational purposes only, are not meant to diagnose or treat any condition, and do not necessarily reflect the views of Seattle Anxiety Specialists, PLLC.

Jennifer Smith examining a Big Brown bat while assisting on a research team, under the direction of Dr. Lance Risley. Note: red lights are typically used as they cause less distress to the bats’ sensitive eyes (and are less harsh for humans, as well).

Photo Credit: Lance Risley, Ph.D. - Hibernating bats

(2) Indiana bats (grayish) - This species is located on the Eastern coast of the US. Heavily impacted by white nose syndrome and listed as Endangered.

(4) Little Brown bats (deeper brown) - This species ranges from East to West coast of the US, including Washington. Heavily impacted by white nose syndrome and likely to be listed as Endangered soon.

Photo Credit: Lance Risley, Ph.D. - Silver-haired bat

These species of bat ranges from East to West coast, including Washington. Since it roosts on the sides of trees, it has faced little impact from white nose syndrome.

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Editor: Jennifer (Ghahari) Smith, Ph.D.